Nursing Care of Clients with UpperRespiratory Disorders

Nursing Care of Patients with Upper Airway Disorders

• Upper airway disorders may be minor, treated outside health care setting– Or may be severe, life threatening

• Require good assessment skills, understanding of variety of disorders that affect upper airway, impact those disorders may have on patient

• Patient teaching is important aspect of care

Specific Disorders

• Infections• Rhinitis• Sinusitis: acute, chronic• Pharyngitis: acute, chronic• Tonsillitis, adenoiditis• Peritonisillar abscess• Laryngitis

Upper Respiratory Tract Disorders and Risk Factors

• Influenza– Highly contagious viral respiratory disease– Usually occurs in epidemics or pandemics– Avian influenza: possible pandemic

• Sinusitis– Sterile air-filled cavities in the facial bones– Sinusitis

Viral Upper Respiratory Infection

• Pathophysiology– Local inflammatory response– Swelling of mucous membranes of nasal passages– Hyperactivity of mucus-secreting glands– Immunity produced only to individual virus

Rhinitis and Sinusitis

Pharyngitis

Viral Upper Respiratory Infection

• Manifestations– Nasal congestion– Profuse nasal discharge (coryza)– Sneezing– Coughing– Sore throat– Low-grade fever– Headache– Malaise– Muscle aches

Viral Upper Respiratory Infection

Sinusitis• Pathophysiology– Sinus opening obstruction, impaired drainage

• Manifestations– Pain and tenderness– Headache, fever, and malaise– Nasal congestion– Purulent nasal discharge– Bad breath

Influenza • Medications

– Prophylaxis– Treatment to reduce severity

• Amantadine• Rimantadine• Zanamivir• Oseltamivir• Ribavirin

– Symptom relief also include• ASA• Acetaminophen• NSAIDs• Antitussives • Antibiotics are not indicated

Sinusitis

• Medication Therapy– Antibiotics– Oral or topical decongestants– Antihistamines– Saline nose drops or sprays– Systemic mucolytic agents

Nursing Process: Care of Patients with Upper Respiratory Infections - Assessment

• Health history• Signs and symptoms: headache, cough,

hoarseness, fever, stuffiness, generalized discomfort and fatigue

• Allergies• Inspection of nose, neck, throat– Include palpation of lymph nodes

Nursing Process: Care of Patients with Upper Respiratory Infections - Diagnosis

• Ineffective airway clearance• Acute pain• Impaired verbal communication• Deficient fluid volume• Deficit of knowledge related to prevention,

treatment, surgical procedure, postoperative care

Nursing Process: Care of Patients with Upper Respiratory Infections - Planning

• Maintenance of patent airway• Relief of pain• Maintenance of effective communication• Normal hydration• Knowledge to how to prevent upper airway

infections • Absence of complications

Interventions

• Interventions to maintain patent airway• Promote comfort – Analgesics – Gargles for sore throat– Use of hot packs for sinus congestion or ice collar

to reduce swelling, bleeding post tonsillectomy and adenoidectomy

Interventions (cont’d)

• Rest • Refrain from speaking, use alternative

communication• Encourage liquids; 2 to 3 L a day, appropriate

foods

Patient Education

• Prevention of upper airway infections• Emphasize frequent hand washing• When to contact health care provider• Need to complete antibiotic treatment

regimen• Annual influenza vaccine for those at risk

Potential Complications

• Sepsis• Meningitis• Peritonsillar abscess• Otitis media• Sinusitis

Health Promotion Activities

Viral Upper Respiratory Infection• Maintaining good general health• Stress-reducing activities• Limiting exposure to crowds• Good handwashingInfluenza• Immunization education• Risk reduction activities– Avoiding crowds– Avoiding those who are ill