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 |