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Management of Patients
With
Upper RespiratoryTract Disorders
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Nursing Care of Patients withUpper Airway Disorders
• Upper airway disorders may be minor,treated outside health care setting
– Or may be severe, life threatening
• Require good assessment skills,
understanding of variety of disorders thataffect upper airway, impact those disordersmay have on patient
• Patient teaching is important aspect of care
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Specific Disorders
• Rhinitis
• Sinusitis: acute, chronic
• Pharyngitis: acute, chronic
• Tonsillitis, adenoiditis
• Peritonisillar abscess
• Laryngitis
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Rhinitis
andSinusitis
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RHINITIS characterized by inflammation
and irritation of the mucus membranes of the
nose
TYPES:
1. ACUTE OR CHRONIC - duration
2. NON-ALLERGIC OR ALLERGIC – causative
3. VIRAL OR BACTERIAL
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CAUSATIVE:• CHANGES IN TEMPERATURE / HUMIDITY
• EXPOSURE TO ALLERGENS
• OTC, ANTI HPN, ANTI LIPID, ANTI DEPRESSANT
DRUGS
• SYSTEMIC DISEASES
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CLINICAL MANIFESTATION:
• RHINORRHEA
• NASAL CONGESTION
• NASAL DISCHARGE
• SNEEZING
• PRURITUS OF THE NOSE
• HEADACHE
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RHINOSINUSITIS
• inflammation of the paranasal sinuses and nasal cavity
• ACUTE RECURRENT CHRONIC: ABRS or AVRS
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UNRESOLVE VIRAL OR BACTERIAL RHINITIS
BLOCK NORMAL FLOW OF SINUS SECRETIONS
CONTINUOUS EXPOSURE ENVIRONMENTAL HAZARDS
STEPTOCOCCUS PNEUMONIAE HAEMOPHILUS INFLUENZAE
STAPHYLOCCOCUS AUREUS
MORAXELLA CATARRHALIS
CHLAMYDIA PNEUMONIAE STREPTOCOCCUS PYROGENES
VIRUSES AND FUNGI
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ACTIVATION OF IMMUNE RESPONSE
VASCULAR CHANGES
VasodilationCapillary permeability
Tissue congestion
CELLULAR CHANGES
Phagocytic immune responseHumoral immune responseCellular immune response
NASAL DRAINAGE = NASAL OBSTRUCTION FACIAL PAIN-PRESSURE-FULLNESS
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ABRS –
10 days ormore
AVRS – less than10 days
RECURRENT CHRONIC = 12
weeks or longer
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• PERIORBITAL EDEMA
• SORE THROAT
• ADENOIDAL HYPERTHROPHY• FATIGUE
• DECREASE IN SMELL AND TASTE
• SENSE OF FULLNESS IN THE EAR EAR PAIN
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DIAGNOSIS:•HEALTH HISTORY
•PHYSICAL ASSESSMENT•IMAGING STUDIES: XRAY,SINOSCOPY OR NASAL
ENDOSCOPY, ULTRASOUND, CTOR MRI
• DRAINAGE ASPIRATE – C/S
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HEALTH HISTORY• RISK FACTORS
SMOKING
PERSONAL/FAMILY HISTORY
OCCUPATIONAL EXPOSURE
ALLERGEN AND ENVIRONMENTAL POLLUTANTS
HEALTH PERCEPTION/PRACTICES
AGE & DEVELOPMENT
PAST HEALTH HISTORY
COUGH
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COUGH
ONSET Sudden or gradual, how long ago
NATURE Dry, moist, barking, hacking,productive, non-productive
PATTERNContinuous, occasional, related totime of the day, position or activity,weather
ASSOCIATED
SYMPTOMSPain, shortness of breath, wheezing
ALLEVIATINGFACTORS
Vaporizers, OTC medications
SPUTUM
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SPUTUM
AMOUNT Scanty, moderate, or copious
COLOR
Normal – clear sputumMucoid – tracheobronchitis or asthmaYellow/Green – bacterial infectionRusty or blood tinged – pneumonia or TBBlack – Chronic lung diseases
Pink – pulmonary edema
CHARACTERS
Watery – thin usually clearViscous – very thick, firm, and staystogetherSemi-liquid (N) – thicker than watery
sputum but not as thick as viscous sputumFrothy sputum – foam-like and containsmany small air bubbles
ODOR Normal sputum has little or no odorAbnormal sputum may have sweaty smell or
foul and offensive smell
SHORTNESS OF BREATH
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SHORTNESS OF BREATH
ONSET
Sudden or gradual, how long ago
NATUREPrecipitating factorDescription of respiration effort
PATTERN Associated with activity or positionContinuous or intermittent
ASSOCIATEDSYMPTOMS
Pain, cough, diaphoresis
ALLEVIATINGFACTORS
Positioning and home remedies
PAIN
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PAIN
ONSET Sudden or gradual, how long ago
NATURE Stabbing, burning, squeezing,crushing
PATTERNLocation and radiationActivity, pain, variable
ASSOCIATED
SYMPTOMS
Dizziness, nausea, diaphoresis or
palpitations
ALLEVIATING and AGGRAVATING FACTORS
Massage, Rest, OTC medications, Environment,warm/cold temperature
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PHYSICAL ASSESSMENT
• ERYTHEMA, PALLOR, ATROPHY, EDEMA, CRUSTING,DISCHARGE, POLYPS, EROSIONS AND SEPTAL
PERFORATION OR DEVIATION
• CERVIAL NODE ADENOPATHY AND SINUS TENDERNESS– percussion
• TRANSILLUMINATION
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INCREASE ILLUMINATION = SINUS FILLED WITH AIR
DECREASE ILLUMINATION = SINUS FILLED WITH FLUID
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MANAGEMENT
• SALINE LAVAGE/STEAM INHALATION
• ANTIBACTERIAL / ANTIVIRAL
• DECONGESTANT
• ANTI HISTAMINE
• CORTICOSTEROIDS
(BUDESONIDES/BECLOMETHASONE)
• MUCOLYTIC, EXPECTORANT AND ANTITUSSIVE
• CORRECTIVE SURGICAL REPAIR
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NURSING DIAGNOSIS
• INEFFECTIVE AIRWAY CLEARANCE – inability toclear secretions or obstructions from therespiratory tract to maintain clear airway
• INEFFECTIVE BREATHING PATTERN –
inspiration and expiration that does not provideadequate ventilation
• IMPAIRED GAS EXCHANGE – excess or deficitin oxygenation and/or carbon dioxideelimination at the alveolar capillary membrane
• ACTIVITY INTOLERANCE – insufficientphysiological or psychological energy to endure
or complete required or desired daily activities
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CORRELATED NURSING DIAGNOSIS
• ANXIETY
• FATIGUE
• FEAR
• POWERLESSNESS
• INSOMNIA
• SOCIAL ISOLATION
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PLANNING
• MAINTAIN PATENT AIRWAY• IMPROVE COMFORT AND EASE OF BREATHING
• MAINTAIN AND IMPROVE PULMONARY
VENTILATION AND OXYGENATION• IMPROVE ABILITY TO PARTICIPATE IN
PHYSICAL ACTIVITIES
• PREVENT RISK ASSOCIATED WITHOXYGENATION PROBLEMS SUCH AS SKIN ANDTISSUE BREAKDOWN, SYNCOPE, ACID – BASEIMBALANCES AND FEELINGS OF
HOPELESSNESS AND SOCIAL ISOLATIONS
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NURSING INTERVENTION
FOR CLIENTWITHPULMONARY PROBLEM
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INTERVENTIONIncludes:
1. Positioning the client to allow maximum chest expansion.
2. Encouraging and providing frequent changes in position.
3. Encouraging ambulation
4. Implementing measures that promote comfort
• Encouraging deep breathing and coughing
• Ensuring adequate hydration
• Health teaching
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Achieve efficient and controlled ventilation > breathingretraining Good gas exchange Prevent exhaustion
Prevent atelectasis and other respiratory complications
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• Pursed lip + abdominal breathing
– Improves ventilation
– Releases trapped air in the lungs
– Keeps the airways open longer and decreases the work of breathing
– Prolongs exhalation to slow the breathing rate
– Improves breathing patterns by moving old air out of the lungsand allowing for new air to enter the lungs
– Relieves shortness of breath
– Causes general relaxation
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Breathing Into a Paper Bag
help to control carbon dioxide levels in your bloodstream.
Relieve Hiccups, Stop Hyperventilating and Retinal ArteryOcclusion
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HYDRATION
• maintain the moisture of the respiratorymucous membrane
– HUMIDIFIERS device that add
water vapor to inspired air
loosen secretions
– NEBULIZERS used to deliver
humidity and medications loosen secretions
– FLUID THERAPY
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Humidifier
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Therapeutic MeasuresPromote Respiratory Function
• Chest PT
• Incentive spirometry
• Postural drainage
• Medications
• Oxygen therapy
• Artificial airways
• Airway suctioning
• Chest tubes
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PERCUSSION AND VIBRATION
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Chest Physiotherapy
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HFCWO
(High-Frequency Chest Wall Oscillation)
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Incentive Spirometry
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POSTURAL DRAINAGE
• Postural drainage is drainage by gravity of secretion from various lung segment.
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MEDICATIONS• different route can be used > respiratory and intravenous
• ACTIONS: bronchodilation = decreasing resistance inthe respiratory airway + increasing airflow to the lung >better oxygenation
• Short-acting β2-agonists ex: Salbutamol
• Long-acting β2-agonists ex:Salmeterol & Formoterol
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BRONCHODILATORS adrenergic, anticholinergic and
methylxanthines
• ADRENERGIC – action like epinephrine
• ANTICHOLINERGICS – long-term COPD ex:ipratropium bromide.
• METHYLXANTHINES – ex: aminophylline andtheophylline
CORTICOSTEROIDS anti-inflammatory properties >steroids (inhibits the synthesis of protein)
Expected Expected
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Receptor PrimaryLocation
Effect if Stimulat
ed
Effect if Blocked
Beta 1 Heart
Increase in HR,Conduction Speed
andContractility
Decrease in HR,Conduction Speed
andContractility
Beta 2 Lungs
Broncho-dilatation
Broncho-constriction
Alpha 1
Blood
Vessels
Vasoconstriction Vasodilatation
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Medication α Affects β 1 Affects β 2 Affects
Epinephrine
+++ ++ ++
Nor-epinephrine +++ + 0
NEBULIZATION
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NEBULIZATION
• solutions/suspensions
intosmall aerosol dropletsthat can be directlyinhaled
• inhaled aerosoldroplets can onlypenetrate into thenarrow branches of thelower airways if theyhave a small diameterof 1-5 micrometers
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OXYGEN THERAPY – administration of oxygen at
a concentration greater than that found in theatmosphere
Factors in Transport of O2:
– Cardiac output
– Arterial oxygen content
– Concentration of hemoglobin
– Metabolic requirement
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• Often used to treat hypoxia (hypoxemic,circulatory, anemic or histotoxic)
• It is prescribed by the physician who specifiedthe concentration, methods of delivery, andliter flow per minute.
• Patient with COPD require low oxygen
concentration (hypoxic drive)
Oxygen Therapy
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SAFETY PRECAUTIONS:
• Avoid smoking or place sign “No Smoking: Oxygen in Use”
• Make sure electric devices are in good working order toprevent short circuit sparks
• Avoid materials that generate static electricity such as
woolen blanket & synthetic fabrics. Cotton blankets andfabrics are advised
• Avoid use of volatile, flammable materials (alcohol,acetone)
• Make know the location of fire extinguisher• Check the level of portable tanks before transporting to
ensure there is enough oxygen in the tank
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1. Source of oxygen supply
a. Oxygen tankb. Wall oxygen outlet
2. Flow metera. Mercury ballb. Gauge flow meter
3. Humidifier
4. Delivery system e.g. cannula
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Oxygen Therapy
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yg py
Oxygen Therapy
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Oxygen Therapy
• It is the most commoninexpensive device
• It is easy to apply anddoes not interfere with
clients ability to talk oreat.
• It is more comfortablebecause it permits
freedom of movement• It delivers about 24-
45% O2 at flow rate of 2-6 L/min
Nasal Cannula
Simple Face Mask
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Simple Face Mask
• Delivers oxygenconcentration fromfrom 40-60% at literflow to a 5-8L/min
• Used whenincreased O2 deliveryis needed for shortperiod
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Partial Rebreather mask
• Delivers oxygen
concentration of 60-90% at liters flow of 6-10 L/min
• Reservoir bag allowsthe client to re-breath exhaled air inconjunction withoxygen
• poor fitting andwarm
Non-Rebreather mask
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Non-Rebreather mask
• It delivers the highestconcentration of oxygen as possible bymeans other thanmechanical ventilatoror intubation, at litersflow of 10-15 L/min
DIFFERENCE
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DIFFERENCE
• Rebreather maskhas a soft plasticreservoir bag attachedat the end that saves
one-third of a person'sexhaled air, while therest of the air gets outvia side ports coveredwith a one-way valve.
• Non-rebreather hasseveral one-way valvesin the side ports. Thistype of mask also has
a reservoir bagattached, but the baghas a one-way valvethat prevents theexhaled carbon dioxidefrom getting into thereservoir.
Venturi mask
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Venturi mask
• Delivers oxygenconcentrationprecisely (Fi02)
• used for pts who
are with COPD – appropriate level
• high airflow withcontrolled oxygen
level excess gasleaves throughexhalation port
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• Type 1 Respiratory
Failure is low paO2(< 55mmHg) and anormal paCO2(40mmHg)
• hypoxia withouthypercapnia Hypoxemic respiratory failure
• ventilation-perfusion(V/Q) mismatch
• Type 2 Respiratory
Failure is variablepaO2 and a highpaCO2 (>50mmHg)
• build up of carbondioxide Hypercapnic respiratory failure
• neuromuscular
disorders and CNSdepression = bothoxygen and carbondioxide are affected
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T-PIECE
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T-PIECE
• 8 – 10 L/min (30 -100 FiO2)
• heavy tubing,requires strictchanging 3 days toprevent VAP
• same withtracheostomy collar
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TRANSTRACHEAL OXYGENCATHETER directly to the trachea forclient with chronic oxygen therapy need
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Transtracheal catheter
Jet ventilation tubing with flow
regulator.
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Aerosol mask
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Aerosol mask
• 8-10 L/min (30-100% ) havingbetter humidity
FACE TENT
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FACE TENT
• 8 -10 L/min (30-
100% FiO2) > goodhumidity and fairlyaccurate O2 delivery
• advantage to be used
for patients with facialtrauma or burns.
• patients are less likely
to feel claustrophobicfor it providescomfort, clear vision,easy for speech
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Artificial Airways
• Are inserted to maintain a patent air passage for clientwhose airways has become or may become obstructed.
• It is indicated for client with decrease level of consciousness or airway obstruction and to aid inremoval of tracheobronchial secretion.
• It has four common types:
a. oropharyngeal
b. nasopharyngeal
c. endotracheal
d. tracheostomy
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Used for client with alteredLOC. (GA,overdose,headinjury)
It is much easier to insert
Disadvantages:increase oralsecretion, decrease patientcomfort, difficulty withstabilization, inability of patientto communicate.
Tolerated better by alert client.
They are inserted through the naresand terminating in oropharynx.
It is more comfortable to patient
and easier to stabilize. Provide frequent nares and oral
care: reposition the airway in othernares as ordered to preventnecrosis of the mucosa.
Oropharyngeal Airway Nasopharyngeal Airway
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The mains risks of its use:
if the person has a gag-reflex they may vomit
when it is too large, it canclose the glottis and thusclose the airway
improper sizing can causebleeding in the airway
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• measuring from the middle of the persons
mouth to the angle of the jaw.
• inserted into the persons mouth upside down
– Once contact is made with the back of thethroat, the airway is rotated 180 degrees,allowing for easy insertion, and assuringthat the tongue is secured
– holding the tongue forward with a tonguedepressor and inserting the airway rightside up
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NPA or a nasal trumpet
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NPA or a nasal trumpet
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• The correct size airway is chosen by measuring
the device on the patient: the device shouldreach from the patient's nostril to the earlobe orthe angle of the jaw
• outside of the tube lubricated with a water-
based lubricant
• until the flared end rests against the nostril contraindicated in patients with severe head orfacial injuries basilar skull fracture
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• c. Nasopharyngeal Insertion Procedures.
(1) Place pt on a firm surface in the supine position with the
cervical spine stabilized.
(2) Lubricate the NPA with a water-soluble lubricant
(3)Push the tip of the patient's nose slightly upward to exposethe opening in the nostril.
(4)Keeping the head neutral position, insert the tip of the
NPA through the nostril.
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• (5) Slowly advance tube along floor of nasal cavity with
bevel pointing toward septum until flange rest firmly againstcasualty's nostril
(a) If resistance is met during insertion, do not continue to
insert.
(b)Stop, remove the adjunct, relubricate, and try the other nostril.
(c)If resistance is still met, check proper size or use alternate
artificial airway method
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Artificial Airways
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Endotracheal tube
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•Are commonly inserted to client who
have had GA and for those in emergencysituation where mechanical ventilation isrequired.
• It is used as short term artificial airwaysto administer mechanical ventilation,relieved upper airway obstruction, protectagainst aspiration or clear secretion
• It is generally removed after 14 days.
Tracheostomy Tube
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y
Tracheostomy Tube
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Tracheostomy tube in place
Components of tracheostomytube
Tracheostomy
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• Inserted to the trachea via the 2nd or 3rd cartilage ring totally bypasses the upperairways.
• It is indicated for client who require long term
oxygen support, wherein an incision is madein the trachea just below the larynx.
• It may be in form of plastic or metal and areavailable in different sizes.
• Patient requiring MV requires a cuffedTracheostomy tube and those that are awakeand alert requires a cuffless tracheostomy
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1 - Vocal folds
2 - Thyroid cartilage
3 - Cricoid cartilage
4 - Tracheal rings
5 - Balloon cuff
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Nursing Management for Patient with Artificial
Airways.
• Ensure adequate ventilation and oxygenation through theuse of mechanical ventilator, CPAP.
• Clear airway secretion as needed with suctioning.• Use sterile technique in entering AA.
• Elevate the patient on a semi fowlers or sitting position if possible.
• Change position at least every two hours
External tube site care:
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Endotracheal tube – provide frequent oral care
if possible, secure the tube at all times
Tracheostomy tube – stoma should be cleanedonce in a shift and tracheostomy ties
changed once a day Have available at all times at the patient
bedside, resuscitation bag, oxygen source,and mask to ventilate the patient in case of
accidental tube removal.
Provide psychological support to thepatient.
SUCTIONING
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• It is aspirating secretion through a catheter connected tosuction machine or wall suction outlet.
• It may be an: A. OPEN TIPPED B.WHISTLE TIPPED
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• Purpose includes:
- to remove secretion that obstruct theairway.
- to facilitate ventilation.- to obtain secretion for diagnosticpurposes.
- to prevent infection that may result fromaccumulated secretion.
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• WHATINTERVENTIONS
ARE APPLICABLETO OUR CLIENT
WITHRHINOSINUSITIS?
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COMPLICATIONS
• MAXILLARY RS MASTICATION PROBLEM
• FRONTAL RS OSTEOMYELITIS OF THEFRONTAL BONE
• ETHMOID RS ORBITAL CELLULITIS INTRACRANIAL INFECTION
• SPHENOID RS VASCULAR COMPLICATION
– Infections that involve either of thesestructures may lead to aneurysms orinfected blood clots in the intracranial cavity
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• The frontal,
ethmoid andsphenoid sinusesare separated from
the intracranialcavity by a layer of bone
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Pharyngitis – inflammation of throat
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RISK FACTORS:
• cold & flu seasons
• close contact w/ someone who has sore throat/cold
• smoking exposure• frequent sinus infection
• allergies, viruses and bacteria
• environmental condition
• voice prompt occupation
• chronic cough
• habitual use of alcohol and tobacco
PATHOPHYSIOLOGY
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BACTERIA/VIRUSES
TRIGGERS INFLAMMATORY RESPONSE
RELEASING CHEMICAL MEDIATORS
DILATION OF BLOOD VESSEL CAPILLARY PERMEABILITY WBC/MACROPHAGES
INCREASE BLOOD FLOW PLASMA FLUID PHAGOCYTOSIS
Redness SWELLING PAIN release toxins
increased temperature in the area temperature increase
GAS MYCOPLASMA PNEUMONIAE NEISSERIA GONORRHEA
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H. INFLUENZA
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• ACUTE
– FIERY-REDpharyngealmembrane andtonsils
– swollen lymphoid
follicles with whitepurplish exudates
– enlarged and tendercervical lymph node
– no cough
– fever, malaise, sorethroat
• CHRONIC
– General thickening andcongestion of thepharyngeal mucousmembrane HYPERTHROPIC
– swollen lymphoid follicleson the pharyngeal wall CHRONIC GRANULAR
“ clergyman’s sore throat”
– Irritation or fullness in thethroat
– with cough
– difficulty swallowing
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Question
• Tell whether the following statement is true or false:
• Acute pharyngitis of a bacterial nature is most commonly
caused by group A, beta-hemolytic streptococci.
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Answer
• True.
• Rationale: Acute pharyngitis of a bacterial nature is most
commonly caused by group A, beta-hemolyticstreptococci.
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Potential Complications
• Sepsis
• Meningitis
• Tonsillitis and Adenoiditis
• Peritonsillar abscess
• Otitis media
• Sinusitis
• TONSILLITIS/ADENOIDITIS
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– composed lympathic tissue
– fever, snoring , difficultyswallowing, mouthbreathing, earache, nasalobstruction
– throat culture affirmativediagnosis of the causativeagent + physicalexamination
– Supportive treatment,antibiotic, analgesics, andsurgery
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Severe sore throatFever
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TrismusDroolingPain
Odynophagia/dysphagiaCervical lymph node enlargement
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CLINICAL SYMPTOMS
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• Hoarseness of voice
• Dry cough worsen in the evening
• Tickling sensation on the throat
– MANAGEMENT:
• SUPPORTIVE
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OBSTRUCTION DURING SLEEP (OSA)
• reduction of ventilation during sleep
– obesity
– male gender
– post-menapausal status
– advanced age
snoring, snorting, gasping, choking, apneic episodes,fatigue4 and hypersomnolence
polysomnographic test
CPAP
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Nursing Process: Care of Patients with
Upper Respiratory Infections -Assessment
• Health history
• Signs and symptoms: headache, cough, hoarseness,fever, stuffiness, generalized discomfort and fatigue
• Allergies
• Inspection of nose, neck, throat
– Include palpation of lymph nodes
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Question
• What should the nurse palpate when assessing for anupper respiratory tract infection?
A. Neck lymph nodesB. Nasal mucosa
C. Tracheal mucosa
D. All of the above
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Answer
• A. Neck lymph nodes
• Rationale: The nurse should palpate the neck lymph
nodes along with the trachea and the frontal andmaxillary sinuses when assessing for an upperrespiratory tract infection. The nurse should inspect thenasal and tracheal mucosa when assessing for an upperrespiratory tract infection.
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Nursing Process: Care of Patients with
Upper Respiratory Infections - Diagnosis
• Ineffective airway clearance
• Acute pain
• Impaired verbal communication
• Deficient fluid volume
• Deficit of knowledge related to prevention, treatment,surgical procedure, postoperative care
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Nursing Process: Care of Patients with
Upper Respiratory Infections - Planning
• Maintenance of patent airway
• Relief of pain
• Maintenance of effective communication
• Normal hydration
• Knowledge to how to prevent upper airway infections
• Absence of complications
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Interventions
• Interventions to maintain patent airway
• Promote comfort
– Analgesics
– Gargles for sore throat
– Use of hot packs for sinus congestion or ice collar toreduce swelling, bleeding post tonsillectomy and
adenoidectomy
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Interventions (cont’d)
• Rest
• Refrain from speaking, use alternative communication
• Encourage liquids; 2 to 3 L a day, appropriate foods
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Patient Education
• Prevention of upper airway infections
• Emphasize frequent hand washing
• When to contact health care provider
• Need to complete antibiotic treatment regimen
• Annual influenza vaccine for those at risk
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Epistaxis
• Hemorrhage from nose
• Risk factors
• Sites of bleeding
– Most common: anterior septum
• Can be serious problem resulting is significant blood lossor airway compromise
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Treatment of Epistaxis
• Topical vasoconstrictors
– Adrenaline
– Cocaine
– Phenylephrine
• Packing of nasal cavity or balloon catheter
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Control of Epistaxis
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Nursing Care of Patients with Epistaxis
• Assessment of bleeding
• Monitor airway, breathing
• Vital signs
• Reduce anxiety
• Patient teaching
– Avoid nasal trauma, nose picking, nose blowing
– Air humidification
– Pressure on nose to stop bleeding; if bleeding doesnot stop in 15 minutes, seek medical attention
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Cancer of the Larynx
• Incidence
• Risk factors
• Categories
– Supraglottic: false vocal cords above vocal cords
– Glottic: true vocal cords
– Subglottic: below vocal cords
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Symptoms
• Hoarseness
• Persistent cough
• Sore throat or pain, burning in throat
• Lump in neck
• Later symptoms: dysphagia, dyspnea, unilateral nasalobstruction, persistent hoarseness, persistent ulceration,
foul breath
• Generalized symptoms: weight loss, debilitation,lymphadenopathy, radiation of pain to ear
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Question
• Tell whether the following statement is true or false:
• An early sign of cancer of the larynx in the glottic are isenlarged cervical nodes.
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Answer
• False.
• Rationale: An early sign of cancer of the larynx in theglottic are is affected voice sounds, not enlarged cervicalnodes.
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Medical Diagnosis
• Diagnosis made by history, physical exam, laryngoscopicexam, biopsy
• Tumors staged by TMN classification
• CT, MRI, PET to assess tumor extent and stage, todetermine reoccurrence
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Medical Treatment
• Radiation therapy
• Chemotherapy
• Surgery
– Partial laryngectomy
– Supraglottic laryngectomy
– Hemilaryngectomy– Total laryngectomy
Changes in Airflow with Total
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Changes in Airflow with Total
Laryngectomy
Nursing Process: Care of a Patient with a
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Nursing Process: Care of a Patient with a
Laryngectomy - Assessment
• Health history
• Assess history of alcohol abuse
• Physical assessment
• Nutritional status
• Assess literacy, hearing, visual ability; may impactcommunication
• Assess learning needs
• Assess patient, family coping, support systems
Nursing Process: Care of a Patient with a
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Nursing Process: Care of a Patient with a
Laryngectomy - Diagnoses
• Deficit knowledge related to surgical procedure,postoperative course
• Anxiety, depression
• Ineffective airway clearance
• Impaired verbal communication
• Imbalanced nutrition
• Disturbed body image
• Self-care deficit
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Potential Collaborative Problems• Respiratory distress
• Hemorrhage
• Infections
• Wound breakdown
• Aspiration
Nursing Process: Care of a Patient with a
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Nursing Process: Care of a Patient with a
Laryngectomy - Planning• Adequate level of knowledge (patient, family)
• Reduction of anxiety
• Maintenance of patent airway
• Effective means of communication
• Attaining optimum hydration, nutrition
• Improved body image, self-esteem• Self-care management
• Absence of complications
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Preoperative Teaching• Instruction regarding type of procedure, resultant
changes (changes in speech, permanent loss of speech,changes in airway)
• Include instruction regarding tubes used postoperatively(drainage tubes, feeding tubes), provide generalpreoperative teaching to prevent postoperativecomplications
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Preoperative Teaching (cont’d) • Include planning for postoperative communication, long-
term speech rehabilitation
• Utilize collaborative approach
• Include physician, speech therapy, dietary, social work,clinical nurse specialist, others as required
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Anxiety and Depression• Allow asking of questions, provide information
• Permit verbalization of feelings
• Interventions to reduce anxiety, promote comfort
• Reassuring manner
• Stay with patient during episodes of anxiety
• Relaxation techniques
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Maintaining a Patent Airway• Semi Fowler’s or high Fowler’s position to decrease
edema
• Monitor for signs, symptoms of respiratory distress
• Tracheostomy or laryngectomy tube assessment, care
• Care of stoma
• Suctioning
• Humidification of air
• Patient teaching
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Communication• Plan communication preoperatively
• Immediate postoperative communication
– Magic slate
– Communication board
• Speech rehabilitation
TEP Voice Prosthesis
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TEP Voice Prosthesis
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Potential for Aspiration• Keep HOB elevated during, after tube feedings
• Check gastric residual when administering tube feedings
• When patient begins oral feeding, maintain upright bedposition during, after feedings
• Swallowing maneuvers to prevent aspiration
• Use of thickened liquids