Unit 2 Flashcards
Tonsils
- Found in pharyngeal area
- Filter pathogenic organisms (viral and bacterial)
- Helps protect the respiratory and gastrointestinal tracts
- Contribute to antibody formation
Palatine tonsils
- Located on both sides of the oropharynx
- Removed during a tonsillectomy
Pharyngeal tonsils
- Also known as the adenoids
- Removed during an adenoidectomy
Risk factors for tonsillitis
- Exposure to a viral or bacterial agent
- Immature immune systems (younger children)
Physical findings of tonsillitis
- Mouth odor
- Mouth breathing
- Snoring
- Nasal qualities in the voice
- Fever
- Tonsil inflammation with redness and edema
NSG care for tonsillitis
- Provide symptomatic treatment for viral tonsillitis (rest, cool fluids, warm salt-water gargles).
- Administer antibiotic therapy as prescribed for bacterial tonsillitis.
What medications are given for tonsillitis
- Antipyretics: acetaminophen (Tylenol) or ibuprofen (Advil)
- Antibiotics: IM PCN G, erythromycin, azithromycin, cephalosporins, amoxicillin
Prior to a tonsillectomy a client should maintain _____ status.
NPO
Positioning after a tonsillectomy
- Place in side-lying position or on abdomen to facilitate drainage.
- Elevate head of bed when child is fully awake.
Assessment after a tonsillectomy
- Assess for evidence of bleeding, which includes frequent swallowing, clearing the throat, restlessness, bright red emesis, tachycardia, and/or pallor
- Assess the airway and vital signs
- Monitor for difficulty breathing related to oral secretions, edema, and/or bleeding
Comfort measures post-tonsillectomy
- Administer analgesics
- Provide an ice collar
- Offer ice chips or sips of water to keep throat moist
- Administer pain medication on a regular schedule
Diet post-tonsillectomy
- Encourage clear liquids and fluids after a return of the gag reflex, avoiding red-colored liquids, citrus juice, and milk-based foods initially.
- Advance the diet with soft, bland foods.
Instructions post-tonsillectomy
- Discourage coughing, throat clearing, and nose blowing in order to protect the surgical site.
- Refrain from placing pointed objects in the back of the mouth.
- Alert parents that there may be clots or blood-tinged mucus in vomitus.
- Ensure the child does not put anything
- Limit strenuous activity and physical play with no swimming for 2 weeks
- Full recovery usually occurs in approximately 14 days
Complications of a tonsillectomy
- Hemorrhage
- Dehydration
- Chronic infection
Nasopharyngitis (common cold)
self-limiting virus that persists for 7-10 days
Clinical manifestations of nasopharyngitis
- Nasal inflammation, rhinorrhea, cough, dry throat, sneezing, and nasal qualities in voice
- Fever, decreased appetite, and irritability
Bacterial tracheitis
Infection of the lining of the trachea
Clinical manifestations of bacterial tracheitis
- thick purulent drainage from the trachea that can obstruct the airway and cause respiratory distress
- fever, croupy cough, stridor
Bronchitis (tracheobronchitis)
- Associated with an upper respiratory infection (URI) and inflammation of large airways
- Self limiting and requires symptomatic relief
Bronchiolitis
- Mostly caused by RSV
- Primarily affects the bronchi and bronchioles
- Occurs at the bronchiolar level
Clinical manifestations of bronchitis
- Persistent cough as a result of inflammation
- Resolves in 5-10 days
Clinical manifestations of bronchiolitis
- Rhinorrhean- intermittent fever, cough, and wheezing
- Coughing that progresses toward wheezing, increased respiratory rate, nasal flaring, retractions, and cyanosis
- Possible posttussive vomiting due to coughing
Allergic rhinitis
-Cause by seasonal reaction to allergens most often in the autumn or spring
Clinical manifestations of allergic rhinitis
- Watery rhinorrhea
- nasal congestion
- itchiness of the nose, eyes, and pharynx
- watery eyes
- nasal quality of the voice
- dry, scratchy throat
- snoring
- poor sleep leading to poor performance in school
- fatigue
Clinical manifestations of Pneumonia (RSV, Streptococcus pneumonia, Haemophilus influenza, Mycoplasma pneumonia)
- High fever
- cough that may be unproductive or productive of white sputum
- retractions and nasal flaring
- rapid, shallow respirations
- report of chest pain
- adventitious breath sounds (rhonchi, crackles)
- pale color that progresses to cyanosis
- irritability, anxiety, agitation, and fatigue
- abdominal pain, diarrhea, lack of appetite, and vomiting
- sudden onset, usually following a viral infection (bacterial pneumonia)
Clinical manifestations of Croup syndromes: Bacterial epiglottis (acute supraglottitis)
MEDICAL EMERGENCY
- Predictive signs: absence of cough, drooling, and agitation
- Sitting with chin pointing out, mouth opened, and tongue protruding
- Dysphonia (hoarseness or difficulty speaking)
- Dysphagia (difficulty swallowing)
- Inspiratory stridor (noisy inspirations)
- Sore throat, high fever, and restlessness
Clinical manifestations of Croup syndromes:
Acute laryngotracheobronchitis
- Low-grade fever
- Restlessness
- Hoarseness
- Barky cough
- Dyspnea
- Inspiratory stridor
- Retractions
Clinical manifestations of Croup syndromes:
Acute spasmodic laryngitis
- Barky cough
- Restlessness
- Difficulty breathing
- Hoarseness
- Nighttime episodes of laryngeal obstruction
Clinical manifestations of Influenza A and B
- Sudden onset of fever and chills
- Dry throat and nasal mucosa
- Dry cough
- Flushed face
- Photophobia
- Myalgia
- Fatigue
Pt centered care of Nasopharyngitis
- Give antibiotic for fever
- Rest
- Provide vaporized air (cool mist)
- Give decongestants for children older than 1 yr
- Give cough suppressants wit caution (avoid over sedation)
- Antihistamines are not recommended
- Antibiotics are not indicated
Pt centered care of Bacterial tracheitis
- Adminster oxygen as prescribed
- Monitor continuous oximetry
- Administer antipyretics for fever
- Administer IV antibiotics as prescribed
Pt centered care of Bronchitis
- Give antipyretics
- Give cough suppressant
- Provide increased humidity (cool mist vaporizer)
Pt centered care of Bronchiolitis
-Provide humidified oxygen as prescribed
-Monitor continuous oximetry
-Encourage fluid intake if tolerated
-Administer IV fluid intake if tolerated
-Administer IV fluids if oral intake not tolerated
-Suction nasopharynx as needed
-Administer nebulizer bronchodilator
Corticosteroids and antihistamines are not recommended
-Antibiotics are not recommended for RSV
-Chest percussion and postural drainage is not recommended
-Ribavirin administration is controversial
Pt centered care of Allergic rhinitis
- Avoid allergens
- Give antihistamines
- Give nasal corticosteroids
Pt centered care of Pneumonia (viral)
- Administer oxygen with cool mist as prescribed
- Monitor continuous oximetry
- Administer antipyretics for fever
- Monitor intake and output
Pt centered care of Pneumonia (bacterial)
- Encourage rest
- Promote increased oral intake
- Monitor I&O
- Administer antipyretics for fever
- Chest percussion and postural drainage is controversial
- Administer IV fluids as prescribed
- Administer oxygen as prescribed
- Monitor continuous oximetry
- Administer IV antibiotics as prescribed
Pt centered care of Bacterial epiglottitis
- Protect airway
- Prepare for intubation
- Provide humidified oxygen
- Monitor continuous oximetry
- Administer racemic epinephrine, corticosteroids, and IV fluids as prescribed
- Administer antibiotic therapy
Pt centered care of Acute laryngotracheobronchitis and acute spasmodic laryngitis
- provide humidity with cool mist
- adminster oxygen if needed
- monitor continuous oximetry
- administer nebulized racemic epinephrine, corticosteroids, and IV fluids as prescribed
- Encourage oral intake if tolerated
Pt centered care of Influenza
- Promote increased fluid intake
- Rest
- Give medications as prescribed
- Influenza vaccine- prevention
- Antipyretic (pain or fever)
Pneumothorax
accumulation of air in the pleural space
Clinical manifestations of pneumothorax and pleural effusion
- dyspnea
- chest pain
- back pain
- labored respirations
- decreased oxygen saturation
- tachycardia
NSG interventions for pneumothorax and pleural effusion
- prepare for an emergent needle aspiration with insertion of chest tube or closed drainage
- provide for chest tube management
- assess respiratory status
- administer oxygen as prescribed
Pleural effusion
accumulation of fluid in the pleural space
Asthma
A chronic inflammatory disorder of the airways that results in intermittent and reversible airflow obstruction of the bronchioles.
Intermittent asthma
- Symptoms occur two or fewer times per week
- No interference with normal activity
- Uses short-acting B-agonist less than two times per week
Mild persistent asthma
- Symptoms occur more than twice a week, but not daily
- Minor limitations with activity
- Use of short-acting B agonist more than two days per week but not daily
Moderate persistent asthma
- Daily symptoms
- Some limitations in activity
- Uses short-acting B-agonist daily
Severe persistent asthma
- Symptoms occur continually
- Limited activity
- Use short-acting B agonist several times per day
Risk factors for asthma
- Family history of asthma
- Family history of allergies
- Allergies
How to use a peak flow meter
- Ensure the marker is zeroed
- Have the child stand up straight
- Close lips tightly around the mouthpiece (ensure the tongue is not occluding)
- Blow out as hard and quickly as possible
- Read the number on the meter
- Repeat two more times (wait at least 30 seconds between attempts)
- Record highest number
Pt education for pts with asthma
- encourage fluids
- encourage taking oral corticosteroids with food
- Instruct child to rinse mouth after corticosteroid use
- Instruct to watch for redness, sores, white patches in the mouth
- Follow prescription (dosage, tapering off, length of time to take)
