INTERVENYION FOR CLIENTS WITH

NONINFECTIOUS PROBLEMS OF UPPER

AND LOWER RESPIRATORY TRACT

Fracture of the NoseFracture of the Nose Displacement of either the bone or Displacement of either the bone or

cartilage of the nose can cause airway cartilage of the nose can cause airway obstruction or cosmetic deformity and obstruction or cosmetic deformity and is a potential source of infection.is a potential source of infection.

Cerebrospinal fluid could indicate skull Cerebrospinal fluid could indicate skull fracture.fracture.

Interventions:Interventions: RhinoplastyRhinoplasty NasoseptoplastyNasoseptoplasty

EpistaxisEpistaxis Nosebleed is a common problem.Nosebleed is a common problem. Interventions if nosebleed does Interventions if nosebleed does

not respond to emergency care:not respond to emergency care: Affected capillaries are cauterized Affected capillaries are cauterized

with silver nitrate or electrocautery with silver nitrate or electrocautery and the nose is packed.and the nose is packed.

Posterior nasal bleeding is an Posterior nasal bleeding is an emergency.emergency.

(Continued)(Continued)

Nasal PolypsNasal Polyps

Benign, grapelike clusters of Benign, grapelike clusters of mucous membranes and mucous membranes and connective tissueconnective tissue

May obstruct nasal breathing, May obstruct nasal breathing, change character of nasal change character of nasal discharge, and change speech discharge, and change speech qualityquality

Surgery: treatment of choiceSurgery: treatment of choice

Cancer of the Nose and Cancer of the Nose and SinusesSinuses

Cancer of the nose and sinuses is Cancer of the nose and sinuses is rare and can be benign or malignant.rare and can be benign or malignant.

Onset is slow and manifestations Onset is slow and manifestations resemble sinusitis.resemble sinusitis.

Local lymph enlargement often Local lymph enlargement often occurs on the side with tumor mass.occurs on the side with tumor mass.

Radiation therapy is the main Radiation therapy is the main treatment; surgery is also used.treatment; surgery is also used.

Facial TraumaFacial Trauma

Le Fort I nasoethmoid complex Le Fort I nasoethmoid complex fracturefracture

Le Fort II maxillary and Le Fort II maxillary and nasoethmoid complex fracturenasoethmoid complex fracture

Le Fort III combination of I and II Le Fort III combination of I and II plus an orbital-zygoma fracture, plus an orbital-zygoma fracture, often called often called craniofacial disjunctioncraniofacial disjunction

First assessment: airwayFirst assessment: airway

Facial Trauma Facial Trauma InterventionsInterventions

Anticipate the need for Anticipate the need for emergency intubation, emergency intubation, tracheotomy, and tracheotomy, and cricothyroidotomy.cricothyroidotomy.

Control hemorrhage.Control hemorrhage. Assess for extent of injury.Assess for extent of injury. Treat shock.Treat shock. Stabilize the fracture segment.Stabilize the fracture segment.

Disorders of the LarynxDisorders of the Larynx

Vocal cord paralysisVocal cord paralysis Vocal cord nodules and polypsVocal cord nodules and polyps Laryngeal traumaLaryngeal trauma

Vocal cord paralysisVocal cord paralysis

Upper Airway ObstructionUpper Airway Obstruction

Life-threatening emergency in Life-threatening emergency in which an interruption in airflow which an interruption in airflow through the nose, mouth, through the nose, mouth, pharynx, or larynx occurs.pharynx, or larynx occurs.

Early recognition is essential to Early recognition is essential to prevent further complications, prevent further complications, including respiratory arrest.including respiratory arrest.

Upper Airway Obstruction Upper Airway Obstruction InverventionsInverventions

Interventions include:Interventions include: Assessment for cause of the Assessment for cause of the

obstructionobstruction Maintenance of patent airway and Maintenance of patent airway and

ventilationventilation CricothyroidotomyCricothyroidotomy Endotracheal intubationEndotracheal intubation TracheostomyTracheostomy

Ineffective Breathing Ineffective Breathing PatternPattern

Interventions include:Interventions include: Treatment goal: to remove or Treatment goal: to remove or

eradicate the cancer while eradicate the cancer while preserving as much normal function preserving as much normal function as possibleas possible

Nonsurgical managementNonsurgical management Radiation therapyRadiation therapy Chemotherapy Chemotherapy

Risk for AspirationRisk for Aspiration Interventions include:Interventions include:

Dynamic swallow studyDynamic swallow study Enteral feedingsEnteral feedings Routine reflux precautionsRoutine reflux precautions

Elevation of the head of bedElevation of the head of bed Strict adherence to tube feeding Strict adherence to tube feeding

regimenregimen No bolus feeding at nightNo bolus feeding at night Checking residual feedingChecking residual feeding

Anxiety InterventionsAnxiety Interventions

Interventions include:Interventions include: Team conferenceTeam conference Explore reason for anxietyExplore reason for anxiety TeachingTeaching Antianxiety drugs such as diazepam Antianxiety drugs such as diazepam

administered with caution because of administered with caution because of the possibility of respiratory the possibility of respiratory depressiondepression

Lorazepam Lorazepam

Asthma Asthma

Intermittent and reversible Intermittent and reversible airflow obstruction affects only airflow obstruction affects only the airways, not the alveoli.the airways, not the alveoli.

Airway obstruction occurs due to Airway obstruction occurs due to inflammation and airway inflammation and airway hyperresponsiveness.hyperresponsiveness.

Interventions Interventions

Client education: asthma is often an Client education: asthma is often an intermittent disease; with guided intermittent disease; with guided self-care, clients can co-manage this self-care, clients can co-manage this disease, increasing symptom-free disease, increasing symptom-free periods and decreasing the number periods and decreasing the number and severity of attacks.and severity of attacks.

Peak flow meter can be used twice Peak flow meter can be used twice daily by client.daily by client.

Drug therapy plan is specific.Drug therapy plan is specific.