question

Deviated Septum

answer

deflection of the normally straight nasal septum most commonly caused by trauma or congenital deficit may be surgically corrected *assess ability to breathe out of both nostrils *goal of nursing: reduce edema, prevent complications, educate pt, provide emotional support airway, airway, airway

question

Nasal Fracture

answer

most commonly caused by trauma can cause airway obstruction and cosmetic deformity *assess ability to breathe out of both nostrils *goal of nursing: reduce edema, prevent complications, educate pt, provide emotional support airway, airway, airway

question

Raccoon Eyes

answer

ecchymosis(bruise) involving both eyes

question

Infectious and Inflammatory Disorders

answer

average person experiences 3 - 5 URI/year URI most common cause for missing work/school 90% of URI are viral (antibiotics won't fix) treat as outpatient

question

Rhinitis

answer

inflammation of mucous membranes of the nose (cold) rhinovirus most common cause spread by inhalined droplets and direst contact *cough/sneeze into elbow; good hand hygiene

question

Symptoms of Rhinitis

answer

sneezing, nasal congestion, sore throat, watery eys, cough, low grade fever, HA, malaise lasts 5 - 14 days treat symptoms with: decongestants- loosen mucus saline gargles- clear throat antitussives- stop cough at night, to help pt sleep expectorant- help cough stuff up, during day antihistamines- blocks histamine, dry mouth, drowsy, (careful in elderly men b/c difficulty urinating antihistamine can increase chance of urinary retention)

question

When is the common cold most infectious?

answer

at the beginning; within the first few days

question

What is best way to prevent transmission?

answer

*hand hygiene* sneeze/cough into elbow

question

How do you use nasal sprays?

answer

make sure nares are patent; ask them to blow nose both nares; occlude one have pt sniff, occlude the other have pt sniff DO NOT SHARE!

question

What is a common adverse effect of nasal decongestants?

answer

nose bleeds addictive rebound

question

Sinusitis

answer

inflammation of sinuses maxillary sinus affected most can lead to infection of the middle ear of brain; happens b/c sinuses are just cavities in the bones of the skull caused by infection from nose to sunuses and by sinus drainage blockage allergies can lead to sinusitis

question

S of Sinusitis

answer

HA, fever, pain, nasal discharge, malaise diagnose with nasal smear which identifies the organism; determines if bacterial, viral, fungal treat with antibiotic therapy or surgical procdure called Caldwell-Luc (rotorooter of sinuses) *not all cases get nasal swabs, if going to walk in clinic they will treat off of what is 'going around' in the community.

question

Nursing Management of Sinusitis

answer

inform pt that mouthwashes, humidification and increase fluid intake (to thin mucus secretions; contraindicated in renal failure and HF) can increase comfort sinus surgery: provide postop care; pt will have nasal packing and drip pad; encourage oral hygiene. (open mouth breathing & smell!); in Fowler's position

question

Pharyngitis

answer

inflammation of throat caused by bacteria and viruses *most serious*: group A beta-hemolytic streptococci that can lead to cardiac complications (endocarditis), renal complications such as (glomerulonephritis) highly contagious *strep throat very dangerous if not treated; can settle on valves of heart; can cause kidney problems *tx of choice penicillin 10 - 14 days (encourage/stress the importance of completing entire dose; and to prevent mutation of strain/ resistant microorganisms)

question

Tonsilitis and adenoditis

answer

infected lymphatic tissue (responsible for catching invading microbes) chronic tonsilitis can lead to airway obstruction both infections can be primary or secondary (gotten from something else) *white patches* may be present on tonsils (if group A beta-hemolytic strep is cause) throat cx and start on antibiotics (then MD will rx new prescription if not covered with old)

question

Treatment of Tonsilitis

answer

antibiotic therapy operative procedures (tonsillectomy/adenoidectomy); mostly outpatient assess bleeding studies bc hemorrhage is greatest risk pts admitted if: vomiting; excess bleeding; must tolerate PO fluids (in order to not dehydrate at home)

question

Laryngitis

answer

inflammation and edema of mucous membranes lining the larynx follows URI due to spread of microorganisms pt hoarse or have complete voice loss tx with voice rest (no talking), antibiotics, cessation of smoking

question

Epistaxis

answer

nosebleed rupture of tiny capillaries in mucous membrane of nose caused by trauma, hypertension, tumors, blood dyscrasias (if from hypertension or blood dyscrasias, could be hard to control) treat with pressure, electrocautery, packing cotton, inflated balloon

question

What position do you place a patient's head with epistaxis?

answer

head forward/down *do NOT put head back*

question

Where do you apply pressure?

answer

at bridge of nose; put ice on bridge of nose

question

Cancer of the Head and Neck

answer

exposure to various fumes and chemicals may predispose to head an neck cancer early detection can lead to cure most laryngeal cancers are squamous cell carcinomas (cancer arises from epithelial cells lining the pharynx)

question

Malignancies of Upper Airway

answer

male to female ratio 3:1 increasing in women due to rising alcohol and tobacco consumption 90% of head and neck cancers arise after prolonged us of tobacco and alcohol *throat and cervical cancer linked (same virus)

question

Cancer of Head and Neck

answer

exposure to various fumes and chemicals may predispose to head and neck cancer early detection can lead to cure most laryngeal cancers are squamous cell carcinomas (cancer arises from the epithelial cells lining the pharynx)

question

Laryngeal Cancer

answer

early symptoms: persistent hoarseness, followed by a lump, then pain when talking. malignant tissue must be removed immediately advancing cancer will see weakness, weight loss, pain, anemia diagnose with laryngoscopy and biopsy tx depends on age, size of lesion, tumor and presences of metastasis. may receive chemo and radiation alone or with surgery

question

Laryngeal Cancer Surgery

answer

laser surgery and partial or complete laryngectomy for early cases radial neck dissection (lymph nodes, muscles, adjacent tissues) in advanced cases

question

*4 Goals of Treatment of Laryngeal Cancer*

answer

* 1. cure 2. preservation of safe effective swallowing 3. preservation of a useful voice 4. avoidance of a permanent trach *

question

Patients with Laryngectomy

answer

permanent tracheal stoma b/c the trachea is no longer connected to the nasopharynx only resp organs used are trachea, bronchi, and lungs no longer feel air entering through the nose; enters and leaves the trach.

question

Laryngeal Cancer: Communication

answer

loss of speech is devastating (permanent loss of speech) *alaryngeal communication* (communication without larynx) espophageal speech: instruct pt to swallow air and regurgitate word, start 1 wk post op, after pt able to take PO fluids electric larynx: throat vibrator. tracheoesophageal puncture: resembles normal speech, requires voice prosthesis, trach tube will be some different *pg 541 - 543

question

Laryngeal Cancer Preop

answer

assess pt understanding of the procedure and outcomes. discuss alternative methods of communication and which on pt prefers let pt express fears and concerns *goals: increase pt knowledge, decrease anxiety, have communication plan*

question

Laryngeal Cancer Postop

answer

assess for patent *airway* and *airway* clearance prevent pain and wound infection assess stoma site, resp system, oxygenation, *airway* patency teach family how to dress wound NO swimming, water enter lungs through trach, careful when showering avoid fabrics and dressings that fray *goals: nutrition and hydration, monitor for bleeding, increase body image/self esteem, optimize self care management.*

question

When assessing post op laryngectomy pt, you discover he has a pulse of 110, resp rate of 26, his skin is cold and clammy. There is thick white sputum bubbling from his trach tube. Your first intervention is?

answer

airway ,airway, airway position in Fowler's suction *if the airway is not open and patient not ventilating gas exhange can not occur

question

Disorders of Lower Respiratory Tract

answer

gas exchange occurs in lower resp tract certain diseases interfere with lower resp tract ability to function some lead to resp failure others affect the pts quality of life, can be deadly or disabiling (some curable some treatable) *where gas exchange occurs*

question

Atelectasis

answer

closure or collapse of the alveoli x-ray finding S&S cough, sputum production, low grade fever, tachypnea, dyspnea, decreased breath sounds, crackles over affected area (from leakage of capillary beds) CXR reveals patchy infiltrates or consolidated areas *PREVENTION* is key; turning, coughing, deep breathing, IS, move. goal of tx: imporve ventilation, remove secretions if pleural effusion is large & collapsing a lung, tx may include thoracentesis or chest tube insertion

question

Acute Bronchitis

answer

inflammation of lower resp tract that usually due to infection and occurs most frequently in pts with chronic resp disease can occur in other individuals as a result of URI cause is usually viral but can also be caused by infection in smokers and nonsmokers *viral =clear sputum *cough make pt seek medical help

question

Acute Bronchitis S&S

answer

persist cough following acute URI is most common symptom cough followed by clear, sputum (viral) fever, HA, malaise physical exam; mildly elevated temp, pulse, and resp rate with normal sounds

question

Acute Bronchitis Tx

answer

CXR shows no consolidation as with pneumonia ttx is supportive, including fluids, rest, cough suppresants antibiotics if person is smoker or has COPD COPD pts are prescribed antibiotics when symptoms of acute bronchitis occurs. increase PO fluids

question

Pneumonia

answer

an inflammatory process involving the brochioles and alveoli until 1936 pneumonia was leading cause of death in the US slufa drugs and penicillin were discovered and used to be tx pneumonia

question

Community Acquired Pneumonia

answer

out in community; come in contact with in every day life activities

question

Hospital Acquire Pneumonia

answer

nosocomial: got in hospital; got 48 hours after admission

question

Aspiration Pneumonia

answer

entry of substances into airway contents into lung (seen in sick and healthy)

question

Pneumonia of the immunocompromised

answer

PCP or pt on chemo, steroid excess, not always HIV/AIDS *rarely observed in immunocompetent hosts *often initial AIDS defining complaint

question

Pneumonia Pathophysiology

answer

pneumonia is still common, some forms have high mortality rate normally, airway distal to larynx is *sterile* due to protective defense mechanisms organisms reach lungs by inhalation of droplets, aspiration of organisms from the upper airway, infiltration from bloodstream (less common) localized response fires: capillaries swells and fluid can leak

question

Typical Pneumonia

answer

bacterial in adult

question

Atypical Pneumonia

answer

caused by mycoplasmas bacteria without cell walls and have many shapes

question

Radiation Pneumonia

answer

...

question

Chemical Pneumonia

answer

pt inhaled something "huffing"

question

Lobar Pneumonia

answer

lobe (1 or more) infected

question

Brochopneumonia

answer

scattered throughout lungs

question

Hypostatic Pneumonia

answer

bed ridden patients breathing with only part of lung not breathing deep enough

question

Pneumonia S&S

answer

Bacteria; onset sudden, fever, chills, productive rusty colored sputum, malaise, pain with breathing. Viral: blood cultures without bacteria, sputum copious, chills less common, respirations and pulse slow. Less severe than bacterial, but patients are weaker and ill longer than successfully treated bacterial. ***Not possible to dx a specific type of pneumonia by clinical manifestations alone***

question

Pneumonia Physical Assessment

answer

wheezing, crackling, and decreased breath sounds, increased tactile fremitus History Sputum cultures, chest x-rays, lab studies, blood cultures. *hang antibiotics only *after* blood cx have been drawn

question

Treatment of Pneumonia

answer

Antibiotics, hydration to thin secretions, oxygen therapy, bed rest, chest physical therapy, bronchodilators, analgesics, antipyretics, cough expectorates and suppressants. Possible intubation and ventilation. Antibiotics *only if* bacterial pneumonia. If community acquired, health care provider will prescribe based on what is "going around at the time" if unable to get sputum culture or until culture is obtained & reported. **core measure! timing: first antibiotic dose within first 4hrs after admission**

question

Pneumonia Nursing Management

answer

Auscultate lung sounds, ABGs, pulse oximetry, quality of breathing. Assess cough and nature of sputum. Semi-fowlers position, encourage fluid, respiratory treatments, Intake and output, vital signs, electrolytes, fever reduction. Encourage pneumonia vaccine over 65, or compromised immune system. *ask every pt if they've had the pneumonia or flu vaccines* *RN must document about vaccines: declined?,why?, contraindicated?, fever?, already received?

question

Preventing Pneumonia

answer

Turn and position Promote coughing and expectoration. Deep breathing and coughing. Prevent infection and aspiration. Stop smoking and alcohol consumption.

question

Pleurisy

answer

Acute inflammation of the parietal and visceral pleura. During the acute phase the pleurae are inflamed, thick, and swollen, exudate forms and the pleurae becomes rigid. *During inspiration the inflamed pleurae rub together causing severe pain. *deep breaths, coughing, sneezing make worse

question

Pleurisy S

answer

*key symptom is PAIN* *Respirations become shallow due to pain.* Pleural fluid accumulates as inflammation worsens. (air moving in and out makes worse) Friction rub heard during inspiration and early expiration. (like sandpaper rubbing together) Usually occurs secondary to pneumonia or secondary infections. May need thoracentesis to remove fluids from the chest.

question

How do you assess for a friction rub?

answer

pain auscultate

question

What does a friction rub sound like?

answer

sandpaper

question

Pleurisy Tx

answer

Treat with analgesics and antipyretic drugs. *Nonsteriodal anti-inflammatory such as indomethacin(Indocin)* helps with pain and promotes coughing.(physician initiated) Nursing (interventions): help splint chest wall by turning onto the affected side, using hands, and pillow. Provide emotional support.

question

Pleural Effusion

answer

Collection of fluid between the visceral and parietal pleurae. Complication of cancer, TB, pulmonary embolism, etc. The fluid *may be great enough to collapse the lung* on the affected side b/c its pushing against air sacs. Fever, pain, dyspnea, diminished breath sounds, friction rub. Chest x-ray shows fluid in the involved area.

question

*Severity of Pleural Effusion Symptoms Depends on 3 Factors*

answer

*size* of effusion *speed* of formation (slowly developed vs fast development) *underlying disease* process

question

Pleural Efusion Tx

answer

eliminate the cause tx with antibiotics, analgesics, v drugs to control CHF, thoracentesis, and cancer surgery nurse will assist with thoracentesis ans provide support take care of chest tube if inserted external sign seen in trachea shift. moves away from affected side collapsing. problem on R, trachea moves to L (and vice-a-versa)

question

Empyema

answer

*a localized infection in the lung that has been 'walled off' like an abscess* Pus or infected fluid within the pleural cavity. Infection following stabs, GSW, pneumonia, TB, etc. The abcessed area will be walled off and enclosed by a membrane. Fever, chest pain, dyspnea, anorexia, and malaise. Diminished breath sounds.

question

Empyema Tx

answer

*drain cavity and achieve complete expansion of lung* Aspirated by thoracentesis, provide antibiotic therapy, chest tube. Thoracatomy (surgical opening of the thorax) and one or more chest tubes are inserted. The tubes are connected to underwater-seal drainage bottle. Healing is long, provide emotional support, turn cough and deep breathing.

question

Thoracic Surgery

answer

Thoracotomy is surgical opening in the chest wall. **Performed for many reasons; remove fluids, pneumonectomy, lobectomy, repair structures, such as open heart, chest trauma, biopsy, remove foreign objects(bullets or metal fragments).** Preoperative management is performed

question

Preop Nursing Management

answer

Assessment- obtain hx; hands on physical assessment Improving airway clearance- patient teaching- preop discuss talking and deep breathing relieving anxiety

question

Thoracic Surgery

answer

Postoperative management: When the thorax is opened, atmospheric pressure collapses the lungs. *Anesthesia ventilates the patient(during surgery).* After surgery air, blood, and secretions are drained so that the lungs can expand. This is done with water-seal.

question

Thoracic Surgery Postop

answer

Immediate postoperative standards are as previously discussed. Assess resp function. Assess sputum production. Assess level of pain using pain scale. treat Suction as needed. (sputum production) Turn, cough, and deep breath. Ambulate as soon as possible. Discuss fears and anxiety( Look at functional health assessment)

question

Post Op Positioning

answer

pneumonectomy: turn q 1 hr from back to operative side & should not be turned completely to unoperated. Lobectomy: turn either side Check with surgeon for specifics but should go from supine to low to mid fowlers as soon as possible

question

Penetrating Wounds

answer

Penetrating wounds are serious due to positive pressure entering the negative chest cavity. The positive pressure causes a pneumothorax. Death can occur. Large wounds make a sucking sound as air enters and leaves the chest. Penetrating wounds can involve pneumothorax and hemothorax Subcutaneous emphysema may be present. Sudden pain and dyspnea are symptoms.

question

Assessing a Penetrating Wound

answer

Auscultation of the chest, history of injury and physical are used for diagnosis. X-ray shows the amount of collapse and the amount of air and blood present. Thoracotomy may be needed to remove bullets and knives. Removal at the scene can allow air to enter. Emergency management include covering the site to prevent air. Tension pneumothorax: air enters and cannot escape. The lungs, heart, and trachea shift away. Spontaneous pneumothorax: just happens

question

Purpose of Chest Tube

answer

The tube is inserted in the pleural space. This restores neg intrathoracic pressure needed for lung re-expansion after surgery or trauma

question

Nursing Management of Chest Tubes

answer

Maintain and restore patients highest level of respiratory function. Protect from injury caused by malfunctioning equipment.

question

Chest Tubes Assessment

answer

Check medical record for reason, date, and amount of chest tubes. Check orders for amt of suction if any. Assess patient as soon as possible. Look for hemostats at bedside. .Monitor pulse oximetry Assess lung sounds. Inspect dressing. Palpate skin around tube for subcutaneous emphysema (presence of air). Inspect all connections for secure tape. Check tubing for kinks and that it hangs freely. Observe fluid in water-seal chamber. If constant bubbling, (in the water seal chamber)clamp tubes at the chest and few inches below. Continue releasing hemostats until bubbling stops. Place tape around the tube where the last clamp was released. Regulate suction for gentle bubbling.

question

Air leaks are indicated by...

answer

constant bubbling in the water seal chamber or in the air leak indicator in dry systems with a one way valve.

question

Chest Tubes

answer

Keep the system below the chest Curl and secure tubing to bed, be careful when turning. Encourage deep breathing and coughing. If tube accidentally pulled out, cover with petroleum gauze dressing. Mark the drainage at the end of the shift, never empty the container. Monitor for air leaks

question

To Clamp or Not to Clamp?

answer

...

question

Pulmonary Circulatory Disorders

answer

Pulmonary hypertension results from heart disease and lung disease. Resistance of blood flow in pulmonary circulation causes pulmonary hypertension. Normal pulmonary arterial pressure is 25/10. Pulmonary hypertension can be 40/15mmhg.

question

Pulmonary Hypertension

answer

Primary pulmonary hypertension rare and exists without other diseases. Secondary pulmonary hypertension occurs with other diseases such as COPD.

question

Pulmonary Hypertension Assessment

answer

Most common dyspnea on exertion and weakness. Secondary symptoms include: chest pain, fatigue, weakness, distended neck veins, orthopnea, peripheral edema. Diagnostic: ECG (right ventricular hypertrophy. Abnormal ABG.

question

Pulmonary Hypertension Medical Management

answer

Vasodilators and anticoagulants. The primary form has poor prognosis. May be candidates for heart-lung transplantation. Secondary: treat underlying disease. Oxygen to increase arterial oxygenation. Right ventricular failure: digitalis, rest, and diuretics. Nursing Management:Respiratory assessment, oxygen therapy, and rest.

question

Pulmonary Embolism

answer

Involves obstruction of one or more pulmonary vessels. Results form thrombus formation in veins or right side of heart. Embolus is any foreign substance: blood clot, air, fat that travels to lungs. Occludes a pulmonary vessel leading to infarction distal to clot. Usually occur from clots in deep veins of lower extremities or pelvis. Fat embolus from fracture of long bone, especially femur. Recent surgery, prolonged bedrest, trauma, postpartum.

question

Assessment of PE

answer

Small area of lung: less severe, pain, tachycardia, dyspnea, maybe fever, cough, bloody sputum. Larger areas: dyspnea, severe pain, cyanosis, tachycardia, restlessness, and shock. Sudden death if large embolism occludes a main section of artery

question

Pulmonary Embolism Manifestations

answer

Small area of lung: less severe, pain, tachycardia, dyspnea, maybe fever, cough, bloody sputum. Larger areas: dyspnea, severe pain, cyanosis, tachycardia, restlessness, and shock. Sudden death if large embolism occludes a main section of artery

question

Pulmonary Embolism Nursing Management

answer

embolism usually occurs suddenly, assessment and early recognition important. IV infusion before shock. Vasopressors (dopamine) for hypotension. Oxygen for dyspnea( most important at this time), pain medication. Monitor vital signs, Intake and output, ABGs, electrolytes, respiratory status, coagulation studies, PTT, PT. Assess for bleeding. Discharge instructions about bleeding. Medications as prescribed. Follow-up blood work and office visits.

question

Flail Chest

answer

Complication of blunt chest trauma Steering wheel injury/air bag Three or more fractured ribs at two or more sites, free floating ribs segments Chest looses stability =respiratory impairment= respiratory distress.

question

*Flail Chest

answer

*As chest expands on inspiration, the detached rib segment (flail segment) moves in a paradoxical manner. Moves inward during respiration ( limits air that can get into lungs) On expiration, flail section bulges outward, impairing the patient's ability to exhale Retained secretions and atelectasis usually accompany flail chest. Patient has hypoxemia,resp acidosis, metabolic acidosis, decreased tissue perfusion

question

Flail Chest Medical Management

answer

Treatment usually supportive Ventilatory support, clearing secretions, controlling pain Turn, cough, db, suction, IV analgesics Monitor for respiratory compromise Severe flail chest: endotracheal intubation and mechanical ventilation Rarely surgery is used to stabilize fractures

question

Flail Chest Management

answer

Carefully monitor with chest x-rays, ABGs, pulse ox., and pulmonary function studies Pain control is key to successful treatment: PCA, nerve blocks, epidural analgesia

question

Acute Respiratory Failure

answer

When CO2 elimination and O2 supply cannot keep up with body supply and demand: Hypoxia (PO2 less than 50), Hypercapnia (PCO2 greater than 50) pH less than 7.35 Common causes: decreased respiratory drive; brain injury, multiple sclerosis, sedatives, hypothyroidism (chemoreceptors in brain do not receive normal responses) drug overdose

question

Dysfunction of chest wall

answer

...

question

Dysfunction of Lung Parenchyma

answer

..

question

Assessment of Acute Respiratory Failure

answer

restlessness, fatigue, headache, dyspnea, air hunger, tachycardia, and increased blood pressure, adventitious breath sounds

question

Treatment of Acute Respiratory Failure

answer

correct underlying cause and restore gas exchange, may have to ventilate. Nursing: assist with intubation and maintain ventilator; assess resp. status, mouth care, turn, pulse ox. Vital signs, skin care. Initiate some form of communication. Assess resp. system and ask questions specific to this episode of distress As patient improves initiate patient education

question

Lung Cancer

answer

Number one cancer killer among men and women in US Continues to rise in women Risk factors: smoking, second-hand smoke, environmental and occupational exposures, gender, genetics, and dietary. *70% of pts. spreads to lymphatics by dx*

question

Lung Cancer Assessment

answer

: develops insidiously and is asymptomatic until late. Most frequent is chronic cough, nonproductive at first, then productive as infection occurs. Often ignored. Wheezing, hemoptysis, fever, chest or shoulder pain, pleural effusion. Most common site of metastases: lymph nodes, bone, brain, lung, liver, adrenal glands

question

Lung Cancer Dx

answer

Chest x-ray, ct scans, MRI, fiberoptic bronchoscopy

question

Lung Cancer Tx

answer

depends on cell type, stage, and physiologic condition. Surgery, radiation, or chemo; or combination of all. Surgery is preferred method if possible (lobectomy or pneumonectomy)

question

Lung Cancer Radiation Therapy

answer

...

question

Lung Cancer Chemo

answer

...

question

Lung Cancer Paliative therapy

answer

radiation to shrink tumor or to relieve pain

question

Lung Cancer Hospice

answer

end -of- life care for pt and family

question

Pulmonary Edema

answer

Accumulation of fluid in the interstitium and alveoli of lungs Right side of heart delivers more blood to pulmonary circulation that left side can handle Fluid escapes capillary walls and fills airways *Severe: life threatening condition*

question

Pulmonary Edema Assessment

answer

dyspnea, sob, feeling of suffocation Cool, moist skin, cyanotic skin Blood tinged sputum, and frothy fluid Crackles can be heard without stethoscope Emergency treatment: lasix, oxygen, dopamine, digoxin (improve ventricular function), calcium channel blockers *sever resp distress air hungry, drowning in fluid

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