Respiratory Disorders

Question 1

Nasal Fracture Causes

Answer 1

facial trauma, fights, accidents, falls, sports

Question 2

nasal fracture manifestations

Answer 2

epistaxis, swelling, difficulty breathing through nose, ecchymosis (raccoon eyes)

Question 3

nasal fracture complications

Answer 3

difficulty breathing, septal deviation, septal hematoma, meningeal tears with CSF leak (clear fluid positive for glucose), diplopia

Question 4

nasal fracture management

Answer 4

rhinoplasty, plastic implant to reshape nose, nasal packing (removed 1-2 days after), nasal septal splint to prevent internal scar tissue (removed after 1-2 weeks)

Question 5

nasal fracture collaborative care

Answer 5

pre-op: No aspirin/NSAIDs for 5 days - 2 weeks, stop smoking
post-op: patent airway, monitor bleeds edema and infection
semi-fowlers, no blowing nose, ice forhead/nose in 10-20 minute intervals, humidifiers, AVOID HOT SHOWERS AND ALCOHOL

Question 6

Anterior epistaxis

Answer 6

more common, occurs in children and young adults, nasal dryness
caused by: allergic rhinitis, street drug use, nasal spray abuse

Question 7

Posterior epistaxis

Answer 7

usually in older population, high blood pressure and CVD most common cause, bleeding in posterior pharynx, more severe and treatment is more challenging

Question 8

management of epistaxis

Answer 8

pinch airway and lean forward for 5-15 minutes, nasal packing (may cause hypoventilation and hypoxemia) using gauze or tampon w/ abx or vasoconstrictor for 48-72 hours, MEDICATE BEFORE REMOVAL
Avoid strenuous activity/straining for 4-6 weeks

Question 9

rhinosinusitis

Answer 9

inflammation of sinus mucosa blocking secretions from exiting. caused by infection, allergies, pollutants, polyps.
Types include allergic rhinitis, viral rhinitis, and bacteria sinusitis

Question 10

allergic rhinitis

Answer 10

allergen exposure (increased IgE), treat with antihistamines, decongestants, corticosteroids)

Question 11

acute viral rhinitis

Answer 11

caused by coronavirus, enterovirus, HSRV
S&S: runny nose, congestion, watery eyes, sneezing, etc.
Treat: rest, rehydrate, saltwater gargles, saline nasal sprays, decongestants (no longer than 3 days)

Question 12

Bacterial sinusitis

Answer 12

S. pneumoniae, H. influenzae, M. catarrhalis
S&S: sinus pain, fever, headache, pain leaning forward, halitosis (foul odor from mouth), purulent discharge
Treat: abx, analgesics, saline sprays, stop smoking, sleep with HOB elevated, nasal corticosteroids, warm compress to face

Question 13

Laryngeal Trauma

Answer 13

D/t: trauma, fracture, prolonged endotracheal intubation
S&S: tachypnea, nasal flaring, SOB, restlessness, striddor, low O2 sat, altered LOC, Hemoptysis (coughing blood), aphonia
Visualize larynx via laryngoscopy to see extent of injury
Pre-op: NPO
Post-op: voice rest for 2/3 days
Manage?: based on situation, artificial airway, O2 with humidification, surgical repair

Question 14

Airways obstructions

Answer 14

Complete or Partial
Cause: aspiration, allergic reactions, inflammation
S&S: stridor, choking, accessory muscle use, tachycardia, cyanosis. ALOC
Manage: establish airways ASAP, heimlich maneuver, ET tube, Trach,

Question 15

Pneumonia

Answer 15

acute inflammation of parenchyma d/t virus, bacteria, fungus, or aspiration resulting in edema or exudate filling alveoli. Alveolar macrophages are most important defense mechanism.
Risk factors: Over 65, pollution, immobility, smoking, immunosuppressed, IV drug use, NGT feeds

Question 16

Pneumonia S&S

Answer 16

fever, chills, malaise, cough (productive or non-productive, but productive more common), increased WBCs, wheezing, crackles, bronchial breath sounds in the periphery, increased fremitus, infiltrates/consolidation

Question 17

Complications of pneumonia

Answer 17

pleurisy, pleural effusion ,atelectasis, acute respiratory failure, bacteremia, sepsis, empyema (pus in pleural space)

Question 18

Community acquired PNA

Answer 18

S. pneumoniae, MRSA, Legionella pneumophila
LTC within 14 days of onset
Macrolide ABX and B-lactam antibiotics (10-14 days)

Question 19

Hospital Acquired PNA

Answer 19

48 hours or longer after hospital admission w/o symptoms at time of admission
VAP 48 hours after ET intubation
Empiric ABX and later switch to defnitive therapy based of Sputum C/S,

Question 20

Aspiration PNA

Answer 20

substances aspirated into trachea, hx of loss of consciousness, depressed gag or cough reflex, dysphagia, tube feedings (pt upright)

Question 21

Opportunistic PNA

Answer 21

depressed immune, protein-calorie malnutrition, chemo, HIV infxn, long-term corticosteroid use
Fungal: P. jiroveci found in HIV pts or blood diseases
Viral: cytomegalovirus, immunocompromised esp after transfusion

Question 22

Pneumonia diagnostics

Answer 22

Chest x-ray, ABG, sputum c/s, blood studies

Question 23

Pneumonia care

Answer 23

rehydration, Antipyretics (max 4000mg tylenol) check liver function tests and renal function tests), O2 therapy, repositioning, cough and deep breath (IS!), vaccinations!!, oral care after inhalers

Question 24

Pleural Effusion

Answer 24

abnormal collection of fluid in pleural space,
Transudative: non-inflammatory disease processes like heart failure, increased hydrostatic pressure, or decreased oncotic pressure (pale yellow liquid)
Exudative: increased capillary permeability d/t inflammation secondary to malgnancies/infections (pus-like)

Question 25

Pleural Effusion management:

Answer 25

S&S: dyspnea, dereased chest wall movement on affected side, stabbing pain, absent breath sounds at bases Treat cause, ABX to prevent infection, Thoracentesis, Sodium restriction, diuretics

Question 26

Influenza

Answer 26

A is most common and virulent, transmitted via droplet, S&S: high fever, chills, headache, fatigue, cough, sore throat, crackles Complications: pneumonia, otitis media, sinus infection Manage: vaccine! symtpom relief, meds like tamiflu, relenza or rapivab

Question 27

Pulmonary Embolism

Answer 27

Clots in pulmonary arteries that obstructs perfusion, usually in lower lobes.

Question 28

PE Risk factors

Answer 28

DVT, immobility, smoking, fractured long bones, a-fib

Question 29

PE S&S

Answer 29

Dyspnea, chest pain, tachypnea, Change in LOC in older clientele, anxiety, sense of doom

Question 30

PE Diagnosis

Answer 30

D-Dimer (protein released when clots break down), spiral CT, V/Q scan (used if patient can't have contrast), ABGs

Question 31

PE Care/Management

Answer 31

Prevention with SCD's, ambulation, anticoagulants (Lovenox, Heparin, Warfarin/Coumadin), fibrinolytic agents (tPA), surgical removal, IVC filter, O2 therapy, elevate HOB

Question 32

Pneumothorax

Answer 32

air in pleural space leading to partial or total collapse of the lung. usually caused by blunt or penetrating trauma S&S: resp. distress, O2 desat, absent breath sounds over affected area, hemoptysis?, tachycardia, dyspnea, dull percussion, signs of shock Care: chest tube to water seal drainage, surgery

Question 33

Closed pneumothorax

Answer 33

no external wound: most common is spontaneous d/t rupture of bleb (smokers!!) broken ribs, subclavian catheter insertion, excess pressure during mechanical ventilation)

Question 34

Open pneumothorax

Answer 34

opening in chest wall d/t external injury cover with vented dressing secured on THREE sides until treated by MD DO NOT REMOVE OBJECT OF INJURY

Question 35

Tension pneumothorax

Answer 35

open or closed wound Rapid accumulation or air or blood resulting in compression of lung

Question 36

Chylothorax

Answer 36

lymphatic fluid in pleural space leak in thoracic duct milky white, increased lipid content

Question 37

Obstructive Sleep Apnea

Answer 37

* Breathing distubance during sleep where RR and depth isn't enough for effective gas exchange * Muscles get relaxed and structures get obstructed * Risks: congential, obesity, short neck, smoking, large tonsils * S&S: snoring heavily during sneep, daytime sleepiness, headaches in the morning, irritability * Care: change sleep position, lose weight, noninvasive positive-pressure ventilation (NPPV) via CPAP