Upper Respiratory Flashcards
Areas of the Upper Respiratory Tract in order
Nose Paranasal sinuses Pharynx Larynx Trachea
what happens in The Nasal Cavity
Air is inhaled through the nostrils.
Warmed as it moves down to the pharynx
Mucous membranes
line the nasal cavity to trap unwanted particles or bacteria and infection
Paranasal Sinuses
Produces the mucous that protects the nasal cavity.
list the 4 Paranasal Sinuses
Frontal sinus
Ethmoid sinus
Sphenoid sinus
Maxillary sinus
The sinuses are a common site of _____
infection.
Pharynx
Serves both the respiratory and the digestive system.
Pharynx is composed of
Nasopharynx
Oropharynx
Laryngopharynx
function of The larynx or “voice box”
vocalization, but it also protects the lower airway from foreign objects and facilitates coughing; it is, therefore, sometimes referred to as the “watchdog of the lungs”
Trachea
Provides airflow to and from lungs for respiration.
Bronchi
- Highways for gas exchange
2. Oxygen enters and CO2 leaves through them.
The right lung has upper, middle, and lower lobes, whereas the left lung
consists of upper and lower lobes
physiologic dead space
airways contain about 150 mL of air in the tracheobronchial tree that does not participate in gas exchange
The lung is made up of about ______ alveoli
300 million
purulent sputum
(thick and yellow, green, or rust colored)
change in color of the sputum is a common sign of a________.
bacterial infection
Pink-tinged mucoid sputum suggests
a lung tumor
mucoid sputum frequently results from
viral bronchitis.
Profuse, frothy, pink material, often welling up into the throat, may indicate
pulmonary edema.
Pulmonary Function Tests (PFTs)
- Such tests include measurements of lung volumes, ventilatory function, and the mechanics of breathing, diffusion, and gas exchange.
- Considers patient’s height, weight, age, gender, and ethnicity.
PFTs can be performed before
surgery
PFT home spirometer is given to
measure patients peak flow rate
Clubbing of the finger:
change in shape of finger tips and nail to be more round like a “club”.
clubbing of fingers It is a sign of
lung disease that is found in patients with chronic hypoxic conditions
Cyanosis
a bluish coloring of the skin, is a very late indicator of hypoxia
Percussion produces audible and tactile vibration and allows
the nurse to determine whether underlying tissues are filled with air, fluid, or solid material.
discuss the 2 main percussion sounds
Healthy lung tissue is resonant.
Dullness over the lung occurs when air-filled lung tissue is replaced by fluid or solid tissue.
Arterial Blood Gas Studies (ABGs) 2 purposes
- Assesses the lung’s ability to provide oxygen and remove CO2.
- Assesses ability of the kidneys to reabsorb or excrete bicarbonate ions to maintain normal pH.
ABG levels are obtained through
an arterial puncture at the radial, brachial, or femoral artery or through an indwelling arterial catheter
delete me
delete me
VBG levels can be obtained by
drawing blood from the venous circulation
Venous Blood Gas Studies:
Checks the amount of O2 used by the tissues vs. the amount being returned to the heart.
Pulse Oximetry
- Monitors the oxygen saturation of hemoglobin.
- Normal value is 95% or greater.
- If less than 90%, the tissues are not receiving enough oxygen
A throat culture or “strep test” is performed by using
a throat swab to detect the presence of group A streptococcus bacteria or “strep throat”
Nasal or nasopharyngeal culture detects
Influenza or Staphylococcus aureus
ETA of culture results
Sits in lab at least 24 hrs for preliminary results, and final results 48-72 hrs.
Ideally, all cultures should be obtained prior to
the initiation of antibiotic therapy.
Sputum Studies are
Analysis of pathogenic organisms and can determine if malignant cells are present
Sputum Studies Usually done with patients who are
receiving antibiotics, corticosteroids, or immunosuppressive medications.
to obtain a sputum sample
Patient coughs deeply and expectorates sputum from the lungs into sterile container.
If the patient cannot expel an adequate sputum sample by coughing
coughing can be induced by administering an aerosolized hypertonic solution via a nebulizer
Sputum samples ideally are obtained in what time of the day
early in the morning before the patient has had anything to eat or drink.
Focused Respiratory Assessment on HISTORY portion
History of respiratory disease Smoking Environmental exposures Cough or sputum appearance Dyspnea Medications (any antibiotics, corticosteroids, immunisuppressive treatment, asthma) Previous treatment
Focused Respiratory Assessment - on INSPECTION
- Use of accessory muscles while breathing
- Symmetry of chest
- Rate of respirations
- Skin color of lips, face, hands, feet
Fine crackles:
sounds like hair rubbing together associated with asthma, COPD, fibrosis.
Coarse crackles:
harsh moist popping sounds associate with COPD, pulmonary edema.
Wheezes:
musical high pitch sound associated with bronchitis, emphysema, asthma
Pleural friction rub:
low pitch rubbing sound (rubbing of fingers together like) associated with pleurisy and loss of lubrication
Normal breath sounds are classified as
tracheal, bronchial, bronchovesicular, and vesicular sounds.
Viral Rhinitis aka Common cold is
Acute inflammation and infection of the mucous membranes
viral rhinitis is Contagious _____ before symptoms appear.
2 days
Viral Rhinitis Survive best when
humidity is low in the colder months.
__(x amount of)__ different viruses can cause a cold
200
most common viral rhinitis virus is
Rhinoviruse
viral rhinitis doesn’t need
antibiotics. Antibiotics are for bacterial infections
Allergic rhinitis is further classified as seasonal or perennial rhinitis and is commonly associated
with exposure to airborne particles such as dust or pollen
Despite popular belief, cold temperatures and exposure to cold rainy weather
do not increase the incidence or severity of the common cold.
Viral rhinitis symptoms
low grade fever. nasal congestion rhinorrhea halitosis sneezing watery eyes sore throat and cough malaise and chills headache and muscle aches
Halitosis:
bad smelling breath
Rhinorrhea:
runny nose
The symptoms of viral rhinitis may last
from 1 to 2 weeks
Viral rhinitis Medical management
TREAT THE SYMPTOMS with medications!
Adequate fluid intake
Rest
Medications for Viral rhinitis Medical management
- Expectorants
- NSAIDs
- Antihistamines
- topical nasal decongestants
- petroleum jelly
Expectorants, what they do and an example of medication
remove secretions (like mucinex, Guaifenesin)
NSAIDs
like ibuprofen and aspirin (relief pain)
Antihistamines help with
(helps with sneezing, nasal congestion)
Petroleum jelly
can soothe irritated, chapped, and raw skin around the nostrils
Use topical nasal decongestants with caution! its overuse can
produce rhinitis medicamentosa, or rebound rhinitis. Maximum 3 days!
Humidified air for viral rhinitis
has not been proven.
Transmission of viral rhinitis is
direct contact and droplet.
Sneezing in elbow is better than sneezing in hands because
patients don’t always wash hands and they can spread the droplets on surfaces.
Most viruses can be transmitted in several ways:
- direct contact with infected secretions
- inhalation of large particles from others’ coughing or sneezing
- inhalation of small particles (aerosol) that may be suspended in the air for up to an hour
Viral Rhinitis patient education
- The transmission of the virus.
- Proper hand hygiene.
3, The use of tissues when coughing and sneezing - Methods to treat symptoms.
- Future prevention techniques.
- Verbal and written instructions should be given.
Rhinosinusitis
Inflammation of the paranasal sinuses and nasal cavity.
Rhinosinusitis can be either
Bacterial or viral
Rhinosinusitis is Classified by duration of symptoms:
Acute (less than 4 weeks)
Subacute (4 to 12 weeks)
Chronic (more than 12 weeks)
If there is an obstruction in sinus,
it’s a great place for bacteria to grow
Acute Rhinosinusitis Usually follows a
cold, or unresolved infection or exacerbation of allergic rhinitis.
Acute Rhinosinusitis two classifications
Acute bacterial rhinosinusitis (ABRS)
Acute viral rhinosinusitis (AVRS)
what percentage of acute rhinosinusitis is caused by bacteria?
60%
Biofilm producing bacterial pathogen are associated with which acute rhinosinusitis virus?
Streptococcus pneumonia aureus
Acute Rhinosinusitis can also be caused by
deviated septum, diving, swimming, tooth infections, trauma to nasal cavity.
Some people are more prone to rhinosinusitis because of environmental hazards such as
as paint, sawdust, and chemicals may result in chronic inflammation of the nasal passages
Although antibiotics kill bacteria in the biofilm margin
cells deep in the biofilm are not affected, allowing for regrowth once antibiotic therapy has been discontinued
Fungal infections occur most often
in patients who are immunosuppressed
Rhinosinusitis symptoms
Purulent nasal drainage
Facial pain and pressure
Headache
Fever
Timeline of symptoms for ABRS and AVRS
ABRS
10 days or more of present symptoms and worsen over time.
AVRS
Fewer than 10 days of present symptoms and do not worsen.
The symptoms of AVRS are similar to those of ABRS, except
the patient does not present with a high fever
assessment for rhinosinusitis
- Obtain history
- Physical examination: (Nose, ears, teeth, sinuses, pharynx, and chest are the focus.)
- sinuses tenderness
- Sinus culture
The sinuses are percussed using the index finger through
tapping lightly to determine whether the patient experiences pain
Complications of rhinosinusitis
Osteomyelitis
Intracranial complications
Mucocele (cystic lesion)
Osteomyelitis
(Inflammation of the bone)
Requires:
Prolonged antibiotic therapy
Removal of necrotic bone
Mucocele
(Cyst of the paranasal sinus)
Requires:
Surgical treatment
Ablation of the sinus cavity
Intracranial complications of rhinosinusitis:
like meningitis, brain abscess, or orbital cellulitis
Goals of treatment for Rhinosinusitis
Treat infection
Relieve pain
Shrink the nasal mucosa
Medical Management - ABRS
Antibiotics that treat antibiotic-resistant organisms: Amoxicillin (Augmentin) Doxycycline (Vibramycin) Levofloxacin (Levaquin) Intranasal saline lavage
antibiotics #1 choice for ABRS
Amoxicillin (Augmentin)
___________ is given if pt is allergic to pennicilin for ABRS
Levofloxacin (Levaquin)
Neither ________ nor ________ are recommended adjunctive medications for treating ABRS
decongestants, antihistamines
Medical Management - AVRS
Nasal saline lavage
Decongestants
Antihistamines (if allergies are suspected)
Intranasal corticosteroids
Decongestants for AVRS
Guaifenesin , Robitussin
Oral decongestants must be used cautiously in patients with
hypertension.
Intranasal corticosteroids for AVRS
Mometa-sone (Nasonex)
Triam-cinolone (Nasacort)
_______ have been shown to produce complete or marked improvement in acute symptoms of either bacterial or viral rhinosinusitis;
Intranasal corticosteroids
patient education for rhinosinusitis
Symptoms of complications Methods to promote drainage Must avoid swimming, diving, and air travel No smoking during infection Nasal spray demonstration Medication use
Must avoid swimming, diving, and air travel be cause
these will increase cranial pressure
rhinosinusitis Symptoms of serious complications :
nuchal rigidity (a sign of minigitis) or orbital edema (eye swelling)
Chronic Rhinosinusitis (CRS) is diagnosed when experiencing for 12+ months, two or more of the following:
Mucopurulent drainage Nasal obstruction Facial pain or pressure Hyposmia Can be accompanied by nasal polyps
Hyposmia
(decreased sense of smell)
nasal polyps
(benign masses in nasal cavity)
Recurrent Acute Rhinosinusitis
classification timeline:
4 or more episodes of ABRS occur per year.
Patho of Chronic Rhinosinusitis & Recurrent Acute Rhinosinusitis
obstruction in the sinuses that prevents drainage and grows bacteria
(delete me) what other causes for Chronic Rhinosinusitis & Recurrent Acute Rhinosinusitis
(delete me) cystic fibrosis, environmental pollution, tabacco
what type of bacteria is found in “Chronic Rhinosinusitis & Recurrent Acute Rhinosinusitis “
Both aerobic and anaerobic bacteria are found
Anaerobic bacteria:
doesn’t need oxygen to survive
Signs of CRS
Impaired mucus clearance Cough Chronic hoarseness Chronic headaches orbital edema Facial pain
physical assessment for CRS focuses on
External nose Nasal mucosal membranes Posterior oropharynx for purulent or mucoid discharge Eyes for edema Palpation of the sinuses (ask if tender)
A crooked-appearing external nose may imply __________
septal deviation internally.
Technique for palpating the frontal sinuses
Using the thumbs, the nurse applies gentle pressure in an upward fashion at the supraorbital ridges (frontal sinuses) and in the cheek area adjacent to the nose (maxillary sinuses)
diagnostic tests for CRS
X-ray
CT scan
Nasal endoscopy
CT scan for rhinosinusitis Identifies
mucosal abnormalities, sinus obstruction, and anatomic variants.
Nasal endoscopy for rhinosinusitis
visualizes
the posterior nasal cavity, nasopharynx, and sinus pathways
complications of CRS
Orbital cellulitis Encephalitis Alterations in consciousness Seizures Coma or death
Frontal rhinosinusitis can lead to
osteomyelitis of the frontal bones
Frontal sinus osteomyelitis symptoms
headache, fever, and edema over the involved bone.
CRS and ABRS medical management
(Similar to acute rhinosinusitis)
Antibiotic regimen usually lasts 2 to 4 weeks or Can last up to 12 months depending on the case
CRS Patients are instructed to sleep with the
head of the bed elevated
CRS Patients are cautioned to avoid caffeine and alcohol, which
can cause dehydration.
Surgical management for CRS
Functional endoscopic sinus surgery (FESS)
Functional endoscopic sinus surgery (FESS) is used for
removing nasal polyps Correcting deviated septum draining the sinuses Aerating the sinuses Removing tumors
FESS is basically a
minimally invasive computer guided surgery to treat CRS
CRS patient education
Blow nose gently
Promote drainage
Early signs of sinus infection
Preventative measures
patients can promote drainage by
Increase fluid intake
Apply local hot wet packs
Elevate the head of the bed
Acute Pharyngitis
Inflammation of the pharynx aka “Sore Throat”
pharyngitis can be viral or bacterial but _____ is the most common
Viral pharyngitis
Viral pharyngitis risk factors
Poorly ventilated rooms
Unclean hands
Droplets of coughs and sneezes
Viral pharyngitis Peaks during
winter and early spring
Viral pharyngitis Usually subsides within
3 to 10 days
viruses that could cause viral Pharyngitis
Adenovirus Influenza Epstein-Barr Herpes simplex HIV
causes of bacterial Pharyngitis
Group A streptococcus (STREP THROAT) Group B streptococci Group G streptococci Neisseria gonorrhoeae Mycoplasma pneumonia
Strep throat comes only from _____
group A strepticoccus
Acute Pharyngitis Clinical Manifestations
Fiery-red pharyngeal membrane and tonsils.
Lymphoid follicles are swollen with white-purple exudate.
Enlarged and tender cervical lymph nodes.
Fever
Malaise
Sore throat
No cough is present in
Acute Pharyngitis
Streptococcal pharyngitis Clinical Manifestations (besides the regular pharyngitis symptoms)
Swollen and erythematous tonsils Headache Myalgia (muscle pain) Nausea Halitosis
Streptococcal pharyngitis, also known as strep throat, or Bacterial tonsillitis is
an infection of the back of the throat including the tonsils caused by group A streptococcus (GAS)
Diagnostic tests for Pharyngitis
Rapid Antigen Detection Testing (RADP)
Throat culture
Rapid Antigen Detection Testing (RADP)
Swabs collect specimens from the posterior pharynx and tonsils.
90%-95% effective.
Medical Management for viral Pharyngitis
Viral pharyngitis is treated with supportive measures because antibiotics have no effect on the causal organism
Medical Management for bacterial Pharyngitis
a variety of antimicrobial agents:
Penicillin (antibiotics): Orally for 5 days
or
Cephalosporin: orally 5-10 days
For patients who are allergic to penicillin, we give:
Macrolides Orally for 3 days
macrolides examples
Clarith-romycin (Biaxin)
Azith-romycin (Zithromax)
Cephalosporin (antibiotics) examples
Cef-podoxime (Vantin)
Cef-uroxime (Ceftin)
in pharyngitis, Severe sore throats can also be relieved by
analgesic medications. For example, aspirin or acetaminophen can be taken at 4 to 6 hour intervals
In severe cases, gargles with ______ may relieve symptoms.
benzocaine
nutritional therapy for pharyngitis
Liquid or soft diet
Cool or warm beverages: (2 to 3 L/day)
Ice pops
IV fluids may be needed
patient education for pharyngitis
Warm saline gargles (105-110F).
Ice collar application (helps with discomfort in the neck).
Preventative measures (not share daily living items).
Replace toothbrush.
for pharyngitis, The nurse instructs the patient about signs and symptoms that warrant prompt contact with the primary provider. These include
dyspnea, drooling, inability to swallow, and inability to fully open the mouth.
Chronic Pharyngitis
Persistent inflammation of the pharynx
Persistent inflammation of the pharynx is Common for people who:
Work in dusty surrounding
Use their voice to excess
Suffer from chronic cough
Habitually use alcohol and tobacco
Types of Chronic Pharyngitis
Hypertrophic
Atrophic (becomes smaller)
Chronic granular
Hypertrophic Chronic Pharyngitis
General thickening and congestion of the pharyngeal mucous membrane.
Atrophic Chronic Pharyngitis
Later stage of hypertrophic.
Membrane is thin, whitish, and wrinkled
Chronic granular Pharyngitis
Numerous swollen lymph follicles on the pharyngeal wall
chronic pharyngitis Clinical Manifestations
postnasal drip (nasal drips into throat
Mucous collection in the throat
throat irritation
Difficulty swallowing
Treatment for chronic pharyngitis
Nasal spray, aspirin
Tonsillectomy may be recommended
patient education for chronic pharyngitis
wear N95 when needed
Laryngitis
Inflammation of the larynx.
Can be viral or bacterial.
Usually associated with rhinitis or pharyngitis.
causes of Laryngitis
Voice abuse
Exposure to dust, chemicals, smoke, or other pollutants
GERD
Gastroesophageal reflux disease (GERD or reflux laryngitis)
occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus).
Laryngitis Clinical Manifestations
Hoarseness or aphonia (loss of voice)
Severe cough
“Tickle” in the throat
Symptoms are aggravated by cold dry wind
Feels worst in the morning and evening
Laryngitis Medical Management
Resting the voice
Avoiding irritants (alcohol, tabacco, certain foods that cause GERD)
Antibiotics
Corticosteroids (if chronic)
Proton Pump Inhibitors if related to GERD
Omeprazole (Prilosec)
Proton-pump inhibitor
It can treat gastroesophageal reflux disease (GERD).
Laryngitis Nursing Management
Encourage rest and fluids (2-3L).
Maintain a well-humidified environment.
using continuous positive airway therapy at bedtime.
When to contact their provider.
Laryngitis patients should contact physican if symptoms
include loss of voice with sore throat that makes swallowing saliva difficult. hemoptysis. noisy respirations. persistent or high fever. increasing shortness of breath. confusion.
Continued hoarseness after voice rest or laryngitis that persists for longer than 5 days must be reported because of
the possibility of malignancy (dangerous)
laryngitis Nursing Interventions
Promoting Communication:
Instruct on refraining from speaking
Encourage written communication
Encourage call bell for assistance
Encourage Fluid Intake:
Provide a list of easily ingested foods
Encourage 2-3 L of water per day
Provide cool or warm beverages
Promoting Home and Transitional Care:
Prevention education
Hand hygiene
Reinforce the need to complete treatment regimen
Dairy is bad because
it thickens the mucus
What do antihistamines do pharmacologically?
They block histamine (which helps with congestions, opening airways)
What is a priority with a suspected infection?
A sputum culture.
