MDC 3 – Exam 2 Review

1 MDC 3 -EXAM 2 MDC 3 – Exam 2 Review 1- Neck cancer: usually squamous cells carcinomas. Caused by: tobacco, ETOH, voice abuse, chronic laryngitis, exposure to chemicals, poor hygiene, long term GERD, HPV • S/S: hoarse voice, SOB, pain, lump in the mouth/neck/throat, dysphagia, color changes in the mouth/tongue, oral lesion, persistent bleeding, numbness mouth/lip/face, ear pain, anorexia, recurrent sore throat • Tx: Sx (cordectomy, laryngectomy), radiation, chemo, biotherapy • Intervention: -Monitor airway patency, VS, monitor for hemorrhage, gas exchange • Education: - Use Fowler’s and semi-Fowler’s positions - Voice improves 4-6wks after radiation therapy - Use voice rest, gargle w/ saline, suck ice. - Mouth washes and throat sprays w/ local anesthetic agent - Avoid exposing skin to the sun/heat/cold/shaving - Wear soft cotton clothes, use mild soap (Dove) 2- Nasal Factures: result from injury, can interfere w/ gas exchange • S/S: deviation, change in nasal breathing, crepitus on palpation, bruising, pain • Tx: Closed reduction, rhinoplasty (severe fractures) • Intervention: Check for edema/bleeding, VS q4h • Education: - Move slowly, stay in a semi-Fowler’s position - Change drip pad as necessary, use cool compresses on the nose/eyes/face - Drink at least 2.5L water/day - Limit Valsalva maneuvers - Do not sniff upward or blow nose, do not sneeze w/ mouth closed - Avoid NSAIDs, ASA - Use a humidifier to prevent mucosal drying 3- Rhinosinusitis: inflammation of the mucous membranes of one or more of the sinuses, usually seen w/ rhinitis, common cold or anything that interferes w/ sinus drainage • S/S: pain over the cheek radiating to teeth, tender sinuses, referred pain to the temple/back of the head, general facial pain when bending forward - Bacterial: purulent nasal drainage w/ postnasal drip, sore throat, fever, erythema, swelling, fatigue, dental pain, ear pressure • Dx: based on S/S, endoscopic exams, CT • Tx: decongestants and intranasal steroid sprain, antipyretics, analgesics. - Bacterial: broad-spectrum ABTs (amoxicillin, phenylephrine), endoscopic sinus sx 4- Differentiating CSF from nasal drainage: CSF contains glucose that will test positive w/ a dipstick test for glucose. 2 MDC 3 -EXAM 2 - Yellow “halo” when CSF dries on filter paper 5- COPD and Oxygen: As the condition worsens, the amount of O 2 in the blood  (hypoxemia), CO2  (hypercarbia) 6- Obstructive sleep apnea: breathing disruption during sleep that lasts at least 10sec - Occurs a min of 5x in 1h • Causes: upper airway obstruction by soft palate/tongue, obesity, large uvula, short neck, smoking, enlarged tonsils, adenoids, oropharyngeal edema • S/S: excessive daytime sleepiness, irritability, inability to concentrate • Treatment: changes in sleeping positions, weight loss, BiPAP, CPAP, APAP - Modafinil: treats narcolepsy NOT OSA - Sx: adenoidectomy, uvulectomy, UPP • Interventions: assess frequency/pattern or breathing. Observe HR, cap refill • Complications: HTN, stroke, cognitive deficits, weight gain, DM, pulmonary & cardiovascular dz 7- Non-invasive ventilation techniques: BiPAP, CPAP • BiPap has 2 pressure setÝngs 8- Therapeutic communication: silence, offer self, active listening, etc 9- ABCS: Airway, Breathing, Circulation 10- Epistaxis: nosebleed, common problem. Occur as a result of trauma, HTN, blood dyscrasia (leukemia), inflammation, tumor,  humidity, nose picking, chronic cocaine use, NG suctioning • Tx: Silver nitrate, cauterization• Interventions: -Position Pt upright & leaning forward - Reassure Pt to reduce anxiety + BP - Apply direct lateral pressure for 10min - Apply ice/cool compresses to the nose/face - Loosely pack both nares w/ gauze or nasal tampons - Instruct Pt not to blow the nose for 24h after bleeding stops 11- Asthma: Reversible airway obstruction occurs intermittently - Affects airways only not alveoli - 2 ways: inflammation and sensitivity  bronchoconstriction • Causes: general irritants, exercise, upper respiratory illness, ASA, NSAIDs, GERD • S/S: SOB, wheezing,  respiratory rate, muscle retraction at the sternum, hypoxemia • Tx: antihistamine, leukotriene inhalers, rescue inhalers, corticosteroids • Interventions: maintain patent airway, improve air flow, gas exchange, relive symptoms • Education: - Directions for medications, avoid triggers 3 MDC 3 -EXAM 2 - When using 2 inhalers, use rescue inhaler 1st (albuterol), wait 5min before the 2nd one - Rinse the mouth after to avoid thrush - Keep a symptom & intervention diary, get adequate rest and sleep 12- Dyspnea management in respiratory disorders: - SOB interferes w/ eating - Pt should plan the biggest meal of the day when mostly hungry and well rested - 4 to 6 meals/day preferred to 3 large ones - Use pursed-lip and abdominal breathing - Use bronchodilator 30min before the meal to reduce bronchospasm - Eat high-calorie, high-protein foods to prevent weight loss 13- Dyspnea management in lung cancer: - Semi-Fowler’s position - O2 and continuous morphine infusion - Most dyspneic Pt may be more comfortable at lounge chair or recliner 14- Bronchitis vs. Emphysema: • Bronchitis: inflammation of bronchi and bronchioles caused by chronic exposure to irritants, especially cigarette smoke - Affects only airways, not alveoli • Emphysema: loss of lung elasticity and hyperinflation of lung - Alveoli are affected 15- Pneumonia: excess fluid in lungs resulting from inflammatory process - Inflammation triggered by infectious organisms, inhalation of irritants • S/S: chest pain, discomfort, myalgia, headache, chills, fever, cough, tachycardia, dyspnea, tachypnea, hemoptysis, sputum production • Dx: CX-R (most common), pulse oximetry, transtracheal aspiration, bronchoscopy • Tx: Abx, bronchodilators, anti-inflammatories • Interventions: – Improve gas exchange (O2 therapy, incentive spirometry) - Prevent airway obstruction (cough, deep breath,  fluid intake, steroids, bronchodilator) - Prevent sepsis (Abx) - Prevent/manage empyema (thoracentesis, chest tube, Abx) • Education: notify provider if s/s returns of fail to go away completely, refer to red. of risk • Vaccinations: Pneumococcal Polysaccharide (PPSV), Pneumococcal Conjugate (PCV-13), Flu vaccine • Reduction of risk: have annual flu + PNA vaccines, avoid crowds during Flu season, don’t smoke, avoid indoor pollutants, drink at least 3L fluids/day, get enough rest, balanced diet 16- COPD – bronchitis/emphysema: tissue damage, not reversible.  in severity  resp. failure • S/S: SOB, slow moving, tripod position, barrel chest, cyanosis, delayed cap. Refill, finger clubbing, lower extremity edema d/t R side HF, thin w/  muscle mass (advanced) • Tx: - Inhaled corticosteroids (beclomethasone, fluticasone), expectorants, NSAIDS 4 MDC 3 -EXAM 2 - Anticholinergics ( ipratropium, tiotropium), Beta adrenergics (Albuterol, salmeterol) - Methylxanthines (theophylline), lung Sx (removal of hyperinflated tissue) • Intervention: Semi-Fowler, O2 therapy, suctioning, vibratory positive pressure device, nutrition, breathing techniques • Education: – Hydration, avoid people w/ respiratory infections - Good oral care, breathing techniques, relaxation therapy, effective coughing 17- Energy conservation in lower respiratory disorders: - Divide activities in smaller parts - Plan/pace daily activities w/ rest periods in between - Avoid working w/ arms raised, avoid jerky motions - Adjust work heights to reduce back strain/fatigue - Use adaptative tools for housework to reduce bending/reaching - Do not talk while engaged in other activities that require energy - Avoid breath holding while performing an activity 18- Cystic Fibrosis: genetic dz affecting many organs, lethally impairing pulmonary function. - Mucus plugs up glands causing atrophy and organ dysfunction • S/S: » Non-pulmonary: GERD, abdominal distention, rectal prolapse, foul-smelling stools, steatorrhea, malnourishment, vitamin deficiencies (ADEK) » Pulmonary: resp. infections, Cx congestion & sputum production,  pulmonary function, limited exercise tolerance • Dx: Sweat chloride test (60 – 200 mEq/L) • Tx: inhaled corticosteroids, bronchodilators, expectorants, exacerbation therapy, O 2, Abx, lung transplant (extends life by 1-15y) • Intervention: nutritional management, preventive/maintenance therapy (meds, infection prevention, pulmonary hygiene, exercise, CPT), exacerbation therapy (O 2 therapy, Abx) • Education: distance from other CF pts (Burkholderia Cepacia), nutrition, weight maintenance, pancreatic enzyme replacement, infection prevention • Clear mucus: fluids, chest physiotherapy, pulmonary hygiene (suctioning, spirometer, percussion, vibration, postural drainage) 19- Pulmonary Fibrosis: Common restrictive lung dz. Excessive wound healing w/ loss of cellular regulation. Inflammation continue beyond normal healing time, causing fibrosis/scarring - Thickens alveolar tissues impairing gas exchange • S/S: Slow onset w/ mild dyspnea on exertion, hypoxemia (as dz progresses) • Tx: Corticosteroids and immunosuppressants 20- Respiratory medications: Bronchodilators: » Beta Adrenergic: Albuterol, Salmeterol, Terbutaline – Acute bronchospasm • Don’t use in pts w/ tachydysrhythmias, caution w: DM, HTN, Heart dz, hyperthyroidism 5 MDC 3 -EXAM 2 • Beta blockers  effects, MAOIs  • S/E: tachycardia, palpitation, tremors » Anticholinergics: Ipratropium, Tiotropium • Prevent bronchospasm: asthma r/t allergens, EIB, COPD • Don’t give to pts w/ peanut allergy, caution in narrow-angle glaucoma, BPH • Max effects may take up to 2wks, shake inhaler well, 5min between 1st and 2nd inhaler » Methylxanthines: Theophylline (long-term control of Asthma) • Don’t give to pts w/ PUD, caution w/: DM, Hyperthyroidism, HTN, Heart Dz, Angina • Phenobarbital/phenytoin  effects. • Caffeine/Lasix/cimetidine/acetaminophen falsely  levels • S/E: irritability, restlessness. Toxicity: tachycardia, tachypnea, seizures • Avoid caffeine intake, smoking  effects, ETOH  • Toxicity tx: stop IV, give activated charcoal, lido for dysrhythmias, diazepam for seizures Anti-Inflammatories: » Steroids: Beclomethasone, Betamethasone (oral), Prednisone (oral) • Used short/long-term post-acute asthma attack, prophylaxis, chronic asthma • Caution in pts w/ DM • S/E: insomnia, psychotic behavior, hyperglycemia, PUD, fluid retention, weight gain, osteoporosis • Take w/ meals, no NSAIDs, taper dose » Leukotrienes: Montelukast • Long term asthma management, prevention of EIB • May  levels of beta blockers • S/E:  liver enzymes • Mast cell stabilizer: Cromolyn Antitussives: • Suppress non-productive coughs (hydrocodone, codeine) » Expectorants: Guaifenesin ( mucous secretion to  cough production) » Mucolytics: Acetylcysteine (enhance flow of secretions in resp. tract) • Used for acute/chronic pulmonary disorder w/ copious secretions, CF • S/E: drowsiness, dizziness, constipation Decongestants & Antihistamines: » Decongestants: Pseudoephedrine, Phenylephrine •  inflammation in nasal membranes 6 MDC 3 -EXAM 2 • Used for allergic rhinitis, sinusitis, common cold » Antihistamines: Diphenhydramine •  allergic response, avoid ETOH, products w/ Pseudoephedrine for no more than 7 days, take @ night • S/E: anticholinergic effects, drowsiness 21- Influenza: highly contagious, acute viral respiratory infection, can lead to PNA • S/S: severe headache, myalgia, fever, chills, fatigue, weakness, anorexia. Type B l/t N/V/D • Tx: Antivirals (Tamiflu), rest,  fluid intake, saltwater gargles, antihistamines • Interventions: Annual flu shot, handwashing, cover mouth/nose when sneezing/coughing • Complications: PNA, death 22- Pulmonary Arterial HTN: blood vessel constriction w/  vascular resistance in the lung • Causes: unknown, occurs in absence of other lung disorders. - Exposure to drugs: Fenfluramine/Phentermine (Pondimin), Dastinib (Sprycel)  risk • S/S: dyspnea and fatigue in healthy adult. Some pts has angina-like cx pain • Tx: Warfarin, Calcium channel blockers, Digoxin, Diuretics, O2, lung, heart transplant • Complications: R side HF (cor pulmonale), w/t tx death within 2y 23- Respiratory failure as a complication of respiratory disorder: •D/T inability to remove CO2 from the blood, causing build up or when resp. system can’t take in enough O2 l/t severely low levels of O2 in the blood • Causes: COPD, complicated PNA, CF, sleep apnea, excess fluid in the lungs 24- Lung Ca: leading cause of death worldwide. Poor long-term survival d/t late-stage dx - Bronchogenic carcinomas – bronchial epithelium • S/S: Labored/painful breathing hemoptysis, respiratory distress, dyspnea, wheezing - Cardiac tamponade, dysrhythmias, bone pain, pathologic fx - Late signs: weight loss, fatigue, anorexia, dysphagia, N/V, confusion, personality changes, gait changes • Interventions: Maintain patent airway, occlusive dressing to cx tube site, sterile gauze at bedside to cover cx tube immediately is dislodged, assess resp. status. - Warm and humidify O2, semi-Fowler’s • Palliative Care: O2 therapy, radiation, thoracentesis, pain management - Drugs (bronchodilators, corticosteroids, mucolytics, Abx) - Semi-Fowler’s, O2, position comfort, morphine 25- Tuberculosis: caused by Mycobacterium tuberculosis, transmitted via aerolization • S/S: Progressive fatigue, lethargy, nausea, anorexia, weight loss, irregular menses - Low-grade fever, night sweats, cough, mucopurulent sputum, blood streaks • Dx: Nucleic Acid Amplification test (NAA) – results in 2h, Sputum culture for M. tuberculosis, Mantoux (PPD), blood analysis (QuantiFERON-TB Gold, T-STOP TB, GeneXpert Omni) 7 MDC 3 -EXAM 2 • Tx: Isoniazid: avoid antacids, take on empty stomach - Rifampin: expect orange-red staining of skin/urine/body secretions,  birth control, interacts w/ other meds - Pyrazinamide:  uric acid production, photosensitivity) - Ethambutol: report vision changes,  uric acid production) • Education: Crucial medication adherence, avoid ETOH,  fluids, cover mouth/nose when sneezing/coughing and dispose in plastic bags, small frequent meals, wear mask in public, rest, resume activities slowly, report s/s of liver toxicity • Interventions: Airway clearance (deep breath before coughing, spirometer,  fluids), airborne precautions, Directly Observed Therapy (DOT) when taking meds (not all pts) -  drug resistance and infection spread, manage anxiety, improve nutrition, manage fatigue 26- Peritonsillar Abscess: complication of acute tonsillitis, spread to surrounding tissue & causes abscess • S/S: pus behind tonsil causing one-sided swelling w/ deviation of the uvula - Trismus and difÏculty breathing, pain radiating to teeth/ear, mufÒed voice, - Halitosis, swollen lymph nodes, difÏculty swallowing • DX: ultrasound, needle aspiration and culture of pus preferred • Tx: Aspiration of abscess, Abx, steroids, OTC topical anesthetics, analgesics, opioids • Interventions: usually treated as outpatient • Education: complete Abx tx, go to the ER if drooling/stridor