Chapter 29 - Problems of the Nose (p.577-588) - Exam 2

Question 1

a deviated septum can interfere with what

Answer 1

airflow and sinus drainage

Question 2

s/s of deviated septum vary but they might include

Answer 2

asymptomatic, nasal congestion, frequent sinus infections, facial pain, nose bleeds, obstruction to nasal breathing

Question 3

the medical management of minor septal deviation focuses on symptom control. For nasal inflammation and congestion use

Answer 3

saline rinses, decongestants to clear nasal passage

Question 4

for severe septal deviation a ________may be needed

Answer 4

nasal septoplasty, which reconstructs and properly aligns the deviated septum

Question 5

nasal fractures occur mostly from

Answer 5

blunt trauma, fights, accidents, falls, sports

Question 6

when assessing for a nasal fracture you may find these symptoms/signs

Answer 6

difficulting breathing, bleeding, edema, hematoma

Question 7

what are the goals of nursing care r/t nasal fracture

Answer 7

maintain patent airway, reduce edema and pain, prevent complications, provide emotional support

Question 8

the best way to maintain airway is to keep the patient in what position

Answer 8

sitting upright.

Question 9

apply ice to the face in 10 to _____ minute intervals to help reduce _______ and bleeding

Answer 9

20, edema

Question 10

tell the patient not to _____ their nose once bleeding has stopped

why?

Answer 10

blow

so they do not disrupt the clot or cause further trauma

Question 11

___________is preferred over NSAIDS or aspirin for the first 48 hours to avoid prolonging clotting time and increasing risk for bleeding

Answer 11

acetaminophen

Question 12

nasal stuffiness may be relieved with

Answer 12

nasal decongestants, saline nasal sprays, humidifier

Question 13

the patient should avoid ________ showers and ______ for the first 48 hours to prevent an increase in swelling

Answer 13

hot, alchohol

Question 14

when fracture is confirmed, the goals are to _________ the fracured bones using either manual manupulation or surgery

Answer 14

realign

Question 15

with complex fractures, considerable swelling occurs it may be necessary to wait to repair the fracture until what subsides

Answer 15

edema

Question 16

an anterior bleed may be treated medically by placing a

Answer 16

pledget, aka nasal tampon

Question 17

_______nitrate may be used to chemically cauterize a specific bleeding point

Answer 17

silver

Question 18

what is an epistaxis

Answer 18

nose bleed

Question 19

why do nose bleeds occur

Answer 19

trauma, low humidity, UPI, allergies, sinusitis, foreign bodies, chemical irritants, overuse of decongestant sprays, facial or nasal surgery, tumors, anatomic malfomation

Question 20

posterior bleed often need packing with

Answer 20

compressed nasal sponges or epistaxis balloons

Question 21

nasal sponges, packing, balloons can impair _______status

Answer 21

respiratory

Question 22

therefore we should closely monitor

Answer 22

LOC, HR, RR, and O2 sat
observe for signs of difficulty breathing or swallowing

Question 23

because of risk for complications due to posterior location of injury all patients with posterior packing should be ___________ for close observation

Answer 23

monitored closely

Question 24

Nasal packing predisposes patient to ___________ from bacteria

Answer 24

infection

Question 25

before discharge, teach the patient about followup care, review how to use

Answer 25

saline nasal spray or humidifier

Question 26

have the patient sneeze with mouth

Answer 26

open

Question 27

teach patient to avoid taking _____for pain

Answer 27

aspirin or NSAIDS

Question 28

characteristics of allergic rhinitis are

Answer 28

sneezing, watery eyes, itchy eyes and nose, decreased sense of smell, thin watery nasal discharge, nasal turbinates appear pale, boggy, swollen

Question 29

___________, soft painless growths in the sinus cavity may form due to chronic exposure to allergens

Answer 29

nasal polyps

Question 30

____________ occurs when mucous runs down the back of the throat

Answer 30

postnasal drip

Question 31

both __________and __________ are the most common causes of cough for people with allergies

Answer 31

nasal polyps and postnasal drop

Question 32

the key to managing allerfic rhinitis is

Answer 32

identifying and avoiding triggers of allergic reactions

Question 33

the goal of drug therapy r/t allergic rhinitis is

Answer 33

reduce inflammation, minimize complications, and maximize quality of life

Question 34

______________ antihistamines are used before first generation antihistamines because of their ___________effects

Answer 34

2nd gen, non-sedating

Question 35

appropriate oral meds r/t allergic rhinitis include

Answer 35

h1 antihistamines, decongestants

Question 36

appropriate intranasal meds r/t allergic rhinitis include

Answer 36

antihistamines, decongestants, anticholinerics, corticosteroids

Question 37

first gen antihistamines may cause

Answer 37

drowsiness and sedation

Question 38

allergens r/t allergic rhinitis include

Answer 38

dust, mites, mold, pets, pollens, smoke

Question 39

an upper respiratory infection URI is an infection of

Answer 39

the nose, sinuses, and/or throat

Question 40

__________cause most URIs

Answer 40

viruses

Question 41

the most common bacterium r/t URI is

Answer 41

streptococcus pyogenes

Question 42

factors that may cause URI

Answer 42

highly contagious, fatigue, emotional/physical distress, compromised immune system

Question 43

true or false: r/t URI, patients are contagious 1 to 2 days before onset and remain contagious until symptoms have subsided

Answer 43

true

Question 44

RN interventions are directed at _______symptoms

Answer 44

relieving

Question 45

care r/t URI includes

Answer 45

rest, fluids, antipyretics, analgesics

Question 46

complications from an URI include

Answer 46

acute broncitis, sinusitis, otitis media, tonsillitis, and pneumonia

Question 47

true or false: r/t URI, antibiotics have no effect on viruses. they are an option only if complications are present

Answer 47

true

Question 48

r/t URI, teach patients to recognize the manifestations of a ____________bacterial infection

Answer 48

secondary

Question 49

Symps of a secondary bacterial infection include

Answer 49

temp higher than 103, tender swollen glands, severe sinus or ear pain, significantly worsening symptoms.

Question 50

what is sinusitis

Answer 50

develops when inflammation or swelling of the mucosa blocks the openings (ostia) in the sinuses, through which mucus drain into the nose

Question 51

what is rhinosinusitis,

Answer 51

may accompany sinusitis, concurrent inflammation or infection of the nasal mucosa

Question 52

nasal ____, foreign bodies, deviated septa, or tumors can cause obstruction of mucus drainage

Answer 52

polyps

Question 53

true or false: secretions that accumulate behind blocked ostia provide a rich medium for growth of bacteria, viruses, fungi, which may call infection

Answer 53

true

Question 54

acute sinusitis causes these symptoms

Answer 54

significant pain, purulent drainage, nasal obstruction, congestion, fever, malaise

Question 55

rn: inspect the nasal mucosa and ______ the paranasal sinuses for pain

Answer 55

palpate

Question 56

findings that indicate acute sinusitis include

Answer 56

edematous mucosa, discolored purulent drainage, enlarged turbinates, tenderness over the sinuses, and halitosis, recurrent headaches.

Question 57

xrays or ________ may help confirm diagnosis of sinusitis

Answer 57

ct scan

Question 58

the symptoms of chronic sinusitis are often_______ although severe ______ and purulent drainage are often present

Answer 58

nonspecific, pain

Question 59

as many as 50% of patients with moderate to severe ________ also have chronic sinusitis

Answer 59

asthma

Question 60

chronic sinusitis is a persistent infection r/t

Answer 60

allergies or nasal polyps

Question 61

initial treatment of acute sinusitis focuses on

Answer 61

symptom relief, including decongestants, intranasal corticosteroids, analgesics, saline nasal spray

Question 62

teach patients to use topical decongestants no longer than 5 days to prevent

Answer 62

rebound congestion

Question 63

nasal polyp form slowly in response to repeated

Answer 63

inflammation of the sinus or nasal mucosa

Question 64

true or false: nasal polyps can exceed the size of a grape

Answer 64

true

Question 65

true or false small polyps are typically asymptomatic.

Answer 65

true

Question 66

manifestations of larger polyps include

Answer 66

nasal obstruction, nasal discharge, speech distortion

Question 67

topical and systemic corticosteroids are primary therapies to used to shrink

Answer 67

nasal polyps

Question 68

acute pharyngitis is __________ which includes

Answer 68

acute inflammation of the pharyngeal wall tonsils, palate, uvula

Question 69

what causes acute pharyngitis

Answer 69

viral, bacterial, fungal infection

Question 70

symptoms r/t acute pharyngitits range from

Answer 70

scratchy throat to difficulty swallowing

Question 71

four classic manifestations present in bacterial pharyngitis

Answer 71

fever greater than 100.4 anterior cervical lymph node enlargement tonsillar or pharyngeal exxudate absence of cough

Question 72

the goals r/t acute pharyngitis

Answer 72

infection control, symptom relief, prevention of secondary complications

Question 73

for viral pharyngitis antibiotics are not recommended. for bacterial pharyngitis caused by group A strep __________ is the drug of choice

Answer 73

penicillin

Question 74

candida infections are treated with

Answer 74

nystatin, an antifungal antibiotic

Question 75

what can we teach the patient w/ acute pharyngitis

Answer 75

ibuprofen or acetaminophen for pain relief increase fluids gargle warm salt water drink warm or cold liquids popsicles, hard candies, lozenges encourage use of humidifier

Question 76

what is a peritonsillar absecess. what are the symptoms

Answer 76

complication of tonsillitis, abscess causes pain, swelling, blockage of throat when severe, causing airway blockage patient may have high fever, chills, leukocytosis, difficulty swallowing, muffled voice

Question 78

some character from little women cant play today because he has the quincy aka

Answer 78

peritonsillar abscess

Question 79

treatment of peritonsillar abscess

Answer 79

needle aspiration, iv antibiotics, tonsillectomy

Question 80

acute laryngitis is swelling and inflammation of the larynx, classic signs include

Answer 80

tingling, burning sensation in the back of throat, persistent need to clear throat, hoarseness, loss of voice

Question 81

patient eduction r/t laryngitis

Answer 81

dont talk, dont whisper, increase fluids, cough suppresents, acetaminophen

Question 82

diagnoses r/t airway infections

Answer 82

ineffective airway clearance r/t acute pain r/t irritation 2' infection fluid volume deficit rt dec intake knowledge deficit regarding prevention or treatment

Question 83

Goals r/t airway infection

Answer 83

avoiding major complication: brain abscess, meningitis, sepsis maintaining airway, promoting comfort, proper fluid intake

Question 84

okay, we have packed the posterior of a patients nose with sponges/gauze/or balloon after a severe epistaxis what are the nurses responsiblity post procedure

Answer 84

monitor LOC, HR, O2, and RR these patients should be very closely monitored it is also painful patient should receive appropriate analgesia