Chapter 22 Upper Respiratory Disorder

Management of Patients With Upper Respiratory Tract Disorders
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Care of Patients with Upper Airway Disorders

Upper airway disorders may be minor, treated outside health care setting Or may be severe, life threatening Require good assessment skills, understanding of variety of disorders that affect upper airway, impact those disorders may have on patient Patient teaching is important aspect of care
Specific Disorders
Rhinitis Sinusitis: acute, chronic Pharyngitis: acute, chronic Tonsillitis, adenoiditis Peritonisillar abscess Laryngitis
Rhinitis and Sinusitis
RHINITIS characterized by inflammation

nose TYPES: 1. ACUTE OR CHRONIC - duration 2. NON-ALLERGIC OR ALLERGIC causative
and irritation of the mucus membranes of the
3. VIRAL OR BACTERIAL
CAUSATIVE:
CHANGES IN TEMPERATURE / HUMIDITY EXPOSURE TO ALLERGENS OTC, ANTI HPN, ANTI LIPID, ANTI DEPRESSANT
DRUGS
SYSTEMIC DISEASES
CLINICAL MANIFESTATION:
RHINORRHEA NASAL CONGESTION NASAL DISCHARGE SNEEZING PRURITUS OF THE NOSE HEADACHE
RHINOSINUSITIS
inflammation of the paranasal sinuses and nasal cavity
ACUTE RECURRENT CHRONIC: ABRS or AVRS
UNRESOLVE VIRAL OR BACTERIAL RHINITIS BLOCK NORMAL FLOW OF SINUS SECRETIONS CONTINUOUS EXPOSURE ENVIRONMENTAL HAZARDS
STEPTOCOCCUS PNEUMONIAE HAEMOPHILUS INFLUENZAE STAPHYLOCCOCUS AUREUS MORAXELLA CATARRHALIS CHLAMYDIA PNEUMONIAE STREPTOCOCCUS PYROGENES VIRUSES AND FUNGI
ACTIVATION OF IMMUNE RESPONSE
VASCULAR CHANGES Vasodilation Capillary permeability Tissue congestion
CELLULAR CHANGES
Phagocytic immune response Humoral immune response Cellular immune response
NASAL DRAINAGE = NASAL OBSTRUCTION FACIAL PAIN-PRESSURE-FULLNESS

ABRS 10 days or more

AVRS less than 10 days RECURRENT CHRONIC = 12 weeks or longer
PERIORBITAL EDEMA
SORE THROAT
ADENOIDAL HYPERTHROPHY
FATIGUE
DECREASE IN SMELL AND TASTE

SENSE OF FULLNESS IN THE EAR EAR PAIN
DIAGNOSIS:
HEALTH HISTORY
PHYSICAL ASSESSMENT
IMAGING STUDIES: XRAY, SINOSCOPY OR NASAL ENDOSCOPY, ULTRASOUND, CT OR MRI

DRAINAGE ASPIRATE C/S
HEALTH HISTORY
RISK FACTORS
SMOKING PERSONAL/FAMILY HISTORY OCCUPATIONAL EXPOSURE ALLERGEN AND ENVIRONMENTAL POLLUTANTS HEALTH PERCEPTION/PRACTICES
AGE & DEVELOPMENT

PAST HEALTH HISTORY
COUGH
ONSET
Sudden or gradual, how long ago Dry, moist, barking, hacking, productive, non-productive
NATURE
PATTERN
Continuous, occasional, related to time of the day, position or activity, weather

Pain, shortness of breath, wheezing Vaporizers, OTC medications
ASSOCIATED SYMPTOMS ALLEVIATING FACTORS
SPUTUM
AMOUNT
Scanty, moderate, or copious
COLOR
Normal clear sputum Mucoid tracheobronchitis or asthma Yellow/Green bacterial infection Rusty or blood tinged pneumonia or TB Black Chronic lung diseases Pink pulmonary edema
Watery thin usually clear Viscous very thick, firm, and stays together Semi-liquid (N) thicker than watery sputum but not as thick as viscous sputum Frothy sputum foam-like and contains many small air bubbles Normal sputum has little or no odor Abnormal sputum may have sweaty smell or foul and offensive smell
CHARACTERS
ODOR
SHORTNESS OF BREATH
ONSET
Sudden or gradual, how long ago

Precipitating factor Description of respiration effort Associated with activity or position Continuous or intermittent
NATURE
PATTERN
ASSOCIATED SYMPTOMS
ALLEVIATING FACTORS
Pain, cough, diaphoresis
Positioning and home remedies
PAIN
ONSET
Sudden or gradual, how long ago

Stabbing, burning, squeezing, crushing Location and radiation Activity, pain, variable Dizziness, nausea, diaphoresis or palpitations
NATURE
PATTERN ASSOCIATED SYMPTOMS
ALLEVIATING and AGGRAVATING FACTORS
Massage, Rest, OTC medications, Environment, Copyright 2010 Wolters Kluwer warm/cold temperature Health | Lippincott Williams & Wilkins
PHYSICAL ASSESSMENT
ERYTHEMA, PALLOR, ATROPHY, EDEMA, CRUSTING, DISCHARGE, POLYPS, EROSIONS AND SEPTAL PERFORATION OR DEVIATION CERVIAL NODE ADENOPATHY AND SINUS TENDERNESS percussion TRANSILLUMINATION
INCREASE ILLUMINATION = SINUS FILLED WITH AIR

DECREASE ILLUMINATION = SINUS FILLED WITH FLUID
MANAGEMENT
SALINE LAVAGE/STEAM INHALATION
ANTIBACTERIAL / ANTIVIRAL
DECONGESTANT
ANTI HISTAMINE CORTICOSTEROIDS (BUDESONIDES/BECLOMETHASONE) MUCOLYTIC, EXPECTORANT AND ANTITUSSIVE
CORRECTIVE SURGICAL REPAIR

NURSING DIAGNOSIS
INEFFECTIVE AIRWAY CLEARANCE inability to clear secretions or obstructions from the respiratory tract to maintain clear airway INEFFECTIVE BREATHING PATTERN inspiration and expiration that does not provide adequate ventilation IMPAIRED GAS EXCHANGE excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar capillary membrane ACTIVITY INTOLERANCE insufficient physiological or psychological energy to endure or complete required or desired daily activities
CORRELATED NURSING DIAGNOSIS
ANXIETY FATIGUE FEAR
POWERLESSNESS
INSOMNIA
SOCIAL ISOLATION
PLANNING MAINTAIN PATENT AIRWAY

IMPROVE COMFORT AND EASE OF BREATHING MAINTAIN AND IMPROVE PULMONARY VENTILATION AND OXYGENATION IMPROVE ABILITY TO PARTICIPATE IN PHYSICAL ACTIVITIES PREVENT RISK ASSOCIATED WITH OXYGENATION PROBLEMS SUCH AS SKIN AND TISSUE BREAKDOWN, SYNCOPE, ACID BASE IMBALANCES AND FEELINGS OF HOPELESSNESS AND SOCIAL ISOLATIONS
NURSING INTERVENTION FOR CLIENT WITH PULMONARY PROBLEM
INTERVENTION
Includes: 1. Positioning the client to allow maximum chest expansion. 2. Encouraging and providing frequent changes in position. 3. Encouraging ambulation 4. Implementing measures that promote comfort Encouraging deep breathing and coughing Ensuring adequate hydration Health teaching
Achieve efficient and controlled ventilation > breathing retraining Good gas exchange Prevent exhaustion Prevent atelectasis and other respiratory complications
Pursed lip + abdominal breathing Improves ventilation Releases trapped air in the lungs Keeps the airways open longer and decreases the work of breathing Prolongs exhalation to slow the breathing rate Improves breathing patterns by moving old air out of the lungs and allowing for new air to enter the lungs Relieves shortness of breath Causes general relaxation
Breathing Into a Paper Bag

help to control carbon dioxide levels in your bloodstream. Relieve Hiccups, Stop Hyperventilating and Retinal Artery Occlusion
HYDRATION
maintain the moisture of the respiratory mucous membrane
HUMIDIFIERS device that add water vapor to inspired air loosen secretions
NEBULIZERS used to deliver humidity and medications loosen secretions FLUID THERAPY
Humidifier
Therapeutic Measures Promote Respiratory Function
Chest PT
Oxygen therapy
Incentive spirometry Artificial airways

Postural drainage Medications Airway suctioning Chest tubes
PERCUSSION AND VIBRATION
Chest Physiotherapy
HFCWO
(High-Frequency Chest Wall Oscillation)
Incentive Spirometry
POSTURAL DRAINAGE
Postural drainage is drainage by gravity of secretion from various lung segment.
MEDICATIONS
different route can be used > respiratory and intravenous
ACTIONS: bronchodilation = decreasing resistance in the respiratory airway + increasing airflow to the lung > better oxygenation Short-acting 2-agonists ex: Salbutamol Long-acting 2-agonists ex:Salmeterol & Formoterol
BRONCHODILATORS adrenergic, anticholinergic and methylxanthines ADRENERGIC action like epinephrine ANTICHOLINERGICS long-term COPD ex: ipratropium bromide. METHYLXANTHINES ex: aminophylline and theophylline CORTICOSTEROIDS anti-inflammatory properties > steroids (inhibits the synthesis of protein)
Receptor
Expected Expected Primary Effect if Effect if Location Stimulat Blocked ed
Beta 1
Heart
Increase in HR, Conduction Speed and Contractility
Decrease in HR, Conduction Speed and Contractility
Beta 2
Lungs
Bronchodilatation
Bronchoconstriction
Blood Alpha 1 Vessels
Vasoconstriction
Vasodilatation
Medication
Affects
1 Affects
2 Affects
Epinephrine
+++
++
++
Norepinephrine
+++
NEBULIZATION
solutions/suspensions into small aerosol droplets that can be directly inhaled inhaled aerosol droplets can only penetrate into the narrow branches of the lower airways if they have a small diameter of 1-5 micrometers
OXYGEN THERAPY administration of oxygen at a concentration greater than that found in the atmosphere
Factors in Transport of O2:
Cardiac output Arterial oxygen content Concentration of hemoglobin Metabolic requirement
Oxygen Therapy Often used to treat hypoxia (hypoxemic, circulatory, anemic or histotoxic) It is prescribed by the physician who specified the concentration, methods of delivery, and liter flow per minute. Patient with COPD require low oxygen concentration (hypoxic drive)
SAFETY PRECAUTIONS:
Avoid smoking or place sign No Smoking: Oxygen in Use Make sure electric devices are in good working order to prevent short circuit sparks Avoid materials that generate static electricity such as woolen blanket & synthetic fabrics. Cotton blankets and fabrics are advised Avoid use of volatile, flammable materials (alcohol, acetone) Make know the location of fire extinguisher Check the level of portable tanks before transporting to ensure there is enough oxygen in the tank
1. Source of oxygen supply a. Oxygen tank b. Wall oxygen outlet

2. Flow meter a. Mercury ball b. Gauge flow meter 3. Humidifier
4. Delivery system e.g. cannula

Oxygen Therapy
Oxygen Therapy
Nasal Cannula
It is the most common inexpensive device It is easy to apply and does not interfere with clients ability to talk or eat. It is more comfortable because it permits freedom of movement
It delivers about 2445% O2 at flow rate of 2-6 L/min

Simple Face Mask

Delivers oxygen concentration from from 40-60% at liter flow to a 5-8L/min Used when increased O2 delivery is needed for short period
Partial Rebreather mask
Delivers oxygen concentration of 6090% at liters flow of 6-10 L/min Reservoir bag allows the client to rebreath exhaled air in conjunction with oxygen
poor fitting and warm

Non-Rebreather mask
It delivers the highest concentration of oxygen as possible by means other than mechanical ventilator or intubation, at liters flow of 10-15 L/min
DIFFERENCE
Non-rebreather has Rebreather mask several one-way valves has a soft plastic reservoir bag attached in the side ports. This type of mask also has at the end that saves one-third of a person's a reservoir bag attached, but the bag exhaled air, while the rest of the air gets out has a one-way valve via side ports covered that prevents the with a one-way valve. exhaled carbon dioxide from getting into the reservoir.
Venturi mask
Delivers oxygen concentration precisely (Fi02) used for pts who are with COPD appropriate level high airflow with controlled oxygen level excess gas leaves through exhalation port
Type 1 Respiratory Failure is low paO2 (< 55mmHg) and a normal paCO2 (40mmHg)
Type 2 Respiratory Failure is variable paO2 and a high paCO2 (>50mmHg) build up of carbon dioxide Hypercapnic
respiratory failure
hypoxia without hypercapnia
Hypoxemic respiratory failure
ventilation-perfusion (V/Q) mismatch
neuromuscular disorders and CNS depression = both oxygen and carbon dioxide are affected
T-PIECE
8 10 L/min (30 100 FiO2) heavy tubing, requires strict changing 3 days to prevent VAP same with tracheostomy collar
TRANSTRACHEAL OXYGEN CATHETER directly to the trachea for client with chronic oxygen therapy need
Transtracheal catheter
Jet ventilation tubing with flow regulator.
Aerosol mask 8-10 L/min (30100% ) having better humidity
FACE TENT
8 -10 L/min (30100% FiO2) > good humidity and fairly accurate O2 delivery advantage to be used for patients with facial trauma or burns. patients are less likely to feel claustrophobic for it provides comfort, clear vision, easy for speech
Artificial Airways
Are inserted to maintain a patent air passage for client whose airways has become or may become obstructed. It is indicated for client with decrease level of consciousness or airway obstruction and to aid in removal of tracheobronchial secretion. It has four common types: a. oropharyngeal
b. nasopharyngeal
c. endotracheal d. tracheostomy
Used for client with altered LOC. (GA,overdose,head injury) It is much easier to insert Disadvantages:increase oral secretion, decrease patient comfort, difficulty with stabilization, inability of patient to communicate.
Tolerated better by alert client. They are inserted through the nares and terminating in oropharynx.
It is more comfortable to patient and easier to stabilize.

Provide frequent nares and oral care: reposition the airway in other nares as ordered to prevent necrosis of the mucosa.
Oropharyngeal Airway Kluwer Health | Lippincott Williams & Wilkins Nasopharyngeal Airway Copyright 2010 Wolters
The mains risks of its use:

if the person has a gagreflex they may vomit when it is too large, it can close the glottis and thus close the airway improper sizing can cause bleeding in the airway
measuring from the middle of the persons mouth to the angle of the jaw.
inserted into the persons mouth upside down
Once contact is made with the back of the throat, the airway is rotated 180 degrees, allowing for easy insertion, and assuring that the tongue is secured
holding the tongue forward with a tongue depressor and inserting the airway right side up
NPA or a nasal trumpet
The correct size airway is chosen by measuring the device on the patient: the device should reach from the patient's nostril to the earlobe or the angle of the jaw outside of the tube lubricated with a waterbased lubricant until the flared end rests against the nostril contraindicated in patients with severe head or facial injuries basilar skull fracture
c. Nasopharyngeal Insertion Procedures. (1) Place pt on a firm surface in the supine position with the cervical spine stabilized.
(2) Lubricate the NPA with a water-soluble lubricant

(3)Push the tip of the patient's nose slightly upward to expose the opening in the nostril. (4)Keeping the head neutral position, insert the tip of the NPA through the nostril.
(5) Slowly advance tube along floor of nasal cavity with

bevel pointing toward septum until flange rest firmly against casualty's nostril
(a) If resistance is met during insertion, do not continue to insert.
(b)Stop, remove the adjunct, relubricate, and try the other nostril.
(c)If resistance is still met, check proper size or use alternate artificial airway method
Artificial Airways
Endotracheal tube
Are commonly inserted to client who have had GA and for those in emergency situation where mechanical ventilation is required. It is used as short term artificial airways to administer mechanical ventilation, relieved upper airway obstruction, protect against aspiration or clear secretion It is generally removed after 14 days.
Tracheostomy Tube
Tracheostomy Tube
Components of tracheostomy tube
Tracheostomy tube in place

Tracheostomy
Inserted to the trachea via the 2nd or 3rd cartilage ring totally bypasses the upper airways. It is indicated for client who require long term oxygen support, wherein an incision is made in the trachea just below the larynx. It may be in form of plastic or metal and are available in different sizes. Patient requiring MV requires a cuffed Tracheostomy tube and those that are awake and alert requires a cuffless tracheostomy
1 - Vocal folds
2 - Thyroid cartilage
3 - Cricoid cartilage
4 - Tracheal rings
5 - Balloon cuff
Nursing Management for Patient with Artificial Airways.

Ensure adequate ventilation and oxygenation through the use of mechanical ventilator, CPAP. Clear airway secretion as needed with suctioning.
Use sterile technique in entering AA.

Elevate the patient on a semi fowlers or sitting position if possible. Change position at least every two hours
External tube site care:
Endotracheal tube provide frequent oral care if possible, secure the tube at all times Tracheostomy tube stoma should be cleaned once in a shift and tracheostomy ties changed once a day Have available at all times at the patient bedside, resuscitation bag, oxygen source, and mask to ventilate the patient in case of accidental tube removal. Provide psychological support to the patient.
SUCTIONING
It is aspirating secretion through a catheter connected to suction machine or wall suction outlet.
It may be an: A. OPEN TIPPED
B.WHISTLE TIPPED
Purpose includes:
- to remove secretion that obstruct the airway.

- to facilitate ventilation. - to obtain secretion for diagnostic purposes. - to prevent infection that may result from accumulated secretion.
WHAT INTERVENTIONS ARE APPLICABLE TO OUR CLIENT WITH RHINOSINUSITIS?

COMPLICATIONS MAXILLARY RS MASTICATION PROBLEM

FRONTAL RS OSTEOMYELITIS OF THE FRONTAL BONE ETHMOID RS ORBITAL CELLULITIS INTRACRANIAL INFECTION
SPHENOID RS VASCULAR COMPLICATION

Infections that involve either of these structures may lead to aneurysms or infected blood clots in the intracranial cavity
The frontal, ethmoid and sphenoid sinuses are separated from the intracranial cavity by a layer of bone
Pharyngitis inflammation of throat
RISK FACTORS:
cold & flu seasons close contact w/ someone who has sore throat/cold
smoking exposure
frequent sinus infection allergies, viruses and bacteria
environmental condition
voice prompt occupation chronic cough
habitual use of alcohol and tobacco

PATHOPHYSIOLOGY
BACTERIA/VIRUSES
TRIGGERS INFLAMMATORY RESPONSE
RELEASING CHEMICAL MEDIATORS
DILATION OF BLOOD VESSEL INCREASE BLOOD FLOW Redness
CAPILLARY PERMEABILITY PLASMA FLUID SWELLING PAIN
WBC/MACROPHAGES PHAGOCYTOSIS release toxins temperature increase
increased temperature in the area

GAS MYCOPLASMA PNEUMONIAE NEISSERIA GONORRHEA H. INFLUENZA
ACUTE
FIERY-RED pharyngeal membrane and tonsils swollen lymphoid follicles with white purplish exudates enlarged and tender cervical lymph node no cough fever, malaise, sore throat
CHRONIC General thickening and congestion of the pharyngeal mucous membrane HYPERTHROPIC
swollen lymphoid follicles on the pharyngeal wall CHRONIC GRANULAR
clergymans sore throat
Irritation or fullness in the throat

with cough
difficulty swallowing
Question
Tell whether the following statement is true or false: Acute pharyngitis of a bacterial nature is most commonly caused by group A, beta-hemolytic streptococci.
Answer
True. Rationale: Acute pharyngitis of a bacterial nature is most commonly caused by group A, beta-hemolytic streptococci.
Potential Complications
Sepsis Meningitis Tonsillitis and Adenoiditis Peritonsillar abscess Otitis media Sinusitis
TONSILLITIS/ADENOIDITIS
composed lympathic tissue
fever, snoring , difficulty swallowing, mouth breathing, earache, nasal obstruction throat culture affirmative diagnosis of the causative agent + physical examination
Supportive treatment, antibiotic, analgesics, and surgery
Severe sore throat Fever Trismus Drooling Pain Odynophagia/dysphagia Cervical lymph node enlargement
CLINICAL SYMPTOMS
Hoarseness of voice Dry cough worsen in the evening Tickling sensation on the throat
MANAGEMENT:
SUPPORTIVE
OBSTRUCTION DURING SLEEP (OSA)

reduction of ventilation during sleep obesity male gender post-menapausal status advanced age
snoring, snorting, gasping, choking, apneic episodes, fatigue4 and hypersomnolence polysomnographic test CPAP
Nursing Process: Care of Patients with Upper Respiratory Infections Assessment

Health history
Signs and symptoms: headache, cough, hoarseness, fever, stuffiness, generalized discomfort and fatigue
Allergies
Inspection of nose, neck, throat

Include palpation of lymph nodes
Question
What should the nurse palpate when assessing for an upper respiratory tract infection? A. Neck lymph nodes
B. Nasal mucosa
C. Tracheal mucosa D. All of the above
Answer
A. 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.
Nursing Process: Care of Patients with Upper Respiratory Infections - Diagnosis

Ineffective airway clearance Acute pain Impaired verbal communication Deficient fluid volume Deficit of knowledge related to prevention, treatment, surgical procedure, postoperative care
Nursing Process: Care of Patients with Upper Respiratory Infections - Planning

Maintenance of patent airway Relief of pain Maintenance of effective communication Normal hydration Knowledge to how to prevent upper airway infections Absence of complications
Interventions
Interventions to maintain patent airway Promote comfort Analgesics Gargles for sore throat Use of hot packs for sinus congestion or ice collar to reduce swelling, bleeding post tonsillectomy and adenoidectomy
Interventions (contd)
Rest Refrain from speaking, use alternative communication Encourage liquids; 2 to 3 L a day, appropriate foods
Patient Education
Prevention of upper airway infections Emphasize frequent hand washing When to contact health care provider Need to complete antibiotic treatment regimen Annual influenza vaccine for those at risk
Epistaxis
Hemorrhage from nose Risk factors Sites of bleeding Most common: anterior septum Can be serious problem resulting is significant blood loss or airway compromise
Treatment of Epistaxis
Topical vasoconstrictors Adrenaline Cocaine Phenylephrine Packing of nasal cavity or balloon catheter
Control of Epistaxis
Nursing Care of Patients with Epistaxis

Assessment of bleeding Monitor airway, breathing Vital signs Reduce anxiety
Patient teaching
Avoid nasal trauma, nose picking, nose blowing Air humidification
Pressure on nose to stop bleeding; if bleeding does not stop in 15 minutes, seek medical attention
Cancer of the Larynx

Incidence Risk factors Categories Supraglottic: false vocal cords above vocal cords Glottic: true vocal cords Subglottic: below vocal cords
Symptoms
Hoarseness Persistent cough Sore throat or pain, burning in throat Lump in neck Later symptoms: dysphagia, dyspnea, unilateral nasal obstruction, persistent hoarseness, persistent ulceration, foul breath Generalized symptoms: weight loss, debilitation, lymphadenopathy, radiation of pain to ear
Question
Tell whether the following statement is true or false: An early sign of cancer of the larynx in the glottic are is enlarged cervical nodes.
Answer
False. Rationale: An early sign of cancer of the larynx in the glottic are is affected voice sounds, not enlarged cervical nodes.
Medical Diagnosis
Diagnosis made by history, physical exam, laryngoscopic exam, biopsy Tumors staged by TMN classification
CT, MRI, PET to assess tumor extent and stage, to determine reoccurrence
Medical Treatment
Radiation therapy Chemotherapy Surgery Partial laryngectomy Supraglottic laryngectomy Hemilaryngectomy Total laryngectomy
Changes in Airflow with Total Laryngectomy
Nursing Process: Care of a Patient with a Laryngectomy - Assessment

Health history Assess history of alcohol abuse Physical assessment Nutritional status Assess literacy, hearing, visual ability; may impact communication
Assess learning needs

Assess patient, family coping, support systems
Nursing Process: Care of a Patient with a Laryngectomy - Diagnoses

Deficit knowledge related to surgical procedure, postoperative course Anxiety, depression
Ineffective airway clearance

Impaired verbal communication Imbalanced nutrition
Disturbed body image

Self-care deficit
Potential Collaborative Problems

Respiratory distress Hemorrhage Infections Wound breakdown Aspiration
Nursing Process: Care of a Patient with a Laryngectomy - Planning

Adequate level of knowledge (patient, family) Reduction of anxiety Maintenance of patent airway Effective means of communication Attaining optimum hydration, nutrition Improved body image, self-esteem Self-care management Absence of complications
Preoperative Teaching
Instruction regarding type of procedure, resultant changes (changes in speech, permanent loss of speech, changes in airway) Include instruction regarding tubes used postoperatively (drainage tubes, feeding tubes), provide general preoperative teaching to prevent postoperative complications
Preoperative Teaching (contd)

Include planning for postoperative communication, longterm speech rehabilitation Utilize collaborative approach
Include physician, speech therapy, dietary, social work, clinical nurse specialist, others as required
Anxiety and Depression

Allow asking of questions, provide information Permit verbalization of feelings Interventions to reduce anxiety, promote comfort Reassuring manner Stay with patient during episodes of anxiety Relaxation techniques
Maintaining a Patent Airway

Semi Fowlers or high Fowlers position to decrease edema Monitor for signs, symptoms of respiratory distress
Tracheostomy or laryngectomy tube assessment, care

Care of stoma Suctioning
Humidification of air
Patient teaching
Communication
Plan communication preoperatively Immediate postoperative communication Magic slate Communication board Speech rehabilitation
TEP Voice Prosthesis
Potential for Aspiration

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

Chapter 22 Upper Respiratory Disorder

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Chapter 22 Upper Respiratory Disorder

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Management of Patients With Upper Respiratory Tract Disorders

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Care of Patients with Upper Airway Disorders

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Rhinitis and Sinusitis

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

RHINITIS characterized by inflammation

and irritation of the mucus membranes of the

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

ACTIVATION OF IMMUNE RESPONSE

VASCULAR CHANGES Vasodilation Capillary permeability Tissue congestion

NASAL DRAINAGE = NASAL OBSTRUCTION FACIAL PAIN-PRESSURE-FULLNESS

ABRS 10 days or more

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

DECREASE IN SMELL AND TASTE

IMAGING STUDIES: XRAY, SINOSCOPY OR NASAL ENDOSCOPY, ULTRASOUND, CT OR MRI

AGE & DEVELOPMENT

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Continuous, occasional, related to time of the day, position or activity, weather

ASSOCIATED SYMPTOMS ALLEVIATING FACTORS

Scanty, moderate, or copious

Sudden or gradual, how long ago

Pain, cough, diaphoresis

Positioning and home remedies

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Sudden or gradual, how long ago

PATTERN ASSOCIATED SYMPTOMS

ALLEVIATING and AGGRAVATING FACTORS

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

INCREASE ILLUMINATION = SINUS FILLED WITH AIR

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

SALINE LAVAGE/STEAM INHALATION

CORRECTIVE SURGICAL REPAIR

CORRELATED NURSING DIAGNOSIS

ANXIETY FATIGUE FEAR

PLANNING MAINTAIN PATENT AIRWAY

NURSING INTERVENTION FOR CLIENT WITH PULMONARY PROBLEM

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Breathing Into a Paper Bag

maintain the moisture of the respiratory mucous membrane

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Therapeutic Measures Promote Respiratory Function

Incentive spirometry Artificial airways

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

PERCUSSION AND VIBRATION