Human Needs - Upper respiratory Problems

assessing nasal fractures

• assess for complications

  • periorbital bruising (racoon eyes)—>suggest basilar fracture and increased risk of CSF leak (clear/pink tinged persistent drainage)

    • check with urine dipstick

    • see frequent swallowing/ nasal drip/ co persistent HA/ halo —> test

    • avoid any movements that increase ICP (bending/coughing)

care for nasal fractures

1. airway (prevent complications- keep pt upright esp w/ bleeding)

• apply ice for 20 min intervals (vasoconstriction)

• treat pain (avoid NSAIDS, they increase bleeding)

• dont blow nose

• use nasal spray and humidifiers

• no hot showers/ alcohol for first 48 hour (will cause vasodilation)

nasal surgery pre-op

pre-op

• avoid aspirin and NSAIDs 5 days-2 weeks

• stop smoking

post-op

• maintain airway

• pain management

• monitor: respiratory status and airway obstruction

• !!observe for : edema / bleeding / infection

patient teaching: nasal surgery

manage edema/ bruising / pain

• cold compress and elevate HOB

prevent bleeding/ injury

• no nose blowing/ swimming/ heavy lifting

epistaxis/ nose bleed : interventions

ABC

• put pt in sitting position, lean forward and hold pressure

  • doesnt stop in 15 min —> get help!!

• do not tilt head back it will cause the blood to spill back in= bad

epistaxis/ nose bleed : patient teaching

• humidifier or nasal spray ( moist)

• sneeze with mouth open (dont increase ICP)

• no aspirin/nsaids

• no vigorous nose blowing/ strenuous activity/ straining 4-6 weeks

Allergic Rhinitis Management

identify and avoid triggers

avoid smoke

• house dust: focus on bedroom (carpet, pillows, bed), blinds, airfiter

Acute Viral Rhinopharyngitis / URI/ common cold management

supportive care- Abx not first line (its viral not bacterial)

• monitor/teach to report 2ndary infection or worsening symptoms (ex-pain with tapping on sinuses)

  • now you qualify for Abx

• pt with chronic disease — report sputum changes/ SOB/ tight chest (may need to increase maintenance meds- COPD/asthma)

• encourage rest/fluids/antipyretics/analgesics

• avoid; crowds/ sick ppl and use good hand hygiene

Influenza management

• preventative: vaccine “active artificial immunization”

  • inactivated: shot, >6 mo, safe in non healthy/ pregnancy

  • live attenuated: nasal spray, 2-49y/o, only safe in health ppl/ non pregnant

  • takes 2 weeks for antibody production so get in sept/oct

  • advocate vaccine for those >6 mo and HIGH risk ppl (LT carm pts)

• symptom relief and prevent secondary infection (rest/fluids/antipyretics/analgesics)

• antivirals: shorten duration of symptoms and decrease risk of complications

  • oseltamivir

sinusitis management

!!report a temp of 100.4 or higher —> indicates secondary infection

• rest / fluids / hydrate

• humidifier/ warm compress

• increase HOB

• no smoking

• rinse sinuses

Managing Acute Pharyngitis

• warm salt water gargle

• non irritating liquids (increase intake)

• lozenges

• humidifier

• avoid citrus

• analgesia

acute laryngitis treatment

• limit use of voice (no whispering)

• no caffeine/ alcohol/ smoking

• last > 3 weeks —> see HCP

  • possibly worried about cancer

Airway Obstruction s/s

partial or complete

• use of accessory muscles

• suprasternal /intercostal retractions

• nasal flaring

• choking

• stridor

Airway Obstruction Interventions

!!immediate assessment —> brain damage or death in 3-5 min

• cric

• heimlich maneuvar

• endotracheal intubation

partial/recurrent symptoms — laryngoscopy/bronchoscopy

Head and Neck Cancer (data)

heath hx

• prolonged tobacco/ alcohol use

• prolonged OTC meds for sore throat/ decongestants (INVESTIGATE!!)

• HPV

S/S

• hoarseness

• change in voice quality

• white/ red patches in mouth

Patient education with Head & Neck Cancer

• avoid tobacco and excessive alcohol use

• HPV vaccine at 11-13 y/o

• good oral hygiene and safe sex

• adequate nutrition

acute bronchitis assessment

• crackles and wheezes

• chest x-ray= normal (abnormal in pneumonia)

• mostly caused by viruses

acute bronchitis treatment

symptom relief and prevent pneumonia

• avoid irritants (citrus/spicy)

• fluids

• humidifiers/ lozenges

• hot tea/ honey

!!see HCP if fever / dyspnea or last longer than 4 weeks!!

!!Respiratory Care/ Hygiene Measures!!

• wash hands often to prevent and avoid spreading

• get T dap / pneumococcal / COVID/ flu vaccine as directed by HCP

• avoid smoking and exposure to environmental smoke

• wear proper PPE when working with prolonged dust/fumes/gases

• avoid exposure to allergens/ indoor/ ambient air pollutants

pneumonia (health information)

health history

• COPD/ DM / malnutrition/ immunosuppresion/ exposure to dust and allergens/ recent surgery

use of med (ASK IF THEY TAKE NAY OF THESE)

• corticosteroids

• chemo

• immunosuppresion

pneumonia symptoms

• decreased appetite (anorexia)

• N/V/chills

• pain with breathing

• fever/ restlessness

• crackles

• use of accessory muscles

• tachycardia

!!exposure the chest wall!! take clothes off and watch front/back of wall

take culture in AM (abnormal chest x ray)

acute care/Management of Pneumonia

• postural drainage / chest percussion/ vibration

• collaborate with PT/OT (ROM exercises and assist with EARLY ambulation— goal is to get them up fast !!)

• oxygen/ hydration/ nutrition/ pain meds

monitor

• ability to cough effectively

• presence of fatigue

• increased WOB

encourage pt to cough / deep breathe / use incentive spirometer

prevent aspiration pneumonia

• side lying and elevate HOB and sit up for meals

• assess gag reflex (tongue depressor/yanker) and gastric residuals/ reflux

• 2x/day oral hygiene w/ chlorex swabs

Pneumonia Patient teaching for at home care

• take full course Abx

• rest/ hydration

• not alcohol or smoking

• cold mist humidifiers / warm bath

• takes several or more weeks to recover

• teach about vaccination (its okay to get flu and pneumonia vaccine the same day)

Post NG/OG insertion

prevent aspiration pneumonia cause by NG/OG tube!!!

• check position before administering / flushing (check with x-ray)

• never use IV pump to give enteral nutrition (use kangaroo pump)

• make sure tube is secured to patient

Tuberculosis (history and symptoms)

health history

• ask pt about any previous hx of TB/ chronic illness/ immunosuppression disease/meds (HIV/AIDS)

• social and occupational risk factors

symptoms

• productive cough (collect sputum in AM)

• night sweats

• unexplained weight loss

Tuberculosis Health Promotion

selective screening programs detect TB in HIGH risk groups

• positive results—> chest x ray to assess active TB (48 hr to read test)

Tb is reportable to puble health authorities

Tuberculosis Acute Care

those strongly expected

1. airborne precautions

• single occupancy room with 6-12 airflow exchanges/hr

• negative pressure/ N95 mask —> visitors arent fitted so they just get surgical mask and pts get them if they leave room)

2. chest x ray and sputum culture

3. drug therapy

teach pt to prevent spread

• cover nose/mouth with tissue and dispose

• hand wash after contact with sputum soiled tissue

• pt wears face mask if outside of room (surgical)

Tuberculosis (ambulatory care)

• may go home even with positive cultures if their household contact have been already exposed and pt is not at risk to other

• 3 consecutive negative cultures= NON infectious

• teach pt how to minimize exposure to others

• directly observed therapy- DOT

• teach symptom of recurrence factors that could reactive TB

Lung Abscess Management

• monitor signs of hypoxemia / respiratory distress—> apply oxygen

• teach effective coughing

  • chest PT not recommended for pt with lung abscess —> do not want to percuss

  • rest/fluids/nutrition

  • encourage good dental hygiene

atelectasis

• prevent with deep breathing exercises/ incentive spirometry / early mobility

pleurisy

• treat underlying cause and pain management

• teach pt to splint while coughing

  • increase patient to in engage , etc

  • gives support and helps decrease pressure/ tension on suture line

pleural effusion

• treat underlying cause

• chest tubes

• thoracentesis

chest trauma (blunt v penetrating)

blunt

• MVV/trauma

• shearing and compression injuries

• external appearance may be minor but may have several internal organ damage

penetrating

• knife

• foreign object impales or passes thru body tissues creating an open wound

• stabilize object- DO NOT REMOVE

Monitoring for chest trauma

assess for respiratory distress

• dyspnea and cyanosis

• audible air escaping from wound

• tracheal deviation (emergency—> call for help)

• decreased breath sounds

• frothy secretions

• decreased oxygen

assess for CV compromise (you can have a CV arrest d/t respiratory arrest)

• rapid/ thready increase HR

• changes in BP

• distended neck veins

• muffled heart sounds / dysrhythmias

assess for visual injuries

• asymmetric chest wall movement

• contusions

• lacerations

initial intervention for chest trauma

ABC- O2 >90% / IV

• expose the chest wall

• cover sucking chest wound with a vented dressing —> allows blood and oxygen to escape but cant enter back in

• stabilize object but dont remove it

• rule out c spine injury

• prepare for emergency needle decompression if tension pneumothorax or cardiac tamponade

C spine precautions

• collar: immobilizes head/neck

• backboard

• log roll— prevents flexion or extension of neck

• CT scan to clear C spine precautions

ongoing monitoring for chest trauma

• VS/ LOC/ Oxygen / HR/ RR/ OUP

• prepare for possible intubation d/t respiratory distress

Types of Pneumothorax

• spontaneous

• iatrogenic (accident, usually caused by surgery)

• tension (air enters but cant escape)

• hemothorax (blood)

symptoms of Tension Pneumothorax

• cyanosis

• agitation

• air hunger

• SQ emphysema

• medistinum shift (late sign)

• tracheal deviation (call HCP!!)

Treatment of Pneumothorax

• needle decompression followed by a chest tube (allows air to escape)

• clamping/milking/ striping increases risk of a pneumothorax

• dont clamp/milk/strip

Pulmonary Edema (causes & initial interventions)

causes

• over hydration with IV fluids

  • change in lung sounds = concern for pulmonary edema when giving IV fluids

initial intervention

1. semi or high fowlers

2. oxygen and diuretics

Pulmonary Embolism (PE) key symptoms

• sudden dyspnea

• hypotension

• impending doom

Pulmonary Embolism (PE) immediate treatment

ABCs

• gentle ambulation is encouraged in pts with acute PE/DVT —- evidence NO longer supports bed rest in semi fowlers

  • pt with PE does NOT have increase risk of death with ambulation

• assess cardiopulmonary status

• give oxygen / IV fluids / Meds

• monitor coagulation therapy

environmental lung diseases

symptoms appear 10-15 years after exposure (hard to trace back to cause)

• lung cancer

Lung cancer data and diagnostic

health hx

• exposure to smoke / carcinogens / pollution / chronic lung diseases

meds

• frequent use of cough meds

• respiratory meds

diagnostic

• lesion on CT

• x ray

• PET scan

• positive sputum culture

Lung Cancer symptoms

• pain (chest/shoulder/arm/bone)— metastasis spreaded

• HA (increase CO2 retention)

• fatigue / cough / dyspnea

• hemoptysis

• confusion/ disorientation

• unsteady gait

Lung Cancer Acute Care

• chest surgery

• teach s/s of recurrence (hemoptysis/ dysphagia/ chest pain/ hoarseness)

patient teaching

• monitor for side effects

• foster coping strategies

• smoking cessation