Chapter 22 Management of Patients with Upper Respiratory Tract Disorders Upper Respiratory System o Nose, paranasal sinuses, pharynx,

x, larynx, trachea, or bronchi. Upper Airway Infections o Rhinitis A group of disorders characterized by inflammation and irritation of the mucus membranes of the nose. Kinds Acute-Sudden in onset Chronic- Occurs for long period of time Allergic (Hay fever)- triggered by hypersensitivity reaction. o Seasonal- occurs during pollen seasons; reoccurs same time next year o Perrineal- exposure to airborne particles such as dust, dander or plant pollens; all year round Medicamentosa o Rebound nasal congestion from overuse of nasal sprays. Factors: temperature or humidity, odor, infection, age, systemic disease, use of OTC and prescribed nasal decongestant, and foreign body. Clinical Manifestation: Acute o Nasal Discharge: Watery, mucoid rhinorrhea o Eyes: tearing o Turbinate: edematous Allergic o Nasal Discharge: thin, watery o Eyes: tearing & itching o Turbinate: edematous Chronic o Nasal Discharge: serous mucopurulent o Eyes: no tearing o Turbinate: enlarged Medical Management Depending on severity, desensitizing immunizations, and corticosteroids may be required If symptoms suggest a bacterial origin, a antimicrobial agent is administered o Viral Rhinitis (common cold) Acute viral Rhinitis(Coryza) An infectious, acute inflammation of the mucous membranes of the nasal cavity characterized by nasal congestion, rhinorrhea, sneezing , sore throat, and general malaise. Highly contagious for the 1st two days before symptoms appear and during the first part of the symptomatic phase. Clinical Manifestations Low-grade fever, nasal congestion, rhinorrhea and nasal discharge, halitosis, sneezing, tearing watery eyes, scratchy or sore throat, general malaise, chills and often headache Medical Management

Antibiotics are not indicated Symptomatic therapy o Adequate fluid intake o Rest o Prevention of Chilling o Use of expectorant as necessary o Warm Saline gargles o NSAIDs for pain o Antihistamine are used to relieve sneezing Nursing Management Instruct to Increase Fluid intake Health teach about hand washing. Teach methods to treat symptoms. Sinusitis Inflammation of a sinus producing an inflammatory mucoid discharge Causes: Infection spread from the nasal passages, blocked routes of normal sinus drainage. Acute Sinusitis an infection of the paranasal sinuses. It frequently develops as a result of an upper respiratory infection, such as an unresolved viral or bacterial infection, or an exacerbation of allergic rhinitis. Nasal congestion, caused by inflammation, edema, and transudation of fluid, leads to obstruction of the sinus cavities Clinical Manifestations o Facial pain or pressure over sinus are o Nasal Obstruction and Purulent discharge o Malaise o Dental pain o Decrease sense of smell o Sore throat o Eyelid edema o Facial Congestion Medical Management o Analgesics- to relieve pain o Amoxicillin or Ampicillin- for bacterial origin o Increase Fluid intake, moist steam o Mucolytics- for expectoration o Promote Rest Chronic Sinusitis is an inflammation of the sinuses that persists for more than 3 weeks in an adult and 2 weeks in a child. Clinical manifestations of chronic sinusitis include impaired mucociliary clearance and ventilation, cough (because the thick discharge constantly drips backward into the nasopharynx), chronic hoarseness, chronic headaches in the periorbital area, and facial pain. Generally most pronounced on awakening in the morning. Assessment & Diagnostic Procedures o CT Scan /MRI Performed to rule out other local or systemic

disorders such as tumor, fistula and allergy Nasal Encoscopy Indicated to rule out underlying diseases such as tumor and sinus mycetomas Medical Management o Same as Acute Sinusitis o Surgical Intervention Maxillary antral puncture & lavage Caldwell-Luc procedure Functional Endoscopic Sinus Surgery Acute Pharyngitis or Strep throat A sudden inflammation or infection in the throat, usually causing symptoms of a sore throat. Usually viral in origin (Adenovirus, Epstein-Barr Virus, Herpes Simplex) Group A- Beta hemolytic streptococcus (Most common) Clinical Manifestation signs and symptoms of acute pharyngitis include a fiery-red pharyngeal membrane and tonsils, lymphoid follicles that are swollen and flecked with white-purple exudates, and enlarged and tender cervical lymph nodes and no cough. Fever, malaise, and sore throat also may be present. Medical Management: Penicillin & Erythromycin. Chronic Pharyngitis is a persistent inflammation of the pharynx. It is common in adults who work or live in dusty surroundings, use their voice to excess, suffer from chronic cough, and habitually use alcohol and tobacco. Three types of chronic pharyngitis are recognized: Hypertrophic: characterized by general thickening and congestion of the pharyngeal mucous membrane Atrophic: probably a late stage of the first type (the membrane is thin, whitish, glistening, and at times wrinkled) Chronic granular (clergymans sore throat): characterized by numerous swollen lymph follicles on the pharyngeal wall Clinical Manifestation Constant sense of irritation or fullness in the throat, mucus that collects in the throat and can be expelled by coughing and difficulty swallowing. Medical Management Treatment is directed toward relieving of symptoms: o Treatment of chronic pharyngitis is based on relieving symptoms, o Avoiding exposure to irritants o Correcting any upper respiratory, pulmonary, or cardiac condition that might be responsible for a chronic cough Tonsillitis Inflammation of lymphatic tissue that are situated on each side of the oropharynx. The facial or palatine tonsils and lingual tonsils are located behind the pillars of fauces and tongue, respectively. Acute Tonsillitis o Sudden Onset o

Etiological origin can be GABHS Initial Symptoms are sore throat, accompanied by fever, anorexia, chills , muscular pain & headache. o In some pus or exudates develop Chronic Tonsillitis o Commonly mistaken for other disorders such as allergy, asthma, and sinusitis o Recurrent episodes of sore throat o Symptoms are safe of acute tonsillitis but throat remains uncomfortable o Tonsils are often enlarged & expression of purulent material from the tonsil cyst Peritonsillar Abscess(Quincy) o is a collection of purulent exudates between the tonsillar capsule and the surrounding tissues, including the soft palate. It is believed to develop after an acute tonsillar infection, which progresses to a local cellulitis and abscess. o usual symptoms of an infection are present, together with such local symptoms as a raspy voice, odynophagia (a severe sensation of burning, squeezing pain while swallowing), dysphagia (difficulty swallowing), otalgia (pain in the ear), and drooling. An examination shows marked swelling of the soft palate, often occluding almost half of the opening from the mouth into the pharynx, unilateral tonsillar hypertrophy, and dehydration. o Diagnostic is done by aspiration of purulent material then is sent for Culture and Grams stain o Medical Management is usually penicillin Surgical Management Tonsillectomy and Adenoidectomy o Indicated for Recurrent tonsillitis when medical treatment is unsuccessful and there is severe hypertrophy, asymmetry or peritonsilar abscess that occludes the pharynx, making swallowing difficult and endangering the airway)particularly during sleep_ Incapacitating episodes of Acute tonsillitis Repeated attacks of purulent otitis media Suspected hearing loss due to serous otitis media that has occurred in association with enlarged tonsils and adenoids o Nursing Responsibility Pre-operative Review of lab studies(CBC, anticoagulation studies) Administration of pre-op medications(antibiotics, atropine, sedatives) Nursing Diagnosis o Anxiety related to anticipation of surgery Postoperative

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Adherence to medication therapy Use of an ice collar Avoid aspirin Increase Fluids Eat soft, warm food Restrict strenuous exercise Normal to have tarry stools Bleeding may occur within 8 days post-op Pain is viable for 3-5 days Alkaline mouthwashes and warm saline solutions are useful in coping with thick mucus and halitosis

Laryngitis an inflammation of the larynx, often occurs as a result of voice abuse or exposure to dust, chemicals, smoke, and other pollutants, or as part of an upper respiratory tract infection. Cause of Infection is almost always a virus. Bacterial invasion may be secondary. Usually associated with allergic rhinitis or pharyngitis. Clinical Manifestation hoarseness or aphonia (complete loss of voice) and severe cough. Chronic laryngitis is marked by persistent hoarseness. Medical Management includes resting the voice, avoiding smoking, resting, and inhaling cool steam or an aerosol. Acute Laryngitis Usually cause by parainfluenza virus Causes: o Overuse of voice o Exposure to dust, chemicals or products of combustion Sudden Onset of hoarseness, dysphagia, dry cough, localized pain when speech, complete voice loss. Diagnostic o Laryngoscopy & Neck x-ray Treatment o Voice Rest o Suppress Cough o Lozenges & Analgesics o Throat spray Chronic Laryngitis Often due to sinus or nasal, problems prolonged voice , excessive smoking, Management is directed toward irritation or cause Obstruction and Trauma of the Upper Airway o Nasal Obstruction Epistaxis A hemorrhage from the nose Caused by the rupture of tiny, distended vessels in the mucous membrane of any area of the nose. Most commonly, the site is the anterior septum, where three major

blood vessels enter the nasal cavity: (1) the anterior ethmoidal artery on the forward part of the roof (Kesselbachs plexus), (2) the sphenopalatine artery in the posterosuperior region, and (3) the internal maxillary branches (the plexus of veins located at the back of the lateral wall under the inferior turbinate). Can be due to trauma, infection, inhalation of illicit drugs, cardiovascular diseases, blood dyscrasias, nasal tumors, low humidity, a foreign body in the nose and vigorous nose blowing and nose picking Management o Emergency Care Position client upright & Leaning forward Reduce Anxiety Apply direct lateral pressure to the soft outer portion of the nose against the midline septum for 5-10 minutes continuously. Nasal Polyps A deviation of the nasal septum, hypertrophy of the turbinate bones, or the pressure of nasal polyps, which are grapelike swellings that arise from the mucous membrane of the sinuses, especially the ethmoids. Gradually forms from recurrent, localized swellings Medical Management o Polypectomy Nasal Fracture Injury that gives rise to obstruction of the nasal air passages and to facial disfigurement Disfiguring soft tissue edema around the nose after injury. Apply ice bag & tightly hold the nose Laryngeal Obstruction Acute Laryngeal Edema a serious, often fatal, condition. The larynx is a stiff box that will not stretch. It contains a narrow space between the vocal cords (glottis) through which air must pass. Swelling of the laryngeal mucous membranes, therefore, may close off the opening tightly, leading to suffocation. Hoarseness and dramatic breathe is evident Medical Management o When obstruction is caused by allergic reaction Subcutaneous epinephrine or a corticosteroid Apply an ice pack to the neck o In emergencies caused by obstruction by a foreign body. Subdiaphragmatic abdominal thrust maneuver is performed If all efforts are unsuccessful, an immediate tracheotomy is necessary Laryngospasm Spasm of laryngeal muscles after administration of some general anesthetics Repeated traumatic attempting Endotracheal Intubation

Nursing Intervention o Administer 100% oxygen until larynx relaxes Cancer of the Larynx is a malignant tumor in the larynx (voice box). It is potentially curable if detected early. Carcinogens that have been associated with the development of laryngeal cancer include tobacco (smoke, smokeless) and alcohol and their combined effects, exposure to asbestos, mustard gas, wood dust, cement dust, tar products, leather, and metals. Other contributing factors include straining the voice, chronic laryngitis, nutritional deficiencies (riboflavin), and family predisposition A malignant growth may occur in three different areas of the larynx: the glottic area (vocal cords), supraglottic area (area above the glottis or vocal cords, including epiglottis and false cords), and subglottis (area below the glottis or vocal cords to the cricoid). Clinical Manifestations o Hoarseness o Dysphagia o Foreign body administration o Difficulty of breathing Diagnosis o Indirect Laryngoscopy o Direct Laryngoscopy o Biopsy o Pulmonary Function Test o CT Scan Treatment o Radiation therapy o Speech Therapy o Chemotherapy o Combinations Nursing Diagnosis o Ineffective airway clearance o Anxiety o Nutritional Imbalance