Timby's MedSurg 14e

292

UNIT 5 Caring for Clients With Respiratory Disorders

relief of sinus congestion. Nasal saline sprays or oral decon gestants may be recommended. Surgery may be indicated for chronic sinusitis. Func tional endoscopic sinus surgery (FESS) helps provide an opening in the inferior meatus to promote drainage. Image guided endoscopic surgery uses CT scanning with infrared lights to ensure that placement of the surgical instruments is accurate and will not endanger the eyes, optic nerve, brain, or major arteries. More radical procedures, such as the Caldwell–Luc procedure and external sphenoethmoid ectomy, are done to remove diseased tissue and provide an opening from the maxillary sinus into the inferior meatus of the nose for adequate drainage. The nurse informs the client receiving medical treat ment that the use of mouthwashes and humidification as well as increased fluid intake may loosen secretions and increase comfort. The nurse instructs the client to take nasal decon gestants as recommended. If the client has had sinus surgery, the nurse insti tutes standards for postoperative care (see Chapter 14) and observes the client for repeated swallowing, a find ing that suggests possible hemorrhage. One risk of si nus surgery is damage to the optic nerve. Thus, the nurse assesses postoperative visual acuity by asking the client to identify the number of fingers displayed. The nurse monitors the client’s temperature at least every 4 hours, assessing for pain over the involved sinuses, a finding that may indicate postoperative infection or impaired drainage. The nurse administers analgesics as indicated and applies ice compresses to the involved sinuses to re duce pain and edema. The postsurgical client will have nasal packing and a dressing under the nares (“moustache” dressing or “drip pad”). Because nasal packing forces the client to breathe through the mouth, the nurse encourages oral hygiene and gives ice chips or small sips of fluids frequently. Such mea sures alleviate the dryness caused by mouth breathing. The nurse instructs the client to change the drip pad as needed. In the first 24 hours, the client can expect to change this pad frequently. If bleeding is copious and/or continuous, the doctor must be notified. After 24 hours, the drainage normally decreases significantly. The client needs to report if excessive drainage persists. Postoperative client and fam ily teaching includes telling the client not to blow the nose, lift objects more than 5 to 10 lb, or do the Valsalva maneu ver for 10 to 14 days postoperatively. Airline travel must be avoided for 2 weeks. The nurse urges the client to remain in a warm environment and to avoid smoky or poorly ven tilated areas. Stop,Think, and Respond 20-1 A neighbor tells you that she is taking antibiotics for an acute sinus infection. She states that she has severe pain in her sinuses and wonders what she can do other than take analgesics. What advice might you give?

Figure 20-2 Pharyngitis—inflammation with exudate.

Pharyngitis Pharyngitis , inflammation of the throat, is often associated with rhinitis and other URIs (Fig. 20-2). Viruses and bacteria cause pharyngitis. The most serious bacteria are the group A streptococci, which cause a condition commonly referred to as strep throat . Strep throat can lead to dangerous cardiac complications (endocarditis and rheumatic fever) and harm ful renal complications (glomerulonephritis). Pharyngitis is highly contagious and spreads via inhalation of or direct contamination with droplets. The incubation period for pharyngitis is 2 to 4 days. The first symptom is a sore throat, sometimes severe, with accom panying dysphagia (difficulty swallowing), fever, chills, head ache, and malaise. Some clients exhibit a white or exudate patch over the tonsillar area and swollen glands. A throat cul ture reveals the specific causative bacteria. Rapid antigen tests can detect strep bacteria within minutes by determining that there are foreign substances (antigens) in the throat. If posi tive, treatment can begin right away. This test is not perfect, however, and may miss some strep infections. In this case, the primary healthcare provider may rely on the throat culture. In addition, there is a rapid DNA test that uses DNA technology to identify strep bacteria in less than a day with equal accuracy and in less time than traditional throat cultures. These tests are done in clinics and primary provider’s offices. Early antibiotic treatment is the best choice for phar yngitis to treat the infection and help prevent potential complications. Penicillin or its derivatives are generally the antibiotics of choice. Clients sensitive to penicillin receive erythromycin, a cephalosporin such as cephalexin (Keflex), or azithromycin (Zithromax). The antibiotic regimen is generally 5 to 14 days. Tonsillitis and Adenoiditis Tonsillitis is inflammation of the tonsils, and adenoiditis is inflammation of the adenoids. These conditions gener ally occur together—the common diagnosis is tonsillitis. Although both disorders are more common in children, they may also be seen in adults.

Copyright © 2025 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.