Respiratory Disorders: Comprehensive Notes

Epistaxis (Nosebleed)

• Definition: A nosebleed.
• Causes:
  • Nerve thickening
  • Chronic infection
  • Topical steroids
  • Trauma
  • High blood pressure
  • Drugs
  • Overuse of nasal spray
• Mechanism: Rupture of capillary membranes in the nose.
• Assessment:
  • Bleeding from the nose.
  • Check the back of the throat for blood.
  • Risk of aspiration (especially in patients on blood thinners).
• Intervention:
  • Rhino rocket (nasal tampon).
  • Cotton packing.
  • Epinephrine (to promote vasoconstriction).
  • Position the patient sitting up, leaning forward.
  • Pinch the nose to apply pressure.
  • Ice compresses (to cause vasoconstriction) or sucking on ice.
• Monitoring:
  • Airway.
  • Vital signs.
  • Signs of hypovolemic shock.
• Patient Education:
  • Avoid blowing the nose.
  • Avoid nasal trauma.
  • Keep the nose moisturized.
  • Humidifiers can help.
  • Be cautious using nasal cannulas with high O_2 flow; may cause dryness.

Deviated Septum

• Definition: Septum deviates from the midline.
• Causes:
  • Allergies
  • Trauma (e.g., broken nose)
  • Nasal polyps
  • Sinus inflammation
  • Congenital anomaly.
• Symptoms:
  • Partially or completely obstructed airways.
  • Difficulty breathing.
  • Loud breathing.
  • Postnasal drip.
  • Higher respiratory rate.
• Treatment:
  • Nasioseptoplasty (surgical correction).
  • Polypectomy (if nasal polyps are present).
  • Antihistamines (for postnasal drip).
  • Post-operative pain meds and prophylactic antibiotics.
• Nursing Care:
  • Monitor airway (risk of inflammation).
  • Advise against blowing the nose.
  • Avoid putting anything in the nose.
  • Avoid straining or coughing.
  • Be careful with bowel movements and straining during bowel movements.

Obstructive Sleep Apnea

• Definition: Airway is blocked during sleep.
• Risk Factors:
  • Obesity
  • Males over 60
  • Enlarged tonsils or adenoids
  • Nasal conditions (allergies, polyps)
  • Thick neck circumference
  • Family history
• Apnea Definition: Periods of absence of breathing.
• Symptoms:
  • Snoring.
  • Gagging or choking sounds.
  • Gasping for air.
  • Tiredness or lethargy during the day.
  • Headache, especially in the morning.
  • Sore throat.
• Diagnosis: Sleep study (in-lab or at-home monitoring).
• Treatment:
  • CPAP (Continuous Positive Airway Pressure).
    • Delivers continuous airway pressure to keep the airway open.
  • Weight loss.
  • Tonsillectomy/adenoidectomy.
• Nursing Care:
  • Ensure CPAP is worn correctly and consistently.
  • Educate on proper CPAP usage and maintenance (e.g., using distilled water, cleaning to prevent mold).
  • Elevate head of bed.

Upper Airway Obstruction

• Definition: Obstruction of the upper airway.
• Causes:
  • Food (choking).
  • Dentures.
  • Aspiration.
  • Secretions.
  • Tongue (especially in unconscious patients or during seizures).
• Symptoms:
  • Cyanosis (turning blue).
  • Grasping or pointing to the neck.
  • Inability to talk.
  • Agitation.
  • Confusion.
  • Periods of apnea.
• Treatment:
  • Remove the obstruction (e.g., abdominal thrusts).
  • Artificial airway (emergency tracheostomy).
• Nursing Priority: Open the airway.

Cancer of the Larynx (Laryngeal Cancer)

• Risk Factors:
  • Smoking.
  • Heavy alcohol use.
  • GERD (Gastroesophageal Reflux Disease).
  • Age over 65.
  • Family history.
  • Voice overuse.
  • Chronic laryngitis.
• Signs and Symptoms:
  • Persistent, progressive hoarseness.
  • Radiating ear pain.
  • Dysphagia (difficulty swallowing) - lump in throat.
  • Bloody sputum.
  • Difficulty breathing.
  • Weight loss.
  • Anemia.
• Diagnosis:
  • CT scan, MRI, PET scan.
  • Biopsy (for definitive confirmation).
• Treatment:
  • Radiation and/or chemotherapy.
  • Surgery (e.g., tracheostomy, removal of the voice box).
• Nursing Interventions:
  • Monitor intake and output.
  • Suction as needed.
  • Address communication difficulties (speech therapy, passy-muir valve).
  • Risk for aspiration.

Acute Rhinitis (Common Cold)

• Definition: The common cold.
• Signs and Symptoms:
  • Runny nose.
  • Fever.
  • Loss of appetite.
  • Aches and fatigue.
• Diagnosis:
  • Sputum culture (to rule out bacterial infection).
  • Throat culture (to rule out strep throat).
• Treatment:
  • Symptomatic relief (decongestants, over-the-counter medications).
• Nursing Care:
  • Encourage fluids.
  • Warm compresses.
  • Saline nasal sprays (Neti pot).
• Patient Education:
  • Wash hands frequently.
  • Limit contact with others for the first 48 hours.

Tonsillitis

• Definition: Inflammation of the tonsils.
• Commonly Associated With: Strep throat.
• Population Most Likely to Get: School-age children.
• Diagnosis:
  • Strep culture (throat swab).
  • CBC (complete blood count) to assess for infection.
• Signs and Symptoms:
  • Severe sore throat.
  • Chills.
  • Lethargy and/or anorexia.
• Treatment:
  • Antibiotics (if bacterial).
  • Tonsillectomy (surgical removal of tonsils).
• Tonsillectomy Nursing Care
  • Pre-op: obtain consent, ensure patient is NPO.
  • Post-op: monitor for bleeding, manage pain, maintain hydration. Ensure adequate hydration
    Avoid
  • Hot or spicy foods.
  • Oral care.
  • Assess for hemorrhage.
  • Ice collar. Provide an ice pack for the neck. Vital signs. Evaluate for infection. Remind patients on antibiotics for post-op recovery to take all of them to prevent infection.