1. Care of Patients with Noninfectious Upper Respiratory Problems
Chapter 31
Care of Patients with Noninfectious Upper Respiratory Problems
Mrs. Marion Kreisel MSN, RN
NU230 Adult Health 2
Fall 2011

2. Anatomy

3. Anatomy and Function of the Larynx

4. Fracture of the Nose
Displacement of either the bone or cartilage of the nose can cause airway obstruction or cosmetic deformity and is a potential source of infection.
Cerebrospinal fluid could indicate skull fracture.
Interventions: Post op HOB elevated to decrease swelling and dyspnea
Closed reduction
Rhinoplasty:
Nasoseptoplasty

5. Rhinoplasty

6. Epistaxis Nosebleed is a common problem.
Interventions if nosebleed does not respond to emergency care:
Affected capillaries are cauterized with silver nitrate or electrocautery, and the nose is packed.
Posterior nasal bleeding is an emergency. Especially Post op from a Rhinoplasty. Excessive swallowing is seen in the patient. Keep HOB elevated at least 48 hours to decrease swelling

7. Epistaxis (Cont’d)
Assess for respiratory distress and for tolerance of packing or tubes.
Administer humidification, oxygen, bedrest, antibiotics, pain medications.
S&P

8. Nasal Polyps
Benign, grapelike clusters of mucous membranes and connective tissue
May obstruct nasal breathing, change character of nasal discharge, and change speech quality
Surgery—treatment of choice is polypectomy

9. Nasal Polyps (Cont’d)

10. Cancer of the Nose and Sinuses
Tumors of the nose and sinuses is rare and can be benign or malignant.
Onset is slow, and manifestations resemble sinusitis.
Local lymph enlargement often occurs on the side with tumor mass.
Radiation therapy is the main treatment; surgery is also used. 80% cure rate

11. Facial Trauma: Interventions
Airway assessment
Anticipate need for emergency intubation
Tracheotomy
Cricothyroidotomy
Fixed occlusion
Débridement
Clear fluid draining from one of the nares, testing positive for glucose

12. Obstructive Sleep Apnea
Breathing disruption during sleep that lasts at least 10 seconds and occurs a minimum of five times in an hour
Excessive daytime sleepiness, inability to concentrate, and irritability
Nonsurgical management—change of sleep position, weight loss, positive-pressure ventilation
Surgical management—adenoidectomy, uvulectomy or uvulopalatopharyngoplasty

13. Positive Airway Pressure

14. Disorders of the Larynx
Vocal cord paralysis
Vocal cord nodules and polyps
Laryngeal trauma
Laryngitis: GERD common cause

15. Upper Airway Obstruction
Life-threatening emergency in which an interruption in airflow through the nose, mouth, pharynx, or larynx occurs.
Early recognition is essential to prevent further complications, including respiratory arrest.

16. Upper Airway Obstruction: Interventions
Interventions include:
Assessment for cause of the obstruction
Maintenance of patent airway and ventilation:
Cricothyroidotomy
Endotracheal intubation, nasotracheal or orotracheal
Tracheostomy

17. Neck Trauma
Neck trauma may be caused by a knife, gunshot, or traumatic accident.
The priority nursing care for a patient with neck trauma is assessing for and maintaining a patent airway.
Assess for other injuries including cardiovascular, respiratory, intestinal, and neurologic damage.
Assess carotid artery and esophagus.
Assess for cervical spine injuries, and prevent excess neck movement.

18. Head and Neck Cancer History Phonation Psychosocial assessment
Laboratory assessment
Imaging assessment
Other diagnostic assessment

19. Head and Neck Cancer: Interventions
Radiation therapy: Voice will improve within 4 to 6 weeks of completing radiation therapy; this is an expected side effect.
Chemotherapy
Cordectomy
Laryngectomy: Preop teaching very important that patient will never speak normally again!

20. Throat After Laryngectomy
Aspiration cannot occur after a total laryngectomy because the airway and esophagus have been completely separated.

21. Laryngectomy: Postoperative Care
The first priorities after head and neck surgery are airway maintenance and ventilation
Wound, flap, and reconstructive tissue care
Hemorrhage
Wound breakdown
Pain management
Nutrition
Speech and language rehabilitation

22. Communication After Laryngectomy
Esophageal speech

23. Community-Based Care Home care management Health teaching: Stoma care
Communication
Smoking cessation
Psychosocial preparation
Health care resources

24. NCLEX TIME

25. Question 1
What is the percentage of cure rate for radiation treatment of small cancers in specific locations?
30% to 50%
At least 55%
40% to 60%
At least 80%
Answer: D
Rationale: Radiation treatment of small cancers in specific locations has a cure rate of at least 80%.

26. Question 2
A patient has been admitted to the emergency department after experiencing a fall while rock climbing. He appears to have several facial fractures. Which
assessment finding, if observed, is most serious?
Malaligned nasal bridge
Clear fluid draining from one of the nares, testing positive for glucose
Clear fluid draining from one of the nares, testing negative for glucose
Crackling of the skin (crepitus) upon palpation
Answer: B
Rationale: A malaligned nasal bridge and crepitus may be observed when evaluating general facial fractures. Blood or clear fluid (cerebrospinal fluid, or CSF) may drain from one or both nares. The presence of CSF draining could indicate a skull fracture. The presence of glucose in the clear drainage indicates the presence of CSF.

27. Question 3
During recovery from a rhinoplasty, the nurse observes that the patient is swallowing repeatedly. This outcome may indicate:
Dry mouth because of medications
Oversecretion from the salivary glands
Posterior nasal bleeding
Edema of the surgical site
Answer: C
Rationale: After a rhinoplasty, repeated swallowing may indicate posterior nasal bleeding. Notify the surgeon if bleeding is present.

28. Question 4
The patient receiving radiation therapy for treatment of head and neck cancer is considering stopping the treatments because the hoarseness of his voice has actually worsened. The nurse should explain that the:
Voice will improve within 4 to 6 weeks of completing radiation therapy; this is an expected side effect.
Hoarseness will improve if the radiation absorbed dose is decreased from 5000 to 4000 rad;
Hoarseness will improve if the treatments are decreased from daily to three times per week; this is an adverse reaction.
Voice will improve within 12 to 15 weeks of completing radiation therapy; this is an expected side effect.
Answer: A
Rationale: Hoarseness is not an adverse reaction. It may become worse with this type of radiation therapy. Reassure the patient and family that the voice improves within 4 to 6 weeks after completion of radiation therapy.

29. Question 5
True or False: Aspiration is still possible after a total laryngectomy.
True
False
Answer: B (False)
Rationale: Aspiration cannot occur after a total laryngectomy because the airway and esophagus have been completely separated.