Chapter 30 Nursing Care of Patients with Upper Respiratory Tract Disorders

Answers CHAPTER 30 NURSING CARE OF PATIENTS WITH UPPER RESPIRATORY TRACT DISORDERS AUDIO CASE STUDY Maxine’s Grandpa Has the Flu 1. Chills, muscle aches and pains, fever, crackles and wheezes, lethargy. 2. Older patients’ immune function is not as robust as younger patients’. Older patients are also at higher risk for dehydration because they have a lower percentage of body water. 3. Hand washing, flu vaccination each year, and staying away from others who are ill. VOCABULARY 1. laryngectomy 2. epistaxis 3. Exudate 4. rhinoplasty 5. dysphagia 6. Rhinitis CRITICAL THINKING: NASAL SURGERY 1. Wake Mr. Jones and examine his throat. He may be swallowing blood. Vital signs should also be checked for signs of blood loss. Make sure that he is in semi-Fowler position to help prevent aspiration and reduce swelling. Notify the health care provider (HCP) if indicated. 2. “You may need to ask your health care provider for an antihistamine or cough suppressant. If you must sneeze, be sure to do so with your mouth open. A stool softener and plenty of liquids and fiber can help keep your stools soft.” 3. “Aspirin and related drugs such as ibuprofen can increase your risk for bleeding and should be avoided.” Check with his HCP to see if acetaminophen can be recommended. CRITICAL THINKING: INFLUENZA 1. Influenza is caused by a virus. Antibiotics will not be effective. Antibiotics must be used with discretion to prevent the development of resistant strains of bacteria. 2. Fever and illness can lead to dehydration. Fluids will also help thin respiratory secretions so that they are more easily expectorated. 3. Fever may be beneficial if it is not too high. Ask the HCP at what temperature acetaminophen should be taken. Some sources say to give it only if fever reaches above 103°F (39.4°C) (in adults) or if discomfort is severe. 4. Influenza is contagious, so if symptoms are the same, it would be reasonable to advise the same care as was recommended for her husband. (If any medications were prescribed, however, they should not be shared.) It is probably not necessary to take her to the urgent care center unless additional symptoms develop or symptoms persist. A call to the center can always be placed to be sure a visit is not recommended. 5. Older adults are more at risk for complications of influenza, especially pneumonia. She should see her HCP. An antiviral agent might be helpful if given within 48 hours of exposure. REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (4) is correct. Interventions were aimed at comfort. (1, 2, 3) do not evaluate effectiveness of comfort measures. 2. (1) is correct. Narcotics depress the respiratory rate and cough reflex, which would increase risk for postoperative complications. (2) is incorrect. Narcotics do not increase secretions. (3) is incorrect. They do not cause stomal edema. (4) is incorrect. Narcotics can be addicting but not when they are taken for legitimate pain. 3. (4) is correct. Dysphagia and hoarseness are common symptoms of cancer of the larynx. (1, 2, 3) may possibly develop later or as complications, but they are not early symptoms. 4. (1) is correct. Facial tenderness is a symptom of a sinus infection. (2, 3, 4) are not symptoms of sinus infection. REVIEW QUESTIONS—TEST PREPARATION 5. (3, 4, 6) are correct. Hot moist packs can help reduce inflammation, humidity will help loosen secretions, and the semi-Fowler position helps reduce pressure. (1, 5) are effective for pulmonary, not sinus, secretions. (2) is not a nursing intervention. 6. (3, 4, 1, 2) is the correct order. A patent airway is always a priority. Remember your ABCs (airway, breathing, 1 2 Chapter 30 Answers circulation). Pain is second, because it is physiological. Physiological needs are priorities according to Maslow. Ambulation is third because it promotes recovery. A visit from someone who has had a laryngectomy is important, but acceptance of the laryngectomy would come after physiological needs. 7. (3) is correct. Pollutants in the tracheostomy can cause infection and irritation. (1) is incorrect. The patient will be taught to suction the tracheostomy as needed. (2) is incorrect. This is not a therapeutic statement. (4) is incorrect. The patient, not the health care provider, will need to do routine tracheostomy care. 8. (4) is correct. A sitting position will help reduce bleeding. Leaning forward will allow the blood to drain out of the nose so that bleeding can be monitored. (1, 3) are incorrect. Lying down increases pressure in the nose and may increase bleeding. (2) is incorrect. Extending the neck will allow blood to drain down the back of the throat and be swallowed, making it impossible to monitor the severity of the bleeding. 9. (4) is correct. Phenylephrine is a vasoconstrictor. (1) is incorrect. Raising the blood pressure can increase bleeding. (2) is incorrect. It may dilate bronchioles, but this will not help bleeding. (3) is incorrect. Epinephrine does not enhance clotting. 10. (3) is correct. West Nile virus is transmitted by mosquitoes. (1) is incorrect. It cannot be caught by eating pork. (2) is incorrect. Travel does not need to be limited. (4) is incorrect. It is not transmitted by bird or bat droppings.