Chapter 29 - Problems of the Nose (p.577-588) - Exam 2 Flashcards
a deviated septum can interfere with what
airflow and sinus drainage
s/s of deviated septum vary but they might include
asymptomatic, nasal congestion, frequent sinus infections, facial pain, nose bleeds, obstruction to nasal breathing
the medical management of minor septal deviation focuses on symptom control. For nasal inflammation and congestion use
saline rinses, decongestants to clear nasal passage
for severe septal deviation a ________may be needed
nasal septoplasty, which reconstructs and properly aligns the deviated septum
nasal fractures occur mostly from
blunt trauma, fights, accidents, falls, sports
when assessing for a nasal fracture you may find these symptoms/signs
difficulting breathing, bleeding, edema, hematoma
what are the goals of nursing care r/t nasal fracture
maintain patent airway, reduce edema and pain, prevent complications, provide emotional support
the best way to maintain airway is to keep the patient in what position
sitting upright.
apply ice to the face in 10 to _____ minute intervals to help reduce _______ and bleeding
20, edema
tell the patient not to _____ their nose once bleeding has stopped
why?
blow
so they do not disrupt the clot or cause further trauma
___________is preferred over NSAIDS or aspirin for the first 48 hours to avoid prolonging clotting time and increasing risk for bleeding
acetaminophen
nasal stuffiness may be relieved with
nasal decongestants, saline nasal sprays, humidifier
the patient should avoid ________ showers and ______ for the first 48 hours to prevent an increase in swelling
hot, alchohol
when fracture is confirmed, the goals are to _________ the fracured bones using either manual manupulation or surgery
realign
with complex fractures, considerable swelling occurs it may be necessary to wait to repair the fracture until what subsides
edema
an anterior bleed may be treated medically by placing a
pledget, aka nasal tampon
_______nitrate may be used to chemically cauterize a specific bleeding point
silver
what is an epistaxis
nose bleed
why do nose bleeds occur
trauma, low humidity, UPI, allergies, sinusitis, foreign bodies, chemical irritants, overuse of decongestant sprays, facial or nasal surgery, tumors, anatomic malfomation
posterior bleed often need packing with
compressed nasal sponges or epistaxis balloons
nasal sponges, packing, balloons can impair _______status
respiratory
therefore we should closely monitor
LOC, HR, RR, and O2 sat
observe for signs of difficulty breathing or swallowing
because of risk for complications due to posterior location of injury all patients with posterior packing should be ___________ for close observation
monitored closely
Nasal packing predisposes patient to ___________ from bacteria
infection
before discharge, teach the patient about followup care, review how to use
saline nasal spray or humidifier
have the patient sneeze with mouth
open
teach patient to avoid taking _____for pain
aspirin or NSAIDS
characteristics of allergic rhinitis are
sneezing, watery eyes, itchy eyes and nose, decreased sense of smell, thin watery nasal discharge, nasal turbinates appear pale, boggy, swollen
___________, soft painless growths in the sinus cavity may form due to chronic exposure to allergens
nasal polyps
____________ occurs when mucous runs down the back of the throat
postnasal drip
both __________and __________ are the most common causes of cough for people with allergies
nasal polyps and postnasal drop
the key to managing allerfic rhinitis is
identifying and avoiding triggers of allergic reactions
the goal of drug therapy r/t allergic rhinitis is
reduce inflammation, minimize complications, and maximize quality of life
______________ antihistamines are used before first generation antihistamines because of their ___________effects
2nd gen, non-sedating
appropriate oral meds r/t allergic rhinitis include
h1 antihistamines, decongestants
appropriate intranasal meds r/t allergic rhinitis include
antihistamines, decongestants, anticholinerics, corticosteroids
first gen antihistamines may cause
drowsiness and sedation
allergens r/t allergic rhinitis include
dust, mites, mold, pets, pollens, smoke
an upper respiratory infection URI is an infection of
the nose, sinuses, and/or throat
__________cause most URIs
viruses
the most common bacterium r/t URI is
streptococcus pyogenes
factors that may cause URI
highly contagious, fatigue, emotional/physical distress, compromised immune system
true or false: r/t URI, patients are contagious 1 to 2 days before onset and remain contagious until symptoms have subsided
true
RN interventions are directed at _______symptoms
relieving
care r/t URI includes
rest, fluids, antipyretics, analgesics
complications from an URI include
acute broncitis, sinusitis, otitis media, tonsillitis, and pneumonia
true or false: r/t URI, antibiotics have no effect on viruses. they are an option only if complications are present
true
r/t URI, teach patients to recognize the manifestations of a ____________bacterial infection
secondary
Symps of a secondary bacterial infection include
temp higher than 103, tender swollen glands, severe sinus or ear pain, significantly worsening symptoms.
what is sinusitis
develops when inflammation or swelling of the mucosa blocks the openings (ostia) in the sinuses, through which mucus drain into the nose
what is rhinosinusitis,
may accompany sinusitis, concurrent inflammation or infection of the nasal mucosa
nasal ____, foreign bodies, deviated septa, or tumors can cause obstruction of mucus drainage
polyps
true or false: secretions that accumulate behind blocked ostia provide a rich medium for growth of bacteria, viruses, fungi, which may call infection
true
acute sinusitis causes these symptoms
significant pain, purulent drainage, nasal obstruction, congestion, fever, malaise
rn: inspect the nasal mucosa and ______ the paranasal sinuses for pain
palpate
findings that indicate acute sinusitis include
edematous mucosa, discolored purulent drainage, enlarged turbinates, tenderness over the sinuses, and halitosis, recurrent headaches.
xrays or ________ may help confirm diagnosis of sinusitis
ct scan
the symptoms of chronic sinusitis are often_______ although severe ______ and purulent drainage are often present
nonspecific, pain
as many as 50% of patients with moderate to severe ________ also have chronic sinusitis
asthma
chronic sinusitis is a persistent infection r/t
allergies or nasal polyps
initial treatment of acute sinusitis focuses on
symptom relief, including decongestants, intranasal corticosteroids, analgesics, saline nasal spray
teach patients to use topical decongestants no longer than 5 days to prevent
rebound congestion
nasal polyp form slowly in response to repeated
inflammation of the sinus or nasal mucosa
true or false: nasal polyps can exceed the size of a grape
true
true or false small polyps are typically asymptomatic.
true
manifestations of larger polyps include
nasal obstruction, nasal discharge, speech distortion
topical and systemic corticosteroids are primary therapies to used to shrink
nasal polyps
acute pharyngitis is __________ which includes
acute inflammation of the pharyngeal wall
tonsils, palate, uvula
what causes acute pharyngitis
viral, bacterial, fungal infection
symptoms r/t acute pharyngitits range from
scratchy throat to difficulty swallowing
four classic manifestations present in bacterial pharyngitis
fever greater than 100.4
anterior cervical lymph node enlargement
tonsillar or pharyngeal exxudate
absence of cough
the goals r/t acute pharyngitis
infection control, symptom relief, prevention of secondary complications
for viral pharyngitis antibiotics are not recommended. for bacterial pharyngitis caused by group A strep __________ is the drug of choice
penicillin
candida infections are treated with
nystatin, an antifungal antibiotic
what can we teach the patient w/ acute pharyngitis
ibuprofen or acetaminophen for pain relief
increase fluids
gargle warm salt water
drink warm or cold liquids
popsicles, hard candies, lozenges
encourage use of humidifier
what is a peritonsillar absecess. what are the symptoms
complication of tonsillitis, abscess causes pain, swelling, blockage of throat when severe, causing airway blockage
patient may have high fever, chills, leukocytosis, difficulty swallowing, muffled voice
some character from little women cant play today because he has the quincy aka
peritonsillar abscess
treatment of peritonsillar abscess
needle aspiration, iv antibiotics, tonsillectomy
acute laryngitis is swelling and inflammation of the larynx, classic signs include
tingling, burning sensation in the back of throat, persistent need to clear throat, hoarseness, loss of voice
patient eduction r/t laryngitis
dont talk, dont whisper, increase fluids, cough suppresents, acetaminophen
diagnoses r/t airway infections
ineffective airway clearance r/t
acute pain r/t irritation 2’ infection
fluid volume deficit rt dec intake
knowledge deficit regarding prevention or treatment
Goals r/t airway infection
avoiding major complication: brain abscess, meningitis, sepsis
maintaining airway, promoting comfort, proper fluid intake
okay, we have packed the posterior of a patients nose with sponges/gauze/or balloon after a severe epistaxis
what are the nurses responsiblity post procedure
monitor LOC, HR, O2, and RR
these patients should be very closely monitored
it is also painful patient should receive appropriate analgesia
