Introduction to Medical-Surgical Nursing, 6th ed.
30
Lesson Plans for
Disorders of the Upper Respiratory Tract
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 30.1:
2. Identify the nursing responsibilities for patients undergoing tests or procedures to diagnose disorders
of the nose, sinuses, or throat.
3. Describe the nurse’s role when the following common therapeutic measures are instituted:
Lesson 30.2:
5. Assist in developing nursing care plans for patients with disorders of the nose, sinuses, or throat.
CHAPTER TEACHING FOCUS
• In this chapter, the student will have an opportunity to learn about the anatomy and physiology of the
nose, sinuses, and throat.
• The student will have the opportunity to learn about the nursing responsibilities for patients who are
undergoing tests or procedures to diagnose disorders of the nose, sinuses, and throat.
2 Chapter 30 Disorders of the Upper Respiratory Tract _____________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) Mucus protects the airway because it __________.
a) cools the airway to prevent bacterial growth
b) contains an enzyme that destroys bacteria
c) is alkaline which prevents bacterial growth
d) keeps the nasal membranes dry
2) The turbinates are __________.
a) the walls that divide the internal nose into two
b) the outermost portions of the internal nose
c) specialized cells that destroy bacteria
d) folds of tissue that project from the sidewalls of the internal nose
3) The paranasal sinuses consist of __________.
a) maxillary, frontal, ethmoid, and sphenoid sinuses
b) turbinates, vestibules, and ethmoid sinuses
c) the internal nose
d) nasopharynx, auditory tube, and pharyngeal tonsils
4) What is commonly referred to as the voice box?
a) Pharynx
b) Larynx
c) Adenoids
d) Epiglottis
5) The nurse’s examination of the nose and sinuses is usually confined to __________.
a) inspecting drainage
b) transillumination of the nares
c) inspection of external nose and palpation over the paranasal sinuses
d) palpation of paranasal sinuses
6) Nasal obstruction is more common as people age because of __________.
a) eating hot foods
b) softening of cartilage
c) hardening of cartilage
d) epistaxis
7) Throat cultures are done to __________.
a) isolate and identify infective organisms
b) check secretions from nasal irrigation
c) monitor the condition of the sinuses
d) treat congestion
8) Suctioning should only be performed for a maximum of __________.
a) 5 seconds
b) 10 seconds
c) 3 seconds
d) 20 seconds
9) Which of the following is a potentially serious complication after nasal surgery?
a) Bowel obstruction
b) Nasal soreness
c) Excessive blood loss
d) Oozing from the nares
10) The most serious complication of sinusitis is __________.
a) meningitis
b) pharyngitis
c) otitis media
d) hypovolemia
____________________________________________ Chapter 30 Disorders of the Upper Respiratory Tract 3
Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: What is the importance of the eustachian tubes?
Question: What is the purpose of upper airway suctioning?
4 Chapter 30 Disorders of the Upper Respiratory Tract _____________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 30.1
Instructor Preparation
Textbook Objectives Covered
1. List the data to be collected for the nursing assessment of the nose, sinuses, and throat.
3. Describe the nurse’s role when the following common therapeutic measures are instituted:
administration of topical medications, irrigations, humidification, suctioning, tracheostomy care,
and surgery.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying nose, sinus, and throat disorders, including:
• Anatomy and physiology of the nose, sinuses, and throat
• Nursing assessment of the nose, sinuses, and throat
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• aerosol (p. 535)
• allergen (p. 541)
• antihistamine (p. 540)
• coryza (p. 541)
• polyp (p. 540)
• rhinitis (p. 541)
• sinusitis (p. 539)
• tonsillitis (p. 545)
Student Preparation
Assignments 2 hours
1
READ – Textbook (pp. 531-534)
REVIEW
• Figure 30-1: The paranasal sinuses (p. 532)
ANSWER – Text
• Review Questions for the NCLEX Examination: 1, 2 (p. 556)
ANSWER – Study Guide
• Part IA: 1-6 (p. 177)
• Part IB: 1-10 (p. 178)
• Part IIG: 1-4 (p. 180)
____________________________________________ Chapter 30 Disorders of the Upper Respiratory Tract 5
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 30.1
2
READ – Textbook (pp. 533-534)
REVIEW
• Figure 30-3: Throat culture technique (p. 535)
• Table 30-1: Diagnostic Tests and Procedures (p. 534)
ANSWER – Study Guide
• Part IIG: 5 (p. 180)
3
READ – Textbook (pp. 534-539)
REVIEW
ANSWER – Text
• Review Questions for the NCLEX Examination: 3, 4, 5 (p. 556)
ANSWER – Study Guide
• Part IIG: 6-10 (pp. 180-181)
50-Minute Lesson Plan
Lecture Outline 20 minutes
Slide 1
Chapter 30
Disorders of the Upper Respiratory Tract
1
Slide 2
Anatomy and Physiology of the Nose, Sinuses, and Throat
• Nose
• External nose
• Internal nose
• Sinuses
• Maxillary, frontal, ethmoid, and sphenoid
• Throat
TALKING POINTS:
• The external nose is made up of bone, cartilage, and mucous membrane.
• Only the upper one-third of the external nose has a bony skeleton; the remainder is
shaped by cartilage.
6 Chapter 30 Disorders of the Upper Respiratory Tract _____________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 30.1
Slide 3
Health History
• Chief complaint and history of present illness
• Obtain detailed description of the patient’s complaints
• Medical history
• Previous streptococcal infections; sinus infections; surgery on the nose, sinuses, or
throat; known allergies; and current and recent medications
Health History (cont.)
• Review of systems
Slide 5
Physical Examination
• External nose examined for size, shape, color, and lesions
• If drainage, note amount, color, and consistency
• Examiner listens for abnormal breath sounds and notes whether the patient is breathing
TALKING POINTS:
• The nurse’s examination of the nose and sinuses is usually confined to inspection of the
external nose and palpation over the paranasal sinuses.
• What is transillumination?
Physical Examination (cont.)
• Examiner palpates over the frontal and maxillary sinuses for tenderness or pain
TALKING POINTS:
• A nasal speculum and a lighted scope are used to observe the mucosa of the nasal
cavity.
• How is the sense of smell assessed?
____________________________________________ Chapter 30 Disorders of the Upper Respiratory Tract 7
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 30.1
Slide 7
Age-Related Changes in the Nose, Sinuses, and Throat
• Nasal obstruction more common because of the softening of the cartilage of the external
nose
• Mucous membrane thinner; produces less mucus
TALKING POINTS:
• Some older people report having a watery or “runny” nose when eating spicy or hot foods.
• What side effects should older people who are on drugs to treat nasal congestion be
assessed for?
2
Slide 8
Diagnostic Tests and Procedures
• Throat culture
• Isolate and identify infective organisms
TALKING POINTS:
• A throat culture usually is done when streptococcal sore throat (“strep throat”) is
suspected.
• What is the difference in a direct and indirect laryngoscopy?
3
Slide 9
Therapeutic Measures
• Nose drops
• Nasal and throat irrigations
• Humidification
• Suctioning
• Tracheostomy care
• Nasal surgery
8 Chapter 30 Disorders of the Upper Respiratory Tract _____________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 30.1
Slide 10
Care of the Patient Having Nasal Surgery
• Assessment
• Pain, pressure, anxiety, and dyspnea
• Monitor vital signs to detect signs of excessive blood loss
• Number of dressings saturated and the frequency of changes
TALKING POINTS:
• Patients often have nasal packing in place with a moustache dressing to absorb drainage.
• If the patient is unable to close the mouth for an oral temperature, what other routes may
be used?
Care of the Patient Having Nasal Surgery (cont.)
• Interventions
• Decreased cardiac output
Question 1
• Which of the following is NOT an age-related change in the elderly?
A. Nasal obstruction is more common.
TALKING POINTS:
• Correct answer: B
• Rationale: Epistaxis (nosebleed) is more common in older people, especially in those
bleeding, the older person is at greater risk for airway obstruction
Slide 13
Question 2
• Which of the following statements is NOT correct when administering nose drops?
A. The patient may be sitting or lying down.
B. Place the dropper at the opening of the nostril, and squeeze to deliver the prescribed
amount of medication.
TALKING POINTS:
• Correct answer: C
• Rationale: The patient should keep his or her head tilted back for several minutes after
administration of nose drops to increase absorption.
____________________________________________ Chapter 30 Disorders of the Upper Respiratory Tract 9
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 30.1
Activities
Classroom Choose from below to make 30 minutes
Online
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Discuss the nurse’s role in educating
patients about the implications of age-
related changes in the nose, sinuses, and
throat.
ASSESS BASELINE
• Post the Pretest and the Background
Assessment online and have your class
complete them. Use the results to guide how
you teach the class.
2
DISCUSS
• Discuss the nursing interventions in
educating patients preparing for diagnostic
tests and procedures.
• Present the following test and procedure to
the class. Ask the class to identify the
nursing responsibilities.
• Throat culture
• Laryngoscopy
• Divide the class into two groups. Assign
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe
common tests used to diagnose disorders of
the nose, sinuses, and throat.
3
DISCUSS
• Discuss nursing considerations for the use
of drug therapy. Refer to Drug Therapy:
Nose, Sinuses, and Throat (pp. 536-537).
• Present the following common therapeutic
measures to the class. Ask the class to
identify and discuss the nurse’s role.
• Administration of topical medications
• Irrigations
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe the
importance of using humidification for the
patient experiencing disorders of the nose,
sinuses, and throat.
• Post the following discussion topic online
and have students comment. Describe the
correct method for providing trach care.
10 Chapter 30 Disorders of the Upper Respiratory Tract _____________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 30.1
Critical Thinking Question
A 20-year-old man is complaining of a severe headache and nasal congestion. The nurse
obtains a health history and finds that the present illness has lasted for 10 days. The patient
also has a medical history of allergies and sinus infections. He tells the nurse that his nasal
discharge is greenish–yellow and thick. What should be included in the nurse’s physical
examination?
Discussion Guidelines: Usually the nurse’s physical examination consists of inspection of the
reveal tenderness or pain.
Instructor Notes/Student Feedback
____________________________________________ Chapter 30 Disorders of the Upper Respiratory Tract 11
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 30.2
Textbook Objectives Covered
4. Explain the pathophysiology, signs and symptoms, complications, and medical or surgical
treatment of selected disorders of the nose, sinuses, and throat.
5. Assist in developing nursing care plans for patients with disorders of the nose, sinuses, or
throat.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying nose, sinus, and throat disorders, including:
• Anatomy and physiology of the nose, sinuses, and throat
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• aerosol (p. 535)
• allergen (p. 541)
• polyp (p. 540)
• rhinitis (p. 541)
Student Preparation
Assignments 2 hours
4
READ – Textbook (pp. 539-555)
REVIEW
• Figure 30-5: Placement of a posterior nasal pack (p. 543)
ANSWER – Text
• Review Questions for the NCLEX Examination: 6-10 (p. 556)
ANSWER – Study Guide
• Part IB: 11-15 (p. 179)
12 Chapter 30 Disorders of the Upper Respiratory Tract _____________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 30.2
5
READ – Textbook (pp. 539-555)
REVIEW
• Figure 30-7: Management of sleep apnea (p. 548)
• Nursing Care Plan: Patient Having a Tonsillectomy (p. 546)
ANSWER – Study Guide
50-Minute Lesson Plan
Lecture Outline 20 minutes
4
Slide 14
Sinusitis
• Inflammation of the sinuses, most often the maxillary and frontal sinuses
• Most common organisms are Staphylococcus pneumoniae, Haemophilus influenzae,
diplococcus, and bacteroides
• Signs and symptoms
• Pain or a feeling of heaviness over the affected area
• Purulent drainage from the nose
• When maxillary sinuses affected, pain may seem like a toothache
• Headache is common, especially in the morning
• Fever may be present; white blood cell count may be elevated
TALKING POINTS:
• What may cause sinusitis?
• Chronic sinusitis is a permanent thickening of the mucous membranes in the sinuses after
repeated infections.
Slide 15
Sinusitis (cont.)
• Complications
• Chronic sinusitis, meningitis, brain abscess, osteomyelitis, and orbital cellulitis
• Medical diagnosis and treatment
• Diagnosis
• Sinus radiographs, CT; sinus aspiration or nasal endoscopy
• Treatment
TALKING POINTS:
• The possibility of brain infection exists because of the location of the sinuses in the skull.
• When should neurologic complications be suspected?
____________________________________________ Chapter 30 Disorders of the Upper Respiratory Tract 13
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 30.2
Slide 16
Care of the Patient Having Sinus Surgery
• After FESS, able to return to work in 4 to 5 days
• Saline nasal sprays ordered to prevent crusting and promote healing
• After the Caldwell-Luc procedure, the semi-Fowler position is recommended to prevent
TALKING POINTS:
• Chronic sinusitis sometimes is treated surgically.
• Underlying problems that might be treated surgically include deviated septum, nasal
polyps, and hypertrophy of turbinates.
Care of the Patient Having Sinus Surgery (cont.)
• Nasal packing is usually left in place until the first postoperative day
• Antral packing is left in place for 36 to 72 hours
Slide 18
Nasal Polyps
• Swollen masses of sinus or nasal mucosa and connective tissue that extend into the
nasal passages
• Exact cause is unknown, but patients often have a history of allergic rhinitis or infections
• The size of the polyps may be reduced by removing allergens or treating the allergic
response
Slide 19
Care of the Patient Having Nasal Polyp Surgery
• Often in an outpatient surgical facility, so patient teaching before discharge is especially
important
• Advise patient not to take aspirin because it increases the risk of bleeding and because
some patients are allergic to aspirin
Allergic Rhinitis
• “Hay fever”: acute (seasonal) or chronic (perennial)
• Follows exposure to a substance (allergen) that causes an allergic response