1. Respiratory Nursing Objectives ◦ 1. Recognize symptoms of disorders of the sinuses, pharynx, and larynx. ◦ 2. Describe the post operative care for a patient having nasal surgery. ◦ 3. List emergency measures for a patient with an airway obstruction. ◦ 4. Discuss safety factors to be considered when caring for the patient with a tracheostomy.

2. Respiratory Nursing In clinical practice: ◦ Institute measures to stop epistaxis. ◦ Perform tracheostomy care. ◦ Develop interventions for the psychosocial care of a patient who has a laryngectomy.

3. Respiratory Nursing URI’s (The Common Cold) Acute viral rhinitis ◦ Most prevalent infection ◦ Many different strains ◦ Nose and upper respiratory tract ◦ Spread by:  Airborne droplet sprays ◦ Who is susceptible?

4. Respiratory Nursing Common cold symptoms ◦ Mild sore throat ◦ Increased secretions ◦ Congestion ◦ Sneezing ◦ Malaise ◦ Muscle aches/headache ◦ Temp <101 ◦ Lasts 10-14 days ◦ Allergic rhinitis—no fever

5. Respiratory Nursing Treatment of allergic rhinitis ◦ Antihistamines ◦ Steriods ◦ Nasal sprays ◦ Avoid allergans Treatment of common cold ◦ Home remedies

6. Respiratory Nursing Treatment of common cold ◦ Prevent secondary bacterial infection ◦ Contagious for 3 days ◦ Increase fluid intake ◦ Vitamin C ◦ Mild analgesia, no ASPIRIN for children ◦ Decongestants ◦ Elder Care: prevent by staying away from infected people

7. Respiratory Nursing Bacterial infection requires medical treatment if cold continues past 10 days or symptoms worsen

8. Respiratory Nursing Sinusitis ◦ Inflammation of the mucosal linings ◦ Pathogens  Pneumococci, streptococci, Haemophilus influenzae ◦ Symptoms  Pressure pain, headache, fever, malaise, purulent drainage from the nose, non-productive cough, upper teeth may be painful

9. Respiratory Nursing Treatment for sinusitis ◦ Relieve pain ◦ Promote drainage ◦ Control fever ◦ Prevent recurrence ◦ Surgical cleaning Complications from sinusitis ◦ Septicemia, meningitis and brain abscess

10. Respiratory Nursing Epistaxis: nosebleed ◦ Crusting, cracking and irritation of the mucus membranes caused by decreased humidity, excessive nose blowing, allergies with inflammation and nose picking, overuse of nasal sprays, street drugs, hypertension, blood disorders and tumors ◦ Symptom: bleeding

11. Respiratory Nursing Treatment of nosebleeds ◦ Sit forward and apply pressure to the soft part of the nose for 10-15 minutes ◦ Apply cold conpresses ◦ Small gauze pad in nasal passage ◦ Continued bleeding proceed to ER ◦ Cauterize bleeding vessels ◦ Do not blow nose post bleeding or rub area, may rebleed

12. Respiratory Nursing Pharyngitis: sore throat caused by virus, bacteria or a fungus ◦ Beta-hemolytic streptococcal infection ◦ Fungal pharyngitis Laryngitis: inflammation of the larynx with diminished voice Epiglottitis: more common in children

13. Respiratory Nursing Signs and symptoms/ pharyngitis ◦ Dry, scratchy throat ◦ Mild fever ◦ Headache ◦ Malaise ◦ Reddened throat ◦ Dysphagia ◦ Hoarse voice ◦ Throat culture to r/o strep

14. Respiratory Nursing Treatment pharyngitis ◦ Rest ◦ Saline gargles ◦ Lozenges ◦ Fluids mild analgesia ◦ Bacterial=antibiotics ◦ Fungal=antifungals

15. Respiratory Nursing Tonsillitis- inflammed tonsils ◦ Children  High fever, sore throat, malaise, pain, chills  Red, swollen tonsils with yellow exudate  Elevated WBC’s ◦ Treatment  Saline gargles  Antibiotic -Penicillin

16. Respiratory Nursing Pre-surgery for tonsils ◦ Free of infection ◦ Pre-op labs ◦ Same day surgery ◦ NPO/MD Post-op for tonsils ◦ Vital signs ◦ Check for hemorrhage ◦ Position on side ◦ Diet ◦ Ice collar

17. Respiratory Nursing Airway obstruction ◦ Laryngeal edema ◦ Laryngeal trauma ◦ Foreign object ◦ Universal sign ◦ Heimlich maneuver ◦ CPR guidelines

18. Respiratory Nursing Obstructive Sleep Apnea ◦ Stops breathing during sleep for 10 seconds or more ◦ Followed by a reflex gasp for air ◦ Caused by muscle relaxation at the back of the throat ◦ Snoring: sleep partner aware ◦ Sleep study ordered ◦ CPAP (continuous positive airway pressure) ◦ Untreated: MI, stroke, constant fatigue

19. Respiratory Nursing Nasal Fractures ◦ Result from MVA, sports injuries and violence ◦ Complications: obstruct airflow, cause nasal deformity and site for infection ◦ Diagnosed by visual inspection of the nose, a change in nasal breathing, crepitation on palpation ◦ Treatment: closed reduction, local or general anesthesia, ice to reduce swelling

20. Respiratory Nursing Rhinoplasty: surgical reconstruction of the nose ◦ Nasal gauze packing ◦ Nasal splint ◦ Mustache dressing ◦ Observe for:  Frequent swallowing  Change in vital signs  Semi-Fowler’s position  Cool compresses  NO to NSAIDS, ASPIRIN, COUGHING, STRAINING  YES to humidifier

21. Respiratory Nursing Cancer of the Larynx ◦ Cause ??  Cigarette smoking  Alcohol abuse  Spicy foods  Infection with human papilloma virus  Chronic laryngitis  Abuse of vocal cords  Radiation exposure  Familiar tendency to cancer  Environmental pollutants

22. Respiratory Nursing Cancer of Larynx ◦ Squamous cell carcinoma grows from the mucous lining of the respiratory tract ◦ Metastasis may occur to lung ◦ Early detection is key for full recovery

23. Respiratory Nursing Cancer of Larynx Signs & Symptoms ◦ Lasting hoarseness ◦ Lasting sore throat ◦ Consistent pain in or around the ears when swallowing ◦ Difficulty swallowing ◦ Dry, persistent cough for no reason ◦ Blood in phlegm or saliva ◦ Lumps or knots on the neck

24. Respiratory Nursing As disease progresses: ◦ Difficulty breathing ◦ Halitosis ◦ Hemopytosis ◦ Fatigue and weakness ◦ Pain near Aham’s apple ◦ Airway obstruction

25. Respiratory Nursing Diagnosis of Larynx Cancer ◦ Visualization with a scope ◦ CT scan ◦ MRI ◦ Tissue biopsy

26. Respiratory Nursing Treatment of Laryngeal Cancer ◦ Typing and staging of the cancer ◦ Outpatient radiation  Combined with laser cordectomy  Brachy-therapy with external beam irradiation  Partial laryngectomy  Microlaryngocopy combined with laser  90% cure rate  No mechanical trauma or swelling with laser  Minimal recovery  Minimal voice rest  Total laryngectomy

27. Respiratory Nursing Treatment of Laryngeal Cancer ◦ Total laryngectomy when vocal cords are paralyzed  Excise entire larynx, epiglottis, thyroid cartilage, hyoid bone, cricord cartilage and rings of the trachea ◦ Near-total laryngectomy preserves voice production and swallowing in advanced disease

28. Airways

29. Parts of trachs