Chapter22 upper respiratroy.pdf

Chapter 22 Management of Patients With Upper Respiratory Tract Disorders Adult Teaching Team  Describe nursing management of Describe patients with upper airway disorders. Learning outcomes...

Chapter 22 Management of Patients With Upper Respiratory Tract Disorders Adult Teaching Team  Describe nursing management of Describe patients with upper airway disorders. Learning outcomes Compare and the upper respiratory Compare tract infections according to cause, and incidence, clinical manifestations, contrast management, and the significance of preventive health care. Use the nursing process as a Use framework for care of patients with upper airway infection. Copyright © 2018 Wolters Kluwer · All Rights Reserved The Top URTD In Our Community The Top URTP In Our The Top URTP outside Hospitals hospital Nasal septal ❖Cold deviation ❖Rhinitis ❖Sinusitis Acute pharyngitis Acute and chronic tonsillitis Copyright © 2018 Wolters Kluwer · All Rights Reserved Deviated septum ❖ It is a deflection of the normally straight nasal septum. ❖ The most common cause of deviated septum is trauma to the nose. ❖ Deviation from midline can interfere with airflow and sinus drainage through the narrowed passageway. Copyright © 2018 Wolters Kluwer · All Rights Reserved Symptoms and signs ❖ Symptoms vary depending on the degree of deviation. ❖ Minor septal deviations may be asymptomatic. ❖ The common manifestations of septal deviation include; o Obstruction to nasal breathing o Nasal congestion o Frequent sinus infections o Nosebleeds (epistaxis) o Facial pain. o Body image disturbances Copyright © 2018 Wolters Kluwer · All Rights Reserved ❖ The medical management of deviated septum is focused on symptom control of nasal inflammation and congestion. ❖ For recurrent or severe symptoms, a nasal septoplasty is performed to reconstruct and properly align the deviated septum. Copyright © 2018 Wolters Kluwer · All Rights Reserved  Septoplasty: Excision and resection of the septum to correct any deviation to improve the functioning capabilities of the NURSING nose—to improve breathing. MANAGEMENT NASAL SURGERY ❖ Preoperative: o Instruct the patient not to take aspirin-containing drugs or NSAIDs for 2 weeks to reduce the risk of bleeding. o Encourage preoperative smoking cessation to promote postoperative wound healing. Copyright © 2018 Wolters Kluwer · All Rights Reserved  o Maintenance of the airway; o Assessment of respiratory status; o Pain management; Postoperative o Observation of the surgical site for bleeding, nursing infection, and edema. interventions: o Elevation of the head can help minimize swelling and discomfort o Instruct the patient to apply cold compresses to reduce edema and ecchymosis o Instruct the patient to restrict activities that can lead to bleeding such as nose blowing, swimming, heavy lifting, and strenuous exercise. Copyright © 2018 Wolters Kluwer · All Rights Reserved  ❖Acute pharyngitis is a sudden painful inflammation of the Acute pharynx, throat, soft Pharyngitis palate, and tonsils. ❖It may viral or bacterial ❖Viral pharyngitis spreads easily in the droplets of coughs and sneezes, as well as from unclean hands. Copyright © 2018 Wolters Kluwer · All Rights Reserved Pathophysiology ❖ Viral infection causes most cases of acute pharyngitis. ❖ Bacterial infection accounts for the remainder of cases. ❖ Ten percent of adults with pharyngitis have group A beta-hemolytic streptococcus (GABHS.) ❖ The body responds by triggering an inflammatory response in the pharynx, resulting the clinical manifestations of pharyngitis. ❖ If left untreated, the complications can be severe and life threatening. ❖ Complications include rhinosinusitis, otitis media, peritonsillar abscess, mastoiditis, and cervical adenitis. ❖ In rare cases, the infection may lead to bacteremia, pneumonia, meningitis, rheumatic fever, and nephritis. Copyright © 2018 Wolters Kluwer · All Rights Reserved Clinical Manifestations ❖ Fiery-red pharyngeal membrane and tonsils, ❖ Swollen of lymphoid follicles. ❖ Enlarge and tender cervical lymph nodes ❖ Fever (higher than 38.3°C [101°F]) ❖ Malaise, and sore throat. ❖ Occasionally, patients with GAS pharyngitis exhibit vomiting, anorexia, painful sore throat ,headache, myalgia and scarlet fever. ❖ O/E the tonsils appear swollen and erythematous, and they may or may not have an exudate. ❖ The roof of the mouth is often erythematous and may demonstrate petechiae. Bad breath is common. Copyright © 2018 Wolters Kluwer · All Rights Reserved Pharyngitis A creamy exudate may be present in the tonsillar pillars (Fig. 22-2). Copyright © 2018 Wolters Kluwer · All Rights Reserved Assessment and Diagnostic Findings ❖ Accurate diagnosis is essential; o to determine the cause (viral or bacterial) and o to initiate treatment early. ❖ Rapid antigen detection testing (RADT) uses swabs that collect specimens from the posterior pharynx and tonsil. Copyright © 2018 Wolters Kluwer · All Rights Reserved Medical Management ❖ Viral pharyngitis is treated with supportive measures ❖ Bacterial pharyngitis is treated with a variety of antimicrobial agents. Penicillin is usually the treatment of choice. ❖ Severe sore throats can be relieved by analgesic medications such as aspirin or acetaminophen ❖ In severe cases, gargles with benzocaine may relieve symptoms. ❖ Nutritional Therapy; A liquid or soft diet is provided during the acute stage of the disease. ❖ Cool beverages, warm liquids, and flavored frozen desserts such as ice pops are often soothing. Copyright © 2018 Wolters Kluwer · All Rights Reserved Management Nursing ❖ Care for patients with viral pharyngitis focuses on symptomatic management. ❖ For patients who demonstrate signs of GAS and have a history of rheumatic fever, the nurse instructs the patient about S/S that warrant prompt contact with the primary provider. ❖ The nurse instructs the patient to stay in bed during the febrile stage of illness. ❖ The nurse should examine the skin once or twice daily for possible rash, because acute pharyngitis may precede some other communicable diseases (e.g., rubella). Copyright © 2018 Wolters Kluwer · All Rights Reserved  Management Nursing..cont… ❖ Using warm saline gargles or throat irrigations is depending on the severity of the pharyngitis and the degree of pain. ❖ The nurse instructs the patient and family about the importance of taking the full course of therapy and informs them about the symptoms to watch for that may indicate complications(nephritis and rheumatic fever). ❖ The nurse instructs the patient about preventive measures ❖ The nurse also instructs the patient with pharyngitis, especially streptococcal pharyngitis, to replace their toothbrush with a new one. Copyright © 2018 Wolters Kluwer · All Rights Reserved Exercise What should the nurse palpate when assessing for an pharyngitis? A. Neck lymph nodes B. Nasal mucosa C. Tracheal mucosa D. Mastoid process Copyright © 2018 Wolters Kluwer · All Rights Reserved  The tonsils are composed of lymphatic tissue and are situated on each side of the oropharynx. They frequently serve as the site of acute infection (tonsillitis). It may bacterial or viral The most common organism is GABHS ACUTE TONSILLITIS Copyright © 2018 Wolters Kluwer · All Rights Reserved Clinical Manifestations ❖ The symptoms of tonsillitis include; ❖ Sore throat ❖ Fever ❖ Snoring ❖ Difficulty swallowing. ❖ When there is enlarged adenoids with tonsillitis the patient may have mouth breathing, earache, draining ears, foul-smelling breath, voice impairment, and noisy respiration. Copyright © 2018 Wolters Kluwer · All Rights Reserved  The diagnosis of acute tonsillitis is primarily clinical RADT. A thorough physical examination is performed, and a careful history is obtained to rule out related or systemic conditions. ASSESSMENT AND DIAGNOSTIC FINDINGS Copyright © 2018 Wolters Kluwer · All Rights Reserved  Tonsillitis is treated with supportive measures that include Increased fluid intake Analgesics Salt-water gargles, and rest. Bacterial infections are treated with penicillin (first-line therapy) or cephalosporins. MEDICAL MANAGEMENT Copyright © 2018 Wolters Kluwer · All Rights Reserved Tonsillectomy (with or without adenoidectomy) remains the treatment of choice for patients with chronic tonsillitis Tonsillectomy is indicated if the patient has had; 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; Copyright © 2018 Wolters Kluwer · All Rights Reserved Nursing Management ❖ Providing Postoperative Care: ❖ Continuous nursing observation because of the risk of hemorrhage ❖ In the immediate postoperative period, the most comfortable position is prone, with the patient’s head turned to the side. ❖ 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. ❖ Pain can be effectively controlled with analgesic medications Copyright © 2018 Wolters Kluwer · All Rights Reserved Nursing Management..cont… ❖ the nurse notifies the surgeon immediately if the patient vomits large amounts of dark or bright-red blood at frequent intervals, or if the pulse rate and temperature rise and the patient is restless. ❖ The patient is advised to avoid vigorous tooth brushing or gargling because these activities can cause bleeding ❖ 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, because these activities can produce throat pain. Copyright © 2018 Wolters Kluwer · All Rights Reserved Nursing Management..cont… ❖ Alkaline mouthwashes and warm saline solutions are useful in coping with the thick mucus and halitosis that may be present after surgery. ❖ The nurse should explain to the patient that a sore throat, stiff neck, minor ear pain, and vomiting may occur in the first 24 hours. ❖ The patient should eat an adequate diet with soft foods, which are more easily swallowed than hard foods. ❖ The patient should avoid spicy, hot, acidic, or rough foods. ❖ The nurse instructs the patient about the need to maintain good hydration. ❖ The patient should avoid smoking and heavy lifting or exertion for 10 days. Copyright © 2018 Wolters Kluwer · All Rights Reserved Check exercise ❖ After a tonsillectomy, a patient begins to vomit bright red blood. The nurse should take which initial action? 1. Maintain NPO status. 2. Turn the patient to the side. 3. Administer the prescribed antiemetic. 4. Notify the health care provider (HCP). Copyright © 2018 Wolters Kluwer · All Rights Reserved ❖Open discussion Copyright © 2018 Wolters Kluwer · All Rights Reserved