respiratory

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Author:
katia
ID:
87868
Filename:
respiratory
Updated:
2011-05-27 15:46:10
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respiratory disorders lung
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Description:
nursing management for respiratory disorders
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  1. definition of rhinitis
    • inflammation of the nasal mucous membranes
    • also referred to as the common cold or coryza
    • may be acute, chronic or allergic
  2. definition of rhinorrhea
    clear nasal drainage
  3. cause of rhinitis
    • most common cause is the rhinovirus
    • spread by inhalation of droplets and direct contact with contaminated articles
  4. cause of allergic rhinitis
    a hypersensitivity to allergens such as pollen, dust, pet dander
  5. symptoms fo rhinitis
    sneezing, nasal congestion, rhinorrhea, sore throat, watery eyes, cough, low-grade fever, headache, muscle aches, malaise
  6. how long do symptoms last for rhinitis
    5 - 14 days
  7. treatment for rhinitis
    antipyretic for fever; decongestants for severe nasal congestion; antitussive for prolonged coughing; saline gargles for sore throat; antihistamines for allergic rhinitis; Antibiotics are only used if a bacteria has been identified
  8. nursing management for rhinitis
    • nurse teachers patient about treatment of rhinitis; about how to minimize and prevent rhinitis by maintaining a healthy lifestyle of adequate sleep and rest, proper diet, and moderate exercise
    • frequent hand washing greatly reduces the spread of infection
  9. definition of sinusitis
    • inflammation of the sinuses
    • most commonly affected is the maxillary sinus
  10. possible complications of sinusitis
    • infection of the middle ear
    • infection of the brain
  11. cause of sinusitis
    • most common is spread of infection from nasal passage to the sinuses and the blockage of normal sinus drainage
    • interference of sinus drainage predisposes the patient to sinusitis because trapped secretions readily become infected
  12. what causes impaired sinus drainage
    allergies (which causes edema of the nasal mucous membranes); nasal polyps; deviated septum
  13. how can you reduce occurrence of sinusitis
    eating well-balanced diet; getting plenty of rest; moderate exercise; avoiding allergens; seeking medical assistance if symptoms last for more than 10 days or if discharge is green, dark yellow or foul smelling
  14. signs and symptoms of sinusitis
    • depend upon which sinus is infected
    • headache, pain over affected sinus, fever, nasal congestion, nasal discharge, pain and pressure around the eyes, malaise
  15. diagnosis of sinusitis
    • nasal smear for culture and sensitivity test
    • transillumination
    • radiographs of sinuses
    • thorough history, including allergy history and if this has happened before
  16. treatment of sinusitis
    • antibiotics for severe infection
    • saline irrigation of maxillary sinus with catheter through normal opening under the middle concha
    • vasoconstrictors (short-term) to relieve nasal congestion and aid in sinus drainage; i.e.: phenylephrine
  17. surgery for sinusitis
    • indicated for chronic sinusitis
    • endoscopic sinus surgery helps provide an opening in the inferior meatus to promote drainage
    • CALDWELL-LUC procedure and sphenoethmoidectomy are done to remove diseased tissue and provide an opening into the inferior meatus of the nose for adequate drainage (this procedure is more radical)
  18. Nursing management for sinusitis (no surgery)
    • encourage mouth-washing and humidification
    • increased fluid intake, which may loosen secretions and increase comfort
    • take nasal decongestants and antihistamines as orders; i.e. only 3 days for nasal spray
  19. nursing management for sinusitis surgery
    • standard post-op care
    • observe for repeated swallowing which may indicate hemorrhage
    • observe for optic nerve damage by checking visual acuity by asking patient to identify # of fingers held up
    • monitor temp at least q4hr
    • assess pain over sinuses
    • administer analgesics as indicated
    • apply ice compresses to reduce swelling and pain
  20. post-op care for nasal packing
    • nasal packing and dressing make pt breath through mouth, therefore encourage good oral hygiene, give ice chips or small, frequent sips of fluid
    • change drip dressing as needed and report excessive drainage
  21. postoperative patient and family teaching for nasal surgery
    • do not blow nose
    • do not lift objects more than 5-10 pounds
    • no straining for 10-14 days
    • remain in warm environment
    • avoid smoky or poorly ventilated areas
  22. definition of pharyngitis
    • inflammation of the throat
    • often associated with rhinitis and other upper respiratory infections
  23. cause of pharyngitis
    • viruses and bacteria
    • group A streptococci is most serious which causes strep throat
  24. what are possible complications of Strep Throat
    • can lead to dangerous cardiac complications like endocarditis and rheumatic fever
    • can lead to harmful renal complications like glomerulonephritis
  25. how is pharyngitis spread
    • pharyngitis is high contagious
    • spreads via inhalation of or direct contamination with droplets
    • hand washing is vital
  26. incubation period for pharyngitis
    2 - 4 days
  27. signs and symptoms of pharyngitis
    • sore throat, sometimes severe; difficulty swallowing; fever; chills, headache, malaise
    • some patients may exhibit a white or exudate patch over tonsillar area
    • swollen glands
  28. diagnosis of pharyngitis
    throat cultures including rapid culture and standard 24-hour lab culture
  29. treatment of pharyngitis
    • early antibiotics is best
    • penicillin derivatives usually work best
    • usually for 7 - 14 days
  30. definition of tonsilitis
    inflammation of the tonsils
  31. adenoiditis
    inflammation of adenoids
  32. tonsillitis and adenoiditis
    • usually occur together
    • common in children, but also in adults
    • usually diagnosed as tonsillitis
  33. cause of tonsillitis
    • because tonsils and adenoids are lymphatic tissue, they are a common site of infection
    • primary infection occurs in tonsils and adenoids or it can be secondary to other upper respiratory infections
  34. complications of chronic tonsillar infection
    may lead to enlargement and partial airway obstruction
  35. complications of chronic adenoiditis
    may result in acute or chronic infection in the middle ear
  36. Signs and symptoms of tonsillitis and adenoiditis
    • sore throat, difficulty or pain swallowing, fever, malaise
    • enlarged adenoids, white patches on tonsils (if group A strep)
  37. diagnosis of tonsillitis and adenoiditis
    • throat culture and sensitivity test
    • visual inspection of tonsils and adenoids reveal enlargement
  38. Medical treatment of tonsillitis and adenoiditis
    antibiotics, analgesics, saline gargles
  39. surgical treatment of tonsillitis and adenoiditis
    • Chronic infections may require a tonsillectomy and adenoidectomy
    • certain criteria must be met: repeated infection; hypertrophy of tonsils; repeated, purulent otitis media; enlarges, obstructive adenoids; hearing loss related to serous otitis media associated with enlarged tonsils and adenoids
    • generally both are outpatient procedures
  40. nursing management of patients undergoing tonsillectomy and adenoidectomy
    • obtain baseline vitals and labs prior to procedure
    • implement post-op standards of care
    • observe for edema and airway patancy
    • observe for lethargy, behavior changes, disorientation which may indicate poor gas exchange/airway movement
  41. definition of peritonsillar abscess
    an abscess that develops in the connective tissue between the capsule on the tonsil and the constrictor muscle of the pharynx
  42. cause of peritonsillar abscess
    usually follows a severe strep or staph infection
  43. signs and symptoms of peritonsillar abscess
    difficulty and pain with swallowing; fever; malaise; ear pain; difficulty talking
  44. diagnosis of peritonsillar abscess
    • visual examination of affected side will show red, swollen
    • if drainage, a culture and sensitivity test will be done
  45. treatment of peritonsillar abscess
    • immediate treatment is necessary to prevent possible systemic spread
    • Antibiotics
    • Surgical incision and drainage of abscess are performed is oropharynx is partially blocked
    • repeat abscess may require tonsillectomy
  46. nursing management for peritonsillar abscess drainage
    • place patient in Semi-Fowler's position to prevent aspiration
    • ice collar if ordered to reduce swelling and pain
    • encourage patient to drink fluids
    • observe patient for signs of respiratory obstruction, i.e.: dyspnea, restlessness, cyanosis
    • observe patient for signs of excessive bleeding
  47. definition of laryngitis
    • inflammation and swelling of the mucous membrane that lines the larynx
    • edema of the vocal cords often accompanies laryngeal inflammation
  48. cause of laryngitis
    • often follows other upper respiratory infections
    • excessive use or improper use of the voice, allergies, smoking
  49. signs and symptoms of laryngitis
    hoarseness, inability to speak above a whisper, aphonia, throat irritation, and dry, nonproductive cough
  50. definition of aphonia
    complete loss of voice
  51. diagnosis of laryngitis
    • based on the symptoms
    • if hoarseness lasts more than two weeks, the larynx needs to be examined
  52. definition of laryngoscopy
    visual inspection of the larynx with a scope
  53. treatment of larygitis
    • voice rest, removal or treatment of cause
    • antibiotics if bacterial infection is the cause
  54. signs of laryngeal cancer
    persistant hoarseness
  55. nursing management for larygitis
    encourage patient to quit smoking if smoking is the cause
  56. definition of Epistaxis
    • nosebleed
    • common occurrence
    • rupture of tiny capillaries in the nasal mucous membrane
  57. causes of epistaxis
    • trauma, rheumatic fever, infection, hypertension, nasal tumors, blood dyscrasias
    • cocaine abuse
    • foreign bodies in nose
    • deviated septum
    • forceful nose blowing
    • frequent or aggressive nose picking
  58. assessment findings for epistaxis
    • inspect nares using nasal speculum and light to reveal bleeding area
    • check back of throat
  59. Medical Management of Epistaxis
    • depends upon severity and location of the bleeding
    • direct, continuous pressure to nares for 5-10 minutes with patients head tilted slightly forward
    • application of ice packs to nose
    • cauterization with silver nitrate, electrocautery, or application of a topical vasoconstrictor
    • nasal packing with a cotton tampon
    • pressure with a balloon inflated catheter inserted posteriorly for a minimum of 48 hours
  60. nursing management for epistaxis
    • monitor vital signs
    • assess for signs of continued bleeding
    • initiate measures to control bleeding within scope of practice (pressure and ice packs)
    • reassure patient
    • educate patient to use humidification, nasal lubricant and avoid aggressive nose blowing, nose trauma, and nose picking
  61. three conditions that lead to nasal obstruction
    • deviated septum
    • nasal polyps
    • hypertrophied turbinates
  62. definition of deviated septum
    • an irregularity in the septum that results in nasal obstruction
    • may be a deflection from the midline in the forms of lumps or sharp projections or an S curvature
    • may be congenital, but often results from trauma
  63. complications of deviated septum
    • possible complete obstruction of one nostril
    • interference with sinus drainage
  64. definition of nasal polyps
    • grape-like swelling that arise from the nasal mucous membrane
    • result from chronic irritation related to infection or allergic rhinitis
    • most often benign, but tend to recur when removed
  65. complications of nasal polyps
    obstruction of nasal breathing and sinus drainage, ultimately leading to sinusitis
  66. definition of hypertrophied turbinates
    • enlargement if the nasal conchae, three bones that project from the lateral wall of the nasal cavity.
    • hypertrophy results from chronic rhinitis
  67. complications of hypertrophied turbinates
    • interferes with air passage and sinus drainage
    • eventually leads to sinusitis
  68. symptoms for nasal obstructions
    history of sinusitis, difficulty breathing out of one nostril, frequent nosebleeds, frequent nasal discharge
  69. assessment findings for nasal obstructions
    inspection with a nasal speculum reveals either deviated septum, nasal polyps, or enlarged turbunates
  70. surgical management of nasal obstructions
    septoplasty for deviated septum
    • septoplasty - submucous surgical resection done to restore normal breathing and permit adequate sinus drainage for the patient with a deviated septum
    • incision through the mucous membrane and removal of the portion of the septum that caused the obstruction
  71. surgical management of nasal obstruction
    rhinoplasty
    • reconstruction of nose
    • enhances the client's appearance cosmetically and corrects any structural nasal deformities that interfere with air passage
    • an incision inside the nostril is made and restructure of the bone and cartilage
  72. medical management for nasal polyps
    • steroidal nasal spray to reduce inflammation
    • direct injection of steroids into polyps
    • polypectomy - surgical removal of polyps with nasal snare or laser
  73. medical management of hypertrophied turbinates
    • often treated with the application of astringents or aerosolized corticosteroids to shrink them close tot he nose
    • turbinectomy - surgical removal of a turbinate
  74. nursing management for nasal obstruction
    surgical
    • nurse explains procedure
    • emphasize nasal packing will mean mouth breathing
    • application of ice packs will reduce pain and swelling
    • place patient in Semi-Fowler's position to promote drainage, reduce edema & enhance breathing
    • inspect nasal packing and dressing frequently for bleeding
    • assess patient for excessive swallowing which may indicate bleeding
  75. Patient and Family teaching for Nasal Obstruction Surgery
    • do not bend over
    • do not blow nose
    • sneeze with mouth open
    • avoid contact with nose or surrounding tissue
    • keep head elevated with pillow when laying down
    • avoid heavy lifting
    • do not use aspirin, ibuprofen, alcohol or tobacco products
  76. Fracture of the Nose
    • results from direct trauma
    • causes swelling and edema of the soft tissues, external and internal bleeding, nasal deformity and nasal obstruction
    • in severe cases, cerebrospinal fluid may drain from nares, that suggest that the cribiform plate has been fractured
  77. diagnosis of fractured nose
    • may be delayed due to severe swelling and bleeding
    • radiograph
    • dextrostix to determine if clear fluid is cerebrospinal fluid
    • internal inspection to check septum
  78. medical management of fracture of the nose
    • if fracture is lateral displacement, pressure is applied to the convex portion of the nose to reduce the fracture
    • cold compresses for bleeding and swelling reduction
    • surgery and splint placement may be necessary if fracture is more complex
  79. nursing management of fracture of the nose

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