Ch. 18: Upper Respiratory Tract Problems Flashcards
What is the purpose of the upper respiratory tract?
to warm, humidify, and filter air
What does nursing care include for upper respiratory tract infections?
-accurate assessments: is the Pt improving or worsening? look at trends!
- Patient education: chain of infection, good hand washing!!!, use tissues when sneezing/coughing, and treatment of s/s
what is rhinitis?
allergies
inflammation and irritation of nasal mucus layer that can impact QOL, contributes to sinus/ear/sleep problems due to increased mucus production
T or F: rhinitis does not coexist with asthma
F
T or F: rhinitis is associated with airborne particles
T
What are the treatment options for rhinitis?
treat cause: allergy shots, corticosteroids, antihistamines, steroid nasal spray
2nd generation antihistamines are preferred for non sedating effects
What is nursing management of rhinitis?
- avoid or reduce exposure to allergens and irritants
- hand hygiene
- yearly flu vaccine
What are the pharmacological treatments for rhinitis?
- antihistamine and corticosteroid nasal sprays
- cromolyn: mast cell stabilizer that inhibits release of histamine
- oral decongestants
- saline nasal spray for mild decongestion
- Singulair: leukotriene modifiers
- Xolair: immunoglobulin E modifiers
What is viral rhinitis
common cold
Coxsackie and adenoviruses are more severe
How is viral rhinitis spread?
airborne droplets
virus can survive up to 3 days on inanimate objects so it can also transmit by direct hand contact
what are the s+s of viral rhinitis?
sore throat, nasal//sinus congestion, runny nose, sneezing, cough and hoarseness
duration: 1-2 weeks
what is the treatment of viral rhinitis?
rest, fluids, and treat symptoms
What are interventions of viral rhinitis?
rest, fluids, analgesics, warm saltwater gargles, ice chips, NSAIDs, antihistamines, nasal decongestant, and expectorants
what are s+s of influenza?
high fever, muscle aches, joint aches, N+V, coughing, HA, sore throat
what are diagnostic studies of influenza?
- Gold standard: viral cultures (able to identify which virus is actual cause)
- Rapid flu test (first 48 hours of symptoms)
what is nursing management of influenza?
VACCINES!!!
-assess for allergies before administration
-mindful of previous reactions
-egg hypersensitivity
what are antiviral medications for influenza and why are they given?
- mainly for Pt’s with compromised immune system/ hx of respiratory disease
- Ex: zanamivir (inhaler), oseltamivir (oral), and peramivir (IV)
- Max benefit: given 2 days of onset of S+S
what is sinusitis?
inflammation/swelling of mucosa (sinuses) that blocks sinus openings
what is rhinosinusitis?
inflammation/infection of nasal mucosa and sinus mucosa
what are the differences of sinusitis v. rhino sinusitis?
rhino sinusitis is more spread through the nasal cavity and is more symptomatic for a longer period of time
what are causes of sinusitis?
viral, bacterial, allergies, pollutants, fungal infections, structural problems with nose, weak immune system
what are s+s of sinusitis?
HA that is not relieved with Tylenol only sinus medications, nasal congestion/discharge, postnasal drip, ST, fever, cough, bad breath, pain/tenderness of sinuses
what are complications of sinusitis?
- Local: osteomyelitis and mucocele (paranasal sinus cyst)
- Intracranial (rare): cavernous sinus thrombosis, meningitis, brain abscess, ischemic brain infarct, and severe orbital cellulitis
Treatment of sinusitis that is caused by bacteria?
- Amoxicillin x 10-14 days
- Broader spectrum ABX if no improvement after 14 days: cephalosporins (ceph- or cef- meds)
what s+s shows bacterial sinusitis?
-green/brown mucus accompanied by nasal obstruction
-facial pain, pressure, or a sense of fullness
-Localized or diffused HA
-High fever (102 degrees F)
the occurrence of s+s for 10 days+ after initial onset of s+s indicates bacterial sinusitis
Treatment of viral sinusitis?
-nasal saline lavage
- decongestants: oral decongestants and topical decongestants (should not be used for more than 3 days)
- OTC/prescribed antihistamine if allergic components suspected
what are s+s of meningitis that Pt’s need to be educated on?
fever, severe HA, and nuchal rigidity (severe stiffness of neck)
what is acute pharyngitis and how is it spread?
it is a sore throat/strep throat that is spread by droplets of coughs and sneezes or unclean hands
what are the causes of acute pharyngitis?
- viral: adenovirus, influenza, Epstein-Barr, and herpes simplex
- bacterial: group A beta-hemolytic streptococcus
how is acute pharyngitis diagnosed?
rapid streptococcal antigen test
If (-), confirm with culture
what are the s+s of acute pharyngitis?
fever, swollen and red throat, lymphoid follicles that are swollen and flecked with white spots, HA, bad breath
what are complications of untreated acute pharyngitis?
sinusitis, otitis media, peritonsillar abscess, mastoiditis, and cervical adenitis
rare: bacteremia, pneumonia, meningitis, rheumatic fever, and nephritis
what are treatments of bacterial acute pharyngitis?
penicillin or azythromycin if allergic to penicillin
what population is chronic pharyngitis common in?
adults that work in dusty environments, use voice to excess, chronic cough, habitual tobacco/alcohol
what are the 3 types of chronic pharyngitis?
- Hypertrophic: general thickening and congestion of pharyngeal MM
- Atrophic: most likely late stage of 1st type; MM is thin, whitish, glistening, and may be wrinkled
- Chronic granular: numerous swollen lymph follicles on pharyngeal wall
what are the clinical manifestations of chronic pharyngitis?
constant fullness in throat/irritation, mucus that collects in throat, difficulty swallowing, and intermittent postnasal drip
what are the treatment options for chronic pharyngitis?
relieve s+s, avoid exposure/irritants, avoid alcohol/tobacco/exposure to cold, increase fluid intake, gargle warm saltwater, nasal sprays, antihistamines, decongestants, ASA, Tylenol
what is tonsillitis and adenoiditis?
Tonsillitis is inflammation of tonsils located on each side of oropharynx
Adenoiditis is inflammation of adenoids (pharyngeal tonsils) that is usually accompanied by tonsillitis
what is the common viral pathogen of tonsillitis?
Epstein Barr
what is the common bacterial pathogen of tonsillitis?
GABHS
what is the difference between viral tonsillitis and bacterial tonsillitis?
- Bacterial: a lot of swelling, pus pockets are present, and gray furry tongue is present
-viral: less swelling, no pus pockets, and no gray furry tongue
what is the treatment of tonsillitis?
increase fluids, analgesics, salt water gargles, rest
If bacterial: PCN or cephalosporins
what are the requirements for a tonsillectomy?
repeat tonsillitis, hypertrophy of tonsils causing obstruction and OSA
what is education for a tonsillectomy?
- Increased risk for hemorrhage
- complete ABX therapy post-op
- Use humidifier
- Avoid spicy, hot, acidic, rough foods and milk/milk products
- Avoid smoking
- Bleeding can occur up to 8 hours post-op
- Good hydration
what is post-op nurse management for a tonsillectomy?
- Place pt in prone with head turned to side for drainage
- NPO until gag/swallowing reflex is present
- Post-op complications s+s: fever, throat pain, ear pain, bleeding
what is a peritonsillar abscess?
a complication of tonsillitis that causes pain, swelling, and airway blockage
what are s+s of peritonsillar abscesses?
fever, chills, elevated WBC, difficulty swallowing, ear pain, raspy voice, bad breath
what is the treatment of peritonsillar abscesses?
- ABX therapy and corticosteroids
- May need an incision and drainage if pt does not improve
T or F: peritonsillar abscesses can be life threatening.
T- due to edema that can spread to neck and chest that compromises the airway
what is laryngitis?
inflammation of larynx due to voice abuse, exposure to chemicals, dust, smoke, pollutants, URI, and GERD
what are s+s of laryngitis?
hoarseness of voice, aphonia, severe cough
what is the treatment of laryngitis?
vocal rest, avoidance of irritants, ABX if bacterial, increase fluids, stop smoking, medications like corticosteroids and PPI’s, and use of CPAP if prescribed for OSA
what is a complication of laryngitis?
report hoarseness of voice if it persists after 5 days of vocal resting b/c it can be a sign of malignancy
what are laryngeal polyps?
polyps that can occur on vocal cords due to vocal abuse, intubation, or smoking
what is the treatment of laryngeal polyps?
voice rest and adequate hydration
surgical removal if polyps are large and cause airway compromise
what is the treatment if the laryngeal polyps are malignant?
radical laryngectomy and mechanical voices due to removal of vocal cords
why does OSA occur?
narrowing of air passages with relaxation of muscle tone during sleep and/or tongue and soft palate falling backward to partially or completely obstruct the pharynx
how long do apnea periods last during OSA?
10 to 90 seconds long
what are s+s of OSA?
snoring, extreme sleepiness, significant periods of apnea, night terrors, waking up at night gasping for air, morning HA, HTN due to increase pulmonary pressures
what are risk factors for OSA?
male gender, postmenopausal, advanced age, structural changes to upper airway, obesity, stout neck
what is medical management of OSA
- CPAP
- BiPAP
- mandibular advancement device
what is pharmacological therapy for OSA?
- Modafinil: decreases daytime sleepiness
- Protriptyline at bedtime: increases respiratory drive and improve airway tone
- Provera and Diamox: opens alveoli
what are risk factors for epistaxis?
local/systemic infections, drying of nasal mucosa, nasal inhalation of drugs, trauma, HTN, atherosclerosis, tumor, blood thinners, liver disease, and low humidity levels
what is nursing care of epistaxis?
- keep patient calm
- sit patient up-right and lean forward
- apply pressure to nasal septum for 10-15 mins
- cauterize with silver nitrate
- pack if nothing else helps
what do nurses need to do for packing to treat epistaxis?
- Assess respiratory status, LOC, and s+s of aspiration
- provide pain relief with Tylenol
- ABX therapy due to high risk of staph infection
what is patient education for epistaxis?
- Avoid vigorous exercise for 4-6 weeks
- Avoid hot and spicy foods, tobacco, ASA and/or NSAIDS
- Avoid forceful nose blowing and picking of nose
- Adequate humidity and use nasal spray to moisten nose if needed
T or F: epistaxis occurs more in summer months.
F- winter months
what is the main cause of deviated septum?
trauma to nose
what can a deviated septum cause for patients?
potential for interference with airflow and sinus drainage
can affect NG tube insertion: assess pt’s nose and ask if pt has hx of trauma to nose, ask which nostril they breath out of better
what are s+s of a deviated septum?
Minor- asymptomatic
Can cause obstruction to nasal breathing, nasal congestion, frequent sinus infections, nosebleeds, and facial pain
what is medical management of a deviated septum?
nasal septoplasty: reconstruction and properly align septum
what are nasal polyps?
soft, painless, benign growths that form slowly due to repeated inflammation of sinus/nasal mucosa
who gets nasal polyps most often?
men are 2x as likely to get it than women, Age > 40 years old
what are s+s of nasal polyps?
- size of grape
- yellow gray or pink that are semitransparent
- small: asymptomatic
- large: nasal obstruction and drainage, speech distortion, pt becomes a mouth breather which dries oral mucosa
what is primary medical therapy of nasal polyps?
- topical and systemic steroids: shrinks polyps
- antihistamine: allergy induced
- endoscopic or laser surgery: to remove polyps
- ABX therapy: underlying bacterial infection with s+s of increased nasal congestion, yellow/green discharge, facial pain/pressure, HA, fatigue, tooth pain
T or F: nasal polyps are always benign.
F- they can become malignant
how do you remove foreign bodies from nose?
- sneezing and blowing the nose with opposite nostril closed to create pressure
- avoid irrigating nose or pushing FB further in due to r/o aspiration and airway obstruction
what causes laryngeal obstructions?
-angioedema: cause of death in severe anaphylaxis
- hereditary angioedema: episodes of life-threatening laryngeal edema
- Foreign bodies: aspirate into pharynx, larynx, or trachea –> difficulty breathing –> asphyxia
*can inhale further down into bronchi and bronchioles that cause increase irritation and inflammation
what are clinical manifestations of laryngeal obstructions?
- normal to low O2 sats
- use of accessory muscles to breathe which causes high risk for respiratory collapse
what should you assess for a pt with a laryngeal obstruction?
heavy alcohol or tobacco use, current meds, hx of airway problems, recent infections, pain or fever, dental pain or poor dentition, previous surgeries, radiation therapy, trauma
what are medical management of laryngeal obstructions?
- Patent airway!
- Immediate tracheostomy
- allergic reactions?: subq epinephrine and corticosteroid
- edema: ice to neck
- continuous pulse oximetry
