Chapter 22

Management of Patients With

Upper Respiratory Tract
Disorders

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Management of Patients With Upper
Respiratory Infections (URIs)
Most common reason for seeking healthcare
May be minor, acute, chronic, severe, or life threatening
Treated in community settings: doctor offices, urgent
care clinics, long-term care facilities, or self-care at home
Early detection of signs and symptoms and appropriate
interventions can avoid unnecessary complications
Patient teaching focus on prevention and health
promotion
Special considerations for older adults
Refer to Chart 22-1
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URIs
Rhinitis and rhinosinusitis: acute, chronic, (refer to Fig.
22-1 and Table 22-1)
Pharyngitis: acute, chronic (refer to Fig. 22-2)
Tonsillitis, adenoiditis
Peritonsillar abscess
Laryngitis

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Rhinitis and Rhinosinusitis

Figure 22-1
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Pharyngitis

Figure 22-2
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 Question
Is the following statement true or false?
Acute pharyngitis of a bacterial nature is most commonly
caused by group A beta-hemolytic streptococci.

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

 Answer
True
Rationale: Acute pharyngitis of a bacterial nature is most
commonly caused by group A beta-hemolytic streptococci.

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

URI Potential Complications
Airway obstruction Medicamentosa
Hemorrhage Acute otitis media
Sepsis Trismus
Meningitis or brain Dysphagia
abscess
Aphonia
Nuchal rigidity
Cellulitis

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URI
Nursing Process: Assessment
Health history
Signs and symptoms: headache, cough, hoarseness,
fever, stuffiness, generalized discomfort, and fatigue
Allergies
Inspection of nose, neck, throat, and palpation of lymph
nodes

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

 Question
What should the nurse palpate when assessing for an
upper respiratory tract infection?
A. Neck lymph nodes
B. Nasal mucosa
C. Tracheal mucosa
D. All of the above

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

 Answer
A. Neck lymph nodes
Rationale: The nurse should palpate the neck lymph
nodes along with the trachea and the frontal and
maxillary sinuses when assessing for an upper
respiratory tract infection.
The nurse should inspect the nasal and tracheal mucosa
when assessing for an upper respiratory tract infection.

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

URI
Nursing Process: Diagnosis
Ineffective airway clearance
Acute pain
Impaired verbal communication
Fluid volume deficit
Knowledge deficit related to prevention, treatment,
surgical procedure, postoperative care

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

URI
Nursing Process: Planning
Airway management, reduce risk of aspiration
Pain management
Effective communication strategy
Increase hydration
Patient teaching: self-care, prevention, and health
promotion
Home care, if indicated

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

URI
Nursing Process: Interventions
Elevate head Gargles for sore throat
Ice collar to reduce Use alternative
inflammation and bleeding communication
Hot packs to reduce Encourage liquids; at least
congestion 2 to 3 L/day
Analgesics for pain Soft bland diet
Rest

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URI
Nursing Process: Evaluation
Maintenance of patent airway
Expresses relief of pain
Able to communicate needs
Evidence of positive hydration
Absence of complications

Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Patient Education

Prevention of upper airway infections

Emphasize frequent handwashing
When to contact health care provider
Need to complete antibiotic treatment regimen
Annual influenza vaccine for those at risk

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Obstruction and Trauma of the Upper
Respiratory Airway
Obstructive sleep apneaS/S: Chart 22-4; Tx: CPAP,
BiPAP, oxygen therapy
Nasal obstructionS/S: deviated septum, turbinate
hypertrophy, polyps
Fractures of the noseS/S: traumatic obstruction; Tx:
reduction of fracture, control epistaxis and edema
Laryngeal obstructionS/S: edema, Table 22-3; Tx:
subcutaneous epinephrine, tracheotomy

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Obstruction and Trauma of the Upper
Respiratory AirwayEpistaxis

Hemorrhage from the nose

Anterior septum, most common site
Serious problem, may result in airway compromise or
significant blood loss
Risk factors, refer to Chart 22-5

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Medical Management

Pinch soft portion of nose for 5 to 10 minutes

Phenylephrine spray, vasoconstriction
Cauterize with silver nitrate or electrocautery
Gauze packing or balloon-inflated catheter inserted into
nasal cavity for 3 to 4 days
Antibiotic therapy

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Control of EpistaxisPacking of Nasal
Cavity or Balloon Catheter

Figure 22-3
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Nursing Management
Airway, breathing, circulation
Vital signs, possible cardiac monitoring and pulse
oximetry
Reduce anxiety
Patient teaching:
Avoid nasal trauma, nose picking, forceful blowing,
spicy foods, tobacco, exercise
Adequate humidification to prevent dryness
Pinch nose to stop bleeding; if bleeding does not stop
in 15 minutes, seek medical attention

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