1/3/2008. Karen Burke Priscilla LeMone Elaine Mohn-Brown. Medical-Surgical Nursing Care, 2e Karen Burke, Priscilla LeMone, and Elaine Mohn-Brown

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1 Medical-Surgical Nursing Care Second Edition Karen Burke Priscilla LeMone Elaine Mohn-Brown Chapter 23 Caring for Clients with Upper Respiratory Disorders Rhinitis Inflammation of Nasal Cavities Types Acute viral rhinitis Allergic rhinitis Influenza Contagious viral respiratory disease Mode of transmission Airborne droplet Direct contact 1

2 TABLE 23-1 Manifestations and Course of Rhinitis and Influenza. Sinusitis Inflammation of mucous membranes of sinuses Usually caused by bacterial infection Usually follows URI Acute Epiglottitis Medical Emergency Monitor for signs of respiratory distress Nasal flaring Restlessness Stridor Use of accessory muscles Oxygen saturation 2

3 Acute Epiglottitis Don t insert nasal or oral airway May cause spasm and airway obstruction Nasotracheal intubation may be necessary Inflammation of larynx Change in voice Sore, scratchy throat Dry, harsh cough Laryngitis URIs Most self-limitinglimiting In long-term care facilities can spread rapidly Control spread 3

4 Throat swab CBC Chest x-ray Nasal swab CT scan URIs Diagnostic Tests Medications Vaccines Antibiotics Decongestants Antihistamines t i Topical nasal steroids Inhaled steroids URIs - Treatment Influenza Vaccine 85% effective in preventing influenza Criteria for clients who should receive vaccine Should not be given to clients with allergy to eggs Serious adverse reactions to vaccine 4

5 Antibiotics Treatment for bacterial infections Use for up to 10 days Client no longer contagious after 24 hours of antibiotic therapy Antibiotics may be used up to 2 weeks for sinusitis URIs - Treatment Sore Throat Warm saltwater gargles Throat lozenges Mild analgesics Cough Antitussives Systemic mucolytic agents (guaifenesin) URIs - Treatment Complementary Therapies Herbal remedies Aromatherapy 5

6 URIs - Treatment Surgical Interventions Endoscopic sinus surgery Nasal packing left in place hours postop Discharge instructions Tonsillectomy Peritonsillar Abscess Treatment: I&D needle aspiration followed by tonsillectomy URIs Nursing Care Assessment Determine effect of URI on client s life Identify risk factors for complications Determine whether problem will require medical treatment or self-care appropriate URIs Nursing Care Nursing Diagnoses Ineffective Breathing Pattern Ineffective Airway Clearance Disturbed Sleeping Pattern Impaired dv Verbal lc Communication 6

7 URIs Nursing Care Ineffective Breathing Pattern Monitor respiratory rate and pattern Auscultate lungs Pace activities Elevate head of bed Ineffective Airway Clearance Monitor effectiveness of cough Note whether cough is productive or nonproductive Auscultate lungs URIs Nursing Care Disturbed Sleep Pattern Assess sleep pattern Place in semi-fowler s or Fowler s position Provide antipyretics and analgesics Cough suppressant at night Impaired Verbal Communication Laryngitis Encourage client to rest voice; use alternative method to communicate (writing pad) Comfort measures: lozenges, gargle, or sprays Encourage client to quit smoking URIs Nursing Care Evaluation 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 Discuss OTC medications for relief of symptoms Assist client to identify possible allergens for allergic rhinitis Stress importance of completing entire course if on antibiotics Teach complications of influenza and URIs 7

8 Pertussis Whooping Cough Acute, highly contagious Infection with Bordetella pertussis Preventative - immunization Pertussis Nursing Care Education Respiratory isolation measures Reportable disease Nosebleed Causes Trauma Drying of membranes Infection Substance abuse Ateriosclerosis Hypertension Epistaxis 8

9 Epistaxis - Treatment Identify and control source of bleeding Pinch nose Apply ice packs Medications Nasal packing Surgery Epistaxis Nasal packing Anterior packing left in place hours Posterior packing left in place up to 5 days Uncomfortable Epistaxis Nasal packing Supplemental oxygen given with posterior packing Complications with posterior packing Foley catheter may be used as alternative to posterior packing 9

10 Figure Posterior nasal packing. Ties exiting through the nose and mouth are used to stabilize the packing in position and remove it when it is no longer needed. Epistaxis Nursing Care Assessment Reduce anxiety Maintain open airway Epistaxis Assessment Nursing diagnosis and interventions Evaluation Continuing care 10

11 Nasal Trauma/Deviated Septum Fracture Swelling can obstruct airway Deviated septum Septal cartilage bulges to one side Nasal Trauma/ Deviated Septum Maintain patent airway and prevent deformity If CSF leak suspected, CT scan performed More complex fractures may need surgery Rhinoplasty Septoplasty or submucosal resection (SMR) Correct deviation Nasal Trauma/ Deviated Septum Nursing care Airway management Control of bleeding, pain & swelling Provide necessary teaching Assessment: for pain, swelling, bleeding, difficulty breathing, deformities, ecchymosis and crepitus 11

12 Nasal Trauma/ Deviated Septum Nursing Diagnoses Ineffective Airway Clearance Interventions: Risk for Infection Interventions Evaluating and documenting Continuing care Laryngeal Obstruction/Trauma Life-Threatening Emergency Obstruction can be caused by: Laryngospasms Laryngeal edema Aspirated df food or foreign object Trauma to larynx Laryngeal Obstruction Manifestations Coughing Choking Gagging Difficulty breathing Use of accessory muscles Stridor 12

13 Laryngeal Trauma Manifestations Swelling impairs airway Subcutaneous emphysema Change in voice Dysphagia Stridor Hemoptysis Cough Laryngeal Obstruction/Trauma Interdisciplinary care X-rays, diagnostic tests, or ultrasound to locate obstruction Insertion of endotracheal tube For laryngeal edema due to anaphylaxis, epinephrine given Complete Airway Obstruction Life-Threatening Emergency Heimlich maneuver 13

14 Figure (A) The Heimlich maneuver performed on a conscious victim who is sitting or standing. (B) The Heimlich maneuver performed on an unconscious victim. A Figure (continued) (A) The Heimlich maneuver performed on a conscious victim who is sitting or standing. (B) The Heimlich maneuver performed on an unconscious victim. B Laryngeal Obstruction/Trauma Nursing care Closely monitor clients at risk for laryngeal obstruction Suction airway Be prepared for endotracheal intubation or tracheotomy Be prepared to initiate iti t CPR Teach prevention 14

15 Sleep Apnea Obstructive Central Risk factors Obesity Enlarged tonsils Use of alcohol or sedatives Sleep Apnea Manifestations Loud snoring Frequent nighttime waking Daytime sleepiness Headache Irritability Sleep Apnea Treatments: CPAP therapy Nursing care Focus on teaching use of respiratory equipment and avoidance or correction of risk factors 15

16 Benign Laryngeal Tumors Common in clients who chronically shout, project, or vocalize in very high or low tone Hoarseness, breathy voice Treat underlying cause Surgery Voice rest Laryngeal Cancer Risk factors Prolonged use of tobacco and alcohol Poor nutrition Occupational exposure Pathophysiology Leukoplakia Erythroplakia Laryngeal Cancer 16

17 BOX 23-8 Manifestations of Laryngeal Cancer. Laryngeal Cancer Diagnostic Tests Laryngoscopy CT scan MRI Needle biopsy py Barium swallow Laryngeal Cancer - Treatment Radiation Chemotherapy Surgery: type determined by size, site, and invasiveness of tumor Carcinoma in situ and vocal polyps treated with laser on outpatient basis 17

18 Removal of larynx Total laryngectomy Laryngectomy Entire larynx removed Normal speech lost Permanent tt tracheostomy t Laryngeal Cancer Modified or radical neck dissection in addition to total laryngectomy if cervical lymph nodes are cancerous Laryngeal Cancer Nursing Care Assessment Nursing diagnoses Impaired Verbal Communication Interventions Imbalanced bl Nutrition: ii Less than Body Requirements Interventions Anticipatory Grieving 18

19 Laryngeal Cancer Evaluation Documentation Continuing care Assessment for discharge 19