Upper Respiratory

cdunbar4's version from 2016-09-24 22:39

Nasal Obstruction

Question Answer
deviated septum or nasal fracture caused by?Trauma (septum can also be congenital)
complications of dev. septum/nasal fx?breathing obstruction, edema, dry mucosa, epstaxis, mucus blockage
assessmentpatency of nostrils; edema, bleeding, hematoma, hemorrhage
What to do if edema?edema ↓'s air, put HOB up to prevent aspiration, bronchodilators, corticosteroids, ice
If you see clear fluid?CSF, get lab tested, bedside test asap!
Main goals:reduce edema, prevent complications
Actions:HOB up for 48 hours to ↓swelling; nasal packing (1D); ICE; prepare for setoplasty or rhinoplasty; continue to monitor for infection/sepsis
5 steps to nasal packing for large epistaxis1. keep pt. quiet 2. sitting position (head/shoulders up) 3. direct pressure by pinching soft lower portion of nose for 10-15 min 4. Ice compresses 5. small gauze pad into nostril
If nasal packing is ineffective, what can you do?vasoconstrictor agents, cauterization agents, anterior or posterior packing for 3days

Allergic Rhinitis & Sinusitis (Inflammation & Infx of nose/paranasal sinuses)

Question Answer
Maniscongestion, sneezing, watery/itchy eyes, altered smell, watery discharge, h/a, congestion, pressure, nasal polyps
Symptomatic Tx measures:tylenol
fluidspush them, hot tubs, neti pots, hot tea, etc.
Pharmacology tx: nasal spraysdon't use >3days could cause rebound vasodilation & congestion
Nasal Spray drug namesbeclomethasone, budesonide, ciclesonide, flunisolide, FLUTICASONE (FLONASE), mometasone, triamcinolone
Mast Cell Stabilizer nasal spray namecromolyn spray
leukotriene receptor Antagonists LTRAszafirlukast, montelukast
anticholinergic nasal sprayipratropium bromide
antihistamines 1st generationazatadine, brompheniramine, chlorpheniramine, clemastine, dexchlorpheniramine, diphenhydramine, levocetirizine
antihistamines 2nd generationlortadine, cetirizine, fexofenadine, desloratadine
oral decongestantspseduoephedrine (Sudafed)
Topical nasal spray decongestantoxymetazoline, phenylephrine, azelastine
monitor sputum colorsgreen/yellow and thick moving to thinner and clearer and easier to clear


Question Answer
population group most affectedelderly with underlying heart/lung disease
high risk groups?> or = 50yo; chronic cardiac or pulmonary; hospitalized in previous year; LTC; immunocompromised; pregnancy in 2nd or 3rd trimester during flu season; people on steroids
why are people with chronic bowel or respiratory diseases at high risk?because they are on a lot of steroids with a lot of SE
course of disease starts with a rapid onsetcough, fever, myalgia, h/a, sore throat
if uncomplicated disease will subside withinabout a week
what can the flu lead to?pneumonia→ exacerbated cough & purulent sputum (the worst complication of influenza, treat with antibiotics
Nursing Role: vaccine teachingencourage vaccines, in fall before flu season, 70-90% effective
Does a person with the flu have crackles or the person with pneumonia?pneumonia; give ppl a chance to clear lungs b4 doing assessment, have them cough and inhale and exhale before listening

Pharynx Problems

Question Answer
Acute pharyngitis descriptionacute inflammation of pharyngeal walls
viral (70%); what is bacterial? or fungal?bacterial = strep throat ; fungal = candida
manifestationsscratchy to dysphagia; red & edematous, patchy yellow exudates; white or irregular patches (candida)
why must you treat pharyngitis completely?could lead to rheumatic heart disease
Push fluids, except for what kinds?citrus-can irritate mucosa
Treatmentantibiotics or nystatin (swish & swallow)

Obstructive Sleep Apnea

Question Answer
Mechanism of sleep apnea?tongue & soft palate fall backward & partially or completely obstruct
How long can it last?15-90 seconds
Severe hypoxemia reduced Pa02
hypercapniaincreased PaCO2
More common and elderly
Manifestationsfrequent awakenings, snoring, partner complains, morning H/A (hypercapnia); irritability, male imoptence
Diagnosispolysomnography (during sleep); all systems monitored; must have multiple episodes for dx
Managment: avoid?sedatives & ETOH
management: weight loss, oral appliance to move mandible & tongue forward
CPAPcontinuous forced air
BiPAPforced air during inspiration
Possible surgery includesremove tissue that could facilitate obstruction


Question Answer
Indications to get a tracheostomybypass upper airway obstruction; facilitate removal of secretions; long-term mechanical ventilation
Advantagesless risk of long-term damage to airway;↑ comfort; pt can eat as tube enters lower airway; ↑mobility
why is an inflated cuff used?for pts at RF aspiration or mech ventilation is needed (has to be a specific order)
Max mmHg cuff should be inflated at?20mmHg or 25cm H20
What happens if there is too much pressure inflated into the cuff>compresses tracheal caplillaries which ↓ blood flow= tissue necrosis
Minimal leak techniqueinflate cuff with min amt of air to form seal; then w/d 0.1ml of air; monitor pressure daily as the underlying tissue may dilate over time (irritation) and pt becomes at RF complications of higher pressures
Suctioning principlessterile; pre-oxygenate pt; max is 30 seconds per pass; insert 5-6" w/o suction, stop if resistance; suction during w/d no longer than 15 seconds total
how many passesstry to make it only 2 passess
After first tube change, how often should it be changed?1x/month
Why do you never put the decannulation cap on unless cuff is deflated?It would completely obstruct the airway!
What does the fenestrated tube allow?allows pt to spontaneously breathe through larynx, speak & cough up secretions w tube in place
When is it time for decannulation?When pt. can adequately exchange air & expectorate
Dressing for decannulationstoma closed with tape & covered with occlusive dressing
what should pt be instructed to do when coughing, swallowing or speaking?splint stoma with fingers
how long does it take for tissue to form24-48hrs; opening will close in several days

Head & Neck Cancer

Question Answer
arisis from what type of cellssquamous cell carcinoma
What areas of the head and neck does it include>paranasal sinuses, oral cavity, nasopharynx, oropharynx & larynx.
Age group it is most prevalent in and why?>50 d/t prolonged/excessive use of ETOH & tobacco
Risk factorsno fruits or vegetables in diet; HPV; men are 2x more likely
Clinical manis of oral cavitypainless growth, non-healing ulcer, change in denture fit; citric acid irritation
oro/supra/hypopharynx early symptomsrarely early signs; Dx is later in disease
laryngeal s/shoarseness; change in voice quality; lumps
late symptomspain, dysphagia; ↓ tongue mobility; airway obstruction; thick oral mucosa; leukoplakia; erythroplakia
Staging is based on what 3 thingsT tumor size; N location of nodes involved and M extent of metastasis
Stage Ismall, localized & curable
Stage II-IIIlocally advanced and/or have spread to local lymph nodes
Stage IVusually metastatic and has spread to distant parts of body
CCchemo can be used in conjunction with all other therapies
3 types of extensive surgeries can happentotal laryngectomy; radical neck dissection; modified neck dissection
nutritional therapy (TPN) after surgery, why?after neck surgery pt. may not be able to take meds orally for a short time
Observations to keep in mind with TPNtolerance of feeding; adjust amount, time and formula if n/v, diarrhea or distention occurs
What should you anticipate when patient resumes eating?swallowing problems
Goals for nursing managmentpatent airway; no spread; no therapy-related complications; adequate nut'l intake; ability to communicate; accept body image

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