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Med Surg > 26 - Upper Respiratory Problems > Flashcards

26 - Upper Respiratory Problems Flashcards

1
Q

primary concerns of upper resp problems

A

1 ventilation

2 O2 availability

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2
Q

epistaxis

A

nosebleed

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3
Q

allergic rhinitis

A

inflammation of nasal mucosa

-often in response to specific allergen

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4
Q

allergic rhinitis classification according to CAUSATIVE allergen

A

seasonal or perennial

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5
Q

allergic rhinitis classification according to FREQUENCY of symptoms

A

episodic
intermittent
persistent

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6
Q

episodic allergic rhinitis

A

sporadic exposure to allergen
-typically not encountered in pt’s normal environment
ie animal dander when visiting friend

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7
Q

intermittent allergic rhinitis

A

symptoms are present LESS than 4 days/wk or

less than 4 weeks/yr

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8
Q

persistent allergic rhinitis

A

symptoms are present MORE than 4 days/wk or

less than 4 weeks/yr

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9
Q

seasonal vs perennial

A

ssnl: sping/fall; allergy to pollens or weeds
prnl: year-round fr environmt allergen like animal dander, dust mites, cockroaches, fungi, molds

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10
Q

allergic rhinitis

s/s

A
  • sneezing
  • watery itchy eyes + nose
  • decr smell
  • thin, water nasal discharge
  • congestion
  • nasal turbinates are pale, boggy, swollen
  • headache
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11
Q

allergic rhinitis

Tx

A
  • ID + avoid triggers
  • drugs to reduce inflammation
  • nasal corticoid sprays
  • H1 antihistamines leukotrine receptor antagonist, decongestant
  • anti Hist, anti chol, corticosteroid
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12
Q

1 gen vs 2 gen antihistamines

A

first gen can cause drowsy + sedation

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13
Q

Acute Viral Rhinopharyngitis aka

A

common cold

nasopharyngitis

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14
Q

Acute Viral Rhinopharyngitis

A

infections of upper resp tract

  • most prevalent infectious disease
  • caused by more than 200 diff viruses
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15
Q

most Acute Viral Rhinopharyngitis are caused by _____ and are ____

A

coronavirus

mild + self limiting

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16
Q

common viruses that cause Acute Viral Rhinopharyngitis

A

1coronavirus
2human respiratory syncytial virus
3enterovirus

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17
Q

Acute Viral Rhinopharyngitis viruses are spread via

A

airborne droplets (cough, sneeze, talk etc)
+ fomites (up to 3 days)
+direct hand contact

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18
Q

Acute Viral Rhinopharyngitis

onset + duration + recovery of symptoms

A

onset: 2-3 days after exposure
dur: 2-14 days
recovery: 7-10 days

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19
Q

Acute Viral Rhinopharyngitis

s/s

A
  • runny nose
  • watery eyes
  • nasal congestion
  • sneeze
  • cough
  • sore throat
  • fever
  • headache
  • fatigue
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20
Q

Acute Viral Rhinopharyngitis

treatments are directed towards…

A

relieving symptoms

  • rest
  • oral fluids
  • antipyretics
  • analgesic
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21
Q

cautions patients to use intranasal decongestants for no more than 3 days to _____

A

prevent rebound congestion

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22
Q

vitamin C, echinacea, zinc products for Acute Viral Rhinopharyngitis

A

no inconclusive evidence

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23
Q

Acute Viral Rhinopharyngitis

complications

A
  • acute bronchitis
  • sinusitis
  • otitis media
  • tonsillitis
  • pneumonia
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24
Q

s/s of secondary bacterial infection

A
  • temp higher than 103
  • tender, swollen glands
  • severe sinus + ear pain
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25
Q

Influenza aka

A

flu

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26
Q

Influenza

A

highly contagious resp illness

-cause significant morbidity + mortality

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27
Q

influenza season + peaks

A

Sept-April

Peak: Dec-Feb

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28
Q

4 serotypes of Influenza

A

A - most common/virulent
B - humans
C - humans
D - animals

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29
Q

Serotype A

A
  • most common + virulent
  • animals + humans
  • subtypes based on H antigen + N antigen
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30
Q

H + N antigen in serotype A

A

H: enables virus to enter cell
N: facilitates cell-to-cell transmission

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31
Q

which serotype can cause pandemics?

A

serotype A

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32
Q

which serotypes can cause epidemics?

A

serotype B

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33
Q

serotype B + C

A

only infects humans

  • can cause an epidemic
  • milder disease than serotype A
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34
Q

Influenza transmission

A
  • infected droplets
  • inhalation of aerosolized particles
  • direct contact w contaminated spaces
  • lesser extent thru fomites
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35
Q

Influenza

onset

A

abrupt onset: 1-4 days

pt is highly contagious 1 day before onset + contunued 5-7 days

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36
Q

Influenza

s/s

A
  • chills
  • fever
  • generalized myalgia w headache, cough, sore throat, + fatigue
  • norm breath sounds
37
Q

Influenza

complications

A
  • primary influenza pneumonia
  • secondary bacterial pneumonia
  • eat or sinus infection

older patients have weak/lethargy lasting weeks

38
Q

Influenza

signs of pulm complications

A
  • dyspnea

- diffuse crackles

39
Q

Influenza

Diagnosis

A

-rapid influenza diagnostic test [RIDT]
-viral culture (throat/nasopharyngeal swab)
-

40
Q

rapid influenza diagnostic test [RIDT]

A
  • results w/in 5 min
  • best used w/in 48 hr
  • helps distinguish influenza fr other viral/bacterial infection
41
Q

most effective strategy for managing influenza

A

prevention

42
Q

2 types of rapid influenza vaccines

A
  • live attenuated
  • inactivated

-changed on yearly basis

43
Q

best time to receive influenza vaccine

A

sept/oct

  • takes 2 wks for full protection
  • high priority to groups that are high risk of transmission like health care workers
44
Q

minimum age for vaccines

A

6 mos

45
Q

most common A/E of vaccines

A

soreness at injection site

46
Q

flu vaccine

CI

A
  • <6mos
  • allergc rxn to previous flu vaccine
  • egg allergy
47
Q

Influenza

Tx

A
  • relief of symptoms
  • prevention of secondary infections
  • rest, hydrate, analgesic, + antipyretic
  • antiviral med may shorten duration
48
Q

Influenza

antiviral meds

A
  • oseltamivir (tamiflu)
  • zanamivir (relenza
  • peramivir (Rapivab)
49
Q

Influenza

antiviral meds MOA

A

neuraminidase inhibitors

-prevents virus from being released + spreading to other cells

50
Q

influenza therapy should begin ____ of onset of symptoms

A

within 2 days

51
Q

acute pharyngitis

A

inflammation of pharyngeal walls

may include tonsil, palate + uvula

52
Q

common causes of acute pharyngitis

A

can be viral, bacterial, fungal
90% viral
5-10% bacterial

53
Q

bacterial pharyngitis aka

A

strep throat

54
Q

bacterial pharyngitis/strep throat is caused by

A

A Beta-hemolytic streptococci

-accounts for 5-10% of pharyngitis

55
Q

fungal pharyngitis aka

A

candidiasis

56
Q

fungal pharyngitis/candidiasis

A

white, irreg patches on oropharynx

-usually candida albicans

57
Q

fungal pharyngitis/candidiasis

high risk

A
  • prolong use of abx or inhaled corticosteroids
  • immunosuppressed (HIV)
  • dry, air, smoking, GERD, allergy, post nasal drip
  • ET intubation, chem fumes, cancer
58
Q

viral pharyngitis/strep throat

s/s

A
  • scratchy throat to severe pain/dysphagia

- red + edematous pharynx

59
Q 
strep throat
classic signs (4)
A

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

60
Q

fungal pharyngitis/candidiasis

Tx

A

nystatin - antifungal abx

  • swish + swallow
  • swish as long as possible
  • continue until symptoms are gone
61
Q

how to prevent candidiasis when using corticosteroids

A

rinse mouth w water

62
Q

drug of choice for A Beta-hemolytic streptococci

A

penicillin

-must be taken several times/day for 10 days

63
Q

alternatives if allergic to penicillin

A

erythromycin + clindamycin

64
Q

most ppl w strep throat are contagious until

A

they have been on abx for 24-48 hours

65
Q

goal of tx for pharyngitis

A

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
66
Q

reasons for a trache

A 
1 establish airway
2 bypass obstructn
3 removl of secretn
4 long-trm mech vent
5 weaning fr mech ventln
67
Q

trache vs ET

A

T is shorter + wider> easy cleaning
-more comfortbl bc nothing in mouth
-

68
Q

outter vs inner cannula

A

O: keeps airway patent
I: disposbl/nondisposbl; can be removed for cleaning

69
Q

cuffed

A
  • most common esp for mechncl ventln

- used to prevent aspiration

70
Q

uncuffed

A
  • for longer term trache
  • –when mech ventln is NOT needed + risk for asprntn is lowered
  • makes talking + eating easier
71
Q

trache surgery

A
  • operating room
  • general anesthesia
  • horizntl incision
  • analgesia + sedatn
72
Q

when is the balloon cuff inflated?

A

immediately after surgery

73
Q

how to confirm trache placement

A

1 auscultate for air entry
2 end-tidal CO2 capnography
3 passage of suction thru tube
4 chest x ray

74
Q

cuff pressure

A
  • monitor + record Q8hr
  • 15-22mmHg
  • 20-25cm H2O
75
Q

Never insert a decannulation plug in trache tube until…

A

cuff is delated + nonfenestrated inner cannula is removed

76
Q

what to monitor post trache surgery

A
  • VS
  • SpO2
  • chest x ray
77
Q

complications to monitor post trache surgery

A
  • airway obstruction
  • bleeding
  • infection
78
Q

how often should sterile dressing changes be done?

A

Q12hr

79
Q

how often to clean inner cannula?

A

Qshift

or Q8hr

80
Q

if tube is accidentally dislodged

A
  • call for help
  • assess pt for resp distress
  • inser obturattor into spare trache tube
  • lube w saline
  • insert in stoma
  • once inserted, remove obturator
81
Q

if tube is dislodged + cannot be replaced bs of tract immaturity (<1wk), then …

A

immediately place pt in semi-fowlers to decr dyspnea

  • cover stoma w sterile dressing
  • provide ventilatin w BVM over nose + mouth
82
Q

suction pressure should be no greater than

A

125 mmHg

83
Q

if you hear wheezing or crackles, then..

A

let pt cough

if unable to cough, then suction

84
Q

how often should trache tube be changed?

A

1 mos after first tube

then Q1-3mos

85
Q

Passy Muir valve

A

device that attaches to tube

-redirects airflow thru vocal cords

86
Q

when can decannulation occur?

A 
patient must be
1 hemodynamically stable
2 stable intact resp drive
3 adequately exchange air
4 independently expectorate secretions
87
Q

during decannulation, it is most important to check that _____

A

cuff is deflated

88
Q

stoma closing

A
  • close w tape strips
  • splint stoma w fingers
  • should close w/in 4-5 days

Med Surg (18 decks)

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