U.R.T.I.(Upper Respiratory Tract Infection)

Submitted to:Ms. Lourdes Saracho

Submitted by:Constantino, Jenna Kristelle R.

Section 2 Group 5

INTRODUCTION

Upper respiratory tract infection (URI) is a nonspecific term used to describe acute infections

involving the nose, paranasal sinuses, pharynx, larynx, trachea, and bronchi. The prototype is the

illness known as the common cold, which will be discussed here in addition to pharyngitis, sinusitis,

and tracheobronchitis. Influenza is a systemic illness that involves the upper respiratory tract and

should be differentiated from other causes of URI. Acute laryngotracheobronchitis (croup), epiglottitis,

and otitis media are infections that occur primarily in the pediatric population and will not be discussed

in this chapter.

Pathophysiology

Mycobacterium Tuberculosis invades mucosal lining leading to intense inflammatory response. Mucosal inflammation leads to increased secretion causes irritation leading to cough that also leads to immune response.

Invades mucosal lining

PhlegmMucosal inflammation

Immune response

Cough

Mycobacterium tuberculosis

Intense inflammatory response

Increased secretion

I. Personal Data

Name of Client: Birosel, Lourdes

Address: 18 alley St. Proj 8. QC

Nationality: Filipino Birth place: Ilocos

Birth date: January 21, 1920 Age: 86 y/o

Religion: Roman Catholic Civil Status: Widow

Educational Attainment: College Graduate Gender: Female

Occupation: Retired

Admission Data

Chief Complaint: cough, productive

Date of Admission: May 5, 2006

Room no.: 806

Provisional Diagnosis: Upper respiratory tract infection

Attending Physician: Dr. Quiogue

II. Nursing History

History of Present Illness:

One week prior to admission, patient experiences cough, non-distressing, non-productive.

Signs and symptoms such as fever, dyspnea or dysuria. They sought consult at UP health service,

patient was given N – acetylcysteine (flumucil). Tablet 2 cifrolaxin 500mg/tab. 1 tab BID x 7 days.

Patient had amnesia and general body weakness.

Few hours prior to admission, still with cough. Patient experienced vomiting of previous

ingested food and phlegm, they sought consult at a private physician and she was advised

admission, they sought consult at an institution hence to admission

Past Medical History:

The patient has history of cholecystectomy year 1957. Has a heart problem starting 2001, also

suffered from heat stroke at year 2005.

Family Medical History

Her parents have no history of Diabetes Mellitus, hypertension, cardiovascular disease and

cancer.

CAPITOL MEDICAL CENTER COLLEGES, INC.College of Nursing

#4 Sto. Domingo Avenue, Quezon City

Drug StudyDrug Dose Classification Mechanism of

ActionIndication Contraindication Side-effect Nursing Responsibilities

Imdur

isosorbide mononitrate

60g 1 tab OD

Antianginal agent

Relaxes vascular smooth muscle with a resultant decrease in venous return and decrease in arterial BP, which reduces left ventricular workload and decreases myocardial oxygen consumption.

Treatment and prevention of angina pectoris (dinitrate)

Prevention of angina pectoris (mononitrate)

Allergy to nitrates, severe anemia, head trauma, cerebral hemorrhage, hypertrophic cardiomyopathy, pregnancy, lactation.

Headache Tachycardia Palpitations Hypotension Nausea Vomiting Perspiration Muscle

twitching

Give oral preparations on an empty stomach, 1 hr before or 2 hr after meals; take with meals if severe, uncontrolled headache occurs.

Maintain life support equipment on standby if overdose occurs or cardiac condition worsens.

Gradually reduce dose if anginal treatment is being terminated; rapid discontinuation can lead to problems of withdrawal.

Cordarone

Amiodarone hydrochloride

1 tab OD

Antiarrhythmic

Acts directly on cardiac cell membrane; prolongs repolarization and refractory period; increases ventricular fibrillation

Only for treatment of the following documented life-threatening recurrent ventricular arrhythmias that do not respond to other antiarrhythmics or when alternative agents are not tolerated: recurrent ventricular

Contraindicated with hypersensitivity to amiodarone, sinus node dysfunction, heart block, severe bradycardia, hypokalemia, lactation.

Malaise Fatigue Dizziness Cardiac arrest Hypotension Liver toxicity

Monitor cardiac rhythm continuously.

Monitor for an extended period when dosage adjustments are made.

Monitor for safe and effective serum levels (0.5–2.5 mcg/mL).

Give drug with meals to decrease

threshold; acts on peripheral smooth muscle to decrease peripheral resistance

fibrillation, recurrent hemodynamically unstable ventricular tachycardia. Serious and even fatal toxicity has been reported with this drug; use alternative agents first; very closely monitor patient receiving this drug

GI problems.

Arrange for ophthalmologic exams; reevaluate at any sign of optic neuropathy.

Norvasc

amlodipine besylate

10g 1 tab OD

Calcium channel-blocker

Antianginal drug

Antihypertensive

Inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells;

   Angina pectoris due to coronary artery spasm

Chronic stable angina, alone or in combination with other agents

Essential hypertension, alone or in combination with other antihypertensive

Contraindicated with allergy to amlodipine, impaired hepatic or renal function, sick sinus syndrome, heart block (second or third degree), lactation

Nausea Dizziness Lightheadedness Headache Fatigue lethargy

Monitor cardiac rhythm regularly during stabilization of dosage and periodically during long-term therapy.

Administer drug without regard to meals

Zithromax

azithromycin

500mg 1 tab

Macrolide antibiotic

Bacteriostatic or bactericidal in susceptible bacteria

Treatment of lower respiratory tract infections: streptococcal pharyngitis/tonsillitis due to Streptococcus pyogenes in those who cannot take penicillin

Contraindicated with hypersensitivity to azithromycin, erythromycin, or any Macrolide antibiotic.

Use cautiously with gonorrhea or syphilis, pseudo membranous colitis, hepatic or renal impairment, lactation.

Dizziness Headache Flatulence Vomiting Diarrhea abdominal pain nausea

Administer on an empty stomach--1 hr before or 2–3 hr after meals. Food affects the absorption of this drug

Counsel patients being treated for STDs about appropriate precautions and additional therapy

CAPITOL MEDICAL CENTER COLLEGES, INC.College of Nursing

#4 Sto. Domingo Avenue, Quezon City

Nursing Care PlanAssessment Nursing Diagnosis

with Background knowledge

Planning Intervention Evaluation

Subjective:“Moody siya madalas, madalas di ka na niya kilala” as verbalized by the daughter

Objective: Difficulty in

comprehension Behavior often

inconsistent

Measurement: BP: 120/80 mmHg PR: 70 bpm RR: 22 cpm Temp. 36.7 C

Weakness related to trauma as manifested by disorientation and confusion

Background KnowledgeDementia of the Alzheimer’s type is a degenerative process occurring primarily in the cells located at the base of the forebrain that send information to the cerebral cortex and hippocampus

1. Provide safe environment; prevent trauma

2. Promote socially acceptable responses; limit inappropriate behavior.

3. Maintain reality orientation/prevent sensory deprivation/overload

4. Encourage participation in self-care within individual abilities

GoalAfter the shift the client will be able to feel the comfort and free from trauma

Expected Outcome:Recognize potential risks in the environment

Independent

1. Assess degree of impairment in ability/competence, presence of impulsive behavior.

2. Eliminate/minimize identified hazards in the environment

3. Monitor behavior routinely, note timing of behavioral changes, increasing confusion, hyperactivity. Initiate least restrictive interventions before behavior escalates.

4. Distract/redirect client’s attention when behavior is agitated or dangerous

5. Obtain identification jewelry showing name, phone number, and diagnosis.

6. Be attentive to nonverbal physiological symptoms. Monitor for medication side effects, signs of over- medication (e.g., extrapyamidal signs, orthostatic hypotension, visual disturbances, GI upsets).

7. Provide quiet room/activity.

Collaborative1. Administer medications as appropriate

Goal Met: The client’s daughter felt the comfort for her mother and free from trauma.

CAPITOL MEDICAL CENTER COLLEGES, INC.College of Nursing

#4 Sto. Domingo Avenue, Quezon City

Nursing Care PlanAssessment Nursing Diagnosis

with Background knowledge

Planning Intervention Evaluation

Subjective:“Di Siya makahinga ng maayos dahil sa ubo niya” as verbalized by the daughter Objective: Generalized Weakness Irritability Flaky skin Cough

Measurement: BP: 120/80 mmHg PR: 70 bpm RR: 22 cpm Temp. 36.7 C

Ineffective be related toAirway Clearancepoor cough effort as evidenced by wheezes

Background KnowledgeUpper Respiratory Tract Infection is an extra pulmonary and affect organs and tissues other than the lungs

1. Achieve/maintain adequate ventilation/oxygenation.2. Prevent spread of infection.3. Support behaviors/tasks to maintain health.4. Promote effective coping strategies.5. Provide information about disease process/prognosis and treatment needs.

GoalAfter the shift the client will be able to clean her secretions without assistance

Expected Outcome:Expectorate secretions without assistance

Independent

1. Assess respiratory functions2. Note ability to expectorate mucus

cough/effectively3. Place patient in Semi or High Fowler’s

position4. Clear secretion from mouth and trachea

Collaborative1. Administer medications as indicated: Azithromycin (Zithromax)

Goal Partially Met: The client was able to expectorate secretion without assistance

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