Upper+Airway+Disorders

Introduction to Nursing Management of Respiratory Disorders

  • Focus on nursing management for clients with respiratory disorders over the next couple of weeks.

  • This week covers upper respiratory and ventilation disorders.

  • Use of a matrix or PowerPoint for note-taking in Canvas.

Normal Respiratory Process

  • Oxygen Intake: Oxygen is breathed in, traveling through bronchi, bronchioles, and alveoli, exchanging with carbon dioxide (CO2) in the capillary beds.

  • Expiration: CO2 is expelled from the body, a constant process influenced by various factors.

Respiratory Physical Assessment

  • Importance of observation in assessing respiratory status:

    • Patient Positioning: Is the patient sitting comfortably or in distress?

    • Anxiety Levels: Does the patient appear anxious?

    • Abdominal Muscle Use: Are they using abdominal muscles to breathe?

    • Respiratory Rate & Pattern: Note the rate of breathing and any periods of apnea.

    • Skin Color: Observe for cyanosis or pallor.

    • Behavior Indicators: Attitude or behavior that suggests respiratory distress.

Abnormal Lung Sounds

  • Focus on identifying abnormal lung sounds associated with respiratory disorders.

Upper Respiratory Disorders

Obstructive Sleep Apnea (OSA)

  • Prevalence: Most common in middle-aged, overweight men; linked to obesity.

  • Mechanism: Pharyngeal collapse during sleep, where throat muscles relax and either the pharynx collapses or the tongue blocks the airway, leading to reduced oxygenation.

  • Symptoms:

    • Frequent loud snoring.

    • Breathing cessation (apneic episodes lasting 1-3 seconds).

    • Sleep deprivation leading to excessive daytime sleepiness, impaired memory, and mood changes.

  • Complications: OSA can increase the workload on the heart, leading to:

    • Higher risk of myocardial infarction, angina, dysrhythmias, and heart failure.

    • Potential for hypertension, pulmonary hypertension, and stroke.

Treatment Options for OSA

  • Noninvasive Approaches:

    • Educate on weight loss and lifestyle modifications (avoiding alcohol/sedatives, positional changes).

    • Encourage semi or high Fowler's position during sleep.

  • Oral Devices: Devices to keep the jaw forward.

  • CPAP (Continuous Positive Airway Pressure):

    • Provides airflow to keep the pharynx open, allowing proper respiration.

    • May include oxygen settings depending on patient needs.

  • Surgical Options:

    • Tonsillectomy or adenoidectomy for enlarged structures.

    • Tracheostomy for severe cases, allowing bypass of upper airway.

Nursing Management for OSA

  • Emphasize education on CPAP use, treatment compliance, and lifestyle modifications to minimize risk factors.

  • Discuss the importance of communication about treatment options and the need for monitoring post-op complications.

Cancer of the Larynx

  • At-Risk Population: History of smoking, exposure to carcinogens, radiation, or HPV.

  • Clinical Manifestations:

    • Persistent hoarseness for more than two weeks.

    • Persistent sore throat and lump sensation.

    • Chronic cough.

  • Treatment Options:

    • Chemotherapy and radiation to shrink tumors.

    • Surgical procedures (partial or total laryngectomy) may be necessary if malignant.

Post-Operative Care After Total Laryngectomy

  • Oxygenation Changes: Air comes directly through a stoma in the neck, bypassing the mouth/nose system.

  • Communication Strategies: Need for alternative communication methods using whiteboards, pen & paper, or electronic devices.

  • Nursing Considerations:

    • Importance of close monitoring near the nurses' station.

    • Airway maintenance and suctioning as necessary.

    • Stoma care and humidified air for oxygen delivery.

  • Long-term Considerations: Post-discharge support groups and nutritional alternatives for patients who cannot eat normally.

  • Education Focus: Critical discussions about smoking and alcohol cessation, promoting methods for enhanced communication post-surgery.

Conclusion

  • Comprehensive review of upper airway disorders, focusing on OSA and cancer of the larynx, emphasizing the importance of nursing management, patient education, and supportive care.