Caring for Patients With Upper Respiratory Disorders

1. Caring for Patients With Upper Respiratory Disorders

2. Learning Outcomes • Describe common disorders affecting the upper respiratory tract, their manifestations, and potential impact on the patient. • Safely administer medications and treatments ordered for patients with upper respiratory disorders.

3. Learning Outcomes • Plan and provide appropriate individualized nursing care for patients with upper respiratory disorders, showing consideration for expressed values, preferences, and needs. • Use technology to identify evidence-based guidelines and document care for patients with upper respiratory system disorders.

4. Learning Outcomes • Provide evidence-based teaching and instructions to ensure continuity of care for patients with upper respiratory system disorders.

5. Upper Respiratory Infections and Inflammations • Most self-limiting • In long-term care facilities can spread rapidly • Control spread • Risk for serious problems in older adults

6. Pathophysiology and Manifestations • Rhinitis • Inflammation of nasal cavities • Types • Acute viral rhinitis • Allergic rhinitis

7. Pathophysiology and Manifestations • Respiratory syncytial virus • Common virus among infants and young children • Usually mild "cold" in adults, unless immunocompromised • Older adults may present with pneumonia.

8. Pathophysiology and Manifestations • Influenza • Contagious viral respiratory disease • Mode of transmission • Airborne droplet • Direct contact

9. TABLE 22-1 Manifestations and Course of Rhinitis and Influenza

10. Pathophysiology and Manifestations • Sinusitis • Inflammation of mucous membranes of sinuses • Usually caused by bacterial infection • Usually follows URI

11. Pathophysiology and Manifestations • Pharyngitis and tonsilitis • Acute inflammation of the throat • Usually viral but may be bacterial • Group A beta-hemolytic Streptococcus (strep throat) most common cause of bacterial form

12. Pathophysiology and Manifestations • Pharyngitis and tonsilitis • Tonsillitis • Acute inflammation of the tonsils • May be caused by streptococcal infection • Infectious, may be spread by droplet nuclei • Dysphagia • Difficulty swallowing

13. Pathophysiology and Manifestations • Epiglottitis • Medical emergency • Monitor for signs of respiratory distress • Nasal flaring • Restlessness • Stridor • Use of accessory muscles • Oxygen saturation

14. Pathophysiology and Manifestations • Epiglottitis • Don't insert nasal or oral airway • May cause spasm and airway obstruction • Nasotracheal intubation may be necessary.

15. Pathophysiology and Manifestations • Laryngitis • Inflammation of larynx • Change in voice • Sore, scratchy throat • Dry, harsh cough

16. Collaborative Care • Diagnostic tests • Throat swab • CBC • Chest x-ray • Nasal swab • CT scan

17. Collaborative Care • Medications • Influenza • Yearly immunization • Bacterial infections • Antibiotic treatment • Use for up to 10 days • Patient no longer contagious after 24 hours of antibiotic therapy • Used up to 2 weeks for sinusitis

18. Collaborative Care • Medications • Rhinitis • Decongestants • Antihistamines • Topical nasal steroids • Inhaled steroids

19. Collaborative Care • Medications • Sore throat • Warm saltwater gargles • Throat lozenges • Mild analgesics • Cough • Antitussives • Systemic mucolytic agents (guaifenesin)

20. Collaborative Care • Complementary therapies • Herbal remedies • Aromatherapy • Surgical interventions • Irrigation • Endoscopic sinus surgery • Tonsillectomy

21. Nursing Care • Prioritizing nursing care • Maintain airway, breathing, rest • Health promotion • Frequent hand washing • Warn of antibiotic misuse

22. Nursing Care • Assessing • Determine effect of URI on patient's life • Identify risk factors for complications • Determine whether problem will require medical treatment or self-care appropriate • Identifying potential complications • High or continuing fever • Change in mental status, hearing

23. Nursing Care • Diagnosing, planning, and implementing • Ineffective breathing pattern • Monitor respiratory rate and pattern • Auscultate lungs • Pace activities • Elevate head of bed

24. Nursing Care • Diagnosing, planning, and implementing • Ineffective airway clearance • Monitor effectiveness of cough • Note whether cough is productive or nonproductive • Auscultate lungs

25. Nursing Care • Diagnosing, planning, and implementing • Disturbed sleep pattern • Assess sleep pattern • Place in semi-Fowler's or Fowler's position • Provide antipyretics and analgesics • Cough suppressant at night

26. Nursing Care • Diagnosing, planning, and implementing • Impaired verbal communication • Encourage patient to rest voice. • Use alternative method to communicate, such as a writing pad. • Comfort measures • Lozenges, gargle, or sprays • Encourage patient to quit smoking.

27. Nursing Care • Managing nursing care • Reminding patient to cough, deep breathe. • Evaluating • Ability to manage symptoms • Documenting • Assessments, understanding of teaching

28. Nursing Care • Continuity of care • Encourage rest • Adequate hydration • Hand washing after coughing • Avoid exposure to crowds • Avoid physical or psychologic stress • Prevention for influenza • Vaccine for high-risk groups

29. Nursing Care • Continuity of care • Discuss OTC medications for relief of symptoms • Assist patient to identify possible allergens for allergic rhinitis • Stress importance of completing entire course if on antibiotics • Teach complications of influenza and URIs

30. Pertussis • Whooping cough • Acute, highly contagious

31. Pathophysiology and Manifestations • Infection with Bordetella pertussis • Symptoms of URI 7–10 days after exposure • Followed by disruptive cough that may end with audible whoop • Adults may present with simple, prolonged cough or typical pattern.

32. Collaborative Care • Nasopharyngeal secretions culture • Blood tests for antibodies • Prevention • Immunization • Erythromycin • Traditional antibiotic of choice

33. Nursing Care • Education • Respiratory isolation measures • Prophylactic antibiotic therapy for all household contacts • Reportable disease

34. Upper Respiratory Trauma or Obstruction

35. Epistaxis • Nosebleed • May be caused by: • Trauma • Drying of membranes • Infection • Substance abuse

36. Pathophysiology and Manifestations • Ninety percent arise from vascular area in anterior nasal septum • Posterior nosebleed • Hypertension • Diabetes

37. Collaborative Care • Pinch toward septum for 5–10 minutes • Instruct patient to spit out blood • If pressure doesn't control bleeding, further interventions may be necessary. • Medications and nasal packing • Topical vasoconstrictors • Anterior packing left in place 24–72 hours

38. Collaborative Care • Medications and nasal packing • Posterior packing left in place up to 5 days • Uncomfortable • Supplemental oxygen given with posterior packing • Surgery • Cautery procedures • Scab must be left undisturbed.

39. Nursing Care • Prioritizing nursing care • Reduce anxiety and maintain airway • Health promotion • Reduce incidence • Management of simple nosebleeds • Assessing • Simultaneous with implementing interventions

40. Nursing Care • Diagnosing, planning, and implementing • Anxiety • Risk for aspiration • Evaluating • Additional bleeding • Documenting • Time, measures required to control bleeding

41. Nursing Care • Continuity of care • Avoid strenuous exercise for days or weeks • Do not blow the nose forcefully • No heavy lifting • Sneeze with mouth open • Lubricate nares with petroleum jelly or bacitracin. • Use humidifier

42. Nasal Polyps • Benign growths on mucous lining inside nose • Usually bilateral • May be asymptomatic or resolve spontaneously • Large polyps may cause obstruction, rhinorrhea, loss of smell

43. Nasal Polyps • Treatment • Topical corticosteroid nasal sprays • Surgery • Polypectomy

44. Nursing Care • Postoperative care instructions • Measures to reduce risk of bleeding • Ice, cold compresses • Avoid blowing nose for 24–48 hours after removal of packing. • Avoid straining, coughing, strenuous exercise. • Manifestations and possible bleeding

45. Nasal Trauma or Deviated Septum • Fracture (broken nose) • Most commonly broken bone of the face

46. Pathophysiology and Manifestations • One or both sides of nose • Swelling can obstruct airway. • Soft tissue damage nearly always accompanies nasal fracture. • Deviated nasal septum • Septal cartilage bulges to one side

47. Collaborative Care • Maintain patent airway and prevent deformity. • If CSF leak suspected, CT scan performed • More complex fractures may need surgery.

48. Collaborative Care • Rhinoplasty • Surgical reconstruction of the nose • Septoplasty or submucosal resection (SMR) • Corrects deviation

49. Nursing Care • Nursing care • Airway management • Control of bleeding, pain and swelling • Health promotion • Provide necessary teaching • Assessing • Pain, swelling, bleeding, difficulty breathing, deformities, ecchymosis and crepitus

50. Nursing Care • Diagnosing, planning, and implementing • Ineffective airway clearance • Risk for infection • Evaluating • Position of septum, appearance of nose • Documenting • Instructions for follow-up