NURSING CARE OF CLIENTS WITH UPPER AIRWAY OR Health Teachings

RESPIRATORY DISORDERS
1. Additional rest
RHINITIS 2. Drink at least 2-3 L of fluid daily
3. Medications: Nasal spray or nose drops 2x-
• Group of disorders characterized by
3x/day as ordered
inflammation and irritation of the mucous
4. Prevent further infection
membrane of the nose
a. Blow nose with both nostrils open.
• Maybe acute or chronic - To avoid ear infection due to
Causes pressure of one nostril being
closed while blowing nose.
• Changes in temperature or humidity b. Avoid exposure to allergens when
• Odors possible.
• Infection c. Seek medical attention: if these are
• Age present.
• Systemic disease - High fever, severe chest pain, earache
• Use of the OTC drug and prescribed nasal - Symptoms lasting longer than 2 weeks
decongestants - Recurrent colds
• Presence of foreign bodies
RHINOSINUSITIS
• Exposure to allergens
• Inflammation of the paranasal sinuses and
Symptoms Acute Rhinitis
nasal cavity.
Nasal discharge Initially watery, then mucoid
Eyes Tearing during early phase • Paranasal sinuses- are air filled spaces.
Turbinates Edematous • Formerly called sinusitis
Nasal polyps No polyps Location of Sinus Pain
Headache Generalized
Frontal Sinus

Symptoms Allergic Rhinitis • Localized to supraorbital

Nasal discharge Thin, watery, Rhinorrhea area
(runny nose) excessive
Eyes Tearing, itching Ethmoid Sinus
Turbinates Pale, edematous, mucoid • Deep to eye
Nasal polyps Sometimes
Headache Generalized Maxillary Sinus

• Referred to teeth
Symptoms Chronic Rhinitis
Acute Chronic
Nasal discharge Serous, mucopurulent or
Assessment/Diagnostic Careful History, x-ray of
purulent
Findings sinuses, CT scan or nasal
Eyes NO Tearing
endoscopy
Turbinates Enlarged
Nasal polyps Sometimes Complications Meningitis Orbital
Headache Generalized Brain Abscess cellulitis
Reduced blood flow - Ischemia Subperiosteal
Injury or death of tissue - Infarction abscess
Management Inflammation in the skull -
Osteomyelitis Cavernous
• NO specific treatment
sinus
• Goals: thrombosis
1. Relieve symptoms – symptomatic Meningitis
management Brain abscess
2. Inhibit spread of infections
3. Reduce the risks of bacterial complications
 Acute Chronic Nursing Management
Duration <4 weeks (Adult) >12 weeks
<2 weeks (Child) (Adult) 1. Instruct patient about methods to promote
>2 weeks (Child) SINUS DRAINAGE:
Pathophysiology Thick mucous occludes sinus cavity - Steam inhalation
& prevents drainage which provides - Increased fluid intake
an excellent medium for bacterial - Local heat (hot wet packs)
growth 2. Stress the importance of medication regimen
Clinical Pressure, pain Impaired 3. Explain to the patient that fever, severe
Manifestations over the sinus mucociliary headache & nuchal rigidity are sign of
area & purulent clearance & potential complications
nasal secretions ventilation,
cough, chronic Surgical Management
hoarseness &
1. FESS (Functional Endoscopic Sinus Surgery)
headaches in the
periorbital area, 2. Caldwell-Luc (Radical Antrum Operation)
facial pain & 3. Transnasal, External, or Transantral
nasal stuffiness Ethmoidectomy
4. Frontal Sinus Surgery
5. Sphenoid Sinus Surgery
Typical Pathogen of Acute Rhinosinusitis
FESS
1. Streptococcus pneumoniae
2. Haemophilus influenzae • A fiber optic endoscope that illuminates and
3. Staphylococcus aureus magnifies, is used to enter the sinus &
4. Moraxella catarrhalis removes diseased mucosa
• Indications:
Diagnostic Test 1. Recurrent or chronic sinusitis
1. Transillumination reveals decrease in the 2. Removal of polyps, foreign bodies or
transmission of light in the affected sinus. other growths
- It reveals the condition of sinus 3. Recurrent or chronic pain caused by
2. X-ray nasal or sinus blockage
3. CT scan- Computerized Tomography Scan 4. Removal of diseased tissue
4. Sinus aspiration Post-operative Care
Medical Management • DO NOT blow your nose 3-5 days after surgery
• Goals • If you feel fluid or congestion in your nose,
1. Treat the infection gently sniff back and expectorate it from your
2. Shrink the nasal mucosa mouth
3. Relieve pain • TRY NOT to sneeze
• Administration of ANTIBIOTICS for 7-10 days • DO NOT bend over, lift heavy objects
or up to 21 days • Rest & activity
• Augmentin drug of choice (Amoxicillin)
Caldwell-Luc Surgery
• Vibramycin if allergic to penicillin
• Others levofloxacin, cefuroxime, cefixime and • An incision is made under the upper lip, part
etc. of the anterior bony wall of the antrum is
• Intranasal saline lavage removed producing a permanent window.
o Lavage- means washing out or
“ilabas”
• Other medication:
- Decongestants, mucolytic agent
- Antihistamine
- Saline spray
- Heated mist and saline irrigation
Post-operative Care • Direct pinch the soft outer portion of the nose
against the midline septum for 5 or 10
• DO NOT chew on affected side
minutes continuously
• Use caution with oral hygiene
• Avoid wearing dentures for 10 days
• Avoid blowing nose for 2 weeks after packing
has been removed
• Avoid sneezing as much as possible

Ethmoidectomy

• Is performed to remove diseased mucosa,

polyps or mucoceles from the ethmoid sinus.
EPISTAXIS
• Nosebleed- originates at the anterior nasal
septum.
• Hemorrhage from the nose
• Is caused by the rupture of tiny, distended
vessels in the mucous membrane of any area
of the nose
• Most nosebleeds originate from the anterior
septum of the nose
• 3 major arteries: anterior ethmoidal artery,
sphenopalatine artery and internal maxillary
branches
o Arterial and vein mapping is used to
diagnose.
Risk Factors
• Trauma
• Infection
• Inhalation of illicit drugs
• Cardiovascular diseases (e.g. arteriosclerosis
(build-up of fats in arteries that causes
narrowed arteries), HPN)
• Thrombocytopenia (decreased number in
platelets)
• Nasal tumors
• Low humidity
• Drying of mucus membrane
• A foreign body in the nose
• Deviated nasal septum
• Vigorous nose blowing and nose picking
• Application of nasal decongestants
• (phenylephrine 1-2 spray)
• Silver nitrate or cautery
Medical Management
• If bleeding is occurring from the posterior
regions, cotton pledgets soaked in a
vasoconstricting solution.
• Cotton tampon to stop the bleeding.
• Suction to remove excess blood and clots.
• Nose packing (nasal packing) with gauze
impregnated with petrolatum jelly or
antibiotic ointment if the origin of bleeding is
not identified.
• Tranexamic Acid (hemostan)- used to control
heavy bleeding that may be given orally or iv.
• Use of cold compress to promote
vasoconstriction and prevent bleeding.
• A topical anesthetic spray and decongestant
prior to inserting the gauze packing, or a
balloon-inflated catheter may be used.
• The packing may remain in place 3 to 4 days if
necessary to control bleeding.
• Antibiotics may be prescribed.

Medical Management

• In anterior nosebleeds, silver nitrate Nursing Management

application and Gelfoam, or by electrocautery
• Monitor vital signs
• Topical vasoconstrictors, such as adrenaline
(11,000), cocaine)0.5%), and phenylephrine • Assist in the control of bleeding
• Applying direct pressure • Health teaching to prevent epistaxis e.g.
avoiding forceful nose blowing, vigorous
• Upright position with the head tilted forward
 exercise, straining, high altitudes, and nasal
trauma (including nose picking)
• Adequate humidification to prevent drying of
the nasal passages
• Avoid hot and spicy foods, tobacco
OBSTRUCTIVE SLEEP APNEA (reduction in ventilation)
• A disorder characterized
by recurrent episodes of
upper airway obstruction
and a reduction in
ventilation
• Apnea during sleep
caused by repetitive
upper airway obstruction
• Common in 26% of adult
ages 30 and 70 years old
• Is the common category of sleep-disordered
breathing
• The muscle tone of the body ordinarily relaxes
during sleep, and at the level of the throat the
human airway is composed of collapsible
walls of soft tissue which can obstruct
breathing during sleep.
• 3’s: Snoring, sleeping, lack of sudden apnea or
SOB.
longer for at least 5 episodes per hour
followed by awakening abruptly
Medical Management
• Avoid alcohol or muscle relaxants
• Losing weight
• Quit smoking
• Sleeping at a 30-degree elevation of the upper
body or higher, as if in a recliner
• Lateral positions are also recommended (side
lying)
• Oral appliances to keep the airway open
during sleep (e.g. oropharyngeal airway)
• Oral appliances (mandibular advancement
devices)
• CPAP (continuous positive airway pressure) is
a machine that uses mild air pressure to keep
breathing airways open while you sleep.
o BiPAP- more pressure in breathing,
for patients w/ severe sleep apnea.
• Administration of low-flow oxygen at night to
help relieve hypoxemia. (normal: 1-2 lpm)
• Surgical procedure to remove and tighten
tissue and widen the airway
Surgical Management

Risk Factors • Tonsillectomy- used for larger or enlarged

tonsils that obstructs the airway.
• Obesity- because of fatty deposits or the • Uvulopalatopharyngoplasty
tongue leaning backwards which obstructs • Nasal septoplasty- for deviated nasal septum.
your airways specifically in the larynx. • Maxillomandibular surgery
• Male
• Postmenopausal status Medication
• Advance age • Provigil reduce daytime sleepiness
Clinical Manifestations • Triptil increase respiratory drive and improve
upper airway muscle tone
• Frequent snoring loud • Provera (for menopause women that lacks
• Breathing cessation progesterone; treats irregular period)
for 10 seconds or • Diamox (decreases bp; treatment for
glaucoma or increased pressure in eyes)

PHARYNGITIS

• Painful inflammation of the pharynx

• Maybe viral or bacterial
• Risk factors:
1. Tobacco & alcohol
2. With chronic cough
3. Dusty environments
4. Use thin voices excessively
Clinical Manifestations build ups of fluid which would cause
swelling or SOB.
• Sore throat
• Cool beverages, warm liquids and flavored
• Dysphagia (difficulty of swallowing)
frozen desserts such as ice pops are often
• Fiery-red pharyngeal membrane tonsils soothing.
• Enlarged & tender cervical lymph nodes
(located at the sternocleidomastoid) TONSILLITIS
• Malaise (discomfort)
• Acute infection of the tonsils usually caused
• Fever
by streptococcus.
• Lymphoid – follicles that are swollen and
• Signs and Symptoms:
flecked with white-purple exudate
1. Sore throat
Diagnostic Test 2. Fever
3. Dysphagia
• Rapid antigen detecting testing 4. Generalized malaise
• Collect specimen from the posterior pharynx 5. Inflamed tonsils with or w/o
Medical Management purulent exudates
6. Nuchal rigidity (stiff neck)
• Viral Pharyngitis
1. Supportive management
2. Nasal spray/decongestants
3. Antihistamines
• Bacterial pharyngitis
• 1-3 of viral
4. Antibiotic Diagnostic Findings
Penicillin drug of choice
Erythromycin if allergic to penicillin • Thorough PE
Other Medication • Careful history
• Clarithromycin • Tonsil culture
• Azithromycin Management
• Cefpodoxime
• Cefuroxime Supportive management

Nursing Management 1. Increase OFI

2. Antibiotic penicillin
1. Instruct the patient to: 3. Analgesics
- Avoid alcohol, tobacco, second hand 4. Saline throat irrigation or gargle
smoke & exposure to cold 5. Tonsillectomy
- Encourage patient to drink plenty of fluids
- Gargling with warm saline solution (or Tonsillectomy – removal of tonsils.
warm water w/ salt) • Streptococcus can migrate up to the heart,
2. Ice collar that is why this procedure is needed to
3. Bedrest prevent further complications.
4. Replace toothbrush with new one
5. Mouth care Signs & Symptoms: Frequent swallowing due to
bleeding after tonsillectomy.
Nutritional Management
Indications:
• Liquid or soft diet
o Hard diet can irritate or cause 1. Recurrent or incapacitating episodes of
abrasion to the inflamed area. chronic tonsilitis
• Increase fluid intake 2-3 liters per day 2. Tonsillar or adenoid hypertrophy
o Contraindicated to patients with 3. Following resolution of tonsillar abscess
cardiac/kidney problems to avoid 4. Ear problems
5. Sinus complications
Nursing Management
• In the immediate postoperative period, the
most comfortable position is prone with the
head turned to the side to allow drainage
from the mouth and pharynx
• The nurse applies an ice collar to the neck,
and a basin and tissues are provided for the
expectoration of blood and mucus
• Monitor for signs of bleeding or hemorrhage
• Avoid spicy, hot-acidic and rough foods
o Eat cold foods instead such as ice
cream.
• Advise to avoid vigorous brushing and
gurgling
• Instruct patient to avoid smoking, heavy lifting
or exertion for 10 days
ADENOIDITIS
• Antibiotic
• Mucolytic agents- to liquefy the secretions
and will be accompanied by severe coughing
to expel mucus.
• Steroids- to reduce inflammation.
• Voice rest
• Eliminating smoking
Nursing Management
• The nurse instructs the patient to rest the
voice and to maintain a well-humidified
environment.
• If laryngeal secretions are present during
acute episodes, expectorant agents are
suggested, along with a daily fluid intake of 3L
to thin secretions.
• Instruct to take medications as prescribed.

• Infection of the adenoids frequently

accompanies acute tonsillitis.
• Adenoids are also called as pharyngeal tonsils.

Signs & Symptoms

• Mouth-breathing
• Noisy respiration
• Voice impairment
• Earache
• Foul-smelling odor

Management

• Antibiotic
- Oral penicillin, which is taken for 7 days
- Amoxicillin and erythromycin are
alternatives
- Surgery (adenoidectomy)
- Nsg mgt: same with tonsilitis

LARYNGITIS

• Inflammation of the larynx often occurs as a

result of voice abuse or exposure to dust,
chemicals, smoke or other pollutants

Clinical Manifestations

• Hoarseness
• Aphonia (loss of voice)
• Painful throat
• Severe cough
• Tickle in the throat

Management

• Inhaling cool steam