Respiratory Infections and Conditions

Laryngitis

• Definition: Inflammation of the larynx.
• Cause: Usually secondary to a respiratory infection (bacterial or viral).
• Diagnosis:
  • Laryngoscopy: A scope is used to visualize the larynx and assess for inflammation.
  • Often diagnosed based on symptoms, but laryngoscopy may be used for severe cases (e.g., difficulty swallowing).
• Signs and Symptoms:
  • Hoarseness
  • Sore throat (scratchy)
  • Cough (productive or non-productive)
• Treatment:
  • Viral:
    • Supportive care: Over-the-counter medications for symptom relief.
    • Let the infection run its course.
  • Bacterial:
    • Antibiotics.
  • Medications for Symptoms:
    • Analgesics (e.g., Tylenol) for pain.
    • Cough medicine.
    • Expectorants (e.g., Mucinex) to break up chest congestion.
• Nursing Interventions & Teaching:
  • Hydration.
  • Hand hygiene.
  • Voice rest.
  • Complete prescribed antibiotics.
  • Smoking cessation.
  • Use of a vaporizer or humidifier (warm or cool mist).

Pharyngitis

• Definition: Inflammation of the pharynx.
• Causes:
  • Viral.
  • Bacterial (e.g., Streptococcus).
• Types: Acute or Chronic
• Diagnosis:
  • Throat culture: To determine if the cause is bacterial (strep) or viral.
• Signs and Symptoms:
  • Difficulty swallowing.
  • Dry cough.
  • Soreness.
  • Enlarged cervical glands.
  • Red and inflamed throat.
  • Scratchy feeling in the throat.
  • Severe pain (especially with strep).
• Treatment:
  • Depends on the cause (viral, bacterial, acute, or chronic).
  • Symptom management (sore throat, cough, fever).
  • Strep Throat:
    • Typically treated with penicillin.
    • Assess for penicillin allergy: type of reaction, when it happened. If a patient reports a penicillin allergy, ask clarifying questions about the nature and timing of the allergic reaction.
• Nursing Interventions & Teaching:
  • Fluids.
  • Pain medication.
  • Rest.
  • Complete antibiotics.

Sinusitis

• Definition: Inflammation of the sinuses.
• Types: Acute or Chronic
• Cause: Usually starts with an upper respiratory infection.
• Diagnosis:
  • CT scan of the head and face: To visualize inflammation of the sinuses.
• Signs and Symptoms:
  • Pressure in the face.
  • Severe headache.
  • Drainage.
  • Increased pain with pressure.
  • Decreased sense of smell and taste.
  • Swollen eyelids.
  • Possible nausea.
  • Fever.
• Treatment:
  • Chronic: Surgery to clean out sinuses.
  • Acute:
    • Determine the cause (bacterial vs. viral) to decide whether to use antibiotics.
    • Saline nasal irrigation (Neti-Pot).
    • Corticosteroid nasal sprays (e.g., Flonase) or oral corticosteroids.
    • Pain relievers (e.g., Tylenol).
• Nursing Interventions & Teaching:
  • Apply warm packs to the sinuses to promote drainage.
  • Saline irrigation with warm, salty water.
  • Review medications used to treat sinusitis (mentioned on page 397).

Acute Bronchitis

• Definition: Inflammation of the bronchi and bronchioles (bronchial tree).
• Causes:
  • Smoking.
  • Inhaled irritants.
  • Upper respiratory infection (bacterial or viral).
  • Chemical irritants (e.g., inhaled bleach).
• Signs and Symptoms:
  • Coughing.
  • Wheezing.
  • Chest pain.
  • Low-grade fever.
  • Thick mucus that is difficult to expectorate.
  • Shortness of breath.
• Diagnosis:
  • Chest X-ray: To rule out pneumonia.
  • Sputum culture: To identify potential bacterial infection (must be sputum, not spit).
• Treatment:
  • Cough syrup.
  • Bed rest.
  • Hydration.
  • Antibiotics (if bacterial).
  • Cough suppressants.
  • Bronchodilators (e.g., albuterol).
• Nursing Interventions & Teaching:
  • Increase fluid intake.
  • Preserve energy.
  • Prevent secondary infections.
  • Limit exposure to others.
  • Watch out for worsening symptoms that may indicate pneumonia (e.g., increased shortness of breath, fever, chest pain, change in sputum color or thickness).
  • Use a humidifier.

Legionnaires' Disease

• Cause: Bacteria called Legionella, found in water reservoirs.
• Transmission: Airborne.
• Sources: Hot tubs, water reservoirs, CPAP machines, spas, air conditioners, humidifiers.
• Pathophysiology:
  • Causes necrosis of the alveoli, impairing gas exchange.
  • Rapid progression (less than a week) leading to respiratory failure.
  • Can progress to renal failure and shock.
• Signs and Symptoms:
  • Significantly elevated temperature (e.g., 103-104°F).
  • Rapid breathing.
  • Difficulty breathing.
  • Increased heart rate.
  • Decreased urine output.
  • Hematuria (blood in urine).
• Diagnosis: Urine culture to detect Legionella bacteria.
• Treatment:
  • Oxygen and possible ventilation.
  • IV fluids.
  • Possible dialysis.
  • Vasopressors.
  • Antibiotics (e.g., erythromycin).
  • Antipyretics for fever.
• Nursing Interventions & Teaching:
  • Monitor for rapid decline and signs/symptoms of shock
  • Lower the fever.
  • Bed rest.
  • Elevate the bed (at least 30 degrees, ideally 45 degrees).
  • Monitor intake and output.
• Mortality Rate: 1 out of 10
  Note: The alveoli can become necrotic, which causes a rapid decline in overall condition.