TRANSES Unit 1 - The Upper Respiratory System and its Disorders PDF

NCM 112A (MS 1) Unit 1 - The Upper Respiratory System and its Disorders D. Larynx LESSON 1: OVERVIEW OF THE o Also called the “Voicebox”, it also...

NCM 112A (MS 1) Unit 1 - The Upper Respiratory System and its Disorders D. Larynx LESSON 1: OVERVIEW OF THE o Also called the “Voicebox”, it also routes air and food into the proper RESPIRATORY SYSTEM channels (epiglottis) and plays a role in speech (most sounds like yung THE RESPIRATORY SYSTEM distinction ng mg sounds dito nabubuo) Along with the cardiovascular system, the o Thyroid cartilage – common called respiratory system share responsibility for the “adam’s apple” is the largest supplying the body with oxygen and hyaline cartilage which protrudes disposing of carbon dioxide. The organs of anteriorly the respiratory system include the nose, o Epiglottis – “guardian of the pharynx, larynx, trachea, bronchi, and their airways”; protects superior opening of smaller branches, and the lungs, which contain the larynx (kapag lumunok nagsasardo the alveoli, or terminal air sacs. yung daanan ng hangin, pag humihinga nagsasarado yung daanan ng pagkain) o Vocal folds or true vocal cords – it vibrates with expelled air which allows us to speak o Glottis – slit-like passageway between the vocal folds E. Trachea o Also called “windpipe”, has a length of 10-12 cm or about 4in, is lined with a ciliated mucosa. o Cilia of the trachea function to propel mucus. Loaded with dust particles and other debris, away from the lungs to the Functional Anatomy of the Upper Respiratory throat, where it can be swallowed or System spat out. A. Nose B. Paranasal sinuses - They lighten the skull, Functional Anatomy of the Lower Respiratory and they act as resonance chambers for System speech. A. Primary Bronchi Classifications: o The right and left primary bronchi are 1. Frontal formed by the division of the trachea 2. Sphenoid o The right primary bronchus is wider, 3. Ethmoid shorter and straighter than the left; 4. Maxillary also more to some lodging of foreign object C. Pharynx o It warm, cleanse and humidify air that o Serves as a passageway for food and enters the lungs air. B. Lungs o Subdivided into three portions: o They occupy the entire thoracic nasopharynx, oropharynx and cavity EXCEPT for the most central laryngopharynx area – mediastinum o Auditory tubes, which drain the middle o Apex – the narrow superior portion of ear, open into the nasopharynx each lung, located just deep to the o Tonsils – found also in the pharynx; the clavicle pharyngeal tonsils (adenoid), o Base – broad lung area resting on the palatine tonsils, and lingual tonsils diaphragm o Each lung is divided into lobes by fissures; the left lung has 2 lobes and the right lung has 3 lobes o Pleura – visceral serosa that cover surface of each lung; 2 forms: the parietal pleura and the visceral pleura o Bronchioles – subdivisions of the primary bronchi inside the lungs before it terminates in alveoli o Alveoli – air sacs; the only site of gas exchange K.A. NCM 112A (MS 1) Unit 1 - The Upper Respiratory System and its Disorders 3. Emotional factors (fear, anger, Respiratory Physiology excitement) A. 4 Distinct Events during Respiration: 4. Chemical factors (serum 02 and C02 Pulmonary ventilation (exchange ng concentrations) (sa osmoreceptors) gases natin mula sa atmosphere papunta sa lungs) F. Neurologic Control of the Respiratory External respiration (ex. yung mula sa System alveoli papunta sa bloodstream) 1. Medulla oblongata – center for Respiratory gas transport (paggalaw ng respiration, sets basic rhythm hangin mula sa site ng gas exchange 2. Pons – control rate and depth of papunta sa certain part ng katawan kung respiration saan gagamitin yung hangin) o Pneumotaxic center – controls Internal respiration (oxygen and carbon pattern of respiration (E.g. dioxide are exchanged between the cells Kussmaul’s – deep rapid breathing and blood vessels) na ginagawa ng body in compensation ng acidosis) B. Mechanics of Breathing o Apneustic center – stimulate the Respiratory – includes Inspiration and inspiratory center (medulla Expiration oblongata) create prolonged and Non-respiratory Air Movements – deep respiration coughing, sneezing, talking, etc 3. Phrenic Nerve – controls diaphragmatic movement. C. Respiratory Volumes and Capacities Tidal volume – the volume of air inhaled and exhaled with normal quiet breathing (500ml) (sa Filipinos usually 360-420ml) LESSON 2: ASSESSMENT OF THE Inspiratory reserve volume – the maximum volume that can be inhaled RESPIRATORY FUNCTIONS following a normal quiet inhalation A. Risk Factors for Respiratory Diseases (2100-3200ml) 1. Smoking (the single most important Expiratory reserve volume - the contributor to lung disease) maximum volume that can be exhaled 2. Exposure to secondhand smoke following a normal quiet exhalation 3. Personal or family history of lung disease (1200ml) 4. Genetic makeup Residual volume – the volume of air that 5. Allergens and environmental pollutants remains in the lungs after forceful 6. Recreational and occupational exposure exhalation Vital capacity – the maximum volume of B. Physical Examination air that can be exhaled after a maximum inhalation; the sum of the TV, IRV, and 1. Dyspnea - Most common manifestations of all ERV (4800ml) respiratory problems - Also referred to as difficulty of breathing Inspiratory Capacity – total amount of (DOB) or shortness of breathing (SOB) air that can be inhaled following normal - Ask the time it started and how it started quiet exhalation; the sum of TV and IRV - Observe for rate, depth, and rhythm (3,600ml) 2. Cough - A reflex that protects the lungs from Total Lung Capacity – the total volume of accumulation of secretions or inhalation of the lungs at maximum inflation; sum of foreign bodies TV, IRV, ERV and RV (6,000ml) - It results from irritation of the mucous membranes anywhere in the respiratory tract D. Respiratory Sounds - Described as dry, hacking/barking, brassy, 1. Bronchial sounds (sa bronchi) wheezing, loose or severe 2. Vesicular breathing sounds (nasa - Ask the time it started, how it started, the bandang baba, medyo sa lung fileds frequency and characteristics nagaauscultate) 3. Sputum production - The reaction of the lungs to any constantly recurring irritant E. Factors Influencing Respiratory Rate and and may also be associated with nasal Depth: discharge 1. Physical factors (02 demands, talking & - Assess for color, odor, quality and quantity of coughing) sputum 2. Volition (Conscious Control) K.A. NCM 112A (MS 1) Unit 1 - The Upper Respiratory System and its Disorders c. Funnel chest (Pectus excavatum) - Common characteristics of sputum with its - Sunken appearance of the sternum which associated condition: may be congenital o Purulent sputum (thick and yellow, d. Thoracic Kyphoscoliosis - combination of green or rust-colored): bacterial kyphosis and scoliosis infection o Thin, mucoid sputum: chronic bronchitis or bronchiectasis o Pink-tinged mucoid sputum: lung tumor o Profuse, frothy, pink-tinged: pulmonary edema o Foul smelling sputum: lung abscess, bronchiectasis or any associated infection 9. Chest Palpation 4. Chest Pain - May be associated with - Palpation of masses pulmonary or cardiac disease - Palpation of tactile fremitus ( air content, - May be described as sharp, stabbing or tactile fremitus) intermittent, or it may be dull, aching and - Palpation of thoracic excursion – (inspection) persistent 10. Chest Percussion ( air content = resonance) - Assess for scale of pain, location and intensity o Resonance – low pitched hollow 5. Adventitious Breath Sounds sound heard over the lung tissue, a. Crackles (Rales) - Soft, high-pitched, reaction percussion to air present in the popping sounds may indicate fluids in the lungs. lungs o Hyperresonance – very loud lower- b. Wheezing - High – pitched; continuous; pitched sound; normally not present; hoarse; whistling presence may indicate emphysema - Rhonchi – low pitch o Dullness/flat – presence of fluid; - Indicates obstruction or narrowing consolidation common among asthma and COPD 11. Rates and Depth of Respiration patients o Eupnea (normal) c. Stridor - Strong gush of air; a turbulent o Bradypnea (slow) gas flow from the upper respiratory airway - o Tachypnea (fast) E.g. obstruction of epiglottis, laryngeal tumor o Hypoventilation (shallow) 6. Clubbing of Fingers o Hyperventilation (deep) - Hypertrophy of o Apnea (absent) tissues in nail beds o Cheyne’s Stokes respiration (apnea, caused by prolonged increasing, decreasing, apnea) hypoxia due to a lung o Biot’s respiration (apnea, rapid, apnea) disease 7. Cyanosis C. Diagnostic Evaluation - Bluish coloring of the skin indicative of hypoxia or due to 1. Chest X-ray - It can reveal an extensive deoxygenation of hemoglobin pathologic process in the lungs in the absence o Central cyanosis – mouth, tongue and of symptoms lips. Deoxygenated Hgb travels in - Normal pulmonary tissue is radiolucent; systemic circulation, can also manifest therefore, densities produced by fluid, tumors, peripheral cyanosis. foreign bodies and other pathologic conditions o Peripheral / acrocyanosis – can be detected extremities. There is oxygenated Hgb, - Nursing Responsibility: problem results from diminished o Instruct the client on how to hold his peripheral blood flow due to breath and to do deep breathing (hindi hypotension. siya mga ddeep breathing) 8. Chest Inspection / Configuration o Instruct the client to remove metals a. Barrel chest - Observed as a rounded, from the chest over-inflated lungs common among 2. Bronchoscopy - The direct inspection and emphysema patients examination of the larynx, trachea, and b. Pigeon chest (Bowed chest or Pectus bronchi through a flexible or rigid carinatum) - It results from sternal bronchoscope displacement and observed as protrusion over the sternum K.A. NCM 112A (MS 1) Unit 1 - The Upper Respiratory System and its Disorders - Nursing intervention: - Diagnostic use: o The patient is instructed to remove any (a) to collect secretions jewelries, watches or any metal items (b) to determine o Interview if the patient has location of pathologic pacemakers, metal plates, prosthetic process and collect joints or any metallic implants specimen for biopsy o The patient is instructed to be - Therapeutic use: motionless during the procedure (a) to remove foreign o Know if the patient has claustrophobia object and secretions 6. Lung Scan - Following injection of a (b) treat postoperative radioisotope, scans are taken with a atelectasis scintillation camera. Measure blood perfusion (c) to destroy and through the lungs. Confirm pulmonary excise lesions embolism or other blood-flow abnormalities - Nursing interventions (Before the o Instruct the client to remain still during Procedure): the procedure o Secure consent before the procedure 7. Sputum examination - Obtained for analysis o Atropine (para di maglaway yung pt.) to identify pathogenic organisms and to and valium (relaxant) pre-procedure; determine whether malignant cells are topical anesthesia is sprayed followed present by local anesthesia injected into larynx - Forms of examination: o NPO for 6 to 8 hours (a) gross appearance o Remove dentures, prostheses, contact (b) sputum C&S, lenses (c) AFB staining - Nursing interventions (After the (d) Cytologic examination / Papanicolau procedure): examination o Side – lying position to prevent - Nursing Responsibility: aspiration o Early morning sputum specimen is to o Check for the return of cough and gag be collected reflexes before giving fluid per orem o Rinse mouth with plain water o Watch for cyanosis, hypotension, o Use sterile container tachycardia, arrhythmias, hemoptysis, o Sputum specimen for C and S is dyspnea. These signs and symptoms collected before the first dose of indicate perforation of bronchial tree antimicrobial 3. Thoracoscopy - A procedure in which the 8. Bronchography - A radiopaque medium is pleural cavity is examined with an instilled directly into the trachea and endoscope wherein a small incisions are bronchi and the entire bronchial tree or made into the pleural cavity in an selected areas may be visualized through x-ray intercostals space - Nursing Responsibility Before the - Indicated in the diagnosis of pleural effusion, Procedure: pleural disease and tumour staging. o Secure written consent - Nursing Responsibility: o Check for allergies to iodine or o Assess for shortness of breath after the seafoods procedure which might indicate o NPO for 6 to 8 hours pneumothorax o Pre – op meds: atropine S04 and 4. Computed Tomography (CT) Scan and valium, topical anesthesia sprayed, Fluoroscopy - Studies the lungs and chest followed by local anesthetic injected via series of x-ray in different dimensions or into larynx in motion like in fluoroscopy o Have oxygen and antispasmodic - Used to assist with invasive procedures, such agents ready as a chest needle biopsy or transbronchial 9. Pulmonary Function Studies (usually by biopsy spirometry) - Nursing Responsibility: a. Vital Capacity - The maximum volume of air o Check for iodine-allergy if with contrast that can be exhaled after a maximum inhalation o Instruct the client to remain still b. Tidal Volume - The volume of air inhaled and o Assess for claustrophobia exhaled with normal quiet breathing 5. Magnetic Resonance Imaging (MRI) - A non- c. Inspiratory Reserve Volume - The invasive diagnostic tool that uses a powerful maximum volume that can be inhaled following magnetic field and computer-generated a normal quiet inhalation pictures to image the lungs and its associated diseases K.A. NCM 112A (MS 1) Unit 1 - The Upper Respiratory System and its Disorders - Analysis of ABG values: d. Expiratory Reserve Volume - The a. Ph level - Normal value: maximum volume that can be exhaled following Acidosis < 7.35 – 7.45 > Alkalosis a normal quiet exhalation b. PaCO2 Alkalosis < 35 – 45 > Acidosis e. Functional Residual Capacity - The volume of air that remains in the lungs after normal, c. HCO3 (Bicarbonate) quiet exhalation Acidosis < 22 – 26 > Alkalosis f. Residual volume - The volume of air that remains in the lungs after forceful exhalation Shortcuts to ABG Analysis 10. Thoracentesis - Aspiration of fluid or air from the pleural space - Nursing Responsibility (Before Procedure): o Secure consent o Take initial VS o Orthopneic position o Instruct to remain still, avoid coughing during insertion of needle o Pressure sensation is felt on insertion of needle - Nursing Responsibility (After Procedure): o Turn on the unaffected side o Bed rest until VS is stable o Check for the expectoration of blood. Notify the physician. o Monitor VS 11. Lung Biopsy - Performed to obtain lung tissue for examination to identify the nature of the lesion - Different techniques of biopsy: o Transbronchoscopic biopsy – done during bronchoscopy o Percutaneous needle biopsy – through the skin, dadaan mula sa labas o Open lung biopsy 12. Pulse Oximetry - A non-invasive method of continuously monitoring 14. Skin Test: Mantoux Test the oxygen - PPD (Purified Protein Derivative) saturation of - Intradermal: 4inches below the elbow hemoglobin - Read after 48-72 hours after injection for skin (SaO2). reaction - Normal value: - (+) Mantoux Test is induration of 10mm or 95 to 100% more; but HIV positive patients, an induration (below 85% of 5mm is considered positive already indicate - (+) Mantoux test reading signifies exposure hypoxia) to Koch’s bacilli or TB 13. Arterial Blood Gas - Performed to assess ventilation and acid-base balance - Radial artery is the common site for withdrawal of blood specimen. - Allen’s test is done to assess for adequacy of collateral circulation of the hand - 10ml pre-heparinized syringe to prevent clotting of specimen - Container with ice to prevent hemolysis of the specimen K.A. NCM 112A (MS 1) Unit 1 - The Upper Respiratory System and its Disorders LESSON 3: COMMON RESPIRATORY Incentive Spirometry INTERVENTION Performed to enhance deep inhalation, especially for post-operative clients; to prevent Oxygen Therapy atelectasis Tracheobronchial Suctioning Closed Chest Drainage (Thoracostomy Tube) Client should be in semi or high Fowler’s Performed to remove air and/or fluids from position the pleural space Use sterile gloves, sterile suction catheter To re-establish negative pressure and Hyperventilate client with 100% oxygen reexpand the lungs before and after the procedure Types: Insert 3-5” length of catheter only for a. One – bottle system - 1 bottle serves suctioning as drainage and water-seal bottle Apply suction only during the withdrawal of b. Two – bottle system catheter in a rotating motion 1st bottle – serves as drainage Suctioning should take only 10 seconds 2nd bottle – serves as water-seal (maximum of 15 seconds) or both water-seal and suction Auscultate breath sounds after the procedure control c. Three – bottle system Chest Physiotherapy 1st bottle – drainage It includes three techniques: 2nd bottle – water-seal (a) Postural drainage 3rd bottle – suction control (b) Percussion (c) Vibration Nursing Intervention: o Verify the doctor’s order o Assess areas for accumulation of mucus secretions o Position to allow expectoration of mucus secretions by gravity o Reposition the patient every 10 to 15 minutes o Percussion and vibration done to loosen mucus secretions o Change position gradually to prevent postural hypotension o Procedure is best done 60 to 90 minutes before meals or in the morning upon awakening and at bedtime o Provide oral care after the procedure K.A. NCM 112A (MS 1) Unit 1 - The Upper Respiratory System and its Disorders LESSON 4: MANAGEMENT OF PATIENTS c. Nasal (saline) spray - H20 + 1tsp or med drop of salt = WITH UPPER RESPIRATORY TRACT 8ounces DISORDERS d. Antimicrobial Epistaxis - If bacterial in origin; if viral just Hemorrhage from the nose; nose bleeding consider bed rest, increase fluid intake Caused by trauma, hypertension, RHD, cancer and symptomatic treatment Nursing Management: NURSING MANAGEMENT: o Sit-up, lean forward, head tilted then pinch soft o Avoid exposure to known allergens and irritants tissues (nose bridge or Kiesselbach’s plexus) of o Saline spray to loosen and remove irritants the nose for 5-10minutes and secretions; instruct the client to blow the o Cold compress / ice pack nose first before spraying and keep the head o Cotton pledgets soaked in vasoconstricting upright during administration solution (usually epinephrine, phenylephrine, o If infectious rhinitis is suspected, always xylometazoline, and oxymetazoline) practice hand hygiene Viral Rhinitis (Common Cold) A viral infection of the nasal mucosa caused by 200 different viruses like rhinovirus, adenovirus, coronavirus and influenza virus SIGNS AND SYMPTOMS: o Nasal congestion Rhinitis o Rhinorrhea A group of disorders characterized by o Sneezing inflammation and irritation of the mucous o Sore throat membrane of the nose; may be infectious, o General malaise allergic, or inflammatory in origin o Watery eyes o Exacerbates Cold sores (herpes simplex) TYPES OF RHINITIS: o Hay Fever (Allergic Rhinitis) – exposure to MEDICAL MANAGEMENT: particles Symptomatic treatment Seasonal (pollen season) a. NSAIDS Perennial (all throughout the year) - E.g. Aspirin, Ibuprofen o Vasomotor Rhinitis (Non-allergic rhinitis) - Relieves aches, pains and fever in adults b. Antihistamine CAUSES OF RHINITIS: - Relieves sneezing, rhinorrhea, nasal o Vasomotor – drug induced, psychological congestion stimulation c. Topical (nasal) decongestants o Mechanical – tumor, foreign body d. Antimicrobial should NOT be used o Chronic Inflammation – sarcoidosis (swollen e. Vitamin C tissue/granuloma formation) o Infection NURSING MANAGEMENT: o Hormonal – pregnancy, use of contraceptives, o Instruct bed rest hypothyroidism o Break the chain of infection, do hand washing o Increase fluid intake SIGNS AND SYMPTOMS: o Warm salt-water gargles to soothe sore throat o Rhinorrhea (runny nose) o Chicken (can help clear nasal congestion), if o Nasal congestion not allergic o Sneezing o Nasal pruritus Sinusitis (Rhinosinusitis) o Headache An infection of the mucous membrane that line MEDICAL MANAGEMENT: the paranasal sinuses which may be bacterial, Pharmacologic Treatment fungal, or viral in origin; could also be an a. Antihistamine autoimmune issue (sariling immune system - E.g. diphenhydramine (Benadryl), yung sumusira) Loratidine (Claritin), Dimetapp 5 SUBTYPES OF SINUSITIS: - Treats symptoms of allergic and 1. Acute – rapid-onset of infection (4 weeks) non-allergic rhinitis 2. Subacute – with persistent purulent nasal b. Decongestants discharge despite of 3mos of therapy nostril K.A. NCM 112A (MS 1) Unit 1 - The Upper Respiratory System and its Disorders 4. Allergic – requires a known allergen Pharyngitis 5. Hyperplastic – can cause malformation of the Inflammation of the pharynx caused by either nasal mucosa; presence of polyps bacterial or viral infection SIGNS AND SYMPTOMS: Commonly referred to as “Sore Throat” o Facial fullness or pressure over the affected Classified as either acute or chronic pharyngitis sinuses o Purulent nasal discharge COMMON CAUSATIVE AGENTS o Fever Viral Bacterial o Headache Adenovirus Group A beta-hemolytic o Otalgia (ear pain) Influenza Virus streptococci o Odontogenic pain (Dental pain) Epstein-Barr Virus N. gonorrhoeae o Periorbital edema Herpes Simplex H. influenza type B o Post nasal drip (makes cough worsens when in Virus Mycoplasma supine) o Other manifestations same with rhinitis *when Group A beta-hemolytic DIAGNOSTIC TEST: streptococci is the cause of infection, o Sinus aspirates the condition is called strep throat o Sinus x-ray and CT scan o Sinus swab for C & S DIFFERENTIATING SIGNS AND SYMPTOMS OF COMPLICATIONS: ACUTE AND CHRONIC PHARYNGITIS o Meningitis Acute Pharyngitis Chronic Pharyngitis o Brain Abscess o Ischemic Brain Infarction Common in younger Common in adults o Osteomyelitis patients (5-15y/o) Excessive mucus Fiery-red pharyngeal that can be expelled MEDICAL MANAGEMENT: membrane by coughing o Antimicrobial Less or no mucus Dysphagia - E.g. Amoxicillin, Ampicillin, Cefuroxime No cough Sore throat - Used to eradicate infecting organisms if Fever, malaise, sore Irritation / fullness in bacterial in origin throat the throat o Oral decongestants or nasal saline spray Urticaria rash - Diphenhydramine (Benadryl) o Heated Mist and saline irrigation 3 TYPES OF CHRONIC PHARYNGITIS: o NSAIDs EXCEPT aspirin because it increases 1. Hypertrophic – thickening and risk of developing nasal polyps congestion of the pharynx SURGICAL MANAGEMENT: 2. Atrophic – late stage of the 1st type; thin, o Functional Endoscopic Sinus Surgery whitish and wrinkled pharyngeal o Caldwell – Luc Surgery membrane o Ethmoidectomy / Sphenoidectomy 3. Chronic granular – also called “clergyman’s sore throat”; characterized by numerous swollen lymph follicles DIAGNOSTIC TEST: o Rapid Strep Test (RST) o Nasal swabs and blood cultures MEDICAL MANAGEMENT: Pharmacologic Treatment a. Antibacterial - E.g. Penicillin, Cephalosporin, Macrolides - Administered at least 10 days (case to case basis) to eradicate infection of the oropharynx b. Analgesics - E.g. aspirin, acetaminophen - First line of intervention is to alleviate pain NURSING MANAGEMENT: (sore throat) o Stress rest periods c. Antitussives (para hindi ubo nang ubo) o Steam inhalation and warm compress to relieve - Codeine, dextromethorphan (Robitussin DM) pressure Nutritional Therapy o Stop smoking Liquid or soft diet o Positioning (Semi-Fowler’s) Cool beverages, warm liquids, flavored o Nasal spray frozen desserts(popsicles) to soothe o Explain signs of complications of sinusitis sore throat (fever, severe headache, nuchal rigidity) K.A. NCM 112A (MS 1) Unit 1 - The Upper Respiratory System and its Disorders NURSING MANAGEMENT: NURSING INTERVENTION: o Avoid clearing of throat. This may cause o Symptomatic management bleeding o Ice collar for sore throat o Avoid coughing, sneezing, blowing of nose for o Provide rest periods 1-2 weeks o Warm saline gargles to relieve sore throat o Increase fluid intake @ 2-3L/day o Compliance on pharmacologic treatment o Avoid hard, scratchy foods especially when on antibiotic o Report signs and symptoms of bleeding o Plenty of rest for 2 weeks Tonsillitis and Adenoiditis o Avoid cold exposure and overcrowded places Usually caused by Group A beta hemolytic which may cause URTI streptococci Can lead to RH fever, Acute Laryngitis Glomerulonephritis, if recurrent and untreated Inflammation of the larynx often due to voice during childhood abuse, dust, chemicals, smoke or as part of Viral: gradual onset, low grade fever, reddened URTI and swollen tonsils Mostly viral in origin Bacterial: sudden onset, high fever, with vomiting, whitish spot on throat, gray furry SIGNS AND SYMPTOMS: tongue o Hoarseness or aphonia (loss of voice) o Severe dry cough SIGNS AND SYMPTOMS: o Painful phonation o Sore throat o Husky sounds o Fever o “Tickle” in the throat (feeling of stimuli that o Snoring / bruxism causes you to cough) o Dysphagia o Mouth – breathing MEDICAL MANAGEMENT: o Otalgia (ear pain) Topical corticosteroid o Halitosis (bad breath) - E.g. beclomethasone o Voice impairment - Reduces local inflammatory process o Otorrhea (Draining ears) Symptomatic treatment - for pain and dry cough DIAGNOSTIC TEST: o Throat swab for C & S SURGICAL MANAGEMENT: Subtotal / Total Laryngectomy MEDICAL MANAGEMENT: Preop care: Pharmacologic Treatment Psychosocial support on the effects of a. Analgesics - Advil, Acetaminophen procedure: loss of voice, permanent (Tylenol) tracheostomy, loss of sense of smell, b. Antimicrobial - Penicillin, Amoxicillin, inability to blow the nose, whistle, Erythromycin usually for 7-10 days gargle, etc. SURGICAL MANAGEMENT: Establish means of communication to Tonsillectomy / Adenoidectomy be used postop - Indicated if tonsillitis recurs 5 to 6 times a year Postop care: despite of antibiotic therapy Care of tracheostomy Preop care: Establish patent airway (suction as Assess for URTI. Coughing and necessary) sneezing postop may cause bleeding Prevent infection (care of dressing) Check Prothrombin time. Bleeding is a Establish means of communication common postop complication. Postop care: NURSING MANAGEMENT: Prone, head turn to side or lateral o Rest the voice and maintain well humidified position environment Oral airway until swallowing reflex o Increase fluid intake to liquefy and easily returns expectorate secretions o Treat symptoms Monitor for hemorrhage Promote comfort (ice collar, avoid ASA (aspirin may cause further bleeding) for pain) Diet (ice-cold fluids, bland foods) K.A.