Module 3: Upper Respiratory Problems Flashcards
Nasal and Paranasal
Sinus Problems: Deviated Septum
Deflection or shift of the nasal septa
Trauma—most common cause
Interferes with airflow and drainage
Symptoms
* Minor: none, congestion, frequent infections
* Severe: facial pain, nosebleeds, obstruction
Diagnoses—speculum exam
Treatment: decongestants, analgesia (pain killers), nasal septoplasty (severe cases)
Nasal Septoplasty - surgical procedure aimed at correcting a deviated nasal septum, which is the partition between the two nasal cavities.
The septum is made of bone and cartilage and ideally sits in the center of the nose, equally dividing the two sides. When it deviates, or bends, to one side, it can cause a blockage in one or both nasal passages. This can lead to problems with breathing through the nose, nasal congestion, frequent nosebleeds, sinus infections, and sometimes snoring or sleep apnea.
Nasal Fracture
Trauma—most common cause
Complications—obstruction, nosebleeds, meningeal
tears with CSF leak, septal hematoma, deformity
Simple—little displacement
Complex—damage to adjacent structures; evaluate
for injury of cervical spine, orbital bone, or mandible
Nasal Fracture Diagnosis
History + Physical
Manifestations: deformity, nosebleed, pain, crepitus (Crepitus refers to a crackling, popping, or grating sound or sensation that can be felt under the skin or heard in various joints when they move),
swelling, difficulty breathing through nose,
ecchymosis (discoloration of the skin resulting from bleeding underneath, typically caused by bruising. It appears as a purplish or bluish patch that occurs when small blood vessels (capillaries) burst or break under the skin, allowing blood to escape into the surrounding tissue.)
- Periorbital ecchymosis—“raccoon eyes” evaluate for
basilar skull fracture - CSF leak—clear or pink persistent drainage; lab
confirmation more accurate than bedside glucose test
Nasal Fracture Nursing Care
Patent Airway
Monitoring: Regularly check for signs of airway obstruction, which can be caused by swelling, bleeding, or the formation of clots in the nasal passages.
Positioning: Encourage the patient to keep their head elevated, even while sleeping, to help reduce swelling and facilitate breathing.
Prevent Complications
Bleeding: Monitor for signs of ongoing or recurrent bleeding. Instruct the patient to avoid blowing their nose, which can exacerbate bleeding.
Edema: Apply ice packs to the nasal area for the first 48 hours post-injury or surgery to reduce swelling. Ice should be applied intermittently (e.g., 20 minutes on, 20 minutes off).
Pain Management: Administer pain relief as prescribed, often acetaminophen is preferred to avoid the increased risk of bleeding associated with NSAIDs. Monitor the patient’s pain level and adjust pain management strategies as needed.
Avoidance of Certain Activities: Advise the patient to avoid activities that could stress the nasal area, including strenuous exercise, bending over, or wearing glasses that rest on the nose until cleared by their healthcare provider.
Environmental Considerations: Recommend the use of a humidifier to keep the nasal passages moist and suggest avoiding hot showers, alcohol, and smoking, which can exacerbate swelling and delay healing.
Infection Prevention: Educate the patient on signs of infection to watch for and ensure they understand the importance of keeping any splints or dressings clean and dry.
Emotional Support
Reassurance: Provide reassurance and support, as facial injuries can be distressing and may impact the patient’s self-esteem and emotional well-being.
Information: Offer clear and concise information about the patient’s condition, treatment plan, and what to expect during the recovery process.
Post Realignment Care
Closed Reduction: If the patient undergoes closed reduction (manipulation without an incision), emphasize the importance of not disturbing the nasal area to ensure proper healing.
Open Reduction, Septoplasty, Rhinoplasty: For more invasive procedures, provide wound care instructions, and educate the patient on the signs of complications such as infection or bleeding.
Septoplasty
Septoplasty is a surgical procedure aimed at correcting a deviated septum, which is the displacement of the nasal septum, the cartilage and bone dividing the two nostrils. A deviated septum can cause nasal obstruction, leading to difficulties in breathing, recurrent sinus infections, nosebleeds, and snoring.
Septal Hematoma: A potential complication of septoplasty is the development of a septal hematoma, which is a collection of blood within the septum. If not treated promptly, a hematoma can lead to cartilage damage, resulting in a nasal deformity, and can also become infected, leading to further complications.
Rhinoplasty
Rhinoplasty, often referred to as a “nose job,” is a surgical procedure that involves the reconstruction or reshaping of the nose. It can be performed for functional reasons, such as improving breathing by correcting structural defects, or for cosmetic reasons, to change the appearance of the nose.
Body Image Considerations: For patients undergoing rhinoplasty for cosmetic reasons, body image is a significant consideration. The decision to alter one’s appearance can have profound psychological impacts, and realistic expectations need to be set.
Digital Photos: Surgeons often use digital photos and imaging software to show patients projected outcomes. This helps in ensuring that the patient’s expectations align with what is surgically achievable.
Outpatient Procedure: Rhinoplasty is usually performed as an outpatient procedure, meaning the patient can go home the same day after surgery.
Post Op Care for Septoplasty + Rhinoplasty
Nasal Packing: After both septoplasty and rhinoplasty, nasal packing may be used to support the new structure of the nose, control bleeding, and prevent the formation of excessive scar tissue. Packing is typically removed a few days after surgery.
Nasal Splint: A splint may also be placed on the outside of the nose to protect the nasal bones and cartilage. The splint helps maintain the new shape of the nose as it heals and is usually worn for about a week.
Monitoring for Complications: It’s crucial to monitor for signs of infection, excessive bleeding, or breathing difficulties after the surgery. Any unusual symptoms should be reported to the surgeon immediately.
Recovery: The first few days after the surgery involve rest and limited physical activity to minimize swelling and promote healing. Swelling and bruising around the eyes and nose are common but gradually subside over the weeks following surgery.
Nasal Surgery Nursing Management
Nursing management
Preoperative:
* Avoid Aspirin and NSAIDs 5 days to 2 weeks
* Smoking cessation
Postoperative:
* Maintain patent airway
* Monitor respiratory status/airway obstruction
* Pain management
* Observe for edema, bleeding, infection
Patient teaching:
Manage edema, bruising, and pain: Cold compresses
and elevate HOB
Prevent bleeding and injury: No nose blowing,
swimming, heavy lifting, or strenuous exercise
May take a year for full cosmetic resul
Epistaxis (Nosebleed)
Many causes; often resolve spontaneously
First aid
* Sitting position, lean forward, with head tilted forward;
direct pressure/squeeze lower part of nose for 5 to 15
minutes
Medical management
* Pledget (A small, absorbent material, often made from cotton, gauze, or a similar fabric, used to deliver medication directly to a specific area) with anesthetic or vasoconstrictor
* Absorbable packing/sponges; balloon
* Chemical or thermal cauterization; embolization
Patient Care for Epistaxis
Monitor respiratory status, LOC, VS, pulse ox,
dyspnea, dysphagia
Administer analgesia and antibiotics
Premedicate before removal of packing
Patient education:
* Humidifier or nasal spray
* Sneeze with mouth open
* Avoid aspirin and NSAIDs
* Avoid vigorous nose blowing, strenuous activity, lifting
or straining for 4 to 6 weeks
Allergic Rhinitis
Inflammation of nasal mucosa
Cause: seasonal (pollen) or perennial (environmental)
allergen
Frequency of symptoms
* Episodic—sporadic exposure
* Intermittent—less than 4 days/week or less than 4
weeks/year
* Persistent—greater than 4 days/week or greater than 4
weeks/year
Exposure leads to IgE (Immunoglobulin E (IgE) is a class of antibodies produced by the immune system. It plays a crucial role in the body’s allergic response and is involved in immunity against parasites) and inflammation
Management
Identify and avoid triggers
Reduce inflammation and symptoms
* Corticosteroids; nasal and/or oral
* Antihistamines; decongestants, LTRAs
* Immunotherapy: allergy shots
Patient education: medications
Drug alerts
Acute Viral Rhinopharyngitis (Upper Respiratory Infection)
Upper Respiratory Infection
Infection of nose, sinuses or throat
Over 200 viruses can cause an URI
Common cold
* Acute viral Rhinopharyngitis
* Nasopharyngitis
Sinusitis
Influenza
Viruses
Contagious: airborne droplets or contact
Frequent in winter months—close contact
* Also influenced by: fatigue, stress, allergies, and
altered immune status
Symptoms—2 to 3 days after infection
* Runny nose, watery eyes, nasal congestions, sneezing,
coughing, sore throat, fever, headache, fatigue
Usual recovery 7 to 10 days
Influenza
Highly contagious; increased morbidity and
mortality
Peak season: December to February
Classified by serotypes (A, B, C, D)
* A subtypes: H and N antigens (e.g., H1 N1)
Influenza A—most common and virulent
* Mutated viruses —no immunity
* Pandemics (worldwide spread)
* Epidemics (localized outbreaks)
Transmission: infected droplets
* 1 day before onset symptoms—5 to 7 days
Sinusitis
Inflammation of sinus mucosa results in blockage
and accumulated secretions
Risk for viral, bacterial, or fungal infection
Classified
* Acute – 1 to 4 weeks
* Subacute – progresses over 4 – 12 weeks
* Recurrent – 4 or more infections/year; lasts 7 to 10
days without continual symptoms
* Chronic – lasts >12 weeks; persistent infection
Manifestations:
Acute: pain/tenderness, purulent drainage,
congestion, fever, malaise, headaches, halitosis
Chronic: facial or dental pain, congestion,
increased drainage
* Affects 50% patients with asthma
Diagnostic studies: X-ray, CT scan, nasal
endoscopy
Nasal Polyps
Nasal polyps—benign growths related to
chronic inflammation
Large polyps—obstruction, discharge, and
speech distortion
Treatment: corticosteroids or endoscopic or
laser surgery
Foreign Bodies - Nasal Obstruction
inorganic or organic
Pain, bleeding, difficulty breathing
Treatment: removal
Pharyngeal Problems
Acute Pharyngitis
Acute pharyngitis is an inflammation of the pharyngeal walls, which can include the tonsils, palate, and uvula. It’s a common condition that leads to a sore throat and is caused by a variety of factors:
Viral Infections: The most common cause, accounting for about 90% of cases. Common viruses include the common cold, influenza, mononucleosis, and respiratory syncytial virus (RSV).
Bacterial Infections: Strep throat, caused by the bacterium Streptococcus pyogenes, is the most well-known bacterial cause. It’s less common than viral pharyngitis but requires specific treatment.
Fungal Infections: Oral candidiasis (thrush) can lead to pharyngitis, especially in immunocompromised individuals or those who use inhaled corticosteroids without proper mouth rinsing.
Other Causes: Dry air, smoking, gastroesophageal reflux disease (GERD), allergies, postnasal drip, prolonged intubation with an endotracheal tube (ETT), exposure to irritating chemicals, and, rarely, cancers of the throat can also cause pharyngitis.
Clinical Manifestations of Acute Pharyngitis
General Symptoms: Sore throat is the primary symptom, often accompanied by pain when swallowing. The pharynx (back of the throat) may appear red and swollen.
Viral Pharyngitis: Can include symptoms like cough, runny nose, hoarseness, and conjunctivitis, reflecting a more generalized upper respiratory infection.
Bacterial Pharyngitis (Classic Strep Throat):
Fever greater than 38°C (100.4°F).
Enlargement of the cervical lymph nodes.
Presence of pharyngeal exudate (white or yellow patches on the tonsils or pharynx).
Absence of cough is more suggestive of a bacterial cause.
**Typically treat with penicillin or amoxicillin
Fungal Pharyngitis: Characterized by white patches or plaques on the oral or pharyngeal mucosa, often with underlying redness.
*Antifungal medications, either topical (nystatin swish and swallow) or systemic (fluconazole), depending on severity and patient factors
Peritonsillar Abscess
Complication of tonsillitis
Most often caused by group A β-hemolytic
streptococci
Pain, swelling, possible blockage of throat
High fever, chills, leukocytosis, difficulty swallowing,
muffled voice
IV antibiotics, needle aspiration, drainage of abscess
May need emergency tonsillectomy
Laryngeal and Tracheal
Problems: Laryngeal Polyps
Benign growth on vocal cords from vocal abuse or
irritation
Most common: hoarseness
Large: dysphagia, dyspnea, stridor
Treatment: vocal rest and hydration
Surgical removal if large or risk of cancer
Acute Laryngitis
Inflammation of larynx (voice box)
Causes: virus, upper respiratory tract infection,
overuse of voice, smoke or chemical
exposure/inhalation
Classic manifestations:
* Tingling or burning back of throat; need to clear throat,
hoarseness, loss of voice
* Other: fever, cough, full feeling in throat
Airway Obstruction
Medical emergency!
Partial or complete
Manifestations: choking, stridor, use of accessory
muscles, suprasternal and intercostal retractions,
nasal flaring, wheezing, restlessness, tachycardia,
cyanosis, change in LOC
Immediate assessment and treatment—brain damage
or death in 3 to 5 minutes
Interventions to Establish Patient Airway
Heimlich Maneuver
Indication: Used in cases of choking due to a foreign body obstructing the upper airway.
Procedure: A sudden, upward abdominal thrust just above the navel and below the ribcage is applied to force the foreign object out of the airway.
Cricothyroidotomy (also known as Cricothyrotomy)
Indication: Emergency procedure used when there is a blockage in the upper airway that cannot be quickly relieved and it’s not possible to secure the airway using endotracheal intubation.
Procedure: Involves making an incision through the skin and cricothyroid membrane to insert a tube directly into the trachea, bypassing upper airway obstructions.
Endotracheal (ET) Intubation
Indication: Used for significant airway obstruction, respiratory failure, or when protecting the airway during anesthesia.
Procedure: A flexible tube is inserted through the mouth or nose, past the vocal cords, and into the trachea to maintain an open airway and enable mechanical ventilation if necessary.
Tracheostomy
Indication: Performed when long-term airway support is needed or when ET intubation is not possible due to facial or upper airway injuries or abnormalities.
Procedure: A surgical opening is created directly in the front of the neck into the trachea, and a tracheostomy tube is inserted to maintain a patent airway.
