Human Needs - Exam 1 complete

Diabetes Mellitus Management Goals and Patient Teaching

goals

• engage in self care behavior

• prevent complications by having fever hyper/hypoeglyc emergencies

• adjust lifestyle to accommodate the DM plan with minimal stress

patient teaching

• nutrition and drug therapy

• exercise

• self-monitoring of glucose levels

DM subjective data

health hx

• family trauma

• recent trauma/stress/infection

• pregnancy (infant >9lbs)

• cushing’s syndrome/ acromegaly

• type 2 (obesity)

DM diagnosis

1. A1c 6.5% or HIGHER (tract 90-120days/last 3 months)

2. fasting plasma glucose : 126 or HIGHER (no calorie intake for at least 8 hours)

!!goal for pt with DM: A1C <7%

glycosuria / ketonurie / proteinuria

• screening for asymptomatic patients

  • screen everyone (type 1 r/t relative)

  • HDL chol <35 / triglyc. >250

  • other condition assoc with insulin resistance

  • overweight BMI >21

Exercise for DM

at least 150min/week

• brisk walking (doesnt have to be vigorous)

• enjoyable activities to promote regularity

• include a warm up and cool down

• exercise best done after meals when glucose is increased

• monitor glucose levels before/during/after to determine effects (dont take extra insulin prior to exercise)

  • exercise induced hypoglycemia could occur hours after

sick day DM guidelines

stress increases glucose — Diabetic pts check glucose q4h during times of illness

• in type 1 if glucose >240 — check urine for ketones q3-4hrs

  • increase insulin in type 1 to prevent DKA

• in type 1 & 2 if glucose >300 twice—- notify HCP

• increase noncaloric fluids (water/sugar free gelatin/ decaffeinated drinks)

• continue taking meds— dont stop even if NPO

Abmbulatory Care in DM

!!self monitoring blood glucose

• wash and dry hands— do not clean site with alcohol (dont wipe first drop)

• if hard to get adequate drop of blood— warm hands in warm water or let arms dangle

• if finger puncture— use side of pad of finger not near the center (less nerve endings)

• regular oral care and dental visits

DKA initial interventions

(if untreated pt can become comatose)

1. ensure airway

2. O2

3. IV

   1. fluids - 0.45%/0.9% NaCl to raise BP and restore OUP (dehydration) —possible add dextrose if BG <250

   2. begin insulin drip

   3. K replacements

DKA ongoing monitoring

• VS/ LOC/ ECG (k)/ Oxygen

• assess breath sounds for FLUID OVERLOAD (crackles/wheezing)
  monitor glucose and K (give k if pt is taking insulin)/ pH/ electrolytes/ and RENAL FUNCTION (monitor I/O)

• give sodium bicarb if severe acidosis pH<7

• add dextrose for BG <250

Hyperosmolar Hyperglycemia Sydrome

medical emergency (severe hyperglycemia BG>600)

• more dehydrated

• no ketones/acidosis

• hx of inadequate fluid intake

• same tx for DKA just more FLUIDS

Hypoglycemia

<70 , if no test available= assume

• give 15g simple carb (juice/soda/gel tablets/cake icing)

• recheck in 15 min (repeat twice until getting help)

• in hospital , give IV dextrose 50% or glucagon IM

• turn pt to side to prevent aspiration

hypophysectomy (consideration) treatment for ___

• patient will need life long replacement therapy for thyroid and sex hormones and clucocorticoids

• risk of DI d/t decrease of ADH

• monitor OUP and electrolytes

• report OUP >200m;/>3hr

post-op hypophysectomy (interventions) treatment for ___

• keep HOB elevated 30 degrees

• oral care q4h

  • no tooth brushes at least 10 days

post-op hypophysectomy monitoring and assessments

monitor:

• neuro / LOC

• PERRLA

• CSF fluid

• Strict I/O

• fluids

• pain

assess

• extremity strength and reflexes

• dressing

• s/s of SIADH/ DI

post-op hypophysectomy (patient teaching)

• encourage incentive spirometer (prevent atelectasis)

avoid

• vigorous coughing/ sneezing/ nose blowing

• bending over/ straining

• toothbrushes until incision heals (at least 10 days)

Assess for CSF leakage

• monitor dressing placed under nose

• assess for frequent swallowing or nasal drop and complains of persistent HA

TEST

• urine dipstick test for glucose and protein (if positive, alert HCP)

• HOB elevated and rest if positive

• discourage all the same straining movements (nothing to increase ICP)

acromegaly

hypophysectomy

• causes immediate decrease in GH

• tissue hypertrophy reversed

• sleep apnea/ DM/ cardiac problems may persist

SIADH

(could occur after any intracranial surgery)

!!seizure precautions & fluid restriction 800-100ml/day)

monitor

• I/O

• daily weights (teach patient to take daily weight

• VS

• heart and lung sounds

D.I.

goal= hydration and electrolytes

??fluid replacemt?

Hyperthyroidism

• increase metabolism

• increase tissue sensitivity to sns (flight/fight)

• everything is up and quick

**ABCs

• connect to cardiac monitor and start IV

!!monitor OUP hourly

give anti-thyroid med and monitor dysrhythmias

**ensure adequate rest

• cool/ quiet room

• ice packs/ cooling blankets

• light bed coverings

prevent corneal injury (if exopthalmos)

• artificial tears

• decrease Na and increase HOB

• dark glasses

thyroidectomy indications

• large goiter causing tracheal compression

• unresponsive to antithyroid therapy

• thyroid cancer

surgery causes= rapid decrease in T3 and T4

• subtotal is preferred

thyroidectomy: preop care

**best time to educate the patient - teach back method (reinforce in post op)

• comfort and safety measures

• leg exercises and neck ROM

• head support

• post-op care routine

• review chapter 18

thyroidectomy: post op care

1. maintain patent airway and respiratory status

   1. o2/ suction equipment (safety checks!)

**assess q2h for first 24hr for signs of hemorrhage or tracheal compressions (assess site/dressing/monitor for drainage

• avoid: flexion to prevent tension on suture line

• assess speech

interventions

• assist with coughing and deep breathing

• semifowlers

• support hear and neck with pillows

monitor calcium (signs of hypocalcemia

• keep iv calcium available for immediate use

safety check

working suction

• source

• yanker

• canister

ambu bag (bag-valve mask)

oxygen source

check ABCs and be prepared (working IV/ airway)

• post surgery!!: tracheostomy tray should be added to the emergency equipment available in patients room

thyroidectomy: discharge teaching

• decrease caloric intake (or rapid weight gain)

• monitor hormone balance

• some hoarseness is expected— maintain semi-fowlers

• regular exercise

• regular follow up

hypothyroidism- pt/caregiver teaching

importance of thyroid hormone therapy (about 6 weeks to start feeling better and may need to adjust dose in the future)

• life long adherence- written instruction (slow to process at first)

• avoid abruptly stopping and dont double up

• take in AM before breakfast

• need for regular follow up care and hormone monitoring

prevent constipation

• gradual increase in activity

• increase fiber

• stool softeners

• regular elimination times

• avoid enemas (vagal stimulation- bad if pt has heart disease)

!!comfortable and warm environment

avoid sedatives or use at lowest dose

myxedema coma

medical emergency

1st priority: ABCs

• mechanical respiratory support

• cardiac monitoring

• IV thyroid hormone replacement

• monitoring core temp

cushings symptoms

• HTN

• hyperglycemia

• hypokalemia

• buffalo hump

• moon face

• petechiae

• striae

• edema

cushing treatment

depends on cause

• if pituitary adenoma: surgical removal of tumor by transsphenoidal approach

acute care:

• pts are seriously ill

• monitor: vs/ daily wt/ glucose

• assess: s/s of inflamm/infection, pt may not have typical signs like fever

  • assess for possible DVZT/PE (sudden chest pain/dyspnea/tachypnea (increase risk of clots)

cushings pre op care (tumor removal)

• control HTN and hyperglycemia

• correct hypokalemia (monitor for arrythmias)

• HIGH protein diet to correct decrease protein

• sensitive to pts feelings about appearance (reassure appearance will return mostly back to normal)

cushings post op care (tumor removal)

initiate VTE prophylaxis

• increase risk for

  • hemorrhage

  • large release of hormones into blood (instabilized BP/ fluid balance/ lyte levels)

    • BED REST UNTIL BP IS STABILIZED

  • problems with glycemic control

  • infection (subtle signs- may not be normal fever, normal inflammatory responses are suppressed)

Addison’s disease symptoms

• hypoglycemia

• hyperkalemia

• postural hypotension

• hyponatremia

• fatigue and weakness

• bronze skin pigmentation

Addison’s disease (acute care)

• frequent monitoring

• prevent infection and injury

  • stresses increase need for steroid and may precipitate crisis

  • assist with daily hygiene

  • protect from extremes (light/noise/temp)

• correct fluid and electrolyte imbalance

  • vs and neuro

  • daily wt/ i/o

• watch for signs of cushings!!

Addison’s disease (patient teaching)

• report s/s of cortisol deficiency (worsening addisons)

• most common cause of cushings is LT steroid therapy for chronic condition (never stop abruptly)

• may need to increase dose in time of stress

  • fever/flu/tooth pull/ vigourous activity

  • written instructions on when to change to dose

addisonian crisis

shock!!
- if pt is profoundly hypotensive DO NOT MOVE THE CLIENT unless necessary until stabilized

pheochromocytoma

• rare

• excess catecholamines

• priority-= severe HTN

• monitor glucose levels

breathing exercises

diaphragmatic breathing- “belly”

• diaphragm muscle instead of accessory

• not useful in COPD (increase WOB and dyspnea)

pursed lip breathing

• prolonged exhalation to prevent air trapping (decrease RR)

• purse lips like whistling (dont puff cheeks)

• make breathing out (exhal) 3x long than breathing in (inhal)

• good for COPD

airway clearance techniques (ACTS)

loosens mucus/ secretions so they can be cleared by coughing

• huff cough

• chest pT

• airway clearance devices

• high frequency chest ventilation

Chest Physiotherapy (CPT)

for patient having trouble clearing excessive bronchial secretions

• improper technique can result in fractured ribs, bruising of chest wall, hypoxemia, discomfort

percussion

• place thin towel over area for comfort

• place hands in “cup”-like position

• alternate hands rhythmically

• you’ll hear a “HOLLOW” sound if done correctly

• promotes movement of thick mucus

vibration

• promotes movement of secretions to largery airways

HUFF coughing

forced expiratory technique that consists of a series of smaller coughs

• benefits patients with copd emphysema

patient teaching:

• inhale slow and deep thru mouth , hold for 2-3 sec

• forcefully exhale quickly as if “fogging up the mirror” creating the “huff”

• repeat the huff 1-2x w/o having a regular cough

• rest for several breathes and repeat 3-5x

oxygen considerations

• giving high levels of oxygen to a mechanical ventilated patient leads to oxygen toxicity (blurred vision / coughing / chest pain / dyspnea / seizures)

• target levels are to keep SpO2=at least 95% (at rest/some pts may live low) and PaO2=60-100 (ASSES!!!)

  • modify for pts with chronic COPD maybe ain’t for SpO1 >88%

• start low and go slow when giving

management

• assess need with pulse ox (isn’t 100% accurate on colored skin) and/or ABGs

Oxygen Administration Complications

combustible

• teach pt (highly flammable)

• can burn

• no smoking

toxicity

• keep at lowest as possible (blurred vision/ cough/ dyspnea/ seizures)

Low flow Oxygen systems v High flow Oxygen System

Low Flow

• provide a mix of O2 and Room Air (exact O2 concentration is unknown)

• amount of oxygen inhaled depends on RA and patients breathing pattern

• nasal prongs/cannula & simple mask & non-rebreather mask

high flow

• delivered fixed O2 concentration Independent of patients respiratory rate or pattern

• have HIGHER oxygen requirements

• venturi mask / high flow nasal cannula

Nasal Cannula (low flow oxygen system)

add humidification if at 3 L or above

• can dry membranes and cause risk of nose bleeds

assess skin

simple face mask (low flow oxygen system)

(may need to switch to NC to eat)

**flow meter set to 6-10L/min and delivers 35-50% oxygen

• has to be at least 6L to wash exhaled gases out of mask— if not high enough, CO2 rebreathing is possible

!!watch for pressure ulcers/ skin at top of ears form straps with long term use

• wash and dry under mask q4h and PRN

Partial / Non-Rebreather

partial- rebreather

• valves stay open

• flow rate: 10-15mL/min

• provide 60-90% O2 concentration

NON- rebreather

• one way valves are closed

• provides 95% O2 with a flight seal

Nasal Cannula (high flow oxygen system)

reaches up to 100% O2 concentration

• flow rate= up to 60 L/min

!!heated humidiefer capable of 100% humidity

• constant

• can cause dripping from nose

venturi mask (high flow oxygen system)

delivers precise rates of o2

• helpful for giving low, constant O2 concentration to patients with COPD

Home O2 Use Education

• do not change rate without talking to HCP

• make sure you have extra oxygen for weekends and holiday

• wash hands before and after oxygen use

• wash NC prongs with liquid soap and rinse 1-2x/week

• replace NC every 2-4 weeks (if you have a cold - replace after symptoms pass

• keep oxygen tanks at least 5 feet from any source of heat (stoves/ fireplace)

• post “NO smoking” - oxygen in use” warning signs on front and back doors

oral/nasal airways

• can be used to maintain patent airway during use of BMV (bag mask valve) but provides NO protection

oropharyngeal (OP)- unconscious pt

Bag Mask Valve (BMV)

ambu bag- “bag the pt”

• used to preoxygenate a patient before intubation and is part of emergency equipment thats on crash carts or kept in room if patient is unstable

Chest Tube (patho/purpose/insertion)

• sterile tube with several drainage hole inserted into the pleural space (not lung tissue)

• may require drainage unit anytime negative pressure in cavity is disrupted

pleural effusion / pneumothorax / hemothorax / cardiac tamponade

• drains the pleural space and reestablishes negative pressure

!!inserted mid-axillary : HOB elev 30-69, arm above head, local anesthetic (lidocain)

• chest x-ray to confirm placement

• advocate for pain meds!

• consent for insertion

assessments for patient with Chest Tube

• lung sounds / pain / drainage amount / assess site

• report >200mL/hr in 1st hour and 100 mL/hr after (risk of repulmonary edema if too much fluid is removed rapidly causing hypotension)

• do not clamp chest tube unless quick to change CDU, do not compress/ milk / strip tube

• keep CDU below chest, pt will need assist with ambulation

• avoid over turning unit

• if system breaks, place distal end in sterile water - mimics negative pressure

subcutaneous emphysema: small amounts of air leaking into SQ at insertion site

• feels like “crackling” when palpating

• large amounts around Head and neck can cause swelling and airway compromise

Teaching for patients with Chest tubes

encourage deep breathing / incentive spirometry / coughing

• decrease risk of atelectasis

ROM exercises

• prevents shoulder stiffness

removal of chest tubes

pre medicate 30-60 min prior

• valsalve maneuvar (increase intrathoracic pressure so air does NOT rush in the patient)

…..OR

• Trendelenburg / holding breath

!occlusive dressing (petroleum gauze)

compartments names of CDU

(a) suction control regulator

(b) water seal chamber

(c ) air leak monitor

(d) collection chamber

(e ) suction monitor bellow

function of each compartments of CDU

(A) suction control dial: controls amount of suction

(B) water seal chamber: look for tidaling

• acts as one way valve with 2cm of water

• air goes in , bubbles up, but doesn’t go back in patient (bubbles are normal with cough/sneeze and then stops)

(C) Air Leak Monitor: look for bubbling

• allows for visual of possible air leaks or connection problems

(D) Collection Chamber: monitor I/O

• fluid stays in and air vents to 2nd compartment

• allows to measure output

(E) how you see its working!

suction control.

dry suction= most common

• wall suction is used to create negative pressure

• excess suction is vented to atmosphere so it doesnt matter how high wall suction is set

• usual pressure = 20 cm H2O]water seal chamber and air leak detector still present

tidaling

normal up down fluctuation of water d/t pressure changes with breathing (look in compartment b- water seal chamber )

• reflects intra-pleural pressure changes during breathing

• gradually disappears as lungs re-expand (normal)

• occluded chest tube can cause sudden stop and needs immediate attention

bubbling

• brisk bubbling at first often occurs as pneumothorax evacuates (look in compartment b- water seal chamber)

• brisk bubbling disappears as lungs re-expand

• intermittent with exhalation, coughing, sneezing (normal)

• if bubbling stops than increases again, suspect a leak (continuous bubbling indicates an air leak)

Chest surgery: pre-op

• assess baseline

• post op teaching (better to do preop)

  • oxygen/ IV/ possible intubation/ blood administration / purpose and function of chest tubes / pain management

• educate on use of ROM exercises/ deep breathing. IS/ splinting

chest surgery: post-op

1. pain meds— ABC

care priorities:

• assessing respiratory functions

• monitory chest tube function

tracheostomy

surgically created stoma (opening) to:

• establish airway / bypass an upper airway obstruction

• facilitate secretion removal

• permit long term mechanical ventilation

• facilitate weaning from mechanical ventilation

EARLY TRACH!!

• within 10-14 days

• reduces number of ventilatory dependent days/ length of hospital stay/ pain

• improves communication when the need for an artificial airway is expected to be prolonged

• can be done emergently (crico), surgically or at bedside

advantages of a tracheostomy v a endotracheal tube

pts can learn to speak/ eat/ drink with trach’s

• easier to keep clean

• better oral and bronchial hygiene

• patient comfort increased (no tube in mouth)

• easy to do breathing test

• great for ventilator weaning

• less risk of long term damage to vocal cords

  • usually pt can have ETT in for about 2 weeks for HCP recommend a trach to prevent vocal cord damage

tracheostomy components

OBTURATOR

• placed in outer cannula when replacing a trach, allows for easy passage into tracheostomy stoma, its removed after trach placement

• needs to be kept in the room

• part of the safety check for pts with trache’s

• want to keep an extra one a size smaller incase pt has swelling

trach collar

attaches to the neck with a strap and can deliver humidity and oxygen

• some oxygen conc is lost into atmosphere bc collar does not fit tightly

• can use venturi mask

• 2 person assist clean/ change of ties

• remove and clean q4h and PRN to prevent aspiration/infection

cuffed vs uncuffed trachestomy tube

cuffed

• pt requires ventilator needs cuffed

• cuff “balloon” blocks air from moving around the tube

• monitor cuff pressure q8h * PRN - use least amount of air as possible (20-30 cmH2O)

  • too high pressures can result in tracheal necrosis / erosion — not enough / low pressure air leaks out

• uncuffed

  • allows air to pass and apes thru voice box and allows pt to speak

  • more comfortable

  • pt who dont need mechanical ventilation

  • used when a risk of aspiration decreases

fenestrated tracheostomy tube

• has an opening on dorsal surface of the tube that helps promote spontaneous breathing

• breathing spontaneously and speaking with a trach is possible when a fenestrated cuffless / deflated cuff is used (when cuff reflates air cant pass thru the vocal cords)(

• must not be at risk for aspiration !!

Tracheostomy Preop care

• emergency equipment available (trach comes out with ambu bag)

• assess bedside suction

• position patient supine

• CPR with trach

Tracheostomy Post op care

• after using obturator to place trach and removing after placed (KEEP OBTURATOR IN ROOM ALWAYS)

• cuff (balloon) is inflated)

confirm placement:

• auscultate for air entry , end tidal CO2 capnography, passage of suction catheter

• chest x ray!

Principles of suctioning

• assess need for suctioning hourly

• suction only when needed (PRN) not routinely

complications of Suctioning

• increase ICP

• HTN or hypotension

• hypoxemia

  • closely assess pt before, during. after suctioning

  • if pt doesnt tolerate it, stop at once

  • resume after patient achieves stability

  • prevent hypoxemia during suctioning by hyperoxygenating before and after — limit each pass to 10 sec or less (max 3 passes)

• dysrhythmias

  • caused by vagal stimulation from tracheal irritation

• mucosal damage

  • prevent by limitiing suction pressures to less than 120 mn

  • avoid overly viogorous catheter insertion

  • note blood streaks or tissue shreds (talk to doctor)

tracheostomy care

• cleaning the trach

• changing the ties (tapes)

  • 2 ppl assist: 1 stabilizes trach and 1 changes tapes

  • tie tapes securely with room for 2 fingers between ties and skin

• changing the inner cannula

prevent dislodgment

• watch when turning and repositioning

• keep replacement tube of equal and one small size and an obturator at bed side

accidental dislodgement of tracheostomy

medical emergency- call for help

quickly assess LOC , ability to breathe, respir distress

place patient in semi fowlers

• attempt to re insert using spare trach (if policy allows)

if you can not reinsert:

• cover stoma with steril dresing

• ventilate patient with BVM over nose and mouth

Speech with a Tracheostomy

• get with speech therapist to assess for swallowing and aspiration risk

• provide patient with wiriting tools if speaking devices are not used

• establish routines- this is distressing on pt

• fenestrated cuffless/ deflated cuff tubes allow for speech

decannulation

removal of trach

• epithelial tissue forms in 24 - 48 hours , opening closes in 4-5 days

• we SLOWLY step down

criteria:

• hemodynamic stability

• respir drive stable intact

• adequare air exchange

• independently expectorates

opening usually closes in 4-5 days

thoracentesis

drains fluid from lungs without chest tubes

nothing is wrong with negative pressure

• usually no more than 1000-1200 ml drained at one time

• larger volumes= hypotension/ hypoxemia/ re-expansion pulmonary edema

!!chest x- ray done after to assess for complications/injuries

• done in pts room

during:

• pt sitting upright with elbows on an overload table and feet supported

  • tell pt not to talk/cough during

which condition will you expect in a pt with decreased breath sounds post op day one from an abdominal surgery

• pneumothorax

• pleural effusion

• atelectasis

• pneumonia

atelectasis

for which condition will a nurse monitor for signs and symptoms in a pt following a bedside thoracentesis

• pneumothorax

• pulmonary edema

• bronchospasm

• respiratory acidosis

pneumothorax

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 and post-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

Radiation Consideration for Head & Neck cancer

!!lots of GI upset give antimetics /bland foods/ protein drinks

• external (most common)- gamma knife / highly accurate

• internal/brachytherapy - pt will be radioactive for first 7 days - treats systemic cancers

  • be aware when pt is radioactive and use principle ALARA (as low as reasonably achievable)

  • cluster care and explain why for limited activity and isolation

in radiation area

• avoid heating pads, ice packs, constricting garments, chemicals, deodorants, rubbing

• dry desquamation: loss of keratinization— use aloe vera / unscented lotion

• wet desquamation: rate of cell sloughing is faster than new growth— dermis exposed— use NS compresses and vaseline gauze

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)

• increase fluid intake

• 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)