Upper Respiratory Disorders

• Acute bronchitis


  Inflammation of the bronchi
• Causes of acute bronchitis


  • Usually viral, after a cold or the flu
  • Can be caused by bacteria or toxins
• Signs and symptoms of acute bronchitis


  • Cough
  • Sputum
  • Fatigue
  • Dyspnea on exertion
  • Wheezing, rhonchi
  • Fever
  • Chest pain
  • URI symptoms
• Diagnosis of acute bronchitis


  • Symptoms and assessment
  • Chest x-ray to rule out pneumonia
• Treatment of acute bronchitis


  • Humidified air
  • Antibiotics
  • Nutrition/Fluids
  • Analgesics
  • Antitussives—dextromethorphan
  • Expectorants--guaifenesin
  • Bronchodilators
• Nursing care for acute bronchitis


  • Patient education and self-care
  • Take full course of antibiotics
  • Good hand hygiene, cough, and sneeze etiquette
  • Avoid others, especially the medically vulnerable, while sick
• Influenza


  • Flu A and B
  • Cause of the yearly flu outbreaks
  • Viral inflammation of the lower airway
  • Acute highly infectious
  • Spread by droplets
  • Yearly immunization available for those 6 months and older
  • Especially important for those with cardiopulmonary disease, those over 65, and people who live in LTC
• Signs and symptoms of influenza


  • Sudden onset
  • Dry hacking cough
  • Headache
  • Fever, chills
  • Sore throat
  • Muscle aches
  • Fatigue and weakness
• Complications of influenza


  • Bronchitis
  • Pneumonia
  • Sinus or ear infections
  • Very serious: acute respiratory failure
• Diagnosis of influenza


  • Based on symptoms and physical exam
  • Rapid lab testing
• Treatment of influenza


  • Symptom management, same meds as given for colds
  • Anti-virals: PO oseltamivir (Tamiflu)
  • Are also inhaled and IV anti-viral meds
  • Need to be given as close to onset as possible
• Pneumonia


  Inflammation of lung structures—alveoli and/or bronchioles
• Causes of pneumonia


  • Infectious agents: bacteria (Streptococcus pneumoniae), viruses, fungi (Pneumocystis jirovecii)
  • Non-infectious agents: chemical irritants or aspirates
• Risk factors for pneumonia


  • Smoking
  • Immunocompromised
  • Altered LOC
  • Chronically ill, especially those with poor nutritional status
• Classifications of pneumonia


  • Hospital-acquired pneumonia (HAP)
  • Community-acquired pneumonia (CAP)
  • Ventilator associated pneumonia (VAP)
  • Aspiration pneumonia
• Risk factors for aspiration pneumonia


  • Dysphagia (stroke)
  • Poor GI motility
  • Tube feedings
  • ETT or trachs
• Pathogenesis of pneumonia


  1. Pathogens enter the lung

  2. Inflammation occurs, causing fluid buildup in the alveoli

  3. Hepatization occurs—capillaries dilate, neutrophils, RBCs, and fibrin fill the alveoli

  4. Blood flow decreases, WBCs and fibrin infiltrate and then consolidate

  5. As the infection resolves, macrophages eliminated the consolidation
• Signs and symptoms of pneumonia


  • High fever, chills
  • WBC elevated
  • Productive cough- purulent, thick, sticky, yellow
  • Pleural pain with inspiration
  • General malaise
  • Abnormal breath sounds
  • Confusion- especially elderly (can be the first s/s in this population)
  • Dyspnea
  • Chest pain
• Complications of pneumonia


  • Pleurisy (inflammation of the pleura)
  • Pleural effusion
  • Atelectasis
  • Empyema
  • Abscesses
  • Sepsis
• Pneumonia is one of the leading causes of death in adults over 65
• Diagnosis of pneumonia


  • Symptoms
  • Sputum culture
  • Chest x-ray
  • CBC
  • Blood cultures
  • Pulse Ox
  • ABGs
  • Severe Covid pneumonia
• Priority problems in pneumonia


  • Airway obstruction
  • Inadequate oxygenation
  • Pain
  • Fatigue
  • Poor nutrition
• Treatment of pneumonia


  • Antibiotics
  • Control temperature
  • I&O's
  • Increased fluid intake
  • TCDB/Positioning
  • Support chest pain
  • Assess vitals/respiratory status
  • HOB up
  • Nutrition
  • Assess for deterioration
  • Suction as needed
  • Mucolytics- PO/Nebulizer
  • Bronchodilators
  • Expectorants
  • HYDRATION IS THE BEST EXPECTORANT
  • O2
  • Postural drainage with or without percussion
  • Stagger rest and activity
• Recommendations for pneumonia vaccine


  • Babies and children from 6 months to 2 years
  • All adults over 65
  • Everyone from 2 to 64 with underlying comorbidities (immune deficiencies, HIV, cancer, organ transplants, chronic heart, lung, and liver diseases, diabetes)
  • Adults 19-64 who smoke or have asthma
• Pleurisy


  Inflammation of the pleura
• Causes of pleurisy


  • Pneumonia
  • Tuberculosis
  • Injury to the chest wall
  • Pulmonary infarction (death of tissue d/t decreased blood flow)
  • Tumors
• Signs and symptoms of pleurisy


  • Abrupt, severe chest pain
  • One sided
  • Breathing and coughing increase pain
  • Breath sounds diminished
  • Pleural friction rub
• Treatment of pleurisy


  • Treat the cause
  • Pain relief
• Pleural effusion


  Accumulation of fluids in pleural space
• Causes of pleural effusion


  • CHF
  • Renal failure
  • Pneumonia
  • Trauma
  • Cancer
• Manifestations of pleural effusion


  • Dyspnea
  • Temperature
  • Air hunger
  • Diminished breath sounds
• Diagnosis of pleural effusion


  • CXR
• Treatment of pleural effusion


  • Diuresis
  • Chest tubes
  • Thoracentesis
• Empyema


  Fluid in pleural cavity becomes infected (pus)
• Causes of empyema


  • Complication of pneumonia, trauma, surgery (chest)
• Manifestations of empyema


  • Similar to pleurisy with pus in pleural fluid
  • Fever
  • ↑ WBC
• Treatment of empyema


  • Antibiotics
  • Chest tubes
  • Decortication—removal of scarred, fibrous tissue
  • Pleurodesis--obliterate pleural space—only used in severe cases
• Types of chest trauma


  • Penetrating
  • Non-penetrating
• Causes of non-penetrating chest wounds


  • MVA
  • Falls
  • Blast injuries
• Common non-penetrating chest injuries


  • Rib fractures
  • Pneumothorax
  • Pulmonary contusion
  • Cardiac contusion