Acute Upper Respiratory Infections:

(U.R.Is)

URIs include infectious processes involving any or all of the structures in the upper respiratory tract. Most are caused by viruses and are self-limited. Acute nasopharyngitis and pharyngitis (including tonsillitis) are extremely common in pediatric age groups.

Nasopharyngitis:

Nasopharyngitis, a viral infection of the nose and throat is the most common URI.

Assessment Criteria:

• Younger child:

• Older child:

• Fever.•Sneezing.

•Irritability. •Vomiting.

•Diarrhea.•Restlessness

•Dryness & irritation of nose& throat.•Sneezing.•Muscular aches.

•Chilly.•Cough.

Complication of Nasopharyngitis:

Complications of nasopharyngitis in infant are more often otitis media. Lower respiratory tract infection the older child may develop sinusitis as a complication.

Pharyngitis:

The throat (including the tonsils) is the principal anatomic site of pharyngitis (sore throat). Although uncommon in children under of age. The disease is prevalent throughout childhood with the peak incidence occurring between 4 and 7 years of age. The etiologic agents are wither viruses or the group AB-hemolytic streptococcus.

Assessment Criteria:

• Younger child:Fever. Headache. Moderate sore throat.

Anorexia. General malaise.

Older child:Fever may reach 40°C. Headache.

Anorexia. Dysphagea.

Abdominal pain. Vomiting.

Complication of Nasopharyngitis:

Complications can include otitis media, acute cervical adenitis, retropharyngeal abscess and lower respiratory tract infection streptococcal infection sometime triggers response in the heart (rheumatic fever) or kidney (acute glomerulonephritis).

Tonsillitis:

The tonsils are masses of lymphoid tissue located in the pharyngeal cavity (Fig. 2). The palatine of facial tonsils is located on each side of the oropharynx and is usually visible during oral examination. The pharyngeal tonsils also known as the adenoids are located in the posterior wall of the nasopharynx, opposite the posterior naris. Their proximity to the naires and Eustachian tubes contributes to obstruction of the passages during inflammation. The lingual tonsils are located at the base of the tongue. The tubal tonsils are found near the posterior nasopharyngeal opening of the ostachean tubes.

Therapeutic Management:

• Treatment of a child with pharyngitis is symptomatic because the illness is short and self-limiting. If streptococcal sore throat is present, an antibiotic is prescribed in a dosage sufficient to control the acute local manifestation and to maintain an adequate level for at least 10 days to eliminate any organism that might remain to initiate symptoms of rheumatic fever.

• Surgical treatment of chronic tonsillitis controversial (tonsillectomy) removal of the (palatine tonsils) has been the most frequently performed pediatric surgical procedure beyond the newborn period. Generally, tonsils should not be removed before 3 or 4 years of age, because of the problem of excessive blood loss in small children and the possibility of regrowth or hypertrophy of lymphoid tissue.

Nursing Management:

Nursing care of the child with tonsillitis and /or pharyngitis mainly involve:

• Provide comfort.• A soft liquid diet is generally preferred.• A cal mist vaporize helps to keep the mucous

membranes moist during periods of mouth breathing.• Warm saline gargles and analgesic, antipyretic drugs are

useful to promote comfort. • If antibiotics are prescribed, parents need counseling

regarding their correct administration and the necessity of completing the treatment period.

Otitis Media:

Stander Terminology for Otitis Media:

• Otitis media: An inflammation of the middle ear without reference to etiology or pathogenesis.

• Acute otitis media (AOM): A rapid and short onset of signs and symptoms lasting approximately 3 weeks.

• Otitis media with effusion (OME): An inflammation of the middle ear in which a collection of fluid is present in the middle ear space.

• Chronic otitis media with effusion middle ear effusion that persists beyond 3 months.

Etiology:

It is caused by streptococcus pneumonia, Haemophilus influenza and staphylococcus. The etiology of non-infectious type is unknown.

Factors Predisposing to Development of Otitis Media in Children:

• The austachian tubes are short, wide and straight and lie in a relatively horizontal plane and it’s different from adult. The cartilage lining is underdeveloped, making the tubes more distensible and therefore more likely to open inappropriately.

• The normally abundant pharyngeal lymphoid tissue readily obstructs the Eustachian tube openings in the nasopharynx.

• Immature humoral defense mechanisms increase the risk of infection.

• The usual lying-down position of infants favors the pooling of fluid, such as formula, in the pharyngeal cavity.

Assessment of Acute Otitis Media:

• It includes clinical manifestations and diagnostic evaluation.

•Otalgia (ear ache).•Purulent discharge may or mayn’t be present.

In infants and young children:•Crying.•Tendency to rub, hold or pull affected ear.•Rolls head side to side.•Difficulty comforting child.

•Fever.

•Fussy.•Restlessness•Irritable.•Lossof appetite.

Diagnostic Evaluation:

In acute otitis media otoscopy reveals an intact membrane that bright red and bulging. In case of purulent discharge, cultured should be done to select the specific antibiotics for the organism.

Tempanometry may be used to measure the change in air pressure external auditory canal from movement of the ear drum.

Assessment of chronic Otitis Media:

•Hearing loss.•Difficulty communication

•Tinnitus.•Feeling of fullness.

Therapeutic Management:

Treatment of acute otitis media is administration of antibiotics Ampicillin or Amoxicillin.

Nursing Care Plan for Child with Acute Otitis Media:

Nursing Diagnosis:

• Pain related to pressure caused by inflammatory process.

• Altered family process related to ill child.• High risk for impaired skin integrity related to

drainage.• Health maintenance altered related to lack of

knowledge about health care.• Anxiety related to alteration in psychology of

child and family.• Sleep pattern disturbance, insomnia, related to

pain.

Planning:

• Nursing objectives for the care of children with acute otitis media include:

• Relieve pain.

• Prevent drainage when possible.

• Prevent complications or recurrence.

• Educate family in care of child.

• Provide emotional support to child and family.

Implementation:

• Application of heating pad may reduce the discomfort. Local heat should be placed be placed over the ear with the child lying on affected side. This position also facilitates drainage of the exudates if the eardrum has ruptured or if myringatomy was performed (opening in the ear drum and putting to drain the purulent discharge).

• Analgesics and antipyretics are helpful in reducing the severe earache and fever.

• An ice bag placed over the affected ear may also be beneficial since it reduces edema and pressure (could be applied between the attack of pain).

• If the ear is draining, the external canal may be cleaned with sterile cotton swabs or pledges soaked in hydrogen peroxide.

• Excoriation should be prevented by frequent cleansing and application of Zinc oxide to the area of exudate.

• A concern presented with the use of myringotomy tubes is the possibility of water entering the middle ear and introducing bacteria.

• Parents should be aware of the potential complications of acute otitis media that can be occurred with inadequate treatment such as:

• Conductive hearing loss.• A perforated and starred eardrum.• Mastoiditis.• Intracranial infections, e.g. meningitis.

Expected outcome:

• Child sleeps and rests quietly and exhibits no signs of discomfort.

• Child exhibits no evidence of excoriated skin.

• Child remains free of complications.

• Family demonstrates the ability to care for child’s condition.

• Family and child express their feelings and concerns.