Upper Respiratory Problems Flashcards
Deviated Septum
CROOKED NASAL SEPTUM, APPEARS BENT
Causes of a DEVIATED SEPTUM
CAUSED BY TRAUMA; ALSO CONGENITAL DISPROPORTION IN THE SIZE OF
THE SEPTUM VS. THE NOSE
SYMPTOMS OF A DEVIATED SEPTUM
OBSTRUCTION, NASAL EDEMA, DRYNESS OF THE
NASAL MUCOSA WITH CRUSTING/EPISTAXIS; IF SEVERE CAN CAUSE BLOCK DRAINAGE OF SINUS CAVITIES RESULTING IN INFECTIONS (SINUSITIS)
MANAGEMENT OF A DEVIATED SEPTUM
CONTROL OF NASAL ALLERGIES (ALLERGIC RHINITIS);
SEVERE SYMPTOMS REQUIRE NASAL SEPTOPLASTY (REALIGNMENT)
CAUSES OF A NASAL FRACTURE
TYPICALLY CAUSED BY TRAUMA
NASAL FRACTURE COMPLICATIONS
EPISTAXIS, AIRWAY OBSTRUCTION, MENINGEAL TEARS, COSMETIC DEFORMITY
CLASSIFICATIONS OF NASAL FRACTURES
UNILATERAL, BILATERAL OR COMPLEX
ASSESSMENTS OF NASAL FRACTURES
ASSESS ABILITY TO BREATH THROUGH EACH NOSTRIL, NOT EDEMA, BLEEDING,
HEMATOMA; MAY BE ECCHYMOSIS UNDER ONE/BOTH EYES ‘RACCOON EYES;
INSPECT FOR SEPTAL DEVIATION, HEMORRHAGE, OR CLEAR DRAINAGE (CHECK CLEAR DRAINAGE FOR CSF)
NASAL FRACTURES NURSING MANAGEMENT
REDUCE EDEMA, PREVENT COMPLICATIONS,
EMOTIONAL SUPPORT; APPLY ICE; MAY REQUIRE SURGERY FOR REALIGNMENT (SEPTOPLASTY, RHINOPLASTY)
NURSING MANAGEMENT: NASAL SURGERY (RHINOPLASTY, SEPTOPLASTY)
• OUTPATIENT PROCEDURE, REGIONAL ANESTHESIA
• INSTRUCT PATIENT TO NOT TAKE ASPIRIN-CONTAINING DRUGS OR NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) FOR 2 WEEKS BEFORE SURGERY.
• TISSUE ADDED OR REMOVED; USE OF PLASTIC IMPLANTS, NOSE LENGTHEN OR SHORTENED
• POST OP: MAY HAVE NASAL SPLINTS AND OR PACKING
• IMMEDIATE POSTOPERATIVE PERIOD INCLUDES ASSESSMENT OF RESPIRATORY STATUS, PAIN MANAGEMENT, AND OBSERVATION OF THE
SURGICAL SITE FOR HEMORRHAGE AND EDEMA.
• TEACHING IS IMPORTANT BECAUSE THE PATIENT MUST BE ABLE TO DETECT COMPLICATIONS AT HOME.
EPISTAXIS
Nosebleed
CAUSES OF EPISTAXIS
TRAUMA, FOREIGN BODIES, NASAL SPRAY ABUSE, STREET DRUG USE, ANATOMICAL MALFORMATION, ALLERGIC RHINITIS, TUMOURS
How does HTN affect epistaxis
HTN IS NOT A CAUSE BUT DOES MAKE CONDITION MORE DIFFICULT TO CONTROL
DRUG CONTRAINDICATIONS
ASPIRIN, NSAIDS, WARFARIN AND CONDITIONS PROLONGING BLEEDING TIME OR ALTERING PLATELET COUNTS PREDISPOSE PATIENTS TO EPISTAXIS
NURSING AND COLLABORATIVE MANAGEMENT: EPISTAXIS
- KEEP THE PATIENT QUIET.
- PLACE THE PATIENT IN A SITTING POSITION, LEANING FORWARD, OR IF NOT POSSIBLE, IN A RECLINING POSITION WITH HEAD AND SHOULDERS ELEVATED.
- APPLY DIRECT PRESSURE BY PINCHING THE ENTIRE SOFT LOWER PORTION OF THE NOSE FOR 10 TO 15 MINUTES.
- APPLY ICE COMPRESSES TO THE FOREHEAD AND HAVE THE PATIENT SUCK ON ICE.
- APPLY DIGITAL PRESSURE IF BLEEDING CONTINUES.
- OBTAIN MEDICAL ASSISTANCE IF BLEEDING DOES NOT STOP.
ALLERGIC RHINITIS
REACTION OF THE NASAL MUCOSA TO ALLERGENS
TYPES ALLERGENS THAT CAUSE ALLERGIC RHINITIS
- SEASONAL: POLLEN – TREES, GRASSES, FLOWERS
* PERENNIAL: PET DANDER, DUST MITES, MOLDS, COCKROACHES
CLINICAL MANIFESTATIONS OF ALLERGIC RHINITIS
- NASAL CONGESTION; SNEEZING; WATERY, ITCHY EYES AND NOSE; ALTERED SENSE OF SMELL; THIN, WATERY NASAL DISCHARGE
- NASAL TURBINATES APPEAR PALE, BOGGY, AND SWOLLEN
- CHRONIC EXPOSURE TO ALLERGENS: HEADACHE, CONGESTION, PRESSURE, POSTNASAL DRIP, NASAL POLYPS
- PATIENT MAY COMPLAIN OF COUGH, HOARSENESS, SNORING, OR RECURRENT NEED TO CLEAR THE THROAT
NURSING AND COLLABORATIVE MANAGEMENT: ALLERGIC RHINITIS
• IDENTIFY AND AVOID TRIGGERS OF ALLERGIC REACTIONS
DRUG THERAPY (TABLE 29-2)
• NASAL SPRAYS, LEUKOTRIENE RECEPTOR ANTAGONISTS (LTRAS), ANTIHISTAMINES, AND DECONGESTANTS TO MANAGE SYMPTOMS
• INTRANASAL CORTICOSTEROID AND CROMOLYN SPRAYS (DECREASE INFLAMMATION LOCALLY)
• PROVIDE INSTRUCTIONS ON PROPER USE OF NASAL INHALERS (THEY CAN CAUSE REBOUND EFFECT FROM PROLONGED USE).
- IMMUNOTHERAPY (“ALLERGY INJECTIONS”) MAY BE USED IF DRUGS ARE NOT TOLERATED OR ARE INEFFECTIVE.
- INVOLVES CONTROLLED EXPOSURE TO SMALL AMOUNTS OF A KNOWN ALLERGEN THROUGH FREQUENT (AT LEAST WEEKLY) INJECTIONS WITH THE GOAL TO DECREASE SENSITIVITY
ACUTE VIRAL RHINITIS
COMMON COLD
ACUTE VIRAL RHINITIS IS CAUSED BY
VIRUSES THAT INVADE THE UPPER RESPIRATORY TRACT; SPREAD BY AIRBORNE DROPLET SPRAYS EMITTED WHILE BREATHING, TALKING, SNEEZING, OR COUGHING OR BY DIRECT HAND CONTACT
RISK FACTORS ACUTE VIRAL RHINITIS
WINTER MONTHS (MORE TIME INDOORS), CHILLING, FATIGUE, EMOTIONAL STRESS, IMMUNOCOMPROMISE
CLINICAL MANIFESTATION OF ACUTE VIRAL RHINITIS
TICKING IRRITATION, SNEEZING OR DRYNESS OF NOSE FOLLOWED BY RHINORRHEA, NASAL CONGESTION, WATERY EYES, ELEVATED TEMPERATURE, HEADACHE, MALAISE
THREE VIRUSES OF INFLUENZA
A, B, C
CLINICAL MANIFESTATIONS OF INFLUENZA
- ONSET ABRUPT; SYSTEMIC SYMPTOMS OF COUGH, FEVER, MYALGIA, HEADACHE, SORE THROAT
- IN UNCOMPLICATED CASES, SYMPTOMS SUBSIDE WITHIN 7 DAYS; OLDER ADULTS MAY EXPERIENCE PERSISTENT WEAKNESS OR LASSITUDE.
MOST COMMON COMPLICATION OF INFLUENZA
PNEMONIA
TREATMENT OF INFLUENZA
- SUPPORTIVE CARE, SYMPTOMS RELIEF – REST, FLUIDS, NUTRITION, ANTIPYRETICS, ANALGESICS
- ANTIVIRALS I.E. TAMIFLU (TO PREVENT OR DECREASE SYMPTOMS)
NURSING AND COLLABORATIVE MANAGEMENT OF INFLUENZA
- HANDWASHING
* INFLUENZA VACCINATION
SINUSITIS IS DUE TO WHAT?
BLOCKAGE OF THE NASAL PASSAGE (INFLAMMATION), SECRETIONS ACCUMULATE – IDEAL ENVIRONMENT FOR THE GROWTH OF VIRUSES, BACTERIA, FUNGI
EXAMPLES OF ACUTE SINUSITIS
URTI, ALLERGIC RHINITIS, SWIMMING, DENTAL MANIPULATION
EXAMPLES OF CHRONIC SINUSITIS
PERSISTENT INFECTION R/T ALLERGIES, NASAL POLYPS
CLINICAL MANIFESTATIONS OF ACUTE SINUSITIS
SIGNIFICANT PAIN, PURULENT NASAL DRAINAGE, NASAL OBSTRUCTION, CONGESTION, FEVER, MALAISE, SINUSES TENDERNESS, HEADACHES, PAIN WITH CHANGE OF POSITION
CLINICAL MANIFESTATIONS OF CHRONIC SINUSITIS
FACIAL PAIN, NASAL CONGESTION, INCREASED DRAINAGE; SEVERE PAIN AND PURULENT DRAINAGE ARE OFTEN ABSENT
• SYMPTOMS MAY MIMIC THOSE SEEN WITH ALLERGIES
• DIFFICULT TO DIAGNOSE BECAUSE SYMPTOMS MAY BE NONSPECIFIC; PATIENT IS RARELY FEBRILE
NURSING AND COLLABORATIVE MANAGEMENT OF SINUSITIS
- ENVIRONMENTAL CONTROL
- APPROPRIATE DRUG THERAPY – ANTIBIOTICS, DECONGESTANTS, NASAL STEROIDS
- PATIENT INTERVENTIONS
• INCREASE FLUID INTAKE
• NASAL CLEANING TECHNIQUES AND IRRIGATION - PERSISTENT COMPLAINTS MAY REQUIRE ENDOSCOPIC SURGERY
TYPES OF SINUSES
- FRONTAL
- ETHMOIDAL
- SPHENOIDAL
- MAXILLARY
TYPES OF OBSTRUCTION OF THE NOSE AND
PARANASAL SINUSES
- POLYPS
- FOREIGN BODIES
POLYPS
BENIGN MUCOUS MEMBRANE MASSES
POLYPS CLINICAL MANIFESTATIONS
NASAL OBSTRUCTION, NASAL DISCHARGE
(USUALLY CLEAR MUCUS), SPEECH DISTORTION
POLYPS TREATMENTS
TOPICAL STEROIDS REDUCE INFLAMMATION; SURGICAL REMOVAL
FOREIGN BODIES OBSTRUCTING THE NOSE OR PARANASAL SINUSES CLINICAL MANIFESTATIONS
- INORGANIC MAY GO UNDETECTED
* ORGANIC PRODUCE LOCAL INFLAMMATION, NASAL DISCHARGE
FOREIGN BODIES OBSTRUCTING THE NOSE OR PARANASAL SINUSES TREATMENTS
SHOULD BE REMOVED THROUGH ROUTE OF ENTRY (SNEEZE WITH OPPOSITE NOSTRIL CLOSED, BLOWING NOSE)
WHAT SHOULD NOT BE DONE WITH FOREIGN BODIES OBSTRUCTING THE NOSE OR PARANASAL SINUSES?
DO NOT IRRIGATE OR PUSH OBJECT UP NOSE (RISK FOR ASPIRATION OR AIRWAY OBSTRUCTION)
ACUTE PHARYNGITIS
- ACUTE INFLAMMATION OF THE PHARYNGEAL WALLS
- MAY INCLUDE TONSILS, PALATE, AND UVULA
- CAN BE CAUSED BY A VIRAL (MOST COMMON), BACTERIAL (“STREP THROAT”), OR FUNGAL INFECTION (CANDIDIASIS)
CLINICAL MANIFESTATIONS OF ACUTE PHARYNGITIS
- RANGE FROM “SCRATCHY THROAT” TO SEVERE PAIN
- APPEARANCE NOT ALWAYS DIAGNOSTIC; CULTURES NEEDED
- RED THROAT +/- EXUDATES
- DIFFERENTIATE FROM CANDIDA (WHITE PATCHES)
NURSING AND COLLABORATIVE MANAGEMENT OF ACUTE PHARYNGITIS
- INFECTION CONTROL
- SYMPTOMATIC RELIEF – INCREASED FLUIDS, ANALGESICS, COOL SOFT FOODS, AVOID ACIDIC JUICES
- PREVENTION OF SECONDARY COMPLICATIONS (TREAT BACTERIAL STREP THROAT)
PERITONSILLAR ABSCESS
A COMPLICATION OF ACUTE PHARYNGITIS OR ACUTE TONSILLITIS WHEN BACTERIAL INFECTION INVADES ONE OR BOTH TONSILS
DANGERS OF PERITONSILLAR ABSCESS
TONSILS MAY ENLARGE SUFFICIENTLY TO THREATEN AIRWAY PATENCY
PERITONSILLAR ABSCESS CLINICAL MANIFESTATIONS
PATIENT EXPERIENCES A HIGH FEVER, LEUKOCYTOSIS, AND CHILLS
