MEDICAL SURGICAL NURSING II
VNRS B85
NURSING CARE OF CLIENTS WITH UPPER RESPIRATORY DISORDERS
INTRODUCTION:
Disorders of the nose and throat are very common, and nurses in particular are often
asked to give advice about these problems. To be effective, nurses need a basic
understanding of the structure and function of the organs of the upper airway, as well as
knowledge of the medical and nursing regimens for problems affecting the upper airway.
LEARNING OUTCOMES:
Upon completion of this unit, the student will be able to:
A.
Theory
1.
Relate the anatomy and physiology of the upper respiratory tract to
commonly occurring disorders and risk factors for these disorders.
2.
Describe the pathophysiology of common upper respiratory tract
disorders, relating their manifestations to the pathophysiologic process.
3.
Discuss nursing implications for medications and other interdisciplinary
care measures to treat upper respiratory disorders.
4.
Describe surgical procedures used to treat upper respiratory disorders and
their implications for client care and recovery.
5.
Identify health promotion activities related to reducing the incidence of
upper respiratory disorders, describing the appropriate population and
setting for implementing identified measures.
6.
Discuss treatment options for oral and laryngeal cancers with their
implications for the client’s body image and functional health.
ASSIGNMENT:
LeMone-Burke Chapter 37
CHAPTER 37
LECTURE OUTLINE
NURSING CARE OF CLIENTS WITH UPPER RESPIRATORY DISORDERS
Upper Respiratory Tract Disorders and Risk Factors
•Infectious or Inflammatory Disorders
–Rhinitis
–Acute viral rhinitis
–Allergic rhinitis
–Vasomotor rhinitis
–Atrophic rhinitis
•Respiratory Syncytial Virus
–Respiratory Syncytial Virus (RSV)
–In older children and adults manifests as a common cold
–May cause severe illness or death in immunocompromised
Upper Respiratory Tract Disorders and Risk Factors
•Influenza
–Highly contagious viral respiratory disease
–Usually occurs in epidemics or pandemics
–Avian influenza: possible pandemic
•Sinusitis
–Sterile air-filled cavities in the facial bones
–Sinusitis
Upper Respiratory Tract Disorders and Risk Factors
•Pharyngitis or Tonsillitis
–Pharyngitis
•Acute inflammation of pharynx
•Generally viral
•May be bacterial
–Tonsillitis
•Acute inflammation of palatine tonsils
•Generally due to streptococcal infection
•May be viral
Upper Respiratory Tract Disorders and Risk Factors
•Epiglottitis
–Rapidly progressive cellulitis
–Begins between base of tongue and epiglottis
–Medical emergency, as airway may be threatened
•Laryngitis
–Inflammation of the larynx
–Occurs alone or with other URI
–May be acute or chronic
Upper Respiratory Tract Disorders and Risk Factors
•Diphtheria
–Acute, contagious disease
–Caused by Corynebacterium diphtheriae
–Uncommon in US
•Pertussis
–Whooping cough
–Highly contagious
Upper Respiratory Tract Disorders and Risk Factors
•Diphtheria
–Acute, contagious disease
–Caused by Corynebacterium diphtheriae
–Uncommon in US
•Pertussis
–Whooping cough
–Highly contagious
Upper Respiratory Tract Disorders and Risk Factors
•Epistaxis
–Nose bleed
–May indicate a bleeding disorder
•Nasal Trauma or Surgery
–Nose is most commonly broken facial bone
–Can result in
•Deviation of the septum
•Soft tissue trauma
Upper Respiratory Tract Disorders and Risk Factors
•Laryngeal Obstruction or Trauma
–Narrowest portion of upper airway
–At risk for obstruction
•Sleep Apnea
–Obstructive sleep apnea
–
–Central sleep apnea
Upper Respiratory Tract Disorders and Risk Factors
•Nasal Polyps
–Benign grapelike growths of lining of nose
–Interfere with air movement
–May obstruct openings, leading to sinusitis
•Laryngeal Tumor
–Benign
•Papillomas
•Nodules
•Polyps
–Malignant
•Fairly uncommon
•Often curable if detected early
Viral Upper Respiratory Infection
•Pathophysiology
–Local inflammatory response
–Swelling of mucous membranes of nasal passages
–Hyperactivity of mucus-secreting glands
–Immunity produced only to individual virus
Viral Upper Respiratory Infection
•Manifestations
–Nasal congestion
–Profuse nasal discharge (coryza)
–Sneezing
–Coughing
–Sore throat
–Low-grade fever
–Headache
–Malaise
–Muscle aches
Viral Upper Respiratory Infection
Sinusitis
•Pathophysiology
–Sinus opening obstruction, impaired drainage
•Manifestations
–Pain and tenderness
–Headache, fever, and malaise
–Nasal congestion
–Purulent nasal discharge
–Bad breath
Viral Upper Respiratory Infection
Epiglottitis
•Pathophysiology
–Inflammation/swelling pushes the epiglottis posteriorly
–Possible airway obstruction
•Manifestations in Adults
–1-2 day history of sore throat
–Painful swallowing
–Dyspnea
–Drooling
–Stridor
Viral Upper Respiratory Infection
Laryngitis
•Pathophysiology
–Mucous membrane lining of larynx becomes inflamed
–Vocal cords edema
•Manifestations
–Change in voice quality
–Sore, scratchy throat
–Dry, harsh cough
Viral Upper Respiratory Infection
Diphtheria
•Pathophysiology
–Tonsils and pharynx are common site of infection
–Thick, grayish, rubbery pseudomembrane forms over posterior pharynx/trachea
•Manifestations
–Fever
–Malaise
–Sore throat
–Malodorous breath
–Lymphadenopathy
–Stridor
–Cyanosis
Viral Upper Respiratory Infection
Pertussis
–Pathophysiology
–Damage/effects caused by bacterial toxins
•Manifestations
–Follow predictable pattern
–Begin with typical URI symptoms
–1-2 weeks cough becomes more frequent
–Paroxysms of coughing occur frequently
–Vomiting commonly follows coughing episode
Viral Upper Respiratory Infection
Laryngeal Trauma
•Manifestations
–Subcutaneous emphysema or crepitus
–Voice changes
–Dysphagia
–Pain with swallowing
–Inspiratory stridor
–Hemoptysis
–Cough
Viral Upper Respiratory Infection
Obstructive Sleep Apnea
•Pathophysiology
–Loss of normal pharyngeal muscle tone
–Pharynx to collapse during inspiration
–Tongue is pulled against posterior pharyngeal wall
–Obstruction causes O2 sat, PO2, and pH to fall, and PCO2 to rise
–Asphyxia causes brief arousal from sleep
–Restores airway patency and airflow
–Episodes may occur hundreds of times a night
•Manifestations
–Loud
snoring during sleep
–Excessive daytime drowsiness
–Headache
–Irritability
–Restless sleep
Influenza
•Medications
–Prophylaxis
–Treatment to reduce severity
•Amantadine
•Rimantadine
•Zanamivir
•Oseltamivir
•Ribavirin
–Symptom relief also include
•ASA
•Acetaminophen
•NSAIDs
•Antitussives
•Antibiotics are not indicated
Sinusitis
•Medication Therapy
–Antibiotics
–Oral or topical decongestants
–Antihistamines
–Saline nose drops or sprays
–Systemic mucolytic agents
Pharyngitis or Tonsillitis
•Medications
–Antibiotics for bacterial infections
–Antipyretics
–Mild analgesics
Epiglottitis and Pertussis
Epiglottitis
•Medications
–Antibiotics for infection
–Corticosteroids
Pertussis
•Medications
–Erythromycin
–Prophylactically to all household/close contacts
Epistaxis and Polyps
Epistaxis
•Medications
–Topical vasoconstrictors
–Chemical agents for cauterization
–Topical anesthetics if packing is required
–Prophylactic antibiotic therapy
Nasal Polyps
•Medications
–Topical corticosteroid nasal sprays
–Low-dose corticosteroids
Treatments
Sinusitis
•Endoscopic sinus surgery
•Antral irrigation
•Caldwell-Luc procedure
•External sphenoethmoidectomy
Pharyngitis and Tonsillitis
•Peritonsillar abscess
•Tonsillectomy
Treatments
Epistaxis
•Chemical or surgical cautery to sclerose involved vessels
•Ligation or embolization of internal maxillary artery
Nasal Trauma or Surgery
•Surgical repair
–Complex nasal fractures
–Nasal septal deviation
–Persistent CSF leakage
–Rhinoplasty is surgical reconstruction of the nose
–Deviation of the septum repair
–Endoscopic repair
Treatments
Obstructive Sleep Apnea
•Tonsillectomy
•Adenoidectomy
•Uvulopalatopharyngoplasty (UPPP)
•Tracheostomy
Nasal Polyps
•Polypectomy
•Laser surgery
•Repeat surgeries may be necessary
Health Promotion Activities
Viral Upper Respiratory Infection
•Maintaining good general health
•Stress-reducing activities
•Limiting exposure to crowds
•Good handwashing
Influenza
•Immunization education
•Risk reduction activities
–Avoiding crowds
–Avoiding those who are ill
Health Promotion Activities
Sinusitis
•Promote nasal drainage
•Encouraging liberal fluid intake
•Judicious use of nasal decongestants
•Treating any obstructive process
Pharyngitis or Tonsillitis
•Education regarding need to seek treatment
Diptheria and Pertussis
•Immunizations
Health Promotion Activities
Obstructive Sleep Apnea
•General teaching about process and treatments
•
Nasal Trauma or Surgery
•Safety measures
–Helmets
–Facial protection
–Seatbelts with shoulder harnesses
–Airbags
–
Laryngeal Obstruction or Trauma
•Measures to prevent food aspiration
•CPR teaching
•Measures to identify/provide rapid intervention for anaphylaxis
Health Promotion Activities
Nasal Polyps
•Possibility of aspirin allergy for those with asthma and nasal polyps
Laryngeal Tumor
•Smoking prevention and cessation activities
•Activities to promote abstinence or moderate alcohol use
Treatment of Laryngeal Cancer
•Determined by staging the cancer
•Radiation therapy
•Chemoradiotherapy
•Chemotherapy
Goals of Surgery
•Remove the malignancy
•Maintain airway patency
•Achieve optimal cosmetic appearance
Procedures
•Laser laryngoscopy
•Laryngectomy
•Radical neck dissection
•Modified neck dissection
Speech Rehabilitation
•Necessary if entire larynx is removed
•Techniques
–Tracheoesophageal puncture with placement of a one-way shunt valve
–Esophageal speech
–Use of speech generators