ACUTE PHARYNGITIS

Description: - A sudden painful inflammation of the pharynx, the back portion of the throat that includes the posterior third of the tongue, soft palate, and tonsils.- commonly known as SORE THROAT.

Incidence:- Increased during winter and early spring.

Pathophysiology:

VIRAL (most cases) BACTERIAL (10%)

PREDISPOSING FACTORS PREDISPOSING FACTORS- Exposure to viral agents - Bacterial upper respiratory tract infections - Poorly ventilated rooms

CAUSATIVE AGENTS CAUSATIVE AGENTSAdenovirus, influenza virus, GABHS, Group A Streptococcus Epstein-Barr virus, (GAS) or Streptococcus pharyngitis

Herpes simplex virus Others: Mycoplasma pneumoniaeNeisseria gonorrhoeae, H. influenzaeType B

Enters into the system by way of droplets of coughs and sneezes and unclean hands that have been exposed to

the contaminated fluids

Lodges in the pharynx and initiates an inflammatory response

Pain Fever Malaise Enlarged and tender Vasodilation Edema Tissue damage(High) cervical lymph nodes

(Fiery-red) Redness and swelling of the tonsillar pillars, uvula and soft palate (may demonstrate petechiae of the roof of the mouth

If untreated Formation of creamy exudate in the tonsillar pillars (white-purple exudate)

COMPLICATIONS: Common: Sinusitis, Otitis media Bad breathePeritonsillar abscess,Mastoiditis, Cervical adenitisRare: Bacteremia, Pneumonia,Meningitis, Rheumatic fever, Nephritis

Note: Painful sore throat (1-5 days), headache, myalgia, & nausea are added S/Sx for streptococcal pharyngitis.

CHRONIC PHARYNGITIS

Description:- Is a persistent inflammation of the pharynx

Pathophysiology:

Risk factors:Working in dusty surroundingsExcessive use of voice RECURRING INFLAMMATION Chronic cough OF THE PHARYNXHabitual use of alcohol and tobacco

General thickening and congestion HypertrophicOf the pharyngeal mucous membrane

If it remains untreated and progresses,The membrane becomes thin, whitish, Atrophicglistening, and at times wrinkled

Swollen lymph follicles becomes Chronic granularnumerous in the pharyngeal wall “clergyman’s sore throat”

constant sense of irritation mucus collects in the throat difficulty intermittent postnasalor fullness in the throat (can be expelled by coughing) swallowing drip causing minor

irritation and inflam-

mation of the pharynx

TONSILITIS AND ADENOIDITIS

Description: - Inflammation of the tonsils and adenoids, often thought as a childhood disorder, but can occur in adults.

Pathophysiology:

Risk factors: - Alcohol use, smoking, splenectomy, weakened immune system (DM, Chemotherapy, etc.), sinusitis, exposure to someone with tonsillitis.

CAUSES:Bacteria VirusGABHS Epstein-Barr virus (90% in adults affected) and

Cytomegalovirus

Entry into the system (tonsils and adenoids) and multiplies

Inflammatory process sets-in

ENLARGED

Tonsils Adenoids

Sore throat Mouth-breathing Fills the space behindFever Earache the posterior naresSnoring Draining earsDifficulty swallowing Frequent head colds

Noisy respiration Nasal obstruction

If untreated: Complications

Infection extends to the middle ears Infection extends to the mastoid cells

Acute otitis media Mastoiditis

Rupture of tympanic membrane

Deafness

PERITONSILLAR ABSCESSDescription:

- Also known as “quincy”, a common major suppurative complication of sore throat.

Pathophysiology:

GABHS

Sore throat (an acute tonsillar infection) (as a consequence of previous infections of the tonsils, adenoids, etc.)

If untreated: Complications

Infection spreads causing the collection of Enlarged and tender purulent exudate between the tonsillar cervical lymph nodes

capsule and the surrounding tissues and soft palate

severe sore throat inflammation of the superior inflammation of the medial ptyregoid musclefever constrictor muscle of the pharynxraspy voice

(severe sensation of burning, pain spasm squeezing pain while swallowing)

Odynophagia

difficulty swallowing trismus

(dysphagia) (inability to open mouth) Drooling

local cellulitis and abscess formation pain on lateral head spreads over the palate, the neck and chest movement

Edema in the palate, neck and chest

Respiratory arrest Infection may spread and may cause Mediastinitis, intracranial abscess, Empyemas

Further spread of infection

Death Systemic infection

LARYNGITIS

Description: - Inflammation of the larynx.

Incidence:- Common during winter (viral laryngitis)

Pathophysiology

Risk factors: Predisposing factors:- Voice abuse - Exposure to sudden changes in temperature- Exposure to dust, chemicals, smoke or - Dietary deficienciesother pollutants - Malnutrition- Upper respiratory infection - Immunosuppressed state(allergic rhinitis and pharyngitis)- Infection of the vocal cords- Gastroesophageal reflux (Reflux laryngitis)

Causes:- Causative agents for common colds and pharyngitis (bacteria and virus-common cause)

Presence of predisposing and risk factors

Entry of causative agents

Inflammation and infection of the larynx uvula is visibly edematous

(if with allergies)ACUTE Laryngitis

Hoarseness of voice Severe cough Sudden onset made worse Throat feels ‘tickle’ in the or Aphonia (complete and dry sore by cold dry wind worst in throat made loss of voice) throat morning and worse by cold

improves when air/liquids in a warmer

climate

CHRONIC Laryngitis

Persistent hoarseness

OBSTRUCTION AND TRAUMA OF THE UPPER RESPIRATORY AIRWAY

OBSTRUCTION DURING SLEEP

Obstructive Sleep Apnea (OSA)Description:

- Is a disorder characterized by recurrent episodes of upper airway obstruction and a reduction in ventilation.

- Cessation of breathing (apnea) during sleep usually caused by repetitive upper airway obstruction.

Pathophysiology:

Risk factors:- Obesity - Alterations in the airway (structural changes like tonsillar - Male gender hypertrophy, abnormal posterior positioning of one or - Post-menopausal status both jaws, and variations in craniofacial structures) that- Advanced age contribute to the collapsibility of the upper airways.

Normally the pharynx is a collapsible tube that can be compressed And during sleep the muscles of the upper airway is reduced

Presence of risk factors

Reduction in the diameter of the upper airway

Obstruction

Frequent and loud snoring with Small amounts of negative pressure breathing cessation for 10 secs are generated during inspiration

or long (5 episodes/hour)

Snorting Apnea Upper airway collapse

Gasping Hypoxia and hypercapnia

Choking Sympathetic response

Apneic episodes Hypertension Dysrhythmias in reported clients with CVD

by the partner Increased risk for MI and Stroke

Sudden awakening Chronic fatigue Insomnia and difficulty DEATH going to sleep

Hypersomnolence Early morning awakenings (Daytime sleepiness) with an inability to go back to sleep

EPISTAXISDescription:

- Also known as nosebleed- a hemorrhage from the nose, is caused by the rupture of tiny, distended vessels in the mucous

membrane of any area of the nose.

Pathophysiology:

Risk factors:- Local infections (vestibulitis, rhinitis, sinusitis) - Thrombocytopenia- Systemic infections (scarlet fever, malaria) - Use of aspirin- Drying of nasal mucous membrane - Liver disease- Nasal inhalation of illicit drugs (cocaine) - Redu-Osler-Weber syndrome- Trauma (picking the nose, blunt trauma, (hereditary hemorrhagic

(fracture, forceful nose blowing) telengiectasia)- Arteriosoclerosis - Hypertension- Tumor (sinus or nsapharynx)

Presence of any of the risk factors

Rupture of any of the following

Anterior ethmoidal artery sphenopalatine artery in the internal maxillaryOn the forward part of the roof posterosuperior region branches

Bleeding

NASAL OBSTRUCTION

Description:- Obstruction of the nose

Pathophysiology:Causes:

- Deviation of nasal septum- Hypertrophy of the turbinate bones- Pressure of nasal polyps

Obstruction of the nose Nasopharyngitis

Difficulty in maintaining an adequate airway Infection extends to the

nasal sinuses

Breathing through Sleep deprivation Rhinosinusitis

the mouthDrainage is obstructed

Dryness of the oral mucosa andpersistent, dry, cracked lips Pain

FRACTURE OF THE NOSE- Is the break in the continuity of the nasal bone.

Pathophysiology:

Cause:

Direct assault on the nose

Tearing of the Rupture of Trauma to the Break in the continuitymucous membrane blood vessels nasal area of nasal bone

Nose bleeding Hematoma Fracture

Complications:InfectionAbscessAvascular or septic necrosis

LARYNGEAL OBSTRUCTIONDescription:- Obstruction of the larynx

Pathophysiology:

Precipitating factors:

History of allergies,exposure to medications, anaphylaxis edema of larynxlatex, foods, and bee stings

Foreign bodies lodges into the larynx

Heavy alcohol consumption; causes tumorheavy tobacco use

Family history of airway angioedemaproblems

Use of ACE-inhibitors angioedema of mucous membranes

Recent throat pain or infectious processRecent fever

History of surgery or subglottic stenosisPrevious tracheostomy

History of nasogastric nasogastric tube syndrometube placement

Laryngeal Obstruction

Closes off the opening in the larynx

Air passage is compromised during inspiration and expiration

Lowered oxygen Use of accessory Retractions in the neck or saturation muscles of respiration abdomen during inspirations

Client may faint or collapse Respiratory arrest

Death

CANCER OF THE LARYNXDescription:

Pathophysiology:

Etiology of cancer is unknown.

Risk Factors:

CARCINOGENS: OTHER FACTORS:- Tobacco (smoke or smokeless) - Straining the voice- Combined effects of alcohol and tobacco - Chronic laryngitis- Asbestos - Nutritional deficiencies (riboflavin)- Secondhand smoke - History of alcohol abuse- Paint fumes - Familial predisposition- Wood dust - Age (higher incidence after 60 yo)- Cement dust - Gender (more common in men)- Chemicals - Race (more prevalent-African Americans)- Tar products - Weakened immune system- Mustard gas- Leather and metals

Failure of the regulatory mechanism of normal cells and growth continues in excess

Neoplasia

Benign Malignant

Uncontrolled growth of cells or cell division

Tumor

Because malignant cells Lack of adhesion and are not encapsulated loss of contact inhibition

Expands into surrounding Spreads to distant parts of tissues (Invasion) the body (Metastasis)

Lump in the neck Impedes the action of - Cervical lymph adenopathy

the vocal cords - Unintentional weight loss- A general debilitated state- Pain radiating to the ear

- Hoarseness (harsh, raspy and low in pitch voice)- Persistent cough or sore throat- Pain and burning in the throat when consuming hot liquids or citrus juices

Late symptoms:

- Dysphagia - Dyspnea - Unilateral nasal obstruction/discharge- Persistent hoarseness - Persistent ulceration - Foul breath

ATELECTASIS

Description:- Refers to closure or collapse of alveoli and often described in relation to x-ray findings and clinical signs and symptoms.

Pathophysiology:

Causes:-Altered breathing patterns -Retained secretions -Pain-Alterations in small airway -Prolonged supine -Increased abdominal

functions positioning pressure-Reduced lung volumes due -Restrictive defects -Specific surgical proceduresto musculoskeletal or (i.e. upper abdominal, neurologic disorders thoracic or open heart surgery)

Reduced ventilation or blockage that obstructs passage of air to and from the alveoli

Alveolar air becomes trapped

Trapped air is absorbed into the bloodstream

No additional air can enter into the alveoli

Patchy infiltrates/consolidated areas in Alveoli collapse Predisposes to infection the lungs in the x-ray

Pulmonary infection

Hypoxemia Dyspnea Cough Sputum production

Respiratory distress

- Tachycardia - Tachypnea - Pleural pain - Central cyanosis - Anxious

Acute Respiratory failure

Death

RESPIRATORY INFECTIONS

Acute TracheobronchitisDescription:

- An acute inflammation of the mucous membranes of the trachea and the bronchial tree of, often follows infection of the upper respiratory tract.

Pathophysiology:

Causes:Streptococcus Haemophilus Mycoplasma Fungal infection

pneumoniae influenzae pneumoniae (Aspergillus)

Enters into the system and initiates inflammatory process

Inflammation of the mucosa of trachea and bronchi

Dry and irritating cough Production of - Fever mucopurulent sputum - Chills

sternal soreness - Night sweats Expectoration of scanty - Headache

amount of mucoid spututm - Body malaise

As infection progresses

Shortness of breath Inspiratory stridor Expiratory wheezesExpectoration of purulent sputum

Irritation of the mucosa of airways

Blood-streaked secretions

SEVERE ACUTE RESPIRATORY SYNDROMEDescription:

Pathophysiology

Predisposing factors:- Living or traveling in places with SARS cases- Close contact with infected people

CAUSE Corona virus CAUSE

through respiratory droplets touching contaminated objects orwhich either lodges on mouth, nose, or eyes) surface and then touching ones

mucous membranes

Incubation period (2-7 days)

Enters into the system and multiplies

Inflammatory process sets in (symptoms appear within 10 days)

Fever greater that 38 Celcius Cough Difficulty breathing

Poor prognosis if accompanied with the following factors:- Old age- Comorbid condition (DM, COPD and Chronic Hep B)- Atypical symptoms- Elevated serum lactate dehydrogenase on admission- Acute renal failure

PULMONARY TUBERCULOSISDescription:

LUNG ABSCESSDescription:

PLEURAL CONDITIONSDescription :

- Are disorders that involve the membranes covering the lungs (visceral pleura) and the surface of the chest wall (parietal pleura) or disorders affecting the pleural space.

PLEURISYDescription:- also known as ‘pleuritis’, is the inflammation of both layers of the pleurae (parietal and visceral) which is in conjunction with other disorders of the respiratory system.

Pathophysiology:

Pneumonia URTI TuberculosisCollagen disease Trauma to the chest Pulmonary infarction or embolismAfter thoracotomy Primary or metastatic cancer

Inflammation of the parietal and visceral pleura

With respiration

Rubbing of the two Pleural friction rub upon pleural membranes auscultation (early stage)

Stimulation of the nerve endings on the parietal pleura

Severe, sharp, knifelike pain (pleuritic pain) which worsens when taking a deep breath,

coughing, or sneezing (usually one sided and becomes absent or minimized when the breath is held)

PLEURAL EFFUSIONDescription:

- a collection of fluid in the pleural space, is rarely a primary disease, usually a secondary to other diseases.

Pathophysiology:

Causes: (pre-existing conditions)Heart failure Tuberculosis Pulmonary infection (viral)

Pulmonary infections Pulmonary embolusNeoplastic tumors Nephrotic syndrome(bronchogenic carcinoma) Connective tissue diseasePneumonia

Causing an imbalance in the Inflammation by bacterial products hydrostatic pressure and or tumors of the pleural surfacesoncotic pressure in the lungs

Formation and reabsorption Extravasation of fluid into of pleural fluid is altered tissues or cavity

Effusion of clear fluid

Transudate Exudate (Meaning pleural membranes are not diseased)

Decreased/Absent breath sounds Decreased fremitus Dull, flat sound on percussion

Small effusion Large effusion Malignant effusion- minimal or no dyspnea - Dyspnea (shortness - Dyspnea

of breath – SOB) - Difficulty lying flat- Coughing

Acute respiratory distress Tracheal deviation away from the affected side

Note: Signs and symptoms are dependent on the size of effusion, speed of formation, and underlying lung disease (eg. If the cause of the effusion is pneumonia, the client will also exhibit signs and symptoms of pneumonia).

EMPYEMADescription:

- Is an accumulation of thick, purulent fluid within the pleural space, often with fibrin development and a loculated (walled-off) area where infection is located.

Pathohpysiology:

Causes:Common cause: As a complication of Other causes: Penetrating chest trauma

Bacterial Pneumonia Hematogenous infection ofor Lung abscess the pleural space

Nonbacterial infectionsIatrogenic causes (after thoracic surgery or thoracentesis)

Initial Stage Pleural fluid is thin Low leukocyte count

Progression

Fibropurulent stage Thick exudative membrane -Decreased or absent breath encloses the lung over the affected area (loculated empyema) -Decreased fremitus

-Dullness on chest percussionFever

Night sweats Pleural pain

Cough Dyspnea Anorexia Weight loss

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