Respiratory Disorders Flashcards
Nasal Fracture Causes
facial trauma, fights, accidents, falls, sports
nasal fracture manifestations
epistaxis, swelling, difficulty breathing through nose, ecchymosis (raccoon eyes)
nasal fracture complications
difficulty breathing, septal deviation, septal hematoma, meningeal tears with CSF leak (clear fluid positive for glucose), diplopia
nasal fracture management
rhinoplasty, plastic implant to reshape nose, nasal packing (removed 1-2 days after), nasal septal splint to prevent internal scar tissue (removed after 1-2 weeks)
nasal fracture collaborative care
pre-op: No aspirin/NSAIDs for 5 days - 2 weeks, stop smoking
post-op: patent airway, monitor bleeds edema and infection
semi-fowlers, no blowing nose, ice forhead/nose in 10-20 minute intervals, humidifiers, AVOID HOT SHOWERS AND ALCOHOL
Anterior epistaxis
more common, occurs in children and young adults, nasal dryness
caused by: allergic rhinitis, street drug use, nasal spray abuse
Posterior epistaxis
usually in older population, high blood pressure and CVD most common cause, bleeding in posterior pharynx, more severe and treatment is more challenging
management of epistaxis
pinch airway and lean forward for 5-15 minutes, nasal packing (may cause hypoventilation and hypoxemia) using gauze or tampon w/ abx or vasoconstrictor for 48-72 hours, MEDICATE BEFORE REMOVAL
Avoid strenuous activity/straining for 4-6 weeks
rhinosinusitis
inflammation of sinus mucosa blocking secretions from exiting. caused by infection, allergies, pollutants, polyps.
Types include allergic rhinitis, viral rhinitis, and bacteria sinusitis
allergic rhinitis
allergen exposure (increased IgE), treat with antihistamines, decongestants, corticosteroids)
acute viral rhinitis
caused by coronavirus, enterovirus, HSRV
S&S: runny nose, congestion, watery eyes, sneezing, etc.
Treat: rest, rehydrate, saltwater gargles, saline nasal sprays, decongestants (no longer than 3 days)
Bacterial sinusitis
S. pneumoniae, H. influenzae, M. catarrhalis
S&S: sinus pain, fever, headache, pain leaning forward, halitosis (foul odor from mouth), purulent discharge
Treat: abx, analgesics, saline sprays, stop smoking, sleep with HOB elevated, nasal corticosteroids, warm compress to face
Laryngeal Trauma
D/t: trauma, fracture, prolonged endotracheal intubation
S&S: tachypnea, nasal flaring, SOB, restlessness, striddor, low O2 sat, altered LOC, Hemoptysis (coughing blood), aphonia
Visualize larynx via laryngoscopy to see extent of injury
Pre-op: NPO
Post-op: voice rest for 2/3 days
Manage?: based on situation, artificial airway, O2 with humidification, surgical repair
Airways obstructions
Complete or Partial
Cause: aspiration, allergic reactions, inflammation
S&S: stridor, choking, accessory muscle use, tachycardia, cyanosis. ALOC
Manage: establish airways ASAP, heimlich maneuver, ET tube, Trach,
Pneumonia
acute inflammation of parenchyma d/t virus, bacteria, fungus, or aspiration resulting in edema or exudate filling alveoli. Alveolar macrophages are most important defense mechanism.
Risk factors: Over 65, pollution, immobility, smoking, immunosuppressed, IV drug use, NGT feeds
Pneumonia S&S
fever, chills, malaise, cough (productive or non-productive, but productive more common), increased WBCs, wheezing, crackles, bronchial breath sounds in the periphery, increased fremitus, infiltrates/consolidation
Complications of pneumonia
pleurisy, pleural effusion ,atelectasis, acute respiratory failure, bacteremia, sepsis, empyema (pus in pleural space)
Community acquired PNA
S. pneumoniae, MRSA, Legionella pneumophila
LTC within 14 days of onset
Macrolide ABX and B-lactam antibiotics (10-14 days)
Hospital Acquired PNA
48 hours or longer after hospital admission w/o symptoms at time of admission
VAP 48 hours after ET intubation
Empiric ABX and later switch to defnitive therapy based of Sputum C/S,
Aspiration PNA
substances aspirated into trachea, hx of loss of consciousness, depressed gag or cough reflex, dysphagia, tube feedings (pt upright)
Opportunistic PNA
depressed immune, protein-calorie malnutrition, chemo, HIV infxn, long-term corticosteroid use
Fungal: P. jiroveci found in HIV pts or blood diseases
Viral: cytomegalovirus, immunocompromised esp after transfusion
Pneumonia diagnostics
Chest x-ray, ABG, sputum c/s, blood studies
Pneumonia care
rehydration, Antipyretics (max 4000mg tylenol) check liver function tests and renal function tests), O2 therapy, repositioning, cough and deep breath (IS!), vaccinations!!, oral care after inhalers
Pleural Effusion
abnormal collection of fluid in pleural space,
Transudative: non-inflammatory disease processes like heart failure, increased hydrostatic pressure, or decreased oncotic pressure (pale yellow liquid)
Exudative: increased capillary permeability d/t inflammation secondary to malgnancies/infections (pus-like)
Pleural Effusion management:
S&S: dyspnea, dereased chest wall movement on affected side, stabbing pain, absent breath sounds at bases
Treat cause, ABX to prevent infection, Thoracentesis, Sodium restriction, diuretics
Influenza
A is most common and virulent, transmitted via droplet,
S&S: high fever, chills, headache, fatigue, cough, sore throat, crackles
Complications: pneumonia, otitis media, sinus infection
Manage: vaccine! symtpom relief, meds like tamiflu, relenza or rapivab
Pulmonary Embolism
Clots in pulmonary arteries that obstructs perfusion, usually in lower lobes.
PE Risk factors
DVT, immobility, smoking, fractured long bones, a-fib
PE S&S
Dyspnea, chest pain, tachypnea, Change in LOC in older clientele, anxiety, sense of doom
PE Diagnosis
D-Dimer (protein released when clots break down), spiral CT, V/Q scan (used if patient can’t have contrast), ABGs
PE Care/Management
Prevention with SCD’s, ambulation, anticoagulants (Lovenox, Heparin, Warfarin/Coumadin), fibrinolytic agents (tPA), surgical removal, IVC filter, O2 therapy, elevate HOB
Pneumothorax
air in pleural space leading to partial or total collapse of the lung. usually caused by blunt or penetrating trauma
S&S: resp. distress, O2 desat, absent breath sounds over affected area, hemoptysis?, tachycardia, dyspnea, dull percussion, signs of shock
Care: chest tube to water seal drainage, surgery
Closed pneumothorax
no external wound: most common is spontaneous d/t rupture of bleb (smokers!!)
broken ribs, subclavian catheter insertion, excess pressure during mechanical ventilation)
Open pneumothorax
opening in chest wall d/t external injury
cover with vented dressing secured on THREE sides until treated by MD
DO NOT REMOVE OBJECT OF INJURY
Tension pneumothorax
open or closed wound
Rapid accumulation or air or blood resulting in compression of lung
Chylothorax
lymphatic fluid in pleural space
leak in thoracic duct
milky white, increased lipid content
Obstructive Sleep Apnea
- Breathing distubance during sleep where RR and depth isn’t enough for effective gas exchange
- Muscles get relaxed and structures get obstructed
- Risks: congential, obesity, short neck, smoking, large tonsils
- S&S: snoring heavily during sneep, daytime sleepiness, headaches in the morning, irritability
- Care: change sleep position, lose weight, noninvasive positive-pressure ventilation (NPPV) via CPAP
