by Cathy Parkes August 27, 2021 Updated: September 09, 2021
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 tonsilitis 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 and 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, coughs, 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 Fowlers 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.
All right. 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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by Cathy Parkes Aug 27, 2021
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