Nursing Management Upper Respiratory Tract

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Nursing ManagementUpper Respiratory Tract

• Edited by
• Cynthia Bartlau, MSN, RN, PHN

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Upper Airway Defenses

• Cough, Gag, Sneeze Reflexes
• Mucus Secretions
• Ciliary Action
• Lot of lymphoid tissue
• Large Blood Supply

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Upper Respiratory Disorders and Infections

• Disorders of Nose and Sinuses
• Epistaxis
• Nasal Polyps
• Sinusitis
• Malignant Disorder
• Cancer of larynx

• Infectious Disorders
• Rhinitis
• Pharyngitis
• Acute and Chronic
• Laryngitis
• Tonsillitis/Adenoiditis
• Influenza

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Epistaxis - AKA Nose bleed

• Anterior Bleed
• Kiesselbach plexus vessels
• Easy to locate and tx
• Posterior Bleed
• Larger vessels
• Severe bleeding
• Harder to locate and tx

• Etiology
• Dry cracked MM
• Trauma
• Forceful nose blowing
• sneezing
• Nose picking
• HTN
• Chronic infection
• Chronic disease
• Leukemia
• Hemophilia
• Anticoagulant, chemo-tx

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Tx Epistaxis

• Sit pt up in chair
• Lean slightly forward
• Standard precautions
• Hold pressure over nose 5-10 min
• Ice, not pr with fx
• Do not blow nose for several hours

• Bleeding does not stop ? notify RN, MD
• MD tx
• Vasoconstrictive oint
• Cautery
• Silver nitrate
• Packing
• Nasal balloon cath

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Nursing Management

• Pt assessment
• Monitor bleeding
• Amount, color
• Monitor Hgb
• Assess s/s increased blood loss
• Notify RN, MD if bleeding severe or continues
• Posterior Packing
• Monitor airway (remove prn)
• Monitor string placement
• Provide comfort measures
• Pt education
• Causes, prevention of bleeding
• Not to pick nose, not to blow forcefully

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Nasal Polyps

• Grape-like mucosal cluster
• Benign
• Obstruct airway
• Etiology
• Unknown, ??allergies (gtrisk)
• Triad dz polyps, asthma and ASA allergy

• Tx
• Allergy s/s control
• Remove obstructive polyps
• Laser, endoscopic

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Deviated Septum

• Etiology
• Trauma
• Unknown
• S/S
• Stuffy nose
• Sinus discomfort
• Blocked drainage
• H/A
• Nose bleed

• Tx
• SMR (submucous resection), Nasoseptoplasty
• Nursing Care
• Monitor v/s, bleeding, excessive swallow, nasal
  packing-mustache dressing
• Semi-Fowlers, avoid cough, sneeze, straining
  (stool softener), avoid ASA

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Sinusitis

• Definition
• Inflammation of sinus mucosa
• Acute
• Chronic
• S/S gt 2 mos
• Unresponsive to tx

• Causes
• Bacterial infection
• Often ff viral-upper respiratory infx
• Most common organisms
• Streptococcus pneumoniae
• Haemophilus influenzae

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Sinusitis

• Facial pain that ?with bending
• Nasal congestion
• Purulent nasal discharge
• Fetid breath
• Maybe fever or other systemic symptoms

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Dx Tx

• Symptomology
• X-ray
• CT
• MRI
• Nasal discharge cx

• Goal relieve pain, promote drainage
• Adrenergic nasal spray
• Afrin, Allerest
• NS nasal irrigation
• Analgesic (pain, swelling)
• Expectorants, humidification ? loosen secretions
• Surgical drainage

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Nursing Management

• Encourage po intake H20
• Semi-Fowlers
• Relieves pr
• Hot-moist packs
• Analgesics
• Antibiotics
• When to call MD
• S/S infx, decreased LOC

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Rhinitis AKA Common Cold, Coryza

• Definition inflammation nasal mucosa
• Etiology histamine release ? vasodilation and
  edema
• Rxn to allergens (Hay fever)
• Pollen, dust molds, foods
• Viral or Bacterial infection
• Viral common cold

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Common Cold

• Etiology--One of over 100 viruses. Rhinoviruses,
  Coronaviruses, Parainfluenza Viruses, and
  Respiratory Syctyial Viruses

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Clinical Manifestations

• Rhinitis
• Nasal Stuffiness
• Throat Irritation
• Mild Malaise/Fatigue
• Mild Chill
• Minimum Fever (lt100)
• Maybe a Cough

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Cold Self-Care

• Avoid Spreading the infection
• Treat Symptoms
• Analgesics
• Decongestants
• Antihistamines

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Cold Nursing Care

• Assessment-Observe for S S.
• Diagnosis - Common cold only if other things can
  be R/O.
• Plans -Teach Self Care if going home
• -Increase observation in Hosp.
• Interventions - Primarily Teaching Self Care as
  previously discussed.

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Antihistamines

• chlorpheniramine maleate
• Chlor-Trimeton, Teldrin
• diphenhydramine (Benadryl)
• Drowziness Dry Mouth

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Histamine Response
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Decongestants

• oxymetazoline maleate (Afrin)
• Nasal Use
• Cause rebound effect
• phenylephrine (Neo-synephrine)
• Nasal Use
• pseudoephedrine (Sudafed)
• Oral Use
• Caution CNS stimulant

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Pharyngitis

• Painful Throat
• Tonsilar Lymph nodes large/tender
• Fever
• Malaise
• Nonproductive cough

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Strep Throat

• Caused By Group A Streptococci
• Symptoms Similar to Pharyngitis
• Treated with Penicillin V 250mg QID for 10 days
• If allergic to PCN, Erythromycin is given
• Poor compliance Give Benzathine
• Penicillin G 600,000 to 1.2 Million Units IM X1

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Penicillin V

• Binds to bacterial cell wall leading to death of
  bacteria
• Many Allergic
• Watch cross sensitivity to Cephalosporins
• When given PO, make sure patient understands to
  take for full course of therapy

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Topical Anesthetics

• Viscous Lidocaine, Xylocaine Oral Spray,
  Cetacaine Spray
• Gargle with viscous solution
• Use Spray in back of throat
• Caution must be used to protect airway
• Assure gag reflex intact before letting patient
  eat

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Laryngitis

• Definition
• Inflammation mm lining larynx
• Etiology
• MM irritation
• TOB, ETOH, Chemical, virus, bacteria, fungus
• Often ff upper resp infx

• S/S
• Hoarseness
• Cough
• Dysphagia
• fever

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Dx Tx

• Dx
• Visualize with laryngeal mirror
• Laryngoscopy for persistant hoarseness
• R/O Carcinoma

• Tx
• Rest
• Fluids
• Humidified air
• ASA, Acetaminophen
• Abx (bacterial)
• Rest voice
• Throat lozenges

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Tonsillitis/Adenoiditis

• Definition
• Inflammation of lymphoid tissue
• Etiology
• Bacterial infection
• Streptococcus
• Staphylococcus aureus
• Haemophilus influenzae
• Pneumococcus

• S/S
• Sudden sore throat
• Fever, Chills
• Painful swallowing
• Voice hoarseness
• H/A, malaise, myalgia
• Tonsils red, swollen exudate
• Adenoids snoring, nasal obstruction, nasal tone
  to voice

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DX and TX

• Symptomology
• Throat cx
• WBC (viral/bact??)
• CXR

• ABX
• Acetaminophen
• Lozenges
• Saline gargle
• Tonsillectomy
• adenoidectomy

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Influenza

• Headache, Fever, Muscle aches, and Malaise.
• Flu usually lasts One Week.
• Three Types
• Influenza A
• Influenza B
• Influenza C

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Treatment

• Medical
• Symptomatic tx
• Acetaminophen
• Fever, H/A, Myalgia
• Avoid ASA (Reyes)
• Rest, Fluids
• ABX (bacterial)
• Antiviral (virus)
• Symmetrel, zanamivir, tamiflu

• Nursing
• Monitor for complications (v/s, resp status)
• Comfort measures
• Hydration, nutrition
• Educate prevention
• handwashing

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Nasal Fracture

• Cause - trauma
• Obstruction of nasal passages
• Facial Deformity

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Management of Fracture of the Nose

• Cold compresses for bleeding
• Nasal packing
• Surgical intervention
• Apply ice packs
• Mouth rinses

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CA of the Larynx

• 1 of all CA
• Common in 50-70 yos
• Glottic area - 2/3 of all laryngeal CA
• Men (5x) gt Women

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Causes of Laryngeal CA

• Tobacco
• Alcohol
• Exposure to asbestos, mustard gas, wood, leather,
  metals
• Straining the voice
• Chronic laryngitis
• Riboflavin deficiency
• Family predisposition

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Prevention

• Education
• Discourage use ETOH, TOB
• Encourage safety equipment for industrial
  exposure
• Encourage to seek prompt tx when
• S/S lst occur, hoarseness gt 2 weeks

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Clinical Manifestation

• Hoarseness
• Pain
• Burning in throat when drinking or citrus juice
• Dysphagia
• Dyspnea
• Foul breath
• Weight loss
• General debilitating state

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Medical Management Laryngeal CA

• Surgery
• Radiation therapy

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Measures to Promote Communication

• Tracheoesophageal puncture (TEP)
• Pencil paper, sign language, alphabet board
• Magic slate
• Call bell
• Esophageal speech/electric larynx

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Assessment

• Assess for hoarseness, sore throat, dyspnea,
  dysphagia, pain, burning in throat
• Pre-op instruction
• Evaluate pts familys coping method.

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Post-op Care

• Assess
• Status
• Physical
• psychosocial
• Comfort
• Nutritional status
• Ability to swallow

• Respiratory status
• Function
• Airway patency
• Lung sounds
• Oxygen saturation

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Nursing Diagnosis

• Knowledge deficit r/t surgical procedure
  post-op course amb asking questions re surgery
• Ineffective airway clearance r/t surgical
  alterations in airway amb labored breathing
• Impaired verbal communication r/t removal of
  larynx edema amb inability to speak

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Outcome

• Attain adequate level of knowledge
• Reduce anxiety
• Improve communication
• Maintain patent airway
• Attain optimal levels of hydration nutrition

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Nursing Interventions

• Explain all procedures to be done
• Instruct on use of pencil pen, magic slate,
  alphabet board
• Position in semi-Fowlers position
• TCDB Q2HR
• Suction PRN

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Evaluation

• Acquired adequate level of knowledge
• Demonstrated less anxiety
• Maintained patent airway
• Acquired effective communication techniques

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Tracheostomy

• An opening through the neck into the trachea
  through which an indwelling tube may be inserted

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Purposes of Tracheostomy

• Bypass an upper airway obstruction
• Remove tracheobronchial secretions
• Permit long term use of mechanical ventilation
• Prevent aspiration oral or gastric secretions in
  unconscious pt.

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Tracheal Suctioning

• Performed when adventitious breath sounds are
  detected or when secretions are present
• Unnecessary suctioning can initiate bronchospasm
  cause mechanical trauma to tracheal mucosa

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Questions???
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