Upper Respiratory Problems ( Nose & Paranasal Sinsues ) Flashcards
Problems of the nose and paranasal sinuses
What is deviated septum?
Deflection or shift of the nasal septa
What is the most common cause of a deviated septum?
Tramua
What does deviated septum interfere with? (2)
Interferes with airflow and sinus drainage
What are the minor symptoms of deviated septum? (3)
None
Congestions
Frequent infections
What are the 4 severe symptoms of a deviated septum?
Irritation, Facial pain, nosebleed, obstruction
What is the diagnoses of deviated septum?
Speculum exam
What are the 2 deviated septum treatments?
Decongestants
Analgesia
What is the severe medication/treatment for deviated septum?
Septoplasty
What is a nasal fracture?
Fracture to the nose
What is the most common cause of a nasal fracture? And example?
Tramua
A ball hitting the person face
What are the complications of a nasal fracture?
(5)
Obstruction
Nosebleed
Meningeal tears with CSF leaks
Septal hematoma
Deformity
What is a simple nasal fracture mean?
Little displacement
What is a complex nasal fracture mean? And we want to evaluate for what (3)
Damage to adjacent structures
Evaluate for injury of cervical spine
, Orbital bone, mandible
What are the manifestations of a nasal fracture?(7)
Deformity
Nosebleed
Pain
Crepitus
Swelling
Difficulty breathing through nose
Ecchymosis
What is periorbital ecchymosis? And want to evaluate what?
Raccoon eyes ( black eyes ) ( bilateral )
Evaluate for basilar skull fracture
What’s the most important thing to watch out for in a nasal fracture?
That if they take a hit to the face, the the fluid they leak out is CSF
What is a basilar skull fracture?
Both eyes are like raccoon like, black eyes
How do you want to check for leak of CSF in a nasal fracture?(7)
And it’s called what
If you take a little drop of nasal drainage and put it on a piece of gauze
You’ll see, center is blood
Then get another ring around that it’s yellow, serus color which is the spinal fluid
Blood will stain the middle and
coagulate together
But on the gauze you’ll see this ring around it, which is called a halo sign
And that could indict that the drainage is cerebral spinal fluid
Which means there is a tear in the meningitis
What’s another way you check for cerebral spinal fluid leak other than on the gauze?
Bedside Glucose stick/test
Which would register that there glucose present at a higher rate
Which indicates it’s CSF
What are tools we can use to help straighten the nose after a nasal fracture?(2 names )
Ash forceps
Walsham forceps
When a patient has a nasal fracture what position do you want the patient to be in? And why?
Sitting up because you don’t want them to swallow that blood which could eventually make them vomit
The patient sits up right for a nasal fracture, what’s another thing the nurse will instruct the patient to do?(2)
Pinch their nose together and apply ice
What are the 3 nursing care for a nasal fracture?
Patent airway
Prevent complications
Emotional support
We want to prevent 3 things to a nasal fracture, what are they?
Bleeding
Edema
Pain
How will we help a patient prevent bleeding, edema, pain for a nasal fracture?(6) we will tell the patient to? And give what?
Sit upright
Ice
Acetaminophen
Decongestants
Nasal spray ( saline spray)
Humidifier
We want to tell our patient to avoid what when having a nasal fracture? (3)
Avoid hot showers
Alcohol
Smoking
What is the best case scenario for a nasal fracture?
Realignment
( close reduction )
If a closed reduction realignment isn’t available for the patient, what is the next best thing for a patient with a nasal fracture ? And 2 examples
Open reduction
Septoplasty
Rhinoplasty
What is a Septoplasty for nasal fracture?
Correct deviated septum
When having a Septoplasty for a nasal fracture we want to watch out for what? And means what?
Septal hematoma
Deformity and infection
What does rhinoplasty mean for nasal fracture? (2)
Surgical reconstruction of nose to open airway or for cosmetic reasons
( outpatient procedure )
When getting a rhinoplasty, we should consider 3 things after it? Not all rhinoplasty are for surgery it could be for?
Body image considerations
Digital photo - projected appearance
Post op- nasal packing and splint
Rhinoplasty isn’t always for the glamor and the beauty, it’s could also be for ?
Which can effect a patients (3)
Being able to breathe properly
Which can effect patient sleep, constant drainage and sinuses infections
Before nasal surgery, most surgery, we are going to teach our patient to avoid what two drugs & what cessation?
Aspirin & NSAIDS
Smoking
Aspirin can increase _____
NSAIDS can reduce _____ ( which means)
Bleeding time
Platelet aggregation ( which means they won’t be able to clot quite as well )
How long do you want to make sure a patient doesn’t do aspirin or NSAIDS for nasal surgery for a nasal fracture?
5 days to 2 weeks
Nasal surgery post op, what do we follow ? (4)
Maintain patent airway
Monitor respiratory status/airway obstruction
Pain management
Observe for edema, bleeding, infection
Patient teaching for a nasal surgery
We want to manage 3 things, what are they? And how will we do this?
Manage edema
Bruising
Pain
Cold compresses & elevate HOB ( head of the bed )
Patient teaching for nasal surgery we want to prevent what? (2)
Bleeding and injury
We want to tell a patient to avoid doing these 4 activities for a nasal surgery
Nose blowing
Swimming
Heavy lifting
Strenuous exercises
We should inform a patient about nasal surgery of how long it’ll take to fully heal, which is?
May last one full year
Another thing to mention to a patient who had nasal surgery is that you don’t want them to nose blow, swim, heavy lift, or strenounius exercise but also ? (3)
Sneeze with mouth open
Reduce coughing
Not bending over
What is epistaxis mean?
Nosebleed
What are the causes of epistaxis ? Examples?
There are too many causes
Hitting your nose
Picking your nose
Allergies
Heat
We want the patient who is having epistaxis to?
(5 steps )
And how long ?
Sit posting
Lean forward
Head tilt forward
Direct pressure/squeeze lower part of nose
For 5-15mins
There is a myth that when a patient has epistaxis, they should tilt there head back? But why is this not it anymore?
Because we want to monitor how much blood comes out and for how long it’s bleeding for
( Tipping your head back into the stomach and may not realize how much blood is coming out)
People get very nervous for epistaxis because it is a lot of blood but most of the times its ? And doesn’t effect?
Insufficient and doesn’t the person hemocrit or blood loss
If squeezing the nose for epistaxis doesn’t work, you can also ? And how does that work? ( using what?)
Nasal pack it
Gauze like material, nasal tampon
Most of the time it’s a matter of one blood vessel that burst, usually you can see it from looking up the nose, so it’s important to tell parents to? (2)
Apply vaseline on a Q-tip
Saline spray to help close up the little vessel
What are the 3 epistaxis medical managements ?
Pledget with anesthetic or vasoconstrictor
Absorbable packing/sponges ; balloon
Chemical or thermal cauterization ; embolization
What are the 3 things for nursing care of epistaxis?
- Monitor respiratory status
( LOC, VS, pulse ox, dyspnea, ( diffcult breathing )dysphasia(diffcult swallowing ) - Administer analgesia & Angibiotics
- pre-medicate before removal of packing
What are the 5 things to tell a patient who is having epistaxis ? Patient education
And for how long?
Humidifier or nasal spray
Sneeze with mouth open
Avoid aspirin and NSAIDS
Avoid virgous nose blowing
Strenuous activity ( Lifting or Straining)
For 4-6 weeks
You may want to give antibiotics to epistaxis because of? But typically you ?
Infection ( from a sinus infection )
Typically you don’t need to
What is allergic rhinitis?
Seasonal allergies
( hay fever )
What are the manifestations of allergic rhinitis? (6)
Sneezing
Water/itching eyes and nose
Congestions
Decresed smell
Thin watery nasal drainage
Pale, boggy, swollen turbinates
What are the chronic manifestations of allergic rhinitis? (4)
( what is the last one cause due to?)
Headache
Nasal congestion
Sinus pressure
Hoarseness ; cough due to nasal polyps & post nasal drip
Allergic rhinitis have frequent symptoms which ranges from 3 things? And what do they mean?
Episodic - sporadic exposure
Intermittent - less than 4 days/week or less than 4 weeks/year
Persistent - greater than 4 days/ week or greater than 4 weeks/ year
Allergic rhinitis can depend on the area and ?(2)
Pollen
People
Allergic rhinitis can be differentiated from a cold due to and happenes?
Not having a fever
Happens year after a year
What is the management for allergic rhinitis (2)
Identify and avoid triggers
Reduce inflammation and symptoms
What are the 3 ways to reduce inflammation and symptoms of allergic rhinitis?
Corticosteroids : nasal or oral
Antihistamine : decongestants ; LTRA’s
Immunotherapy : allergy shot
What is the gold, or example of corticosteroids for helping aid a patient with allergic rhinitis?
Flonase nasal spray
example of antihistamines for helping aid a patient with allergic rhinitis?
(3)
Claritin & zyrtec during the day that’s nondrowsy
Really bad use
Benadryl
example of immunotherapy for helping aid a patient with allergic rhinitis?
Allergy shots
What do we want to educated patients on who has allergic rhinitis?
Medications
Such as the ones we previous mention
What is acute viral rhinopharynigitis?
The common cold
How many viruses are out there for the acute viral rhinopharynigitis? And example?
Over 200
Coronavirus
Acute viral rhinopharynigits is what? And can travel through?(2)
Is contagious
Airborne droplets or contact
Acute viral rhinopharynigits happens most often during which type of months?
Winter months
Usually acute viral rhinopharynigits happens to kids when they are in?
Close contact
Acute viral rhinopharynigits is also influenced by? (4)
Fatigue
Stress
Allergies
Altered immune system
What are the symptoms/Clincal manifestations of acute viral rhinopharynigits ? (9)
Runny nose
Watery eyes
Nasal congestions
Sneezing
Coughing
Sore throat
Fever
Headache
Fatigue
Symptoms of acute viral rhinopharynigits don’t start showing until ?
2 to 3 days after infection
How long does it take to recover after getting acute viral rhinopharynigits?
7-10 days
Do we use antibiotics on acute viral rhinopharynigits ? And why?
No we don’t
Because it’s a virus
How do we want to treat acute viral rhinopharynigits ? We want to use what?
Over the counter supportive therapy
What are some examples of Over the counter supportive therapy to help aid patients with acute viral rhinopharynigits? (3)
Tyneol
Moltren
NyQuil
Additional information about acute viral rhinopharynigits, we don’t want to tell our patients to take too many over the counter medications because other medications may have other things in it. What are examples of medications you don’t want to mix?
Tyneol and NyQuil
The Influenza virus is what? And has an increase of what (2)
Highly contagious
Morbidity & mortality
What are the peak season of influenza virus?
December to February
What are the 4 classified by seeotypes of influenza virus?
A b c d
What are the 2 A subtypes of influenza virus?
H and N antigens (H1 N1)
What type of influenza virus is the most common and virulent?
Influenza A
Influenza virus, mutated viruses means?
No immunity
What does pandemics mean?
Worldwide spread
What does epidemic means?
Localized outbreak
What is the transmission of influenza virus?
Infected droplets
Influenza has what type of onset ?
Abrupt onset
What does abrupt onset mean for influenza virus? ( sudden thing ) and how long? (7 things to mention )
7 days
Chills
Fever
Myalgia ( body aches )
Headache
Cough
sore throat
fatigue
What are the complications of influenza virus? (2)
Pneumonia
Ear or sinus infections
What are the older adults complication for influenza virus? (2)
Weak and lethargic
What is the treatment for influenza virus? And what does it do?
And side effects
Tamiflu
( antiviral medication, it reduces the amount of days you have the flu & reduce the symptoms )
( Nausea )
What is rhinosinusitis?
Inflammation of sinus mucosa results in blockage and accumulated secretions
( constantly congested, sits in your sinus )
Rhinosinusitis usually start as viral infections but if it sits there for too long it can turn into what? And caused what?
A bacterial infection or fungal infection
Causes pain if you tap on their sinus
( bruise on their face )
Rhinosinusitis can be classified as what 3 things?
Acute
Subacute
Chronic
What are the acute manifestations of rhinosinusitis?(7)
( PIGGY, PURRS CONTINOUSLY, FOR MIA HAZY HAT )
Pain/tenderness
Purulent drainage
Congestion
Fever
Malaise - discomfort
Headaches
Halitosis - bad breath
What are the chronic manifestations of rhinosinusitis?(3)
Facial or dental pain
Congestion
Increased drainage
What are the 3 diagnostic studies of rhinosinusitis?
X-ray
CT scan
Nasal endoscopy
How do we manage or symptom relief for our patient who had rhinosinusitis?(5)
(DECON CAUSES ANA SPAMS IRREGULARLY )
Decongestant
Corticosteroids - help inflammation
Analgesia
Saline spray
Irrigation
For rhinosinusitis if the symptoms get worse, we might want to give what if it’s worse and greater than 1 week?
Antibiotics
Patient caregiver/education for rhinosinusitis
We want to tell the patient to? (9)
Hot showers
Rest
Hydration
Humidifier
Warm compresses
HOB -^ ( elevate head of bed )
Meds as prescribed
No smoking
Reduce exposure to allergens
We want to mobilize the secretions for rhinosinusitis because if they aren’t sitting there they aren’t? ( what procedure )
Causing infections
Nasal rinses
Antibiotics examples of rhinosinusitis ?
Namoxacillin
Obstruction of the nose and sinuses can be from what? (2)
Nasal polyps
Foreign bodies ( inorganic or organic )
What is a nasal polyps?
Benign growth related to chronic inflammation
What is a large polyps ? (3)
Obstruction, discharge, and speech distortion
What is the treatment of obstruction of nose and sinuses ? Like polyps? (3)
Corticosteroids
Endoscopic
Laser surgery
When it comes to obstruction of nose and sinuses, usually we’ll see what?
Drainage from one side, the side that has something in it usually
What are the clinical manifestation of obstruction of nose and sinuses? (3)
Pain
Bleeding
Difficult breathing
What is the treatment of obstruction of nose and sinuses? And how?
Removal
Through rinses or taking it out manually
Normally I’d they have a cold, it comes out of both sides but if it comes out of one side and it’s foul smelling you might suspect what?
A foreign body, obstruction of nose and sinuses
