Respiratory Disorders

Upper Respiratory Disorders

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.

An Allergic Reaction

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.

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

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..

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.

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

What is an important Preventive measure against the Flu?

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

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.

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.

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

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.

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.

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.

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.

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.

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.

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).

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.

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

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.

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

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

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

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

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

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.