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ACUTE VIRAL RHINITIS/Sx
appear suddenly with a full blown infection in 48 hours – usually last 5-14 days – IF A significant temp elevation occurs with a cold, may indicate a concurrent infection, e.g., Otitis media (middle ear), pneumonia, sinusitis or immediately following a cold
ACUTE VIRAL RHINITIS/Tx
Antibiotics are not effective against viruses – no need for treatment – for the common cold, other than decongestants, antitussives (cough) – •Should rest, increase fluids, balanced diet – •Nasal decongestants can cause increased congestion when over used (rebound effect = vasodilation) limit use to 2-3 times a day
ALLERGIC RHINITIS
hay fever rhinitis affects 35 million Americans – Caused by hypersensitivity to allergens such from ragweed, grass, tree pollens, dust, wool, foods, industrial chemicals, animal dander, dust mites and cockroaches
ALLERGIC RHINITIS/CM
•Nasal obstruction – sneezing *watery eyes, thin watery nasal discharge *post nasal drip, itchy eyes and nose and N/A – •Mucous membranes appear pale and edematous instead of red (erythematous) as in the common cold – may develop nasal polyps – •Can ID allergen via careful detailed history and skin testing
ALLERGIC RHINITIS/Tx
•Avoiding antigen •Antihistamines •Decongestants •Desensitization and suppression of the immune response •Air conditioning removes 99% of pollens
SINUSITIS
inflammation of the sinuses
ACUTE SINUSITIS
Caused by obstruction of the sinus drainages such as tooth abscess, rhinitis, swimming/diving nasal polyps, a deviated septum, direct trauma, long-term nasotrachial and endotrachial intubations – common infectious organisms may be viruses – strep, staph, fungal, in immuno-compromised patients
ACUTE SINUSITIS/CM
fever could be up to 104 degrees, chills, nasal congestion and discharge, pain and tenderness over the involved sinuses and H/A
ACUTE SINUSITIS/Dx
History, X-ray of sinuses or CT scans
ACUTE SINUSITIS/Tx
broad spectrum antibiotics such as PCN, erythromycin – decongestants such as phenylephrine (Neo-synepherine) or pseudoephedrine – some times nasal steroid nasal sprays
ACUTE SINUSITIS/ Complications
abscess, sepsis, meningitis (all rare) but very serious osteomyletis
CHRONIC SINUSITIS
caused from prolonged infections, irritations, dust, cigarette smoke, other irritants
CHRONIC SINUSITIS/CM
chronic, purulent, nasal discharge, persistent H/A, stiffness
CHRONIC SINUSITIS/Dx
patient’s history, CT Scan and X-ray
CHRONIC SINUSITIS/Tx
antibiotics after identification of the causative organism – in very severe cases surgical intervention – •A) Caldwell-Luc Procedure •B) Spheno-ethmoidectomy removes diseased tissue and requires hospitalization These surgeries can cause damage to the optic nerve and or infection
RHINITIS
is inflammation of the mucus membrane of the nose
ACUTE VIRAL RHINITIS
•The common cold resulting from an infection for a rhinovirus – there are over 100 rhinoviruses – •They are highly contagious by inhalation of droplet nuclei and direct contact – very rarely require hospitalization, but many more serious illnesses start with a cold
ACUTE VIRAL RHINITIS/CM
nasal congestion with red (erythematosis) mucos membranes, purulent nasal discharge (rhinorrhea), sneezing, watery eyes, coughing, possible low grade fever, chills, dry or sore throat.
PHARYNGITIS
inflammation of the throat – “sore throat” –
PHARYNGITIS/Causes
accompanies an URI and causes by several different bacteria and viruses – the most serious = group A Beta-hemoltyic strep because of potential for heart and renal complications – its considered contagious (common strep throat)
PHARYNGITIS/CM
– for strep 2-4 day incubation period, sudden onset of sore throat associated with fever, chills, H/A, dysphasia (difficulty swallowing) – white or yellow patchy exudates may cover the tonsil area – lymph node enlargement may develop in cervical neck area
PHARYNGITIS/Dx
positive diagnosis is via throat culture after 24 hours – is most reliable – also, rapid tests – optical immunoassay O1A, and “Biostar”
PHARYNGITIS/*Tx
antibiotics if strep – drug of choice Penicillin, if allergic, use erythromycin – usually for 7-10 days – always complete the course of treatment
PHARYNGITIS/ *Complications
complication of strep = rheumatic fever, glomerular nephritis (kidney infection), otitis media, mastoiditis – heart complications from rheumatic fever
TONSILITIS*
– inflammation of the tonsils – tonsils are masses, lymphoid tissue
TONSILITIS/*Causes
from primary bacterial infection or 2 secondary to a URI viral infection caused by a variety of organisms – •Group A Beta hemolytic strep – frequent and the worst because of heart and renal complications
TONSILITIS/CM
severe, dry scratchy sore throat accompanied by fever and chills – H/A, muscle aches, general malaise – tonsils will appear red and swollen – if group A B-hemolytic strep, may travel to the middle ear with associated ear pain
TONSILITIS/Dx
C&S (culture and sensitivity) throat culture
TONSILITIS/Tx
if sensitive to the causative organism, Group A B-hemolytic, PCN for 10 days – if other erythromycin 250mg qid for 10 days – note 10 day administration – depends on sensitivities
PERITONSILAR ABSESS
a secondary infection, an abscess that develops in the tissue above the tonsils
PERITONSILAR ABSESS/Causes
a secondary infection from tonsillitis
PERITONSILAR ABSESS/CM
sore throat, dysphagia of the affected side, redness and swelling
PERITONSILAR ABSESS/Dx
physical exam, history and C&S
PERITONSILAR ABSESS/Managament
antibiotics from bacterial infection and warm saline irrigations – tonsillectomy only removed if tonsils obstruct air passages, or tonsils become infected more than 3 times a year – can be done in day surgery – complications from tonsillectomy – bleeding even 5-10 days after surgery – watch for spotting on pillow case up to 5-10 days – swallowing blood, aspirate and throw up blood
PERITONSILAR ABSESS/Post-op Nursing
observe for S&S of bleeding with frequent swallowing – bloody drainage, vomiting blood, increased HR, restlessness, pallor, decreased BP – give cool, clear liquids (ice chips, ice pops) after the return of the gag reflex – avoid hot food – saline gargles if ordered, avoid coughing and clearing throat
LARYNGITIS
inflammation of mucosa of larynx, may accompany edema of the vocal chords
LARYNGITIS/Causes
acute, usually from URI or abuse of vocal chords
LARYNGITIS/Chronic Causes
smoking repeated acute episodes, prolonged voice abuse, allergies
LARYNGITIS/CM
from slight hoarseness to complete loss of voice (aphonia), dry cough
Chronic LARYNGITIS
persistent hoarseness
Chronic LARYNGITIS/Dx
history, symptoms – visual exam – laryngoscope
Chronic LARYNGITIS/Tx
– if bacteria suspected Antibiotics – topical anesthetics via throat lozenges or sprays
EPISTAXIS
nose bleed
EPISTAXIS/Causes
diseases, arterial hypertension, leukemia and clotting disorders
EPISTAXIS/Trama
cocaine abuse, allergies, excessive coughing or sneezing, low humidity, fractures
EPISTAXIS/CM
•Kiesselbachs area – in anterior septum, most common area of bleeding – “more annoying than serious” •Posterior area – more serious, more likely with patients with heart disease – hematological disorders and in patients with anticoagulation therapy
EPISTAXIS/ Management
•Medical – clotting times checked, possible transfusion if very severe, but basically pressure on the nares with ice packs •Vasoconstrictive topical application – i.e., silver nitrate •Nasal packing with silver nitrate – and topical vasoconstricting medications
EPISTAXIS/Nursing Care
help patient to sitting position with the head tilted slighter forward while pinching the nose for 10 minutes – ice can be applied to the forehead and nose or an ice collar can be applied
DEVIATED SEPTUM
projections which deflect from the midline of the nose – rhinoplasty corrects the deviated septum and can also improve cosmetic appearance of the nose – nares are packed and a splint applied and secured with tape to maintain shape and present edema – Post-op swelling and ecchymosis will appear around the eyes
*RADICAL NECK DISSECTION
•This is done for advanced cancer – •The neck is opened between the jaw and the clavicle and the following is removed – subcutaneous tissue, sternocleidmastoid muscles and other muscles, jugular vein and the spinal accessory nerve, a skin graft is done over the carotid artery – •The shoulder will droop after because of the spinal accessory nerve loss.
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