(3) Upper Respiratory Tract Disorder.pdf

MANAGEMENT OF PATIENTS WITH UPPER RESPIRATORY TRACT DISORDER Professor: Joseph Christian G. Bacleon, RN OFFICIAL REFERENCE  TABLE OF CONTENTS UPPER AIRWAY INFECTIONS RHINITIS and RHINOSINUSITIS PHARYNGITIS TONSILLITIS AND ADENOIDITIS PERITONSILLAR ABSCESS LARYNGITIS  TABLE O...

MANAGEMENT OF PATIENTS WITH UPPER RESPIRATORY TRACT DISORDER Professor: Joseph Christian G. Bacleon, RN OFFICIAL REFERENCE  TABLE OF CONTENTS UPPER AIRWAY INFECTIONS RHINITIS and RHINOSINUSITIS PHARYNGITIS TONSILLITIS AND ADENOIDITIS PERITONSILLAR ABSCESS LARYNGITIS  TABLE OF CONTENTS OBSTRUCTION AND TRAUMA OF THE UPPER RESPIRATORY AIRWAY OBSTRUCTIVE SLEEP APNEA EPISTAXIS NASAL OBSTRUCTION FRACTURES OF THE NOSE LARYNGEAL OBSTRUCTION UPPER AIRWAY INFECTIONS UPPER AIRWAY INFECTIONS ▪ Upper airway infections (otherwise known as upper respiratory infections or URIs) are the most common cause of illness and affect most people on occasion. ▪ Maybe acute or chronic. UPPER AIRWAY INFECTIONS 1. Rhinitis and rhinosinusitis: acute, chronic 2. Pharyngitis: acute, chronic 3. Tonsillitis, adenoiditis 4. Peritonsillar abscess 5. Laryngitis  1 RHINITIS and RHINOSINUSITIS RHINITIS ▪ a group of disorders characterized by inflammation and irritation of the mucous membranes of the nose. ▪ It affects between 10% and 30% of the population worldwide annually. RHINITIS ▪ Rhinitis may be acute or chronic, and allergic or nonallergic. ▪ ALLERGIC RHINITIS ▪ exposure to air borne particles such as dust, dander, plant pollens who are allergic to these substances. ▪ Seasonal Rhinitis, Perennial Rhinitis RHINITIS CAUSATIVE FACTORS: ▪ Changes in temperature or humidity ▪ Odors ▪ Infection ▪ Age ▪ Systemic disease ▪ Use of over-the- counter (OTC) and prescribed nasal decongestants ▪ Presence of a foreign body RHINITIS Allergic rhinitis: allergens such as foods, medications and particles in the indoor and outdoor environment The most common cause of non-allergic rhinitis is the common cold. RHINITIS CLINICAL MANIFESTATIONS: ▪ Rhinorrhea ▪ Nasal congestion ▪ Nasal discharge ▪ Sneezing ▪ Pruritus of the nose, roof of the mouth, throat, eyes, and ears. ▪ Headache may occur RHINITIS MEDICAL MANAGEMENT ▪ Antihistamines and Corticosteroid nasal sprays ▪ Brompheniramine/Pseudoephedrine (Dimetapp) ▪ Cromolyn (NasalCrom) ▪ Oral decongestant agents (Decolgen Forte) ▪ Saline Nasal Spray ▪ Ipratropium (Atrovent) RHINITIS NURSING MANAGEMENT ▪ Instruct the patient with allergic rhinitis to avoid or reduce exposure to allergens and irritants. ▪ Educate patient on medication regimen. ▪ Instruct the patient in correct administration of nasal medications. ▪ Discuss the importance of hand hygiene practices. VIRAL RHINITIS (COMMON COLD) ▪ Viral rhinitis is the most frequent viral infection in the general population. ▪ Highly contagious because virus is shed for about 2 days before the symptoms appear. ▪ Seasonal changes in relative humidity may affect the prevalence of colds. VIRAL RHINITIS (COMMON COLD) ▪ Colds are caused by as many as 200 different viruses. ▪ RHINOVIRUSES are the most likely causative organisms. ▪ Other viruses implicated in the common cold include coronavirus, adenovirus, respiratory syncytial virus, influenza virus, and parainfluenza virus. VIRAL RHINITIS (COMMON COLD) CLINICAL MANIFESTATIONS: ▪ Low-grade fever ▪ “Scratchy” or sore throat ▪ Nasal congestion ▪ General malaise ▪ Rhinorrhea and nasal discharge ▪ Chills ▪ Halitosis ▪ Often headache and muscle ▪ Sneezing aches. ▪ Tearing watery eyes VIRAL RHINITIS (COMMON COLD) MEDICAL MANAGEMENT SYMPTOMATIC THERAPY: 1. Adequate fluid intake 2. Rest 3. Use of expectorants as needed. 4. Warm salt-water 5. NSAIDs 6. Antihistamines 7. Petroleum jelly VIRAL RHINITIS (COMMON COLD) MEDICAL MANAGEMENT ▪ Antimicrobial agents (antibiotics) SHOULD NOT BE USED ▪ Topical Nasal decongestants → should be used with caution ▪ Lead to RHINITIS MEDICAMENTOSA (see pathophysiology discussion) - ”rebound congestion” REBOUND CONGESTION (see pathophysiology) CAUSE: ▪ using nasal decongestant sprays for > 3 days in a row. (OVERUSE) ▪ nasal sprays containing either oxymetazoline or phenylephrine PRINCIPLE: ▪ Nasal decongestant sprays deliver the decongestant in a localized manner, these products relieve nasal congestion almost immediately (Dr. Ahmed, 2022) REBOUND CONGESTION CAUSE → blood vessels in your nasal passageways become sensitized to their active ingredients → Once your blood vessels come to expect the vasoconstriction provided by the spray, it has this paradoxical effect where, as the medication wears off, the blood vessels react by swelling back up — causing what's called rebound' congestion.” EFFECT: blood vessels in your nose can become dependent on these sprays. VIRAL RHINITIS (COMMON COLD) NURSING MANAGEMENT ▪ Emphasis on appropriate hand hygiene measures. ▪ Instruct the patient about methods to treat symptoms of the common cold. RHINOSINUSITIS ▪ formerly called sinusitis, is an inflammation of the paranasal sinuses and nasal cavity. ▪ Classified by duration of symptoms as acute, subacute, and chronic. ▪ Rhinosinusitis can be caused by a bacterial or viral infection. ACUTE RHINOSINUSITIS ▪ Classified as acute bacterial rhinosinusitis (ABRS) or acute viral rhinosinusitis (AVRS). ▪ Usually follows a viral URI or cold. ▪ If their drainage is obstructed by mechanical causes, sinus infection may persist as a persistent secondary infection or progress to an acute suppurative process (causing purulent discharge). ACUTE RHINOSINUSITIS ▪ Nasal congestion leads to obstruction of the sinus cavities. ▪ Bacterial organisms account for more than 60% of the cases of acute rhinosinusitis. ▪ Typical pathogens include Streptococcus pneumoniae, Haemophilus influenzae, and less commonly Staphylococcus aureus, and Moraxella catarrhalis. ACUTE RHINOSINUSITIS CLINICAL MANIFESTATIONS: ▪ Purulent nasal drainage ▪ Nasal obstruction or a combination of facial pain, pressure, or a sense of fullness ▪ Cloudy or colored nasal discharge congestion. ▪ Blockage, or stuffiness ▪ Localized or diffuse headache. ACUTE RHINOSINUSITIS CLINICAL MANIFESTATIONS: ▪ Patients with ABRS may present with a high fever (i.e., 39°C [102°F] or higher). ▪ Symptoms of AVRS are similar to those of ABRS, except the patient does not present with a high fever. ▪ Symptoms of AVRS occur for fewer than 10 days after the onset of upper respiratory symptoms and do not worsen. ACUTE RHINOSINUSITIS Assessment and Diagnostic Findings ▪ Tenderness to palpation over the infected sinus area. ▪ Sinus aspirates may be obtained. ▪ Diagnostic Imaging is NOT RECOMMENDED, if there are no complications or alternative diagnosis is suspected. ACUTE RHINOSINUSITIS COMPLICATIONS ▪ Local complications include osteomyelitis and mucocele (cyst of the paranasal sinuses). ▪ Brain abscesses occur by direct spread and can be life threatening. ▪ Frontal epidural abscesses are usually quiescent but can be detected by CT scan. ACUTE RHINOSINUSITIS MEDICAL MANAGEMENT FOR ABRS: ▪ A 5- to 7-day course of antibiotics is prescribed for bacterial cases. ▪ The goals of treatment are to shrink the nasal mucosa, relieve pain, and treat infection. ▪ Oral antibiotics are only prescribed when there is sufficient empiric evidence that the patient has ABRS. ACUTE RHINOSINUSITIS MEDICAL MANAGEMENT ▪ Amoxicillin – Clavulanic acid (Augmentin) is the antibiotic of choice. ▪ For patients who are allergic to penicillin, Doxycycline (Vibramycin), Levofloxacin (Levocin) or Moxifloxacin (Avelox) can be used. ▪ Intranasal saline lavage is an effective adjunct therapy to antibiotics. ACUTE RHINOSINUSITIS MEDICAL MANAGEMENT FOR AVRS: ▪ Nasal saline lavage and decongestants. ▪ Oral decongestants must be used cautiously in patients with hypertension. ▪ OTC antihistamines are used if an allergic component is suspected. ACUTE RHINOSINUSITIS NURSING MANAGEMENT ▪ Instruct the patient about symptoms of complications that require immediate follow-up. ▪ Instruct the patient about methods to promote drainage of the sinuses. ▪ Avoid swimming, diving, and air travel during the acute infection. ACUTE RHINOSINUSITIS NURSING MANAGEMENT ▪ Instruct to stop smoking or using any form of tobacco. ▪ Instruct the patient about the correct use of prescribed nasal sprays. ▪ Educates the patient about the side effects of prescribed and OTC nasal sprays and about rebound congestion (rhinitis medicamentosa). ▪ Explain to the patient that fever, severe headache, and nuchal rigidity are signs of potential complications. CHRONIC RHINOSINUSITIS & RECURRENT ACUTE RHINOSINUSITIS CHRONIC RHINOSINUSITIS: Diagnosed when the patient has experienced 12 weeks or longer of two or more of the following symptoms: ▪ mucopurulent drainage, nasal obstruction, facial pain–pressure–fullness, or hyposmia (decreased sense of smell). RECURRENT ACUTE RHINOSINUSITIS: Diagnosed when four or more episodes of ABRS occur per year with no signs or symptoms of rhinosinusitis between the episodes. CHRONIC RHINOSINUSITIS & RECURRENT ACUTE RHINOSINUSITIS CAUSATIVE AGENT: ▪ Common aerobic bacteria include alpha-hemolytic streptococci, microaerophilic streptococci, and S. aureus. ▪ Common anaerobic bacteria include gram- negative bacilli, Peptostreptococcus, and Fusobacterium. CHRONIC RHINOSINUSITIS & RECURRENT ACUTE RHINOSINUSITIS CLINICAL MANIFESTATIONS: ▪ Impaired mucociliary clearance and ventilation ▪ Cough ▪ Chronic hoarseness ▪ Chronic headaches in the periorbital area ▪ Periorbital edema ▪ Facial pain CHRONIC RHINOSINUSITIS & RECURRENT ACUTE RHINOSINUSITIS CLINICAL MANIFESTATIONS: ▪ As a result of chronic nasal congestion, the patient is usually required to breathe through the mouth. ▪ Snoring, sore throat, and, in some situations, adenoidal hypertrophy may also occur. ▪ Decrease in smell ▪ Sense of fullness in the ears CHRONIC RHINOSINUSITIS & RECURRENT ACUTE RHINOSINUSITIS Assessment and Diagnostic Findings ▪ External nose is evaluated for any evidence of anatomic abnormality. ▪ Assessment of the posterior oropharynx may reveal purulent or mucoid discharge, which is indicative of an infection caused by CRS. ▪ Transillumination and Palpation of the sinuses ▪ Imaging studies such as x-ray, sinoscopy, ultrasound, CT scanning, and MRI may be used in the diagnosis of CRS. CHRONIC RHINOSINUSITIS & RECURRENT ACUTE RHINOSINUSITIS MEDICAL MANAGEMENT ▪ Medical management of CRS and recurrent acute rhinosinusitis is similar to that of acute rhinosinusitis. ▪ The course of antibiotic treatment for CRS and recurrent ABRS is typically as long as 2 to 4 weeks and may be indicated for up to 12 months in some cases. CHRONIC RHINOSINUSITIS & RECURRENT ACUTE RHINOSINUSITIS SURGICAL MANAGEMENT ▪ Functional Endoscopic Sinus Surgery (FESS) may be indicated to correct structural deformities that obstruct the ostia (openings) of the sinuses. ✓ Computer-assisted or computer- guided surgery is used to increase the precision of the surgical procedure and to minimize complications. CHRONIC RHINOSINUSITIS & RECURRENT ACUTE RHINOSINUSITIS SURGICAL MANAGEMENT Caldwell- Luc Surgery (Radical Antrum Surgery) ▪ the incision is between the upper gum and upper lip. CHRONIC RHINOSINUSITIS & RECURRENT ACUTE RHINOSINUSITIS SURGICAL MANAGEMENT Caldwell- Luc Surgery (Radical Antrum Surgery) – cont. TO PREVENT TRAUMA ON INCISION SITE POST-SURGERY: ▪ Do not chew on affected side. Caution with oral hygiene. ▪ To prevent trauma on incision. ▪ Do not wear dentures for 10 days ▪ Advice client not to blow nose for 2 weeks after removal of packing. ▪ To prevent bleeding. ▪ Avoid sneezing for two weeks after surgery. CHRONIC RHINOSINUSITIS & RECURRENT ACUTE RHINOSINUSITIS NURSING MANAGEMENT ▪ Patients usually perform care measures for rhinosinusitis at home; therefore, nursing management consists of good patient education.  2 PHARYNGITIS ACUTE PHARYNGITIS ▪ commonly referred to as a sore throat. ▪ a sudden painful inflammation of the pharynx, the back portion of the throat that includes the posterior third of the tongue, soft palate, and tonsils. ACUTE PHARYNGITIS CAUSATIVE AGENT ▪ Viral infection causes most cases of acute pharyngitis. ▪ Adenovirus, Influenza Virus, Epstein–barr Virus, and Herpes Simplex Virus ACUTE PHARYNGITIS CAUSATIVE AGENT ▪ Ten percent of adults with pharyngitis have group A beta-hemolytic streptococcus, which is commonly referred to as GROUP A STREPTOCOCCUS (GAS) OR STREPTOCOCCAL PHARYNGITIS. ▪ Streptococcal pharyngitis warrants the use of antibiotic treatment. ▪ GAS causes acute pharyngitis= STREP THROAT ACUTE PHARYNGITIS CLINICAL MANIFESTATIONS: ▪ Fiery-red pharyngeal membrane and tonsils, ▪ Lymphoid follicles that are swollen and flecked with white-purple exudate ▪ Enlarged and tender cervical lymph nodes, and no cough. ▪ Fever (higher than 38.3°C [101°F]), malaise, and sore throat also may be present. ACUTE PHARYNGITIS ASSESSMENT AND DIAGNOSTIC FINDINGS ▪ Rapid antigen detection testing (RADT) uses swabs that collect specimens from the posterior pharynx and tonsil. ▪ Once a definitive diagnosis of GAS is made, administration of appropriate antibiotics hastens symptom resolution and reduces the transmission of the illness. ACUTE PHARYNGITIS MEDICAL MANAGEMENT ▪ Viral pharyngitis is treated with supportive measures because antibiotics have no effect on the causal organism. ▪ Bacterial pharyngitis is treated with a variety of antimicrobial agents. ACUTE PHARYNGITIS MEDICAL MANAGEMENT Pharmacologic Therapy ▪ Bacterial: Penicillin is usually the treatment of choice. Penicillin V potassium given orally for 5 days is the regimen of choice. ▪ Analgesic: for relief of severe sore throats ACUTE PHARYNGITIS MEDICAL MANAGEMENT Nutritional Therapy ▪ Liquid or Soft diet ▪ Cool beverages, warm liquids, and flavored frozen desserts such as ice pops are often soothing. ACUTE PHARYNGITIS NURSING MANAGEMENT ▪ Prompt initiation and correct administration of prescribed antibiotic therapy. (History of RHF) ▪ Instruct the patient about signs and symptoms that warrant prompt contact with the primary provider. ▪ Instruct the patient to stay in bed during the febrile stage of illness and to rest frequently once up and about. ACUTE PHARYNGITIS NURSING MANAGEMENT ▪ Discuss the importance of proper hygiene measures. ▪ Warm saline gargles or throat irrigations may be used. ▪ Ice collar also can relieve severe sore throats. ▪ Discuss the importance of following the proper medication regimen. ▪ Instructs the patient about preventive measures. CHRONIC PHARYNGITIS ▪ a persistent inflammation of the pharynx. ▪ It is common in adults who work in dusty surroundings, use their voice to excess, suffer from chronic cough, or habitually use alcohol and tobacco. CHRONIC PHARYNGITIS There are three types of chronic pharyngitis: ▪ Hypertrophic – characterized by general thickening and congestion of the pharyngeal mucous membrane ▪ Atrophic – probably a late stage of the first type (the membrane is thin, whitish, glistening, and at times wrinkled) ▪ Chronic granular – characterized by numerous swollen lymph follicles on the pharyngeal wall Hypertrophic Pharyngitis ATROPHIC PHARYNGITIS CHRONIC PHARYNGITIS CLINICAL MANIFESTATIONS: ▪ Complain of a constant sense of irritation or fullness in the throat ▪ Mucus that collects in the throat and can be expelled by coughing ▪ Difficulty swallowing ▪ Intermittent postnasal drip CHRONIC PHARYNGITIS MEDICAL MANAGEMENT ▪ Treatment of chronic pharyngitis is based on relieving symptoms. ▪ Avoiding exposure to irritants. ▪ Correcting any upper respiratory, pulmonary, gastrointestinal, or cardiac condition that might be responsible for a chronic cough. CHRONIC PHARYNGITIS NURSING MANAGEMENT ▪ Avoidance of alcohol, tobacco, secondhand smoke, and exposure to cold or to environmental or occupational pollutants. ▪ Minimize exposure to pollutants by wearing a disposable facemask. ▪ Encourage the patient to drink plenty of fluids. ▪ Gargling with warm saline solution may relieve throat discomfort. ▪ Lozenges keep the throat moistened.  3 TONSILLITIS AND ADENOIDITIS TONSILLITIS AND ADENOIDITIS ▪ Tonsils are composed of lymphatic tissue and are situated on each side of the oropharynx. ▪ Adenoids or pharyngeal tonsils consist of lymphatic tissue near the center of the posterior wall of the nasopharynx. TONSILLITIS AND ADENOIDITIS CLINICAL MANIFESTATIONS TONSILLITIS: ▪ 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. TONSILLITIS AND ADENOIDITIS ASSESSMENT AND DIAGNOSTIC FINDINGS ▪ The diagnosis of acute tonsillitis is PRIMARILY CLINICAL, with attention given to whether the illness is viral or bacterial in nature. TONSILLITIS AND ADENOIDITIS MEDICAL MANAGEMENT ▪ Tonsillitis: SUPPORTIVE MEASURES ✓ increased fluid intake, analgesics, salt-water gargles, and rest. ▪ Bacterial infections are treated with penicillin (first-line therapy) or cephalosporins. TONSILLITIS AND ADENOIDITIS SURGICAL MANAGEMENT ▪ Tonsillectomy (with or without adenoidectomy) TONSILLITIS AND ADENOIDITIS SURGICAL MANAGEMENT TONSILLECTOMY INDICATIONS ▪ repeated episodes of tonsillitis despite antibiotic therapy. ▪ hypertrophy of the tonsils and adenoids that could cause obstruction and obstructive sleep apnea (OSA) ▪ repeated attacks of purulent otitis media ▪ suspected hearing loss due to serous otitis media that has occurred in association with enlarged tonsils and adenoids. TONSILLITIS AND ADENOIDITIS SURGICAL MANAGEMENT ADENOIDECTOMY INDICATIONS ▪ chronic nasal airway obstruction ▪ chronic rhinorrhea ▪ obstruction of the eustachian tube with related ear infections ▪ abnormal speech TONSILLITIS AND ADENOIDITIS NURSING MANAGEMENT POST-OP MANAGEMENT: ▪ Continuous monitoring for bleeding. ▪ Immediate post-op: ✓ Place patient in prone position with head turned to the side to allow drainage from the mouth and pharynx. TONSILLITIS AND ADENOIDITIS NURSING MANAGEMENT ▪ Must not remove the oral airway until the patient’s gag and swallowing reflexes have returned. ▪ Apply an ice collar to the neck, and a basin and tissues are provided for the expectoration of blood and mucus. TONSILLITIS AND ADENOIDITIS NURSING MANAGEMENT ▪ Symptoms of postoperative complications include fever, throat pain, ear pain, and bleeding. ▪ Postoperative bleeding may be seen as bright red blood if the patient expectorates it before swallowing it. ▪ NOTIFY surgeon immediately if patient vomits large amount of dark blood, with increased PR, temperature and restlessness is noted. TONSILLITIS AND ADENOIDITIS NURSING MANAGEMENT HEALTH TEACHINGS: ▪ Discuss with patient and family members the signs and symptoms of hemorrhage. ▪ Discuss with the patient the importance of proper medication regimen. ▪ Explain to the patient that a sore throat, stiff neck, minor ear pain, and vomiting may occur in the first 24 hours. TONSILLITIS AND ADENOIDITIS NURSING MANAGEMENT HEALTH TEACHINGS: ▪ Should eat an adequate diet with soft foods, which are more easily swallowed than hard foods. ▪ Instructs the patient about the need to maintain good hydration. ▪ Avoid vigorous tooth brushing or gargling because these activities can cause bleeding. ▪ Avoid smoking and heavy lifting or exertion for 10 days.  4 PERITONSILLAR ABSCESS PERITONSILLAR ABSCESS ▪ also called quinsy ▪ collection of purulent exudate between the tonsillar capsule and the surrounding tissues ▪ is the most common major suppurative complication of sore throat accounting for roughly 30% of soft tissue head and neck abscesses. PERITONSILLAR ABSCESS CAUSATIVE AGENT: Bacteria involved: ▪ S. pyogenes, S. aureus, Neisseria species, and Corynebacterium species PERITONSILLAR ABSCESS CLINICAL MANIFESTATIONS: ▪ severe sore throat ▪ odynophagia ▪ fever ▪ dysphagia ▪ trismus ▪ otalgia ▪ drooling ▪ tender and enlarged cervical lymph ▪ raspy voice nodes PERITONSILLAR ABSCESS ASSESSMENT AND DIAGNOSTIC FINDINGS ▪ Intraoral ultrasound and transcutaneous cervical ultrasound are used in the diagnosis of peritonsillar cellulitis and abscesses. PERITONSILLAR ABSCESS SURGICAL MANAGEMENT ▪ Needle aspiration ✓ sitting position ▪ Incision and Drainage (more painful) ▪ Tonsillectomy PERITONSILLAR ABSCESS NURSING MANAGEMENT ▪ Assist with the procedure and provide support to the patient before, during, and after the procedure. ▪ Encourage the patient to use prescribed topical anesthetic agents and assists with throat irrigations. PERITONSILLAR ABSCESS NURSING MANAGEMENT ▪ Instructs the patient to gargle gently at intervals of 1 or 2 hours for 24 to 36 hours. ▪ Adequate fluids must be provided to treat dehydration and prevent its recurrence. ▪ Observe the patient for complications ▪ Instruct the patient about signs and symptoms of complications  5 LARYNGITIS LARYNGITIS ▪ an inflammation of the larynx ▪ often occurs as a result of voice abuse or exposure to dust, chemicals, smoke, and other pollutants or as part of a URI. LARYNGITIS MEDICAL MANAGEMENT ▪ Resting the voice ▪ Avoiding irritants (including smoking) ▪ Resting ▪ Inhaling cool steam or an aerosol. LARYNGITIS MEDICAL MANAGEMENT Chronic Laryngitis: ▪ Resting the voice. ▪ Eliminating any primary respiratory tract infection. ▪ Eliminating smoking. ▪ Avoiding secondhand smoke. ▪ Corticosteroids may be given. LARYNGITIS MEDICAL MANAGEMENT Reflux Laryngitis: ▪ Use of proton pump inhibitors such as Omeprazole (Prilosec) given once daily. LARYNGITIS NURSING MANAGEMENT ▪ Instruct the patient to rest the voice and to maintain a well-humidified environment. ▪ Instruct the patient about the importance of taking prescribed medications. ▪ Instruct the patient about signs and symptoms that require contacting the primary provider.  OBSTRUCTION AND TRAUMA OF THE UPPER RESPIRATORY AIRWAY  6 OBSTRUCTIVE SLEEP APNEA OBSTRUCTIVE SLEEP APNEA ▪ a disorder characterized by recurrent episodes of upper airway obstruction and a reduction in ventilation. ▪ cessation of breathing (apnea) during sleep usually caused by repetitive upper airway obstruction. OBSTRUCTIVE SLEEP APNEA RISK FACTORS: ▪ obesity ▪ male gender ▪ postmenopausal status ▪ advanced age MAJOR RISK FACTOR IS OBESITY OBSTRUCTIVE SLEEP APNEA CLINICAL MANIFESTATIONS ▪ frequent and loud snoring with breathing cessation for 10 seconds or longer, for at least five episodes per hour ▪ followed by awakening abruptly with a loud snort as the blood oxygen level drops. OBSTRUCTIVE SLEEP APNEA CLINICAL MANIFESTATIONS 3’S of OSA: ▪ Snoring ▪ Sleepiness ▪ Significant–other report of sleep apnea episodes. OBSTRUCTIVE SLEEP APNEA ASSESSMENT AND DIAGNOSTIC FINDINGS ▪ Diagnosis of sleep apnea is based on clinical features plus a polysomnographic finding. OBSTRUCTIVE SLEEP APNEA MEDICAL MANAGEMENT ▪ Weight loss ▪ Avoidance of alcohol ▪ Positional therapy ▪ Oral appliances (MADs) ▪ CPAP: prevent airway collapse ▪ BiPAP: makes breathing easier and results in a lower average airway pressure. MANDIBULAR AIRWAY DEVICE (MADs) OBSTRUCTIVE SLEEP APNEA SURGICAL MANAGEMENT ▪ Simple tonsillectomy ▪ Uvulopalatopharyngoplasty ▪ Nasal septoplasty ▪ Maxillomandibular surgery ▪ Tracheostomy (but has numerous adverse effects) OBSTRUCTIVE SLEEP APNEA PHARMACOLOGIC THERAPY ▪ Modafinil (Provigil) – reduce daytime sleepiness ▪ Protriptyline (Triptil) – increase the respiratory drive and improve upper airway muscle tone. ▪ Medroxyprogesterone acetate (Provera) and acetazolamide (Diamox) – benefits have not been well established. OBSTRUCTIVE SLEEP APNEA NURSING MANAGEMENT ▪ Explain the disorder in terms that are understandable to the patient and relates symptoms to the underlying disorder. ▪ Instruct the patient and family about treatments. ▪ Educate the patient about the risk of untreated OSA and the benefits of treatment approaches.  7 EPISTAXIS (NOSEBLEED) EPISTAXIS (NOSEBLEED) ▪ a hemorrhage from the nose ▪ caused by the rupture of tiny, distended vessels in the mucous membrane of any area of the nose. EPISTAXIS (NOSEBLEED) THREE MAJOR BLOOD VESSELS ENTER THE NASAL CAVITY: 1. The ANTERIOR ETHMOIDAL ARTERY on the forward part of the roof (Kiesselbach Plexus) 2. The SPHENOPALATINE ARTERY in the posterosuperior region 3. The INTERNAL MAXILLARY BRANCHES (the plexus of veins located at the back of the lateral wall under the inferior turbinate). EPISTAXIS (NOSEBLEED) MEDICAL MANAGEMENT ▪ Initial treatment – applying direct pressure ▪ The patient sits upright with the head tilted forward and is directed to pinch the soft outer portion of the nose against the midline septum for 5 or 10 minutes continuously. ▪ Application of nasal decongestants (phenylephrine, one or two sprays) to act as vasoconstrictors may be necessary. EPISTAXIS (NOSEBLEED) MEDICAL MANAGEMENT ▪ Visible bleeding sites may be cauterized with silver nitrate or electrocautery (high-frequency electrical current). ▪ A supplemental patch of Surgicel or Gelfoam may be used. ▪ Alternatively, a cotton tampon may be used to try to stop the bleeding. EPISTAXIS (NOSEBLEED) MEDICAL MANAGEMENT ▪ Suction may be used to remove excess blood and clots from the field of inspection. ▪ If origin is not identified, the nose may be packed with gauze impregnated with petrolatum jelly or antibiotic ointment. ▪ A balloon-inflated catheter may be used. ▪ Alternatively, a compressed nasal sponge may be used. EPISTAXIS (NOSEBLEED) NURSING MANAGEMENT ▪ Monitor the patient’s vital signs. ▪ Assists in the control of bleeding. ▪ Provide tissues and an emesis basin to allow the patient to expectorate any excess blood. ▪ Assuring the patient in a calm, efficient manner that bleeding can be controlled can help reduce anxiety. ▪ Continuously assess the patient’s airway and breathing as well as vital signs.  8 NASAL OBSTRUCTION NASAL OBSTRUCTION ▪ Frequently obstructed by: 1. deviation of the nasal septum 2. hypertrophy of the turbinate bones 3. pressure of nasal polyps ▪ Persistent nasal obstruction also may lead to chronic infection of the nose and result in frequent episodes of nasopharyngitis. NASAL OBSTRUCTION MEDICAL MANAGEMENT ▪ Treatment: Removal of obstruction. ▪ Nasal corticosteroids – 1 to 3 months ▪ Oral corticosteroids – obstruction due to polyps ▪ Antibiotics and Antihistamines ▪ FUNCTIONAL RHINOPLASTY NASAL OBSTRUCTION NURSING MANAGEMENT ▪ Preoperatively, explains the procedure to the patient. ▪ Postoperatively, elevates the head of the bed. ▪ Prior to discharge, instruct to avoid blowing the nose with force during the postoperative recovery period. ▪ Instruct about the signs and symptoms of bleeding and infection and when to contact the primary provider.  9 FRACTURES OF THE NOSE FRACTURES OF THE NOSE ▪ is the most common facial fracture and the most common fracture in the body. ▪ Complications include hematoma, infection, abscess, and avascular or septic necrosis. FRACTURES OF THE NOSE CLINICAL MANIFESTATIONS ▪ Pain ▪ Bleeding from the nose externally and internally into the pharynx ▪ Swelling of the soft tissues adjacent to the nose ▪ Periorbital ecchymosis ▪ Nasal obstruction ▪ Deformity FRACTURES OF THE NOSE ASSESSMENT AND DIAGNOSTIC FINDINGS ▪ Intranasal examination ▪ Usually, careful inspection or palpation discloses any deviations of the bone or disruptions of the nasal cartilages. ▪ An x-ray may reveal displacement of the fractured bones. FRACTURES OF THE NOSE MEDICAL MANAGEMENT ▪ Bleeding is controlled with the use of packing. ▪ Cold compresses are used to prevent or reduce edema. ▪ Uncomplicated nasal fractures may be treated initially with antibiotics, analgesic agents, and a decongestant nasal spray. FRACTURES OF THE NOSE MEDICAL MANAGEMENT ▪ Aimed at restoring nasal function and returning the appearance of the nose to baseline. ▪ If immediate reduction in the fracture is not possible, it is performed within 3 to 7 days. ▪ Septorhinoplasty is performed when the nasal septum needs to be repaired. FRACTURES OF THE NOSE NURSING MANAGEMENT ▪ Immediately after the fracture, apply ice and encourages the patient to keep the head elevated. ▪ Mouth rinses help to moisten the mucous membranes. ▪ Encourage the use of acetaminophen or NSAIDs as prescribed. FRACTURES OF THE NOSE NURSING MANAGEMENT ▪ When removing the cotton pledgets, carefully inspect the mucosa for lacerations or a septal hematoma. ▪ Instruct the patient to avoid sports activities for 6 weeks.  10 LARYNGEAL OBSTRUCTION LARYNGEAL OBSTRUCTION ▪ is a serious condition that may be fatal without swift, decisive intervention. ▪ Swelling of the laryngeal mucous membranes may close off the opening tightly, leading to life-threatening hypoxia or suffocation. ▪ Foreign bodies frequently are aspirated into the pharynx, the larynx, or the trachea and cause a twofold problem. LARYNGEAL OBSTRUCTION CLINICAL MANIFESTATIONS ▪ Lowered oxygen saturation ▪ The use of accessory muscles (retractions in the neck or abdomen during inspirations) LARYNGEAL OBSTRUCTION ASSESSMENT AND DIAGNOSTIC FINDINGS ▪ A thorough history can be very useful in diagnosing and treating the patient with a laryngeal obstruction. ▪ However, emergency measures to secure the patient’s airway should not be delayed to obtain a history or perform tests. LARYNGEAL OBSTRUCTION MEDICAL MANAGEMENT ▪ Initial evaluation of the patient and the need to ensure a patent airway. ▪ If the airway is obstructed by a foreign body and signs of asphyxia are apparent, immediate treatment is necessary. ▪ If unsuccessful, an immediate tracheotomy is necessary. LARYNGEAL OBSTRUCTION MEDICAL MANAGEMENT ▪ Allergic Reaction (anaphylaxis) – IMMEDIATE administration of subcutaneous epinephrine and a corticosteroid. ▪ Ice may be applied to the neck in an effort to reduce edema. ▪ Continuous pulse oximetry is essential in the patient who has experienced acute upper airway obstruction. END Thank you for listening! 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