Upper Respiratory Problems

Front 1

Nasal fractures account for what percentage of bone injuries in cases of facial tauma?

Back 1

40%

Front 2

What is epistaxis?

Back 2

NOSEBLEED

cause - trauma, foreign bodies, topical corticosteroid use, nasal spray abuse, street drug use,anatomic malformation, allergic rhinitis, & tumors

WATCH FOR ASPIRATION! continue to check levels of consciousness.

hypertension doesn't cause epistaxis but makes it hard to manage.

Front 3

what medications could prolonge bleeding?

Back 3

aspirin or NSAIDs

Front 4

Nursing management for epistaxis?

Back 4

Pinch nose for 10-15 minutes to stop bleeding, apply ice, have the patient suck on ice, DO NOT TILT HEAD BACK. insert small gauze pads and apply pressure if bleeding continues.

nurse should closely monitor respiratory rate, heart rate and rhythm, oxygen saturation w/pulse oximetry, level of consciousness and observe signs of aspiration

discharge teaching - taught about home care, instructed to avoid vigorous nose blowing, strenuous activity, lifting, and straining for 4 to 6 weeks, taught to sneeze w/mouth open and to avoid aspirin products or NSAIDs

Front 5

What is Influenza?

Back 5

it is a virus.
there are 2 types - A and B.

clinical manifestations: cough, fever, myalgia, headache, sore throat,common cold symptoms.

IS HARD TO TREAT
get annual vaccine in the fall
70-90% effective. get to prevent secondary infections to others.

uncomplicated cases resolve w/in 7 days

watch for hypersensitivity to EGGS = Guillain-Barre syndrome, because vaccine is produced in eggs.

Front 6

Most common complication of the flu?

Back 6

pneumonia.

Front 7

Drug therapy for influenza

Anti-viral agents

Back 7

Flumadine & symmetrel - decrease signs of flu

they stop the cells from budding and duplicating. should be given within 2 days of initial onset to work.

has GI side effects (heartburn, reflux)

newer drugs - Relenza & Tamiflu

Front 8

What are nasal polyps?

Back 8

Benign mucous membrane masses that form slowly in response to repeated inflammation of the sinus.

They can be removed.

Can cause obstruction.

clinical manifestations - nasal obstruction, nasal discharge, & speech distortion.

Front 9

What is allergic rhinitis?

Back 9

The reaction of the nasal mucosa to a specific allergin.

Clinical manifestations: sneezing, watery & itchy eyes &nose, altered sense of smell, and thin watery discharge that can lead to a more sustained nasal congestion. Nasal turbinates appear pale, boggy & swollen.

Front 10

Two types of allergic rhinitis?

Back 10

Intermittent - syptoms are present <4 days/wk or <4 wks/yr. (usually occur in spring & fall)

Persistant - symptoms are present >4 days/wk or >4 wks/yr

Front 11

Complication that could arise from allergic rhinitis?

Back 11

Sinusitis

Front 12

Steps to manage allergic rhinitis?

Back 12

1. Identify and avoid triggers of allergic reactions. Keep a diary of times when the allergic reaction occurs and the cause.

Taking medications to reduce inflammation & reduce nasal symptoms. -Antihistamine-Corticosteriods-

Front 13

What is important to tell a patient who is taking antihistamines?

Back 13

drink plenty of fluids to reduce adverse symptoms.

Front 14

What is the therapeutic use for nasal corticosteroid sprays?

Back 14

to decrease inflammation locally with little absorption in the systemic circulation.

Front 15

What is immunotherapy?

Back 15

"allergy shot"
is used when drugs are not tolerated or effective and when the allergin is known.

expose the patient to a small amount of allergin weekly in hopes to decrease sensitivity.

Front 16

DRUG THERAPY ALLERGIC RHINITIS & SINUSITIS

Corticosteroids - Nasal Spray

Back 16

Flonase
Nasocort
Rhinocort
Vancenase

Inhibits inflammatory response

side effects: nasal burning & stinging

teach: correct use, begin 2wk before pollen season starts and use thru out pollen season.

*low systemic effect = low side effects

Front 17

DRUG THERAPY ALLERGIC RHINITIS & SINUSITIS

Mast cell stabilizer

Back 17

NasalCrom

inhibits degranulation of sensitized mast cells, which occurs after exposure to specific antigens.

effects: occasional burning or nasal irritation.

teach: correct use, begin 2wk before pollen season starts and thru out it

Front 18

DRUG THERAPY ALLERGIC RHINITIS & SINUSITIS

Anticholinergic - Nasal Spray

Back 18

Atrovent

blocks hypersecretory effects by competing for binding sites on the cell. Reduces rhinorrhea(runny nose) in the common cold & nonallergic reactions.

side effects: dryness of mouth & nose

teach: correct use

Front 19

DRUG THERAPY ALLERGIC RHINITIS & SINUSITIS

Antihistamine

Back 19

Relieves acute symptoms of allergic response (itching,sneezing,secretions)

binds with H1 receptors on target cells, blocking histamine.

side effects: sedation, restlessness, nervousness, insomnia, loss of appitite, epigastric distress.

Front 20

DRUG THERAPY ALLERGIC RHINITIS & SINUSITIS

Decongestants

Back 20

Sudafed

Stimulate adrenergic receptors on blood vessels, Promote vasoconstriction & reduce nasal edema and rhinorrhea

side effets: CNS stimulation causeing insomnia, excitation, heachache, irritability, increased BP, dysuria, palpitations, tachycardia

teach: don't take if patient has cardiovascular disease, hypertension, diabetes, glaucoma, hepatic & renal disease.

Front 21

What is Sinusitis?

Back 21

develops when the ostia (exit) from the sinuses are narrowed or blocked by inflammation or hypertrophy (swelling) of mucosa.

-the secretions that form behind the blockage cause a good enviroment for growth of bacteria, viruses, and fungi - all will cause an infection.

Front 22

Sinusitis can either be __________ , ____________
or ___________

Back 22

Bacterial, Viral or Fungal

Front 23

Bacterial Sinusitis is caused by what?

Back 23

-Streptococcus pneumoniae
-Haemophilus influenzae
-Moraxella catarrhalis

Front 24

What is a common cause of Viral Sinusitis?

Back 24

Usually follows an upper respiratory infection in which virus penetrates the mucous membranes and decreases ciliary transport.

Front 25

Clinical manifestations of sinusitis

Back 25

Pain over affected sinus, purulent nasal drainage, nasal obstruction, congestion, fever, malaise (just don't feel good)

Front 26

Management of Sinusitis

Back 26

Treat if symptoms persist longer than 7 days

Antibiotics - for bacterial infection (amoxicillin is first choice for 10-14 days, if symptoms do not resolve, change the antibiotic to a broader specrum one like Bactrim or erythromycin)

Decongestants - to promote drainage

Nasal corticosteroids - to decrease inflammation

Mucolytics - to promote mucous flow

encourage patient to DRINK DRINK DRINK!!!

Front 27

What is acute pharyngitis?

Back 27

an acute inflammation of the pharyngeal walls. May include tonsils, palate, and uvula.

caused by: viral, bacterial or fungal infection. (70% are viral)

Acute follicular pharyngitis = STREP THROAT

Fungal pharyngitis (candidiasis) can developed with prolonged use of antibiotics or inhaled corticsteroids.

Front 28

Clinical manifestations of acute pharyngitis

Back 28

range from scratchy throat to severe pain when swallowing.

Both viral and strep infections appear red and edematous with or without patchy yellow exudates.

Rapid strep test is taken to establish cause and direct appropriate management.

**inadequate treatment of acute streptococcal pharyngitis can result in RHEUMATIC HEART DISEASE***

Front 29

Management of Pharyngitis

Back 29

infection control, symptomatic relief, and prevention of secondary complications.

Candida infections are treated with Nystatin (anti-fungal antibiotic). Should be swished in mouth as long as possible before it is swallowed & treatment should continue until symptoms are gone.

***Pateint Taking inhaled corticosteroids are at risk for candida infection.***