upper respiratory week 5

Nursing Care of Patients with Upper Respiratory Tract Disorders

Epistaxis (Nosebleeds)

  • Definition: A condition more commonly known as a nosebleed.

  • Causes:
      - Dry, cracked mucous membranes
      - Trauma
      - Hypertension
      - Hemophilia
      - Medications

  • Therapeutic Interventions:
      - Positioning: Patient should be seated upright to reduce blood pressure in the vessels of the nose.   - Direct Pressure: The most common first response; applying pressure to the anterior portion of the nose can help to stop bleeding.   - Ice: Application of ice to the nose helps in vasoconstriction, reducing blood flow and promoting healing.   - Nasal Packing: Insertion of gauze or hemostatic agents into the nasal cavity to provide pressure and absorb blood.   - Nasal Balloon Catheter: A device used to apply pressure internally to stop the bleeding.   - Vasoconstrictive Agents: Medications that narrow the blood vessels, reducing blood flow to the region.   - Electrocautery: A surgical technique that uses heat to stop bleeding by cauterizing the blood vessels.

Nasal Polyps

  • Description: Usually benign growths on the nasal mucosa, often associated with allergic conditions.

  • Therapeutic Interventions:
      - Control Allergies: Implementing treatment for allergies can reduce the size and occurrence of polyps.   - Surgery: Polypectomy may be required for larger or problematic nasal polyps.   - Avoid Aspirin Post-Op: Aspirin can exacerbate bleeding and should be avoided after surgical procedures.

Deviated Septum

  • Symptoms:
      - Stuffy nose, making it hard to breathe through one or both nostrils.   - Blocked sinus drainage, leading to recurrent sinus infections.   - Headaches due to sinus pressure.

  • Therapeutic Interventions:
      - Nasoseptoplasty: A surgical procedure to correct the deviation of the septum.     - Monitoring:       - Monitor vital signs and observe for any bleeding post-surgery.       - Report any signs of excess swallowing, which may indicate bleeding.       - Monitor dressing for excessive drainage.     - Post-Operative Care Instructions:
          - Avoid activities that increase nasal pressure (e.g., bending over, heavy lifting).       - Avoid aspirin to prevent bleeding complications.

Sinusitis

  • Definition: Inflammation of the sinus mucosa, which can be due to bacterial or allergic causes.

  • Signs and Symptoms:
      - Pain over the affected sinus area.   - Fever indicating infection.   - Nasal discharge, which may be purulent.

  • Therapeutic Interventions:
      - Saline Irrigation: Helps to clear mucus and allergens from the nasal passages.   - Intranasal Corticosteroids: Reduces inflammation in the nasal passages.   - Decongestants: Provides relief from nasal congestion and sinus pressure.   - Hot Packs: Applied to the face to alleviate pain and promote drainage.   - Acetaminophen/Ibuprofen: Pain relief medications to decrease discomfort and fever.   - Humidification: Increases moisture in the air, making breathing easier and alleviating dryness.   - Oral Fluids: Important for hydration and mucous membrane health.   - Positioning: Keeping the head elevated can assist with drainage.   - Antibiotics: Prescribed if a bacterial infection is confirmed or suspected.   - Surgical Drainage: In cases of severe sinusitis where there is significant pus accumulation.

Obstructive Sleep Apnea

  • Definition: A condition characterized by apnea episodes during sleep.

  • Risk Factors:
      - Obesity increases the likelihood of airway obstruction.   - High palate may affect the structure of the airway.   - Receded mandible, which can compress the airway during sleep.   - Smoking exacerbates airway inflammation and obstruction.

  • Complications:
      - Can lead to heart disease due to increased strain on the cardiovascular system.   - Hypertension as a result of sleep disturbances.   - Increased risk of stroke due to vascular complications.   - Diabetes risk increases due to hormonal and metabolic changes caused by disrupted sleep.

  • Signs and Symptoms:
      - Snoring loud enough to disturb others.   - Excessive daytime sleepiness, affecting lifestyle and productivity.   - Headaches upon waking, often due to oxygen deprivation.   - Memory and attention problems, potentially affecting cognitive function.

  • Diagnostic Test:
      - Nocturnal Polysomnography: A comprehensive sleep study that records various parameters during sleep, diagnosing the severity of sleep apnea.

  • Treatment:
      - Avoid Sedatives: Prevent exacerbating airway obstruction.   - Weight Loss: Recommended as a primary intervention to decrease severity.   - Nasal Patch: A device that helps keep the airway open during sleep.   - Continuous Positive Airway Pressure (CPAP): A machine used during sleep to maintain open airways.   - Surgery: Considerations for structural corrections if other treatments fail.

Infectious Disorders of the Upper Respiratory Tract

  • Viral Rhinitis:
      - Also known as the common cold, caused by various viruses.

  • Pharyngitis:
      - Inflammation of the pharynx, often caused by beta-hemolytic streptococci, known colloquially as strep throat.

  • Laryngitis:
      - Inflammation of the mucous membrane of the larynx, leading to voice changes.

  • Tonsillitis:
      - Infection of the tonsils, resulting in soreness and swelling.

Influenza (Flu)

  • Definition: A contagious viral infection commonly referred to as the flu.

  • Transmission: Spread through respiratory droplets from coughing and sneezing.

  • Prevention:
      - Yearly Vaccination: Recommended to protect against seasonal strains of the virus.   - Hand Washing: Effective at reducing transmission of infectious agents.   - Avoidance of Infected People: Minimizing contact with sick individuals can prevent infection.

  • Signs and Symptoms:
      - Fever, which can be high.   - Chills experienced alongside fever.   - Myalgia or muscle aches throughout the body.   - Sore throat as a result of viral infection.   - Cough that may persist.   - General malaise, feeling unwell.   - Headache due to systemic inflammatory response.

  • Therapeutic Interventions:
      - Acetaminophen: For fever and pain relief.   - Avoid Aspirin: Particularly in children, as it can lead to Reye's syndrome.   - Antiviral Agents: Medications that can reduce the duration and severity of symptoms.   - Rest: Essential for recovery from viral infections.   - Fluids: Maintains hydration and helps thin mucus.

Other Respiratory Viruses

  • West Nile Virus: Transmitted by mosquitoes; primarily affects the central nervous system.

  • COVID-19: Caused by the novel coronavirus SARS-CoV-2, with respiratory symptoms and systemic effects.

  • Avian Influenza (Bird Flu): Typically zoonotic; outbreaks can occur in poultry populations and may transmit to humans.

  • Severe Acute Respiratory Syndrome (SARS): A viral respiratory disease that emerged in the early 2000s, characterized by severe pneumonia.

  • Swine Flu (H1N1): A subtype of influenza virus that caused a pandemic in 2009, affecting both humans and animals.

Review Question

  • Ice packs are used for epistaxis for which reason?
      - To promote comfort.
      - To promote vasoconstriction.
      - To reduce swelling.
      - To reduce congestion.