Presentation on theme: "Management of pt.s with upper respiratory tract disorder"— Presentation transcript:
1Management of pt.s with upper respiratory tract disorder Mrs. Mahdia Samaha Alkony
21-Rhinitis:Is a group of disorders characterized by inflammation & irritation of the mucous membranes of the nose. It may be classified as:Non allergic rhinitis may be caused by:Environmental factors; change temp. Humidity, odorsFoodsInfectionAgeSystemic diseaseDrugs (cocaine), or prescribed medication, foreign body.
31-Rhinitis: Drug-induced rhinitis: is associated with antihypertensive agentsoral contraceptiveschronic use of nasal decongestants.Allergic rhinitis
41-Rhinitis: Clinical manifestations: Rinorrhea (excessive nasal drainage, runny nose)Nasal congestionNasal discharge (purulent with bacterial rhinitis)Nasal itchingSneezingHeadache (if sinusitis is also present) .TreatmentDepend on cause if viral, medication given to reduce symptoms.In allergic rhinitis tests may perform, corticosteroid desensitizing immunization may require.
51-Rhinitis: If bacterial infection- antimicrobial agent. Antihistamine for allergy for sneezing, itching, rinorrhea.Oral decongestant agent.Intranasal corticosteroids may be used for severe congestion
61-Rhinitis: NSG Management. Avoid or decrease exposure to allergens & irritants.Controlling environment.Technique of administer nasal medication.Hygiene, blow the nose before medication.Treat symptom.In elderly, nurse discusses value of vaccine in the fall to achieve immunity prior the beginning of flu season.
72-Viral rhinitis (common cold). The term “common cold” often is used when referring to an upper respiratory tract infection that is self-limited and caused by a virus (viral rhinitis).Characterized by:Nasal congestionRhinorrheasneezing,sore throatTearing watery eyesGeneral malaiseSpecifically, the term “cold” refers to an a febrile, infectious, acute inflammation of the mucous membranes of the nasal cavity.Cold are highly contagious because virus is shed for about two days before the symptoms appear.
82-Viral rhinitis (common cold). Treatment:symptomatic therapyAdequate fluid intake.RestIncrease intake of vitamin CExpectorant.Warm salt water garglesNSAID as aspirin, ibuprofen relieves the aches, pain, & fever.Antibiotic should not be used.Immunity after recovery is variable and depends on many factors, including a person’s natural host resistance and the specific virus that caused the cold.
93-Acute sinusitisThe sinuses, mucus lined cavities filled with air that drain normally into the nose, are involved in a high proportion of URTI.If opening to nasal are clear, the infection resolve promptly.Some individual are more prone to sinusitis because of their occupation as paint, sawdust, and chemicals
10Path physiology of sinusitis: Infection of the Para nasal sinuses frequently developed as a result of an URTI.Nasal congestion caused by inflammation, edema, transudation of fluid, lead to obstruction of the sinus cavity.This provide an excellent medium for bacterial growth.Bacterial organism account for 60% of acute sinusitis as streptococcus pneumonia, hemophilus influenza.Dental infection is associated with acute sinusitis
11Clinical manifestation Facial painNasal obstructionFatiguePurulent nasal dischargeFeverHeadacheFacial ear pain & fullnessDental painCoughDecrease sense of smellSore throatEyelid edema.
12Assessment & DX finding History & physical examination.Tenderness over the infected sinus area.Sinus x-ray. (Fluid level, mucosal thickening).Computed tomography scanning is most effective DX tool.Complication:MeningitisBrain abscessIschemic infarctionOsteomyelitisSever orbital cellulites.
13Medical ManagementGoal to treat infection, shrink the nasal mucosa & relieve pain.Antimicrobial, amoxicillin, erythromycin.Mucolytic agent, decease nasal congestion.AntihistamineIf pt. continues to have symptom 7-10 days, the sinuses may need to be irrigated & hospital may be required.
14Nursing ManagementTeach method to promote drainage as inhaling system, increase fluid intake, local heat.Inform pt. about S.E of nasal spray.Teach early sign of a sinus infection & recommended preventive measures as following health practices, avoid contact with people have URTI.Explain the fever nuchal rigidity, sever headache as sign of potential complication.
154- Acute PharyngitisIs an inflammation or infection in the throat usually causing symptoms of a sore throat.PathophysiologyMost cases are caused by viral infection.When group A beta-hemolytic streptococcus- most common cause acute pharyngitis the condition know as strep throat.Body response by triggering an inflammatory response in the pharynx, this results in pain, fever, vasodilation, edema, tissue damage, manifested by redness & swelling in the tonsillar pillars, uvula & soft palate, creamy exudates may be presented in tonsillar pairs.
16Complications Sinusitis Otitis media Peritonsillar abscess Mastoiditis Cervical adenitis.In rare cases may lead to bacteremia, pneumonia, meningitis, rheumatic fever, or nephritis
17Signs and symptoms A fiery-red pharyngeal membrane and tonsils Lymphoid follicles are swollen and flecked with white-purple exudateEnlarged and tender cervical lymph nodesNo cough.FeverMalaiseSore throat.
18Assessment & DX. Latex agglutination (LA) / strep antigen Throat cultureNasal swab & blood cultureMedical ManagementViral; supportive measuresBacterial; penicillin, erythromycin, cephalosporin (10 day).Analgesia, aspirin, acamol.Antitussive med. CodianNutritional therapy; liquid, soft, in sever case IV
19NSG Management Bed rest during febrile stage. Used tissue should be disposed to decrease spread of infection.Examine skin for rash, because pharyngitis may precede some communicable disease as rubella.Warm saline gargles.Ice collar can relieve sever sore throats.Mouth care.Full course of antibiotics, A beta-hemolytic strep.Nurse must instruct the importance of taking full course of med.)
20TONSILLITIS AND ADENOIDITIS The tonsils are composed of lymphatic tissue & are situated on each side of oropharynx.Group A beta streptococcus is the most common organism associated with tonsillitis & adenoiditis.
21Clinical manifestation: Sore throat, fever, snoring, difficulty of swallowing.Mouth breathing, earache, draining earsBronchitis, foul smelling breathNoisy respiration voice impairment.Acute otitis media, which can lead to spontaneous rupture of the eardrums and further extension of the infection into the mastoid cells, causing acute mastoiditis.Infection may reside in middle ear cause permanent deafness.
22Assessment and Diagnostic Findings Physical examinationCareful historyCulture swab.If recurrent episodes of suppurative otitis media result in hearing loss, the patient should be given a comprehensive audiometric examination
23Tonsillectomy or adenoidectomy Indications:Repeated attack of tonsillitisHypertrophy of the tonsils and adenoids that could cause obstruction and obstructive sleep apneaRepeated attacks of purulent otitis mediaSuspected hearing loss due to serous otitis mediaAn exacerbation of asthma or rheumatic fever.Appropriate antibiotic therapy is initiated for patients undergoing tonsillectomy or adenoidectomy.The most common antimicrobial agent is oral penicillin,which is taken for 7 days.Amoxicillin and erythromycin are alternatives.
24POSTOPERATIVE CAREComfortable position; prone with the head turned to the side .Must not remove the oral airway until the patient’s gag and swallowing reflexes have returned.Apply an ice collar to the neck,Bleeding may be bright red if the patient expectorates blood before swallowing itNotify the surgeon immediately if:The patient vomits large amounts of dark blood or bright-red blood at frequent intervalsIf the pulse rate and temperature rise and the patient is restlessIf no bleeding water, ice chips are given to ptInstruct pt. to refrain coughing & talking because may produce throat pain.
25PERITONSILLAR ABSCESS A peritonsillar abscess is a collection of purulent exudate between the tonsillar capsule and the surrounding tissues, including the soft palate.It is believed to develop after an acute tonsillar infection, which progresses to a local cellulitis and abscess.
26Clinical Manifestations A raspy voiceOdynophagia (a severe sensation of burning, squeezing pain while swallowing)Dysphagia (difficulty swallowing)Otalgia (pain in the ear)Drooling.An examination shows marked swelling of the soft palate, often occluding almost half of the opening from the mouth into the pharynx, unilateral tonsillar hypertrophy, and dehydration
27Assessment and Diagnostic Findings Aspiration of purulent material (pus) by needle aspiration is requiredThe aspirated material is sent for culture and Gram’s stain.A CT scan is performed when it is not possible to aspirate the abscess
28Medical ManagementAntibiotics (usually penicillin) are extremely effective .If antibiotics are prescribed early in the course of the disease, the abscess may resolve without needing to be incised.30% of pt. with aspiration with periorpital abscess have indication for tonsillectomy.
29Nursing ManagementUse topical anesthetic agents. Throat irrigation, mouth wash Q 1-2 hr / hr.Liquids that are cool or at room temperature are usually well tolerated
30LaryngitisAn inflammation of the larynx often occurs at dust, chemicals, smoke or other pollutions, or as part of an URTIMay be caused by isolated infection involving only vocal cord.Cause always virus, bacterial may be secondary. Laryngitis is usually associated with pharyngitis or allergic rhinitis.Common in winterOnset exposure sudden temp. change, immuno suppressed, dietary deficiencies, malnutrition.
31Signs and symptomsPersistence hoarseness or aphonia (complete loss of voice).Sever cough.Management:Avoid smokingComplete voice restInhaling humidified air promotes moisture of the upper airway, helping to clear secretions and exudateAntibiotics (if cause bacteria)In elderly may lead to pneumonia.
32Nursing Management Rest the voice Well humidified environment. Expectorant agents for secretion if presentedFluid intake 3L to thin secretion.
33Obstruction and Trauma of the Upper Respiratory Airway
34OBSTRUCTION DURING SLEEP A variety of respiratory disorders are associated with sleep, the most common is being sleep apnea syndrome.Sleep apnea syndrome is defined as cessation of breathing (apnea) during sleep.
35Path physiology Sleep apnea is classified into three types: • Obstructive—lack of air flow due to pharyngeal occlusion• Central—simultaneous cessation of both air flow and respiratory movements• Mixed—a combination of central and obstructive apneawithin one apneic episode.The most common type of sleep apnea syndrome, obstructivesleep apnea.
36Obstructive sleep apnea Is defined as frequent and loud snoring and breathing cessationfor 10 seconds or more for five episodes per hour or more, followed by awakening abruptly with a loud snort as the blood oxygen level drops
37Clinical features Excessive day time sleepiness Frequent nocturnal awakeningInsomniaLoud snoringMorning headachesIntellectual deteriorationPersonality changes, irritabilityImpotence
38Clinical features Systemic hypertension Dysrhythmias Pulmonary hypertension, cor pulmonalePolycythemiaEnuresis
39Risk factors Gender: It is more prevalent in men Age: those who are olderOverweight.Cigarette smoking
40Causes Mechanical factors ; a reduced diameter of the upper airway Dynamic changes in the upper airway during sleep.The activity of the tonic dilator muscles of the upper airway is reduced during sleep.These sleep related changes may predispose the patient to increased upper airway collapse with the small amounts of negative pressure generated during inspiration.Obstructive sleep apnea may be associated with obesity and with other conditions that reduce pharyngeal muscle tone (eg, neuromuscular disease, sedative/ hypnotic medications, acute ingestion of alcohol)..
41DiagnosisThe diagnosis of sleep apnea is made based on clinical featuresPolysomnographic findings (sleep test), in which the cardiopulmonary status of the patient is monitored during an episode of sleep
42Effects of obstructive sleep apnea Repetitive apneic events result in hypoxia and hypercapnia, which triggers a sympathetic response.As a consequence, patients have a high prevalence of hypertensionAn increased risk of myocardial infarctionStroke.In patients with underlying cardiovascular disease, the nocturnal hypoxemia may predispose to dysrhythmias.
43Medical ManagementSeek medical treatment because they experience excessive sleeplessness at inappropriate times or settings (eg, while driving a car).In mild cases, the patient is advised to avoid alcohol and medications that depress the upper airway and to lose weight.In more severe cases involving hypoxemia with severe CO2 retention (hypercapnia), the treatment includes continuouspositive airway pressure or bilevel positive airway pressure therapy with supplemental oxygen via nasal cannula
44Medical ManagementSurgical procedures (eg, uvulopalatopharyngoplasty) may beperformed to correct the obstruction.As a last resort, a tracheostomy is performed to bypass the obstruction if the potential for respiratory failure or life-threatening dysrhythmias exists.
45Nursing ManagementExplains the disorder in language that is understandable to the patient and relates symptoms (daytime sleepiness) to the underlying disorder.Instructs the patient and family about treatments, including the correct and safe use of oxygen, if prescribed.
46EPISTAXIS (NOSEBLEED) A hemorrhage from the nose, caused by the rupture of tiny, distended vessels in the mucous membrane of any area of the nose. Causes associated with epistaxis:TraumaInfectionInhalation of illicit drugsCardiovascular diseasesBlood disordersNasal tumorslow humiditya foreign body in the nosea deviated nasal septum.vigorous nose blowing and nose picking
47Medical ManagementDepend on location of bleeding, most from anterior portion of the nose.If bleeding is from the anterior portion of the nose:Apply direct pressure; the pt sits upright with head tilled forward to prevent swallowing & aspiration of blood and is directed to pinch the soft outer portion of the nose against the midline septum for 5 or 10 minutes continuouslyIf unsuccessful silver nitrate applied or electrocauteryTopical vasoconstriction as adrenalin 1:1000, cocain .5%.
48If bleeding is occurring from the posterior region: Cotton pledgets soaked in a vasoconstricting solution may be inserted into the nose to reduce the blood flow and improve the examiner’s view of the bleeding site.A cotton tampon may be used to try to stop the bleeding.Suction may be used to remove excess blood and clots from the field of inspection.Only about 60% of the total nasal cavity can actually be seen, however
49When the origin of the bleeding cannot be identified: The nose may be packed with gauze soaked with petrolatum jelly or antibiotic ointment; a topical anesthetic spray and decongestantagentA balloon-inflated catheter may be used.The packing may remain in place for 48 hours or up to 5 or 6 days if necessary to control bleeding.Antibiotics may be prescribed because of the risk of iatrogenic sinusitis and toxic shock syndrome.
51Nursing Management Monitor the vital signs Assist in the control of bleeding,Provide tissues and an emesis basin to allow the patient to expectorate any excess blood.Assuring the patient in a calm, efficient manner that bleeding can be controlled can help reduce anxiety.
52TEACHING PATIENTS SELF-CARE avoiding forceful nose blowing, straining, high altitudes, and nasal trauma (including nose picking).Adequate humidification may prevent drying of the nasal passages.Instruct the patient how to apply direct pressure to the nose with the thumb and the index finger for 15 minutesIf recurrent bleeding cannot be stopped, seek additional medical attention