Oxygenation and Circulation

Allergic Rhinitis Treatment

*Antihistamines (Brompheniramine is a first-generation antihistamine used to treat allergic rhinitis)(Contraindication: acute asthma attack and pneumonia) *Topical Nasal Steroid Decongestants (Contraindication: Acute Infection) *Intranasal corticosteroids (Flonase) are more effective for treating allergic rhinitis and related symptoms than intranasal antihistamines (Afrin).

Which is true regarding the drug therapy for treating allergic and nonallergic rhinitis?

*Intranasal sprays that contain antihistamines are considered as first-line treatment. *Saline nasal sprays do not have the negative effects that other medications do. *Oral decongestants are not prescribed for clients with a history of cardiac disease.

Empiric therapy for treating acute bacterial rhinosinusitis (ABRS) in adults

*The empiric therapy should be started as quickly after diagnosis of ABRS is confirmed. *In an adult client with ABRS, amoxicillin-clavulanate is recommended over amoxicillin alone for five to seven days. *Second- and third-generation oral cephalosporins and trimethoprim-sulfamethoxazole are not recommended for empiric therapy. *Macrolides are NOT recommended for empiric therapy for treating ABRS in an adult client. Adjunct therapy: intranasal saline irrigation, intranasal corticosteroids.

Not recommended as an adjunct therapy for treating ABRS

*Topical or oral antihistamines *Nasal Spray Decongestants

Which systemic condition of a client is most likely to result in distension of the internal jugular vein?

*hypervolemia due to increased fluid volume. *valvular disease. *cardiac tamponade

Schilling test

10. The nurse is preparing the patient for a test to determine the cause of vitamin B12 deficiency. The patient will receive a small oral dose of radioactive vitamin B12 followed by a large parenteral dose of nonradioactive dose of B12. What test is the patient being prepared for? a. Bone marrow aspiration b. Schilling test c. Bone marrow biopsy d. Magnetic resonance imaging (MRI) study

SCD hemolytic crisis

A hemolytic crisis results from an increased rate of RBC hemolysis with decreased hemoglobin levels and jaundice.

Pernicious anemia (a subcategory of B12 deficiency related to lack of INTRINSIC FACTOR)

A patient had gastric bypass surgery 3 years ago and now, experiencing fatigue, visits the clinic to determine the cause. The patient takes pantoprazole (Protonix) for the treatment of frequent heartburn. What type of anemia is this patient at risk for? a. Aplastic anemia b. Iron deficiency anemia c. Sickle cell anemia d. Pernicious anemia

SCD Sequestration crisis

A sequestration crisis is caused by sudden, massive pooling of RBCs in the spleen with resulting hypovolemic shock and cardiovascular failure.

SCD vaso-occlusive crisis

A vaso-occlusive crisis is caused by obstruction of vessels by hemolyzed cells leading to tissue hypoxia and pain. #1 reason for hospitalization among SCD pts

Afterload

Afterload is the force or resistance the ventricles must overcome to eject blood into the pulmonary circuit or aorta.

SCD Aplastic crisis

An aplastic crisis is caused when the bone marrow ceases to produce RBCs with a subsequent decrease in blood reticulocyte count.

Brompheniramine

Antihistamines like brompheniramine cause dry mouth and constipation.

Cardiac output

Cardiac output is the volume of blood pumped by the heart in 1 minute.

Signs and symptoms of OSA

Daytime sleepiness, insomnia, loud snoring, personality changes, impotence, hypertension, and cardiac dysrhythmias.

Why a client with laryngitis is instructed to use a humidifier?

Humidification reduces inflammation. Therefore, a client with laryngitis is instructed to use a humidifier to reduce inflammation.

How do we treat acute chest syndrome (ACS) with SCD?

Incentive spirometry (every 2 hours while awake) Pain management Fluids Oxygen for hypoxic patients Bronchodilators Transfusions Antibiotics if infectious source --Remember it's not a clot, it's blood cells jammed up

First-line treatment of allergic and nonallergic rhinitis?

Intranasal sprays containing antihistamines

Intranasal sprays caution

Intranasal sprays, if used for longer than a week, may cause complications. Therefore, it is not recommended and discontinuation may result in rebound congestion (severe congestion).

Clinical manifestation of iron deficiency anemia

Iron deficiency anemia is defined by decreased oxygenation to the blood tissues. Clinical manifestations of the condition include fatigue, pallor, tachycardia, tachypnea, and shortness of breath. Also, glossitis

Which upper-airway disorder is characterized by the development of mucoceles?

Mucoceles are a collection of fluid that can develop within the frontal or ethmoid sinuses because of obstruction and can result in bony erosion in clients with acute rhinosinusitis.

Symptoms of rhinitis

Nasal congestion, rhinorrhea, sneezing, and itching of the nose, eyes, and ears.

Which classification of rhinitis does the common cold fall under?

Nonallergic acute rhinitis Acute rhinitis generally lasts one to three weeks. The common cold is an example of a nonallergic acute rhinitis. It is a type of infectious rhinitis caused by a variety of viruses and is usually self-limiting unless a bacterial infection develops simultaneously.

The hospital nurse cares for many patients who have hypertension. What nursing diagnosis is most common among patients who are being treated for this health problem?

Noncompliance with therapeutic regimen related to adverse effects of prescribed therapy

A patient in hypertensive urgency is admitted to the hospital. The nurse should be aware of what goal of treatment for a patient in hypertensive urgency?

Normalizing BP within 24 to 48 hours

O2 toxicity

O2 toxicity- lung damage that occurs when O2 delivered in concentrations > than 50% for longer than 48-72 hoursDifficult to reverse

OSA, how to sleep

OSA is a condition where the upper airway is obstructed during sleep resulting in intermittent breathing patterns. A client with OSA should sleep in a nonsupine position and use pillows to prevent obstruction during sleep.

Oral decongestant caution

Oral decongestants may cause vasoconstriction; therefore, these medications are usually not prescribed or recommended for clients with a history of cardiac disease. Ex. Phenylephrine/ Pseudoephedrine (can cause insomnia as a side effect)

Potential complication of Rhinosinusitis

Osteomyelitis is a potential complication of rhinosinusitis that may occur if the disease is left untreated or inadequately treated.

Uvulopalatopharyngoplasty

Performed in a client with OSA to maintain adequate airflow

Preload

Preload is the end diastolic pressure that stretches the right or left ventricle. It is affected by blood volume, heart rate, body position, and many other factors.

Symptoms of Rhinosinusitis

Purulent nasal drainage, a sense of pressure, and facial pain.

The primary health-care provider prescribes a decongestant to a client with rhinosinusitis. Which side effect does the nurse expect in the client?

Reduced ostiomeatal complex inflammation The ostiomeatal complex is the bony structure present around the drainage openings of sinuses. Decongestants reduce ostiomeatal complex inflammation.

Decongestants

Should be taken at the onset of symptoms.

folic acid deficiency

The clinical manifestation of folic acid deficiency is related to incomplete DNA synthesis that affects the formation of the heme and the maturation of the red blood cells, causing a decreased hemoglobin level. Symptoms include fatigue, pallor, dizziness, tachycardia, and shortness of breath.

polycythemia

The clinical manifestation of polycythemia is related to hyperviscosity of blood. Some of the clinical manifestations include headache, dizziness, weakness, splenomegaly, and shortness of breath.

Vitamin B12 deficiency

The clinical manifestation of vitamin B12 deficiency is related to the impairment of DNA synthesis required for the formation and maintenance of myelin, neurotransmitters, and phospholipids. Symptoms include a stinging sensation on the tongue, depression, and an altered mental state.

Rhinosinusitis

This disease may affect the facial bones of the client.

Rhinitis

Upper respiratory disorder caused by allergic reactions

Rhinosinusitis

Upper respiratory disorder caused by the organism Streptococcus pneumonia.

Laryngitis

Upper respiratory disorder caused by vocal misuse

OSA

Upper respiratory disorder that can be caused by certain lifestyle factors such as obesity and cigarette smoking

CPAP for OSA

Use of continuous positive airway pressure helps to prevent the collapse of the upper airway in a client with OSA.

Nasal Spray Decongestant

Use of nasal spray decongestants should be limited to less than four days, since continuous use may result in serious complications.

Rhinitis may cause...

excessive nasal congestion, sneezing, and nasal drainage.

Rhinitis medicamentosa

is nasal congestion without rhinorrhea or sneezing and is known as rebound rhinitis or chemical rhinitis.

Stroke volume

volume of blood pumped by one ventricle, usually the left ventricle, with each heartbeat.