Medical Surgical Nursing - Upper Respiratory Tract Infection Complete Notes With MCQs Practice

UNITY MEDICAL ACADEMY | UPNURSING NOTES

Upper Respiratory Tract Infections (URTIs)

Complete Nursing Notes | Clinical Concepts | NORCET Preparation

BSc Nursing • GNM • ANM • Medical-Surgical Nursing

📘 Study Guide: Learn the anatomy, causes, pathophysiology, clinical manifestations, diagnosis, medical management, nursing interventions, complications and prevention of upper respiratory tract infections.

📑 Table of Contents

1. Definition
2. Anatomy of Upper Respiratory Tract
3. Classification
4. Causes and Causative Organisms
5. Risk Factors
6. Pathophysiology
7. Signs and Symptoms
8. Types of URTIs
9. Diagnostic Evaluation
10. Medical Management
11. Nursing Management
12. Infection Prevention and Isolation
13. URTIs in Children
14. Complications
15. Prevention and Health Education
16. Important Differences
17. Nursing Diagnoses
18. NORCET High-Yield Points
19. Practice MCQs
20. Quick Revision
21. FAQs

1. Definition of Upper Respiratory Tract Infections

Upper respiratory tract infections (URTIs) are infections involving one or more structures of the upper respiratory system, including the nose, nasal cavity, paranasal sinuses, pharynx, tonsils and larynx.

Most uncomplicated URTIs are caused by viruses and are self-limiting. Some infections, such as streptococcal pharyngitis, may be bacterial and require specific treatment.

⭐ Important: A common cold is one of the most frequent types of viral URTI. Antibiotics are not effective against viruses.

2. Anatomy of the Upper Respiratory Tract

Structure	Function
Nose and nasal cavity	Filter, warm and humidify inspired air.
Paranasal sinuses	Air-filled cavities that communicate with the nasal cavity.
Pharynx	Passage for air; connects nasal and oral cavities with the laryngeal region.
Tonsils	Lymphoid tissues involved in immune defense.
Larynx	Maintains the airway and produces voice.

Exam Tip: The trachea and bronchi are generally classified as part of the lower respiratory tract.

3. Classification of URTIs

🤧 Common Cold

Acute viral infection of the nose and upper airway.

🌡️ Pharyngitis

Inflammation of the pharynx, commonly presenting with sore throat.

🔴 Tonsillitis

Inflammation of the tonsils.

👃 Rhinosinusitis

Inflammation of the nasal cavity and paranasal sinuses.

🗣️ Laryngitis

Inflammation of the larynx, often associated with hoarseness.

👂 Otitis Media

Middle-ear infection, often associated with an upper respiratory infection.

🚨 Epiglottitis

A potentially life-threatening inflammation around the epiglottis and supraglottic airway.

🦠 Influenza

A viral respiratory illness that can involve upper and lower respiratory tracts.

4. Causes and Causative Organisms

Organism	Associated Infection
Rhinovirus	Common cold; a leading cause.
Influenza virus	Influenza.
Respiratory syncytial virus (RSV)	Respiratory infection, especially important in infants and young children.
Adenovirus	Pharyngitis and other respiratory infections.
Coronavirus	Common cold and other respiratory infections.
Group A Streptococcus (Streptococcus pyogenes)	Streptococcal pharyngitis and tonsillopharyngitis.
Haemophilus influenzae type b (Hib)	Can cause epiglottitis, particularly in inadequately immunized populations.

Remember: Most sore throats are viral. Group A Streptococcus is an important bacterial cause, particularly in school-aged children.

5. Risk Factors

• Close contact with an infected person.
• Exposure to respiratory droplets and contaminated hands or surfaces.
• Overcrowded living or working environments.
• Smoking and second-hand smoke exposure.
• Reduced immunity or immunocompromised status.
• Young age, especially infancy and early childhood.
• Chronic respiratory or other underlying diseases.
• Inadequate hand hygiene.
• Seasonal circulation of respiratory viruses.

6. Pathophysiology of URTIs

Infectious agent enters the respiratory tract
↓
Adheres to and infects respiratory epithelial cells
↓
Local immune and inflammatory response
↓
Release of inflammatory mediators
↓
Mucosal edema, increased secretions and irritation
↓
Nasal congestion, rhinorrhea, sore throat, cough and other symptoms

The severity of symptoms depends on the causative organism, host immune response, age and underlying health conditions.

7. Signs and Symptoms

Symptom	Clinical Explanation
Rhinorrhea	Runny nose due to increased nasal secretions.
Nasal congestion	Swelling of nasal mucosa and increased secretions.
Sore throat	Inflammation or irritation of the pharynx.
Cough	May result from airway irritation or postnasal drainage.
Sneezing	Reflex response to nasal irritation.
Fever	May occur depending on the infection and host response.
Hoarseness	May occur when the larynx and vocal cords are inflamed.
Facial pressure	May occur with rhinosinusitis.
Fatigue and malaise	Systemic response to infection.

🚨 Warning Signs Requiring Urgent Assessment

• Difficulty breathing or stridor.
• Cyanosis or severe respiratory distress.
• Inability to swallow saliva or drooling.
• Altered level of consciousness.
• Severe dehydration or inability to maintain oral intake.
• Rapid deterioration or signs of sepsis.

8. Types of Upper Respiratory Tract Infections

A. Common Cold

Definition: An acute, usually viral infection of the upper respiratory tract, predominantly affecting the nose and throat.

Common Symptoms

• Runny or blocked nose.
• Sneezing.
• Sore throat.
• Mild cough.
• Watery nasal discharge.
• Malaise; fever may occur, particularly in children.

Management

• Rest and adequate fluid intake.
• Saline nasal spray or drops for symptom relief.
• Appropriate analgesics/antipyretics when indicated.
• Humidified air may provide comfort.
• Antibiotics are not indicated for an uncomplicated viral cold.

Exam Point: Yellow or green nasal mucus alone does not prove that the infection is bacterial.

B. Pharyngitis

Definition: Inflammation of the pharynx, commonly presenting as a sore or painful throat.

Clinical Manifestations

• Sore throat.
• Painful swallowing (odynophagia).
• Pharyngeal redness.
• Fever may occur.
• Cough and rhinorrhea may suggest a viral cause.
• Tender anterior cervical lymph nodes may occur in streptococcal infection.

Management

• Fluids and rest.
• Warm saline gargles when appropriate.
• Prescribed analgesics/antipyretics.
• Rapid antigen detection test (RADT) or throat culture when indicated.
• Prescribed antibiotics for confirmed or appropriately diagnosed bacterial infection.

High-Yield: Clinical symptoms alone may not reliably differentiate viral from group A streptococcal pharyngitis.

C. Tonsillitis

Definition: Inflammation of the palatine tonsils, which may be caused by viruses or bacteria.

Clinical Manifestations

• Enlarged, erythematous tonsils.
• Sore throat and dysphagia.
• Fever.
• Enlarged cervical lymph nodes.
• Tonsillar exudates may be present.

Nursing Care

• Assess pain, temperature and ability to swallow.
• Encourage fluids as tolerated.
• Provide prescribed pain relief.
• Monitor for dehydration.
• Observe for airway compromise or signs of peritonsillar abscess.

D. Rhinosinusitis (Sinusitis)

Definition: Inflammation of the nasal cavity and paranasal sinuses, often occurring after a viral upper respiratory infection.

Clinical Manifestations

• Nasal congestion.
• Nasal discharge.
• Facial pain or pressure.
• Headache.
• Postnasal drip.
• Reduced sense of smell.

Important Clinical Clue

Symptoms that persist for more than 10 days without improvement, become severe, or worsen after initial improvement may suggest acute bacterial rhinosinusitis and require clinical evaluation.

Management

• Saline nasal spray or irrigation using safe, appropriately prepared water.
• Warm compress for facial discomfort.
• Appropriate analgesics.
• Clinical review if symptoms are persistent, severe or worsening.
• Antibiotics only when bacterial infection is appropriately diagnosed and treatment is indicated.

E. Laryngitis

Definition: Inflammation of the larynx, commonly associated with viral infection or voice overuse.

Clinical Manifestations

• Hoarseness or loss of voice.
• Throat irritation.
• Dry cough.
• Voice fatigue.

Nursing Management

• Encourage relative voice rest.
• Maintain hydration.
• Avoid smoking and other airway irritants.
• Monitor for breathing difficulty or stridor.

F. Otitis Media

Definition: Inflammation or infection of the middle ear, frequently associated with a preceding upper respiratory infection.

Clinical Manifestations

• Ear pain (otalgia).
• Fever may occur.
• Reduced hearing or ear fullness.
• Irritability and disturbed sleep in children.
• Bulging tympanic membrane may be seen on examination in acute otitis media.

Management

• Appropriate analgesia.
• Clinical assessment and otoscopic examination.
• Observation or antibiotics depending on age, severity and clinical findings.
• Monitor for worsening pain, fever or complications.

G. Epiglottitis – Airway Emergency

Epiglottitis is a potentially life-threatening condition involving inflammation around the epiglottis and supraglottic airway. It requires urgent medical assessment.

🚨 Classic Warning Signs

• Severe sore throat with difficulty swallowing.
• Drooling or inability to swallow saliva.
• Muffled voice.
• Stridor or respiratory distress.
• Tripod positioning in a distressed patient.

Nursing Priority: Maintain a calm environment, summon urgent expert airway assistance and avoid unnecessary throat examination or procedures that may precipitate airway obstruction.

9. Diagnostic Evaluation

Investigation	Purpose
History and physical examination	Assess symptom onset, duration, severity and associated findings.
Vital signs and pulse oximetry	Assess fever, respiratory status and oxygenation when indicated.
Throat swab / RADT	Evaluate suspected group A streptococcal pharyngitis.
Throat culture	May confirm group A Streptococcus when indicated.
Viral testing	Testing for influenza, COVID-19 or other viruses when clinically indicated.
Otoscopy	Evaluate suspected otitis media.
Imaging	Not routinely required for uncomplicated URTIs; reserved for selected complications or alternative diagnoses.

Important: Most uncomplicated URTIs are diagnosed clinically. Investigations depend on the suspected infection and the patient's clinical condition.

10. Medical Management

1. Supportive Treatment

• Rest and adequate oral fluids.
• Analgesics and antipyretics when appropriate.
• Saline nasal spray or drops for nasal symptoms.
• Humidified air for comfort.
• Warm fluids or soothing throat measures when appropriate.

2. Antibiotic Therapy

Antibiotics are used only when a bacterial infection is suspected or confirmed and treatment is clinically indicated. The choice depends on the diagnosis, allergy history, age, local guidelines and clinical condition.

Antibiotic Stewardship: Antibiotics do not treat viral colds, and most viral sore throats do not require antibiotics. Unnecessary use can cause adverse effects and contribute to antimicrobial resistance.

3. Antiviral Therapy

Specific antiviral medicines may be prescribed for selected viral infections, such as influenza, particularly when the patient is at increased risk of complications. Benefit may depend on early treatment.

4. Important Medication Safety

• Use medicines only as prescribed or according to appropriate product directions.
• Check combination cold medicines to avoid duplicate ingredients.
• Do not give aspirin to children or teenagers with suspected viral illness unless specifically directed by a specialist.
• Over-the-counter cough and cold medicines are not appropriate for young children unless advised by a qualified healthcare professional.
• Consider pregnancy, comorbidities, allergies and current medicines before medication administration.

11. Nursing Management of URTIs

A. Nursing Assessment

• Assess onset, duration and progression of symptoms.
• Monitor temperature, pulse, respiratory rate and oxygen saturation when indicated.
• Assess cough, nasal discharge and throat discomfort.
• Assess airway patency and work of breathing.
• Assess swallowing ability and oral intake.
• Monitor hydration status and urine output when indicated.
• Assess pain severity and its effect on sleep and nutrition.
• Review medical history, allergies and prescribed medicines.
• Identify high-risk patients, including infants, older adults and immunocompromised patients.

B. Nursing Interventions

🫁 Airway and Breathing

Assess respiratory effort, airway patency and oxygenation. Escalate respiratory distress immediately.

💧 Hydration

Encourage fluids as tolerated, monitor intake and assess for dehydration.

🌡️ Fever Management

Monitor temperature, promote comfort and administer prescribed antipyretics.

😷 Symptom Relief

Provide appropriate comfort measures for nasal congestion, throat pain and cough.

🛏️ Rest and Nutrition

Promote rest and offer suitable foods and fluids according to swallowing ability.

🧼 Infection Prevention

Perform hand hygiene, teach respiratory etiquette and follow indicated precautions.

C. Evaluation of Nursing Care

• Patient maintains a patent airway and adequate breathing.
• Temperature and discomfort improve as expected.
• Patient maintains adequate hydration.
• Patient demonstrates understanding of infection prevention.
• Patient and family can identify warning signs requiring medical attention.

12. Infection Prevention and Isolation

Measure	Nursing Application
Hand hygiene	Perform before and after patient contact and after contact with respiratory secretions.
Respiratory etiquette	Cover coughs and sneezes; dispose of tissues safely.
Masking	Use appropriate masks according to pathogen, exposure risk and facility policy.
Standard precautions	Apply to all patients.
Transmission-based precautions	Use additional contact, droplet or airborne precautions as indicated by the suspected or confirmed pathogen and institutional policy.
Environmental cleaning	Clean frequently touched surfaces and shared equipment appropriately.

Nursing Exam Point: The exact isolation category depends on the causative organism. Follow current infection-control guidance and facility policy rather than applying one isolation type to every URTI.

13. URTIs in Children

Children may experience frequent respiratory infections because of developing immunity and repeated exposure in households, schools and childcare settings.

Important Nursing Considerations

• Assess feeding, hydration and urine output.
• Monitor respiratory rate, work of breathing and oxygen saturation when indicated.
• Observe for nasal flaring, chest retractions, apnea or cyanosis.
• Use age-appropriate medication dosing prescribed by a qualified clinician.
• Do not routinely administer OTC cough and cold medicines to young children.
• Never give aspirin to children with suspected viral illness unless specifically directed by a specialist.
• Educate caregivers about danger signs and when to seek urgent care.

🚨 Pediatric Red Flags

• Severe breathing difficulty or chest retractions.
• Blue lips or skin.
• Unable to feed or drink.
• Markedly reduced urine output.
• Unusual drowsiness or poor responsiveness.
• Apnea or stridor.

14. Complications of URTIs

Complication	Clinical Significance
Otitis media	Middle-ear infection may follow an upper respiratory infection.
Acute bacterial rhinosinusitis	May develop in a subset of patients following a viral illness.
Peritonsillar abscess	May cause severe unilateral throat pain, trismus and muffled voice.
Dehydration	May occur due to fever, poor oral intake or painful swallowing.
Airway obstruction	Rare but serious; may occur with conditions such as epiglottitis.
Rheumatic fever	Can follow untreated group A streptococcal pharyngitis in susceptible individuals.
Post-streptococcal glomerulonephritis	Immune-mediated complication that may follow certain streptococcal infections.

15. Prevention and Health Education

• Wash hands regularly with soap and water.
• Cover coughs and sneezes with a tissue or elbow.
• Avoid touching the eyes, nose and mouth with unwashed hands.
• Avoid close contact with people who are acutely ill when possible.
• Stay home when ill, according to public health and workplace guidance.
• Keep recommended vaccinations up to date, including influenza and COVID-19 vaccines when indicated.
• Avoid smoking and second-hand smoke.
• Maintain adequate nutrition, hydration and rest.
• Do not share personal items contaminated with respiratory secretions.
• Use antibiotics only when prescribed for an appropriate bacterial infection.

16. Important Differences for Nursing Exams

Condition	Characteristic Finding
Common cold	Rhinorrhea, sneezing and nasal congestion.
Streptococcal pharyngitis	Sore throat, fever, tender anterior cervical nodes; cough is often absent.
Sinusitis	Facial pressure/pain with nasal symptoms.
Laryngitis	Hoarseness or loss of voice.
Otitis media	Ear pain with abnormal middle-ear findings.
Epiglottitis	Drooling, dysphagia, muffled voice and possible stridor; airway emergency.

Clinical Reminder: These findings may overlap. Diagnosis depends on history, examination and appropriate testing.

17. Possible Nursing Diagnoses

Choose nursing diagnoses according to the patient's actual assessment findings.

1. Ineffective Airway Clearance related to increased respiratory secretions, if supported by assessment.
2. Acute Pain related to inflammation of the throat or associated structures.
3. Hyperthermia related to infectious process, if fever is present.
4. Deficient Fluid Volume related to inadequate intake or increased fluid loss, if supported by assessment.
5. Disturbed Sleep Pattern related to cough, congestion or discomfort.
6. Deficient Knowledge regarding infection prevention, medication use or home care, when identified.

18. NORCET High-Yield Points

• URTI affects the nose, sinuses, pharynx, tonsils and/or larynx.
• Rhinovirus is a leading cause of the common cold.
• Most uncomplicated URTIs are viral.
• Antibiotics do not treat viral infections.
• Group A Streptococcus causes streptococcal pharyngitis.
• RADT or throat culture may be used to evaluate suspected strep throat.
• Hoarseness is characteristic of laryngitis.
• Facial pressure with nasal symptoms may occur in rhinosinusitis.
• Otitis media affects the middle ear.
• Drooling, stridor and respiratory distress are airway warning signs.
• Suspected epiglottitis requires urgent airway-focused assessment.
• Hand hygiene is essential for infection prevention.
• Assess hydration and respiratory status, especially in children.
• Yellow/green mucus alone does not establish bacterial infection.
• Uncomplicated viral URTIs usually require supportive care.

19. Upper Respiratory Tract Infection – Practice MCQs

Instructions: Attempt each question before checking the answer and explanation.

Q1. The most common cause of the common cold is:

1. Mycobacterium tuberculosis
2. Rhinovirus
3. Plasmodium vivax
4. Candida albicans

Answer: B — Rhinovirus.
Rhinoviruses are a leading cause of the common cold.

Q2. Which medication does not treat an uncomplicated viral URTI?

1. Appropriate analgesic
2. Saline nasal spray
3. Antibiotic
4. Prescribed antipyretic

Answer: C — Antibiotic.
Antibiotics are ineffective against viruses.

Q3. A patient with laryngitis is most likely to present with:

1. Hematuria
2. Jaundice
3. Bradycardia
4. Hoarseness

Answer: D — Hoarseness.
Laryngeal inflammation can affect the voice.

Q4. Which organism is associated with streptococcal pharyngitis?

1. Group A Streptococcus
2. Rhinovirus
3. RSV
4. Adenovirus only

Answer: A — Group A Streptococcus.
Streptococcus pyogenes is the cause of group A streptococcal pharyngitis.

Q5. Which finding is most concerning for possible epiglottitis?

1. Mild sneezing
2. Drooling with stridor
3. Watery nasal discharge
4. Mild hoarseness without distress

Answer: B — Drooling with stridor.
These findings may indicate a threatened airway and require urgent assessment.

Q6. A patient with a common cold asks for antibiotics because nasal mucus is green. The nurse should explain:

1. Green mucus always means bacterial infection
2. Antibiotics prevent every complication
3. Mucus color alone does not prove bacterial infection
4. All colds require antibiotics after 3 days

Answer: C — Mucus color alone does not prove bacterial infection.
Viral illnesses can also cause colored nasal discharge.

Q7. Which structure is primarily affected in tonsillitis?

1. Alveoli
2. Pleura
3. Bronchioles
4. Tonsils

Answer: D — Tonsils.
Tonsillitis is inflammation of the tonsils.

Q8. Which assessment is a priority in a child with URTI and respiratory distress?

1. Airway patency and work of breathing
2. Hair texture
3. Visual acuity
4. Appetite preference only

Answer: A — Airway patency and work of breathing.
Airway and breathing take priority in an acutely distressed child.

Q9. Which test may be used to evaluate suspected group A streptococcal pharyngitis?

1. Urine ketone test
2. Rapid antigen detection test
3. ECG
4. Spirometry in every case

Answer: B — Rapid antigen detection test.
RADT is one method used to detect group A Streptococcus.

Q10. A patient with rhinosinusitis may complain of:

1. Flank pain only
2. Joint deformity
3. Facial pressure
4. Hematemesis

Answer: C — Facial pressure.
Facial pain or pressure is a common symptom of rhinosinusitis.

Q11. Which intervention helps reduce the transmission of respiratory infections?

1. Sharing used tissues
2. Touching the face frequently
3. Avoiding hand hygiene
4. Performing regular hand hygiene

Answer: D — Performing regular hand hygiene.
Hand hygiene reduces transmission of infectious agents.

Q12. Otitis media involves the:

1. Middle ear
2. Alveoli
3. Frontal lobe
4. Kidney

Answer: A — Middle ear.
Otitis media is inflammation or infection of the middle ear.

Q13. Which symptom is a warning sign in a patient with sore throat?

1. Mild sneezing
2. Inability to swallow saliva
3. Occasional watery nasal discharge
4. Mild fatigue

Answer: B — Inability to swallow saliva.
This may indicate significant swallowing difficulty or an airway-threatening condition.

Q14. Which nursing intervention is appropriate for a patient with uncomplicated URTI?

1. Restrict all oral fluids
2. Encourage smoking
3. Encourage adequate fluids as tolerated
4. Administer antibiotics without an order

Answer: C — Encourage adequate fluids as tolerated.
Hydration supports comfort and helps prevent dehydration.

Q15. Which symptom is particularly characteristic of pharyngitis?

1. Hematuria
2. Ascites
3. Jaundice
4. Sore throat

Answer: D — Sore throat.
Pharyngitis is inflammation of the pharynx.

Q16. Which statement about OTC cough and cold medicines in young children is correct?

1. They should not be routinely given to young children without professional guidance
2. They are always safe at adult doses
3. They replace assessment of respiratory distress
4. They should be given to every infant with a cold

Answer: A — They should not be routinely given to young children without professional guidance.
Some products can cause serious adverse effects in young children.

Q17. Which condition may be associated with hoarseness and voice fatigue?

1. Otitis media
2. Laryngitis
3. Sinusitis only
4. Nephritis

Answer: B — Laryngitis.
Inflammation of the larynx may affect voice production.

Q18. A child with URTI has reduced feeding and markedly reduced urine output. The nurse should suspect:

1. Improved hydration
2. Normal fluid balance
3. Possible dehydration
4. Increased renal perfusion for certain

Answer: C — Possible dehydration.
Poor intake and reduced urine output are concerning for fluid deficit.

Q19. Which is an appropriate nursing action when epiglottitis is suspected?

1. Force the child to lie flat
2. Perform repeated throat examinations
3. Delay escalation until a routine round
4. Keep the patient calm and seek urgent expert airway assistance

Answer: D — Keep the patient calm and seek urgent expert airway assistance.
Unnecessary throat manipulation may precipitate airway compromise.

Q20. Which statement about uncomplicated viral URTIs is correct?

1. They usually receive supportive treatment
2. They always require antibiotics
3. They always require hospital admission
4. They are all caused by bacteria

Answer: A — They usually receive supportive treatment.
Most uncomplicated viral URTIs resolve with supportive care.

20. Quick Revision – URTIs

• URTI: Infection of upper respiratory structures.
• Common cold: Usually viral; rhinovirus is a leading cause.
• Pharyngitis: Inflammation of pharynx.
• Tonsillitis: Inflammation of tonsils.
• Sinusitis: Nasal and paranasal sinus inflammation.
• Laryngitis: Hoarseness is a characteristic symptom.
• Otitis media: Middle-ear infection/inflammation.
• Group A Streptococcus: Important bacterial cause of pharyngitis.
• RADT: Rapid antigen detection test for suspected strep throat.
• Antibiotics: Not effective against viral infections.
• Priority assessment: Airway, breathing and hydration.
• Epiglottitis: Potential airway emergency.
• Prevention: Hand hygiene, respiratory etiquette and recommended vaccination.

21. Frequently Asked Questions

What is the most common cause of URTIs?

Viruses are the most common causes of uncomplicated URTIs. Rhinovirus is a leading cause of the common cold.

Do all URTIs require antibiotics?

No. Most uncomplicated URTIs are viral and do not require antibiotics. Antibiotics may be prescribed for selected bacterial infections when indicated.

What is the difference between pharyngitis and tonsillitis?

Pharyngitis is inflammation of the pharynx, whereas tonsillitis is inflammation of the tonsils. They may occur together.

Which URTI can cause hoarseness?

Laryngitis commonly causes hoarseness because it involves inflammation of the larynx.

What is the priority in suspected epiglottitis?

Urgent airway-focused assessment and expert airway assistance. Avoid unnecessary throat examination or manipulation.

What are important nursing responsibilities in URTI?

Assess airway and breathing, monitor vital signs and hydration, provide symptom relief, prevent infection transmission and educate the patient about warning signs.

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⚠️ Educational Disclaimer: This article is intended for educational purposes for nursing and healthcare students. It does not replace professional medical advice, clinical training, institutional protocols or qualified clinical judgment. Treatment decisions must be made by an authorized healthcare professional according to the patient's condition and current guidelines.

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