14 Chapter 30 Disorders of the Upper Respiratory Tract _____________________________________________
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LESSON 30.2
Slide 21
Allergic Rhinitis (cont.)
• Signs and symptoms
• Nasal obstruction; sneezing; clear nasal discharge; frontal headache; and itchy,
watery eyes
• Nasal mucosa is often pale, but it can be red or bluish
• Medical diagnosis
• This can help identify possible allergens
Allergic Rhinitis (cont.)
• Medical treatment
• Desensitizing injections may be advised to decrease the patient’s reaction to the
TALKING POINTS:
• Allergy testing
• The allergist applies solutions of common allergens to the skin.
• The allergens are applied in a specific pattern so that the patient’s reaction to them
can be assessed individually.
• Desensitizing injections
• Patients often call these injections “allergy shots.”
Slide 23
Acute Viral Coryza
• The common cold
• Can be caused by any of some 30 viruses
• It is contagious and spread by droplet infection
• Signs and symptoms
TALKING POINTS:
• Who has a high risk of complications?
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LESSON 30.2
Slide 24
Acute Viral Coryza (cont.)
• Medical treatment
• Antihistamines, decongestants, and antipyretics
• Prevention
TALKING POINTS:
• Medical management of the common cold is primarily directed at relief of symptoms.
Slide 25
Tumors
• Signs and symptoms
• Nasal obstruction
• Bloody discharge from one nasal passage
TALKING POINTS:
• Tumors can be benign or malignant.
• Sinus malignancies are more common among people in certain occupations—notably
Slide 26
Tumors (cont.)
• Medical treatment
• Combination of surgery, radiation therapy, and chemotherapy
• Surgical procedures may be extensive and disfiguring, depending on the site and
TALKING POINTS:
• Why are benign tumors usually removed even though they do not metastasize?
16 Chapter 30 Disorders of the Upper Respiratory Tract _____________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 30.2
Deviated Nasal Septum
• Nose divided into two passages by a cartilaginous wall called the septum
• In most adults, septum is slightly deviated, meaning it is off-center
TALKING POINTS:
• What are two major complications of submucosal resection?
Slide 28
Epistaxis
• Nosebleed; from trauma, clotting disorders, dryness, inflammation, and hypertension
• First aid
• The patient should sit down and lean forward
• Direct pressure should be applied for 3 to 5 minutes
• Medical treatment
• Infection, blockage of the eustachian tube, and airway obstruction
TALKING POINTS:
• The nose has an abundant blood supply that permits it to bleed easily.
• When should pressure not be applied to the nose?
Slide 29
Epistaxis (cont.)
• Assessment
• Inspect the nose and back of the throat for obvious bleeding and observe for frequent
swallowing
• Level of consciousness and vital signs to detect signs of hypovolemia
TALKING POINTS:
• If a nasal balloon catheter or nasal packing has been placed, what assessments should
be made?
____________________________________________ Chapter 30 Disorders of the Upper Respiratory Tract 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 30.2
Pharyngitis
• Inflammation of the mucous membranes of the throat or pharynx
• Also can follow exposure to irritating substances in the environment
TALKING POINTS:
• Usually occurs along with acute rhinitis or sinusitis.
• When does pharyngitis most commonly occur?
Slide 31
Pharyngitis (cont.)
• Signs and symptoms
• Dryness, pain, dysphagia (difficulty swallowing), and fever
TALKING POINTS:
• What additional signs of infection associated with beta-hemolytic streptococci may be
observed?
Slide 32
Pharyngitis (cont.)
• Complications
• Acute glomerulonephritis and rheumatic fever
• Medical diagnosis
• Throat culture and a complete blood count
TALKING POINTS:
Slide 33
Pharyngitis (cont.)
• Medical treatment
• Rest, fluids, analgesics, throat gargles or irrigations
• Bedrest as long as patient has a fever
• If oral intake is low, intravenous fluids
TALKING POINTS:
• Obtain the culture specimen before the antibiotics are started.
• How long will the course of antibiotic therapy continue?
Pharyngitis (cont.)
• Prevention
• People with poor resistance should avoid others with upper respiratory infections
18 Chapter 30 Disorders of the Upper Respiratory Tract _____________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 30.2
Slide 35
Pharyngitis (cont.)
• Assessment
• Throat pain, dysphagia, muscle and joint pain, nausea and vomiting, and rash
• Take the patient’s temperature, and inspect the throat for redness and enlarged
tonsils
Slide 36
Pharyngitis (cont.)
• Interventions
• Reinforce physician’s directions for drug therapy
TALKING POINTS:
• Fluids must be increased cautiously in the elderly because they do not adjust well to
sudden changes in blood volume.
• What symptoms should be reported to the physician?
Slide 37
Tonsillitis
• Inflammation of tonsils/other throat lymphatic tissue
• Common in children but more severe in adults
• Causes
• Usually bacterial, but sometimes caused by a virus
• Causative organisms: streptococci, staphylococci, H. influenzae, and pneumococci
Slide 38
Tonsillitis (cont.)
• Signs and symptoms
• Sore throat, difficulty swallowing, fever, chills, muscle aches, and headache
• If swollen tissue blocks eustachian tubes, ear pain
• Offensive breath odor often with chronic infection
Tonsillitis (cont.)
• Medical diagnosis
TALKING POINTS:
• What does an elevated white blood cell count suggest?
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 30.2
Tonsillitis (cont.)
• Medical treatment
• Antibiotic therapy for 7 to 10 days
Slide 41
• Malignancy of the tonsil
Tonsillitis (cont.)
• Complications
• Peritonsillar abscess
• Surgical treatment
• Tonsillectomy and adenoidectomy
TALKING POINTS:
• A peritonsillar abscess is an infection of the tissue surrounding the tonsil.
• What is the immediate treatment of a peritonsillar abscess?
• Tonsillectomy is usually recommended under the following conditions:
Slide 42
Care of the Patient Having a Tonsillectomy
• Assessment
• Frequently monitor responsiveness/vital signs
• Inspect drainage from the mouth or vomited fluid for blood
Care of the Patient Having a Tonsillectomy (cont.)
• Interventions
• Decreased cardiac output
Slide 44
Obstructive Sleep Apnea
• Airway obstruction during sleep
• The tongue and soft palate fall backward partially or completely blocking the airway,
causing apnea and hypopnea (abnormally slow, shallow breathing)
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 30.2
Slide 45
Obstructive Sleep Apnea (cont.)
• Symptoms related to disrupted sleep pattern
• Patient often irritable and sleepy during the day
• Sleeping partner may report loud snoring or episodes of apnea
Obstructive Sleep Apnea (cont.)
• Conservative treatment: weight loss if obese, avoidance of sedatives and alcohol for 3–4
TALKING POINTS:
• Management of sleep apnea often involves sleeping with a nasal mask in place. The
Slide 47
Laryngitis
• Inflammation of the larynx
• Causes: upper respiratory infections, voice strain, smoking, alcohol ingestion, and
inhalation of irritating fumes
• Signs and symptoms
• Hoarseness, cough, and scratchy or painful throat
TALKING POINTS:
• The physician may use a laryngeal mirror to examine the larynx for color, edema, and
growths such as polyps and tumors.
Slide 48
Laryngitis (cont.)
• Medical treatment
• Voice rest is advised, meaning that the patient should not talk
• Removal of the irritant
Slide 49
Laryngitis (cont.)
• Assessment
• Document severity, how long it has persisted, and factors that aggravate or precipitate
it
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 30.2
Slide 50
Laryngitis (cont.)
• Interventions
• Pad and pencil or Magic Slate for communication
• Sign over the bed noting that patient should not speak
Laryngeal Nodules
• Benign masses of fibrous tissue result primarily from voice overuse but can follow
infections
TALKING POINTS:
• The removal of nodules is usually fairly simple, but they may recur if the voice is again
misused.
• What interventions are necessary postoperatively?
Slide 52
Laryngeal Polyps
• Swollen mass of mucous membrane attached to vocal cord
• Can cause continuous or intermittent hoarseness, depending on its location and
attachment
Cancer of the Larynx
• Factors: exposure to smoke or other noxious fumes, alcohol consumption, vocal strain,
and chronic laryngitis
TALKING POINTS:
• Cancer of the larynx accounts for more than 10,000 new cancers each year.
Cancer of the Larynx (cont.)
• Signs and symptoms
• Early symptoms include persistent hoarseness or sore throat and ear pain
22 Chapter 30 Disorders of the Upper Respiratory Tract _____________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 30.2
Cancer of the Larynx (cont.)
• Prevention
• Stop smoking and drinking alcohol
Cancer of the Larynx (cont.)
• Medical diagnosis
Slide 57
Cancer of the Larynx (cont.)
• Medical treatment
• Surgery, radiotherapy, chemotherapy, or a combination
• Surgery: from simple removal of the tumor to extensive procedures, such as
TALKING POINTS:
• Radiotherapy alone can cure some small cancers that have not spread to surrounding
tissues.
• What is brachytherapy?
Slide 58
Care of the Patient Having a Total Laryngectomy
• If patient will lose the ability to speak, information about other means of communication
should be available
• Listen compassionately and accept the patient’s expressions of anger or despair
• A total laryngectomy will require that the patient breathe through the trachea
TALKING POINTS:
• The physician and speech therapist can advise the patient about appropriate alternatives
for speech.
• What structures are removed with a total laryngectomy?
Slide 59
Care of the Patient Having a Total Laryngectomy (cont.)
• Complications
• Salivary fistula, carotid artery blowout, tracheal stenosis
• Assessment
• Patient’s level of consciousness
• Ask about pain and observe for signs of discomfort
• Fluid intake and output, wound drainage
____________________________________________ Chapter 30 Disorders of the Upper Respiratory Tract 23
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 30.2
Slide 60
Care of the Patient Having a Total Laryngectomy (cont.)
• Interventions
• Ineffective airway clearance
• Anxiety
• Decreased cardiac output
• Acute pain
• Risk for injury
Care of the Patient Having a Supraglottic Laryngectomy
• Care like that for total laryngectomy except the tracheostomy is temporary, the voice is
not lost, and swallowing is more problematic
TALKING POINTS:
• The patient with a supraglottic laryngectomy is at increased risk for aspiration pneumonia.
• What swallowing techniques may be taught?
Care of the Patient Having a Partial Laryngectomy
• Temporary tracheostomy for 2 to 5 days
• IV fluids and enteral feedings are ordered at first
Activities
Classroom Choose from below to make 30 minutes
Online
4
DISCUSS
• Discuss and review with the class the
pathophysiology of nose and throat
disorders.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe signs
and symptoms associated with nasal cancer.
24 Chapter 30 Disorders of the Upper Respiratory Tract _____________________________________________
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LESSON 30.2
5
DISCUSS
• Discuss a nursing care plan for a patient
with a nose, sinus, or throat disorder,
including goals and outcome criteria.
Provide students with a sample to look at.
• Divide the class into small groups and have
each group refer to Nursing Diagnoses,
POST AND COMMENT
• Post the following discussion topic online
and have students comment. List the top two
nursing diagnoses and interventions for the
patient with:
• Nasal cancer
• A tracheostomy
Critical Thinking Question
A nurse is reviewing the medical record of a 65-year-old man whose throat condition was
diagnosed as laryngeal cancer. The patient has consumed alcohol and used tobacco for the
last 50 years. What signs and symptoms should the nurse expect?
Instructor Notes/Student Feedback
____________________________________________ Chapter 30 Disorders of the Upper Respiratory Tract 25
Introduction to Medical-Surgical Nursing, 6th ed.
30
Assessments for
Disorders of the Upper Respiratory Tract
CHAPTER 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:
administration of topical medications, irrigations, humidification, suctioning, tracheostomy care, and
surgery.
Lesson 30.2:
5. Assist in developing nursing care plans for patients with disorders of the nose, sinuses, or throat.
Assessments by Lesson & Objective
Lesson 30.1
1
Study Guide
• Part IA: 1-6 (p. 177)
• Part IB: 1-10 (p. 178)
• Part IIG: 1-4 (p. 180)
2
Study Guide
• Part IIG: 5 (p. 180)
Evolve Instructor Resources
• Test Bank: 29
3
Study Guide
• Part IIG: 6-10 (pp. 180-181)
Evolve Instructor Resources
• Test Bank: 3, 4, 7-9, 16
Evolve Student Resources
• NCLEX Review: 1, 7, 8
Lesson 30.2
4
Study Guide
• Part IB: 11-15 (p. 179)
• Part IC: 1-4 (p. 179)
Evolve Instructor Resources
• Test Bank: 1, 2, 5, 6, 10, 13-15, 17, 18, 20, 24, 26-28
26 Chapter 30 Disorders of the Upper Respiratory Tract _____________________________________________
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Assessments by Lesson & Objective
5
Study Guide
• Part IIG: 41 (p. 183)
• Part IIIH: 1-8 (pp. 184-185)
• Part III I: 1-7 (p. 185)
Evolve Instructor Resources
Instructor’s Notes/Student Feedback