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Exam 3 > Upper Respiratory > Flashcards

Upper Respiratory Flashcards

1
Q

Areas of the Upper Respiratory Tract in order

A 
Nose
Paranasal sinuses
Pharynx
Larynx
Trachea
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2
Q

what happens in The Nasal Cavity

A

Air is inhaled through the nostrils.

Warmed as it moves down to the pharynx

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3
Q

Mucous membranes

A

line the nasal cavity to trap unwanted particles or bacteria and infection

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4
Q

Paranasal Sinuses

A

Produces the mucous that protects the nasal cavity.

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5
Q

list the 4 Paranasal Sinuses

A

Frontal sinus
Ethmoid sinus
Sphenoid sinus
Maxillary sinus

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6
Q

The sinuses are a common site of _____

A

infection.

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7
Q

Pharynx

A

Serves both the respiratory and the digestive system.

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8
Q

Pharynx is composed of

A

Nasopharynx
Oropharynx
Laryngopharynx

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9
Q

function of The larynx or “voice box”

A

vocalization, but it also protects the lower airway from foreign objects and facilitates coughing; it is, therefore, sometimes referred to as the “watchdog of the lungs”

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10
Q

Trachea

A

Provides airflow to and from lungs for respiration.

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11
Q

Bronchi

A
  1. Highways for gas exchange

2. Oxygen enters and CO2 leaves through them.

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12
Q

The right lung has upper, middle, and lower lobes, whereas the left lung

A

consists of upper and lower lobes

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13
Q

physiologic dead space

A

airways contain about 150 mL of air in the tracheobronchial tree that does not participate in gas exchange

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14
Q

The lung is made up of about ______ alveoli

A

300 million

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15
Q

purulent sputum

A

(thick and yellow, green, or rust colored)

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16
Q

change in color of the sputum is a common sign of a________.

A

bacterial infection

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17
Q

Pink-tinged mucoid sputum suggests

A

a lung tumor

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18
Q

mucoid sputum frequently results from

A

viral bronchitis.

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19
Q

Profuse, frothy, pink material, often welling up into the throat, may indicate

A

pulmonary edema.

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20
Q

Pulmonary Function Tests (PFTs)

A
  1. Such tests include measurements of lung volumes, ventilatory function, and the mechanics of breathing, diffusion, and gas exchange.
  2. Considers patient’s height, weight, age, gender, and ethnicity.
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21
Q

PFTs can be performed before

A

surgery

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22
Q

PFT home spirometer is given to

A

measure patients peak flow rate

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23
Q

Clubbing of the finger:

A

change in shape of finger tips and nail to be more round like a “club”.

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24
Q

clubbing of fingers It is a sign of

A

lung disease that is found in patients with chronic hypoxic conditions

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25
Q

Cyanosis

A

a bluish coloring of the skin, is a very late indicator of hypoxia

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26
Q

Percussion produces audible and tactile vibration and allows

A

the nurse to determine whether underlying tissues are filled with air, fluid, or solid material.

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27
Q

discuss the 2 main percussion sounds

A

Healthy lung tissue is resonant.

Dullness over the lung occurs when air-filled lung tissue is replaced by fluid or solid tissue.

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28
Q

Arterial Blood Gas Studies (ABGs) 2 purposes

A
  1. Assesses the lung’s ability to provide oxygen and remove CO2.
  2. Assesses ability of the kidneys to reabsorb or excrete bicarbonate ions to maintain normal pH.
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29
Q

ABG levels are obtained through

A

an arterial puncture at the radial, brachial, or femoral artery or through an indwelling arterial catheter

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30
Q

delete me

A

delete me

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31
Q

VBG levels can be obtained by

A

drawing blood from the venous circulation

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32
Q

Venous Blood Gas Studies:

A

Checks the amount of O2 used by the tissues vs. the amount being returned to the heart.

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33
Q

Pulse Oximetry

A
  1. Monitors the oxygen saturation of hemoglobin.
  2. Normal value is 95% or greater.
  3. If less than 90%, the tissues are not receiving enough oxygen
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34
Q

A throat culture or “strep test” is performed by using

A

a throat swab to detect the presence of group A streptococcus bacteria or “strep throat”

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35
Q

Nasal or nasopharyngeal culture detects

A

Influenza or Staphylococcus aureus

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36
Q

ETA of culture results

A

Sits in lab at least 24 hrs for preliminary results, and final results 48-72 hrs.

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37
Q

Ideally, all cultures should be obtained prior to

A

the initiation of antibiotic therapy.

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38
Q

Sputum Studies are

A

Analysis of pathogenic organisms and can determine if malignant cells are present

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39
Q

Sputum Studies Usually done with patients who are

A

receiving antibiotics, corticosteroids, or immunosuppressive medications.

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40
Q

to obtain a sputum sample

A

Patient coughs deeply and expectorates sputum from the lungs into sterile container.

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41
Q

If the patient cannot expel an adequate sputum sample by coughing

A

coughing can be induced by administering an aerosolized hypertonic solution via a nebulizer

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42
Q

Sputum samples ideally are obtained in what time of the day

A

early in the morning before the patient has had anything to eat or drink.

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43
Q

Focused Respiratory Assessment on HISTORY portion

A 
History of respiratory disease
Smoking
Environmental exposures
Cough or sputum appearance
Dyspnea
Medications (any antibiotics, corticosteroids, immunisuppressive treatment, asthma)
Previous treatment
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44
Q

Focused Respiratory Assessment - on INSPECTION

A
  1. Use of accessory muscles while breathing
  2. Symmetry of chest
  3. Rate of respirations
  4. Skin color of lips, face, hands, feet
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45
Q

Fine crackles:

A

sounds like hair rubbing together associated with asthma, COPD, fibrosis.

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46
Q

Coarse crackles:

A

harsh moist popping sounds associate with COPD, pulmonary edema.

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47
Q

Wheezes:

A

musical high pitch sound associated with bronchitis, emphysema, asthma

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48
Q

Pleural friction rub:

A

low pitch rubbing sound (rubbing of fingers together like) associated with pleurisy and loss of lubrication

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49
Q

Normal breath sounds are classified as

A

tracheal, bronchial, bronchovesicular, and vesicular sounds.

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50
Q

Viral Rhinitis aka Common cold is

A

Acute inflammation and infection of the mucous membranes

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51
Q

viral rhinitis is Contagious _____ before symptoms appear.

A

2 days

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52
Q

Viral Rhinitis Survive best when

A

humidity is low in the colder months.

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53
Q

__(x amount of)__ different viruses can cause a cold

A

200

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54
Q

most common viral rhinitis virus is

A

Rhinoviruse

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55
Q

viral rhinitis doesn’t need

A

antibiotics. Antibiotics are for bacterial infections

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56
Q

Allergic rhinitis is further classified as seasonal or perennial rhinitis and is commonly associated

A

with exposure to airborne particles such as dust or pollen

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57
Q

Despite popular belief, cold temperatures and exposure to cold rainy weather

A

do not increase the incidence or severity of the common cold.

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58
Q

Viral rhinitis symptoms

A 
low grade fever.
nasal congestion
rhinorrhea
halitosis
sneezing
watery eyes
sore throat and cough
malaise and chills
headache and muscle aches
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59
Q

Halitosis:

A

bad smelling breath

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60
Q

Rhinorrhea:

A

runny nose

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61
Q

The symptoms of viral rhinitis may last

A

from 1 to 2 weeks

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62
Q

Viral rhinitis Medical management

A

TREAT THE SYMPTOMS with medications!
Adequate fluid intake
Rest

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63
Q

Medications for Viral rhinitis Medical management

A
  1. Expectorants
  2. NSAIDs
  3. Antihistamines
  4. topical nasal decongestants
  5. petroleum jelly
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64
Q

Expectorants, what they do and an example of medication

A

remove secretions (like mucinex, Guaifenesin)

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65
Q

NSAIDs

A

like ibuprofen and aspirin (relief pain)

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66
Q

Antihistamines help with

A

(helps with sneezing, nasal congestion)

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67
Q

Petroleum jelly

A

can soothe irritated, chapped, and raw skin around the nostrils

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68
Q

Use topical nasal decongestants with caution! its overuse can

A

produce rhinitis medicamentosa, or rebound rhinitis. Maximum 3 days!

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69
Q

Humidified air for viral rhinitis

A

has not been proven.

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70
Q

Transmission of viral rhinitis is

A

direct contact and droplet.

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71
Q

Sneezing in elbow is better than sneezing in hands because

A

patients don’t always wash hands and they can spread the droplets on surfaces.

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72
Q

Most viruses can be transmitted in several ways:

A
  1. direct contact with infected secretions
  2. inhalation of large particles from others’ coughing or sneezing
  3. inhalation of small particles (aerosol) that may be suspended in the air for up to an hour
73
Q

Viral Rhinitis patient education

A
  1. The transmission of the virus.
  2. Proper hand hygiene.
    3, The use of tissues when coughing and sneezing
  3. Methods to treat symptoms.
  4. Future prevention techniques.
  5. Verbal and written instructions should be given.
74
Q

Rhinosinusitis

A

Inflammation of the paranasal sinuses and nasal cavity.

75
Q

Rhinosinusitis can be either

A

Bacterial or viral

76
Q

Rhinosinusitis is Classified by duration of symptoms:

A

Acute (less than 4 weeks)
Subacute (4 to 12 weeks)
Chronic (more than 12 weeks)

77
Q

If there is an obstruction in sinus,

A

it’s a great place for bacteria to grow

78
Q

Acute Rhinosinusitis Usually follows a

A

cold, or unresolved infection or exacerbation of allergic rhinitis.

79
Q

Acute Rhinosinusitis two classifications

A

Acute bacterial rhinosinusitis (ABRS)

Acute viral rhinosinusitis (AVRS)

80
Q

what percentage of acute rhinosinusitis is caused by bacteria?

A

60%

81
Q

Biofilm producing bacterial pathogen are associated with which acute rhinosinusitis virus?

A

Streptococcus pneumonia aureus

82
Q

Acute Rhinosinusitis can also be caused by

A

deviated septum, diving, swimming, tooth infections, trauma to nasal cavity.

83
Q

Some people are more prone to rhinosinusitis because of environmental hazards such as

A

as paint, sawdust, and chemicals may result in chronic inflammation of the nasal passages

84
Q

Although antibiotics kill bacteria in the biofilm margin

A

cells deep in the biofilm are not affected, allowing for regrowth once antibiotic therapy has been discontinued

85
Q

Fungal infections occur most often

A

in patients who are immunosuppressed

86
Q

Rhinosinusitis symptoms

A

Purulent nasal drainage
Facial pain and pressure
Headache
Fever

87
Q

Timeline of symptoms for ABRS and AVRS

A

ABRS
10 days or more of present symptoms and worsen over time.
AVRS
Fewer than 10 days of present symptoms and do not worsen.

88
Q

The symptoms of AVRS are similar to those of ABRS, except

A

the patient does not present with a high fever

89
Q

assessment for rhinosinusitis

A
  1. Obtain history
  2. Physical examination: (Nose, ears, teeth, sinuses, pharynx, and chest are the focus.)
  3. sinuses tenderness
  4. Sinus culture
90
Q

The sinuses are percussed using the index finger through

A

tapping lightly to determine whether the patient experiences pain

91
Q

Complications of rhinosinusitis

A

Osteomyelitis
Intracranial complications
Mucocele (cystic lesion)

92
Q

Osteomyelitis

A

(Inflammation of the bone)
Requires:
Prolonged antibiotic therapy
Removal of necrotic bone

93
Q

Mucocele

A

(Cyst of the paranasal sinus)
Requires:
Surgical treatment
Ablation of the sinus cavity

94
Q

Intracranial complications of rhinosinusitis:

A

like meningitis, brain abscess, or orbital cellulitis

95
Q

Goals of treatment for Rhinosinusitis

A

Treat infection
Relieve pain
Shrink the nasal mucosa

96
Q

Medical Management - ABRS

A 
Antibiotics that treat antibiotic-resistant organisms:
Amoxicillin (Augmentin) 
Doxycycline (Vibramycin)
Levofloxacin (Levaquin)
Intranasal saline lavage
97
Q

antibiotics #1 choice for ABRS

A

Amoxicillin (Augmentin)

98
Q

___________ is given if pt is allergic to pennicilin for ABRS

A

Levofloxacin (Levaquin)

99
Q

Neither ________ nor ________ are recommended adjunctive medications for treating ABRS

A

decongestants, antihistamines

100
Q

Medical Management - AVRS

A

Nasal saline lavage
Decongestants
Antihistamines (if allergies are suspected)
Intranasal corticosteroids

101
Q

Decongestants for AVRS

A

Guaifenesin , Robitussin

102
Q

Oral decongestants must be used cautiously in patients with

A

hypertension.

103
Q

Intranasal corticosteroids for AVRS

A

Mometa-sone (Nasonex)

Triam-cinolone (Nasacort)

104
Q

_______ have been shown to produce complete or marked improvement in acute symptoms of either bacterial or viral rhinosinusitis;

A

Intranasal corticosteroids

105
Q

patient education for rhinosinusitis

A 
Symptoms of complications
Methods to promote drainage
Must avoid swimming, diving, and air travel
No smoking during infection
Nasal spray demonstration
Medication use
106
Q

Must avoid swimming, diving, and air travel be cause

A

these will increase cranial pressure

107
Q

rhinosinusitis Symptoms of serious complications :

A

nuchal rigidity (a sign of minigitis) or orbital edema (eye swelling)

108
Q

Chronic Rhinosinusitis (CRS) is diagnosed when experiencing for 12+ months, two or more of the following:

A 
Mucopurulent drainage
Nasal obstruction
Facial pain or pressure
Hyposmia 
Can be accompanied by nasal polyps
109
Q

Hyposmia

A

(decreased sense of smell)

110
Q

nasal polyps

A

(benign masses in nasal cavity)

111
Q

Recurrent Acute Rhinosinusitis

classification timeline:

A

4 or more episodes of ABRS occur per year.

112
Q

Patho of Chronic Rhinosinusitis & Recurrent Acute Rhinosinusitis

A

obstruction in the sinuses that prevents drainage and grows bacteria

113
Q

(delete me) what other causes for Chronic Rhinosinusitis & Recurrent Acute Rhinosinusitis

A

(delete me) cystic fibrosis, environmental pollution, tabacco

114
Q

what type of bacteria is found in “Chronic Rhinosinusitis & Recurrent Acute Rhinosinusitis “

A

Both aerobic and anaerobic bacteria are found

115
Q

Anaerobic bacteria:

A

doesn’t need oxygen to survive

116
Q

Signs of CRS

A 
Impaired mucus clearance
Cough
Chronic hoarseness
Chronic headaches
orbital edema
Facial pain
117
Q

physical assessment for CRS focuses on

A 
External nose
Nasal mucosal membranes
Posterior oropharynx for purulent or mucoid discharge
Eyes for edema
Palpation of the sinuses (ask if tender)
118
Q

A crooked-appearing external nose may imply __________

A

septal deviation internally.

119
Q

Technique for palpating the frontal sinuses

A

Using the thumbs, the nurse applies gentle pressure in an upward fashion at the supraorbital ridges (frontal sinuses) and in the cheek area adjacent to the nose (maxillary sinuses)

120
Q

diagnostic tests for CRS

A

X-ray
CT scan
Nasal endoscopy

121
Q

CT scan for rhinosinusitis Identifies

A

mucosal abnormalities, sinus obstruction, and anatomic variants.

122
Q

Nasal endoscopy for rhinosinusitis

visualizes

A

the posterior nasal cavity, nasopharynx, and sinus pathways

123
Q

complications of CRS

A 
Orbital cellulitis
Encephalitis
Alterations in consciousness
Seizures
Coma or death
124
Q

Frontal rhinosinusitis can lead to

A

osteomyelitis of the frontal bones

125
Q

Frontal sinus osteomyelitis symptoms

A

headache, fever, and edema over the involved bone.

126
Q

CRS and ABRS medical management

A

(Similar to acute rhinosinusitis)

Antibiotic regimen usually lasts 2 to 4 weeks or Can last up to 12 months depending on the case

127
Q

CRS Patients are instructed to sleep with the

A

head of the bed elevated

128
Q

CRS Patients are cautioned to avoid caffeine and alcohol, which

A

can cause dehydration.

129
Q

Surgical management for CRS

A

Functional endoscopic sinus surgery (FESS)

130
Q

Functional endoscopic sinus surgery (FESS) is used for

A 
removing nasal polyps
Correcting deviated septum
draining the sinuses
Aerating the sinuses
Removing tumors
131
Q

FESS is basically a

A

minimally invasive computer guided surgery to treat CRS

132
Q

CRS patient education

A

Blow nose gently
Promote drainage
Early signs of sinus infection
Preventative measures

133
Q

patients can promote drainage by

A

Increase fluid intake
Apply local hot wet packs
Elevate the head of the bed

134
Q

Acute Pharyngitis

A

Inflammation of the pharynx aka “Sore Throat”

135
Q

pharyngitis can be viral or bacterial but _____ is the most common

A

Viral pharyngitis

136
Q

Viral pharyngitis risk factors

A

Poorly ventilated rooms
Unclean hands
Droplets of coughs and sneezes

137
Q

Viral pharyngitis Peaks during

A

winter and early spring

138
Q

Viral pharyngitis Usually subsides within

A

3 to 10 days

139
Q

viruses that could cause viral Pharyngitis

A 
Adenovirus
Influenza 
Epstein-Barr
Herpes simplex
HIV
140
Q

causes of bacterial Pharyngitis

A 
Group A streptococcus (STREP THROAT)
Group B streptococci
Group G streptococci
Neisseria gonorrhoeae
Mycoplasma pneumonia
141
Q

Strep throat comes only from _____

A

group A strepticoccus

142
Q

Acute Pharyngitis Clinical Manifestations

A

Fiery-red pharyngeal membrane and tonsils.
Lymphoid follicles are swollen with white-purple exudate.
Enlarged and tender cervical lymph nodes.
Fever
Malaise
Sore throat

143
Q

No cough is present in

A

Acute Pharyngitis

144
Q

Streptococcal pharyngitis Clinical Manifestations (besides the regular pharyngitis symptoms)

A 
Swollen and erythematous tonsils
Headache
Myalgia (muscle pain)
Nausea
Halitosis
145
Q

Streptococcal pharyngitis, also known as strep throat, or Bacterial tonsillitis is

A

an infection of the back of the throat including the tonsils caused by group A streptococcus (GAS)

146
Q

Diagnostic tests for Pharyngitis

A

Rapid Antigen Detection Testing (RADP)

Throat culture

147
Q

Rapid Antigen Detection Testing (RADP)

A

Swabs collect specimens from the posterior pharynx and tonsils.
90%-95% effective.

148
Q

Medical Management for viral Pharyngitis

A

Viral pharyngitis is treated with supportive measures because antibiotics have no effect on the causal organism

149
Q

Medical Management for bacterial Pharyngitis

A

a variety of antimicrobial agents:
Penicillin (antibiotics): Orally for 5 days
or
Cephalosporin: orally 5-10 days

For patients who are allergic to penicillin, we give:
Macrolides Orally for 3 days

150
Q

macrolides examples

A

Clarith-romycin (Biaxin)

Azith-romycin (Zithromax)

151
Q

Cephalosporin (antibiotics) examples

A

Cef-podoxime (Vantin)

Cef-uroxime (Ceftin)

152
Q

in pharyngitis, Severe sore throats can also be relieved by

A

analgesic medications. For example, aspirin or acetaminophen can be taken at 4 to 6 hour intervals

153
Q

In severe cases, gargles with ______ may relieve symptoms.

A

benzocaine

154
Q

nutritional therapy for pharyngitis

A

Liquid or soft diet
Cool or warm beverages: (2 to 3 L/day)
Ice pops
IV fluids may be needed

155
Q

patient education for pharyngitis

A

Warm saline gargles (105-110F).
Ice collar application (helps with discomfort in the neck).
Preventative measures (not share daily living items).
Replace toothbrush.

156
Q

for pharyngitis, The nurse instructs the patient about signs and symptoms that warrant prompt contact with the primary provider. These include

A

dyspnea, drooling, inability to swallow, and inability to fully open the mouth.

157
Q

Chronic Pharyngitis

A

Persistent inflammation of the pharynx

158
Q

Persistent inflammation of the pharynx is Common for people who:

A

Work in dusty surrounding
Use their voice to excess
Suffer from chronic cough
Habitually use alcohol and tobacco

159
Q

Types of Chronic Pharyngitis

A

Hypertrophic
Atrophic (becomes smaller)
Chronic granular

160
Q

Hypertrophic Chronic Pharyngitis

A

General thickening and congestion of the pharyngeal mucous membrane.

161
Q

Atrophic Chronic Pharyngitis

A

Later stage of hypertrophic.

Membrane is thin, whitish, and wrinkled

162
Q

Chronic granular Pharyngitis

A

Numerous swollen lymph follicles on the pharyngeal wall

163
Q

chronic pharyngitis Clinical Manifestations

A

postnasal drip (nasal drips into throat
Mucous collection in the throat
throat irritation
Difficulty swallowing

164
Q

Treatment for chronic pharyngitis

A

Nasal spray, aspirin

Tonsillectomy may be recommended

165
Q

patient education for chronic pharyngitis

A

wear N95 when needed

166
Q

Laryngitis

A

Inflammation of the larynx.
Can be viral or bacterial.
Usually associated with rhinitis or pharyngitis.

167
Q

causes of Laryngitis

A

Voice abuse
Exposure to dust, chemicals, smoke, or other pollutants
GERD

168
Q

Gastroesophageal reflux disease (GERD or reflux laryngitis)

A

occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus).

169
Q

Laryngitis Clinical Manifestations

A

Hoarseness or aphonia (loss of voice)
Severe cough
“Tickle” in the throat

Symptoms are aggravated by cold dry wind
Feels worst in the morning and evening

170
Q

Laryngitis Medical Management

A

Resting the voice
Avoiding irritants (alcohol, tabacco, certain foods that cause GERD)
Antibiotics
Corticosteroids (if chronic)
Proton Pump Inhibitors if related to GERD

171
Q

Omeprazole (Prilosec)

A

Proton-pump inhibitor

It can treat gastroesophageal reflux disease (GERD).

172
Q

Laryngitis Nursing Management

A

Encourage rest and fluids (2-3L).
Maintain a well-humidified environment.
using continuous positive airway therapy at bedtime.
When to contact their provider.

173
Q

Laryngitis patients should contact physican if symptoms

A 
include loss of voice with sore throat that makes swallowing saliva difficult.
hemoptysis.
noisy respirations.
persistent or high fever.
increasing shortness of breath.
confusion.
174
Q

Continued hoarseness after voice rest or laryngitis that persists for longer than 5 days must be reported because of

A

the possibility of malignancy (dangerous)

175
Q

laryngitis Nursing Interventions

A

Promoting Communication:
Instruct on refraining from speaking
Encourage written communication
Encourage call bell for assistance

Encourage Fluid Intake:
Provide a list of easily ingested foods
Encourage 2-3 L of water per day
Provide cool or warm beverages

Promoting Home and Transitional Care:
Prevention education
Hand hygiene
Reinforce the need to complete treatment regimen

176
Q

Dairy is bad because

A

it thickens the mucus

177
Q

What do antihistamines do pharmacologically?

A

They block histamine (which helps with congestions, opening airways)

178
Q

What is a priority with a suspected infection?

A

A sputum culture.

Exam 3 (6 decks)

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