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OBSTRUCTION AND TRAUMA OF THE UPPER RESPIRATORY AIRWAY - Coggle Diagram
OBSTRUCTION AND TRAUMA OF THE UPPER RESPIRATORY AIRWAY
OBSTRUCTION DURING SLEEP
OSA is a disorder characterized by recurrent episodes of upper airway obstruction and a reduction in ventilation.
It is defined as cessation of breathing (apnea) during sleep usually caused by repetitive upper airway obstruction
Risk factors for OSA include obesity, male gender, postmenopausal status, and advanced age. The major risk factor is obesity; a larger neck circumference and increased amounts of peripharyngeal fat narrow and compress the upper airway
PATHOPHYSIOLOGY
The pharynx is a collapsible tube that can be compressed by the soft tissues and structures surrounding it
The tone of the muscles of the upper airway is reduced during sleep
SIGNS AND SYMPTOMS
snoring, sleepiness, and significant-other report of sleep apnea episodes
MEDICAL MANAGEMENT
Patients usually seek medical treatment because their sleeping partners express concern or because they experience excessive sleepiness at inappropriate times or settings.
A variety of treatments are used. Weight loss, avoidance of alcohol, positional therapy, and oral appliances such as mandibular advancement devices (MADs)
PHARMACOLOGIC THERAPY
Some medications are useful in managing symptoms associated with OSA.
Modafinil (Provigil) has been used to reduce daytime sleepiness
Protriptyline (Triptil) given at bedtime may increase the respiratory drive and improve upper airway muscle tone
Medroxyprogesterone acetate (Provera) and acetazolamide (Diamox) have been used for sleep apnea associated with chronic alveolar hypoventilation; however, their benefits have not been well established
NURSING MANAGEMENT
The nurse explains the disorder in terms that are understandable to the patient and relates symptoms (daytime sleepiness) to the underlying disorder
The nurse also instructs the patient and family about treatments, including the correct and safe use of CPAP, BiPAP, MAD, and oxygen therapy, if prescribed
The nurse educates the patient about the risk of untreated OSA and the benefits of treatment approaches
EPISTAXIS
A hemorrhage from the nose, is caused by the rupture of tiny, distended vessels in the mucous membrane of any area of the nose.
distended vessels in the mucous membrane of any area of the nose.
MEDICAL MANAGEMENT
Management of epistaxis depends on its cause and the location of the bleeding site.
A nasal speculum, penlight, or headlight may be used to identify the site of bleeding in the nasal cavity. Most nosebleeds originate from the anterior portion of the nose
Initial treatment may include applying direct pressure. The patient sits upright with the head tilted forward to prevent swallowing and aspiration of blood and is directed to pinch the soft outer portion of the nose against the midline septum for 5 or 10 minutes continuously
NURSING MANAGEMENT
The nurse monitors the patient’s vital signs
assists in the control of bleeding, and provides tissues and an emesis basin to allow the patient to expectorate any excess blood
The nurse continuously assesses the patient’s airway and breathing as well as vital signs
NASAL OBSTRACTION
The passage of air through the nostrils is frequently obstructed by a deviation of the nasal septum, hypertrophy of the turbinate bones, or the pressure of nasal polyps
Chronic nasal congestion forces the patient to breathe through the mouth, thus producing dryness of the oral mucosa and associated problems including persistent dry, cracked lips
Patients with chronic nasal congestion often suffer from sleep deprivation due to difficulty maintaining an adequate airway while lying flat and during sleep
MEDICAL MANAGEMENT
The treatment of nasal obstruction requires the removal of the obstruction, followed by measures to treat whatever chronic infection exists
Measures to reduce or alleviate nasal obstruction include nonsurgical as well as surgical techniques
A more aggressive approach in treating nasal obstruction caused by turbinate hypertrophy involves surgical reduction in the hypertrophy. Surgical procedures used to treat obstructive nasal conditions are collectively known as functional rhinoplasty
NURSING MANAGEMENT
The nurse explains the procedure to the patient
the nurse elevates the head of the bed to promote drainage and to alleviate discomfort from edema
Oral hygiene is very important
the nurse elevates the head of the bed to promote drainage and to alleviate discomfort from edema
Oral hygiene is very important
FRACTURE OF THE NOSE
The location of the nose makes it susceptible to injury. Nasal fracture is the most common facial fracture and the most common fracture in the body
Fractures of the nose usually result from a direct assault. Nasal fractures may affect the ascending process of the maxilla and the septum
The torn mucous membrane results in a nosebleed. Complications include hematoma, infection, abscess, and avascular or septic necrosis. However, as a rule, serious consequences usually do not occur
SIGNS AND SYMPTOMS
The signs and symptoms of a nasal fracture are pain, bleeding from the nose externally and internally into the pharynxswelling of the soft tissues adjacent to the nose, periorbital ecchymosis, nasal obstruction, and deformity.
The patient’s nose may have an asymmetric appearance that may not be obvious until the edema subsides.
MEDICAL MANAGEMENT
A nasal fracture very often produces bleeding from the nasal passage. As a rule, bleeding is controlled with the use of packing. Cold compresses are used to prevent or reduce edema
For the patient who has sustained enough trauma to break the nose or any facial bone, the emergency medical team must consider the possibility of a cervical spine fracture.
Timing is important when treating nasal fractures because further delay in treatment may result in significant bone healing, which ultimately may require surgical intervention that includes rhinoplasty to reshape the external appearance of the nose
NURSING MANAGEMENT
Immediately after the fracture, the nurse applies ice and encourages the patient to keep the head elevated
The nurse instructs the patient to apply ice packs to the nose to decrease swelling
The patient who experiences bleeding from the nose (epistaxis) is usually frightened and anxious and needs reassurance
LARYNGEAL OBSTRUCTION
Obstruction of the larynx because of edema is a serious condition that may be fatal without swift, decisive intervention
SIGNS AND SYMPYTOMS
The patient may demonstrate lowered oxygen saturation: The larynx is a stiff box thatwill not stretch. It contains a narrow space between the vocal cords (glottis), through which air must pass.
Swelling of the laryngeal mucous membranes may close off the opening tightly, leading to life-threatening hypoxia or suffocation.
Edema of the glottis occurs rarely in patients with acute laryngitis, occasionally in patients with urticaria, and more frequently in patients with severe inflammation of the throat, as in scarlet fever. It is an occasional cause of death in severe anaphylaxis (angioedema).
MEDICAL MANAGEMENT
Medical management is based on the initial evaluation of the patient and the need to ensure a patent airway, If the airway is obstructed by a foreign body and signs of asphyxia are apparent, immediate treatment is necessary
CANCER OF THE LARYNX
Cancer of the larynx accounts for approximately half of all head and neck cancers
Almost all malignant tumors of the larynx arise from the surface epithelium and are classified as squamous cell carcinoma. Approximately 55% of patients with laryngeal cancer present with involved lymph nodes at the time of diagnosis, with bilateral lesions present in 16% of patients
SIGNS AND SYMPTOMS
The voice may sound harsh, raspy, and lower in pitch. Affected voice sounds are not always early signs of subglottic or supraglottic cancer
The patient may complain of a persistent cough or sore throat and pain and burning in the throat, especially when consuming hot liquids or citrus juices
MEDICAL MANAGEMENT
The goals of treatment of laryngeal cancer include cure; preservation of safe, effective swallowing; preservation of useful voice; and avoidance of permanent tracheostoma
Treatment options include surgery, radiation therapy, and adjuvant chemoradiation therapy
The treatment plan also depends on whether the cancer is an initial diagnosis or a recurrence. In addition, before treatment begins, a complete dental examination is performed to rule out any oral disease
Patients should be educated so that they carefully consider the various side effects and complications associated with the different treatment modalities