upper respiratory disorders

upper respiratory tract

nose, sinuses, pharynx, larynx

warms, humidifies, filters air

stridor

high pitched sound caused by upper airway narrowing / obstruction

airway warning sign

position, retractions, accessory muscles, nasal flaring, cyanosis

signs of UAO

red flags of UAO

stridor at rest, drooling, tripod, LOC altered

mucociliary apparatus

primary lung defense

traps, cilia moves mucus, expelled by swallowing or coughing

affected by resp. infections, smoking, air pollution, dehydration

impaired mucociliary clearance

increases the risk of of upper respiratory infections and can contribute to mucus buildup / airway obstruction

allergic rhinitis etiology

allergen exposure, triggers IgE mediated mast cell activation, leads to nasal inflammation, edema, increased secretions

hallmark findings of allergic rhinitis

sneezing, itching, watery rhinorrhea, congesion, watery eyes

allergic rhinits management

2nd gen antihistamines, corticosteroids, decongestants

pharyngitis and tosillitis etiology

viral infection - cold, influenza, adenovirus, or GAS

bacterial tosilitis

red, swollen tonsils with exudate; GAS

viral pharyngitis

red, inflammed throat, no exudate

findings of pharyngitis and tonsilitis

sore throat and painful swallowing, erythema and white spots, fever, tender cervical lymph nodes

management for bacterial tonsilitis

antibiotics, fluids, analgesics, rest

treating GAS helps prevent complications such as

acute rheumatic fever

sinusitis

inflammation of the sinuses causing facial pains

sinusitis etiology

begins with viral URI, edema blocks sinus drainage ; muscosal retention and pressure

findings of sinusitis

facial pain / pressure, nasal congestion and drainage, headache, decrease sense of smell

bacterial sinusitis

symptoms over 10 days without improvement

high fever, severe pain

“double worsening”

croup

viral infection causing swelling below vocal cords, leading to a noisy barking cough and breathing difficulty

pathophysiology of croup

inflammation and edema of the subglottic airway, large increase in airway resistance s

signs of croup

barking cough, inspiratory stridor, hoarseness, retractions, worse at night

croup treatment

dexamethason (reduces inflammation), neb epinephrine if severe

assess stridor at rest (could indicate it’s worse), keep child calm

epiglottitis etiology

HIB, rapid infection of epiglottis, upper airway obstruction

epiglottitis findings

severe sore throat and fever, drooling, dysphagia, muffled voice, inspiratory stridor, tripod

priority in epiglottitis

airway, dont place patient supine

symptom relief drugs for URD

antitussives, expectorants, mucolytics

targetted treatments for URD

decongestants, antihistamines, corticosteroids, antibiotics

diphenydramine (benadryl) and fexofenadine (allegra)

block H1 receptors to reduce histamine effects - decreased itching, sneezing, rhinorrhea, swelling

diphenydramine

crosses BBB - sedation and anticholiergic effects

adrs: dry mouth, drowsiness, blurred vision, urinary retention, confusion

avoid alcohol, cns depressants

fexofenadine

minimal cns penetration - less sedation

adr: headache, nausea, dry mouth

avoid fruit juice

pseudoephedrine (sudafed)

stimulates a adrenergic receptors → vasoconstruction → deceased nasal mucosal edema

sudafed ADRs

hypertension, tachycardia, palpitations, insomnia, nervousness

considerations for sudafed

monitor BP/HR, caution with hypertension/cad/dysrthymias

limit to 3-5 days to prevent rebound congestion

fluticasone (flosane)

decreases inflammatory mediator releases, decreases nasla inflammation and edema

flonase adrs

nasal irritation, dryness, epitaxis, headache, hyperglycemia

Not immediate relief

dextromethorphan

antitissive, acts on the cough center in medulla to suppress reflex

does not remove mucus

dextromethorohan considerations

avoid alcohol, cns depressants, avoid w maois, caution with serotonergic meds

high doses have abuse / toxicity potential

guaifenesin (mucinex)

increases respiratory tract fluid, decreases mucus viscosity, does NOT suppress cough

guaifenesin considerations

increase fluid intake

acetylcysteine

breaks disulfide bonds in mucus, decreases viscosity, use in acetaminophen overdose

acetylcysteine adrs

n/v, bronchospasm, sulfur odor, use cautiosly with asthma

laryngitis

horaseness, voice loss

treat with rest, hydration

bacterial tracheitis

infection of trachea, inflammation/secretions obstruct airwat

fever, barking cough

treat with iv antibiotics, airwat support

peritonsillar abscess

localized infection with pus on tonsils

bad sore throat, unilateral tonsil swelling, hard to swallow, hot potato voice

treat with abx and drainage

petropharyngeal absecess

deep neck infection behind the pharynx

fever, neck pain, difficully swallowing

treat with abx, drainage, airway support