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Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Epistaxis Causes Trauma Foreign bodies Drugs Steroids Tumors Location Anterior (80%) – Kiesselbach plexus Posterior – posterior branch sphenopalatine artery
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Chapter 27
Nursing ManagementUpper Respiratory Problems
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Structural and Traumatic Disorders of the Nose
Deviated septum Nasal fracture
40% of bone injuries in facial trauma Obstruction, epistaxis, meningeal tears
• What might clear nasal drainage indicate? Rhinoplasty
Surgical reconstruction of the nose
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Epistaxis
Causes Trauma Foreign bodies Drugs Steroids Tumors
Location Anterior (80%) – Kiesselbach plexus Posterior – posterior branch sphenopalatine artery
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Care for Nosebleed
Sit forward or high Fowler’s position Direct pressure for 10 – 15 minutes Vasoconstrictive medications
• Cocaine, neosynephrine (Afrin nasal spray) Cauterization Nasal packing
Patient teaching Avoid blowing nose, strenuous activity, lifiting,
sneeze with mouth open, avoid ASA & NSAIDs
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Fig. 27-1
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Inflammation and Infection of the Nose and Paranasal Sinuses
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Allergic Rhinitis
Clinical manifestations Sneezing Watery eyes Watery nasal
draingage or congestion
Pale, boggy turbinates
Cough (post-nasal drip)
Management:Allergic rhinitis Indentify causative
agent Antihistamines
• What are the side effects?
Nasal corticosteroids Immunotherapy
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Acute Viral Rhinitis
AKA the common cold or acute coryza Most prevalent infectious disease Spread by droplet transmission
Management: Acute viral rhinitis Rest Fluids Antipyretics Observe for secondary bacterial infection
• Fever >100.4, mucopurulent discharge, swollen & tender nodes, pharyngeal erythema
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Influenza
Causes 36,000 deaths annually in the U.S. Usually in people > 60 years
Clinical manifestations Fever Aches Chills Tiredness Sudden symptoms
• Runny nose and GI symptoms are more common in children
• Most common complication is pneumonia
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Influenza
Management: Influenza Identify high-risk individuals and recommend
vaccination (attenuated live virus or inactivated)• Age > 50, health care workers, chronic respiratory illness• Most effective when given in the fall• Contraidications – egg allergy or Hx of Guillain-Barré
syndrome Symptom management
• Fluids, rest, antipyretics (no ASA in children – Reye’s syndrome)
Antiviral medications• Must be started within 48 hrs of illness onset• May be prescribed for prophylaxis
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Sinusitis
Ostia of one or more of the sinuses becomes blocked by swollen or inflamed nasal mucosa May be viral, bacterial, or fungal (rare) Acute is usually related to URI, allergic rhinitis,
swimming, or dental manipulation Chronic > 3 weeks duration; linked with allergies &
nasal polyps Clinical manifestations
Pain over the affected sinus, fever, malaise, HA, congestion, purulent nasal discharge
Chronic presentation is nonspecific
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Fig. 27-3
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Sinusitis
Management: Sinusitis Antibiotics if symptoms last > 7 days
• Due to difficulty with treating the infection courses may last from 10 days to several weeks
Decongestant sprays• Do not use for more than 72 hours – rebound effect
Topical steroids Antihistamines
• Avoid usage Saline nasal lavage
• Neti pot, bulb syringe
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Obstruction of the Nose and Paranasal Sinuses
Polyps Benign masses that develop in response to
repeated inflammation Foreign bodies
Inorganic• May produce no symptoms
Organic • Cause local reaction • Purulent, foul smelling drainage
Sneezing or blow nose Do not irrigate
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Problems Related to the Pharynx
Acute pharyngitis Viral Bacterial
• Strep throat What complication(s) can arise untreated strep throat?
Candida albicans Thrush
• Opportunistic infections may indicate? Diphtheria
What population(s) would you expect to have diphtheria?
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Acute Pharyngitis
Clinical manifestations Fever, pharyngeal erythema, pain, N/V, tonsillar
exudates, cough (not with strep throat) Management: Acute pharyngitis
Rapid strep Supportive care
• Fluids, rest, antipyretics, analgesia
Antibiotics• Penicillin – drug of choice
Immunization – diphtheria
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Obstructive Sleep Apnea
Clinical manifestations and diagnostic studies Frequent awakening at night (as many as 200-
400), insomnia, excessive daytime sleepiness, witnessed apenic episodes, snoring, irritability, morning HA (hypercapnia dilates cerebral vessels)
Polysmnography Management: Sleep apnea
Avoid sedatives & alcohol before sleep, weight loss, oral appliances, CPAP, BiPAP, surgery
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Obstructive Sleep Apnea
Uvulopalatopharyngoplasty UPPP or UP3
Geniglossal advancement & hyoid myotomy
GAHM
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Fig. 27-5
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Problems Related to the Trachea and Larynx
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Airway Obstruction
Medical emergency May be partial or complete
• Aspiration, foreign bodies, CNS depression, laryngeal spasms, edema, allergic reaction
Clinical manifestations Stridor, wheezes, retractions, cyanosis,
restlessness, tachcardia, snoring• How do you assess for airway patentcy?
Management: Airway obstruction Reversal agents, CPAP, BIPAP, intubation, OPA,
NPA, surgically created airways
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Tracheostomy
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Tracheostomy
What is a tracheostomy? Surgically created airway entering the trachea
Indications Bypass upper airway obstruction Facilitate removal of secretions Long-term mechanical ventilation
• Permit oral intake and speech• Increased comfort• Less risk of damage to airway• Increased mobility
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Fig. 27-6
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Nursing Management Tracheostomy
Providing tracheostomy care What structures are bypassed with a
trach? What is the client at risk for? What interventions do you anticipate?
Swallowing dysfunction How is the airway protected with a trach? How is swallowing assessed?
Speech with a tracheostomy tube Cuffed vs. fenstrated tubes
Decannulation
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Fig. 27-7
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Fig. 27-8
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Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Fig. 27-10
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Head and Neck Cancer
Clinical manifestations Early signs
• Painless growth• Sore that does not heal• Change in fit of dentures• Persistent sore throat, lump, unilateral ear pain, or
hoarseness Late signs
• Pain• Dysphagia• ↓ tongue mobility• Airway obstruction
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Head and Neck Cancer
Diagnostic studies CT scan, MRI, PET scan, biopsy
Collaborative care Stage & grade What are the treatment options? What structures can be affected? Nutritional therapy
• How does radical neck dissection or supraglottic larygectomy impact nutrition?
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Fig. 27-12
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Fig. 27-14
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Nursing Management Head and Neck Cancer
Nursing assessment Nursing diagnoses Planning Nursing implementation
Health promotion• What places a person at risk?
Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.
Fig. 27-15