Exam 2 Respiratory

Overview of Upper Respiratory System and Complications

This section discusses the upper respiratory system, including the anatomy, potential complications, and associated nursing assessments related to various disorders, especially focusing on airway management.

Structure and Function of the Upper Airway

  • The upper airway consists of the nose, sinuses, oropharynx, larynx, and trachea.

  • Major functions include:

    • Oxygenation: Providing oxygen to the lungs for gas exchange.

    • Airway Patency: Ensuring an unobstructed airway is critical for breathing.

  • Importance of anatomy: Knowledge of the structure is vital for understanding dysfunction and potential complications.

Airway Complications

  • Peak Airway: A critical assessment point as any obstruction (swelling, trauma, fluid) can severely hinder airflow.

  • Importance of Priority Assessment: Recognizing airway patency as the number one priority in nursing assessments.

Upper Airway Disorders

Nose Fractures

  • Definition: Displacement of bone or cartilage leading to airway obstruction and potential cosmetic deformity.

  • Complications: Risk of infection due to compromised nasal structure.

  • Diagnosing: Visual inspection, assessing for cerebral spinal fluid (CSF) leakage (halo effect).

  • Treatment Options:

    • Closed Reduction: Resetting the nasal bone and should be performed within 24 hours for best results.

    • Rhinoplasty: Surgical reconstruction of the nose, either for cosmetic purposes or functional correction.

    • Septoplasty: Adjusting the septum to improve airflow.

Nosebleeds (Epistaxis)

  • Causes: Trauma, hypertension, dry nasal passages, nasal cocaine use, etc.

  • Management:

    • Position the patient leaning forward, pinch the nose, apply cold compresses.

    • Severe cases may require cauterization or nasal packing.

  • Packing types include anterior and posterior packing, requiring specific handling to avoid disturbing clots.

Nasal Polyps

  • Benign growths that can obstruct airflow, often associated with chronic inflammation.

  • Treatment: Endoscopic or laser surgical removal and corticosteroids to reduce inflammation.

Facial Trauma and Fractures

LeFort Fractures

  • Classification system for quantifying facial trauma:

    • LeFort I: Maxillary fractures.

    • LeFort II: Maxillary and nasoethmoid fractures.

    • LeFort III: Complete craniofacial disjunction.

  • Associated complications include impaired airway, significant swelling, and bruising.

  • Management includes early airway assessment, imaging for diagnosis, potential intubation, and stabilization.

Traumatic Injuries

  • Blunt force damage may require immediate airway stabilization.

  • Vigilance for symptoms of airway distress, changes in consciousness, and monitor for neurological signs.

Surgical Interventions for Upper Airway Issues

Rhinoplasty and Septoplasty

  • Rhinoplasty focuses on cosmetic and functional correction of the nasal structure.

  • Post-operative considerations include:

    • Managing swelling and bruising with cold compresses.

    • Avoiding strenuous activities to maintain airway stability.

    • Recovery may last several months before final results are visible.

Intubation and Tracheostomy

  • In acute airway obstructions, intubation may be required to secure breathing.

  • Cricoid thyroidomy may be necessary for temporary airway creation in severe cases.

  • Jaw Wiring (Maxillomandibular Fixation): For patients with jaw fractures requiring immobilization.

Obstructive Sleep Apnea (OSA)

  • Definition: A sleep disorder characterized by repeated episodes of breathing cessation during sleep due to airway obstruction.

  • Risk factors include obesity, large neck circumference, and anatomical variations.

  • Treatment strategies include non-surgical methods (CPAP) and surgical options (UPPP, adenoidectomy).

  • Monitor for symptoms like daytime sleepiness and inhalation difficulties.

Rhinitis and Sinusitis

Rhinitis

  • Inflammation of the nasal mucosa triggered by allergens.

  • Management includes:

    • Avoidance of allergens,

    • Use of antihistamines, nasal decongestants, and glucocorticoids for symptom relief.

  • Potential complications: Chronic rhinitis leading to sinusitis.

Sinusitis

  • Inflammation of the sinus membranes, can lead from rhinitis.

  • Symptoms include facial pain, nasal congestion, fever, and purulent discharge.

  • Treatment options range from antibiotics to sinus surgery (functional endoscopic sinus surgery).

Laryngitis

  • Caused primarily by vocal cord irritation (overuse, infection).

  • Symptoms: Hoarseness, throat irritation, cough.

  • Treatment involves vocal rest, hydration, and avoiding irritants.

Laryngeal Trauma

  • Caused by blunt or penetrating injury leading to potential airway compromise.

  • Symptoms can include stridor, hemoptysis, and vocal changes.

  • Requires immediate assessment and interventions to secure the airway and assess for internal damage.