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Med-Surg Chap 33

Ignativicius, med-surg

Rhinitis an inflammation of the nasal mucosa
Allergic rhinitis Often called hay fever or allergies, is triggered by hypersensitivity reactions to airborne allergens, especially plant pollens or molds. Some episodes are "seasonal" because they recur at the same time each year and last a few weeks.
Perennial rhinitis occurs either intermittently with no seasonal pattern or continuously whenever the person is exposed to an offending allergen such as dust, animal dander, wool, or foods
Acute viral rhinitis (coryza, or the common cold) is caused by any of over 200 viruses. It spreads from person to person by droplets from sneezing or coughing and by direct contact. Colds are most contagious in the first 2 to 3 days after symptoms appear.
Sinusitis An inflammation of the mucous membranes of one or more of the sinuses. Swelling can obstruct the flow of secretions from the sinuses, which may then become infected. The disorder often follows rhinitis. Other conditions leading to sinusitis include deviat
Manifestations of sinusitis Nasal swelling and congestion, headache, facial pressure, and pain (usually worse when the head is tilted forward or is in a dependent position). Other manifestations include tenderness to touch over the involved area, low-grade fever, cough, and purulent
Nonsurgical treatment of sinusitis Treatment includes the use of broad-spectrum antibiotics, analgesics for pain and fever, decongestants, steam humidification, hot and wet packs over the sinus area, and nasal saline irrigations. Teach the patient to increase fluid intake unless another me
Surgical treatment of sinusitis A common procedure used for sinusitis that does not respond to drug therapy is functional endoscopic sinus surgery (FESS). Small endoscopes (sinoscopes) are used to first visualize the area. Instruments attached to the sinoscopes are used to open the nasa
How do you obtain a specimen for a throat culture? To obtain a specimen, rub a sterile cotton swab from a throat culture kit first over the right tonsillar area, moving across the right arch, the uvula, and then across the left arch to the left tonsillar area (Rushing, 2007). Remove the swab without touch
When is a CBC performed? A complete blood count (CBC) is performed when the patient's condition is severe or does not improve. Patients who need a CBC are those who have high fevers, lethargy, or manifestations of complications.
When should the patient be re-evaluated regarding bacterial pharyngitis? The patient should be re-evaluated if there is no improvement in 3 days or if manifestations are still present after completion of the antibiotic course. Persistent bacterial pharyngitis may occur with immunosuppression. Any patient whose bacterial pharyn
Tonsillitis An inflammation and infection of the tonsils and lymphatic tissues located on each side of the throat
When are surgical interventions necessary for tonsillitis? Surgical intervention for tonsillitis may be needed for recurrent acute infections (especially group A beta-hemolytic streptococcal infections), chronic infections that do not respond to antibiotics, a peritonsillar abscess, and enlarged tonsils or adenoi
Peritonsillar abscess (PTA) A complication of acute tonsillitis. The infection spreads from the tonsil to the surrounding tissue, which forms an abscess. The most common cause of PTA is group A beta-hemolytic Streptococcus.
When does a peritonsillar abscess become of concern? Hospitalization is required when the airway is in jeopardy or when the infection does not respond to antibiotic therapy. Incision and drainage of the abscess and additional antibiotic therapy may be needed. A tonsillectomy may be performed to prevent recu
Laryngitis An inflammation of the mucous membranes lining the larynx and may or may not include edema of the vocal cords.
What causes laryngitis? Common causes include exposure to irritating inhalants (e.g., chemical fumes, tobacco, alcohol, smoke), voice overuse, inhalation of fumes (e.g., glue, paint thinner, butane), or intubation. Recurrent laryngitis may be caused by gastroesophageal reflux di
Aphonia temporary voice loss
What should you teach the patient regarding laryngitis? Teach the patient and family about relief measures, infection prevention, and avoidance of alcohol, tobacco, and pollutants, which can irritate the larynx. Teach about preventive strategies such as reducing tobacco and alcohol use. Emphasize the need to a
How prevalent is the flu virus? Between 5% and 20% of the U.S. population develop influenza each year, and more than 36,000 deaths per year are caused by it.
What are some signs of the flu? severe headache, muscle aches, fever, chills, fatigue, and weakness. Adults are contagious from 24 hours before symptoms occur and up to 5 days after they begin. Patients who are immunosuppressed may be contagious for several weeks. Sore throat, cough, a
Pandemic having the potential to spread globally
What are manifestations of avian influenza (H5N1)? The initial manifestations of avian influenza are similar to other respiratory infections—cough, fever, and sore throat. These progress rapidly to shortness of breath and pneumonia. In addition, diarrhea, vomiting, abdominal pain, and bleeding from the no
What treatments are available for avian influenza? No effective treatment for this infection currently exists. Antibiotics and antiviral drugs cannot kill the virus or prevent its replication. Interventions are supportive to allow the patient's own immune system to fight the infection. Oxygen is given whe
What is some important teaching for visitors of an H5N1 infected patient? Teach others to self-monitor for disease symptoms, especially of respiratory infection, for at least a week after the last contact with the patient. Use the antiviral drug oseltamivir (Tamiflu) or zanamivir (Relenza) within 48 hours of contact with the in
Pneumonia An excess of fluid in the lungs resulting from an inflammatory process.
Empyema A collection of pus in the pleural cavity
How does pneumonia affect the body? The inflammation occurs in the interstitial spaces, the alveoli, and often the bronchioles. The process begins when organisms penetrate the airway mucosa and multiply in the alveoli. White blood cells (WBCs) migrate to the area of infection, causing local
The fibrin and edema of inflammation stiffen the lung, reducing compliance and decreasing the vital capacity. Alveolar collapse (atelectasis) further reduces the ability of the lung to oxygenate the blood moving through it. As a result, arterial oxygen le
What are infectious causes of pneumonia? Pneumonia can be caused by bacteria, viruses, mycoplasmas, fungi, rickettsiae, protozoa, and helminths (worms).
What are noninfectious causes of pneumonia? Noninfectious causes of pneumonia include inhalation of toxic gases, chemical fumes, and smoke and aspiration of water, food, fluid, and vomitus.
How often should clients receive the pneumococcal polysaccharide vaccine (PPV23)? This vaccine is usually given once; however, some experts believe that older adults and those with chronic health problems could benefit from a second vaccination if more than 5 years have passed since the first vaccination.Especially encourage people old
What are clinical manifestations of pneumonia? Many patients with pneumonia have flushed cheeks, bright eyes, and an anxious expression. The patient may have chest or pleuritic pain or discomfort, myalgia, headache, chills, fever, cough, tachycardia, dyspnea, tachypnea, hemoptysis, and sputum producti
Observe the patient's breathing pattern, position, and use of accessory muscles. The hypoxic patient may be uncomfortable in a lying position and will sit upright, balancing with the hands. Assess the cough and the amount, color, consistency, and odor of
Crackles are heard with auscultation when fluid is in interstitial and alveolar areas. Wheezing may be heard if inflammation or exudate is in the airways. Bronchial breath sounds are heard over areas of density or consolidation. Fremitus is increased over
In evaluating vital signs, compare the results with baseline values. The patient with pneumonia is likely to be hypotensive with orthostatic changes as a result of vasodilation and dehydration, especially the older adult. A rapid, weak pulse may indicate
What are some considerations for older adults when assessing for pneumonia? The older adult with pneumonia has weakness, fatigue, lethargy, confusion, and poor appetite. Fever and cough may be absent, but hypoxemia is often present. The most common manifestation of pneumonia in the older adult patient is acute confusion from hypo
What is the most common diagnostic test for pneumonia? Chest x-ray continues to be the most common diagnostic test for pneumonia but may not show changes until 2 or more days after manifestations are present. It usually appears on chest x-ray as an area of increased density. It may involve a lung segment, a l
What are priority problems for the patient with pneumonia? Priority problems for the patient with pneumonia are:
1. Hypoxemia related to decreased diffusion at the alveolar-capillary membrane
2. Potential for airway obstruction related to excessive tracheobronchial secretions, fatigue, chest discomfort, muscle weakness
3. Potential for sepsis related to the presence of microorganisms in a very vascular area
Severe acute respiratory syndrome (SARS) An easily spread respiratory infection first identified in China in November 2002. At first appearing as an atypical pneumonia, it is caused by a new, more virulent form of coronavirus, and there is no known effective treatment.
It infects cells of the respiratory tract, triggering inflammatory responses, and stays in the respiratory passageways rather than spreading into the blood.
The virus is easily spread by airborne droplets from infected people through sneezing, coughing, and talking. People at greatest risk for SARS are those in close direct contact with an infected person. The portals of entry are the mucous membranes of the
Coronaviruses These viruses have ribonucleic acid (RNA) as their genetic material and have many projections that look like a halo or "corona." This family of viruses causes many forms of the common cold.
What are common manifestations of SARS? Usually, the patient has a fever higher than 100.4° F (38.0° C), a headache, and general body aches. Mild cold symptoms of a runny nose, sore throat, and watery eyes may also be present. Within 2 to 7 days, the patient develops a dry cough and has difficu
Tuberculosis (TB) A highly communicable disease caused by Mycobacterium tuberculosis. It is the most common bacterial infection worldwide.
The organism is transmitted via aerosolization (i.e., an airborne route)
Far more people are infected with the bacillus than actually develop active TB.
How does the process of TB infections occur? 1. The granulomatous inflammation created by the tubercle bacillus in the lung becomes surrounded by collagen, fibroblasts, and lymphocytes.
2. Caseation necrosis, which is necrotic tissue being turned into a granular mass, occurs in the center of the lesion. If this area shows on x-ray, it is called Ghon's tubercle, or the primary lesion.
Where is an initial TB infection seen? Initial infection is seen more often in the middle or lower lobes of the lung.
What is secondary TB? Secondary TB is a reactivation of the disease in a previously infected person. It is more likely when defenses are lowered, such as with older adults and people with HIV disease. The upper lobes are the most common site of reactivation and are referred to
Calmette-Guérin (BCG) vaccine The BCG vaccine contains attenuated tubercle bacilli and is used in many countries to produce increased resistance to TB. Anyone who has received BCG vaccine within the previous 10 years will have a positive skin test that can complicate interpretation. U
The effectiveness of BCG vaccine in preventing TB is controversial, and it is not used widely for this purpose in the United States or Canada.
nucleic acid amplification test (NAAT) The acid-fast bacillus test is not specific for TB (other organisms are also acid-fast), but it is used as a quick method to determine whether TB precautions should be started until more definitive testing can be completed with either the purified protein
QuantiFERON-TB Gold (QFT-G) Blood analysis by an enzyme-linked immunosorbent assay using the QuantiFERON-TB Gold (QFT-G) is a relatively rapid test for the presence of M. tuberculosis. Results are ready in 24 hours and are most useful in the acute care setting to determine whether a
Directly observed therapy (DOT) A health care professional watches the patient swallow the drugs.
Lung Abscess A lung abscess is a localized area of destruction caused by liquefaction necrosis, which is usually related to pyogenic bacteria. Patients with an abscess often have a history of pneumonia, aspiration of stomach contents, or obstruction as a result of a t
Multiple abscesses and cavities form in patients with tuberculosis (TB) or fungal infections of the lung.
Pleuritic chest pain A stabbing pain upon taking a deep breath
Inhalation anthrax (respiratory anthrax) is a bacterial infection caused by the gram-positive organism Bacillus anthracis, which lives as a spore in contaminated soil. Infection with this organism occurs through the skin, the intestinal tract, or the lungs. Inhalation anthr
What are the stages of inhalation anthrax illness? Inhalation anthrax is a two-stage illness—prodromal and fulminant.
Describe the prodromal stage early and difficult to distinguish from influenza or pneumonia. Manifestations include fever, fatigue, mild chest pain, and a dry, harsh cough. A special feature of inhalation anthrax is that it is not accompanied by upper respiratory manifestations of so
Describe fulminant stage begins after the patient feels a little better. Usually there is a sudden onset of breathlessness. This sensation rapidly progresses to severe respiratory distress, dyspnea, diaphoresis, stridor, and cyanosis. The patient has a high fever. Mediastinitis a
Pulmonary empyema A collection of pus in the pleural space.
What are possible causes of pulmonary empyema? The most common cause of empyema is pulmonary infection, lung abscess, or infected pleural effusion. Pneumonia or lung abscess can spread across the pleura. Lymph node obstruction can cause a retrograde (backward) flood of infected lymph into the pleural
What are some important assessment findings regarding pulmonary empyema? Important history findings include recent febrile illness (including pneumonia), chest pain, dyspnea, cough, and trauma. Observe and document the character of the sputum. Chest wall motion may be reduced on physical examination. If a pleural effusion is p
Ask about fever, chills, night sweats, and weight loss. The patient may be hypotensive because of a mediastinal deviation placing pressure on the heart. Palpate the point of maximal impulse (PMI) because it may be displaced.
Created by: bethwebb