Upper Respiratory Tract Disorders Lecture Notes PDF

Al-Zaytoonah University of Jordan Faculty of Nursing Course name: Adult Nursing I/ Theory Course Number: 0301215 Lecture 12: Upper Respiratory Tract Disorders 12/15/2024...

Al-Zaytoonah University of Jordan Faculty of Nursing Course name: Adult Nursing I/ Theory Course Number: 0301215 Lecture 12: Upper Respiratory Tract Disorders 12/15/2024 1  PILOs- CILOs- topic PILOs- CILOs- topic PILO # 1: Comprehend the basic nursing CILO1: now the safe and effective rules to Etiology, clinical manifestation, knowledge needed to provide a safe and provide evidence-based, comprehensive diagnostic testing, and medical effective care environment, and nursing care for adult patients with management of upper respiratory comprehensive nursing care based on medical and surgical health conditions. tract disorders. research and scientific evidence PILO # 5: Demonstrate the ability to maintain 1. Provide comfort and assistance in the performance of Provide nursing care for patients with activities of daily living based on evidence-based practice the physiological integrity of patients while 2. Recognize the administration of medications and parenteral Upper respiratory tract disorders. providing high quality nursing care. therapies based on evidence-based practice 3. Reduce the likelihood that clients will develop complications or health problems related to existing conditions, treatments or procedures based on evidence-based practice 4. Manage care for clients with acute, chronic or life- threatening physical health conditions based on evidence- based practice 12/15/2024 2  Learning Outcomes On completion of this chapter, the learner will be able to: 1. Recognize causes, diagnostic studies, and clinical manifestations for upper respiratory tract. disorders. 2. Demonstrate knowledge of management strategies for upper respiratory tract disorders. 3. Explain nursing interventions in the care of patients with upper respiratory tract disorders 4. Use the nursing process as a framework for care of the patient with upper respiratory tract disorders 12/15/2024 3 Upper Respiratory Tract Upper Respiratory Tract  Upper Respiratory Tract Disorders Upper respiratory tract disorders are those that involve the nose, paranasal sinuses, pharynx, larynx, trachea, or bronchi. Upper airway/respiratory infections May be acute or chronic Infection of the mucous membranes of the nose, sinuses, pharynx, upper trachea, or larynx. Viruses are the most common cause and then bacterial infection.  Rhinitis Inflammation and irritation of the mucous membranes of the nose. May be acute or chronic, and allergic or nonallergic. The most common cause of nonallergic rhinitis is the common cold. ❑ Risk factors: changes in temperature or humidity; odors; infection; age; systemic disease; use of over the-counter (OTC) and prescribed nasal decongestants; and the presence of a foreign body.  Rhinitis Allergic rhinitis (seasonal rhinitis) is associated with exposure to allergens such as foods (e.g., peanuts, shellfish, soy, cow’s milk, eggs), medications (e.g., penicillin, sulfa medications, aspirin), and particles in the indoor and outdoor environment.  Clinical Manifestations and Management Manifestations: Rhinorrhea (excessive nasal drainage, runny nose); nasal congestion; nasal discharge (purulent with bacterial rhinitis); sneezing; and pruritus of oropharynx, eyes, and ears. Medical Management Corticosteroids; antibiotic; antihistamines; pseudoephedrine; saline nasal spray as a decongestant; ipratropium for rhinorrhea; ophthalmic agents (cromolyn) Nursing Management Avoid or reduce exposure to allergens and irritants. Controlling the environment at home and work. Instructs the patient in correct administration of nasal medications. In the case of infectious rhinitis, the nurse reviews hand hygiene  Viral Rhinitis (Common Cold) Acute inflammation of the mucous membranes of the nasal cavity. Viral infections. It is highly contagious. Caused mainly by rhinoviruses (200 different viruses). Other viruses include coronavirus, adenovirus, respiratory syncytial virus, influenza virus, and parainfluenza virus. Each virus may have multiple strains.  Viral Rhinitis (Common Cold) Clinical Manifestations Low-grade fever, nasal congestion, rhinorrhea and nasal discharge, halitosis, sneezing, tearing watery eyes, “scratchy” or sore throat, general malaise, chills, headache and muscle aches, and cough. In some people, the virus exacerbates herpes simplex (cold sore). The symptoms last from 1 to 2 weeks. Medical Management Adequate fluid intake, rest, prevention of chilling, expectorants, warm salt-water gargles, NSAIDs, antihistamines, petroleum jelly for irritated skin around the nares.  Acute Pharyngitis Acute pharyngitis is a sudden painful inflammation of the pharynx (sore throat). Pathophysiology Viral infection causes most cases of acute pharyngitis (Adenovirus, influenza virus, Epstein–Barr virus, and herpes simplex virus). Bacterial infection accounts for the remainder of cases “Group A streptococcus (GAS) or streptococcal pharyngitis, and groups B and G streptococci”.  Acute Pharyngitis Clinical Manifestations o Swollen and flecked with white-purple exudate in pharyngeal membrane and tonsils, lymphoid follicles, enlarged and tender cervical lymph nodes, fever (higher than 38.3°C), and malaise. o Patients with GAS pharyngitis: Nausea, vomiting, anorexia, rash with urticaria, painful sore throat, painful cervical adenopathy headache, myalgia, and bad breath. Complications o can be severe and life-threatening. o Rhinosinusitis, otitis media, peritonsillar abscess, mastoiditis, and cervical adenitis, sepsis, pneumonia, meningitis, rheumatic fever, and glomerulonephritis.  Acute Pharyngitis Assessment and Diagnostic Findings To determine the cause (viral or bacterial). Rapid antigen detection testing (RADT) uses swabs from the posterior pharynx and tonsil, and throat culture. Medical Management Viral pharyngitis: supportive and symptom management. Bacterial pharyngitis: antibiotic. Pharmacologic Therapy Penicillin, erythromycin, and cephalosporins. Nutritional Therapy A liquid or soft diet, cool beverages, warm liquids, and flavored frozen desserts. Intravenous (IV) fluids may be needed.  Acute Pharyngitis Nursing Management The nurse instructs the patient to: Report dyspnea, drooling, inability to swallow, and inability to fully open the mouth. Stay in bed during the febrile stage and to rest. Infection prevention measures (dispose used tissue and hand washing).  Chronic Pharyngitis It is a persistent inflammation of the pharynx. Risk factors: work in dusty surroundings, use voice excessively, suffer from chronic cough, or habitually use alcohol and tobacco. There are three types of chronic pharyngitis: Hypertrophic: characterized by general thickening and congestion of the pharyngeal mucous membrane. Atrophic: the membrane is thin, whitish, glistening, and at times wrinkled. Chronic granular: characterized by numerous swollen lymph follicles on the pharyngeal wall.  Chronic Pharyngitis Clinical Manifestations Constant sense of irritation or fullness in the throat, mucus in the throat and can be expelled by coughing, and difficulty swallowing. Medical Management Avoid exposure to irritants Short-term use of nasal sprays or medications containing ephedrine sulfate or phenylephrine Antihistamine/decongestant medications (e.g. pseudoephedrine or brompheniramine/pseudoephedrine). For adults with chronic pharyngitis, tonsillectomy may be offered as an option.  Chronic Pharyngitis Nursing Management o The nurse recommends: Avoid of alcohol, tobacco, ENDS use, secondhand smoke, and exposure to cold or to environmental or occupational pollutants. Drink plenty of fluids. Gargling with warm saline solution may relieve throat discomfort.  Tonsillitis and Adenoiditis The tonsils are composed of lymphatic tissue and are situated on each side of the oropharynx. The adenoids or pharyngeal tonsils consist of lymphatic tissue near the center of the posterior wall of the nasopharynx. Infection of the adenoids frequently accompanies acute tonsillitis. Bacterial infection: include Group A streptococcus (the most common organism). The most common viral pathogen is Epstein–Barr virus, and then cytomegalovirus.  Tonsillitis and Adenoiditis Clinical Manifestations Sore throat, fever, snoring, and difficulty swallowing. Enlarged adenoids may cause mouth breathing, earache, draining ears, frequent head colds, bronchitis, foul-smelling breath, voice impairment, and noisy respiration. Enlarged adenoids may cause nasal obstruction. Complication: Acute otitis media, spontaneous rupture of the tympanic membranes, mastoiditis, and permanent deafness. Assessment and Diagnostic Findings Determine viral or bacterial pathogens. RADT and throat swab culture.  Tonsillitis and Adenoiditis Medical Management Increase fluid intake, salt-water gargles, and rest. Bacterial infections: penicillin (first-line therapy) or cephalosporins (cefdinir or moxifloxacin). Tonsillectomy (with or without adenoidectomy) is a treatment choice for chronic infection and repeated episodes of tonsillitis.  Tonsillitis and Adenoiditis Nursing Management Providing Postoperative Care in Tonsillectomy (with or without adenoidectomy): Observe for risk of hemorrhage, which may also compromise the patient’s airway. Prone position, with head turned to the side to allow drainage from the mouth and pharynx. The nurse must not remove the oral airway until the patient’s gag and swallowing reflexes have returned. The nurse applies an ice collar to the neck, and a basin and tissues are provided for the expectoration of blood and mucus. If there is no bleeding, water and ice chips may be given to the patient as soon as desired. The patient is instructed to refrain from too much talking and coughing.  Tonsillitis and Adenoiditis Nursing Management o Educating Patients About Self-Care Bleeding may occur up to 8 days after surgery. Use of liquid acetaminophen. Alkaline mouthwashes and warm saline solutions for coping with the thick mucus and halitosis that may be present after surgery. The patient should eat an adequate diet with soft foods, which are more easily swallowed than hard foods. The nurse instructs the patient about the need to maintain good hydration.  Tonsillitis and Adenoiditis Nursing Management o Educating Patients About Self-Care The patient should avoid spicy, hot, acidic, or rough foods. Milk and milk products (ice cream and yogurt) may be restricted because they make removal of mucus more difficult for some patients. The patient is advised to avoid vigorous toothbrushing or gargling because these activities can cause bleeding. The nurse encourages the use of a cool-mist vaporizer or humidifier in the home postoperatively. The patient should avoid smoking and heavy lifting or exertion Thank You