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resp lecture 2
G. Mcgregor lecture 2 respiratory
| Question | Answer |
|---|---|
| Non-infectious Upper Airway Problems | Nasal Fracture, Epistaxis, Trauma, Polyps, Cancer of the mouth & trachea, Foreign Body Aspiration, Obstructive Sleep Apnea |
| Assessment for airway obstruction | Assess for septal deviation or misalignment, Palpate for crepitus, swelling and pain, presence of bleeding or CSF from nose |
| Crepitus | a continuous grating sensation caused by irregular cartilage, may be felt or heard as the joint goes through range of motion. |
| Interventions for nasal problems | diagnostic nasal x-rays, rhinoplasty, nasoseptoplasty |
| Epistaxis interventions | Direct pressure to the nose for 5 minutes, Ice, Have client lean forward to prevent blood from going down throat, Anterior packing/ tampons, Instruct not to blow nose |
| Maxillofacial trauma | LeFort Fractures: Le Fort I is a nasoethmoid complex fracture. Le Fort II is a maxillary and nasoethmoid complex fracture. Le Fort III is a combination of I and II plus an orbital-zygoma fracture |
| Complications of maxillofacial fractures | swelling and bleeding may cause airway compromise |
| Priority nursing intervention for facial fractures | PROTECT THE AIRWAY, LEVEL OF CONSCIOUSNESS |
| Interventions for facial trama | Maintain the airway, Control the hemorrhage, Stabilize the c-spine, Stabilization of the fractures, Surgical fixation of the fractures, Prophylactic antibiotics |
| Polyps are growths that can occur in either the | nose or on the vocal cords |
| Nasal polyps usually occur bilaterally and are caused by | chronic irritation of the nasal mucosa |
| Nodules of the vocal cords are usually | hypertrophied fibrous tissue that occurs as a result of infections or overuse of the voice |
| Polyps of the vocal cords are | chronic edema that occurs in people who smoke, have multiple allergies or live in dry climates. |
| Types of Polyps | Benign nasal polyps, inverting papilloma, juvenile angofibromas |
| Benign nasal polyps | can be treated with nasal inhaled steroids or surgical removal |
| Inverting papilloma- | rare, invasive growth that invades or erodes facial structures and requires extensive surgery & reconstruction |
| Juvenile angiofibromas- | benign tumor that occurs most often in adolescent males. Usually resolves spontaneously but may require surgical removal |
| Tumors of the Nose & Sinus | Can be benign or malignant |
| Sinus cancer can mimic sinus infections. It is | slow growing |
| Treatment of sinus cancer is usually | radiation and/or surgical resection |
| Oropharyngeal cancer can cause | airway obstruction |
| Tumors of the Larynx | Slow growing, usually squamous cell carcinoma (80%), May appear as ulcerations, Can disrupt eating, breathing, speech and appearance |
| Cancer of the larynx is described by | degree of malignancy is determined by cellular analysis. Staging. |
| Warning Signs of Head & Neck Cancer | Pain, Lumps. Difficulty swallowing, Color changes, Oral lesions (lasts >2wks), oral bleeding, mouth/lips/face numb, Ϫ fit of dentures, Burning,unilateral ear pain, Hoarseness Ϫvoice quality,sore throat, SOB, Anorexia & wt loss, |
| Diagnosis of head/neck cancer | History – symptoms, duration, smoking & alcohol habits, P.A. CBC, coagulation studies, UA, chemistries, X-Ray ,CT, MRI, PET, Endoscopic exams, |
| Treatment head/neck cancer | radiation, chemotherapy, surgical removal of tumor |
| Laryngectomy | Surgical removal of the larynx. Can be partial or total |
| If the patient has a total laryngectomy, they will have | no vocal cords & thus will be unable to speak without a device |
| The difference between a laryngecomy and a tracheotomy is that | the patient can change the laryngectomy tube daily or as needed. |
| Aids to Speech after Laryngectomy | magic board, pen and paper or computer, then uses an artificial larynx and, ideally, eventually learns esophageal speech. |
| Aspiration CANNOT occur after a total laryngectomy because the | airway and esophagus have been completely separated. |
| Tracheostomy | An airway established through an opening in the trachea. Performed as a surgical procedure. Can be an emergency procedure in upper airway obstruction |
| Passy-Muir Valves | a one-way speaking valve for use with tracheostomy tubes |
| The passy-muir valve is a valve that allows | the passage of air but also has a valve which allows speech |
| Obstructive Sleep Apnea | Breathing disruption during sleep |
| Most common form is a result of | obstruction by the tongue or soft palate |
| Contributing factors 4 sleep apnea | a large uvula, short neck, smoking, enlarged tonsils or adenoids and obesity |
| s/s of sleep apnea | snore loudly, disturb your bedroom partner, wake yourself up, a sore throat, dry mouth or HA in the morning, fall asleep during the day, high blood pressure |
| OSA Diagnosis | on symptoms & sleep study (polysomnograph) |
| Non-surgical intervention OSA | use of positive pressure ventilation (BiPAP or CPAP) |
| Medications OSA | Xyrem (sodium oxybate)and Provigil (modafinil) |
| Surgical intervention OSA | uvulopalatopharyngoplasty is the removal of some of the soft palate. Permanent tracheostomy. |
| Asthma can be | Intermittent and reversible airflow obstruction |
| Asthma is considered a disease | of the airways (bronchospasm), not alveoli (gas exchange) |
| Asthma is | Inflammation of the mucous membranes lining the airways is a key factor in precipitating an attack that causes airflow restriction |
| Asthma can be stimulated by | allergens, cold, dry air, microorganisms or aspirin, exercise, with upper respiratory illness. |
| Asthma: Both inflammation and hyper-responsiveness | may have a genetic component |
| Pathophysiology asthma | hyper-responsive:pollutants or respiratory viruses; Stimulation of vagal nerve fibers causing constriction of bronchial smooth muscle, Results in decreased airflow |
| In asthma if both inflammation and hyper-responsiveness occur simultaneously, it will potentiate | the bronchoconstriction |
| Asthma caused by inflammatory response. Allergens bind to specific | immunoglobulin molecules. |
| In asthma, a histamine is released along with other | mast cell and basophil substances. Inflammatory response is initiated that causes BV dilation, capillary leakage in the airway mucosa→swelling→airway restriction→↓O2 |
| In asthma the same mechanism occurs in | anaphylactic shock |
| Assessment for asthma | ABCs, History, Vital signs, Breath sounds/ chest exam, Cardiac exam, Mental status, Do a clinical asthma score |
| Clinical Asthma Scale | is a step process that evaluates the severity of asthma an need for hospitalization |
| An acute asthma attack will require | oxygen, bronchodilators, steroids. |
| ABGs in asthma will show | severity of exacerbation, condition is deteriorating |
| Use ABGs in asthma if | Unable to do a good clinical evaluation |
| CXR | defines the extent of associated parenchymal disease, evidence of extra-alveolar air and differentiate other diseases. Usually shows hyperinflation and streaky atelectasis |
| Pulmonary Function Tests | evaluate lung function and breathing problems |
| PFT’s include | lung volumes and capacities, flow rates, diffusion capacity, gas exchange, airway resistance, and distribution of ventilation. |
| How are PFTs evaluated | interpreted by comparing the patient's data with expected findings for age, gender, race, height, weight, and smoking status. |
| EKG – May show | right axis deviation, cor pulmonale, increased pulmonary vascular resistance |
| Standard Interventions asthma | vital signs, Nebulizer treatments & chest physiotherapy& meds |
| Medications for asthma | Albuterol, Helium, Ipatroprium (atrovent), Ketamines, Isofluorance (only use with intubated patients), Magnesium, Oxygen, Terbultaline, Theophylline, Steroids |
| Bronchodilators | beta agonists, methylxanthines, cholinergic antagonists (anticholinergics), corticoidsteroids, leukotriene antagonists, inhaled anti-inflammatory (NSaids), mast cell stabilizers |
| Beta agonists: | Short-acting- albuterol, terbutaline; Long-acting- salmeterol |
| Methylxanthines | theophylline, aminophylline |
| Cholinergic antagonists | ipratropium |
| Anti-inflammatories | Corticosteroids; |
| Corticosteroids | Oral- prednisone, prednisolone, Inhaled- budesonide, fluticasone, beclomethasone, triamcinolone |
| Leukotrine Antagonists | zafirlukast, zileuton, montelukast |
| Inhaled anti-inflammatory- | nedocromil |
| Mast Cell Stabilizers | Inhaled mast cell stabilizers such as cromolyn sodium; Keep mast cells membranes from opening; Help prevent asthmatic episodes but are not helpful in acute episodes |
| Corticosteroids | Decrease inflammatory responses, Can be given orally, intravenous or inhaled |
| Corticosteroids: systemic (oral or IV) are given for | moderate or severe asthma |
| Inhaled corticosteroids are used for | mild to moderate. Most useful in preventing symptoms |
| Compromises in chest wall | pneumothorax and hemothorax |
| Pneumothorax | Air enters the pleural space, Increases intrathoracic pressure, Lung tissue is compressed, Vital capacity is decreased |
| Hemothorax | Caused by chest trauma and penetrating injuries. |
| A simple hemothorax is one where there is less than | 1500 ml blood in the thoracic cavity |
| A massive hemothorax is the loss of greater than | 1500 ml of blood into the thoracic cavity |
| Massive hemothorax in blunt force trauma can be from | the rupture of the heart, major vessels or the intercostal arteries |
| Tension Pneumothorax | Displaces the inferior vena cava and obstructs venous return to the right atrium, ↓stroke volume, blood not returning to heart, treatment→decompress the tention |
| Symptoms of Tension Pneumothorax | Increased anxiety, Dyspnea, Tachycardia, Hypotension, Unequal breath sounds and chest expansion, Tracheal shift to contralateral side, Sudden cardiovascular collapse or ↓in BP and/or CO |
| Reasons for Chest Tubes | Pneumothorax, Tension Pneumothorax, Hemothorax |
| Chest Tubes | Treatment to reinflate lung, drain off fluid or blood, Placed in the pleural space, Types of chest tubes |
| Chest Tube Drainage Systems. Keeping the collection device below the chest | allows gravity to drain the pleural space. |
| Stationary chest tube drainage systems usually use a water seal mechanism that acts as a | one-way valve to prevent air or liquid from moving back into the chest cavity. |
| The Pleur-Evac system is a common device using a one-piece disposable plastic unit with | three chambers. |
| Chamber one chamber is the | drainage collection container. |
| The second chamber in the series is the | water seal to prevent air from moving back up the tubing system and into the chest. |
| The third chamber, when suction is applied, is the | suction regulator. |
| Excessive bubbling in the water seal chamber (chamber two) may indicate | an air leak. |
| The health care provider prescribes the amount of water to be placed | in the 3rd chamber |
| Drainage greater than 70 mL/hr, Tracheal deviation or O2sat <90% | immediately notify the physician |
| Infectious Upper Airway Problems | , sinus infection, Pharyngitis, Tonsillitis, Peritonsillar abscess, Upper Respiratory Infection (URI), Influenza |
| Sinus Infection (Sinusitis) | Inflammation of the mucous membranes in the sinuses. Most often develops in frontal and maxillary sinus |
| Sinus infection is most often caused by: | Streptococcus pneumoniae, Haemophilus influenzae |
| Treatment of sinus infection consists of | treatment with broad spectrum antibiotics, decongestants, analgesics |
| Nursing implementations for sinus infection | Encourage fluid intake, Can use moist heat over area, humidifier, In severe cases, may need surgical drainage |
| Pharyngitis | Sore throat, Can be viral or bacterial – may be difficult to distinguish just by physical examination |
| Group A Beta Streptococcus is the | most common bacterial cause of pharyngitis. Symptoms include pain, erythema of the throat, difficulty swallowing and fever |
| Tonsillitis | Inflammation of the tonsils and lymphatic tissues on either side of the throat |
| Tonsils are lymphatic tissue that | filters organisms to protect the respiratory tract |
| Tonsillitis is a | contagious airborne infection. Usually lasts 7 to 10 days and is caused by bacteria. Should be treated with antibiotics |
| Peritonsillar Abscess | Sometimes called quinsy. Usually a complication of acute tonsillitis |
| Peritonsillar Abscess forms in the | tissue around the tonsil Can be a danger to the airway. PROTECT |
| Treatment for peritonsillar abscess | antibiotics, aspiration, analgesics |
| Upper Respiratory Infections | URI – the common cold, Usually viral in nature, Treatment is supportive and symptomatic, Rest, fluids |
| Influenza | , highly contagious acute viral infection. Can occur in all age groups |
| Symptoms of influenza | severe headache, muscle aches, fever, chills, weakness, fatigue and anorexia. Symptoms of fatigue, cough, weakness may persist for up to two weeks |
| Influenza can have dangerous complication of | pneumonia. Prevention is the best treatment |
Created by:
Jillzs
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