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68c Ph2 Exam 5
Upper airway disorders
| Question | Answer |
|---|---|
| adrenergics (sympathomimetics) | drugs that effect autonomic nervous system; neurotransmitter; fight-flight; increases HR, RR, |
| Antagonist | works against action of the drug (blocker) |
| Anticholinergic (parasympatholytics) | Calms the body back down after fight-flight |
| Antitussive | cough syrups |
| Corticosteroids | hormones produced by adrenal cortex, has antiinflammatory properties |
| Decongestants | Reduces swelling of the nasal passages To treat congestion associated with rhinitis, hay fever, allergic rhinitis, sinusitis and the common cold |
| Epistaxis | nose bleed |
| deviated septum | Caused by congenital abnormality or injury Deviation from midline with obstruction of nasal passageway |
| nasal polyps | Tissue growths on the nasal tissues, caused by inflammation Allergies |
| allergic rhinitis | allergies inflamming nose |
| obstructive sleep apnea | not breathing while sleeping (usually tongue) |
| expectorants | liquify the mucus (decrease viscosity of secretion in respiratory tract) |
| antihistamine agents | Antihistamines / histamine antagonist are drugs that directly compete with histamine for specific receptor sites. |
| there is ________ for upper airway obstruction | no diagnostic test |
| laryngeal cancer--who is more at risk | females; smokers |
| how much secretion does respiratory tract produce in one day | 1L |
| epistaxis subjective data | interview pt and identify precipitating factors |
| epistaxis causes | congestion of nasal membrane causing rupture; injuries; primary or secondary condition (related to menstrual cycle, HTN, disease processes, medication) |
| epistaxis clinical manifestations | bright red blood from one or more nostril, severe hemmorhage losing up to 1L of blood (body has 5L of blood), |
| epistaxis objective data | Assess bleeding from one or both nostrils Bleeding occurring from anterior or posterior nasal passageway Assess vital signs Assess for hypovolemic shock |
| epistaxis anterior | coming out of nose |
| epistaxis posterior | pt swallowing blood |
| epistaxis diagnostic tests | HGB and HCT Coagulation studies Rhinoscopy |
| epistaxis medical management | Nasal packing with cotton saturated with Epinephrine 1:1000 (constricts vessels) Cautery Posterior packing (balloon tamponade) |
| balloon tamponade | balloon put in nostril and expanded to stop bleeding |
| epistaxis NI | Keep pp quiet (talking brings pressure) sitting position, leaning forward Reclining patient with head and shoulders elevated direct pressure to soft portion of nose (10-15mins) ice compresses/suck on ice (vasoconstriction) Monitory for SS |
| Nursing Diagnosis and Interventions for Epistaxis | Tissue perfusion, ineffective cerebral and/or cardiopulmonary, related to blood loss Assess vital signs and level of consciousness every 15 min. and report any changes Document estimated blood loss |
| Nursing Diagnosis and Interventions for Epistaxis | Aspiration, risk for, related to bleeding Elevate head of bed Encourage patient to let blood drain from the nose Pinch nostrils, apply ice |
| If the patient has an epistaxis, the correct nursing intervention(s) would be to: | place the patient in Fowler’s position with head forward place the patient in Fowler’s position with the head extended. place ice compress over the nose. |
| deviated septum clinical manifestations | Stertorous breathing Dyspnea Postnasal drip |
| if PT has epistaxis of posterior portion, what effect might it have on your patient | swallowing blood leading to N/V, GI irritation, hypovolemic shock, aspirations HTN (late sign of shock) |
| nasal polyps clinical manifestation | Stertorous breathing Dyspnea Postnasal drip |
| stertorous breathing | harsh breathing sound |
| postnasal drip | swallowing, running nose, spitting up, etc of shit in nose |
| deviated septum and nasal polyps assessment | Subjective Data History of previous injuries, infections, allergies Dyspnea Objective Data Identification and location Rate and character of respirations |
| Deviated Septum & Nasal Polyps diagnostic tests | Sinus x-rays Visual examination |
| Deviated Septum & Nasal Polyps medical management | Surgical correction Medications |
| Deviated Septum & Nasal Polyps NI and PT teaching | Contact physician if bleeding or infections develops Caution about use of nasal sprays and drops Avoid nose blowing, vigorous coughing or Valsalva maneuver Ecchymosis and edema will be present for several days |
| Airway clearance, ineffective related to nasal exudate Nursing interventions | 1) Document pt's ability to clear secretions, and note respiratory status 2) Elevate hob, apply ice compresses to the nose to decrease edema, discoloration, discomfort, and bleeding 3) Change nasal drip pad prn doc color, consistency and amount |
| Injury, risk for, related to trauma to bleeding site associated with vigorous nose blowing. Nursing interventions | 1) Assess and report exudate. 2) Instruct patient against blowing nose in immediate postoperative period, because this could increase bleeding, edema and ecchymosis |
| Allergic Rhinitis etiology/pathophysiology | atopic allergic condition from inhaled or contact allergins seasonal or pariential conditions vasodilation |
| Allergic Rhinitis common allergens | trees, grass, pollins, mole spores (smaller than pollen), fungi, animal dander, some foods, insects, and drugs |
| allergic rhinitis clinical manifestation | Acute ocular manifestations: Edema Photophobia Excessive tearing Blurring of vision Pruritus Rhinitis: Excessive secretions Inability to breathe through the nose Otitis media |
| allergic rhinitis initial complaints | Severe sneezing Congestion Pruritus Lacrimation |
| allergic rhinitis if untreated may develop | Otitis media Bronchitis Sinusitis Pneumonia |
| allergic rhinitis diagnostic test | Physical exam Skin testing Serum radioallergosorbent test (RAST) |
| allergic rhinitis medical management | Relieve signs and symptoms Prevent infections Medications (Antihistamines; Decongestants; Topical or nasal corticosteroids) |
| allergic rhinitis nursing interventions | Focus on health promotion and maintenance |
| allergic rhinitis PT teaching | Teach patient ways to avoid allergen Teach patient self-care management through symptom control Teach medication action and usage; assess for medication effectiveness |
| obstructive sleep apnea Etiology/Pathophysiology | |
| obstructive sleep apnea signs and | Apneic Headache Personality changes Hypertension and cardiac dysrhythmias |
| obstructive sleep apnea clinical manifestations | Frequent awaking at night and insomnia. Excessive sleepiness during regular hours. Witnessed apneic episodes. |
| obstructive sleep apnea diagnostic test | Polysomnography. |
| otitis media | inner ear infection of eustacian tube |
| obstructive sleep apnea medical management | Mild sleep apnea – conservative management. Moderate to severe sleep apnea-- Nasal continuous positive airway pressure (nCPAP). Bi-level positive airway pressure (BiPAP). |
| two types of histamine receptors | Histamine 1 (H1) receptors Mediate smooth muscle contraction and dilation of capillaries. Histamine 2 (H2) receptors Mediate acceleration of the heart rate and gastric acid secretion. |
| antihistamines relieve... | symptoms associated with allergies: Rhinitis Urticaria Angioedema Adjunctive therapy in anaphylactic reactions |
| antihistamine indications | Topical and ophthalmic antihistamines may immunize systemic side effects Treat motion sickness dimenhydrinate and meclizine Insomnia Diphenhydramine Parkinson-like reactions: Diphenhydramine Antitussive (syrup only). |
| antihistamine contraindications | Acute asthmatic attacks or bronchial asthma Narrow angle glaucoma Cardiac disease HTN Kidney disease Benign prostatic hyperplasia (BPH) Seizure disorders Peptic ulcer disease Prego / lactation Not recommended for children < 2-6 of age Geriatrics |
| traditional antihistamines | diphenhydramine (Benadryl) azatadine (Optimine) dimenhydrinate (Dramamine) promethazine (Phenergan) brompheniramine (Dimetane) |
| non-sedating antihistamines | fexofenadine (Allegra) loratadine (Claritin) |
| antihistamine side effects | Drowsiness Sedation Headache Thickening of bronchial secretions Anorexia Dry mouth Urinary retention |
| differences between allergic rhinitis, conjunctivitis, and acute rhinitis | allergic rhinitis--allergies (seasonal or year round) conjunctivitits--hay fever acute rhinitis--common cold |
| antihistamines nursing implications | Assess allergy symptoms before and periodically Monitor vital signs: Pulse and BP prior to and throughout therapy Assess lung sounds and character of bronchial secretions Maintain fluid intake of 1500-2000 mL/day motion sickness Anxiety Pruritus |
| antihistamine admin for prophylaxis of motion sickness | at least 30 min and preferably 1-2 hr before exposure to conditions that may precipitate motion sickness |
| antihistamine admin for insomnia | administer 20 min before bedtime and schedule activities to minimize interruption of sleep |
| antihistamine PT teaching | Do not perform hazardous tasks if drowsiness occurs Avoid alcohol/drugs that cause sleepiness or drowsiness while taking this medication dryness of the mouth and throat Notify health care professional if symptoms worsen or persist |
| antihistamine evaluation | Decrease in allergic symptoms Prevention of or decrease in nausea and vomiting caused by motion sickness Decrease in anxiety Relief of pruritus Sedation when used as a hypnotic |
| Antihistamines should be administered: | a. PRN throughout the day b. After contact with an allergen c. 45 to 60 minutes before exposure to an allergen d. 45 to 60 days before the allergy season |
| 3 separate groups of decongestants | Adrenergics ( sympathomimetics) Topical corticosteroids Anticholinergics |
| Anticholinergics | ipratropium (Atrovent) |
| Adrenergics ( sympathomimetics) | oxymetazoline (Afrin) pseudoephedrine (Sudafed) phenylephrine (Neo-Synephrine) |
| Topical corticosteroids | beclomethasone dipropionate (Beconase) fluticasone (Flonase) triamcinolone (Nasacort) |
| decongestant contraindications | Hypersensitivity Acute attacks of asthma Narrow angle glaucoma Hypertension Hyperthyroidism Prostatitis Lactation |
| decongestant precautions | History of cerebrovascular accident or transient ischemic Benign prostatic hyperplasia Diabetes Geriatrics: more susceptible to adverse reactions Children < 12 yrs old (safety not established). |
| decongestant side effects | when used as directed Anxiety Insomnia Palpitations Tremor Most common of intranasal are localized and include mucosal irritation and dryness. Excessive dosages HTN Palpitations Headache Anxiety Dizziness Rebound congestion |
| only _________ antihistamines work for ansomnia | 1st generations |
| decongestant interactions | Few significant drug interactions with nasal decongestants. |
| NI decongestant | Assessment: Redness, swelling, pain in nasal passages before and during treatment. Implementation: Review proper technique on administration of nose drops and sprays. Do not use for more than 3 days. |
| decongestant PT teaching and NI | Patient Teaching: Nasal burning and stinging. Use product as directed. Overuse Evaluation: decrease nasal congestion. |
| When assessing a patient who is to receive a decongestant, the nurse will recognize that a potential contraindication to this drug would be: | glaucoma |
| subjective data for upper airway conditions | Patient unable to talk; nurse makes prompt, accurate assessment |
| objective data for upper airway conditions | Signs of hypoxia- cyanosis Signs of respiratory distress- stertorous respirations, stridor, wheezing Bradycardia |
| NI and PT teaching for upper airway conditions | Prompt opening of airway |
| Airway clearance, ineffective, R/T obstruction in airway | Reestablish and maintain secure airway. Administer oxygen as ordered |
| Aspiration precautions; R/T partial airway obstruction | Monitor respiratory rate, rhythm, and effort Assess swallow reflex Assess breath sounds |
| Laryngeal Cancer Etiology/Pathophysiology | Squamous cell carcinoma Occur in people over age 60 90% occur in men Chronic laryngitis Vocal abuse Familial history |
| Laryngeal Cancer clinical manifestations | Progressive or persistent hoarseness Metastasis includes pain in larynx radiating to ear Difficulty swallowing Lump in throat Enlarged cervical lymph nodes |
| laryngeal assessment | Subjective data Assess onset of symptoms Difficulty breathing or swallowing Objective data Examine sputum for presence of blood |
| laryngeal diagnostic tests | Visual examination with direct laryngoscopy with biopsy |
| laryngeal medical management | Radiation Therapy Surgery |
| laryngeal cancer NI and PT teaching | Airway patency Skin integrity Monitor I&O Tube feedings Daily weight Psychological concerns with disfigurement |
| Airway clearance, ineffective, related to secretions or obstruction | Suction secretions Provide tracheostomy care Offer small frequent meals Turn, cough and deep breathe Auscultate lung sounds |
| Communication, impaired verbal, related to removal of larynx | Provide patient with implements for communication, including pencil, paper, Magic Slate; picture books or electronic voice device. Use simple question technique requiring "yes" or "no" responses. |
| acute rhinitis | Inflammatory condition of mucous membranes of nose and accessory sinuses Usually caused by one or more viruses May also be complicated by bacterial infection |
| acute rhinitis clinical manifestations | Productive cough Thin serous nasal exudate Sore throat |
| acute rhinitis assessment | Subjective Data question patient regarding health and presence of sore throat, dyspnea and congestion Objective Data Visual examination of throat and noting erythema, edema, and local irritation Monitor vital signs |
| acute rhinitis diagnostic tests | Throat and sputum cultures to determine presence of bacterial infection |
| acute rhinitis medical management | Analgesia Antipyretics Cough suppressant and expectorant Antibiotics |
| acute rhinitis nursing goal | To facilitate recovery and prevention of secondary infections |
| Airway clearance, ineffective, related to nasal exudate | Encourage fluids to liquefy secretions and aid in their expectoration |
| Health-seeking behaviors: illness prevention, related to preventing exacerbation or spread of infection | Remind patient and family of health maintenance behaviors to decrease risk of illness Teach importance of hygiene measures to decrease spread of infection |
| tonsillitis | Can be a cause by microorganism group A beta-hemolytic Streptococcus Caused by air or food borne bacterial infection Most common in school-age children |
| tonsillitis clinical manifestations | Sore throat Fever Chills Malaise Enlarged tonsils with purulent exudate |
| tonsillitis nursing goal | To facilitate recovery and prevent secondary infections |
| Pain, related to inflammation/irritation of throat | Assess degree of pain and need for analgesics Maintain bed rest Offer warm saline gargles, ice chips and ice collar |
| Fluid volume, deficit, risk for, related to inability to maintain usual oral intake because of painful swallowing | Assess hydration status by noting mucous membranes, skin turgor, and urine output |
| Aspiration, risk for related to postoperative bleeding | Maintain patent airway Observe for vomiting of dark brown fluid Watch for frequent swallowing |
| tonsillitis prognosis | Self limiting Complications can occur |
| laryngitis | Secondary to other respiratory disorders Accompanies viral or bacterial infections Excessive use of voice Inhalation of irritating fumes Cause severe respiratory distress in children |
| laryngitis clinical manifestation | Hoarseness of varying degrees Scratchy and irritated throat Persistent cough |
| laryngitis diagnostic testing | Laryngoscopy |
| laryngitis medical management | If viral, no antibiotics Comfort measures to reduce coughing and decrease irritation If cause is bacterial, antibiotic therapy |
| Pain, related to throat irritation | Assess level of pain, and offer medications to promote comfort |
| Communication, impaired verbal, related to edematous vocal cord | Instruct patient on the importance of resting the voice Provide other means for communication Anticipate needs |
| laryngitis prognosis | Good for adults Respiratory distress for children |
| pharyngitis | Either acute or chronic Most common throat inflammation Viral in origin Severe form known as strep throat |
| pharyngitis clinical manifestations | Dry cough Tender tonsils Erythematous |
| pharyngitis assessment | Subjective data Presence of fever and difficulty swallowing Objective data Palpate for enlarged, edematous glands, associated tenderness and elevated temperature |
| pharyngitits diagnostic tests | Throat cultures |
| pharyngitis medical management | Antibiotic therapy Analgesics/Antipyretics |
| Oral Mucous membrane, impaired, related to edema | Provide warm saline gargles Assess level of pain and offer medications Offer frequent oral care |
| Fluid volume, deficient, risk for, related to decreased oral intake | Observe and record patient’s hydration status Monitor I&O |
| pharyngitis prognosis | Symptoms resolve in 4-6 days |
| sinusitis | Chronic or acute Maxillary or frontal Viral or bacterial |
| sinusitis clinical manifestations | Constant severe headache Pain and tenderness in affected area Purulent exudate |
| sinusitis | Subjective data complaints of decreased appetite or nausea, malaise, headache and pain in region Objective data |
| sinusitis diagnostic tests | Sinus x-rays Transillumination |
| sinusitis medical management | Nasal windows or opening in sinus to facilitate drainage Caldwell-Luc operation to remove diseased tissue Medications |
| medication for sinusitis | Antibiotics - control infection Analgesics - relieve discomfort Antihistamines - reduce congestion Vasoconstrictors - reduce vascular congestion Warm moist heat - to promote drainage and provide comfort |
| Breathing pattern, ineffective, related to nasal congestion | Assess respiratory status frequently |
| Pain, related to sinus congestion | Document comfort level Assess need for pain medication Elevate HOB Apply warm moist packs |
| sinusitis prognosis | Uncomplicated sinusitis is good Spread of infection possible |
Created by:
sydcpepper
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