1. Management of Patients With Upper Respiratory Tract Disorders

2. 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

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

4. Rhinitis and Rhinosinusitis
Figure 22-1

5. Pharyngitis
Figure 22-2

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

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

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

9. 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

10. 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

11. 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.

12. 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

13. 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

14. 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

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

16. 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

17. 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

18. 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

19. 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

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

21. 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

22. 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

23. 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

24. 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.

25. 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.

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

27. 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

28. Changes in Airflow With Total Laryngectomy
Figure 22-4

29. 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

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

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

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

33. Tracheoesophageal Puncture
Figure 22-5