Sinusitis, Influenza, H&N cancer, Lung cancer, & Asthma

Sinusitis

• Inflamed Sinus cavities
• Bacterial, viral, fungal
• Follows cold or allergies

Sinusitis Classifications

• Acute
• Subacute
• Chronic

Sinusitis symptoms

Facial pain/pressure, Congestion

Altered taste and smell

Postnasal drip, Fever, Headache

Fatigue, Malaise, Dental pain

Bad breath, Cough, Earache

Sinusitis Symptom Relief

• Decongestants- pseudoephedrine (Sudafed),
corticosteroids-fluticasone (Flonase)

Analgesia, saline spray/Irrigation; antibiotics if Sx worse or greater than 1 week (7-10 day)

Sinusitis Patient/caregiver education

• Rest, hydration, humidifier, warm compresses, HOB ^, Rx; No smoking
• Reduce allergen exposure
• Chronic, persistent, recurrent sinusitis

Influenza (Viral-Droplet)

• Compromises alveolar function
• Highly contagious; increased morbidity and mortality
• Epidemic: October to April
• Serotypes (A, B, C, D)
• A subtypes: H and N antigens (H1 N1)

Influenza A—most common and virulent

• Mutated—no immunity
• Pandemics (worldwide)
• Epidemics (localized)

-Incubation 1-4 days

Influenza Risk

• Indigenous
• < 5 yr
• Pregnancy
• Immunocompromised
• Chronic conditions

Influenza Manifestations

-Sudden onset— 7 days: (FACTS)fever aches cough tiredness

• Diagnostic Studies
• H and P, prevalence in community
• Viral cultures
• Rapid influenza diagnostic tests (RIDTs)

Influenza Complications

Pneumonia, Ear/Sinus infections;

Older adults—weak, lethargic

Flu Prevention

Vaccine

Inactivated (Egg)/Live Attenuated

2 wks for antibody production

Those greater than 6 months and high risk

Head & Neck Cancer

• Etiology: Smoking –#1
• Age: over age of 50
• Risk- HPV
• Excess alcohol
• Radiation
• Poor oral hygiene

Head & Neck Cancer Manifestations

Lump/sore throat (pharyngeal)
(leukoplakia & erythroplakia)
Changing voice, hoarseness > 2 weeks (laryngeal)
Ear pain, tinnitus, lump in neck, constant cough, Hemoptysis, swollen jaw

Head & Neck Cancer Late signs

Weight loss; difficult chewing, swallowing, moving tongue/jaw, or breathing; airway obstruction (partial or full)

Head & Neck Cancer Surgery Types

Partial or total laryngectomy,

Neck dissection (Radical, Modified, or Selective)

—-Life changing appearance

—-Reconstructive

—-Body dysmorphia

Head & Neck Cancer Radiation, Chemo and Targeted

External beam or internal implants

C&T- Used in combination with radiation for stages III or IV

Nutritional therapy H&N Cancer

Concerns with swallowing after surgery,

Side effects of chemotherapy/radiation

Oral mucositis; gastrostomy tube and enteral feedings;

Assess tolerance, weight, Aspiration

Speech therapy H&N Cancer

• Preoperative: effect of therapy on voice and potential adaptations or restoration; support groups
• Postoperative restoration: electrolarynx, *transesophageal puncture, esophageal speech

Post Laryngectomy Airway

PRIMARY CONCERN immediately postop, Humidified O2 to moisten mucous membranes

Post Laryngectomy Positioning

Semi-Fowler’s, all times, limit edema

Prevent suture line tension

Deep breathing

Post Laryngectomy Suctioning

Tracheostomy suctioning due to initial serosanguinous drainage, often copious

Post Laryngectomy Wound Drainage

Jackson-Pratt, Hemovac or both— copious at first,

200 mL/shift not unusual

Keep patent & emptied, recorded

Head & Neck Cancer: Post Laryngectomy Nutrition

Often have NG tube for feedings later

NPO at first

Oral care (infection-pneumonia)

Post Laryngectomy Pain Management

Use previously agreed upon tool to communicate

Visual FACES scale to assess

Lung Cancer Risk

• Smoking-most important risk factor in 80%-90% of all lung cancers; no safe form of tobacco
—Smoking cessation reduces risk
• Pollution
• Asbestos

Lung Cancer Types

• Non-small-cell lung cancer (NSCLC); 82%; SCC,

—Common
• Small-cell lung cancer (SCLC); 14%; Rapid growth; poor prognosis

Lung Cancer Metastasis

Common sites: Lymph nodes, Liver, Brain, Bones, and Adrenal glands (LLBBA)

Lung Cancer Early Manifestations

• Persistent cough with sputum (most common)
• Hemoptysis
• Dyspnea
• Wheezing
• Chest pain

Lung Cancer Late Manifestations

• Anorexia, N/V, fatigue,

—Weight loss (Tumor)
• Hoarseness
• Dysphagia
• Palpable lymph nodes

Lung Cancer Diagnostics

• CXR- not diagnostic
• CT scan
• Lung biopsy-definitive diagnosis
• Pleural fluid analysis
• CBC, Chemistry panel
• Liver/Renal (Metastasis) Pulmonary function tests

Lung Cancer Metastasis Diagnostics

• Bone & CT scans-Brain, Abdomen, Pelvis
• PET scan
• MRI

Lung Cancer Screening Diagnostics

• 30-pack-year hx (Years smoking x pack a day)
• Current smoker
• Quit less than 15 years ago

Lung Cancer Treatment Surgery

• Treatment of choice for NSCLC stages I-IIA; better chance for cure
• Types
-Segmental/Wedge resection
-Lobectomy
-Pneumonectomy

Lung Cancer Treatment Chemo and Immuno

Chemo- Primary Tx for SCLC

Immuno- Boosts immune response against cancer cells, slows growth

Lung Cancer Treatment Radiation

• Curative, palliative, or adjuvant therapy
• For patients can’t tolerate surgery

—Incentive Spirometer- Pneumonia

Asthma Pathophysiology

Airway inflammation = bronchospasm

Asthma Epidemiological Risk Factors

• Linked to tobacco smoke
• Prevalent in developed countries

Asthma- Different Phenotypes

Allergy (Common)

Non-allergy

Aspirin

Exercise (Inhaler prior)

Asthma Nose and Sinus

• Allergic rhinitis
• Chronic sinusitis
• Viral URIs

Asthma Allergens

• Dust mites
• Cockroaches
• Animal dander
• Mold
• Pollen

Asthma Irritants

• Tobacco smoke
• Air pollutants (smoke, exhaust)

Asthma Drugs

-Beta-blockers (Bronchospasm)

-Ace inhibitors (Cough)

-Give Beta Agonists

Asthma Manifestations

Wheezing, cough, dyspnea, chest tightness
• Hyperinflation and prolonged expiration from air trapping in narrowed airways

Asthma Acute Attack

Wheezing most common
• Initially expiration, with progression, inspiration and expiration

Asthma Diagnostics

• Peak expiratory flow rate (PEFR)
• Peak flow meter (Predict attack/monitor severity)
• Allergy testing
• Oximetry; ABGs
• Chest x-ray—rule out other disorders
• Sputum culture and sensitivity
—Rule out bacterial infection

Asthma Diagnostics Spirometry

Volumes and Capacities

• Stop bronchodilators 6 to 12 hours prior (find baseline)
• Reversibility of obstruction following bronchodilator important for diagnosis

Status Asthmaticus Manifestations

• Life threatening episode of severe acute asthma
• Extreme SOB
• Chest tightness
• Confusion- hypoxia
• Cyanosis

Status Asthmaticus Acute Care

• Monitor respiratory and cardiovascular systems
-Lung sounds: Wheezing louder =airflow increases
• HR, rhythm, RR, breathin work, BP
• Pulse oximetry, PEFR, and ABGs
• Give ordered drugs
• Evaluate therapy response; take several days

Asthma Action Plan

• Yellow zone*
• Symptomatic: cough, wheeze, ect.
• OR
• Peak flow 50-79%
• Teach-SABAs, and recheck

Green Zone

Salmeterol, Flovent

No symptoms

Red Zone

Medicines didn’t help

less than 50 %

Hospital

Asthma Bronchodilators

• Short-acting inhaled B2- adrenergic agonists (SABAs)—all patients should have
• Albuterol- Acute Attack
• Inhaled anticholinergics; often used with SABA
• Ipratropium (SAMA)
• Long-acting inhaled or oral B2-adrenergic agonists (LABAs) (maintenance)
• Salmeterol

Asthma Anti-inflammatory Drugs

• IV corticosteroids
• Hydrocortisone (Solu- Cortef)
• Oral/Inhaled corticosteroids (ICS)
• Fluticasone (Flovent)
• Leukotriene modifiers
• Montelukast (Singulair)