Chapter 27: Upper Respiratory Problems
Deviated Septum: septum appears to be bent to one side altering air passage way
Trauma or congenital
S&S: can’t breathe out of nose, nasal edema, dryness, bleeding
Management: allergy control – Severe cases: septoplasty

Nasal Fracture: unilateral (little or no displacement), bilateral (flattened look), complex (other facial structured damaged as well)
Inspection: assess ability to breathe, look for edema, bleeding, or hematoma
Look of clear drainage= leakage of CSF
Management: maintain airway, reduce edema (ice), emotional support
Septoplasty or rhinoplasty sometimes necessary to avoid septal hematoma

Nursing Management for Nasal Surgery
No NSAIDS or aspirin for 2 weeks before surgery!
No hot showers or alcohol after surgery
Note that edema and ecchymosis are normal for short time after surgery

Epistaxis: nose bleed
Most common in people younger than 10 and older than 50
Treated with vasoconstrictor (lidocaine/cocaine), cauterization, anterior packing
Management: encourage frequent swallowing, give mild opioid & antibiotic for nasal packing
Monitor RR, heart rate/rhythm, O2 stats, pulse Ox, LOC, signs of aspiration

Allergic Rhinitis: Allergies
Intermittent (less than 4 days a week or less than 4 weeks a year) or Persistent
S&S: sneezing, itching, rhinorrhea, congestion
Chronic exposure to allergen= headache, pressure, post nasal drip=cough
*patient may complain of cough, hoarseness, need to clear throat, snoring bc of congestion
Management: identify and avoid triggers, antihistamines, intranasal corticosteroids, LTRAs to reduce symptoms & inflammation.
Immunotherapy (allergy shots) can be used if drugs aren’t tolerated well
Patient should start intranasal corticosteroid 2-3 weeks before allergy season

Acute Viral Rhinitis: common cold
Virus invades upper respiratory system and often accompanies an acute respiratory infection
Recommend rest, fluids, proper diet, antipyretics, analgesics
If no relief after 7 days, it may be treated with antibiotics bc it may be a bacterial infection

Influenza:
Patients who can receive inactivated influenza vaccine:
6 months or older, chronic medical conditions, long term health facilities, immunocompromised, pregnant women
Patients who can receive attenuated flu vaccine (nasal spray):
Ages 2-49, healthy non-pregnant people

S&S: cough, fever, myalgia, headache, sore throat
**Most common complication of influenza is pneumonia!**
----influenza patient should have normal chest auscultation assessment—dyspnea & crackles indicate pulmonary problems (crackles are expected in patient with pneumonia)

Sinusitis: sinus infection of maxillary and front sinuses
Inflammation of mucosa- narrows or blocks the exit and these secretions accumulate and are a place for bacteria, viruses, and fungi to grow which later causes infection
Purulent drainage present
Often follows rhinitis (common cold)
Don’t give antibiotics unless symptoms are still present after 10 days
**Amoxicillin is drug of choice**

Acute pharyngitis: sore throat
*Pharynx = back of throat
Inflammation of the pharyngeal walls—caused by virus (most cases), bacteria (strep), or fungal (candidiasis) -- *cultures are taken to know how to treat*
S&S: scratchy throat, difficulty swallowing, red/swollen pharynx, sometimes has yellow exudates—white/irregular patches indicate fungal infection
Management: Antibiotics if bacterial (Penicillin drug choice), increase fluids, cool/bland liquids & gelatin
*Acute streptococcal pharyngitis can lead to rheumatic heart disease or glomerulonephritis if not treated correctly
Peritonsilar Abcess: bacterial infection of 1 or both tonsils caused from complications from acute pharyngitis (sore throat) or tonsillitis
S&S: high fever, difficulty breathing, leukocytosis, chills
Treatment: IV antibiotics, needle aspiration, incision & drainage

Obstructive Sleep Apnea
Partial or complete airway obstruction during sleep—breathing disruption that lasts at least 10 seconds