Exam 2: Upper Resp Flashcards
Rhinitis
inflammation of the mucous membranes of the nose
can be acute (coryza), chronic, allergic
What are the symptoms of acute rhinitis
Nasal discharge
Eyes
Turbinates
Nasal polyps
Headache
watery then mucoid
tearing early
edematous
No
generalized
What are the symptoms of allergic rhinitis
Nasal discharge
Eyes
Turbinates
Nasal polyps
Headache
thin, watery
tearing, itching
pale, mucoid, edamatous
sometimes
generalized
What are the symptoms of chronic rhinitis
Nasal discharge
Eyes
Turbinates
Nasal polyps
Headache
serous, purulent
no tearing
enlarged
sometimes
generalized
Sinusitis
inflammation of the mucous membranes lining the sinuses (air-filled cavities)
Sinusitis
acute
subacute
chronic bacterial
fungal
Acute: less than 4 weeks: allergic, viral, and bacterial
Subacute: 4 to 12 weeks
Chronic bacterial: over 12 weeks
Fungal
Acute bacterial sinusitis is usually caused by
Strep pneumoniae, H. influenzae
Acute bacterial sinusitis: symptoms worsen over
48 to 72 hours with severe, localized pain and tenderness over involved sinu
Acute bacterial sinusitis examination revelas
enlarged turbinates with visible fluid
Acute bacterial sinusitis diagnosis
H and P, X ray, CT, MRI
Acute laryngitis
inflammation of the mucous membrane lining the larynx and edema of the vocal cords
Acute laryngitis symptoms
sore throat, hoarseness, loss of voice
WE DO SYMPTOMATIC TREATMENT
if persistant we may do a laryngoscopy
Laryngeal paralysis
laryngeal nerves or vagal nerve due to varied reason (prolonged intubation) that can be unilateral or bilateral
What are possible treatments of laryngeal paralysis
treat the underlying cause
tracheostomy
Acute laryngeal edema includes
anaphylaxis, urticaria, acute laryngitis, edema related to intubation
Acute laryngeal edema treatment
corticosteroid, epi, intubation, trach
What do traumas to upper airway include
fractures of nasal bones, septum
fractures of maxillary or zygomatic bones
jaw wiring
Epistaxis
kiesselbach plexus damage due to trauma, irritation, coagulant disorder resulting in nose bleeding
Epistaxis is
unilateral
Management of epistaxis
ice 10 to 15 minutes
alpha 1 agonist
silver nitrate cauterizing
nasal packing
Obstructive sleep apnea
airflow obstruction from narrowing of the air passages or obstruction of the pharynx by the tongue
What are complications of obstructive sleep apnea
HTN, cardiovascular disease, weight gain, memory loss, mood changes, job impairement
Sleep apnea s/s
snoring, choking, daytime sleepiness
management of sleep apnea
avoid alcohol, sleep medication
weight loss
lateral sleep position
CPAP if over 15 episodes in one hour
surgery if all else fails: uvulopalatopharyngoplasty
Restrictive pulmonary disorder
limited expansion of the lungs
intrinsic: pneumonia, acute bronchitis)
extrinsic: chest trauma, obesity, kyphoscoliosis
Vascular (pulmonary) disorders
narrowing or occlusion of the pulmonary blood vessels (PE)
Obstructive pulmonary disorder
limited airflow on expiration
e.g. COPD
When are antivirals effective with seasonal flu
if started within 24 to 48 hours of symptoms
Risk factors of COVID
cardio, DM, HTN, Lung disease, CKD, obesity, smoking, cancer
Physical findings with COVID
tachypnea, tachycardia, respiratory distress, abnormal CN l, rales, rhonchi, wheezing
Acute bronchitis
acute inflammation of the bronchi and usually the trach
Clinical manifestations of acute bronchitis
painful cough, sputum production, low-grade fever, malaise, rhonchi, wheeze
Acute bronchitis can progress to
pneu
Pneumonia
acute inflammation of the lung tissue
most common cause of death in US
Prevention of pneu
PCV 13, PPSV 23, flu vaccine
Patho of pneu
inflammatory response, alveoli fill with fluid (consolidation) and/or increased production of mucus (obstruction), decreased gas exchange, resolution of infection
Types of pneu
community acquired
hospital acquired
ventilator associated (over 48 hours on it)
What do we hear with pneumonia
tactile fremitus over these areas because fluid emphasizes vibration and ecophene
What are the guidelines for hospital acquired pneu
following 48 hours or more hospital stay
VAP
Pleural effusion vs empysema
Pleural: fluid in pleural space
Emphysema is fluid with pus in pleural space
W/ emphysema what can we do to test the fluid
a thoracentesis
COPD
disease state characterized by airflow obstruction resulting from chronic bronchitis or emphysema
COPD is commonly caused by
smoking
tissue damage is not reversible and increases in severity lead to respiratory failure
What are the two major changes that occur with emphysema
loss of lung elasticity and hyperinflation of the lung and use of accessory muscles
With emphysema air is
trapped due to loss of elastic recoil in the alveolar walls, overstretching and enlarging the alveoli into bullae
Drug therapy for COPD
beta adrenergic agents: bronchodilator prior to anticholinergic
choinergic antagonist
methylxanthines
corticosteroid (inhaled; IV for emergent)
muculytics
What is asthma
bronchial asthma is intermittent and reversible airflow obstruction affecting only the airways, not the alveoli
inflammation
airway hyperresponsiveness
Which nurse assessment finding during an acute asthma attack requires immediate interventions
diminished breath sounds
What is status asthmaticus
severe, life threatening, acute episode of airway obstruction
intensifies once it begins and does not respond to common therapy
TB is
highly contagious cause by mycobacterium TB transmitted via aerosolization
What are signs of TB
low grade fever, hemoptysis, weight loss, night sweats
Later with TB what do we see
elevated liver enzymes, RUQ pain, dyspnea, chest pain
If the TB test is over 5mm induration what is the possible cause
HIV
people who had contact w/ a person with TB
people with fibrotic lesion on chest x ray consistent with TB
organ tranplants
immunosupressant
If the TB test is over 10 mm induration what is the cause
recent immigrants
IV drug users
Residence and employees of high risk settings
people w/ clinical conditions
mycobacteriology lab personnel
If the TB test is over 15 mm induration what is the cause
all other people who are at low risk
Latent TB meds
6 to 9 months of INH and Vitamin B6
Active TB meds
INH + RIF + PZA + ETM + Vitamin B6 x 2 months
INH + RIF + vitamin B6 x 4 months
Negative sputum culture = ______ TB
no longer TB infection
Rifampin can turn
urine, saliva or tears orange so avoid contact use
make patients sensitive to the sun
decrease birth control
decrease methadone levels
What isolation is TB
airborne
Both lungs connect to the _______ through the vessels and bronchus
mediastinum
Who do we breathe: inspiration
CNS stimulates diaphragm to contract and descend
external intercostals contract and raise ribs
volume of chest cavity increases
pull them outwards
negative pressure increases
air flows in
How do we breathe: expiration
respiratory muscles relax
chest wall and diaphragm return to normal position
volume of chest decreases
pressure increases
air flows out of the lungs
what is flail chest
Flail chest is a life-threatening medical condition that occurs when a segment of the rib cage breaks(usually 4 or more in 2 or more locations) due to trauma and becomes detached from the rest of the chest wall. Two of the symptoms of flail chest are chest pain and shortness of breath
Management of flail chest
supplemental O2, pain contro, respiratory care
Pneumothorax causes
surgery
trauma
line placement
air enters the lung and moves through the visceral pleura to the pleural space
makes the pressure more positive
Open pneumothorax
opening in the chest wall allows outside air to enter through the chest and parietal pleura into the pleural space
Hemothorax
blood or serosanguineous fluid collects in the pleural space instead of air
Hemopneumothorax
air and blood
Tension pneumothorax
more serious than simple
air leaks in and becomes trapped so volume of air continues to build
can cause a mediastinal shift
compression of heart and great vessels
Chest tube sizes
small for air
large for blood/fluid
Placement of chest tube
air rises so high on chest for pneumothorax and blood settles so low on chest for hemothorax
Collection chamber
collects drainage
allows for monitoring of the volume, rate, and nature of drainage
holds up to 2500 cc
Collection chamber: blood drainage should be monitored for
clots –> notify HCP if they are seen
stripping a collection tube
a technique used to remove clots or debris from the tube by squeezing and moving it in a way that pushes the contents toward the drainage chamber
do not routinely strip the tube as stripping can create high negative pressure, causing discomfort and tissue damage
Water seal chamber
used as a seal or a one way valve to allow air or fluid to drain from the patient’s chest but not return
What do we monitor for with water seal chamber
bubbling, tidaling, negative pressure
bubbling may be present after initial insertion when patient has an air leak into the pleural space
What is true about bubbling in a water seal chamber
in large amounts it can indicate a large air leak
should stop once lung is re inflated
if excessive rule out a leak in drainage system
check all connection sites and notify MD
What is tidaling
fluctuation in the fluid level of the water seal chamber
reflects changes in pressure in the pleural space
normally will fluctuate 5 to 10 cm, the column of water will go up with inspiration and down with expiration
Suction control chamber
suction will increase the drainage rate and help re expand the lungs
dry system the suction is controlled by a dial
wet system it is controlled by water
Chest tubes should be _______ below a patients chest
1 foot
What do we do if a chest tube becomes dislodged
place a gauze with tape on three sides, leave lower part untaped
either case, notify HCP and prepare x ray
When do we change dressings for chest tubes
every 48 hours
do not remove Dsg for 24 hours post insertion
use petroleum gauze
