Med-Surg Respiratory System, part 8: Upper Respiratory Tract Disorders, Influenza, Pneumonia
In this article, we are going to talk about upper respiratory tract disorders, influenza, and pneumonia. The Med-Surg Nursing video series follows along with our Medical-Surgical Nursing Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
Upper respiratory tract disorders (rhinitis, sinusitis, pharyngitis, laryngitis, tonsillitis)
Upper respiratory tract infections are caused by viral infection, bacterial infection, or allergies that cause the release of histamine, resulting in local vasodilation (a widening, or dilation, of the blood vessels) and edema (swelling).
Not that all of these disorders end in "-itis," which means "inflammation." If the name of a condition ends in -itis, it means inflammation of the part of the body referred to in the first part of the word. Rhinitis is inflammation of the nasal mucosa. Sinusitis is inflammation of the sinuses. Pharyngitis is inflammation of the pharynx. Laryngitis is inflammation of the larynx. And tonsillitis is inflammation of the tonsils.
Signs and symptoms
Symptoms of an upper respiratory tract disorder may include rhinorrhea (a runny nose), sore throat, headache, facial pain, fever, hoarseness, and difficulty swallowing.
Labs and diagnostics
The presentations of upper respiratory tract disorders tend to overlap, often making it difficult to diagnose exactly what illness the patient is suffering from. That means it is important to discover the cause of the condition, which means administering a throat culture. This will rule out group A beta-hemolytic streptococcal infection (strep throat), for example. It is also important to rule out other serious illnesses such as influenza or COVID-19.
Treatments may include nasal saline irrigation. One effective way to irrigate is using a neti pot. A neti pot is a small container with a long spout used to rinse the nasal cavities. Saline solution is poured into one nostril and allowed to exit the other nostril.
Influenza (the flu) is a highly contagious acute viral respiratory infection.
It is caused by the influenza A, B, or C virus, and it is spread primarily through droplets. When people with flu cough, sneeze, or talk, they expel droplets that can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.
Influenza may be prevented by thorough hand washing, annual vaccination, and by avoiding close contact with infected people. As evidenced during the COVID-19 pandemic, masking is a highly effective means of preventing transmission of influenza — as more people wore masks, rates of influenza decreased.
Signs and symptoms
The signs and symptoms of influenza include fever and chills, malaise, muscle aches, headache, rhinorrhea, cough, and sore throat.
Labs and diagnostics
To diagnose influenza, a rapid influenza diagnostic test may be administered, which is conducted by swabbing up the nares (nostrils).
When treating influenza, encourage the patient to increase their fluid intake and get lots of rest. Treatment may also include salt water gargles, which can help clean the mouth and ease symptoms of a sore throat.
If medications are to be used, they must be administered within the first 48 hours of the onset of influenza symptoms. Studies show that early treatment mitigates the severity and may reduce the duration of the illness by 1–3 days. An antiviral, such as Tamiflu, may be effective in this early period. Medications — analgesics and antitussives (for cough) — can help alleviate the symptoms of influenza.
Pneumonia is an infection where inflammation causes excess fluid to fill the air sacs in one or both lungs.
Pneumonia is caused by an infectious organism — bacterial, viral, or fungal — that causes fluid to collect in the alveoli, and this in turn causes thickening of the alveolar walls. This leads to what is known as impaired gas exchange, which can lead to hypoxemia (low levels of oxygen in the blood, specifically in the arterial blood) and hypercapnia (retention of carbon dioxide in the lungs).
Signs and symptoms
A patient with pneumonia may exhibit symptoms such as fever, shortness of breath, chest pain, cough, and dyspnea (breathing difficulties). Confusion may also be a symptom, especially with older patients. When listening to the patient's lungs, you may hear crackles and wheezes.
The labs of a patient with pneumonia typically show elevated white blood cell counts. An ABG will show a decrease in the patient's PaO2 and an increase in their PaCO2.
If a sputum culture is collected, it must be done prior to the onset of antibiotic therapy. This to ensure the correct identification of the causative agent in order to select the appropriate antibiotic. The best time to collect a sputum sample is early in the morning (after the patient has awoken from a night’s sleep).
A diagnosis of pneumonia can be made with a chest X-ray, which will show consolidation in the lungs. Consolidation is a solidifying of the lungs, when an exudate (pus) or other product of disease replaces alveolar air.
Nursing care includes positioning the patient in a high Fowler's position, which makes it easier for them to breathe. Administer oxygen, as ordered by a provider. And encourage coughing and deep breathing to help eliminate secretions from the lungs.
The patient should be shown how to use an incentive spirometer, which will help to expand their lungs and allow them to breathe more deeply. This device should be used approximately 10 times every hour the patient is awake.
Pneumonia patients should also be encouraged to increase their fluid intake.
Hi, I'm Cathy with Level Up RN. In this video, we are going to talk about upper respiratory tract disorders, as well as influenza and pneumonia. Be sure to stay with me until the end of the video because I'll be giving you guys a quiz to test your knowledge of some of the facts I'll be presenting in this video.
Let's first talk about upper respiratory tract disorders. And all of these disorders will end in -itis, which means inflammation. So whenever you see a word that ends in -itis, it means inflammation of whatever is at the first part of the word.
So with rhinitis, we have inflammation of the nasal mucosa.
Sinusitis is inflammation of the sinuses.
Pharyngitis is inflammation of the pharynx.
Laryngitis is inflammation of the larynx.
And tonsillitis is inflammation of the tonsils. So these upper respiratory tract disorders can be caused by a viral infection, a bacterial infection, or allergies.
And symptoms may include rhinorrhea - which is a fancy name for a runny nose - a sore throat, headache, facial pain, fever, hoarseness and difficulty swallowing.
So if a patient presents with some of these symptoms, then we're going to need to rule out a number of conditions. So we'll want to get a throat culture to rule out strep throat.
We also probably need to rule out influenza and COVID-19 as well.
In terms of treatment, we can use nasal saline irrigation. So if you've ever seen one of those neti pots, where you pour it in one nostril and then it comes out the other side - it's not super sexy, but super effective.
Medications that can help include expectorants, decongestants, analgesics. And then if the patient has a bacterial infection, we can give them antibiotics as well.
Next, let's talk about influenza, which is a highly contagious acute viral respiratory infection.
And it is caused by the influenza A, B, or C virus, and it is spread primarily through droplets.
We can prevent influenza through handwashing, annual vaccinations, and avoiding close contact with infected people. And masking also is highly effective, as we saw through the COVID-19 pandemic. So when everybody was wearing their masks, rates of influenza went way down.
So symptoms of influenza include fever and chills, malaise, muscle aches, headache, rhinorrhea, cough, and sore throat.
Diagnosis can be done through a rapid influenza diagnostic test, so a little swab up the nares.
And then treatment can include salt water gargles, and we should encourage the patient to increase their fluid intake and get lots of rest.
If we are within the first 48 hours of the onset of influenza symptoms, we can give the patient an antiviral, Tamiflu, but again, we would only want to give that if it is only been less than 48 hours since they first started having symptoms. We can also provide analgesics as well as antitussives for cough.
All right. Now let's talk about pneumonia, which is where we have excess fluid in the lungs due to inflammation.
So the pathophysiology behind pneumonia is that we have an infectious organism, which could be bacterial, viral, or fungal, and it causes fluid collection in the alveoli, and this in turn causes thickening of the alveolar walls. And this, in turn, causes impaired gas exchange.
So a patient who has pneumonia may exhibit symptoms such as fever, shortness of breath, chest pain, cough, dyspnea, and confusion is possible, especially with older patients. And then when you listen to their lungs, you may hear crackles and wheezes.
In terms of some abnormal labs that may be present, their white blood cell count will be elevated. If we run ABGs, their PaO2 will be decreased, their PaCO2 will be increased.
And then when we are collecting a sputum culture, we want to make sure we do so prior to the onset of antibiotic therapy. So we want to identify the causative agent and select the appropriate antibiotic. So, again, we want to collect that culture before starting antibiotics.
In terms of diagnosis, we can do this with a chest X-ray, which will show consolidation in the lungs. Treatment includes antibiotics, bronchodilators, as well as oxygen therapy.
Nursing care would include positioning the patient in a high Fowler's position so that it's easier for them to breathe, we would provide oxygen as ordered. We want to encourage coughing and deep breathing so they can get those secretions out of the lungs.
And then we also want to teach the patient how to use an incentive spirometer correctly. So they should be using this about 10 times an hour while they're awake. And then we also want to encourage the patient to increase their fluid intake.
Alright. Time for a quiz. I have three questions for you.
First question, what is the mode of transmission of influenza? The answer is... "droplet." It is spread through droplets.
Second question, antiviral agents must be initiated within 48 hours of the onset of influenza symptoms. True or false? The answer is... "true."
Third question, when should a sputum sample be taken for a patient with suspected pneumonia? The answer is... "before initiation of antibiotic therapy." And bonus points if you said "an early morning sputum sample," which is always best.
Okay, that is it for this video. I hope you enjoyed it and you learned a lot. If you like our little quiz questions, leave me a comment and be sure to like the video.
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