Caring fo adult unit2 test review chapter 53 Snow Nursing

• Assessment: Postoperative Phase: frequentlymonitor pt’s responsiveness & vital signs. Usually every 5 minutes untilstable, the n every 15 minutes for 1 hour. Then hourly for remainder first 24postoperative hours. Inspect drainage from mouth or vomited fluid for blood.Blood-tinged drainage is normal at first but should decrease. Note excessiveswallowing. Monitor respiratory effort, skin color, pain & dysphagia
• Interventions: Decreased Cardiac output,ineffective airway clearance, acute pain, deficient knowledge

• Early symptoms: Persistent hoarseness, sorethroat, & ear pain
• Late: hemoptysis (blood in sputum), difficultyswallowing or breathing, pain & anorexia leading to weight loss

• Nasal obstruction more common. Softening of htcartilage of the external nose
• Mucous membrane, thinner, produces less mucus
• Epistaxis: more common in older people
• Decline in the sense of smell as people ageTissues of larynx: drier and less elastic inolder adult
• Weakened esophageal sphincter: allows gastriccontents to flow back into the throat when the pt lies down

• Conditions of nose, sinuses, and throat arediagnosed by cultures, measures of antibodies, & procedure to visualizedinternal structure
• Nursing care: confirm orders & check agencyprotocol. Tell the pt what to expect

• Topical anesthetics: anesthetic effect on skinand mucous membranes
• Anti-infectives: kill or suppress growth ofmicroorganisms
• Antipyretics: reduce body temp; used to treatfever. Analgesic effects, Salicylates & other NSAIDs are anti-inflammatory
• Opioid analgesics: reduce pain
• Sympathomimetics (adrenergics): decongestion,vasoconstriction
• Anticholinergics: decrease salivary &respiratory secretions
• Antihistamines: block effects of histamine. Usedto treat allergic reactions & prevent motion sickness
• Antiflammatory drugs: decrease bronchial &nasal inflammation. Decrease mucus production

• Inspiration of dry air is uncomfortable, because’sloss of body fluid, & can contribute to upper airway infections. Nasalobstruction causes the pt to breathe through the mouth
• Work in one of two ways: by creating an aerosol(dispense tiny droplets of water into the room) or by creating steam (increasehumidity by distributing vaporized water)
• Used sterile distilled water with aerosol units& plain distilled water with steam units. Check & refill regularly.Daily cleaning reduces risk of bacterial contamination
• After nasal or sinus surgery bedside roomhumidifier may be orderedPt with a tracheostomy inspires air directlyinto trachea until airway adjusts. Humidification is essential to preventexcessive drying of the mucosa & secretions

• Decreased cardiac output: risk of hemorrhage.Advise pt not to blow nose or stain. Laxatives or stool softeners may beordered.  Pt should not take aspirin
• Acute pain: semi or high-fowlers helps controlswelling. Analgesic agents & ice packs. Frequent mouth care & oralfluids are soothing
• Impaired gas exchange: nasal packing caninterfere with breathing. Semi-fowlers with head flat against bed. Humidifier.Frequent oral hygiene
• Disturbed body image: Cool compresses may reduceor prevent “black-eyes” which are common

External nose: bone, cartilage, & mucousmembrane. Upper 1/3 of nose has a bony skeleton, remainder is shaped bycartilage

Internal nose: divided by nasal septum (thinwall that creates two passages), nares (openings on each side of septum),Vestibule (outermost portion, covered by skin that contains nasal hairs). Restis lined with a mucous membrane. Supplied with blood by branches of internal& external carotids

Layer of mucus covers the membrane. It trapsinspired particles & moisturized dry air. Mucus protects airway because itis acidic & contains an enzyme that destroys most bacteria. Cilia sweepparticles trapped in mucus toward throat to be swallowed

Olfactory cells line roof of nasal cavity. Theyare specialized sensory cells that detect odors & relay info to brain

Turbinate’s: folds of tissue on side walls ofthe internal nose.  They increase thesurface area that inspired air crosses. As air swirls over then it is warmed tobody temperature. Contain openings through which secretions drain from sinuses

• Isolate & identify organisms. Usually donwhen streptococcal sore throat is suspected. Can be uses to screen for carriesof Neisseria meningitides ordiphtheria
• A culture specimen should be obtained beforestarting antibiotic agents
• Kits available, they contain sterile swab orapplicator & tube of culture medium

Tilt the patients head back, and depress thetongue with the tongue blade. Firmly, but gently rotate the swab over the backof the throat, tonsils, and any obvious lesion. The swab should not touch anyother area of the mouth. Because the patient often gags of cough, stand to oneside and wear a mask. Immediately place the swab in the culture medium

• a.       Pain or a feeling of heaviness over the affected area
• b.      Purulent drainage from the nose
• c.       When maxillary sinuses affected, pain may seem like a toothache.
• d.      Headache is common, especially in the morning.
• e.       Fever may be present; WBC count may be elevated.  
• f.       Sinusitis is inflammation of the sinuses.
• g.      Patients with sinusitis usually report pain or a feeling of heaviness over the infected area. They may report purulent drainage from the nose. When the maxillary sinuses are affected, the pain may seem like a toothache. Headache is common. Especially in the morning. Fever may persist, and the white blood cell count may be elevated

S/S of Acute Viral Coryza (common cold) usually consists of fever, fatigue, nasal discharge, and sore throat

Drug therapy of the common cold is directed primarily at relief of symptoms and consists of antihistamine agents, and decongestant agents, and anti pyretic agents.

Patients often expect to receive antibioticagents but THEY ARE FOOLS!Antibiotics are NOT effective against infections caused by viruses, like AcuteViral Coryza or the common cold. Duh

• Nosebleed: caused by Trauma, Clotting disorders, Dryness, Inflammation, Hypertension
• First aid:  Pt should sit down & lean forwards, Apply direct pressure for 3-5 minutes
• Medical treatment: Nasal balloon catheter, Nasal packing

semi-Fowler

36-72 hours