Conditions 1
What is Rhinitis and what are the types?
Runny nose!
Typically from a cold or allergies
Vasomotor: unknown cause
Atrophic: mucus membranes have changed
How to deal with nasal trauma
-most common break from MVA
-Bed up 30 degrees
-MAINTAIN GOOD AIRWAY
-Monitor BP/O2 Stats
Epiglottis
MEDICAL EMERGENCY!!!
obstructed airway
most common in kids with a quick onset
-Can hear stridor
#1 goal=obtain airway patency!
-May need antibiotics and intubation
Laryngeal
-squamous cell
-4x more common in men
-not very common
-risk factors: alcohol/tobacco use
-commonly discovered by dentist
S/S: bad breath, neck lumps, increased food sensitivity, white or red spots, change in voice
What components are measured and what are the Normal Values?
Oxygen
Ventilation
Acid/base balance
pH: 7.35-7.45
PaCo2: 35-45
HCO3: 22-26
PaO2: 70-100
SaO2: 92-100%
URI support
Symptomatic relief (NO antihistamines if pt has asthma/COPD)
-Decongestants (sudafed)
-Antihistamines
-Complementary therapies
Epitaxis
Nose bleeds! (epitaxis)
-ask about anticoagulants
-suction at bedside
-airway management is KEY
Nose packing
Sneeze with mouth open
ice back 20 min on/off
eye bruising
90% anterior bleeds (vascular)
10% posterior
Sinusitis
Organisms: Staph, Pneumonia, flu
Bacteria becomes trapped in membranes
Can have long term complications
S/S: Pain, tenderness, purulent drainage, res/swollen nasal membranes
Complications: Meningitis, epidural/subdural/brain abscess, venous sinus thrombosis
Dx testing: Transillumination
Sinus X ray or CT
Treatment: Antibiotics, decongestants, nasal/saline sprays
DONT USE ANTIHISTAMINES: only feels good for a short term, can worsen long term
Treatments
Radiation
sometimes need surgery and radiation
VERY PAINFUL
Respiratory Acidosis
Excess of carbonic acid, caused by CO2 retention in lungs
pH<7.45
PaCO2>45 mmHg
Bicarb >26 mEg/L
Accompanied by hypoxemia
Pursed lip breathing
Manifestations: weakness, dull headache, daytime sleepiness, personality changes
Influenza Basics!
-Deaths are due to bacterial pneumonia
-Incubation is 18-72 hrs
-S/S: fever, chills, malaise, inflamed membranes
-CANNOT HAVE VACCINE IF ALLERGIC TO EGGS
CSF
CSF Leaks
-clear fluid from nose
-test for glucose, positive=CSF
-risk for meningitis
Pharyngitis/Tonsillitis
Viral
Tonsillitis: beta hemolytic staph
-Glomerulonephritis and rheumatic fever (can result in heart complications)
infectious Mono (kissing disease)
Surgery
Laryngectomy
partial: (vertical)
supraglottic: above vocal cords (can still talk)
total: no longer can speak
Education is so important!!!
Respiratory Alkalosis
ALWAYS caused by HYPERventilation
pH>7.45
PaCO2<35
HCO3<22
Assess: RR, depth, assessment data, breathe into paper bag
Influenza intermediate!
Prevention: Handwashing and Vaccine
Medications (MUST be given within 48hrs) Decrease length and severity of flu
-Oseltamivir, zanamivir, peramivir, the -MIVIRs
Analgesics, antitussives
Larynx
Trauma: from intubation
car accidents/strangulations
can also effect vagus nerve
Aspiration risk
Diphtheria
(not super common b/c of vaccine)
VERY CONTAGEOUS!
S/S: Fever, malaise, sore throat, bad breath
Duration: up to 10 weeks, long lasting!
W/O treatment 50% mortality rate
WITH treatment 10% mortality rate
Partial Post surgical care
Clean stoma 3x daily
anticipate bleeding/drainage for 1-2 days
Focus on lifestyle changes
AIRWAY!!!!
Metabolic Acidosis
Caused by: accumulation of metabolic acids, loss of bicarb, increase in chloride
pH<7.35
Bicarb<22
Monitor: LOC (leading to death), RR, pulses, skin temp/color
Dx tests: ABG, serum electrolytes
Sleep Apnea
ABG: Dec. PO2, Inc. Ph
Fragmented sleep, daytime sleepiness
Obstructive: Something impeding airflow (catching up with air) common in men, obese persons, 50-80 yr
Central: Brain signal problems
Mixed: mixed
CPAP or BiPAP for treatment
Aspiration
S/S: coughing, choking, SOB, drooling
if pt coughs while drinking they are at high aspiration risk (and risk for pneumonia)
Swallow study: barium
Tuck chin in to swallow easier
Screening criteria: Age (70+), extubated, nausea/vomiting, hx of swallowing problems, hx of pulmonary problems, use of O2 at home, Trach/NG tubes
Laryngeal Obstruction
Food! Specifically meat
Other obstructions foreign objects, spasms, edema, anaphylaxis.
S/S: nasal flares, restlessness, decreased O2
Risk factors: alcohol consumption, dentures, trauma, extubated persons
Radiation Therapy
-used in a smaller area
-either done by a beam or by implanting beads into the cancerous tissue
Metabolic Alkalosis
pH>7.45
Bicarb>26
Slow Respirations, accompanied by fluid deficit
Monitor: RR, cyanosis or hypoxia, need for supplemental O2