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CHAPTER 20 Caring for Clients With Upper Respiratory Disorders

to rule out a fracture of the nasal septum or a septal he matoma. Both conditions require treatment to prevent de struction of the septal cartilage. If drainage of clear fluid is observed, a Dextrostix is used to determine the presence of glucose, which is diagnostic for cerebrospinal fluid. Radiog raphy studies are done to ascertain any other facial fractures. Medical and Surgical Management If the fracture is a lateral displacement, pressure applied to the convex portion of the nose reduces the fracture. Cold compresses control the bleeding. If the fracture is more com plex, surgery is done after the swelling subsides, usually af ter several days. The surgeon applies a splint postoperatively Nursing management is similar to that for nasal obstruction. The nurse instructs the client to keep the head elevated and apply ice four times a day for 20 minutes to reduce the swell ing and pain. They give analgesics as ordered to alleviate pain. Postoperatively, the nurse assesses the client for airway obstruction, respiratory difficulty (i.e., tachypnea, dyspnea), dysphagia, signs of infection, pupillary responses, level of consciousness, and periorbital edema. In addition, the nurse helps reduce the client’s anxiety by answering questions and offering reassurance that the bruising and swelling will sub side and sense of smell will return. Stop,Think, and Respond 20-3 On your way to class, you see a person suddenly slip on ice and fall on their face. As you approach, they get to a sitting position.They are wearing a scarf. Blood is pouring from their nose, and your initial impression is that the nose appears deformed. What actions should you take? Laryngeal trauma occurs from blunt trauma in the neck re gion, such as during motor vehicle accidents when the neck strikes the steering wheel. Endoscopic and endotracheal in tubations are other possible causes. Although uncommon, a fracture of the thyroid cartilage is also traumatic to the larynx. Laryngeal obstruction is an extremely serious and of ten life-threatening condition. Some causes of upper airway obstruction include edema from an allergic reaction, severe head and neck injury, severe inflammation and edema of the throat, and aspiration of foreign bodies. Laryngeal trauma causes neck swelling, bruising, and ten derness. If the tissues surrounding the larynx are greatly swollen, the client will exhibit stridor , a high-pitched, harsh sound during respiration, indicative of airway obstruction. The client also has dysphagia, hoarseness, cyanosis, and possible hemoptysis (expectoration of bloody sputum). to maintain the alignment. Nursing Management LaryngealTrauma and Laryngeal Obstruction Pathophysiology and Etiology Assessment Findings Signs and Symptoms

Total obstruction prevents the passage of air from the upper to the lower respiratory airway; choking clients will clutch their throats—the universal distress sign for choking. Unless total obstruction is relieved immediately, death oc curs from respiratory arrest. Partial obstruction results in dif ficulty breathing. Diagnostic Findings Laryngoscopy reveals the extent of trauma and internal swelling. X-rays and oxygenation studies will be performed Maintenance of a patent airway is crucial. If the client has aspirated a foreign body, abdominal thrusts are initiated to force the object out of the upper respiratory passages (Nursing Guidelines 20-1). Allergic reactions resulting in severe inflammation and edema may be treated with epi nephrine or a corticosteroid and, possibly, intubation. Severe obstruction requires an emergency tracheostomy (surgical opening into the trachea). See the “Nursing Process for the Client With Laryngeal Obstruction” section for related nurs ing care of this client. Obstructive Sleep Apnea Obstructive sleep apnea (OSA) is characterized by re current and frequent episodes of upper airway obstruction and reduced ventilation. Apnea (cessation of breathing) occurs as a result of upper airway obstruction, generally when the tongue collapses against the soft palate and, in turn, the soft palate collapses against the back of the throat. Central sleep apnea is not a result of obstruc tion but rather occurs because the brain fails to signal the muscles to breathe. It is not as common and is usually the result of specific medical conditions or medications. Complex sleep apnea is a combination of the two condi tions. OSA is the most common and is the primary focus of this discussion. Pathophysiology and Etiology An estimated 39 million Americans have OSA (Messineo et al., 2024; National Council on Aging [NCOA], 2024) with half of those affected classified as overweight. Sleep apnea affects 24% to 35% of males and 9% to 21% of fe males. Females are more likely to have sleep apnea after menopause. Women are more likely to have sleep apnea after menopause. In a study of people over the age of 65, 56% have a higher risk of developing OSA (NCOA, 2024). Other factors that may predispose people to sleep apnea are race or ethnicity (people who are Black, Hispanic or Latinx ethnicity, or Pacific Islander are more likely to de velop sleep apnea), heredity, and having smaller airways, allergies, or other conditions that contribute to increased congestion (Johnson et al., 2022). Cigarette smokers are at increased risk, as are clients with any condition that reduces pharyngeal muscle tone: neuromuscular disease, use of sedative or hypnotic medications, and frequent and heavy intake of alcohol. after a patent airway has been established. Medical and Surgical Management

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