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68C 2014 P2 Test 5
Upper Airway Disorders
| Question | Answer |
|---|---|
| Adrenergics (sympathomimetics): | Drugs that stimulate the sympathetic nerve fibers of the autonomic nervous system which use epinephrine or epinephrine-like substances as neurotransmitters. |
| Antagonist: | Any drug that exerts an action opposite to that of another or competes for the same receptor sites. |
| Anticholinergic (parasympatholytics): | Drugs that block the action of acetylcholine and similar substances at acetylcholine receptors, resulting in inhibition of the transmission of parasympathetic nerve impulses. |
| Antihistamines: | Substances capable of reducing the physiologic and pharmacologic effects of histamine, including a wide variety of drugs that block histamine receptors. |
| Antitussive: | A drug that reduces coughing, often by inhibiting neural activity in the cough center of the central nervous system. |
| Corticosteroids: | Any of the hormones produced by the adrenal cortex, either in natural or synthetic drug form. They influence or control many key processes in the body. |
| Decongestants: | Drugs that reduce congestion or swelling especially of the upper or lower respiratory tract. |
| Expectorants: | Drugs that increase the flow of fluid in the respiratory tract, usually by reducing the viscosity of bronchial and tracheal secretions, and facilitate their removal by coughing and ciliary action. |
| Epistaxis | Bleeding from the nose cause by congestion of the nasal membranes leading to capillary rupture. |
| Epistaxis is FREQUENTLY caused by __________. | injury |
| Epistaxis OCCURS MORE FREQUENTLY in (men or women) | Men |
| Epistaxis is related to: | Related to menstrual flow in women AND Hypertension |
| Epistaxis causes: | Irritation of nasal mucosa, dryness, chronic infection or nose picking; Vigorous nose blowing |
| Epistaxis: True/False: Either PRIMARY or SECONDARY disorder to other conditions. | True |
| Epistaxis Clinical Manifestations: | (1) Presence of bright red blood, draining from one or both nostrils. (2) Severe nasal hemorrhage, adults may lose up to 1 liter of blood per hour. |
| Epistaxis Subjective Data: | (a) Interview patient (note duration and severity of bleeding). (b) Identification of precipitating factors |
| Epistaxis Objective Data: | (a) Assess bleeding from one or both nostrils. (b) Bleeding occurring from anterior or posterior nasal passageway. (c) Assess vital signs. (d) Assess for hypovolemic shock. |
| Epistaxis Diagnostic Tests: | (1) Hemoglobin and Hematocrit. (2) Coagulation studies (PT, PTT, INR). (3) Rhinoscopy: to locate bleeding site, possible cause and treatment. |
| Epistaxis Medical Management: | (1) Nasal packing with cotton saturated with Epinephrine 1:1000. (2) Cautery (electrical or chemical). (3) Posterior packing. |
| Epistaxis Nursing Interventions/Patient Teaching: | (1) Keep patient quiet. (2) Place in sitting position, leaning forward, if not possible reclining position with head and shoulders elevated. |
| Epistaxis Nursing Interventions/Patient Teaching: | (3) Apply direct pressure to soft portion of nose, hold for 10-15 minutes. (4) Apply ice compresses. (5) Monitor for signs and symptoms. |
| Epistaxis: Nursing Diagnosis: Ineffective tissue perfusion, ineffective cerebral and/or cardiopulmonary, related to blood loss: | Assess vital signs, level of consciousness every 15minutes, and report any changes. Document estimated blood loss. |
| Epistaxis: Nursing Diagnosis: Aspiration, risk for, related to bleeding | Elevated head of bed, position with head forward. Encourage patient to let blood drain from nose. Pinch nostrils; apply ice compresses over the nose. |
| Epistaxis: Nursing Diagnosis: Aspiration, risk for, related to bleeding | Assist patient to clear secretions. Maintain patent airway. Instruct patient expectorate clots and blood rather than swallow blood. |
| Epistaxis Prognosis: | good with treatment |
| Deviated Septum and Nasal Polyps | (1) Congenital abnormality or injury. (2) Deviation from midline with obstruction of nasal passageway. |
| Nasal Polyps | (1) Tissue growths on the nasal tissues, caused by prolonged sinus inflammation. (2) Allergies. |
| Deviated Septum and Nasal Polyps Clinical Manifestations: | (1) Stertorous respirations (2) Dyspnea. (3) Postnasal drip. |
| Stertorous respirations: | pertaining to respiratory effort that is struggling and strenuous, provoking a snoring sound. |
| Deviated Septum and Nasal Polyps Subjective Data: | (a) History of previous injuries, infections, allergies, sinus congestion. (b) Dyspnea. |
| Deviated Septum and Nasal Polyps Objective Data: | (a) Identify the condition and location. (b) Rate and character of respirations. |
| Deviated Septum and Nasal Polyps Diagnostic Tests: | (1) Sinus radiographic studies. (2) Visual examination (deviated septum). |
| Deviated Septum and Nasal Polyps Medical Management: | (1) Surgical correction (2) Nasal packing (3) Nasal mucosa hydration (4) Installation of medications |
| Nasoseptoplasty: | reconstruct, align and straighten the nasal septum. |
| Nasal polypectomy: | remove polyps |
| Nasal packing: | control bleeding for 24 hours. |
| Nasal mucosa hydration: | irrigation or application of petroleum. |
| Deviated Septum and Nasal Polyps Installation of medications: | reduce inflammation, congestion, prevent infection. |
| Deviated Septum and Nasal Polyps Installation of medication Types: | (a) Corticosteroids (prednisone). (b) Antihistamines. (c) Antibiotic agents (penicillin). (d) Analgesics (acetaminophen [Tylenol]). |
| Deviated Septum and Nasal Polyps Nursing Interventions / Patient Teaching: | (1) Contact physician if bleeding or an infection develops. (2) Caution about use of nasal sprays and drops (rebound effect on mucous membranes). |
| Deviated Septum and Nasal Polyps Nursing Interventions / Patient Teaching: | (3) Avoid nose blowing, vigorous coughing, or Valsalva maneuver for 2 days post-operative. (4) Ecchymosis and edema will be present for several days. |
| Deviated Septum and Nasal Polyps Nursing Diagnosis: Ineffective airway clearance, related to nasal exudate | Document patient's ability to clear secretions, and note respiratory status. Elevate head of bed, and apply ice compresses to the nose to decrease edema, discoloration, discomfort, and bleeding. |
| Deviated Septum and Nasal Polyps Nursing Diagnosis: Ineffective airway clearance, related to nasal exudate | Elevate head of bed, and apply ice compresses to the nose to decrease edema, discoloration, discomfort, and bleeding. Change nasal drip pad prn document color, consistency and amount of exudate |
| Deviated Septum and Nasal Polyps Nursing Diagnosis: Risk for injury, related to trauma to bleeding site associated with vigorous nose blowing. | Assess and report exudate. Instruct patient against blowing nose in immediate postoperative period, because this could increase bleeding, edema and ecchymosis. |
| Deviated Septum and Nasal Polyps Prognosis: | excellent with surgical correction. |
| Allergic Rhinitis and Allergic Conjunctivitis | (1) Atopic allergic condition that results from antigen-antibody reactions occurring in the nasal membranes, nasopharynx, and conjunctiva from inhaled or contact allergens. (2) May be seasonal or perennial condition. |
| Allergic Rhinitis and Allergic Conjunctivitis S/S: | (a) Ciliary action slows. (b) Mucosal gland secretion increases. (c) Leukocyte (eosinophil) infiltration occurs resulting in local tissue edema. |
| Common allergens: | Trees; Grass; Weeds; Mold spores; Fungi; House dusts; Mites; Animal dander; Some foods, drugs and insect stings. |
| Allergic Rhinitis and Allergic Conjunctivitis: Acute ocular manifestations | Edema; Photophobia; Excessive tearing; Blurring of vision; Pruritus |
| Allergic Rhinitis and Allergic Conjunctivitis Rhinitis: | Rhinitis; Otitis Media |
| Rhinitis: | Excessive secretions; Inability to breathe through the nose. |
| Allergic Rhinitis and Allergic Conjunctivitis Initial complaints: | Severe sneezing; Congestion; Pruritus; Lacrimation |
| Allergic Rhinitis and Allergic Conjunctivitis Chronic signs and symptoms: | Headache; Severe nasal congestion; Post nasal drip; Cough. |
| Allergic Rhinitis and Allergic Conjunctivitis If untreated, may develop: | Otitis media; Bronchitis; Sinusitis; Pneumonia |
| Allergic Rhinitis and Allergic Conjunctivitis Diagnostic Tests: | (1) Physical examination: pale mucosa of the turbines. (2) Skin testing. (3) Serum radioallergosorbent test (RAST). |
| Allergic Rhinitis and Allergic Conjunctivitis Medical Management: | (1) Relieve signs and symptoms. (2) Prevent infections. (3) Medications |
| Allergic Rhinitis Medications: | (a) Perennial use of antihistamines. (b) Decongestants: (c) Topical or nasal corticosteroids. |
| Allergic Conjunctivitis Medications: | Lodoxamide (Alomide) |
| Topical or nasal corticosteroids | 1) Beclomethasone (Vancenase, Beconase). 2) Dexamethasone (Decadron, Turbinaire). 3) Flunisolide (Nasalide). 4) Fluticasone (Flonase). 5) Budesonide (Rhinocort). |
| Allergic Rhinitis and Allergic Conjunctivitis Nursing Interventions/Patient Teaching: | (1) Focus on health promotion and maintenance. (2) Patient Education: |
| Allergic Rhinitis and Allergic Conjunctivitis Patient Education: | (a) Teach patient ways to avoid allergen. (b) Teach patient self-care management through symptom control. (c) Teach medication action and usage; assess for medication effectiveness. |
| Obstructive Sleep Apnea | (1) Characterized by partial or complete upper airway obstruction during sleep, causing apnea and hypopnea. (2) Caused when the tongue and the soft palate relax and partially or completely obstructs the pharynx. |
| Obstructive Sleep Apnea | (3) More common in men. (4) Incidence increases with age and weight gain. (5) Structural anomalies of the nare(s) and / or pharynx |
| Obstructive Sleep Apnea S/S: | (a) Apneic period (b) Headache in the morning (c) Personality changes (d) Hypertension and cardiac dysrhythmias |
| Apneic period | severe hypoxemia and hypercapnia. |
| Apneic period: Changes are ventilatory stimulants causing | a startle response, snorts, and gasps |
| Apnea and arousal cycles occur as many as | 200-400 times during hours of sleep |
| Obstructive Sleep Apnea: Clinical Manifestations: | Frequent awaking at night and insomnia; Excessive sleepiness during regular hours; Witnessed apneic episodes. |
| Obstructive Sleep Apnea: Diagnostic Tests: | Polysomnography |
| Sleep Apnea: Diagnosis made after repeated documented episodes of apnea or diminished respiratory effort of | 30-50% during study |
| Obstructive Sleep Apnea Medical Management: Mild Sleep Apnea-conservative management: | Avoid sedatives and alcoholic beverages 3-4 hours before sleep; Referral to a weight loss program; Oral appliance during sleep; Support group. |
| Obstructive Sleep Apnea Medical Management: Moderate to severe sleep apnea: | Nasal continuous positive airway pressure (nCPAP); Bi-level positive airway pressure (BiPAP); In severe cases, surgical management is an option. |
| Histamine Locations: | Present in various tissues of the body such as heart, lungs, gastric mucosa and skin. |
| Histamine: | It is involved in nerve impulse transmission in the central nervous system, dilation of capillaries, contraction of smooth muscles, stimulation of gastric secretion, and acceleration of the heart rate. |
| 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 Action: | Antihistamines / histamine antagonist are drugs that directly compete with histamine for specific receptor sites. They do not block histamine release, antibody production, or antigen-antibody reactions. |
| Antihistamines Action Indications: | Nasal allergies; Seasonal or perennial allergic rhinitis; Useful in the treatment of allergic reactions; Treat motion sickness; Vertigo; Insomnia; Parkinson-like reactions; Antitussive (syrup only) |
| Antihistamines Contraindications: | Hypersensitivity; Acute asthmatic attacks or bronchial asthma; Narrow angle glaucoma; Cardiac disease; Hypertension (HTN); Kidney disease; Benign prostatic hyperplasia (BPH); Seizure disorders; Peptic ulcer disease; Pregnancy; children < 2-6 of age. |
| Antihistamines Geriatric Patients: | more susceptible to adverse drug reactions and anticholinergic effects (deliriums, acute confusion, dizziness, dry mouth, blurred vision, urinary retention, constipation, tachycardia); dosage reduction or non-anticholinergic antihistamine recommended |
| Antihistamines: Traditional | 1) diphenhydramine (Benadryl). 2) azatadine (Optimine). 3) dimenhydrinate (Dramamine) 4) promethazine (Phenergan) 5) brompheniramine (Dimetane). |
| Antihistamines: Non-sedating | 1) fexofenadine (Allegra). 2) loratadine (Claritin). |
| Antihistamines Adverse Effects Most Common: | Drowsiness / Sedation; Dry mouth; Dry eyes; Thickening of bronchial secretions; Changes in vision; Difficulty urinating; Constipation |
| Antihistamines Other Adverse Effects: | Cardiovascular-dysrhythmias, arrest, hypotension, palpitations Central nervous-Dizziness, paradoxical excitement, nervousness, seizures GI-Anorexia, N/V, diarrhea or constipation |
| Antihistamines Other Adverse Effects: | Impotence, tinnitus, headache (HA); Rarely-agranulocytosis, hemolytic anemia, leukopenia, thrombocytopenia |
| Antihistamines Interactions: | (1) Increased concentrations of fexofenadine (Allegra) possible when given with erythromycin (2) Increased concentrations of loratadine (Claritin) possible when given with ketaconazole, cimetidine, or erythromycin. |
| Antihistamines Interactions: | (3) Risk of increased CNS depression with other antihistamines, alcohol, monoamine oxidase inhibitors (MAOI’s), opioid analgesics, and sedative/hypnotics |
| Antihistamines Interactions: | 4) Increased anticholinergic effects with tricyclic antidepressants, quinidine. (5) Antihistamine effects may be potentiated excessively by interactions with apple, grapefruit, and orange juice as well as with St. John’s wart. |
| Antihistamines Assessment: | a) Assess allergy symptoms before and periodically throughout therapy. (b) Monitor vital signs: pulse and BP prior to and throughout therapy. |
| Antihistamines Assessment: | Assess lung sounds and character of bronchial secretions. Maintain fluid intake of 1500-2000 mL/day to decrease viscosity of secretions. (d) Motion Sickness: assess nausea, vomiting, bowel sounds, and abdominal pain. |
| Antihistamines Assessment: | (e) Anxiety: assess mental status, mood and behavior when administering for anxiety. (f) Pruritus: observe the character, location, and size of affected area when administering for pruritic skin conditions. |
| Antihistamines Implementation: | (a) When used for prophylaxis of motion sickness, administer at least 30 min and preferably 1-2 hr before exposure to conditions that may precipitate motion sickness. |
| Antihistamines Implementation: | (b) When used for insomnia, administer 20 min before bedtime and schedule activities to minimize interruption of sleep. (c) Administer with meals or milk to minimize GI irritation. Capsule may be emptied and contents taken with water or food. |
| Antihistamines Evaluation: | (a) Do not drive or perform other hazardous tasks if drowsiness occurs. (b) Avoid the use of alcohol as well as other drugs that cause sleepiness or drowsiness while taking this medication. |
| Antihistamines Evaluation: | (c) Decrease in anxiety. (d) Relief of pruritus. (e) Sedation when used as a hypnotic |
| Decongestants Action: | produces vasoconstriction (rapid, long-acting) of arterioles, thereby decreasing fluid exudation, mucosal engorgement by stimulation of alpha-adrenergic receptors in the vascular smooth muscle or through modulation of the inflammatory response. |
| Decongestants Use: | to treat congestion associated with acute or chronic rhinitis, the common cold, and hay fever or other allergies |
| Three separate groups of nasal decongestants | Adrenergics ( sympathomimetics) Topical corticosteroids Anticholinergics |
| Adrenergics ( sympathomimetics) | oxymetazoline (Afrin) pseudoephedrine (Sudafed) phenylephrine (Neo-Synephrine) |
| Topical corticosteroids | beclomethasone dipropionate (Beconase) fluticasone (Flonase) triamcinolone (Nasacort) |
| Anticholinergics | ipratropium (Atrovent) |
| Decongestants Contraindications: | Hypersensitivity; Acute attacks of asthma; Narrow angle glaucoma; Hypertension; Hyperthyroidism; Prostatitis |
| Decongestants 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). |
| Adverse Effects: (1) Adrenergic drugs are usually well tolerated when used as directed, Some Adverse Effects: | Nervousness; Insomnia; Palpitations; Tremor |
| (2) Excessive dosages or prolonged use of topically applied adrenergic decongestants may cause systemic effects: | Hypertension; Palpitations; Headache; Nervousness; Dizziness; Rebound congestion |
| Most common adverse effects of intranasal steroids are | localized and include mucosal irritation and dryness. |
| Decongestants Interactions: | Few significant drug interactions with nasal decongestants. |
| Decongestants Nursing Assessment: | Redness, swelling, pain in nasal passages before and during treatment. |
| Decongestant's Nursing Implementation: | Review proper technique on administration of nose drops and sprays; Do not use for more than 3 days. |
| Decongestants Patient Teaching: | Nasal burning and stinging may occur with the topical decongestants. If this becomes severe, discontinue use and discuss problem with health care provider. |
| Decongestants Patient Teaching: | Use product as directed. Explain that overuse of topical nasal decongestants can make the symptoms worse. |
| Decongestants Patient Teaching: | If using a spray, do not allow the tip of the container to touch the nasal mucosa and do not share the container with anyone. To administer the spray, sit upright and sniff hard for a few minutes after administration. |
| Decongestants Evaluation | decrease nasal congestion |
| Upper Airway Obstruction | Precipitated by recent respiratory event; Trauma to surrounding tissues; Dentures; Aspirations of vomitus, secretions; Tongue most common airway obstruction in an unconscious person |
| Upper Airway Obstruction Clinical Manifestations: | Stertorous respirations - altered rate, character, and apneic periods |
| Upper Airway Obstruction Subjective Data: | patient unable to talk; nurse makes prompt, accurate assessment |
| Upper Airway Obstruction Medical Management: | Heimlich maneuver; Emergency tracheostomy - removal of obstruction; Artificial airways - pharyngeal, endotracheal, tracheal |
| Upper Airway Obstruction Nursing Intervention and Patient Teaching | Prompt opening of airway and restoring patency; the best goal is patient education. |
| Ineffective airway clearance, related to obstruction in airway | Re-establish and maintain secure airway. Administer oxygen as ordered. Suction frequently and assess ability to mobilize secretions |
| Risk for aspiration precautions R/T partial airway obstruction | Monitor respiratory rate, rhythm, and effort. Assess swallow reflex. Assess breath sounds |
| Cancer of the Larynx | Squamous cell carcinoma; Occur in people over age 60; 90% occur in men, due to alcohol and tobacco use; Chronic laryngitis; Vocal abuse; Familial history |
| Cancer of the Larynx Clinical Manifestations: | Progressive or persistent hoarseness (early sign) > 2 weeks; Metastasis includes pain in larynx radiating to ear; Difficulty swallowing (dysphagia); Lump in throat; Enlarged cervical lymph nodes |
| Cancer of the Larynx Subjective Data | Assess onset of symptoms; Difficulty breathing or swallowing |
| Cancer of the Larynx Objective Data | Examine sputum for presence of blood |
| Cancer of the Larynx Diagnostic Tests | Visual examination with direct laryngoscopy with biopsy; Imaging studies (i.e. CT, MRI, or PET) |
| Cancer of the Larynx Medical Management | Radiation therapy; Surgery such as - Total or partial laryngectomy; Radical neck dissection removal of the cervical lymph nodes; Chemotherapy |
| Radical neck dissection | removal of the cervical lymph nodes |
| Cancer of the Larynx Nursing Intervention/Patient Teaching | Airway patency, frequent suctioning; Skin integrity, monitor for infection; Monitor intake and output; Tube feedings; Daily weight; Psychological concerns with disfigurement |
| Ineffective airway clearance, related to secretions or obstruction | Suction secretions as needed. Provide tracheostomy care according to protocol; ensure the availability of emergency equipment (oxygen and tracheostomy tray) teach patient stoma care. Offer small frequent meals such as pureed foods, to prevent choking. |
| Ineffective airway clearance, related to secretions or obstruction | Turn, cough, and encourage deep breathing every 2 to 4 hours. Auscultate lung sounds. Provide constant humidity. Suction trachea prn. Perform trach care as necessary. Clean inner cannula of laryngectomy tube. |
| Impaired communication, verbal, related to removal of larynx | Provide patient with implements for communication, including pencil, paper, Magic Slate; picture books or electronic voice device. Keep call bell within easy reach. Refer to local Cancer Support Group |
| Cancer of the Larynx Prognosis | Varied, dependent on extent of involvement |
| Acute Rhinitis (common cold) | Defined as 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 Subjective Data | question patient regarding health and presence of sore throat, dyspnea and congestion |
| Acute Rhinitis Objective Data | Visual examination of throat and noting erythema, edema, and local irritation; Monitor vital signs |
| Acute Rhinitis Diagnostic test | Throat and sputum cultures to determine presence of bacterial infection. |
| Acute Rhinitis Medical Management | aimed at accurate diagnosis and prevention of complications |
| Acute Rhinitis Medications: | Analgesia; Antipyretics (Tylenol); Cough suppressant and expectorant; Antibiotics- for active infection |
| Acute Rhinitis Nursing Interventions - the goal | of nursing interventions is to facilitate recovery and prevention of secondary infections |
| Ineffective airway clearance, 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, such as adequate fluid and nutritional management and sufficient rest. Teach importance of hygiene measures to decrease spread of infection. |
| Acute Follicular Tonsillitis | Can be caused by microorganism group A beta-hemolytic Streptococcus; Caused by air or food borne bacterial infection; Most common in school-age children |
| Acute Follicular Tonsillitis Clinical Manifestations: | Enlarged cervical lymph nodes; Sore throat; Fever; Chills; Malaise, general muscle aching; Enlarged tonsils with purulent exudate |
| Acute Follicular Tonsillitis Subjective Data: | Note severity of throat pain, with complaints of pain to ears, headache or joint pain |
| Acute Follicular Tonsillitis Objective Data: | Enlarged erythematous tonsils; Increased throat secretions |
| Acute Follicular Tonsillitis Diagnostic Tests | Throat cultures to identify the causative agent; White Blood Count |
| Acute Follicular Tonsillitis Medical Management: | Antibiotic for active infection; Surgery for individuals who have had recurrent infection over a period of time (i.e. one year). |
| Acute Follicular Tonsillitis Nursing Interventions- the goal | is to facilitate recovery and prevent secondary infections. |
| Pain, related to inflammation / irritation of throat | Assess degree of pain and need for analgesics. Document effectiveness of medication, and offer analgesic as ordered. Maintain bed rest, and promote rest. Offer warm saline gargles, ice chips and ice collar as needed. |
| Risk for deficient fluid volume, related to inability to maintain usual oral intake because of painful swallowing | Assess hydration status by noting mucous membranes, skin tugor, and urine output. ice chips, and increased oral intake: cold liquids; carbonated drinks may be taken if patient tolerates; avoid offering citrus juices, because they may burn the throat. |
| Risk for aspiration, related to postoperative bleeding | Avoid coughing and clearing the throat the first week postoperatively |
| Acute Follicular Tonsillitis Prognosis | Self limiting, however complication can occur such sinusitis, otitis media, mastoiditis, rheumatic fever, nephritis or peritonsillar abscess. |
| Laryngitis | Secondary to other respiratory disorders; Accompanies viral or bacterial infections; Excessive use of voice; Inhalation of irritating fumes; May cause severe respiratory distress in children younger than 5 |
| Laryngitis Clinical Manifestations | Hoarseness of varying degrees; Scratchy and irritated throat; Persistent cough |
| Laryngitis Subjective Data | note patient reporting progressive hoarseness and cough |
| Laryngitis Objective Data | evaluate patient's voice quality as well as characteristics of sputum produced. |
| Laryngitis Diagnostic Test | Laryngoscopy - scope to visualize vocal cords and laryngeal mucosa |
| Laryngitis Medical Management | If cause is viral - no antibiotic therapy; Comfort measures to reduce coughing and decrease irritation; If cause is bacterial - antibiotic therapy in addition to comfort measures |
| Pain, related to throat irritation | Assess level of pain, and offer medications to promote comfort |
| Impaired communication, verbal, related to edematous vocal cord | Instruct patient on the importance of resting the voice. Provide other means for communication (written word, gestures) Anticipate patient's needs whenever possible. |
| Laryngitis Prognosis | Good for adults, however, for children can lead to respiratory distress. |
| Pharyngitis | Viral in origin, can be caused by hemolytic streptococci, staphylococci or other bacteria. Most common throat inflammation. Either acute or chronic. |
| Pharyngitis Severe form referred to as strep throat | contagious for 2-3 days after onset of signs and symptoms |
| Pharyngitis Clinical Manifestations | Dry cough; Tender tonsils, enlarged lymph glands; Erythematous, sore throat |
| Pharyngitis Subjective Data: | report pharyngeal discomfort, presence of fever and difficulty swallowing |
| Pharyngitis Objective Data: | palpating for enlarged, edematous glands, associated tenderness and elevated temperature |
| Pharyngitis Diagnostic tests | Throat cultures performed to document whether bacterial infection present |
| Impaired oral mucous membrane, related to edema | Antibiotic therapy such penicillin or erythromycin Analgesics/Antipyretics (Tylenol |
| Pharyngitis: | Provide warm saline gargles to promote comfort. Assess level of pain and offer medications as ordered. Encourage oral intake of fluids. Offer frequent oral care |
| Pharyngitis: | Observe and record patient's hydration status. Monitor I&) and patient's temperature. Maintain IV therapy if indicated. |
| Pharyngitis Prognosis: | Symptoms will usually resolved in 4-6 days, unless complications arise. |
| Sinusitis | Viral or bacterial in origin. Maxillary or frontal. Chronic or acute. |
| Sinusitis Clinical Manifestations: | Constant, severe headache; Pain and tenderness in affected area; Purulent exudate |
| Sinusitis Subjective Data: | note patient's complaints of decreased appetite or nausea, malaise, headache and pain in region |
| Sinusitis Objective Data: | assess vital signs, with attention to temperature and assess character of drainage |
| 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 Warm moist heat - to promote drainage and provide comfort |
| Sinusitis Medication: | 1) Antibiotics - control infection 2) Analgesics - relieve discomfort 3) Antihistamines - reduce congestion 4) Vasoconstrictors - reduce vascular congestion i.e. Afrin |
| Ineffective breathing pattern, related to nasal congestion | Assess respiratory status frequently, noting any changes; mouth breathing may be necessary because of nasal airway/sinus discomfort |
| Pain, related to sinus congestion | Document comfort level. Assess need for analgesics, and document patient response |
| Pain, related to sinus congestion | Elevate head of bed to promote drainage of secretions. Apply warm moist packs four times a day to promote secretion drainage and provide relief. |
| Sinusitis prognosis | Uncomplicated sinusitis is good. Complications include cavernous sinus thrombosis. Spread of infection to bone, brain, meninges and develop meningitis, osteomyelitis or septicemia |
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