Nursing Care of Upper Respiratory Tract Disorders Flashcards by Crystal Sanders

Disorders of the nose/sinuses

Epistaxis
Deviated septum/nasal polyps
Allergic rhinitis/ Hay fever
Obstructive sleep apnea
Upper airway obstruction
Cancer of the larynx
Acute follicular tonsilitis
Acute rhinitis
Laryngitis
Pharyngitis

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Epistaxis

Bleeding from the nose (anterior, posterior)
Congestion of the nasal membranes leading to capilarry rupture
Bright red bleeding from one or both nostrils
Can lose as much as 1L/hr of blood
From dry, cracked mucous membranes
Trauma, forceful nose-blowing, and picking (EWW!)

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Epistaxis is dangerous to who?

People with a decreased/inability to clot

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Diagnostic tests for epistaxis

H+H
PT & PTT
INR
May need PRBCs (in extreme cases)

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Medical interventions for epistaxis

Nasal packing with gauze saturated with epinephrine
Electric cautery
Chemical cautery- silver nitrate
Posterior packing- balloon tamponade
Antibiotics
Strings brought out through the outh and taped to face (2-4 days)
Petrolieum jelly helps keep packing from sticking to nose

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NIs for epistaxis

Monitor VS
Keep client quiet
Maintain sitting position, leaning forwards
If in bed, keep head/shoulders elevated
Pinch entire soft lower portion of the nose for 5-10 minutes
Determine home medications = why? (ASA, NSAIDS, Coumadin)
Ice packs = vasoconstriction
Afrin = promotes vasoconstriction
Partially insert small gauze and apply digital pressure if needed
Monitor for S&S of hypovolemic shock
Swallowing may indicate bleeding***
Avoid increased pressure to nose

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Client teaching for epistaxis

Do not pick or irritate nose
Do not blow nose forcefully/vigorously
Avoid dryness of nose (use vaporizer, NSS, or nasal lubricants)
No putting foreign objects in the nose
MD to remove packing

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Nasal polyps

Tissue growths usually due to prolonged inflammation

Asthma, nasal polyps, and ASA allergy ~ Aspirin triad asthma

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Therapeutic measures for nasal polyps

Nasal corticosteroids
Oral antihistamines
Polypectomy

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Deviated septum

Congenital abnormality
Injury
Nasal septum deviates from the midline and can cause a partial obstruction

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S&S of deviated septum

Stuffy nose
H/A
Inflamed sinuses
Stertorous respirations- a struggling respiratory effort producing a snoring sound
Possible postnasal drip
Dysphagia
Dyspnea

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Medications for deviated septum

Steroids
Antihistamines
Antibiotics

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Surgical correction for deviated septum

Naso-septoplasty

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Nasal surgery

Polypectomy
Naso-septoplasty
Rhinoplasty

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Nasal surgery teaching- 7

Instruct client may feel stuffy and drain
Drink fluids
Cool mist vaporizer
Head elevated on 2 pillows or semi-fowlers
Ice packs
Pain meds
Call if complications

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Naso-septoplasty post op care

Watch for excessive swallowing (sign of bleeding)
Stool softeners
Antibiotics
Semi-fowlers
Ice packs
Call MD if fever or excess pain
Return in 24-48 hours

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Acute sinusitis

Inflammation of the mucosa of one or more sinuses

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Potential causes of sinusitis

Allergies
Nasal polyps
Fungal infections
Intubation
NG tubes

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Diagnostic tests for sinusitis

X-ray
Nasal endoscopy
CT
MRI
Culture + sensitivity
Transillumination- shine a light into the mouth with the lips closed aroung the light. Sinus infection will show up as a dark area (HOW COOL!)

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Complications of sinusitis

Osteomyelitis
Cellulites of the orbit
Abscess
Meningitis
May trigger asthma

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Therapeutic measures for sinusitis

Promote sinus drainage
Nasal irrigation with NSS
Hot packs
Antibiotics
Corticosteroids (Flonase + Afrin)
Pain relief (tylenol, ibuprofen, opioids)
Caldwell-Luc procedure

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Nursing care

Increased H2O intake
Moisture in air
Semi-fowlers
Hot packs
Pain meds

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Chronic sinusitis

Symptoms have existed for >2 months and are unresponsive to treatment
Might be bacterial infection following viral infection (Strep or H. influnzae.)

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In chronic sinusits, which sinuses are commonly affected?

Study These Flashcards

Maxillary

Ethmoid

Pathophysiology of rhinitis, hay fever, & common cold

Inflammation of the mucous membranes Result of antigen-antibody reactions Seasonal Ciliary action slows, mucosal secretions increase, and because of increased capillary permiability and vasodilation, local tissue edema occurs

S&S of rhinits, hay fever, & common cold

``` Nasal congestion Itching Sneezing Sore throat Nasal discharge ```

Diagnostic tests for rhinits

Skin testing IgE antibodies can be tetes Examination of the mucosa of the turbinates is usually pale bc of venous engorgement which is in contrast to the erythema of viral rhinits

Therapeutic measures of rhinits

``` Control symptoms Tylenol for discomfort Rest Fluids Adrenergic nasal spray- (constrict capillaries, teach for "rebound") ```

S*S of rebound congestion

Long-term redness and swellling inside nose | Increased runny nose

Teaching for rhinits

``` Avoid allergens Self-care management through S&S control Meds teaching (action, dose, SE) Assess for med effectiveness Reinforce no need for antibiotics if viral ```

Pharyngitis

Inflammation of the throat often r/t cold

S&S of pharyngitis

Dry cough Enlarged lymph nodes Tender tonsils

You have pharyngitis, what do you do?

Get throat cultures Adequate fluids Avoid inhaled irritants

When should S&S of pharyngitis resolve?

4-6 days

Medical management for pharyngitis

``` If viral- no specific treatment If bacterial- usually give: EES or levoflaxin Analgesics Antipyretics Antitussives to relieve cough Throat lozenges ```

NIs/Teaching for pharyngitis

Provide steam inhalaton Offer meds as ordered Encourage cessation of smoking Instruct to rest voice

Acute laryngitis

acute infection of the mucosal lining of the larynx (voice box) Usually secondary to other infections Can come from trauma Viral or bacterial infection (strep)

Why is acute laryngitis tough in children?

Small larynx

Acute laryngitis is precipitated by?

Overuse of voice

S&S of acute laryngitis

Hoarsenes- Most common Cough Dysphagia Fever

S&S of chronic laryngitis

Hoarseness Voice loss Scratchy throat Persistent cough

Chronic laryngitis

Inflammation of the laryngeal mucosa or edematous vocal cords

Acute follicular tonsillitis

Acute inflammation of the tonsils

Acute follicular tonsilitis can be a result of

Airborne of food borne bacterial infection | Can be viral

Acute follicular tonsilitis sequelae

Rheumatic fever Carditis Nephritis

S&S of acute follicular tonsilits

``` Enlarged, tender lymph nodes Fever Chills Muscle aches Malaise Myalgia ```

Diagnositc tests for acute folicular tonsilitis

Culture and sensitivity Elevated WBC- 10000-20000/mm3 Throat cultures

Medical management of acute folicular tonsilitis

``` Antibiotics- specific to organism Somtimes T+A Analgesics Antipyretics Warm saline gargles ```

NIs for acute folicular tonsilitis

Good oral care Warm saline gargles Ice chips

Tonsillectomies & Children

Should be >3 Use age-appropriate language Not done during acute infection Observe for evidence of bleeding

S&S of bleeding

Increased P, RR Restlessness Frequent swallowing!!****

T&A post-op child

``` Keep quiet Don't let cough, clear their throats, blow their noses Try to avoid crying Clear liquids Hemorrhage can occur Tylenol for pain ```

New guideline for removing tonsils

Kids must have: At least 7 episodes of throat infection (tonsilitis, strep) OR at least 5 episodes each year for 2 years OR 3 episodes annually for 3 years Before they are candidates **Throat infection must be documented by MD, not just reported by parent

Upper airway obstruction

``` Precipitated by recent viral event (such as trauma to airways) Dentures Aspiration of vomitus or secretions Tongue Laryngeal spasm Laryngeal edema ```

Medical management of upper airway obstruction

``` Choking- inability to breathe/speak Heimlich Laryngeal spasm Suctioning Ambu Mechanical ventilation ```

Obstructive sleep apnea

Patial or complete obstruction during sleep Apnea or hypopnea Lasts 15-90 secs Apnea and arousal cycles occur repeatedly often as 200-400X during 6-8 hours of sleep

Medical management of sleep apnea

Avoid sedatives and ETOH for 3-4 hours before bed Weight loss program referral Oral appliance that brings mandible and tongue forward Support group BiPAP- higher pressure during inspiration CPAP Surgery

Sleep apnea affects what percent of the population

2-10%

Sleep apnea largely affects the _____

Obese

Nursing Care of Upper Respiratory Tract Disorders Flashcards

(59 cards)