Upper Respiratory Flashcards
Epistaxis (nosebleed) Causes
-Irritation, trauma, infection, foreign bodies, tumors
-Systemic disease
Hypertension/blood dyscrasias
-Anticoagulant therapy
-Systemic treatment
Chemotherapy/anticoagulants
Epistaxis Care Anterior - How to treat?
-Position upright/lean forward
-Reassure/calm
-Lateral pressure
-Ice
-Nasal tampons
-Teaching:
Avoid blowing nose
Epistaxis Care Posterior - How to Treat?
-Emergency/hospitalization
-Posterior packing (balloon catheters)
-Assess respiratory status
-Humidification, oxygen, bedrest, pain control, oral care
-Teaching:
Saline spray/humidification
Avoid aspirin/NSAIDS
Avoid strenuous activities
How to stop an anterior nose bleed
Lean forward-
Pinch to press both sides of your nose firmly against the septum.
-Hold continuously for 10 minutes.
What is Obstructive Sleep Apnea?
-obstructive apneas
-hypopneas
-respiratory effort-related arousals r/t repetitive
collapse of upper airway during sleep
OSA: Risk Factors
- Increased age
- Male
- Obesity
- Nasopharyngeal structural abnormalities
- Smoking (less est. risk factor)
OSA: Signs/Symptoms
- Daytime sleepiness
- Snoring, choking, gasping during sleep
- Morning headaches r/t lack of sleep
OSA: Physical Exam
- Obesity
- Large neck &/or waist circumference
OSA: Signs associated with complications
- Motor vehicle crashes
- Neuropsychiatric dysfunction
- Hypertension
- Heart failure
- Metabolic syndrome
OSA: Diagnostic Test
Polysomnography (Gold Standard)
OSA Treatment: Positive Airway Pressure Therapy
CPAP (most common)
Continuous Positive Airway Pressure
-Simplest to use, works well & is cheapest
-Only maintains upper airway patency
-Adherence estimated 20-40% non use
(patient teaching opportunity)
What is CPAP?
-For spontaneously breathing patients to improve
oxygenation
-For nocturnal ventilation to prevent upper airway
obstruction in patients with OSA
What is BiPAP (noninvasive)?
-2 pressures
one during inhalation – one during exhalation
-Nocturnal ventilation in patients with:
- neuromuscular disease
- chest wall deformity
- OSA & COPD
-To prevent intubationOSA Treatment
- Weight reduction & exercise
- Avoid alcohol and smoking
- Sleep on side
- Improved sleep hygiene
- Oral appliances (mild to moderate)
- Surgery
- Tissue removal or shrinkage
- Jaw repositioning
- Implant
- Tracheostomy
What are the two types of trachs?
-Shiley trach Disposable inner cannula Cuff Obturator -Jackson trach Reusable inner cannula No cuff Obturator
Tube Dislodgement & Accidental Decannulation: What to do
-Obturator taped at bedside AAT
-Insert obturator into outer cannula
-Extend neck & open tissue; insert outer
cannula/obturator
-Remove obturator immediately
-Check bilateral breath sounds
-Secure trach
Acute Pharyngitis: Defined
Inflammation of pharynx or tonsils
Viral Pharyngitis - s/s
-Viral difficult to distinguish viral from Bacterial - DO NOT GIVE ANTIBIOTICS -Viral symptoms - rhinorrhea - cough - oral ulcers - ulcers - diarrhea - conjunctivitis
Viral Pharyngitis Treatment
- Local soothing treatments of warm/cool fluids &
analgesics/antipyretics - DO NOT GIVE ANTIBIOTICS
Bacterial Pharyngitis - how to test for it
-10% of adult & 30% of childhood pharyngitis is caused
by group A strep
-Rapid streptococcal antigen testing is indicated in all
patients w/o overt viral features
Bacterial Pharyngitis Treatment
- Treat with:
- antibiotics
- Local soothing treatments (warm/cool fluids) &
analgesics/antipyretics
Fungal pharyngitis (Thrush)
- Caused by Candida albicans
Fungal Pharyngitis Treatment
- Treatment nystatin “swish & swallow” or “swish & spit”
- Local soothing treatments (warm/cool fluids) &
analgesics/antipyretics
Streptococcal pharyngitis - S/S
-Sudden onset of sore throat with tonsillar hypertrophy
& erythema
-Tender lymphadenopathy & fever
