MED SURG I CHAPTER 26

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MED SURG I CHAPTER 26

• CARING FOR CLIENTS WITH UPPER RESPIRATORY
  DISORDERS

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• RHINITIS
• inflammation of the mucus membranes of the nose
• also called the common cold or coryzna-
• s/s sneezing, nasal congestion, clear nasal
  drng, watery eyes, cough, low-grade fever, h/a,
  aching muscles
• treat symptoms box 26-1

• SINUSITUS
• inflammation of the sinuses
• h/a, fever, pain pressure over the affected
  sinus, nasal congestion discharge
• treat symptoms antiobiotics if severe
• surgery if chronic Possible damage to the optic
  nerve

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• PHARYNGITIS
• an inflammation of the throat fig 26-2
• caused by viruses bacteria- can lead to
  dangerous cv or renal complications if not
  treated group A strep most commmon
• s/s sore throat, dysphagia, fever, chills, h/a,
  malaise, white patches
• early antibiotics

• TONSILLITIS ADENOIDITIS
• inflammation of the tonsils adenoids, sometimes
  chronic
• sore throat, dysphagia, fever, malaise,
  enlargement of the tonsils
• antiobiotics, antipyretics, if chronic may need
  surgery-nursing process-client family teaching

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• LARYNGITIS
• inflammation of the mucous membrane lining of the
  larynx
• hoarseness,-inability to speak above a whisper,
  aphonia, throat irritation, dry, nonproductive
  cough
• voice rest, antiobiotic therapy, smoking cessation

• EPISTAXIS
• nosebleed
• trauma or disease, rheumatic fever, infection,
  HTN, blood dyscrasias, cocaine abuse
• pressure to the nares for 5-10 min, head tilted
  forward, cauterization, nasal packing

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• NASAL OBSTRUCTION
• deviated septum
• nasal polyps
• hypertrophied turbinates
• hx of sinusitus, difficulty breathing out of one
  nostril, frequent nosebleeds, nasal discharge
• surgical procedures
• septoplasty
• rhinoplasty
• polypectomy
• See client family teaching

• Nasal fractures
• swelling edema of the soft tissues usually
  caused by trauma
• external or internal bleeding
• deformity of the nose
• nasal obstruction
• severe cases may have CSF leakage
• pressure to stop bleeding and to reduce the
  fracture or surgery

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LARYNGEAL TRAUMA AND LARYNGEAL OBSTRUCTION

• Occurs during MVA or other blunt trauma allergic
  reaction or foreign object
• neck swelling, bruising tenderness
• stridor, hemoptysis, choking

• If total obstruction must do the Heimlich
  maneuver
• If that doesnt work must do an emergency
  tracheostomy or death will soon occur
• O2, drugs for allergic rxn such as epinephrine
  or corticosteroids

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SLEEP APNEA SYNDROME

• Characterized by frequent, brief episodes of
  respiratory standstill during sleep. Increases
  their risk for CVA MI
• Classifications
• central due to a brain malfunction
• obstructive most common secondary to
  pharyngeal obstruction
• mixed
• Those at risk
• older, obese men
• smokers
• use of sedative or hypnotic medications
• heavy use of ETOH

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SLEEP APNEA SYNDROME

• s/s box 26-3
• Medical/surgical management
• Obstructive
• uvulopalatopharyngoplasty
• CPAP
• BIPAP
• APAP
• tracheostomy
• Central
• medications, Vivactil, Triptil

• Nursing management
• reassurance teacing about their condition
• explanation about treatment
• refer to self help groups or counseling for wt
  loss, smoking ETOH cessation programs
• collaborates with RT

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LARYNGEAL CANCER

• Associated with use of tobacco, etoh, industrial
  pollutants
• most common 50-70 yr olds, men
• usually squamous cell carcinomas
• persistent hoarseness, feeling of swelling in the
  throat, dysphagia pain with talking
• surgery-laser, partial or total
  laryngectomy-table 26-1

• If total laryngectomy will have tracheal stoma
• esophageal speech
• electric larynx
• tracheoesophageal puncture TEP-fig 26-3 26-4
• Nursing process

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TREATMENT MODALITIES

• TRACHEOTOMY-surgical procedure that makes an
  opening into the trachea
• TRACHEOSTOMY-the surgical opening into which a
  tracheostomy or laryngectomy tube is inserted-can
  be temporary or permanent
• ENDOTRACHEAL INTUBATION-when an ET tube is
  inserted into the mouth or nose to provide a
  patent airway-fig 26-5
• MECHANICAL VENTILATION-when the ET tube is
  attached to a ventilator.

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Tracheostomy Care

• Nursing Guidelines 26-2
• Nursing care plan 26-1

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ET Intubation Mechanical Ventilation

• ET tube inserted through nose or mouth into
  trachea to provide patent airway
• Types of ventilators table 26-2
• negative pressure does not require intubation
• positive pressure usually requires intubation

• Nursing Mgmt
• improve respirations
• maintain patent airway
• communicate needs to others

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General Nutritional Considerations

• Megadoses of vitamin C have not been proven to
  prevent or cure colds, but do appear to minimize
  its severity or duration
• ½ of the studies done on zinc lozenges show that
  they may shorten duration of colds, but they may
  impair the immune system lower HDL levels if
  taken excessively
• Following a laryngectomy the client may have
  anorexia related to diminished taste smell.
  Tell the client that they will return.

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General Pharmacologic Considerations

• Multiple-ingredient cold preparations may be
  contraindicated in those with glaucoma, HTN,
  heart disease prostate enlargement due to the
  side effects of their ingredients. Tell the
  client to check with the MD prior to taking them
• Some cold medications contain antihistamines that
  tend to thicken nasal secretions which may lead
  to blockage of drainage openings chronic
  infection

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General Gerontologic Considerations

• The common cold may be potentially serious for
  older adults if they also have other disorders
  such as chronic respiratory or heart disease.
  Advise them to seek medical advise if cold
  symptoms are severe or breathing is difficult