Upper Respiratory Disorders: Symptoms and Care

• Chapter 13 covers the care of patients with disorders of the upper respiratory system.
• Theory objectives include recognizing symptoms of disorders of the sinuses, pharynx, and larynx.
• Additional objectives are to describe postoperative care for tracheostomy patients and prioritize emergency measures for airway obstruction.
• Further objectives are presenting nursing care plans for laryngectomy patients and analyzing safety factors for tracheostomy patients.
• Clinical practice objectives include measures to stop epistaxis and providing tracheostomy care.
• Devising interventions for the psychosocial care of laryngectomy patients is also an objective.
• Another objective includes visiting a patient with a permanent tracheostomy to learn about their coping strategies.

Disorders of the Nose and Sinuses

• Upper respiratory infection refers to the common cold and rhinitis.
• A primary goal in managing the common cold is preventing secondary bacterial infections.
• Individuals with a cold are typically contagious for about 3 days after symptoms first appear.
• Colds are spread through droplet infection.

Upper Respiratory Infections and Rhinitis: Etiology and Pathophysiology

• Viral spread occurs through airborne droplets from infected individuals during breathing, speaking, coughing, or sneezing.
• Spread can also occur through direct hand contact with contaminated objects followed by touching mucous membranes.

Upper Respiratory Infections and Rhinitis: Signs, Symptoms, and Diagnosis

• It usually starts with a mild sore throat or a hot, dry, prickly sensation in the nose and back of the throat.
• The nose becomes congested with increased secretions, the eyes begin to water, with sneezing, malaise, and an irritating, nonproductive cough
• Muscle aches and headaches may also occur.
• A low grade or no elevation of temperature is common.
• Symptoms usually last for 7 to 11 days, but full recovery can take up to 14 days.

Upper Respiratory Infections and Rhinitis: Treatment and Nursing Management

• Treatment is primarily symptomatic.
• Antihistamines, steroids, mast cell stabilizers and decongestants are commonly used.
• Complementary therapies involve Echinacea, goldenseal, or combinations of herbs, minerals, vitamins, and amino acids.
• Aspirin should not be given to children under 18, there's an association with Reye's syndrome.
• Adults on anticoagulants or nonsteroidal anti-inflammatory drugs shouldn't take aspirin due to prolonged clotting time.

Sinusitis

• Sinusitis is an inflammation of the mucosal lining of the sinuses.
• The causes of sinusitis includes infections spreading from the nasal passages and blockage of normal sinus drainage.
• Common infecting organisms are Pneumococci, streptococci, or Haemophilus influenzae.
• A deviated septum or nasal polyps can contribute to sinus blockage.

Sinusitis: Symptoms

• Symptoms include headache, fever, and tenderness over the sinuses.
• Malaise and purulent nasal drainage can be present.
• A nonproductive cough and pain in the upper teeth may occur.

Sinusitis: Treatment

• Hot, moist packs over the sinus area are beneficial.
• Inhaling moist steam helps to thin secretions and promote drainage.
• Medications can be used to promote vasoconstriction, reduce swelling, and promote drainage.
• Decongestants may be prescribed.
• Infection is often treated with antibiotics or antiinfective agents for at least 10 days.
• Rest, reduced stress, a balanced diet, and allergy control help prevent recurrence.
• Analgesics help to manage pain.
• Increase fluid intake while lowering dairy product intake decreases the thickness of secretions.

Epistaxis (Nosebleed)

• Causes include crusting, cracking, or irritation of the mucous membrane.
• A symptom is bleeding from the nose.
• Management involves sitting forward and applying direct pressure by pinching the nose just below the bone.
• Cold compresses, cauterization, packing, or a small balloon is effective in stopping the bleeding.

Pharyngitis

• Pharyngitis is inflammation of the pharynx, commonly called a sore throat.
• The inflammation can be caused by viruses, bacteria, or fungi, but is usually viral.
• Acute follicular pharyngitis, or strep throat, is caused by beta-hemolytic streptococcal infection.
• Laryngitis is the inflammation of the larynx leading to diminished voice or hoarseness.
• Epiglottitis occurs when the inflammation extends to the epiglottis and is more common in children.

Pharyngitis: Signs, Symptoms, and Diagnosis

• Symptoms include a dry, "scratchy" feeling in the throat and a mild fever.
• Includies headache and malaise alongside throat, tonsils, palate, and uvula that will be involved and reddened.
• Laryngitis is indicated with a voice that is hoarse or absent.

Pharyngitis: Treatment and Nursing Management

• Conservative measures include rest, warm saline gargles (1/2 to 1 tsp of table salt to a glass of warm water).
• Throat lozenges/antiseptic spray, plenty of fluids and mild analgesics for aches and pains provide relief.
• Bacterial pharyngitis needs antibiotics, particularly if the infecting organism is Streptococcus.

Tonsillitis

• An infection with inflammation of the tonsils.
• Signs and symptoms of it are high fever, sore throat, general malaise, pain referred to the ears, and chills.
• Redness and swelling of tonsils and surrounding tissues with patches of yellow exudate.
• Elevated white blood cell counts
• Treatment can involve a throat culture and surgery.
• Nursing management involves preoperative and postoperative care.

Airway Obstruction and Respiratory Arrest

• Laryngeal edema from an infection or allergic reaction can cause airway obstruction.
• A crush injury of the larynx or object down the airway can be reasons.
• Management includes opening the airway with a nasal/oropharyngeal airway for edema alongside abdominal thrusts for foreign objects.

Obstructive Sleep Apnea

• During sleep, breathing effort occurs with little or no airflow.
• A symptom is snoring.
• Management can include sleep study of continuous positive airway pressure.
• Untreated, may lead to myocardial infarction, stroke or constant fatigue.

Nasal Fracture

• Diagnosis involves visual inspection for deformity and assessment of nasal breathing.
• Crepitation, a grating sound or feeling of rough surfaces rubbing together upon palpation is diagnostic.

Nasal Fracture: Treatment

• Closed reduction is typically performed under local or general anesthetic within 24 hours of injury, alongside pain relief.
• Ice or cold compresses reduce swelling.
• Cosmetic rhinoplasty can be considered.

Cancer of the Larynx

• Is a common malignant tumor, most of the time it is squamous cell carcinoma.
• Persistent hoarseness that doesn't respond to the usual methods of treatment
• Treatment includes the options of radiation, surgery, chemotherapy.

Signs of Possible Throat Cancer

• Hoarseness lasting more than 3 weeks
• Sore throat lasts more than 2 weeks
• Consistent pain in or around the ear when swallowing
• Difficulty swallowing
• Dry, persistent cough for no known reason
• Blood in phlegm or saliva lasting more than a few days
• Lumps or knots on the neck indicating enlarged cervical lymph nodes

Endotracheal Intubation and Tracheostomy

• Endotracheal intubation: an endotracheal tube is put into the trachea, through the nose or mouth, using a laryngoscope.
• Tracheostomy: incision into trachea to put in a tube for the patient to breathe.

Purpose of a Tracheostomy

• To assist or control ventilation during a prolonger period of time.
• To make suctioning easier for those who are unable to cough.
• Prevent aspiration of oral gastric secretions.
• Bypass constricted or obstructed airways.
• Continuous monitoring for any signs of respiratory issues alongside immediate postoperative care, psychological support, communication, and rehabilitation.