Upper Respiratory Disorders: Nursing Care

Nursing Care of Patients With Upper Respiratory Tract Disorders

• Common issues include infections, inflammation, and structural abnormalities in the upper respiratory tract.
• Timely recognition and treatment are crucial to prevent complications.

Important Medical Terms

• Dysphagia: Difficulty in swallowing, a symptom of various upper respiratory disorders.
• Epistaxis: Commonly known as a nosebleed, it can arise from anterior or posterior nasal vessels.
• Exudate: Fluid that leaks out of blood vessels into nearby tissues, often seen in infections.
• Laryngectomee: A patient who has undergone laryngectomy, a surgical procedure to remove the larynx.
• Laryngitis: Inflammation of the larynx, often causing hoarseness or loss of voice.
• Myalgia: Muscle pain, which can accompany respiratory infections.

Upper Respiratory Disorders

• Disorders affect the nose, sinuses, pharynx, larynx, and trachea, ranging from minor to serious conditions.

Pathophysiology and Etiology of Upper Respiratory Disorders

• Epistaxis:
• Nosebleeds can originate from anterior (Kiesselbach plexus) or posterior regions; anterior bleeds are more common and manageable.
• Causes include dry mucous membranes, trauma, anticoagulant therapy, and certain drugs like cocaine.
• Conditions like hemophilia or leukemia can predispose individuals to epistaxis.
• Nasal Polyps:
• Benign growths in the nasal passages, often related to chronic inflammation and allergies.
• Associated with conditions like cystic fibrosis and asthma; linked to aspirin-exacerbated respiratory disease (AERD).
• Can obstruct nasal passages and lead to sinus infections.

Deviated Septum

• A common condition where the nasal septum is displaced, potentially blocking sinus drainage.
• Often results from trauma but can occur without a clear cause.
• Patients may experience chronic nasal congestion, headaches, and recurrent sinus infections.

Care for Deviated Septum

• Symptomatic Treatment: Decongestants and intranasal cortisone sprays can alleviate symptoms.
• Surgical Intervention: Septoplasty may be indicated for patients with chronic issues due to severe deviation.
• Patient Education: Inform patients about the importance of follow-up care and symptom management.

Therapeutic Measures and Nursing Care

• Management of Epistaxis:
• First Aid: Instruct patients to lean forward and pinch the nose to control bleeding; apply ice packs to constrict vessels.
• Medical Interventions: Use of vasoconstrictive agents, cauterization, or packing the nasal cavity may be necessary.
• Monitoring: Vital signs and hemoglobin levels should be monitored to assess for excessive blood loss.
• Treatment for Nasal Polyps:
• Symptom Control: Use of antihistamines, leukotriene antagonists, and corticosteroid sprays to manage symptoms.
• Surgical Options: Outpatient procedures may be performed to remove obstructive polyps, often under local anesthesia.
• Postoperative Care: Avoid aspirin post-surgery to reduce bleeding risk.
• Nursing Care After Septoplasty:
• Vital signs and bleeding should be monitored closely post-surgery until the patient is stable.
• Patients will have nasal packing and a mustache dressing to manage drainage.
• Education on self-care at home is crucial, including avoiding nose blowing and using ice packs for swelling.
• Sinusitis:
• Pathophysiology and Etiology:
• Inflammation of the mucosa of one or more sinuses, classified as acute or chronic.
• Chronic sinusitis is diagnosed when symptoms persist for over three months and are unresponsive to treatment.
• Common causes include bacterial infections, allergies, and anatomical abnormalities.
• Signs and Symptoms:
• Patients typically report facial pain, purulent nasal discharge, and possible fever.
• Pain location varies: maxillary sinusitis causes cheek pain, ethmoid sinusitis causes pain between the eyes, and frontal sinusitis causes forehead pain.
• Foul breath and fatigue may accompany acute infections.
• Diagnostic Tests:
• Diagnosis can often be made based on symptoms alone, but imaging may be required for recurrent cases.
• X-rays, CT scans, or nasal endoscopy can help confirm the diagnosis and identify underlying causes.
• Culturing nasal discharge may guide antibiotic therapy.
• Therapeutic Measures:
• Treatment focuses on pain relief and promoting sinus drainage, often using nasal irrigation and corticosteroids.
• Warm, moist packs can help reduce inflammation, while analgesics manage pain.
• Antibiotics are typically reserved for persistent symptoms beyond seven days.

Sleep Apnea

• Pathophysiology and Etiology:
• Obstructive sleep apnea (OSA) involves periods of apnea during sleep due to airway obstruction, often when sleeping on the back.
• Risk factors include obesity, smoking, and anatomical features like a high arched palate.
• OSA is linked to serious health risks, including heart disease and diabetes.
• Signs and Symptoms:
• Patients may experience loud snoring followed by periods of silence, indicating apnea episodes.
• Daytime sleepiness, headaches, and memory issues are common due to disrupted sleep quality.
• Spouses often report waiting for the patient to resume breathing, highlighting the severity of the condition.
• Diagnostic Tests:
• A sleep study (polysomnography) is the gold standard for diagnosing OSA, monitoring various physiological parameters during sleep.
• Home sleep tests may be available but are less comprehensive.
• The test can be uncomfortable due to the number of sensors, but sedatives are avoided to ensure accurate results.

Nursing Care for Sleep Apnea

• Nurses should educate patients on lifestyle changes to improve sleep quality, such as weight loss and avoiding alcohol.
• Continuous Positive Airway Pressure (CPAP) therapy may be recommended for severe cases.
• Monitoring for complications and providing support for adherence to treatment plans is essential.

Therapeutic Measures for Sleep Apnea

• Sleep apnea is a disorder characterized by repeated interruptions in breathing during sleep, leading to poor sleep quality and daytime fatigue.
• Common risk factors include obesity, smoking, and sleeping position, particularly sleeping on the back.
• The condition can be diagnosed through sleep studies, which may be conducted at home or in a sleep clinic.
• Nursing Interventions:
• LPN/LVN should educate patients on lifestyle modifications to improve sleep quality, such as weight loss and avoiding alcohol or sedatives before bedtime.
• Patients should be advised to avoid sleeping on their backs; a practical tip is to sew a pocket on the back of a shirt to hold a tennis ball, encouraging side sleeping.
• Continuous Positive Airway Pressure (CPAP) therapy is a common treatment that keeps airways open during sleep.

Evidence-Based Treatment Recommendations

• Three primary recommendations for managing sleep apnea include:
• Weight loss to reduce airway obstruction.
• CPAP therapy to maintain airway patency during sleep.
• Mandibular advancement devices to reposition the jaw and tongue to keep the airway open.
• Surgical options may be considered if conservative measures fail, particularly in cases of anatomical obstructions.

Infectious Disorders

• Viral Rhinitis and Pharyngitis:
• Viral Rhinitis (Common Cold):
• Viral rhinitis, commonly known as the cold, is primarily caused by the rhinovirus and is highly contagious.
• Symptoms include nasal congestion, sneezing, sore throat, and malaise, with diagnostic tests like throat cultures helping to differentiate from influenza.
• Treatment is symptomatic; antibiotics are ineffective against viral infections and can lead to resistance.
• Pharyngitis:
• Pharyngitis is inflammation of the pharynx, often due to viral or bacterial infections, with strep throat being a common bacterial cause.
• Symptoms include a sore throat, dysphagia, and possible fever; diagnostic tests can confirm the presence of streptococcal bacteria.
• Treatment for bacterial pharyngitis typically involves antibiotics, while symptomatic relief can be provided through analgesics and throat lozenges.

Nursing Care Plan for Upper Respiratory Infections

• Nursing diagnosis for patients with upper respiratory infections may include 'Impaired Comfort' related to the infectious process.
• Expected outcomes should focus on patient comfort, ability to swallow, and quality of sleep.
• Interventions should include pain management, hydration, and education on the importance of rest and hygiene.
• Nursing Interventions for Hyperthermia:
• Nursing Diagnosis: Hyperthermia related to infectious process, indicating an elevated body temperature due to infection.
• Expected Outcomes: The patient will maintain a temperature lower than 103°F (39.4°C) and show no signs of dehydration, ensuring safety and comfort during recovery.
• Monitoring and Evaluation:
• Monitor temperature daily; every 4 hours if fever is present to detect changes early and manage fever effectively.
• Evaluate if the patient is febrile and if temperature checks need to be more frequent, especially if chills are present, indicating a potential rise in temperature.
• Signs of Dehydration and Fluid Management:
• Monitor for signs of dehydration such as dry skin, mucous membranes, thirst, weakness, and hypotension, as fever can lead to fluid loss.
• Encourage oral fluids if not contraindicated to prevent dehydration, ensuring the patient is taking fluids well.
• Antipyretic Administration and Guidelines:
• Administer antipyretics like acetaminophen if fever exceeds 102°F (39°C) or if the patient is uncomfortable, as they help reduce fever.
• If fever rises above 103°F (39.4°C), contact the healthcare provider, as this may indicate a more serious infection.

Laryngitis: Pathophysiology and Management

• Laryngitis is the inflammation of the mucous membrane lining the larynx, often caused by irritants like smoking, alcohol, GERD, or infections.
• It is commonly associated with upper respiratory infections and can also be a symptom of laryngeal cancer.
• The primary symptom is hoarseness, but patients may also experience cough, dysphagia, and fever, indicating inflammation.
• Symptoms can vary based on the underlying cause, with viral infections being the most common.
• Diagnostic Tests and Procedures:
• A healthcare provider may use a mirror to examine the larynx; persistent hoarseness may require laryngoscopy and biopsy to rule out cancer.
• Diagnostic tests help determine the cause of laryngitis and guide treatment options.
• Therapeutic Measures and Patient Care:
• Treatment includes rest, hydration, humidified air, and medications like acetaminophen for pain relief.
• Patients should be encouraged to avoid whispering and use alternative communication methods to rest their voice.

Tonsillitis and Adenoiditis

• Pathophysiology and Etiology:
• Tonsillitis is the inflammation of the tonsils, often due to viral or bacterial infections, with common bacteria including Streptococcus and Staphylococcus.
• Adenoiditis involves the adenoids and can lead to complications such as obstructive sleep apnea, especially in children.
• Symptoms typically include a sudden sore throat, fever, chills, and pain during swallowing, with visible redness and swelling of the tonsils.
• If adenoids are involved, patients may experience nasal obstruction and altered voice quality.
• Diagnostic Tests and Treatment Options:
• A throat culture is essential for identifying the causative organism, while blood tests can differentiate between viral and bacterial infections.
• Antibiotics are prescribed for bacterial infections, while symptomatic relief includes acetaminophen and throat lozenges.
• Surgical Considerations and Postoperative Care:
• Tonsillectomy may be considered for chronic cases or when breathing/swallowing is affected; postoperative care includes monitoring for bleeding and hydration.
• Patients should be positioned in semi-Fowler's to reduce swelling and promote drainage, with cold fluids recommended for pain relief.

Respiratory Viruses: Transmission and Prevention

• Respiratory viruses like influenza and COVID-19 are transmitted via respiratory droplets, with varying incubation periods.
• Older adults and individuals with comorbidities are at higher risk for severe complications from these viruses.

Impact of Social Determinants on Health

• Social determinants such as race and socioeconomic status significantly affect health outcomes, particularly in the context of COVID-19.
• Disparities in healthcare access and outcomes highlight the need for targeted public health interventions.

Vaccination Recommendations

• The CDC recommends annual flu vaccinations for individuals over 6 months, while COVID-19 vaccinations are advised for those over 5 years.
• Emphasizing the safety of vaccines can help increase uptake, especially among older adults who may be hesitant.

Public Health Goals and Statistics

• Healthy People 2030 aims to increase flu vaccination rates, addressing the significant morbidity and mortality associated with influenza and COVID-19.
• Statistics from the CDC highlight the severe impact of these viruses, underscoring the importance of preventive measures.

Respiratory Viruses

• The recommendation for yearly COVID-19 vaccinations is still under consideration, highlighting the evolving nature of public health guidelines.
• Preventive measures against respiratory viruses include:
• Hand hygiene: Regular washing with soap and water or using hand sanitizer.
• Mask wearing: Especially in crowded or high-risk areas.
• Avoiding contact with infected individuals: Stay away from those showing symptoms of influenza or COVID-19.
• Crowds: Limit exposure during peak infection periods.
• For more information, visit the CDC website: CDC Influenza.

Signs and Symptoms of Respiratory Infections

• Symptoms of influenza typically present abruptly and include fever, chills, myalgia, sore throat, cough, malaise, and headache.
• COVID-19 symptoms may include:
• Cough, myalgia, headache, and changes in taste or smell.
• Recovery time varies significantly, from 2 weeks to several months for severe cases.
• Flu symptoms generally last 2 to 5 days, with malaise potentially extending for weeks.
• Complications of Influenza and COVID-19:
• Pneumonia is a common complication, which can be viral or secondary bacterial infection.
• Symptoms indicating pneumonia include persistent fever and shortness of breath, along with lung crackles or wheezes.
• Respiratory failure is a leading cause of death in COVID-19 patients, necessitating immediate medical attention for breathing difficulties.
• Diagnostic and Therapeutic Measures:
• Viral cultures and rapid tests are used to diagnose influenza and COVID-19.
• Viral cultures: Throat or nasal swabs can confirm influenza but take 3 to 10 days for results.
• Rapid tests: Provide results in under 15 minutes but are less reliable than cultures.
• Testing frequency may decrease once influenza is confirmed in a community.
• Treatment Protocols for Influenza and COVID-19:
• Treatment is primarily symptomatic, focusing on alleviating symptoms rather than curing the virus.
• Common treatments include: Acetaminophen for fever and pain relief, avoiding aspirin in children due to Reye syndrome risk, and rest and hydration.
• Antiviral medications (e.g., oseltamivir) can reduce severity if administered within 48 hours of symptom onset.
• Nursing Care and Patient Management:
• High-risk patients, such as older adults, may require hospitalization for close monitoring.
• Key nursing interventions include: Monitoring vital signs and lung sounds every 4 hours, assessing for dehydration and reporting changes, and encouraging rest and fluid intake.

Critical Thinking in Nursing Practice

• Case study: Mrs. Murdock, a 97-year-old with flu symptoms, presents a dilemma regarding hospitalization.
• Considerations include: Interventions to prevent complications and collaboration with healthcare team members for comprehensive care.
• Recognizing symptoms of decline in older adults is crucial for timely intervention.

Malignant Disorders

• Cancer of the Larynx:
• Pathophysiology and Etiology:
• Laryngeal cancer typically arises from squamous cells and is evaluated using the TNM staging system.
• Risk factors include tobacco and alcohol use, exposure to industrial chemicals, chronic voice overuse, and diet low in fruits and vegetables.
• Men are more frequently affected than women.
• Prevention and Early Detection:
• Education is key in preventing laryngeal cancer, including informing patients about the risks associated with tobacco and alcohol use.
• Any persistent hoarseness lasting longer than 2 weeks should prompt medical evaluation.
• Signs, Symptoms, and Diagnostic Tests:
• Common symptoms include persistent hoarseness, throat pain, and difficulty swallowing.
• Late signs may involve weight loss and halitosis.
• Diagnostic methods include laryngoscopy and biopsy, along with imaging tests to assess metastasis.
• Laryngeal Cancer Signs and Symptoms:
• Hoarse Voice: Often the first noticeable symptom, indicating vocal cord involvement.
• Pain and worsening with swallowing.
• Persistent cough that may produce blood-tinged sputum.
• Shortness of Breath: Resulting from airway obstruction or tumor growth.
• Difficulty Swallowing: Due to tumor presence affecting the esophagus.
• Weight Loss: Often due to pain while eating or swallowing difficulties.
• Diagnostic Tests:
• Examination with Laryngeal Mirror: Allows visualization of the larynx and detection of abnormalities.
• Laryngoscopy with Biopsy: Direct examination and tissue sampling for histological analysis.
• Blood and Radiographic Studies: Used to assess for metastasis and overall health status.
• Therapeutic Measures:
• Radiation Therapy: Effective in early-stage laryngeal cancer, can preserve voice function.
• Chemotherapy: Typically used in conjunction with radiation or surgery, not as a standalone treatment.
• Endoscopic Laser Surgery: Minimally invasive technique to destroy tumors.
• Partial Laryngectomy: Preserves some voice function, suitable for select patients.
• Radical Neck Dissection with Total Laryngectomy: Involves complete removal of the larynx and surrounding tissues, resulting in loss of voice.
• Nursing Diagnoses and Care:
• Priority Nursing Diagnoses:
• Ineffective Airway Clearance: Related to excessive secretions and new tracheostomy/laryngectomy.
• Acute Pain: Associated with surgical intervention and tumor presence.
• Impaired Verbal Communication: Due to loss of vocal cords post-surgery.
• Risk for Imbalanced Nutrition: Less than body requirements due to inability to eat post-surgery.
• Impaired Swallowing: Resulting from edema or presence of laryngectomy tube.
• Grieving: Emotional response to loss of voice and changes in body image.
• Preoperative Care:
• Routine Preoperative Teaching: Essential to prepare the patient for surgery and recovery.
• Communication Preparation: Initial instruction in alternative communication methods to alleviate post-operative anxiety.
• Consultation with Speech Therapist: To provide tools like picture boards for communication pre-surgery.
• Dietary Consultation: Important for patients who may be undernourished before surgery.
• Postoperative Care and Management:
• Data Collection and Monitoring:
• Physical and Psychosocial Assessment: Evaluate comfort, nutritional status, and ability to swallow pre and post-surgery.
• Airway Monitoring: Prioritize monitoring lung sounds, oxygen saturation, and arterial blood gases post-surgery.
• Patient Education: Assess understanding of the disease process and self-care needs after surgery.
• Nursing Interventions:
• Ineffective Airway Clearance: Monitor secretions, vital signs, and provide suctioning as needed.
• Impaired Verbal Communication: Use alternative communication methods like picture boards or writing tools.
• Risk for Imbalanced Nutrition: Monitor weight and provide nutritional support through parenteral or tube feeding.
• Impaired Swallowing: Consult speech therapy for swallowing assessments and recommendations.
• Laryngectomy Care and Patient Support:
• Swallowing Assessment and Management:
• Consult a speech therapist for swallowing assessments and recommendations, as they are trained to treat swallowing disorders.
• Assure patients that aspiration is unlikely due to the absence of a connection between the mouth and lungs post-surgery.
• Position the patient in high-Fowler's position to facilitate easier swallowing during meals.
• Stay with the patient during initial eating attempts to alleviate anxiety and provide support.
• Emotional and Psychological Support:
• Recognize the situational low self-esteem related to loss of voice and its impact on the patient's identity and future plans.
• Demonstrate compassion and understanding of the emotional loss associated with the inability to speak, which may affect career opportunities.
• Actively listen to the patient's feelings to validate their experiences and provide emotional support.
• Involve the patient's support system, including family and friends, to aid in long-term adjustment post-laryngectomy.
• Image and Self-Care:
• Address disturbed body image due to changes in body structure and function after laryngectomy, encouraging acceptance of the new self.
• Allow patients to express their feelings about body image changes, facilitating emotional processing.
• Contact local support groups with the patient's permission to connect them with others who have similar experiences.
• Assist patients in finding ways to camouflage changes, such as using scarves, to help them feel less conspicuous.
• Evaluation of Patient Progress:
• Evaluate the patient's airway for clarity and absence of infection or obstruction as a primary health indicator.
• Assess the patient's comfort level and understanding of self-care practices at home.
• Monitor the patient's weight stability and ability to swallow if consuming oral nutrition.
• Ensure the patient has emotional support and is processing grief appropriately.
• Patient Education and Home Care:
• Self-Care Instructions: - Instruct patients on self-care measures for laryngectomy, including cleaning and suctioning techniques. - Emphasize the importance of protecting the laryngectomy from water and debris, using lightweight scarves or specialized products. - Encourage gentle range-of-motion exercises for the neck to prevent muscle contracture due to avoidance of movement post-surgery.
• Home Health Care and Resources:
• Recommend referral to a home health-care agency for post-discharge assessment and follow-up instruction.
• Suggest contacting social services for financial or psychosocial support if needed, especially for patients facing lifestyle changes.
• Provide information on local laryngectomee support groups and resources from organizations like the American Cancer Society.
• Encourage cessation of alcohol and tobacco use to reduce the risk of cancer recurrence.
• Upper Respiratory Disorders:
• Disorders of the upper respiratory tract include conditions affecting the nose, sinuses, pharynx, larynx, and trachea, ranging from minor to serious.
• Common disorders include epistaxis, nasal polyps, deviated septum, sinusitis, sleep apnea, and infections like pharyngitis and laryngitis.
• Surgical options such as nasoseptoplasty for deviated septum and rhinoplasty for cosmetic or corrective purposes are available.
• Sinusitis and Sleep Apnea:
• Sinusitis is characterized by inflammation of the sinus mucosa, which can be acute or chronic, with chronic cases lasting over three months.
• Obstructive sleep apnea involves repeated episodes of apnea during sleep, often due to muscle relaxation in the throat, leading to airway obstruction and hypoxemia.
• Cancer of the Larynx:
• Laryngeal cancer typically arises from squamous cells and can metastasize to other organs, with persistent hoarseness being a primary symptom.
• Early diagnosis may allow for treatment options like radiation therapy, which can preserve the voice, while advanced cases may require partial or total laryngectomy.
• Post-surgery, patients may need to learn alternative communication methods due to the loss of voice.