UPPER RESPIRATORY DISEASES and Disorders.
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The document discusses various upper respiratory diseases and disorders, detailing conditions such as epistaxis, nasal obstruction, rhinitis, and sinusitis, along with their symptoms, causes, and medical management. Treatment methods range from simple pressure application for nosebleeds to surgical interventions for chronic conditions. Different types of rhinitis are explored, including allergic and non-allergic forms, as well as the management of sinusitis and pharyngitis.
UPPER RESPIRATORY DISEASES and Disorders.
- 1. UPPER RESPIRATORY DISEASES & DISORDERS DR. PALLAVI PATHANIA
- 3. EPISTAXIS (NOSEBLEED) A hemorrhage from the nose, referred to as epistaxis, is caused by the rupture of tiny, distended vessels in the mucous membrane of any area of the nose.
- 4. Most commonly, the site is the anterior septum, where three major blood vessels enter the nasal cavity: (1) the anterior ethmoidal artery on the forward part of the roof (2) the sphenopalatine artery in the posterosuperior region, and (3) the internal maxillary branches There are a variety of causes associated with epistaxis, including trauma, infection, inhalation of illicit drugs, cardiovascular diseases, , nasal tumors, low humidity, a foreign body in the nose.
- 5. CONT…D Sitting position leaning forward. 5
- 6. Medical Management Management of epistaxis depends on the location of the bleeding site. If nosebleeds originate from the anterior portion of the nose. Initial treatment may include applying direct pressure. The patient sits upright with the head tilted forward to prevent swallowing and aspiration of blood and is directed to pinch the soft outer portion of the nose against the midline septum for 5 or 10 minutes continuously. If this measure is unsuccessful, additional treatment is indicated. In anterior nosebleeds, the area may be treated with a silver nitrate applicator and Gelfoam, or by electrocautery. Topical vasoconstrictors, such as adrenaline (11,000), cocaine (0.5%), and phenylephrine may be prescribed. If bleeding is occurring from the posterior regions, cotton pledgets soaked in a vasoconstricting solution may be inserted into the nose to reduce the blood flow and improve the examiner’s view of the bleeding site. Alternatively, a cotton tampon may be used to try to stop the bleeding. Suction may be used to remove excess blood and clots from the field of inspection. Desmopressin, fibrinolytic therapy,
- 8. NASAL OBSTRUCTION The passage of air through the nostrils is frequently obstructed by a deviation of the nasal septum, hypertrophy of the turbinate bones, or the pressure of nasal polyps, which are grapelike swellings that arise from the mucous membrane of the sinuses, especially the ethmoids. This obstruction also may lead to a condition of chronic infection of the nose and result in frequent episodes of nasopharyngitis. When sinusitis develops and the drainage from these cavities is obstructed by deformity or swelling within the nose, pain is experienced in the region of the affected sinus.
- 9. MEDICAL MANAGEMENT The treatment of nasal obstruction requires the removal of the obstruction, followed by measures to overcome whatever chronic infection exists. In many patients an underlying allergy requires treatment. At times endoscopic surgery is necessary to drain the nasal sinuses. The specific procedure performed depends on the type of nasal obstruction found. Usually, surgery is performed under local anesthesia. If a deviation of the septum is the cause of the obstruction, the surgeon makes an incision into the mucous membrane and, after raising it from the bone, removes the deviated bone and cartilage with bone forceps. The mucosa then is allowed to fall back in place and is held there by tight packing. Generally, the packing is soaked in liquid petrolatum so that it can be removed easily in 24 to 36 hours. This operation is called a submucous resection or septoplasty. Nasal polyps are removed by clipping them at their base with a wire snare.
- 10. RHINITIS
- 11. RHINITIS Rhinitis, also known as coryza,
- 12. Rhinitis is a group of disorders characterized by inflammation and irritation of the mucous membranes of the nose. It may be classified as nonallergic or allergic. Rhinitis is irritation and inflammation of the mucous membrane inside the nose. Common symptoms are a stuffy nose, runny nose, sneezing, and post-nasal drip
- 13. Caused by viruses, bacteria, irritants or allergens. The most common kind of rhinitis is allergic rhinitis, such as pollen and dander .
- 14. TYPES Infectious : Common cold and Sinusitis Rhinitis is commonly caused by a viral or bacterial infection, including the common cold, which is caused by Rhinoviruses, Coronaviruses, and influenza viruses, others caused byadenoviruses, ETC . Symptoms of the common cold include rhinorrhea, sneezing, sore throat (pharyngitis), cough, congestion, and slight headache
- 15. Nonallergic rhinitis Nonallergic rhinitis refers to rhinitis that is not due to an allergy. It includes vasomotor, idiopathic, hormonal, atrophic, occupational, and gustatory rhinitis, as well as rhinitis medicamentosa (rebound congestion) It was formerly known as vasomotor rhinitis as the cause was thought to be vasodilation caused by an overactive parasympathetic nerve response. In vasomotor rhinitis, certain nonspecific stimuli, including changes in environment (temperature, humidity, barometric pressure, or weather), airborne irritants (odors, fumes), dietary factors (spicy food, alcohol), sexual arousal, exercise, an emotional factors trigger rhinitis, So it is thought that these non-allergic triggers cause dilation of the blood vessels in the lining of the nose, which results in swelling and drainage.
- 16. Allergic rhinitis Allergic rhinitis or hay fever may follow when an allergen such as pollen, dust, is inhaled by an individual with a sensitized immune system, triggering antibody production. These antibodies mostly bind to mast cells, which contain histamine. When the mast cells are stimulated by an allergen, histamine (and other chemicals) are released. This causes itching, swelling, and mucus production.
- 17. Rhinitis medicamentosa: Rhinitis medicamentosa is a form of drug-induced nonallergic rhinitis which is associated with nasal congestion brought on by the use of certain oral medications (primarily sympathomimetic amine and imidazoline derivatives) and topical decongestants (e.g., oxymetazoline, phenylephrine, xylometazoline, and naphazoline nasal sprays) that constrict the blood vessels in the lining of the nose. Chronic atrophic rhinitis : Chronic rhinitis is a form of atrophy of the mucous membrane and glands of the nose. Rhinitis sicca: Chronic form of dryness of the mucous membranes. Polypous rhinitis: Chronic rhinitis associated with polyps in the nasal cavity.
- 18. PATHOPHYSIOLOGY Allergy , infection , structural deformity Rhinorhea Nasal congestion Inflammation Rhinitis
- 19. Clinical Manifestations Rhinorrhea (excessive nasal drainage, runny nose), nasal congestion, nasal discharge (purulent with bacterial rhinitis), nasal itchiness, and sneezing. Headache may occur, particularly if sinusitis is also present
- 21. Management The management of rhinitis depends on the underlying cause. For allergic rhinitis, intranasal corticosteroids and antihistamines can be used to suppress inflammation and control symptoms.
- 22. GENERAL MANAGEMENT Anti microbal agent Corticosteroid Antihitamanic drugs Avoid allergy Saline nasal drop
- 23. VIRAL RHINITIS (COMMON COLD)
- 24. VIRAL RHINITIS (COMMON COLD) The term “common cold” often is used when referring to an upper respiratory tract infection that is self-limited and caused by a virus (viral rhinitis). Nasal congestion, Rhinorrhea, sneezing, sore throat, and general malaise characterize it.
- 25. A chronic inflammation of the nasal mucosal membrane characterized by increased nasal mucus. Cause Repeated acute infection or allergy. Chronic irritation by nasal drug Rhinovirus influenza virus corona virus, adenovirus.
- 26. Clinical Manifestations nasal congestion, runny nose, sneezing, nasal discharge, nasal itchiness, tearing watery eyes, “scratchy” or sore throat, general malaise, low-grade fever, chills, and often headache and muscle aches cough usually appears. In some people, viral rhinitis exacerbates the herpes simplex, commonly called a cold sore (Chart 22-1). The symptoms last from 1 to 2 weeks. Allergic conditions can also affect the nose, mimicking the symptoms of a cold.
- 27. Medical Management Providing adequate fluid intake, encouraging rest, Warm salt-water gargles soothe the sore throat and nonsteroidal anti- inflammatory agents (NSAIDs) such as aspirin or ibuprofen relieve the aches, pains, and fever in adults. Antihistamines are used to relieve sneezing, rhinorrhea, and nasal congestion. Topical (nasal) decongestant agents may relieve nasal congestion. Antimicrobial agents (antibiotics) should not be used because they do not affect the virus or reduce the incidence of bacterial complications.
- 28. SINUSITIS It is an inflammation of the mucous membranes in the sinuses. Sinusitis can be; 1. Acute bacterial. 2. Sub acute. 3. Chronic. 28
- 29. ACUTE SINUSITIS
- 30. ACUTE SINUSITIS Acute sinusitis, also called acute rhinosinusitis, is a short-term infection or inflammation of the membranes that line your sinuses. It prevents mucus from draining from your nose. It is a short-term infection or inflammation of the membranes that line your sinuses.
- 31. What Causes Acute Sinusitis? Viruses, bacteria, fungi and allergens can cause sinusitis. Specific triggers for sinusitis include: The common cold. The flu (influenza). Streptococcus pneumoniae bacteria. Haemophilus influenza bacteria. Moraxella catarrhalis bacteria. Nasal and seasonal allergies.
- 33. Who Is at Risk for Acute Sinusitis? Nasal allergies. Asthma. Nasal polyps (growths). Deviated septum. Your septum is a line of tissue that divides your nose. A deviated septum isn’t straight, narrowing the passage on one side of your nose. This can cause a blockage. A weakened immune system. This can be from illnesses like HIV or cancer, or from certain medications. Smoking.
- 35. What are the Symptoms of Acute Sinusitis? Nasal Congestion Thick, Yellow, Or Green Mucus Discharge From The Nose Sore Throat A Cough (Usually Worse At Night) Drainage Of Mucus In The Back Of Your Throat Headache Pain, Pressure, Or Tenderness Behind Your Eyes, Nose, Cheeks, Or Forehead Earache Toothache Bad Breath Reduced Sense Of Smell Reduced Sense Of Taste Fever Fatigue
- 36. How Is Acute Sinusitis Diagnosed? Nasal endoscopy. Nasal swabs. Your provider may use a soft-tipped stick to get a fluid sample from your nose. They’ll test it for viruses or other germs that might be causing your symptoms. Imaging. In some cases, your provider might order a computed tomography (CT) scan to better understand what’s happening inside your sinuses. Allergy testing. If you have chronic sinusitis, your provider may test you for allergies that could be triggering it. Biopsy. Rarely, a provider may take a tissue sample from your nose for testing.
- 37. There are many treatment options for sinusitis, depending on your symptoms and how long you’ve had them. You can treat a sinus infection at home with: Decongestants. Over-the-counter (OTC) cold and allergy medications. Nasal saline rinses. Drinking plenty of fluids. If symptoms of sinusitis don’t improve after 10 days, a provider may prescribe: Antibiotics. Oral or topical decongestants. Prescription intranasal steroid sprays. (Don’t use nonprescription sprays or drops for longer than three to five days — they may actually increase congestion.) Providers treat chronic sinusitis by focusing on the underlying condition. Treatments can include: Intranasal steroid sprays. Topical antihistamine sprays or oral pills. Leukotriene antagonists, like montelukast. Surgery to treat structural issues, polyps or fungal infections.
- 38. What are the best medications for a sinus infection? If you need an antibiotic, which one your provider prescribes depends on your specific situation. Some options include: Augmentin (amoxicillin/clavulanate). Amoxicillin. Doxycycline. Levofloxacin. Cefixime. Cefpodoxime. Clindamycin.
- 40. CHRONIC SINUSITIS Chronic bacterial sinusitis develops when irreversible mucosa damage occurs. Damage can result from recurrent attacks of acute sinusitis or either being untreated or inadequately treated during the acute or sub acute phase. Etiology S.aureus H. influenza Anaerobes (Klebsiella) 40
- 41. CHRONIC SINUSITIS Chronic sinusitis is an inflammation of the sinuses that persists for more than 3 weeks in an adult.
- 42. Pathophysiology Due to etiological factors Inflammation of mucosal membrane of sinuses A narrowing or obstruction preventing adequate drainage to the nasal passages. Blockage that persists for greater than 3 weeks in an adult may occur because of infection, allergy, or structural abnormalities. This results in stagnant secretions, cause chronic sinusitis.
- 43. Clinical Manifestations Impaired mucociliary clearance and ventilation, cough Chronic hoarseness, facial pain. Fatigue. A decrease in smell and taste and a fullness in the ears. Nasal congestion, Thick, green purulent discharge, Fever ,
- 44. Assessment and Diagnostic Findings A careful history and diagnostic assessment, Computed tomography scan Magnetic resonance imaging Nasal endoscopy
- 45. Medical Management The antimicrobial agents of choice include amoxicillin or ampicillin (Ampicin). Clarithromycin (Biaxin) and third-generation cephalosporins such as cefuroxime axetil (Ceftin), cefpodoxime (Vantin), and cefprozil (Cefzil) have also been effective. Decongestant agents, Antihistamines, nasal sprays.
- 46. SURGICAL MANAGEMENT When standard medical therapy fails, surgery, usually ENDOSCOPIC, may be indicated to correct structural deformities that obstruct the (openings) of the sinus. EXCISING AND CAUTERIZING NASAL POLYPS, incising and draining the sinuses, aerating the sinuses, and removing tumors are some of the specific procedures performed. Oral and topical cortico-steroids are usually prescribed. Antimicrobial agents are administered before and after surgery. Some patients with severe chronic sinusitis obtain relief only by moving to a dry climate.
- 47. ANATOMIC AND PHYSIOLOGIC REVIEW OF THROAT 47
- 48. PHARANGITIS
- 49. ACUTE PHARYNGITIS CHRONIC PHARYNGITIS
- 50. . ACUTE PHARYNGITIS Pharyngitis, or sore throat, is discomfort, pain, or scratchiness in the throat. It often makes it painful to swallow. Acute pharangitis is a febrile inflammation of the throat that is caused by hemolytic streptococci, staphylococci. It is the most common throat inflammation. 50
- 51. CAUSES Pharyngitis is caused by swelling in the back of the throat (pharynx) between the tonsils and the (larynx). Most sore throats are caused by colds, the flu, Adeno virus, herpes simplex virus Bacteria that can cause pharyngitis in some cases. •Strep throat is caused by group A streptococcus. •Less commonly, bacteria such as gonorrhea, and chlamydia can cause sore throat.
- 52. PATHOPHYSIOLOGY Viral infection (adenovirus,influenza,herpes simplex) & bacterial (group A beta hemolytic streptococcus) Leads to inflammatory response(in pharynx) Result in pain ,fever, edema, tissue damage, redness, & swelling in tonsils & soft palate Pharyngitis
- 53. CONT…D Clinical manifestation Fiery read throat and pharyngeal membrane and tonsils Sever pain which lead to difficulty in swallowing Enlarged and tender cervical lymph nodes Fever Malaise Sore throat Hoarseness cough Rhinitis 53
- 54. CONT…D Diagnosis Throat culture. Nasal swabbing and blood culture may be done. 54
- 55. CONT…D Medical management Analgesics such as NSAIDs and acetaminophen can help reduce the pain associated with a sore throat. Steroids (such as dexamethasone) have been found to be useful for severe pharyngitis. Viscous lidocaine relieves pain by numbing the mucus membranes. Antibiotics are useful if a bacterial infection is the cause of the sore throat. For viral infections, antibiotics have no effect. Oral analgesic solutions, the active ingredient usually being phenol, chloride and menthol. 55
- 57. CHRONIC PHARYNGITIS It is a persistent inflammation of the pharynx. Risk factors Work or live in dusty surroundings, use their voice to excess, suffer from chronic cough, an habitually use alcohol and tobacco. 57
- 58. THREE TYPES OF CHRONIC PHARYNGITIS ARE RECOGNIZED: Hypertrophic:-general thickening and congestion of the pharyngeal mucous membrane Atrophic: probably a late stage of the first type (the membrane is thin, whitish patches, glistening, inflamed ) Chronic granular : characterized by numerous swollen lymph follicles on the pharyngeal wall.
- 60. CONT…D Clinical Manifestations; a constant sense of irritation or fullness in the throat, Fever Sore, swollen glands in your neck or jaw Swollen, red tonsils White patches or pus on your tonsils Hoarse or muffled voice mucus that collects in the throat and can be expelled by coughing difficulty swallowing. Medical Management; Nasal sprays. Antihistamine, decongestant medications{tramazoloine,epinephrine} Anti-inflammatory and analgesic agent like Aspirin or acetaminophen. Antibiotic therapy 60
- 61. TONSILLITIS AND ADENOIDITIS Tonsillitis is inflammation and enlargement of the tonsil tissue. Tonsil tissue are situated on each side of the oropharynx Cause Group A streptococcus is the most common organism associated with tonsillitis. Adenoiditis is the inflammation of the adenoid tissue, usually caused by an infection Adenoiditis is inflammation of the adenoid tissue. The adenoid consist of an abnormally large lymphoid tissue mass near the center of the posterior wall of the nasopharynx. Infection of the adenoids frequently accompanies acute tonsillitis. 61
- 62. CAUSES OF TONSILLITIS When caused by a bacterium belonging to the group A streptococcus, it is typically referred to as strep throat viral infection and includes adenovirus, rhinovirus, influenza, coronavirus,
- 63. CAUSES OF ADENOIDITIS Viruses that may cause adenoiditis include adenovirus , rhinovirus and paramyxovirus. Bacterial causes include Streptococcus pyogenes, Streptococcus pneumoniae, and various species including Staphylococcus aureus.
- 64. CONT…D Clinical manifestation Tonsillitis Sore throat red, swollen tonsils pain when swallowing high temperature (fever) coughing headache tiredness chills a general sense of feeling unwell (malaise) white pus-filled spots on the tonsils swollen lymph nodes (glands) in the neck pain in the ears or neck weight loss difficulty ingesting and swallowing meal/liquid intake difficulty sleeping 64
- 65. SIGNS AND SYMPTOMS {ADENOIDITIS} Fever, Runny Nose, Earache Nasal Airway Obstruction Bad Breathing, Snoring And Sleep Apnea, Rhinorrhoea Mucous-purulent Secretion. Adenoiditis Is Sometimes Accompanied By Tonsillitis. Repeated Adenoiditis May Lead To Enlarged Adenoids.
- 66. CONT…D Diagnosis Hx. P/E. Culture of tonsil swab. Audiometric examination (hearing loss). 66
- 67. CONT…D Treatment Pain Relief, Anti-inflammatory, fever reducing medications ( paracetamol/acetaminophen and/or ibuprofen) Sore throat relief (warm salt water gargle, lozenges, dissolved aspirin. If the tonsillitis is caused by group A streptococcus, then antibiotics are useful, with penicillin or amoxicillin Tonsillectomy Adenoidectomy Mouth care may for comfort 67
- 68. CONT…D In cases of adenoiditis, treatment with analgesics or antipyretics antibiotics, such as amoxicillin or a cephalosporin. In case of adenoid hypertrophy, adenoidectomy may be performed to remove the adenoid. 68
- 69. LARYNGITIS It is inflammation of the larynx. Predisposing factor /associated to; Voice abuse. Exposure to dust. Chemicals. Smoke and other pollutants. 69
- 70. CONT…D Etiology Almost alloys is a virus bacterial invasion may be Acute rhinitis or Naso pharyngitis. The onset of infection may be associated with exposure to sudden temperature change. Diet as deficiencies Lack of immunity Laryngitis is common in the winter and is easily transmitted. 70
- 71. PATHOPHYSIOLOGY Exposure to dust , chemicals, smoke, infection inflammation (involving vocal cord) hoarseness aphonia (loss of voice)
- 72. CONT…D Clinical manifestation Chronic laryngitis Persistent hoarsoness. Hoarseness or complete loss of voice (aphonia). Severe may be a complication of chronic sinusitis and chronic bronchitis. 72
- 73. CONT…D Management resting the voice, Avoid smoking, Resting in bed , and inhaling cool steam or an aerosol For chronic laryngitis Resting the voice. Eliminating any primary respiratory tract infection. Restricting smoking. 73
- 74. CONT…D Nursing interventions The patient is instructed to rest the voice and to maintain a well humidified environment. High fluid intake. 74
- 75. CANCER OF LARYNX
- 76. CANCER OF LARYNX Cancer of the larynx is a malignant tumor in the larynx (voice box). Laryngeal cancer, also known as cancer of the larynx or laryngeal carcinoma, are mostly squamous cell carcinomas, reflecting their origin from the skin of the larynx.
- 77. Risk Factors for Laryngeal Cancer Carcinogens Tobacco (smoke, smokeless) Combined effects of alcohol and tobacco Second-hand smoke Paint fumes Wood dust Cement dust Chemicals Tar products Mustard gas Leather and metals Other Factors Chronic laryngitis Nutritional deficiencies (riboflavin) History of alcohol abuse Familial predisposition Age (higher incidence after 60 years of age) Gender (more common in men) Race (more prevalent in African Americans) Weakened immune system
- 78. Clinical Manifestations The symptoms of laryngeal cancer depend on the size and location of the tumour. Symptoms may include the following: Hoarseness or other voice changes A lump in the neck A sore throat or feeling that something is stuck in the throat Persistent cough Stridor - a high-pitched wheezing sound indicative of a narrowed or obstructed airway Bad breath Earache ("referred") Difficulty swallowing
- 79. Assessment and Diagnostic Findings A complete history and physical examination of the head and neck. An indirect laryngoscopy, The TNM classification system, to classify head and neck tumors. The classification of the tumor determines the suggested treatment modalities. Computed tomography and magnetic resonance imaging (MRI). Positron emission tomography (PET scan).
- 80. Medical Management Treatment of laryngeal cancer depends on the staging of the tumor, which includes the location, size, and histology of the tumor and the presence and extent of cervical lymph node involvement. Treatment options include surgery, radiation therapy, and chemotherapy. The prognosis depends on a variety of factors: tumor stage, the patient’s gender and age, and pathologic features of the tumor, including the grade and depth of infiltration. Surgery and radiation therapy are both effective methods in the early stages of cancer of the larynx. Chemotherapy traditionally has been used for recurrence or metastatic disease. It has also been used more recently in conjunction with either radiation therapy to avoid a total laryngectomy or preoperatively to shrink a tumor before surgery A complete dental examination is performed to rule out any oral disease.
- 81. SURGICAL MANAGEMENT Depending on the location and staging of the tumor, four different types of laryngectomy (surgical removal of part or all of the larynx and surrounding structures) are considered: • Partial laryngectomy • Supraglottic laryngectomy • Hemi laryngectomy • Total laryngectomy
- 82. UPPER AIRWAY INFECTIONS 495 Rhinitis 495 Viral Rhinitis (Common Cold) 496 Acute Sinusitis 497 Chronic Sinusitis 499 Acute Pharyngitis 500 Chronic Pharyngitis 501 Tonsillitis and Adenoiditis 501 Peritonsillar Abscess 502 Laryngitis 502 CANCER OF THE LARYNX 508
- 83. LOWER RESPIRATORY DISORDER ATELECTASIS 519 RESPIRATORY INFECTIONS 521 Acute Tracheobronchitis 521 Pneumonia 522 Nursing Process: The Patient With Pneumonia 531 Pulmonary Tuberculosis 534 Nursing Process: The Patient With Tuberculosis 538 Lung Abscess 540 PLEURAL CONDITIONS 542 Pleurisy 542 Pleural Effusion 542 Empyema 543 PULMONARY EDEMA 544 ACUTE RESPIRATORY FAILURE 545 ACUTE RESPIRATORY DISTRESS SYNDROME 546 PULMONARY HYPERTENSION 548 PULMONARY HEART DISEASE (COR PULMONALE) 549 PULMONARY EMBOLISM 550 SARCOIDOSIS 554 OCCUPATIONAL LUNG DISEASES: PNEUMOCONIOSES 554 Silicosis 555 Asbestosis 555 Coal Workers’ Pneumoconiosis 555 CHEST TUMORS 556 Lung Cancer (Bronchogenic Carcinoma) 556 Tumors of the Mediastinum 559 CHEST TRAUMA 559 Blunt Trauma 560 Penetrating Trauma: Gunshot and Stab Wounds 562 Pneumothorax 563 Cardiac Tamponade 564 Subcutaneous Emphysem