Chapter 22
Management of Patients With
Upper Respiratory Tract
Disorders
Adult Teaching Team
Learning outcomes
1. Describe nursing management of patients with upper
airway disorders.
2. Compare and contrast the upper respiratory tract
infections according to cause, incidence, clinical
manifestations, management, and the significance of
preventive health care.
3. Use the nursing process as a framework for care of
patients with upper airway infection.
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The Top URTP In Our Hospitals
 Nasal septal deviation
 Acute pharyngitis
 Acute and chronic tonsillitis
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Deviated septum
 It is a deflection of the normally straight nasal
septum.
 The most common cause of deviated septum is
trauma to the nose.
 Deviation from midline can interfere with airflow
and sinus drainage through the narrowed
passageway.
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 Symptoms vary depending on the degree of
deviation.
 Minor septal deviations may be asymptomatic.
 The common manifestations of septal deviation
include;
o Obstruction to nasal breathing
o Nasal congestion
o Frequent sinus infections
o Nosebleeds (epistaxis)
o
Facial pain.
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 The medical management of deviated septum is
focused on symptom control of nasal inflammation
and congestion .
 For recurrent or severe symptoms, a nasal
septoplasty is performed to reconstruct and
properly align the deviated septum.
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NURSING MANAGEMENT NASAL SURGERY
Septoplasty: Excision and resection of the
septum to correct any deviation to improve the
functioning capabilities of the nose—to improve
breathing.
Preoperative:
o Instruct the patient not to take aspirincontaining drugs or NSAIDs for 2 weeks to
reduce the risk of bleeding.
o Encourage preoperative smoking cessation
to promote postoperative wound healing.
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 Postoperative nursing interventions:
o Maintenance of the airway;
o Assessment of respiratory status;
o Pain management;
o Observation of the surgical site for bleeding,
infection, and edema.
o Elevation of the head can help minimize swelling
and discomfort
o Instruct the patient to apply cold compresses to
reduce edema and ecchymosis
o Instruct the patient to restrict activities that can
lead to bleeding such as nose blowing, swimming,
heavy lifting, and strenuous exercise.
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Acute Pharyngitis
Acute pharyngitis is a sudden painful
inflammation of the pharynx, throat, soft
palate, and tonsils.
It may viral or bacterial
Viral pharyngitis spreads easily in the
droplets of coughs and sneezes, as well
as from unclean hands.
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Pathophysiology
 Viral infection causes most cases of acute pharyngitis.
 Bacterial infection accounts for the remainder of cases.
 Ten percent of adults with pharyngitis have group A
beta-hemolytic streptococcus (GABHS.)
 The body responds by triggering an inflammatory
response in the pharynx, resulting the clinical
manifestations of pharyngitis.
 If left untreated, the complications can be severe and
life threatening.
 Complications include rhinosinusitis, otitis media,
peritonsillar abscess, mastoiditis, and cervical adenitis.
 In rare cases, the infection may lead to bacteremia,
pneumonia, meningitis, rheumatic fever, and nephritis.
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Clinical Manifestations
 Fiery-red pharyngeal membrane and tonsils,
 Swollen of lymphoid follicles .
 Enlarge and tender cervical lymph nodes
 Fever (higher than 38.3°C [101°F])
 Malaise, and sore throat.
 Occasionally, patients with GAS pharyngitis exhibit
vomiting, anorexia, painful sore throat ,headache,
myalgia and scarlet fever.
 O/E the tonsils appear swollen and erythematous, and
they may or may not have an exudate.
 The roof of the mouth is often erythematous and may
demonstrate petechiae. Bad breath is common.
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Pharyngitis
A creamy exudate may be present in the tonsillar pillars
(Fig. 22-2).
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Assessment and Diagnostic Findings
 Accurate diagnosis is essential;
o to determine the cause (viral or bacterial) and
o to initiate treatment early.
 Rapid antigen detection testing (RADT) uses swabs
that collect specimens from the posterior pharynx
and tonsil.
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Medical Management
 Viral pharyngitis is treated with supportive
measures
 Bacterial pharyngitis is treated with a variety of
antimicrobial agents. Penicillin is usually the
treatment of choice.
 Severe sore throats can be relieved by analgesic
medications such as aspirin or acetaminophen
 In severe cases, gargles with benzocaine may
relieve symptoms.
 Nutritional Therapy; A liquid or soft diet is provided
during the acute stage of the disease.
 Cool beverages, warm liquids, and flavored frozen
desserts such as ice pops are often soothing.
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Management Nursing
 Care for patients with viral pharyngitis focuses on
symptomatic management.
 For patients who demonstrate signs of GAS and
have a history of rheumatic fever, the nurse
instructs the patient about S/S that warrant
prompt contact with the primary provider.
 The nurse instructs the patient to stay in bed
during the febrile stage of illness .
 The nurse should examine the skin once or twice
daily for possible rash, because acute pharyngitis
may precede some other communicable diseases
(e.g., rubella).
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Management Nursing ..cont…
 Using warm saline gargles or throat irrigations is
depending on the severity of the pharyngitis and the
degree of pain.
 The nurse instructs the patient and family about the
importance of taking the full course of therapy and
informs them about the symptoms to watch for that
may indicate complications(nephritis and rheumatic
fever).
 The nurse instructs the patient about preventive
measures
 The nurse also instructs the patient with pharyngitis,
especially streptococcal pharyngitis, to replace their
toothbrush with a new one.
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Exercise
What should the nurse palpate when assessing for an
pharyngitis?
A. Neck lymph nodes
B. Nasal mucosa
C. Tracheal mucosa
D. Mastoid process
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Acute tonsillitis
 The tonsils are composed of lymphatic tissue and
are situated on each side of the oropharynx.
 They frequently serve as the site of acute infection
(tonsillitis).
 It may bacterial or viral
 The most common organism is GABHS
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Clinical Manifestations
 The symptoms of tonsillitis include;
 Sore throat
 Fever
 Snoring
 Difficulty swallowing.
 When there is enlarged adenoids with tonsillitis the
patient may have mouth breathing, earache,
draining ears, foul-smelling breath, voice
impairment, and noisy respiration.
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Assessment and Diagnostic Findings
 The diagnosis of acute tonsillitis is primarily clinical
 RADT.
 A thorough physical examination is performed and
a careful history is obtained to rule out related or
systemic conditions.
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Medical Management
 Tonsillitis is treated with supportive measures that
include
o Increased fluid intake
o Analgesics
o Salt-water gargles, and rest.
 Bacterial infections are treated with penicillin
(first-line therapy) or cephalosporins.
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 Tonsillectomy (with or without adenoidectomy)
remains the treatment of choice for patients with
chronic tonsillitis
 Tonsillectomy is indicated if the patient has had;
o repeated episodes of tonsillitis despite
antibiotic therapy;
o hypertrophy of the tonsils and adenoids that
could cause obstruction and obstructive sleep
apnea (OSA);
o repeated attacks of purulent otitis media;
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Nursing Management
 Providing Postoperative Care:
 Continuous nursing observation because of the risk
of hemorrhage
 In the immediate postoperative period, the most
comfortable position is prone, with the patient’s
head turned to the side .
 The nurse must not remove the oral airway until
the patient’s gag and swallowing reflexes have
returned.
 The nurse applies an ice collar to the neck, and a
basin and tissues are provided for the
expectoration of blood and mucus.
 Pain can be effectively controlled with analgesic
medications
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Nursing Management ..cont…
 the nurse notifies the surgeon immediately if the
patient vomits large amounts of dark or bright-red
blood at frequent intervals, or if the pulse rate and
temperature rise and the patient is restless.
 The patient is advised to avoid vigorous tooth
brushing or gargling because these activities can
cause bleeding
 If there is no bleeding, water and ice chips may be
given to the patient as soon as desired.
 The patient is instructed to refrain from too much
talking and coughing, because these activities can
produce throat pain.
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Nursing Management ..cont…
 Alkaline mouthwashes and warm saline solutions are
useful in coping with the thick mucus and halitosis that
may be present after surgery.
 The nurse should explain to the patient that a sore throat,
stiff neck, minor ear pain, and vomiting may occur in the
first 24 hours.
 The patient should eat an adequate diet with soft foods,
which are more easily swallowed than hard foods.
 The patient should avoid spicy, hot, acidic, or rough foods.
 The nurse instructs the patient about the need to
maintain good hydration.
 The patient should avoid smoking and heavy lifting or
exertion for 10 days.
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Check exercise
 After a tonsillectomy, a patient begins to vomit
bright red blood. The nurse should take which
initial action?
1. Maintain NPO status.
2. Turn the patient to the side.
3. Administer the prescribed antiemetic.
4. Notify the health care provider (HCP).
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Open discussion
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