disorders of the upper airway pn 132. learning objectives identify common disorders / diseases of...
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DISORDERS OF THE UPPER AIRWAY
PN 132
Learning Objectives
Identify common disorders / diseases of the upper respiratory system
Discuss etiology and pathophysiology associated with disorders / diseases of the upper airway
Identify cardinal signs and symptoms associated with disorders / diseases of the upper airway
Identify components used in the management of a client with an upper respiratory disorder or illness
Discuss assessment, diagnostic, nursing interventions and management, and patient education important to clients with upper respiratory disorders
Upper Respiratory Disorders
Upper Respiratory Infections
Common Respiratory Infections
Acute Rhinitis
Acute Follicular Tonsillitis
Laryngitis
Pharyngitis
Sinusitis
Acute Rhinitis (Coryza)
Etiology and Pathophysiology Also known as the “common cold”
Inflammation of mucous membranes in nose and sinuses
Usually caused by one or more viruses Can be complicated by bacterial infection
Contaminate hands when coughing or sneezing Spreads by touching things Commonly spread by shaking hands with infected person
Signs and Symptoms Evident within 24 to 48 hours after exposure
Increased sinus drainage Postnasal drip Throat irritation Headache Earache Fever
Acute Rhinitis (Coryza)
Diagnostics and Labs Throat and sputum cultures
Medical Treatment No treatment available for Coryza Treat symptoms
ASA, Tylenol to reduce fever Cough suppressant for non-productive cough Expectorant for productive cough Antibiotics if bacterial
Acute Follicular Tonsillitis
Etiology and Pathophysiology Inflammation of the tonsils
Results from airborne or foodborne bacterial infection Commonly streptococcus Most common in school age children
Signs and Symptoms Sore throat Fever Chills General muscle aching General malaise Elevated WBCs Increased throat secretions Enlarged tonsils
Acute Follicular Tonsillitis
Diagnostics and Labs Throat Cultures CBC (to determine WBC count)
Medical Treatment Antibiotics Elective tonsillectomy and adenoidectomy (T&A)
Tonsils and adenoids are surgically excised Usually for those who have recurrent attacks
Analgesics and antipyretics Warm saline gargles
Laryngitis Etiology and Pathophysiology
Often occurs secondary to another respiratory infection
Common disorder Acute and/or chronic
Acute Laryngitis Can cause respiratory distress in young children (small larynx)
Chronic Usually associated with inflammation of laryngeal mucosa or edema in vocal cords
Accompanies viral or bacterial infections
Other Causes Excessive use of the voice Inhalation of irritating fumes
Laryngitis
Signs and Symptoms
Hoarseness Complete voice loss Throat feels scratchy and irritated Patient may have persistent cough
Diagnostics and Labs Laryngoscopy
Visualizes edema, drainage
Medical Management Antibiotics (if bacterial) Analgesics or antipyretics Antitussives (to relieve cough) Throat lozenges
Pharyngitis
Etiology and Pathophysiology
May be chronic or acute Most common throat inflammation Frequently accompanies the common cold Usually viral Can be caused by bacteria
Streptococci Staphylococci
Contagious for 2 to 3 days after the onset of signs and symptoms
Signs and Symptoms Dry cough Tender tonsils Enlarged cervical lymph glands Throat looks edematous Throat soreness
Severe pain to scratchy Difficulty swallowing
Pharyngitis
Diagnostics and Labs Rapid strep screen (to detect streptococci) Two throat swabs obtained so culture can be performed if strep
screen test is negative
Medical Management Antibiotics Analgesics and antipyretics Throat rinses and gargles Rest Vaporizer
Sinusitis
Etiology and Pathophysiology Acute or chronic Involves any sinus area Can be viral or bacterial Often complication of pneumonia or nasal polyps Begins as upper respiratory tract infection that leads to sinus
infection
Signs and Symptoms Complaints of constant/severe headache Pain and tenderness in the affected sinus area Purulent exudate
Sinusitis
Diagnostics and Labs Sinus X-ray and/or CT scan Trans-illumination
Shining bright light into the mouth with the lips closed around it
Infected areas of sinuses will look dark Unaffected areas will trans-illuminate
Medical Treatment Nasal windows
Surgical incisions that allow sinuses to drain Medication
Antibiotics Analgesics Antihistamines Vasoconstrictors (nasal sprays)
Epistaxis
Epistaxis (Nose Bleed)
Pathophysiology
Congestion of the nasal membranes that leads to rupture of the capillaries Abundance of capillaries in the
nasal passages Frequently caused by Injury
Primary or secondary disorder Can be related to
Menstrual flow Hypertension
With treatment, prognosis is good
Epistaxis
Etiology
DrynessChronic infectionTraumaTopical corticosteroid useNasal spray abuseStreet drug use (cocaine)Disorder that results in decreased platelet count
Bleeding can be prolonged if usingAspirinNSAIDS
Epistaxis
Clinical Manifestations
Bright, red blood One or both nostrils
Severe hemorrhage Up to 1 liter of blood loss / hour
Can result in EXSANGUINATION (rare) Fatal blood loss
Epistaxis
EpistaxisAssessment
Subjective Assessment Patient interview Ask about:
Duration Severity of bleeding Precipitating factors
Objective Assessment Assess presence of bleeding
Anterior / posterior to nasal passage Blood pressure (severe drop may be indication of shock) Temperature Pulse Respirations Evidence of hypovolemic shock
Epistaxis
Medical InterventionNasal packingCotton saturated with epinephrine
CauteryBurning the bleeding vesselUse of silver nitrate stick (chemical)
Balloon TamponadeFoley-like catheter inflated in the nose
AntibioticsReduce chance of infection
Balloon Tamponade
Epistaxis
Diagnostics and Labs
Blood Labs (HCT, PT, INR, PTT)Blood loss severityClotting abnormalities
Nasal Endoscopy Identify source of
bleeding
Epistaxis
Nursing Diagnoses
Ineffective tissue perfusion: R/T Blood Loss
Risk for Aspiration: R/T Bleeding
Epistaxis
Nursing Interventions
Keep patient quiet Sitting position / leaning forward Reclining with head and shoulders
elevated
Apply direct pressure 10 to 15 minutes Pinch lower soft portion of the nose
Apply ice compresses to the nose Have patient suck on ice
If bleeding continues Insert a small gauze pad into the
bleeding nostril Apply direct pressure
Monitor vital signs
Monitor for s/s hypovolemic shock Anxiety Cool , clammy skin Confusion Decreased urine
output Weakness Pale skin color Rapid breathing Moist skin / sweating unconsciousness
EpistaxisPatient Teaching
Don’t pick or scratch in or around nares
Don’t blow the nose vigorously
Avoid dryness to the nose
Use: Vaporizer Saline or nasal lubricants
Avoid Aspirin and NSAIDs
Sneeze with mouth open
Don’t insert foreign objects into the nose
Deviated Septum and Nasal Polyps
Deviated Septum and Nasal Polyps
Deviated SeptumNasal septum deviates
from the midline
Partial nasal obstruction
Nasal PolypsTissue growths on nasal
tissues
Pathophysiology
Deviated Septum Nasal Polyps
Deviated Septum and Nasal Polyps
Congenital abnormality Injury
Prolonged sinus inflammation
Allergies
Etiology
Deviated Septum and Nasal Polyps
Clinical Manifestations Blockage of nostrils / Nasal congestion
Frequent nose bleeds
Facial pain
Headache
Post nasal drip
Noisy breathing during sleep (infants and children)
Dyspnea (struggling / strenuous respirations)
Harsh snoring sounds (Stertorous Respirations)
Deviated Septum / Nasal PolypsAssessment
Subjective
Ask about: Previous injuries / infections Allergies Sinus congestion Complaints of
Dyspnea Post nasal drip
Objective
Identify condition and location Rate and character of respirations Note s/s of dyspnea
Deviated Septum / Nasal Polyps
Diagnostics
Visual Examination
Sinus Radiographic StudiesShadowy sinuses =
polyps present
-
Deviated Septum
Deviated Septum / Nasal Polyps
Surgical Correction
Nasoseptoplasty (to align nasal septum)
Nasal Polypectomy Surgical removal of polyps
Following surgery Nasal packing (controls
bleeding) Nasal irrigation (saline) Petroleum jelly to nares
(prevent drying)
Medications
Corticosteroids (Prednisone) Cause polyps to decrease/
disappear
Antihistamines Reduce allergy signs/symptoms Decreases congestion
Antibiotics To prevent infection
Analgesics Relieve headache
Medical Management
Deviated Septum / Nasal Polyps
Ineffective airway clearance R/T nasal exudates
Risk for injury R/T trauma to bleeding site associated with
vigorous nose blowing
Nursing Diagnoses
Deviated Septum / Nasal Polyps
Nursing Interventions
Maintain patent airway and prevent infection
Monitor for s/s of infection Monitor for s/s hemorrhage Maintain patient comfort
Deviated Septum / Nasal PolypsPatient Teaching
Avoid: vigorous nose blowing coughing holding your breath while
bearing down (at least 2 days post-op)
Notify Physician if bleeding infection occurs
Use nasal sprays and drops sparingly
Facial edema and
ecchymosis may appear post-op
Antigen-Antibody Allergic Rhinitis and Allergic Conjunctivitis
HAY FEVER
Hay Fever
Atopic allergic condition
Affects Nasal membranes Nasopharynx Conjunctiva
Ciliary action slows Mucosal gland secretion increases Leukocyte infiltration occurs Increased capillary permeability and
vasodilation Local tissue edema results
Pathophysiology
Hay Fever (AKA allergic Rhinitis)
Etiology
Antigen / Antibody Reaction Inhalation or contact with allergens
Common allergens Tree, Grass, Weed Pollen Mold spores Fungi House dust Mites Animal dander Foods Drugs Insect bites and stings
Hay FeverClinical Manifestations and Assessment Photophobia Edema Blurred vision / watery eyes Pruritus Excessive tear production Cough / Sneezing Epistaxis Headache
Congestion Excessive nasal secretions (rhinitis)
Otitis media complaints of:
Ear fullness and popping Decreased hearing
Chronic S/S
• Headache• Severe nasal congestion• Post nasal drip• Cough
• If untreated secondary infections may occur
• Otitis media• Bronchitis• Sinusitis• pneumonia
Hay FeverDiagnostics
Physical exam of eyes and ears
Skin Testing RAST test (blood test
Measures allergy antibody produced when mixed with allergens
Hay FeverMedical Management
Relieve symptoms Avoid allergen Antihistamines Topical or Nasal
Corticosteroids Leukotriene Receptor
Antagonists Decongestants Lodoxamide (conjunctivitis) Analgesics (headache) Hot Packs
Hay Fever
Nursing Interventions
Self-limiting illnessFocus on:Health promotion and self-care teaching
Ways to avoid allergensSymptom controlMedication action and usage
Upper Airway Obstruction
Upper Airway Obstruction
Etiology and Pathophysiology
Recent respiratory event
Trauma to the airway or to the surrounding tissues
Laryngeal spasm
Laryngeal edema
Common items that obstruct the upper airway are: Choking on food Dentures Aspiration of vomitus or secretions The tongue (the most common in an unconscious person)
Upper Airway Obstruction
Clinical Manifestations
Main SignsStertorous or Stridor RespirationsAltered respiratory rate and characterApneic periods
Upper Airway ObstructionAssessment
SubjectiveLimitedDifficult time with breathing Difficulty speaking
Objective Signs of hypoxia Disorientation, fatigue, anxiety Cyanosis of the skin, lips, and nail beds Snoring, wheezing, or stridorous respirationsBradycardia Shallow, slow respirations (bradypnea)
Upper Airway Obstruction
Diagnostics
Medical emergency
No diagnostic tests
Prompt, accurate assessment and treatment
Upper Airway Obstruction
Medical Management
Abdominal Thrusts To remove obstruction
Maintain patent airway Artificial Airway
Endotracheal Pharyngeal Tracheal
Emergency Tracheostomy
(Video)
http://www.youtube.com/watch?v=d_5eKkwnIRs
Upper Airway Obstruction
Nursing Diagnoses
Ineffective airway clearanceR/T obstruction in airway
Risk for aspiration R/T partial airway obstruction.
Upper Airway Obstruction
Nursing InterventionsEmergent
Open the airway and restore patencyRemove foreign body Abdominal Thrusts (Heimlich) Reposition the head and neck Head-tilt/chin lift technique
Upper Airway Obstruction
Patient Teaching
Prevention!!!!!! Educate about Heimlich Maneuver
Recommend a CPR class Discourage talking while eating Encourage eating slowly and chewing food
thoroughly
Summary Identified common disorders / diseases of the upper respiratory
system
Discussed etiology and pathophysiology associated with disorders / diseases of the upper airway
Identified cardinal signs and symptoms associated with disorders / diseases of the upper airway
Identified components used in the management of a client with an upper respiratory disorder or illness
Discussed assessment, diagnostic, nursing interventions and management, and patient education important to clients with upper respiratory disorders
Assignment
Read and ReviewAHN – Chapter 9 (Pp. 384-390)PowerPoint Handout
Begin research for Mid-Term PaperDue Day 6Topic will be assigned for paper and group presentation
Next Class
Disorders of the Lower Airway
AHN – Chapter 9 (Pp. 395 – 420)
Questions?