UPPER RESPIRATORY TRACT INFECTIONS (URTIs)

1. CORYZA/VIRAL RHINITIS

Definition

Coryza, also known as common cold or viral rhinitis, is defined as a viral infection impacting the lining of the nose, throat, sinuses, and airways. It is characterized as self-limiting, meaning it resolves without significant medical intervention (Brunner and Suddarth, 2008). It represents a group of disorders defined by inflammation and irritation of the mucous membranes of the nose.

Causes

Numerous viruses can lead to coryza, with the rhinovirus being the most prevalent cause.

Mode of Transmission
  • Direct Contact: Touching contaminated surfaces or persons.
  • Inhalation: Breathing in airborne droplets expelled by an infected individual.
  • Indirect Transmission: Contact via hands or articles that have been contaminated by the nasal or throat secretions of an infected person.
Pathophysiology and Signs/Symptoms

Upon inhalation of an irritant, such as a virus or pollen, the mucous membranes of the nose, pharynx, and tonsils become inflamed and swollen due to irritation. This inflammation leads to the secretion of mucoid fluid and potential blockage of sinus openings. The common signs and symptoms include:

  • Runny Nose (Rhinorrhea) and Tearing (Lacrimation)
  • General Body Malaise: Lasting 2-7 days.
  • Nasal Congestion
  • Sneezing
  • Sore Throat
  • Body Chills
  • Headache
  • Coughing
Treatment

There is no specific treatment for coryza, but supportive measures include:

  • Hydration: Offering plenty of fluids to facilitate recovery.
  • Salt Gargles: (1 teaspoon in 1L warm water).
  • Anti-inflammatory Medications: Aspirin in a dose of 600mg t.d.s for 3 days.
  • Antihistamines: Such as Piriton 4mg b.d for 3 days.
  • Decongestants: To dry secretions, including nose drops like ephedrine for adults and normal saline for children.
  • Vitamin C: Increased intake advised.
  • Bed Rest
Complications

Complications from coryza can occur, including:

  • Infection spreading to the lower respiratory tract.
  • Sinusitis.
  • Otitis Media: Particularly common in children; occurs due to blockage of the Eustachian tube and abscess formation in the middle ear.
  • Tonsillitis.
  • Bronchitis.
  • Pneumonia: More prevalent in infants and the elderly.
Health Education
  • Advise staying home for a day or two to limit contagion.
  • Instruct on covering the mouth and nose with a cloth or handkerchief while coughing or sneezing.
  • Protect vulnerable populations such as infants and immunocompromised individuals from exposure.
  • Emphasize the importance of frequent hand washing to curb infection spread.

2. SWINE FLU

Introduction

Swine flu is identified as a highly contagious respiratory infection. First identified in the U.S. in 2009, it escalated into a pandemic, which concluded by 2010.

Definition

Swine flu refers to a highly contagious form of human influenza caused by a virus that is identical or closely related to one originally isolated from infected swine. It is a human respiratory infection caused by an influenza strain that began in pigs.

Causes

This illness is caused by a mutated strain of the influenza virus known as the ‘novel’ H1N1. This virus is a genetic mix derived from swine, avian, and human viruses, making it easily transmissible among humans.

Mode of Transmission

Transmission occurs through:

  • Inhalation of infected droplets from a person who coughs or sneezes.
  • Direct Contact with an infected person’s secretions, particularly nasopharyngeal secretions.
Risk Factors

People at heightened risk for swine flu include:

  • Individuals with lowered immunity such as those with HIV/AIDS, malignancies, children, and chronic conditions.
  • Health care professionals.
  • Travelers or those who have been in recent contact with swine flu cases.
Signs and Symptoms

Symptoms typically mirror other influenza infections and include:

  • Fever of 38˚C or higher due to viral infection.
  • Cough resulting from irritation.
  • Sore throat due to inflammation.
  • Nasal secretions resulting from irritation and inflammation.
  • Fatigue and headache from anoxia.
Diagnosis

Diagnosis involves:

  • History: Recent travel to pandemic areas.
  • Symptoms: Flu-like signs and fever or chills.
  • Laboratory Testing: The only confirmatory method is performing a nasopharyngeal swab to identify specific antigens associated with the virus.
Treatment

Treatment is predominantly supportive and includes:

  • Bed Rest and steam inhalation to alleviate symptoms.
  • Encouragement of oral fluid intake to maintain hydration.
  • Decongestant: Ephedrine 2-3 drops in each nostril.
      - Side Effects: May include palpitations, insomnia, dizziness, and euphoria. Therefore, patients should be advised against driving or operating heavy machinery while on treatment.
  • Antiviral Treatment: Amantadine 100mg BD, which can minimize effects if administered within 48 hours of symptom onset.
      - Side Effects: Depression, fatigue, peripheral edema, and orthostatic hypotension. Patients should be instructed to change positions slowly and take the medication several hours before bedtime to prevent insomnia.
Prevention

Preventative measures include:

  • Routine vaccination for individuals over 6 months of age, deemed the best defense against the novel H1N1 swine flu.
  • Isolation of infected individuals until they are non-infectious, typically about 7-10 days after symptom resolution.
  • Wearing of face masks to minimize droplet transmission during coughing and sneezing.
  • Proper disposal of contaminated tissues and hand hygiene practices, including the use of alcohol-based hand sanitizers.
  • Avoidance of crowded areas and close contact with coughing or sneezing individuals.

3. HAY FEVER

Definition

Hay fever refers to an atopic (allergic) inflammation of the mucous membrane of the nose.

Causes

Causative agents include:

  • Microorganisms.
  • Allergens such as dust and animal dander.
  • Foods such as onion and garlic, sprays, and perfumes.
  • Seasonal pollen, predominantly from flowering plants.
Signs and Symptoms
  • Sneezing due to nasal mucosal irritation.
  • Headache from anoxia.
  • Rhinorrhea from nasal mucosal irritation and inflammation.
  • Nasal Congestion due to mucoid secretion.
  • Fever/Chills.
  • Coughing caused by mucosal irritation.
  • Wheezing due to airway congestion.
  • Anorexia as a consequence of loss of appetite.
  • Red Eyes resulting from irritation.
Treatment

Management includes:

  • Nasal Examination: Reveals pale, edematous turbinates.
  • Antihistamines: Such as Piriton for symptomatic relief.
  • Antipyretics: Like paracetamol.
  • Decongestants: Includes nasal drops.
  • Avoidance: Of known allergens.
  • Fluid Intake: Adequate hydration is recommended.

4. PHARYNGITIS

Definition

Pharyngitis refers to a sudden painful inflammation of the pharynx, involving the posterior third of the tongue, soft palate, and tonsils; commonly referred to as a sore throat (Smeltzer et al., 2010).

Causes
  • Viral Infections: Such as adenovirus, influenza virus, Epstein-Barr virus, and herpes simplex virus.
  • Bacterial Infections: The most common cause is group A beta-hemolytic streptococcus.
Pathophysiology

The body reacts to antigens by activating an inflammatory response within the pharynx, producing pain, fever, vasodilation, edema, and potential tissue damage, reflected by redness and swelling of the tonsillar pillars, uvula, and soft palate. Creamy exudates may be present in the tonsillar pillars.

Signs and Symptoms
  • Enlarged Cervical Lymph Nodes due to inflammation.
  • Fever resulting from infection.
  • General Body Malaise.
  • Pain caused by inflammation.
  • Difficulty in Swallowing due to pharyngeal inflammation.
Diagnosis

Diagnosis can involve:

  • Rapid screening tests for streptococcal antigens.
  • Streptolysin Titers: Testing for antibodies against streptolysin.
  • Throat Cultures: To pinpoint the causative organism (M.C.S).
  • Nasal Swabs for M.C.S.
  • Blood Cultures: May be needed to identify the causative agent.
Treatment
  • For viral pharyngitis: Supportive care is provided.
  • For bacterial infections: Antibiotics such as penicillins, erythromycin, or clarithromycin, prescribed for 10 days if the bacterial cause is confirmed.
  • Anti-inflammatory medications: Such as aspirin.
  • Warm Saline Gargles: To soothe inflammation.
Treatment Cont.
  • Nutritional Therapy: Liquid or soft diets may be advised during the acute phase, depending on the patient's swallowing tolerance and appetite.
  • Warm Beverages/Liquids and Warm Flavored Desserts are often soothing.
  • Bed Rest.
  • Mouth Care: Essential for comfort during recovery.
Complications

Complications can arise if the infection spreads, potentially leading to:

  • Glomerulonephritis.
  • Rheumatic Fever.
  • Rheumatic Heart Disease.

5. LARYNGITIS

Definition

Laryngitis is characterized by inflammation of the larynx. It often results from voice overuse, exposure to dust, chemicals, smoke, and other pollutants. The condition causes reddening, warmth, and painful sensations in the larynx’s mucous membrane.

Causes
  • Viral Infections: Acute laryngitis commonly arises from upper respiratory infections caused by viruses, particularly common cold or influenza.
  • Irritation: From cigarette smoke, which contains nicotine that irritates the laryngeal mucous membranes.
  • Environmental Factors: Such as exposure to dust, chemicals, or fumes.
  • GERD: Gastroesophageal reflux disease can also irritate the throat.
  • Repeated Sinus Infections.
  • Throat Cancer.
Types
  • Acute Laryngitis: This occurs due to inflammation lasting less than three weeks, commonly caused by rhinoviruses, para-influenza viruses, and adenoviruses.
  • Chronic Laryngitis: Lasts longer than three weeks, often due to environmental irritants or misuse of the voice, leading to swollen vocal folds.
Pathophysiology

Injury or infection of the larynx leads to inflammation in the vocal cords, resulting in increased blood flow and swelling, thickening the vocal cords. This affects phonation, potentially resulting in dysphonia (impaired sound production) or aphonia (loss of voice).

Signs and Symptoms

Symptoms vary in severity and may include:

  • Impaired Speech: Ranges from hoarseness to complete voice loss due to laryngeal inflammation.
  • Fever: Attributed to infectious processes.
  • Headache: Generally accompanies a common cold and results from sinus congestion.
  • Sore Throat: Due to throat inflammation.
  • Coughing: Resulting from irritation in the throat.
  • Swelling Sensation in the laryngeal area.
  • Difficulty Swallowing: A symptom of laryngeal irritation.
Diagnostic Tests
  • Acid Test: Measures how often and how long stomach acid enters the esophagus over 24 hours.
  • Biopsy: Involves taking tissue samples from the larynx for analysis.
  • Esophagoscopy: Examines the esophagus for acid reflux.
  • Laryngoscopy: Direct examination of the larynx using a flexible, lighted tube.
Note

Laryngitis is often treated at home without requiring hospitalization. Management is similarly aligned to pharyngitis guidelines.

6. TRACHEITIS

Definition

Tracheitis is the inflammation of the trachea, leading to chest pain and coughing. It frequently co-exists with laryngitis and acute pharyngitis.

Cause

Tracheitis may arise from viral or bacterial infections, with common bacteria being:

  • Staphylococcus aureus.
  • Streptococcus pneumoniae.
  • Pseudomonas aeruginosa.
What is Bacterial Tracheitis?

Bacterial tracheitis refers to an infection impacting the trachea or windpipe.

Signs and Symptoms

Common signs include:

  • Sore Throat: Due to inflammation.
  • Pain on Swallowing: Resulting from inflammation.
  • Hoarse Voice: Caused by irritation and inflammation.
  • Cough: A result of throat irritation.
Treatment

Symptomatic relief includes:

  • Steam Inhalations and gargles.
  • Simple Linctus: Such as cough syrup.
  • Rarely, antibiotics may be utilized.

7. GENERAL NURSING CARE FOR PATIENTS WITH URTI

Maintaining a Patent Airway

Patients with upper respiratory infections may have secretions that obstruct their airway, leading to altered respiratory patterns and increased work of breathing. Nursing interventions to maintain airway patency may include:

  • Encouraging increased fluid intake to thin mucus.
  • Utilizing room vaporizers or steam inhalation to loosen secretions and reduce mucous membrane inflammation.
  • Educating patients about optimal positioning to enhance sinus drainage, often an upright position for conditions like sinusitis or rhinitis.
  • Administering prescribed topical or systemic medications that may relieve nasal or throat congestion.
Promoting Communication

Hoarseness and loss of voice due to upper airway infections may require the nurse to encourage patients to minimize speaking and utilize alternative communication methods, such as writing or signaling for assistance to minimize strain on vocal cords.

Encouraging Fluid Intake

Upper airway infections can induce fluid loss. Symptoms like sore throat, malaise, and fever may hinder the patient’s desire to consume fluids. Nurses can provide lists of easily digestible foods to enhance caloric intake and promote hydration.

  • Recommendations include consuming 2-3 liters of fluids per day, barring contraindications.
Promoting Comfort

Localized discomfort is typical in URTIs. Nurses can recommend analgesics, such as acetaminophen with codeine, to alleviate symptoms of discomfort.

8. LOWER RESPIRATORY TRACT DISORDERS

BRONCHITIS
Definition

Bronchitis is the inflammation of the mucous membrane of the bronchial tree, often characterized by thickened mucus. It can stem from viral, bacterial, or environmental pollutants, leading to sensations such as coughing, yellow-grey mucus expectoration, sore throat, wheezing, and nostril blockage.

Types
  • Acute Bronchitis: Characterized by inflammation lasting for a short duration. It often arises post-upper respiratory infection, primarily caused by viruses, and includes symptoms akin to those of acute airway infections.
  • Chronic Bronchitis: A form of chronic obstructive pulmonary disease (COPD) marked by a productive cough persisting for over three months per year for at least two consecutive years, often due to recurrent airway injury.
Pathophysiology

In healthy individuals, the respiratory tract’s defenses generally combat inhaled pathogens. However, weakened defenses can promote colonization of pathogenic bacteria in the trachea and bronchi, provoking infection. Inflammatory processes enhance blood flow, increasing pulmonary secretions leading to symptomatic coughing, fever, and wheezing.

Signs and Symptoms
  • Cough: Initially dry, transitioning to a productive cough as mucosal secretions increase.
  • Headache and Chest Pain: Often secondary to coughing.
  • Fever: Arises due to the infection, affecting body temperature regulation.
  • Exercise-Induced Dyspnoea: Shortness of breath on physical exertion due to airway narrowing.
  • Malaise: Resulting from reduced tissue perfusion.
  • Wheezing: May be detected during a physical examination.
Investigations
  • Chest X-ray: Indicates flat diaphragm or lung over-distention.
  • Sputum Culture: Often reveals high levels of microorganisms and neutrophils.
  • Arterial Blood Gas Analysis: Characterizes hypoxemia or hypercapnia.
Treatment

Treatment incorporates resting, hydration, and avoiding irritants:

  • Inhaled Bronchodilators: To relieve spasms and enhance airway clearance.
  • Steroids: For chronic cases, provided orally to diminish swelling.
  • Cough Suppressants/Expectorants: If the cough remains troublesome.
  • Broader antibiotic prescriptions may be necessary for bacterial infections of the lower respiratory tract.
BRONCHIECTASIS
Definition

Bronchiectasis is characterized by persistent, irreversible dilation of the bronchi due to the destruction of airway cartilage and elastic tissues, resulting in bronchial wall damage.

Causes
  • Infective organisms: Viruses or bacteria.
  • Cystic Fibrosis: A hereditary disorder affecting mucous production.
  • Obstruction: From foreign bodies, tumors, or inflammatory processes.
  • Inhalation of Corrosive Gas.
Predisposing Factors
  • Measles and Bronchopneumonia.
  • Chronic Bronchitis and Tuberculosis.
Pathology

Intense, chronic inflammation triggers inflammatory mediator release and neutrophil activity, leading to tissue damage, ultimately causing permanent bronchial dilation and respiratory dysfunction.

Signs and Symptoms
  • Chronic, Purulent Cough: Often accompanied by sputum.
  • Clubbing of Fingers: Due to chronic hypoxemia.
  • Hemoptysis: Indicative of blood vessel irritation.
  • Generalized Fatigue and anorexia.
Diagnosis

Utilizes the patient’s detailed history alongside:

  • Physical Examination
  • Chest X-ray and other modalities to reveal abnormalities or confirm diagnosis.
  • Pulmonary Function Tests to evaluate the extent of lung function impairment.
Treatment
  • Physiotherapy: Breathing exercises and drainage techniques.
  • Fluid Intake: At least 3000 mL per day to aid mucous clearance.
  • Specific Antibiotics to address ongoing infections.
  • Surgical intervention may be indicated for irreparably damaged areas.
ATELECTASIS
Definition

Atelectasis embodies incomplete lung expansion or collapse due to collapsed pulmonary areas characterized by dyspnea and chest discomfort.

Classification/Types
  • Resorption Atelectasis: Resulting from airway obstruction leading to oxygen trapping in the alveoli.
  • Compression Atelectasis: Develops when the pleural cavity is obstructed by fluid, tumors, or air.
  • Contraction Atelectasis: Results from fibrotic changes hindering full lung expansion.
Pathophysiology

Obstruction leads to alveolar air resorption, causing lung collapse. This hinders normal ventilation and progression of respiratory compounds from entering affected areas, causing respiratory compromise.

Signs and Symptoms
  • Cough, albeit non-prominent: Due to airway irritation.
  • Sputum Production.
  • Chest Pain: Due to impairment in lung expansion.
  • Dyspnea and Occasional Cyanosis: A sign of profound oxygen deprivation.
Investigations
  • History Taking and Physical Examination reveals crucial symptoms.
  • Chest X-ray shows collapsed regions of the lung.
  • Bronchoscopy and Other Imaging Techniques: Assist in evaluating for blockage or neoplasm.
Treatment
  • Postural Drainage and Deep Breathing Exercises: Help optimize oxygenation.
  • Bronchodilators: Improve mucociliary clearance.
  • Continuous Positive Airway Pressure (CPAP): Utilized for managing hypoxemia.
  • In severe cases, surgical intervention may be warranted for underlying causes.
LUNG ABSCESS
Definition

Lung abscess refers to localized lung infections that result in pus accumulation and tissue destruction.

Types
  • Primary Lung Abscess: Develops from a pre-existing lung infection.
  • Secondary Lung Abscess: Results from a complication of another process, such as embolism or the rupture of an extra-pulmonary abscess.
Predisposing Factors

Localized pneumonia, necrosis from neoplasms, and infectious conditions are considered risk factors.

Causes

Anaerobic bacteria are most frequently implicated, including:

  • Peptostreptococcus, Bacteriodes, and Fusobacterium species.
  • Aerobic bacteria such as Staphylococcus aureus and S. pneumoniae may also contribute.
Pathophysiology

Often originating from aspirated material, bacteria infiltrate the lower lung pathways typically in patients harboring periodontal disease, leading to aspiration pneumonia and subsequent tissue necrosis, and abscess formation.

Signs and Symptoms

Symptoms arise gradually unless associated with severe infections:

  • Fever, Night Sweats: Indicative of infectious processes.
  • Foul Smelling Purulent Sputum (approx. 70% of cases).
  • Hemoptysis, Chest Pain, Dyspnea due to tissue destruction.
Investigations

Involves:

  • Detailed physical assessment and chest X-ray results indicating abscess presence.
  • Sputum Cultures and Blood Cultures may help ascertain causative bacteria.
Treatment
  • Bronchial Drainage: Necessary for abscess management.
  • Broad-Spectrum Antibiotics: Form the foundation for treatment.
  • Pulmonary Physiotherapy to aid in recovery.
  • Surgical procedures may be considered in severe cases.
EMPYEMA
Definition

Empyema entails the collection of pus within the pleural cavity, resembling a dry pleuritis or pyothorax. It must be differentiated from lung abscess which indicates pus-filled cavities formed due to necrosis.

Predisposing Factors

Includes:

  • Bacterial Pneumonia, Lung Abscess, Thoracic Trauma, or Esophageal Rupture.
Causes

Up to 40% of empyema cases can be attributed to tuberculosis. Bacterial infections from organisms such as S. pneumoniae and E. coli may also be responsible.

Pathophysiology

It progresses through three stages:

  1. Exudative Stage: Accumulation of pus.
  2. Fibrinopurulent Stage: Formation of loculated pockets of pus.
  3. Organizing Stage: Referral scarring within the pleural cavity, possibly resulting in lung entrapment.
Signs and Symptoms

Signs may include:

  • Fever and Chills: linked to underlying infections.
  • Chest Pain during inhalation, exacerbated by inflammation.
  • Dry Cough and Dyspnea related to lung compressibility.
Investigations

Assessment may be in line with:

  • Physical Examination, revealing diminished breath sounds.
  • Chest X-ray to rule out related conditions.
  • Fluid sampling via thoracentesis for causative organisms identification.
Treatment

Comprises:

  • IV Antibiotics: Such as ampicillin.
  • Thoracocentesis: To manage pus drainage.
  • Analgesics for pain management.
CONCLUSION

Empyema signifies an underlying medical condition; thus, treatment should incorporate management of the underlying disease in addition to the symptoms presented. Overall, close monitoring and care for respiratory diseases are crucial within healthcare settings.