Chapter 2: Management of Patients with Upper Respiratory Tract Disorders

Rhinitis

- inflammation and irritation of hte mucous membranes of the nose

- allergic or non-allergic

Allergic Rhinitis

- Seasonal Rhinitis

- Perennial Rhinitis

Seasonal Rhinitis

occurs during pollen seasons

Perennial Rhinitis

occurs throughout the year

Factors that may lead to Rhinorrhea

- changes in temperature or humidity

- odors

- infection

- age

- use of OTC

Factors that may lead to Rhinorrhea

- presence of foreign body

- exposure to allergens

- food

- medication

- particles both indoor and outdoor

Factors that may lead to Rhinorrhea

- non allergic (common colds)

- drug induced

Drugs that may induce Rhinorrhea

- ACE inhibitors (-prils)

- beta blockers (-olols)

- "statins"

- antidepressants

- antipsychotic

- aspirin

- antianxiety

Rhinorrhea

runny nose

symptoms of Rhinitis

- rhinorrhea

- nasal congestion

- nasal discharge

- sneezing

- pruritus of nose, roof of mouth, throat, eyes, ears

Management of Rhinitis

- depends on the cause

- Antihistamines: symptom relief

- Saline nasal spray

- avoid or reduce exposure to allergens and irritants

Meds to relieve symptoms

management of viral rhinitis

allergy tests

- management of allergic rhinitis

- done to identify possible allergens

antibiotics

management of bacterial rhinitis

refer to EENT

management for nasal and septal deformities

saline nasal spray

mild decongestant and can liquefy mucus to prevent crusting

Nasal spray

1 Instruct the patient to blow the nose before applying the medication

2. Keep the head upright

3. Spray quickly and firmly into each nostril away from nasal septum

4. Wait atleast 1 minute before administering the second spray (if 2 sprays per nostril)

5. After care (clean) and never share to avoid cross contamination.

Viral rhinitis

- common cold

- most frequent viral infection in the general population

- often is used when referring to a URI that is self-limited and caused by a virus

- cold temperatures and exposure to cold rainy weather do not increase the incidence or severity

Symptoms of Viral Rhinitis

- low-grade fever

- nasal congestion

- rhinorrhea

- nasal discharge

- halitosis

Symptoms of Viral Rhinitis

- sneezing

- tearing watery eyes

- "scratchy" or sore throat

- general malaise

- chills

Symptoms of Viral Rhinitis

- headache

- muscle aches

- As the illness progresses, cough usually appears

- virus exacerbates herpes simplex (cold sore)

- symptoms may last from 1 to 2 weeks

Management of Viral Rhinitis

- Adequate fluid intake, rest, prevention of chilling, and the use of expectorants as needed

- Wam salt-water gargles

- NSAIDs

- Antihistamines

- Topical nasal decongestants/spray

- hand hygiene to reduce transmission

warm salt-water gargles

soothes sore throat

NSAIDs

- aspirin and ibuprofen

- relieves aches and pains

Antihistamines

relieve sneezing, rhinorrhea, and nasal congestion

Topical nasal decongestants

- Phenylnephrine nasal and oxymetazoline nasal

- should be used with CAUTION

- overuse can produce rhinitis medicamentosa

Rhinitis Medicamentosa

rebound rhinitis

Rhinosinusitis

- formerly called sinusitis

- an inflammation of the paranasal sinuses and nasal cavity

- may be acute, subacute, chronic

- can be viral or bacterial

Acute Rhinosinusitis

- type of rhinosinusitis that lasts for less than 4 weeks

- can be viral or bacterial

Subacute Rhinosinusitis

type of rhinosinusitis that lasts for 4 to 12 weeks

Chronic Rhinosinusitis (CRS)

type of rhinosinusitis that lasts for more than 12 weeks of two or more of the following:

- Mucopurulent discharge

- Nasal obstruction

- Facial pain-pressure fullness

- Hyposmia

Pathophysiology of Rhinosinusitis

unresolved viral or bacterial infection/exacerbation of allergic rhinitis

↓

Obstruction of sinus openings

↓

Secondary infection (progress to an acute suppurative process)

↓

Nasal congestion leads to obstruction of the sinus cavities

↓

Bacterial growth

causes of obstruction of sinus openings

- deviated septum

- hypertrophied turbinates

- nasal polyps

Other factors for Rhinosinusitis

- Abnormal structure of nose

- Diving and swimming

- Tooth infection

- Trauma

- Tumors

- Pressure of foreign objects

- Environmental hazards (exposure to paint, dust, chemicals)

Acute Bacterial Rhinosinusitis (ABRS)

- purulent nasal discharge accompanied by nasal obstruction or a combination of facial pain

- localized or diffuse headache

- high fever

- occurrence of symptoms for 10 days or more

Acute Viral Rhinosinusitis (AVRS)

- same with ABRS but without fever

- nasal discharge is clear, not purulent

- facial pain may be absent

- occurrence of symptoms less than 10 days

Complications of Rhinosinusitis

- osteomyelitis and mucocele

- rare: meningitis, brain abscess, ischemic brain infarction, and severe orbital cellulitis

- meningitis: watch out for fever, severe headache, nuchal rigidity

Mucocele

cyst of the paranasal sinuses

Management for Rhinosinusitis

- Antibiotic therapy (14 days course treatment for ABRS)

- nasal saline lavage and decongestants (for AVRS)

- amoxicillin, amoxiclav, levofloxacin or moxifloxacin can be prescribed

- Topical decongestants

- Air humidification

- Warm compress

- Avoid swimming, diving, and air travel during infection

Amoxicillin/Amoxicillin-Clavulanic Acid

DOC for Rhinosinusitis

Recurrent acute rhinosinusitis

diagnosed when four or more episodes of ABRS occur per year with no signs or symptoms of rhinosinusitis between the episodes

Clinical Manifestation of CRS

- Impaired ventilation

- Cough

- Chronic headaches in the periorbital area

- periorbital edema, and facial pain

- Pt breathes through mouth

Complications of CRS

- meningitis

- encephalitis

- osteomyelitis

Management of CRS

- same with acute rhinosinusitis

- antibiotic treatment 2-4 weeks

Functional endoscopic sinus surgery

surgical management of CRS

Patient education for CRS

- blow the nose gently

- encourage oral fluids

- application of hot wet packs

- positioning: HOB elevated

Acute Pharyngitis

- sudden painful inflammation of the pharynx, the back portion of the throat that includes the posterior third of the tongue, soft palate, and tonsils

- commonly referred to as a sore throat

Most common causes of Viral Pharyngitis

- Adenovirus

- Influenza virus

- Epstein-Barr virus

- Herpes simplex virus

GABHS (Group A Beta-hemolytic streptococcus)

cause of bacterial pharyngitis

Viral Pharyngitis

if uncomplicated, usually subside 3-10 days after onset

Signs and Symptoms of Acute Pharyngitis

- fiery-red pharyngeal membrane and tonsils

- lymphoid follicles that are swollen and flecked with white-purple exudate

- enlarged and tender cervical lymph nodes, and no cough

- Fever and malaise may be present

- Bad breath is common

Penicillin

DOC for Acute Pharyngitis

Penicillin V Potassium

- DOC for Acute Pharyngitis

- oral for 10 days

IV Penicillin

- DOC for Acute Pharyngitis

- recommended only if there is a concern that the patient will not adhere to therapy

Cephalosporin (Cefuroxime)

- DOC for Acute Pharyngitis for those allergic to Penicillin

- 1 tab 2x a day for 5-10 days

Macrolides (Azithromycin)

- DOC for Acute Pharyngitis for those allergic to Penicillin

= 1 tab OD for 3 days

Acetaminophen

given for pain relief for Acute Pharyngitis

Management for Acute Pharyngitis

- liquid or soft diet

- encourage oral fluids

- warm liquids, cool beverages, and flavored frozen desserts

- warm saline gargles every after oral care

- do not share utensils

- cough etiquette

- replace toothbrush

Rheumatic Heart Fever

potential complication for Acute Pharyngitis