The common cold—acute viral rhinitis—is an inflammation of the nose and upper respiratory tract. It is the most prevalent infectious disease among people of all ages. Many different strains of viruses can produce the symptoms of a common cold, thus total immunity is unlikely. Avoiding exposure to those who have a cold and maintaining a state of good health are the only ways one can avoid “catching” a cold.

Etiology and Pathophysiology

Viruses are spread by airborne droplet sprays from infected people during breathing, speaking, coughing, or sneezing, or by direct hand contact with a contaminated object. A chill, fatigue, physical or emotional stress, a compromised immune status or inflammation caused by allergic rhinitis makes one more susceptible to contracting an upper respiratory virus.

Signs, Symptoms, and Diagnosis

The common cold usually starts with a mild sore throat or a hot, dry, prickly sensation in the nose and back of the throat. Within hours after the onset of a cold, the nose becomes congested with increased secretions, the eyes begin to water, and sneezing, malaise, and an irritating, nonproductive cough appear. The invading organism causes inflammation and swelling of the mucosa. Muscle aches and headache may occur. There usually is no elevation of temperature; if a fever does develop, it is low grade (<101° F [38.3° C]). In most instances, a cold will last 10 to 14 days before all symptoms are gone.

Allergic rhinitis may have many of the symptoms of a cold, except there is no fever. It is caused by reaction of the nasal mucosa to an allergen, such as pollen or dust.

Treatment and Nursing Management

The treatment of allergic rhinitis is symptomatic. Antihistamines, steroids, and sprays that stabilize the mucous cell membranes are often prescribed (Table 14-1). The patient is taught to avoid the offending allergens as much as possible. If the disorder is severe, an allergy evaluation is indicated so that a desensitization program can be started.

Table 14-1

Commonly Prescribed Drugs for Allergic Rhinitis and Sinusitis

Classification	Action	Nursing Implications	Patient Teaching
Antihistamines
First-Generation Agents
Diphenhydramine (Benadryl) Clemastine (Tavist) Brompheniramine (Dimetane) Chlorpheniramine (Chlor-Trimeton)	Relieve sneezing, excessive secretions, itching, and nasal congestion. Block histamine binding by binding with H₁ receptor sites	Tend to cause sedation and slow reaction time May cause stimulation in some people May cause GI side effects: anorexia, constipation or diarrhea, or epigastric distress May cause urinary retention or frequency	Warn patient not to operate machinery and that driving may be dangerous due to sedation; this usually passes after the first 2 wk of treatment Ask patient to report changes in heart rate, palpitations, or urinary retention or frequency Warn that alcohol will have additive depressant effect
Second-Generation Agents
Loratadine (Claritin) Fexofenadine (Allegra) Cetirizine (Zyrtec) Desloratadine (Clarinex) Azelastine (Astelin) nasal		Have limited attachment to H₁ receptors in the brain, do not cause sedation, and have less effect on reflexes; they do not affect bladder function	Do not take with alcohol or other CNS-active drugs Do not take with any monoamine oxidase inhibitor These drugs are more expensive than first-generation drugs
Corticosteroid Sprays
Beclomethasone (Vancenase) Budesonide (Rhinocort) Flunisolide (Nasalide) Fluticasone (Flonase) Triamcinolone (Nasacort) Ciclesonide (Omnaris) Mometasone (Nasonex)	Inhibit inflammatory response Have low systemic absorption with normal doses	Encourage use as directed on a daily basis	Teach to use on a daily basis rather than PRN Discontinue if infection occurs May initially cause some burning in nostrils
Mast Cell Stabilizer
Cromolyn sodium spray (Nasalcrom)	Stabilizes mast cells, preventing inflammatory reaction	Minimal side effects	Begin 2 wk before pollen season starts and use throughout pollen season to prevent allergy symptoms May be used prophylactically for isolated allergy (i.e., cat) Use 10-15 min before exposure
Decongestants
Oral Pseudoephedrine (Sudafed) Oxymetazoline (Dristan) Phenylephrine (Neo-Synephrine) Saline nasal spray or rinse*	Promote vasoconstriction by stimulating adrenergic receptors on blood vessels; reduce nasal edema and rhinorrhea	May cause insomnia, headache, irritability, dysuria, palpitations, or tachycardia Can cause rebound nasal congestion	Some products are contraindicated for those with hypertension, cardiac disease, glaucoma, diabetes, prostatic hypertrophy, or liver or renal disease Use only three or four times a day for no more than 3 days

CNS, central nervous system; GI, gastrointestinal; H₁, histamine-1; PRN, as needed.

*Saline nasal sprays and rinses wash away pollen and dust, thin secretions, and soothe the nasal mucosa.

There is no cure for the common cold. However, zinc lozenges have proven effective in limiting a cold’s duration and severity for many people, if started at the first signs of symptoms (Prasad et al., 2008).

Complementary and Alternative Therapies

Alternative Treatment for a URI

Echinacea, goldenseal, or a combination of herbs, minerals, vitamins, and amino acids such as those contained in the product “Airborne” can be taken at the first sign of a cold, or before going into crowded areas during cold season. This product was developed by a schoolteacher and has been effective for many people.

A major goal in the care of a common cold is prevention of a secondary bacterial infection. Individuals with a cold should avoid contact with others so as to avoid picking up a bacterial infection or giving their viral infection to someone else. A person with a cold is contagious for about 3 days after symptoms first appear.

Colds are spread by droplet infection and most people realize that coughing and sneezing will spread viruses. Coughing and sneezing into tissues does limit the viruses’ travel by air, but the viruses are also very likely to be on the person’s hands, where they can be transferred to anything touched. Hand hygiene is important in the prevention of spreading infection to others and patients should also be taught not to share personal use items, such as drinking glasses.

The patient should stay indoors, preferably in bed or resting, during the first few days of the illness. Fluid intake should be increased. Fruit juices are recommended, especially citrus juices, because of their vitamin C content. Aspirin or another mild nonprescription analgesic can help relieve the muscle aches and headache of a cold.

Elder Care Points

The elderly should be encouraged to stay away from people who have a cold or URI because of decreased immune function and if a cold develops a secondary infection is more likely. Older patients should continue the extra fluids and rest until symptoms are resolved.

Safety Alert

Caution with Aspirin

Aspirin should not be given to children. Aspirin has an association with Reye’s syndrome, which occurs after a viral illness and may result in brain inflammation and possibly death. For children under 18, aspirin should only be given when prescribed by a physician (National Reye’s Syndrome Foundation, 2009). Adults taking anticoagulants or nonsteroidal anti-inflammatory drugs should not take aspirin, because aspirin will further prolong the clotting time.

Decongestant nose drops or sprays such as oxymetazoline (for the relief of nasal congestion) can have a rebound effect, leaving the nose “stuffier” if used for more than 3 days. Frequent use of saline nasal spray decreases congestion without side effects. Antibiotics are not given because a cold is a viral infection.

A bacterial infection, which requires medical treatment, is present when a “cold” persists for more than a week to 10 days without improvement, or if the patient begins to feel worse, has a temperature of 101° F(38.3° C), and develops chest pains or coughs up purulent sputum.

Think Critically

What are the various ways you can prevent contracting a cold?

Sinusitis

Sinusitis is an inflammation of the mucosal lining of the sinuses. Pneumococci, streptococci, or Haemophilus influenzae are the usual pathogens and infection can spread from the nasal passages to the sinuses. The nasal passages can be blocked by a deviated septum which may occur congenitally, or from injury to the nose, or by nasal polyps. Polyps occur from repeated inflammation of the nasal mucosa and are tissue growths that obstruct airflow. Sinusitis often occurs after colds or other respiratory infections and during periods of uncontrolled allergic rhinitis. People with a deviated nasal septum or allergy problems tend to have recurrent sinusitis.

As exudate accumulates in the sinuses, pressure builds up causing pain. Symptoms include headache, fever, tenderness over the sinuses, malaise, purulent drainage from the nose, and sometimes a nonproductive cough. The upper teeth may become painful.

Treatment of sinusitis includes relieving pain, promoting sinus drainage, controlling infection, and preventing recurrence. Hot, moist packs over the sinus area can be helpful. Inhaling moist steam thins secretions and kits for sinus irrigation available at drugstores help to promote drainage. Medications are prescribed to promote decongestion or vasoconstriction and to reduce swelling, to promote drainage and to relieve pain. Infection may be treated with an antibiotic or anti-infective agent, often for at least 10 days. Rest, reduced stress, a balanced diet, and control of allergies can help prevent recurrence. Fluid intake should be increased. Dairy products increase the thickness of secretions, therefore are limited during the illness.

Think Critically

How would you know if you or a patient has a sinus infection rather than just an ordinary cold?

Acute or chronic sinus infection can cause a variety of complications, including septicemia, meningitis, and brain abscess. When sinus infection is chronic, surgery to clean out the sinuses may be necessary. A deviated septum can be surgically repaired, and polyps can be removed by laser treatment.

Epistaxis

Epistaxis (nosebleed) is a common occurrence and usually results from crusting, cracking, or irritation of the mucous membrane covering the front of the nasal septum. Blood loss is usually minimal. Decreased humidity, excessive nose blowing, allergy with inflammation, and nose picking may cause nosebleeds. Overuse of nasal spray, street drug use (particularly “snorting”), and tumors are other causes. Any condition that prolongs bleeding time or lowers the platelet count may predispose to nosebleeds. Nosebleeds can also result from trauma, hypertension, and blood disorders such as leukemia. They are common in boys during pubescence.

Bleeding from the nose is the only sign of epistaxis. When epistaxis occurs, the patient should sit forward and apply direct pressure by pinching the soft portion of the nose for 10 to 15 minutes. This position prevents blood from running down the back of the throat. Cold compresses or ice may be applied to the nose to constrict the blood vessels. If there is still bleeding at the end of a 10- to 15-minute period, a small gauze pad may be inserted into the bleeding nostril and digital pressure applied (Figure 14-1). If bleeding continues, the patient should go to the emergency department, where a physician will cauterize the bleeding vessels or solidly pack the nose, or insert a small balloon device, to stop the bleeding (Figure 14-2). Once bleeding stops, the patient should rest quietly for a few hours and be warned not to blow the nose, pick at it, or rub it for 24 hours after the nosebleed has stopped.

Clinical Cues

If the patient is having an active nosebleed, instruct her to spit the blood into a basin or tissue rather than swallowing it. Accumulation of blood in the stomach will eventually cause nausea and vomiting and the patient’s cooperation will help you to assess the amount of bleeding.