Respiratory - Unit 3 - Problems of the upper respiratory tract Flashcards
What does the nose do to the air we breathe?
Warms air! So if it’s got a problem…
What do we assess for with the nose?
Asymmetry, lesions, inflammation, look inside nares
Swollen and red nose =
Swollen and pink nose =
Rudolph —
Just kidding. Swollen and RED = Cold
Swollen and PINK = allergies.
With the pharynx (back of throat and such) what are we looking for?
Color, symmetry, exudate, ulceration, enlargement, etc.
What are we looking for with the trachea?
Is it MIDLINE!!
What might we use nasal packing for?
Should we know how to remove it?
If someone has a nosebleed!
We should know how to remove it in case there is an emergency.
What are balloon catheters used for?
Nose bleeds!
What are mustache dressings used for?
Rhinoplasty, neuro OR - it’s tape under the nose.
What are some symptoms of a cold?
Nasal congestion, sore throat, cough, sneezing, malaise, fever/chills.
What is rhinitis?
viral or bacterial cause - inflammation of the mucous membranes of the nose - caused by a foreign body in the nose, structural deformities, neoplasms, chronic use of nasal decongestants
What is rhinitis a side effect of?
Cocaine, antihypertensives, PO contraceptives
What is acute pharyngitis?
Sore throat - usually caused by a virus, typically Group A Strep
What are some symptoms of pharyngitis?
Sore throat, swollen cervical lymph nodes, hoarseness, cough, rhinitis
What’s a complication of pharyngitis if left untreated and it’s caused by strep A?
Rheumatic fever!
How do we treat pharyngitis?
Penicillin (if bacterial!), fluids, bedrest while febrile, comfort (warm saline gargle, ice collar, analgesics), antitussives, mouth care
What is chronic pharyngitis? Who is it common in?
Pharyngitis that is lasting a long time. Common in adults who work or live in dusty surroundings (singers, public speakers), those who suffer from chronic cough, habitually use tobacco/alcohol.
What is acute sinusitis?
Inflammation of mucous membranes in sinuses
How do we treat acute sinusitis?
Control infection (broad spectrum antibiotics), shrink nasal mucosa (head – shower), relieve pain, promote drainage (inhale steam, increase fluids, apply local heat)
What is chronic sinusitis?
Chronic nasal obstruction - discharge and edema of the nasal passages
What are some symptoms of chronic sinusitis?
Cough (constant nasal dripping causes this), chronic headache, fatigue
Is the treatment for chronic sinusitis the same or different as that of acute sinusitis?
THE SAME! :)
Might someone with chronic sinusitis need surgery?
Yes, they might need a functional endoscopic sinus surgery - corrects deformities, deviated septums, polyps, drains sinuses, etc.
If someone has sinus/nose surgery, what might we need to tell them to do?
Facial compresses, humidification!, no coughing/sneezing/vomiting, and check BP twice a day
What are some complications of sinusitis?
Orbital cellulitis, subperiosteal abcess, meningitis, brain abscess (fever, severe headache, nucchal rigidity)
Displaced nose fracture = HORRIBLE. T/F?
False - they’ll be fine. It’ll go back to normal.
Broken nose = not that bad. T/F?
FALSE = it needs fixed!
If a broken nose starts leaking cerebrospinal fluid, what might that mean?
Possible skull fracture.
If someone has a broken nose, what are some interventions for them?
Cold compresses, semi-fowler’s position, avoid aspirin/blood thinners, etc.
What is epistaxis?
Nose bleed!
How do we treat epistaxis?
Direct pressure, silver nitrate, electrocautery, gel foam, packing - 48 hours up to 6 days – it’s a cath that’s inserted into the nose! Packing is for a posterior nose bleed because it’s harder to reach.
What are some nursing interventions for a nose bleed?
Monitor VS, control bleeding, administer humidification, bed rest, pain meds, assess for respiratory distress and tolerance of packing or tubes, watch for hemorrhage, airway clearance, teach future prevention techniques (don’t blow so hard, humidification, etc)
What are nasal polyps?
Benign, grapelike clusters of mucous membranes and connective tissues in the nares.
Can nasal polyps cause obstruction?
Yes
What are some disorders of the larynx?
Vocal cord nodules and polyps, laryngeal edema (trauma, etc)
How do we treat laryngeal edema?
Intubation, epi, corticosteroids, etc.
What are laryngeal nodules?
Fibrous - infection or over use of voice - happens a lot in smokers, people with allergies, etc.
If there’s an upper airway obstruction, is it essential to detect early?
YES - this is cutting off air!!! It needs to be detected QUICK so treatment can be started right away!
What are some interventions for an upper airway obstruction?
Assessment for the cause, cricothyroidectomy (inserting piece into thyroid - breathe through this), endoctracheal tube, tracheostomy
What are some early warning signs of head and neck cancers?
Color changes in mouth and/or tongue, sore that does not heal in two weeks, lump in mouth or neck, hoarseness, persistent or unexplained bleeding, numbness of mouth or lips, persistent low grade pain in ears or face (unilateral)
What are some causes of laryngeal cancer?
1 = tobacco use, #2 = alcohol, then exposure to abestos, fumes, voice straining, chronic laryngitis
What are some early warning signs of laryngeal/throat cancer?
hoarseness, pain or burning in throat, lumps in neck, ear pain, lump or sore that does not heal, dysphagia, dyspnea, foul breath, weight loss and general debilitation
What are some diagnostic tests for laryngeal cancer?
Laryngoscopy, Laryngeal biopsy, soft tissue x-ray, CT/MRI, Pet scan to see if it has metastasized
What’s a total laryngectomy?
total - removal of both cords —> no speech, they’ll have a trach, etc.
What’s a partial laryngectomy?
One cord is removed, they will have speech and normal airway but the speech might be hoarse.
What’s a radical neck dissection?
Tumor is in neck and lymph - it’s the very deforming surgery.
What should we do preoperatively for patients have laryngeal surgery?
Teaching to help with anxiety, discuss voice loss, that they’ll be in the ICU after, the surgery will take 8 or so hours, pain control methods, goals for discharge, etc.
What do we assess after surgery for a patient who had laryngeal surgery?
Monitor airway pattern, monitor for restlessness, breathing, apprehension, increased pulse, positioning, comfort level, trach care every 8 hours, watch for complications
What are some complications of laryngeal surgery?
Airway obstruction, hemorrhage, wound breakdown, tumor recurrence
Should the call light always be in reach for someone who had laryngeal surgery?
YES - they might not be able to speak sooooo!
Should we give patients who had laryngeal surgery a ton of narcotics?
NO, it might reduce their breathing!
Does humidified air help with secretions?
YES
Is hemorrhage common or uncommon with laryngectomy?
Uncommon because of surgical drain placed by surgeon
Is wound breakdown a common complication for a laryngectomy? A major risk for what?
YES - caused by poor nutrition, alcohol use, wound contamination, etc. Packing and local care as prescribed to keep wound clean and to stimulate growth of healthy tissue - also a major risk for carotid artery rupture!
If someone has a laryngectomy, how might they get their nutrients
NG, Gastrostomy, jejunostomy, parenteral nutrition, etc
If someone has a total laryngectomy, do they have a risk for aspiration?
NOPE!
If a patient has a feeding tube with a partial laryngectomy, what must they do first before they can go to solid food?
Show that they can swallow!
What is esophageal speech?
They swallow air and BURP it up and can sometimes speak that way!
What are some ways to prevent aspiration in partial laryngectomy patients?
Elevate head of bed, adhere to tube feeding program, no bolus feeding at night, checking residual feeding, tucking chin = basically any routine reflux precaution!
Might patients with a laryngectomy/similar surgeries be anxious and worry about their body image?
YES
When bathing or shaving, a person with a laryngectomy should place a shield over what? And the air in their home should be ___?
The stoma! They should have humidified air as well
Stridor is caused by what?
Obstruction of the windpipe
For clients with asthma problems, which inhaler should be taken first - a bronchodilator or a corticosteroid?
Bronchodilator
What are antitussives used for?
Suppressing cough
