7/30/2019 NCM103 16th Respi II

1/5

jcmendiola_Achievers2013

Care of Clients with Problems In Oxygenation,

Fluids and Electrolytes, Metabolism and Endocrine

(NCM103)

Patients With Respiratory Alterations II

Nursing Care of Clients

With Upper Respiratory AirwayComplications

Epistaxis Hemorrhage of the nose Caused by the rupture of tiny distended vessels in the mucous membrane Common site Anterior Septum Anterior nasal bleeding is common among younger clients due to injury to nose / nasal membrane Post. Occur among elderly whom the blood vessels and artery become hardened and break

RISK FACTORS:

1. Local Infection2. Systemic Infection3. Drying of nasal mucosa4. Inhalation of certain drugs5. Trauma6. HTN7. Tumor8. Thrombocytopenia9. Use of certain medications (ACE Inhibitors Angioedema Fragile Blood Vessels)10. Liver Disease11. Hereditary12. Hemorrhagic Disease

Medical Management

1. Nasal packing can be done2. Use of nasal decongestant, topical cocaine, antibiotic3. Cauterization-electrocautery4. Balloon inflated catheter5. Suctioning6. When Nose bleeds occur:

a. Ask patient to do an upright position with slightly leaning forwardb. Inform patient to breathe through the mouthc. And pinch the nose

Nursing Management- Assess airway and breathing- Monitor VS- WOF: BleedingIdentify factors that contributed to the development of bleeding- Alleviate anxiety and provide adequate humidification- Provide Health Teaching

o Avoid vigorous exerciseo Provide discharge planning

Topics Discussed Here Are:

1. Epistaxis2. Nasal Obstruction3. Laryngeal Obstruction

Laryngospasm4. Nasal Trauma5. Obstructive Sleep Apnea

LOOKY

HERE

7/30/2019 NCM103 16th Respi II

2/5

jcmendiola_Achievers2013

Nasal Obstruction Nasal congestion forces the patient to breathe through the mouth that causes dryness of the oral

membrane

Often experience deprivation of oxygen Persistent nasal obstruction can lead to chronic infection of the nose

RELATED FACTORSStructural Factor

Deviated nasal septum Hypertrophy of turbinate bone Pressure of the nasal polyps Large adenoids

Non-Anatomic Factors

Chronic sinusitis Allergies Overuse of nasal spray (AE: Rhinomedicamentus) Birth control pills ( Estrogen = Congestion) HTN

Medical Management- The Goal of Care is to remove the obstruction- Medications will include:

o Corticosteroidso Antibioticso Decongestants, humidification

- SURGICAL PROCEDURE Functional Rhinoplasty Nasal PolypectomyNursing Management

- Assess the respiration and airway of patients- For surgery clients, perform care of patients with surgical procedures- Elevate the head of the bead- Frequent oral hygiene- Instruct client to avoid blowing the nose with force- Instruct client the signs and symptoms of bleeding

Nursing Responsibility- Provide adequate room humidification- Mouth care- Encourage increased oral fluid intake- WOF: Frequent swallowing- NO TO ASPIRIN

Laryngeal Obstruction This is a LIFE THREATENING condition This may be due to edema or swelling of the laryngeal mucosa May be due to foreign bodies frequently aspirated to the pharynx

Types:

Acute Laryngeal Edema Associated with inflammation, injury or anaphylaxis Laryngeal Injury Trauma during vehicular accidents Chronic Laryngeal Edema Occurs when lymphatic drainage is obstructed Laryngeal Paralysis Results from neck surgery, CNS disorder, tumor or viral infection

7/30/2019 NCM103 16th Respi II

3/5

jcmendiola_Achievers2013

Laryngospasm After administration of some general anesthetic agents After repeated and traumatic ET attempts Response to some inhaled agents Hypocalcemia (Soft tissues)

o DepolarizationETIOLOGY

Allergy Foreign body Family history of airway problems History of surgery, radiation or trauma on neck area Heavy smoking and alcohol consumption Use of ACE-Inhibitors =Angioedema History of throat pain / fever Previous tracheostomy Subglottis stenoid History of NGT placement Nasogastric Tube Syndrome

Management of Care- Based on initial evaluation- Tracheostomy- Administration of epinephrine and corticosteroids- Ice application on the neck

Nursing Management- History of patient and family history alcoholism- Current medications- History of airway problem- Recent infection, pain, fever, and dental pain, and poor dentition- History of surgery, radiation / trauma- Monitor for lowered oxygen saturation- Check for the use of accessory muscle- Assess for post cricoid ulceration- Review X-ray result that will confirm diagnosis of laryngeal obstruction

Nasal Trauma Nasal fracture is the most common facial feature It can result to the following complications:

o Hematomao Infectiono Abscesso Avascular / Septic necrosis

Clinical Manifestations

- Pain- Nasal bleeding- Periorbital ecchymosis- Nasal obstruction- Deformities- Swelling of***

7/30/2019 NCM103 16th Respi II

4/5

jcmendiola_Achievers2013

Medical Management- Control of bleeding- Consider possibility of cervical spine damage- Treat with antibiotics, nasal decongestants and analgesic agents- May perform rhinoplasty and septoplasty- Draining of nasal hematoma

Nursing Management- Diagnose the internal and external nose- Assess for any clear liquid draining the nose- Palpate carefully the nose for deformity- Review x-ray result for confirmation of fracture and the extension of fracture to the skull- Cold compress may be applied- Elevate the head

Obstructive Sleep Apnea (OSA)- It is characterized by:

o RECURRENT episodes of upper airway obstructiono REDUCTION in ventilation

- It is the cessation of breathing during sleep usually caused by repetitive upper airway obstructionRISK FACTORS

Obesity, large neck circumference Male gender Post menopausal status Advanced age Upper airway structural defect

Manifestations- Snoring- Snorting- Gasping- Choking- Apneic Episodes- Complains of INSOMNIA / FATIGUE

Medical Management Continuous Positive Arterial Pressure (CPAP): Prevents airway collapse Bilevel Positive Arterial Pressure (BiPAP): Makes breathing easier Surgical Procedures:

o Tonsillectomy, Uvulopalatopharyngoplastyo Low flow Oxygen via Nasal canula at night

Pharmacologic Management Protriptyline: Improve upper airway muscle tone Medroxyprogesterone andAcetazolamide: Sleep apnea, assist with alveolar

hypoventilation

Modafinil: Reduces DAYTAIME sleepinessNursing Management

- Assess for complain of fatigue, insomnia- Assess for the classic signs of OSA- Obtain health history, sleeping pattern- Explain the disorder to the client- Health teaching about the treatment- The risk of untreated OSA

7/30/2019 NCM103 16th Respi II

5/5

jcmendiola_Achievers2013

GENERAL GUIDELINES Assess for:

o Respiratory rateo Use of accessory muscleso Condition of the upper airway

Assess for health history and precipitating factors Assess for bleeding, location and other effect to client ADLs Assess for social history and upper airway disorders

POSSIBLE NURSING DIAGNOSES Ineffective airway clearance related to foreign body in the airway, retained secretions Alteration in comfort: Pain r/t irritant / compression of nerve endings Knowledge deficit Risk for body image disturbance r/t biophysical factors Risk for infection r/t inadequate***

Plan of Care- To promote patent airway- Gain information regarding prevention of complications, diagnosis and management of care- Decrease the level of pain- Verbalize feeling and alleviate anxiety- Prevent development of infection- Promote acceptance of self situation

Nursing Intervention Teaching the client preoperatively Allow verbalization of feelings Maintaining a patent airway Promoting adequate hydration

Evaluation

Demonstrate adequate knowledge Verbalize feelings Exhibit patent airway ***** ** ****