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Exam 7 > Nursing Care of Upper Respiratory Tract Disorders > Flashcards

Nursing Care of Upper Respiratory Tract Disorders Flashcards

1
Q

Disorders of the nose/sinuses

A 
Epistaxis
Deviated septum/nasal polyps
Allergic rhinitis/ Hay fever
Obstructive sleep apnea
Upper airway obstruction
Cancer of the larynx
Acute follicular tonsilitis
Acute rhinitis
Laryngitis
Pharyngitis
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2
Q

Epistaxis

A

Bleeding from the nose (anterior, posterior)
Congestion of the nasal membranes leading to capilarry rupture
Bright red bleeding from one or both nostrils
Can lose as much as 1L/hr of blood
From dry, cracked mucous membranes
Trauma, forceful nose-blowing, and picking (EWW!)

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3
Q

Epistaxis is dangerous to who?

A

People with a decreased/inability to clot

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4
Q

Diagnostic tests for epistaxis

A

H+H
PT & PTT
INR
May need PRBCs (in extreme cases)

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5
Q

Medical interventions for epistaxis

A

Nasal packing with gauze saturated with epinephrine
Electric cautery
Chemical cautery- silver nitrate
Posterior packing- balloon tamponade
Antibiotics
Strings brought out through the outh and taped to face (2-4 days)
Petrolieum jelly helps keep packing from sticking to nose

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6
Q

NIs for epistaxis

A

Monitor VS
Keep client quiet
Maintain sitting position, leaning forwards
If in bed, keep head/shoulders elevated
Pinch entire soft lower portion of the nose for 5-10 minutes
Determine home medications = why? (ASA, NSAIDS, Coumadin)
Ice packs = vasoconstriction
Afrin = promotes vasoconstriction
Partially insert small gauze and apply digital pressure if needed
Monitor for S&S of hypovolemic shock
Swallowing may indicate bleeding***
Avoid increased pressure to nose

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7
Q

Client teaching for epistaxis

A 
Do not pick or irritate nose
Do not blow nose forcefully/vigorously
Avoid dryness of nose (use vaporizer, NSS, or nasal lubricants)
No putting foreign objects in the nose
MD to remove packing
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8
Q

Nasal polyps

A

Tissue growths usually due to prolonged inflammation

Asthma, nasal polyps, and ASA allergy ~ Aspirin triad asthma

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9
Q

Therapeutic measures for nasal polyps

A

Nasal corticosteroids
Oral antihistamines
Polypectomy

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10
Q

Deviated septum

A

Congenital abnormality
Injury
Nasal septum deviates from the midline and can cause a partial obstruction

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11
Q

S&S of deviated septum

A 
Stuffy nose
H/A
Inflamed sinuses
Stertorous respirations- a struggling respiratory effort producing a snoring sound
Possible postnasal drip
Dysphagia
Dyspnea
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12
Q

Medications for deviated septum

A

Steroids
Antihistamines
Antibiotics

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13
Q

Surgical correction for deviated septum

A

Naso-septoplasty

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14
Q

Nasal surgery

A

Polypectomy
Naso-septoplasty
Rhinoplasty

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15
Q

Nasal surgery teaching- 7

A

Instruct client may feel stuffy and drain
Drink fluids
Cool mist vaporizer
Head elevated on 2 pillows or semi-fowlers
Ice packs
Pain meds
Call if complications

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16
Q

Naso-septoplasty post op care

A 
Watch for excessive swallowing (sign of bleeding)
Stool softeners
Antibiotics
Semi-fowlers
Ice packs
Call MD if fever or excess pain
Return in 24-48 hours
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17
Q

Acute sinusitis

A

Inflammation of the mucosa of one or more sinuses

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18
Q

Potential causes of sinusitis

A 
Allergies
Nasal polyps
Fungal infections
Intubation
NG tubes
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19
Q

Diagnostic tests for sinusitis

A 
X-ray
Nasal endoscopy
CT
MRI
Culture + sensitivity
Transillumination- shine a light into the mouth with the lips closed aroung the light. Sinus infection will show up as a dark area (HOW COOL!)
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20
Q

Complications of sinusitis

A 
Osteomyelitis
Cellulites of the orbit
Abscess
Meningitis
May trigger asthma
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21
Q

Therapeutic measures for sinusitis

A 
Promote sinus drainage
Nasal irrigation with NSS
Hot packs
Antibiotics
Corticosteroids (Flonase + Afrin)
Pain relief (tylenol, ibuprofen, opioids)
Caldwell-Luc procedure
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22
Q

Nursing care

A 
Increased H2O intake
Moisture in air
Semi-fowlers
Hot packs
Pain meds
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23
Q

Chronic sinusitis

A

Symptoms have existed for >2 months and are unresponsive to treatment
Might be bacterial infection following viral infection (Strep or H. influnzae.)

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24
Q

In chronic sinusits, which sinuses are commonly affected?

A

Maxillary

Ethmoid

25
Q

Pathophysiology of rhinitis, hay fever, & common cold

A

Inflammation of the mucous membranes
Result of antigen-antibody reactions
Seasonal
Ciliary action slows, mucosal secretions increase, and because of increased capillary permiability and vasodilation, local tissue edema occurs

26
Q

S&S of rhinits, hay fever, & common cold

A 
Nasal congestion
Itching
Sneezing
Sore throat
Nasal discharge
27
Q

Diagnostic tests for rhinits

A

Skin testing
IgE antibodies can be tetes
Examination of the mucosa of the turbinates is usually pale bc of venous engorgement which is in contrast to the erythema of viral rhinits

28
Q

Therapeutic measures of rhinits

A 
Control symptoms
Tylenol for discomfort
Rest
Fluids
Adrenergic nasal spray- (constrict capillaries, teach for "rebound")
29
Q

S*S of rebound congestion

A

Long-term redness and swellling inside nose

Increased runny nose

30
Q

Teaching for rhinits

A 
Avoid allergens
Self-care management through S&S control
Meds teaching (action, dose, SE)
Assess for med effectiveness
Reinforce no need for antibiotics if viral
31
Q

Pharyngitis

A

Inflammation of the throat often r/t cold

32
Q

S&S of pharyngitis

A

Dry cough
Enlarged lymph nodes
Tender tonsils

33
Q

You have pharyngitis, what do you do?

A

Get throat cultures
Adequate fluids
Avoid inhaled irritants

34
Q

When should S&S of pharyngitis resolve?

A

4-6 days

35
Q

Medical management for pharyngitis

A 
If viral- no specific treatment
If bacterial- usually give:
EES or levoflaxin
Analgesics
Antipyretics
Antitussives to relieve cough
Throat lozenges
36
Q

NIs/Teaching for pharyngitis

A

Provide steam inhalaton
Offer meds as ordered
Encourage cessation of smoking
Instruct to rest voice

37
Q

Acute laryngitis

A

acute infection of the mucosal lining of the larynx (voice box)
Usually secondary to other infections
Can come from trauma
Viral or bacterial infection (strep)

38
Q

Why is acute laryngitis tough in children?

A

Small larynx

39
Q

Acute laryngitis is precipitated by?

A

Overuse of voice

40
Q

S&S of acute laryngitis

A

Hoarsenes- Most common
Cough
Dysphagia
Fever

41
Q

S&S of chronic laryngitis

A

Hoarseness
Voice loss
Scratchy throat
Persistent cough

42
Q

Chronic laryngitis

A

Inflammation of the laryngeal mucosa or edematous vocal cords

43
Q

Acute follicular tonsillitis

A

Acute inflammation of the tonsils

44
Q

Acute follicular tonsilitis can be a result of

A

Airborne of food borne bacterial infection

Can be viral

45
Q

Acute follicular tonsilitis sequelae

A

Rheumatic fever
Carditis
Nephritis

46
Q

S&S of acute follicular tonsilits

A 
Enlarged, tender lymph nodes
Fever
Chills
Muscle aches
Malaise
Myalgia
47
Q

Diagnositc tests for acute folicular tonsilitis

A

Culture and sensitivity
Elevated WBC- 10000-20000/mm3
Throat cultures

48
Q

Medical management of acute folicular tonsilitis

A 
Antibiotics- specific to organism
Somtimes T+A
Analgesics
Antipyretics
Warm saline gargles
49
Q

NIs for acute folicular tonsilitis

A

Good oral care
Warm saline gargles
Ice chips

50
Q

Tonsillectomies & Children

A

Should be >3
Use age-appropriate language
Not done during acute infection
Observe for evidence of bleeding

51
Q

S&S of bleeding

A

Increased P, RR
Restlessness
Frequent swallowing!!**

52
Q

T&A post-op child

A 
Keep quiet
Don't let cough, clear their throats, blow their noses
Try to avoid crying
Clear liquids
Hemorrhage can occur
Tylenol for pain
53
Q

New guideline for removing tonsils

A

Kids must have:
At least 7 episodes of throat infection (tonsilitis, strep)
OR
at least 5 episodes each year for 2 years
OR
3 episodes annually for 3 years
Before they are candidates
**Throat infection must be documented by MD, not just reported by parent

54
Q

Upper airway obstruction

A 
Precipitated by recent viral event (such as trauma to airways)
Dentures
Aspiration of vomitus or secretions
Tongue
Laryngeal spasm
Laryngeal edema
55
Q

Medical management of upper airway obstruction

A 
Choking- inability to breathe/speak
Heimlich 
Laryngeal spasm
Suctioning
Ambu
Mechanical ventilation
56
Q

Obstructive sleep apnea

A

Patial or complete obstruction during sleep
Apnea or hypopnea
Lasts 15-90 secs
Apnea and arousal cycles occur repeatedly often as 200-400X during 6-8 hours of sleep

57
Q

Medical management of sleep apnea

A

Avoid sedatives and ETOH for 3-4 hours before bed
Weight loss program referral
Oral appliance that brings mandible and tongue forward
Support group
BiPAP- higher pressure during inspiration
CPAP
Surgery

58
Q

Sleep apnea affects what percent of the population

A

2-10%

59
Q

Sleep apnea largely affects the _____

A

Obese

Exam 7 (6 decks)

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