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Management of Patients with Conditions of the Upper Respiratory Tract
Lecture 3 Chapter 22 Brunner’s
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Common Cold AKA: Rhinitis Viral rhinitis Pathophysiology Rhinovirus
“Infection with acute inflammation of the mucous membrane of the nasal cavity”
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Common Cold Etiology Airborne Peak Times Duration Sept, Jan & April
5-14 days
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Common Cold Clinical Manifestations Nasal congestion Runny nose
Sore throat Sneezing Malaise Afibrile H/A Cough
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Common Cold Dx exams & Procedures S&S Culture
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Common Cold Tx methodology Focus – relief Tx not shorten Fluids
Warm, moist air Medications OTC
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Common Cold Medications Antihistamines Action
H1 blockers inhibits action X push off Take early Allergies
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Common Cold Medications Antihistamines Rx effect
Prevents salivary, gastric, lacrimal and bronchial secretions Relieves Sneezing Rhinorrhea Nasal congestion
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Common Cold Medications Antihistamines Side effects Examples
Drowsiness Drying Examples Allergra Claritin Benadryl
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Common Cold Medications Decongestants Rx Actions Side Effects
Shrink engorged nasal mucus membranes Side Effects Rebound congestion Insomnia
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Common Cold Medications Decongestants Examples Sudafed Vicks inhaler
Afrin
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Common Cold Medications Anti-tussives Rx Action Side effects Example
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Common Cold Medications Analgesics Tylenol (Acetomenaphen)
Motrin (ibuprofen) NSAID Non-narcotic
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Common Cold Medications Vitamin C
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Common Cold Medications Antibiotics Prophylactic Examples Sulfonamides
Penicillins Cephalosporins Tetrcyclines Aminglycosides Quinolones Macrolides Vancomycin
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Common Cold Medications Anti-biotic Side-effects N/V Yeast infections
Resistance
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Common Cold Medications Echinacea Action Use Long tem use
Stim. immune system Anti-bacterial Anti-inflammatory Use 10-14 days Long tem use i immune system
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How do you prevent the cold from getting you?
Common Cold Nrs Managements See MD > 2 wks Prevention How do you prevent the cold from getting you? Hand wash Cover mouth Throw away tissue Avoid crowds Vaccine Eat right Sleep Stress Exercise Smoking Allergens Animals Carpet
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Common Cold Complications Bronchitis Pneumonia Conjunctivitis
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Sinusitis: sinus infection
Pathophysiology Inflammation of the mucus membrane of one or more sinuses Blocks the egress of sinuses
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Sinusitis: sinus infection
Etiology Bacterial or viral? #1 bacterial Tooth abscess Allergies Structural abnormalities
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Sinusitis: sinus infection
Clinical manifestations Pain Maxillary Over cheek and upper teeth Ethmoid Btw & behind eyes Frontal Forehead Ethmoid sinusitis
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Sinusitis: sinus infection
Clinical manifestations Anosnia H/A Fever? Fatigue? Foul breath?
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Sinusitis: sinus infection
Dx S&S X-ray, CT, MRI C & S
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Sinusitis: sinus infection
Med Tx Antibiotics Analgesics No aspirin Nasal decongestants Mucolytic agents Surgery
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Sinusitis: sinus infection
NRS interventions Fluids h Position HOB h Activity Rest Moist hot-packs Cleaning techniques Irrigate nose
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Sinusitis: sinus infection
Prevention Avoid contributing factors: Cold Smoking Fatigue URI Dentist
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Sinusitis: sinus infection
Complications Osteomylitis Cellulitis of the orbit Abscess Meningitis
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Sinusitis: sinus infection
Surgery Post-op care Position Side lying semi-fowler Ice Monitor for Bleeding i visual acuity Pain S&S of infection Oral care Packing x 48 hrs No blowing Tarry stools Avoid constipation
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Acute Pharyngitis Pathophysiology AKA: sore throat, strep throat
Inflammation of the throat
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Acute Pharyngitis Etiology 70% Viral Bacterial Streptococcus
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Acute Pharyngitis Clinical manifestations Sore throat Febrile
Dysphagia Exudate Lymphnoids Malaise* Hoarseness* Cough* Rhinitis*
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Acute Pharyngitis Dx exams Throat culture Rapid screening
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Acute Pharyngitis - Tx Viral Bacterial Supportive Like a cold
Antibiotics Diet Liquid/soft Analgesics Tylenol Anti-tussive
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Acute Pharyngitis - Nrs
Rest Rashes? Communicable disease Warm saline gargles Temp F Diet Liquid Fluids h Ice collar Oral care
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Acute Pharyngitis Complications Sinusitis Ottis media
Peritonsillar abscess Scarlet fever Rheumatic Fever 2-3 wk /p subsides Heart damage Mital valve damage Scarlet fever is an exotoxin-mediated disease caused by Group A streptococcal infection that occurs most often in association with a sore throat and rarely with impetigo or other streptococcal infections. It is characterized by sore throats, fever and a rash over the upper body that may spread to cover almost the entire body. Scarlet fever is not rheumatic fever, but may progress into that condition as the infection develops (rheumatic fever is the autoimmune disease that occurs after infection with Group A strep).
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Tonsillitis & Adenoiditis
Pathophysiology Tonsils Location Oropharynx Lymph tissue Adenoids Nasopharynx
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Tonsillitis & Adenoiditis
Etiology Streptococcus Low resistance Children
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Tonsillitis & Adenoiditis – S&S
Sore throat Febrile & chills Snoring Dysphagia Adenoids Mouth breathing Duration 1-2 wks
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Tonsillitis & Adenoiditis - Dx
Visualize C&S Mono
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Tonsillitis & Adenoiditis
Post-op care Hemorrhaging Coffee ground emeses Bright red emeses Pulse h Temp Restlessness Tarry stool h swallowing
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Tonsillitis & Adenoiditis
Post-op Position Prone/side lying until… Gag returns Semi-fowler’s Pain control Ice collar Acetaminophen Not aspirin
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Tonsillitis & Adenoiditis
Post-op Diet Ice cold fluids Adv. To normal ASAP 2-3 days Milk products i Avoid Spicy Hot Acidic Rough
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Tonsillitis & Adenoiditis
Post-op Pt education S&S of hemorrhaging Mouthwash good Avoid Coughing Sneezing Vigorous nose blow Vigorous gargling Rough foods Expect black tarry stools Normal activity ASAP
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Peritonsillar Abscess
Pathophysiology Pus & blood filled sacs on tonsil Etiology Complication of strep throat
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Peritonsillar Abscess
Pain Local Radiates ear Dysphagia drooling Dysphasia Fever Red throat
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Peritonsillar Abscess
Tx Antibiotics Incision & drain Lanse Warm saline irrigation Hydrogen peroxide Analgesics Topical Tylenol No aspirin ? narcotics Ice collar No smoking Ventilator?
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Laryngitis Pathophysiology
Inflammation of the mucous membrane lining the larynx With edema of the vocal cords
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Laryngitis Etiology Viral Voice abuse Dust
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Laryngitis Risk factors Airborne irritants Cold Resent RTI Smoking
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Laryngitis Clinical manifestations Aphonia Hoarseness Cough?
Voice loss Hoarseness Cough? Severe
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Laryngitis Treatment Voice rest Bed rest Smoking? Humidifier Fluids?
NO! Humidifier Fluids? h Expectorants
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Laryngitis Prevention Avoid… Irritants Cold Voice strain Smoking
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Epistaxis Pathophysiology Tiny blood vessels in nose rupture
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Epistaxis Anterior bleeds usually stop spontaneously or self treated
Posterior bleeds may require med treatment
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Epistaxis Etiology Irritation Infection Drugs Humidity Trauma
Hypertension Blood dyscrasias
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Epistaxis Tx Initial Initial d/t trauma Apply direct pressure 5-10 min
Position Head tilted down Initial d/t trauma Do not pinch Ice pack over nose & eye Head down ? Neck injury
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Epistaxis Tx ER Packing Topical vasoconstrictor
Silver nitrate & gelfoam Painful Remains 4-5 days Topical vasoconstrictor Epinephrine
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Epistaxis Nrs Management V/S Control bleeding P Hgb level P PT/PTT
Take BP meds X aspirin X vigorous blowing X strenuous exercise
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Epistaxis Complications?
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Nasal Polyps Pathophysiology
Benign grape-like growths of mucous membrane and loose connective tissue within the nasal cavity
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Nasal Polyps Etiology Recur Triad disease Polyps Asthma
Allergy to aspirin
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Nasal Obstruction Etiology Deviated septum
Hypertrophy of turbinate bone Polyps Foreign object
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Nasal Obstruction Clinical Manifestations Foul odor Halitosis
Malodorous Halitosis h allergies Noisy breathing h post-nasal drip
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Nasal Obstruction Tx Remove obstruction Surgery Out the same way in
Sneezing w/ opposite nasal closed X irrigate X push backwards Surgery
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Nose surgery Submucous resection: Nasoseptoplasty: Rhinoplasty:
Polypectomy:
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Nrs Care – Post OP nasal surgery
P hemorrhaging P Infection Comfort Nutrition Pt. Ed Avoid aspirin
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Nasal Obstructions Complications Chronic infections of the nose
Anosmia Pharyngitits Sinusitis
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Fracture of the Nose Etiology S&S #1 bone broken Pain Bleeding
Swelling Deformity
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Fracture of the Nose Clear fluid drainage Fx of cribiform plate CSF
Mucus vs. CSF P glucose
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Fracture of the Nose Tx Control bleeding Reduce after Cold compress
i swelling 7-10 days later Re-brake nose
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Fracture of the Nose Nrs Management #1 Assess breathing Ice Pack
Mouth breathing Dry X adjust Pain med Acetaminophen Trauma P neck injury
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Laryngeal Obstruction
Pathophysiology Edema Etiology Anaphylaxis Meds Bees Nuts Sea food Foreign object
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Laryngeal Obstruction
S&S Can not… Talk Cough Breath Universal sign Color changes Affect distressed
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Laryngeal Obstruction
Tx Choking Heimlich maneuver Anaphylaxis Sub q epinephrine Corticosteroids Ice pack
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Laryngeal Obstruction
Prevention Avoid Epi-pen Complication Death
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Sleep Apnea Pathophysiology
Partial or complete upper airway obstruction during sleep causing apnea & hypopnea Occurs when tongue and soft palate fall backwards
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Sleep Apnea Duration of apnea 15-90 seconds Sever hypoemia Hypercapnia
PaO2 i Hypercapnia PaCO2 h
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Sleep Apnea Causes partial awake Startle, snort, gasps
Soft palate & tongue move forward Airway opens
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Sleep Apnea S&S Personality changes Driving accidents h waking at noc
Insomnia Daytime sleepiness Loud snoring AM h/a h Pa CO2 vasodilitation H/a Personality changes Driving accidents Family problems Employment compromised
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Sleep Apnea Tx Mild Avoid Sedatives Alcohol Wt loss Oral appliance
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Sleep Apnea Tx Severe CPAP Surgery Continuous Positive Airway Pressure
Mask High flow Prevents collapse Surgery
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CA of the larynx Classification T – tumor N – Nodes M – Metastasis
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CA of the larynx Pathophysiology Squamous cells Metastasis Lung Liver
Lymphs
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CA of the Larynx Etiology Curable if detected early but…
Men vs. women? > men Carcinogens Tobacco Alcohol Asbestos Mustard gas Etc Family predisposition
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CA of the Larynx S&S Early Hoarseness Middle Change in voice Pain Lump
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CA of the Larynx S&S Late Dysphagia Dyspnea Foul breath
Enlarged lymph's Wt loss Debilitative state Pain ear
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CA of the Larynx Dx H&P X-ray MRI Laryngoscopy Biopsy
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CA of the larynx Tx Radiation Surgery/laryngectomy Partial Early
Remove Portion 1 vocal cord Tumor Still talk Airway intact No dysphagia
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CA of the larynx Tx Total laryngectomy Remove Permanent tracheal stoma
2-3 rings of trachea Permanent tracheal stoma Laryngectomy tube Total voice loss Normal swallowing
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CA of the larynx Nrs management Assess Hoarseness Pain Dyspnea
Dysphagia Palpate neck Diet h protein
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CA of the larynx Nrs management Pre-op Assess Anxiety Ability to See
Hear Read Write Anxiety
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CA of the larynx Nrs management Post-op Airway Pain Communication
Suction PRN Pain Communication Nutrition NPO x 14 days Parenteral / NGT Mobility
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CA of the larynx Laryngectomy tube
Shorter but h diameter than tracheostomy tube Care same as trach Clean q day with normal saline No tissues No swimming Humidify air
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