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Nursing Management: Patients With Upper Respiratory Tract Disorders
Chapter 9 Nursing Management: Patients With Upper Respiratory Tract Disorders
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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
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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 ???
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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.
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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
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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
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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.
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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
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Question Is the following statement true or false?
The most important measure for preventing the spread of URIs is the administration of prophylactic antibiotics.
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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.
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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.
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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.
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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
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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.
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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
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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
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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.
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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.
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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.
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Artificial Airways Endotracheal tube (ETT)
Intubation procedure- through the mouth or nose into the trachea Tracheostomy Procedure opening in trachea
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Endotracheal Tube
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Types of Tracheostomy Tubes
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