Chapter 27 Nursing Management Upper Respiratory Problems Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved

Chapter 27

Nursing ManagementUpper Respiratory Problems

Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.


Structural and Traumatic Disorders of the Nose

Deviated septum Nasal fracture

40% of bone injuries in facial trauma Obstruction, epistaxis, meningeal tears

• What might clear nasal drainage indicate? Rhinoplasty

Surgical reconstruction of the nose


Epistaxis

Causes Trauma Foreign bodies Drugs Steroids Tumors

Location Anterior (80%) – Kiesselbach plexus Posterior – posterior branch sphenopalatine artery


Care for Nosebleed

Sit forward or high Fowler’s position Direct pressure for 10 – 15 minutes Vasoconstrictive medications

• Cocaine, neosynephrine (Afrin nasal spray) Cauterization Nasal packing

Patient teaching Avoid blowing nose, strenuous activity, lifiting,

sneeze with mouth open, avoid ASA & NSAIDs



Fig. 27-1


Inflammation and Infection of the Nose and Paranasal Sinuses


Allergic Rhinitis

Clinical manifestations Sneezing Watery eyes Watery nasal

draingage or congestion

Pale, boggy turbinates

Cough (post-nasal drip)

Management:Allergic rhinitis Indentify causative

agent Antihistamines

• What are the side effects?

Nasal corticosteroids Immunotherapy


Acute Viral Rhinitis

AKA the common cold or acute coryza Most prevalent infectious disease Spread by droplet transmission

Management: Acute viral rhinitis Rest Fluids Antipyretics Observe for secondary bacterial infection

• Fever >100.4, mucopurulent discharge, swollen & tender nodes, pharyngeal erythema


Influenza

Causes 36,000 deaths annually in the U.S. Usually in people > 60 years

Clinical manifestations Fever Aches Chills Tiredness Sudden symptoms

• Runny nose and GI symptoms are more common in children

• Most common complication is pneumonia


Influenza

Management: Influenza Identify high-risk individuals and recommend

vaccination (attenuated live virus or inactivated)• Age > 50, health care workers, chronic respiratory illness• Most effective when given in the fall• Contraidications – egg allergy or Hx of Guillain-Barré

syndrome Symptom management

• Fluids, rest, antipyretics (no ASA in children – Reye’s syndrome)

Antiviral medications• Must be started within 48 hrs of illness onset• May be prescribed for prophylaxis


Sinusitis

Ostia of one or more of the sinuses becomes blocked by swollen or inflamed nasal mucosa May be viral, bacterial, or fungal (rare) Acute is usually related to URI, allergic rhinitis,

swimming, or dental manipulation Chronic > 3 weeks duration; linked with allergies &

nasal polyps Clinical manifestations

Pain over the affected sinus, fever, malaise, HA, congestion, purulent nasal discharge

Chronic presentation is nonspecific


Fig. 27-3


Sinusitis

Management: Sinusitis Antibiotics if symptoms last > 7 days

• Due to difficulty with treating the infection courses may last from 10 days to several weeks

Decongestant sprays• Do not use for more than 72 hours – rebound effect

Topical steroids Antihistamines

• Avoid usage Saline nasal lavage

• Neti pot, bulb syringe


Obstruction of the Nose and Paranasal Sinuses

Polyps Benign masses that develop in response to

repeated inflammation Foreign bodies

Inorganic• May produce no symptoms

Organic • Cause local reaction • Purulent, foul smelling drainage

Sneezing or blow nose Do not irrigate


Problems Related to the Pharynx

Acute pharyngitis Viral Bacterial

• Strep throat What complication(s) can arise untreated strep throat?

Candida albicans Thrush

• Opportunistic infections may indicate? Diphtheria

What population(s) would you expect to have diphtheria?


Acute Pharyngitis

Clinical manifestations Fever, pharyngeal erythema, pain, N/V, tonsillar

exudates, cough (not with strep throat) Management: Acute pharyngitis

Rapid strep Supportive care

• Fluids, rest, antipyretics, analgesia

Antibiotics• Penicillin – drug of choice

Immunization – diphtheria


Obstructive Sleep Apnea

Clinical manifestations and diagnostic studies Frequent awakening at night (as many as 200-

400), insomnia, excessive daytime sleepiness, witnessed apenic episodes, snoring, irritability, morning HA (hypercapnia dilates cerebral vessels)

Polysmnography Management: Sleep apnea

Avoid sedatives & alcohol before sleep, weight loss, oral appliances, CPAP, BiPAP, surgery


Obstructive Sleep Apnea

Uvulopalatopharyngoplasty UPPP or UP3

Geniglossal advancement & hyoid myotomy

GAHM


Fig. 27-5


Problems Related to the Trachea and Larynx


Airway Obstruction

Medical emergency May be partial or complete

• Aspiration, foreign bodies, CNS depression, laryngeal spasms, edema, allergic reaction

Clinical manifestations Stridor, wheezes, retractions, cyanosis,

restlessness, tachcardia, snoring• How do you assess for airway patentcy?

Management: Airway obstruction Reversal agents, CPAP, BIPAP, intubation, OPA,

NPA, surgically created airways


Tracheostomy


Tracheostomy

What is a tracheostomy? Surgically created airway entering the trachea

Indications Bypass upper airway obstruction Facilitate removal of secretions Long-term mechanical ventilation

• Permit oral intake and speech• Increased comfort• Less risk of damage to airway• Increased mobility



Fig. 27-6


Nursing Management Tracheostomy

Providing tracheostomy care What structures are bypassed with a

trach? What is the client at risk for? What interventions do you anticipate?

Swallowing dysfunction How is the airway protected with a trach? How is swallowing assessed?

Speech with a tracheostomy tube Cuffed vs. fenstrated tubes

Decannulation


Fig. 27-7


Fig. 27-8

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Fig. 27-10


Head and Neck Cancer

Clinical manifestations Early signs

• Painless growth• Sore that does not heal• Change in fit of dentures• Persistent sore throat, lump, unilateral ear pain, or

hoarseness Late signs

• Pain• Dysphagia• ↓ tongue mobility• Airway obstruction


Head and Neck Cancer

Diagnostic studies CT scan, MRI, PET scan, biopsy

Collaborative care Stage & grade What are the treatment options? What structures can be affected? Nutritional therapy

• How does radical neck dissection or supraglottic larygectomy impact nutrition?


Fig. 27-12


Fig. 27-14


Nursing Management Head and Neck Cancer

Nursing assessment Nursing diagnoses Planning Nursing implementation

Health promotion• What places a person at risk?


Fig. 27-15

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Chapter 27 Nursing Management Upper Respiratory Problems Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved