Upper Airway Disorders Study Guide PDF

**[Upper Airway Disorders Study Guide]** **I. Epistaxis (Nosebleed)** - **Etiology/Pathophysiology:** - Nasal membrane congestion leading to capillary rupture. - Frequently caused by injury. - Can be primary or secondary to other conditions. - Related to menstrual flo...

**[Upper Airway Disorders Study Guide]** **I. Epistaxis (Nosebleed)** - **Etiology/Pathophysiology:** - Nasal membrane congestion leading to capillary rupture. - Frequently caused by injury. - Can be primary or secondary to other conditions. - Related to menstrual flow in women. - Hypertension can contribute. - Irritation of nasal mucosa, dryness, chronic infection, or nose picking. - Vigorous nose blowing. - Prolonged bleeding with aspirin or NSAID use. - **Clinical Manifestations:** - Bright red blood draining from one or both nostrils. - Severe hemorrhage can lead to a loss of up to one liter of blood per hour in adults. - **Assessment:** - *Subjective Data*: Duration and severity of bleeding, precipitating factors. - *Objective Data*: Bleeding from one or both nostrils, anterior or posterior bleeding, vital signs, signs of hypovolemic shock (hypotension is a late sign). - **Diagnostic Tests:** - Hemoglobin and Hematocrit. - Coagulation studies (PT, PTT, INR). - Rhinoscopy to locate the bleeding site. - **Medical Management:** - Nasal packing with epinephrine-soaked cotton. - Cautery (electrical or chemical). - Posterior packing. - Balloon tampon using a Foley-like catheter. - Antibiotics to minimize infection risk after bleeding is controlled. - **Nursing Interventions/Patient Teaching:** - Keep the patient calm. - Position the patient sitting and leaning forward, or reclining with head and shoulders elevated. Have an emesis basin available. - Apply direct pressure to the soft part of the nose for 10-15 minutes. - Apply ice compresses. - Monitor for signs of hypovolemic shock. - Instruct the patient and family to avoid nose picking, vigorous nose blowing, scratching, or placing foreign objects in the nose. - Encourage keeping nasal mucous membranes moist. - Advise the patient to avoid aspirin and NSAIDs. - Teach the patient to sneeze with their mouth open. - **Patient Problems/Nursing Interventions:** - Compromised blood flow: Assess vital signs and level of consciousness every 15 minutes, and document blood loss. - Potential for aspiration: Elevate the head of the bed, encourage the patient to let blood drain, pinch nostrils, have patient breathe through mouth, apply ice, assist in clearing secretions, and instruct the patient to expectorate rather than swallow blood. **II. Deviated Septum & Nasal Polyps** - **Etiology/Pathophysiology:** - Deviated Septum: Congenital abnormality or injury causing deviation from midline. - Nasal Polyps: Tissue growths caused by prolonged sinus inflammation, often due to allergies. - **Clinical Manifestations:** - Stertorous respirations (strenuous, snoring sound). - Dyspnea. - Postnasal drip. - **Assessment:** - *Subjective Data*: History of injuries, infections, allergies, sinus congestion, dyspnea. - *Objective Data*: Identify the condition and location; assess rate and character of respirations. - **Diagnostic Tests:** - Sinus radiographic studies. - Visual examination for deviated septum. - **Medical Management:** - Surgical correction - Nasoseptoplasty to straighten the septum. - Nasal polypectomy to remove polyps. - Nasal packing for 24 hours to control bleeding. - Nasal mucosa hydration with irrigation or petroleum. - Medications to reduce inflammation, congestion, and prevent infection. - Corticosteroids. - Antihistamines. - Antibiotics. - Analgesics. - **Nursing Interventions/Patient Teaching:** - Maintain airway patency and prevent infection. - Monitor for infection or hemorrhage postoperatively. - Contact physician for bleeding or infection. - Caution against nasal sprays and drops (rebound effect). - Avoid nose blowing, vigorous coughing, or Valsalva maneuver for 2 days post-op. - Expect ecchymosis and edema for several days. - **Patient Problems/Nursing Interventions:** - Inability to Clear Airway: Document ability to clear secretions and respiratory status. Elevate the head of the bed, apply ice to decrease edema, change nasal drip pad, and document exudate. - Potential for Injury: Assess and report exudates; instruct patient against blowing nose postoperatively. **III. Allergic Rhinitis and Allergic Conjunctivitis** - **Etiology/Pathophysiology:** - Atopic condition resulting from antigen-antibody reactions in nasal membranes, nasopharynx, and conjunctiva. - May be seasonal or perennial. - Common allergens include trees, grass, weeds, mold, fungi, dust, mites, animal dander, foods, drugs, and insect stings. - **Clinical Manifestations:** - *Acute ocular*: Edema, photophobia, excessive tearing, blurred vision, pruritus. - *Rhinitis*: Excessive secretions, inability to breathe through the nose. - Otitis media. - *Chronic*: Headache, severe nasal congestion, postnasal drip, cough. - *If Untreated*: Otitis media, bronchitis, sinusitis, pneumonia. - **Assessment:** - *Initial complaints*: Severe sneezing, congestion, pruritus, lacrimation. - *Chronic signs*: Headache, severe nasal congestion, postnasal drip, cough. - Physical exam: pale mucosa of the turbines. - **Diagnostic Tests:** - Skin testing. - Serum radioallergosorbent test (RAST). - **Medical Management:** - Relieve signs and symptoms. - Prevent infections. - Medications: - Antihistamines. - Decongestants. - Lodoxamide for conjunctivitis. - Topical or nasal corticosteroids. - Beclomethasone. - Dexamethasone. - Flunisolide. - Fluticasone. - Budesonide. - **Nursing Interventions/Patient Teaching:** - Focus on health promotion and maintenance. - Teach ways to avoid allergens. - Teach self-care management through symptom control. - Teach medication action and usage, assess for effectiveness. **IV. Obstructive Sleep Apnea** - **Etiology/Pathophysiology:** - Partial or complete upper airway obstruction during sleep. - Relaxation of the tongue and soft palate obstructs the pharynx. - More common in men, incidence increases with age and weight gain. - Structural anomalies of the nares and/or pharynx. - **Clinical Manifestations and Assessment:** - Apneic period with severe hypoxemia and hypercapnia. - Startle response, snorts, and gasps as ventilatory stimulants. - Apnea and arousal cycles 200-400 times during sleep. - Morning headache, personality changes, hypertension, cardiac dysrhythmias. - Frequent awakening at night and insomnia, excessive daytime sleepiness. - Witnessed apneic episodes. - **Diagnostic Tests:** - Polysomnography. - Diagnosis after repeated episodes of apnea or diminished respiratory effort (30-50%). - **Medical Management:** - *Mild Apnea:* Avoid sedatives and alcohol before sleep, weight loss, oral appliance, support group. - *Moderate to Severe Apnea:* Nasal continuous positive airway pressure (nCPAP). - Nasal mask attached to high-flow blower. - Provides positive pressure to prevent airway collapse. - Bi-level positive airway pressure (BiPAP). - Higher pressure during inspiration, lower during expiration. **V. Upper Airway Obstruction** - **Etiology/Pathophysiology:** - Recent respiratory event, trauma, choking, dentures, aspiration, tongue obstruction, laryngeal spasm, laryngeal edema. - **Clinical Manifestations:** - Stertorous respirations, altered rate, character, and apneic periods. - Agitation, changes in level of consciousness, and confusion. - **Assessment:** - *Subjective*: Patient unable to talk. - *Objective*: Signs of hypoxia, respiratory distress (stertorous respirations, stridor, wheezing), cyanosis, bradycardia, hand over throat. - **Medical Management:** - Heimlich maneuver. - Emergency tracheostomy. - Artificial airways (pharyngeal, endotracheal, tracheal). - **Diagnostic Tests:** - Diagnosis made by prompt assessment. - Radiographic studies to identify foreign bodies. - **Nursing Interventions/Patient Teaching:** - Promptly open airway and restore patency. - **Patient Problems/Nursing Interventions:** - Inability to Clear Airway: Reestablish and maintain airway, administer oxygen, suction as needed, monitor vital signs and breath sounds. - Potential for Aspiration: Monitor respiratory rate, rhythm, and effort; assess ability to swallow secretions; elevate the head of the bed, document breath sounds and secretions, and suction as needed. **VI. Laryngeal Cancer** - **Etiology/Pathophysiology:** - Most often in people over age 65. - Prolonged tobacco use. - Chronic laryngitis. - Vocal abuse. - Family history. - Gastroesophageal reflux disease. - Heavy alcohol use. - **Clinical Manifestations:** - Progressive or persistent hoarseness (early sign) \> 2 weeks. - Pain in larynx radiating to ear. - Dysphagia. - Lump in throat. - Enlarged cervical lymph nodes. - **Assessment:** - *Subjective*: Onset of symptoms, difficulty breathing or swallowing. - *Objective*: Examine sputum for blood. - **Diagnostic Tests:** - Visual examination with direct laryngoscopy with biopsy. - Imaging studies (X-Ray, CT, MRI, PET). - **Medical Management:** - Radiation therapy if tumor confined to the vocal cord without limitation of movement. - Surgery: Total or partial laryngectomy, radical neck dissection, chemotherapy. - **Nursing Interventions/Patient Teaching:** - Airway patency, frequent suctioning. - Skin integrity, monitor for infection. - Monitor intake and output. - Tube feedings. - Daily weight. - Address psychological concerns. - **Patient Problems/Nursing Interventions:** - Inability to Clear Airway: Suction secretions; provide tracheostomy care; ensure emergency equipment available; offer small, frequent feedings; teach stoma protection; assess respiratory rate and characteristics; auscultate lung sounds; monitor SaO2; elevate head of bed; turn patient and encourage coughing/deep breathing; provide humidity; suction trach tube; clean inner cannula. - Compromised Verbal Communication: Provide communication tools; use a notebook; keep call bell nearby; ask yes/no questions; refer to support groups; assist with speech rehab; reinforce follow-up appointments. **VII. Acute Rhinitis (Common Cold/Coryza)** - **Etiology/Pathophysiology:** - Inflammation of the mucous membranes of the nose and sinuses. - Usually caused by viruses, can be complicated by bacteria. - **Clinical Manifestations:** - Productive cough. - Thin, serous nasal exudate. - Sore throat. - Fever. - **Assessment:** - *Subjective*: Sore throat, dyspnea, congestion. - *Objective*: Erythema, edema, local irritation of the throat, monitor vital signs. - **Diagnostic Tests:** - Throat and sputum cultures to determine bacterial infection. - **Medical Management:** - Analgesia, antipyretics, cough suppressant and expectorant. - Antibiotics for bacterial infection. - **Nursing Interventions/Patient Teaching:** - Promote comfort. - **Patient Problems/Nursing Interventions:** - Inability to Clear Airway: Encourage fluids, use a vaporizer. - Willingness for Improved Health Management: Monitor respiratory status, assess swallowing, document breath sounds and secretions, elevate the head of the bed, suction as needed. - **Patient Teaching:** - Teach handwashing and proper tissue disposal. - Limit exposure to others for 48 hours. - Check temperature every 4 hours. - Use a neti pot. - **Prognosis:** Resolves in 2-10 days. **VIII. Acute Follicular Tonsillitis** - **Etiology/Pathophysiology:** - Caused by group A beta-hemolytic Streptococcus. - Air or foodborne bacterial infection, most common in school-age children. - **Clinical Manifestations:** - Enlarged cervical lymph nodes. - Sore throat, fever, chills, malaise, general muscle aching. - Enlarged tonsils with purulent exudate. - **Assessment:** - *Subjective*: Severity of throat pain, pain to ears, headache, joint pain. - *Objective*: Enlarged erythematous tonsils, increased throat secretions. - **Diagnostic Tests:** - Throat cultures. - White Blood Count. - **Medical Management:** - Antibiotic for active infection. - Surgery for recurrent infections, 4-6 weeks after attack subsides. - **Nursing Interventions:** - Facilitate recovery and prevent secondary infections. - **Patient Problems/Nursing Interventions:** - Discomfort: Assess pain and need for analgesics, document effectiveness of meds, offer warm saline gargles, ice chips, and ice collar; maintain airway and position; observe for vomiting. - Potential for Inadequate Fluid Volume: Assess hydration status, encourage ice pops, ice chips, and increased oral intake, avoid citrus. - Potential for Aspiration: Maintain patent airway; keep patient lying on their side; observe for swallowing and vomiting. - **Prognosis:** Self-limiting, but complications include sinusitis, otitis media, mastoiditis, rheumatic fever, nephritis, or peritonsillar abscess. **IX. Laryngitis** - **Etiology/Pathophysiology:** - Secondary to other respiratory disorders, viral or bacterial infections. - Excessive use of voice, inhalation of irritating fumes. - May cause severe respiratory distress in children under five. - **Clinical Manifestations:** - Hoarseness, scratchy and irritated throat, persistent cough. - **Assessment:** - *Subjective*: Progressive hoarseness and cough. - *Objective*: Evaluate patient\'s voice quality and sputum. - **Diagnostic Test:** - Laryngoscopy. - **Medical Management:** - No antibiotic therapy for viral causes; comfort measures. - Antibiotic therapy for bacterial causes. - **Nursing Interventions and Patient Teaching:** - **Patient Problems/Nursing Interventions** - Discomfort: Assess pain level and offer medication for comfort, use steam inhalation. - Compromised Verbal Communication: Instruct on voice rest; provide other means of communication, anticipate needs. - **Prognosis:** Good for adults, but can lead to respiratory distress in children. **X. Pharyngitis** - **Etiology/Pathophysiology:** - Acute or chronic, common throat inflammation. - Viral origin, or caused by hemolytic streptococci, staphylococci, or other bacteria. - \"Strep throat\" is contagious for 2-3 days after onset of signs. - **Clinical Manifestations:** - Dry cough, tender tonsils, enlarged lymph glands, erythematous, sore throat. - **Assessment:** - *Subjective*: Pharyngeal discomfort, fever, difficulty swallowing. - *Objective*: Palpate for enlarged, edematous glands, associated tenderness, and elevated temperature. - **Diagnostic Tests:** - Throat cultures. - **Medical Management:** - Antibiotics (penicillin or erythromycin). - Analgesics/antipyretics (Tylenol). - **Nursing Interventions and Patient Teaching:** - **Patient Problems/Nursing Interventions** - Compromised Oral Mucous Membrane: Provide warm saline gargles; assess pain and provide meds, encourage oral fluids; offer oral care. - Potential for Inadequate Fluid Volume: Instruct on voice rest, observe and record hydration, monitor intake and output and temp, maintain IV therapy if indicated. - **Prognosis:** Symptoms usually resolve in 4-6 days. **XI. Sinusitis** - **Etiology/Pathophysiology:** - Chronic or acute, maxillary or frontal, viral or bacterial. - **Clinical Manifestations:** - Constant, severe headache, pain and tenderness in affected area, purulent exudate. - **Assessment:** - *Subjective*: Decreased appetite, nausea, malaise, headache, pain in the region. - *Objective*: Vital signs (temperature), character of drainage. - **Diagnostic Tests:** - Sinus x-rays, transillumination, CT scan. - **Medical Management:** - Nasal windows to facilitate drainage, Caldwell-Luc operation to remove diseased tissue. - Medications: Saline nasal irrigation, nasal corticosteroids, oral or injected corticosteroids, decongestants, analgesics, antibiotics (if bacterial). - **Nursing Interventions and Patient Teaching:** - **Patient Problems/Nursing Interventions:** - Inability to Maintain Adequate Breathing Pattern: Assess respiratory status, mouth breathing may be necessary; consider neti pots. - Discomfort: Document comfort level, assess need for analgesics, elevate HOB, apply warm packs. - **Prognosis:** Uncomplicated sinusitis has a good prognosis; complications include cavernous sinus thrombosis, spread of infection to bone, brain, meninges, leading to meningitis, osteomyelitis, or septicemia.