Exam 2, Ch 29 (Week 4): Upper Respiratory Problems Flashcards
What is a deviated septum?
A nasal septum that is deviated from the midline.
What symptoms does a deviated septum present with?
Pain, deformities and crepitus
Severe deviated septum symptoms are what 3 things?
-Facial pain
-Epistaxis
-Breathing obstruction
What is crepitus?
Rice-crispy crackling from joints or cartilage moving.
What is the priority action of the nurse when assessing for nasal trauma?
Assess their airway!
What is epistaxis?
A nosebleed
A patient presenting with nasal trauma arrives in an ER. The attending physician orders a nurse to assess the fluid dripping from the patients nose to check if the fluid contains glucose. What does the nurse use to assess the fluid? What does it mean if there is glucose found?
A dipstick is used to assess the fluid.
If the fluid has glucose in it, then it means that the fluid contains cerebrospinal fluid, meaning a patient may have a spinal injury.
What is the best way to maintain a patient’s airway?
Keep them sitting up.
What are two goals for the treatment of a deviated septum/trauma to the nose?
-Restore function and appearance
-Control bleeding and edema
A “Closed Reduction” is a procedure to do what?
Set (or reduce) a broken bone without surgery
When is the best time to do a Closed Reduction?
a.) Within 5 hours of the trauma
b.) Within 3 hours of the trauma
c.) Within 24 hours of the trauma
d.) Within 3-7 days of the trauma
b.) Within 3 hours of the trauma.
The sooner the better
What is the longest amount of time you can wait before attempting a Closed Reduction?
3-7 days of the trauma
A patient with nasal trauma is self-conscious about her disfigurement and so she starts to ask her nurse about Rhinoplasty. What is Rhinoplasty?
Reshaping the exterior of the nose
A patient with a deviated septum is inquiring about nasal surgeries and asks about Rhinoplasty. Will Rhinoplasty repair his deviated septum?
No, not technically.
Septorhinoplasty is used to repair the deviated septum. Regular rhinoplasty just repairs the exterior of the nose.
If a patient with nasal trauma keeps swallowing, what could that mean?
Possible bleeding in the throat
What is Epistaxis?
a.) Hemorrhaging in the laryngopharynx caused by an allergic reaction.
b.) Hemorrhaging of a deviated septum caused by a rupture.
c.) Hemorrhaging in the mucous membrane vessels, caused by a rupture.
d.) Hemorrhage of the cervix due to trauma
c.) Epistaxis is hemorrhaging of the vessels in mucosal membranes due to a rupture.
aka nosebleed. Because these words were made by scientists, so they use Latin and shit to make themselves sound smarter, like fuckin’ dorks.
Which type of epistaxis is emergent and can cause hypoxia?
-Anterior epistaxis
-Posterior epistaxis
Posterior Epistaxis is emergent and can cause Hypoxia
Anterior Epistaxis stops eventually through what?
Posterior Epistaxis, on the other hand, requires what?
Anterior Epistaxis stops eventually through clotting.
Posterior Epistaxis requires “Packing”
Name 4 tools a nurse would use to “Pack” Posterior Epistaxis
-Gauze
-Foley catheter
-Nasal sponges
-Epistaxis balloon
-
Sinus infections are marked by pain in what area?
What would you treat it with?
Marked by tooth pain.
Treated with an Antibiotic.
Inflammation of the nasal mucosa, often is response to an allergen, is known as what?
Rhinitis/Allergic Rhinitis
“This develops when swelling or inflammation of nasal mucosa block the openings in the sinuses, through which mucus drains into the nose.”
What is this describing?
a.) Rhinitis
b.) Allergic Rhinitis
c.) Sinusitis
d.) Epistaxis
d.) Sinusitis is the result of sinus openings being blocked, due to nasal mucosa inflammation.
Rhinosinusitis, a disease that often accompanies sinusitis, is a resulting sinus infection due to what precipitating affliction?
Rhinitis
Rhinitis is inflammation of the nasal mucosa. This leads to the sinuses being blocked from leaking their mucus out of the nose. The buildup of this mucus can cause an infection. This resulting infection is known as Rhinosinusitis, because it was CAUSED by Rhinitis.
What should a patients CO2 levels be, btw?
between 3.4-5
What type of drugs would be used to treat Allergic/Viral Rhinitis?
-Anticholinergic Nasal Spray
-Antihistamines
-Corticosteroid nasal sprays
-Decongestants
Viral Rhinitis, aka the common cold (URI), isn’t treated with corticosteroids, or antihistamines. It is treated symptomatically. So, if Viral Rhinitis cause a fever, what would be a pharmacological method of treatment?
What if it was causing a cough?
Fever: Tylenol, or another Antipyretic
Cough: Mucolytic, or an Antitussive (Anticough)
The highly contagious respiratory illness that is casually known as “The Flu” is called what?
Influenza
Why is the Influenza virus so contagious?
It is constantly mutating to adapt.
What is the only real way to treat Influenza?
Prevention through vaccination
Through what method is Influenza spread?
Infected droplets
Even though prevention through vaccines is the only real measure to fight influenza, there is a drug class that can treat it as well. What is this drug class?
Antivirals
Also, the drug Tamiflu
“Fever, chills, cough, sore throat, fatigue, crackles.”
These are symptoms of what?
a.) Influenza
b.) Rhinitis
c.) Epistaxis
d.) Sinusitis
a.) Influenza
Influenza is known as “The Flu”.
Fever, chills, cough, sore throat, and crackles are all symptoms associated with the flu.
The forced air particles of gas that pull against the arteries is called what?
Partial Pressure
A viral sinus infection in a patient has led to symptoms of a headache, a fever, and stiffness in the neck. What is this patient experiencing?
Meningitis. Specifically, Acute VIral Meningitis due to the viral sinus infection.
Meningitis can be recognized by the stiffness in the neck.
A patient comes in experiencing pain, erythema and pressure around his face, specifically around his nose. He reports stuffiness, and there is visible nasal discharge. Upon inspection, his temperature is 101.4F, his mucosa is inflamed, and there seems to be blockage in his sinus as a result of the inflammation. What is he most likely experiencing?
Acute Viral Rhinosinusitis.
(Acute Viral because of the temperature)
What chronic condition could a patient have that you would have to consider when planning treatment for Rhinosinusitis?
Asthma
Soft, painless, benign growths that form due to repeated inflammation of the nasal mucosa and the sinuses, are known as what?
Nasal Polyps.
Yellow, gray, pink, and semitransparent projections in the nares, that can exceed the size of a grape, are called what?
Nasal Polyps
What methods are usually used to treat Nasal Polyps?
Topicals and Systemic Corticosteroids.
How do large Nasal Polyps usually manifest as symptoms?
-Nasal obstruction
-Mucus discharge
-Voice change
-Mouth breathing
When educating a client about at home care for Nasal Polyps, what are 3 things that a nurse would educate the client on?
-Medication use (Topicals and Corticosteroids)
-Avoid blowing your nose (May irritate and further inflame the polyps
-Watch for epistaxis and signs of an infection
What is the range for blood platelet counts (thrombocytes)?
Between 150K-450K
“Pharynx” means throat.
“-itis” means “Inflammation.”
What does Pharyngitis mean?
Throat inflammation.
or basically…
A sore throat caused by an infection (Bacterial, Viral, Fungal).
The Pathology of Acute VIRAL Pharyngitis is what? (3 viral diseases)
-Influenza
-Epstein Barr
-Herpes
The pathology of Acute BACTERIAL Pharyngitis is what?
Streptococcus/Strep
A patient is presenting with inflammation, and erythema. He explains that he has had a fever above 101F for several days. Upon inspection of his throat, he has small, white pockets of exudate, and terrible breath.
-What are these symptoms indicative of?
-How would this be treated?
-Acute Bacterial Pharyngitis, most likely strep, AEB the white pockets of exudate and bad breath
It is treated with Antibiotics
It is the nurse’s responsibility to educate the patient about symptom management. What are some questions you would teach a patient with Acute viral/bacterial pharyngitis to ask themselves in order to recognize symptoms in the future?
-Are you able to swallow?
-Are you running a fever?
-Do you have white markings in your throat?
-Does your throat have a marble feeling?
What is another way Strep throat can present itself as?
a.) Viral Rhinitis
b.) Scarlet fever
c.) Fungal Pharyngitis
d.) Pneumonia
d.) Strep throat can present itself as Scarlet Fever
Which of these is Acute Pharyngitis, Chronic Pharyngitis, or both:
-Hypertrophy of the pharyngeal mucous membrane
-Atrophy of the pharyngeal mucous membrane
-Numerous swollen lymph follicles
All are Chronic Pharyngitis
After 10 minutes of packing and treatment, an Anterior Epistaxis continues. At this point, what would be the appropriate step to take to stop the epistaxis?
a.) Corticosteroids
b.) Silver Nitrate usage
c.) Antihistamines
d.) Nasal suctioning
b.) Silver Nitrate, aka Cauterization, would be the next step to control an Anterior epistaxis
Tonsils belong to what bodily system?
What kind of tissue are the Tonsils?
-The Lymphatic system
-Tonsils are Lymphatic tissue
Tonsilitis is an infection of the tonsils. This infection can be Viral or Bacterial and involves inflammation. What aspect of the word “Tonsilitis” tells you that there is inflammation involved?
“-itis” suffix means “Inflammation.”
If you ever see a word with the suffix “itis” it means that there is inflammation involved. Possibly due to a viral, bacterial, or fungal infection
What secondary infection usually accompanies Tonsilitis in the same area?
What does the name of the infection tell you about it?
Adenoiditis
It’s an infection, viral or bacterial, that results in the inflammation of the Adenoids.
Which pathology class of Tonsilitis can be mistaken for allergies, asthma, and rhinosinusitis?
a.) Acute Viral
b.) Chronic
c.) Epstein Barr
d.) Beta Hemolytic
b.) Chronic Tonsilitis can be mistaken for alleries, asthma, and rhinosinusitis.
-Epstein Barr a type of herpes virus, and is example of an Acute Viral pathology
-Beta Hemolytic is a group of streptococci and is an example of Bacterial pathology
How are viral infections treated?
Symptomatically
Untreated bacterial Tonsilitis and Adenoiditis can be life-threatening and should be treated with Cephalosporin and PCN. What treatment types are Cephalosporin and PCN?
Antibiotics
Bacterial infections are treated with Antibiotics.
Untreated Tonsilitis can also lead to Otitis media. What does the breakdown of the name “Otitis media” tell you about the infection?
“Ot-“ prefix means “Ear.”
‘-itis” means inflammation
So, Otitis means ear inflammation (due to infection)
-Media refer to the location. Specifically, media is the middle of the ear. The middle ear is the air-filled space behind the ear drum.
A patient presents with a sore throat, a fever of 101F, and has difficulty swallowing. You assess their oral cavity and find that both their Tonsils and Adenoids are inflamed. On a hunch, you check their ears using an otoscope, and you find drainage in the ear canal, as well as a slight perforation to the tympanic membrane.
What is the patient most likely suffering from? What would be a non-surgical treatment option?
Bacterial Tonsilitis/Adenoiditis that has led to otitis media.
Most likely an infection of streptococcus
Treat with an Antibiotic such as Cephalosporin or PCN
A patient has opted for surgical removal of their tonsils to avoid future infection of tonsilitis. During post-op surgery, what would be some of the nurses’ priorities for proper patient care?
-Assess the patient for risk of hemorrhaging
-Turn the patient on their side and elevate the HOB (keep that head up) to facilitate drainage.
-Provide ice chips, ice pack, and a cool vaporizer
A Peritonsillar Abscess is a complication of what infection?
Tonsilitis
A peritonsillar abscess is also known as “Quinsy”, or “The Quinsy.” What is Quinsy? (Its fuckin gross)
A Peritonsillar abscess, aka Quinsy, is a pocket of puss caused by a strep infection.
What bacterial strain is the most common cause of Quinsy?
B-hemolytic Streptococci is the most common cause of a peritonsillar abscess, because strep is the most common cause of bacterial Tonsilitis.
A severe peritonsillar abscess is life-threatening, and is characterized by pain, inflammation, fever, swelling, and difficulty swallowing.
-Why is a severe Quinsy considered life-threatening?
-What would be 2 treatments for a quinsy, aside from antibiotics?
(1 immediate, and 1 future)
-It blocks the airway, making it difficult to breath
-(Immediate) Drainage of the quinsy via needle aspiration. It’s a pocket of puss, so it needs to be popped and drained.
-(Future) A Tonsillectomy to remove the possibility of further peritonsillar abscesses
What are 3 nurse roles for a peritonsillar abscess (aside from drainage)?
-Observe their airway
-Educate them about gentle gargling with salt water every 1-2 hours for 24-36 hours.
-Encourage fluids
“Laryngitis”. What about the word tells you what the infection is?
-“Larynx” is the voice box of the throat.
-“itis” is inflammation (usually via an infection)
Laryngitis is inflammation of the Larynx.
Laryngitis can be cause by several things. What are at least 3 things that can cause Laryngitis?
-Snoring
-Exposure to irritants (dust, chemicals, smoke)
-Allergens
-GERD
-Infection (Viral or Bacterial)
A patient explains that he has had the flu for the past week, but as he explains this, his voice is hoarse, so his wife takes over. She explains that her husband’s voice is completely lost in the morning, but gets better over the day, only to get worse again in the evening.
-What is the patient most likely experiencing?
-What is the word for his complete loss of voice?
-Most likely experiencing Viral Laryngitis as a side effect from the flu, causing him to lose his voice.
-The complete loss of voice is called: “Aphonia”.
“A-“ as a prefix means “not” or “opposite/against” something.
Atypical means not typical
Asexual means not sexual
Phonia/Phone means “Sound of voice/Speech.” So, Aphonia means No voice/Speech.
How would you treat Viral Laryngitis?
How would you treat bacterial Laryngitis?
How would you treat Chronic Laryngitis?
Viral: Rest the voice, avoid irritants and smoking, use ice chips
Bacterial: Antibiotics
Chronic: Corticosteroids
If a patients Laryngitis lasts for more than 5 days, what life-threatening risk could this mean for the patient?
Malignancy
Where should the HOB be for a patient suffering from Laryngitis due to GERD?
HOB is up for GERD
If a patient with Laryngitis is experiencing OSA, what would the nurse encourage the use of?
A cpap machine
What should the nurse palpate when assessing for an upper respiratory tract infection?
A.) Neck lymph nodes
B.) Nasal mucosa
C.) Tracheal mucosa
D.) All of the above
A.) Neck lymph nodes
The nurse should INSPECT the nasal and tracheal mucosa when assessing for an upper respiratory tract infection.
True or False:
The purpose of the cilia is to move mucus back to the larynx.
True
The cilia move mucus back to the larynx
