UPPER RESPIRATORY TRACT INFECTION

1. UPPER RESPIRATORY TRACT INFECTION

2. Nasopharyngitis • Nasopharyngitis: common cold . • Causes: rhinovirus, adenovirus, influenza virus, Resp. syncytial virus (RSV), Para influenza virus. • Clinical manifestations: • Younger child :fever, irritability, restlessness, sneezing, vomiting, diarrhea.

3. Nasopharyngitis • Older child: dryness, irritation of nose, & Throat, cough, sneezing , chilly sensation, muscular aches. • Physical signs: edema& vasodilatation of mucosa.

4. Therapeutic management: • Mostly treated at home , no vaccine, antipyretics for fever. • Decongestants: nose drops more effective than orally. • Cough suppressant may prescribed for a dry hacking cough in older children.

5. Nasopharyngitis • Antihistamine are ineffective. • Rest is recommended until the child is free of fever for at least • The provision of humidified enviroment and increasing oral fluid may be benefiecial

6. Nasopharyngitis • Decongestant may be prescribed for children older than 6 months to shrink swollen nasal passages • Antibiotic: usually not indicated because most infections are viral

7. Nasopharyngitis • Nursing consideration: • For nasal obstruction: elevate head of bed, suctioning and vaporization, saline nasal drops. • Maintain adequate fluid intake to prevent dehydration. Offer favorite fluids to prevent dehydration • Avoiding spread the virus.

8. Pharyngitis • Causes : 80-90%of cases are viral cause , other is group A and B hemolytic streptococci (GABHS). • Clinical manifestation: • May be mild so no symptoms. • Headache, fever, abdominal pain exudates on pharynx & tonsils 3-5 days usually symptoms are subside

9. Pharyngitis • Complication if not treated : • Acute glumerulonephritis syndrome in about 10 days. • Acute Rheumatic Fever (ARF) in an average 18 days those complication if the cause is GABHS • Children are risk for ARF, an inflammatory disease of the heart, joints, and central nervous system

10. Pharyngitis • Diagnostic evaluation: although 80 to 90% of pharyngitis are viral, throat culture should be performed to rule out: GABHS • Therapeutic management: • if streptococcal sore throat infection: oral Penicillin for 10 days ,or IM Benzathine penicillin G. - Oral Erythromycin if the child has allergy to penicillin.

11. Pharyngitis • Nursing consideration: - Obtain throat swab for culture. • Administer penicillin & analgesic. • Cold or warm compresses to the neck may provide relief. • Warm saline gargles. • Soft liquid food are more acceptable than solid.

12. Pharyngitis • Continue oral medication to complete the course. • IM injection applied in deep muscle as vastus lateralis or ventrogluteal muscle, use Emla cream before IM around 2 hours. • Nurse role to prevent the spread of disease. • Children are considered non infectious to other 24 hours after initiation of antibiotics therapy.

13. Tonsillitis • Tonsils are masses of lymphoid tissue, first immune defense. • Tonsillitis often occur with pharyngitis, viral or bacterial causes. • Common cause of morbidity in young children • S& S: • enlarge tonsils__ difficult breathing & swallow. • Enlargement of adenoid__ blocked postnasal space__ mouth breathing.

14. Tonsillitis • Therapeutic management: • throat culture to determine the causative agent ,viral or bacterial as GABHS. • If cause is GABHS, antibiotic is recommended • Tonsillectomy- a surgical removal of palatine tonsils- is indicated when recurrent pretonsillar abscess, airway obstruction and malignancy • Adenoidectomy- surgical removal of adenoid- is reciommended for children who have hypertrophied adenoid that may obstruct nasal breathing

15. Tonsillitis • Contraindicating for Ts &As: cleft palate, tonsillitis, blood disorder. • Nursing consideration: • Providing comfort & maintain minimize activities. • A soft or liquid diet is prescribed. • Warm salt water gargles • Analgesic, antipyretic.

16. Tonsillitis • Post operative care: • Position (place child on abdomen or side). • Discourage child from coughing frequency. • Some secretion are common as dried blood. • Crushed ice& ice water to relief pain. • Analgesic may be rectally or IV, avoid oral route.

17. Tonsillitis • Avoid red or brown fluid, and citrus juice. • Soft food, milk or ice cream not offered. • Check post operative He by using good light to look direct on site of operation,: • Increase pulse more than 120b/min. • Pallor. - Frequent swallowing. -Vomiting of bright blood • Decrease blood pressure is late sign of shock.

18. Otitis Media:OM • OM is inflammation of middle ear. • Episode of acute OM occur in the first 24 month, decrease at 5 years, r/to drainage through the Eustachian tube & inflammatory of Resp. system. • Etiology: - Acute (AOM) __ streptococcus, Haemophilus influenza, moraxella catarrhlis, are the most common bacteria. • OM __blocked Eustachian tube from edema of URTI , allergic hypertrophy adenoid. • Chronic (COM)__ extension of AOM.

19. Otitis Media:OM • Diagnostic evaluation: assessment of tympanic membrane with otoscope: AOM__ purulent discolored effusion, bulging • S&S: otalgia (earache), fever, purulent discharge, infant rolls his head from side to side, loss of appetite, crying or verbalized feeling of discomfort (older child). • COM__ hearing loss, feeling of fullness, vertigo, tinnitus. • Therapeutic management: • Antibiotic for 10-14 days e.g. Amoxicillin. • Myringotomy: surgical incision of eardrum& grommets. • Hear test after 3 month of AOM.