Respiratory NursingObjectives

◦1. Recognize symptoms of disorders of the sinuses, pharynx, and larynx.

◦2. Describe the post operative care for a patient having nasal surgery.

◦3. List emergency measures for a patient with an airway obstruction.

◦4. Discuss safety factors to be considered when caring for the patient with a tracheostomy.

Respiratory NursingIn clinical practice:

◦Institute measures to stop epistaxis.◦Perform tracheostomy care.◦Develop interventions for the

psychosocial care of a patient who has a laryngectomy.

Respiratory NursingURI’s (The Common Cold) Acute viral rhinitis

◦Most prevalent infection◦Many different strains◦Nose and upper respiratory tract◦Spread by:

Airborne droplet sprays

◦Who is susceptible?

Respiratory NursingCommon cold symptoms

◦Mild sore throat◦Increased secretions◦Congestion◦Sneezing◦Malaise◦Muscle aches/headache◦Temp <101◦Lasts 10-14 days◦Allergic rhinitis—no fever

Respiratory NursingTreatment of allergic rhinitis

◦Antihistamines◦Steriods◦Nasal sprays◦Avoid allergans

Treatment of common cold◦Home remedies

Respiratory NursingTreatment of common cold

◦Prevent secondary bacterial infection◦Contagious for 3 days◦Increase fluid intake◦Vitamin C◦Mild analgesia, no ASPIRIN for children◦Decongestants

◦Elder Care: prevent by staying away from infected people

Respiratory NursingBacterial infection requires

medical treatment if cold continues past 10 days or symptoms worsen

Respiratory NursingSinusitis

◦Inflammation of the mucosal linings◦Pathogens

Pneumococci, streptococci, Haemophilus influenzae

◦Symptoms Pressure pain, headache, fever, malaise,

purulent drainage from the nose, non-productive cough, upper teeth may be painful

Respiratory NursingTreatment for sinusitis

◦Relieve pain◦Promote drainage◦Control fever◦Prevent recurrence◦Surgical cleaning

Complications from sinusitis◦Septicemia, meningitis and brain

abscess

Respiratory NursingEpistaxis: nosebleed

◦Crusting, cracking and irritation of the mucus membranes caused by decreased humidity, excessive nose blowing, allergies with inflammation and nose picking, overuse of nasal sprays, street drugs, hypertension, blood disorders and tumors

◦Symptom: bleeding

Respiratory NursingTreatment of nosebleeds

◦Sit forward and apply pressure to the soft part of the nose for 10-15 minutes

◦Apply cold conpresses◦Small gauze pad in nasal passage◦Continued bleeding proceed to ER◦Cauterize bleeding vessels◦Do not blow nose post bleeding or

rub area, may rebleed

Respiratory NursingPharyngitis: sore throat caused

by virus, bacteria or a fungus◦Beta-hemolytic streptococcal

infection◦Fungal pharyngitis

Laryngitis: inflammation of the larynx with diminished voice

Epiglottitis: more common in children

Respiratory NursingSigns and symptoms/ pharyngitis

◦Dry, scratchy throat◦Mild fever◦Headache◦Malaise◦Reddened throat◦Dysphagia◦Hoarse voice◦Throat culture to r/o strep

Respiratory NursingTreatment pharyngitis

◦Rest◦Saline gargles◦Lozenges◦Fluids mild analgesia◦Bacterial=antibiotics◦Fungal=antifungals

Respiratory NursingTonsillitis- inflammed tonsils

◦Children High fever, sore throat, malaise, pain,

chills Red, swollen tonsils with yellow exudate Elevated WBC’s

◦Treatment Saline gargles Antibiotic -Penicillin

Respiratory NursingPre-surgery for tonsils

◦Free of infection◦Pre-op labs◦Same day surgery◦NPO/MD

Post-op for tonsils◦Vital signs◦Check for hemorrhage◦Position on side◦Diet◦ Ice collar

Respiratory NursingAirway obstruction

◦Laryngeal edema◦Laryngeal trauma◦Foreign object◦Universal sign◦Heimlich maneuver◦CPR guidelines

Respiratory NursingObstructive Sleep Apnea

◦Stops breathing during sleep for 10 seconds or more

◦Followed by a reflex gasp for air◦Caused by muscle relaxation at the back

of the throat◦Snoring: sleep partner aware◦Sleep study ordered◦CPAP (continuous positive airway

pressure)◦Untreated: MI, stroke, constant fatigue

Respiratory NursingNasal Fractures

◦Result from MVA, sports injuries and violence

◦Complications: obstruct airflow, cause nasal deformity and site for infection

◦Diagnosed by visual inspection of the nose, a change in nasal breathing, crepitation on palpation

◦Treatment: closed reduction, local or general anesthesia, ice to reduce swelling

Respiratory NursingRhinoplasty: surgical reconstruction of

the nose◦Nasal gauze packing◦Nasal splint◦Mustache dressing◦Observe for:

Frequent swallowing Change in vital signs Semi-Fowler’s position Cool compresses NO to NSAIDS, ASPIRIN, COUGHING, STRAINING YES to humidifier

Respiratory NursingCancer of the Larynx

◦Cause ?? Cigarette smoking Alcohol abuse Spicy foods Infection with human papilloma virus Chronic laryngitis Abuse of vocal cords Radiation exposure Familiar tendency to cancer Environmental pollutants

Respiratory NursingCancer of Larynx

◦Squamous cell carcinoma grows from the mucous lining of the respiratory tract

◦Metastasis may occur to lung◦Early detection is key for full

recovery

Respiratory NursingCancer of Larynx Signs &

Symptoms◦Lasting hoarseness◦Lasting sore throat◦Consistent pain in or around the ears

when swallowing◦Difficulty swallowing◦Dry, persistent cough for no reason◦Blood in phlegm or saliva◦Lumps or knots on the neck

Respiratory NursingAs disease progresses:

◦Difficulty breathing◦Halitosis◦Hemopytosis◦Fatigue and weakness◦Pain near Aham’s apple◦Airway obstruction

Respiratory NursingDiagnosis of Larynx Cancer

◦Visualization with a scope◦CT scan◦MRI◦Tissue biopsy

Respiratory NursingTreatment of Laryngeal Cancer

◦Typing and staging of the cancer◦Outpatient radiation

Combined with laser cordectomy Brachy-therapy with external beam irradiation Partial laryngectomy Microlaryngocopy combined with laser

90% cure rate No mechanical trauma or swelling with laser Minimal recovery Minimal voice rest

Total laryngectomy

Respiratory NursingTreatment of Laryngeal Cancer

◦Total laryngectomy when vocal cords are paralyzed Excise entire larynx, epiglottis, thyroid

cartilage, hyoid bone, cricord cartilage and rings of the trachea

◦Near-total laryngectomy preserves voice production and swallowing in advanced disease

Airways

Parts of trachs

Parts of trachs