Presentation on theme: "Timby/Smith: Introductory Medical-Surgical Nursing, 11/e"— Presentation transcript:
1 Timby/Smith: Introductory Medical-Surgical Nursing, 11/e Chapter 20:Caring for Clients With Upper Respiratory Disorders
2 Infectious and Inflammatory Disorders RhinitisPathophysiology and EtiologyInflammation of the nasal mucous membranes; acute, chronic, or allergicAssessment Findings: sneezing, nasal congestion, rhinorrhea, sore throat, watery eyes, cough, low-grade fever, headache, aching muscles, and malaiseMedical Management: antipyretics, decongestants, antitussives, saline gargles, saline spray, and antihistaminesNursing Management: prevention and minimizing potential complications; handwashing
3 Infectious and Inflammatory Disorders—(cont.) SinusitisPathophysiology and Etiology: inflammation of the sinuses; maxillary sinusComplications: infection of middle ear or brainAssessment Findings: headache, fever, pain over affected sinus, nasal congestion, pain, pressure around eyes, malaiseMedical and Surgical Management: saline irrigation, antibiotic therapy, vasoconstrictors, nasal corticosteroidsCaldwell-Luc procedure, external sphenoethmoidectomyNursing Management: mouthwashes, humidification, increased fluid intake, nasal decongestants, antihistamines
4 Sinus Surgery Nursing Postoperative Care Observe for repeated swallowing: hemorrhageOptic nerve function assessmentTemperature every 4 hours; pain over involved sinusesAdminister analgesics as indicated; ice compressesNasal packing and dressing under nares (“moustache” dressing or “drip pad”)
5 NCLEXOf the following instructions, which is most important for the nurse to teach the client to help loosen secretions and increase comfort during medical treatment for sinusitis?A) Blow the nose frequently.B) Elevate the head of the bed by 45°.C) Engage in normal activity.D) Increase fluid intake.
6 NCLEXAnswer: D) Increase fluid intake. Rationale: If the client is receiving medical treatment, the nurse informs the client to use mouthwashes and humidification, as well as increased fluid intake, which may loosen secretions and increase comfort.
7 Infectious and Inflammatory Disorders—(cont.) PharyngitisPathophysiology and EtiologyInflammation of throat; rhinitis and other URIsGroup A streptococci: strep throatComplications: endocarditis, rheumatic fever, glomerulonephritisHighly contagious: inhalation or direct contamination with droplets
8 Infectious and Inflammatory Disorders—(cont.) Pharyngitis—(cont.)Assessment Findings: sore throat with dysphagia, fever, chills, headache, white or exudates patch over tonsillar area, swollen glandsMedical ManagementThroat cultureAntibiotic treatment: assess allergy to penicillin; erythromycin
9 Infectious and Inflammatory Disorders—(cont.) Tonsillitis and AdenoiditisPathophysiology and EtiologyPrimary or secondaryChronic tonsillar infection: partial upper airway obstruction; chronic adenoidal infection: otitis mediaAssessment Findings: sore throat, difficult or pain on swallowing, fever, malaise, enlarged adenoids: nasal obstruction, snoringMedical and Surgical Management: antibiotic therapy, analgesics, saline gargles, tonsillectomy, and adenoidectomyNursing Management: precare/postcare: lab results: hematocrit, platelet count, clotting time, aspirin use, NSAIDsRisk for Aspiration, Risk for Impaired Tissue Integrity, and Acute Pain.
10 NCLEXThe nurse is providing postoperative care for a client who has undergone tonsillectomy. In which position will the nurse place the head of the bed when the client is fully awake?A) Flat with the head elevated on a pillowB) Slightly raised at a 15° angleC) Raised at a 45° angleD) Raised at a 90° sitting position
11 NCLEXAnswer: C) Raised at a 45° angle Rationale: Elevate head of bed 45° when client is fully awake. This position decreases surgical edema and increases lung expansion.
12 Infectious and Inflammatory Disorders—(cont.) Peritonsillar AbscessPathophysiology and Etiology: develops in connective tissue between tonsil and pharynxStreptococcal or staphylococcal tonsillar infectionAssessment Findings: difficulty and pain with swallowing, fever, malaise, ear pain, and difficulty talkingDiagnostic Findings: sensitivity studies and culture
13 Infectious and Inflammatory Disorders—(cont.) Peritonsillar Abscess—(cont.)Medical and Surgical Management: antibiotic therapy, needle aspiration, surgical incision, and drainageNursing ManagementSemi-Fowler’s position; prevent aspirationIce collar, topical anesthetics, throat irrigations, drink fluids, cool or room temperatureObserve for respiratory obstruction—dyspnea, restlessness, or cyanosis—or excessive bleeding
14 Infectious and Inflammatory Disorders—(cont.) LaryngitisPathophysiology and EtiologyInflammation and swelling of the mucous membrane that lines larynxCauses: URI, excessive/improper use of voice, allergies, smokingAssessment Findings: cannot speak above a whisper; aphonia; throat irritation; dry, nonproductive coughHoarseness longer than 2 weeks: laryngoscopyPersistent hoarseness: sign of laryngeal cancerMedical ManagementVoice rest; treatment or removal of causeAntibiotic therapy if bacterialSmoking cessation
15 Structural Disorders Epistaxis Pathophysiology and Etiology: rupture of tiny capillaries in the nasal mucous membraneRisk factors: trauma, systemic infections (rheumatic fever), local infections, dry nasal mucosa, hypertension, aspirin, nasal tumors, and blood dyscrasias; cocaine abuse/inhale drugsAssessment Findings: nasal speculum and tongue blade reveals bleeding
16 Structural Disorders—(cont.) Epistaxis—(cont.)Medical and Surgical Management: direct continuous pressure, ice packs, cauterization, electrocautery, topical vasoconstrictor, nasal packing, balloon-inflated catheterNursing ManagementVS, evidence of continued bleedingHumidification, nasal lubricant, and avoidance of vigorous nose blowing or picking
17 NCLEXA client was seen in the emergency room with severe epistaxis. After the physician places a nasal packing, the bleeding is controlled. What should the nurse include as part of the discharge instructions? Select all that apply.A) Call physician if bleeding persists or becomes worse.B) Continue taking baby aspirin as ordered.C) Do not blow the nose.D) Keep nasal packing in place until seen for follow-up appointment.
18 NCLEXAnswers: A) Call physician if bleeding persists or becomes worse. C) Do not blow the nose. D) Keep nasal packing in place until seen for follow-up appointment. Rationale: The nurse assesses for signs of continued bleeding and educates the clients on measure to prevent bleeding.
19 Structural Disorders—(cont.) Nasal ObstructionPathophysiology and EtiologyPrimary conditions: deviated septum, nasal polyps or grapelike swellings, and hypertrophied turbinatesAssessment Findings: hx of sinusitis, difficulty breathing out of one nostril, frequent nosebleedsMedical and Surgical Management: submucous surgical resection or septoplasty, rhinoplasty or reconstruction of the nose, steroidal nasal sprayNursing Management: nasal packing, mouth breathing, semi- Fowler’s, VS, oral hygiene
20 Trauma and Obstruction of the Upper Airway Fractures of the NosePathophysiology and Etiology: traumaAssessment Findings: swelling and edema of soft tissue, external and internal bleeding, nasal deformity, nasal obstructionCSF—DextrostixMedical and Surgical ManagementLateral displacement: pressure applied; cold compresses; complex fracture: surgeryNursing Management: HOB elevated, apply ice, analgesics, assess for airway obstruction, pupillary responses, LOC, and periorbital edema; anxiety
21 Trauma and Obstruction of the Upper Airway—(cont.) Laryngeal Trauma and ObstructionPathophysiology and Etiology: motor vehicle accidents, blunt trauma in neck regionAssessment Findings: neck swelling, bruising, and tendernessStridor, dysphagia, hoarseness, cyanosis, and hemoptysisDiagnostic Studies: laryngoscopy, x-rays, oxygenation studiesMedical and Surgical Management: patent airway, Heimlich maneuverNursing Management: LS, respiratory pattern, nasal swelling, bleeding, and laryngeal edema
22 Trauma and Obstruction of the Upper Airway—(cont.) Obstructive Sleep ApneaPathophysiology and Etiology: recurrent and frequent episodes of upper airway obstruction and reduced ventilationClassifications: central, obstructive, mixedAssessment FindingsSnore loudly, cessation of breathing for at least 10 secs, awaken suddenly with loud snortDaytime fatigue, morning headache, inability to concentrate, sore throat, enuresis, and erectile dysfunction
23 Trauma and Obstruction of the Upper Airway—(cont.) Obstructive Sleep Apnea—(cont.)Medical Management: lose weight, smoking cessation, eliminate alcohol, and use special pillowsContinuous positive airway pressure (CPAP)Bilevel positive airway pressure (BIPAP)Surgical Management: uvulopalatopharyngoplasty and tracheostomyNursing Management: reassurance, adequate instruction, explanations, self-help groups, counseling
24 Laryngeal Cancer Pathophysiology and Etiology Causes: carcinogens: tobacco, alcohol, pollutantsAssessment Findings: persistent, progressive hoarseness; swelling or lump in throat or neck; dysphagia; pain when talking; weight lossDiagnostic Studies: laryngoscopy, biopsy, CT, MRI, and PETMedical and Surgical Management: chemotherapy, radiation therapy, laryngectomyNursing ManagementAssess for hoarseness, dysphagia, dyspnea, pain, burning in throat, anxiety level, coping strategies, ability to communicate
25 Alternative Measures of Communication Methods of laryngeal speech used after a laryngectomy includes the following:Esophageal speech: regurgitation of swallowed air and formation of words with lipsArtificial (electric) larynx: throat vibrator held against neck, projects sound into mouthTracheoesophageal puncture (TEP): surgical insertion of prosthesis; Blom-Singer devicePsychosocial issuesNursing Management: social isolationPromote positive self-esteem, encourage social relationships, support services
26 Treatment Modalities for Airway Obstruction or Airway Maintenance Tracheotomy and TracheostomyTracheotomy: surgical procedure making an opening into the tracheaTracheostomy: surgical opening into the trachea into which a tracheostomy or laryngectomy tube is insertedTemporary or permanent
27 Treatment Modalities for Airway Obstruction or Airway Maintenance—(cont.) Tracheotomy and Tracheostomy—(cont.)Nursing ManagementRisk for Ineffective Airway Clearance: VS, breath sounds, assess skin color, LOC, and mental status; airway patencyRisk for Infection: monitor stoma, provide routine tracheostomy care, positionRisk for Ineffective Management of Therapeutic Regimen
28 Treatment Modalities for Airway Obstruction or Airway Maintenance—(cont.) Endotracheal Intubation and Mechanical VentilationUses: respiratory difficulties, comatose clients, general anesthesiaMechanical ventilation: negative pressure, positive pressureNursing Management: vital signs; blood gas studies; pulse oximetry; evaluate mental status, confusion, agitation; lung auscultation; suctioning and humidification; communication; “magic slate”; wipe board