Management of Patients with Conditions of the Upper Respiratory
Tract
Lecture 3Chapter 22 Brunner’s
Common Cold
AKA:• Rhinitis• Viral rhinitisPathophysiology• Rhinovirus• “Infection with acute
inflammation of the mucous membrane of the nasal cavity”
Common Cold
Etiology• Airborne• Peak Times– Sept, Jan & April
• Duration– 5-14 days
Common Cold
Clinical Manifestations• Nasal congestion• Runny nose• Sore throat• Sneezing• Malaise• Afibrile• H/A• Cough
Common Cold
Dx exams & Procedures• S&S• Culture
Common Cold
Tx methodology• Focus – relief• Tx not shorten• Fluids • Warm, moist air• Medications– OTC
Common Cold
Medications• Antihistamines– Action
• H1 blockers inhibits action
• push off – Take early
• Allergies
Common Cold
Medications• Antihistamines– Rx effect
• Prevents salivary, gastric, lacrimal and bronchial secretions
• Relieves– Sneezing– Rhinorrhea– Nasal congestion
Common Cold
Medications• Antihistamines– Side effects
• Drowsiness• Drying
– Examples• Allergra• Claritin• Benadryl
Common Cold
Medications• Decongestants– Rx Actions
• Shrink engorged nasal mucus membranes
– Side Effects• Rebound congestion• Insomnia
Common Cold
Medications• Decongestants– Examples
• Sudafed• Vicks inhaler• Afrin
Common Cold
Medications• Anti-tussives– Rx Action– Side effects– Example
Common Cold
Medications• Analgesics– Tylenol
(Acetomenaphen)– Motrin (ibuprofen)
• NSAID
– Non-narcotic
Common Cold
Medications• Vitamin C
Common Cold
Medications• Antibiotics
– Prophylactic– Examples
• Sulfonamides• Penicillins• Cephalosporins• Tetrcyclines• Aminglycosides• Quinolones• Macrolides• Vancomycin
Common Cold
Medications• Anti-biotic– Side-effects
• N/V• Yeast infections• Resistance
Common Cold
Medications• Echinacea– Action
• Stim. immune system• Anti-bacterial • Anti-inflammatory
– Use• 10-14 days
– Long tem use• immune system
Common ColdNrs Managements• See MD > 2 wks• Prevention
How do you prevent the cold from getting you?
– Hand wash– Cover mouth– Throw away tissue– Avoid crowds– Vaccine– Eat right– Sleep– Stress– Exercise– Smoking– Allergens– Animals– Carpet
Common Cold
Complications• Bronchitis• Pneumonia• Conjunctivitis
Sinusitis: sinus infection
Pathophysiology• Inflammation of the
mucus membrane of one or more sinuses
• Blocks the egress of sinuses
Sinusitis: sinus infection
Etiology• Bacterial or viral?– #1 bacterial
• Tooth abscess• Allergies• Structural abnormalities
Sinusitis: sinus infection
Clinical manifestations• Pain– Maxillary
• Over cheek and upper teeth
– Ethmoid• Btw & behind eyes
– Frontal• Forehead
• Ethmoid sinusitis
Sinusitis: sinus infection
Clinical manifestations• Anosnia• H/A• Fever?• Fatigue?• Foul breath?
Sinusitis: sinus infection
Dx• S&S• X-ray, CT, MRI• C & S
Sinusitis: sinus infection
Med Tx• Antibiotics• Analgesics– No aspirin
• Nasal decongestants• Mucolytic agents• Surgery
Sinusitis: sinus infection
NRS interventions• Fluids
– • Position
– HOB • Activity
– Rest• Moist hot-packs• Cleaning techniques
– Irrigate nose
Sinusitis: sinus infection
Prevention• Avoid contributing
factors:– Cold– Smoking– Fatigue– URI
• Dentist
Sinusitis: sinus infection
Complications• Osteomylitis• Cellulitis of the orbit• Abscess• Meningitis
Sinusitis: sinus infection• Surgery• Post-op care
– Position• Side lying • semi-fowler
– Ice– Monitor for
• Bleeding• visual acuity• Pain• S&S of infection
– Oral care– Packing x 48 hrs– No blowing– Tarry stools– Avoid constipation
Acute Pharyngitis
Pathophysiology• AKA: sore throat, strep
throat• Inflammation of the
throat
Acute Pharyngitis
Etiology• 70% – Viral
• Bacterial– Streptococcus
Acute Pharyngitis
Clinical manifestations• Sore throat• Febrile• Dysphagia• Exudate• Lymphnoids
– Malaise*– Hoarseness*– Cough*– Rhinitis*
Acute Pharyngitis
Dx exams• Throat culture• Rapid screening
Acute Pharyngitis - Tx
• Viral– Supportive – Like a cold
• Bacterial– Antibiotics– Diet
• Liquid/soft– Analgesics
• Tylenol– Anti-tussive
Acute Pharyngitis - Nrs
• Rest• Rashes?
– Communicable disease• Warm saline gargles
– Temp 105-110 F• Diet
– Liquid• Fluids
– • Ice collar• Oral care
Acute PharyngitisComplications• Sinusitis• Ottis media• Peritonsillar abscess• Scarlet fever• Rheumatic Fever– 2-3 wk /p subsides– Heart damage
• Mital valve damage
Tonsillitis & Adenoiditis
Pathophysiology• Tonsils– Location
• Oropharynx
– Lymph tissue
• Adenoids– Location
• Nasopharynx
Tonsillitis & Adenoiditis
Etiology• Streptococcus• Low resistance• Children
Tonsillitis & Adenoiditis – S&S
• Sore throat• Febrile & chills• Snoring• Dysphagia• Adenoids– Mouth breathing
• Duration– 1-2 wks
Tonsillitis & Adenoiditis - Dx
Dx• Visualize• C&S
• Mono
Tonsillitis & Adenoiditis
Post-op care• Hemorrhaging
– Coffee ground emeses– Bright red emeses– Pulse
• – Temp
• – Restlessness– Tarry stool– swallowing
Tonsillitis & Adenoiditis
Post-op• Position– Prone/side lying until…
• Gag returns– Semi-fowler’s
• Pain control– Ice collar– Acetaminophen
• Not aspirin
Tonsillitis & Adenoiditis
Post-op• Diet
– Ice cold fluids– Adv. To normal ASAP
• 2-3 days– Milk products
• – Avoid
• Spicy• Hot• Acidic• Rough
Tonsillitis & Adenoiditis
• Post-op• Pt education
– S&S of hemorrhaging– Mouthwash good– Avoid
• Coughing• Sneezing• Vigorous nose blow• Vigorous gargling• Rough foods
– Expect black tarry stools– Normal activity ASAP
Peritonsillar Abscess
Pathophysiology• Pus & blood filled sacs
on tonsilEtiology• Complication of strep
throat
Peritonsillar Abscess
S&S• Pain– Local– Radiates ear
• Dysphagia– drooling
• Dysphasia• Fever• Red throat
Peritonsillar AbscessTx• Antibiotics• Incision & drain
– Lanse• Warm saline irrigation• Hydrogen peroxide• Analgesics
– Topical – Tylenol– No aspirin– ? narcotics
• Ice collar• No smoking• Ventilator?
Laryngitis
• Pathophysiology– Inflammation of the
mucous membrane lining the larynx
– With edema of the vocal cords
Laryngitis
• Etiology– Viral– Voice abuse– Dust
Laryngitis
• Risk factors– Airborne irritants– Cold– Resent RTI– Smoking
Laryngitis
• Clinical manifestations– Aphonia
• Voice loss
– Hoarseness– Cough?
• Severe
Laryngitis
• Treatment– Voice rest– Bed rest– Smoking?
• NO!
– Humidifier– Fluids?
•
– Expectorants
Laryngitis
• Prevention– Avoid…
• Irritants• Cold• Voice strain• Smoking
Epistaxis
• Pathophysiology– Tiny blood vessels in
nose rupture
Epistaxis
• Anterior bleeds usually stop spontaneously or self treated
• Posterior bleeds may require med treatment
Epistaxis
• Etiology– Irritation– Infection– Drugs– Humidity– Trauma– Hypertension– Blood dyscrasias
Epistaxis
• Tx– Initial
• Apply direct pressure• 5-10 min• Position
– Head tilted down– Initial d/t trauma
• Do not pinch• Ice pack over nose & eye• Position
– Head down– ? Neck injury
Epistaxis
• Tx– ER
• Packing– Silver nitrate &
gelfoam– Painful– Remains 4-5 days
• Topical vasoconstrictor– Epinephrine
Epistaxis
• Nrs Management– V/S– Control bleeding– Hgb level– PT/PTT– Take BP meds– aspirin– vigorous blowing– strenuous exercise
Epistaxis
• Complications?
Nasal Polyps
• Pathophysiology– Benign grape-like
growths of mucous membrane and loose connective tissue within the nasal cavity
Nasal Polyps
• Etiology– Recur– Triad disease
• Polyps• Asthma• Allergy to aspirin
Nasal Obstruction
• Etiology– Deviated septum– Hypertrophy of
turbinate bone– Polyps– Foreign object
Nasal Obstruction
• Clinical Manifestations– Foul odor
• Malodorous
– Halitosis– allergies– Noisy breathing– post-nasal drip
Nasal Obstruction
• Tx– Remove obstruction
• Out the same way in• Sneezing w/ opposite
nasal closed• irrigate• push backwards
– Surgery
Nose surgery
Submucous resection: Nasoseptoplasty: Rhinoplasty: Polypectomy:
Nrs Care – Post OP nasal surgery
• hemorrhaging• Infection• Comfort• Nutrition• Pt. Ed• Avoid aspirin
Nasal Obstructions
Complications• Chronic infections of the
nose• Anosmia • Pharyngitits• Sinusitis
Fracture of the Nose
• Etiology– #1 bone broken
• S&S – Pain– Bleeding– Swelling– Deformity
Fracture of the Nose
• Clear fluid drainage • Fx of cribiform plate• CSF• Mucus vs. CSF– glucose
Fracture of the Nose
• Tx– Control bleeding
• Cold compress
– Reduce after • swelling • 7-10 days later• Re-brake nose
Fracture of the Nose
• Nrs Management– #1 Assess breathing– Ice– Pack – Mouth breathing
• Dry– adjust– Pain med
• Acetaminophen– Trauma
• neck injury
Laryngeal Obstruction
• Pathophysiology– Edema
• Etiology– Anaphylaxis
• Meds• Bees• Nuts• Sea food
– Foreign object
Laryngeal Obstruction
• S&S– Can not…
• Talk• Cough• Breath
– Universal sign– Color changes– Affect
• distressed
Laryngeal Obstruction
• Tx– Choking
• Heimlich maneuver
– Anaphylaxis• Sub q epinephrine• Corticosteroids• Ice pack
Laryngeal Obstruction
• Prevention– Avoid– Epi-pen
• Complication– Death
Sleep Apnea
• Pathophysiology– Partial or complete
upper airway obstruction during sleep causing apnea & hypopnea
– Occurs when tongue and soft palate fall backwards
Sleep Apnea
– Duration of apnea• 15-90 seconds• Sever hypoemia
– PaO2 »
• Hypercapnia– PaCO2
»
Sleep Apnea
– Causes partial awake – Startle, snort, gasps – Soft palate & tongue move
forward – Airway opens
Sleep Apnea
• S&S– waking at noc– Insomnia– Daytime sleepiness– Loud snoring– AM h/a
• Pa CO2 • vasodilitation • H/a
– Personality changes– Driving accidents– Family problems– Employment
compromised
Sleep Apnea
• Tx– Mild
• Avoid – Sedatives– Alcohol
• Wt loss• Oral appliance
Sleep Apnea
• Tx– Severe
• CPAP– Continuous Positive
Airway Pressure– Mask– High flow– Prevents collapse
• Surgery
CA of the larynx
• Classification– T –
• tumor
– N – • Nodes
– M –• Metastasis
CA of the larynx
• Pathophysiology– Squamous cells– Metastasis
• Lung• Liver• Lymphs
CA of the Larynx
• Etiology– Curable if detected early
but…– Men vs. women?
• > men– Carcinogens
• Tobacco• Alcohol• Asbestos• Mustard gas • Etc
– Family predisposition
CA of the Larynx
• S&S– Early
• Hoarseness
– Middle• Change in voice• Pain• Lump
CA of the Larynx
• S&S– Late
• Dysphagia• Dyspnea• Foul breath• Enlarged lymph's• Wt loss• Debilitative state• Pain ear
CA of the Larynx
• Dx– H&P– X-ray– MRI– Laryngoscopy
• Biopsy
CA of the larynx
• Tx– Radiation– Surgery/laryngectomy
• Partial– Early– Remove
» Portion» 1 vocal cord» Tumor
– Still talk– Airway intact– No dysphagia
CA of the larynx
• Tx – Total laryngectomy
• Remove– Larynx– 2-3 rings of trachea
• Permanent tracheal stoma
• Laryngectomy tube• Total voice loss• Normal swallowing
CA of the larynx
• Nrs management– Assess
• Hoarseness• Pain• Dyspnea• Dysphagia• Palpate neck• Diet
– protein
CA of the larynx
• Nrs management– Pre-op
• Assess– Ability to
» See» Hear» Read» Write
• Anxiety
CA of the larynx
• Nrs management– Post-op
• Airway– Suction PRN
• Pain • Communication• Nutrition
– NPO x 14 days– Parenteral / NGT
• Mobility
CA of the larynx
• Laryngectomy tube– Shorter but
diameter than tracheostomy tube
– Care same as trach– Clean q day with
normal saline– No tissues– No swimming– Humidify air