NCM 112 Lec - Module 3 - URT

Increase Fremitus

Occurs with lung consolidation (e.g., Pneumonia, Pulmonary Edema). Sound waves travel faster and better through dense, fluid-filled/solidified lung tissue than through air-filled alveoli

Lung Consolidation

Increased fremitus is associated with?

Decreased/Absent Fremitus

Occurs when something blocks sound transmission from the vocal cords to the chest wall:

○ Fluid or Air in Pleural Space: Pneumothorax, Pleural Effusion, Hemothorax.

○ Obstruction: Atelectasis, bronchial plug.

○ Hyperinflation: COPD, Emphysema.

Blockage

Decreased or Absent fremitus is associated with?

Tactile Fremitus

changes depending on what is inside the lung parenchyma and pleural space

Subcutaneous Crepitus

Air leaks from a lung puncture, trachea, or chest tube site into the surrounding soft tissue.

Subcutaneous Crepitus (2)

Highly associated with pneumothorax, flail chest, tracheostomy complications, or chest tube leaks/malfunctions.

Spreading or Resolving

Outlining the boundary where crepitus is observed, using a surgical marker, is used to monitor if the air leak is?

Bone Crepitus

A crunchy, grating sensation felt over a broken rib during chest wall movement or palpation.

Bone Crepitus (2)

Direct indicator of rib fractures or flail chest.

Talking

To measure tactile fremitus, _________ is needed. Vocal cord vibration specifically the word "Ninety-nine"

Crackling

Crepitus is described as ____________. Feels like rice krispies or bubble wrap under the skin

Pleural Fluid

A thin, clear serous fluid (typically around 5-15 mL total in a healthy adult

5-15 ml

Normal pleural fluid for a healthy adult

Pleural Fluid (2)

Allows the visceral and parietal layers to glide smoothly against each other during inhalation and exhalation without friction.

Cohesive Force

The pleural fluid creates _____________ that holds the lungs against the chest wall, ensuring the lungs expand when the chest wall expands.

Upper Respiratory Tract Disorders

Involve inflammation and infection of the mucous membranes lining the structures of the upper airway: the nose, sinuses, pharynx, larynx, and trachea.

Epistaxis

Hemorrhage from the nose caused by the rupture of tiny, distended blood vessels in the mucous membrane of any area of the nasal cavity.

Kiesselbach's Plexus

Most nosebleed originate where?

Anterior Septum

Location of the Kiesselbach's Plexus

Anticoagulants, Antiplatelets, or NSAIDs

3 medications that when overused can lead to epistaxis

1. securing the airway

2. stopping the bleed, and;

3. preventing aspiration.

3 nursing interventions done for epistaxis

Upright, leaning forward, head tilted forward

When the pt's nose is bleeding, position them into?

5-10 minutes

Apply direct, continuous pressure by pinching the soft outer portion of the nose against the nasal septum for ____________ to stop bleeding

Ice Packs

Used for someone having nose bleeds to induce local vasoconstrictions

Oxymetazoline or Epinephrine

If direct pressure fails to stop the hemorrhage, : Application of topical vasoconstrictors such as ____________ or _____________ is done

Chemical Cautery

Application of silver nitrate sticks directly to the bleeding site for chronic epistaxis

Electrocautery

Thermal cauterization for active arterial bleeding points for chronic epistaxis

Anterior Nasal Packing

Nasal tampons, gauze impregnated with petrolatum/antibiotic ointment, or inflatable nasal balloons inserted into the anterior nasal cavity. Left in place for 24-72 hrs

24-72 hours

How long are Anterior Nasal Packing left on patient's nose

Posterior Nasal Packing

Used for severe, posterior bleeding. Gauze packs or specialized double-balloon catheter tubes are inserted into the posterior nasopharynx.

Posterior Nasopharynx

Point of entry for Posterior Nasal Packing for severe posterior epistaxis

Open-Mouth Sneezing

Type of sneezing done to avoid having nosebleeds.

Aspirin and NSAIDs

Contraindicated for someone with Chronic Epistaxis (Medications)

Rhinitis

an inflammation and irritation of the mucous membranes lining the nasal cavity.

Allergic Rhinitis

environmental allergens or IgE-mediated hypersensitivity reaction

Viral Rhinitis

rhinoviruses, coronaviruses, or adenoviruses. Also known as the common Cold

Common Cold

Other term for viral rhinitis

Non-Allergic or Vasomotor Rhinitis

Triggered by temperature changes, strong odors, spicy foods, alcohol and stress

Rhinorrhea

Excessive clear, watery nasal discharge (may become thick or purulent in bacterial infection).

Nasal Congestion & Sneezing

Swelling of nasal turbinates and hypersecretion leading to nasal passage obstruction and reflex sneezing.

Nasal & Ocular Pruritis

Itching of the nose, roof of the mouth, throat, eyes, and ears (most prominent in allergic rhinitis)

Antihistamines

First-line therapy for allergic rhinitis to block histamine receptors.

First Generation Antihistamines

Cause sedating effects and anticholinergic side effects

Diphenhydramine and Chlorpheniramine

2 kinds of First Generation Antihistamines

2nd Generation Antihistamine

Non-sedating antihistamine and preferred for daily maintenance.

Loratadine, Cetirizine, and Fexofenadine

3 kinds of 2nd Generation Antihistamine

Intranasal Corticosteroid

Highly effective first-line anti-inflammatory agents for allergic rhinitis. Must be used consistently for full effect.

Fluticasone, Mometasone, and Budenoside

3 kinds of Intranasal Corticosteroid

Decongestants

Cause vasoconstriction of nasal mucosa capillaries to reduce swelling.

Saline Nasal Spray or Irrigation

Helps flush out allergens, liquefy mucous secretions, and keep membranes hydrated.

Tilt Head slightly forward

What position should we put the head into when spraying nasal sprays

Rhinisinusitis

is an inflammation of the paranasal sinuses and nasal cavity

Acute Viral Rhinosinusitis (ARVS)

Most commonly follows a viral upper respiratory tract infection (e.g., rhinovirus, influenza, coronavirus).

Acute Bacterial Rhinosinusitis (ABRS)

Cause: Common pathogens include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

Chronic Rhinosinusitis (CRS)

Persistent inflammation lasting 12 weeks, often associated with nasal polyps, structural abnormalities (e.g., deviated septum), allergies, fungal infections.

Purulent Nasal Drainage

Thick, opaque, or yellow-green nasal discharge or postnasal drip

Nasal Obstruction/Congestion

Difficulty breathing through the nose due to mucosal edema

Facial Pain, Pressure, and Fullness

Pain localized over the involved sinuses:

Hyposmia/Anosmia

Decreased or lost sense of smell

Maxillary Sinuses

Facial pain over cheeks/upper teeth is indicatory for inflammation of?

Frontal Sinuses

Forehead Pain/Headache is indicatory for inflammation of?

Ethmoid Sinuses

Retro-orbital (Behind the eyes) or nasal bridge pain is indicatory for inflammation of?

Sphenoid Sinuses

Deep, dull head pain is indicatory for inflammation of?

Rhinitis (2)

The patient presented with Rhinorrhea, Nasal Congestion, Sneezing, Nasal & Ocular Pruritis, low grade fever, and malaise.

Diagnose the patient.

Rhinosinusitis (2)

The patient presented with Purulent Nasal Drainage, Nasal Obstruction, Congestion, Facial Pain, pressure, and fullness. They also described loss of smell and ear fullness, and halitosis.

Diagnose the patient.

Transillumination

To diagnose Rhinosinusitis, _________ of the sinuses is done. Decreased light transmission = fluid filled = inflammed.

Anterior Rhinoscopy

Done to see the purulent discharge in the nasal cavity

CT Scan of Paranasal Sinuses

Gold standard imaging modality for recurrent or chronic rhinosinusitis; reveals mucosal thickening, air-fluid levels, or ostial obstruction.

Nasal Endoscopy

Allows direct visualization of the ostiomeatal complex and collection of culture specimens.

Acetaminophen or NSAIDs

Given for patients with Rhinosinusitis for facial pain and headache.

ABRS

Use antibiotic to which type of Rhinosinusitis?

Functional Endoscopic Sinus Surgery or FESS

Using high-definition endoscopes, micro-instruments, or debriders, the surgeon navigates through the nasal passages to enlarge the natural sinus openings (ostia) and remove obstructive tissue/polyps

FESS

gold-standard surgical intervention for chronic rhinosinusitis unresponsive to medical therapy

Caldwell-Luc Procedure

The surgeon makes a sublabial incision in the gingivobuccal sulcus (above the upper premolar teeth/canine fossa), creates a bone window into the maxillary sinus, directly visualizes the sinus, strips irreversible diseased mucosa, and establishes an artificial drainage window

Gingivobuccal Sulcus

In the caldwell-luc procedure, the surgeon makes an incision in the _________ to create a bone window

Periorbital Edema and Erythema

For patients with Rhinosinusitis, this Indicates orbital cellulitis or abscess.

A RED FLAG SIGN!

Severe Headache, Nuchal Rigidity, or Altered Mental Status

Indicates intracranial complications (e.g., meningitis, epidural abscess, cavernous sinus thrombosis).

- A RED FLAG SIGN FOR RHINOSINUSITIS

Pharyngitis

sudden, painful inflammation of the pharynx (the back of the throat), including the soft palate, tonsils, and posterior pharyngeal wall.

Sore Throat

Other term used for Pharyngitis

Viral Pharyngitis

Caused by viruses such as Adenovirus, Influenza virus, Epstein-Barr virus Rhinovirus, and Coronavirus.

Bacterial Pharyngitis

caused Group A Beta-Hemolytic Streptococcus / GABHS

Strep Throat

Other term for Bacterial Pharyngitis

Group A Beta-Hemolytic Streptococcus

Main cause of Bacterial Pharyngitis

GERD

___________ can cause Pharyngitis if untreate

Odynophagia

Severe pain when swallowing

Dysphagia

Difficulty swallowing due to tissue swelling and pain.

Erythema

A fiery red appearance of the posterior pharynx and tonsils

Lymphadenopathy

Enlarged and tender cervical lymph nodes.

Pharyngitis (2)

The patient presented with Odynophagia, Dysphagia, Erythema in their Tonsils, and swollen cervical lymph nodes.

Diagnose the patient.

RADT or Rapid Antigen Detection

A swab of the posterior pharynx and tonsils is performed. Provides quick results (within minutes) with high specificity for GABHS.

Throat Culture

The gold standard for diagnosing bacterial pharyngitis. Performed if the RADT is negative but clinical suspicion for GABHS remains high.

Supportive Care

Most viral infections needs __________ only. Antibiotics should not be given

Penicillin V and Penicillin G Benzathine

First line antibiotics for GABHS

Erythromycin, Clarithromycin, and Azitromycin

Used for Bacterial Pharyngitis when the pt is allergic to penicillin

Rheumatic Fever

Bacterial Pharyngitis, if left untreated, will lead to?

Warm Saline Gargle

Recommend ___________ for a pt with Pharyngitis to reduce swelling

1/2 tsp of salt, 8 oz of water

Th component of a warm saline gargle for a pt with Pharyngitis

Toothbrush

After starting antibiotic therapy, a pt with pharyngitis should change their ___________ to prevent reinfection

Laryngitis

an inflammation of the larynx (voice box) mucosa, often involving the vocal cords.