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Chapter: Medical Surgical Nursing: Management of Patients With Upper Respiratory Tract Disorders

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Nasal Obstruction - Upper Respiratory Airway

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.

NASAL OBSTRUCTION

 

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, which are grapelike swellings that arise from the mucous membrane of the sinuses, especially the ethmoids. This obstruction also may lead to a condition of chronic infection of the nose and result in frequent episodes of nasopharyngitis. Frequently, the infection extends to the sinuses of the nose. When sinusitis develops and the drainage from these cavities is obstructed by deformity or swelling within the nose, pain is experienced in the region of the affected sinus.

 

Medical Management

 

The treatment of nasal obstruction requires the removal of the obstruction, followed by measures to overcome whatever chronic infection exists. In many patients an underlying allergy requires treatment. At times endoscopic surgery is necessary to drain the nasal sinuses. The specific procedure performed depends on the type of nasal obstruction found. Usually, surgery is performed under local anesthesia.

 

If a deviation of the septum is the cause of the obstruction, the surgeon makes an incision into the mucous membrane and, after raising it from the bone, removes the deviated bone and cartilage with bone forceps. The mucosa then is allowed to fall back in place and is held there by tight packing. Generally, the packing is soaked in liquid petrolatum so that it can be removed easily in 24 to 36 hours. This operation is called a submucous resection or septoplasty.

 

Nasal polyps are removed by clipping them at their base with a wire snare. Hypertrophied turbinates may be treated by apply-ing an astringent agent to shrink them.

 

Nursing Management

 

Most of these procedures are performed on an outpatient basis. If the patient is hospitalized, the nurse elevates the head of the bed to promote drainage and to help alleviate discomfort from edema. Frequent oral hygiene is encouraged to overcome dryness caused by breathing through the mouth.

 

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