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CHAPTER 20 Caring for Clients With Upper Respiratory Disorders

infection, antibiotics are not used. Clients may be advised to use antipyretics, such as acetaminophen or nonsteroidal analgesics, for fever. Decongestants such as pseudoephedrine may be recommended for severe nasal congestion. For clients experiencing a prolonged cough, antitussives may be ordered. Saline gargles are useful for a sore throat, as is saline spray for nasal congestion and prevention of crusting. For allergic rhinitis, antihistamines are often used. An example of a first-generation antihistamine is diphenhydramine (Benadryl). Newer antihistamines include loratadine (Claritin), fexofenadine (Allegra), and cetirizine (Zyrtec). Combined decongestants and antihistamines may also be helpful. An example of this is brompheniramine/ pseudoephedrine (Dimetapp). Medications that desensi tize or suppress immune responses, such as cromolyn (NasalCrom), or intranasal glucocorticosteroids, such as fluticasone (Flonase), may also be prescribed for allergic rhinitis (Drug Therapy Table 20-1).

Gerontologic Considerations ( continued )

INFECTIOUS AND INFLAMMATORY DISORDERS The most common upper airway illnesses are infectious and inflammatory disorders. The average person experiences three to five URIs each year. For some people, URIs develop into bronchitis or pneumonia, which involves more serious symptoms and may require antibiotics or other treatments (see Chapter 21). Rhinitis Rhinitis is inflammation of the nasal mucous membranes. It is also referred to as the common cold , or coryza . Rhi nitis may be acute, chronic, or allergic, depending on the cause. The most common cause is the rhinovirus, of which more than 100 strains exist. Colds are rapidly spread by in halation of droplets and direct contact with contaminated articles (e.g., telephone receivers, doorknobs). Allergic rhi nitis is a hypersensitive reaction to allergens, such as pollen, dust, animal dander, or food. Rhinitis is usually not a seri ous condition; however, it may lead to pneumonia and other more serious illnesses for debilitated, immunosuppressed, or older clients. Symptoms associated with rhinitis include sneezing, nasal congestion, rhinorrhea (clear nasal discharge), sore throat, watery eyes, cough, low-grade fever, headache, ach ing muscles, and malaise. With the common cold, these symptoms continue for 5 to 14 days. A sustained elevated temperature suggests a bacterial infection or infection in the sinuses or ears. Symptoms of allergic rhinitis will persist as long as the client is exposed to the specific allergen. For most clients, treatment for rhinitis is minimal. Unless specific bacteria are identified as the cause of the ■ Older adults who experience sleep apnea should be carefully evaluated for fall risks owing to cardiopulmonary changes and the tendency to drift into short frequent daytime naps from which they may have difficulty being aroused. production, especially in those who have weakened respira tory musculature. Specifically, pseudoephedrine side effects are potentially serious, and the following should be reported to a healthcare provider: low blood pressure, heart palpita tions or rapid heart rate, chest tightness, confusion, halluci nations, visual changes, seizures, or other signs that could indicate an allergic reaction. ■ Older adults must carefully weigh the potential risks and benefits of steroid use. The intended benefit of decreasing inflammation may be warranted in some situations. How ever, the potential risk of tissue thinning may contribute to gastrointestinal tract bleeding, or prolonged use may be a factor in the development of avascular necrosis of hip joints. ■ Large neck circumference, obesity, and other comorbidi ties experienced by older adults increase the risk for sleep apnea.

Pharmacologic Considerations

■ Encourage clients to read labels carefully. Second-­ generation antihistamines have less sedative effect. Antihistamines also dry out mucus, making it thicker and more likely to block nasal passages.

The nurse teaches the client simple measures to treat rhinitis (Client and Family Teaching 20-1). Teaching clients about URIs helps prevent them and minimizes potential complications. Maintaining a healthy lifestyle of adequate rest and sleep, proper diet, and moderate exercise is the best prevention (Nutrition Notes). Another important preventive factor is frequent hand washing, which greatly reduces the spread of infection.

Client and FamilyTeaching 20-1 Treating Rhinitis

For all types of rhinitis: • Rest as much as possible. • Increase fluid intake to assist in liquefying secretions. • Use a vaporizer to help liquefy secretions. • Blow nose with mouth open slightly to equalize pressure. • Wash hands frequently to avoid spreading infection. • Use OTC medications as directed; be aware of pos sible side effects, especially interactions with food and alcohol. For allergic rhinitis: • Be tested for allergen sensitivity. • Avoid specific allergens. • Use antihistamines and decongestants as ordered.

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