Fund 51 - Ch 18 Flashcards
URI - most common cause viral or bacterial?
URI is often defined as an infection of the mucous membranes of the nose, sinuses, pharynx, upper trachea, or larynx. Virus is the most common cause. can be acute or chronic.
Allergic rhinitis is further classified as
seasonal or perennial rhinitis a
Drug-induced rhinitis (Ace ventra and beta have rhinitis)
may occur with antihypertensive agents, such as angiotensin-converting enzyme (ACE) inhibitors and beta-blockers; “statins,” such as atorvastatin and simvastatin; antidepressants and antipsychotics such as risperidone; aspirin; and some antianxiety medications
vasometer - cause of rhinosinutisis
idoiopathic, abuse of nasal decongestants
mechanical - - cause of rhinosinutisis (mechanical tumor)
tumor, deviated septum, crusting
chronic inflammatory - - cause of rhinosinutisis (just 2, think of Tu)
polyps, sarcoidosis (rare condition that causes small patches of swollen tissue, called granulomas)
infectious - - cause of rhinosinutisis
viral
hormonal - - cause of rhinosinutisis
pregnancy, use of oral contraceptives, hypothyroidism
Cromolyn (chrome mast)
inhibits release of histamine. a mast cell stabilizer for rhinitis
nasal spray use
keep head upright, spray quickly wait 1 min before second spray
common cold (the cold is self-limited)
URI that is self-limited and caused by a virus.
colds are highly contagious because
virus is shed for about 2 days before the symptoms appear and during the first part of the symptomatic phase
viral rhinitis lasts (think about your viruses)
1 to 2 weeks
overuse of topical nasal decongestants can cuase
rhinitis medicamentosa = rebound rhinitis
rhinosinitus (pair of sinuses)
inflammation of paranasal sinuses and nasal cavity
Rhinosinusitis is classified by duration of symptoms (Jimmy is a rhino)
as acute (less than 4 weeks), subacute (4 to 12 weeks), and chronic (more than 12 weeks).
Recurrent acute rhinosinusitis (4 is a cute rhino number)
is characterized by four or more acute episodes of ABRS per year
Although antibiotics kill bacteria in the biofilm margin,
cells deep in the biofilm are not affected, allowing for regrowth
Symptoms of ABRS (acute bacterial rhinosinitus) include (think bacteria..and it’s full)
purulent nasal drainage (anterior, posterior, or both) accompanied by nasal obstruction or a combination of facial pain, pressure, or a sense of fullness
The symptoms of AVRS are similar to those of ABRS, except (a virus fever)
the patient does not present with a high fever, nor with the same intensity of symptoms (e.g., there tends to be an absence of facial pain–pressure–fullness), nor with symptoms that persist for as long a period of time
ARBS duration (10 arbors)
10 or more days
untreated rhinosinitis can lead to
osteomyelitis and mucocele (cyst of the paranasal sinuses).
ARBS treatment
antibotics
AVRS treatment - virus gets the lavage
saline lavage and decongestant. Dont use topical decongestants longer than 3 to 4 days.
intranasal steroids - only use with which patients?
help both bacterial adn viral rhinosinisuitis, but should only be used with pts who have a history of allergic rhinosinitius
nurse management rhinosininutis - and when can’t you use meds?
start decongestants like ephedrine at first sign of symptoms. check if pt has hypertension - can’t use.
nuchal rigiditiy
stiff neck, sign of meninegitis
reoccuring rhinosinusitis (reoccuring is like cute, 4)
when 4 or more episodes of ABRS occur within a year and no signs of it between episodes.
CRS (chronic recurring rhinosinositis) cause (a chronic problem is just mechanical)
mechanical obstruction of frontal and maxillary ethmoid - obstruction prevents drainage
Clinical manifestations of CRS include
impaired mucociliary clearance and ventilation, cough (because the thick discharge constantly drips backward into the nasopharynx), chronic hoarseness, chronic headaches
CRS assessment
nasal mucous membranes are assessed for erythema, pallor, atrophy, edema, crusting, discharge, polyps, erosions, and septal perforations or deviations. teeth pain, eyes, pharnyx
Ethmoid rhinosinusitis
orbital cellulitis, which usually begins with edema of the eyelids and rapidly progresses to ptosis (droopy eyelid), proptosis (bulging eye), chemosis (edema of the bulbar conjunctiva), and diminished extraocular movements.
CRS management
hydration, saline sprays, NSAIDs, decongestants. elevated HOB during sleep. avoid caffeine and alcohol.
CRS surgery - FESS
excising and cauterizing nasal polyps, correcting a deviated septum, incising and draining the sinuses, aerating the sinuses, and removing tumors
Acute pharyngitis
Acute pharyngitis is a sudden painful inflammation of the pharynx = sore throat
Acute pharyngitis - viral or bacterial? (pharrell is a virus)
mostly viral. includes tongue and tonsils. can be from dry heat.
strep (GAS) - how long after exposure do get symptoms? (strep fast, I’m dying)
can turn into scarlet fever, sore throat starts 1 to 5 days after exposure. fever without chills, malaise. usually give penicillin. group A strep. IV penicillin can be every 4 hrs. warm saline or heat or ice.
pharnygitis nursing practices (pharrell needs liquid and watch out for ruby)
stay in bed, 2 - 3L of liquid, check for rash, may proceed rubella,
illness that has familial ties (families PAAP)
Asthma is a respiratory illness that has genetic factors. Sleep apnea, asthma, pneumonia, and pulmonary edema
oxygen toxicity symptoms - (O2 is toxic and I can breathe in the subway)
Dyspnea and substernal pain
mechanical ventilation - how often to monitor cuff pressure? (one cuff in my shift)
monitor cuff pressure every 8 hours
saline gargles temp (saline is hot 40s)
40.6 to 43.3 C
Chronic pharyngitis
Chronic pharyngitis is a persistent inflammation of the pharynx. It is common in adults who work in dusty surroundings, use their voice to excess, suffer from chronic cough, or habitually use alcohol and tobacco.
3 types of chronic pharynrgitis
Hypertrophic—characterized by general thickening and congestion of the pharyngeal mucous membrane
Atrophic—probably a late stage of the first type (the membrane is thin, whitish, glistening, and at times wrinkled)
Chronic granular—characterized by numerous swollen lymph follicles on the pharyngeal wall
chronic pharyngitis feels like (pharrell has a full throat)
constant sense of irritation or fullness in the throat, mucus that collects in the throat and can be expelled by coughing, and difficulty swallowing
tonsilitis (tonsils by the ears)
sore throat, fever, snoring, and difficulty swallowing. Enlarged adenoids may cause mouth breathing, earache, draining ears, frequent head colds, ear drum can explode, deafness
tonsilitis treatment
rest, fluid, salt water, bacterial - antibiotics, viral - nothing. tonsilectomy
post op tonsilectomy -most comfortable position post op (Kristian lying down)
risk of hemmorage so constant monitoring. MOST comfortable position is prone, head turned to side to allow drainage from mouth and pharnyx. ice collar. provide a basin and tissues.
post op tonsilectomy when to remove oral airway?
when gag and swallow reflexes have returned
tonsilectomy - symptoms post op
Symptoms of postoperative complications include fever, throat pain, ear pain, and bleeding (bright red if not swalloed, if swallowed becomes brown)
post op tonsilectomy - If the patient vomits large amounts of dark blood
If the patient vomits large amounts of dark blood or bright-red blood at frequent intervals, or if the pulse rate and temperature rise and the patient is restless, the nurse notifies the surgeon immediately
tonsilectomy or adenioidectomy - bleeding can occur up to (Kristian was 8)
8 days after surgery
tonsilectomy or adenioidectomy aftercare (Kristian gets alkaline)
Alkaline mouthwashes and warm saline solutions are useful in coping with the thick mucus and halitosis that may be present after surgery.
peritonsillar abscess
purulent btwn tonsil and surrounding tissue. can cause edema and airway obstruction. infection can spread. It is an acute illness. rancid breath.
peritonsillar abscess medical management -what antibiotic?
Antimicrobial agents and corticosteroid therapy are used for the treatment of peritonsillar abscess, usually penicillin
peritonsillar abscess needle aspiration body position
performed best with the patient in the sitting position to make it easier to expectorate the pus and blood that accumulate in the pharynx. head back with neck slightly extended.
peritonsillar abscess nursing management (cool the abcess)
cool saline gargle 40.6 - 43.3 C. pt upright. liquids at room temp. push fluids.
laryngitis - cause and when is it better or worse? (laryngitis from a virus in the warm sun)
can occur as a result of voice abuse, exposure to dust, chemicals, smoke and other pollutants; or as part of a URI. most common cause is a virus. aphonia (loss of voice) worse in am and better in warmer climate
laryngitis medical management (larngitis is cool too)
rest voice, inhale cool steam. steroids if chronic. proton pump inhibitors 1x daily for reflux larngitis.
laryngitis medical management
rest voice, inhale cool steam. steroids if chronic. proton pump inhibitors 1x daily for reflux larngitis. push fluids 2-3L.
laryngitis symptoms last (singing 10 days after meds)
a week to 10 days after finishing antibiotic therapy.
laryngitis assessment (singer is boggy and blue)
cause, swallowing, pain relief, nasal mucus, turbinates may be swollen (boggy) and pale bluish-gray. palpate maxillary and frontal, enlarged tonsils.
laryngitis complications
sepsis, meningitis, peritonsillar abscess
laryngitis nursing management
keep airway clear, increase fluids, room vaporizer, positioning,
OSA (obstructive sleep apnea)
recurrent episodes of upper airway obstruction and a reduction in ventilation. often found in adults with hypertension.
OSA pathology (OSA has negative pressure, negative image)
pharnyx is collapsable, muscle reduced during sleep, collpase may be caused by negative pressure during inspiration.
repetetive apnea causes hypoxia and
hypercapnia, which triggers sympathetic response. this inceases rates of hypertension
OSA definition
OSA is characterized by frequent and loud snoring with breathing cessation for 10 seconds or longer, for at least five episodes per hour, followed by awakening abruptly with a loud snort as the blood oxygen level drops
3S of sleep apnea
snoring, sleepiness, and significant-other report of sleep apnea episodes.
polycythemia - what disorder? (poly gets chubby)
high RBCS (sleep apnea)
MAD device - sleep apnea (mandible is MAD)
advances the mandible so that it is slightly anterior to the upper front teeth, preventing airway obstruction by the tongue and soft tissue during sleep
OSA medication
modafinil (wakefulness drug)
epistaxis
hemorrage from the nose. head forward. pinch soft outer part of nose against midline septum for 5 to 10 min continuously. Visible bleeding sites may be cauterized with silver nitrate or electrocautery. tampon (lubricated) catheter - leave in for 3 -4 days if necessary. phenylephrine spray (acts as a vasoconstrictor)
epistaxis nursing management - how long to apply pressure? (broken nose in 15)
ABCs. vital signs. don’t blow nose to hard. avoid exercise for several days, avoid hot or spicy foods, tobacco use by smoking, avoiding forceful nose blowing, straining, high altitudes, and nasal trauma. apply pressure for 15 min.
nasal obstruction treatment - how long to use meds? (that obstruction reconstruction took several months)
. Treatment with nasal corticosteroids for 1 to 3 months. If surgery is needed, elevate HOB, oral hygiene,
nasal fracture
Because of the swelling and bleeding that occur with a nasal fracture, an accurate diagnosis can be made only after the swelling subsides
nasal fracture clear fluids
Clear fluid draining from either nostril suggests a fracture of the cribriform plate with leakage of cerebrospinal fluid
nasal fracture management - how long to avoid sports?
cold compress, maintain airway and consider cervical spine fracture, uncomplicated can use antibiotics, analgesic agents, and a decongestant nasal spray. keep head eleveated. avoid sport for 6 weeks.
nasal fracture - improved outcomes are obtained when (fracture is your fav number)
reduction in the fracture is performed during the first 3 hours after the injury, this is often not possible because of the edema. if not, within 3 to 7 days.
swelling of larynx - cause
dos not stretch - may close off the opening tightly, leading to life-threatening hypoxia or suffocation. can be hereditary.
obstruction larynx - treatment (ice the lynx)
lowered oxygen saturation; however, normal oxygen saturation should not be interpreted as a sign that the obstruction is not significant. The use of accessory muscle during inspirations. Patients who demonstrate these symptoms are at an immediate risk of collapse, and respiratory support. use ice on neck and pulse oximeter.
larynx cancer - symptoms - liquids when…
smoking, hereditary. vitamin deficiency. surface epithelium and are classified as squamous cell carcinoma. Hoarseness of more than 2 weeks’ duration, The voice may sound harsh, raspy, and lower in pitch. persistent cough or sore throat and pain and burning in the throat, especially when consuming hot liquids or citrus juices. A lump may be felt in the neck.
late symptoms of larnyx cancer (late cancer is hoarse and smells bad)
dysphagia, dyspnea (difficulty breathing), unilateral nasal obstruction or discharge, persistent hoarseness more than 2 weeks, persistent ulceration, and foul breath. CT and MRI used. radiation can cause vocal cords to become immobile.
middle lobe of lung - location (middle child is 4th)
anterior surface on right side between 4th and 5th rib.
alveolar effectiveness is measured how?
by PaCO2
esophageal speech
The patient needs the ability to compress air into the esophagus and expel it. starts 1 week after surgery. pt learns to belch and does 1 hr after eating. tranforms into speech. low success rate.
laryngecotmy nursing assessement
health history, hoarseness, sore throat, dyspnea, dysphagia, and pain or burning in the throat. head and neck inspection. nutrition.
albumin
keeps fluids from leaking into tissues
after laryngecotmy -when is drain removed? and what is normal? (Larry’s draining me at 30 and 2)
encourage pt to turn, cough and take deep breaths. suctioning if necessary. early ambulation. when drainage is less than 30/ml a day for 2 consecutive days, drain is removed. brassy sounding cough is normal and will subside.
tracheostomy home care
can’t get water in when showering - Wearing a loose-fitting plastic bib over the tracheostomy or simply holding a hand over the opening is effective. use humidifier. can’t swim. caution hairdresser about loose hairs. hand hygiene. no strenous exercise. brush teeth several times a day.
ectesis (ectoplasm is dilated)
dilation
bronchiectasis (bronchs needs collagen)
causes chronic inflammation which damages airways, elastin is destroyed and collagen is deposited. this makes lungs stiff, have large airways and get plugged with mucus.
rhinosinutisis causes (the rhino is ace ventura and beta)
humidity, decongestants, aging, food allergies, colds. drugs. ace-inhibitors and beta blockers, statins, and respiradone. oral contraceptive.
rhinosinutisis causes
humidity, decongestants, aging, food allergies, colds. drugs. ace-inhibitors and beta blockers, statins, and respiradone. oral contraceptive.
URI complications
Airway obstruction
Hemorrhage
Sepsis
Meningitis or brain abscess
Nuchal rigidity- ridged neck
Medicamentosa-concerning drugs
Acute otitis media
Trismus- tonic contraction of muscles of mastication
Dysphagia
Aphonia
Cellulitis
