Module 1A URD

COLLEGE OF NURSING AND PHARMACY
C-NCM 112–Care of Clients with Problems in Oxygenation, Fluid and

Electrolytes, Infectious, Inflammatory and Immunologic Response,
Cellular Aberrations, Acute and Chronic
First Semester | AY 2021-2022
Module: Module 1A: Upper Airway Disorders

Time Frame: Week 1 (3 hours)
Schedule of synchronous sessions: Tuesday/Thursday 3:00 – 6:00 pm
Mapped Learning Outcomes and Course Content for C-NCM 112, Module 1A
Target Learning Outcomes Content and Activities
Hours (At the close of the period allotted, Online Session Offline Session
students should have :)
• Describe nursing Care of Clients: Creation of a Concept Map for
3 management of patients with Upper Airway Upper Airway Disorders
upper airway disorders. Disorders
• Compare and contrast the
upper respiratory tract
infections according to cause,
incidence, clinical
manifestations, management,
and the significance of
preventive health care.
• Use the nursing process as
a framework for care of
patients with upper airway
infection
1. Content / Discussion / Learning Resources / Link
Intoduction: Respiratory System
https://youtu.be/2zNPRqKwSc8
A. Rhinitis
 Group of disorders characterized by inflammation and irritation of the mucous membranes of the
nose.
Rhinitis may be:

1. Acute
2. Chronic
3. Non-allergic
4. Allergic
Faculty: Maria Ana B. Buenaventura, RN, MAN Page 1 of 19
a. Seasonal
b. Perennial rhinitis - commonly associated with exposure to airborne particles such as dust, dander,
or plant pollens in people who are allergic to these substances
Rhinitis may be caused by:

 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
Allergic rhinitis caused by:

 Exposure to allergens such as foods (e.g., peanuts, walnuts, brazil nuts, wheat, shellfish,
 soy, cow’s milk, and eggs)
 Medications (e.g., penicillin, sulfa medications, aspirin, and others with the potential to produce an
allergic reaction)
 Particles in the indoor and outdoor environment
Non- allergic rhinitis

 Common colds
 Drug-induced rhinitis may occur with antihypertensive agents, such as angiotensin-converting
enzyme (ACE) inhibitors and beta-blockers; “statins,” such as atorvastatin (Lipitor) and simvastatin
(Zocor); antidepressants and antipsychotics such as risperidone (Risperdal); aspirin; and some
antianxiety medications.
Clinical Manifestations
 Rhinorrhea (excessive clear nasal drainage, runny nose)
 Nasal congestion
 Nasal discharge (purulent with bacterial rhinitis)
 Sneezing
 Pruritus of the nose, roof of the mouth, throat, eyes, and ears
 Headache

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Medical Management
 Ask the patient about recent symptoms as well as possible exposure to allergens in the home,
environment, or workplace
 If viral rhinitis is the cause, medications may be prescribed to relieve the symptoms
 In allergic rhinitis, allergy tests may be performed to identify possible allergens.
 Depending on the severity of the allergy, desensitizing immunizations and corticosteroids
 If symptoms suggest a bacterial infection, an antimicrobial agent
 Patients with nasal septal deformities or nasal polyps may be referred to an ear, nose, and throat
specialist
Pharmacologic Therapy Medication

Therapy for allergic and non-allergic rhinitis focuses on symptom relief
 Antihistamines – most common
 Corticosteroid nasal sprays
 Oral decongestant agents
 Combination antihistamine/decongestant medication
Ex: Brompheniramine/pseudoephedrine (Dimetapp Cromolyn)
 Mast cell stabilizer
 Saline nasal spray
 Ophthalmic agents (cromolyn ophthalmic solution 4%)
 Allergy treatments include leukotriene modifiers (e.g., montelukast, zarlukast [, zileuton )
 Immunoglobulin E modifiers (omalizumab)
 Immunomodulatory medications
Nursing Management
 Instruct patient to avoid or reduce exposure to allergens and irritants
 Educate in the use of all medications to prevent possible drug interactions

 Instruct the about importance of controlling the environment at home and at work
 Instruct in correct administration of nasal medications
 Instruct to blow the nose before applying any medication into the nasal cavity
 Review hand hygiene technique
 Emphasize the importance of receiving an influenza vaccination each year
 Viral Rhinitis (Common Cold)

 Most frequent viral infection in the general population
 Self-limiting
 An infectious, acute inflammation of the mucous membranes of the nasal cavity
 Term is also used when the causative virus is influenza (flu)
 Colds are highly contagious because virus is shed for about 2 days before the symptoms appear and
during the first part of the symptomatic phase
 Caused by as many as 200 different viruses
Causative Agent
 Rhinoviruses are the most likely causative organisms
 Coronavirus
 Adenovirus
 Respiratory syncytial virus
 Influenza virus
 Parainfluenza virus
 Development of a vaccine against the multiple strains of virus is almost impossible.

 Immunity after recovery is variable and depends on many factors, including a person’s natural host
resistance and the specific virus that caused the cold.
 Despite popular belief, cold temperatures and exposure to cold rainy weather do not increase the
incidence or severity of the common cold.
Clinical Manifestations Viral Rhinitis

 Low-grade fever
 Nasal congestion
 Rhinorrhea and nasal discharge
 Halitosis
 Sneezing
 Tearing watery eyes
 “Scratchy” or sore throat
 General malaise, chills
 Headache
 Muscle aches
 As the illness progresses, cough usually appears
 In some people, the virus exacerbates herpes simplex, commonly called a cold sore
Medical Management
 Symptomatic therapy that includes:

 Adequate fluid intake
 Rest
 Prevention of chilling
 Use of expectorants
 Warm salt-water gargles soothe the sore throat
 Non-steroidal anti-inflammatory drugs (NSAIDs),such as aspirin or ibuprofen
 Antihistamines are used to relieve sneezing, rhinorrhea, and nasal congestion
 Petroleum jelly can soothe irritated, chapped, and raw skin around the nares
 Guaifenesin an expectorant, used to promote removal of secretions
 Antiviral medications are available by prescription, including amantadine (Symmetrel) and
rimantadine (Flumadine)
 Topical nasal decongestants (e.g., phenylephrine nasal , oxymetazoline nasal) should be used with
caution. Overuse can produce rhinitis medicamentosa, or rebound rhinitis.
 Inhalation of steam or heated, humidified air as a home remedy
Nursing Management
 Educate about transmission: direct contact with infected secretions, inhalation of large particles from
others’ coughing or sneezing, or inhalation of small particles (aerosol) that may be suspended in the
air for up to an hour.
 Implement appropriate hand hygiene measures and the use of tissues to avoid the spread of the virus
with coughing and sneezing, and to cough or sneeze into the upper arm if tissues are not readily
available (cough etiquette)
B. Rhinosinusitis
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 Formerly called sinusitis

 Inflammation of the paranasal sinuses and nasal cavity

 Uncomplicated rhinosinusitis occurs without extension of inflammation outside of the paranasal

sinuses and nasal cavity
Classification
Duration of Symptoms
1. Acute (less than 4 weeks)
 Acute Bacterial Rhinosinusitis (ABRS)
 Acute Viral Rhinosinusitis (AVRS)
 Recurrent acute rhinosinusitis - characterized by four or more acute episodes of ABRS per year
2 Subacute (4 to 12 weeks)
3. Chronic (CRS)(more than 12 weeks)
Cause:
 Bacteria
 Viru
Pathophysiology
 Acute rhinosinusitis usually follows a viral URI or cold, such as an unresolved

viral or bacterial infection, or an exacerbation of allergic rhinitis.
 If the sinus openings into the nasal passages are clear infections resolve promptly.
 If their drainage is obstructed by a deviated septum or by hypertrophied turbinates, spurs, or nasal
polyps or tumors, sinus infection may persist as a smoldering (persistent) secondary infection or
progress to an acute suppurative process (causing purulent discharge).
 Nasal congestion, caused by inflammation, edema, and transudation of fluid secondary to URI, leads
to obstruction of the sinus cavities which provides an excellent medium for bacterial growth.
Other conditions that can block the normal flow of sinus secretions:
 Abnormal structures of the nose
 Enlarged adenoids
 Diving and swimming
 Tooth infection
 Trauma to the nose
 Tumors
 Pressure of foreign objects
 Exposure to environmental hazards such as paint, sawdust, and chemicals
Pathogens include:
 Streptococcus pneumonia
 Haemophilus influenzae
 Staphylococcus aureus
 Moraxella catarrhalis
 Fungal infections occur most often in immunosuppressed patients
Symptoms of ABRS:
 Purulent nasal drainage
 Nasal obstruction
 Facial pain, pressure, or a sense of fullness may involve the anterior face or the periorbital region
 Cloudy or colored nasal discharge congestion, blockage, or stuffiness as well as a localized or diffuse
headache
 High fever (39°C or higher)
Symptoms of AVRS:
 Similar to those of ABRS, except the patient does not present with a high fever, nor with the same
intensity of symptoms (e.g., there tends to be an absence of facial pain–pressure–fullness), nor with
symptoms that persist for as long a period of time.
 Occur for fewer than 10 days after the onset of upper respiratory symptoms and do not worsen
Assessment and Diagnostic Findings

 History
 Physical examination:
o Head and neck, particularly the nose, ears, teeth, sinuses, pharynx, and chest
o Tenderness to palpation over the infected sinus area
o Sinuses are percussed using the index finger, tapping lightly to determine whether the
patient experiences pain
 Transillumination of the affected area may reveal a decrease in the transmission of light
 Diagnostic imaging (x-ray, computed tomography [CT], magnetic resonance imaging identify the
pathogen, sinus aspirates may be obtained.
 Flexible endoscopic culture techniques and swabbing of the sinuses
Medical Management
Treatment for ABRS:
 5- to 7-day course of antibiotics is prescribed for bacterial cases
 Intranasal saline lavage an adjunct therapy to antibiotics in that it may relieve symptoms, reduce
inflammation, and help clear the passages of stagnant mucus.
Treatment of AVRS:
 Nasal saline lavage and decongestants (guaifenesin/pseudoephedrine) increase patency of the
ostiomeatal unit and improve drainage of the sinuses
 Topical decongestants should not be used for longer than 3 or 4 days

 Oral decongestants must be used cautiously in patients with hypertension
 OTC antihistamines, such as diphenhydramine (Benadryl) and cetirizine (Zyrtec), and prescription
antihistamines, such as fexofenadine (Allegra), are used if an allergic component is suspected
 Intranasal corticosteroids have been shown to produce complete or marked improvement in acute
symptoms of either bacterial or viral rhinosinusitis
Nursing Management
 Referral is indicated if periorbital edema and severe pain on palpation occur.
 Humidication of the air in the home and the use of warm compress
 Advise to avoid swimming, diving, and air travel during the acute infection
 Instruct to stop smoking or using any form of tobacco.
 Instruct about the correct use of prescribed nasal sprays
 Educate patient about the side effects of prescribed and OTC nasal sprays and about rebound
congestion (rhinitis medicamentosa).
 Medications to use for pain relief include acetaminophen (Tylenol) and NSAIDs such as ibuprofen
(Advil), naproxen sodium (Aleve), and aspirin for adults older than 20 years
 Antibiotic regimen compliance
 Recommends preventive measures such as following healthy practices and avoiding contact with
people with URIs.
 Explain to patient that fever, severe headache, and nuchal rigidity (stiffness of the neck or inability to
bend the neck) are signs of potential complications.
 Patients with nasotracheal and nasogastric tubes in place are at risk for development of sinus
infections. Thus, accurate assessment of patients with these tubes is critical. Removal of the
nasotracheal or nasogastric tube as soon as the patient’s condition permits allows the sinuses to
drain, possibly avoiding septic complications.
C. Chronic Rhinosinusitis and Recurrent Acute Rhinosinusitis CRS

 Most common in young and middle-aged adults
 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

 Four or more episodes of ABRS occur per year with no signs or symptoms of rhinosinusitis between
the episodes.
Causative Agents:
Common aerobic bacteria include
 Alpha-hemolytic streptococci
 Microaerophilic streptococci
 S. aureus
Common anaerobic bacteria include

 Gram-negative bacilli
 Peptostreptococcus
 Fusobacterium
 Chronic fungal sinusitis
 Immunodeficiency should be considered in patients with CRS or acute recurrent rhinosinusitis.
 Chronic fungal sinusitis commonly attributed to aspergillus in immunocompromised sinusitis.
 The fungus generally remains contained in the fungus ball, which consists of mucopurulent cheesy or
claylike materials within the sinus, but can become invasive when immunosuppression occurs,
leading to encephalopathy.

 History
o Focuses on onset and duration of symptoms. It addresses the quantity and quality of nasal
discharge and cough, the presence of pain, factors that relieve or aggravate the pain, and
allergies.
o Obtain any history of comorbid conditions, including asthma, and history of tobacco use
o History of fever, fatigue, previous episodes and treatments, and previous response to
therapies is also obtained.
 Physical assessment
o External nose is evaluated for any evidence of anatomic abnormality. A crooked-appearing
external nose may imply septal deviation internally.
o Nasal mucous membranes are assessed for erythema, pallor, atrophy, edema, crusting,
discharge, polyps, erosions, and septal perforations or deviations.
o Appropriate lighting improves visualization of the nasal cavity and should be used in every
examination.
o Pain on examination of the teeth, with tapping with a tongue blade, suggests tooth decay.
o Assessment of the posterior oropharynx may reveal purulent or mucoid discharge, indicative
of an infection caused by CRS.
o Patient’s eyes are examined for conjunctival erythema, tearing, photophobia and edema of
the lids.
o Transillumination of the sinuses and palpation of the sinuses whether this produces
tenderness.
o Pharynx is inspected for erythema and discharge and palpated for cervical node adenopathy.
 Imaging studies such as: x-ray, sinoscopy, ultrasound, CT scanning, and MRI
 Nasal endoscopy allows for visualization of the posterior nasal cavity, nasopharynx, and sinus
drainage pathways and can identify posterior septal deviation and polyps.
Medical Management
General Measures:
 Encouraging adequate hydration
 Use of OTC nasal saline sprays, analgesics such as acetaminophen or NSAIDs, and decongestants such
as oxymetazoline and pseudoephedrine
 Sleep with the head of the bed elevated

 Avoid exposure to cigarette smoke and fumes
 Avoid caffeine and alcohol, which can cause dehydration
 First-line antibiotics include amoxicillin clavulanic acid, erythromycin–sulsoxazole (E, and second-
generation antibiotics such as cefuroxime. The course of antibiotic treatment for CRS and recurrent
ABRS is typically as long as 2 to 4 weeks
 Corticosteroid nasal sprays such as uticasone or beclomethasone may be indicated in patients with
concomitant allergic rhinitis or nasal polyps.
 Patients with allergic rhinitis may also benefit from the addition of a mast cell stabilizer such as
cromolyn
 Patients with concomitant asthma, leukotriene inhibitors such as montelukast and zarlukast
Surgical Management
 If standard medical therapy fails and symptoms persist, Functional Endoscopic Sinus Surgery (FESS)
may be indicated to correct structural deformities that obstruct the ostia (openings) of the sinuses.
 Excising and cauterizing nasal polyps
 Correcting a deviated septum
 Incising and draining the sinuses
 Aerating the sinuses
 Removing tumors
 Surgical debridement and drainage in acute invasive fungal rhinosinusitis to excise the fungus ball
and necrotic tissue and drain the sinuses
Nursing Management
 Instruct to blow the nose gently and to use tissue to remove the nasal drainage.promote drainage of
the sinuses
 Instruct patient about the importance of following the prescribed medication regimen
 Instruct on the early signs of a sinus infection are provided, and preventive measures are reviewed
D. Acute Pharyngitis
 Sudden painful inflammation of the pharynx, the back portion of the throat that includes the
posterior third of the tongue, soft palate, and tonsils
 Commonly referred to as a sore throat.
Causative Viral Agents

 Adenovirus, influenza virus
 Epstein-Barr virus
 Herpes simplex virus
 HIV
Causative Bacterial Agents

 Group A beta-hemolytic streptococcus (GABHS), which is commonly referred to as group A
streptococcus (GAS) or streptococcal pharyngitis – causes strep throat
 Groups B and G streptococci,

 Neisseria gonorrhoeae,
 Mycoplasma pneumoniae,
 C. pneumoniae,
 Arcanobacterium hemolyticuS
Acute Pharyngitis
 Fiery-red pharyngeal membrane and tonsils
 Lymphoid follicles that are swollen and flecked with white purple exudate,
 Enlarged and tender cervical lymph nodes
 No cough
 Fever (higher than 38.3°C with or without chills)
 Malaise
 Sore throat also may be present. develop a painful sore throat 1 to 5 days after being exposed to the
streptococcus bacteria
 Vomiting
 Anorexia
 Scarlatina - form rash with urticaria known as scarlet fever
 Headache
 Myalgia
 Painful cervical adenopathy
 Nausea
 Tonsils appear swollen and erythematous, and they may or may not have an exudate
 Roof of the mouth is often erythematous and may demonstrate petechiae
 Bad breath is common

 Determine the cause (viral or bacterial) and to initiate treatment early.
 Rapid antigen detection testing (RADT) uses swabs that collect specimens from the posterior
pharynx and tonsil
 Negative results should be confirmed by a throat culture
Medical Management
Viral pharyngitis
 Treated with supportive measures
Bacterial pharyngitis
 Penicillin is usually the treatment of choice. Penicillin V potassium given for 5 days is the regimen of
choice.
o For patients who are allergic to penicillin or have organisms that are resistant to
erythromycin cephalosporins and macrolides (clarithromycin and azithromycin) may be
used.
o Once-daily azithromycin may be given for only 3 days due to its long half-life
o A 5- or 10-day course of cephalosporin may be prescribed.

o Five-day administration of cefpodoxime and cefuroxime has also been successful in
producing bacteriologic cures.
 Analgesic medications, aspirin or acetaminophen can be taken at 4- to 6-hour intervals; if required,

acetaminophen with codeine can be taken three or four times daily
 Gargles with benzocaine may relieve symptoms
Nutritional Therapy
 Soft diet is provided during the acute stage of the disease, depending on the patient’s appetite and
the degree of discomfort that occurs with swallowing
 Cool beverages, warm liquids
 Flavored frozen desserts such as ice pops are often soothing
 In severe situations, intravenous (IV) fluids may be needed
 Encourage to drink as much fluid (at least 2 to 3 L/day).
Nursing Management
 Prompt initiation and correct administration of prescribed antibiotic therapy
 Instruct patient about signs and symptoms that warrant prompt contact with the primary provider.
These include dyspnea, drooling, inability to swallow, and inability to fully open the mouth
 Instruct patient to stay in bed during the febrile stage of illness and to rest frequently once up and
about
 Used tissues should be disposed of properly to prevent the spread of infection
 Examine the skin once or twice daily for possible rash, because acute pharyngitis may precede some
other communicable diseases (e.g., rubella)
 Warm saline gargles or throat irrigations Irrigating the throat may reduce spasm in the pharyngeal
muscles and relieve soreness of the throat
 Ice collar also can relieve severe sore throats
 Mouth care may promote the patient’s comfort and prevent the development of fissures (cracking) of
the lips and oral inflammation
 Instruct 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
 Instruct patient about preventive measures that include:
o Not sharing eating utensils, glasses, napkins, food, or towels
o Cleaning telephones after use
o Using a tissue to cough or sneeze
o Disposing of used tissues appropriately; and avoiding exposure to tobacco and secondhand
smoke
o Instructs the patient with pharyngitis, especially streptococcal pharyngitis, to replace his or
her toothbrush with a new one
E. Chronic Pharyngitis
 Persistent inflammation of the pharynx

 Common in adults who work in dusty surroundings, use their voice to excess, suffer from chronic
cough, or habitually use alcohol and tobacco
Types of Chronic Pharyngitis:

1. Hypertrophic—characterized by general thickening and congestion of the pharyngeal mucous membrane
2. Atrophic—probably a late stage of the first type (the membrane is thin, whitish, glistening, and at times
wrinkled)
3. Chronic granular—characterized by numerous swollen lymph follicles on the pharyngeal wall
 Constant sense of irritation or fullness in the throat
 Mucus that collects in the throat and can be expelled by coughing, and
 Difficulty swallowing
 Pharyngitis caused by more virulent bacteria, such as GAS, is a more severe illness. If left untreated,
the complications can be severe and life threatening.
Complications include:
 Rhinosinusitis
 Otitis media
 Peritonsillar abscess
 Mastoiditis
 Cervical adenitis
Medical Management
 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
 Nasal congestion may be relieved by short-term use of nasal sprays or medications containing
ephedrine sulfate or phenylephrine.
 Antihistamine decongestant medications, such as pseudoephedrine or
brompheniramine/pseudoephedrine, is prescribed orally every 4 to 6 hours for a patient with
history of allergy
 Aspirin (for patients older than 20 years) or acetaminophen is recommended for its analgesic
properties. For adults with chronic pharyngitis
 Tonsillectomy
Nursing Management
 Recommend avoidance of alcohol, tobacco, secondhand smoke, and exposure to cold or to
environmental or occupational pollutants
 Minimize exposure to pollutants recommend wearing a disposable facemask. The nurse
 Encourage the patient to drink plenty of fluids.

 Gargling with warm saline solution may relieve throat discomfort. Lozenges keep the throat
moistened.
F. Tonsillitis and Adenoiditis

 Tonsils are composed of lymphatic tissue and are situated on each side of the oropharynx.
 Acute tonsillitis can be confused with pharyngitis.
 Chronic tonsillitis is less common and may be mistaken for other disorders such as allergy, asthma,
and rhinosinusitis.
 The adenoids or pharyngeal tonsils consist of lymphatic tissue near the center of the posterior wall of
the nasopharynx.
 Infection of the adenoids frequently accompanies acute tonsillitis.
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Causative Agents
 Group A B – hemolytic streptococcus
 Epstein-Barr virus
 Cytomegalovirus
Tonsillitis:
 Sore throat
 Fever
 Snoring
 Difficulty swallowing
Enlarged adenoids cause:

 Mouth breathing
 Earache
 Draining ears
 Frequent head colds
 Bronchitis
 Foul-smelling breath
 Voice impairment
 Noisy respiration
 Unusually enlarged adenoids fill the space behind the posterior nares, making it difficult for the air to
travel from the nose to the throat and resulting in nasal obstruction
 Infection can extend to the middle ears by way of the auditory (eustachian) tubes and may result in
acute otitis media, which can lead to spontaneous rupture of the tympanic membranes (eardrums)
and further extension of the infection into the mastoid cells, causing acute mastoiditis

 Attention given to whether the illness is viral or bacterial in nature
Acute pharyngitis
 RADT
 Throat swab culture
 Physical examination
 History
 In adenoiditis, if recurrent episodes of suppurative otitis media result in hearing loss, comprehensive
audiometric assessment is warranted
Medical Management
 Tonsillitis is treated with supportive measures
 Increased fluid intake
 Analgesics
 Salt-water gargles
 Rest
 Bacterial infections are treated with penicillin (first-line therapy) or cephalosporins
 Tonsillectomy indicated if the patient has had repeated episodes of tonsillitis despite antibiotic
therapy
 Indications for adenoidectomy include chronic nasal airway obstruction, chronic rhinorrhea,
obstruction of the eustachian tube with related ear infections, and abnormal speech.
 Surgery is also indicated if the patient has developed a peritonsillar abscess that occludes the
pharynx, making swallowing difficult and endangering the patency of the airway
Nursing Management
 Providing Postoperative Care
 Nursing observation is required in the immediate postoperative and recovery periods because of the
risk of hemorrhage
 Most comfortable position is prone, with the patient’s head turned to the side to allow drainage from
the mouth and pharynx
 Nurse 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
 Pain can be effectively controlled with analgesic medications

 Postoperative bleeding may be seen as bright red blood if the patient expectorates it before swallowing
it
 If the patient swallows the blood, it becomes brown because of the action of the acidic gastric juice. If
the patient vomits large amounts of dark blood or bright-red blood at frequent intervals, or if the
pulse rate and temperature rise and the patient is restless, the nurse notifies the surgeon
immediately.
 Have the following items ready for examination of the surgical site for bleeding: a light, a mirror,
gauze, curved hemostats, and a waste basin. Occasionally, suture or ligation of a bleeding vessel is
required.
 If there is no bleeding, water and ice chips may be given to the patient as soon as desired.
 Instruct to refrain from too much talking and coughing
 Alkaline mouthwashes and warm saline solutions are useful in coping with the thick mucus and
halitosis that may be present after surgery
 Eat an adequate diet with soft foods, which are more easily swallowed than hard foods
 Avoid spicy, hot, acidic, or rough foods. Milk and milk products (ice cream and yogurt) may be
restricted because they make removal of mucus more difficult for some patients
 Maintain good hydration
 Avoid vigorous tooth brushing or gargling because these activities can cause bleeding.
 Use of a cool-mist vaporizer or humidifier
 Instruct to avoid smoking and heavy lifting or exertion for 10 days
G. Peritonsillar Abscess - also called quinsy

 Most common major suppurative complication of sore throat
 Collection of purulent exudate between the tonsillar capsule and the surrounding tissues, including
the soft palate, may develop after an acute tonsillar infection that progresses to a local cellulitis and
abscess
 Edema can cause airway obstruction, which can be life threatening and is a medical emergency
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Causative Agents

 S. pyogenes
 S. aureus
 Neisseria species
 Corynebacterium species
 Severe sore throat
 Fever
 Trismus - inflammation of the medial pterygoid muscle that lies lateral to the tonsil results in spasm,
severe pain, and difficulty in opening the mouth fully
 Drooling
 Breath often smells rancid
 Raspy voice
 Odynophagia
 Otalgia

 Intraoral ultrasound
 Transcutaneous cervical ultrasound are used in the diagnosis of peritonsillar cellulitis and abscesses
Medical Management
 Antimicrobial agents - usually penicillin
 Corticosteroid therapy are used for treatment of peritonsillar abscess
 If the abscess does not resolve, treatment choices include needle aspiration, incision and drainage
under local or general anesthesia, and drainage of the abscess with simultaneous tonsillectomy
 Topical anesthetic agents and throat irrigations may be prescribed to promote comfort along with
administration of prescribed analgesic agents
 Patient with a peritonsillar abscess with acute airway obstruction and requires immediate airway
management : intubation, cricothyroidotomy, or tracheotomy
Surgical Management
 Needle aspiration - single or repeated needle aspirations are performed to decompress the abscess.
Alternatively, the abscess may be incised and drained.
 Incision and drainage is also an effective option but is more painful than needle aspiration.
 Tonsillectomy
Nursing Management
 If the patient requires intubation, cricothyroidotomy, or tracheotomy to treat airway obstruction, the
nurse assists with the procedure and provides support to the patient before, during, and after the
procedure.
 Assist with the needle aspiration when indicated.

 Encourage the patient to use prescribed topical anesthetic agents and assists with throat irrigations
or the frequent use of mouthwashes or gargles, using saline or alkaline solutions at a temperature of
40.6°C to 43.3°C
 Gentle gargling after the procedure with a cool normal saline gargle may relieve discomfort. The
patient must be upright gargle gently at intervals of 1 or 2 hours for 24 to 36 hours. Liquids that are
cool or at room temperature are usually well tolerated.
 Adequate fluids must be provided to treat dehydration and prevent its recurrence.
 Provide verbal and written instructions regarding foods to avoid
 Instruct to refrain from or cease smoking
 Good oral hygiene is reinforced
H. Laryngitis
 Inflammation of the larynx
Causes
 Voice abuse or exposure to dust, chemicals, smoke, and other pollutants or as part of a URI
 May be caused by isolated infection involving only the vocal cord
 Also associated with gastroesophageal reflux (reflux laryngitis)
 Often caused by the pathogens that cause the common cold and pharyngitis; the most common cause
is a virus, and laryngitis is often associated with allergic rhinitis or pharyngitis; Bacterial invasion
may be secondary.
 Onset of infection may be associated with exposure to sudden temperature changes, dietary
deficiencies, malnutrition, or an immunosuppressed state
 Viral laryngitis is common in the winter and is easily transmitted to other
CTTO: https://2minutemedicine-wpengine.netdna-ssl.com/wp-content/uploads/2014/11/Chronic-Laryngitis.jpg

https://youtu.be/hHtx1eho-Uk
3. Evaluation of Learning
For the evaluation of learning for Module 1A, a scheduled quiz will be assigned in the Google Classroom and
will be taken before the start of the next Module during the Synchronous Class.
References
Medical-Surgical Nursing Concepts for Interprofessional Collaborative Care 9th ed. , Donna D.
Ignatavicius M. Linda Workman Cherie Rebar
Medical-Surgical Nursing Critical Thinking For Person-Centered Care 3rd ed. , Levett Jones, Tracey
Lemone, Priscilla Burke
Lewis's Medical-Surgical Nursing Assessment and Management of Clinical Problems
e-book 11th ed, Mariann M. Harding, RN, PhD, FAADN, CNE
Brunner and Suddarths Textbook of Medical Surgical Nursing 12th ed., Suzanne C. Smeltzer, Brenda
G. Bare, Janice L. Hinkle, Kerry H. Cheever
Smelter and Bare’s Textbook of Medical-Surgical Nursing 4th ed., Maureen Farrell
Congratulations for having completed this C-NCM 112 Module 1A ! See you in the next
Module.

Module 1A URD

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COLLEGE OF NURSING AND PHARMACY

C-NCM 112–Care of Clients with Problems in Oxygenation, Fluid and

Module: Module 1A: Upper Airway Disorders

1. Content / Discussion / Learning Resources / Link

Intoduction: Respiratory System

Rhinitis may be:

Rhinitis may be caused by:

Allergic rhinitis caused by:

Non- allergic rhinitis

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Pharmacologic Therapy Medication

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 Viral Rhinitis (Common Cold)

 Development of a vaccine against the multiple strains of virus is almost impossible.

Clinical Manifestations Viral Rhinitis

 Symptomatic therapy that includes:

 Formerly called sinusitis

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 Uncomplicated rhinosinusitis occurs without extension of inflammation outside of the paranasal

 Acute rhinosinusitis usually follows a viral URI or cold, such as an unresolved

Assessment and Diagnostic Findings

 Topical decongestants should not be used for longer than 3 or 4 days

C. Chronic Rhinosinusitis and Recurrent Acute Rhinosinusitis CRS

 Recurrent acute rhinosinusitis

Common anaerobic bacteria include

Assessment and Diagnostic Findings

 Sleep with the head of the bed elevated

Causative Viral Agents

Causative Bacterial Agents

 Groups B and G streptococci,

Assessment and Diagnostic Findings

o A 5- or 10-day course of cephalosporin may be prescribed.

 Analgesic medications, aspirin or acetaminophen can be taken at 4- to 6-hour intervals; if required,

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Types of Chronic Pharyngitis:

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F. Tonsillitis and Adenoiditis

Enlarged adenoids cause:

Assessment and Diagnostic Findings

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G. Peritonsillar Abscess - also called quinsy

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Assessment and Diagnostic Findings

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