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68c Ph2 Exam 5

Upper airway disorders

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