MEDSURG Nursing MIDTERM BSN

MS. Meyan Rose Malabanan | SY: 2022-2023 LEVEL III

RESPIRATORY SYSTEM
TONSILITIS AND ADENOIDITIS • Symptoms include odynophagia, otalgia,
- Is the inflammation of tonsils and adenoids. dysphagia, thickening of the voice, drooling & local
- Infection of the adenoids frequently accompanies pain, and swelling of the soft palate
acute tonsillitis.
- Group A beta-streptococcus is the most common
organism associated with tonsillitis and adenoiditis
SAFETY ALERT!
 Frequent tonsillitis (strep throat) may place
patient at high risk of developing rheumatic
heart disease.
 Clinical Manifestations
1. Sore throat  Medical Management
2. Fever - Antibiotics (usually penicillin)
3. Snoring - Abscess must be drained
4. Difficulty in swallowing - Abscess may also be incised and drained
5. Ear ache
6. Draining ears  Surgical Management
7. Bronchitis 1. Tonsillectomy or Adenoidectomy. However,
8. Foul smelling they may only be indicated if:
9. Voice impairment 2. Repeated period of illness of tonsillitis
10. Noisy respiration 3. Hypertrophy of the tonsils and adenoids that
could cause obstruction and obstructive sleep
apnea
4. Repeated attacks of purulent Otitis media

 Nursing Responsibilities
- Patient Education
- Advise adequate fluid intake
- Frequent use of mouth washes and gargles
using saline solution

ACUTE PHARYNGITIS (STREP THROAT)

➢ This is a sudden painful inflammation of the
pharynx, which is the back portion of the throat that
includes the posterior third of the tongue, soft
palate, and tonsils. It is most commonly referred to
as sore throat.
➢ Most cases are caused by viral infection since it
spreads easily through droplet transmission as
well as from unclean hands that were exposed to
the contaminated fluids.
➢ Group A beta-hemolytic streptococcus (GABHS;
GAS), is the most common bacterial organism,
causing Acute Pharyngitis (Strep Throat).
CLINICAL MANIFESTATION
• Affected pharyngeal membrane and tonsils
• Lymphoid follicles that are swollen with exudates.
• Enlarged and tender cervical lymph nodes
• Fever and malaise
• Sore throat
• Hoarseness, cough and rhinitis
DIAGNOSIS
• Rapid antigen detection tests for streptococcal
PERITONSILLAR ABCESS infection (RADT)
• Is a collection of purulent exudate between the o Rapid antigen detection tests (RADT) are very
tonsillar capsule and the surrounding tissues, specific for Group A beta-hemolytic
including the soft palate. streptococci, but their sensitivity varies widely,
• Develop after an acute tonsillar infection, from about 70% to 90%. If the test is positive,
progresses to a local cellulitis & abscess treatment should be initiated. If it is negative,
 particularly in children, a throat culture should o Peritonsillar abscess
be obtained and should guide treatment. o Mastoiditis
• Anti-streptolysin titers (ASO) o Cervical Adenitis
o Antistreptolysin O (ASO) titer is a blood test o Rheumatic fever
to measure antibodies against streptolysin O, o Nephritis
a substance produced by group A DIFFERENTIAL DIAGNOSIS
streptococcus bacteria. Antibodies are A sore throat that is worse when swallowing without
proteins our bodies produce when they detect pharyngitis suggests a possibility of thyroiditis which
harmful substances, such as bacteria. should be referred to evaluation and treatment to the
• Throat cultures proper specializations.
• Nasal swabs and blood cultures
MEDICAL MANAGEMENT CHRONIC PHARYNGITIS
 Viral pharyngitis is treated with supportive  Chronic Pharyngitis is the persistent
measures. inflammation of the pharynx common in adults
 Bacterial pharyngitis is treated with Antibiotics. who work or live in dusty surroundings, use their
Antibiotics are administered for at least 10 days. voice to excess, suffer from chronic cough, and
Treatment options for Group A beta-hemolytic habitually use alcohol and tobacco.
streptococcal pharyngitis include oral treatment CLINICAL MANIFESTATION
with penicillin V or oral amoxicillin. o Constant sense of irritation or fullness in the
Cephalosphorins, macrolides, and clindamycin throat
may also be used. Resistance may develop during o Mucus that collects in the throat and can be
treatment with azithromycin and clarithromycin, expelled by coughing and;
and it is not considered a first-line antibiotic for this o Difficulty swallowing
indication. In patients with a mild penicillin allergy, MEDICAL MANAGEMENT
cephalosporins can be used. - Based on relieving symptoms
 In patients with a history of anaphylaxis to - Avoiding exposure to irritants, and correcting
penicillin, azithromycin or clindamycin can be used any upper respiratory, pulmonary, or cardiac
(MA, et al., 2009). The disease is no longer condition that might cause chronic cough.
infectious after 24 hours of antibiotics. Single- - Nasal congestion may be relieved by short-term
dose corticosteroids like dexamethasone may be use of nasal sprays or medications containing
given to reduce the severity of symptoms, although ephedrine sulfate or phenylephrine
the evidence for this approach is limited. hydrochloride.
Symptomatic treatment with gargles and - Antihistamine decongestant medications,
acetaminophen or nonsteroidal anti-inflammatory such as Drixoral or Dimetapp, is taken orally
drugs should be recommended. every 4 to 6 hours.
 Liquid or soft diet is provided during the acute - Aspirin or Acetaminophen is recommended
stage of the disease. for its anti-inflammatory and analgesic
 In severe situations; fluids are administered by properties.
intravenously. - Encourage the patient to drink plenty of fluids.
NURSING RESPONSIBILITIES - Gargling with warm saline solutions may relieve
• Patient education especially on the importance throat discomfort.
of finishing the full course of antibiotic therapy - Lozenges will keep the throat moistened.
• Patient should stay in bed during the febrile ***Diagnosis and Nursing Responsibilities for Acute
stage. and Chronic Pharyngitis are relatively the same
• Alcohol, tobacco, second-hand smoke, and
exposure to cold are avoided LARYNGITIS
• Encourage the patient to drink plenty of fluids. - Inflammation of the larynx
• Gargling with warm saline solutions may relieve - Often occurs as a result of voice abuse or
throat discomfort. exposure to dust, chemicals, smoke & other
• Lozenges will keep the throat moistened pollutants, or as part of an URTI.
• Instruct patient to change toothbrush to a new - It also may be caused by isolated infection
one, and avoid sharing eating utensils even with involving only the vocal cords.
family members. - The cause of infection is almost always a virus.
SAFETY ALERT - Usually associated with allergic rhinitis or
 Make sure that used tissues or personal items in pharyngitis.
contact with bodily fluids are disposed of properly - It may also be caused by gastroesophageal reflux
to prevent the spread of infection. The nurse (reflux laryngitis).
should monitor the skin for rashes twice daily, - The onset of infection may be associated with
because acute pharyngitis may precede other exposure to sudden temperature changes, dietary
communicable diseases (eg rubella) deficiencies, malnutrition, and an immune
POSSIBLE COMPLICATIONS suppressed state.
o Sinusitis CLINICAL MANIFESTATION
o Otitis media o Hoarseness
o Pneumonia o Aphonia (complete loss of voice)

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o Severe cough - Continuous monitoring of oxygen levels is a
o Chronic laryngitis is marked by persistent MUST.
hoarseness Definition of terms:
o May be a complication of URTI Polyp – Grape-like swellings that arise from the
o The throat feels worse in the morning mucous membrane of the sinuses, especially the
MEDICAL MANAGEMENT ethmoids.
- Resting the voice Malaise – a general feeling of discomfort, illness, or
- Avoiding smoking uneasiness whose exact cause is difficult to identify.
- Avoiding second-hand smoke
- Inhaling cool steam or an aerosol LOWER RESPIRATORY TRACT INFECTION
- Appropriate antibacterial therapy ACUTE BRONCHITIS
- Topical corticosteroids, such as - Is a common acute inflammation of the mucous
Beclomethasone (Vanceril) inhalation membrane lining the inside of the bronchi
NURSING RESPONSIBILITIES - Often follows URTI and often occurs in people with
- Instruct to rest the voice and explore other chronic lung disease.
options for communication CAUSES
- To maintain a well-humidified environment.  Bacteria (Streptococcus pneumonia and
- Expectorant agents are suggested along with Haemophilus influenza)
a daily fluid intake of 3 L to thin secretions.  Virus and chemical and smoke irritants also can
POSSIBLE COMPLICATIONS cause inflammation
o Sepsis CLINICAL MANIFESTATION
o Meningitis o Dry, irritating cough
o Peritonsillar abscess o Scanty amount of mucoid sputum
o Otitis media o Sternal soreness
o Sinusitis o Fever (low grade)
o Purulent sputum
OBSTRUCTION AND TRAUMA OF THE UPPER o Chills
AIRWAY o Night sweats
Nasal Obstruction o Headache
 The passage of air may be obstructed by a o General malaise
deviation in the nasal septum, hypertrophy of the o Shortness of breath
turbinate bones, or the pressure of a nasal polyp. DIAGNOSIS
 Chronic nasal congestion seriously affects - Health History
patients throughout the day as well as during - Physical Exam - Rhonchi and Wheezes
sleep. It forces the patient to breathe through the - Chest Xray to rule out Pneumonia
mouth producing dryness in the oral mucosa. MEDICAL MANAGEMENT
These patients often suffer from sleep • Antibiotic treatment
deprivation due to difficulty in the maintaining • Usually don’t prescribe Antihistamines because
adequate airway while lying flat and during sleep. they can cause excessive drying.
 Persistent nasal obstruction also may lead to • Expectorants may be prescribed
chronic infection of the nose and result in • Increase fluid intake
frequent episodes of nasopharyngitis. • Suctioning (if patient is unable to expectorate on
Laryngeal Obstruction their own)
 Obstruction of the larynx because of edema is a • Moist heat to the chest may relieve the soreness
serious, often fatal, condition. The larynx is a soft and pain.
box that will not stretch. It contains a narrow
• Mild analgesics or antipyretics may be indicated.
space between vocal cords through which air
must pass.
 Swelling of the laryngeal mucous membrane may PNEUMONIA
close off the opening tightly, leading to life - An inflammation of the lower respiratory tract that
threatening hypoxia of suffocation. involves the lung parenchyma.
 This may also occur in patients suffering from - Pathogens can be introduced into the lungs by 3
urticaria and scarlet fever. primary routes
CLINICAL MANIFESTATION CAUSES
o lowered oxygen saturation - bacteria
o use of accessory muscles to maximize airflow - virus
(retraction in the neck or abdomen during - fungus
inspiration) - chemical or radiations
MEDICAL MANAGEMENT MODE OF TRANSMISSION
- Ensure patent airway 1. Aspiration: transmitted micro-organisms from the
- Ultimately, the goal is to remove the obstruction oropharynx and GIT to the lungs by direct-contact
- If the obstruction is caused by edema (as in Causes:
laryngitis) treatment may include immediate o Glottis disorder
administration of ephedrine and a corticosteroid o Pts with NGT

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 o Unconscious patients 2. Bronchopneumonia
2. Inhalation: It is an important MOT for organisms o Describes pneumonia that is distributed in a
suspended in water droplets and spread into the patchy fashion
air with coughing, sneezing and talking.
3. Circulatory spread: Spread of infection occurs C. According to causative agents
when pathogens are transmitted through the 1. Bacterial Pneumonia
circulatory system to lung from pre-existing - Can be caused by both from gram (–) and
infection in other parts of the body. gram (+) bacteria.
KEY POINTS - Streptococcus Pneumonia is the most
 Pneumonia can be transmitted through different common bacteria & causative agent
modes - Most prevalent during the winter and spring
 It is a common disease that may affect the elderly when URTIs are more frequent
and immunocompromised
 It may be classified into different types depending 2. Viral pneumonia
on where it is acquired, its clinical manifestations, - Influenza virus type A is the most type of
it’s causative agents. causative agent in a healthy person
 Pneumonitis is a more general term that - CMV is the most common cause of viral
describes an inflammatory process in the lung pneumonia in Immunosuppressed patient with
tissue that may predispose or place the patient at high mortality rate
risk for microbial invasion.
 Standard transmission precautions should always 3. Fungal pneumonia
be maintained when around patients with - Most common in immune compressed and
pneumonia. ALWAYS WASH YOUR HANDS! neurogenic patients
CLASSIFICATION OF PNEUMONIA - Histoplasmosis is caused by Histoplasma
A. Based on the place where it’s acquired Capsulatum
1. Community-acquired pneumonia
o Pneumonia that occurs in the community 4. Other pneumonia
o CAP occurs either in the community setting or - Protozoa and Helminths (worms)
within the first 48 hours of hospitalization. - PCP which caused by Pneumocystic Carini
o Usually begins as common respiratory has high incidence with AIDS
infections
o Streptococcus pneumonia is the most D. Pneumonia classified as based of Clinical
common cause Manifestations
o Common agents are S. pneumoniae, H. A. Typical
influenzae, Legionella, Pseudomonas - The most common causative agents:
Aeruginosa, and other gram negative rods Streptococcus pneumonia, staphylococcus
o H. Influenzae is another cause of CAP pneumonia, klebsiella pneumonia,
o Mycoplasma Pneumonia, occurs most often in pseudomonas pneumonia, H. influenza.
older
o children and young adults Manifestations:
o Viruses are the most common cause of o Chills
pneumonia in infants and children but are o Abrupt onset of fever
relatively uncommon causes of CAP in adults. o Cough with purulent sputum
o Chest pain
2. Hospital-acquired pneumonia o Tachypnea
o HAP, also known as nosocomial pneumonia, o Granting
is defined as the onset of pneumonia o Nasal flare
symptoms more than 48 hours after o accessory muscles use
admission to the hospital
o Results from exposure to potentially infectious Physical Examinations
agents, such as P. Aeruginosa, S.Aurous in o Dullness to percussion on the affected area of
the hospital setting lung
o These bacilli colonize in the Oropharyngeal o Increased fremitus on palpation
region and are aspirated to the lungs o Bronchophony, Egophony, Crackles on
o Common organisms: Enterobacter species, auscultation
Escherichia coli, Klebsiella species, Proteus, o WBC generally elevated
Serratia marcescens, P. aeruginosa, and B. Atypical
methicillin-sensitive or methicillin-resistant - Pneumonia associated with mycoplasma
Staphylococcus aureus. pneumonia, influenza virus, legionella
B. Anatomical classification pneumonia, Pneumocystis carinii , fungal
1. Lobar pneumonia pneumonia.
o A substantial portion of one or more lobes is
involved.

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Manifestations ➢ Some of the causes of URTI are common
- Gradually many patients have had symptoms organisms found in normal human adult skin flora
of URTI (nasal congestion, sore throat) ➢ Environmental and occupational factors contribute
- Symptom are headache, low-grade fever, greatly to the development of URTI.
pleuritic pain, myalgia, rash and pharyngitis ➢ URTI may develop into Pneumonia if unattended
- Dry cough and sub-mucoid sputum or not properly treated.
- Physical examination reveal scattered wheeze DEFINITION OF TERMS
and crackles o CMV – Cytomegalovirus; a member of the herpes
- WBC commonly < 10,000 virus family, it is a very common microorganism
and can be found in most people although does not
Diagnosis usually cause symptoms. However, a weakened
o History immune system become ill with CMV infection.
o Physical Examination - Teratogenic (TORCH)
o Chest X-Ray - Tetanus, others, rubella, cytomegalovirus,
o Blood culture herpes simplex
o Sputum Examination
o PCP – Pneumocystis Pneumonia
Medical Management
- Administration of appropriate antibiotic as o Bronchophony – Phenomenon where the
determined by the result of Gram Stain. patient’s voice remains loud at the periphery of the
- Supportive therapy lungs or sounding louder than usual over a distinct
- Bed rest, maintenance of adequate fluid and area of consolidation as in pneumonia.
nutritional intake. As soon as patients are
hemodynamically stable, they should be o Egophony – Increased resonance of voice sounds
shifted from IV to oral medications. heard when auscultating the lungs, often caused
- Warm, moist inhalation to relieve bronchial by lung consolidation and fibrosis.
irritation, mild
- analgesic to relieve pain, and administration of o Pleuritic pain – Characterized by sudden and
O2 if hypoxia develops. intense sharp, stabbing, or burning pain in the
- For patients suspected of HAP, treatment is chest while inhaling and exhaling. It is exacerbated
usually started with broad-spectrum by deep breathings, coughing, sneezing, or
antibiotics. Patients with no known allergies laughing.
are usually started with ceftriaxone, ampicillin-
sulbactam, levofloxacin, or ertapenem. o Superinfection – Infection occurring after or on
Nursing Responsibilities top of an earlier infection, especially following
o Improving airway potency treatment with broad-spectrum antibiotics.
o Removing secretions
o High level of fluid intake (2-3 L/d) is encouraged o Atelectasis – Collapse of airless condition of the
that thins and loosens pulmonary secretion and alveoli caused by hypoventilation, obstruction to
also replace fluid losses resulting from fever, the airway, or compression.
diaphoresis.
NOTES:
o Chest Physiotherapy : important in loosening
- Odynophagia – painful swallowing.
and mobilization secretions
- Laging lumulunok – sign ng post-surgical hemorrhage
o Promote rest and conserving energy - Incision and Drainage (minor surgical set):
o Promoting fluid intake  1 kelly curved / mosquito
o Monitoring of oxygen saturation and managing  1 kelly straight
potential complications  1 mayo / metz scissor
 1 tissue / thumb forceps
Possible Complications  Needle holder **
o Hypotension and shock  Blade holder**
o Respiratory failure  Sterile gloves
o Atelectasis  Sterile gauze
o Pleural Effusion  Povidone iodine
o Delirium  Peroxide**
o Superinfection  Irrigation solution
 Tape
 Syringe
KEY POINTS  Lidocaine**
➢ If within 48 hours of hospitalization, it is still - Mas matagal gumaling ang Bacterial Pharyngitis
considered CAP - Atypical: mababa ang WBC
- Typical: mataas ang WBC
➢ S. Pneumonia is the most common cause of CAP
- Pseudomonas Aeruginosa – highly contagious
➢ Pneumonia may be a serious, life-threatening (causes gangrene)
condition especially to the elderly and
immunocompromised.

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