Viral Rhinitis (Common Cold) - Upper Airway Infections

VIRAL RHINITIS (COMMON COLD)

The term “common cold” often is used when referring to an upper respiratory tract infection that is self-limited and caused by a virus (viral rhinitis). Nasal congestion, rhinorrhea, sneezing, sore throat, and general malaise characterize it. Specifically, the term “cold” refers to an afebrile, infectious, acute inflammation of the mucous membranes of the nasal cavity. More broadly, the term refers to an acute upper respiratory tract infection, whereas terms such as “rhinitis,” “pharyngitis,” and “laryngitis” distinguish the sites of the symptoms. It can also be used when the causative virus is influenza (“the flu”). Colds are highly contagious because virus is shed for about 2 days before the symptoms appear and during the first part of the symptomatic phase. It is estimated that adults in the United States average two to four colds each year. The common cold is the most common cause of absenteeism from work and school (Mandell, Bennett, & Dolin, 2000).

The six viruses known to produce the signs and symptoms of the viral rhinitis are rhinovirus, parainfluenza virus, coronavirus, respiratory syncytial virus (RSV), influenza virus, and adenovirus. Each virus may have multiple strains. For example, there are over 100 strains of rhinovirus, which accounts for 50% of all colds. The incidence of viral rhinitis follows a specific pattern during the year, depending on the causative agent (Fig. 22-2). Even though viral rhinitis can occur at any time of the year, three waves ac-count for the epidemics in the United States:

·        In September, just after the opening of school

·         In late January

·         Toward the end of April

Immunity after recovery is variable and depends on many fac-tors, including a person’s natural host resistance and the specific virus that caused the cold.

Clinical Manifestations

Signs and symptoms of viral rhinitis are nasal congestion, runny nose, sneezing, nasal discharge, nasal itchiness, tearing watery eyes, “scratchy” or sore throat, general malaise, low-grade fever, chills, and often headache and muscle aches. As the illness progresses, cough usually appears. In some people, viral rhinitis exacerbates the herpes simplex, commonly called a cold sore (Chart 22-1).

The symptoms last from 1 to 2 weeks. If there is significant fever or more severe systemic respiratory symptoms, it is no longer viral rhinitis but one of the other acute upper respiratory tract infections. Allergic conditions can also affect the nose, mim-icking the symptoms of a cold.

Medical Management

There is no specific treatment for the common cold or influenza. Management consists of symptomatic therapy. Some measures include providing adequate fluid intake, encouraging rest, pre-venting chilling, increasing intake of vitamin C, and using ex-pectorants as needed. Warm salt-water gargles soothe the sore throat and nonsteroidal anti-inflammatory agents (NSAIDs) such as aspirin or ibuprofen relieve the aches, pains, and fever in adults. Antihistamines are used to relieve sneezing, rhinorrhea, and nasal congestion. 

Topical (nasal) decongestant agents may relieve nasal congestion; however, if they are overused they may create a rebound congestion that may be worse than the original symptoms. Some research suggests that zinc lozenges may reduce the duration of cold symptoms if taken within the first 24 hours of onset (Prasad, Fitzgerald, & Bao, 2000). Amantadine (Symme-trel) or rimantadine (Flumadine) may be prescribed prophylac-tically to decrease the signs and symptoms as well. Antimicrobial agents (antibiotics) should not be used because they do not affect the virus or reduce the incidence of bacterial complications.

Nursing Management

TEACHING PATIENTS SELF-CARE

Most viruses can be transmitted in several ways: direct contact with infected secretions; inhalation of large particles that land on a mucosal surface from coughing or sneezing; or inhalation of small particles (aerosol) that may be suspended in the air for up to an hour. It is important to teach the patient how to break the chain of infection. Hand washing remains the most effective mea-sure to prevent transmission of organisms. The nurse teaches methods to treat symptoms of the common cold and preventive measures (Chart 22-2).