Donloada!le Key Points Upper respiratory infections include the common cold, acute rhinitis, sinusitis, and acute pharyngitis. The common cold is the most prevalent type of upper respiratory infection. A cold is not considered a life-threatening illness, but it causes physical and mental discomfort and loss of time at work and school. The common cold is caused by the rhinovirus and primarily affects the nasopharyngeal tract. Acute rhinitis (acute inflammation of the mucous membranes of the nose) usually accompanies the common cold. A cold is most contagious to ! days before the onset of symptoms and during the first " days of the cold. Transmission occurs more fre#uently from touching contaminated surfaces and then touching the nose or mouth than it does from viral droplets released by snee$ing. The groups of drugs used to manage cold symptoms include antihistamines, decongestants, antitussives, and e%pectorants. &f a bacterial infection secondary to the cold occurs, infectious rhinitis may result, and nasal discharge becomes tenacious, mucoid, and yellow or yellow-green. Antihistamines compete with histamine for receptor sites, preventing a histamine response. 'hen the ( receptor is stimulated, the e%travascular smooth muscles, including those lining the nasal cavity, are constricted. The antihistamine group can be divided into first and second generations. )ost first-generation antihistamines cause drowsiness, dry mouth, and other anticholinergic symptoms, whereas second-generation antihistamines have fewer anticholinergic effects and a lower incidence of drowsiness. )any *T+ cold remedies contain a first-generation antihistamine, which can cause drowsiness, therefore, patients should be alerted not to drive or operate dangerous machinery when taking such medications. -asal congestion results from dilation of nasal blood vessels caused by infection, inflammation, or allergy. 'ith this dilation, there is a transudation of fluid into the tissue spaces, resulting in swelling of the nasal cavity. -asal decongestants stimulate the alpha-adrenergic receptors, producing vascular constriction of the capillaries within the nasal mucosa. The result is shrinking of the nasal mucous membranes and a reduction in fluid secretion. .re#uent use of decongestants, especially nasal spray or drops, can result in tolerance and rebound nasal congestion. /ebound nasal congestion is caused by irritation of the nasal mucosa. 0phedrine, phenylephrine, and pseudoephedrine are fre#uently combined with an antihistamine, analgesic, or antitussive in oral cold remedies. 1econgestants can make a patient 2ittery, nervous, or restless. Usage of nasal decongestants for as little as " days could result in rebound nasal +opyright 3 456, 454, 4557, 4558, 455", 4555, 779, 77" by :aunders, an imprint of 0lsevier &nc. 1ownloadable ;ey <oints !5-4 congestion. The nurse should emphasi$e the importance of limiting the use of nasal sprays and drops. &ntranasal glucocorticoids or steroids are effective for treating allergic rhinitis. These have an antiinflammatory action, thus decreasing the allergic rhinitis symptoms of rhinorrhea, snee$ing, and congestion. 'ith continuous use, dryness of the nasal mucosa may occur. Antitussives act on the cough-control center in the medulla to suppress the cough refle%. The three types of antitussives are nonnarcotic, narcotic, or combination preparations. 0%pectorants loosen bronchial secretions so they can be eliminated by coughing. (ydration is the best natural e%pectorant. 'hen taking an e%pectorant, one should increase fluid intake to at least = glasses per day to help loosen mucus. :inusitis is an inflammation of the mucous membranes of one or more of the ma%illary, frontal, ethmoid, or sphenoid sinuses. Acetaminophen, fluids, and rest may also be helpful. .or acute or severe sinusitis, an antibiotic may be prescribed. Acute pharyngitis can be caused by a virus, beta-hemolytic streptococci, or other bacteria. &t can occur alone or with the common cold and rhinitis or acute sinusitis. A throat culture should be obtained to rule out beta-hemolytic streptococcal infection. &f the culture is positive for beta-hemolytic streptococci, a 5-day course of antibiotics is often prescribed. :aline gargles, lo$enges, and increased fluid intake are usually indicated in acute pharyngitis. Acetaminophen may be taken to decrease an elevated temperature. Antibiotics are not effective for viral pharyngitis. +opyright 3 456, 454, 4557, 4558, 455", 4555, 779, 77" by :aunders, an imprint of 0lsevier &nc.