Management of Patients With Upper Respiratory Tract Disorders

Management of Patients With Upper Respiratory Infections (URIs) Most common reason for seeking healthcare May be minor, acute, chronic, severe, or life threatening Treated in community settings: doctor offices, urgent care clinics, long-term care facilities, or self-care at home Early detection of signs and symptoms and appropriate interventions can avoid unnecessary complications Patient teaching focus on prevention and health promotion Special considerations for older adults Refer to Chart 22-1

URIs Rhinitis and rhinosinusitis: acute, chronic, (refer to Fig. 22-1 and Table 22-1) Pharyngitis: acute, chronic (refer to Fig. 22-2) Tonsillitis, adenoiditis Peritonsillar abscess Laryngitis

Rhinitis and Rhinosinusitis Figure 22-1

Pharyngitis Figure 22-2

Question Is the following statement true or false? Acute pharyngitis of a bacterial nature is most commonly caused by group A beta-hemolytic streptococci.

Answer True Rationale: Acute pharyngitis of a bacterial nature is most commonly caused by group A beta-hemolytic streptococci.

URI Potential Complications Airway obstruction Hemorrhage Sepsis Meningitis or brain abscess Nuchal rigidity Medicamentosa Acute otitis media Trismus Dysphagia Aphonia Cellulitis

URI Nursing Process: Assessment Health history Signs and symptoms: headache, cough, hoarseness, fever, stuffiness, generalized discomfort, and fatigue Allergies Inspection of nose, neck, throat, and palpation of lymph nodes

Question What should the nurse palpate when assessing for an upper respiratory tract infection? Neck lymph nodes Nasal mucosa Tracheal mucosa All of the above

Answer Neck lymph nodes Rationale: The nurse should palpate the neck lymph nodes along with the trachea and the frontal and maxillary sinuses when assessing for an upper respiratory tract infection. The nurse should inspect the nasal and tracheal mucosa when assessing for an upper respiratory tract infection.

URI Nursing Process: Diagnosis Ineffective airway clearance Acute pain Impaired verbal communication Fluid volume deficit Knowledge deficit related to prevention, treatment, surgical procedure, postoperative care

URI Nursing Process: Planning Airway management, reduce risk of aspiration Pain management Effective communication strategy Increase hydration Patient teaching: self-care, prevention, and health promotion Home care, if indicated

URI Nursing Process: Interventions Elevate head Ice collar to reduce inflammation and bleeding Hot packs to reduce congestion Analgesics for pain Gargles for sore throat Use alternative communication Encourage liquids; at least 2 to 3 L/day Soft bland diet Rest

URI Nursing Process: Evaluation Maintenance of patent airway Expresses relief of pain Able to communicate needs Evidence of positive hydration Absence of complications

Patient Education Prevention of upper airway infections Emphasize frequent handwashing When to contact health care provider Need to complete antibiotic treatment regimen Annual influenza vaccine for those at risk

Obstruction and Trauma of the Upper Respiratory Airway Obstructive sleep apnea—S/S: Chart 22-4; Tx: CPAP, BiPAP, oxygen therapy Nasal obstruction—S/S: deviated septum, turbinate hypertrophy, polyps Fractures of the nose—S/S: traumatic obstruction; Tx: reduction of fracture, control epistaxis and edema Laryngeal obstruction—S/S: edema, Table 22-3; Tx: subcutaneous epinephrine, tracheotomy

Obstruction and Trauma of the Upper Respiratory Airway—Epistaxis Hemorrhage from the nose Anterior septum, most common site Serious problem, may result in airway compromise or significant blood loss Risk factors, refer to Chart 22-5

Medical Management Pinch soft portion of nose for 5 to 10 minutes Phenylephrine spray, vasoconstriction Cauterize with silver nitrate or electrocautery Gauze packing or balloon-inflated catheter inserted into nasal cavity for 3 to 4 days Antibiotic therapy

Control of Epistaxis—Packing of Nasal Cavity or Balloon Catheter Figure 22-3

Nursing Management Airway, breathing, circulation Vital signs, possible cardiac monitoring and pulse oximetry Reduce anxiety Patient teaching: Avoid nasal trauma, nose picking, forceful blowing, spicy foods, tobacco, exercise Adequate humidification to prevent dryness Pinch nose to stop bleeding; if bleeding does not stop in 15 minutes, seek medical attention

Cancer of the Larynx Accounts for approximately half of all head and neck cancers 12,360 new cases and 3,650 deaths annually Most common in people over age 65 Four times more common in men Risk factors: refer to Chart 22-6

Signs and Symptoms Later: Early: Dysphagia, dyspnea Hoarseness Persistent cough Sore throat or pain burning in throat Raspy voice, lower pitch Lump in neck Later: Dysphagia, dyspnea Nasal obstruction Persistent hoarseness Persistent ulceration Foul breath General debilitation

Question Is the following statement true or false? An early sign of cancer of the larynx includes changes in speech, the voice may sound harsh, raspy, and lower in pitch.

Answer True Rationale: An early sign of cancer of the larynx includes changes in speech, the voice may sound harsh, raspy, and lower in pitch.

Medical Diagnostics History and physical Laryngoscopy FNA biopsy Barium swallow study Endoscopy, CT, MRI, PET scan Tumors grade and stage by TNM system

Medical Management of Laryngeal Cancer Stages I and II Radiation therapy Cordectomy Endoscopic laser excision Partial laryngectomy Stages III and IV Radiation therapy Chemotherapy Chemoradiation Total laryngectomy

Changes in Airflow With Total Laryngectomy Figure 22-4

Nursing Process: Assessment Health history Physical assessment Nutrition, BMI, albumin, glucose, electrolytes Literacy, hearing, and vision; may impact communication after surgery Coping skills and available support systems for patient and family after surgery

Nursing Process: Diagnosis Ineffective airway clearance Impaired verbal communication Imbalanced nutrition Disturbed body image Anxiety, depression Self-care deficit Knowledge deficit

Collaborative Problems/Potential Complications Respiratory distress Hemorrhage Infection Wound breakdown Aspiration Tracheostomal stenosis

Postoperative Nursing Care Maintain patent airway, control secretions Reduce anxiety Support alternative communication, refer to Chart 22-9 and Figure 22-5 Promote adequate nutrition and hydration Promote positive body image, self-esteem Self-care management, refer to Chart 22-8

Tracheoesophageal Puncture Figure 22-5