2 Upper Airway Disorders PDF

1.
Brings oxygen through the airways of the

lungs into the alveoli.
2. Expels carbon dioxide, as a metabolic waste

product that is transported from the tissues to
the lungs for elimination.
3. Filters and humidifies air that enters the

lungs.
4. Traps particulate matter in the mucus of the

airways and propels it toward the mouth for
elimination by coughing or swallowing.
UPPER AIRWAYS
 nasal cavity
 pharynx
 larynx
LOWER AIRWAYS
 trachea
 bronchi and bronchioles
 lungs
 alveoli
Review of the
Inflammatory Process
1. RHINITIS
• aka. rhinosinusitis
• basically defined as the inflammation of the nasal mucosa.
• classic manifestation:
 increased nasal drainage
 nasal congestion
 sneezing
 secretions (clear, yellowish or greenish)
• classifications:
 acute rhinitis
 allergic rhinitis
 vasomotor rhinitis
 rhinitis medicamentosa
ACUTE RHINITIS
• aka. cough or coryza
• can be bacteria (Staphylococcus) and viral (rhinovirus) in origin
• self-limiting within 5-7 days
• common manifestations:
 begins with a feeling of dryness and stuffiness affecting
the nasopharynx.
 excessive production of nasal secretions
 lacrimation
 secretions (watery, greenish or yellowish)
fever
• management:
 symptomatic
 humidification (steam inhalation)
 decongestants and antibiotics
 increasing oral fluid intake
steam inhalation
liquefy secretions
warm and humidify inspire air
relieve edema of the airways
soothe irritated airways

ALLERGIC RHINITIS
• aka. hay fever
• seasonal disorder
• cause: allergen
 manifestations common to acute rhinitis
 nasal obstruction (mouth breathers) – noisy breathing
 nasal quality of voice
• management:
 symptomatic
 allergy evaluation
 desensitization and avoidance of the known allergen
 decongestants
 anti-histamines
 mast-cell stabilizing sprays
VASOMOTOR RHINITIS
• a type of rhinitis that has no identifiable cause
• clinical manifestations mimic that of acute rhinitis and
allergic rhinitis.
• treatment is symptomatic and is similar to that of the

aforementioned types of rhinitis.
RHINITIS MEDICAMENTOSA
• overdosage of the medications used to treat rhinitis.
• abrupt disocontinuation
2. SINUSITIS
• inflammation of the paranasal sinuses
• caused by a deviated nasal septum, bony abnormalities,
congenital malformations, infections or allergy.
 manifestations of the inflammatory process (with fever
and chills)
 headache
 facial pain (exacerbated by bending)
 pain or numbness on the upper teeth
 decreased sense of smell
 purulent nasal discharges
 post nasal drip
 unpleasant breath
• diagnostics
 CT scans may show opacification of the ostia, thickened
mucus meembrane and an air-fluid level.
SINUSITIS
• medical management:
 use of the appropriate antibiotic to manage bacterial
infection
 decongestants
 nasal corticosteroids
 humidification by use of NSS irrigations or a vaporizer or
humidifier to prevent nasal crusting and moisten secretions
 antral irrigation or sinus lavage (indicated to those who
are not responding to medications and with severe purulent
exudate in the maxillary sinus
• surgical management:
 functional endoscopic sinus surgery (FESS)
 Caldwell-Luc Procedure
 external sphenoethmoidectomy
SINUSITIS
• nursing management of the surgical client:
 monitor for profuse bleeding
 evaluate respiratory status
 apply ice compress
 maintain semi- to high-Fowler’s position within 24 to 48
hours
 removal of the nasal pack morning after the surgery
 increase oral fluid intake
 use drip pad under the nose
 avoid nasal blowing within 7 – 10 days; after, sneeze only
with an open mouth
 avoid strenuous activities within 2 weeks
3. NASAL POLYPS
• these are grapelike growth on the mucous membrane and loose
connective tissue
• commonly seen among clients with prolonged sinusitis and
those with severe allergy
• treatment is sought only when the patient is already suffering
chronic obstruction and mouth breathing becomes progressive.
• manifestations:
 anosmea
 nasal quality of voice
 mouth breathing
 symptomatic
 treatment of the underlying factor
NASAL POLYPS
 nasal polypectomy
 instruct the client that the nasal pack will remain for 24 –
48 hours; obligatory mouth breathers
 use humidification, mouth care, oral fluid intake is
increased
 position: semi- to high – Fowler’s position
 ice compression is necessary for the first 24 hours
 assess for respiratory status
 assess for frequent swallowing
 mild analgesics, but not aspirin
4. Deviated nasal septum
• usually caused by nasal fracture
• manifestations:
 obstruction to nasal breathing
 noisy breathing
 nasal drip
 dryness of the nasal and oral mucosa
• reduction of a nasal fracture
• rhinoplasty
• nasal septoplasty
4. TONSILLITIS
• inflammation of the tonsils (pharyngeal, palatine and lingual)
• commonly by group-A beta hemolytic streptococcus
• can be caused by Haemophilus influenzae
• manifestations:
 sore throat/throat pain
 odynophagia
 dysphagia • complications:
 otalgia  pneumonia
 fever and chills  acute glomerulonephritis
 mouth breathing  osteomyelitis
 anorexia  rheumatic fever
 general malaise
 cervical lymphadenopathy
ACUTE TONSILLITIS
 antibiotics
 saline throat gargles
 instruct the client to minimize activity
 maximize bed rest
 increase oral fluid intake
 tonsillectomyand adenoidectomy
(tonsilloadenectomy)
• indications:
 recurrent, incapacitating episodes
 hypertrophy
 resolution of a peritonsillar abscess
 repeated ear problems r/t eustachian tube obstruction
 sinus complications
ACUTE TONSILLITIS
 after surgery, position of choice: lateral decubitus or
prone position, head oriented towards the side
 frequently assess the oropharynx and mouth for bleeding
 assess for frequent swallowing
 closely monitor the vital signs (hemorrhage is the most
common complication of tonsillectomy that occurs within
the first 24 – 48 hours)
 administer fluids after assessing for the swallowing reflex
 diet: cool, soft and less seasoned diet
 pain management would include analgesics
(acetaminophen, codeine) ; increased swalolwing of fluids
5. PHARYNGITIS
• inflammation of the pharynx (includes the soft palate,
pharyngeal tonsils and uvula)
• bacterial infection (group-A beta hemolytic streptococci)
• manifestations:
 similar manifestations with tonsillitis
 antibiotics
 analagesics
 anti-pyretics
• nursing management:
 stress the importance of proper hand washing
 bed rest is enforced in acute stages
 increase fluid intake to lessen throat pain
 warm saline irrigations and gargles
CHRONIC PHARYNGITIS
• causes:
 chronic smokers
 chronic cough
 those who are living in dusty environments
 those who use their voices excessively
• management:
 identification and correcting the underlying factor
 management of acute phrayngitis
6. LARYNGITIS
• causes:
 vocal abuse
 gastroesophageal reflux disorder (GERD)
• manifestations:
 hoarseness
 aphonia
 stridor
 dyspnea
 sore throat
 fever
 respiratory distress
LARYNGITIS
• management:
 humidification
 voice rest
 increase fluid intake’
 antibiotics
 systemic corticosteroids
 management for GERD

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1.

Brings oxygen through the airways of the

2. Expels carbon dioxide, as a metabolic waste

3. Filters and humidifies air that enters the

4. Traps particulate matter in the mucus of the

• basically defined as the inflammation of the nasal mucosa.

warm and humidify inspire air

relieve edema of the airways

soothe irritated airways

• treatment is symptomatic and is similar to that of the

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