ch.20

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Author:
jscallan
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128472
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ch.20
Updated:
2012-01-17 20:33:35
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20 medsurg
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Description:
medsurg. test 1 upper respiratory disorders
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  1. what is the best choice of treatment for pharyngitis?
    early antibiotic treatment such as penicillin. (if patient is allergic to that, patient will receive erythromycin)
  2. _____ is the inflammation of the tonsils.
    _____ is the inflammation of the adenoids.
    (these conditions typically occur together)
    • tonsillitis
    • adenoiditis
    • (this is a common site of infection)
  3. Chronic tonsillar infection leads to _____ and partial ______.
    Chronic adenoidal infection can result in acute or chronic _______________.
    enlargement; upper airway obstruction

    infection in the middle ear
  4. what is otitis media?
    infection and inflammation in the middle ear
  5. explain these 4 main points for client and family teaching for at home self-care after a tonsillectomy and adenoidectomy:
    • 1. report any signs of bleeding to physician. important first 12-24 hrs and then 7-10 days after as throat heals
    • 2. gently gargle with warm saline to assist in removing thick mucous
    • 3. maintaine a liquid or very soft diet for several days after
    • 4. avoid milk and milk products if client doesnt tolorate them well
  6. a visual examination of tonsilitis reveals:
    enlarged and reddened tonsils. white patches may appear on tonsils if group A streptococci is the cause.
  7. after a throat culture and sensitivity test determines the cause, tonsilitis and adenoiditis is treated by:
    • antibiotic therapy
    • analgesics (acetaminophen) and saline gargles
  8. during the assessment of a client about to undergo a tonsillectomy, pay special attention to lab results for ___, ___, and ___ because of the high risk for postoperative hemorrhage.

    ask client about recent use of ___, ___, or other medications that prolong bleeding time
    • hematocrit
    • platelet count
    • clotting time

    • aspirin
    • nonsteroidal anti-inflammatory drugs (NSAIDs)
  9. after tonsillectomy surgery, implement what postoperative standard of care? (7)
    • 1. position client, until alert, on either side with emesis basin
    • 2. elevate HOB 45degrees when fully awake
    • 3. monitor RR, rhythm and effort (at least every hour), breath sounds
    • 4. encourage client to spit secretions/vomitus into emesis basin.
    • 5. have oral suction available
    • 6. instruct client not to cough, clear throat, blow nose, or use straw for first few days
    • 7. no carbinated drink or drinks with high citrus content
  10. _____ is an abcess that develops in the connective tissue btw the capsule of the tonsil and the constrictor muscle of the pharynx. it may follow a severe streptococcal or staphylococcal tonsillar infection.
    peritonsillar abscess

    drainage from abscess is cultured to identify microorganism and sensitivity studies determine antibiotic therapy
  11. why is immediate treatment of a peritonsillar abscess recommended?

    explain treatment:
    to prevent the spread of the causative microorganisms to the bloodstream or adjacent structures.

    • immediate antibiotics are given. a surgical incision and drainage of the abscess are done if abscess partially blocks the oropharynx (patient is in semi-fowler position to prevent aspiration)
    • *repeated episodes may necessitates a tonsillectomy*
  12. ____ is the inflammation and swelling of the mucous membrane that lines the larynx.

    usual symptoms: (4)
    laryngitis

    • 1. hoarseness
    • 2. inability to speak above a whisper (aphonia)
    • 3. throat irritation
    • 4. dry, nonproductive cough
    • *diagnosis based on symptoms*
  13. list some causes of laryngitis: (5)
    • 1. excessive or improper use of voice
    • 2. allergies
    • 3. smoking
    • 4. may follow a URI and results from spread of infection to larynx
    • 5. edema of the vocal cords
  14. in laryngitis, if hoarseness persists more than _____, the larynx is examined (laryngoscopy)
    persistent hoarsness is sign of laryngeal cancer.

    treatment includes: (2)
    2 weeks

    • 1. voice rest
    • 2. antibiotic therapy (if bacteria is the cause)
  15. _____ aka nosebleeds occur most commonly in the ___ ____ referred to as Kiesselback's plexus.
    epistaxis

    anterior septum
  16. severe epistaxis which are also very difficult to control derives from _______ or _______.
    • hypertension
    • blood dyscrasias (pathologic condition of the blood. disease state of the blood)
  17. treating epistaxis, severity and location of the bleeding determine the treatment. 1 or combination of following may be used: (5)
    • 1. direct pressure to the nares for 5-10 min with client head tilted slightly forward
    • 2. apply ice pack to nose
    • 3. cauteriztion with silver nitrate, electrocautery, or a topical vasoconstrictor
    • 4. nasal packing with cotton tampon
    • 5. pressure with a balloon inflated catheter (minimum 48 hours)
  18. 3 recommendations to help avoid nosebleeds (epistaxis):
    • 1. use a humidification
    • 2. use a nasal lubricant
    • 3. avoid vigorous nose blowing/nose picking/and other nose traumas
  19. 3 primary conditions that lead to nasal obstructions:
    • 1. a deviated septum
    • 2. nasal polyps
    • 3. hypertrophied turbinates
  20. _____ is an irregularity in the septum that results in nasal obstruction. may be congenital, but often it results from trauma.

    2 treatments to correct this is:
    deviated septum

    • 1. septoplasty (submucous surgical resection- removal of portion of septum that is the obstruction) nose is packed with gauze for 12-24 hrs and moustache dressing is applied
    • *restores normal breathing and permits adequate sinus drainage

    2. rhinoplasy (also will enhance clients appearance cosmetically)nose packed with gauze and splint is put on nose
  21. ____ are grapelike swelling that arise from the nasal mucous membranes. result from chronic irritation related to infection or allergic ___. obstruct nasal breathing and sinus drainage, ultimately leading to ___.
    nasal polyps

    • rhinitis
    • sinusitis
  22. what is the treatment for nasal polyps? (2)
    if severe? (1)
    • 1. steroidal nasal spray (reduce inflammation)
    • 2. direct injection of steroids into polyps

    1. polypectomy
  23. _____ are enlargements of the nasal conchae, 3 bones that project from the lateral wall of the nasal cavity.
    the hypertrophy, which results from _____, interferes with air passage and sinus drainage and eventually leads to ____.
    • hypertrophied turbinates
    • chronic rhinitis
    • sinusitis
  24. what are the treatment for hypertrophied turbinates? (1)
    1. application of astringents or an aerosolized corticosteroid to shrink them close to the nose
  25. list some client and family teaching for surgury for nasal obstructions: (7)
    • 1. do not bend over
    • 2. do not blow nose
    • 3. if sneezing, keep mouth open
    • 4. avoid contact with nose and surroundin tissue
    • 5. keep head elevated. use extra pillows when lying down
    • 6. avoid heavy lifting
    • 7. do not use aspirin, ibuprofen, alcohol, or tobacco products
  26. in severe nasal fractures, what may drain from the nares?
    what does this suggest?
    • cerebrospinal fluid.
    • a fracture in the cribriform plate.
  27. why would a diagnosis of a nasal fracture may be delayed?
    because of significant swelling and bleeding.
  28. in a nasal fracture, if drainage of clear fluid is observed, what is used to determine if it is cerebrospinal fluid or not? what does it look for?
    • Dextrostix
    • the presence of glucose, which is diagnostic for cerebrospinal fluid.
  29. if a nasal fracture is _______, pressure is applied to the convex portion of the nose reduces the fracture.
    surgery is needed for more complex breaks and a splint is applies post-op to maintain alignment.
    lateral displacement
  30. nursing management for nose fractures are: (4)
    • 1. keep head elevated
    • 2. apply ice 4 times a day for 20 min
    • 3. give analgesics PRN to alleviate pain
    • 4. assess client VS, any airway obstructions, respiratory difficulties, dysphagia, signs of infection, LOC, periorbital edema..
  31. this type of trauma occurs during motor vehicle accidents when the neck strikes the steering wheel or other blunt trauma occurs. other possible causes are endoscopic and endotracheal intubations.
    laryngeal trauma
  32. ____ is an extremely serious and often life threatening condition.
    causes include: allergic reactions, severe head and neck trauma, severe inflammation and edema of the throat, and aspiration of foreign bodies.
    laryngeal obstruction
  33. laryngeal trauma causes neck ____, _____, and _____.
    if tissue surrounding the larynx are greatly swollen, the client will exhibit ____, high-pitched, harsh sound during respiration, indicative of airway obstruction.
    • swelling, bruising, tenderness
    • stridor
  34. with laryngeal trauma, the client will exhibit: (4)
    • 1. dyspagia
    • 2. hoarseness
    • 3. cyanosis
    • 4. possible hemoptysis (expectoration of bloody sputum)
  35. severe obstruction requires an emergency ______.
    tracheostomy
  36. _____is characterized by frequent, brief episodes of repiratory standstill during sleep.
    sleep apnea syndrome
  37. sleep apnea is classified according to respiratory muscle efforts. 1. central, 2. obsructive, and 3. mixed. describe each:
    1. central- an absence of ventilation efforts causes air movement to be absent bc the brain malfuntions in its normal signal to breathe.

    2. obstructive- pharyngeal obstruction causes air movement to be absent. chest and abdominal movements are present. *most common form

    3. mixed- combination of central and obstructive in one apneic episode
  38. clients with obstructive sleep apnea snore loudly, with cessation of breathing for at least __ seconds.
    clients awaken suddenlyas the partial pressure of oxygen (PaO2) levels ___, usually with a loud snort.
    10

    drop
  39. _____ are tests that monitor the clients respiratory and cardiac status while he or she sleeps.
    polysomnography
  40. depending on severity of sleep apnea, clients can change their lifestyle, including: (5)
    • 1. quit smoking
    • 2. lose weight
    • 3. eliminate alchohol and other meds that depress RR
    • 4. using special pillows that keep you in a side-lying positon
    • 5. use allergy meds or saline nasal sprays to reduce congestion and dryness.
  41. additional treatment for sleep apnea is the use of a noninvasive positive pressure ventilation (NPPV). 2 types:
    1. ________- provides constant airway pressure during inspiration and expiration.
    2. ________- provides 2 levels of pressure: inspiratory and expiratory airway pressures.
    continuous positive airway pressure (CPAP)

    Bilevel positive airway pressure (BIPAP)
  42. _______ a surgical procedure to remove tissues in the throat, including the uvula, palate, and pharynx, to relieve obstruction. most common surgury for obstructive sleep apnea.
    uvulopalatopharyngoplasty

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