Management of Patients with Conditions of the Upper Respiratory Tract

1
Management of Patients with Conditions of the
Upper Respiratory Tract

• Lecture 3A

2
Common Cold

• AKA
• Rhinitis
• Viral rhinitis
• Pathophysiology
• Rhinovirus
• Infection with acute inflammation of the mucous
  membrane of the nasal cavity

3
Common Cold

• Etiology
• Airborne
• Peak Times
• Sept, Jan April
• Duration
• 5-14 days

4
Common Cold

• Clinical Manifestations
• Nasal congestion
• Runny nose
• Sore throat
• Sneezing
• Malaise
• Afibrile
• H/A
• Cough

5
Common Cold

• Dx exams Procedures
• SS
• Culture

6
Common Cold

• Tx methodology
• Focus relief
• Tx not shorten
• Fluids
• Warm, moist air
• Medications
• OTC

7
Common Cold

• Medications
• Antihistamines
• Action
• H1 blockers ? inhibits action
• X push off ?
• Take early
• Allergies

8
Common Cold

• Medications
• Antihistamines
• Rx effect
• Prevents salivary, gastric, lacrimal and
  bronchial secretions
• Relieves
• Sneezing
• Rhinorrhea
• Nasal congestion

9
Common Cold

• Medications
• Antihistamines
• Side effects
• Drowsiness
• Drying
• Examples
• Allergra
• Claritin
• Benadryl

10
Common Cold

• Medications
• Decongestants
• Rx Actions
• Shrink engorged nasal mucus membranes
• Side Effects
• Rebound congestion
• Insomnia

11
Common Cold

• Medications
• Decongestants
• Examples
• Sudafed
• Vicks inhaler
• Afrin

12
Common Cold

• Medications
• Anti-tussives
• Rx Action
• Side effects
• Example

13
Common Cold

• Medications
• Analgesics
• Tylenol (Acetomenaphen)
• Motrin (ibuprofen)
• NSAID
• Non-narcotic

14
Common Cold

• Medications
• Vitamin C

15
Common Cold

• Medications
• Antibiotics
• Prophylactic
• Examples
• Sulfonamides
• Penicillins
• Cephalosporins
• Tetrcyclines
• Aminglycosides
• Quinolones
• Macrolides
• Vancomycin

16
Common Cold

• Medications
• Anti-biotic
• Side-effects
• N/V
• Yeast infections
• Resistance

17
Common Cold

• Medications
• Echinacea
• Action
• Stim. immune system
• Anti-bacterial
• Anti-inflammatory
• Use
• 10-14 days
• Long tem use
• i immune system

18
Common Cold

• Nrs Managements
• See MD gt 2 wks
• Prevention
• How do you prevent the cold from getting you?

• Hand wash
• Cover mouth
• Throw away tissue
• Avoid crowds
• Vaccine
• Eat right
• Sleep
• Stress
• Exercise
• Smoking
• Allergens
• Animals
• Carpet

19
Common Cold

• Complications
• Bronchitis
• Pneumonia
• Conjunctivitis

20
Sinusitis sinus infection

• Pathophysiology
• Inflammation of the mucus membrane of one or more
  sinuses
• Blocks the egress of sinuses

21
Sinusitis sinus infection

• Etiology
• Bacterial or viral?
• 1 bacterial
• Tooth abscess
• Allergies
• Structural abnormalities

• Coronal CT scan showing right maxillary sinus
  opacification.  Also, note the septal deviation
  to the right and the hypertrophy of the left
  inferior turbinate

22
Sinusitis sinus infection

• Clinical manifestations
• Pain
• Maxillary
• Over cheek and upper teeth
• Ethmoid
• Btw behind eyes
• Frontal
• Forehead

• Ethmoid sinusitis

23
Sinusitis sinus infection

• Clinical manifestations
• Anosnia
• H/A
• Fever?
• Fatigue?
• Foul breath?

• MRI scan showing opacification of the left
  maxillary sinus

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Sinusitis sinus infection

• Dx
• SS
• X-ray, CT, MRI
• C S

25
Sinusitis sinus infection

• Med Tx
• Antibiotics
• Analgesics
• No aspirin
• Nasal decongestants
• Mucolytic agents
• Surgery

26
Sinusitis sinus infection

• NRS interventions
• Fluids
• h
• Position
• HOB h
• Activity
• Rest
• Moist hot-packs
• Cleaning techniques
• Irrigate nose

27
Sinusitis sinus infection

• Prevention
• Avoid contributing factors
• Cold
• Smoking
• Fatigue
• URI
• Dentist

28
Sinusitis sinus infection

• Complications
• Osteomylitis
• Cellulitis of the orbit
• Abscess
• Meningitis

29
Sinusitis sinus infection

• Surgery
• Post-op care
• Position
• Side lying ?
• semi-fowler
• Ice
• Monitor for
• Bleeding
• i visual acuity
• Pain
• SS of infection

• Oral care
• Packing x 48 hrs
• No blowing
• Tarry stools
• Avoid constipation

30
Acute Pharyngitis

• Pathophysiology
• AKA sore throat, strep throat
• Inflammation of the throat

31
Acute Pharyngitis

• Etiology
• 70
• Viral
• Bacterial
• Streptococcus

32
Acute Pharyngitis

• Clinical manifestations
• Sore throat
• Febrile
• Dysphagia
• Exudate
• Lymphnoids
• Malaise
• Hoarseness
• Cough
• Rhinitis

33
Acute Pharyngitis

• Dx exams
• Throat culture
• Rapid screening

34
Acute Pharyngitis - Tx

• Viral
• Supportive
• Like a cold
• Bacterial
• Antibiotics
• Diet
• Liquid/soft
• Analgesics
• Tylenol
• Anti-tussive

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Acute Pharyngitis - Nrs

• Rest
• Rashes?
• Communicable disease
• Warm saline gargles
• Temp 105-110 F
• Diet
• Liquid
• Fluids
• h
• Ice collar
• Oral care

36
Acute Pharyngitis

• Complications
• Sinusitis
• Ottis media
• Peritonsillar abscess
• Scarlet fever
• Rheumatic Fever
• 2-3 wk /p subsides
• Heart damage
• Mital valve damage

• Scarlet fever

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Tonsillitis Adenoiditis

• Pathophysiology
• Tonsils
• Location
• Oropharynx
• Lymph tissue
• Adenoids
• Location
• Nasopharynx

38
Tonsillitis Adenoiditis

• Etiology
• Streptococcus
• Low resistance
• Children

39
Tonsillitis Adenoiditis SS

• Sore throat
• Febrile chills
• Snoring
• Dysphagia
• Adenoids
• Mouth breathing
• Duration
• 1-2 wks

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Tonsillitis Adenoiditis - Dx

• Dx
• Visualize
• CS

• Mono

41
Tonsillitis Adenoiditis - Tx

• Tx
• Antibiotics
• Indications for TA
• Recurrent
• ? Obstruction
• Repeat otitis media

• Kissing tonsil's

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• THIS IS NOT TONSILLITIS!
• In this picture taken a week after tonsillectomy,
  the tonsils have been removed and the whitish
  discoloration in the tonsillectomy bed is the
  eschar that forms postoperatively.
• This is normal after a tonsillectomy and should
  not be confused with infection.
• Occasionally, this white eschar falls off 
  prematurely, causing delayed postoperative
  hemorrhage

43
Tonsillitis Adenoiditis

• Post-op care
• Hemorrhaging
• Coffee ground emeses
• Bright red emeses
• Pulse
• h
• Temp
• h
• Restlessness
• Tarry stool
• h swallowing

44
Tonsillitis Adenoiditis

• Post-op
• Position
• Prone/side lying until
• Gag returns
• Semi-fowlers
• Pain control
• Ice collar
• Acetaminophen
• Not aspirin

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Tonsillitis Adenoiditis

• Post-op
• Diet
• Ice cold fluids
• Adv. To normal ASAP
• 2-3 days
• Milk products
• i
• Avoid
• Spicy
• Hot
• Acidic
• Rough

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Tonsillitis Adenoiditis

• Post-op
• Pt education
• SS of hemorrhaging
• Mouthwash good
• Avoid
• Coughing
• Sneezing
• Vigorous nose blow
• Vigorous gargling
• Rough foods
• Expect black tarry stools
• Normal activity ASAP

47
Peritonsillar Abscess

• Pathophysiology
• Pus blood filled sacs on tonsil
• Etiology
• Complication of strep throat

48
Peritonsillar Abscess

• SS
• Pain
• Local
• Radiates ? ear
• Dysphagia
• drooling
• Dysphasia
• Fever
• Red throat

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Peritonsillar Abscess

• Tx
• Antibiotics
• Incision drain
• Lanse
• Warm saline irrigation
• Hydrogen peroxide
• Analgesics
• Topical
• Tylenol
• No aspirin
• ? narcotics

• Ice collar
• No smoking
• Ventilator?

50
Laryngitis

• Pathophysiology
• Inflammation of the mucous membrane lining the
  larynx
• With edema of the vocal cords

51
Laryngitis

• Etiology
• Viral
• Voice abuse
• Dust

52
Laryngitis

• Risk factors
• Airborne irritants
• Cold
• Resent RTI
• Smoking

53
Laryngitis

• Clinical manifestations
• Aphonia
• Voice loss
• Hoarseness
• Cough?
• Severe

54
Laryngitis

• Treatment
• Voice rest
• Bed rest
• Smoking?
• NO!
• Humidifier
• Fluids?
• h
• Expectorants

55
Laryngitis

• Prevention
• Avoid
• Irritants
• Cold
• Voice strain
• Smoking

56
Epistaxis

• Pathophysiology
• Tiny blood vessels in nose rupture

57
Epistaxis

• Anterior bleeds usually stop spontaneously or
  self treated
• Posterior bleeds may require med treatment

58
Epistaxis

• Etiology
• Irritation
• Infection
• Drugs
• Humidity
• Trauma
• Hypertension
• Blood dyscrasias

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Epistaxis

• Tx
• Initial
• Apply direct pressure
• 5-10 min
• Position
• Head tilted down
• Initial d/t trauma
• Do not pinch
• Ice pack over nose eye
• Position
• Head down
• ? Neck injury

60
Epistaxis

• Tx
• ER
• Packing
• Silver nitrate gelfoam
• Painful
• Remains 4-5 days
• Topical vasoconstrictor
• Epinephrine

61
Epistaxis

• Nrs Management
• V/S
• Control bleeding
• P Hgb level
• P PT/PTT
• Take BP meds
• X aspirin
• X vigorous blowing
• X strenuous exercise

62
Epistaxis

• Complications?

63
Nasal Polyps

• Pathophysiology
• Benign grape-like growths of mucous membrane and
  loose connective tissue within the nasal cavity

64
Nasal Polyps

• Etiology
• Recur
• Triad disease
• Polyps
• Asthma
• Allergy to aspirin

65
Nasal Obstruction

• Etiology
• Deviated septum
• Hypertrophy of turbinate bone
• Polyps
• Foreign object

66
Nasal Obstruction

• Clinical Manifestations
• Foul odor
• Malodorous
• Halitosis
• h allergies
• Noisy breathing
• h post-nasal drip

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Nasal Obstruction

• Tx
• Remove obstruction
• Out the same way in
• Sneezing w/ opposite nasal closed
• X irrigate
• X push backwards
• Surgery

68
Nose surgery

• Submucous resection
• Nasoseptoplasty
• Rhinoplasty
• Polypectomy

69
Nrs Care Post OP nasal surgery

• P hemorrhaging
• P Infection
• Comfort
• Nutrition
• Pt. Ed
• Avoid aspirin

70
Nasal Obstructions

• Complications
• Chronic infections of the nose
• Anosmia
• Pharyngitits
• Sinusitis

71
Fracture of the Nose

• Etiology
• 1 bone broken
• SS
• Pain
• Bleeding
• Swelling
• Deformity

72
Fracture of the Nose

• Clear fluid drainage ?
• Fx of cribiform plate
• CSF
• Mucus vs. CSF
• P glucose

73
Fracture of the Nose

• Tx
• Control bleeding
• Cold compress
• Reduce after
• i swelling
• 7-10 days later
• Re-brake nose

74

In addition to the nasal fractures, these coronal
CT scan slices show the severe soft tissue
deformity and the deviation of the fractured
nasal septum
75
Fracture of the Nose

• Nrs Management
• 1 Assess breathing
• Ice
• Pack
• Mouth breathing
• Dry
• X adjust
• Pain med
• Acetaminophen
• Trauma ?
• P neck injury

76
Laryngeal Obstruction

• Pathophysiology
• Edema
• Etiology
• Anaphylaxis
• Meds
• Bees
• Nuts
• Sea food
• Foreign object

77
Laryngeal Obstruction

• SS
• Can not
• Talk
• Cough
• Breath
• Universal sign
• Color changes
• Affect
• distressed

78
Laryngeal Obstruction

• Tx
• Choking
• Heimlich maneuver
• Anaphylaxis
• Sub q epinephrine
• Corticosteroids
• Ice pack

79
Laryngeal Obstruction

• Prevention
• Avoid
• Epi-pen
• Complication
• Death

80
Sleep Apnea

• Pathophysiology
• Partial or complete upper airway obstruction
  during sleep causing apnea hypopnea
• Occurs when tongue and soft palate fall backwards

81
Sleep Apnea

• Duration of apnea
• 15-90 seconds
• Sever hypoemia
• PaO2 ?
• i
• Hypercapnia
• PaCO2
• h

82
Sleep Apnea

• Causes partial awake ?
• Startle, snort, gasps ?
• Soft palate tongue move forward ?
• Airway opens

83
Sleep Apnea

• SS
• h waking at noc
• Insomnia
• Daytime sleepiness
• Loud snoring
• AM h/a
• h Pa CO2 ?
• vasodilitation ?
• H/a

• Personality changes
• Driving accidents
• Family problems
• Employment compromised

84
Sleep Apnea

• Tx
• Mild
• Avoid
• Sedatives
• Alcohol
• Wt loss
• Oral appliance

85
Sleep Apnea

• Tx
• Severe
• CPAP
• Continuous Positive Airway Pressure
• Mask
• High flow
• Prevents collapse
• Surgery

86
CA of the larynx

• Classification
• T
• tumor
• N
• Nodes
• M
• Metastasis

87
CA of the larynx

• Pathophysiology
• Squamous cells
• Metastasis
• Lung
• Liver
• Lymphs

88
CA of the Larynx

• Etiology
• Curable if detected early but
• Men vs. women?
• gt men
• Carcinogens
• Tobacco
• Alcohol
• Asbestos
• Mustard gas
• Etc
• Family predisposition

89
CA of the Larynx

• SS
• Early
• Hoarseness
• Middle
• Change in voice
• Pain
• Lump

90
CA of the Larynx

• SS
• Late
• Dysphagia
• Dyspnea
• Foul breath
• Enlarged lymph's
• Wt loss
• Debilitative state
• Pain ? ear

91
CA of the Larynx

• Dx
• HP
• X-ray
• MRI
• Laryngoscopy ?
• Biopsy

92
CA of the larynx

• Tx
• Radiation
• Surgery/laryngectomy
• Partial
• Early
• Remove
• Portion
• 1 vocal cord
• Tumor
• Still talk
• Airway intact
• No dysphagia

93
CA of the larynx

• Tx
• Total laryngectomy
• Remove
• Larynx
• 2-3 rings of trachea
• Permanent tracheal stoma
• Laryngectomy tube
• Total voice loss
• Normal swallowing

94
CA of the larynx

• Nrs management
• Assess
• Hoarseness
• Pain
• Dyspnea
• Dysphagia
• Palpate neck
• Diet
• h protein

95
CA of the larynx

• Nrs management
• Pre-op
• Assess
• Ability to
• See
• Hear
• Read
• Write
• Anxiety

96
CA of the larynx

• Nrs management
• Post-op
• Airway
• Suction PRN
• Pain
• Communication
• Nutrition
• NPO x 14 days
• Parenteral / NGT
• Mobility

97
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98
CA of the larynx

• Laryngectomy tube
• Shorter but h diameter than tracheostomy tube
• Care same as trach
• Clean q day with normal saline
• No tissues
• No swimming
• Humidify air