Chapter 18 Management of Patients with Upper Respiratory Tract Disorders (PDF)

Chapter 18 Management of Patients with Upper Respiratory Tract Disorders Management of Patients With Upper Respiratory Infections (URIs)  Most common cause for illness, reason for seeking health care and absences from school and work  May be minor, acute, chronic, severe, or life t...

Chapter 18 Management of Patients with Upper Respiratory Tract Disorders Management of Patients With Upper Respiratory Infections (URIs)  Most common cause for illness, reason for seeking health care and absences from school and work  May be minor, acute, chronic, severe, or life threatening  Treated in community settings: doctor offices, urgent care clinics, long-term care facilities, or self-care at home  Early detection of signs and symptoms and appropriate interventions can avoid unnecessary complications  Patient teaching focus on prevention and health promotion  Special considerations for older adults: Refer to Chart 18- 1 Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #1 Is the following statement true or false? The term “common cold” refers to an infectious, chronic inflammation of the mucous membranes of the nasal cavity requiring hospitalization and treatment with IV antibiotics. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #1 False Rationale: The “common cold” is acute inflammation of the nasal cavity that is typically self‐limiting with nasal congestion, rhinorrhea, sneezing, sore throat, and general malaise. The term is used with acute URIs such as rhinitis, pharyngitis, and laryngitis and often when the causative agent is the influenza virus. Copyright © 2022 Wolters Kluwer · All Rights Reserved Epistaxis Hemorrhage from the nose Anterior septum, most common site Serious problem, may result in airway compromise or significant blood loss Risk factors, refer to Chart 18-5 Copyright © 2022 Wolters Kluwer · All Rights Reserved Medical Management of Epistaxis Identify cause and location Pinch soft portion of nose for 5 to 10 minutes, patient sits upright Phenylephrine spray, vasoconstriction Cauterize with silver nitrate or electrocautery Gauze packing or balloon-inflated catheter inserted into nasal cavity for 3 to 4 days Antibiotic therapy Copyright © 2022 Wolters Kluwer · All Rights Reserved Control of Epistaxis—Packing of Nasal Cavity or Balloon Catheter Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Management of Epistaxis Airway, breathing, circulation Vital signs, possible cardiac monitoring and pulse oximetry Reduce anxiety Patient teaching: o Avoid nasal trauma, nose picking, forceful blowing, spicy foods, tobacco, exercise o Adequate humidification to prevent dryness o Pinch nose to stop bleeding; if bleeding does not stop in 15 minutes, seek medical attention Copyright © 2022 Wolters Kluwer · All Rights Reserved URIs Rhinitis and rhinosinusitis: acute, chronic, bacterial, viral (Charts 18-2 and 18-3) Pharyngitis: acute, chronic Tonsillitis, adenoiditis Peritonsillar abscess Laryngitis Copyright © 2022 Wolters Kluwer · All Rights Reserved Rhinitis and Rhinosinusitis Copyright © 2022 Wolters Kluwer · All Rights Reserved Pharyngitis Reprinted with permission from the Wellcome Trust, National Medical Slide Bank, London, UK. Copyright © 2022 Wolters Kluwer · All Rights Reserved Potential Complications and Collaborative Problems with URIs Airway obstruction Medicamentosa Hemorrhage Acute otitis media Sepsis Trismus Meningitis or brain Dysphagia abscess Aphonia Nuchal rigidity Cellulitis Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #2 What should the nurse recommend a patient with pharyngitis avoid? A. ENDS use B. Exposure to extreme heat C. Secondhand smoke D. A and C Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #2 D. A and C Rationale: Patients diagnosed with chronic pharyngitis should avoid alcohol, tobacco, secondhand smoke, ENDS use, exposure to cold and environment and occupational pollutants. The patient can wear a disposable face mask to filter out small particles such as dust and mold. This patient should also stay hydrated with oral fluids and use lozenges or gargle with warm saline solution to relieve throat discomfort. Copyright © 2022 Wolters Kluwer · All Rights Reserved Assessment of the Patient with URI Health history Signs and symptoms: headache, cough, hoarseness, fever, stuffiness, generalized discomfort, and fatigue Allergies Inspection of nose, neck, throat, and palpation of lymph nodes Copyright © 2022 Wolters Kluwer · All Rights Reserved Planning and Goals for the Patient with URI Airway management, reduce risk of aspiration Pain management Effective communication strategy Normal hydration Patient teaching: prevention of URI, and absence of complications Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Interventions for the Patient with URI  Elevate head Gargles for sore throat  Ice collar to reduce Use alternative inflammation and communication bleeding Encourage liquids and  Hot packs to reduce use of room vaporizers congestion or steam inhalation to keep secretions loose  Analgesics for pain and moist for easier  Topical anesthetics expectoration  Monitor for severe Rest complications Copyright © 2022 Wolters Kluwer · All Rights Reserved Evaluation of the Patient with URI Maintenance of patent airway Expresses relief of pain Able to communicate needs Evidence of positive hydration Free of signs and symptoms Absence of complications Copyright © 2022 Wolters Kluwer · All Rights Reserved Patient Education for URI Prevention of upper airway infections Emphasize frequent hand washing When to contact health care provider Need to complete antibiotic treatment regimen Annual influenza vaccine for those at risk Copyright © 2022 Wolters Kluwer · All Rights Reserved Assessment of the Patient Undergoing Laryngectomy Health history Physical, psychosocial, and spiritual assessment Nutrition, BMI, albumin, glucose, electrolytes Literacy, hearing, and vision; may impact communication after surgery Coping skills and available support systems for patient and family after surgery Copyright © 2022 Wolters Kluwer · All Rights Reserved Collaborative Problems and Potential Complications for the Patient Undergoing Laryngectomy Respiratory distress Hemorrhage Infection Wound breakdown Aspiration Tracheostomal stenosis Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Interventions for the Patient Undergoing Laryngectomy Preoperative teaching Reduce anxiety Maintain patent airway, control secretions Support alternative communication Promote adequate nutrition and hydration Promote positive body image, self-esteem Monitor for potential complications Self-care management; homecare (Chart 18-7) Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #3 What is a priority education component for a patient scheduled for a total laryngectomy? A. Clarify misconceptions after the patient speaks with the provider B. Discuss the effect of surgery on speech postoperatively C. Explain methods for communication postoperatively D. All of the above Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #3 D. All of the above Rationale: Patients may experience severe anxiety at the thought of waking up from surgery and not being able to speak. Preoperatively, the nurse must clarify any misconceptions regarding the procedure and outcomes, discuss alternative strategies for communication after surgery, and reinforcement of teaching with patient and family that the patient’s natural voice will be lost. Copyright © 2022 Wolters Kluwer · All Rights Reserved