CLASS 16 - Acute Respiratory Conditions / Upper Respiratory Conditions Flashcards
What is an upper respiratory condition?
What are the 4 general categories of upper respiratory conditions?
A condition in which the upper respiratory tract is altered.
- allergic rhinitis
- infection (viral rhinitis, sinusitis, peritonsillar abscess, pharyngitis)
- trauma + other altered states
- obstruction (foreign body or swelling)
What is Allergic Rhinitis?
Inflammation of the nasal mucosa in response to a specific allergen.
Can be seasonal or perennial
What are the 3 components of the upper respiratory tract?
nasal cavity
pharynx
larynx
Which drugs can be used to manage allergic rhinitis?
to manage symptoms:
- nasal sprays
- LTRAs
- antihistamines
- decongestants
intranasal corticosteroid sprays to decrease local inflammation
What causes acute viral rhinitis? What spreads it?
What mgmt strategies can be implicated?
caused by viruses that invade the upper respiratory tract
spread by airborne droplet sprays emitted while breathing, talking, sneezing or coughing or by direct hand contact
mgmt strategies: rest, fluids, proper diet, antipyretics, analgesics
A client with allergic rhinitis reports severe nasal congestion, sneezing and watery, itchy eyes and nose at various times of the year. What should the nurse advise the client to do?
a. Avoid all intranasal sprays and oral antihistamines
b. Limit the duration of use of nasal decongestant spray to 10 days
c. Use oral decongestants at bedtime to prevent symptoms during the night
d. Keep a diary of when the allergic rxn occurs and what precipitates it.
b) should be limited to 3 days, not 10
c) wrong because decongestants wake you up and increase SNS activity
D is correct.
What is sinusitis?
Inflamed sinuses.
What are the acute clinical manifestations of sinusitis?
significant pain purulent nasal drainage nasal obstruction congestion fever malaise
What are the chronic clinical manifestations of sinusitis?
facial pain
nasal congestion
increased drainage
severe pain + purulent drainage are often absent
symptoms may mimic those seen with allergies
difficult to diagnose because symptoms are nonspecific and client is rarely febrile
Identify the 5 mgmt strategies for sinusitis
environmental control drug therapy increase fluid intake nasal cleaning + irrigation techniques persistent complaints may require endoscopic surgery
What is acute pharyngitis?
What are the potential causes?
Acute inflammation of the pharyngeal walls, may include tonsils, palate, and uvula
can be caused by:
- viral infection (most common)
- bacterial infection (strep)
- fungal infection (candidiasis)
What are the clinical manifestations of acute pharyngitis? How is it diagnosed?
Manifestations range from scratchy throat to severe pain
Apeearance is not always diagnostic so cultures or a rapid strep antigen test is needed to diagnose.
What is a peritonsillar abscess?
What are the clinical manifestations?
Complication of acute pharyngitis or acute tonsillitis when the bacterial infeection invades one or both tonsils.
Tonsils may enlarge sufficiently to threaten airway patency
Pt experiences a high fever, leukocytosis, and chills
What is quincy?
Inflammation of the uvula
What are the 5 signs of quincy?
- fever which may lead to febrile seizure
- respiratory distress
- odynophagia (painful swallowing)
- drooling of saliva bc it’s too painful to swallow
- thick + muffled voice.
An 18 yo client w pharyngitis has tested positive for GABHS (group a beta hemolytic strep). She has no known allergies (NKA). Which of the following would the nurse expect as orders from the HCP?
a. Amoxicillin
b. Tetracycline
c. Penicillin g
d. Vancomycin
Penicillin g bc it specifically addresses GABHS
Does epistaxis in children occur anteriorly or posteriorly? In older adults?
Children = anterior bleeding
Older adults = posterior bleeding
What are the 8 potential causes of epistaxis?
- trauma
- foreign bodies (ex - kids shove all types of shit up their nose)
- abuse of nasal sprays
- street drug use
- anatomical malformation (need surgery)
- allergic rhinitis
- tumors
- uncontrolled HTN
What drugs predispose a client to epistaxis
Aspirin
NSAIDs
Clopidogrel (antiplatelet)
and conditions prolonging bleeding time or altering platelet counts
What is the treatment for epistaxis?
Lay down - not totally supine - and pinch off anterior / posterior part
If that doesn’t fix it, use a nasal pack (of gauze)
If that doesn’t work, use a nasal balloon.
A client is seen in the clinic for an episode of epistaxis, which is controlled by placement of anterior nasal packing. During discharge teaching, what should the nurse instruct the client to do?
a. Use aspirin for pain relief
b. Remove the packing later that day
c. Skip the next dose of antihypertensive medication
d. Avoid vigorous nose blowing and strenuous activity
A) NO
B) Should not remove packing, there to provide pressure
C) NO!
D) yes :)
What are the potential causes of partial airway obstruction?
aspiration of food or foreign body laryngeal edema laryngeal or tracheal stenosis CNS depression allergic rxns
What are the symptoms of airway obstruction?
stridor use of accessory muscles suprasternal + intercostal retractions wheezing restlessness tachycardia cyanosis
How do we treat complete airway obstruction?
** medical emergency **
TRACHEOSTOMY
Which 3 drug classes are used for acute respiratory conditions?
Antihistamines (diphenhydramine)
Decongestants (pseudoephedrine)
Corticosteroid nasal sprays (Fluticasone)
What are the 5 main lower respiratory conditions?
Influenza Pneumonia Empyema Pleural effusion Pulmonary edema
Compare + Contrast Influenza and the Common Cold (Viral Rhinitis) in terms of:
- onset + duration
- symptoms
Influenza
- abrupt onset
- systemic symptoms (fever, myalgia, headache, sore throat, dry cough)
- risk of pneumonia
- subsides in 7-10 days
- treated w influenza vaccine or antivirals in severe cases
COLD (viral rhinitis)
- gradual onset, mild symptoms
- tickling, itching, irritation of throat, sneezing + copious nasal secretions, nasal congestion, elevated temperature, malaise, headache
- subsides in 3-4 days
What is pneumonia?
Pneumonia is an infection in the alveoli which leads to an inflammatory response.
Alveoli fill with fluid + exudate which affects gas exchange
Consolidation occurs as exudate replaces air in alveoli
What are the 3 types of Pneumonia? which is the most common?
1) LOBAR pneumonia (most common)
2) Bronchopneumonia
3) Interstitial
What is LOBAR pneumonia?
Infection of lung lobe or entire lung
What is Bronchopneumonia?
Scattered patches of infiltrate in both lungs
What is Intersitial Pneumonia?
Infiltrates in alveolar walls between alveoli
Which populations are at a higher risk for pneumonia?
- smokers (4x more likely)
- alcohol + substance addictions
- influenza or other viral infection
- pre-existing lung disease such as COPD
- neurological disease (ex - paralyzed)
- renal disease
- cardiac disease
- immunocompromised or immunosuppressed patients (such as chemo patients, HIV, organ transplants)
- v/ young (under 5) or v/ old (over 85 yo)
- post-op patients (immobile, in pain)
- ventilated patients
What does it mean if a patient’s position of comfort is the tripod position (leaning over, palms of hands on knees)?
This position allows lungs to expand more easily, sign of increased WOB
What does it mean if we hear coarse crackles on auscultation?
Fluid in lungs
What does it mean if we hear bronchial breath sounds on auscultation?
All sounds heard should be vesicular. This is a sign of decreased air entry.
T or F: symptoms of pneumonia are similar to those of a pulmonary embolism?
True.
What symptoms of pneumonia would we find on inspection?
- dry lips
- cyanotic oral mucosa
- accessory muscle use in neck
- indrawing between intercostal spaces
What symptoms of pneumonia would we find on palpation?
- pain over R anterior and lateral chest wall
- decreased chest expansion of R lung
- increased fremitus (vibratory tremors) in RML
What symptoms of pneumonia would we find on percussion?
dullness over RML
What symptoms of pneumonia would we find on auscultation?
Bronchial breath sounds over RML
Egophony
Whispered petrology
Pleural rub over R lower lung field
Which test is used to assess the severity of pneumonia?
How does the test work?
CURB65 score (1 point for each feature)
- confusion
- urea
- respiratory rate
- bp
- age > 65
a score of 5+ indicated a 57% mortality rate
4 - 42%
3 - 17%
2 - 13%
How does pneumonia affect the V/Q ratio?
decreases it.
how does pneumonia affect the alveoli?
alveolar sacs filled w fluid + exudate, alveolar walls thickened therefore increased distance for diffusion required) .
How does the body compensate to improve VQ mismatching?
hypoxic pulmonary vasoconstriction in areas of low ventilation, redirects blood to areas of better ventilation
Can we treat shunt w oxygen?
Shunt is difficult to treat with ocygen as the blood will never benefit from increased FiO2
What are 3 common intrapulmonary forms of shunt?
- pulm edema
- pneumnia consolidatino (exudate replaces air in alveoli)
- atelectasis
What occurs as a result of alveolar hypoventilation?
What does alveolar hypoventilation occur in?
causes both hypoxemia and hypercapnia
occurs in:
- opioid use
- chest wall injury / pain
- neuromuscular respiratory weakness
- injury to respiratory center
- restrictive lung disease
What is empyema?
pockets of pus that have collected inside the pleural space
forms if a bacterial infection is left untreated or fails to fully respond to treatment.
what is pleurisy?
inflammation of pleura
what are the potential complications of pneumonia in the lung?
- atelectasis
- pleural effusion
- empyema
- pleurisy
- lung abcess
what are 4 other complications of pneumonia?
pericarditis
bacteremia –> sepsis
meningitis
endocarditis
what is atelectasis?
lung collapse or incomplete expansion of the lung or a portion of the lung
What are the 3 potential causes of atelectasis?
1) airway obstruction (aspiration or mucus plug formation)
2) lung compression (tumot mass, air, fluid)
3) increased alveolar surface tension (ex - decreased surfactant)
Question 1:
A client is seen at the clinic with fever, muscle aches, sore throat with yellowish exudate, and headache. Which of the following does the nurse anticipate that the collaborative management will include? (Select all that apply)
a. Antiviral agents to treat influenza
b. Treatment with antibiotics starting ASAP
c. A throat culture or rapid strep antigen test
d. Supportive care, including cool, bland liquids
e. Comprehensive history to determine possible etiology
C, D, E
Question 2: A client with pneumonia has a nursing diagnosis of Ineffective Airway Clearance r/t excess mucus and retained secretions. Which of the following would be appropriate nursing interventions? Select all that apply.
• a) Promote fluid intake as appropriate to liquefy secretions
• b) Provide opioid analgesics as ordered to promote comfort
• c) Provide antitussive to relieve cough associated with thick secretions
• d) Provide expectorants as ordered to promote removal of secretions
• e) Teach client effective cough technique to bring secretions to the mouth
A, D, E
NOT C because the cough is productive therefore you do not want to suppress it
