Chapter 29: Upper Respiratory Problems Flashcards
To treat chronic bacterial sinusitis, ______________________ may be used for ____________ (time period) due to presence of ___________________.
broad-spectrum antibiotics, 4-6 weeks, mixed bacterial flora
clear or pink-tinged persistent drainage after bleeding is controlled after a nasal fracture suggests ______________
CSF leakage
Treatment for posterior nosebleeds after packing includes monitoring ___________ status, _______ management, and prophylactic ______________.
respiratory, pain, antibiotics
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
______________________ 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
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
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)
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)
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
Acute pharyngitis is an acute inflammation of the pharyngeal walls, which may include the _________, ____________, and ___________.
tonsils, palate, uvula
two main manifestations of nasal fracture: _____________ is common, but only manifestation may be ___________
facial deformity, nosebleed
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
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
Saline irrigation of nasal cavity can ________ nasal passages, promote __________, and decrease _____________.
rinse, drainage, inflammation
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
hand-held, battery-powered device that creates speech with the use of sound waves
electrolarynx
a concentrated and localized method of delivering radiation that involves placing a radioactive source near or into the tumor (head and neck cancer)
brachytherapy
type of sinusitis that lasts longer than 12 weeks and is a persistent infection usually related to allergies or nasal polyps
chronic sinusitis
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
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
Patient with a laryngectomy needs frequent _______________ to help decrease secretions
suctioning (via tracheostomy tube)
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
After a laryngectomy, check skin flaps ____________ for _________ and any change in ________ or ____________.
hourly, color, size, edema
diffuse crackles and dyspnea in an influenza patient can indicate this complication
pneumonia
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.
5
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
- gargle with warm salt water (1/2 tsp salt in 8 oz water)
- drink warm or cold liquids
- suck on popsicles, hard candies, throat lozenges
five nursing care priorities after laryngectomy
- airway management
- wound care
- nutrition
- communication
- 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
- oral care basics
- wearing mouth protection during radiation
- warm bland rinses 4-6 times daily
- 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
