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) PREDISPOSING FACTORS - Exposure to viral agents - Poorly ventilated rooms CAUSATIVE AGENTS Adenovirus, influenza virus, Epstein-Barr virus, Herpes simplex virus BACTERIAL (10%) PREDISPOSING FACTORS - Bacterial upper respiratory tract infections

CAUSATIVE AGENTS GABHS, Group A Streptococcus (GAS) or Streptococcus pharyngitis Others: Mycoplasma pneumoniae Neisseria gonorrhoeae, H. influenzae Type 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 (High) cervical lymph nodes

Vasodilation Edema

Tissue damage

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

(Fiery-red) Redness and swelling of the tonsillar pillars, uvula and soft palate (may demonstrate petechiae of the roof of the mouth Formation of creamy exudate in the tonsillar pillars (white-purple exudate)

If untreated COMPLICATIONS:

Common: Sinusitis, Otitis media Bad breathe Peritonsillar abscess, Mastoiditis, Cervical adenitis Rare: Bacteremia, Pneumonia, Meningitis, Rheumatic fever, Nephritis

CHRONIC PHARYNGITIS Description: - Is a persistent inflammation of the pharynx Pathophysiology: Risk factors: Working in dusty surroundings Excessive use of voice Chronic cough Habitual use of alcohol and tobacco General thickening and congestion Of the pharyngeal mucous membrane If it remains untreated and progresses, The membrane becomes thin, whitish, glistening, and at times wrinkled Swollen lymph follicles becomes numerous in the pharyngeal wall

RECURRING INFLAMMATION OF THE PHARYNX

Hypertrophic

Atrophic

Chronic granular clergymans sore throat

constant sense of irritation or fullness in the throat inflam-

mucus collects in the throat (can be expelled by coughing)

difficulty swallowing

intermittent postnasal drip causing minor irritation and 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 GABHS Virus Epstein-Barr virus (90% in adults affected) and Cytomegalovirus

Entry into the system (tonsils and adenoids) and multiplies Inflammatory process sets-in ENLARGED Tonsils Sore throat Fever Snoring Difficulty swallowing Adenoids Mouth-breathing Earache Draining ears Frequent head colds Noisy respiration Fills the space behind the posterior nares Nasal obstruction

If untreated: Complications Infection extends to the middle ears Acute otitis media Rupture of tympanic membrane Deafness Infection extends to the mastoid cells Mastoiditis

PERITONSILLAR ABSCESS Description: - 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 purulent exudate between the tonsillar capsule and the surrounding tissues and soft palate severe sore throat fever raspy voice inflammation of the superior constrictor muscle of the pharynx (severe sensation of burning, squeezing pain while swallowing) Odynophagia Enlarged and tender cervical lymph nodes

inflammation of the medial ptyregoid muscle

pain

spasm

difficulty swallowing (dysphagia) Drooling local cellulitis and abscess formation spreads over the palate, the neck and chest Edema in the palate, neck and chest Respiratory arrest

trismus (inability to open mouth)

pain on lateral head movement

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

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 ACUTE Laryngitis Hoarseness of voice or Aphonia (complete loss of voice) Severe cough and dry sore throat Sudden onset made worse by cold dry wind Throat feels tickle in the worst in throat made morning and worse by cold improves when air/liquids in a warmer climate uvula is visibly edematous (if with allergies)

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 - Male gender - Post-menopausal status - Advanced age - Alterations in the airway (structural changes like tonsillar hypertrophy, abnormal posterior positioning of one or both jaws, and variations in craniofacial structures) that 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 breathing cessation for 10 secs or long (5 episodes/hour) Snorting Gasping Choking Apneic episodes reported by the partner Sudden awakening Chronic fatigue Insomnia and difficulty going to sleep DEATH Apnea Hypoxia and hypercapnia Sympathetic response Hypertension Increased risk for MI and Stroke Dysrhythmias in clients with CVD Small amounts of negative pressure are generated during inspiration Upper airway collapse

Hypersomnolence Early morning awakenings (Daytime sleepiness) with an inability to go back to sleep EPISTAXIS Description: - 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) - Systemic infections (scarlet fever, malaria) - Drying of nasal mucous membrane - Nasal inhalation of illicit drugs (cocaine) - Trauma (picking the nose, blunt trauma, (fracture, forceful nose blowing) - Arteriosoclerosis - Tumor (sinus or nsapharynx) - Thrombocytopenia - Use of aspirin - Liver disease - Redu-Osler-Weber syndrome (hereditary hemorrhagic telengiectasia) - Hypertension

Presence of any of the risk factors Rupture of any of the following Anterior ethmoidal artery On the forward part of the roof sphenopalatine artery in the posterosuperior region 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 Difficulty in maintaining an adequate airway Breathing through Sleep deprivation Nasopharyngitis Infection extends to the nasal sinuses Rhinosinusitis internal maxillary branches

the mouth Drainage is obstructed Dryness of the oral mucosa and persistent, dry, cracked lips FRACTURE OF THE NOSE - Is the break in the continuity of the nasal bone. Pathophysiology: Cause: Direct assault on the nose Tearing of the mucous membrane Rupture of blood vessels Trauma to the nasal area Hematoma Break in the continuity of nasal bone Fracture Pain

Nose bleeding Complications: Infection Abscess Avascular or septic necrosis

LARYNGEAL OBSTRUCTION Description: - Obstruction of the larynx Pathophysiology: Precipitating factors: History of allergies, exposure to medications, latex, foods, and bee stings Foreign bodies Heavy alcohol consumption; heavy tobacco use Family history of airway problems Use of ACE-inhibitors Recent throat pain or Recent fever History of surgery or Previous tracheostomy History of nasogastric tube placement anaphylaxis lodges into the larynx causes tumor angioedema angioedema of mucous membranes infectious process subglottic stenosis nasogastric tube syndrome Laryngeal Obstruction Closes off the opening in the larynx Air passage is compromised during inspiration and expiration Lowered oxygen saturation Use of accessory muscles of respiration Retractions in the neck or abdomen during inspirations Respiratory arrest Death edema of larynx

Client may faint or collapse

CANCER OF THE LARYNX Description: Pathophysiology: Etiology of cancer is unknown.

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

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 are not encapsulated Expands into surrounding tissues (Invasion) Lump in the neck Impedes the action of Lack of adhesion and loss of contact inhibition Spreads to distant parts of the body (Metastasis) - 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 - Persistent hoarseness - Persistent ulceration - Unilateral nasal obstruction/discharge - 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 -Alterations in small airway functions -Reduced lung volumes due to musculoskeletal or neurologic disorders -Retained secretions -Prolonged supine positioning -Restrictive defects -Pain -Increased abdominal pressure -Specific surgical procedures (i.e. upper abdominal, 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 the lungs in the x-ray Alveoli collapse Predisposes to infection Pulmonary infection Hypoxemia Respiratory distress - Tachycardia - Tachypnea - Pleural pain - Central cyanosis - Anxious Acute Respiratory failure Dyspnea Cough Sputum production

Death

RESPIRATORY INFECTIONS Acute Tracheobronchitis Description: - 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 pneumoniae Haemophilus influenzae Mycoplasma pneumoniae Fungal infection (Aspergillus)

Enters into the system and initiates inflammatory process Inflammation of the mucosa of trachea and bronchi Dry and irritating cough sternal soreness Expectoration of scanty amount of mucoid spututm As infection progresses Shortness of breath Inspiratory stridor Expiratory wheezes Expectoration of purulent sputum Irritation of the mucosa of airways Blood-streaked secretions Production of mucopurulent sputum - Fever - Chills - Night sweats - Headache - Body malaise

SEVERE ACUTE RESPIRATORY SYNDROME Description: Pathophysiology Predisposing factors: - Living or traveling in places with SARS cases - Close contact with infected people CAUSE Corona virus CAUSE through respiratory droplets which either lodges on mouth, nose, or eyes) touching contaminated objects or 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 TUBERCULOSIS Description:

LUNG ABSCESS Description:

PLEURAL CONDITIONS Description : - 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. PLEURISY Description: - 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 Collagen disease After thoracotomy URTI Trauma to the chest Tuberculosis Pulmonary infarction or embolism Primary or metastatic cancer

Inflammation of the parietal and visceral pleura With respiration Rubbing of the two pleural membranes Pleural friction rub upon 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 EFFUSION Description: - 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 infections Neoplastic tumors (bronchogenic carcinoma) Pneumonia

Pulmonary infection (viral) Pulmonary embolus Nephrotic syndrome Connective tissue disease

Causing an imbalance in the hydrostatic pressure and oncotic pressure in the lungs Formation and reabsorption of pleural fluid is altered

Inflammation by bacterial products or tumors of the pleural surfaces Extravasation of fluid into tissues or cavity

Effusion of clear fluid Transudate (Meaning pleural membranes are not diseased) Exudate

Decreased/Absent breath sounds Decreased fremitus Dull, flat sound on percussion Small effusion - minimal or no dyspnea Large effusion - Dyspnea (shortness of breath SOB) Malignant effusion - Dyspnea - 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). EMPYEMA Description: - 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 Bacterial Pneumonia or Lung abscess Other causes: Penetrating chest trauma Hematogenous infection of the pleural space Nonbacterial infections Iatrogenic causes (after thoracic surgery or thoracentesis)

Initial Stage Progression Fibropurulent stage

Pleural fluid is thin

Low leukocyte count

Thick exudative membrane encloses the lung (loculated empyema) Fever Night sweats Pleural pain Cough Dyspnea Anorexia Weight loss

-Decreased or absent breath over the affected area -Decreased fremitus -Dullness on chest percussion

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