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Management of Patients with Conditions of the Upper Respiratory Tract Lecture 3 Chapter 22 Brunner’s.

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Presentation on theme: "Management of Patients with Conditions of the Upper Respiratory Tract Lecture 3 Chapter 22 Brunner’s."— Presentation transcript:

1 Management of Patients with Conditions of the Upper Respiratory Tract Lecture 3 Chapter 22 Brunner’s

2 Common Cold AKA: Rhinitis Viral rhinitis Pathophysiology Rhinovirus “Infection with acute inflammation of the mucous membrane of the nasal cavity”

3 Common Cold Etiology Airborne Peak Times – Sept, Jan & April Duration – 5-14 days

4 Common Cold Clinical Manifestations Nasal congestion Runny nose Sore throat Sneezing Malaise Afibrile H/A Cough

5 Common Cold Dx exams & Procedures S&S Culture

6 Common Cold Tx methodology Focus – relief Tx not shorten Fluids Warm, moist air Medications – OTC

7 Common Cold Medications Antihistamines – Action H1 blockers  inhibits action  push off  – Take early Allergies

8 Common Cold Medications Antihistamines – Rx effect Prevents salivary, gastric, lacrimal and bronchial secretions Relieves – Sneezing – Rhinorrhea – Nasal congestion

9 Common Cold Medications Antihistamines – Side effects Drowsiness Drying – Examples Allergra Claritin Benadryl

10 Common Cold Medications Decongestants – Rx Actions Shrink engorged nasal mucus membranes – Side Effects Rebound congestion Insomnia

11 Common Cold Medications Decongestants – Examples Sudafed Vicks inhaler Afrin

12 Common Cold Medications Anti-tussives – Rx Action – Side effects – Example

13 Common Cold Medications Analgesics – Tylenol (Acetomenaphen) – Motrin (ibuprofen) NSAID – Non-narcotic

14 Common Cold Medications Vitamin C

15 Common Cold Medications Antibiotics – Prophylactic – Examples Sulfonamides Penicillins Cephalosporins Tetrcyclines Aminglycosides Quinolones Macrolides Vancomycin

16 Common Cold Medications Anti-biotic – Side-effects N/V Yeast infections Resistance

17 Common Cold Medications Echinacea – Action Stim. immune system Anti-bacterial Anti-inflammatory – Use days – Long tem use  immune system

18 Common Cold Nrs Managements See MD > 2 wks Prevention How do you prevent the cold from getting you? – Hand wash – Cover mouth – Throw away tissue – Avoid crowds – Vaccine – Eat right – Sleep – Stress – Exercise – Smoking – Allergens – Animals – Carpet

19 Common Cold Complications Bronchitis Pneumonia Conjunctivitis

20 Sinusitis: sinus infection Pathophysiology Inflammation of the mucus membrane of one or more sinuses Blocks the egress of sinuses

21 Sinusitis: sinus infection Etiology Bacterial or viral? – #1 bacterial Tooth abscess Allergies Structural abnormalities

22 Sinusitis: sinus infection Clinical manifestations Pain – Maxillary Over cheek and upper teeth – Ethmoid Btw & behind eyes – Frontal Forehead Ethmoid sinusitis

23 Sinusitis: sinus infection Clinical manifestations Anosnia H/A Fever? Fatigue? Foul breath?

24 Sinusitis: sinus infection Dx S&S X-ray, CT, MRI C & S

25 Sinusitis: sinus infection Med Tx Antibiotics Analgesics – No aspirin Nasal decongestants Mucolytic agents Surgery

26 Sinusitis: sinus infection NRS interventions Fluids –– Position – HOB  Activity – Rest Moist hot-packs Cleaning techniques – Irrigate nose

27 Sinusitis: sinus infection Prevention Avoid contributing factors: – Cold – Smoking – Fatigue – URI Dentist

28 Sinusitis: sinus infection Complications Osteomylitis Cellulitis of the orbit Abscess Meningitis

29 Sinusitis: sinus infection Surgery Post-op care – Position Side lying  semi-fowler – Ice – Monitor for Bleeding  visual acuity Pain S&S of infection – Oral care – Packing x 48 hrs – No blowing – Tarry stools – Avoid constipation

30 Acute Pharyngitis Pathophysiology AKA: sore throat, strep throat Inflammation of the throat

31 Acute Pharyngitis Etiology 70% – Viral Bacterial – Streptococcus

32 Acute Pharyngitis Clinical manifestations Sore throat Febrile Dysphagia Exudate Lymphnoids – Malaise* – Hoarseness* – Cough* – Rhinitis*

33 Acute Pharyngitis Dx exams Throat culture Rapid screening

34 Acute Pharyngitis - Tx Viral – Supportive – Like a cold Bacterial – Antibiotics – Diet Liquid/soft – Analgesics Tylenol – Anti-tussive

35 Acute Pharyngitis - Nrs Rest Rashes? – Communicable disease Warm saline gargles – Temp F Diet – Liquid Fluids –– Ice collar Oral care

36 Acute Pharyngitis Complications Sinusitis Ottis media Peritonsillar abscess Scarlet fever Rheumatic Fever – 2-3 wk /p subsides – Heart damage Mital valve damage

37 Tonsillitis & Adenoiditis Pathophysiology Tonsils – Location Oropharynx – Lymph tissue Adenoids – Location Nasopharynx

38 Tonsillitis & Adenoiditis Etiology Streptococcus Low resistance Children

39 Tonsillitis & Adenoiditis – S&S Sore throat Febrile & chills Snoring Dysphagia Adenoids – Mouth breathing Duration – 1-2 wks

40 Tonsillitis & Adenoiditis - Dx Dx Visualize C&S Mono

41 Tonsillitis & Adenoiditis Post-op care Hemorrhaging – Coffee ground emeses – Bright red emeses – Pulse  – Temp  – Restlessness – Tarry stool –  swallowing

42 Tonsillitis & Adenoiditis Post-op Position – Prone/side lying until… Gag returns – Semi-fowler’s Pain control – Ice collar – Acetaminophen Not aspirin

43 Tonsillitis & Adenoiditis Post-op Diet – Ice cold fluids – Adv. To normal ASAP 2-3 days – Milk products  – Avoid Spicy Hot Acidic Rough

44 Tonsillitis & Adenoiditis Post-op Pt education – S&S of hemorrhaging – Mouthwash good – Avoid Coughing Sneezing Vigorous nose blow Vigorous gargling Rough foods – Expect black tarry stools – Normal activity ASAP

45 Peritonsillar Abscess Pathophysiology Pus & blood filled sacs on tonsil Etiology Complication of strep throat

46 Peritonsillar Abscess S&S Pain – Local – Radiates  ear Dysphagia – drooling Dysphasia Fever Red throat

47 Peritonsillar Abscess Tx Antibiotics Incision & drain – Lanse Warm saline irrigation Hydrogen peroxide Analgesics – Topical – Tylenol – No aspirin – ? narcotics Ice collar No smoking Ventilator?

48 Laryngitis Pathophysiology – Inflammation of the mucous membrane lining the larynx – With edema of the vocal cords

49 Laryngitis Etiology – Viral – Voice abuse – Dust

50 Laryngitis Risk factors – Airborne irritants – Cold – Resent RTI – Smoking

51 Laryngitis Clinical manifestations – Aphonia Voice loss – Hoarseness – Cough? Severe

52 Laryngitis Treatment – Voice rest – Bed rest – Smoking? NO! – Humidifier – Fluids?  – Expectorants

53 Laryngitis Prevention – Avoid… Irritants Cold Voice strain Smoking

54 Epistaxis Pathophysiology – Tiny blood vessels in nose rupture

55 Epistaxis Anterior bleeds usually stop spontaneously or self treated Posterior bleeds may require med treatment

56 Epistaxis Etiology – Irritation – Infection – Drugs – Humidity – Trauma – Hypertension – Blood dyscrasias

57 Epistaxis Tx – Initial Apply direct pressure 5-10 min Position – Head tilted down – Initial d/t trauma Do not pinch Ice pack over nose & eye Position – Head down – ? Neck injury

58 Epistaxis Tx – ER Packing – Silver nitrate & gelfoam – Painful – Remains 4-5 days Topical vasoconstrictor – Epinephrine

59 Epistaxis Nrs Management – V/S – Control bleeding –  Hgb level –  PT/PTT – Take BP meds –  aspirin –  vigorous blowing –  strenuous exercise

60 Epistaxis Complications?

61 Nasal Polyps Pathophysiology – Benign grape-like growths of mucous membrane and loose connective tissue within the nasal cavity

62 Nasal Polyps Etiology – Recur – Triad disease Polyps Asthma Allergy to aspirin

63 Nasal Obstruction Etiology – Deviated septum – Hypertrophy of turbinate bone – Polyps – Foreign object

64 Nasal Obstruction Clinical Manifestations – Foul odor Malodorous – Halitosis –  allergies – Noisy breathing –  post-nasal drip

65 Nasal Obstruction Tx – Remove obstruction Out the same way in Sneezing w/ opposite nasal closed  irrigate  push backwards – Surgery

66 Nose surgery Submucous resection: Nasoseptoplasty: Rhinoplasty: Polypectomy:

67 Nrs Care – Post OP nasal surgery  hemorrhaging  Infection Comfort Nutrition Pt. Ed Avoid aspirin

68 Nasal Obstructions Complications Chronic infections of the nose Anosmia Pharyngitits Sinusitis

69 Fracture of the Nose Etiology – #1 bone broken S&S – Pain – Bleeding – Swelling – Deformity

70 Fracture of the Nose Clear fluid drainage  Fx of cribiform plate CSF Mucus vs. CSF –  glucose

71 Fracture of the Nose Tx – Control bleeding Cold compress – Reduce after  swelling 7-10 days later Re-brake nose

72 Fracture of the Nose Nrs Management – #1 Assess breathing – Ice – Pack – Mouth breathing Dry –  adjust – Pain med Acetaminophen – Trauma   neck injury

73 Laryngeal Obstruction Pathophysiology – Edema Etiology – Anaphylaxis Meds Bees Nuts Sea food – Foreign object

74 Laryngeal Obstruction S&S – Can not… Talk Cough Breath – Universal sign – Color changes – Affect distressed

75 Laryngeal Obstruction Tx – Choking Heimlich maneuver – Anaphylaxis Sub q epinephrine Corticosteroids Ice pack

76 Laryngeal Obstruction Prevention – Avoid – Epi-pen Complication – Death

77 Sleep Apnea Pathophysiology – Partial or complete upper airway obstruction during sleep causing apnea & hypopnea – Occurs when tongue and soft palate fall backwards

78 Sleep Apnea – Duration of apnea seconds Sever hypoemia – PaO2  »» Hypercapnia – PaCO2 »»

79 Sleep Apnea – Causes partial awake  – Startle, snort, gasps  – Soft palate & tongue move forward  – Airway opens

80 Sleep Apnea S&S –  waking at noc – Insomnia – Daytime sleepiness – Loud snoring – AM h/a  Pa CO2  vasodilitation  H/a – Personality changes – Driving accidents – Family problems – Employment compromised

81 Sleep Apnea Tx – Mild Avoid – Sedatives – Alcohol Wt loss Oral appliance

82 Sleep Apnea Tx – Severe CPAP – Continuous Positive Airway Pressure – Mask – High flow – Prevents collapse Surgery

83 CA of the larynx Classification – T – tumor – N – Nodes – M – Metastasis

84 CA of the larynx Pathophysiology – Squamous cells – Metastasis Lung Liver Lymphs

85 CA of the Larynx Etiology – Curable if detected early but… – Men vs. women? > men – Carcinogens Tobacco Alcohol Asbestos Mustard gas Etc – Family predisposition

86 CA of the Larynx S&S – Early Hoarseness – Middle Change in voice Pain Lump

87 CA of the Larynx S&S – Late Dysphagia Dyspnea Foul breath Enlarged lymph's Wt loss Debilitative state Pain  ear

88 CA of the Larynx Dx – H&P – X-ray – MRI – Laryngoscopy  Biopsy

89 CA of the larynx Tx – Radiation – Surgery/laryngectomy Partial – Early – Remove » Portion » 1 vocal cord » Tumor – Still talk – Airway intact – No dysphagia

90 CA of the larynx Tx – Total laryngectomy Remove – Larynx – 2-3 rings of trachea Permanent tracheal stoma Laryngectomy tube Total voice loss Normal swallowing

91 CA of the larynx Nrs management – Assess Hoarseness Pain Dyspnea Dysphagia Palpate neck Diet –  protein

92 CA of the larynx Nrs management – Pre-op Assess – Ability to » See » Hear » Read » Write Anxiety

93 CA of the larynx Nrs management – Post-op Airway – Suction PRN Pain Communication Nutrition – NPO x 14 days – Parenteral / NGT Mobility

94 CA of the larynx Laryngectomy tube – Shorter but  diameter than tracheostomy tube – Care same as trach – Clean q day with normal saline – No tissues – No swimming – Humidify air


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