Chapter 26: Concepts of Care for Patients With Noninfectious Upper Respiratory Problems

Upper airway obstruction represents a life-threatening emergency necessitating rapid assessment for stridor, restlessness, and cyanosis, with nurses prepared to implement interventions ranging from suctioning and repositioning to emergency procedures such as cricothyrotomy or tracheostomy when airway patency is compromised by tongue edema, foreign bodies, or trauma. Obstructive sleep apnea emerges as a prevalent chronic condition characterized by recurrent upper airway collapse during sleep, with risk factors including obesity, anatomical variations, and smoking history. Management strategies encompass weight reduction, positional therapy, and continuous positive airway pressure devices, requiring nurses to educate patients on equipment maintenance and avoidance of substances that depress respiratory drive. Epistaxis management varies based on bleeding location, with anterior hemorrhage controlled through forward leaning and sustained pressure application, while posterior bleeding constitutes an emergency requiring specialized interventions such as nasal packing or balloon catheterization. Nasal injuries and rhinoplastic procedures demand careful postoperative monitoring for hemorrhage, airway compromise, and appropriate wound care with head positioning and ice application while avoiding maneuvers that increase intranasal pressure. Facial and laryngeal trauma present significant airway risks from progressive edema or hemorrhage, requiring immediate airway assessment and management with humidified oxygen and potential surgical intervention. Head and neck malignancies, frequently associated with tobacco and alcohol use or human papillomavirus infection, present with persistent hoarseness, difficulty swallowing, and nonhealing oral lesions, with treatment modalities including surgery, radiation therapy, and chemotherapy. Patients undergoing laryngectomy face substantial life changes requiring comprehensive postoperative care including tracheostomy management, speech rehabilitation, nutritional support, and psychological adjustment. Throughout all these conditions, nurses serve as critical coordinators of interprofessional care, prioritizing airway protection, performing thorough assessments, implementing evidence-based interventions, and delivering specialized patient education to optimize respiratory function and quality of life.