NUR 240 E3 ch 18 upper resp Flashcards
most common cause for illness, reason for seeking care, missing work
Upper respiratory infections (URIs)
Treatment of URI and duration
usually treated at home
usually last 3-5 days, if it last longer it could be something like sinusitis
common cold
Viral rhinitis
acute inflammation of the nasal cavity that is typically self-limiting with nasal congestion, rhinorrhea, sneezing, sore throat, and general malaise.
rhinitis, pharyngitis and laryngitis- distinguish sites of the symptoms
Epistaxis
hemorrhage from the nose (most common site- anterior septum- very thin and vascular)
can be caused by aspirin or changes in atmospheric pressure
medical management of epistaxis
pinch soft portion of nose for five mins, sit upright
phenylephrine spray, vasoconstriction
avoid nasal trauma, picking, forceful blowing, spicy foods (vasodilation), tobacco, and exercise (vasodilation)
Rhinitis and Rhinosinuitis presents as
congestion, runny nose, itchy nose, mouth/throat itching
Rhinitis
inflammation and irritation of the mucous membranes of the nose
can be acute or chronic
most common cause is the common cold
rhinorrhea
excessive nasal drainage, runny rose
signs and symptoms of rhinitis
rhinorrhea, nasal congestion , nasal discharge, sneezing, and pruritus of the nose, roof of mouth, throat, eyes, and ears
most common treatment for sneezing, pruritus, and rhinorhhea
Antihistamines
Medical treatments for allergic and nonallergic rhinitis
antihistamines, nasal sprays, decongestant, intranasal corticosteroids
how to use nasal medications
blow the nose before applying any medication into the nasal cavity.
keep the head upright; spray quickly and firmly into each nostril away from the nasal septum wait at least 1 minute before administering the second spray.
most contagious time of VIRAL rhinitis (common cold)
highly contagious 2 days before the symptoms appear and during the first part of the symptomatic phase
fall and spring
common symptoms of VIRAL rhinitis
low-grade fever,
nasal congestion,
rhinorhhea,
nasal discharge
halitosis
sneezing
tearing/watery eyes
“scratchy” or sore throat
general malaise
chills
headache
muscle aches
viral rhinitis may exacerbate
herpes simplex
viral rhinitis duration
often last 1-2 weeks
Rhinitis medicamentosa (rebound rhinitis)
caused by an overuse of topical nasal decongestants
most effect way to prevent viral rhinitis
WASH HANDS
and use tissues to prevent spread of virus
cough into upper arm
Rhinosinusitis (sinusitis)
what is it
duration
caused by
inflammation of the paranasal sinuses and nasal cavity
acute (less than 4 weeks), subacute (4 to 12 weeks), and chronic (more than 12 weeks)
caused by bacterial or viral infections
Acute rhinosinusitis is classified as acute bacterial rhinosinusitis (ABRS)(MOST ARE BACTERIAL) or acute viral rhinosinusitis (AVRS)
chronic rhinosinusitis- four or more acute episodes of ABRS per year
difference between the symptoms of ABRS and AVRS
ABRS: nasal drainage, nasal obstruction, facial pain, pressure or a sense of fullness, high fever
- occurrence of symptoms for 10 days or MORE after the initial onset of upper respiratory symptoms indicates ABRS
AVRS: similar to those of ABRS but no fever, and not the same intensity (tends to be an absence of facial pain),
- shorter duration
- symptoms of AVRS occur FEWER than 10 days after the onset of the URI and do not worsen
treatment of acute rhinosinusitis
for bacterial: 14 day course antibiotic (most common= Amoxicillin),
for patients allergic to penicillins: doxycycline or respiratory quinolones (levofloxacin or moxifloxacin) can be prescribed
ABRS adjunctive treatments with antibiotics
okay: nasal lavage- reduces inflammation
not okay: decongestants and antihistamines
treatment of AVRS
typically nasal lavage and decongestants (guaifenesin/pseudoephedrine)
decongestants or nasal saline sprays increases the…
increases the potency of the ostiomeatal unit and improve drainage
oral decongestants should be used cautiously in ____ patients
hypertensive
topical decongestants shouldn’t be used for more than
3-4 days
Patients with nasotracheal and nasogastric tubes in place are at the risk for development of sinus infections
chronic rhinosinusitis (CRS) duration for diagnosis
CRS is accompanied by nasal polyps
last for at least 12 weeks
nuchal rigidity
stiffness of the neck or inability to bend the neck
symptom of meningitis along with fever, and severe headache
medical management of CRS
adequate hydration
OTC nasal saline spray
NSAIDs or acetaminophen
decongestants -pseudoephedrine
surgical management of CRS
excising and cauterizing nasal polyps, correcting a deviated septum, incising and draining the sinuses, aerating the sinuses, and removing tumors.
Computer-assisted or computer-guided surgery is used to increase the precision of the surgical procedure and to minimize complications
first line treatment for acute invasive fungal rhinosinsusitis
surgery - it requires debridement
Acute Pharyngitis
sudden painful inflammation of the pharynx (includes the posterior third of the tongue, soft palate, and tonsils)
commonly referred to as sore throat
droplet precautions
winter and early spring
viral
Group A streptococcus causes (bacterial)
acute pharyngitis (strep throat)
pain, fever, vasodilation, edema, and tissue damage. redness and swelling in tonsils, uvula, soft palate - a creamy white exudate may be present
viral pharyngitis duration
3 to 10 days
signs and symptoms of acute pharyngitis
fiery-red pharyngeal membrane and tonsils, lymphoid follicles that are swollen and flecked with white-purple exudate, enlarged and tender cervical lymph nodes, and no cough. Fever (higher than 38.3°C [101°F]) and malaise
test for pharyngitis
rapid antigen detection test
pharyngitis is treated with (med and no meds)
antibiotics
10 day course
in hospital: check hydration, offer ice chips, warm liquids or popsicles— reduction in swelling, lozenges, warm salt water gargle
pharyngitis if left untreated can cause
sepsis (infection can enter your blood), meningitis, and pneumonia
complications of URIS
Airway obstruction
● Hemorrhage
● Sepsis
● Meningitis or brain
abscess
● Nuchal rigidity
Medicamentosa
● Acute otitis media***
● Trismus- lockjaw
● Dysphagia
● Aphonia- unable to speak
● Cellulitis
a patient with pharyngitis should avoid
vape, electronic nicotine device
second hand smoke
(Assessment) Signs and symptoms of URI & info to obtain
headache, cough, hoarseness, fever, stuffiness, generalized discomfort and fatigue
health history- ALLERGIES
inspect- nose neck throat and palpate lymph nodes
Nursing diagnosis for URI
activity intolerance
ineffective airway clearance
ineffective airway clearance
pain
anxiety always consider
impaired comfort
laryngitis - impaired verbal communication
impaired swallowing
vital signs to watch for URI
temp and O2 stat
prevention of URI
HAND WASHING
annual influenza vaccine (esp. for elderly and very young)
tonsilitis symptoms
sore throat, fever, snoring, and difficulty swallowing
treatment of tonsillitis
increased fluid intake, antispasmodic agents, salt-water gargles, and rest.
Bacterial infections are treated with penicillin (first-line therapy) or cephalosporins.
Viral tonsillitis is not effectively treated with antibiotic therapy.
after tonsillectomy, patient is at risk for ___ which can compromise patient airway
hemorrhage
peritonsillar abscess
most common major suppurative complication of sore throat accounting for roughly 30% of soft tissue head and neck abscesses
severe throat throat, fever, trismus (lockjaw) and drooling
inflammation of the pterygoid muscle leads to spasm
medical management of peritonsillar abscess
antibiotics (usually amoxicillin) and corticosteroid therapy
laryngitis
inflammation of the larynx as a result of voice abuse, exposure to dust, chemicals, smoke, or as a part of a URI
most commonly- viral (caused by the same pathogen as pharyngitis and the common cold
acute laryngitis symptoms
hoarseness or aphonia (loss of voice) and severe cough
sudden onset worse in cold dry climate and improves in warmer climate
management of laryngitis
resting the voice, avoiding irritants (smoking), resting, inhaling cool steam or an aerosol
nursing education: rest the voice and maintain a well humidified environment, increase fluid intake
laryngectomy
results in permanent loss of voice, often have a trach after
low levels of albumin are associated with
laryngeal cancer
before laryngectomy…
make a communication plan before surgery
assess hearing as that affects communication
laryngeal cancers account for ____ of head and neck cancers
half
complications post laryngectomy
respiratory distress– hypoxia
hemorrhage- check for bleeding postop
infection- loss of protective structure
wound breakdown
aspiration
tracheostomal stenosis- narrowing of opening
nursing interventions post laryngectomy
COUGH and DEEP breathing
Preoperative teaching
● Reduce anxiety
● Maintain patent airway, control secretions
● Support alternative communication
● Promote adequate nutrition and hydration- NPO for a week post op (may have TPN)
● Promote positive body image, self-esteem
● Monitor for potential complications
● Self-care management; homecare
Which diagnostic test is used to confirm the diagnosis of maxillary and frontal sinusitis?
Sinus aspirates
CT scan
MRI
Sinus x-rays
Sinus aspirates
A client finished a course of antibiotics for laryngitis but continues to experience persistent hoarseness. Which symptom would cause the nurse to suspect laryngeal cancer?
a feeling of swelling at the back of the throat
weight loss
discomfort when drinking cold liquids
headaches in the morning
a feeling of swelling at the back of the throat
The nurse in the ICU is caring for a client with a nasotracheal tube. Because of the tube placement, the nurse understands that the client is at risk for developing
severe epistaxis.
subperiosteal abscess.
sinus infection.
orbital cellulitis.
sinus infection
A surgeon completes a total laryngectomy. Postoperatively, the nurse explains to the patient’s family that:
-One vocal cord was removed along with a portion of the larynx.
-The voice was spared and a tracheostomy would be in place until the airway was established.
-A permanent tracheal stoma would be necessary.
-A portion of the vocal cord was removed.
A permanent tracheal stoma would be necessary
A client has been diagnosed with acute rhinosinusitis caused by a bacterial organism. What antibiotic of choice for treatment of this disorder does the nurse anticipate educating the client about?
amoxicillin
Which diagnostic test is used to confirm the diagnosis of maxillary and frontal sinusitis?
Sinus aspirates
A nurse is caring for a client who has a history of sleep apnea. The client understands the disease process when he says:
“I should become involved in a weight loss program.”
After a tonsillectomy, a client is being prepared for discharge. The nurse should instruct the client to report which sign or symptom immediately?
bleeding
The nurse is providing discharge instructions to a client who has nasal packing in place following nasal surgery. Which discharge instructions would be most appropriate for the client?
Avoid sports activities for 6 weeks.
Decrease the amount of daily fluids.
Take aspirin for nasal discomfort.
Administer normal saline nasal drops as ordered.
Avoid sports activities for 6 weeks
