Management of Patients with Conditions of the Upper Respiratory

Tract

Lecture 3Chapter 22 Brunner’s

Common Cold

AKA:• Rhinitis• Viral rhinitisPathophysiology• Rhinovirus• “Infection with acute

inflammation of the mucous membrane of the nasal cavity”

Common Cold

Etiology• Airborne• Peak Times– Sept, Jan & April

• Duration– 5-14 days

Common Cold

Clinical Manifestations• Nasal congestion• Runny nose• Sore throat• Sneezing• Malaise• Afibrile• H/A• Cough

Common Cold

Dx exams & Procedures• S&S• Culture

Common Cold

Tx methodology• Focus – relief• Tx not shorten• Fluids • Warm, moist air• Medications– OTC

Common Cold

Medications• Antihistamines– Action

• H1 blockers inhibits action

• push off – Take early

• Allergies

Common Cold

Medications• Antihistamines– Rx effect

• Prevents salivary, gastric, lacrimal and bronchial secretions

• Relieves– Sneezing– Rhinorrhea– Nasal congestion

Common Cold

Medications• Antihistamines– Side effects

• Drowsiness• Drying

– Examples• Allergra• Claritin• Benadryl

Common Cold

Medications• Decongestants– Rx Actions

• Shrink engorged nasal mucus membranes

– Side Effects• Rebound congestion• Insomnia

Common Cold

Medications• Decongestants– Examples

• Sudafed• Vicks inhaler• Afrin

Common Cold

Medications• Anti-tussives– Rx Action– Side effects– Example

Common Cold

Medications• Analgesics– Tylenol

(Acetomenaphen)– Motrin (ibuprofen)

• NSAID

– Non-narcotic

Common Cold

Medications• Vitamin C

Common Cold

Medications• Antibiotics

– Prophylactic– Examples

• Sulfonamides• Penicillins• Cephalosporins• Tetrcyclines• Aminglycosides• Quinolones• Macrolides• Vancomycin

Common Cold

Medications• Anti-biotic– Side-effects

• N/V• Yeast infections• Resistance

Common Cold

Medications• Echinacea– Action

• Stim. immune system• Anti-bacterial • Anti-inflammatory

– Use• 10-14 days

– Long tem use• immune system

Common ColdNrs Managements• See MD > 2 wks• Prevention

How do you prevent the cold from getting you?

– Hand wash– Cover mouth– Throw away tissue– Avoid crowds– Vaccine– Eat right– Sleep– Stress– Exercise– Smoking– Allergens– Animals– Carpet

Common Cold

Complications• Bronchitis• Pneumonia• Conjunctivitis

Sinusitis: sinus infection

Pathophysiology• Inflammation of the

mucus membrane of one or more sinuses

• Blocks the egress of sinuses

Sinusitis: sinus infection

Etiology• Bacterial or viral?– #1 bacterial

• Tooth abscess• Allergies• Structural abnormalities

Sinusitis: sinus infection

Clinical manifestations• Pain– Maxillary

• Over cheek and upper teeth

– Ethmoid• Btw & behind eyes

– Frontal• Forehead

• Ethmoid sinusitis

Sinusitis: sinus infection

Clinical manifestations• Anosnia• H/A• Fever?• Fatigue?• Foul breath?

Sinusitis: sinus infection

Dx• S&S• X-ray, CT, MRI• C & S

Sinusitis: sinus infection

Med Tx• Antibiotics• Analgesics– No aspirin

• Nasal decongestants• Mucolytic agents• Surgery

Sinusitis: sinus infection

NRS interventions• Fluids

– • Position

– HOB • Activity

– Rest• Moist hot-packs• Cleaning techniques

– Irrigate nose

Sinusitis: sinus infection

Prevention• Avoid contributing

factors:– Cold– Smoking– Fatigue– URI

• Dentist

Sinusitis: sinus infection

Complications• Osteomylitis• Cellulitis of the orbit• Abscess• Meningitis

Sinusitis: sinus infection• Surgery• Post-op care

– Position• Side lying • semi-fowler

– Ice– Monitor for

• Bleeding• visual acuity• Pain• S&S of infection

– Oral care– Packing x 48 hrs– No blowing– Tarry stools– Avoid constipation

Acute Pharyngitis

Pathophysiology• AKA: sore throat, strep

throat• Inflammation of the

throat

Acute Pharyngitis

Etiology• 70% – Viral

• Bacterial– Streptococcus

Acute Pharyngitis

Clinical manifestations• Sore throat• Febrile• Dysphagia• Exudate• Lymphnoids

– Malaise*– Hoarseness*– Cough*– Rhinitis*

Acute Pharyngitis

Dx exams• Throat culture• Rapid screening

Acute Pharyngitis - Tx

• Viral– Supportive – Like a cold

• Bacterial– Antibiotics– Diet

• Liquid/soft– Analgesics

• Tylenol– Anti-tussive

Acute Pharyngitis - Nrs

• Rest• Rashes?

– Communicable disease• Warm saline gargles

– Temp 105-110 F• Diet

– Liquid• Fluids

– • Ice collar• Oral care

Acute PharyngitisComplications• Sinusitis• Ottis media• Peritonsillar abscess• Scarlet fever• Rheumatic Fever– 2-3 wk /p subsides– Heart damage

• Mital valve damage

Tonsillitis & Adenoiditis

Pathophysiology• Tonsils– Location

• Oropharynx

– Lymph tissue

• Adenoids– Location

• Nasopharynx

Tonsillitis & Adenoiditis

Etiology• Streptococcus• Low resistance• Children

Tonsillitis & Adenoiditis – S&S

• Sore throat• Febrile & chills• Snoring• Dysphagia• Adenoids– Mouth breathing

• Duration– 1-2 wks

Tonsillitis & Adenoiditis - Dx

Dx• Visualize• C&S

• Mono

Tonsillitis & Adenoiditis

Post-op care• Hemorrhaging

– Coffee ground emeses– Bright red emeses– Pulse

• – Temp

• – Restlessness– Tarry stool– swallowing

Tonsillitis & Adenoiditis

Post-op• Position– Prone/side lying until…

• Gag returns– Semi-fowler’s

• Pain control– Ice collar– Acetaminophen

• Not aspirin

Tonsillitis & Adenoiditis

Post-op• Diet

– Ice cold fluids– Adv. To normal ASAP

• 2-3 days– Milk products

• – Avoid

• Spicy• Hot• Acidic• Rough

Tonsillitis & Adenoiditis

• Post-op• Pt education

– S&S of hemorrhaging– Mouthwash good– Avoid

• Coughing• Sneezing• Vigorous nose blow• Vigorous gargling• Rough foods

– Expect black tarry stools– Normal activity ASAP

Peritonsillar Abscess

Pathophysiology• Pus & blood filled sacs

on tonsilEtiology• Complication of strep

throat

Peritonsillar Abscess

S&S• Pain– Local– Radiates ear

• Dysphagia– drooling

• Dysphasia• Fever• Red throat

Peritonsillar AbscessTx• Antibiotics• Incision & drain

– Lanse• Warm saline irrigation• Hydrogen peroxide• Analgesics

– Topical – Tylenol– No aspirin– ? narcotics

• Ice collar• No smoking• Ventilator?

Laryngitis

• Pathophysiology– Inflammation of the

mucous membrane lining the larynx

– With edema of the vocal cords

Laryngitis

• Etiology– Viral– Voice abuse– Dust

Laryngitis

• Risk factors– Airborne irritants– Cold– Resent RTI– Smoking

Laryngitis

• Clinical manifestations– Aphonia

• Voice loss

– Hoarseness– Cough?

• Severe

Laryngitis

• Treatment– Voice rest– Bed rest– Smoking?

• NO!

– Humidifier– Fluids?

•

– Expectorants

Laryngitis

• Prevention– Avoid…

• Irritants• Cold• Voice strain• Smoking

Epistaxis

• Pathophysiology– Tiny blood vessels in

nose rupture

Epistaxis

• Anterior bleeds usually stop spontaneously or self treated

• Posterior bleeds may require med treatment

Epistaxis

• Etiology– Irritation– Infection– Drugs– Humidity– Trauma– Hypertension– Blood dyscrasias

Epistaxis

• Tx– Initial

• Apply direct pressure• 5-10 min• Position

– Head tilted down– Initial d/t trauma

• Do not pinch• Ice pack over nose & eye• Position

– Head down– ? Neck injury

Epistaxis

• Tx– ER

• Packing– Silver nitrate &

gelfoam– Painful– Remains 4-5 days

• Topical vasoconstrictor– Epinephrine

Epistaxis

• Nrs Management– V/S– Control bleeding– Hgb level– PT/PTT– Take BP meds– aspirin– vigorous blowing– strenuous exercise

Epistaxis

• Complications?

Nasal Polyps

• Pathophysiology– Benign grape-like

growths of mucous membrane and loose connective tissue within the nasal cavity

Nasal Polyps

• Etiology– Recur– Triad disease

• Polyps• Asthma• Allergy to aspirin

Nasal Obstruction

• Etiology– Deviated septum– Hypertrophy of

turbinate bone– Polyps– Foreign object

Nasal Obstruction

• Clinical Manifestations– Foul odor

• Malodorous

– Halitosis– allergies– Noisy breathing– post-nasal drip

Nasal Obstruction

• Tx– Remove obstruction

• Out the same way in• Sneezing w/ opposite

nasal closed• irrigate• push backwards

– Surgery

Nose surgery

Submucous resection: Nasoseptoplasty: Rhinoplasty: Polypectomy:

Nrs Care – Post OP nasal surgery

• hemorrhaging• Infection• Comfort• Nutrition• Pt. Ed• Avoid aspirin

Nasal Obstructions

Complications• Chronic infections of the

nose• Anosmia • Pharyngitits• Sinusitis

Fracture of the Nose

• Etiology– #1 bone broken

• S&S – Pain– Bleeding– Swelling– Deformity

Fracture of the Nose

• Clear fluid drainage • Fx of cribiform plate• CSF• Mucus vs. CSF– glucose

Fracture of the Nose

• Tx– Control bleeding

• Cold compress

– Reduce after • swelling • 7-10 days later• Re-brake nose

Fracture of the Nose

• Nrs Management– #1 Assess breathing– Ice– Pack – Mouth breathing

• Dry– adjust– Pain med

• Acetaminophen– Trauma

• neck injury

Laryngeal Obstruction

• Pathophysiology– Edema

• Etiology– Anaphylaxis

• Meds• Bees• Nuts• Sea food

– Foreign object

Laryngeal Obstruction

• S&S– Can not…

• Talk• Cough• Breath

– Universal sign– Color changes– Affect

• distressed

Laryngeal Obstruction

• Tx– Choking

• Heimlich maneuver

– Anaphylaxis• Sub q epinephrine• Corticosteroids• Ice pack

Laryngeal Obstruction

• Prevention– Avoid– Epi-pen

• Complication– Death

Sleep Apnea

• Pathophysiology– Partial or complete

upper airway obstruction during sleep causing apnea & hypopnea

– Occurs when tongue and soft palate fall backwards

Sleep Apnea

– Duration of apnea• 15-90 seconds• Sever hypoemia

– PaO2 »

• Hypercapnia– PaCO2

»

Sleep Apnea

– Causes partial awake – Startle, snort, gasps – Soft palate & tongue move

forward – Airway opens

Sleep Apnea

• S&S– waking at noc– Insomnia– Daytime sleepiness– Loud snoring– AM h/a

• Pa CO2 • vasodilitation • H/a

– Personality changes– Driving accidents– Family problems– Employment

compromised

Sleep Apnea

• Tx– Mild

• Avoid – Sedatives– Alcohol

• Wt loss• Oral appliance

Sleep Apnea

• Tx– Severe

• CPAP– Continuous Positive

Airway Pressure– Mask– High flow– Prevents collapse

• Surgery

CA of the larynx

• Classification– T –

• tumor

– N – • Nodes

– M –• Metastasis

CA of the larynx

• Pathophysiology– Squamous cells– Metastasis

• Lung• Liver• Lymphs

CA of the Larynx

• Etiology– Curable if detected early

but…– Men vs. women?

• > men– Carcinogens

• Tobacco• Alcohol• Asbestos• Mustard gas • Etc

– Family predisposition

CA of the Larynx

• S&S– Early

• Hoarseness

– Middle• Change in voice• Pain• Lump

CA of the Larynx

• S&S– Late

• Dysphagia• Dyspnea• Foul breath• Enlarged lymph's• Wt loss• Debilitative state• Pain ear

CA of the Larynx

• Dx– H&P– X-ray– MRI– Laryngoscopy

• Biopsy

CA of the larynx

• Tx– Radiation– Surgery/laryngectomy

• Partial– Early– Remove

» Portion» 1 vocal cord» Tumor

– Still talk– Airway intact– No dysphagia

CA of the larynx

• Tx – Total laryngectomy

• Remove– Larynx– 2-3 rings of trachea

• Permanent tracheal stoma

• Laryngectomy tube• Total voice loss• Normal swallowing

CA of the larynx

• Nrs management– Assess

• Hoarseness• Pain• Dyspnea• Dysphagia• Palpate neck• Diet

– protein

CA of the larynx

• Nrs management– Pre-op

• Assess– Ability to

» See» Hear» Read» Write

• Anxiety

CA of the larynx

• Nrs management– Post-op

• Airway– Suction PRN

• Pain • Communication• Nutrition

– NPO x 14 days– Parenteral / NGT

• Mobility

CA of the larynx

• Laryngectomy tube– Shorter but

diameter than tracheostomy tube

– Care same as trach– Clean q day with

normal saline– No tissues– No swimming– Humidify air