Caring for Clients With Upper Respiratory Disorders

Question 1

What observations and assessments will the nurse make that are specific for the client following sinus surgery?

Answer 1

If a client has had sinus surgery, the nurse institutes standards for postoperative care and observes the client for repeated swallowing, a finding that suggests possible hemorrhage. One risk of sinus surgery is damage to the optic nerve. Thus, the nurse assesses postoperative visual acuity by asking the client to identify the number of fingers displayed. The nurse monitors the client’s temperature at least every 4 hours, assessing for pain over the involved sinuses, a finding that may indicate postoperative infection or impaired drainage. The nurse administers analgesics as indicated and applies ice compresses to involved sinuses to reduce pain and edema. The nurse will encourage oral hygiene and gives ice chips or small sips of fluids frequently. The nurse instructs the client to change the drip pad as needed and completes postoperative teaching.

Question 2

What complications can occur following pharyngitis caused by group A streptococci?

Answer 2

Pharyngitis caused by group A streptococci can lead to dangerous cardiac complications (endocarditis and rheumatic fever) and harmful renal complications (glomerulonephritis).

Question 3

What interventions may the nurse initiate independently to control bleeding for epistaxis?

Answer 3

The nurse may initiate measures to control bleeding, such as applying pressure and ice packs. Other treatments require a primary provider’s order.

The head should not be tilted back because

Question 4

What are the symptoms of obstructive sleep apnea?

Answer 4

• Clients snore loudly, with cessation of breathing for at least 10 seconds. These episodes may occur many times within 1 hour.
• Clients awaken suddenly as the partial pressure of oxygen (PaO2) level drops, usually with a loud snort.
• Other symptoms include daytime fatigue, morning headache, inability to concentrate when awake, sore throat, enuresis, erectile dysfunction, dysrhythmias, systemic hypertension, decreased interest in sex, and forgetfulness.
• Partners may report that the individual behaves differently and is not the same personality and that snoring progressively worsens.

Question 5

Which carcinogens are associated with laryngeal cancer?

Answer 5

Carcinogens such as tobacco, smokeless tobacco, secondhand smoke, alcohol, and industrial pollutants are associated with laryngeal cancer. In addition, chronic laryngitis, specific viruses such as the human papilloma virus (HPV), and acid reflux may be factors.

Question 6

What are indications for an endotracheal tube?

Answer 6

Indications for an endotracheal tube include clients with respiratory difficulty, comatose clients, those undergoing general anesthesia, and clients with extensive edema of upper airway passages.

Question 7

A client presents at the primary provider’s office with a peritonsillar abscess. Immediate treatment is recommended. Why?

Answer 7

Immediate treatment is recommended to prevent the spread of the causative microorganism to the bloodstream or adjacent structures.

Question 8

What teaching should older clients with upper respiratory infections receive about over-the-counter (OTC) medications?

Answer 8

Over-the-counter (OTC) medications may be potentially serious for older adults, especially when they have other diseases such as chronic respiratory disorder or heart disease. Teaching for older clients must include potential side effects of OTC medications such as antihistamines or cough suppressants. Antihistamines may increase dryness and contribute to confusion or dizziness, which increases fall risk. These OTC medications may also prevent effective airway clearance by cough production, especially in those who have weakened respiratory musculature. Pseudoephedrine side effects are potentially serious. The nurse should teach the older adult to carefully weigh the potential risks and benefits and should report the following to a health care provider: low blood pressure, heart palpitations or rapid heart rate, chest tightness, confusion, hallucinations, visual changes, seizures, or other signs that could indicate an allergic reaction.

Question 9

Why should the head of the bed be elevated 45 degrees when the client is fully awake after a tonsillectomy and adenoidectomy?

Answer 9

The head of the bed should be elevated 45 degrees when the client is fully awake after a tonsillectomy and adenoidectomy because this position decreases surgical edema and increases lung expansion.

Question 10

How does sleep apnea cause serious side effects that affect the cardiopulmonary system?

Answer 10

Clients with sleep apnea often have hypertension and are therefore at greater risk of cerebrovascular accident and myocardial infarction as well as heart arrhythmias and heart failure.

Question 11

What are the benefits of ice packs or ice collars?

Answer 11

Ice collars are beneficial because the cold reduces swelling and inflammation in the soft tissues surrounding the surgical incision. Ice packs help to control bleeding, reduce edema and inflammation, and block pain receptors.

Question 12

How can the creation of a new opening following a tracheostomy cause a life-threatening situation?

Answer 12

The respiratory passages react to the creation of the new opening with inflammation and excessive mucous secretion. Copious respiratory secretions are life-threatening. The client cannot be left unattended during the immediate postoperative period because the secretions make frequent suctioning necessary. In addition, inspired air passes directly into the trachea without becoming warmed and moistened, which can subsequently form crusts and obstruct the lower airway, causing serious respiratory problems.

Question 13

A client who is obese is diagnosed with sleep apnea syndrome. Why might a tracheostomy not be an option of treatment for this client?

Answer 13

For clients who are obese, it can be technically difficult to place a tracheostomy. Clients may also reject this option because of the trauma, the seemingly barbaric nature of the procedure, and the alteration in appearance that it creates.

Question 14

What are the risk factors for sleep apnea?

Answer 14

• An estimated 12 to 18 million Americans have obstructive sleep apnea; half of those affected are classified as overweight.
• Sleep apnea affects 1 out of 25 middle-aged men and 1 out of 50 middle-aged women.
• Women are more likely to have sleep apnea after menopause.
• In general, as people age, they are at higher risk for sleep apnea, with 1 out of 10 people over 65 years of age diagnosed with sleep apnea.
• Ethnicity—people who are Black American or African in origin, Hispanic or Latinx ethnicities, or Pacific Islander origin are more likely to develop sleep apnea.
• Heredity
• Smaller airways, allergies, or other conditions that contribute to increased congestion
• Cigarette smokers are at increased risk.
• Clients with any condition that reduces pharyngeal muscle tone: neuromuscular disease, use of sedative or hypnotic medications, and frequent and heavy intake of alcohol

Question 15

Describe the physical changes associated with a total laryngectomy.

Answer 15

• The client with a total laryngectomy has a permanent tracheal stoma (opening) because the trachea is no longer connected to the nasopharynx. The larynx is severed from the trachea and removed completely.
• The only respiratory organs in use are the trachea, bronchi, and lungs. Air enters and leaves through the tracheostomy. The client no longer feels air entering the nose.
• Because the anterior wall of the esophagus connects with the posterior wall of the larynx, it must be reconstructed. Tube feeding facilitates healing by preventing muscle activity and irritation of the esophagus.
• Loss of the ability to speak normally is a devastating consequence of laryngeal surgery. The methods of laryngeal speech used after a laryngectomy are esophageal speech, artificial larynx, and tracheoesophageal puncture.

Question 16

Why is a humidified mist collar usually necessary following a tracheostomy?

Answer 16

Following a tracheostomy, inspired air passes directly into the trachea, bronchi, and lungs without becoming warmed and moistened by passing through the nose. Dry secretions can subsequently develop, which easily form crusts and can break off, obstruct the lower airway, and cause serious respiratory problems. Humidification by a mist collar is usually necessary to prevent drying and incrustation of the mucous membrane in the trachea and the main bronchus.

Question 17

What is the nursing management for the client with an endotracheal tube?

Answer 17

• The nurse monitors vital signs periodically, depending on the client’s condition and the reason for endotracheal tube insertion.
• Blood gas studies and pulse oximetry provide methods of ongoing evaluation of the client’s respiratory status. The nurse reviews the results of these studies and reports changes to the primary provider.
• The nurse observes the client at frequent intervals for response to respiratory support and complications associated with endotracheal intubation.
• The nurse evaluates any change in mental status. Confusion may result from abnormal blood gas levels or electrolyte imbalances. Sudden restlessness or agitation may indicate obstruction of the endotracheal tube, which can be life-threatening.
• The nurse auscultates the lungs and observes the symmetrical rise and fall of the chest every 30 to 60 minutes. If the nurse cannot detect bilateral breath sounds, the primary provider is notified immediately.
• Humidification is necessary to keep the inspired air moist.
• Clients with endotracheal intubation cannot cough, secretions are often thick and tenacious, and swallowing reflexes are depressed.
• Keeping the airway patent at all times is absolutely necessary, using the same suctioning technique as for a tracheostomy.
• If the client is biting on the tube, a bite block or oral airway may be used to keep the tube patent.
• The nurse changes the client’s position every 2 hours to prevent atelectasis.
• The nurse gives oral care as needed to keep the mouth and lips free of crusts and mucus.
• The nurse suctions the oropharynx and mouth as needed and cleans the teeth with applicators.
• The nurse inspects the oral cavity frequently and reports any signs of oral bleeding to the primary provider.
• The client may display anxiety or fear because of the tube, an inability to speak, suctioning, and dependence on a machine for breathing. Each time suctioning is needed, the nurse reassures the client that the procedure takes only a short time.
• The client may attempt to remove or pull on the tube if they are awake or partially awake. Restraining the client may be necessary. The nurse should contact the primary provider if the client is extremely restless.
• Providing a “Magic Slate,” wipe board, electronic device, or pencil and paper to the client enables communication, as does asking questions that the client can answer by shaking the head yes or no.

Question 18

Describe a tracheoesophageal puncture.

Answer 18

a surgical opening in the posterior wall of the trachea, followed by the insertion of a prosthesis.
* Air from the lungs is diverted through the opening in the posterior tracheal wall to the esophagus and out of the mouth.
* The client covers the stoma with their finger and forces air through the esophagus; this causes the walls of the throat to vibrate as the client speaks. It sounds more natural than an artificial larynx.

Question 19

A 30-year-old client who is scheduled for a tonsillectomy and adenoidectomy asks the nurse, “How long will I be in the hospital?” What is the appropriate nurse response? What post-procedure instructions will the nurse provide to the client about fluids?

Answer 19

Tonsillectomy and adenoidectomy are generally done as outclient procedures. Recovery time is generally at least 10 days to 2 weeks or longer, especially for adults. The nurse will instruct the client to avoid carbonated fluids and fluids high in citrus content. Such fluids are caustic to the surgical site and may traumatize tissue, disrupting the suture line. The nurse will encourage the client first to try ice chips, then small sips of cold fluids, and then popsicles and full liquids as tolerated. Gradual introduction of increasingly thick fluids provides the client with an opportunity to try swallowing little by little, without disrupting the suture line.

Question 20

Which of the following is an important preventive factor that the nurse should teach a client with rhinitis?
a. Not to blow the nose.
b. Consume small doses of ice chips.
c. Not to lift objects weighing more than 5 to 10 lb.
d. Wash hands frequently.

Answer 20

Answer: d
RATIONALE: Hand washing is an important preventive factor that a nurse should teach a client with rhinitis. This reduces the spread of infection to a large extent. The consumption of small doses of ice chips, not lifting objects weighing more than 5 to 10 lb, and not blowing the nose are recommended to clients who have had a sinus surgery and not for clients with rhinitis.

Question 21

Which of the following signs may be revealed in a visual examination if the client has a tonsillar infection caused by group A streptococci?
a. White patches on the tonsils.
b. Hemorrhage in the tonsils
c. Hypertrophied tonsils.
d. Bleeding in the tonsils.

Answer 21

Answer: a
RATIONALE: A visual examination of a client with tonsillar infection reveals enlarged and reddened tonsils. White patches may appear on the tonsils if group A streptococci are the cause. Conditions such as hemorrhage in the tonsils, hypertrophied tonsils, and bleeding in the tonsils are not associated with group A streptococci tonsillar infection.