LARYNGITIS

What is Laryngitis
Laryngitis is the medical term for inflammation and swelling of the larynx, which is also known as the voice box. Most of the causes of laryngitis, such as common viruses infections or using your voice too much, are not serious. A few causes, however, require medical attention and can be cause for concern such as laryngeal cancer.

Pathophysiology
In acute infectious laryngitis there is generally a viral or bacterial insult, leading to inflammation of the endolaryngeal structures. This results in tissue edema and erythema. Tissue edema decreases the pliability of the true vocal fold mucosa over the lamina propria and increases the bulk of the vocal folds. This leads to lowered vocal pitch and hoarseness. Meanwhile, there is increased mucus, as well as purulence.

Causes:
acid reflux disease allergies bacterial or fungal infection excessive coughing, smoking, or alcohol consumption inflammation due to overuse of the vocal chords use of inhaled corticosteroids for asthma treatment viral infection

Symptoms
The most common symptoms of laryngitis: Hoarseness Feeling a tickle in the throat (that may be from reflux laryngitis) The urge to constantly clear the throat (that may be from reflux laryngitis) Fever Cough (that can be from bronchitis or sinusitis) Congestion

Prevention
Because most cases of laryngitis are caused by viruses, the best prevention is making sure to wash hands often, especially before touching the face, to minimize the transmission of contagious microbes. Despite these efforts, much like a common cold, it is impossible to eliminate the risk altogether. For children, it is important to receive the Haemophilus influenzae vaccine in order to protect them from possibly life-threatening contagious bacterial

infections. Otherwise, taking care not to overuse the voice is the only other preventive step.

Nursing Interventions
Encourage adequate rest Encourage fluid intake Advise to rest voice Throat lozenges

SINUSITIS
It is an inflammation of the sinuses and nasal passages. A sinus infection can cause a headache or pressure in the eyes, nose, cheek area, or on one side of the head. A person with a sinus infection may also have a cough, a fever, bad breath, and nasal congestion with thick nasal secretions. Sinusitis is categorized as acute (sudden onset) or chronic (long term, the most common type).

Sinus Infection Causes

Usually follows a viral infection in the upper respiratory tract, but allergens (allergy-causing substances) or pollutants may also trigger acute sinusitis. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. These microorganisms, along with Staphylococcus aureus and anaerobes (bacteria that live without oxygen), are involved in chronic sinusitis. Fungi are also becoming an increasing cause of chronic sinusitis, especially in people with diseases that weaken the immune system, such as AIDS, leukemia, and diabetes.

Sinusitis can be:

Acute -- symptoms last up to 4 weeks Sub-acute -- symptoms last 4 - 12 weeks Chronic -- symptoms last 3 months or longer

Signs and Symptoms

The classic symptoms of acute sinusitis in adults usually follow a cold that does not improve, or one that worsens after 5 - 7 days of symptoms. Symptoms include: Bad breath or loss of smell Cough, often worse at night Fatigue and generally not feeling well

Fever Headache -- pressure-like pain, pain behind the eyes, toothache, or facial tenderness Nasal congestion and discharge Sore throat and postnasal drip Symptoms of chronic sinusitis are the same as those of acute sinusitis, but tend to be milder and last longer than 12 weeks.

Symptoms of sinusitis in children include: Cold or respiratory illness that has been improving and then begins to get worse High fever, along with a darkened nasal discharge, for at least 3 days Nasal discharge, with or without a cough, that has been present for more than 10 days and is not improving

Medication
Antibiotics are usually not needed for acute sinusitis. Antibiotics may be prescribed sooner for: Children with nasal discharge, possibly with a cough, that is not getting better after 2 - 3 weeks Fever higher than 102.2 Fahrenheit (39 Celsius) Headache or pain in the face Severe swelling around the eyes Acute sinusitis should be treated for 10 - 14 days. Chronic sinusitis should be treated for 3 - 4 weeks. Some people with chronic sinusitis may need special medicines to treat fungal infections.

Prevention
The best way to prevent sinusitis is to avoid or quickly treat flus and colds: Eat plenty of fruits and vegetables, which are rich in antioxidants and other chemicals that could boost your immune system and help your body resist infection. Get an influenza vaccine each year. Reduce stress. Wash your hands often, particularly after shaking hands with others. Other tips for preventing sinusitis: Avoid smoke and pollutants. Drink plenty of fluids to increase moisture in your body. Take decongestants during an upper respiratory infection. Treat allergies quickly and appropriately. Use a humidifier to increase moisture in your nose and sinuses.

Nursing Interventions

 Encourage intake of water Advise semi-fowlers position Apply hot-moist packs

Acute Bronchitis
Definition
Acute bronchitis is an inflammation of the large bronchi (medium-size airways) in the lungs that is usually caused by viruses or bacteria and may last several days or weeks.

Pathophysiology
The symptoms of acute bronchitis are due to acute inflammation of the bronchial wall, which causes increased mucus production together with oedema of the bronchus. This leads to the productive cough that is the hallmark of a lower respiratory tract infection. While the infection may clear in several days, repair of the bronchial wall may take several weeks. During the period of repair, patients will continue to cough. Pulmonary function studies of patients with acute bronchitis demonstrate bronchial obstruction similar to that in asthma.

What causes acute bronchitis?

Acute bronchitis occurs most often due to a viral infection that causes the inner lining of the bronchial tubes to become inflamed and undergo the changes that occur with any inflammation in the body. Common viruses include the rhinovirus, respiratory syncytial virus (RSV), and the influenza virus. Bacteria can also cause bronchitis (a few examples include, Mycoplasma, Pneumococcus, Klebsiella, Haemophilus). Chemical irritants (for example, tobacco smoke, gastric reflux, solvents) can cause acute bronchitis.

Signs and Symptoms

expectorating cough shortness of breath (dyspnea) wheezing occasionally, chest pains, fever, and fatigue or malaise may also occur .

Treatment
Antibiotics

Only about 5-10% of bronchitis cases are caused by a bacterial infection. Most cases of bronchitis are caused by a viral infection and are "self-limited" and resolve themselves in a few weeks. Acute bronchitis should not be treated with antibiotics unless microscopic examination of the sputum reveals large numbers of bacteria. Smoking cessation Many physicians recommend that, to help the bronchial tree heal faster and not make bronchitis worse, smokers should quit smoking completely in order to allow their lungs to recover from the layer of tar that builds up over time.

Prevention
DO NOT smoke. Get a yearly flu vaccine and a pneumococcal vaccine as directed by your doctor. Reduce your exposure to air pollution. Wash your hands (and your children's hands) frequently to avoid spreading viruses and other infections.

Nursing Interventions
Increased

rest (especially if febrile) Adequate hydration (8-10 glasses of fluid per day) Increased humidity in the environment Avoidance of pulmonary irritants (e.g., stop or decrease smoking, avoid irritants)

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