Care of Clients with Problems In Oxygenation, Fluids and Electrolytes, Metabolism and Endocrine (NCM103) Patients With Respiratory

Alterations II

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Nursing Care of Clients With Upper Respiratory Airway Complications

Epistaxis

Topics Discussed Here Are: 1. Epistaxis 2. Nasal Obstruction 3. Laryngeal Obstruction Laryngospasm 4. Nasal Trauma 5. Obstructive Sleep Apnea

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 Infection 2. Systemic Infection 3. Drying of nasal mucosa 4. Inhalation of certain drugs 5. Trauma 6. HTN 7. Tumor 8. Thrombocytopenia 9. Use of certain medications (ACE Inhibitors 10. Liver Disease 11. Hereditary 12. Hemorrhagic Disease

Angioedema

Fragile Blood Vessels)

Medical Management 1. Nasal packing can be done 2. Use of nasal decongestant, topical cocaine, antibiotic 3. Cauterization-electrocautery 4. Balloon inflated catheter 5. Suctioning 6. When Nose bleeds occur: a. Ask patient to do an upright position with slightly leaning forward b. Inform patient to breathe through the mouth c. And pinch the nose Nursing Management - Assess airway and breathing - Monitor VS - WOF: Bleeding Identify factors that contributed to the development of bleeding - Alleviate anxiety and provide adequate humidification - Provide Health Teaching o Avoid vigorous exercise o Provide discharge planning

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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 FACTORS Structural 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 Corticosteroids o Antibiotics o Decongestants, humidification - SURGICAL PROCEDURE Functional Rhinoplasty Nasal Polypectomy Nursing 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

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Laryngospasm
After administration of some general anesthetic agents After repeated and traumatic ET attempts Response to some inhaled agents Hypocalcemia (Soft tissues) o Depolarization ETIOLOGY 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 Hematoma o Infection o Abscess o Avascular / Septic necrosis Clinical Manifestations - Pain - Nasal bleeding - Periorbital ecchymosis - Nasal obstruction - Deformities - Swelling of***

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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 obstruction o REDUCTION in ventilation It is the cessation of breathing during sleep usually caused by repetitive upper airway obstruction RISK 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, Uvulopalatopharyngoplasty o Low flow Oxygen via Nasal canula at night Pharmacologic Management Protriptyline: Improve upper airway muscle tone Medroxyprogesterone and Acetazolamide: Sleep apnea, assist with alveolar hypoventilation Modafinil: Reduces DAYTAIME sleepiness Nursing 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

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GENERAL GUIDELINES
Assess for: o Respiratory rate o Use of accessory muscles o 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 ***** ** ****

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