Summary Med Surg 27: Nursing Management Upper Respiratory Problems

Med Surg 27: Nursing Management Upper Respiratory Problems I. Problems of Nose and Paranasal Sinuses A. Deviated Septum: deflection of the normally straight nasal septum 1. Up to 80% are slightly off center, but dx is for severely shifted 2. Common causes: trauma to the nose, either at birth or later in life 3. Can interfere with airflow and sinus drainage through the narrowed passageway 4. S/sx a. Minor: may be asymptomatic b. Major: obstruction to nasal breathing, nasal congestion, frequent sinus infections, nosebleeds (epistaxis), and facial pain 5. Medical management: focused on symptom control of nasal inflammation and congestion a. For recurrent or severe s/sx: Nasal Septoplasty is performed to reconstruct and properly align the deviated septum B. Nasal fracture: fracture of the nose as a result of blunt trauma, such as occurs with fights, car accidents, falls, and sports injuries 1. Most common facial fracture, 3rd most common bone fx 2. Many cases can be prevented by using protective equipment and protection against falls 3. Complications: airway obstruction, epistaxis, meningeal tears causing CSF leakage, septal hematoma, and cosmetic deformity 4. Classified as either simple or complex a. Simple fractures: may be unilateral or bilateral and typically produce little or no displacement b. Complex fractures: may also involve subsequent damage to adjacent facial structures such as teeth, eyes, or other facial bones; orbital fractures may be seen with midfacial trauma 5. Diagnosis: based on health hx and physical exam 6. S/sx: localized pain, crepitus on palpation, swelling, ecchymosis, cosmetic deformity, epistaxis, and difficulty breathing out of nostrils a. often epistaxis may be the only initial sign 7. Nursing Management a. Assess~ ability to breathe through