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UPPER RESPIRATORY INFECTIONS ALLERGIC RHINITIS Is clinically defined as a symptomatic disorder of the nose induced an IgE-mediated inflammation after exposure of the membranes liningthe nose Onset is common in childhood, adolescence and early adulthood Symptoms often wane in older adults, but may develop or persist at any No apparent gender selectivity or predisposition for developing allergic rhinitis May contribute to other conditions such Sleep disorders Fatigue Learning problems The Allergic Reaction How are the symptoms caused? Irritation of endings Itching and sneezing Increased mucus production Rhinorrhoea Vasodilation Congestion Increased vascular permeability Edema Clinical Manifestations Nasal congestion Postnasal drainage Nasal pruritus Ear symptoms Watery rhinorrhea Eye symptoms Repetitive sneezing Diagnosis of AR History Physical / Nasal Examination LaboratoryTesting Skin Prick Test Peak Nasal Inspiratory Flow Rate Rhinomanometry Management of AR Allergen Avoidance Pharmacotherapy Immunotherapy Medications used to treat allergic rhinits: Antihistamines chlorpheneramine Decongestants oxymetaxoline AH--D combinations Corticosteroids beclomethasone MastCell stabilizers Cromolyn sodium Anticholinergics Antileukotrienes Antihistamines Act by preventing histamine from binding to the H11 receptors


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itching & rhinorrhoea Ineffective in releiving nasal blockage 1st generation anti-histamines 2nd generation antihistamines chlorpheniramine cetrizine diphenylhydramine azelastine fexofenadine loratadine 11 VIRAL RHINITIS Common causative organisms: Rhinovirus 1° causative organism Respiratory syncytial virus Adenovirus . painful inflammation of the pharynx. Clinical Manifestations Fiery-red pharyngeal membrane and tonsils Swollen lymphoid follicles flecked with white-purple exudate Enlarged and tender cervical lymph nodes ( .) cough 12 13 14 15 16 17 2 . Commonly referred to as sore throat .9/5/2010 Antihistamines Act by preventing histamine from binding to the H11 receptors Primarily helpful in controlling: Sneezing.mainly spreads by droplet infection Clinical Manifestations Rhinnorea Sneezing Nasal congestion Sore throat Lethargy Fatigue Complications Pharyngitis Sinusitis Otitis media Tonsilitis Chest infections RHINOSINUSITIS Formerly called sinusitis An inflammation of the paranasal sinuses and nasal cavity Classified by duration of symptoms: Acute (less than 4 weeks) Subacute (4-12 weeks) Chronic (more than 12 weeks) Signs & Symptoms Purulent nasal drainage Facial pain-pressure-fullness Cloudy or colored nasal discharge Localized or diffused headache ACUTE PHARYNGITIS Sudden.

) cough Fever (higher than 38.3°) Malaise Sore throat Diagnosis of AP Culture study / swab specimens (Posterior pharynx and tonsils) RSAT Medical Management Viral: Supportive measures Bacterial: Antibiotics Penicillin Cephalosporins Macrolides (clarithromycin.9/5/2010 18 Enlarged and tender cervical lymph nodes ( . acetaminophen Nursing Management Oral hygiene (salt-water gargle) Liquid or soft diet Cool beverages. suffer from chronic cough Habitual use of alcohol and tobacco Medical Management Avoid exposure to irritants Relief of nasal congestion by short term use of decongestants Ephedrine sulfate (Kondon s Nasal) Phenylephrine hydrochloride (Neo-synpehrine) Pseudoephedrine (Sudafed) Brompheneramine Surgery TONSILLITIS AND ADENOIDITIS Signs and Symptoms: (Tonsillitis) Sore throat Fever Snoring Difficulty swallowing 22 23 24 3 . warm liquids and flavored frozen desserts Increase fluid intake Assess skin for rashes 19 20 21 Signs of Complications Dyspnea Drooling Inability to swallow Inability to fully open mouth CHRONIC PHARYNGITIS Persistent inflammation of the pharynx Risk Factors: Dusty surroundings People who use their voice to excess. azithromycin) Analgesics Aspirin.

or clindamycin 2. or ENT office Continue as above with ATBX and pain controlASD 3.9/5/2010 Snoring Difficulty swallowing 25 26 Management Increase fluid intake Administer analgesics Salt-water gargles Promote rest Surgery Tonsillectomy Adenoidectomy Pharmacologic therapy Penicillin Cephalosphorins PERITONSILLAR ABSCESS Epidemiology: Accumulation of pus between the tonsillar capsule and the surrounding tissues. Also called quinsy More common in adolescents than in children Greatest risk to airway Spontaneous rupture of abscess SIGNS & SYMPTOMS Appear acutely ill Deviation of tonsil toward midline with rotation of anterior or tonsillar pillar Dysphagia Enlargement of the tonsil Fever Trismus Drooling Hoarse. liquids Diagnosis Uvular deviation Marked soft palate displacement Severe trismus Airway compromise Localized areas of fluctuance 27 28 29 Treatment 1. a macrolide. If patient is nontoxic-appearing. Tonsillectomy 30 Management Encourage the use of prescribed topical anesthetic agents 4 .D. muffled hot potato voice Ipsilateral ear pain and torticollis Refusal of food and. Definitive tx for PTA is either I&D in OR or needle aspiration in E. in severe cases. has findings most consistent with peritonsillar cellulitis and has good follow up with PCP or ENT then may tx as outpatient with penicillin.

chemicals. and other pollutants 32 33 34 35 36 Signs and Symptoms Hoarseness Aphonia Severe cough OBSTRUCTION AND TRAUMA OF THE UPPER RESPIRATORY AIRWAY OBSTRUCTION DURING SLEEP Recurrent episodes of upper airway obstruction and a reduction in ventilation. followed by awakening abruptly with a loud snort. BiPAP Surgery: Tonsillectomy Uvulopalatopharyngoplasty Nasal septoplasty Tracheostomy Pharmacologic Therapy Modafinil (Provigil) Protriptyline (Triptil) 39 5 . 5 episodes per hour. Risk Factors Obesity Male Postmenopausal stage Advanced age Clinical Manifestations Frequent and loud snoring with apnea for 10 seconds or longer. Defined as cessation of breathing (apnea) during sleep. smoke. Gasping Choking 37 38 Diagnosis of OSA Sleep study (Polysomnographic finding) which includes the following: EEG Electro-oculogram ECG Respiration Oximetry Medical Management Weight management and avoidance of alcohol and hypnotic medications CPAP.9/5/2010 Management Encourage the use of prescribed topical anesthetic agents Assist with throat irrigation (Saline or alkaline gargles) Adequate hydration Observe and instruct the client for signs of complications (hemorrhage) 31 LARYNGITIS Inflammation of the larynx Commonly. viral Often as a result of: Voice abuse Exposure to dust.

Causes Non .Anatomic: Chronic sinusitis Allergies Overuse of nose sprays Birth control pills Hypertension Thyroid abnormality Medical Management Surgical Functional Rhinoplasty Pharmacologic Nasal corticosteroids Leukotriene inhibitors Antibiotics Astringent (for hypertrophied turbinates) Nursing Management Position: Elevate the head of the bed. Two major components of the nasal passages are the septum and the turbinates.9/5/2010 40 4 42 Modafinil (Provigil) Protriptyline (Triptil) Medroxyprogesterone acetate (Provera) Acetazolamide (Diamox) EPISTAXIS (NOSEBLEED) Bleeding from the nose caused by rupture of tiny. head tilted Apply direct pressure. nasal tumor. distended vessels in the mucus membrane Most common site: Anterior septum Causes: Trauma Infection Hypertension Blood dyscracisa. notify the physician Bleeding Infection FRACTURES OF THE NOSE Bones of the nose are broken more often than any other facial bone. Pinch nose against the middle septum. cardio diseases Management Position patient: Upright. Clinical Manifestations Pain Bleeding from the nose (Externally and Internally into the pharynx) Swelling of the soft tissues 43 44 45 46 47   6 . May affect the ascending process of the maxilla and the septum. leaning forward. gel foams) Assist in electrocautery and apply nasal packing for posterior bleeding NASAL OBSTRUCTION Sense of blockage within the nose or difficulty breathing out of one or both sides. administer topical vasoconstrictors (silver nitrate. 5-10 minutes If unrelieved. Oral hygiene Instruct to avoid blowing the nose with force Observe for signs of complications.

history of airway problems. Men Race. Most begin in the glottis Etiology: Unknown 53 54 55 Risk Factors Age. pain or fever. nickel and asbestos. fatal condition 50 51 52 Clinical Manifestations X-ray confirms the diagnosis May have lowered oxygen saturation Retractions in the neck or abdomen during inspirations Assessment and Diagnosis Patient s history (heavy alcohol or tobacco consumption. A personal history of head and neck cancer. Gender. radiation therapy or trauma) Medical Management Ensure patent airway Finger sweep Subdiaphragmatic abdominal thrust maneuver Tracheotomy Pharmacologic Epinephrine Corticosteroid Ice compress on the neck to reduce edema CANCER OF THE LARYNX Also known as laryngeal cancer. current medications. African Americans Smoking. previous surgeries. Occupation. Diet low in vitamin A GERD Signs & Symptoms of LC Hoarseness or other voice changes A lump in the neck 7 . dental pain or poor dentition. recent infections. often. It can develop in any part of the larynx. Over the age of 55. Alcohol.9/5/2010 Bleeding from the nose (Externally and Internally into the pharynx) Swelling of the soft tissues Periorbital ecchymosis Nasal obstruction Deformity 48 49 Assessment & Diagnosis Intranasal examination to rule out septal hematoma Clear fluid draining from either nostril suggests a fracture of the cribiform plate with leakage of cerebrospinal fluid. Exposure to sulfuric acid mist. Deviations of the bone or disruptions of the nasal cartilages X-ray LARYNGEAL OBSTRUCTION Serious.

9/5/2010 56 57 58 Hoarseness or other voice changes A lump in the neck A sore throat or feeling that something is stuck in your throat A cough that does not go away Problems in breathing Bad breath An earache Weight loss Diagnosis Physical exam Indirect laryngoscopy Direct laryngoscopy CT scan Biopsy Medical Management Radiation therapy Radiation therapy combined with surgery Radiation therapy combined with chemotherapy Surgery Total laryngectomy Partial laryngectomy (hemilaryngectomy) Supraglottic laryngectomy: The surgeon takes out the supraglottis. Cordectomy: The surgeon removes one or both vocal cords. the top part of the larynx. Chemotherapy Nursing Management Pre-operative Provide the patient pre-operative teachings Clarify misconceptions Tell that the natural voice will be lost Teach communication alternatives Reduce anxiety Provide opportunities for patient and family to ask questions Referrals to previous patients with LA and cancer groups Maintain patent airway Position: Semi or High Fowler s Suction secretions Encourage to deep breath. turn and cough Nursing Management Post-operative: Administer care of the laryngectomy tube Suction as needed Cleanse the stoma with saline Administer humidified oxygen Laryngectomy tube is usually removed within 3-6 weeks after surgery Promote alternative communication methods Call bell or hand bell Magic slate Hand signals Collaborate with speech therapist 59 8 .

avoid sweets Promote positive body image and self-esteem Encourage verbalization of feelings Allow independence in self-care Monitor for signs of complications Respiratory distress Hemorrhage Wound infection and breakdown Increased temperature. powders and loose hair near the opening Frequent oral hygiene 9 . TPN are alternative nutrition routes Start oral feedings with thick liquids. purulent drainage and redness/tenderness 61 Nursing Management Administer antibiotics Clean and change dressing OD Humidification system at home Avoid swimming Cover the stoma with hands or plastic bib over the opening Advise beauty salons to avoid hair sprays.9/5/2010 60 Nursing Management Post-operative: Provide adequate nutrition NPO after operation for 10 days IVF.