Book cover for Understanding Medical-Surgical

Nursing, Seventh Edition.

Chapter 30
Nursing Care of Patients
With Upper Respiratory
Tract Disorders

Copyright ©2023 F.A. Davis Company

 Learning Outcomes
 Explain the pathophysiology of disorders of
the upper respiratory tract.
 Describe etiologies and signs and symptoms
of disorders of the upper respiratory tract.
 Describe current therapeutic measures for
disorders of the upper respiratory tract.

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 Learning Outcomes (continued)
 Assist in planning nursing care for the patient
with an upper respiratory disorder.
 Discuss how you will know if your care has
been effective.
 Identify the special needs of the patient who
has undergone a laryngectomy.

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 Epistaxis
 More commonly known as a nosebleed
 Causes
• Dry, cracked mucous membranes
• Trauma
• Hypertension
• Hemophilia
• Medications – anticoagulants
‒ Coumadin
‒ Eliquis

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 Epistaxis (continued)
 Therapeutic interventions
• Positioning - forward
• Direct pressure – nares 5-10 minutes
• Ice
• Nasal packing – tampon
• Nasal balloon catheter
• Vasoconstrictive agent – neosynephrine
• Silver nitrate stick
• Electrocautery
• IV fluids, Fresh Frozen Plasma, Blood transfusion
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 Epistaxis cont…
 Nursing care
• Monitor the bleeding
• Suction back of throat to clear airway
• Monitor V/S and Hgb
• When packing removed
‒ Do not blow nose
‒ Avoid bending over
‒ Do not lift anything heavy
‒ Use nasal saline spray for dryness
‒ Use humidifier or put pot of water on stove

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 Nasal Polyps
 Usually benign – grapelike clusters
 Occur more often with allergies
 Therapeutic interventions
• Control allergies - antihistamines, corticosteroids,
singulair
• Surgery

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 Deviated Septum
 Slightly deviated separation of nasal
passages
• Boxers
• Block sinus drainage and interfere with breathing
 Symptoms
• Stuffy nose
• Blocked sinus drainage
• Headaches

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 Deviated Septum (continued)
 Therapeutic intervention
• Nasoseptoplasty
‒ Monitor vital signs/bleeding.
‒ Report excess swallowing.
‒ Monitor dressing.
‒ Teach post-op care: Avoid activities that increase
pressure; avoid aspirin.

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 Sinusitis
 Inflammation of sinus mucosa
• Bacterial – infection
• Fungal
• Allergic
• Irritation
 Signs and symptoms
• Pain over affected sinus/pressure/frontal HA
• Fever & fatigue
• Nasal discharge
• Foul breath
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 Sinusitis cont…
 Complications
• Cellulitis of eye orbit
• Abscess
• Meningitis – infection/swelling of brain lining
 Diagnostics
• Xray
• CT / MRI
• CBC – check WBC

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 Sinusitis (continued)
 Therapeutic
interventions
• Saline irrigation – Netti
pot • Humidification
• Intranasal corticosteroids • Oral fluids
• Decongestants • Positioning – sit up
• AVOID ANTIHISTAMINES – • Antibiotics – finish the
make secretions thicker prescription
• Hot packs • Surgical drainage – very
• Acetaminophen/ painful
ibuprofen

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 Obstructive Sleep Apnea
 Apnea during sleep – throat relaxes and
tongue falls back to obstruct airway
• Brain senses decreased O2 level and triggers a
breath
 Risk factors
• Obesity
• High palate
• Receded mandible
• Smoking

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 Obstructive Sleep Apnea (continued_1)
 Complications  Signs and symptoms
• Heart disease • Snoring
• Hypertension – • Daytime sleepiness
decreased sleep • Headache
increases BP • Memory and attention
• Stroke problems
• Diabetes
• Spouses get less sleep

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 Obstructive Sleep Apnea (continued_2)
 Diagnostic test
• Nocturnal polysomnography – sleep study
 Treatment
• Avoid alcohol/sedatives
• Lose weight & stop smoking
• Do not sleep on back
• Nasal patch
• Noninvasive positive-pressure ventilation
(N I P P V) – CPAP
• Surgery
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 Infectious Disorders
 Viral rhinitis
• Another name for common cold (Rhinovirus)
• Inflammation of the nasal mucus membranes
‒ Progresses slowly
‒ Nasal congestion, runny nose, sneezing, sore throat,
low –grade fever, cough, malaise
• Treatment – REST & FLUIDS, decongestants, cough
meds, Tylenol, motrin
• Prevention – good hand hygiene
• Elderberry, Echinacea
• Vit C & zinc

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 Infectious Disorders cont…
 Pharyngitis – sore throat
• Causes
• Overuse of voice, cold/sinus drainage
• beta-hemolytic streptococci - strep throat
• Rheumatic fever – will affect the heart valves
• Scarlet fever – scarlet rash
• Glomerulonephritis – inflammation of kidney
• Signs/symptoms
• Difficulty swallowing, exudate, fever, HA, malaise
•

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 Infectious Disorders cont…
• Treatment
• Penicillin if Strep
• warm saltwater gargles, lozenges, fluids, Tylenol,
motrin
• Popsicles, soft foods
 Laryngitis
• Inflammation of the larynx (voice box)
‒ Common symptom is hoarseness
‒ Causes – smoking, alcohol, GERD, infection
‒ Treat with resting voice & fluids

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 Infectious Disorders cont…
 Tonsillitis/Adenoiditis
• Infection of tonsils/adenoids
• Viral or bacterial – throat culture
• Symptoms – sore throat, fever, chills, malaise, myalgia,
reddened, swollen tonsils
• Yellow or white exudate
• Treatment
• Throat lozenges, saltwater gargles, Tylenol
• Antibiotics
• Tonsillectomy/Adenoidectomy
• Sit up semi-fowlers
• Monitor for bleeding in throat – keep suction available
• Cold fluids – avoid red coloring
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 Influenza Virus
 Transmitted easily by coughing and sneezing
and starts suddenly
 Diagnosis – nasal swab
 Prevention
• Yearly vaccination – takes 2 weeks to be effective
‒ Cannot take if allergic to eggs
• Handwashing
• Elderberry, Echinacea, Vit C and zinc
• Avoidance of infected people
‒ Flu season occurs with beginning of school semesters
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 Influenza (continued)
 Signs and symptoms  Therapeutic
• Fever interventions
• Chills • Acetaminophen/Motrin
• Myalgia • Avoid aspirin - REYES
SYNDROME
• Sore throat
• Antiviral agents – MUST
• Cough BE TAKEN WITHIN 48
• Malaise HOURS (Tamiflu)
• Headache • Rest
• Fluids

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 Influenza (continued)
 Isolation – droplet
 Complications
• Pneumonia
‒ Persistent fever
‒ Shortness of breath
‒ Crackles & wheezes
• Ventilator support
• Sepsis

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 Other Respiratory Viruses
 West Nile - Transmitted by mosquitoes
• Flu-like symptoms
‒ Can cause microcephaly if contracted during
pregnancy
‒ Encephalitis or meningitis
 Eliminate standing water
 Mosquito repellant

 Avian influenza (bird flu) - Transmitted from

sick birds and spread by coughs and sneezes
‒ Flu-like symptoms
‒ High mortality

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 Other Respiratory Viruses cont…
 Severe acute respiratory syndrome (S A R S)
– contagious, sometimes fatal respiratory
illness caused by specific coronavirus (2003)
 Caused by animals/bats
 Spreads by coughing and sneezing
 Flu-like symptoms plus difficulty breathing
 No vaccine
 Swine flu (H1 N1) – caused epidemic 1918
 Spread by coughing & sneezing
 50 million deaths worldwide
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 Other Respiratory Viruses cont…
 COVID 19 – SARS virus with a wide range of
symptoms from mild to severe spread by
coughing & sneezing
• Symptoms
‒ Flu-like symptoms, pneumonia symptoms
‒ Respiratory distress, chest pain, cyanosis
‒ Loss of taste and smell
• Treatment – Isolation
• Hydroxychloroquine – antimalarial/antirheumatic/
immunosuppressant
‒ Dexamethasone – steroid to decrease imflammation
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 Other Respiratory Viruses cont…
• Treatment cont…
‒ Remdesivir – antiviral
‒ Nebulizer treatments
‒ Ventilator support
‒ Sepsis treatment – antibiotics/cardiac support
• Prevention
‒ Handwashing
‒ Wearing masks and social distancing
‒ Flu vaccine
‒ Pneumovax

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 Nursing Diagnoses for Upper
Respiratory Infections
 Impaired Comfort
 Hyperthermia
 Risk for Infection (transmission to others)

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 Cancer of the Larynx
 Pathophysiology
• Primary tumor of mucosal epithelium
• Metastasizes to lungs, liver, lymph nodes
 Etiology
• Associated with singers
• Associated with smoking, alcohol
• Exposure to chemicals, dust
• Diet low in fruits & vegetables
• More common in men

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 Cancer of the Larynx (continued_1)
 Signs and symptoms
• Hoarseness
• Change in voice
• Pain
• Dyspnea
• Cough
• Dysphagia
• Airway obstruction – stridor

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 Cancer of the Larynx (continued_2)
 Diagnostic tests
• Laryngoscopy & biopsy
• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI)

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 Cancer of the Larynx (continued_3)
 Therapeutic interventions
• Radiation if caught early
• Chemotherapy – with
metastasis
• Laryngectomy – removal of
the larynx
A. Before laryngectomy
B. After laryngectomy

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 Cancer of the Larynx (continued_4)
 Nursing interventions
− A) Before laryngectomy – teaching to prepare the pt
− (B) After laryngectomy – trach & no voice
− AIRWAY PATENCY
− RESPIRATORY STATUS
− Assess pain and monitor sedation if meds given
− Monitor stoma
− Suction using sterile technique
− Monitor nutrition & fluid status – swallow eval
− Coping
− Communication – ACTIVE LISTENING

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 Cancer of the Larynx (continued_4)
 Postoperative nursing diagnoses
• Ineffective Airway Clearance
• Acute Pain
• Impaired Verbal Communication
• Imbalanced Nutrition
• Impaired Swallowing
• Grieving
• Disturbed Body Image

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 Devices to Aid Speech

A. UltraVoice is an electronic device B. The Blom-Singer voice

placed inside a denture or retainer; prosthesis diverts air into
the patient speaks into a the esophagus and out the
small microphone. mouth to form tracheo-
esophageal speech.

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 Case Study for ISBARR Communication

Mr. Gray is a 90-year-old resident of long-

term care.
Mr. Gray is usually alert and oriented and ready
with a joke when you come by with his
medications. This morning he is confused, and
you note that he has not touched his breakfast.

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 Case Study for ISBARR Communication
(continued)
You ask the assistive personnel to collect a full
set of vital signs. Results are as follows: BP
110/84, R 24, P 104, Temp 100.9°F. You note
that his mucous membranes are dry, he is
reporting a headache, and he refuses to remove
his winter jacket because he feels so cold. Lung
sounds are clear.

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 ISBARR Communication: Activity
 You are preparing to call the health-care
provider (HCP) regarding Mr. Gray’s change
in condition.
 Think about the information you should
include in the phone call.
 Now turn to your neighbor and communicate
a phone call using ISBARR.
 Afterwards, review suggested ISBARR
communication on next slide.

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 ISBARR Communication:
Suggested Answers
Identify: Your name, title
Situation: Mr. Gray is a 90-year-old resident of
long-term care who is full code.
Background: He has no known allergies. He has
a history of hypertension and
hypothyroidism. Mr. Gray is usually alert and
oriented and usually has a good appetite.

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 ISBARR Communication: Suggested
Answers (continued)
Assessment of Situation: Mr. Gray has new
confusion and poor appetite. Vital signs are BP
110/84, R 24, P 104, Temp 100.9°F. Lung sounds
are clear. Mucous membranes are dry. Patient
reports a headache.
Recommendation: I would like to start Mr. Gray
on some IV fluids and complete a rapid influenza
test to see if he would benefit from an antiviral
medication.
Read back/Repeat: Restate message received.
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 Case Study With Concept Map

Mr. Aydem is a 75-year-old retired businessman

with a history of hypertension. He has a 40-pack
year history of smoking and daily alcohol use.
He is married and has three children and
five grandchildren.
Mr. Aydem visited his physician after coaxing
from his wife due to his persistent complaint of
hoarseness and sore throat. He was diagnosed
with stage 3 cancer of the larynx, supraglottis.

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 Case Study With Concept Map (continued)

The patient received chemotherapy as well as

radiation. This morning he had a partial
laryngectomy. He is complaining of pain at
level 7.

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 Case Study With Concept Map: Activity
 What nursing concepts would be used for Mr.
Aydem’s case?
 Can you see how the concepts in Mr. Aydem’s
care are related?
 Work with your group to create a concept map
showing relationships between the concepts.
 Continue the map to show patient cues,
nursing interventions, and
collaborative relationships.

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 Mr. Aydem: Suggested Relationships
Pain
Surgery
level 7

Comfort

Loss of
voice
Surgery

Infection
Mr. Grief and
Aydem Loss
Cancer
diagnosis

Age

History of
Impaired Oxygenation smoking
airway

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 Mr. Aydem: Suggested Relationships
(continued)
Pain level
7 Surgery

Comfort

Loss of
voice
Surgery

Mr. Grief and

Infection
Aydem Loss
Cancer
diagnosis
Age

Oxygenation

History of Impaired
smoking airway

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 Review Question #1

Ice packs are used for epistaxis for

which reason?
1. To promote comfort
2. To promote vasoconstriction
3. To reduce swelling
4. To reduce congestion

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 Review Question #1 Answer

Correct Answer: 2

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 Review Question #2

What nursing instructions should be provided

following septoplasty? Select all that apply.
1. Maintain semi-Fowler position.
2. Take stool softeners as prescribed.
3. Use ice for swelling.
4. Blow nose gently to remove clots.
5. Expect a low-grade fever for 3 days.

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 Review Question #2 Answer

Correct Answer: 1, 2, 3

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 Review Question #3

Which nursing intervention is appropriate for

a sore throat?
1. Warm, moist pack
2. Hot tea
3. Bedrest
4. Saltwater gargle

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 Review Question #3 Answer

Correct Answer: 4

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 Review Question #4

Which patient is most at risk for complications

of influenza?
1. 46-year-old teacher
2. 19-year-old student
3. 78-year-old retiree
4. 32-year-old factory worker

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 Review Question #4 Answer

Correct Answer: 3

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 Review Question #5

What are common risk factors for laryngeal

cancer? Select all that apply.
1. Female
2. Smoker
3. Obesity
4. Alcohol abuse
5. Diet low in fruits and vegetables

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 Review Question #5 Answer

Correct Answer: 2, 4, 5

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