Timby's MedSurg 14e

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UNIT 5 Caring for Clients With Respiratory Disorders

Once the endotracheal tube is removed, the nurse places the client in a high Fowler or semi-Fowler position to pro mote optimal chest and lung expansion. The posterior phar ynx may be dry, and the voice may be hoarse. The nurse observes the client frequently for signs of laryngeal edema and increased respiratory distress. They immediately report any sign of respiratory distress because reinsertion of the en dotracheal tube may be necessary.

● 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. ■ Laryngeal cancer: Most laryngeal malignancies are squa mous cell carcinomas, that is, malignancies arising from the epithelial cells lining the larynx. The tumor may be located on the glottis (true vocal cords), above the glottis (supraglottis or false vocal cords), or below the glottis (subglottis). ■ Tracheotomy is the surgical procedure that makes an opening into the trachea. ■ Tracheostomy is a surgical opening into the trachea into which a tracheostomy or laryngectomy tube is inserted; a tracheostomy may be temporary or permanent. CLINICAL JUDGMENT EXERCISES 1. A client with severe pharyngitis is diagnosed with a group A streptococcal infection. The primary provider prescribes penicillin. What discharge instructions should you give the client? 2. The licensed practical nurse (LPN) is assigned to assist the registered nurse (RN) in the care of a client on a positive pressure ventilator. A primary nursing goal is for the client to maintain optimal gas exchange. What nursing actions would promote this? 3. Your client is scheduled for a total laryngectomy. What information must you share to help prepare the client for the postoperative period? 4. A client arrives at the emergency department with uncontrolled epistaxis. What actions should the RN instruct the LPN to take? 1. The nurse is reviewing what the client can expect when taking diphenhydramine, a decongestant. Which of the following statements by the client indicates that more teaching is needed? a. “I may experience a headache with this medication.” b. “I might need something to help me sleep.” c. “It is important that I increase my fluid intake.” d. “My mouth will most likely be quite dry.” 2. Of the following instructions, which is most important for the nurse to teach the client to help loosen secre tions and increase comfort during medical treatment for sinusitis? a. Blow the nose frequently. b. Elevate the head of the bed by 45 degrees. c. Engage in normal activity. d. Increase fluid intake. NEXT-GENERATION NCLEX-STYLE REVIEW QUESTIONS

KEY POINTS

■ Infectious and Inflammatory Disorders: ● Rhinitis is inflammation of the nasal mucous mem branes. It is also referred to as the common cold , or coryza. ● Sinusitis, also known as rhinosinusitis , is inflammation of the sinuses. ● Pharyngitis, inflammation of the throat, is often associ ated with rhinitis and other URIs. ● Tonsillitis is inflammation of the tonsils, and adenoid itis is inflammation of the adenoids. These conditions generally occur together—the common diagnosis is tonsillitis. ● Peritonsillar abscess is an abscess that develops in the connective tissue between the capsule of the tonsil and the constrictor muscle of the pharynx. ● Laryngitis is inflammation and swelling of the mucous membrane that lines the larynx. ■ Structural disorders: ● Epistaxis, or nosebleeds: the rupture of tiny capillaries in the nasal mucous membrane ● Nasal polyps: are grapelike swellings that arise from the nasal mucous membranes. They probably result from chronic irritation related to infection or allergic rhinitis and can obstruct nasal breathing and sinus drainage, ultimately leading to sinusitis. ● Hypertrophied turbinates: enlargements of the nasal conchae, the three bones that project from the lateral wall of the nasal cavity, which results from chronic rhinitis, interferes with air passage and sinus drainage, and eventually leads to sinusitis ■ Deviated septum is an irregularity in the septum that re ● Nasal fracture usually results from direct trauma, it causes swelling and edema of the soft tissues, exter nal and internal bleeding, nasal deformity, and nasal obstruction. ● Laryngeal trauma and laryngeal obstruction: neck swelling/bruising ● OSA is characterized by recurrent and frequent episodes of upper airway obstruction and reduced ventilation. sults in nasal obstruction. ■ Trauma or obstruction:

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