m






 
  

Ê


 


 

Ô
 


 
 

  
 



˜


 
  

  



 



 

  



 
 
  

 



  
  
   
  



  

 
 
 




 



 

 

  



 
 




 
  


  

 




 



 

 

  


 
  
j alaryngeal communication: alternative modes of
speaking that do not involve the normal larynx; used
by patients whose larynx has been surgically removed
j aphonia: impaired ability to use one·s voice due to
disease or injury to the larynx
j apnea: cessation of breathing
j ysphagia: difficulties in swallowing
j epistaxis: hemorrhage from the nose due to rupture of
tiny, distended vessels in the mucous membrane of
any area of the nose
j herpes simplex: cold sore (cutaneous viral infection
with painful vesicles anderosions on the tongue,
palate, gingival, buccal membranes, or lips)
j laryngitis: inflammation of the larynx; may be
due to voice abuse, exposure to irritants, or
infectious organisms
j laryngectomy: removal of all or part of the larynx
and surrounding structures
j pharyngitis: inflammation of the throat; usually
viral or bacterial in origin
j rhinitis: inflammation of the mucous membranes
of the nose; may be infectious, allergic, or
inflammatory in origin
j rhinorrhea: drainage of a large amount of fluid from
the nose
j sinusitis: inflammation of the sinuses; may be acute or
chronic; may be viral, bacterial, or fungal in origin
j submucous resection: surgical procedure to correct
nasal obstruction due to deviated septum; also called
septoplasty
j tonsillitis: inflammation of the tonsils, usually due to
an acute infection
j xerostomia: dryness of the mouth from a variety of
causes
j ?pper airway infections are common conditions
that affect most people on occasion. Some
infections are acute, with symptoms that last
several ays; others are chronic, with symptoms
that last a long time or recur. Patients with these
conditions seldom require hospitalization.
However, nurses working in community settings
or long-term care facilities may encounter patients
who have these infections. Thus, it is important
for the nurse to recognize the signs and symptoms
and to provide appropriate care.
 
 
 


 
  
   
 
 


 
 
  


a

 £t is a group of isorers characterized by
inflammation an irritation of the mucous
membranes of the nose.
 £t may be classified as;
a. Non-allergic.
b. allergic.
£t may be;
a. an acute or
b. chronic condition.
Caus s
˜ Nonallergic;
environmental factors (changes in temperature or humidity,
odors, or foods)
 £nfection
 age
 systemic disease
 drugs(cocaine) or prescribed medications
(antihypertensive agents, OCP)
 presence of a foreign body.
 chronic use of nasal decongestants.
ë allergic;
 any allergic agent (dusts, molds, animals, fumes, odors,
powders, sprays, and tobacco smoke).
Êathophysiology
Clal Ma
sas;
 rhinorrhea (excessive nasal drainage, runny nose),
 nasal congestion,
 nasal discharge (purulent with bacterial rhinitis),

 nasal itchiness, and

 sneezing.
Headache may occur, particularly if sinusitis is also
present.
M al Maag
;
j The management of rhinitis depends on the cause,
which may be identified in the history and physical
examination.
Ñ £f viral rhinitisO-medications are given to relieve the
symptoms.
Ñ £n allergic rhinitis :-desensitizing immunizations,
intranasal corticosteroids (Depending on the severity
of the allergy) 
^ntihistamines.
Ñ £f a bacterial infectionO-antimicrobial agent.
Ñ ophthalmic agents are used to relieve irritation,
itching, and redness of the eyes.
Ñ Oral decongestant agent.
iursg Maag
;
instructs the patient with allergic rhinitis to avoi or
reuce exposure to allergens an irritants.
Raline nasal or aerosol sprays may be helpful in
soothing mucous membranes, softening crusted
secretions, and removing irritants
blow the nose before applying any medication into the
nasal cavity.
han hygiene technique as a measure to prevent
transmission of organisms.
reviews the value of receiving a vaccination (elderly
and other high-risk Populations)
ð an upper respiratory tract infection that is self-limite and caused by a
virus (viral rhinitis)
ð Specifically, the term ´coldµ refers to an a febrile, infectious, acute
inflammation of the mucous membranes of the nasal cavity
ð £t can also be used when the causative virus is influenza (´the fluµ).
ð Colds are highly contagious because virus is shed for about 2 days before
the symptoms appear and during the first part of the symptomatic phase
ð The six viruses known to produce the signs and symptoms of the viral
rhinitis are;
- rhinovirus, - respiratory syncytial virus (RR ),
- parainfluenza virus, - influenza virus, an
- coronavirus, - aenovirus
j Dach virus may have multiple strains. For example, there are over ˜


strains of rhinovirus, which accounts for 5
 of all cols
Clal Ma
sas;
The symptoms last from ˜ to ë weeks
j £t includes;
- nasal congestion, - runny nose,
- sneezing, - nasal ischarge,
- nasal itchiness, - tearing watery eyes,
- ´scratchyµ or sore throat, - general malaise,
- low-grae fever, - chills,
0 heaache, - muscle aches
j £n some people, viral rhinitis exacerbates the herpes
simplex, commonly calle a col sore
M al Maag
;
º ^dequate fluid intake.
º Dncouraging rest.
º Preventing chilling.
º £ncreasing intake of vitamin C.
º ?sing expectorants as needed.
º Warm salt-water gargles soothe the sore throat.
º Nonsteroidal anti-inflammatory agents (NS^£Ds) such as aspirin or ibuprofen
j ^ntihistamines (chlorpheniramine maleate , iphenhyramine (Benaryl)
j Topical (nasal) decongestant ( e.g. oxymetazoline maleate (^frin),
phenylephrine (Neo-synephrine), pseudoephedrine (Sudafed) orally.
º Îinc lozenges may reduce the duration of cold symptoms if taken within
the first 24 hours of onset.
º ^mantadine (Symmetrel) or rimantadine (Flumadine) may be prescribed
prophylactically.
º ^ntimicrobial agents (antibiotics) should not be used because they do not
affect the virus or reduce the incidence of bacterial complications.
iursg Maag
;
j Perform hand hygiene often.
j ?se disposable tissues.
j ^void crowds during the flu season.

j ^void individuals with colds or respiratory

infections.
j Obtain influenza vaccination, if recommended
(especially if elderly or diagnosed with a chronic
illness)
£t is an Inflammation of mucous membranes of sinuses.
Sinuses are air-filled cavities in facial bones
Lined with ciliated mucous membranes Help
move fluid & microorganisms out of sinuses
into nasal cavity. Normally sterile environment
Frontal and maxillary sinuses commonly involved in
adults.
£t can be;
˜ cute
ë hronic
 ˜


 !
  
an infection of the paranasal sinuses.


° Often following viral/bacterial upper respiratory infection.
° ^n exacerbation of allergic rhinitis.
° Dental infections
° Bacterial organisms account for more than 6
 of the cases of acute
sinusitis, namely;
A Rtreptococcus pneumoniae
A aemophilus influenzae
A Rtaphylococci
Rome iniviuals are more prone to sinusitis because of their occupations
For example, continuous exposure to environmental hazars such as
paint, sawust, an chemicals may result in chronic inflammation of the
nasal passages
Êa slg ;
£nflammation of mucous membranes

Obstruction (other Nasal polyps, Deviated septum,

Rhinitis, Tooth abscess, Swimming or diving trauma,
Prolonged nasotracheal intubation

£mpaired drainage

Mucus secretions collect in sinus cavity (Medium for

bacterial growth)
£nflammatory response (Serum & leukocytes invade
area to combat infection)

£ncrease in swelling & pressure

Clal Ma
sas;
 facial pain or pressure over the affected sinus area,
 nasal obstruction,
 fatigue,
 purulent nasal discharge,
 fever, headache, ear pain and fullness,
 dental pain,
 cough,
 a decreased sense of smell,
 sore throat,
 eyelid edema,
 facial congestion or fullness.
^ss ss
 a aags F gs
- Hx and P/D.
- Sinus X-rays.
- CT scan.
- Magnetic resonance imaging (MR£).
° Rule out malignancy of sinus
C
las;
C


j Meningitis ,
j Brain abscess,
j ischemic infarction, and
j Osteomyelitis.
?


j Severe orbital cellulitis,
j Subperiosteal abscess, and
j Cavernous sinus thrombosis.
M al Maag
;
The goals of treatment of acute sinusitis are to;
- treat the infection,
- shrink the nasal mucosa, and
- relieve pain.
ð meications
A ^ntibiotics (orally) for two weeks. Longer if needed to
prevent relapse
e.g.- amoxicillin, 1st line
- cothrimoxazole (Bactrim) as
- cephalosporins, 2nd line
- amoxicillin clavulanate (^ugmentin) as
-ciprofloxacin
Ú ^ntibiotics £ in hospital if no response to oral treatmë 
Ú decongestant agents
- oral e.g. pseudoephedrine
- Topical e.g. oxymetazoline (^frin) up to 72 hours.
Ú a mucolytic agent e.g. Guaifenesin.

Ú Heated moist and saline irrigation.

Ú ^ntihistamines such as diphenhydramine
(Benadryl), cetirizine (Îyrtec), and fexofenadine
(^llegra).
iursg Maag
;
j £nhaling steam (steam bath, hot shower, and facial
sauna),
j £ncreasing fluid intake, and
j ^pplying local heat (hot wet packs).
j ^voiding contact with people who have upper
respiratory infections.
j Teach about the s/s of sinusitis complication.

j Teach about the side effects of drug.

 ë
Ô! 
 !
  
j Chronic sinusitis is an inflammation of the sinuses
that persists for more than 3 weeks in an adult
and 2 weeks in a child.
j £t is estimated that 32 million people a year
develop chronic sinusitis.
Caus a Êa slg ;
^ narrowing or obstruction in the ostia of the frontal,
maxillary, an anterior ethmoi sinuses usually
causes chronic sinusitis preventing adequate
drainage to the nasal passages. This combined area is
known as the osteomeatal complex. Blockage that
persists for greater than 3 weeks in an adult may occur
because of infection, allergy, or structural
abnormalities stagnant secretions, an ideal
medium for infection.
£mmunocompromised patients, however, are at
increased risk for developing fungal sinusitis.
^


 
is the most common organism

associated with fungal sinusitis.
Clal Ma
sas;
ð impaire mucociliary clearance an ventilation,
ð ough (because the thick ischarge constantly rips
backwar into the nasopharynx),
ð hronic hoarseness,
ð hronic heaaches in the periorbital area, an
ð Facial pain
These symptoms are generally most pronounced on
     
ð Fatigue an nasal stuffiness,
ð a ecrease in smell an taste, an
ð a fullness in the ears
^ss ss
 a aags F gs;
0history an Ê
,
- compute tomography scan

- magnetic resonance imaging (if fungal sinusitis is

suspected), are performed to rule out other local or
systemic disorders, such as tumor, fistula, and allergy.
- Nasal enoscopy may be indicated to rule out
underlying diseases such as tumors and sinus
mycetomas (fungus balls). The fungus ball is usually a
brown or greenish-black material with the
consistency of peanut butter or cottage cheese.
C
las;
j severe orbital cellulitis,

j subperiosteal abscess,
j cavernous sinus thrombosis,
j meningitis,
j encephalitis, an
j ischemic infarction
M al Maag
;
j Medical management of chronic sinusitis is almost the same as for
acute sinusitis. The course of treatment may be 3 to 4 weeks.
jRurgery
Dndoscopic sinus surgery
A ntral irrigation
° Saline solution instilled via 16-gauge needle.
° Patient seated with head forward & mouth open to allow drainage
of purulent irrigating solution.
A alwell-Luc proceure
° £f endoscopic surgery unsuccessful.
° Creates an opening between maxillary sinus & lateral nasal wall.
A xternal sphenoethmoiectomy
j Êost-op Nursing are
A Gauze packing 24-48 hours post-op.
A ?pper lip & teeth numbness for several months.
A £mpaired chewing on affected side.
A Liquids only first 24 hours post-op.
° Followed by soft diet
A ^void for 2 weeks after removal of packing
° Dentures
° alsalva maneuver
G  ral iursg ar ;
AGenerally no packing required
AFrequent nasal cleaning & irrigation
°Sterile normal saline
ATeach
°Open mouth sneezing
°^void blowing nose
°^void lifting or straining
j increasing fluid intake, and applying local heat (hot wet
packs).
j Remi-Fowler·s position
A Relieves pain.
˜


"#!  
j ^cute pharyngitis is an inflammation or infection in the throat,
usually causing symptoms of a sore throat.
Caus a Êa slg
j Most cases of acute pharyngitis are caused by viral infection.
j When group  beta-hemolytic streptococcus, the most
common bacterial organism, causes acute pharyngitis, the
condition is known as strep throat
j The body responds by triggering an inflammatory response in
the pharynx.
j This results in pain, fever, vasodilation, edema, and tissue
damage, manifested by redness and swelling in the tonsillar
pillars, uvula, and soft palate. ^ creamy exudate may be present
in the tonsillar pillars.
Clal Ma
sas;
j a fiery-re pharyngeal membrane an tonsils,

j lymphoi follicles that are swollen an flecke

with white-purple exuate, an enlarge,
j tener cervical lymph noes,
j Fever, malaise, an sore throat also may be
present
^ss ss
 a aags F gs;
j the latex agglutination (L^) antigen test
j solid-phase enzyme immunoassays (DL£S^),
j optical immunoassay (O£^),

j streptolysin titers,
j and throat cultures.
j Nasal swabs and blood cultures may also be
necessary to identify the organism.
M al Maag
;
º Supportive measures for iral pharyngitis.
º ^ntimicrobial agents (penicillin) for Bacterial
pharyngitis at least 10 days.
º ^nalgesic agent e.g. aspirin or acetaminophen
(Tylenol) can be taken at 3- to 6-hour intervals.
º ^ liquid or soft diet.
º ^ntitussive medication e.g. codeine,
dextromethorphan (Robitussin DM), or
hydrocodone bitartrate (Hycodan).
iursg Maag
;
- Bed rest.
- Proper tissue disposal.
- Warm saline gargles or irrigations with a temperature of
105°F to 110°F (40.6°C to 43.3°C)
- ^n ice collar.
- Teach about the complication.
C
las;
Ñ sinusitis,

Ñ otitis meia,
Ñ peritonsillar abscess,
Ñ mastoiitis, an
Ñ cervical aenitis
j £n rare cases the infection may lead to bacteremia,
pneumonia, meningitis, rheumatic fever, or
nephritis.
 ë
Ô! 
"#!  
£t is a persistent inflammation of the pharynx.
£t is common in adults who work or live in usty
surrounings, use their voice to excess, suffer from
chronic cough, an habitually use alcohol an tobacco
hree types of chronic pharyngitis are recognizedO

ypertrophicO-general thickening and congestion of the
pharyngeal mucous membrane

trophicO probably a late stage of the first type (the
membrane is thin, whitish, glistening, and at times
wrinkled)

hronic granular (´clergyman·s sore throatµ):
characterized by numerous swollen lymph follicles on the
pharyngeal wall.
Clal Ma
sas;
-a constant sense of irritation or fullness in the throat,
- mucus that collects in the throat and can be expelled by coughing, and
- difficulty swallowing.
M al Maag
;
j is based on
-relieving symptoms,
- avoiing exposure to irritants, an
- correcting any upper respiratory, pulmonary, or cariac conition
that might be responsible for a chronic cough
j Nasal sprays or medications containing ephedrine sulfate (Kondon·s
Nasal) or phenylephrine hydrochloride (Neo-Synephrine).
j ^ntihistamine decongestant medications, such as Drixoral or
Dimetapp, is taken orally every 4 to 6 hours.
j ^ntiinflammatory and analgesic agent like ^spirin or acetaminophen
iursg Maag
;
j avoid contact with others until the fever subsides.
j ^lcohol, tobacco, second-hand smoke, and
exposure to cold are avoided.
j The patient may minimize exposure to pollutants
by wearing a disposable facemask.
j drink plenty of fluids.
j Gargling with warm saline solutions

j Lozenges will keep the throat moistened.