1. Nursing Management: Patients With Upper Respiratory Tract Disorders
Chapter 9
Nursing Management: Patients With Upper Respiratory Tract Disorders

2. URI Most common cause of illness and affect most people on occasion.
Many causative organisms
Symptoms last several day, chronic symptoms will last longer
Seldom require hospitalizations
Affect nasal cavity, sinuses frontal and maxillary, larynx and trachea
90 % Viral infection and mucous inflammation

3. Rhinitis Most common cause of nonallergic rhinitis is the common cold
Patho- RSV, influenza, drug induced interactions- HTN, oral contraceptives, chronic use of nasal decongestants (rhinitis medicamentosa).
Risk factors- cold temperatures, exposure to cold, rainy weather does not increase the incidence or severity of the “cold”
Manifestations- rhinorrhea, nasal congestion, sneezing, pruritus of the nose, pharynx, headache, sore throat, fever, chills, muscle aches,
Management-symptomatic therapy, tylenol or NSAIDS to releive pain and aches, antihistamines, decongestants, antitussives, and expectorants. Herbs, echinacea- humidified air,
NO ANTIBIOTICS ???

4. Rhinosinusitis
Inflammatory process of the sinuses and nasal cavities, acute or chronic, and viral or bacterial
Patho- usually follows URI or cold, prolonged inflammation, may last longer then 3 months. Bacterial 60% of the time, s. pneumoniae, H. influenzae, staphylococs aureus, Moraxella catarrhalis.
Risk factors- environment exposure, paint, sawdust, deviated septum or hypertrophied turbinates or polyps
Manifestations and complications- ABRS nasal drainage with facial pain, pressure, or sense of fullness, cough, hoarseness, lasting longer then 10 days
Management- adequate hydration, steam inhalation, saline irrigation, avoid carcinogens, decongestants, oral decongestants and antibiotics if indicated.

5. Upper Airway Infections
Pharyngitis- GABHS, GAS, inflammation of the pharynx, chronic cough, habitually use alcohol and tobacco risks. Fiery- red pharynx, flecked with white-purple exudate, enlarged lymphnodes, may have N/V, anorexia and scarlatina-form rash. Treat with supportive measures, ABX if indicated.
Laryngitis- Inflammation of the larynx- usually r/t voice abuse or exposure to pollutant, may be associated with GERD. s/s include hoarseness or aphonia, and sever cough, dry sore throat, “tickle” in the throat. Resting the voice, avoid irritants

6. Question
A nursing student is caring for a patient with viral pharyngitis. What principle should the student integrate into the patient’s care plan?
Teaching should include the importance of taking all the antibiotics prescribed
Teaching should emphasize the need for temporary fluid restriction
The focus of nursing care will be symptom management
The focus of care will be resting the patient’s voice

7. Answer C. The focus of nursing care will be symptom management
Rationale: Viral pharyngitis is treated with supportive measures. Antibiotics will have no effect on the organism. Fluid restriction and resting the voice are not necessary measures.

8. Nursing Care of Patients With Upper Airway Infections
Assessment: Includes history, inspection, and palpation
Major goals include:
Maintenance of a patent airway
Pain relief
Maintenance of effective communication
Hydration
Knowledge of how to prevent upper airway infections
Absence of complications

9. Question Is the following statement true or false?
The most important measure for preventing the spread of URIs is the administration of prophylactic antibiotics.

10. Answer
False
Rationale: Most URIs have a viral etiology. Even in the management of those caused by bacteria, prophylactic antibiotics are not normally used to prevent spread.

11. Obstructive Sleep Apnea (OSA)
Pathophysiology- recurrent episodes of upper airway obstruction and reduction in ventilation.
Risk factors-HTN, older, obesity, enlarged tonsils
Manifestations- frequent and loud snoring, with breathing cessation for 10 seconds or longer, dx w/ sleep study
Management- weight loss and avoid alcohol and hypnotic medications, oral appliances to reposition mandible or tongue
Continuous positive airway pressure (CPAP) keeps the upper airway and trachea open during sleep.
Bilevel positive airway pressure (BiPAP) via nasal mask or oral mask
Surgery- tonsillectomy, or surgical resection of pharyngeal soft tissue and uvula. Reserved for higher acuity
Medications-modafinil (Provigil) reduce daytime sleepiness, Protriptyline (Triptil) HS increase resp drive, and improve upper airway muscle tone.

12. Upper Airway Trauma
Epistaxis- direct pressure, pt upright head tilted forward, cotton applicators soaked in vasoconstriciting solution may reduce blood flow, packing, silver nitrate, usually anterior bleed.
Nasal obstruction- deviated septum, nasal polyps, removal of obstruction, nasal corticosteroids
Fractures of the nose-pain, bleeding, swelling of tissue, analgesic agents, use of ice, and ENT follow up.
Laryngeal obstruction- most common cause edema of the glottis, anaphylaxis, inhalation/ingestion of FB, hx of surgery, or previous tracheostomy.

13. Question
An obese man arrives in a clinic with complaints of excessive daytime sleepiness and frequent, loud snoring. What is the patient most likely exhibiting manifestations of?
Rhinosinusitis
Chronic nasal obstruction
Obstructive sleep apnea

14. Answer C. Obstructive sleep apnea
Rationale: OSA is often accompanied by daytime fatigue and loud snoring. Obesity is a major risk factor for the disease. Nasal obstructions and rhinosinusitis do not have this clinical presentation.

15. Cancer of the Larynx
SCC malignant tumor around the larynx (voice box) usually carcinogen associated
Risk factors- men age 60-70, african american
Manifestations- Hoarseness more than 2 weeks, voice sounds harsh, raspy and lower in pitch, dysphagia, and dyspnea common later symptoms
Treatment:
Surgery (laryngectomy)
Radiation therapy

16. Nursing Management of the Patient With Laryngeal Cancer
Preoperative teaching
Reducing anxiety and depression
Maintaining a patent airway
Promoting alternative communication methods
Promoting adequate nutrition and hydration
Promoting positive body image and self-esteem
Promoting self-care

17. Managing Potential Complications of Laryngectomy
Respiratory distress and hypoxia
Hemorrhage
Infection
Wound breakdown
Aspiration
Tracheostomal stenosis- abnormal narrowing of the trachea or the tracheostomy stoma.

18. Question Is the following statement true or false?
The highest priority in the care of a patient who has undergone a laryngectomy is establishing and maintaining the patency of the patient’s airway.

19. Answer
True
Rationale: The establishment and maintenance of a patent airway is a priority. This is true not only of patients with a laryngectomy but of all individuals.

20. Artificial Airways Endotracheal tube (ETT)
Intubation procedure- through the mouth or nose into the trachea
Tracheostomy
Procedure opening in trachea

21. Endotracheal Tube

22. Types of Tracheostomy Tubes