Upper Respiratory Tract Disorders

Front 1

Nursing Care of Patients with Upper Airway Disorders

Back 1

1.Upper airway disorders may be minor and treated outside of the health care setting, or may be severe and life-threatening.
2.Require good assessment skills, an understanding of the variety of disorders that affect the upper airway, and the impact that those disorders may have upon the patient.
3.Patient teaching is an important aspect of care.

Front 2

Specific Disorders

Back 2

1.Infections
2.Rhinitis
3.Sinusitis: acute and chronic
4.Pharyngitis: acute and chronic
5.Tonsillitis and adenoiditis
6.Peritonisillar abscess
7.Laryngitis

Front 3

Tonsillitis and Pharyngitis

Back 3

*Viral or bacterial
*Majority of cases viral but a culture needs to be done to rule out strep throat
-Antibiotics have no effect on viral pharnygitis
-Viral – treat symptoms (rest, fluids, Tylenol, anesthetic lozenges and gargling with warm saline)
-Strep – needs antibiotic treatment
-Can result in scarlet fever, rheumatic heart disease and acute glomerulonephritis if not treated.
-Pen V or erythromycin commonly used

Front 4

Tell whether the following statement is true or false.

Viral rhinitis is the most frequent viral infection in the general population.

Back 4

True.

Rationale: Viral rhinitis is the most frequent viral infection in the general population.

Front 5

Potential Complications

Back 5

1.Sepsis
2.Meningitis
3.Peritonsillar abscess
4.Otitis media
Sinusitis

Front 6

Nursing Process: The Care of Patients with Upper Respiratory Infections: Assessment

Back 6

-Health history
-Signs and symptoms: headache, cough, hoarseness, fever, stuffiness, and generalized discomfort and fatigue
-Allergies – may involve skin testing or blood testing
-Inspection of nose, neck, throat
Include palpation of lymph nodes

Front 7

Nursing Process: The Care of Patients with Upper Respiratory Infections: Diagnosis

Back 7

-Ineffective airway clearance
-Acute pain
-Impaired verbal communication
-Deficient fluid volume
-Deficit of knowledge related to prevention, treatment, surgical procedure, or postoperative care

Front 8

Which of the following would be a priority nursing diagnosis for a patient with an upper respiratory infection?
a.Acute pain
b.Ineffective airway clearance
c.Deficient fluid volume
d.Impaired verbal communication

Back 8

b.Ineffective airway clearance

Rationale: Ineffective airway clearance would be the priority nursing diagnosis, eg, ineffective airway clearance related to excessive mucus production secondary to retained secretions and inflammation

Front 9

Nursing Process: The Care of Patients with Upper Respiratory Infections: Planning

Back 9

1.Maintenance of a patent airway
2.Relief of pain/ promote comfort
3.Maintenance of effective communication
4.Normal hydration
5.Knowledge of how to prevent upper airway infections – teach pt. self-care
6.Monitor and manage potential complications

Front 10

Interventions to maintain a patent airway

Back 10

Promote comfort
-Analgesics
-Gargles for sore throat
Use of hot packs for sinus -congestion or ice collar to reduce swelling, and also bleeding post tonsillectomy and adenoidectomy
-Rest
-Refrain from speaking, use alternative communication
-Encourage liquids; 2-3 L a day and appropriate foods

Front 11

Patient Education:
Prevention of upper airway infectionsSee Chart 22-3

Back 11

-Emphasize frequent handwashing
-When to contact health care provider
-Need to complete antibiotic treatment regimen
-Annual influenza vaccine for those at risk

Front 12

Medical management – Rhinitis (allergic or non-allergic)

Back 12

1.Oral antihistamines
2.Allergy control eye drops
3.Decongestants
4.Steroid nasal sprays and inhalers
5.Desensitization therapy
6.Air conditioning/ special filtering systems
7.Limiting exposure to offending agents
8.Antibiotics if secondary infection occurs

Front 13

Medical management –upper airway

Back 13

1.Bronchodilators
2.Antihistamines
3.Expectorants
4.Antitussives
5.Glucocorticoids
6.Mucolytics
7.Antibiotics

Front 14

Epistaxis

Back 14

1.Hemorrhage from the nose
2.Risk factors
3.Sites of bleeding; most common: anterior septum
4.This can be a serious problem resulting in significant blood loss or airway compromise.

Front 15

Treatment of Epistaxis

Back 15

1.Topical vasoconstrictors
a.Adrenaline
b.Cocaine
c.Phenylephrine
2.Packing of the nasal cavity or balloon catheter
3.Silver nitrate applicator and GElfoam or by electrocautery

Front 16

Nursing Care of Patients with Epistaxis

Back 16

1.Assessment of bleeding
2.Monitor airway and breathing
3.Vital signs
4.Reduce anxiety
Patient teaching
Avoid nasal trauma, nose picking, and nose blowing
Air humidification
Pressure on the nose to stop bleeding. If bleeding does not stop in 15 minutes, seek medical attention.

Front 17

Topical adrenaline is used to reduce blood flow in the patient with epistaxis.

Back 17

True.
Rationale: Topical vasoconstrictors, such as adrenaline (1:1000), cocaine (0.5%), and phenylephrine, may be prescribed.

Front 18

Cancers of the Head and Neck

Back 18

1.Fairly common
2.Includes cancer of the lips, tongue, mouth, throat and larynx
3.Invariably squamous cell carcinomas occur with the highest frequency in smokers
4.Combination of alcohol and smoking makes one particularly at risk for this form of cancer

Front 19

Cancer of the Larynx

Back 19

1.Incidence
2,Risk factorscarcinogens and other factors
3.Categories:
-Supraglottic: false vocal cords above the vocal cords
-Glottic: true vocal cords
-Subglottic: below the vocal cords

Front 20

Laryngeal Cancer - Symptoms

Back 20

1.Hoarseness
2.Persistent cough
3.Sore throat or pain and burning in the throat
4.Lump in the neck
5.Later symptoms: dysphagia, dyspnea, unilateral nasal obstruction, persistent hoarseness, persistent ulceration, foul breath
6.Generalized symptoms: weight loss, debilitation, lymphadenopathy, and radiation of pain to the ear

Front 21

Medical Diagnosis

Back 21

-Diagnosis is made by history, physical exam, and laryngoscopic exam and biopsy.
-Tumors are staged by TNM classification.
-CT, MRI, and PET to assess tumor extent and stage and to determine recurrence.

Front 22

Medical Treatment

Back 22

1.Radiation therapy
2.Chemotherapy
3.Surgery
a.Partial laryngectomy
b.Supraglottic laryngectomy
c.Hemilaryngectomy
d.Total laryngectomy

Front 23

Changes in Airflow with Total Laryngectomy

Back 23

before surgery: airflow out of mouth/nose
after surgery: airflow into mouth/nose

Front 24

QUESTION: Why are the following functions altered in the client with a total laryngectomy?
-Sense of smell
-Ability to gargle or whistle
-Ability to blow his nose
-Ability to perform Valsalva’s maneuver
-Ability to breathe in a normal manner

Back 24

*check notes*

Front 25

Which of the following is an early clinical manifestation of cancer of the larynx?
a.Persistent cough
b.Foul breath
c.Dysphagia
d.Dyspnea

Back 25

a.Persistent cough

Rationale: The patient may complain of a persistent cough, sore throat, or pain and burning in the throat, especially when consuming hot liquids or citrus juices. Later symptoms include dysphagia, dyspnea, and foul breath.

Front 26

Nursing Process: The Care of a Patient with a Laryngectomy: Assessment

Back 26

1.Health history
2.Assess history of alcohol abuse.
3.Physical assessment
4.Nutritional status
5Assess literacy, hearing and visual ability; these may have an impact on communication.
6.Assess learning needs.
7.Assess patient and family coping and support systems.

Front 27

Nursing Process: The Care of a Patient with a Laryngectomy: Diagnosis

Back 27

-Deficit knowledge related to surgical procedure and postoperative course
-Anxiety and depression
-Ineffective airway clearance
-Impaired verbal communication
-Imbalanced nutrition
-Disturbed body image
-Self-care deficit

Front 28

Potential Collaborative Problems

Back 28

-Respiratory distress
-Hemorrhage
-Infections
-Wound breakdown
-Aspiration

Front 29

Nursing Process: The Care of a Patient with a Laryngectomy: Planning

Back 29

-Adequate level of knowledge (patient and family)
-Reduction of anxiety
-Maintenance of patent airway
-Effective means of communication
-Attaining optimal hydration and nutrition
-Improved body image and self-esteem
-Self-care management
-Absence of complications

Front 30

Preoperative Teaching (part 1)
for lary. surgery

Back 30

1.Instruction regarding the type of procedure and the resultant changes such as changes in speech or permanent loss of speech and changes in airway.
2.Include instruction regarding tubes used postoperatively such as drainage tubes and feeding tubes, and provide general preoperative teaching to prevent postoperative complications.

Front 31

Preoperative Teaching (part 2)
for lary. surgery

Back 31

3.Include planning for postoperative communication and long-term speech rehabilitation.
4.Use a collaborative approach.
Include the physician, speech therapy, dietary, social work, clinical nurse specialist, and others as required.

Front 32

Anxiety and Depression

Back 32

-Allow asking of questions and provide information.
-Permit verbalization of feelings.
-Interventions to reduce anxiety and promote comfort
-Reassuring manner.
-Stay with the patient during episodes of anxiety.
-Relaxation techniques

Front 33

Maintaining a Patent Airway – Watch for airway obstruction from swelling or inc secretions

Back 33

-Semi-Fowler’s or high Fowler’s position to decrease edema
-Monitor for sign and symptoms of respiratory distress
-Tracheostomy or laryngectomy tube assessment and care
-Care of the stoma
-Suctioning
-Humidification of air
Patient teachingSee Chart 22-9

Front 34

Communication

Back 34

-About 75% learn to use “plosive speech” – mechanical aids are also available. Plan communication preoperatively
Immediate postoperative -communication
Magic slate
Communication board
Speech rehabilitation

Front 35

Potential for Aspiration

Back 35

-Keep HOB elevated during and after tube feedings.
-Check gastric residual when administering tube feedings.
-When the patient begins oral feeding, maintain upright bed position during and after feedings.
-Swallowing maneuvers to prevent aspiration
-Use of thickened liquids

Front 36

Suture line and stoma care

Back 36

-Assess suture line and stoma site every 4 hours
-Report erythema, purulent drainage, hematoma
-Care for suture line and stoma site as ordered by surgeon
-Monitor drain function and output
-Maintain suction to drain at level ordered
-Milk tubing every 1-2 hours for 24 hours, then every 4 hr prn
-Report changes in amount and color of drainage or air leak

Front 37

Discharge teaching (Home care checklist)

Back 37

-Trach/stoma hygiene
-How to disguise stoma
-Strategies to prevent infection
-Need for follow up care
-Alternative communication techniques