Upper Respiratory Tract Disorders Flashcards
What are the most common causes of illness?
Upper Respiratory Tract Infections
Most Upper Respiratory Infections are what kind of infections?
Viral Infections
Upper Respiratory Tract Infections
Group of disorders characterized by inflammation and irritation of the mucous membranes of the nose and maybe eyes
-Acute or chronic
Rhinitis
the most frequent viral infection - common cold
S/S Rhinitis
- Rhinorrhea
- Nasal Congestion
- Nasal discharge
- Headache
- General malaise, low grade fever, chills, and muscle aches
Risk Factors for Rhinitis
- highly contagious
- Adults avg 2-4 colds/year
- Adult women are more susceptible
What is the most common treatment for Rhinitis?
Antihistamines
Side effects of Antihistamines
Sedation, dry mouth, GI upset, cardiac arrhythmias
What patients must be cautious w/ taking antihistamines?
Patients w/ asthma, urinary retention, hypertension, open-ended glaucoma, BPH
What other medications can be used to help w/ Rhinitis?
- Nasal spray
- Expectorants
- Herbal medications
- Bacterial infections may need antibiotics
How much fluids should the patient be encouraged to drink?
2-3 L
Who should not be encouraged to increase fluid intake?
Patients w/ kidney problems, CHF, or pulmonary edema
Rhinosinusitis = Sinusitis
Classified as Acute Bacterial or Viral rhinosinusitis
- Acute < 4 weeks
- Chronic >12 weeks
When is Rhinosinusitis considered recurrent?
3 or more episodes in 1 year
S/S of Rhinosinusitis
- Purulent Nasal Drainage
- Drainage
- Cough
- Chronic hoarseness
- Chronic headaches
- Hyposmia
Goals for Rhinosinusitis
Treat infection, shrink the nasal mucosa and relieve pain
Nursing Management for Rhinosinusitis
- Adequate hydration
- Steam inhalation 20-30 mins tid
- Saline irrigation
- Avoid smoking
- Medications (Amoxicillin-Doxycycline)
Pharyngitis
Inflammation of the pharynx involving the back portion of the tongue, soft palate, and tonsils
-Acute or chronic
Who is more likely to develop pharyngitis?
< 25 years old
ages 5-15
teachers, singers, alcoholics
S/S of Pharyngitis
- fiery-red pharyngeal membrane and tonsils
- tonsils are swollen and flecked w/ white-purple exudate
- NO cough
- Tender cervical lymph nodes
- Fever > 100.4, malaise, sore throat, vomiting, anorexia
What 2 diagnostic tests may be used for pharyngitis?
RADT- rapid antigen detecting testing
STCX- strep culture
RADT
Ask the patient to open their mouth, tilt head back, stick out tongue, then take qtip around the back of the throat and around the tonsils
-may gag/vomit
Bacterial Pharyngitis Medications
- Penicillin (Choice treatment)
- Nasal congestion = meds w/ ephedrine sulfate
- Aspirin/acetaminophen for anti-inflammatory/analgesic
Laryngitis Causes
voice abuse or exposure to dust, chemicals, smoke, pollutants, or viruses that cause the common cold
Laryngitis may be associated w/?
exposure to sudden temperature changes
dietary deficiencies
malnutrition
immunosuppressed state
What is a patient likely to have w/ laryngitis?
Pharyngitis
S/S Laryngitis
- Aphonia- complete loss of voice
- Hoarseness
- Dry cough
- Tickle in throat
- Pain in throat worse in the morning
Nursing Management of Laryngitis
- Resting the voice
- Avoid irritants
- Hydration
- Avoid decongestants
- Bacterial = antibiotics
Obstructive Sleep Apnea (OSA)
Cessation of breathing during sleep, usually caused by repetitive upper airway obstruction
What characterizes OSA?
Recurrent episodes of upper airway obstruction and reduction in ventilation
What has to happen to be diagnosed w/ OSA?
the presence of at least 5 obstructive events per hour during sleep
Repetitive Apneic Events result in what?
hypoxia and hypercapnia which triggers a SNS response
Risk Factors for OSA
- Older/overweight women
- Postmenopausal and overweight women
- Obesity around the neck that narrows and compresses the upper airway
Manifestations of OSA
- Frequent and loud snoring w/ breathing cessation for 10 seconds or longer
- Minimum of 5 episodes per hour
- Followed by waking abruptly w/ a loud snort as the blood oxygen levels decrease
Classic S/S of OSA
- excessive daytime sleepiness
- frequent nocturnal wakening
- insomnia
- loud snoring
- morning headaches
- personality changes
- arrhythmias
- enuresis
What is used to diagnose OSA?
- Clinical symptoms
- Polysomnographic findings
Treatment for OSA
- weight loss
- avoidance of alcohol
- avoidance of hypnotics/sedatives
- oral appliances to reposition the mandible/tongue
- non-invasive positive pressure ventilation
Non-invasive positive pressure ventilation machines
CP AP
BiP AP
CPAP
provides positive pressure to the airways throughout the respiratory cycle, preventing collapse
-leak-proof mask keeps the alveoli open, preventing respiratory failure
Epistaxis (Nosebleeds)
Hemorrhage from the nose, caused by a rupture of tiny, distended vessels in the mucous membranes if any are of the nose
What is the most common site for nose bleeds?
Anterior septum
Risk Factors for Epistaxis
- local infections
- dry nose
- deformities
- inhalation of illicit drugs
- hypertension
- tumor
- coagulopathy
- drugs
What to do when epistaxis occurs?
- Apply direct pressure
- Sit upright w/ head tilted forward
- Pinch soft outer portion of the nose for 5-10 mins continuously
- May need cauterization
- May need to be packed for 48 + hrs
What the nurse monitors w/ epistaxis?
- VS
- Airway
- Avoid vigorous exercise
- Avoid forceful nose bleeds, straining, high altitudes, trauma, etc..
- For re-bleeds that can’t be stopped call 911/ER
Fractures of the Nose
Usually result from direct assault
S/S of Fractured Nose
pain, bleeding, swelling, periorbital ecchymosis, nasal obstruction, deformity
What may clear fluid indicate w/ a fractured nose?
CSF leakage
CSF fluid tests positive for what?
glucose
How to diagnose a fracture?
Careful inspection of the deviations of the bone
-X-rays
What to do for an Uncomplicated fracture
- Analgesics
- Ice
- ENT follow up
What to do for a Complicated fracture
- Reduction ASAP
- Drainage of hematoma
- Antibiotics
Pneumonia
Infection of the lower respiratory tract caused by a variety of microorganisms
What is the leading cause of death for the elderly and the 8th leading cause of death in the world?
Pneumonia
Four Classifications of Pneumonia
- Community acquired pneumonia (CAP)
- Hospital-acquired and ventilator associated pneumonia (HAP)
- Health Care-associated pneumonia (HCAP)
- Pneumonia in immunocompromised hosts
Community-Acquired Pneumonia
Occurs in either community dwelling person or within first 48 hours after hospitalization/institutionalization
Why would a person w/ CAP need hospitalization?
- altered mental status
- respiratory rate > 30
- low blood pressure
- tachycardia > 125
- fever > 104
- PaO2 < 70
Hospital-Acquired and Ventilator Associated Pneumonia (HAP/VAP)
The onset of pneumonia symptoms more than 48 hours after admission in patients who ahs no evidence of infection at the time of entry
VAP
type of HAP that is associated w/ endotracheal intubation and mechanical ventilation
-occurs after the patient has been on the ventilator for at lest 48 hours
Health-Care Associated Pneumonia (HCAP)
Occurs in non-hospitalized patients who have extensive health care contact
Pneumonia in the Immunocompromised Host
Occurs in patients who use corticosteroids, take chemo, are nutritionally compromised, AIDS, long term life support on mechanical ventilators
Risk Factors for CAP
- Smoking/alcohol
- Altered mental status
- Malnutrition
- Age > 65
- Previous episodes of pneumonia
HAP/VAP Risk Factors
- Malnutrition
- Altered mental status
- Hospital stays > 5 days
- Immunosuppressive therapies/diseases
- Prolonged > 48 hours of intubation/ventilation
S/S of Pneumonia
- Fever
- Cough (productive/nonproductive
- Dyspnea
- Leukocytosis
- Rigors
- Tachypnea
- Use of accessory muscles
- Tachycardia
- Chest pain
- Fatigue
- Anorexia
What is used to diagnose Pneumonia?
- history/physical
- chest x-ray
- blood cultures
- sputum analysis
Pharmacological Treatment for Pneumonia
- Initial treatment is empiric antibiotics unless sputum culture and sensitivity results are available
- Recommended treatment is minimum 5 days
- Afebrile for 2 days before antibiotics are discontinued
- HAP pneumonia is treated for 7-10 days
- Antibiotics are ineffective in viral pneumonia
Oxygen Inhalation Therapy
Administration of oxygen at a concentration > that found in the environment atmosphere
What is the goal of oxygen inhalation therapy?
To prevent or correct hypoxia, which is decreased oxygen supply to the tissues
Signs of Hypoxia
- change in respiratory pattern
- change in mental status
- change in BP and HR
- development of arrhythmias
- diaphoresis
- fatigue, drowsiness
- dyspnea on exertion
- cyanosis
What should be done when administering oxygen?
Oxygen should be moistened by passing through a humidification system to prevent drying of the mucous membranes of the respiratory tract
Low Flow Oxygen
patient breaths some room air along w/ oxygen through NC, simple mask, partial rebreather, and nonrebreather mask
High Flow Oxygen
a specific percentage of oxygen is delivered independent of the patients breathing
-patients who require a constant, precise amount of oxygen through venturi masks, tracheostomy collars, face tents, trans tracheal catheters
Venturi Mask
Most reliable and accurate method for delivering precise concentrations of oxygen
- should fit snugly
- must understand how to convert % of oxygen w/ mask to liters
Liters to Percentages
1 L/min = 24%
2 L/min = 28%
3 L/min = 32%
4 L/min = 36%
What can be done to support the recovery from pneumonia?
- hydration
- antipyretics
- nutritional assessment
- DVT prophylaxis
What can be done to prevent Pneumonia?
Pneumococcal vaccination has been demonstrated to prevent pneumonia in otherwise healthy populations by 90%
Who should receive a pneumonia vaccine?
- Anyone 2-64 w/ chronic disease
- immunocompromised
- > 65 years old
- Smokers w/ asthma 19-64
How often should the vaccine be repeated if it was given prior to age 65?
every 5 years
