Respiratory System Part Two

RESPIRATORY SYSTEM PART TWO 2- Disorders of the Respiratory System

Rhinitis 

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Definition: inflammation and irritation of mucous membranes of the nose Etiology  allergic or nonallergic - often called "hay fever"  caused by a variety of factors including environmental exposures, infection, age, systemic disease, drugs, or presence of foreign object Findings  excessive nasal drainage  nasal congestion  purulent nasal discharge if the cause is bacterial  nasal itchiness and sneezing  watery eyes  sore throat, general malaise, fever, chills, and headache in cases of viral rhinitis (common cold)

Rhinitis  

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Diagnostics - history of findings, type / color of drainage Management  identify the cause  relieve findings (NSAIDS, antihistamines, decongestants  antiinfectives for infectious causes  desensitizing immunizations for allergic causes  common cold treatment includes:  encourage more fluids  rest  the use of salt water gargles, vitamin c, zinc Nursing interventions  administer prescribed medications for symptom relief  reinforce client teaching regarding:  to avoid irritants  specific medication instructions  handwashing to avoid the spread of the common cold

Sinusitis 

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Definition: inflammation of one or more of the paranasal sinuses often occurring during an upper respiratory infection when a nasal infection spreads to the sinuses. Etiology  upper respiratory infection  tooth infection  allergy  infectious diseases such as pneumonia and measles  structural defects of the nose  underwater swimming

Sinusitis

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Findings  pain over affected areas especially when palpated or percussed  purulent nasal drainage and congestion  nasal obstruction  fever  malaise  headache

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Diagnostics - X-ray or CT shows fluid in sinuses and mucous membrane swelling

Sinusitis 

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Management  antibiotics, decongestants, and antihistamines are most often prescribed  surgery to drain and open sinuses  antral irrigation (sinus irrigation)  Caldwell-Luc procedure Nursing interventions  reinforce teaching regarding avoiding things that precipitate sinusitis (allergens)  administer prescribed medications  decongestants  nasal corticosteroids  mucolytics  antihistamines  antibiotics  encourage fluid intake of six to eight glasses, eight ounces, daily  hot showers twice daily following nose blowing  nasal irrigation PRN

Upper airway obstruction

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Complete or partial Etiology  food or foreign body  laryngeal edema secondary to hypersensitivity response  trauma Findings  stridor (harsh vibration sound) during inspiration  use of accessory muscles  restlessness  tachycardia  skin color changes (pallor, cyanosis)  inability to talk with complete obstruction Diagnostics - observations at time of occurance

Upper airway obstruction 

Management - emergency treatment 

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Heimlich maneuver cricothyrotomy (cut cricoid cartilage) tracheotomy/ tracheostomy

Nursing interventions - BCLS guidelines for obstructed airway

Pharyngitis 

Definition: inflammation of mucous membranes of pharynx

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Etiology: bacterial, viral, fungal, environmental causes

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Findings  scratchy throat  throat pain, especially with swallowing  pharynx can appear red and edematous with or without patchy yellow exudates

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Diagnostics - cultures may show bacterial causes

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Management  antiinfectives  symptomatic relief  prevent secondary complications

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Nursing interventions  administer prescribed medications  encourage increased fluid intake  provide cool, bland liquids and gelatin

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have client avoid citrus juices

Tonsillitis and adenoiditis   

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Definition: inflammation and infection of tonsils Etiology: acute form is usually bacterial Findings  sore throat - may be recurrent  fever  difficulty swallowing  enlarged tonsils and adenoids  foul smelling breath  noisy respirations - snoring loudly during sleep if enlarged adenoids  recurrent ear infections Diagnostics - positive throat cultures for causative microbes Management  antiinfectives, antipyretics, analgesics  tonsillectomy and/or adenoidectomy if indicated

Tonsillitis and adenoiditis

Vocal cord disorders 

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Laryngitis  inflammation of vocal cords and surrounding mucous membranes  cause: something irritates the larynx  occurs in viral and bacterial infections  in children, called croup (larynx blocked by edema, spasm or both)  treat findings, rest voice, remove irritants Vocal cord paralysis  injury, trauma or disease of larynx, laryngeal nerves or vagus nerve  determine how well client can protect airway  can be surgically treated with Teflon injection

Cancer of the larynx

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Etiology  most tumors of the larynx are squamous cell carcinoma  more common among men, age 50 to 65  cigarette smoking and alcohol consumption are associated with cancer of the larynx

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Findings  sore throat  dyspnea, dysphasia  increasing hoarseness  weight loss  enlarged cervical lymph nodes

Cancer of the larynx  

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Diagnostics - X-ray, biopsies Management  radiation therapy  chemotherapy  surgery: removal of all or part of the larynx to treat cancer  thyrotomy  total laryngectomy: no voice, permanent stoma at the base of the neck  radical neck dissection: when cancer has metastasized to surrounding tissues Nursing interventions - post laryngectomy  assist clients with larnygectomies to meet with support groups  establish a method for communication, before surgery, to use after surgery  know that aspiration from upper airway is not possible  maintain airway with suction equipment at bedside for PRN use; will usually have tracheostomy tube in surgical site to maintain airway  assist with period of grieving for loss of voice and usual physical looks  provide routine tracheostomy care

Disorders in which lung tissue collapses 

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Definition: There are a number of disorders in which the pleural space is abnormally occupied by air or fluid. The result is pressure on lung tissue reducing lung capacity. pneumothorax: air between the pleurae  open pneumothorax: hole in the chest wall, communicating with lung  closed pneumothorax: hole in lung, chest wall intact  tension pneumothorax - a medical emergency  closed pneumothorax  air is forced into pleural space, pressure builds up  shifts mediastinum and trachea away from affected side and compresses heart  treated with chest tube insertion