Respiratory Chapter 22

A patient playing softball was hit in the nose by the ball and has been determined to have an uncomplicated fractured nose with epistaxis. The nurse should prepare to assist the physician with what tasks? a) Preparing patient for septoplasty b) applying nasal packing c) administering nasal lavage d) applying steroidal nasal spray

A - applying nasal packing

A patient comes to the clinic complaining of a possible URI. What should the nurse inspect that would indicate that an URI may be present? a) the nasal mucosa b) the buccal mucosa c) the frontal sinus d) the tracheal mucosa

A - the nasal mucosa

A patient prescribed a medication for HTN started taking it 3 days ago and arrives in the ED with an edematous face and tongue and have a difficult time speaking. What medication is the nurse aware of that may produce this type of side effect? a) Metoprolo b) Amlodipine c) Enalapril d) Valsartan

C - Enalapril

A patient comes to the clinic and is diagnosed with tonsillitis and adenoiditiis. What bacterial pathogen does the nurse knows is commonly associated with tonsillitis and adenoiditis? a) Gram-negative Klebsiella b) pseudomonas aeruginosa c) Group A beta-hemolytic streptococcus d) Staphylococcus aureus

C - Group A beta-hemolytic streptococcus

The nurse is educating a patient diagnosed with acute bacterial rhinosinusitis about interventions that may assist with symptom control. What should the nurse include in this information? select all that apply a) Take an OTC nasal decongestant b) Take an OTC antihistamine c) Ensure adequate fluid intake d) increase the humidity in the home e) apply local heat to promote drainage

C, D, E

URI clinical manifestations

Headache Cough Hoarseness Fever Stuffiness Generalized discomfort Fatigue

Nursing Assessment for Laryngeal cancer

Health History Physical Assessment Nutritional Status (height/weight/BMI) Labs: (Albumin, protein, glucose and electrolyte levels) Ability to see, hear and write in case pt cannot speak after surgery Patter of alcohol intake (to be able to watch for alcohol withdrawal symptoms and delirium)

Bacterial pharyngitis

if left untreated complications can be severe and life threatening thinosinusitis, otitis media peritonsillar abscess mastoiditis cervical adenitis (rare: bacteremia, pneumonia, meningitis, rheumative fever, nephritis)

Acute Pharyngitis

sudden, painful inflammation of the pharynx (the back portion of the throat that includes the posterior third of the tongue, soft palate and tonsils) - commonly referred to as sore throat

URI complications

Airway obstruction Hemorrhage Sepsis Meningitis Brain Abscess Nuchal rigidity Medicamentosa Acute otitis media Trismus Dysphagia Aphonia Cellulitis

A patient with an advanced laryngeal tumor is to have radiation therapy. The patient tells the nurse, "If I am going to have radiation I won't need surgery". What is the best response by the nurse? a) "that is correct. the radiation will eradicate the tumor and you won't have to do further treatments b) Radiation is used to shrink the tumors size and is an adjunct to surgery c) all patients have to have radiation before they have surgery, it's protocol. d) you really don't have to have radiation but you won't have to have such invasive surgery if you have the radiation first.

B - radiation is used to shrink the tumor and is adjunct to surgery

A patient comes to the clinic with a cold and wants something to help relieve the symptoms. What should the nurse include in educating the patient about the uncomplicated common cold? Select all that apply a) Tell the patient to take prescribed antibiotics to decrease the severity of symptoms b) Inform the patient about the symptoms of secondary infection c) Suggest that the patient take adequate fluids and get plenty of rest d) Inform the patient that the virus is contagious for 2 days before symptoms appear and during the first part of the symptomatic phase e) Inform the patient that taking an antihistamine will help to decrease the duration of the cold

B, C, D

Diagnosis of Laryngeal Cancer

Complete H&P Laryngoscopy using glexible endoscope Fine Needle Aspiration (FNA) Barium Swallow Endoscopy CT MRI PET scan

The nurse is assessing a patient who smoke 2 packs a day of cigarettes and has a strong family hx of cancer. What early sign of cancer of the larynx does the nuse look for in this patient. a) burning of the throat when hot liquids are ingested b) enlarged cervical lymph nodea c) dysphagia d) affected voice sounds

D

Clinical Manifestation of Larynx cancer

Hoarseness (2 weeks or more) Persistent cough sore throat pain/burning in throat (worse when consuming hot liquids or citrus juices) lump felt in back of throat Late Signs: dysphagia dyspnea unilateral nasal obstruction/discharge persistent hoarseness persistent ulceration & foul breath cervical lymph node adnopahty unintentional weight loss general debilitated state

Upper Respiratory Infection Nursing Interventions

Maintain patent airway Promote comfort (analgesics, gargles for sore throat, hot pack for sinus congestion, ice collar to reduce swelling/bleeding post tonsillectomy/adenoidectomy) Rest Refrain from speaking Increase fluids to 2-3L/day

Viral pharyngitis

spreads easily in the droplets of coughs and sneezes as well as from unclean hands that have been exposed to the contaminated fluids

Obstructive Sleep Apnea (OSA)

recurrent episodes of upper airway obstruction and reduction in ventilation cessation of breathing during sleep

Viral pharyngitis

usually resolves in 3-10 days

OSA medical management

weight loss avoidance of alcohol positional therapy oral appliances CPAP - to prevent airway collapse BiPAP - makes breathing eaiser and results in lower average airway pressure

Larynx Cancer

1/2 of all head and neck cancers most common in ppl older than 65 years four times more common in men

The nurse is caring for a patient who had a total laryngectomy and has drains in place. When does the nurse understand that the drains will most likely be removed? a) when the patient has less than 30mL/day for 2 consecutive days b) when the patients states that there is no discomfort and requests removal c) when the drainage tube becomes blocked d) in 1 week when the physicial no longer has serious drains.

A

A patient has been diagnosed with acute rhinosinusitis caused by a bacterial organism. What antibiotic of choice for treatment of this disorder does the nurse anticipate educating the patient about? a) Amoxicillin-clavulanate b) cephalexin c) azithromycin d) clarithromycin

A - Amoxicillin-clavulanate

A patient has herpes simplex infection that developed after having the common cold. What medication does the nurse anticipate will be administered for this infection? a) An antiviral such as acyclovir b) An antibiotic such as amoxicillin c) An antihistamine such as benadryl d) An ointment such as bacitracin

A - An antiviral such as acyclovir

A patient comes to the clinic with complaints of a sore throat and is diagnosed with acute pharyngitis. What does the nurse understand is the cause of acute pharyngitis? a) Group A, beta-hemolytic streptococci b) Gram-Negative Klebsiella c) Pseudomonas aeruginosa d) Staphylococcus aureus

A - Group A, beta-hemolytic streptococci

The nurse is educating the patient diagnosed with acute pharyngitis on methods to alleviate discomfort. What interventions should the nurse include in the information? Select all that apply a) Apply ice colar b) stay on bed rest during the febrile stage of the illness c) gargle with an alcohol-based mouthwash d) try a liquid/soft diet during the acute stage e) drink warm or hot liquids during the acute stage

A - apply ice collar B - stay on bedrest during febrile stage C - Try a liquid/soft diet

Risk Factors for Laryngeal Cancer (chart 22-6 p.558)

Tobacco Combined effects of alcohol & tobacco Asbestos Secondhand smoke Paint fumes Wood dust Cement dust Chemicals Tar Products Mustard gas Leather and metals Nutritional deficiencies Hx of alcohol abuse Genetic predisposition Age (higher over 65) Gender (more common in men) Race (more prevalent in African Americans) Weakened immune system

Surgical mgt of OSA

Tonsilectomy Uvulopalatopharyngoplasty (removal of pharyngeal soft tissue and approx 15mm of free edge of the soft palate and uvula) Nasal septoplasty Maxillomandibular suregery Tracheostomy

A patient diagnosed 2 weeks ago with acute pharyngitis comes to the clinic stating that the sore throat got better for a couple of day and is now back along with an earache. What complications should the nurse be aware of related to acute pharyngitis? select all that apply a) Mastoiditis b) otitis media c) peritonsillar abscess d) pericarditis e) encephalitis

A - mastoiditis B - Otitis media C - peritonsillar abscess

A patient diagnosed as being in the early stage of layngeal cancer of the glottis with only 1 vocal cord involved. For what type of surgical intervention will the nurse plan to provide education? a) total laryngectomy b) cordectomy c) vocal cord stripping d) partial laryngectomy

D - partial laryngectomy

Medical Mgmt of Pharyngitis

if bacterial: penicillin V potassium for 5 days Cephalsosporins (5-10 days) Macrolides (clarithromycin, azithromycin once days for 3 days) Cefpodoxime / cefuroxime (5-10 days) Aspirin/Acetaminophen q4-6 hrs for sore throat if severe benzocaine gargles may be given

Bacterial pharyngitis

caused by group A beta-hemolytic streptococcus, streptococcal pharyngitis

Pharyngitis - when to contact HCP

dyspnea, drooling, inability to swallow, inability to fully open mouth

Laryngectomy Potential Complications

Respiratory distress (hypoxia, airway obstruction, tracheal edema) Hemorrhage Infection Would breakdown Aspiration Tracheostomal stenosis

Clinical Manifestation of OSA (chart 24-4 p.554)

frequent/loud snoring w/breathing cessation for 10 seconds or longer, at least 5 times per hour followed by awakening abruptly with a snort Excessive daytime sleepiness Frequent nocturnal awakening Insomnia Loud Snoring Morning headaches Intellectual deterioration Personality changes, irritability Impotence Systemic hypertension Dysrhythmias Pulmonary HTN, cor pulmonale Polycythemia Enuresis

Medical Mgt of Laryngeal Cancer

Stage I and II: Radiation Cordectomy Endoscopic laser excision Partial laryngectomy Stage III and IV: Radiation Chemotherapy Chemo-radiation Total laryngectomy

Viral Rhinitis (common cold)

adequate fluid intake, rest, prevention of chilling, expectorants as needed, warm salt water gargles to soothe sore throat, NSADS for aches and pains, antihistamines to relieve sneezing and nasal congestion

Risk factors for OSA

**obesity** male gender postmenopausal status advanced age

Causes of Rhinosinusitis (chart 22-1 p.540)

Vasomotor - idiopathic, abuse of nasal decongestants, psychological stimulation (anger, sexual arousal), Irritants such as smoke, pollution, exhaust, cocaine Mechanical - tumor, deviated septum, crusting, hypertrophied turbinates, foreign body, cerebrospinal fluid leak Chronic inflammatory - polyps (in cystic fibrosis), sarcoidosis, wegener's granulomatosis, midline granuloma Infectious - acute viral infection, acute or chronic rhinosinusitis, rare nalas infections (syphilis, tuberculosis) Hormonal - pregnancy, oral contraceptive, hypothyroidism

S/S of acute pharyngitis

fiery-red pharyngeal membrane and tonsils lymphoid follicles that are swollen and flecked with white-purple exudate enlarged/tender cervical lymph nodes no cough fever over 101 malaise, sore throat sometimes: vomiting, anorexia, scarlatina-form rash with urticaria (scarlet fever)