Upper Resp Flashcards
Problems in the upper resp system are primarily a
ventilation prob
When it comes to itis’s do we treat them aggresively
yes
What does IND mean
incision and drainage
What if the itis is caused by a virus
treat the symptoms and let it resolve itself
What are structural causes of upper resp probs
deviated septum nasal fracture edema epitaxis rhinoplasty
What are interventions for someone with a traumatic prob causing edema and swelling
elevate HOB for 48 hrs
use ice to limit swelling
What are the steps for treating epitaxis
keep the patient get them sitting apply direct pressure for 10-15mins use ice compresses apply small gauze pads into nostrils
What do you do if the initial steps for treating epitaxis are not effective
use vasoconstrictor agents, cauterization, or anterior or posterior packing packing for minimum 3 days
What type of trauma is still considered to affect the person in the same way (edema bleeding and swelling) as blunt force trauma
surgeries for example rhino and septoplasty
What are some interventions to treat a surgery of the nose
elevate HOB
reduce agents that increase bleeding
What do we need to teach to nose surgery patients
dont change their dressing, let the surgeon do it
What are manifestations of rhinisitis and sinusitis
Nasal congestion, sneezing, watery/itchy eyes, altered smell, watery discharge, headache, congestion, pressure
What are some interventions for rhinisitis and sinusitis
if their symptomatic give tylenol
push fluids to liquify secretions
reduce exposure to causal agents
What is the first line med specifically for treating nasal probs
inhaled corticosteroid spray
What should we teach our patients with rhinisitis or sinusitis
avoid allergens
get refill/use intranasal corticosteroids before allergy season
Wash hands often bec common cold could be a trig
monitor suptum for color moving towards yellow/clear and thin from greenish and thick
Who are high risk pop for influenza
elderly longterm steroid use chemotherapy Chronic cardiac or pulmonary (COPD cancer) Hospitalized in previous year LongtermcareTC residents Immunocompromised Pregnancy – in 2nd or 3rd trimester during flu season
What are some symptoms of the flu
cough, fever, myalgia, HA, sore throat
What could the flu lead to and what does it look like
pneumonia that has exacerbated cough and purulent sputum
If the flu is uncomplicated how fast should it subside
within a week
What is a potential occurance with elderly that get the flu
the symptoms last for weeks
What should you teach about the flu
get vaccinated unless contraindicated like egg allergies
What are some causes of nasal and paranasal sinus obstruction
nasal polyps
foreign objects
What do nasal polyps look like
bluish glossy protrusions
What are the manifestations of nasal polyps
clear discharge
speech distortion
What are some treatments for nasal polyps
endoscopy into laser surgery
What is the prognosis of nasal ppolyps if untreated
probs recurrent
What can slow the growth of nasal polyps
corticosteroids
What are the manifestations of foreign objects
clear dis
local inflammation
How do you treat foreign object obstruction
remove via point of entry/ sneese with the opposite nostril closed
What is acute pharyngitis usu caused by
virus
What is acute follicular pharyngitis caused by
strep
What is fungal acute pharyngitis usu caused by
candida
Who are at the most risk for fungal acute pharyngitis
long term corticosteroid or antibiotic use
immunocomp
What are the common manifestations for all types of acute pharyngitis
redness
edema
progresses from scratchy to dysphagia
What are some manifestation of acute pharyngitis that might apppear
patchy yellows eudate
white patches
if untreated or not fully treated what can acute pharyngitis lead to
rheumatic heart dis
How do we treat acute pharyngitis
Infection control- wash hands, throw away tissues
Symptomatic relief
Prevent secondary infections
Fluid . . . . . Citrus could irritate
Treat with antibiotics or nystatin (fungal)
What shoudl you teach the patient when they are treating acute pharyngitis with oral solutions
swish and swallow
What is a complication of acute pharyngitis or acute tonsilitis
tonsilar abscess
What are the mani’s of tonsilar abscess
hi fever (>101.5), leukocytosis, and chills
What are some treatments of tonsilar absscess
Antibiotics
Needle aspiration
IND
Tonsillectomy
What is OSA
partial or complete obstruction of aurways from tongue or soft palate falling back
What happens during a OSA attack
airway is obst’d for 15-90 seconds causing severe hypoemia and hypercapnia, jolting the patient awake
What are mani’s of OSA
Frequent awakenings with HA
Loud snoring (partner complains)
Complains (in part) – Morning headaches (hypercapnia), irritability, male impotence
How is OSA usu diagnosed
with polysomnography with multiple episodes
What are some ways to treat OSA
lose weight oral apps that move the tongue and mandible forward CPAP BiPAP Surgery to remove tissue
What is a recommendation to give patients with OSA
avoid alc and sedatives
What are some advantages of a tracheostomy over a endotracheal tube
less risk for long term damage
hygeine improved
increased mobility
can still eat
What shoudl you teahc your pat before getting a trach
you wont be able to speak while the inflated cuff is in
What are some guidelines for inflating a cuff on a trach
use the min volume to create a seal
dont inflate more than 20mmHG or 25cm H2O
Use the min leak technique
What is the min leak technique
after inflating min enough to create the seal, withdraw 0.1 ml of air
Why should you monitor the pressure of the cuff daily after inflating it
the underlying tissue can swelling up from the irritation causing an increase in pressure
What type of cleanliness does suctioning need
sterile
What are the steps for suctioning
pre O2
insert 5-6 in or until resistance
suction up the way up
What are some guidelines for trach suctioning
use sterile technique
dont suction for longer than 15 secs total
try to aim for as little passes as possible
What is a potential problem with trachs
dislodgement
When is dislodgement most likely
first 5-7 days
What are some precautioins we can take to prevent/help dislodgement
keep replacement tube at bedside
do not change ties for 24 hours
let the physician perform the first tube cchange
When does the first tube change typically happen
after 7 days
Is the tube can be replaced what should you do for dislodgement of the trach
spread the opening by the rentention sutures
call for help
use a hemostat to keep airways open
insert replacemnt tube with an obturator
insert suction catheter for passage of air and to guide the insertion of replacement tube
What should you do if the trach tube cannot be replaced after dislodgement
call for help
assess level of resp distress
position in semi-fowles
Cover the stoma with a sterile dressing and ventilate them with a BMV (bag-mask-ventilation)
