Chapter 31
Care of Patients with
Noninfectious Upper
Respiratory Problems
Mrs. Marion Kreisel MSN, RN
NU230 Adult Health 2
Fall 2011
Anatomy
Anatomy and Function
of the Larynx
Fracture of the Nose
• Displacement of either the bone or
cartilage of the nose can cause airway
obstruction or cosmetic deformity and is a
potential source of infection.
• Cerebrospinal fluid could indicate skull
fracture.
• Interventions: Post op HOB elevated to
decrease swelling and dyspnea
• Closed reduction
• Rhinoplasty:
• Nasoseptoplasty
Rhinoplasty
Epistaxis
• Nosebleed is a common problem.
• Interventions if nosebleed does not
respond to emergency care:
• Affected capillaries are cauterized with
silver nitrate or electrocautery, and the
nose is packed.
• Posterior nasal bleeding is an
emergency. Especially Post op from
a Rhinoplasty. Excessive swallowing
is seen in the patient. Keep HOB
elevated at least 48 hours to
decrease swelling
Epistaxis (Cont’d)
• Assess for respiratory distress and for
tolerance of packing or tubes.
• Administer humidification, oxygen,
bedrest, antibiotics, pain medications.
Nasal Polyps
• Benign, grapelike clusters of mucous
membranes and connective tissue
• May obstruct nasal breathing, change
character of nasal discharge, and change
speech quality
• Surgery—treatment of choice is
polypectomy
Nasal Polyps (Cont’d)
Cancer of the Nose and Sinuses
• Tumors of the nose and sinuses is rare
and can be benign or malignant.
• Onset is slow, and manifestations
resemble sinusitis.
• Local lymph enlargement often occurs on
the side with tumor mass.
• Radiation therapy is the main treatment;
surgery is also used. 80% cure rate
Facial Trauma: Interventions
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Airway assessment
Anticipate need for emergency intubation
Tracheotomy
Cricothyroidotomy
Fixed occlusion
Débridement
Clear fluid draining from one of the
nares, testing positive for glucose
Obstructive Sleep Apnea
• Breathing disruption during sleep that lasts
at least 10 seconds and occurs a minimum
of five times in an hour
• Excessive daytime sleepiness, inability to
concentrate, and irritability
• Nonsurgical management—change of
sleep position, weight loss, positivepressure ventilation
• Surgical management—adenoidectomy,
uvulectomy or uvulopalatopharyngoplasty
Positive Airway Pressure
Disorders of the Larynx
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Vocal cord paralysis
Vocal cord nodules and polyps
Laryngeal trauma
Laryngitis: GERD common cause
Upper Airway Obstruction
• Life-threatening emergency in which an
interruption in airflow through the nose,
mouth, pharynx, or larynx occurs.
• Early recognition is essential to prevent
further complications, including respiratory
arrest.
Upper Airway Obstruction:
Interventions
• Interventions include:
• Assessment for cause of the
obstruction
• Maintenance of patent airway and
ventilation:
• Cricothyroidotomy
• Endotracheal intubation,
nasotracheal or orotracheal
• Tracheostomy
Neck Trauma
• Neck trauma may be caused by a knife,
gunshot, or traumatic accident.
• The priority nursing care for a patient with
neck trauma is assessing for and
maintaining a patent airway.
• Assess for other injuries including
cardiovascular, respiratory, intestinal, and
neurologic damage.
• Assess carotid artery and esophagus.
• Assess for cervical spine injuries, and
prevent excess neck movement.
Head and Neck Cancer
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History
Phonation
Psychosocial assessment
Laboratory assessment
Imaging assessment
Other diagnostic assessment
Head and Neck Cancer:
Interventions
• Radiation therapy: Voice will improve
within 4 to 6 weeks of completing
radiation therapy; this is an expected
side effect.
• Chemotherapy
• Cordectomy
• Laryngectomy: Preop teaching very
important that patient will never speak
normally again!
Throat After
Laryngectomy
Aspiration cannot
occur after a total
laryngectomy
because the airway
and esophagus have
been completely
separated.
Laryngectomy: Postoperative
Care
• The first priorities after head and neck
surgery are airway maintenance and
ventilation
• Wound, flap, and reconstructive tissue
care
• Hemorrhage
• Wound breakdown
• Pain management
• Nutrition
• Speech and language rehabilitation
Communication After
Laryngectomy
• Esophageal speech
Community-Based Care
• Home care management
• Health teaching:
• Stoma care
• Communication
• Smoking cessation
• Psychosocial preparation
• Health care resources
NCLEX TIME
Question 1
What is the percentage of cure rate for
radiation treatment of small cancers in
specific locations?
A.
B.
C.
D.
30% to 50%
At least 55%
40% to 60%
At least 80%
Question 2
A patient has been admitted to the
emergency department after experiencing
a fall while rock climbing. He appears to
have several facial fractures. Which
assessment finding, if observed, is most
serious?
A. Malaligned nasal bridge
B. Clear fluid draining from one of the nares,
testing positive for glucose
C. Clear fluid draining from one of the nares,
testing negative for glucose
D. Crackling of the skin (crepitus) upon
palpation
Question 3
During recovery from a rhinoplasty, the nurse
observes that the patient is swallowing
repeatedly. This outcome may indicate:
A.
B.
C.
D.
Dry mouth because of medications
Oversecretion from the salivary glands
Posterior nasal bleeding
Edema of the surgical site
Question 4
The patient receiving radiation therapy for treatment of
head and neck cancer is considering stopping the
treatments because the hoarseness of his voice has
actually worsened. The nurse should explain that
the:
A. Voice will improve within 4 to 6 weeks of completing
radiation therapy; this is an expected side effect.
B. Hoarseness will improve if the radiation absorbed
dose is decreased from 5000 to 4000 rad;
C. Hoarseness will improve if the treatments are
decreased from daily to three times per week; this is
an adverse reaction.
D. Voice will improve within 12 to 15 weeks of
completing radiation therapy; this is an expected
side effect.
Question 5
True or False: Aspiration is still possible after
a total laryngectomy.
A. True
B. False