Chpt. 26: Upper Respiratory Disorders

1
Chpt. 26 Upper Respiratory Disorders
2
Overview

• The most common upper airway illnesses are
  infectious and inflammatory disorders.
• Although it is easy to dismiss these illnesses as
  unimportant, the average person experiences 3 to
  5 upper respiratory infections per year.

3
Rhinitis PG 355

• An inflammation of the mucous membranes of the
  nose. Often called the common cold or coryza
• Most common cause is the rhinovirus
• Allergic rhinitis is a hypersensitive reaction to
  allergens such as pollen, dust, animal dander, or
  food
• Usually not a serious condition unless
  debilitated, immunocompromised or elderly

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Symptoms

• Sneezing
• nasal congestion
• rhinorrhea (clear nasal discharge
• sore throat, watery eyes
• cough, low grade fever
• headache
• aching muscles
• malaise

5
Rhinitis

• A sustained temp elevation suggests a bacterial
  infection in sinus or ears
• Symptoms will continue as long as he is exposed
  to the allergen
• Should use antipyretic for fever, decongestants
  for severe nasal congestion, antitussives for
  prolonged cough, saline gargles for sore throat
  or antihistamines for allergic rhinitit.
  Antibiotics used if bacterial

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Rhinitis

• Maintaining a healthy life style is the best
  prevention
• Adequate rest and sleep, proper diet and moderate
  exercise recommended
• Proper handwashing

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Treating Rhinitis Box 26-1

• Rest as much as possible
• Increase fluids to help liquify secretions
• Blow nose with mouth open slightly to equalize
  pressure
• Use overcounter drugs as directed but be aware of
  possible side effects (antihistamines and
  decongestants)
• Teach to get allergy testing, assess for exposure
  to allergens, avoid allergens

8
Sinusitis PG 355

• Inflammation of the sinuses. Can lead to
  infection of the middle ear or brain
• Interferes with drainage of sinuses predisposing
  to sinusitis because trapped secretions become
  infected
• Allergy can cause edema of the nasal mucous
  membranes leading to obstruction of sinus
  drainage and sinusitis, polyps and deviated
  septum can also cause sinusitis

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Signs and Symptoms

• headache
• fever
• pain over area of the affected sinus
• nasal congestion and discharge
• pain and pressure around the eyes
• malaise

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Nursing Management PG 356

• humidification, an increase in the fluid intake
  and mouthwash may loosen secretions and increase
  comfort
• If he has undergone surgery, use post-op care in
  chapter 20
• Observe for repeated swallowingmay be sign of
  possible hemorrhage
• assess visual acuity as surgery can damage optic
  nerve

11
Nursing Management

• Assess temp q 4 hrs.
• Assess for pain over sinus areas to determine
  infection or impaired drainage
• Apply ice compresses to involved sinus to reduce
  pain and edema
• If nasal pack, will have mustache dressing or
  drip pad---must be mouth breather so encourage
  oral hygeine

12
Nursing Managment

• A priority in the immediate post-op period is to
  assess visual acuity

13
Post -op Teaching

• Encourage good oral hygiene and ice chips as must
  breathe thru mouth
• Do not blow nose, lift objects more than 5 lbs or
  do the valsalva maneuver for 10 to 14 days
• Remain in a warm environment and avoid smoky or
  poorly ventilated areas

14
Measures to Reduce Incidence or Severity of
Sinusitis

• Eat a well balanced diet
• Get plenty of rest
• Encourage moderate exercise
• Avoid allergens
• See Dr. if cold symptoms last more than 10 days
  or if nasal discharge is green or dark yellow and
  foul smelling

15
Pharyngitis PG 356

• Inflammation of the throat. May be associated
  with rhinitis or upper respiratory infections
• Highly contagious and spreads via inhalation of
  or direct contamination with droplets
• Incubation period is 2 to 4 days
• Must take antibiotics 7 to 14 days

16
Pharyngitis

• Ist symptom is sore throat--sometimes severe
• Dysphagia (difficulty swallowing
• fever, chills, headache and malaise
• may have white or exudate patch over the
  tonsillar area and swollen glands
• Remember strept throat causes rheumatic fever,
  rheumatic heart and glomerulonephritis

17
Tonsillitis and Adenoiditis PG 357

• Chronic infection of tonsils leads to enlargement
  and partial upper airway obstruction
• Chronic infection of adenoids can result in an
  acute or chronic infection of the middle ear
  (otitis media)
• White patches may be present on tonsils if strept

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Signs and Symptoms

• Sore throat, difficulty or pain on swallowing,
  fever and malaise are most common symptoms
• Enlargement of the adenoids may produce nasal
  obstruction, noisy breathing, snoring, and a
  nasal quality of the voice

19
Medical Management

• Saline gargles help treat the infection and
  discomfort
• Tylenol, antibiotics given
• Surgery may be needed if chronic

20
Criteria for TA

• Repeated episodes of tonsilitis
• Hypertrophy of the tonsils
• Enlarged adenoids that are obstructive
• Repeated purulent otitis media
• Hearing loss related to serous otitis media
  associated with enlarged tonsils adenoids
• Other conditions, such as asthma or rheumatic
  fever, exacerbated by tonsilitis

21
TA Assessment PG 357

• Post -op hemorrhage is greatest risk
• Check clotting factors, ask about bleeding
  tendencies and recent use of Asa, non-steroidal
  anti-inflammatory drugs or other med that prolong
  bleeding time

22
TA Care Plan

• Elevate HOB to 45 degrees when fully awake
• Auscultate breath sounds hourly
• Instruct not to cough, clear throat, blow nose or
  use a straw the 1st few days
• Avoid fluids high in citrus content or carbonated
  drinks
• Apply ice collar and observe for swallowing

23
Teaching

• Report any signs of bleeding especially in the
  1st 12 to 24 hours and then 7 to 10 days
  following surgery as throat heals
• Gently gargle with warm saline
• Liquid or very soft diet 1st several days--avoid
  spicy food and rough textured foods
• Milk and milk products increases mucus

24
Peritonsillar Abscess PG 358

• Abscess that develops in the connective tissue
  between the capsule of the tonsil and the
  constrictor muscle of the pharynx
• Will have difficulty and pain in swallowing,
  fever, malaise, ear pain and difficulty talking
• On visual exam, the affected side is red and
  swollen. Posterior pharynx is also swollen
• Culture drainage, antibiotics given

25
Peritonsillar Abscess

• Surgical incision and drainage of abscess may be
  done if it blocks airway
• Place in semifowlers position to prevent
  aspiration. An ice collar ordered to reduce
  swelling and pain
• Fluids encouraged and client observed for
  respiratory obstruction (dyspnea, restlessness,
  cyanosis or excessive bleeding

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Laryngitis PG 358

• Inflammation and swelling of the mucus membrane
  lining the larynx
• May follow a upper respiratory infection
• Excessive or improper use of the voice,
  allergies, or smoking can cause
• Hoarseness, inability to speak above a whisper or
  aphonia (complete loss of voice) are usual
  symptoms , throat irritation and a dry,
  nonproductive cough may be present

27
Laryngitis

• If hoarseness persists more than 2 weeks and
  examination of larynx should be done as
  persistent hoarseness is sign of cancer
• Treatment is voice rest and removal of cause

28
Epistaxis PG 359

• Initiate measures to control bleeding--pressure
  and ice packs
• Direct continuous pressure to nares 5 to 10 min
  with head tilted slightly forward
• Ice packs to the nose
• Dr. will cauterize with silver nitrate,
  electrocartery, or application of a topical
  vasoconstrictor--epinephrine

29
Epistaxis treatment

• Nasal packing with a cotton tampon
• Pressure with a balloon inflated
  catheter--inserted posteriorly for a minimum of
  48 hours

30
Teaching

• If recurs apply pressure to nares with two
  fingers. Breathe thru the mouth and sit with head
  tipped forward slightly to prevent blood from
  running down throat
• Do not swallow blood spit out any blood that is
  oozing from area. Do not blow nose
• If blood has been swallowed, diarrhea and black
  tarry stools may be seen for a few days

31
Epistaxis Teaching

• Do not attempt to remove nasal packing or to cut
  the string anchoring the packing
• Take pain meds as ordered. Do not use Asa or
  ibuprofen products until bleeding is controlled
  (several days)
• Notify Dr. if bleeding persists or resp problems
  develop

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Nasal Obstruction PG 359

• Common causes deviated septum, nasal polyps and
  hypertrophied turbinates
• Deviated septum is an irregularity in the septum
  that results in nasal obstruction
• Nasal polyps are grapelike swellings that arise
  from mucous membranes of the nose. Result of
  chronic irritation from infection or allergic
  rhinitis

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Nasal Obstruction PG 360

• Hypertrophied turbinates are enlargements of
  nasal concha due to chronic allergic
  rhinitis--interferes with drainage and leads to
  sinusitis
• symptoms include history of sinusitis, difficulty
  breathing out of one nostril, frequent
  nosebleeds, and nasal discharge
• Rhinoplasty, reconstruction of nose may be
  done--packed with gauze and nose taped

34
Rhinoplasty

• Place in semi-Fowlers to promote drainage,
  reduce edema, and enhance breathing
• Inspect nasal packing and dressings frequently
  for bleeding
• Watch for frequent swallowing as may be bleeding
• Good oral hygiene and saline mouth rinses (when
  permitted)

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Teaching for Rhinoplasty

• Tell him it is normal to feel or hear a sucking
  noise when swallowing until packing removed
• Do not bend over, blow nose. Avoid lifting
• If sneezing, keep mouth open
• Avoid contact with nose or surrounding tissue
  Keep head elevated with extra pillow when lying
  down. Do not use alcohol, tobacco, Asa or
  ibuprofin

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Nose Fracture PG 360

• Causes swelling and edema of soft tissues,
  external and internal bleeding, deformity of nose
  and nasal obstruction
• Cerebrospinal fluid, which is colorless and clear
  may drain from nares--Test with Dextrostix--if
  glucose present it is spinal fluid
• Cold compresses used to control bleding--if Fx
  severe will require surgery

37
Nasal Fracture

• Instruct to keep head elevated and to apply ice
  four times a day for 20 min. to reduce pain and
  swelling.
• Assess for airway obstruction, respiratory
  difficulty--tachypnea, SOB
• Assess for dysphagia, signs of infection,
  pupillary responses, LOC and periorbital edema

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Laryngeal Obstruction PG 361

• Extremely serious and often life-threatening
• Some causes of upper airway obstruction include
  edema due to allergic reaction, severe head and
  neck injury, severe inflammation and edema of
  throat or aspiration of foreign bodies and food

39
Signs and Symptoms

• Laryngeal trauma causes neck swelling, bruising
  and tenderness. If extreme he will have stridor,
  a high-pitched, harsh sound during respiration
• Also has dysphagia, hoarsness, cyanosis, and
  possible hemoptysis
• If choking they clutch their throats--universal
  sign for choking--Heimlich maneuver

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Management

• Nurse uses the Heimlich to force object out. If
  it fails the Dr. will do an emergency
  tracheostomy
• Give oxygen and have equipment available

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Important Information!!

• Review care of the client with trauma to upper
  airway page 362

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Cancer of the Larynx PG 364

• Common over age 50, especially men.
• Industrial pollutants, tobacco and alcohol,
  chronic laryngitis, habitual overuse of the voice
  and heredity may predispose
• Persistent hoarseness is usually earliest
  symptom--at 1st usually slight and often ignored.
  Later may have a sensation of swelling or a lump
  in the throat, dysphagia and pain when talking

43
Symptoms

• May also complain of burning in throat when
  swallowing hot or citrus liquids.
• Symptoms of advancing Ca--dyspnea, weakness,
  weight loss, enlarged cervical lymph nodes, pain
  and anemia

44
Medical Surgical Management

• If a total laryngectomy done will have a
  permanent tracheal stoma. Trachea no longer
  connected to nasopharynx. Larynx is severed and
  removed. Air enters and leaves thru the
  tracheostomy and he no longer feels air entering
  the nose
• Will not have a voice but will be able to swallow

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Nursing for Laryngeal surgery

• Determine airway patency, lung sounds,
  respiratory rate and rhythm, mental status, and
  oxygenation
• Assess neck incisions and stoma for swelling,
  bleeding or subcutaneous emphysema.
• Monitor vitals, I O and pain levels
• Give pad and pen to communicate

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Care Plan

• Review nursing care page 364- 366

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Tracheostomy PG 367

• Surgical opening into trachea with tube inserted
• Copious respiratory secretions are
  life-threatening and cannot be left alone during
  the immediate post-op period as frequent
  suctioning needed.
• Inspired air passes directly into trachea without
  warming or moisture so dry secretions can block
  airway

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Tracheostomy

• Assess frequently for patent airway because
  secretions can block the inner lumen and airway
  quickly
• Monitor vitals and auscultate breath sounds.
  Assess skin color, LOC and mental status.
• Monitor for complications
• When awake and B/P stable, elevate HOB to 45 as
  decreases edema and makes breathing easier

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Tracheostomy

• Keep a tracheal dilator at bedside. If trach
  comes out, insert the dilator to hold edges of
  stoma apart until Dr can put it back in.
• Never try to force it back in as can cause
  respiratory arrest
• Keep an extra tube of the same size at bedside so
  if it becomes plugged with mucus that cant be
  removed
• Suctioning will be covered in skills

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Tracheostomy

• Review care of Tracheostomy page 368 -370