Nursing Care of Clients Nursing Care of Clients with Upper Respiratory with Upper Respiratory

DisordersDisorders

Chapter 22Chapter 22

InfluenzaInfluenza

Viral, highly contagious, airborne droplet Viral, highly contagious, airborne droplet and direct contactand direct contact

Clinical ManifestationsClinical Manifestations

RespiratoryRespiratory• cough, substernal chest pain, sore throatcough, substernal chest pain, sore throat

SystemicSystemic• fever, chills, malaise, muscle aches, fatiguefever, chills, malaise, muscle aches, fatigue

InfluenzaInfluenza

Collaborative CareCollaborative Care immunization of at-risk personsimmunization of at-risk persons

DiagnosisDiagnosis based on client historybased on client history

PharmacologyPharmacology vaccine, aspirin, tylenolvaccine, aspirin, tylenol

TonsillitisTonsillitis

Acute inflammation of tonsilsAcute inflammation of tonsils usually bacterial infectionusually bacterial infection spread by dropletspread by droplet

Clinical ManifestationsClinical Manifestations pain, difficulty swallowingpain, difficulty swallowing feverfever enlarged and tender lymph nodesenlarged and tender lymph nodes tonsils appear bright red and edematoustonsils appear bright red and edematous

TonsillitisTonsillitis

TonsillitisTonsillitis

Interdisciplinary CareInterdisciplinary Care usually self-limitingusually self-limiting Antipyrectic and mild analgesicsAntipyrectic and mild analgesics Penicillin for group A streptococciPenicillin for group A streptococci Tonsillectomy for recurrent infectionsTonsillectomy for recurrent infections

The Client with EpistaxisThe Client with Epistaxis

Precipating factorsPrecipating factors traumatrauma drynessdryness systemic infectionsystemic infection hypertensionhypertension bleeding disorders - thrombocytopeniableeding disorders - thrombocytopenia

EpistaxisEpistaxis

Nasal Trumpets - EpistaxisNasal Trumpets - Epistaxis

The Client with EpistaxisThe Client with Epistaxis

Interdisciplinary CareInterdisciplinary Care first aid measures - apply pressurefirst aid measures - apply pressure Nasal packingNasal packing

• 1/4 inch petroleum gauze1/4 inch petroleum gauze• leave in for up to 3 daysleave in for up to 3 days

Surgical cauterySurgical cautery

Treatment of Epistaxis Treatment of Epistaxis

Nasal trauma - dog biteNasal trauma - dog bite

Nasal TraumaNasal Trauma

Nasal fracture/deviated septumNasal fracture/deviated septum epistaxisepistaxis deformity deformity displacement to one sidedisplacement to one side crepituscrepitus periorbital edemaperiorbital edema

TreatmentTreatment reduction, plasterreduction, plaster rhinoplastyrhinoplasty

Laryngeal ObstructionLaryngeal Obstruction

Life-threatening emergency- Food or Life-threatening emergency- Food or laryngospasm. laryngospasm.

Clinical ManifestationsClinical Manifestations coughing, choking, gagging, difficulty breathingcoughing, choking, gagging, difficulty breathing

TreatmentTreatment Heimlich maneuverHeimlich maneuver Medications such Medications such As epinepherine, ET.As epinepherine, ET.

Laryngeal Obstruction - PolypLaryngeal Obstruction - Polyp

Vocal Cord PolypVocal Cord Polyp

Sleep ApneaSleep Apnea

Absence of airflow through upper airways Absence of airflow through upper airways for 10 or more secondsfor 10 or more seconds

30 episodes per night30 episodes per night Contributing factorsContributing factors

obesityobesity ageage male gendermale gender

Sleep ApneaSleep Apnea

Clinical ManifestationsClinical Manifestations

loud cyclic snoringloud cyclic snoring cessation of breathing during sleepcessation of breathing during sleep restlessness, thrashing during sleeprestlessness, thrashing during sleep daytime fatiguedaytime fatigue headache, personality changes, depressionheadache, personality changes, depression

Sleep ApneaSleep Apnea

Interdisciplinary CareInterdisciplinary Care weight lossweight loss Continuous positive airway pressure (CPAP)Continuous positive airway pressure (CPAP)

• tight fitting masktight fitting mask• air compressor blows air into the back of the throatair compressor blows air into the back of the throat

SurgerySurgery• tonsillectomy and adenoidectomytonsillectomy and adenoidectomy

Upper Respiratory Tumors and Upper Respiratory Tumors and CancersCancers

Laryngeal CarcinomaLaryngeal Carcinoma accounts for 1-3% of all canceraccounts for 1-3% of all cancer curable if early detectioncurable if early detection Risk FactorsRisk Factors

• ETOH, smoking, poor nutritionETOH, smoking, poor nutrition Affects men more than women 9:1Affects men more than women 9:1

The LarynxThe Larynx

Laryngeal CarcinomaLaryngeal Carcinoma

Clinical ManifestationsClinical Manifestations hoarsenesshoarseness change in voicechange in voice painful swallowing, earachepainful swallowing, earache dyspneadyspnea palpable lump in neckpalpable lump in neck foul breathfoul breath

Laryngeal CarcinomaLaryngeal Carcinoma

Interdisciplinary CareInterdisciplinary Care laryngoscopylaryngoscopy

• direct visualizationdirect visualization• biopsybiopsy

Chemotherapy, radiation, surgeryChemotherapy, radiation, surgery• LaryngectomyLaryngectomy

removal of the larynxremoval of the larynx

• Radical neck dissection - nodes, neck and Radical neck dissection - nodes, neck and mandible removalmandible removal

Laryngeal CarcinomaLaryngeal Carcinoma

Nursing CareNursing Care Impaired Verbal CommunicationImpaired Verbal Communication Ineffective Airway ClearanceIneffective Airway Clearance Impaired SwallowingImpaired Swallowing PainPain Altered Nutrition:Less than Body Altered Nutrition:Less than Body

RequirementsRequirements AnxietyAnxiety

Laryngeal CarcinomaLaryngeal Carcinoma

Nursing CareNursing Care Altered Body ImageAltered Body Image TeachingTeaching

• Trach CareTrach Care