URI, rsv, CF, acute epiglottitis, mono

Deviated septum

Minor symptoms:

• none, _________, ____________

Congestion, frequent infections

Deviated Septum

Severe s/sx:

• facial pain

• _________

• ___________

Nosebleeds, obstruction

Deviated septum diagnosis

Speculum exam

Deviated septum treatment

Decongestants, analgesia

Severe deviated septum treatment

Nasal septoplasty

Nasal Fracture

Complications:

• obstruction

• Nosebleeds

• _____________

• ______________

• Deformity

meningeal tears with CSF leak, septal hematoma

Nasal fracture diagnosis

H&P

Nasal Fracture Manifestations:

• deformity

• Nosebleeds, pain

• _______

• Swelling

• Difficulty breathing through nose

• _______________

• Periorbital ecchymosis

• CSF leak

Crepitus, ecchymosis

Nasal Fracture

Periorbital ecchymosis——> “raccoon eyes” evaluate for ____________

Basilar skull fracture

Nasal fracture: CSF Leak

___________ persistent drainage, lab confirmation more accurate than bedside gluclose test

Clear or pink

Nasal fracture

• Patent airway; prevent complications; emotional support

• - bleeding, edema, pain —>

  • sit _______, ________, __________, decongestants, nasal spray, humidifier

  • AVOID _________, _________, and smoking

Upright, ice packs 10-20 min, acetaminophen, hot showers, alcohol

Rhinoplasty:

surgical reconstruction of nose to open airway or for cosmetic reasons; outpatient procedure

• Postop: __________, _________

Nasal packing, splint

Nasal surgery PreOp:

• avoid _____ & ______ 5 days to 2 weeks

• Smoking cessation

Aspirin, NSAIDs

Nasal Surgery PostOp:

• maintain patent airway

• Monitor respiratory status/airway obstruction

• ____ management

• Observe for edema, bleeding, infection

Pain

Nasal Surgery

Manage edema, bruising, and pain: __________ and __________

Cold compresses, elevate hob

Genetic disorder , increased mucus production

Also affects Pancreas, biliary tract and reproductive organs

Cystic fibrosis

CF: early manifestations

• ___________ in newborn

• Acute or persistent respiratory symptoms:

  • failure to thrive or _________

  • __________

  • Bronchiectasis

  • Family Hx

Meconium ileus, malnutrition, steatorrhea

CF: adult presentation

• new onset of _______

• _______

• Commonly seen: ____________

- - becomes persistent and produces thick purulent sputum

• with recurring lung infections: bronchiolitis, bronchitis, pneumonia

• _________ (advanced lung disease)

Diabetes, infertility, frequent cough, clubbing

CF: adult

Exacerbations increase in frequency

• increased cough and _______

• ____________

• Decreased lung function

• Eventually results in respiratory failure

Sputum, weight loss

CF: adult: DIOS : Distal intestinal obstruction syndrome

• _____, nausea, vomiting, palpable mass

• Thin, low BMI

• frequent, ____________

RLQ pain, foul smelling stools

CF: adult: delayed puberty

F: menstrual irregularities, amenorrhea, difficult to conceive: most ____________

M: do not make sperm normally

Able to conceive

CF: Complications

• CF- related diabetes

• _____, _____, ______ disease

• Pneumothorax

• Hemoptysis

• Severe: bowel obstruction

Bone, sinus, liver

Late CF complications caused by pulmonary hypertension

Respiratory failure, cor pulmonale

CF diagnostic gold standard

Sweat chloride test

Sweat chloride values > ____ mmol/L is considered positive for CF

60

CF drugs

dornase alpha, hypertonic saline, bronchodilators

CF: pseudomonas infection

• ________ used longer than 6 months decreases exacerbations frequency

• Home O2 for Cor pulmonale or hypoxemia

Azithromycin

CF: airway clearance techniques (ACTs) to loosen mucus

Do before meals

CPT

CF

Replace _____ losses

Observe for dehydration

Pancreatic enzyme replacement therapy

Aerobic exercise for clearing airways

Salt

RSV transmission

Direct or close contact

T or F

RSV seen more frequent in breastfed infants

F, less

RSV risk factors

• __________

• Crowded conditions

• Daycare settings

Premature infants

RSV diagnostics

Direct fluorescent antibody staining, ELISA

Initial RSV assessment findings

• ______

• _______

• Coughing, sneezing

• Wheezing

• Possible ____________

• Intermittent fever

Rhinorrhea, pharyngitis, ear or eye drainage

RSV progressive assessment

• increased coughing and wheezing

• ________

• Tachypnea and ________

• ____________

• Copious secretions

Fever, retractions, refusal to feed

RSV severe illness

• Tachypnea, greater than ___ breaths/min

• Listlessness (lacking energy)

• __________

• Altered air exchange (retractions, crackles)

• _______________

70, apneic spells, diminished breath sounds

RSV → hospitalization d/t ARDS

• ______ , lethargy, dehydration, apnea, or hypoxemia

• Caregiver inability to provide adequate care

• Treated __________and mechanical vent (CPAP, BiPAP, intubation)

Poor feeding, heated high flow NC

RSV therapeutic management

• _________ before feeding

• IV/NG fluids replacement

• ___________ oxygen

• Noninvasive oxygen monitoring

• Blood gas values

Suction, cool humidified

RSV medications

• 3% nebulized________________

• __________

• Coexisting infection → anbx

• _________ to high risk infants

Hypertonic, corticosteroids, palvizumab

RSV: **medication** inhaled antiviral agent (synthetic nucleoside analog)

Ribavirin

Ribavirin

• ONLY for hospital use (TOXIC)

• high risk infants younger than 6 months

• Special precautions include : _______, _________

• ______ ________ personnel involved

Mask, goggles, no pregnant

RSV isolation and room

Droplet, separate

RSV client education

• encourage breastfeeding

• Avoid _________ exposure

• Preventative measures (hand hygiene)

• Parents taught :

  • how to instill normal saline drops into the nares

  • Suction with bulb syringe before feedings and before bedtime

  • Offer small amounts of fluids (______ml) with med syringe Q10minutes

Passive tobacco smoke, 5-10ml

Infectious mononucleosis transmitted by

Direct contact, blood transfusion, transplantation

Infectious mononucleosis: Diagnostics

• H&P

• _____

• _______

Monospot, IgM antibody test

Infectious mononucleosis: assessment

• __________

• _________

• Malaise

• Fatigue

• Chills

• __________

• Loss of appetite

• Puffy eyes

Headache, epistaxis, low grade fever

Infectious mononucleosis: progression assessment:

Fever, sore throat, cervical adenopathy

Infectious mononucleosis: common features

• ___________

• Palatine petechiae

• Macular eruption (esp. on trunk)

• Exudative pharyngitis or __________

• __________

Splenomegaly, tonsillitis, jaundice

Infectious mononucleosis: therapeutic management: NO SPECIFIC TREATMENT AVAIL,

• analgesic

• Rest

• Adequate fluid intake

• ___________

Corticosteroids

Infectious mononucleosis: Nursing Care

• avoid ampicillin, amoxicillin

• Avoid ______________________

• ______________ until several months after recovery

• gargles , liquid med, warm drinks for sore throat

• Monitor for complications

Contact sports for 21 days, avoid live vaccines

Acute epiglottitis: common in children _____

2-5 yrs

Acute epiglottitis:

Abrupt and rapid

Infection caused by: _______, _______

HiB, strep

Administration of the ____________helps prevent acute epiglottitis

Hib conjugate vaccine

Acute epiglottitis: diagnostics

• clinical findings

• __________

• __________

Laryngoscopy, blood cultures

Acute epiglottitis: assessment

• cough

• Agitation

• Increased respiratory effort (_________)

• Mouth-breathing or ________

• Difficulty breathing (_________)

• ____________/muffled voice

• Pain or difficulty swallowing

• Increase RR & HR

• fever

• __________

• croaking sound on inspiration

• ______________

• Hypoxia

• Hypercapnia

Retractions, drooling, tripod position, difficulty speaking, stridor, red inflamed epiglottis

Acute epiglottitis: therapeutic management

• ______________

• Advanced airway protection (ETT)

• May require ______

• Maintain ______

• Supplemental O2

• fluids

• Emotional support

Avoid PO meds, trach, NPO

Acute epiglottitis

• avoid using tongue depressor for examination

  • inspect when ETT is needed

• _________ humidifier

• ____________

• Avoid child becoming upset/crying

• __________ isolation

Cool mist, elevate HOB, droplet

Acute epiglottitis:

Corticosteroids decrease inflammation

Antipyretics for fever

Analgesics for throat pain , ________

Popsicles