upper respiratory part 1 flashcards

deviated septum

deflection of normally straight nasal septum

Sx: vary w/ degree of deviation: obstructed breathing, chronic nasal congestion, mouth breathing epistaxis (nose bleeds)

management of deviated septum

focuses on SX control of nasal inflammation and congestion

septoplasty if needed.

no mouth tapping: chronic mouth breathing can lead to jaw deformities (lower jaw recedes over time)

manifestations of severe deviated septum

include facial pain, nosebleeds ( epistaxis), and obstruction to nasal breathing

nasal fractures

usually occurs from blunt trauma (fights, sports, MVA)

classified as simple or complex

simple nasal fracture

may be unilateral or bilateral. They typically have little or no displacement

• Simple fractures are often reduced with manual manipulation.

complex nasal fractures

complex fractures, which may involve damage to adjacent facial structures, such as the teeth or eyes

• complex nasal fractures, considerable swelling of soft tissues occurs.

complications of nasal fracture

Complications include airway obstruction, nosebleeds, meningeal tears causing cerebrospinal fluid (CSF) leakage, septal hematoma, and cosmetic deformity.

nursing assess of nasal fracture

Assess the patient’s ability to breathe through each side of the nose. Note the presence of edema, bleeding, or hematoma

diagnosis of nasal fracture

Diagnosis of a nasal fracture is based on health history and physical assessment.

goals of nasal fracture

Goals of nursing care are to maintain a patent airway, reduce edema and pain, prevent complications, and provide emotional support.

• goals are to realign the fractured bones using either manual manipulation or surgery.

rhinoplasty

surgical reconstruction/reshaping of the nose done for cosmetic

after surgery what we do as nurse (rhinoplasty)

nasal packing in place; external splint on nose

elevate head of bed (HOB) to reduce swelling & bleeding

watch for bleeding & frequent swallowing (its posterior bleeding)

pain mgt for rhinoplasty

analgesics as orders, cold compresses to reduce swelling and brusing

what to avoid post op of rhinoplasty

smoking - impairs healing

NSAIDs - increase bleeding risk

blowing the nose, straining, and bending over for 4wks to not disrupt surgical repair or have increased bleeding

nursing interventions of rhinoplasty

(1) ensuring patency of the airway, (2) continuous assessment of respiratory status, (3) monitoring for airway obstruction, (4) pain management, and (5) observation of the surgical site for edema, bleeding, and infection.

epistaxis - nose bleed

bleeding may result from trauma, dry mucus membranes, clotting disorder

EDU: pitch & look downward, sit upright, allows blood to drain from the nose and prevent aspiration

avoid - forceful blows to the face and heavy activity

anterior nose bleeds

may be treated medically by placing a pledget (nasal tampon) impregnated with anesthetic solution (lidocaine) and/or vasoconstrictive agents (epinephrine) into the nasal cavity.

posterior nose bleed

Posterior bleeds often need packing. Packing with compressed nasal sponges (e.g., Merocel) or epistaxis balloons (e.g., Rapid Rhino) is best because of the ease of placement.

epistaxis discharge teaching

• Review how to use saline nasal spray and/or a humidifier

• Have the patient sneeze with the mouth open and avoid the use of aspirin-containing products or NSAIDs

• patient to avoid vigorous nose blowing, engaging in strenuous activity, and lifting and straining for 4 to 6 week

allergic rhinitis

occurs when exposure to allergens that triggers a immune response

allergic rhinits mangement

identify and avoid whats triggering your allergies

keep a diary to keep track of what activities trigger your allergies

goal of drug therapy: is to reduce inflammation from allergic rhinitis, reduce nasal symptoms, minimize complications, and maximize quality of life.

viral rhinitis

common cold congestion, sore throat, Malaise.

complications of viral rhinitis

sinus congestion, earache

management of viral rhinitis

rest, hydration, decongestants, acetaminophen or ibuprofen for headache, aches, and pains.

• symptomatic care.

Episodic allergic rhinitis

Episodic refers to symptoms related to sporadic exposure to allergens not typically encountered in the patient’s normal environmen

Intermittent allergic rhinitis

Intermittent means that the symptoms are present less than 4 days a week or less than 4 week

Persistent allergic rhinitis

Persistent means that symptoms are present more than 4 days a week and for more than 4 weeks per year

Seasonal rhinitis

Seasonal rhinitis usually occurs in the spring and fall. It is caused by an allergy to pollens from trees, flowers, grasses, or weeds

manifestations of allergic rhinitis

sneezing; watery, itchy eyes and nose; decreased sense of smell; and thin, watery nasal discharge, nasal turbinates appear pale, boggy, and swollen.

complications of viral rhinitis

Pharyngitis, sinusitis, otis media, tonsilitis, lung infections

• teach the patients to recognize the symptoms of a secondary infection.

influenza

contagious respiratory illness having high morbidity and mortality rate

clinical manifestations of influenza

chills, fever, and generalized myalgia, often accompanied by a headache, cough, sore throat, and fatigue.

common complications: pneumonia either primary w/ influenza or secondary bacterial. Ear and sinus infections as well.

diagnostic studies of influenza

culture swabs - done either by nose (preferred) or throat.

Rapid influenza diagnostic tests (RIDTs) can help detect the virus in secretions from the respiratory tract

management of influenza

flu vaccine - production of antibodies against the viruses in the vaccine. (if allergic to eggs talk to HCP)

Rest, hydration, analgesics, and antipyretics can provide symptom relief. (supportive care)

sinusitis

inflammation or hyperthrophy of the mucosa that blocks the openings in the sinuses through which the mucus drains into the nose

acute sinusitis

develop after viral respiratory infection

chronic sinusitis

involves prolonged inflammation longer than 2 weeks

clinical manifestations

upper cheek and pressure.

• purulent nasal drainage, nasal obstruction, congestion, fever, and malaise.

clinical manifestations of acute sinuitis

edematous mucosa, discolored purulent nasal drainage, enlarged turbinates, tenderness over the involved frontal and/or maxillary sinuses, and halitosis (bad breath).

nursing management for acute sinuitis

• Decongestants (oral/topical): Promote drainage

• Intranasal Corticosteroids: Decrease inflammation

• Analgesics: Relieve pain

  • Saline Nasal Spray: Relieve congestion - USE FOR 5 DAYS

chronic sinusitis nursing management

Broad-spectrum antibiotics may be used for 4 to 6 weeks.

• symptoms worsen or last longer than 1 week, antibiotic therapy may be prescribed.

nasal polyps

soft painless bengin gorwths that form slowly in response to repeated inflammation of the sinus or nasal mucosa

clinical manifestations of nasal polyps

Manifestations of larger polyps include nasal obstruction, nasal discharge (usually clear mucus), and speech distortion.

management of nasal polyps

Topical and systemic corticosteroids are primary therapies used to shrink nasal polyps.

Endoscopic or laser surgery can remove nasal polyps, but recurrence is common.

foreign bodies

object inside of nose

inorganic - beads, small toys, buttons, batteries

organic - beans, seeds, nuts, plant material

signs of a foreign body in the nose

unilateral foul smell, pain, difficulty breathing, and nasal bleeding.

kid get sick w/ runny nose think foreign body

avoid what w/ foreign bodies

Avoid irrigating the nose or pushing the object backward since these could cause aspiration and airway obstruction.

acute pharyngitis

acute inflammation of the pharyneal walls, resorting in a sore throat

clinical manifestations of acute pharyngitis

(1) fever greater than 100.4°F (38°C);

(2) anterior cervical lymph node enlargement;

(3) tonsillar or pharyngeal exudate;

(4) absence of cough.

nursing care of acute pharyngitis

goals of treatment are infection control, symptom relief, and prevention of secondary complications

bacterial pharyngitis- drug of choice

caused by group A β-hemolytic streptococci, penicillin is the drug of choice.

• patients allergic to penicillin, erythromycin and clindamycin are substitutes

• azithromycin (Zithromax) or a 1st generation cephalosporin, are options

Candida infections (acute phyrngitits)

Candida infections are treated with nystatin, an antifungal antibiotic. Teach

• patients to swish the preparation in their mouths for as long as possible before swallowing it

symptom relief for acute pharyngitis

Pain relief: Ibuprofen or acetaminophen

• Hydration & diet: Increase fluid intake; drink warm or cold liquids; suck on popsicles, hard candies, or throat lozenges; consume cool, bland liquids and gelatin (avoid citrus juices, which are irritating)

• Sore throat relief: Gargle with warm salt water (12 tsp21​tsp salt in 8 oz8oz water)

  • Environment: Encourage using a cool-mist vaporizer or humidifier