26 - Upper Respiratory Problems Flashcards
primary concerns of upper resp problems
1 ventilation
2 O2 availability
epistaxis
nosebleed
allergic rhinitis
inflammation of nasal mucosa
-often in response to specific allergen
allergic rhinitis classification according to CAUSATIVE allergen
seasonal or perennial
allergic rhinitis classification according to FREQUENCY of symptoms
episodic
intermittent
persistent
episodic allergic rhinitis
sporadic exposure to allergen
-typically not encountered in pt’s normal environment
ie animal dander when visiting friend
intermittent allergic rhinitis
symptoms are present LESS than 4 days/wk or
less than 4 weeks/yr
persistent allergic rhinitis
symptoms are present MORE than 4 days/wk or
less than 4 weeks/yr
seasonal vs perennial
ssnl: sping/fall; allergy to pollens or weeds
prnl: year-round fr environmt allergen like animal dander, dust mites, cockroaches, fungi, molds
allergic rhinitis
s/s
- sneezing
- watery itchy eyes + nose
- decr smell
- thin, water nasal discharge
- congestion
- nasal turbinates are pale, boggy, swollen
- headache
allergic rhinitis
Tx
- ID + avoid triggers
- drugs to reduce inflammation
- nasal corticoid sprays
- H1 antihistamines leukotrine receptor antagonist, decongestant
- anti Hist, anti chol, corticosteroid
1 gen vs 2 gen antihistamines
first gen can cause drowsy + sedation
Acute Viral Rhinopharyngitis aka
common cold
nasopharyngitis
Acute Viral Rhinopharyngitis
infections of upper resp tract
- most prevalent infectious disease
- caused by more than 200 diff viruses
most Acute Viral Rhinopharyngitis are caused by _____ and are ____
coronavirus
mild + self limiting
common viruses that cause Acute Viral Rhinopharyngitis
1coronavirus
2human respiratory syncytial virus
3enterovirus
Acute Viral Rhinopharyngitis viruses are spread via
airborne droplets (cough, sneeze, talk etc)
+ fomites (up to 3 days)
+direct hand contact
Acute Viral Rhinopharyngitis
onset + duration + recovery of symptoms
onset: 2-3 days after exposure
dur: 2-14 days
recovery: 7-10 days
Acute Viral Rhinopharyngitis
s/s
- runny nose
- watery eyes
- nasal congestion
- sneeze
- cough
- sore throat
- fever
- headache
- fatigue
Acute Viral Rhinopharyngitis
treatments are directed towards…
relieving symptoms
- rest
- oral fluids
- antipyretics
- analgesic
cautions patients to use intranasal decongestants for no more than 3 days to _____
prevent rebound congestion
vitamin C, echinacea, zinc products for Acute Viral Rhinopharyngitis
no inconclusive evidence
Acute Viral Rhinopharyngitis
complications
- acute bronchitis
- sinusitis
- otitis media
- tonsillitis
- pneumonia
s/s of secondary bacterial infection
- temp higher than 103
- tender, swollen glands
- severe sinus + ear pain
Influenza aka
flu
Influenza
highly contagious resp illness
-cause significant morbidity + mortality
influenza season + peaks
Sept-April
Peak: Dec-Feb
4 serotypes of Influenza
A - most common/virulent
B - humans
C - humans
D - animals
Serotype A
- most common + virulent
- animals + humans
- subtypes based on H antigen + N antigen
H + N antigen in serotype A
H: enables virus to enter cell
N: facilitates cell-to-cell transmission
which serotype can cause pandemics?
serotype A
which serotypes can cause epidemics?
serotype B
serotype B + C
only infects humans
- can cause an epidemic
- milder disease than serotype A
Influenza transmission
- infected droplets
- inhalation of aerosolized particles
- direct contact w contaminated spaces
- lesser extent thru fomites
Influenza
onset
abrupt onset: 1-4 days
pt is highly contagious 1 day before onset + contunued 5-7 days
Influenza
s/s
- chills
- fever
- generalized myalgia w headache, cough, sore throat, + fatigue
- norm breath sounds
Influenza
complications
- primary influenza pneumonia
- secondary bacterial pneumonia
- eat or sinus infection
older patients have weak/lethargy lasting weeks
Influenza
signs of pulm complications
- dyspnea
- diffuse crackles
Influenza
Diagnosis
-rapid influenza diagnostic test [RIDT]
-viral culture (throat/nasopharyngeal swab)
-
rapid influenza diagnostic test [RIDT]
- results w/in 5 min
- best used w/in 48 hr
- helps distinguish influenza fr other viral/bacterial infection
most effective strategy for managing influenza
prevention
2 types of rapid influenza vaccines
- live attenuated
- inactivated
-changed on yearly basis
best time to receive influenza vaccine
sept/oct
- takes 2 wks for full protection
- high priority to groups that are high risk of transmission like health care workers
minimum age for vaccines
6 mos
most common A/E of vaccines
soreness at injection site
flu vaccine
CI
- <6mos
- allergc rxn to previous flu vaccine
- egg allergy
Influenza
Tx
- relief of symptoms
- prevention of secondary infections
- rest, hydrate, analgesic, + antipyretic
- antiviral med may shorten duration
Influenza
antiviral meds
- oseltamivir (tamiflu)
- zanamivir (relenza
- peramivir (Rapivab)
Influenza
antiviral meds MOA
neuraminidase inhibitors
-prevents virus from being released + spreading to other cells
influenza therapy should begin ____ of onset of symptoms
within 2 days
acute pharyngitis
inflammation of pharyngeal walls
may include tonsil, palate + uvula
common causes of acute pharyngitis
can be viral, bacterial, fungal
90% viral
5-10% bacterial
bacterial pharyngitis aka
strep throat
bacterial pharyngitis/strep throat is caused by
A Beta-hemolytic streptococci
-accounts for 5-10% of pharyngitis
fungal pharyngitis aka
candidiasis
fungal pharyngitis/candidiasis
white, irreg patches on oropharynx
-usually candida albicans
fungal pharyngitis/candidiasis
high risk
- prolong use of abx or inhaled corticosteroids
- immunosuppressed (HIV)
- dry, air, smoking, GERD, allergy, post nasal drip
- ET intubation, chem fumes, cancer
viral pharyngitis/strep throat
s/s
- scratchy throat to severe pain/dysphagia
- red + edematous pharynx
strep throat classic signs (4)
1 >100.4
2 anterior cervical lymph node enlargement
3 tonsillar pharyngeal exudate
4 absence of cough
**when 2-3 signs are present, take a rapid antigen test/throat culture to establish cause
fungal pharyngitis/candidiasis
Tx
nystatin - antifungal abx
- swish + swallow
- swish as long as possible
- continue until symptoms are gone
how to prevent candidiasis when using corticosteroids
rinse mouth w water
drug of choice for A Beta-hemolytic streptococci
penicillin
-must be taken several times/day for 10 days
alternatives if allergic to penicillin
erythromycin + clindamycin
most ppl w strep throat are contagious until
they have been on abx for 24-48 hours
goal of tx for pharyngitis
mgmt of infection + symptom relief + prevention of complications
- ibuprofen or APAP
- incr fluid intake
- salt water gargle
- warm/cold liquids
- popsicle, hard candy, lozenges
- cool mist vaporizer/humidifier
- OJ is irritating
reasons for a trache
1 establish airway 2 bypass obstructn 3 removl of secretn 4 long-trm mech vent 5 weaning fr mech ventln
trache vs ET
T is shorter + wider> easy cleaning
-more comfortbl bc nothing in mouth
-
outter vs inner cannula
O: keeps airway patent
I: disposbl/nondisposbl; can be removed for cleaning
cuffed
- most common esp for mechncl ventln
- used to prevent aspiration
uncuffed
- for longer term trache
- –when mech ventln is NOT needed + risk for asprntn is lowered
- makes talking + eating easier
trache surgery
- operating room
- general anesthesia
- horizntl incision
- analgesia + sedatn
when is the balloon cuff inflated?
immediately after surgery
how to confirm trache placement
1 auscultate for air entry
2 end-tidal CO2 capnography
3 passage of suction thru tube
4 chest x ray
cuff pressure
- monitor + record Q8hr
- 15-22mmHg
- 20-25cm H2O
Never insert a decannulation plug in trache tube until…
cuff is delated + nonfenestrated inner cannula is removed
what to monitor post trache surgery
- VS
- SpO2
- chest x ray
complications to monitor post trache surgery
- airway obstruction
- bleeding
- infection
how often should sterile dressing changes be done?
Q12hr
how often to clean inner cannula?
Qshift
or Q8hr
if tube is accidentally dislodged
- call for help
- assess pt for resp distress
- inser obturattor into spare trache tube
- lube w saline
- insert in stoma
- once inserted, remove obturator
if tube is dislodged + cannot be replaced bs of tract immaturity (<1wk), then …
immediately place pt in semi-fowlers to decr dyspnea
- cover stoma w sterile dressing
- provide ventilatin w BVM over nose + mouth
suction pressure should be no greater than
125 mmHg
if you hear wheezing or crackles, then..
let pt cough
if unable to cough, then suction
how often should trache tube be changed?
1 mos after first tube
then Q1-3mos
Passy Muir valve
device that attaches to tube
-redirects airflow thru vocal cords
when can decannulation occur?
patient must be 1 hemodynamically stable 2 stable intact resp drive 3 adequately exchange air 4 independently expectorate secretions
during decannulation, it is most important to check that _____
cuff is deflated
stoma closing
- close w tape strips
- splint stoma w fingers
- should close w/in 4-5 days
