Chapter18 (1) 2

Management of Patients with Upper Respiratory Tract Disorders

Overview of Upper Respiratory Infections (URIs)

• URIs are the most common cause of illness, often leading to healthcare visits and missed work or school.

• They can vary in severity: minor, acute, chronic, severe, or life-threatening.

• Treatment typically occurs in community settings such as doctor offices, urgent care clinics, long-term care facilities, or through self-care at home.

• Early detection of symptoms and timely interventions are essential to prevent complications.

• Emphasis on patient education regarding prevention and health promotion.

• Special considerations for older adults are highlighted in Chart 18-1.

Common Conditions Associated with URIs

• Rhinitis and Rhinosinusitis: Can be acute or chronic, bacterial or viral.

• Pharyngitis: Also classified as acute or chronic.

• Tonsillitis and Adenoiditis: Both acute and chronic forms exist.

• Peritonsillar Abscess and Laryngitis: Other significant URI conditions.

Question on Common Cold

• Question: Does the term "common cold" refer to an infectious, chronic inflammation of the nasal cavity requiring hospitalization and IV antibiotics?

  • Answer: False.

  • Explanation: The common cold is an acute, self-limiting condition characterized by inflammation of the nasal cavity, with symptoms like nasal congestion, rhinorrhea, sneezing, and sore throat. It is often associated with acute URIs like rhinitis and pharyngitis.

Epistaxis

• Definition: Hemorrhage from the nose, commonly from the anterior septum.

• Potentially serious if it leads to airway compromise or significant blood loss.

• Risk factors are detailed in Chart 18-5.

Medical Management of Epistaxis

• Identify the cause and site of bleeding.

• Initial first-aid: pinch the soft part of the nose for 5-10 minutes while sitting upright.

• Medications: Phenylephrine can be applied for vasoconstriction.

• Cauterization techniques include silver nitrate or electrocautery.

• Options for severe cases include gauze packing or the insertion of a balloon-inflated catheter for 3-4 days.

• Antibiotic therapy may be necessary if indicated.

Nursing Management of Epistaxis

• Assess airway, breathing, and circulation.

• Monitor vital signs, possible cardiac monitoring, and pulse oximetry.

• Manage patient anxiety.

• Educate the patient on strategies to avoid nasal trauma, adequate humidification, and when to seek medical attention after 15 minutes of bleeding.

Rhinitis and Rhinosinusitis

• Rhinitis: Can be viral or bacterial, acute or chronic.

  • Causes include allergies and environmental factors.

  • Symptoms include rhinorrhea, congestion, pruritus, and headache.

• Rhinosinusitis: Also viral or bacterial, classified by duration:

  • Acute < 4 weeks

  • Subacute 4-12 weeks

  • Chronic > 12 weeks.

  • Symptoms may include purulent nasal drainage, facial pain, fever, etc.

  • Treatment focuses on antibiotics, decongestants, and saline lavage.

Pharyngitis

• Types: Acute (viral or bacterial).

• Symptoms: Red throat, exudates, enlarged lymph nodes, fever, malaise.

• Treatment depends on the cause:

  • Viral: symptomatic management.

  • Bacterial: antibiotics, typically penicillin.

Tonsillitis and Adenoiditis

• Tonsillitis: Can be acute or chronic, viral or bacterial.

  • Symptoms include sore throat, fever, and difficulty swallowing.

• Adenoiditis: Similar in pathology, symptoms include mouth breathing and earaches.

  • Treatment options include comfort measures and possibly surgery.

Peritonsillar Abscess

• Symptoms include severe sore throat, fever, trismus (lockjaw), and drooling.

• Treatment: Antimicrobials, corticosteroids, analgesics, and possibly aspiration of the abscess.

Laryngitis

• Can also be viral or bacterial.

• Symptoms: Hoarseness or complete loss of voice, severe cough.

• Treatment involves voice rest, avoiding irritants, and steam inhalation.

Complications of URIs

• Potential complications include airway obstruction, hemorrhage, sepsis, meningitis, and otitis media.

Assessment of the Patient with URI

• Collect comprehensive health history.

• Identify signs and symptoms: headache, cough, fever, etc.

• Conduct physical examinations of the nose, neck, and throat.

Nursing Interventions for URI

• Recommendations include maintaining airway patentcy, pain management, and effective communication strategies.

• Encourage fluid intake and use of humidifiers.

• Monitor for and address any severe complications.

Patient Education for URI

• Emphasis on prevention strategies, hand hygiene, and understanding when to seek medical care. Annual vaccinations for influenza should be recommended for at-risk individuals.

Obstruction and Trauma of the Upper Respiratory Airway

• Common issues: obstructive sleep apnea managed by CPAP/BiPAP, nasal obstruction including deviated septum and polyps.

• Symptoms of nasal fractures: traumatic obstruction requiring intervention.

• Laryngeal obstruction treatment may include epinephrine and tracheotomy.

Signs of Obstructive Sleep Apnea

• Major symptoms include excessive daytime sleepiness, loud snoring, and morning headaches.

• Complications can include systemic hypertension and cognitive changes.

Cancer of the Larynx

• Represents about half of head and neck cancers with significant statistics on incidence and demographics.

• Risk factors are further detailed in Chart 22-6.

Signs and Symptoms of Laryngeal Cancer

• Early signs: Persistent cough, hoarseness, or neck lumps.

• Later symptoms may include dysphagia and nasal obstruction.

Assessment for Laryngectomy Patients

• Holistic evaluations including health, psychosocial, and nutritional assessments are crucial.

Collaborative Problems for Patients Undergoing Laryngectomy

• Potential complications include respiratory distress, hemorrhage, and aspiration.

Nursing Interventions for Laryngectomy Patients

• Preoperative education and strategies for coping and maintaining nutrition are critical.

Changes in Airflow with Total Laryngectomy

• Description of airflow dynamics post-surgery emphasizing changes from normal anatomy.

Patient Education for Total Laryngectomy

• Important to discuss the changes in speech and communication methods post-surgery.