1. Respiratory Disorders

2. Upper Respiratory Disorders

3. Allergic rhinitis
Inflammatory disorder of nasal mucosa, characterized by pruritus, sneezing, rhinorrhoea and nasal congestion.
Adversely affects social life, school performance, and work productivity; especially in patients with severe disease
Loss of productivity, missed school and work days, and direct costs associated with treatment create substantial costs to society.

4. An Allergic Reaction

5. Rhinitis Clinical Manifestations: Sneezing Watery itchy eyes and nose
Altered sense of smell
Thin, watery nasal discharge
Nasal polyps and postnasal drip are most common causes of cough.

6. Nursing Care Patient teaching related to Allergens to Avoid
Medications:
Corticosteroid nasal spray
Mast cell nasal spray
Leukotriene Receptor Antagonists and Inhibitors
Anticholinergic nasal spray
Decongestants

7. Is it a Cold or the Flu runny or stuffy nose sore throat sneezing
Common Cold
Flu
dry, hacking cough
moderate to high fever, although not everyone with the flu will run a fever
sore throat
shaking chills
severe muscle or body aches
headache
stuffy and runny nose
severe fatigue that may last up to two weeks
nausea and vomiting
Symptoms come on quickly and can be severe. They usually last 1 to 2 weeks  
runny or stuffy nose
sore throat
sneezing
cough
headache or body aches
mild tiredness
come on gradually over a few days and are often milder than the flu. They usually get better in 7 to 10 days, although symptoms can last for up to 2 weeks..

8. Nursing Care - Cold
Because it is a viral infection, antibiotics are not effective at treating a cold.
May use over-the-counter medications such as:
Antihistamines
Decongestants
Acetaminophen and NSAIDs
Drink plenty of fluids to avoid dehydration.
Some people take natural remedies, such as zinc, vitamin C, or echinacea, to prevent or relieve cold symptoms. The evidence is mixed on whether they work.

9. Nursing Care - Flu Antiviral drugs oseltamivir (Tamiflu)
zanamivir (Relenza)
peramivir (Rapivab)
These drugs can shorten the duration of the flu and prevent complications such as pneumonia. However, they must be taken within the first 48 hours of getting sick for them to work.
Fluids
Rest
Analgesics

10. What is an important Preventive measure against the Flu?

11. Sinusitis – Clinical Manifestations
Thick, discolored discharge from the nose or drainage down the back of the throat (postnasal drainage)
Nasal obstruction or congestion, causing difficulty breathing through the nose
Pain, tenderness and swelling around the eyes, cheeks, nose or forehead
Reduced sense of smell and taste
Other Clinical Manifestations:
Ear pain
Aching in the upper jaw and teeth
Cough that might worsen at night
Sore throat
Bad breath (halitosis)
Fatigue or irritability
Nausea

12. Sinusitis Diagnosis
Nasal endoscopy. A thin, flexible tube (endoscope) with a fiber-optic light is inserted through the nose allowing the HCP to see the inside of the sinuses. This also is known as rhinoscopy.
Imaging studies. Images taken using a CT scan or MRI can show details of sinuses and nasal area. These might pinpoint a deep inflammation or physical obstruction that's difficult to detect using an endoscope.
Nasal and sinus cultures. Cultures are generally unnecessary for diagnosing chronic sinusitis. However, when the condition fails to respond to treatment or is worsening, tissue cultures might help determine the cause, such as bacteria or fungi.
An allergy test. Done if the HCP suspects that the condition might be triggered by allergies.

13. Sinusitis - Treatment
Nasal irrigation, with nasal sprays or solutions, reduces drainage and rinses away irritants and allergies.
Nasal corticosteroids. These nasal sprays help prevent and treat inflammation. Examples include fluticasone (Flonase, Veramyst), triamcinolone (Nasacort 24), budesonide (Rhinocort), mometasone (Nasonex) and beclomethasone (Beconase AQ, Qnasl, others).
Oral or injected corticosteroids. These medications are used to relieve inflammation from severe sinusitis. Only used only to treat severe symptoms.
Antibiotics - sometimes necessary for a bacterial infection.

14. Sinusitis - Treatment Surgery
Endoscopic sinus surgery – using a thin, flexible tube with an attached light (endoscope), the HCP explores the sinus passages.

15. Obstructive Sleep Apnea
Also called obstructive sleep apnea-hypopnea syndrome (OSAHS)
Partial or complete upper airway obstruction during sleep
Apneic period may include hypoxemia and hypercapnia
Copyright © 2017, Elsevier Inc. All Rights Reserved.

16. How Sleep Apnea Occurs How sleep apnea occurs:
The patient predisposed to obstructive sleep apnea (OSA) has a small pharyngeal airway.
During sleep, the pharyngeal muscles relax, allowing the airway to close. Lack of airflow results in repeated apneic episodes.
Continuous positive airway pressure (CPAP) splints the airway open, preventing airflow obstruction.
Copyright © 2017, Elsevier Inc. All Rights Reserved.

17. Obstructive Sleep Apnea
Clinical manifestations
Frequent arousals during sleep
Insomnia
Excessive daytime sleepiness
Witnessed apneic episodes
Snoring
Morning headache
Irritability
Copyright © 2017, Elsevier Inc. All Rights Reserved.

18. Obstructive Sleep Apnea
Complications can result in
Hypertension
Cardiac changes
Poor concentration/memory
Impotence
Depression
Diagnosis is based on PSG
Copyright © 2017, Elsevier Inc. All Rights Reserved.

19. Sleep Apnea Nursing and Interprofessional Mgmt
Mild Sleep Apnea
Sleeping on one’s side
Elevating head of bed
Avoiding sedatives and alcohol 3 to 4 hours before sleep
Weight loss
Oral appliance
Copyright © 2017, Elsevier Inc. All Rights Reserved.

20. Sleep Apnea Nursing and Interprofessional Mgmt
Severe Sleep Apnea (>15 apnea/hypopnea events/hr)
CPAP
Poor compliance
BiPAP
Surgery
Uvulopalatopharyngoplasty (UPPP or UP3)
Genioglossal advancement and hyoid myotomy (GAHM)
Copyright © 2017, Elsevier Inc. All Rights Reserved.

21. Devices for Sleep Apnea
Examples of positive airway pressure devices for sleep apnea.
Patient wearing a nasal mask and headgear (positive pressure only through nose).
Patient wearing nasal pillows (positive pressure only through nose).
Patient wearing a full face mask (positive pressure to nose and mouth).

22. CPAP With Nasal Mask
Management of sleep apnea often involves sleeping with a nasal mask in place. The pressure supplied by air coming from the compressor opens the oropharynx and nasopharynx.
Copyright © 2017, Elsevier Inc. All Rights Reserved.

23. Head and Neck Cancer Incidence Risk Factors Tobacco Plus alcohol HPV
Diet poor in fruits and vegetables
Men 2-5x more than women

24. Head and Neck Cancer Symptoms
Occur in people over 50 years who have a history of tobacco and alcohol use
Cancer of mouth can be a painless growth, leukoplakia or erythroplakia in the mouth, an ulcer that does not heal or a change in fit of dentures.
May have persistent unilateral sore throat, otalgia or a lump in the throat.
Swelling or lumps in the neck.
Coughing up blood
Late symptoms:
Difficulty chewing and swallowing.
Difficulty moving the tongue or jaw.
Difficulty breathing.

25. Head and Neck Cancer Diagnostics
Good oral exam.
Biopsy leukoplakia and erythroplakia or other lesions.
Nasopharyngoscope to examine the larynx.
CT or MRI
TNM staging I-IV

26. Head and Neck Cancer Treatment Options
Radiation therapy
External beam therapy
Brachytherapy

27. Head and Neck Cancer Treatment Options
Surgery
Radical Neck Dissection
Advanced lesions
Removes the entire larynx, and pre-epiglottic region
Permanent trach
Other areas involved may require removal
Modified Neck Dissection
Chemotherapy
Targeted therapy
Combination therapy

28. Head and Neck Cancer Nutrition
50 % patients - malnourished before treatment.
Treatment can increase malnutrition in the patient
Radical neck surgery
Chemotherapy side effects
Painful oral mucositis
Management of malnutrition
Enteral nutrition pre and post treatment
Antiemetics/analgesics before meals
Bland food
Add calories

29. Head and Neck Cancer Nursing Implementation
Prepare patient in advance for expectations.
Radiation Therapy
Xerostomia
Oral mucositis
Fatigue
Surgical Therapy
Educate in advance of anticipated changes
Tailor to planned procedure
Immediately after surgery
Airway, wound care, nutrition, communication, psychosocial issues
Monitor for respiratory compromise and hemorrhage

30. Head and Neck Cancer Discuss tobacco cessation
Keep airway patent - key
Nursing focus: swallowing, communication, and aspiration
Keep head elevated while eating or drinking
Stomatitis is common when radiation is used. Rinse frequently with water and avoid spicy foods.
Discuss alternative ways to communicate. Vocal rehabilitation may be necessary.