UPPER RESPIRATORY

TRACT INFECTIONS
By Brenda Nyanchoka
• Upper respiratory tract infection refers to an
infection that affects the upper part of the
respiratory system, which includes;
 The nose

 The pharynx

 The larynx

 Sinuses
• Infections that affect the upper respiratory tract
include;
 Coryza or common cold

 Influenza

 Laryngitis
 Pharyngitis

 Sinusitis

 Tonsillitis

 Adenoiditis
What are the organs of the
upper respiratory tract??
This Photo by Unknown Author is licensed under CC BY-SA
INFLUENZA

• Influenza is an acute viral disease that

affects the nose , throat and airways . In
severe cases it can affect the lungs
causing complications such as pneumonia

• The virus can easily spread from host to

host through droplet exposure.
Transmission is most likely to occur in the
Causes of influenza

• Person to person transmission- it is

highly contagious and spreads through
respiratory droplets when an infected
person coughs, sneezes or talks. It can also
spread by touching contaminated surfaces
Cont…
• Weakened immune system- people
with weakened immune system such as
the elderly, young children or those with
chronic illness are more susceptible to
transmission
• Seasonal changes- influenza is more
common in colder seasons
Predisposing factors

 Age , young children and elderly adults

are susceptible to infection.

 Individuals with compromised immune

system.

 Occupational exposure
 Obesity

 Malnutrition, poor nutrition weakens

immune system
Pathophysiology

• Inhalation of the virus- influenza is

typically spread via respiratory droplets
when an infected person coughs, sneezes.
The virus is inhaled into the upper
respiratory tract
• Attachment to host cells – the influenza
virus uses its surface protein to bind to
receptors on the epithelial cells lining the
• Viral replication- once inside the host
cell, the virus releases its genetic
material(RNA) . The viral RNA is transported
to the host cell nucleus where it hijacks the
cell’s machinery to replicate and produce
viral proteins.
• New viral particles are assembled and
then exit the host cell by a process
called budding, facilitated by the viral
enzyme neuraminidase. This allows the
virus to spread to nearby cells leading to
further infection and cell damage
• Immune response – the body’s immune
responds to the infection through
activation of interferons and inflammatory
cytokines and activation of cytotoxic T
lymphocytes to target infected cells
Cont…

The immune response to the infection,

combined with the destruction of epithelial
cells in the respiratory tract lead to the
characteristic symptoms of influenza.
Clinical features
 Shortness of breath
 Fever
 Chills
 Cough
 Sore throat
 Runny or stuffy nose
 Muscle aches
 Headache
 Fatigue
Medical management of influenza

• Fever management – ibuprofen, NSAIDs

• Pain management- paracetamol

Nursing management

• Assess vitals, temperature , oxygen

saturation
• Advise patient to cough and sneeze into a
tissue
• Encourage patient to take fluids
• Encourage handwashing
• Encourage patient to wear a mask
• Encourage bed rest
CORYZA

• Coryza refers to the inflammation of the

mucous membranes in the nose usually
associated with symptoms of a common
cold

• Coryza is a symptom rather than a

disease itself and its most commonly
caused by viral infections like;
 Rhinoviruses
 Influenza viruses
 Corona virus
 Adenoviruses
Causes of coryza

• Viral infections like rhinoviruses, corona

virus, adenovirus
• Exposure to allergens like pollen, dust,
mites or mold
• Bacterial infections
• Irritants such as strong odors, smoke,
air pollution
• Seasonal changes
• Medications such as nasal decongestant
sprays when over used
Predisposing factors

• Weakened immune system

• Allergies
• Environmental factors- exposure to cold
weather, air pollution
• Smoking
• Use of nasal sprays
• Stress and fatigue
Pathophysiology
• In viral coryza, virus enters the body
through inhalation or direct contact. The
virus binds to specific host cells and
replicates causing cellular damage and
triggering an immune response.
• Infected epithelial cells release pro
inflammatory cytokines which attract
immune cells to site of infection. These
inflammatory mediators cause
vasodilation and increased permeability
of blood vessels in the nasal mucosa
leading to swelling, nasal congestion and
fluid leakage
• In allergic coryza, when an individual is
exposed to the allergen, the allergen
binds to mast cells triggering the
release of histamine, which causes
vasodilation, increased vascular
permeability and stimulation of mucus
secretion leading to nasal congestion,
sneezing and runny nose
Clinical manifestations

 Nasal congestion
 Runny nose
 Sneezing
 Sore throat
 Mild fever
Medical management

 Decongestants – e.g pseudoephedrine

to reduce nasal congestion

 Antihistamines – e.g cetirizine to

alleviate runny nose and sneezing

 Saline nasal sprays- to keep nasal

passages moist
 Increased fluid intake
Nursing management

• Monitor patient for nasal congestion,

sneezing, runny nose and any signs of
respiratory distress
• Administer medications for symptom
relief as prescribed
Cont…

• Encourage increased fluid intake

• Educate patient about use of saline
sprays and to avoid irritants
• Encourage rest and comfort
LARYNGITIS

• This is the inflammation of the larynx

from overuse, irritation or infection
often resulting in hoarseness or loss of
voice.
• It can be acute or chronic
Causes of laryngitis
Acute laryngitis is temporary and improve
after the underlying cause gets better.
Causes include;
 Viral infections

 Vocal strain caused by overusing voice

 Bacterial infections
Chronic laryngitis lasts longer than 3
weeks and it is caused by;
• Inhaled irritants such as chemical
fumes, allergens or smoke.
• Acid reflux
• Chronic sinusitis
• Excessive alcohol use
• Habitual overuse of your voice
• Smoking
Predisposing factors

• Having a respiratory infection such as

cold, bronchitis or sinusitis
• Exposure to irritating substances such as
cigarette smoke, excessive alcohol
intake
• Overusing voice
This Photo by Unknown Author is licensed under CC BY-SA
Clinical manifestations

 Hoarseness
 Loss of voice
 Sore throat
 Dry throat
 Coughing
 Difficulty speaking
 Tickling sensation in the throat
Pathophysiology of laryngitis

In acute laryngitis, in response to an

infection or irritant, the body triggers an
inflammatory cascade leading to release
of cytokines and immune cells to the
laryngeal tissue.
Cont…

Inflammation results in increased

permeability of blood vessels causing
swelling of the laryngeal mucosa and
especially vocal cords. The edema distorts
their normal vibration which is critical for
sound production resulting in hoarseness or
aphonia (loss of voice).
Cont…
Goblet cells in the laryngeal mucosa
increase mucus secretion, contributing to
irritation, cough and the need to clear
throat.
Dilation of blood vessels in the larynx
causes redness and a sensation of warmth
in the throat
Cont…
In chronic laryngitis, ongoing exposure to
irritants such as smoking leads to
persistent low grade inflammation.
Repeated irritation and inflammation cause
the vocal cords to thicken, leading to
dysphonia (persistent hoarsness)
Cont…
Prolonged inflammation can cause scarring
of the vocal cords resulting in reduced
flexibility and vibratory capacity which
worsens voice changes
 Medical management of laryngitis

 Analgesics or antipyretics- NSAIDs

such as ibuprofen or acetaminophen can
relieve pain, throat discomfort and fever
 Decongestants – nasal congestion
contributes to throat irritation, over the
counter decongestants
 Antibiotics- for bacterial laryngitis on
rare cases. Penicillin or amoxicillin
Cont..
Corticosteroids- in severe cases, when acute
laryngitis causes significant vocal cord and
swelling difficulties, a short course of oral or
systemic corticosteroids e.g prednisone is
used to reduce inflammation
Proton pump inhibitors- for patients with
laryngitis caused by gastroesophageal reflux
disease (GERD) e.g omeprazole to reduce acid
reflux and prevent irritation of the larynx
Cont…
Antihistamines- in cases of allergic
laryngitis, antihistamines help reduce
allergic inflammation. Should be taken in
moderation as some histamines can dry
out the mucosa
Nursing management of laryngitis
Advise patient to avoid excessive use of
voice
Encourage the patient to drink plenty of fluid
to keep the throat moist and reduce irritation
Administer pain relievers as prescribed to
alleviate throat discomfort
Encourage coughing and deep breathing to
clear mucus from the throat and airways
Cont…
Educate patient on importance of vocal
rest and avoiding irritants
 ACUTE SINUSITIS
Acute sinusitis is the inflammation of the
sinuses and nasal passages.
It is usually caused by infections.
Causes of acute sinusitis
Viral infections- most common cause;
Rhinovirus, influenza virus and adenovirus
Bacterial infections
Fungal infections
Allergic rhinitis
Pathophysiology
.

Acute sinusitis frequently develops as a result

of an upper respiratory infection, such as an
unresolved viral or bacterial infection, or due
to allergic rhinitis.
Nasal congestion, caused by inflammation,
edema, and production of fluid, leads to
obstruction of the sinus cavities providing a
medium for bacterial growth.
Clinical manifestation

Facial pain or pressure over the affected

sinus area
 nasal obstruction
 fatigue
purulent nasal discharge
 fever
headache
Cont…
ear pain and fullness
 dental pain
cough
 a decreased sense of smell
sore throat
 eyelid edema
Medical management
Patient is put on analgesics,
decongestants to relieve swelling &
antibiotics
Medical therapy may not relieve the
symptoms of some patients with
persistent or recurrent sinusitis.
They may require nasal surgery to relieve
any blockage caused by hypertrophy or
septal deviation.
Nursing management

Instruct the patient about methods to

promote drainage such as inhaling steam,
increasing fluid intake, and applying local
heat (hot wet packs).
The nurse also informs the patient about
the side effects of nasal sprays and about
rebound congestion.
Nursing management

Stress the importance of following the

recommended antibiotic regimen.
Instruct them to avoid smoking &
allergens.
Teach the patient the complications to
watch out for.
 Acute pharyngitis
This is an acute inflammation of
pharyngeal walls – may include: tonsils,
palate and uvula.
May occur due to viral, bacterial and
fungal infections.
Cont…

Other causes may be

immunosuppression, allergies,
smoking, chemicals, endotrachial
intubation.
Prolonged administration of inhaled
corticosteroids
Clinical manifestations

Pain in the throat

 Painful swallowing
 red oedematous pharynx with
or without exudates
 fever
 anterior cervical lymphnode
enlargement.
Medical management
Incase of bacterial infections antibiotics
such as penicillins are given.
Analgesics are administered to relieve
pain.
Antipyretics for fever
Antihistamines
CHRONIC PHARYNGITIS
Chronic pharyngitis is a persistent
inflammation of the pharynx.
It is commonly caused by: inhalation of
dust and industrial fumes,
use of voice excessively.
Chronic cough,
Habitual use of alcohol and tobacco.
Clinical Manifestations
Patients with chronic pharyngitis
complain of a constant sense of irritation
or fullness in the throat
 mucus that collects in the throat and can
be expelled by coughing
 difficulty swallowing.
Medical management
Treatment of chronic pharyngitis is based
on relieving symptoms, avoiding
exposure to irritants, and correcting any
upper respiratory, pulmonary, or cardiac
condition that might be responsible for a
chronic cough.
Nasal congestion may be relieved by
short-term use of nasal sprays
Cont…
 If there is a history of allergy,
antihistamine decongestant medications
are given.
Antiinflammatory and analgesic drugs
are recommended
Nursing care of pharyngitis
 Teaching patients self-care : instruct
the patient to:
 prevent the infection from spreading by
avoiding contact with others until the
fever subsides.
Cont…
Avoid alcohol, tobacco, and exposure to
cold as well as environmental or
occupational pollutants if possible.
minimize exposure to pollutants by
wearing a disposable facemask.
Cont…
drink plenty of fluids.
Take prescribed medication
Gargle with warm saline solutions to
relieve throat discomfort.
Tonsilitis and adenoiditis

The tonsils are composed of lymphatic

tissue and are situated on each side of
the oropharynx.
They frequently serve as the site of
acute infection (tonsillitis).
Cont…
The adenoids or pharyngeal tonsils
consist of lymphatic tissue near the
center of the posterior wall of the
nasopharynx.
Infection of the adenoids frequently
accompanies acute tonsillitis. Group A
beta-streptococcus is the most common
infecting organism
Clinical Manifestations

sore throat
 fever
snoring
 difficulty swallowing.
mouth breathing due to enlarged adenoids
 earache
draining ears
Cont…
frequent headaches
 colds, bronchitis
foul-smelling breath
voice impairment
 noisy respiration.
nasal obstruction.
Medical management
Appropriate antibiotic therapy.
Tonsillectomy is usually performed for
recurrent tonsillitis when medical
treatment is unsuccessful and there is
severe hypertrophy, or peritonsillar
abscess that occludes the pharynx,
making swallowing difficult and
endangering the airway (particularly
Postoperative Nursing
management
Observe pt closely and monitor for the
risk of hemorrhage.
Place pt in a prone position with the head
turned to the side to allow drainage from
the mouth and pharynx.
Cont…
Do not remove the oral airway until the
patient’s gag and swallowing reflexes
have returned.
Apply an ice collar to the neck.
Provide a basin and tissues for the
expectoration of blood and mucus