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Alterations in Ventilation Adult Patients with Upper Respiratory Infections Alterations in Ventilation Adult Patients with Upper Respiratory Infections

Alterations in Ventilation Behavioral Objectives n Describe clinical manifestations, causes, therapeutic interventions, & collaborative Alterations in Ventilation Behavioral Objectives n Describe clinical manifestations, causes, therapeutic interventions, & collaborative care of adult patients with upper respiratory infections n Allergic rhinitis, sinusitis, Influenza n Describe clinical manifestations, causes, therapeutic interventions & collaborative care for adult patients with lower respiratory infectons Pneumonia n Tuberculosis n

Alterations in Ventilation Allergic Rhinitis n Reaction of the nasal mucosa to a specific Alterations in Ventilation Allergic Rhinitis n Reaction of the nasal mucosa to a specific allergen. n Seasonal n Environmental triggers – molds, dust mites, pet dander n Clinical Manifestations: n Nasal congestion, sneezing, watery, itchy eyes & nose, n Nasal turbinates – pale, boggy, edematous n Chronic exposure: headache, congestion, pressure, postnasal drip, nasal polyps n Cough, hoarseness, recurrent throat clearing, snoring

Alterations in Ventilation Allergic Rhinitis n Collaborative Care: n Avoidance is the best treatment Alterations in Ventilation Allergic Rhinitis n Collaborative Care: n Avoidance is the best treatment n House dust, dust mites, mold spores, pollens, pet allergens, smoke n Medications: nasal sprays, antihistamines, decongestants n Nasal corticosteroid sprays – decrease inflammation § Local with little systemic absorption n Antihistamines § First-generation: sedative side effectives § Second-generation: less sedation, increase cost n Nasal decongestants – short duration; long term causes rebound effect n Immunotherapy – “desensitization” – controlled exposure to small amounts of a known allergen through frequent injections

Alterations in Ventilation Sinusitis n Develops when the ostia (exist) from the sinuses is Alterations in Ventilation Sinusitis n Develops when the ostia (exist) from the sinuses is narrowed or blocked by inflammation or hypertrophy n Secretions accumulate behind the obstruction n Rich medium for growth of bacteria n Most common infections: § Bacterial: Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis § Viral: Penetrate mucous membrane & decrease ciliary transport

Interferences with Ventilation Sinus Locations Interferences with Ventilation Sinus Locations

Interferences with Ventilation Acute Sinusitis n Results from upper respiratory infection (URI), allergic rhinitis, Interferences with Ventilation Acute Sinusitis n Results from upper respiratory infection (URI), allergic rhinitis, swimming, or dental manipulation All cause inflammatory changes & retention n Clinical Manifestation: pain over the affected sinus, purulent nasal drainage, nasal obstruction, congestion, fever, malaise, headaches n Clinical Findings: Hyperemic & edematous mucosa, enlarged turbinates, & tenderness over the involved sinuses. Sinusitis may trigger asthma n Treatment: antibiotics (10 - 14 days), decongestants, nasal corticosteroids, mucolytics, non-sedating antihistamines; hydration, hot showers, no smoking, environmental control of allergens n

Interferences with Ventilation Chronic Sinusitis n Persistent infection usually associated with allergies and nasal Interferences with Ventilation Chronic Sinusitis n Persistent infection usually associated with allergies and nasal polyps. n Results from repeated episodes of acute sinusitis – loss of normal ciliated epithelium lining the sinus cavity n Diagnosis: X-ray or CT – confirm fluid levels & mucous membrane thickening n Mixed bacteria flora are present – difficult to eliminate n Broad-spectrum antibiotics – 4 to 6 weeks n Nasal endoscopic surgery to relieve blocked or correct septal deviation.

Alterations in Ventilation Rhinoplasty Alterations in Ventilation Rhinoplasty

Alterations in Ventilation Influenza n Flu-related deaths in US – average 20, 000 per Alterations in Ventilation Influenza n Flu-related deaths in US – average 20, 000 per year n Persons >60 years with heart or lung disease n Prevented with vaccination of high risk groups n Three Groups of Influenza -- A, B & C n n Viruses have remarkable ability to change over time Widespread disease & need for annual vaccination n Clinical Manifestations: Abrupt onset of cough, fever, myalgia, headache, sore throat n Physical Signs: minimal with normal breath sounds n Uncomplicated cases – resolve within approx 7 days n Complications: Pneumonia n dyspnea & rales - Tx: antibiotics

Interferences with Ventilation Influenza n Medical Management Goals: n Prevention: vaccine 70 -90& effective Interferences with Ventilation Influenza n Medical Management Goals: n Prevention: vaccine 70 -90& effective – mid-Oct n Contraindication: hypersensitivity to eggs n Nursing Management Goals: n Supportive – relief of symptoms & prevention of secondary infection n n Rest, hydration, antipyretics, nutrition, positioning, effective cough & deep breathing, handwashing Medications to decrease symptoms: § Oral rimantadine (Flumadine) or amantadine (Symmetrel) – § Zanamivir (Relenza) & oseltamivir (Tamiflu) – neuraminidase inhibitors prevent the virus from budding & spreading – shorten the course of influenza

Interferences with Ventilation Influenza n Collaborative Care: n Patient Education n n Goal: Reduce Interferences with Ventilation Influenza n Collaborative Care: n Patient Education n n Goal: Reduce the spread though hand-washing, staying home from work until symptoms resolve, using tissues when sneezing with prompt disposal Flu reduction Etiquette from CDC: Cough or sneeze into upper sleeve rather than into one’s hand