Timby/Smith: - PowerPoint Presentation

Slide1

Timby/Smith: Introductory Medical-Surgical Nursing, 11/e

Chapter 20:Caring for Clients

With Upper

Respiratory DisordersSlide2

Infectious and Inflammatory Disorders

Rhinitis

Pathophysiology and Etiology

Inflammation of the nasal mucous membranes; acute, chronic, or allergic

Assessment Findings: sneezing, nasal congestion, rhinorrhea, sore throat, watery eyes, cough, low-grade fever, headache, aching muscles, and malaise

Medical Management: antipyretics, decongestants, antitussives, saline gargles, saline spray, and antihistamines

Nursing Management: prevention and minimizing potential complications;

handwashingSlide3

Infectious and Inflammatory Disorders—(cont.)

Sinusitis

Pathophysiology and Etiology: inflammation of the sinuses; maxillary sinus

Complications: infection of middle ear or brain

Assessment Findings: headache, fever, pain over affected sinus, nasal congestion,

pain, pressure

around eyes,

malaise

Medical

and Surgical Management

: saline irrigation, antibiotic therapy, vasoconstrictors, nasal

corticosteroids

Caldwell-Luc

procedure, external

sphenoethmoidectomy

Nursing Management: mouthwashes, humidification, increased fluid intake, nasal

decongestants, antihistaminesSlide4

Sinus SurgeryNursing Postoperative CareObserve for repeated swallowing: hemorrhage

Optic nerve function assessment

Temperature every 4 hours; pain over involved sinuses

A

dminister analgesics as indicated; ice compresses

Nasal packing and dressing under nares (“moustache” dressing or “drip pad”)Slide5

NCLEXOf the following instructions, which is most important for the nurse to teach the client to help loosen secretions and increase comfort during medical treatment for sinusitis?

A) Blow the nose frequently.

B) Elevate the head of the bed by

45

°.

C) Engage in normal activity.

D) Increase fluid intake.Slide6

NCLEXAnswer:

D) Increase fluid intake.

Rationale: If the client is receiving medical treatment, the nurse informs the client to use mouthwashes and humidification, as well as increased fluid intake, which may loosen secretions and increase comfort.Slide7

Infectious and Inflammatory Disorders—(cont.)

Pharyngitis

Pathophysiology and Etiology

Inflammation of throat; rhinitis and other URIs

Group A streptococci: strep throat

Complications: endocarditis, rheumatic fever, glomerulonephritis

Highly contagious: inhalation or direct contamination with dropletsSlide8

Infectious and Inflammatory Disorders—(cont.)

Pharyngitis—(cont.)

Assessment Findings: sore throat with dysphagia, fever, chills, headache, white or exudates patch over tonsillar area, swollen glands

Medical Management

Throat culture

Antibiotic treatment: assess allergy to penicillin; erythromycinSlide9

Infectious and Inflammatory Disorders—(cont.)

Tonsillitis and Adenoiditis

Pathophysiology and Etiology

Primary or secondary

Chronic tonsillar infection: partial upper airway obstruction; chronic adenoidal infection: otitis media

Assessment Findings: sore throat, difficult or pain on swallowing, fever, malaise, enlarged adenoids: nasal obstruction, snoring

Medical and Surgical Management: antibiotic therapy, analgesics,

saline gargles, tonsillectomy,

and

adenoidectomy

Nursing Management:

precare/

postcare

: lab

results:

hematocrit

, platelet count,

clotting

time, aspirin use,

NSAIDs

Risk for Aspiration, Risk for Impaired Tissue Integrity, and A

cute Pain.Slide10

NCLEXThe nurse is providing postoperative care for a client who has undergone tonsillectomy. In which position will the nurse place the head of the bed when the client is fully awake?

A) Flat with the head elevated on a pillow

B) Slightly raised at a 15° angle

C) Raised at a 45° angle

D) Raised at a 90° sitting positionSlide11

NCLEXAnswer:

C) Raised at a 45° angle

Rationale: Elevate head of bed 45° when client is fully awake. This position decreases surgical edema and increases lung expansion.Slide12

Infectious and Inflammatory Disorders—(cont.)

Peritonsillar Abscess

Pathophysiology and Etiology: develops in connective tissue between tonsil and pharynx

Streptococcal or staphylococcal tonsillar infection

Assessment Findings: difficulty and pain with swallowing, fever, malaise, ear pain, and difficulty talking

Diagnostic Findings: sensitivity studies and cultureSlide13

Infectious and Inflammatory Disorders—(cont.)

Peritonsillar Abscess—(cont.)

Medical and Surgical Management: antibiotic therapy, needle aspiration, surgical incision, and drainage

Nursing Management

Semi-Fowler’s position; prevent aspiration

Ice collar, topical anesthetics, throat irrigations, drink fluids, cool or room temperature

O

bserve for respiratory obstruction—dyspnea, restlessness, or cyanosis—or excessive bleedingSlide14

Infectious and Inflammatory Disorders—(cont.)

Laryngitis

Pathophysiology and Etiology

Inflammation and swelling of the mucous membrane that lines larynx

Causes: URI, excessive/improper use of voice, allergies, smoking

Assessment Findings: cannot speak above a whisper; aphonia; throat irritation; dry, nonproductive cough

Hoarseness longer than 2 weeks:

laryngoscopy

Persistent hoarseness: sign of laryngeal

cancer

Medical

Management

V

oice rest;

treatment or removal of cause

Antibiotic therapy if

bacterial

Smoking

cessationSlide15

Structural DisordersEpistaxis

Pathophysiology and Etiology: rupture of tiny capillaries in the nasal mucous membrane

Risk factors: trauma, systemic infections (rheumatic fever), local infections, dry nasal mucosa, hypertension, aspirin, nasal tumors, and blood dyscrasias; cocaine abuse/inhale drugs

Assessment Findings: nasal speculum and tongue blade reveals bleedingSlide16

Structural Disorders—(cont.)Epistaxis—(cont.)

Medical and Surgical Management: direct continuous pressure, ice packs, cauterization, electrocautery, topical vasoconstrictor, nasal packing, balloon-inflated catheter

Nursing Management

VS, evidence of continued bleeding

Humidification, nasal lubricant, and avoidance of vigorous nose blowing or pickingSlide17

NCLEXA client was seen in the emergency room with severe epistaxis. After the physician places a nasal packing, the bleeding is controlled. What should the nurse include as part of the discharge instructions? Select all that apply.

A) Call physician if bleeding persists or becomes worse.

B) Continue taking baby aspirin as ordered.

C) Do not blow the nose.

D) Keep nasal packing in place until seen for follow-up appointment.Slide18

NCLEXAnswers:A) Call

physician if bleeding persists or becomes

worse.

C) Do not blow the nose

.

D) Keep nasal packing in place until seen for follow-up

appointment.

Rationale: The nurse assesses for signs of continued bleeding and educates the clients on measure to prevent bleeding.Slide19

Structural Disorders—(cont.)

Nasal Obstruction

Pathophysiology and Etiology

Primary conditions: deviated septum, nasal polyps or grapelike swellings, and hypertrophied turbinates

Assessment Findings:

hx

of sinusitis, difficulty breathing out of one nostril, frequent nosebleeds

Medical and Surgical Management: submucous surgical resection or septoplasty, rhinoplasty or reconstruction of the nose, steroidal nasal spray

Nursing Management: nasal packing, mouth breathing, semi-Fowler’s, VS, oral hygieneSlide20

Trauma and Obstruction of the Upper Airway

Fractures of the Nose

Pathophysiology and Etiology: trauma

Assessment Findings: swelling and edema of soft tissue, external and internal bleeding, nasal deformity, nasal obstruction

CSF—Dextrostix

Medical and Surgical Management

L

ateral displacement: pressure applied; cold compresses; complex fracture: surgery

Nursing Management: HOB elevated, apply ice, analgesics, assess for airway obstruction, pupillary responses, LOC, and periorbital edema; anxietySlide21

Trauma and Obstruction of the Upper Airway—(cont.)

Laryngeal Trauma and Obstruction

Pathophysiology and Etiology: motor vehicle accidents, blunt trauma in neck region

Assessment Findings: neck swelling, bruising, and tenderness

Stridor, dysphagia, hoarseness, cyanosis, and hemoptysis

Diagnostic Studies: laryngoscopy, x-rays, oxygenation studies

Medical and Surgical Management: patent airway, Heimlich maneuver

Nursing Management: LS, respiratory pattern, nasal swelling, bleeding, and laryngeal edemaSlide22

Trauma and Obstruction of the Upper Airway—(cont.)

Obstructive Sleep Apnea

Pathophysiology and Etiology: recurrent and frequent episodes of upper airway obstruction and reduced ventilation

Classifications: central, obstructive, mixed

Assessment Findings

Snore loudly, cessation of breathing for at least 10 secs, awaken suddenly with loud snort

Daytime fatigue, morning headache, inability to concentrate, sore throat, enuresis, and erectile dysfunctionSlide23

Trauma and Obstruction of the Upper Airway—(cont.)

Obstructive Sleep Apnea—(cont.)

Medical Management: lose weight, smoking cessation, eliminate alcohol, and use special pillows

Continuous positive airway pressure (CPAP)

Bilevel positive airway pressure (BIPAP)

Surgical Management: uvulopalatopharyngoplasty and tracheostomy

Nursing Management: reassurance, adequate instruction, explanations, self-help groups, counselingSlide24

Laryngeal CancerPathophysiology and EtiologyCauses: carcinogens: tobacco, alcohol, pollutants

Assessment Findings: persistent, progressive hoarseness; swelling or lump in throat or neck; dysphagia; pain when talking; weight loss

Diagnostic Studies: laryngoscopy, biopsy, CT, MRI, and PET

Medical

and Surgical Management: chemotherapy

, radiation therapy,

laryngectomy

Nursing Management

Assess for hoarseness, dysphagia, dyspnea, pain, burning in

throat, anxiety

level, coping strategies, ability to

communicateSlide25

Alternative Measures of Communication

Methods of laryngeal speech used after a laryngectomy includes the following:

Esophageal speech: regurgitation of swallowed air and formation of words with lips

Artificial (electric) larynx: throat vibrator held against neck, projects sound into mouth

Tracheoesophageal puncture (TEP): surgical insertion of prosthesis; Blom-Singer device

Psychosocial issues

Nursing Management: social isolation

P

romote positive self-esteem, encourage social relationships, support servicesSlide26

Treatment Modalities for Airway Obstruction or Airway Maintenance

Tracheotomy and Tracheostomy

Tracheotomy

: surgical procedure making an opening into the

trachea

Tracheostomy: surgical opening into the trachea

into which

a tracheostomy or laryngectomy tube is

inserted

Temporary or

permanentSlide27

Treatment Modalities for Airway Obstruction or Airway Maintenance—(cont.)

Tracheotomy and Tracheostomy—(cont.)

Nursing Management

Risk for Ineffective

A

irway Clearance: VS, breath sounds, assess skin color, LOC, and mental status; airway patency

Risk for Infection: monitor stoma, provide routine tracheostomy care, position

Risk for Ineffective Management of Therapeutic RegimenSlide28

Treatment Modalities for Airway Obstruction or Airway Maintenance—(cont.)

Endotracheal Intubation and Mechanical Ventilation

Uses: respiratory difficulties, comatose clients, general anesthesia

Mechanical ventilation: negative pressure, positive pressure

Nursing

Management: vital signs;

blood gas

studies;

pulse

oximetry; evaluate

mental

status,

confusion,

agitation; lung auscultation; suctioning and humidification; communication

; “magic slate

”;

wipe

board