15.5 Upper Respiratory Tract Infection

An upper respiratory tract infection (URI), also known as the common cold, can be described as the swelling and irritation of the upper airways, including the nose, sinuses, throat, larynx, and larger airways. Although a variety of infectious organisms can lead to a URI, the most common causative organism is rhinovirus. Risk factors for a URI include contact with school-aged children, underlying respiratory issues, exposure to smoke, and immunodeficiency.^[1]

Pathophysiology

A URI results when a client inhales infected respiratory droplets that then invade the mucosa of the upper respiratory tract. Once deposited in the mucosa, the infectious organism begins to replicate. The infected individual will then mount an inflammatory response, which leads to dilation and increased permeability of blood vessels, ultimately contributing to the symptoms of the URI.^[2]

Assessment (Recognizing Cues)

Physical Exam

Signs and symptoms may vary based on the causative organism of the URI. However, common signs and symptoms are as follows:

• Cough
• Sore throat
• Runny nose
• Stuffy nose
• Headache
• Fever (low-grade)
• Increased pressure in the facial region
• Sneezing
• Malaise (a general feeling of illness, weakness, or discomfort)
• Muscle aches

Symptoms begin one to three days after exposure to the infectious organism and usually last seven to ten days. However, symptoms can sometimes last up to three weeks. Potential complications of a URI caused by rhinovirus are exacerbations of asthma, ear infections, sinus infections, bronchitis, or pneumonia.

Common Laboratory and Diagnostic Tests

A URI is a clinical diagnosis that can be made based on the presence of common signs and symptoms and the absence of more serious illnesses. However, diagnostics may be used to rule out other disorders that lead to similar symptoms, such as influenza or strep throat.^[3],[4]

Nursing Diagnosis (Analyzing Cues)

Nursing priorities for clients with a URI include symptom management and preventing the spread of infection to others.

Nursing diagnoses for clients with a URI are created based on the specific needs of the client, their signs and symptoms, and the etiology of the disorder. These nursing diagnoses guide the creation of client-specific care plans that include expected outcomes, nursing interventions, and evaluation of those outcomes.

Possible nursing diagnoses for clients with a URI are as follows^[5],[6]:

• Ineffective airway clearance r/t increased secretions
• Fatigue r/t disease process
• Hyperthermia r/t disease process
• Risk for fluid volume deficit r/t poor oral intake

Outcome Identification (Generate Solutions)

Outcome identification encompasses the creation of short- and long-term goals for the client. These goals are used to create expected outcome statements that are based on the specific needs of the client. Expected outcomes should be specific, measurable, and realistic. These outcomes should be achievable within a set time frame based on the application of appropriate nursing interventions.

Sample expected outcomes related to the suggested nursing diagnoses are listed below:

• The client will exhibit a reduction in secretions within 48 hours.
• The client will display an increase in energy and engage in age-appropriate play within 48 hours.
• The client will exhibit a temperature that is within normal limits for age within 48 hours.
• The client will exhibit blood pressure and heart rate within normal limits for age, moist mucous membranes, urine output appropriate for their age, and non-sunken fontanels for infant clients during the course of the illness.

Interventions (Generate Solutions & Take Action)

Medical Interventions

There is no cure for the common cold. Medical interventions focus on symptomatic relief with the use of over-the-counter medications. Examples of commonly used over-the-counter medications for children with a URI include the following:

• Acetaminophen or ibuprofen to help with fever and discomfort.
• Saline nose spray for relief of nasal symptoms.
• Menthol rubs to help with cough and nasal congestion (can only be used in children older than two years of age).
• Certain formulations of guaifenesin can be used in children to help thin secretions and ease congestion.

Many other over-the-counter medications exist to treat URI symptoms such as cough suppressants, decongestants, and antihistamines. However, these may not be appropriate for children of all ages. Antihistamines and decongestants should not be given to children under the age of two because of potential serious or life-threatening side effects such as convulsions, rapid heart rate, and death.^[7] When giving children over-the-counter medications, it is essential to follow the advice of the health care provider and follow age-limit and dosage guidelines.^[8],[9],[10]

Nursing Interventions

Registered nurses plan interventions based on the expected outcomes of the client. Prior to implementation, the nurse must determine if all previously planned interventions are still suitable based on the current situation of the client.

When caring for a client with a URI, nursing interventions can be divided into nursing assessments, nursing actions, and client teaching as described in the following subsections.^{[11],[12],[13],[14],[15]}

Nursing Assessments

• Assess the client for exposure to known sick contacts, as this may aid in diagnosis.
• Consider indications of a bacterial infection or serious respiratory condition that could mimic the signs of a URI.

Nursing Actions

• Encourage fluid intake to prevent and treat dehydration. Dehydration may be caused by a sore throat that limits oral intake and increased mouth breathing due to stuffy nose. Warm liquids can also help soothe a sore throat. Adequate fluid intake is also commonly recommended to thin respiratory secretions, although research studies supporting this intervention are inconclusive.^[16]
• Encourage the use of humidifiers or vaporizers to alleviate nasal congestion.
• Encourage the client to lie in a semi-Fowler’s position or higher to increase lung expansion.
• Encourage adequate rest, as well as frequent ambulation. Rest will allow the client to heal, and ambulation helps prevent the development of further respiratory complications.

Client Teaching

• Teach the client and caregivers about properly using a humidifier to obtain the benefits of humidified air without increasing the risk of additional illness from bacterial and mold growth. Distilled water should be used instead of tap water that contains minerals that can irritate mucosal tissue when inhaled. The humidifier should be run only when needed because an overly humid environment encourages bacteria and mold growth. The unit should be cleaned daily to discourage microbial growth, and disinfectant cleansers should be rinsed thoroughly to prevent irritation to the respiratory tissues.^[17]
• Teach the client and their caregivers about over-the-counter medications that can be administered for symptom relief.
• Teach the client and their caregivers that a dose of honey at bedtime can also be an effective remedy for cough suppression in children older than one year of age. Honey should not be given to infants less than one year of age due to the risk of botulism.
• Teach caregivers how to use a suction bulb to remove mucus from the nose of infants or small children. See Figure 15.2^[18] for an image of a suction bulb.
• Teach clients and their caregivers about respiratory etiquette and good handwashing to prevent the spread of disease. Respiratory etiquette refers to actions performed to decrease the spread of infection to others, such as covering the mouth and nose with a tissue when coughing or sneezing and then disposing of the tissue in the trash. If a tissue is not available, clients should sneeze into their inner elbow instead of their hands.^[19]

Evaluation (Evaluate Outcomes)

Evaluation of client outcomes refers to the process of determining whether or not client outcomes were met by the indicated time frame. This is done by reevaluating the client as a whole and determining if their outcomes have been met, partially met, or not met. If the client outcomes were not met in their entirety, the care plan should be revised and reimplemented. Evaluation of outcomes should occur each time the nurse assesses the client, examines new laboratory or diagnostic data, or interacts with another member of the client’s interdisciplinary team.