Coursera 1.

1 The Respiratory System and the lungs, which contain the alveoli, or
and its disorders terminal air sacs
Quick Recap of Anatomy and
Physiology
Functional Anatomy of the Upper
Respiratory System
 Care of the Clients with Respiratory
Disorders:
o i. Common Assessment A. NOSE
o ii. Diagnostic Tests
o iii. Respiratory Interventions B. PARANASAL SINUSES
-Classifications:
 Management of Patients with Upper
>> Frontal
Respiratory Problem
>> Sphenoid
o Epistaxis, Rhinitis, Sinusitis,
>> Ethmoid
Pharyngitis, Tonsillitis, Laryngitis
>> Maxillary bones
 Management of Patients with Lower
Respiratory Problem
o Atelectasis, Acute
Tracheobronchitis, Pneumonia,
Pulmonary Heart Disease,
Pulmonary Embolism, COPDs
Anatomy and Physiology

Respiratory is defined as…

Along with the cardiovascular system, the
respiratory system, the respiratory share
responsibility for supplying the body with
oxygen and disposing of carbon dioxide.
The organs of the respiratory system
include the nose, pharynx, larynx, trachea,
bronchi, and their smaller branches,
C. PHARYNX
 Subdivided into 3 major portions:
o Nasopharynx
o Oropharynx
o Laryngopharynx
>> Auditory tubes (eustachian
tube)
>> Tonsils – pharyngeal tonsils
(adenoid), palatine tonsils, and
lingual tonsils (collects cell debris)
D. LARYNX
 “Voice box”
o Thyroid cartilage – commonly
called the Adam’s apple is the
largest hyaline cartilage which
protrudes anteriorly
o Epiglottis – “guardian of the
airways”, protects superior
opening of the larynx (protects
airway from solid particles)

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 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
 Also called “windpipe”, has a length of
10-12 cm or about 4 in, is lined with a
ciliated mucosa
o Cilia – function to propel mucus.
Loaded with dust particles and
other debris, away from the
lungs to the throat, where it can >> Bronchioles – subdivisions of the
be swallowed or spat out. primary bronchi inside the lungs before
it terminates in alveoli
A. PRIMARY BRONCHI
 The right and left primary bronchi are >> Alveoli – air sacs; the only site of
formed by the division of the trachea gas exchange
 The right primary bronchus is wider,
shorter, and straighter than the left;
also, more prone to some lodging of
foreign object it warm, cleanse and
humidify air that enters the lungs

B. LUNGS

 Apex (the narrow superior portion of

each lung, located just deep to the
clavicle)
 Base (broad lung area resting on the A. 4 Distinct Events during
diaphragm) Respiration:
 Each lung is divided into lobes by 1. Pulmonary ventilation
fissures; the left lung has 2 lobes, and 2. External respiration
the right lung has 3 lobes 3. Respiratory gas transport
4. Internal respiration
>> Pleura – the parietal pleura and the
visceral pleura (self-enclosing) protects B. Mechanics of Breathing
and cushions lungs (a serous 1. Inspiration
membrane/ serosa) 2. Expiration
3. Non respiratory Air Movements
Outer (Parietal Pleura) (Coughing, Hiccups, Sneezing
Between (Pleural Space) Laughing, Crying)
Inner (Visceral Pleura)
C. Respiratory Volumes and
Capacities

 Tidal volume – volume air inhaled and

exhaled with normal quiet breathing
(500mL)

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 Inspiratory reserve volume – maximum
volume that can be inhaled following a
normal quiet exhalation
 Expiratory reserve volume – the
maximum volume that can be exhaled
following a normal quiet inhalation
(1200 mL)
 Residual volume – the maximum air
that remains in the lungs after a forceful
exhalation
 Vital capacity – the maximum volume of
air that can be exhaled after a
maximum inhalation; the sum of the TV,
IRV, and ERV (4800mL)
 Inspiratory Capacity – total amount of
air that can be inhaled following a
normal quiet exhalation; the sum of VC
and IRV (3,600mL)
 Total Lung Capacity – the total volume
of the lungs at maximum inflation; the
sum of TV, IRV, ERV and RV (6,000
mL)
D. Respiratory Sounds
1. Bronchial sounds
2. Vesicular breathing sounds
E. Factors Influencing Respiratory
Rate Depth:
1. Physical factors
2. Volition (conscious Control)
3. Emotional factors
4. Chemical factors (CO2, O2,
Bicarbonate)
F. Neurological Control Respiratory
System
1. Medulla oblongata –
responsible for being the center
of respiration (main source of
commands
2. Pons – control rate and depth of
respiration
3. Phrenic Nerve – controls
diaphragmatic movement
4. Pneumotaxic center – controls
pattern of respiration (E.g
Kussmaul’s)
5. Apneustic center – stimulate
medulla or create prolonged and
deep respiration
Care of the Clients with Respiratory
Disorders
(An ADPIE Approach)
A. Risk Factors for Respiratory
Diseases
1. Smoking (the single most important
contributor to lung disease)
2. Exposure to secondhand smoke
3. Personal or family history of lung
disease
4. Genetic make up
5. Allergens and environmental
pollutants
6. Recreational and occupational
exposure
B. Physical Examination
1. Dyspnea
 Most common manifestations of all
respiratory problems
 Also referred to as difficulty of breathing
(DOB) or shortness of breathing (SOB)
 Ask the time it started and how it
started
2. Cough
 A reflex that protects the lungs from
accumulation of secretions or inhalation
of foreign bodies
 It results from irritation of the mucous
membranes anywhere in the respiratory
tract
 Described as dry, hacking/barking,
brassy, wheezing, loose or severe
 Ask the time it started, how it ended,
the frequency and characteristics
3. Sputum Production
 The reaction of the lungs to any
constantly recurring irritant and may
also be associated with nasal discharge
 Assess for color, odor, quality, and
quantity of sputum
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 Common characteristics of sputum with
it associated condition:
o Purulent sputum (yellow, green
or rust colored): bacterial
infection
o Thin, mucoid sputum: chronic
bronchitis or bronchiectasis
o Pink-tinged mucoid sputum:
lung tumor or cancer
o Profuse, frothy, pink-tinged:
pulmonary edema
o Foul smelling sputum: lung
abscess, bronchiectasis, or any
associated infection
4. Chest Pain
 May be associated with pulmonary or
cardiac disease
 May be described as sharp, stabbing,
or intermittent, or it may be dull, aching
and persistent
 Assess for scale of pain, location, and
intensity
OPQRST – Onset, Provoking Factors
Quality of pain, Radiation, Severity,
Timing
COLD SPA – Characteristic, Onset
Location, Duration, Severity, Provoking
Factors, Associated/ Aggravating
Factors
Intermittent – on and off
5. Breath sounds
 Crackles (Soft, high – pitched popping
sounds may have fluids in the lungs)
 Wheezing (High – pitched; continuous;
hoarse; whistling; indicates obstruction
or narrowing common among asthma
and COPD
 Stridor (Strong gush of air; a turbulent
gas flow from the upper respiratory
airway, may indicate obstruction of
epiglottis, laryngeal tumor
6. Clubbing of Fingers
 Hypertrophy of tissues in nail beds
caused by prolonged hypoxia due to a
lung disease
7. Cyanosis
 Bluish coloring of the skin indicative of
hypoxia or due to deoxygenation of
hemoglobin
a. Central cyanosis – tongue
and lips
b. Peripheral/ acrocyanosis –
extremities
8. Chest Inspection/ Configuration
a. Barrel chest
b. Pigeon chest (Bowed chest
or Pectus carinatum)
c. Funnel chest (Pectus
excavatum)
d. Thoracic Kyphoscoliosis
INSERT PHOTO
9. Chest Palpation
 Palpation of masses
 Palpation of tactile fremitus
 Palpation of thoracic excursion
10. Chest Percussion
 Resonance – low pitched hollow sound
heard over the lung tissue (heard by
percussion)
 Hyper resonance – very load lower –
pitched sound; normally not present;
presence may indicate emphysema
11. Rates and Depth of Respiration
 Eupnea (normal)
 Bradypnea (slower)
 Tachypnea (rapid)
 Hypoventilation (less rate and depth of
breathing)
 Hyperventilation (hyper rate and depth
of breathing)
 Apnea (abrupt stopping and starting of
breathing)
 Cheyne’s Stokes respiration
 Biot’s respiration
Diagnostic Evaluation
1. Chest X-ray
 It can reveal an extensive pathologic
process in the lungs in the absence of
symptoms
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 Normal pulmonary tissue is radiolucent;
therefore, densities produced by fluid,
tumors, foreign bodies and other
pathologic conditions can be detected
o Nursing Responsibility:
A. Instruct the client on how to
hold his breath and to do
deep breathing
B. Instruct the client to remove
metals from the chest
2. Bronchoscopy
 The direct inspection and examination
of the larynx, trachea and bronchi
through a flexible or rigid bronchoscope
Diagnostic use:
a. To collect secretions and
b. To determine location of
pathologic process and
collect specimen for biopsy
 Therapeutic use:
a. To remove foreign object and
secretions,
b. Treat postoperative
atelectasis, and.
c. To destroy and excise
lesions
o Nursing interventions (Before
the Procedure):
a. Atropine and valium pre –
procedure; topical
anesthesia injected into
larynx
b. NPO for 6-8 hours
c. Remove dentures,
prostheses, contact lenses
o Nursing interventions (After
the procedure):
a. Side – lying position
b. Check for return of cough
and gag reflexes before
giving fluid per Orem
c. Watch for cyanosis,
hypotension, tachycardia,
arrythmias, hemoptysis,
dyspnea. These signs and
symptoms indicate
perforation of bronchial tree
“AtSO4” as your “Anticholinergics”
 Sometimes referred to as
antispasmodics or antimuscarinic
 “cholinergic” pertains to
parasympathetic actions
 Producing sympathetic effects such
decreased salivation helpful for patients
undergoing oral procedures as to
prevent aspiration-related risks.
3. Thoracoscopy
 A procedure in which the pleural cavity
is examined with an endoscope wherein
small incisions are made into the
pleural cavity in an intercostals space
 Indicated in the diagnosis of pleural
effusion, pleural disease, and tumor
staging
o Nursing Responsibility:
a. Assess for shortness of
breath after the procedure
which might indicate
pneumothorax.
4. Computed Tomography (CT)
Scan and Fluoroscopy
 Studies the lungs and chest via series
of x-ray in different dimensions or in
motion like in fluoroscopy
 Used to assist with invasive
procedures, such as a chest needle
biopsy or transbronchial biopsy
o Nursing Responsibility:
a. Check for iodine-allergy if
with contrast (seafood
allergy)
b. Instruct the client to remain
still
c. Assess for claustrophobia
5. Magnetic Resonance Imaging
(MRI)
 A non-invasive diagnostic tool that uses
a powerful magnetic field and
computer-generated pictures to image
the lungs and its associated diseases.
o Nursing intervention:
a. The patient is instructed to
remove any jewelries,
watches, or any metal items
b. Interview if the patient has
pacemakers, metal plates,
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 prosthetic joints, or any
metallic implants
c. The patient is instructed to
be motionless during the
procedure
d. Know if the patient has
claustrophobia
6. Lung Scan
 Following injection of radioisotope,
scans are taken with scintillation
camera. Measure blood perfusion
through the lungs. Confirm pulmonary
embolism or other blood-flow
abnormalities
 Instruct the client to remain still during
the procedure
INSERT PHOTO
7. Sputum examination
 Obtained for analysis to identify
pathogenic organisms and to determine
whether malignant cells are present
o Forms of examination:
a. Gross appearance
b. Sputum C&S
c. AFB staining
d. Cytologic examination/
Papanicolaou examination
o Nursing Responsibility:
a. Early morning sputum
specimen is to be collected
b. Rinse mouth with plain water
c. Use sterile container
d. Sputum specimen for C and
S is collected before the first
dose of antimicrobial
8. Bronchography
 A radiopaque medium is instilled
directly into the trachea and bronchi
and the entire bronchial tree or selected
areas may be visualized through x-ray
o Nursing Responsibility
Procedure:
a. Secure written consent
b. Check for allergies to iodine
or seafoods
c. NPO for 6 to 8 hours
d. Pre – op meds: atropine S04
and valium, topical
anesthesia sprayed,
followed by local anesthetic
injected into larynx
e. Have oxygen and
antispasmodic agents ready
9. Pulmonary Functions Studies
 Vital Capacity
 Tidal Volume
 Inspiratory Reserve Volume
 Expiratory Reserve Volume
 Functional Residual Capacity
 Residual volume
10. Thoracentesis
 Aspiration of fluid or anything in the
pleural space
o Nursing Responsibility
(Before Procedure):
a. Secure consent
b. Take initial VS
c. Orthopneic position
d. Instruct to remain still. Avoid
coughing during insertion of
needle
e. Pressure sensation is felt on
insertion of needle
o Nursing Responsibility (After
Procedure):
a. Turn on the unaffected side
to prevent leakage of fluid in
the thoracic cavity
b. Bed rest until VS is stable
c. Check for the exploration of
blood. Notify the physician
d. Monitor VS
11. Lung Biopsy
 Performed to obtain lung tissue for
examination to identify the nature of the
lesion
 Different techniques of biopsy:
a. Trans bronchoscopic biopsy
– done during bronchoscopy
b. Percutaneous needle biopsy
c. Open lung biopsy
12. Pulse Oximetry
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 A non-invasive method of continuously “If both pH and PaCO2 show similar acid-
monitoring the oxygen saturation of base imbalance (i.e., both acidic and
hemoglobin (SaO2) alkalinic), respiratory acid-base imbalance
 Normal value: 95 to 100% (below 85% will result.,chronic
indicate hypoxia)
And vice versa, “if both pH and HCO3
values show similar acid-base imbalance
13. Arterial Blood Gas
(i.e., both acidic and alkaline), metabolic
 Performed to assess ventilation and
acid-base imbalance will result.”
acid-base balance
 Radial artery is common site for Always remember ROME...
withdrawal of blood specimen.
 Allen’s test is done to assess for Respiratory Opposite (Arrow)
adequacy of collateral circulation of the Metabolic Equal (Arrow)
hand
 10 mL pre-heparinized syringe to
prevent clotting of specimen
 Container with ice to prevent hemolysis
of the specimen

14. Analysis of ABG value

 pH level (carbon dioxide
(lungs) and bicarbonate (kidneys)
balances pH in blood)
Normal value: 7.35-7.45
Acidosis: <7.35
Alkalosis: >7.45

 PaCO2 (Arterial Pressure of Carbon

dioxide) (respiratory) (acid in
composition)
Normal value: 35-45 mmHg
Acidosis: >45 mmHg
Alkalosis: <35 mmHg

 HCO3 (Bicarbonate) (metabolic)

(Base in composition)
Normal value: 22-26
Acidosis: <22
Alkalosis: >26

 PaO2: 80-100 mmHg

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 Seat work 1, 2, 3 Common Respiratory Interventions

1. Oxygen Therapy
Key Considerations
1. Oxygen concentrations
2. Methods of delivery
3. Liter flow per minute
a. Nasal Cannula
>> Delivers 24 to 45% of
oxygen
>> Regulations is at 2-6 lpm
b. Face masks
Simple face masks
>> Delivers 40-60% O2
>> Regulations: 5-8 lpm
Partial rebreather mask
>> Delivers 60-90% O2
>> Regulations: 6-10 lpm
>> Rebreathes 1/3 of
exhaled air
Nonrebreather mask
>> Delivers 95-100% O2
>>Regulations: 10-15 lpm
>> With one-way valve entry
so that no room air or
15. Determining compensation acid- exhaled air will be
base imbalance rebreathed
Venturi Mask
 Full compensation – when balancing
between CO2 and HCO3 result normal
pH levels
 Partial Compensation – when
balancing between CO2 and HCO3
results to near-to-normal pH levels
 No compensation/Uncompensated –
When neither CO2 nor HC03 remains
normal despite the presence of an
abnormal pH level.

16. Skin Test: Mantoux

 PPD (Purified Protein Derivative)
 Intradermal: 4 inches below the elbow
 Read after 48-72 hours after injection >>Delivers 40-50%
for skin reaction c. Face tent
 (+) Mantoux Test is induration of 10mm >> Delivers 30-40%O2
or more; but HIV positive patients, an >> Regulations: 4-8 lpm
induration of 5mm is considered d. Transtracheal O2 delivery
positive already >> Delivers 30-40%
 (+) Mantoux test reading signifies >> Regulations: 4-8 lpm
exposure to Koch’s bacilli

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 Parts of Oxygen Delivery System
2. Tracheobronchial Suctioning
 Client should be in semi or high
Fowler’s position
 Use sterile gloves, sterile suction
catheter
 Hyperventilate client with 100% oxygen
before
 Insert 3-5” length of catheter only for
suctioning
 Apply suction only during the
withdrawal of catheter in a rotating
motion
 Suctioning should take only 10 seconds
(maximum of 15 seconds)
 Auscultate breath sounds after the
procedure
3. Chest Physiotherapy (CPT)
 It includes three techniques:
a. Postural drainage
b. Percussion
c. Vibration
o Nursing Intervention:
a. Verify the doctor’s order
b. Assess areas for
accumulation of mucus
secretions
c. Position to allow expelling of
mucus secretions
d. Reposition the patient from
10-15 minutes
e. Percussion and vibration
done to loosen mucus
secretions
f. Change position gradually to
prevent postural hypotension
g. Procedure is best done 60-
90 minutes before meals or
in the morning upon
awakening and bedtime
h. Provide oral care after the
procedure
4. Incentive Spirometry
 Performed to enhance deep inhalation,
especially for post-operative clients; to
prevent atelectasis (abnormal collapse
of
alveoli)
5. Closed Chest Drainage or Chest
Thoracostomy Tube (CTT)
 A kind of intervention that free the
pleural space from over accumulation of
fluids like watery discharge, blood, pus
and even air.
 To establish negative pressure and re-
expand lungs
Types:
a. One-bottle system
>>Serves as drainage and water-
seal bottle
>>Tip of the tube immersed 2-3 cm
below NSS level
>>Bottle kept 2-3 ft below the chest
level
>> Assess for patency of the tube
>> Observe for
fluctuation/intermittent bubbling of the
bottle (normal finding); continuous
bubbling means air leak (abnormal
finding)
>> If not fluctuating, consider lung
re-expansion as validated by x-ray
b. Two-bottle system
>> 1st bottle – serves as drainage
>> 2nd bottle – serves as water-seal
or both water-seal and suction control
B.1 Not connected to Suction:
>> Observe for
fluctuation/intermittent bubbling in the
water-seal or 2nd bottle (normal finding)
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 B.2 Connected to Suction
>> Expect a continuous bubbling in
the suction bottle (2nd bottle)
>> Immerse tip of CTT in the
drainage bottle (1st bottle) 2-3 cm below
NSS level
>>Immerse tip of CTT in the suction
(2nd bottle) 10-20cm below the NSS
level
c. Three-bottle system
 Types:
>> 1st bottle – drainage
>> 2nd bottle – water-seal
>> 3rd bottle – suction control
>> Observe for fluctuation/intermittent
bubbling in the water-seal during
respiration
>>Observe for continuous bubbling in
the suction control bottle
Coursera 1.2 Medical Surgical
Management of Upper Respiratory
Disorders
1. Epistaxis
 Hemorrhage from the nose; nose
bleeding
 Caused by trauma, htn, RHD, cancer
o Nursing management
a. Sit-up, lean forward, head
tilled then pinch soft tissues
(nose bridge or
Kiesselbach’s plexus) of the
nose for 5-10 minutes
b. Cold compress/ice pack
c. Cotton pledget soaked in
vasoconstricting solution
2. Rhinitis
 A group of disorders characterized by
inflammation and irritation of the
mucous membrane of the nose’ may
be infectious, allergic, or inflammatory
in origin
Types of Rhinitis
1. Hay Fever (Seasonal or Allergic
Rhinitis
 It occurs during pollen seasons
2. Perennial Rhinitis
 It occurs throughout the year
 It is triggered by animal’s dust,
feather, dander
3. Non-allergic rhinitis (Vasomotor
Rhinitis)
 Unknown etiology characterized by
abnormal vasodilation
 It may be due to sexual arousal
Causes of Rhinitis
 Vasomotor (idiopathic, anger, sexual
arousal, smoking)
 Mechanical (foreign body like
NGT, CSF leaks, deviated
septum)
 Chronic Inflammation (polyps,
sarcoidosis, Wegener’s
granulomatosis)
 Infection (acute viral infection,
sinusitis, tuberculosis)
 Hormonal (pregnancy, use of
oral contraceptives,
hypothyroidism)
Signs and Symptoms
 Rhinorrhea (excessive nasal
discharge, runny nose)
 Nasal congestion
 Sneezing
 Nasal pruritus
 Headache
Pathophysiology
Vasomotor, mechanical,
infection, hormonal changes
Inflammatory response
Production of inflammatory
mediators (e.g., histamine)
Rhinorrhea, nasal congestion,
nasal pruritus, headache
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 Difference between Signs and Symptoms
Medical Management
(Pharmacologic Treatment)
Coursera 1.3 Medical Surgical
1. Antihistamine Management of Upper Respiratory
 E.g diphenhydramine (Benadryl), Disorders
Loratidine (Claritin), Dimetapp
 Treats symptoms of allergic and non- Medical Management
allergic rhinitis 1. Symtomatic treatment
a. NSAIDS
2. Decongestants  E.g Aspirin, Ibuprofen
 Intranasal ipratropium (Atrovent) per
 Relieves aches, pains and fever
nostril in adults
 Nasal (saline) spray
b. Antihistamine
 H20 + 1tsp or med drop of salt  Relieves sneezing, rhinorrhea,
= 8 ounces
nasal congestion
c. Topical (nasal) decongestants
3. Antimicrobial
d. Antimicrobial should not be used
 If bacterial in origin; if viral just consider e. Vitamin C
bed rest, increase fluid intake and
symptomatic treatment
Nursing Management
Nursing Management
1. Instruct bed rest
1. Avoid exposure to known allergens 2. Break the chain of infection/mode of
and irritant transmission, do hand washing
2. Saline spray to loosen and remove 3. Increase fluid intake
irritants and secretions; instruct the 4. Warm salt-water gargles to soothe
client to blow the nose first before sore throat
spraying and keep the head upright 5. Chicken soup may be given, if not
during administration allergic
3. If infectious rhinitis is suspected,
always practice hand hygiene 4. Sinusitis

3. Viral Rhinitis (Common Cold)  An infection of the mucous

membrane that line the paranasal
 A viral infection of the nasal mucosa sinuses which may be bacterial,
caused by 200 different viruses like fungal, or fungal, or viral in origin;
rhinovirus, adenovirus, coronavirus, could also be an autoimmune issue
and influenza virus
5 Subtypes of Sinusitis
Signs and Symptoms 1. Acute – rapid-onset of infection
2. Subacute – with persistent purulent
 Nasal congestion nasal discharge despite of <3mos of
 Rhinorrhea therapy
 Sneezing 3. Chronic – episodes of prolonged
 Sore throat inflammation lasting >3mos of with
 General malaise or without therapy
 Watery eyes 4. Allergic – requires a known allergen
 Cold sores (herpes simplex)

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5. Hyperplastic – can cause
malformation of the nasal mucosa;
presence of polyps
Modifiable and Non Modifiable
Reasons why Medication don’t work
1. Age (Modifiable)
2. Drug tolerance (non-mod)
Pathophysiology
URTI, Cigarette Smoking
Inflammatory response
Edema of the mucous
membrane
Hypersecretion of mucus
Infection and pressure along the
sinuses
Signs and Symptoms
1. Facial fullness or pressure
over the affected sinuses
2. Purulent nasal discharge
3. Fever
4. Headache
5. Otalgia (Ear Pain)
6. Dental pain
7. Periorbital edema
8. Cough that worsens when in
supine
9. Other manifestations same
with rhinitis
Diagnostic Test
1. Sinus aspirates
 To confirm diagnosis and identify
pathogen
2. Sinus x-ray and CT scan
3. Sinus swab for C & S
Bear in your mind.
Sinus/ Nasal/ Throat
swabbing confirms URTI
while Sputum exam LRTI…
Complications
1. Meningitis
2. Brain Absess
3. Ischemic Brain Infraction
4. Osteomyelitis
Medical Management
1. Antimicrobial
>> E.g. Amoxicilin,
Ampicilin, Cefuroxime
>> Used to eradicate
infecting organisms if
bacterial in origin
2. Oral decongestants or
nasal saline spray
>> Diphenhydramine
(Benadryl)
3. Heated Mist and saline
irrigation
4. NSAIDs except aspirin
because it increases risk
of developing nasal
polyps
Surgical Management
1. Functional Endoscopic Sinus Surgery
2. Caldwell – Luc Surgery
1. Do not chew on the affected site
2. Do not wear dentures for 10 days
3. Do not blow the nose for 2 weeks
after removal or packing
4. Avoid sneezing for 2 weeks after
surgery
3. Ethmoidectomy / Sphenoidectomy
Figure 1: Caldwell – Luc Surgery
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 o Nursing Management

a. Stress rest periods

b. Steam inhalation and warm
compress to relieve pressure
c. Stop smoking
d. Positioning (Semi-Fowler’s)
e. Nasal spray
f. Explain signs of complications
of sinusitis (fever, severe 3 Types of Chronic Pharyngitis
headache, nuchal rigidity) 1. Hypertrophic – thickening and congestion
of the pharynx
5. Pharyngitis
 Inflammation of the pharynx caused by 2. Atrophic – late stage of the 1st type; thin,
either bacterial or viral infection whitish and wrinkled
 Commonly referred to as “Sore Throat” pharyngeal membrane
 Classified as either acute or chronic
pharyngitis 3. Chronic granular – also called
“clergyman’s sore throat”; characterized
Common Causative Agents
by numerous swollen lymph follicles
Diagnostic Test
1. Rapid Strep Test (RST)
2. Nasal swabs and blood cultures

Medical Management
1. Pharmacologic Treatment
a. Antibacterial
- E.g. Penicillin, Cephalosporin, Macrolides
- Administered at least 10 days to eradicate
infection of the
oropharynx
b. Analgesics
- E.g. aspirin, acetaminophen

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- First line of intervention is to alleviate pain
(sore throat) Medical Management
1. Pharmacologic Treatment
c. Antitussives
a. Analgesics
- Codeine, dextromethorphan (Robitussin - Advil, Acetaminophen (Tylenol)
DM) b. Antimicrobial
- Penicillin, Amoxicillin, Erythromycin usually
2. Nutritional Therapy for 7-10 days
- Liquid or soft diet
Surgical Management
- Cool beverages, warm liquids, flavoured 1. Tonsillectomy / Adenoidectomy
frozen desserts(popsicles) to soothe sore - Indicated if tonsillitis recurs 5 to 6 times a
throat year despite of antibiotic
o Nursing Intervention therapy
o Symptomatic management
o Preop care:
o Ice collar for sore throat
i. Assess for URTI. Coughing and sneezing
o Provide rest periods
postop may cause
o Warm saline gargles to bleeding
relieve sore throat ii. Check Prothrombin time. Bleeding is a
o Compliance on common postop
pharmacologic treatment complication
especially when on antibiotic
6. Tonsillitis and Adenoiditis o Postop care:
1. Prone, head turn to side or lateral
 Usually caused by Group A beta position
hemolytic streptococci 2. Oral airway until swallowing reflex returns
 Can lead to RH fever, AGN, if 3. Monitor for hemorrhage
recurrent and untreated during 4. Promote comfort (ice collar, avoid ASA
childhood for pain)
5. Diet (ice-cold fluids, bland foods)
 Viral: gradual onset, low grade fever,
reddened and swollen tonsils
 Bacterial: sudden onset, high fever, o Nursing management
with vomiting, whitish spot-on throat, 1. Avoid clearing of throat. This may cause
gray furry tongue bleeding
2. Avoid coughing, sneezing, blowing of
Signs and Symptoms nose for 1-2 weeks
- Sore throat 3. Increase fluid intake @ 2-3L/day
- Fever 4. Avoid hard, scratchy foods
- Snoring / bruxism 5. Report signs and symptoms of bleeding
- Dysphagia 6. Plenty of rest for 2 weeks
- Mouth – breathing 7. Avoid cold exposure and overcrowded
- Otalgia places which may cause URTI
- Bronchitis
- Halitosis 7. Laryngitis
- Voice impairment  Inflammation of the larynx often due
- Draining ears to voice abuse, dust,
 chemicals, smoke or as part of URTI
Diagnostic Test always viral in origin
1. Throat swab for C & S
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 o Signs and Symptoms

- Hoarseness or aphonia
- Severe dry cough
- Painful phonation
- Husky sounds
- “Tickle” in the throat
Medical Management

1. Topical corticosteroid
- E.g., beclomethasone
- Reduces local inflammatory process

2. Symptomatic treatment

Surgical Management
1. Subtotal / Total Laryngectomy

o Preop care:
1. Psychosocial support on the effects of
procedure: loss of
voice, permanent tracheostomy, loss of
sense of smell,
inability to blow the nose, whistle, gargle,
etc.
2. Establish means of communication to be
used postop

o Postop care:
1. Care of tracheostomy
2. Establish patent airway (suction as ADDITIONAL INFORMATION
necessary)
Antibiotic Therapy
3. Prevent infection (care of dressing)
4. Establish means of communication A. Drug Actions:
i. Bacteriostatic vs.
o Nursing Management
Bacteriacidal
1. Rest the voice and maintain well ii. Narrow vs. Broad Spectrum
humidified environment
2. Increase fluid intake to liquefy and easily i. Bacteriocidal – kills
expectorate secretions ii. Bacteriostatic – aim is to slow
3. Treat symptoms down the synthesis, manufacturing,
and developing of cell
membrane/cell wall
i. Narrow – can only attack selective
number of bacteria
ii. Broad spectrum – can attack both
positive and negative gram bacterial
groups

B. Antibacterial Classes
i. Sulfonamide
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 >> Bacteriostatic/broad-spectrum Coursera 1.4 Management of Patients
>>E.g., Bactrim, Contrimoxasole with Upper Respiratory Tract
Disorders
ii. Penicillins
>>Bacteriostatic/narrow-spectrum
>>E.g., Co-Amoxiclav, Amoxicillin

iii. Cephalosporins
>>Bacteriacidal/bacteriostatic
>>Generations:
a. First: good gram (+) coverage
(e.g., Cefazolin, Cefalexin)
b. Second: good gram (+); some
gram (-) coverage (e.g.,
Cefaclor)
c. Third: less gram (+); more
gram (-) coverage (e.g.,
Ceftriaxone)
d. Fourth: good gram (-)
coverage (Cefepime)

iv. Tetracycline
>>Bacteriostatic/broad-spectrum
>>E.g., Doxycycline
>>Watch out: can cause
permanent teeth discoloration from
fetal development to 8 years of
age
v. Macrolide
>>Bacteriostatic/broad-spectrum
>>E.g., Erythromycin

vi. Aminoglycoside
>>Bactericidal/narrow-spectrum
>>E.g., Gentamicin, Amikacin

vii. Fluoroquinolones
>>Bactericidal/broad-spectrum
E.g., Ciprofloxacin, Levofloxacin

viii. Carbapenems
>>Bacteriostatic/broad-spectrum

ix. Ketolide
>> A macrolide-derivative
>>Treats macrolide-resistant strep infections

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