Chapter 29: Upper Respiratory Problems Flashcards by Jennifer Latimer

To treat chronic bacterial sinusitis, ______________________ may be used for ____________ (time period) due to presence of ___________________.

broad-spectrum antibiotics, 4-6 weeks, mixed bacterial flora

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clear or pink-tinged persistent drainage after bleeding is controlled after a nasal fracture suggests ______________

CSF leakage

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Treatment for posterior nosebleeds after packing includes monitoring ___________ status, _______ management, and prophylactic ______________.

respiratory, pain, antibiotics

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After a laryngectomy, monitor patency of drainage tubes every ________ in the first few hours after surgery, then every ___________ to ensure proper functioning.

hour, 4 hours

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______________________ can be used to realign a simple nasal fracture, while complex nasal fractures will require __________ after edema subsides, which may take _________ days

Manual manipulation, surgery, 5-10

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type of allergic rhinitis in which symptoms are present more than 4 days a week and for more than 4 weeks per year

persistent allergic rhinitis

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four risk factors for head and neck cancer
(health promotion for each)

tobacco use (tobacco cessation)
excess alcohol use (alcohol cessation)
poor oral hygiene (encourage good oral hygiene)
HPV infection (safe sex practices, condoms)

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Anterior nosebleeds are typically treated by placing a _________ impregnated with ____________ and/or ____________ into the nasal cavity

pledget (nasal tampon)
anesthetic solution (lidocaine)
vasoconstrictive agents (epinephrine)

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Laryngectomy: The purpose of an NG tube is to remove _______________ via intermittent suction for the first _______________ (time period) until peristalsis returns. Do not manipulate or move the tube because _____________________________________.

gastric contents, 24-48 hours, the NG tube lies close to internal incision lines

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Acute pharyngitis is an acute inflammation of the pharyngeal walls, which may include the _________, ____________, and ___________.

tonsils, palate, uvula

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two main manifestations of nasal fracture: _____________ is common, but only manifestation may be ___________

facial deformity, nosebleed

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preoperative nursing care for rhinoplasty includes considering (psychosocial) changes in ____________, obtaining a _______________ history, and encouraging __________________

body image, medication (may need to stop ASA/NSAIDs for 5-14 days beforehand to reduce risk of bleeding), smoking cessation

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A self-expanding implant called __________ may be placed directly in the sinus during surgery to help maintain _________ and provide local _____________ delivery directly to the sinus lining before dissolving after 30 days.

Propel, patency, corticosteroid

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Saline irrigation of nasal cavity can ________ nasal passages, promote __________, and decrease _____________.

rinse, drainage, inflammation

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After a laryngectomy, drainage from Hemovac, Jackson-Pratt, or Penrose drains may be ___________ at first, then _______________. Drainage should gradually decrease in volume over _____________ (time period).

bloody, serosanguineous, 24-48 hours

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hand-held, battery-powered device that creates speech with the use of sound waves

electrolarynx

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a concentrated and localized method of delivering radiation that involves placing a radioactive source near or into the tumor (head and neck cancer)

brachytherapy

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type of sinusitis that lasts longer than 12 weeks and is a persistent infection usually related to allergies or nasal polyps

chronic sinusitis

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four classic manifestations/criteria of acute pharyngitis

fever greater than 100.4 degrees F
anterior cervical lymph node enlargement
tonsillar or pharyngeal exudate
absence of cough

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stoma care and head and neck cancer: cover the stoma when ______________ and during any activity that may lead to inhalation of _______________; wear a _______________ when taking a shower

coughing, foreign materials, plastic collar

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Patient with a laryngectomy needs frequent _______________ to help decrease secretions

suctioning (via tracheostomy tube)

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drug of choice for pharyngitis caused by group A beta-hemolytic streptococci; is taken for ________ (time period) to prevent complications such as ____________

penicillin, full 10 days, rheumatic fever

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After a laryngectomy, check skin flaps ____________ for _________ and any change in ________ or ____________.

hourly, color, size, edema

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diffuse crackles and dyspnea in an influenza patient can indicate this complication

pneumonia

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5-10% of cases of acute pharyngitis (viral or bacterial)

bacterial

most effective treatment strategy for influenza

prevention with vaccines

after rhinoplasty, this may be inserted to apply pressure and prevent bleeding or septal hematoma formation and is left in place for 1-2 days

nasal packing

After laryngectomy, patient should be kept in this position to decrease edema and limit tension on suture lines

Semi-Fowler's

Topical decongestants should be used for no longer than _____ days to prevent rebound congestion caused by vasodilation.

nasal fracture type: unilateral or bilateral with little or no displacement

simple nasal fractures

type of allergic rhinitis that occurs year-round from exposure to environmental allergens

perennial allergic rhinitis

four activity restrictions aimed at preventing bleeding and injury after rhinoplasty and epistaxis

no nose blowing no swimming no heavy lifting/straining no strenuous exercise

stoma care and head and neck cancer: wash area around stoma _______ with a(n) ___________

daily, moist cloth

stoma care and head and neck cancer: use a _____________ spray every ________ (time period) to keep the stoma moist and prevent crusting

nasal wash, 1-2 hours

acute pharyngitis caused by Candida albicans is treated with this drug

nystatin

periorbital bruising involving both eyes is called ______________, which suggests a(n) ______________________

raccoon eyes, basilar skull fracture

Other manifestations of head and neck cancer may include ear _____ or _________, ____________ or ________ in the neck and/or jaw, constant ____________ (sometimes with blood).

pain, ringing, swelling, lumps, coughing

Early manifestations of head and neck cancer vary with the location of the tumor but may include a feeling of a _______ in the throat, ______ throat that does not get better, ________ or ______ patches in the mouth, a change in ________ quality, and/or ___________ that lasts more than 2 weeks.

lump, sore, white, red, voice, hoarseness

Patients with acute pharyngitis should use ______________ or ___________ for pain relief and increase _________ intake.

ibuprofen, acetaminophen, fluid

nasal fracture patients should be evaluated for injury to these three places

cervical spine orbital sockets mandible

lotions and skin products that can be used while undergoing radiation therapy; avoid using within __________ before radiation treatment

prescribed; 2 hours

immediate postoperative nursing care for rhinoplasty: ensuring _________________, continuous assessment of ____________________, monitoring for __________________, ________ management, and observing surgical site for ______, _________, and ___________

airway patency, respiratory status, airway obstruction, pain, edema, bleeding, infection

Patients taking _______________________ are at risk for developing infection with Candida organisms. To prevent this, do this

inhaled corticosteroids thoroughly rinse mouth with water after use

radiation therapy and head and neck cancer: to help with fatigue, ______ 15-30 minutes a day; perform ____________ activities, and _____ during periods of low energy

walk, most important, rest

Total laryngectomy changes _______________, and normal __________ production will not be possible.

airflow, voice

most common and most virulent influenza virus

influenza A

to treat head and neck cancer, radiation therapy can be delivered in these two ways

external-beam therapy internal implants (brachytherapy)

After a nasal fracture, keep patient in this position

sitting upright

_____ present criteria for acute pharyngitis indicates a _________________ test or ____________ to assist with diagnosis

2-3, rapid antigen detection, throat culture

Physical therapy for post op patients with head and neck cancer focuses on exercising the ________________ to help support and move the head and maintaining strength and movement in the _____________ and _______.

upper extremities, shoulders, neck

first-line treatment for head and neck cancer

surgery

removal of part or all of larynx

laryngectomy

Laryngectomy: If tubing becomes obstructed, fluid will ______________ under the skin flap, which predisposes the patient to ________________ or _________________, impaired _____________________, and increased risk for _______________.

accumulate, hematomas, seromas, wound healing, infection

treatment used in combination with radiation therapy for patients with stage 3 or 4 head and neck cancers

chemotherapy

key step to managing allergic rhinitis

identifying and avoiding triggers of allergic reactions

To relieve symptoms of sore throat with acute pharyngitis, patients may use these three techniques

1. gargle with warm salt water (1/2 tsp salt in 8 oz water) 2. drink warm or cold liquids 3. suck on popsicles, hard candies, throat lozenges

five nursing care priorities after laryngectomy

1. airway management 2. wound care 3. nutrition 4. communication 5. psychosocial issues related to body image changes

a fistula is created in the tracheoesophageal wall which diverts pulmonary air across the pharyngoesophageal mucosa for phonation when the tracheostoma is occluded

tracheoesophageal puncture (TEP) voice restoration

Medications/therapies for sinusitis include oral or topical _________________ to promote drainage, ___________________ to decrease inflammation, ___________ to relieve pain, and _______________ to relieve congestion.

decongestants, intranasal corticosteroids, analgesics, saline nasal spray

three oral drug classes used to treat allergic rhinitis

H1-antihistamines decongestants leukotriene receptor antagonists (LTRAs)

white, irregular patches on the oropharynx suggest this cause of acute pharyngitis

fungal infection with Candida albicans

radiation therapy and head and neck cancer: four methods to help irritation, ulceration, and pain associated with oral mucositis

1. oral care basics 2. wearing mouth protection during radiation 3. warm bland rinses 4-6 times daily 4. ice chips

In sinusitis patients where medical therapy does not relieve symptoms, _________________________ may relieve blockage.

nasal endoscopic surgery

A (high, low) calorie diet is needed for tissue repair after surgery for head and neck cancer.

high

type of analgesic preferred for first 48 hours after a nasal fracture

acetaminophen (avoids prolonged clotting time and increased risk of bleeding)

type of allergic rhinitis that usually occurs in the spring and fall from a pollen allergy

seasonal allergic rhinitis

bacterial pharyngitis usually results from infection with _______________

group A beta-hemolytic streptococci

stoma care and head and neck cancer: dried secretions can be removed with __________

tweezers

treatment preferred for early head and neck cancer and reason why

radiation therapy offers good results with voice preservation

corticosteroid nasal sprays (do, do not) typically cause systemic effects

do not

stoma care and head and neck cancer: provide ______________ with mechanical ventilation or tracheostomy mask

humidification

90% of cases of acute pharyngitis (viral or bacterial)

viral

Late manifestations of head and neck cancer may include unintentional _______________; difficulty with ______________, _________________, moving the __________ or ______, and ___________; and a partially or fully __________________

weight loss, chewing, swallowing, tongue, jaw, breathing, obstructed airway

manifestations include sneezing; watery, itchy eyes/nose; decreased sense of smell; thin, watery nasal discharge; nasal polyps; postnasal drip

allergic rhinitis

head and neck cancer: speech therapy option that allows for speech immediately after surgery

electrolarynx

Most people with streptococcal pharyngitis are contagious until they have been on antibiotics for ____________ (time period)

24-48 hours

complications of nasal fracture include __________ obstruction, _________, __________ tears causing ________ leakage, septal __________, and cosmetic __________

airway, nosebleeds, meningeal, CSF, hematoma, deformity

Head and neck cancers, especially post op: To help with difficulty swallowing, add mild ______ and ________ to food, provide (thick, thin) liquids, and avoid (thick, thin) liquids.

sauces, gravies, thick, thin

head and neck cancer: frequent adverse effect of radiation therapy (four symptom relief methods)

xerostomia (dry mouth) (increasing fluids, sugarless gum/candy, nonalcoholic mouth rinses, artificial saliva)

A muffled voice can indicate a __________________.

swollen airway (is a priority and emergency)

surgical reconstruction of the nose

rhinoplasty

these two methods can help minimize swelling and discomfort after rhinoplasty

cold compresses elevating head

type of sinusitis that is present when symptoms progress over 4-12 weeks

subacute sinusitis

depends upon air entering the esophagus and then being expelled past the pharyngoesophageal segment

esophageal speech

nasal fracture type: powerful frontal blows that may involve damage to adjacent facial structures (teeth, eyes)

complex nasal fractures

head and neck cancer: speech therapy option that offers the best speech quality with the highest degree of patient satisfaction

tracheoesophageal puncture (TEP) voice restoration

type of allergic rhinitis in which symptoms are present less than 4 days a week or less than 4 weeks per year

intermittent allergic rhinitis

inflammation of the nasal mucosa, often in response to a specific allergen

allergic rhinitis

(First-generation, Second-generation) antihistamines are used first to treat allergic rhinitis and why

Second-generation due to their non-sedating effects

Diagnosis of head and neck cancer involves a focused assessment of these six things

ears, nose, throat, mouth, neck, lymph nodes

type of allergic rhinitis that refers to symptoms related to sporadic exposure to allergens not typically encountered in the patient's normal environment

episodic allergic rhinitis

three ways nasal stuffiness may be relieved after a nasal fracture

nasal decongestants saline nasal sprays humidifier

goals of nursing care for nasal fracture: maintain ________________, reduce ________ and _________, prevent ____________, and provide __________________

patent airway, edema, pain, complications, emotional support

After a focused assessment, diagnosis of head and neck cancer involves an indirect _____________________ and _____________________ with multiple _________________ for suspected lesions, a _____ or ______ to detect local and regional spread, and _______ scanning.

pharyngoscopy, laryngoscopy, biopsy specimens, CT, MRI, PET

patients with head and neck cancer are at risk for ______________ due to manifestations such as difficulty ____________ and treatment modalities

malnutrition, swallowing

after rhinoplasty, this is inserted to protect and support the new shape of the nose during the healing process and is left in place for 1-2 weeks

external plastic splint

type of sinusitis that typically begins within 1 week of a URI and lasts less than 4 weeks

acute sinusitis

Antibiotics may be prescribed if symptoms of sinusitis worsen or last longer than __________.

1 week

Posterior nosebleeds often need ____________ with compressed nasal ________ or epistaxis _________, which apply pressure along the _________ of the nasal cavity. If not stopped in this way, the patient may need _____________________.

packing, sponges, balloons, floor, arterial embolization

surgery that corrects a deviated septum

septoplasty

Simple first aid for a nosebleed: 1. Place patient in a(n) ____________ position, leaning slightly __________ with head tilted __________. 2. Apply _____________ by squeezing the entire soft lower part of the nostrils together for ________ minutes. 3. If bleeding does not stop within __________, seek medical assistance.

sitting, forward, forward direct pressure, 5-15 15 minutes