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129 Cards in this Set
- Front
- Back
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Causes of deviated septum
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trauma or congenital defect
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Cause of altered nasal air passage on smaller side of deviated septum
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obstruction
edema bleeding |
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Name four complications of a nasal fracture
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airway obstruction
bleeding septal hematoma cosmetic deformity |
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3 types of nasal fractures and what do they mean
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Unilateral (little or no displacement)
Bilateral (most common - nose looks flattened) Complex (multiple facial injuries) |
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Nursing assessment for nasal fracture:
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ability to breathe through each nare
note if there is septal deviation bleeding clear drainage - could be CSF fluid - glucose test to identify |
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Nursing Implementation for nasal fracture:
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Airway Airway Airway
HOB > 45 degrees reduce edema and bleeding -use ice packs |
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Two reasons for rhinoplasty
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airway function
cosmetic appearance |
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Pre-op Nursing Actions for Rhinoplasty
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Educate about procedure and what to expect
No ASA or NSAIDS for 2 weeks! |
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Nursing Actions for Rhinoplasty
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Monitor airway
Manage pain - ice, semi/high Fowler's Monitor s/sx - infection, bleeding Educate - identify complications, avoid straining |
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fancy name for nose bleed
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epistaxis
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Causes of epistaxis:
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trauma
foreign body corticosteroid drug use allergies tumors antiplatelet and anticoagulant medications |
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Nursing Care for expistaxis
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Pt to remain calm and quiet
direct pressure 10-15 min sit upright no wiping or dabbing monitor respiratory status -aspiration risk control pain monitor for infection educate |
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Medical treatment for continual nose bleeding
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cautery or packing
vasotensive agents |
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What do you educate your pt on nosebleeds
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No nose blowing
No strenuous activity No NSAIDS, ASA |
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Most common type of nose bleeds (epistaxis) in older adults 50+
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posterior bleeding
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What is allergic rhinitis
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inflammation of nasal mucosa in reaction to an allergen
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Two kinds of allergic rhinitis - what does each mean
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Intermittent (seasonal) - lasts < 1 week and < 4x a year
Persistant (perinneal) - lasts > 1 weeks and > 4x a year |
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When pt is exposed to an allergen, ___ is formed and the pt develops an allergy. When this happens, the pts white blood cells release a(n) ____ response.
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IgE
inflammatory response |
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Symptoms of allergic rhinitis
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red, itchy, watery eyes
sneezing congestion runny nose itchy or sore throat post nasal drip cough |
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How can the pt avoid allergic rhinits
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identify and avoid the triggers
medication therapy |
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What are the four kinds of medication therapy that can be given for allergic rhinitis
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antihistamines
intranasal corticosteroids Leukotriene receptor antagonists Immunotherapy-allergy shots |
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Kinds of Antihistamines
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1st generation: Benadryl (diphenhydramine)
sedative effects 2nd generation: less sedative effects - preferred *increase hydration with antihistamines |
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What are intranasal corticosteroids used for?
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used to decrease the inflammation in the nasal and sinus tissues.
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Why do side effects not normally occur with intranasal corticosteroids?
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The medication is not absorbed into the system as well via intranasally.
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Pts w/ allergic rhinitis are usually treated with a combination of:
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Intranasal corticosteroids and antihistamines
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What is immunotherapy?
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allergy shots - expose the pt to small frequent doses of the allergen to help decrease the allergic response
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Side effects of 1st generation Antihistamines are
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Anticholinergic symptoms:
-sedation -dry mouth -decreased secretions -blurred vision -urine retention |
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Name four 2nd generation Antihistamines
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cetirizine (Zyrtec)
fexofenadine (Allegra) loratadine (Claritin) azelastine (Astelin) |
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Conditions in pts that contraindicate the pt to receive Benadryl
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asthma
narrow angle glaucoma liver disease breastfeeding mothers |
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Nursing considerations for Benadryl
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baseline assessment - respiratory, cardiac, neuro
monitor liver function labs administer PO w/ food or IM large muscle |
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Name two Leukotriene Receptor Antagonists
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accolate (Zafirlukast)
montelukast (Singulair) |
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What do Leukotriene Receptor antagonists do
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decrease inflammation
decrease edema and bronchoconstriction |
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Side effects of Zafirlukast and Singulair
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headache
dizziness rash abdominal pain |
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drug - drug interactions w/ Leukotriene receptor antagonists
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theophylline and warfarin
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Nursing considerations for Leukotriene receptor antagonists
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Monitor liver function
Give PO on empty stomach Education: do not stop suddenly Flu symptoms: Churg-Strauss syndrome-SEE Physician! |
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intranasal corticosteroids have ____ properties that decrease ___, ____, and ____
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anti-inflammatory
decreases sneezing, congestion, and rhinorrhea |
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intranasal corticosteroids have a short duration of use ....less than....
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30 days
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Name four intranasal corticosteroids
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budesonide (Rhinocort)
fluticasone (Flonase) mometasone (Nasonex) triamcinolone (Nasacort) |
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decongestants stimulate __ ___ receptors which causes ____ in the nasal mucosa. This means less drainage
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alpha adrenergic
vasoconstriction |
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side effects of decongestants
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increased blood pressure
increased glucose nervousness, restlessness rebound congestion |
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Pts with ___, ___, and ____ should not take decongestants without consulting a physician.
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hypertension
diabetes heart disease |
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Systemic decongestants come in ___ and ___ form. They include ____, ____, and ____
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tablet and liquid
ephedrine neosynephrine pseudoephedrine |
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nasal decongestants come in which four forms
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spray
drops tablets liquid |
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systemic decongestants last ____ than nasal decongestants.
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longer
Start at 15:00 |
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Viral Rhinitis is caused by the ____
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adenovirus
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People who are ___, ___, and ___ are more likely to catch the cold
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fatigued
stressed immunocompromised |
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signs and symptoms of viral rhinitis
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itchy throat
sneezing nasal drainage / stuffiness headache fever malaise |
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Treatment for viral rhinitis
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fluids, diet, rest
antipyretics, analgesia |
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Viral rhinitis can cause other problems such as ( Name 5)
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pharyngitis, sinusitis, tonsillitis, otitis media, and lung infections
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Type ___ influenza is the most common. It is further divided into H-hemaglutinin and N-neuraminidase. H is the ___. It lets the virus in. N is the ___.
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Type A is most common.
H is the key N is the spreader |
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widespread outbreak of new flu
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pandemic
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local outbreak of known flu
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epidemic
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symptoms of influenza
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sudden onset:
cough, fever, generalized aches, headache, sore throat, fatigue |
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how to diagnose influenza
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nasopharyngeal culture
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Nursing considerations for Influenza
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symptom relief
prevent secondary infection Administer antivirals |
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Name two antivirals for influenza
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zanamivir (Relenza)
oseltamivir (Tamiflu) |
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Sinusitis is caused by a ____ infection
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bacterial OR viral
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signs and symptoms of sinusitis
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headache, congestion, fever, malaise, purulent (yellow to green) nasal drainage.
Pain when palpating sinuses |
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___ and sinusitis are definitely linked
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asthma
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Name three antibiotics for sinusitis
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amoxicillin
trimethoprim/suflamethoxazole (bactrim) erythromycin |
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What are benign mucous membrane masses
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polyps
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What causes nasal polyps? what color are they? size?
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caused by repeated inflammation
usually bluish in color can get as big as a grape |
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inflammation of pharynx (tonsils, palate, uvula) is
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pharyngitis
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pharyngitis can be viral, bacterial, or fungal. if bacterial it is usually caused by the ______ bacteria
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streptococcus "strep throat"
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Pts who are on long term antibiotics or corticosteroids can develop ____
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candidiasis
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Pharyngitis symptoms
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sore throat w/ redness/swelling
yellow pus patches white patches = fungal infection gray film = diptheria |
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untreated strep infections can lead to ____ or ____
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rheumatic heart disease
glumerulonephritis |
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Nursing goals for pharyngitis
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infection control (rinse after corticosteroids)
symptom management (increase fluids, cool, bland) complication prevention |
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Fungal infections are treated with a _____ swish and swallow
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Niastatin
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What is the most serious complication of a tonsillectomy in the first 24 hours
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hemorrhage
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After tonsillectomy; No ____ fluids, and No ____
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No red fluids (looks like blood)
No straw |
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Pt will have pain in ___ and ____ for 7-10 days. They should not take ____
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throat and ears
Do not take ASA |
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What is a tracheotomy?
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act of surgically cutting into trachea
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What is a tracheostomy?
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actual stoma
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Why do pts need a tracheotomy?
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airway obstruction
laryngeal trauma compromise of airway during head or neck surgery |
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Never Never Never cap the tracheostomy when ... This cuts off the pts airway.
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the inner cannula is in position
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The tracheostomy cuff is used only to keep the trach in place. It does not prevent against ________
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aspiration
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You must ___ the cuff when capping the trach. Failure to do so will compromise the airway.
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deflate the cuff...start at 29:50
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Always keep a ____ in the room for a patient with a trach
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2nd trach set (trach tube/obturator, insertion try)
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Nursing diagnosis for pts with tracheostomy
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reduced oxygenation
inadequate communication inadequate nutrition intake risk for infection |
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tracheotomy post-op complications
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bleeding, swelling, infection
obstruction dislodged tube displaced air - pneumothorax (at apex of lung) |
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How does trach tube obstruction occur
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dislodged tube
secretions displaced cuff |
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signs of trach obstruction
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noisy dyspnea (difficulty breathing)
low pulse ox |
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If trach obstruction is caused by secretions, what can be done
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deep breath and cough
suctioning trach care humidify O2 |
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If the trach is dislodged within ___ hours. it is an ____. Call ____. What do you do/not do?
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72 hours
Emergency Call Rapid Response team Do not attempt to put the trach back Do manually ventilate the patient |
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If a trach tube becomes dislodged after 72 hrs after surgery, what do you do?
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extend neck-open stoma
replace tube call respiratory therapy!!! assess airway/breathing ventilate prn |
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If there is a hole in the trach, air can get into the surrounding tissues. As a result the pt gets ___ ___. With this condition, there will be ___ around the neck and trach. When palpated, it will feel like____
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subcutaneous emphysema
swelling that feels like crunchy tissue "rice krispies" |
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a small amount of bleeding after trach surgery is normal, but constant oozing of blood is not. What should the nurse do?
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Pack gauze around the tube and into the wound gently
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What should the trach cuff pressure be at?
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14-20 mmHg for wall unit
20-30 cm H2O for portable |
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If trach cuff is inflated to high, it puts too much pressure on tracheal mucosa. This can cause ____. If it is too low, it can cause ___ and ____
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Too high: ischemia (restriction in blood supply to tissues)
Too low: movement and friction |
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Pts who are at risk for trach tissue damage are (5 things)
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dehydrated
malnourished hypoxic take corticosteroids elderly |
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The nose and mouth have the job of warming air before it reaches the trach. When that is bypassed, cool, dry air goes directly to the trach which dries mucosa and secretions. What can be done about this?
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Use humidifier
encourage fluid intake |
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When providing oral care for trach pt, avoid __ and ___ . You can use ___ sparingly for dry secretions.
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mouthwash - has alcohol
glycerin swabs - changes pH, dries mucosa out hydrogen peroxide |
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Remember to always ____ before deflating cuff
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suction
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Pts w/ trach are at risk for aspiration. What can you as a nurse do to prevent this.
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HOB 90 degrees
small meals thicken liquids slow/small bites small sip liquid in between bites chin tuck swallow |
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Only some trach pts can talk. How is this.
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they have a cuffless tube or fenestrated tube that is capped.
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When weaning a pt from a temporary trach, what do you do
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tube sizes are gradually decreased until removed. Always monitor respiratory status!!!
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When should a trach be suctioned?
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when movement of secretions can be heard with breathing
auscultated lung sounds yield wheezes or crackles |
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What is the first sign that a pts oxygen levels are dropping
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restlessness
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when suctioning a pt, ____ can occur because we are not only suctioning secretions, but also removing oxygen. To prevent this ____ the pt prior to suctioning.
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hypoxia
hyperoxygenate |
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How long can you suction a trach?
How big is the suction cath? |
10-15 second
12-14 Fr (never bigger than 1/2 the size of the trachea) |
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When the suctioning cath touches the carina and the pt coughs this can cause
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bronchospasm, vagal stimulation and lead to cardiac dysrhythmia
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always monitor the pts ___ and ___ while suctioning
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heart rate
pulse ox |
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If complications occur during suctioning, ____ the procedure and ____ the patient
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STOP and reoxygenate
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always suction the _____ before the _____
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nasopharynx before oropharynx
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laryngeal polyps occur from ....
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excessive talking/singing
smoking intubation |
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A sign of laryngeal polyps is ____. And if it is cancerous, a pt may exhibit _____
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hoarseness
cancerous-hemoptysis (coughing up blood) |
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when cancer occurs in the oral mucosas it is usually___ and related to ___ or ____
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squamous cell carcinoma
related to smoking or ETOH |
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Late signs of head and neck cancer
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Pain
airway obstruction dysphagia white patches (leukoplakia) red patches (erythroplakia) |
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Cancer is staged between level I-IV according to T, N, and M. What do these letters stand for?
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Tumor size
Node involvement Metastasis |
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The use of focused radiation usually with radiation "seeds" that are implanted into the cancerous area
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brachytherapy
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when surgery cannot be done, ____ in combination with radiation therapy is an option
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chemotherapy
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Surgery: part of 1 cord removed
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cordectomy
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surgery: cord removal...pt will wear temporary trach
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hemilaryngectomy
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surgery: removal of tissues above vocal cords and epiglottis...pt will wear temp trach
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supraglottic laryngectomy
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Cancer pt can have a radical or modified neck dissection to prevent..... This will result in a ___ trach
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to prevent spread of cancer through lymph nodes. Pt will have a permanent trach
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After surgery of head and neck, pt will have increased ___ and decreased ___. This will put the pt at risk for ____
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increased swelling
decreased swallowing ability risk for aspiration |
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Post operative nutrition for head and neck cancer surgery includes:
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NG or gastrostomy tube. If the trach is temp, the tube will be temp.
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pts who have a supraglottic laryngectomy will have to learn a new way to swallow. It is also likely they will need ___ therapy. The need to avoid _____ fluids
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speech therapy
thin watery fluids |
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Signs to look for in head and neck cancer...
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hoarseness
palpable lymph nodes deviated trachea dyspnea tongue patches (red/white) |
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What is xerostomia?
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dry mouth
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Radiation therapy for head and neck cancer can cause...
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dry mouth, fatigue, stomatitis, skin redness and burning
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Do not use ___ on skin before radiation therapy. Avoid ___
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No lotion
avoid sunlight |
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Post-operative complications for head and neck surgery.
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impaired speech
impaired swallowing tracheostomy |
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head and neck surgery airway considerations...
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deep breath and cough
oral care frequent care and suctioning of trach |
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The Pt needs to be in the ____ position post surgery. This helps reduce ____
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semi-fowler
edema |
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The dressings post head and neck surgery should go from serosanguinous to just
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serous
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after head and neck surgery, pts should notify their physician if there are changes to their trach such as the ____, they feel a ___ in their throat, or have difficulty ____
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stoma narrowing
lump in throat difficulty swallowing |
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The tracheostomy should Never be submerged under ____
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water
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