Upper Respiratory

1
Upper Respiratory

• Class 5/6

2
Structural Traumatic Disorders of the Nose

• Deviated Septum (trauma or congenital deformity)
  
• severe cases result in infection
• Nasal fracture
• complications airway obstruction, epistaxis
• assess air exchange, bruising, edema, color of
  drainage
• Management reduce edema,prevent complications ,
  educate , emotional support

3

• Rhinoplasty
• What are the expectations of the patient?
• How can disappointment be avoided?
• What is the rationale for nasal packing?
• Management of nasal surgery
• avoid ASA 2 weeks prior to surgery
• teach early and late complications
• discuss interim period while edema and ecchymosis
  resolve before the final effect can be appreciated

4

• Epistaxis
• The patient is in the clinic for an appointment
  and her nose begins to bleed.
• What is the 1st nursing action?
• After resolving the meeting the physical needs of
  the patient, what questions will the nurse ask?

5

• If first aid is not effective?
• nasal packing needed (anterior or posterior)
• vasoconstrictive agent
• cauterization
• What is the greatest risk with posterior packing?
• What is a mustache dressing??

6
Inflammation and infection of the Nose
Paranasal Sinuses

• Allergic Rhinitis response to allergens,
  sneezing,watery eyes, slt smell, nasal secretions
• teaching reduction of symptoms
• Management use of antihistamines, decongestants,
  nasal corticosteroids ( pg584)
• avoidance is best therapy

7

• Acute Viral Rhinitis (common cold)
• Management supportive care, fluids,
  antihistamine, decongestant, watch for secondary
  infection (t-100.4)
• What is the indication for COPD patients?

8

• Influenza Abrupt onset, fever, h/a, chills,
  myalgia, cough, sore throat
• dyspnea,diffuse crackles s/s of pulmonary
  complications
• pneumonia most common complication
• Management
• prevent with vaccinations
• What is the contraindication for vaccination?
• Nursing management is supportive care
• Symmetrel, Relenza

9

• Sinusitis
• acute usually results from an upper resp
  infection
• chronic assoc with allergy and nasal polyps
• chronic results in loss of ciliated epithelium
  lining in the sinus cavity
• Management
• antibiotics, decongestants or expectorants, nasal
  corticosteroids
• Teaching
• pg. 588-589

10
Obstruction of the Nose Paranasal Sinuses

• Polyps
• Foreign Bodies
• What are the complications associated with
  irrigation of the nose or trying to retrieve a
  foreign body from the nose?

11
Problems related to the Pharynx

• Acute Pharyngitis
• White, irregular patches candida
• red-purple,patchy yellow exudate strep
• gray-white false membrane over oro-naso-laryngo-ph
  arynx diphtheria
• Management
• throat cultures
• Peritonsillar Abcess Potential airway
  obstruction

12
URI (common cold)

• Management antipyretics, decongestants, cough
  suppressants, ??antihistamines??
• Nursing HOB elevated, suctioning vaporization,
  saline nose gtts, fluids, avoid infected contacts
• What family support may be indicated?

13
Pharyngitis

• Strep throat risk of serious sequelae
• Acute rheumatic fever
• acute gomerulonephritis
• tonsils and pharynx may be inflamed and covered
  with exudate
• Tx penicillin, rifampin
• kids may return to daycare-24hours

14
Tonsillectomy

• Position on abdomen or side until awake
• child may prefer to sit up
• Discourage coughing, clearing throat, blowing
  nose
• Secretions are common dried dark blood

15

• Pain relief tetracaine pops, ice pops phenergan
  patch
• Hemorrhage
• nurse may observe throat carefully with tongue
  blade
• findings increase pulse, frequent clearing of
  throat, frequent swallowing, restlessness,
• Action notify physician

16
Croup Syndromes

• Epiglotitis
• Laryngotracheo bronchitis
• Acute Spasmodic Laryngitis
• See table 23-1
• Prevention H. flu vaccine
• Tx cool-air vaporizer at bedside, racemic
  epinephrine

17
Obstructive Sleep Apnea

• Cessation of airflow during sleep
• tongue and soft palate fall backward and
  partially obstruct the pharynx
• hyoxia ,hypercapnia these cause the patient to
  waken,snoring, h/a,personality changes,
  irritability, memory problems, depression
• Management
• weight loss, group support,oral appliances, CPAP

18

• The Rn identifies a nursing diagnose of altered
  health maintenance related to lack of knowledge
  of therapeutic regiment for a patient with acute
  sinusitis who
• a.continues to take antibiotics for a week after
  symptoms are relieved
• b.uses aspirin or NSAIDS to relieve h/a and
  facial pain
• c.uses over-the-counter antihistamines to relieve
  symptoms of congestion and drainage
• d.reports a lack of improvement in symptoms after
  3 days of taking broad spectrum antibiotics

19

• A patients wife tells the RN that she thinks her
  husband has sleep apnea because he snores so
  loudly. Additional information that should be
  collected by the RN related to obstructive sleep
  apnea includes a history of
• a.evening h/a
• b.sleeping on a soft mattress
• c.frequent awakening at night
• d.frequent upper respiratory infection