CH 29 Patients With Noninfectious Upper Respiratory Problems

Chapter 29
Care of Patients with Noninfectious

Upper Respiratory Problems
From Christensen, B.L. & Kockrow, E.O. (2006). Foundations and Adult Health Nursing, 5th Ed. St. Louis: Mosby.
Copyright © 2018 Elsevier Inc. All rights reserved.

Concepts
 The priority concept in this chapter is
 CELLULAR REGULATION
 GAS EXCHANGE
The CELLULAR REGULATION exemplar for this
chapter is Head and Neck Cancer
 The interrelated concepts in this chapter are
 NUTRITION
 TISSUE INTEGRITY
2
Anatomy of the Nose and Sinuses
From Seidel, H.M., Stewart, R.W., Ball, J.W., Dains, J.E., Flynn, J.A., & Solomon, B.S. (2011). Mosby's Guide to Physical Examination, 7th Ed. St. Louis: Mosby.
3
Cellular Regulation Exemplar:
Head and Neck Cancer
 Squamous cell carcinoma and slow growing
 Begins with mucus that is chronically irritated,
becoming tougher and thicker
 Leukoplakia and erythroplakia lesions
4
Interprofessional Collaborative Care
Assessment: Noticing
 Lumps in mouth, throat, neck
 Difficulty swallowing
 Color changes in mouth or tongue
 Oral lesion or sore that does not heal in 2 weeks
 Persistent, unilateral ear pain
 Persistent/unexplained oral bleeding
 Numbness of mouth, lips, or face
 Change in fit of dentures
5
Assessment: Noticing (Cont.)
 Hoarseness or change in voice quality
 Persistent/recurrent sore throat
 Shortness of breath
 Anorexia and weight loss
 Change in fit of dentures
 Burning sensation when drinking citrus or hot
liquids
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Analysis: Interpreting
 The priority interprofessional collaborative
problems for patients with head and neck cancer
include
 Potential for airway obstruction
 Potential for aspiration
 Anxiety
 Decreased self esteem
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Planning and Implementation: Responding
 Radiation therapy
 Chemotherapy
 Cordectomy
 Laryngectomy
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Laryngectomy Postoperative Care
 First priorities are airway maintenance and
gas exchange
 Wound, flap, reconstructive tissue care
 Hemorrhage
 Wound breakdown
 Pain management
 Nutrition
 Speech and language rehabilitation
9
Communication After Laryngectomy
10
Care Coordination and Transition
Management
 Home care management
 Self-management education
 Stoma care
 Communication
 Smoking cessation
 Psychosocial preparation
 Health care resources
11
Cancer of the Nose and Sinuses
 Tumors rare, benign or malignant
 Seen with exposure to dust from wood,
textiles, leather, flour, nickel, chromium
mustard gas, radium
 Slow onset, resembles sinusitis
 Lymph enlargement often occurs on side
with tumor mass
 Surgical removal is treatment; may be
combined with radiation (IMRT)
12
Fracture of the Nose
 Displacement of bone or cartilage can cause
airway obstruction or cosmetic deformity;
potential source of infection
 CSF may indicate skull fracture
 Interventions
 Closed reduction
 Rhinoplasty
 Nasoseptoplasty
13
Postoperative Care
after Rhinoplasty
 Observe for edema and bleeding
 Check vital signs every 4 hours
 Change drip pad as needed
14
Epistaxis
 Nosebleed is a common problem
 Cauterization of affected capillaries may be
needed; nose is packed
 Posterior nasal bleeding is an emergency!
 Assess for respiratory distress, tolerance of
packing or tubes
 Humidification, oxygen, bedrest, antibiotics,
pain medications
15
Facial Trauma
 Priority action is airway assessment
 Manifestations
 Stridor
 Shortness of breath/dyspnea
 Anxiety/restlessness
 Hypoxia and hypercarbia
 Decreased oxygen saturation
 Cyanosis, loss of consciousness
16
Le Fort Fracture
 I—Nasoethmoid complex
fracture
 II—Maxillary and nasoethmoid
complex fracture
17
Le Fort Fracture (Cont.)
 III — Combination of I & II
plus orbital-zygoma
fracture; often called
craniofacial disjunction
18
Facial Trauma
 Airway assessment
 Anticipate need for emergency intubation
 Tracheotomy
 Cricothyroidotomy
 Fixed occlusion
 Débridement
19
Obstructive Sleep Apnea
 Breathing disruption during sleep
 Excessive daytime sleepiness, inability to
concentrate, irritability
 Nonsurgical management: Change of sleep
position, weight loss, positive-pressure
ventilation
 Surgical management: Adenoidectomy,
uvulectomy, or uvulopalatopharyngoplasty
20
Positive Airway Pressure
21
Disorders of the Larynx
 Vocal cord paralysis
 Vocal cord nodules and polyps
 Laryngeal trauma
From Osma-Ruiz, V., Godino-Llorente, J.I., Sáenz-Lechón, N., Fraile, R. (2008). Segmentation of the glottal space from laryngeal images using the watershed transformation. Comput Med Imaging
Graph 23(3): 193–201.
22
Upper Airway Obstruction
 Interruption in airflow through nose, mouth,
pharynx, or larynx
 Life-threatening emergency
 Early recognition essential in preventing
further complications, including respiratory
arrest
23
Upper Airway Obstruction
 Assess cause of obstruction
 Maintenance of patent airway and ventilation
 Cricothyroidotomy
 Endotracheal intubation (nasotracheal or
orotracheal)
 Tracheotomy
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Chapter 29

Care of Patients with Noninfectious

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Graph 23(3): 193–201.

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