Epistaxis
 More commonly known as a nosebleed/More severe to
control
• Anterior
 (Easier to locate)
• Posterior
 Most common from Keiesselbach plexus
 Causes
• Dry, cracked mucous membranes
• Trauma (cocaine use/ forceful nose-blowing)
• Hypertension (Prolongs bleeding, not a cause)
• Hemophilia
• Medications (Aspirin, Chemo, and Anticoagulants)
 Therapeutic interventions
• Positioning (Sit in a chair lean forward)
• Direct pressure (5-10 mins if no fracture)
• Ice (Constricts blood vessels)
• Nasal packing (Gauze with petroleum or idoform) (No
more than 5 days, sleep on your side, do not blow nose)
Can lead to hypoxia, toxic shock syndrome, O2 should
95% or above
• Nasal balloon catheter (Rapid Rhino, pressure on artery
to stop bleeding)
• Vasoconstrictive agent (Neo-Synephrine)
• Electrocautery (or silver nitrate)
• Prevent straining exercises, sneeze with open mouth,
humidifiers help keep nasal passages moist
Nasal Polyps
 Usually benign/Occur more often with allergies
 Grapelike clusters of mucosa that obstruct the airways also
associated with cystic fibrosis.
 Some patients with nasal polyps also have asthma and are
allergic to aspirin. This is called aspirin-exacerbated
respiratory disease (AERD).
 Therapeutic interventions
• Control allergies (Oral antihistamines, leukotriene
antagonists, corticosteroid spray (decrease
inflammation))
• Antibiotics(if sinus infection present)
• Surgery (Laser or endoscopic with local anesthesia)
• Avoid aspirin post-op (Decreases risk of bleeding)
Deviated Septum
 Pathophysiology
• Septum dividing the nasal passages is slightly deviated
(crooked)
• Result of trauma or no cause at all
• Can interfere with breathing
 Symptoms
• Stuffy nose/Blocked sinus drainage
• Sinus infections
• Epistaxis occasionaly
• Headaches
Therapeutic intervention
 Decongestants, antihistamines, and cortisone nasal sprays
can treat symptoms
 Nasoseptoplasty (revise the septum)
• Monitor vital signs/bleeding until stable
• Report excess swallowing (bleeding running down
throat)
• Monitor dressing drainage (Clean dry and Intact)
• Teach post-op care: Avoid activities that increase
pressure; avoid aspirin.
• Ice to reduce swelling
• Reduce straining (Stool softener), sneezing
• Fever, excessive pain, swelling bleeding report to HCP
• Follow up after 24-48 hours
Rhinoplasty
 Surgical reconstruction of the nose (Trauma/Cosmetic)
Sinusitis
 Inflammation of the mucosa of the maxillary and ethmoid
sinuses
 Follows an Upper respiratory infection
 2 types
• Acute- Less than 3 months of symptoms
• Chronic is diagnosed if symptoms have existed more
than 3 months and unresponsive to treatment
 Inflammation of sinus mucosa
• Bacterial
 Over-growth of Streptococcus pneumoniae and
Haemophilus influenzae
• Allergic




Swelling
Nasal Polyps
Fungal infection
Intubation
 Signs and symptoms
• Pain over affected
 Maxillary Sinus pain over the cheek and upper
teeth
 Ethmoid Sinus between and behind the eyes
• Fever, Fatigue, and Foul breath
• Purulent Nasal discharge
• Pain while leaning forward
 Complications
• Uncontrolled infection spreads causing osteomyelitis,
cellulitis of the orbit (infection of the soft tissues around
the eye), abscess, or meningitis.
• Sinusitis can also trigger asthma symptoms.
 Diagnostic Tests
• Nasal discharge can be cultured
 Therapeutic interventions
• Avoid Antihistamines dry secretions making them too
thick
• Saline irrigation
• Intranasal corticosteroids
• Decongestants (Flownase)
• Hot packs
• Acetaminophen/ ibuprofen/ Mucinex
• Humidification
• Oral fluids (8- 10 glasses)
• Positioning (Semi-fowlers)
• Antibiotics (Full course of meds)
• Surgical drainage
Obstructive Sleep Apnea
 Apnea while sleeping supine
 Muscles of the throat relax; the tongue and soft tissues
obstruct the airway/can occur up to 100 times per night
 Risk factors
• Men more than women
• Obesity
• High palate
• Receded mandible
• Smoking/Alcohol/ Sedatives to help sleep
 Complications
• Heart disease
• Hypertension
• Stroke
• Diabetes
 Signs and symptoms
• Loud Snoring/ Frequently waking in the middle of the
night
• Daytime sleepiness
• Headache
• Irritable, HTN
• Impotence, personality changes,
• Memory and attention problems
 Diagnostic test
• Nocturnal polysomnography
 Overnight stay hooked up to an
electroencephalogram, ECG, and
electromyography (EMG), oxygen saturation, and
eye movement monitors, and someone observing
 Treatment
• Avoid sedatives/ alcohol
• Lose weight/ Stop smoking
• Do not sleep on back
• Nasal patch to open airways
• Non-invasive positive-pressure ventilation (N I P P V)
• Surgery
Infectious Disorders
Viral rhinitis
 Coryza is the inflammation of the nasal mucous membranes
 Viral (Common cold highly contagious)
 Seasonal Allergies- (Hayfever (Pollen fever), mold, Animals)
histamines are released… post-nasal drip,
 Symptoms sneezing, fever, malaise
 Throat culture to diagnose viral or bacterial/ Rapid flu test
 Mild decongestants, inhaled steroids, guaiphenesin
Pharyngitis
 Inflammation of the pharynx
 Caused by beta-hemolytic streptococci, commonly referred
to as strep throat
 Symptoms
• Sore throat
• Dysphagia
• Exudate (Drainage or pus) may be present with
bacterial infection
 Fever
 Chills
 Headache
 Generalized malaise
 Diagnostic tests/treatment
• Rapid strep test
• Antibiotics (Penicillin, or tetracycline if allergic)
Laryngitis
 Inflammation of mucous membrane of the larynx
 Cause by smoking, alcohol, chemical exposure,
gastroesophageal reflux disease (GERD), or a viral, bacterial,
or fungal infection
 Symptoms
• Hoarseness
• Cough
• Dysphagia
• Fever
 Treatment
• Rest
• Fluids
• Humidified air
• Aspirin
• Acetaminophen
• Antibiotics (bacterial infection)
• Throat lozenges
Tonsillitis
• Infection of tonsils and uvula (red and swollen) (Group A
Strep)
• Generalized symptoms: headaches, sudden onset of
sore throat, fever, chills, ear pain or infection, and pain
on swallowing
• Pus pockets can form behind the tonsils
• Antibiotics for bacterial infection, Acetaminophen,
lozenges, and saline gargles
• Monitor for bleeding and airway clearance, Encourage
fluids, Humidifier, and suction if necessary
• Diagnostic tests: CBC, Throat culture, chest x-ray
Influenza
 Commonly called the flu/ viral infection of the respiratory
tract
 Transmitted by coughing and sneezing/ Droplets Precaution
 Flu A responsible for most infections found in humans and
animals
 Flu B more common in humans less outbreaks
 Flu C typically mild with hardly any symptoms/ not
recognized as the flu
 Rapid flu tests needed
 Prevention
• Yearly vaccination (Egg allergies cannot take the
vaccine) (
• Handwashing
• Avoidance of infected people
 Signs and symptoms (Abrupt onset lasts between 2-5 days)
• Fever
• Chills
• Myalgia
• Sore throat
• Cough
• Malaise
• Headache
 Complications
• Pneumonia
• Fever, sob, crackles or wheezes auscultation of lungs
 Therapeutic interventions
• Assess lung sounds and vitals q 4h
• Monitor electrolytes
• Acetaminophen
• Avoid aspirin
• Antiviral agents (Tamiflu) Can cause diarrhea and
nausea and vomiting
• Rest
• Fluids
Other Respiratory Viruses
 West Nile
• Transmitted from birds to humans by mosquitoes
• No symptoms/ Flu-like symptoms
• Can progress to Encephalitis or meningitis in older
adults
• Educate patients to wear insect repellent and rid yard
of standing water so no mosquito eggs
 Avian influenza (bird flu)
 Severe acute respiratory syndrome (S A R S)
 Swine flu (H1 N1)
Nursing Diagnoses for Upper Respiratory Infections
 Impaired Comfort (
 Hyperthermia
 Risk for Infection (transmission to others)
Cancer of the Larynx (Voice box)
 Pathophysiology
• Primary tumor of mucosal epithelium
• Metastasizes to lungs, liver, lymph nodes
• Persistent hoarseness and change in the voice
(Laryngitis)
• Benign (Develops on vocal chords) Malignancy (Can be
cured)
 Etiology
• Associated with smoking, alcohol/More common in men
 Signs and symptoms
• Hoarseness, Change in voice
• Throat/Ear Pain
• Dyspnea, Cough, Halitosis
• Dysphagia/Weight-loss, Airway obstruction, Stridor
 Diagnostic tests
• Laryngoscopy (Diagnose and determine stage of
cancer)
• CT/MRI to detect presence of metastasis
• Needle biopsy for pathology
 Therapeutic interventions
• Radiation (If caught early)
• Chemotherapy (Targeted) (Used before surgery)
• If cancer has spread beyond the larynx, a radical neck
dissection, which removes adjacent muscle (difficulty
turning the head, drooping shoulder), lymph nodes, and
tissue, may be done
• Increase ROM exercises, control bleeding
• After a partial laryngectomy, the patient may have a
permanently hoarse voice.
• If a total laryngectomy is done, the patient will have a
permanent tracheostomy (in this case, called a
laryngectomy) tube in place and no voice.
• The patient will need to learn alternative methods of
communication.
 Esophageal speech involves swallowing air and
forming words as the air is regurgitated back up
the esophagus
 Electronic devices are available, which the patient
places next to the neck or mouth. These devices
use sound vibrations to help the patient form
words. Ultra-Voice is an electronic device that is
placed inside an upper denture or retainer, and
the patient speaks into a small microphone
 Another alternative is a tracheoesophageal
puncture (TEP), such as the Blom-Singer voice
prosthesis, which uses a surgically implanted voice
prosthesis that creates a valve between the
trachea and esophagus. If the patient holds a
finger over the laryngectomy, air is diverted into
the esophagus and the patient forms words as the
air exits the mouth
 Postoperative nursing diagnoses
• Ineffective Airway Clearance (Monitor for obstructions)
• Acute Pain
• Impaired Verbal Communication
• Imbalanced Nutrition
• Impaired Swallowing
• Grieving
• Disturbed Body Image
 Aids to Speak
• UltraVoice – Placed Inside Denture or Retainer;
Patient Speaks into Small Microphone
• Blom-Singer Voice Prosthesis –Helps Form
Tracheoesophageal Speech