Transcript Learning Outcomes

Caring for Patients With Upper Respiratory Disorders
Learning Outcomes
1.
Describe common disorders affecting the upper respiratory tract,
their manifestations, and potential impact on the patient.
2.
Safely administer medications and treatments ordered for patients
with upper respiratory disorders.
Learning Outcomes
3.
Plan and provide appropriate individualized nursing care for patients
with upper respiratory disorders, showing consideration for
expressed values, preferences, and needs.
4.
Use technology to identify evidence-based guidelines and document
care for patients with upper respiratory system disorders.
Learning Outcomes
5.
Provide evidence-based teaching and instructions to ensure
continuity of care for patients with upper respiratory system
disorders.
Upper Respiratory Infections
and Inflammations
Most self-limiting
In long-term care facilities can spread rapidly
◦ Control spread
Risk for serious problems in older adults
Pathophysiology and
Manifestations
Rhinitis
◦ Inflammation of nasal cavities
◦ Types
◦ Acute viral rhinitis
◦ Allergic rhinitis
Pathophysiology and
Manifestations
Respiratory syncytial virus
◦ Common virus among infants and young children
◦ Usually mild "cold" in adults, unless immunocompromised
◦ Older adults may present with pneumonia.
Pathophysiology and
Manifestations
Influenza
◦ Contagious viral respiratory disease
◦ Mode of transmission
◦ Airborne droplet
◦ Direct contact
TABLE 22-1 Manifestations and
Course of Rhinitis and Influenza
Pathophysiology and
Manifestations
Sinusitis
◦ Inflammation of mucous membranes of sinuses
◦ Usually caused by bacterial infection
◦ Usually follows URI
Pathophysiology and
Manifestations
Pharyngitis and tonsilitis
◦ Acute inflammation of the throat
◦ Usually viral but may be bacterial
◦ Group A beta-hemolytic Streptococcus (strep throat) most common cause of
bacterial form
Pathophysiology and
Manifestations
Pharyngitis and tonsilitis
◦ Tonsillitis
◦ Acute inflammation of the tonsils
◦ May be caused by streptococcal infection
◦ Infectious, may be spread by droplet nuclei
◦ Dysphagia
◦ Difficulty swallowing
Pathophysiology and
Manifestations
Epiglottitis
◦ Medical emergency
◦ Monitor for signs of respiratory distress
◦ Nasal flaring
◦ Restlessness
◦ Stridor
◦ Use of accessory muscles
◦ Oxygen saturation
Pathophysiology and
Manifestations
Epiglottitis
◦ Don't insert nasal or oral airway
◦ May cause spasm and airway obstruction
◦ Nasotracheal intubation may be necessary.
Pathophysiology and
Manifestations
Laryngitis
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Inflammation of larynx
Change in voice
Sore, scratchy throat
Dry, harsh cough
Collaborative Care
Diagnostic tests
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Throat swab
CBC
Chest x-ray
Nasal swab
CT scan
Collaborative Care
Medications
◦ Influenza
◦ Yearly immunization
◦ Bacterial infections
◦ Antibiotic treatment
◦ Use for up to 10 days
◦ Patient no longer contagious after 24 hours of antibiotic therapy
◦ Used up to 2 weeks for sinusitis
Collaborative Care
Medications
◦ Rhinitis
◦ Decongestants
◦ Antihistamines
◦ Topical nasal steroids
◦ Inhaled steroids
Collaborative Care
Medications
◦ Sore throat
◦ Warm saltwater gargles
◦ Throat lozenges
◦ Mild analgesics
◦ Cough
◦ Antitussives
◦ Systemic mucolytic agents (guaifenesin)
Collaborative Care
Complementary therapies
◦ Herbal remedies
◦ Aromatherapy
Surgical interventions
◦ Irrigation
◦ Endoscopic sinus surgery
◦ Tonsillectomy
Nursing Care
Prioritizing nursing care
◦ Maintain airway, breathing, rest
Health promotion
◦ Frequent hand washing
◦ Warn of antibiotic misuse
Nursing Care
Assessing
◦ Determine effect of URI on patient's life
◦ Identify risk factors for complications
◦ Determine whether problem will require medical treatment or self-care
appropriate
Identifying potential complications
◦ High or continuing fever
◦ Change in mental status, hearing
Nursing Care
Diagnosing, planning, and implementing
◦ Ineffective breathing pattern
◦ Monitor respiratory rate and pattern
◦ Auscultate lungs
◦ Pace activities
◦ Elevate head of bed
Nursing Care
Diagnosing, planning, and implementing
◦ Ineffective airway clearance
◦ Monitor effectiveness of cough
◦ Note whether cough is productive or nonproductive
◦ Auscultate lungs
Nursing Care
Diagnosing, planning, and implementing
◦ Disturbed sleep pattern
◦ Assess sleep pattern
◦ Place in semi-Fowler's or Fowler's position
◦ Provide antipyretics and analgesics
◦ Cough suppressant at night
Nursing Care
Diagnosing, planning, and implementing
◦ Impaired verbal communication
◦ Encourage patient to rest voice.
◦ Use alternative method to communicate, such as a writing pad.
◦ Comfort measures
◦ Lozenges, gargle, or sprays
◦ Encourage patient to quit smoking.
Nursing Care
Managing nursing care
◦ Reminding patient to cough, deep breathe.
Evaluating
◦ Ability to manage symptoms
Documenting
◦ Assessments, understanding of teaching
Nursing Care
Continuity of care
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Encourage rest
Adequate hydration
Hand washing after coughing
Avoid exposure to crowds
Avoid physical or psychologic stress
Prevention for influenza
◦ Vaccine for high-risk groups
Nursing Care
Continuity of care
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Discuss OTC medications for relief of symptoms
Assist patient to identify possible allergens for allergic rhinitis
Stress importance of completing entire course if on antibiotics
Teach complications of influenza and URIs
Pertussis
Whooping cough
Acute, highly contagious
Pathophysiology and
Manifestations
Infection with Bordetella pertussis
Symptoms of URI 7–10 days after exposure
◦ Followed by disruptive cough that may end with audible whoop
Adults may present with simple, prolonged cough or typical pattern.
Collaborative Care
Nasopharyngeal secretions culture
Blood tests for antibodies
Prevention
◦ Immunization
Erythromycin
◦ Traditional antibiotic of choice
Nursing Care
Education
Respiratory isolation measures
◦ Prophylactic antibiotic therapy for all household contacts
Reportable disease
Upper Respiratory Trauma or Obstruction
Epistaxis
Nosebleed
May be caused by:
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Trauma
Drying of membranes
Infection
Substance abuse
Pathophysiology and
Manifestations
Ninety percent arise from vascular area in anterior nasal septum
Posterior nosebleed
◦ Hypertension
◦ Diabetes
Collaborative Care
Pinch toward septum for 5–10 minutes
Instruct patient to spit out blood
If pressure doesn't control bleeding, further interventions may be
necessary.
Medications and nasal packing
◦ Topical vasoconstrictors
◦ Anterior packing left in place 24–72 hours
Collaborative Care
Medications and nasal packing
◦ Posterior packing left in place up to 5 days
◦ Uncomfortable
◦ Supplemental oxygen given with posterior packing
Surgery
◦ Cautery procedures
◦ Scab must be left undisturbed.
Nursing Care
Prioritizing nursing care
◦ Reduce anxiety and maintain airway
Health promotion
◦ Reduce incidence
◦ Management of simple nosebleeds
Assessing
◦ Simultaneous with implementing interventions
Nursing Care
Diagnosing, planning, and implementing
◦ Anxiety
◦ Risk for aspiration
Evaluating
◦ Additional bleeding
Documenting
◦ Time, measures required to control bleeding
Nursing Care
Continuity of care
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Avoid strenuous exercise for days or weeks
Do not blow the nose forcefully
No heavy lifting
Sneeze with mouth open
Lubricate nares with petroleum jelly or bacitracin.
Use humidifier
Nasal Polyps
Benign growths on mucous lining inside nose
Usually bilateral
May be asymptomatic or resolve spontaneously
Large polyps may cause obstruction, rhinorrhea, loss of smell
Nasal Polyps
Treatment
◦ Topical corticosteroid nasal sprays
◦ Surgery
◦ Polypectomy
Nursing Care
Postoperative care instructions
◦ Measures to reduce risk of bleeding
◦ Ice, cold compresses
◦ Avoid blowing nose for 24–48 hours after removal of packing.
◦ Avoid straining, coughing, strenuous exercise.
◦ Manifestations and possible bleeding
Nasal Trauma or Deviated
Septum
Fracture (broken nose)
Most commonly broken bone of the face
Pathophysiology and
Manifestations
One or both sides of nose
Swelling can obstruct airway.
Soft tissue damage nearly always accompanies nasal fracture.
Deviated nasal septum
◦ Septal cartilage bulges to one side
Collaborative Care
Maintain patent airway and prevent deformity.
If CSF leak suspected, CT scan performed
More complex fractures may need surgery.
Collaborative Care
Rhinoplasty
◦ Surgical reconstruction of the nose
Septoplasty or submucosal resection (SMR)
◦ Corrects deviation
Nursing Care
Nursing care
◦ Airway management
◦ Control of bleeding, pain and swelling
Health promotion
◦ Provide necessary teaching
Assessing
◦ Pain, swelling, bleeding, difficulty breathing, deformities, ecchymosis and
crepitus
Nursing Care
Diagnosing, planning, and implementing
◦ Ineffective airway clearance
◦ Risk for infection
Evaluating
◦ Position of septum, appearance of nose
Documenting
◦ Instructions for follow-up
Nursing Care
Continuity of care
◦ Ice packs for 20 minutes 4 times/day
◦ Elevate head of bed
◦ Patient with CSF leak
◦ Rest with head elevated and monitor for infection
Laryngeal Obstruction or
Trauma
Life-threatening emergency
Narrowest part of upper airway
Partial or full obstruction
Pathophysiology and
Manifestations
Obstruction can be caused by:
◦ Laryngospasm
◦ Muscles of the larynx
◦ Laryngeal edema
◦ Aspirated food or foreign object
◦ Trauma to larynx
Pathophysiology and
Manifestations
Manifestations
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Coughing
Choking
Gagging
Difficulty breathing
Use of accessory muscles
Stridor
Pathophysiology and
Manifestations
Manifestations
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Swelling impairs airway
Subcutaneous emphysema
Change in voice
Dysphagia
Stridor
Hemoptysis
Cough
Collaborative Care
X-rays, diagnostic tests, or ultrasound to locate obstruction
Insertion of endotracheal tube
For laryngeal edema due to anaphylaxis, epinephrine given
Nursing Care
Closely monitor patients at risk for laryngeal obstruction.
Suction airway.
Be prepared for endotracheal intubation or tracheotomy.
Be prepared to initiate CPR.
Teach prevention.
Obstructive Sleep Apnea
Temporary absence of breathing during sleep
Risk factors
◦ Obesity
◦ Large neck
◦ Use of alcohol or sedatives
Pathophysiology and
Manifestations
Upper airway obstructed as muscles relax
Collapse during inspiration
Fall in oxygen saturation
Leads to fragmented sleep and disruption of normal sleep cycles
Pathophysiology and
Manifestations
Manifestations
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Loud snoring
Frequent nighttime waking
Daytime sleepiness
Headache
Irritability
Collaborative Care
Diagnosis in sleep laboratory
Weight loss prescribed
Strict avoidance of alcohol, hypnotic medication
Collaborative Care
Positive pressure air compressors
◦ CPAP therapy
◦ BiPAP therapy
◦ AutoPAP therapy
Surgery
◦ Uvulopalatopharyngoplasty (UPPP)
Nursing Care
Focus on teaching
◦ Use of respiratory equipment
◦ Avoidance or correction of risk factors
Laryngeal Cancer
Risk factors
◦ Prolonged use of tobacco and alcohol
◦ Poor nutrition
◦ Occupational exposure
Men affected nearly four times more than women
Pathophysiology and
Manifestations
Benign tumors
◦ Common in patients who chronically shout, project, or vocalize in very high
or low tone
◦ Hoarseness, breathy voice
Malignant tumors
◦ Leukoplakia
◦ Erythroplakia
BOX 22-7 Manifestations of
Laryngeal Cancer
Pathophysiology and
Manifestations
Malignant tumors
◦ Lesions of true vocal cords, glottis more common
◦ Supraglottic
◦ Change in voice primary manifestation
◦ Tumor prevents complete closure of vocal cords during speech.
◦ Subglottic tumors least common
Collaborative Care
Diagnostic tests
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Laryngoscopy
CT scan
MRI
Needle biopsy
Barium swallow
Collaborative Care
Radiation
◦ Treatment of choice if localized
Chemotherapy
◦ Before surgery or in combination
Surgery
◦ Type determined by size, site, and invasiveness of tumor
◦ Carcinoma in situ and vocal polyps treated with laser on outpatient basis
Collaborative Care
Surgery
◦ Tracheostomy
◦ Total laryngectomy
◦ Entire larynx removed
◦ Normal speech lost
◦ Permanent tracheostomy
◦ Modified or radical neck dissection
◦ If cervical lymph nodes contain cancer cells
Nursing Care
Prioritizing nursing care
◦ Maintain patent airway
Health promotion
◦ Prevent smoking
◦ Early warning signs of laryngeal cancer
Nursing Care
Assessing
◦ Subjective data from patient vital
◦ Symptoms not until advanced stages
Diagnosing, planning, and implementing
◦ Risk for impaired airway clearance
◦ Monitor for airway obstruction
◦ Cold packs as ordered
Nursing Care
Diagnosing, planning, and implementing
◦ Risk for impaired airway clearance
◦ Withhold food until gag reflex has returned
◦ Impaired verbal communication
◦ Provide alternative ways to communicate
◦ Refer to speech therapist
Nursing Care
Diagnosing, planning, and implementing
◦ Imbalanced nutrition: less than body requirements
◦ Grieving
Managing nursing care
◦ Importance of responding promptly to patient's call, supporting head and
neck, and reporting respiratory distress.
Nursing Care
Evaluating
◦ Effectiveness of interventions
Documenting
◦ Note patient's, family's responses
Continuity of care
◦ Voice rest for benign tumors
◦ Tracheostomy care
◦ Assessment for discharge