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

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

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

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

Common Cold Dx exams & Procedures S&S Culture

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

Common Cold Medications Antihistamines Action H1 blockers  inhibits action X push off  Take early Allergies

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

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

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

Common Cold Medications Decongestants Examples Sudafed Vicks inhaler Afrin

Common Cold Medications Anti-tussives Rx Action Side effects Example

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

Common Cold Medications Vitamin C

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

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

Common Cold Medications Echinacea Action Use Long tem use Stim. immune system Anti-bacterial Anti-inflammatory Use 10-14 days Long tem use i immune system

How do you prevent the cold from getting you? 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

Common Cold Complications Bronchitis Pneumonia Conjunctivitis

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

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

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

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

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

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

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

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

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

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

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

Acute Pharyngitis Etiology 70% Viral Bacterial Streptococcus

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

Acute Pharyngitis Dx exams Throat culture Rapid screening

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

Acute Pharyngitis - Nrs Rest Rashes? Communicable disease Warm saline gargles Temp 105-110 F Diet Liquid Fluids h Ice collar Oral care

Acute Pharyngitis Complications Sinusitis Ottis media Peritonsillar abscess Scarlet fever Rheumatic Fever 2-3 wk /p subsides Heart damage Mital valve damage Scarlet fever is an exotoxin-mediated disease caused by Group A streptococcal infection that occurs most often in association with a sore throat and rarely with impetigo or other streptococcal infections. It is characterized by sore throats, fever and a rash over the upper body that may spread to cover almost the entire body. Scarlet fever is not rheumatic fever, but may progress into that condition as the infection develops (rheumatic fever is the autoimmune disease that occurs after infection with Group A strep).

Tonsillitis & Adenoiditis Pathophysiology Tonsils Location Oropharynx Lymph tissue Adenoids Nasopharynx

Tonsillitis & Adenoiditis Etiology Streptococcus Low resistance Children

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

Tonsillitis & Adenoiditis - Dx Visualize C&S Mono

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

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

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

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

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

Peritonsillar Abscess Pain Local Radiates  ear Dysphagia drooling Dysphasia Fever Red throat

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

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

Laryngitis Etiology Viral Voice abuse Dust

Laryngitis Risk factors Airborne irritants Cold Resent RTI Smoking

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

Laryngitis Treatment Voice rest Bed rest Smoking? Humidifier Fluids? NO! Humidifier Fluids? h Expectorants

Laryngitis Prevention Avoid… Irritants Cold Voice strain Smoking

Epistaxis Pathophysiology Tiny blood vessels in nose rupture

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

Epistaxis Etiology Irritation Infection Drugs Humidity Trauma Hypertension Blood dyscrasias

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

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

Epistaxis Nrs Management V/S Control bleeding P Hgb level P PT/PTT Take BP meds X aspirin X vigorous blowing X strenuous exercise

Epistaxis Complications?

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

Nasal Polyps Etiology Recur Triad disease Polyps Asthma Allergy to aspirin

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

Nasal Obstruction Clinical Manifestations Foul odor Halitosis Malodorous Halitosis h allergies Noisy breathing h post-nasal drip

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

Nose surgery Submucous resection: Nasoseptoplasty: Rhinoplasty: Polypectomy:

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

Nasal Obstructions Complications Chronic infections of the nose Anosmia Pharyngitits Sinusitis

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

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

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

Fracture of the Nose Nrs Management #1 Assess breathing Ice Pack Mouth breathing Dry X adjust Pain med Acetaminophen Trauma  P neck injury

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

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

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

Laryngeal Obstruction Prevention Avoid Epi-pen Complication Death

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

Sleep Apnea Duration of apnea 15-90 seconds Sever hypoemia Hypercapnia PaO2  i Hypercapnia PaCO2 h

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

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

Sleep Apnea Tx Mild Avoid Sedatives Alcohol Wt loss Oral appliance

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

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

CA of the larynx Pathophysiology Squamous cells Metastasis Lung Liver Lymphs

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

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

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

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

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

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

CA of the larynx Nrs management Assess Hoarseness Pain Dyspnea Dysphagia Palpate neck Diet h protein

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

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

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