question

For the Trivalent Inactivated Influenza Vaccine, what it the route of administration, and what is the most common side effects?

answer

Given by injection IM Injection site reactions, pain, swelling, and redness

question

What is approved age for adminstrtion of the Inactivated Flu Vaccine?

answer

> 6 months old

question

The inactivated flu vaccine can be used in people that are at increased risk; these groups of people include?

answer

People at any age with chronic medical condition, residents of nursing homes and long-term care facilities, people who are immunocomprimised, Pregnant women

question

The live attenuated influenza vaccine is given by what route, and what are the most common side effects?

answer

Given by nasal spray runny nose, nasal congestion in all ages, fever in children ages 2-6 yr, and sore throat in adults

question

What age is the live attenuated influenza intended for?

answer

Approved for healthy people ages 2-49 yrs old

question

When is the live attenuated influenza vaccine contraindicated?

answer

Children 50 yr, Pregnant Women, Immunodefiency, Children adolescents receiving aspirin or other salicylates, medical conditions that place them at increased risk for complications from influenza (chronic cardiovascular, pulmonary, or neurologic diseases; diabetes mellitus, renal or hepatic dysfunction, hemoglobinopathies), HCP of high-risk patients because of risk of viral transmission from vaccine (should not care for patients for 7 days after vaccination)

question

What things would you teach your patient or caregiver regarding acute or chronic sinusitis?

answer

Get plenty of rest to promote recovery, keep well hydrated 6-8 glasses of water to loosen secretions, hot showers twice a day, use a steam inhaler 15 minutes of vaporization of boiled water, beside humidifier, or nasal saline spray to promote drainage, Apply warm damp towels around nose, cheeks, and eyes to ease facial pain, sleep with head elevated, follow precription regimen, analgesics for pain, decongestants/expectorants to releive swelling, antibiotics for infection, properly administer nasal sprays, perform large-volume nasal saline washes once or twice a day, do not smoke and avoid smoke exposure, if allergies predispose sinusitis, follow instructions regarding environmental control, drug therapy, immunotherapy to reduce inflammation and prevent sinusitis

question

When allergies predispose sinusitis, what would you teach the patient to help reduce sinus inflammation and infection?

answer

environmental control of allergens appropriate drug therapy

question

What is the initial treatment for sinusitis?

answer

symptom relief oral or topical decongestants to promote drainage, nasal corticostersteriods to decrease inflammation, analgesics for pain, and saline spray to relieve congestion

question

How long can you use a topical decongestant, and what might occur if you use it longer than the recommended timeframe?

answer

no longer than 3 days rebound congestion caused by vasodilation

question

What are saline irrigations use for?

answer

rinse the nasal passages, facilitate drainage, and decrease inflammation

question

Saline nasal spray is availble over the counter as a sterile solution in spray bottles, but can also be prepared at home using what method?

answer

1/4 teaspoon of salt dissolved in 8 ounces of tap water Patients may also add a pinch of baking soda to soften the effect of salt

question

How often should the nasal saline spray be administered?

answer

2 to 4 puffs at least 3 to 4 times a day

question

What is a alternative, more aggressive method in symptom relief of sinusitis?

answer

lavage with a squeeze bottle, neti pot, or syringe while leaning over the sink with mouth open Repeated full-syringe wash recommended at least once a day to wash out the secretions if they cannont be effectively removed with saline spray alone

question

When would antibiotics be prescribed for sinusitis?

answer

if symptoms worsen or persist longer than 10 days

question

What types of antibiotics are used for treatment of sinusitis?

answer

Amoxicillin as the first line drug of choice ir continued for 10 to 14 days to prevent the formation of antibiotic-resistant organisms. If symptoms do not resolve, antibiotic should be changed to a broader spectrum cephalosporin antibiotic.

question

How long would broad spectrum antibiotics be used for with sinusitis?

answer

4 to 6 weeks

question

Persistent and recurrent sinus complaints may require further treatment when medical therapy does not work. What is a more invasive method to corrent sinusitis?

answer

Nasal endoscopic surgery to relieve blockage caused by hypertrophy or septal deviation, which is an outpatient procedure perform using local anesthesia. Propel, a self expanding dissolvable implant, can be placed directly in the sinus during surgery to maintain postoperative patency and provide localized corticosteroid delivery directly to the sinus lining.

question

Nasal Fracture occurs as result of?

answer

Blunt trauma, icluding Automobile accidents, Falls, Sports injuries

question

Nasal Fractures can be prevented by?

answer

Protective equipment and protecting against falls

question

Complications assoicated with Nasal Fractures?

answer

Airway obstruction, Epistaxis, Meningeal tears causing cerebrospinal fluid (CSF) leakage, Septal hematoma, Cosmetic deformity

question

Two types of classifications of Nasal Fractures

answer

Simple Fractures and Complex Fractures

question

What type of nasal fracture is unilateral or bilateral and typically produces little to no displacement?

answer

Simple Fracture

question

What type of nasal fracture may involve subsequent damage to adjacent facial structures such as teeth, eyes, or other facial bones and may be seen with mid-facial trauma?

answer

Complex Fracture

question

Diagnosis of a Nasal Fracture is based on?

answer

Health history and Physical Exam

question

The clinical Manifestations of a Nasal Fracture include?

answer

Localized pain, Crepitus on palpation, Swelling, Ecchymosis, Cosmetic deformity, Epistaxis, Difficulty breathing out of nostrils, Facial deformity common, epistaxis may be the only initial sign

question

When inspecting the nose after nasal fracture, what would you need to note and assess?

answer

Patient's ability to breathe through each side of their nose Note any presence of edema, bleeding or hematoma Ecchymosis under the eyes, referred to as raccoon eyes, may suggest orbital or basilar skull fracture Inspect the nose for septal deviation, hemmorrhage, or clear fluid

question

What suggests that there is a CSF leakage after a nasal fracture, and what test is used to determine the presence of CSF fluid?

answer

Clear, pink-tinged, or persistant drainage after control of epistaxis suggest CSF leak Perform quick test near bedside to determine if glucose is present

question

When might you have to wait to repair a nasal fracture?

answer

when there is extensive swelling or until edema subsides, which may be 5 to 10 days

question

What are the goals of nursing management for nasal fractures?

answer

Maintain airway, keep pt in upright position Reduce Edema, apply ice to face/nose in 10 to 20 min intervals Reduce Pain, administer analgesics, acetaminophen if preferred over nonsterodial anti-inflammatory drugs NSAID or acetylsalicyclic acid aspirin for first 48 hrs to avoid prolonging clotting time Prevent Complications, nasal decongestants, saline sprays, humidifier can releive nasal stiffness, and encourage patient to quite smoking to maximize healing time Provide emotional support

question

When the nasal fracture is confirmed what are the methods to correct the issue?

answer

Goal is to realign the fracture using closed or open reduction and to ensure that a septal hematoma does not develop, since this increases the patient's risk for infection. Surgical procedure provides adequate airway and function of nose, and reestablishes the cosmetic appearance.

question

When correcting Epistaxis you should first use simple first aid measures. These measure include?

answer

Keep patient quite. Place the pt in the sitting position, leaning slightly forward with head tilted forward. Apply direct pressure by pinching the entire soft lower portion of the nose against the nasal septum for 10-15 mins. If it does not stop within 15-20 mins, seek medical assistance.

question

Medical Management of Epistaxis include?

answer

Apply vasoconstrictive agent, cauterization, or anterior packing. Pledgets (nasal tampon) with anesthetic solution (lidocaine) and/or vasoconstrictive agent such as cocaine or epinephrine; left in place for 10-15 mins. Silver nitrate may be used to chemically cauterize bleeding point. Thermal nitrate is reserved for more severe bleeding, which requires the use of local or general anesthesia.

question

What type of packing can be used for epistaxies if bleeding does not stop?

answer

Compressed sponges or Epistaxis balloons Both preferred over traditional Vaseline ribbon gaze because of ease of placement

question

How is packing inserted into the nares?

answer

It is advanced along the floor of the nasal cavity, the sponge expands with moisture and fill cavity and tamponade bleeding, provides pressure, Increases clot formation, protects nasal mucosa from further trauma

question

What are the complications associated with nasal packing?

answer

may impair the respiratory status, especially in older adults

question

What would you need to monitor in a patient with nasal packing?

answer

Respiratory rate, Heart rate and rhythm, Oxygen saturation using pulse oximetry (SpO2), Level of consciousness, Observe for signs of aspiration

question

What type of patient with nasal packing needs to be admitted to the hospital for close observation?

answer

any patient with posterior packing

question

Packing can be painful due to sufficient pressure and also predispose the patient to bacteria. What medication should a patient receive with nasal packing?

answer

Pts should receive mild analgesic for pain (acetaminophen with codeine) and antibiotic effective against staphylococci to protect against infection

question

How long is nasal packing left in place, and what must you do before and after removal?

answer

Nasal packing may be left in place for few days. Medicate the patient during removal to relieve discomfort. After removal, Cleanse the nares gently and Lubricate them with water-soluble jelly

question

What would you want to educate the patient on regarding home care for epitaxis?

answer

Avoid vigorous nose blowing, engaging in strenuous activity, lifting, straining for 4 to 6 weeks. Use of nasal spray and/or humidifier, to sneeze with mouth open, and to avoid the ise of aspirin containing products or NSAIDs

question

When does influenza season start and peak?

answer

Starts in September through April, and peaks November to March

question

What are the three stereotypes of Influenza?

answer

A, B, and C

question

What is the most common flu virus, most virulent, and infects a variety of animals, as well as humans?

answer

Influenza A

question

How are Influenza B and C similar?

answer

they are not divided into subtypes and only infect humans

question

What influenza causes regional epidemics and is milder than influenza A?

answer

Influenza B

question

What influenza causes a mild illness and dosen't cause an epidemic or pandemic?

answer

Influenza C

question

How often is the flu vaccine updated?

answer

annually, depending on virus strains identified by the CDC

question

When there is fewer changes in the flu, there are fewer cases resulting in the flu virus. Why does this occur?

answer

Since the flu only changed minorly the patient will have partial immunity to that flu strain, and will less likely be affected.

question

How is the influenza virus transmitted?

answer

Direct contact with infected animals, exposed to water, and surfaces or Droplet contact and inhalation or aerosolized particles

question

What is the incubation period for influenza?

answer

1 to 4 days

question

What is the peak transmission time for influenza?

answer

1 day before the onset of symptoms, continuing for 5 to 7 days

question

The onset of influenza is usually abrupt, with symptoms of?

answer

Systemic symptoms, Chills, Fever, Anorexia, Malaise, Generalized myalgia and Accompanied by Headache, Cough, Rhinorrhea, Sore throat

question

The physical finding of Influenza are usually?

answer

minimal, normal assessment on chest auscultation

question

What pulmonary complication may be associated with influenza?

answer

Dyspnea, and diffuse crackles

question

When influenza is uncomplicated, how long should the symptoms last?

answer

symptoms should subside within 7 days

question

What type of patient may experience weakness or lassitude that persist for weeks with influenza?

answer

Older adults

question

What symptoms can occur during the receovery of influenza?

answer

Hyperractive airways an chronic cough

question

What is the most common complication with influenza?

answer

Pneumonia, Primary influenza (viral) pneumonia, Experience gradual improvement of flu symptoms, then worsening cough and purulent sputum. Treatment with antibiotics usually effective if started early

question

What are important diagnostic factors associated with influenza?

answer

Health history, clinical findings, and other cases of flu in the community

question

What type of flu test involves detecting the virus in the nasal secretions, can be compeleted in physician office in less than 30 mins, results are available same day, help differentiate flu from other viral/bacterial infections, is more effective if performed within 48 hours of symptoms, and determines if an antiviral medication is an option?

answer

Rapid Flu Test

question

What are the disadvantages of the Rapid Flu Test?

answer

Miss some cases or occasionally be positive when person does not actually have flu

question

What lab test is the gold standard to diagnosis the flu, with results in 3 to 10 days, can identify viruses A, B, and other respiratory ciruses, and which strains are present, and is used as data to formulate the seasonal flu vaccine?

answer

Viral Cultures

question

What is the most effective strategy in combating the flu virus?

answer

Prevention

question

What are the two types of Flu Vaccines?

answer

Inactivated and Live Attenuated

question

What is the best time of year to receive the flu vaccine?

answer

September before exposure to the flu, because it take 2 weeks for full protection to occur

question

When is the Flu vaccine contraindicated?

answer

Guillain-Barre syndrome within 6 wks post flu vaccine, Hypersensitivity to eggs

question

What are the primary Nursing Goals associated to influenza?

answer

relief of symptoms and prevention of secondary infection

question

Unless the patient is high risk or complcations arise, what type of treatment for influenza is suggested?

answer

Supportive therapy is only necessary, including Rest, Hydration, Analgesics, Antipyretic, and Older adults and those with chronic illness may require hospitalization

question

What two types of medications can be used to prevent and treat influenza A and B, and should be given within 2 days of onset, but can be started later based on clinical judgement?

answer

Zanamivir (Relenza) an inhaler and Oseltamivir (Tamiflu) as oral capsules. Neuraminidase inhibitors that help prevent the virus from budding and spreading to other cells

question

What interventions are associated with acute viral rhinitis?

answer

Rest, Fluids, Proper diet, Antipyretics, Analgesics

question

What methods may help alleviate a sore throat?

answer

Warm salt water gargles, Ice chips, Throat lozenges, Throat sprays

question

What medications help reduce post nasal drip, cough, nasal obstruction, and nasal discharge?

answer

Antihistamines and Decongestants

question

What complications are associated with acute viral rhinitis?

answer

Pharynigitis, Sinusitis, Otitis media, Tonsillitis, Lung infections

question

When are antibiotics indicated for acute viral rhinitis?

answer

only when symptoms of complications are present, since antibitoics are not effective against viruses, and may produce antibiotic resistant bacteria If symptoms last longer than 10 to 14 days an acture bacterial sinusitis may be present, and antibiotics are prescribed

question

What is included in patient teaching associated with acute viral rhinitis?

answer

Recognize secondary infection, green, purluent drainage is a later sign and not indicative of bacterial infection, patients with chronic illness or compromised immune should avoid crowded situations and other people with cold symptoms, teach patients with chronic respiratory disease to report sputum changes, increased SOB, and chest tightness.

question

What are the symptoms of secondary bacterial infection?

answer

Temp higher than 100.4, Tender, swollen glands, Severe sinus or ear pain, and Worsening symptoms

question

In patients with pulmonary disease, signs of a infection include?

answer

change in consistency, color, or volume of sputum

question

What can help prevent the direct spread of acute viral rhinitis?

answer

Frequent hand washing and avoid face to face contact

question

What is the most important step in nursing management of allergic rhinitis?

answer

Identify and avoid triggers of allergic reactions, Instruct patient to keep diary of times when reactions occur and activities, patients are often more aware of triggers than you, patients are often more aware of intermittent allergens pets than persistent allergens dust mites, cockroaches, mold

question

What are the goals associated with the use of medications when combating allergic rhinitis?

answer

Reduce inflammation associated w/ symptoms, Reduce nasal symptoms, Minimize associated complications, Maximize quality of life

question

What medications are used for allergic rhinitis?

answer

H1 antihistamines Second generation preferred over first generation because of non-sedating effect, Advise to increase fluid intake to reduce adverse symptoms, Corticosteroids, Cromolyn, Decongestants If symptoms aren't reduce using one medication, and two drug combination using a oral and intranasal medication may be helpful

question

When the is a specific, unavoidable allergen that is detected or drugs seem to be ineffective that the patient may receive what type of therapy?

answer

Immunotherapy Allergy Shots

question

How often are allergy shots administered and what is the goal? What are alternative routes of administration?

answer

Involves controlled exposure to small amounts of the known allergen through frequent weekly injections, goal to decrease sensitivity Can also be administered sublingual or intranasal

question

What is Rhinoplasty?

answer

surgical reconstruction of the nose, performed for cosmetic reasons or improve airway function with trauma or developmental deformities result in nasal obstruction

question

What must be conducted before rhinoplasty surgery?

answer

Assess the patient's expectations of the surgery, Actual or perceived alterations of body image can affect self esteem, Computerized images can be used for patient's appearance before and after surgery, Images also used to help pt decide whether to underago surgery, and Explain expected results truthfully to avoid disappointment

question

During rhinoplasty surgery, what type of anesthesia is used and how is it performed?

answer

Performed as outpatient procedure using regional or general anesthesia, Nasal tissue added or removed, Nose may be lengthened or shortened, Plastic implants may be used to reshape nose, Incisions typically inside the nose. Sonic Rhinoplasty incorporates the use of an ultrasonic device to gently aspirate bone, enabling a refined cosmetic result

question

Nasal packing and an External plastic slpint may be applied after rhinoplasty. What do they help protect or prevent after surgery?

answer

Nasal packing may be inserted to apply pressure and prevent bleeding or septal hematoma formation. External plastic splint protects and supports the new shape of the nose during the healing

question

When is nasal packing removed after surgery, and how long is the splint left on, regarding rhinoplasty?

answer

The nasal packing is removed the day after surgery, the splint is left on for approximately 1 week

question

Before rhinoplasty the nurse should instruct and encourage the patient to do what?

answer

Instruct pt not to take aspirin containing drugs or NSAIDs for 2 weeks prior, Encourage preoperative smoking cessation to promote postoperative wound healing

question

What nursing interventions are associated with immediate care after rhinoplasty?

answer

Maintenance of the airway, Assessment of respiratory status, Pain management, Observation of surgical site for bleeding, infection, and edema

question

Patient teaching with rhinoplasty is important to help the patient detect early and late complications associated with nasal surgery. What should the nurse teach the patient?

answer

Patients typically experience temporary edema and ecchymosis, Cold compresses and elevation can help minimize swelling and discomfort. Activity restrictions to prevent bleeding and injury, No nose blowing, Swimming, Heavy lifting, Strenuous exercise. Full cosmetic result may take up to 1 year

question

An airway emergency is a medical emergency caused by?

answer

aspiration of food or foreign body, allergic reactions, edema, and inflammation caused by infections or burn, peritonsillar or retropharyngeal abcesses, malignancy, laryngeal or tracheal stenosis, and trauma

question

Symptoms of an airway obstruction include?

answer

choking, stridor, use of accessory muscles, suprasternal and intercostal reactions, flaring nostrils, wheezing, restlessness, tachycardia, cyanosis, and change in LOC

question

What are the two types of airway obstructions?

answer

Partial or complete

question

What can a complete airway obstruction result in?

answer

permanent brain damage or death if not corrected in 3 to 5 minutes

question

What interventions are associated with reestablishing a patent airway?

answer

the obstructed airway maneuver Heimlich, cricothyroidotomy, endotracheal intubation, and tracheostomy

question

Unexplained or recurrent airway obstructions would indicate the need for additional tests, what are these tests?

answer

chest x-ray, laryngoscopy, bronchoscopy

Med-Surg Nursing Ch. 27 (499-509) – Flashcards

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