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GreywolfRed Ms. April Anne D.Balanon

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HA DOUT 3 OXY E ATIO :

Disorders and management of patients with diseases of the Upper Respiratory SystemA. ALLERGIC RHINITIS (hay fever)

Non allergic: changes in temperature, odors, food Allergic: exposure to an irritant or an allergen VIRAL RHINITIS (COMMON COLD)- Nasal congestion, rhinorrhea, sneezing, sore throat, and general malaise Specifically, the term cold refers to an afebrile, infectious, acute inflammation of the mucous

membranes of the nasal cavity. More broadly, the term refers to an acute upper respiratory tract infection, whereas terms such as

rhinitis, pharyngitis, and laryngitis distinguish the sites of the symptoms.

Clinical Manifestations: nasal congestion runny nose sneezing nasal discharge nasal itchiness

tearing watery eyes, scratchy or sore throat general malaise low-grade fever

chills headache and muscle aches.

In some people, viral rhinitis exacerbates the herpes simplex, commonly called a cold sore. If there is significant fever or more severe systemic respiratory symptoms, it is no longer viral rhinitis but one of the

other acute upper respiratory tract infections.

PHARMA MANAGEMENT: Antihistamines are administered. Oral decongestant agents intranasal corticosteroids Ophthalmic agents

NURSING MANAGEMENT: Reduce exposure to allergens and irritants, such as dusts, molds, animals, fumes, odors, powders, sprays, and tobacco

smoke. The patient is instructed about the importance of controlling the environment at home and work.

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Saline nasal or aerosol sprays may be helpful in soothing mucous membranes, softening crusted secretions, and removingirritants.

The nurse instructs the patient in the proper use of and technique for administrating nasal medications. To achieve maximal relief, the patient is instructed to blow the nose before applying any medication into the nasal

cavity. In the case of infectious rhinitis, the nurse reviews with the patient hand hygiene technique as a measure to prevent

transmission of organisms.

6 VIRUSES KNOWN TO CAUSE RHINITIS: Rhinovirus parainfluenza virus coronavirus,

respiratory syncytial virus(RSV)

influenza virus adenovirus

B. SINUSITIS: inflammation of mucus membranes in the sinuses which may be followed by infection with a yellowish-green discharge

Pathophysiology: Acute sinusitis is an infection of the paranasal sinuses. It frequently develops as a result of an upper respiratory infection, such as an unresolved viral or bacterial infection,

or an exacerbation of allergic rhinitis. Nasal congestion, caused by inflammation, edema, and transudation of fluid, leads to obstruction of the sinus cavities

Focus of Management: treatment with antibiotics, decongestants, antihistamines surgery to drain and open sinuses antral irrigation (sinus irrigation)

Clinical Manifestations: facial pain or pressure over the affected

sinus area

nasal obstruction fatigue purulent nasal discharge fever headache

ear pain and fullness dental pain cough a decreased sense of smell sore throat eyelid edema facial congestion or fullness

PHARMA MANAGEMENT:o The goals of treatment of acute sinusitis are to treat the infection, shrink the nasal mucosa, and relieve pain.

First-line antibiotics amoxicillin(Amoxil) trimethoprim/sulfamethoxazole (Bactrim, Septra)

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erythromycin. Second-line antibiotics

Cephalosporinssuch as cefuroxime axetil (Ceftin), cefpodoxime (Vantin), cefprozil (Cefzil) and amoxicillinclavulanate (Augmentin).

Macrolidessuch as azithromycin (Zithromax), and clarithromycin (Biaxin). Quinolonessuch as ciprofloxacin (Cipro), levofloxacin (Levaquin) (used with severe penicillin allergy), and

sparfloxacin (Zagam) have also been used.

o The course of treatment is usually 10 to 14 days. OTHER MEDICATIONS:

Use of oral and topical decongestant agents Heated mist and saline irrigation. Decongestant agents such as pseudoephedrine (Sudafed, Dimetapp) Guaifenesin (Robitussin, Anti-Tuss),

NURSING MANAGEMENT: instruct the patient about methods to promote drainage

inhaling steam (steam bath, hot shower, and facial sauna) increasing fluid intake Applying local heat (hot wet packs).

Inform the patient about the side effects of nasal sprays and about rebound congestion. In the case of rebound congestion, the bodys receptors, which have become dependent on the decongestant sprays

to keep the nasal passages open, close and congestion results after the spray is discontinued.

C. CHRONIC SINUSITIS- is an inflammation of the sinuses that persists for more than 3 weeks in an adult and 2weeks in a child

Pathophysiology

A narrowing or obstruction in the ostia of the frontal, maxillary, and anterior ethmoid sinuses usually causes chronicsinusitis, preventing adequate drainage to the nasal passages.

This combined area is known as the osteomeatal complex. Blockage that persists for greater than 3 weeks in an adult may occur because of infection, allergy, or structural

abnormalities. This results in stagnant secretions, an ideal medium for infection.

Clinical Manifestations: impaired mucociliary clearance and ventilation cough chronic hoarseness chronic headaches in the periorbital area facial pain. Fatigue and nasal stuffiness are also common. some patients experience a decrease in smell and taste fullness in the ears

PHARMA MANAGEMENT:

antimicrobial agents of choice include the following amoxicillin clavulanate (Augmentin) ampicillin (Ampicin) Clarithromycin (Biaxin)

third-generation cephalosporins such as cefuroxime axetil (Ceftin) cefpodoxime (Vantin) cefprozil (Cefzil)

Quiolones such as: Levofloxacin (Levaquin)

o The course of treatment may be 3 to 4 weeks.o Decongestant agents, antihistamines, saline sprays, and heated mist are also recommended

Nursing Management:

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Because the patient usually performs care measures for sinusitis at home, nursing management consists mainly of patientteaching.

TEACHING PATIENTS SELF-CARE:

teach the patient how to promote sinus drainage by increasing the environmental humidity (steam bath, hot shower,and facial sauna)

increasing fluid intake applying local heat (hot wet packs) instructs the patient about the importance of following the medication regimen.

D. TONSILITIS1. Inflammation and/or infection of tonsils2. Acute form is usually bacterial3. Treat findings; if culture shows bacteria, use antibiotics

Disorders of Lower Respiratory System (LRS): Obstructive General facts: process in chronic obstructive pulmonary diseases

Block airflow out of lungs Trap air, with impairment of gas exchange Increase the work of breathing

A. Emphysema Destroys alveoli Narrows and collapses small airways Overall lung loses elasticity Traps air As alveolar walls die, there is less surface for vital gas exchange

B. Chronic bronchitis1. Definition

a. inflammatory response in the lungb. affects few alveoli, mostly airways

2. Findingsa. lungs chronically produce fluidsb. inflammation and mucus narrow the airways

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C.Asthma1. Definition/etiology

a. reversible obstruction of airwaysb. inflammation of airwaysc. airways hypersensitive to variety of stimulid. bronchospasm is a minor componente. disease waxes and wanes, remissions and exacerbations

2. Findingsa. orthopnea, expiratory wheezingb. barrel chest, cyanosis, clubbing of fingersc. distention of neck veinsd. edema of extremitiese. increased PCO2 and decreased PO2f. polycythemia

3. Diagnosticsa. physical examination with history of findingsb. arterial blood gasesc. chest x-ray

4. Complicationsa. hypoxemiab. hypercapniac. variety of respiratory infectionsd. cor pulmonalee. dysrhythmias

Pharmacologic Management for obstructive diseases: Antibiotics and corticosteroids for infection or chronic inflammation Bronchodilators Mucolytics Expectorants Respiratory program: postural drainage, exercise, nebulizer, high protein diet

Nursing interventions common to obstructive diseases Assess client's risk of respiratory failure Assess for degree of respiratory effort for an increased work of breathing or dyspnea Assess oxygenation with pulse oximeter if hemoglobin level is within normal limits Measure arterial blood gases (ABG) to evaluate gas exchange Administer oxygen as indicated If risk of respiratory failure, anticipate ventilation Assist with secretion removal as indicated Pace client activities to reduce oxygen demand Teach diaphragmatic breathing and pursed-lip breathing Position in a high Fowler's to ease breathing effort Provide for nutritional consults as indicated Reinforce the plan for small, frequent high carbohydrate meals
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Provide referrals for:a. depression associated with diseaseb. pulmonary rehabilitationc. stop smoking support groups

For asthma, teach clients that aspirin or peanuts may stimulate an asthma attack

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