B& S Ch 20
Colds
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S/S nasal congestion, rhinorrhea, nasal discharge, scratchy, sore throat, sneezing & pruritis of the nose, tearing watery eyes, malaise, fever, chills & sometimes headache and muscle aches
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Symptoms last 5 days to 2 weeks
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In some people a cold exacerbates the herpes simplex(HSV-1 or cold sore)
Common cold
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Febrile, infectious, acute inflammation of the mucous membranes of the nasal cavity
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Pt begins shedding virus 2 days before symptoms
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Affects 1 billion people in US/yr
– Accounts for ½ of work absences
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3 waves of colds in US
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September just after school begins
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In late January
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Toward end of April
Upper Respiratory - Colds
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200 different viruses cause colds.
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No cure – only TX symptoms
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Adequate fluid intake
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Rest
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Prevent chilling
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Aqueous nasal decongestants
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Antihistamines
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Vitamin C
Medical Management
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Expectorants
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Warm salt water gargles
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Asa, ibuprofen, or acetaminophen for fever, pain & aches
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Nursing care
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Prevent transmission
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Hand washing
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Prevention and managing (ch 22 B&S)
Acute Sinusitis.
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Is an inflammation of the sinuses lasting fewer than 8 weeks in the adult and 2 weeks in a child.
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Resolves more quickly if the sinus passages are open and not obstructed by deviated septum, hypertrophied turbinates, spurs, nasal polyps or tumors.
Rates highest in:

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South and Midwest
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Among carpenters, leather tanners
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Manufacturers of paint, dye and solvents
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Often results after upper respiratory infection or allergic rhinitis.
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Nasal congestion leads to obstruction of the sinus cavities providing a medium for bacteria growth.
•
Tooth infection is associated with sinusitis .
Symptoms
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Symptoms
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Pain & pressure over sinus area
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Purulent nasal secretions
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Assessment
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H&P
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CT scan of sinuses to R/O tumor, fistula or allergy
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If left untreated may lead to potentially life threatening complications such as
– Meningitis
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Brain abscess
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Ischemic infarction
– Osteomyelitis
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Orbital cellulitis
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Medical management
– TX infection
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Shrink nasal muscosa
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Relieve pain
Sinusitis
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Antimicrobial agents of choice are amoxicillin & augmentin for 7 – 10 days
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If allergy to penicillin give Bactrim DS, Septra DS.
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Oral/ topical decongestants
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Heated mist
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Saline irrigation
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Hot wet packs over sinus area
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Pt teaching
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Fever, severe headache & nuchal rigidity are signs of potential complications
Chronic Sinusitis
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Usually caused by narrowing or obstruction of opening of the sinuses
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S/S
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Cough (post nasal drip)

– Fatigue
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Chronic hoarseness
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Nasal stuffiness
– Headaches
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Facial pain
Medical management
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Antibiotics for 21 days
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May use surgical intervention
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Same interventions as for acute sinusitis
Rhinitis
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Rhinitis (B&S 589)
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Inflammation of the mucous membranes of the nose
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Classified as: Infections, Allergic, Nonallergic
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Common causes: upper respiratory infections, from viruses, bacteria, fungi
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Less common causes: foreign bodies & other.
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Clinical manifestations
– Rhinorrhea
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Nasal congestion
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Nasal discharge
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Medical management
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Depends on the cause
- Sneezing
- Headache
- Nasal itchiness
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TX infections with antimicrobial
– If allergy is the cause, identify allergens
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Avoid allergens
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Desensitizing immunizations and corticosteroids
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Medications for symptom relief
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Antihistamines
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Oral decongestants
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Intranasal corticosteroids
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Saline nasal sprays
Acute Pharyngitis
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A febrile inflammation of the throat caused by a virus 70% of time
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Called strep throat when caused by group A streptococci
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Viral infections usually subsides in 3 – 10 days
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Strep throat more severe illness with dangerous complications
– Sinusitis
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Otitis media
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Peritonsillar abscess
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Mastoiditis, rheumatic fever, & nephritis

Assessment
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Streptococci antigen screening
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Streptolysin titers
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Throat cultures
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Fiery-red pharyngeal membrane
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Enlarged, tender lymph nodes
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Fever
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Malaise
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Sore throat
What Are Some of the Dangerous Complications of Strep Throat?
Sinusitis,
Rheumatic fever
Otitis media,
Nephritis
Peritonsillar abscess;
Mastoiditis
Management of Acute Pharyngitis
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Viral pharyngitis – treat symptoms
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Bacterial Pharyngitis – treat with antimicrobials (penicillin or erythromycin) or cephalosporins for 10 days
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Pain meds- ASA or acetaminophen /w or w/o codeine
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Antitussive
Nursing interventions for acute pharyngitis.
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Diet – fluids up to 2 – 3 liters/day
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Bed rest
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Proper disposal of tissue
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Observe for rash as pharyngitis may precede other communicable diseases
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Warm, saline gargles
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Ice collar
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Mouth care
Chronic Pharyngitis
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Common in adults who:
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Work or live in dusty surroundings
– Use voice to excess
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Have chronic cough
– Use alcohol & tobacco habitually .
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C/o:
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Constant sense of irritation or fullness in the throat
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Mucus
– Difficulty swallowing

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Medical management:
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Relieve symptoms
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Avoid exposure to irritants
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Correct problems contributing to chronic cough.
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Short-term use of nasal sprays
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Antihistamine decongestants
Tonsillitis and Adenoiditis
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Symptoms: Sore throat, fever, snoring, difficulty swallowing
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Enlarged adenoids can cause
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Mouth breathing - Earache
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Frequent colds
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Foul smelling breath
- Bronchitis
- Voice impairments
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Noisy respirations
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Assessment
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Tonsillar site is cultured to identify bacterial infections
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Treat with appropriate antibiotic therapy
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Treat symptoms
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Warm saline gargles
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Pain meds
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Ice collar
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Tonsillectomy if recurrent bouts of tonsillitis
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Some controversy over tonsillectomies
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Nursing care for post op tonsillectomy
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Observation for hemorrhage
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Turn head to side to facilitate drainage
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Remove oral airway only when swallowing reflex has returned
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Ice collar
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Basic and tissues for expectoration of blood
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Nursing care.
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Notify the physician immediately if:
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Pt vomits large amts of coffee ground emisis or
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If vomits frequent small amts of bright red blood or
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Pulse rate & temp rise and pt is restless.
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A gauze , light, mirror, & curved hemostats should be available.
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If no bleeding can give water and ice chips as soon as pt desires.
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Surgery is done as out-patient.

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Instruct family that hemorrhage can occur in first 12 – 24 hours. Instruct on S/S of hemorrhage.
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Alkaline mouthwash & warm saline mouth rinses are helpful in controlling mucus and bad breath.
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Teach family that a stiff neck, sore throat and vomiting may occur in 1 st 24 hours pot-op.
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Liquid or semi liquid diet for several days is recommended.
Laryngitis
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Inflammation of the larynx
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Caused by:
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Voice abuse
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Exposure to dust, chemicals, smoke & pollutants
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Respiratory tract infections
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S/Sx
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Hoarseness
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Aphonia – complete loss of voice
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Cough
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May be complication of chronic sinusitis & chronic bronchitis
Laryngitis - Medical Management
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Voice rest
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Avoid smoking
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Rest
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Inhalation of cool steam
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Treat underlying cause
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Topical corticosteroids (Vanceril)
Obstruction (B&S 410)
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SLEEP APNEA – cessation of air flow during sleep
Pathophysiology 3 types
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Obstructive – lack of airflow due to pharyngeal occlusion
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Central – simultaneous cessation of both air flow and respiratory movements
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Mixed – a combination of central and obstructive apnea within one apnea period
Obstructive Sleep Apnea
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Usually occurs in men
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Especially older &/or over weight men
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Cigarette smoking is a risk factor
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Defined as frequent and loud snoring & breathing cessation for 10 seconds or more for 5 episodes per hour, followed by awakening abruptly with a loud snort as blood O
2
drops

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From 5 to several hundred apneic periods can occur per night
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Other symptoms are
– Excessive daytime sleepiness
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Morning headache
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Intellectual deterioration
– Behavioral disorders
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Impotence
- Sore throat
- obesity
- personality changes
- enuresis
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Obstruction might be caused by reduced diameter of upper airway.
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Changes during sleep may predispose pt to upper airway collapse with the small amounts of negative pressure generated during inspiration.
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Diagnosis made based on history and polysomnographic tests
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Obstructive Sleep Apnea
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Medical management
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In mild cases instructed to avoid alcohol 7 meds that depress the upper airway & to lose weight
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In more severe cases with hypoxemia with severe CO
2
retention, TX includes continuous positive pressure airway or believe positive pressure therapy with O
2
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Surgical procedures.
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Uvulopalatopharyngoplasty may be performed.
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Tracheostomy is last resort.
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Protriptyline at bedtime increases respiratory drive and muscle tone.
Epistaxis
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Nose bleed
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Common site is anterior septum
Epistaxis - Associated Causes
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Trauma
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Drugs
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Blood dyscrasias
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Low humidity
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Deviated septum
- Infection
- Cardiovascular diseases
- Nasal tumors
- Foreign body
Epistaxis - Treatment
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Pt sits upright with head tilted forward
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Pinches soft outer portion of nose against septum for 5 – 10 minutes
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Silver nitrate
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Gelfoam
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Electrocautery
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Vasoconstrictors such as adrenaline (1:1000), cocaine (0.5%) & phenylephrine

Fractures of the Nose
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Most fx do not cause serious problems but can interfere with breathing after they heal.
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A serious fx can cause a hematoma that can abscess and destroy cartilage if not drained.
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Fx of cribriform plate may cause leaking of CSF.
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Bleeding internally or externally
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Swelling of the soft tissue
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Deformity
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Inspection & Palpation
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X-ray
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Management
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Control bleeding with cold compresses
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Pt referred to specialist 3 – 5 days after injury
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Surgically reduced 7 – 10 days after injury
Nursing management
•
Apply ice packs 20 minutes 4 times per day
•
Mouth rinses
Cancer of the Larynx
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Represents less than 1% of all cancers
•
8 times more common in men
•
More common in people 50 – 70 yrs old
•
10,600 new cases in US per yr
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4,200 people die from it per yr
SYMPTOMS of Cancer of the Larynx
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Hoarseness with cancer near glottis
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Pain or burning in throat when drinking hot liquids
•
Lump near neck
Later symptoms
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Difficulty swallowing or breathing
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Unilateral nasal obstruction or discharge
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Persistent ulceration
•
Foul breath
Assessment
•
H & P
•
Exam of head and neck
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Indirect laryngoscopy follower by direct laryngoscopy
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Biopsy
•
CT scan
•
MRI

Cancer of the Larynx
•
Tumor is staged to determine TX
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T (tumor) or extent of primary tumor
– N (node) or location & extent of nodal involvement
–
M (metastasis) or spread of tumor outside sit of origin
•
Treatment options include
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Radiation
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Chemotherapy
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Surgery (laryngectomy)
–
Laryngectomy
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Partial
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Supraglottic
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Hemilaryngectomy
•
Total laryngectomy
•
Speech therapy
•
A laryngeal communication
1. Esophageal speech
2. Artificial larynx
3. Tracheoesophageal – a valve is placed in trach stoma to divert air into esophagus and out of mouth. Fitted with a prosthesis when stoma healed