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Med Surg > 26 - Upper Respiratory Problems > Flashcards

26 - Upper Respiratory Problems Flashcards

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1
Q

primary concerns of upper resp problems

A

1 ventilation

2 O2 availability

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2
Q

epistaxis

A

nosebleed

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3
Q

allergic rhinitis

A

inflammation of nasal mucosa

-often in response to specific allergen

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4
Q

allergic rhinitis classification according to CAUSATIVE allergen

A

seasonal or perennial

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5
Q

allergic rhinitis classification according to FREQUENCY of symptoms

A

episodic
intermittent
persistent

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6
Q

episodic allergic rhinitis

A

sporadic exposure to allergen
-typically not encountered in pt’s normal environment
ie animal dander when visiting friend

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7
Q

intermittent allergic rhinitis

A

symptoms are present LESS than 4 days/wk or

less than 4 weeks/yr

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8
Q

persistent allergic rhinitis

A

symptoms are present MORE than 4 days/wk or

less than 4 weeks/yr

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9
Q

seasonal vs perennial

A

ssnl: sping/fall; allergy to pollens or weeds
prnl: year-round fr environmt allergen like animal dander, dust mites, cockroaches, fungi, molds

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10
Q

allergic rhinitis

s/s

A
  • sneezing
  • watery itchy eyes + nose
  • decr smell
  • thin, water nasal discharge
  • congestion
  • nasal turbinates are pale, boggy, swollen
  • headache
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11
Q

allergic rhinitis

Tx

A
  • ID + avoid triggers
  • drugs to reduce inflammation
  • nasal corticoid sprays
  • H1 antihistamines leukotrine receptor antagonist, decongestant
  • anti Hist, anti chol, corticosteroid
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12
Q

1 gen vs 2 gen antihistamines

A

first gen can cause drowsy + sedation

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13
Q

Acute Viral Rhinopharyngitis aka

A

common cold

nasopharyngitis

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14
Q

Acute Viral Rhinopharyngitis

A

infections of upper resp tract

  • most prevalent infectious disease
  • caused by more than 200 diff viruses
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15
Q

most Acute Viral Rhinopharyngitis are caused by _____ and are ____

A

coronavirus

mild + self limiting

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16
Q

common viruses that cause Acute Viral Rhinopharyngitis

A

1coronavirus
2human respiratory syncytial virus
3enterovirus

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17
Q

Acute Viral Rhinopharyngitis viruses are spread via

A

airborne droplets (cough, sneeze, talk etc)
+ fomites (up to 3 days)
+direct hand contact

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18
Q

Acute Viral Rhinopharyngitis

onset + duration + recovery of symptoms

A

onset: 2-3 days after exposure
dur: 2-14 days
recovery: 7-10 days

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19
Q

Acute Viral Rhinopharyngitis

s/s

A
  • runny nose
  • watery eyes
  • nasal congestion
  • sneeze
  • cough
  • sore throat
  • fever
  • headache
  • fatigue
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20
Q

Acute Viral Rhinopharyngitis

treatments are directed towards…

A

relieving symptoms

  • rest
  • oral fluids
  • antipyretics
  • analgesic
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21
Q

cautions patients to use intranasal decongestants for no more than 3 days to _____

A

prevent rebound congestion

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22
Q

vitamin C, echinacea, zinc products for Acute Viral Rhinopharyngitis

A

no inconclusive evidence

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23
Q

Acute Viral Rhinopharyngitis

complications

A
  • acute bronchitis
  • sinusitis
  • otitis media
  • tonsillitis
  • pneumonia
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24
Q

s/s of secondary bacterial infection

A
  • temp higher than 103
  • tender, swollen glands
  • severe sinus + ear pain
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25
Influenza aka
flu
26
Influenza
highly contagious resp illness | -cause significant morbidity + mortality
27
influenza season + peaks
Sept-April | Peak: Dec-Feb
28
4 serotypes of Influenza
A - most common/virulent B - humans C - humans D - animals
29
Serotype A
- most common + virulent - animals + humans - subtypes based on H antigen + N antigen
30
H + N antigen in serotype A
H: enables virus to enter cell N: facilitates cell-to-cell transmission
31
which serotype can cause pandemics?
serotype A
32
which serotypes can cause epidemics?
serotype B
33
serotype B + C
only infects humans - can cause an epidemic - milder disease than serotype A
34
Influenza transmission
- infected droplets - inhalation of aerosolized particles - direct contact w contaminated spaces - lesser extent thru fomites
35
Influenza | onset
abrupt onset: 1-4 days | pt is highly contagious 1 day before onset + contunued 5-7 days
36
Influenza | s/s
- chills - fever - generalized myalgia w headache, cough, sore throat, + fatigue - norm breath sounds
37
Influenza | complications
- primary influenza pneumonia - secondary bacterial pneumonia - eat or sinus infection older patients have weak/lethargy lasting weeks
38
Influenza | signs of pulm complications
- dyspnea | - diffuse crackles
39
Influenza | Diagnosis
-rapid influenza diagnostic test [RIDT] -viral culture (throat/nasopharyngeal swab) -
40
rapid influenza diagnostic test [RIDT]
- results w/in 5 min - best used w/in 48 hr - helps distinguish influenza fr other viral/bacterial infection
41
most effective strategy for managing influenza
prevention
42
2 types of rapid influenza vaccines
- live attenuated - inactivated -changed on yearly basis
43
best time to receive influenza vaccine
sept/oct - takes 2 wks for full protection - high priority to groups that are high risk of transmission like health care workers
44
minimum age for vaccines
6 mos
45
most common A/E of vaccines
soreness at injection site
46
flu vaccine | CI
- <6mos - allergc rxn to previous flu vaccine - egg allergy
47
Influenza | Tx
- relief of symptoms - prevention of secondary infections - rest, hydrate, analgesic, + antipyretic - antiviral med may shorten duration
48
Influenza | antiviral meds
- oseltamivir (tamiflu) - zanamivir (relenza - peramivir (Rapivab)
49
Influenza | antiviral meds MOA
neuraminidase inhibitors | -prevents virus from being released + spreading to other cells
50
influenza therapy should begin ____ of onset of symptoms
within 2 days
51
acute pharyngitis
inflammation of pharyngeal walls | may include tonsil, palate + uvula
52
common causes of acute pharyngitis
can be viral, bacterial, fungal 90% viral 5-10% bacterial
53
bacterial pharyngitis aka
strep throat
54
bacterial pharyngitis/strep throat is caused by
A Beta-hemolytic streptococci | -accounts for 5-10% of pharyngitis
55
fungal pharyngitis aka
candidiasis
56
fungal pharyngitis/candidiasis
white, irreg patches on oropharynx | -usually candida albicans
57
fungal pharyngitis/candidiasis | high risk
- prolong use of abx or inhaled corticosteroids - immunosuppressed (HIV) - dry, air, smoking, GERD, allergy, post nasal drip - ET intubation, chem fumes, cancer
58
viral pharyngitis/strep throat | s/s
- scratchy throat to severe pain/dysphagia | - red + edematous pharynx
59
``` strep throat classic signs (4) ```
1 >100.4 2 anterior cervical lymph node enlargement 3 tonsillar pharyngeal exudate 4 absence of cough **when 2-3 signs are present, take a rapid antigen test/throat culture to establish cause
60
fungal pharyngitis/candidiasis | Tx
nystatin - antifungal abx - swish + swallow - swish as long as possible - continue until symptoms are gone
61
how to prevent candidiasis when using corticosteroids
rinse mouth w water
62
drug of choice for A Beta-hemolytic streptococci
penicillin | -must be taken several times/day for 10 days
63
alternatives if allergic to penicillin
erythromycin + clindamycin
64
most ppl w strep throat are contagious until
they have been on abx for 24-48 hours
65
goal of tx for pharyngitis
mgmt of infection + symptom relief + prevention of complications - ibuprofen or APAP - incr fluid intake - salt water gargle - warm/cold liquids - popsicle, hard candy, lozenges - cool mist vaporizer/humidifier - OJ is irritating
66
reasons for a trache
``` 1 establish airway 2 bypass obstructn 3 removl of secretn 4 long-trm mech vent 5 weaning fr mech ventln ```
67
trache vs ET
T is shorter + wider> easy cleaning -more comfortbl bc nothing in mouth -
68
outter vs inner cannula
O: keeps airway patent I: disposbl/nondisposbl; can be removed for cleaning
69
cuffed
- most common esp for mechncl ventln | - used to prevent aspiration
70
uncuffed
- for longer term trache - --when mech ventln is NOT needed + risk for asprntn is lowered - makes talking + eating easier
71
trache surgery
- operating room - general anesthesia - horizntl incision - analgesia + sedatn
72
when is the balloon cuff inflated?
immediately after surgery
73
how to confirm trache placement
1 auscultate for air entry 2 end-tidal CO2 capnography 3 passage of suction thru tube 4 chest x ray
74
cuff pressure
- monitor + record Q8hr - 15-22mmHg - 20-25cm H2O
75
Never insert a decannulation plug in trache tube until...
cuff is delated + nonfenestrated inner cannula is removed
76
what to monitor post trache surgery
- VS - SpO2 - chest x ray
77
complications to monitor post trache surgery
- airway obstruction - bleeding - infection
78
how often should sterile dressing changes be done?
Q12hr
79
how often to clean inner cannula?
Qshift | or Q8hr
80
if tube is accidentally dislodged
- call for help - assess pt for resp distress - inser obturattor into spare trache tube - lube w saline - insert in stoma - once inserted, remove obturator
81
if tube is dislodged + cannot be replaced bs of tract immaturity (<1wk), then ...
immediately place pt in semi-fowlers to decr dyspnea - cover stoma w sterile dressing - provide ventilatin w BVM over nose + mouth
82
suction pressure should be no greater than
125 mmHg
83
if you hear wheezing or crackles, then..
let pt cough if unable to cough, then suction
84
how often should trache tube be changed?
1 mos after first tube | then Q1-3mos
85
Passy Muir valve
device that attaches to tube | -redirects airflow thru vocal cords
86
when can decannulation occur?
``` patient must be 1 hemodynamically stable 2 stable intact resp drive 3 adequately exchange air 4 independently expectorate secretions ```
87
during decannulation, it is most important to check that _____
cuff is deflated
88
stoma closing
- close w tape strips - splint stoma w fingers - should close w/in 4-5 days

Med Surg (18 decks)

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