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Allergic rhinitis teaching
- Happens due to exposure to allergen
- Teach:
- reduce exposure to allergen/irritants
- correct administration of nasal meds (clean nasal passages, avoid spraying toward nasal septum. Wait one minute btwn sprays)
- If using Afrin (OTC nasal spray) don’t use more than 3 days.
- Hand hygiene.
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Allergic rhinitis tx
- *depends on cause
- antihistamines
- OTC nasal spray ex: Afrin (no more than 3 day use)
- desensitization tx
- corticosteroids,
- Cromolyn (mast cell stabilizers) (montelukast/Singulair)
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Bacterial pharyngitis diet
- (Strep Throat) liquid or soft diet.
- Drink 2-3 L/day
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Common cold communicability
- Shed virus 2 days before symptoms appear, you’re contagious.
- Cough particulates can stay in air for 1 hour.
- Lasts up to two weeks.
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epistaxis teaching
- "bloody nose"
- Avoid
- forceful nose blowing,
- nose picking,
- avoid vigorous exercise,
- spicy foods & tobacco (vasodilation)
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epistaxis treatment modalities
- Sit, lean forward, apply direct pressure
- nasal tampon
- nasal decongestants will vasoconstrict
- cauterization (use good illumination) with silver nitrate or electrocautery
- suction blood
- pack nose with petroleum gauze
- sponge with saline (when taking antibiotics)
- prevent dry nose.
- humidification
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Laryngitis teaching
- Rest voice
- daily fluid 2-3 L
- humidity
- take PPI if has GERD
- use expectorants if secretions present
- avoid irritants, don't smoke
- corticosteroids if chronic. (teach SE)
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OSA - s/s
- (Obstructive Sleep Apnea)-cessation of breathing for 10 sec or more-
- Snoring
- sleepiness
- significant other report
- Risk factors: Obesity, male gender, age, alterations in upper airway.
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Pharyngitis risk
- caused by same crap that causes measles, chickenpox, whooping cough/pertussis
- commonly spread by unclean hands
- Higher risk in winter and especially those immunocompromised
- Most prescribed-Penicillin
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Sinusitis teaching
- Increase intake of fluids
- humidifiers to promote drainage
- warm compresses
- rebound congestion with Afrin
- call doctor if periorbital edema and severe pain with palpation, nuccal/neck rigidity
- OTC med and prescribed med side effects
- correct use of intranasal sprays
- no caffeine(diuretic-dries nasal passages) and alcohol
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sleep apnea dx
- sleep study/polysomnography
- (Respiratory assessment for nursing care).
- Holds breathe for 10 seconds or longer, at least five episodes per hour
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sleep apnea tx
- CPap (prevents airway collapse) or Bipap
- weight loss
- positional treatments with tennis ball
- alcohol avoidance (disrupts how quickly you fall asleep causing sleep disturbance)
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Tonsillitis med care
- Antibiotics
- Pain meds
- tonsillectomy
- Nursing care:increase fluid intake
- cool liquid diet
- rest
- salt water gargle 1-2 hr for 24 hrs
- rest
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viral pharyngitis nursing care
- educate importance of finishing abx
- Rest
- examine skin for rashes = signs and symptoms of deeper illness like scarlet fever
- replace toothbrush
- don’t share eating utensils and ice collar
- salt gargles
- soft diet
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aspiration risk
- CVA/STROKE GREATEST RISK
- seizures
- decreased LOC
- flat body positioning
- swallowing disorders
- cardiac arrest
- severe disability
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Asthma peak flow meters
- measures airflow during forced expiration
- used to evaluate effectiveness of Rx or exacerbation of symptoms
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Asthma tx
- best managed by early tx and education
- beta adrenergic short acting and long acting
- anti-inflammatories, inhaled and oral (prednisone for exacerbations)
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Asthma triggers
- allergy is strongest predisposing factor
- most common: dust & dust mites
- pets
- soap
- certain foods
- molds and pollens
- air pollutants:
- cold & hot weather changes
- odors & smoke
- occupational
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Atelectasis prevention
- *alveoli collapse
- Frequent turning
- early ambulation
- deep breathing
- incentive spirometry
- coughing
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Bronchitis s/s
- initially has dry, irritating cough - scant amt of mucoid sputum
- reports of sternal soreness from coughing
- fever, chills, night sweats
- HA and general malaise
- as is progresses, purulent sputum
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COPD assessments
- barrel chest
- leans forward and uses accessory muscles (to breathe)
- Dyspnea and hypoxemia,
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COPD breathing exercises
- pursed lip
- diaphragmatic breathing
- tripod position
- Priority nursing diagnosis: Impaired Gas Exchange (as getting air in and out isn't the problem, it's that gas exchange is not happening)
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COPD s/s
- Lean forward (tripod)
- use of accessory muscles
- cough, wheezing,
- dyspnea
- barrel chest
- hypoxemia
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Emphysema positioning
- leans forward
- supraclavicular fossa retraction
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HAP preventions
- Hospital Acquired Pneumonia
- get pneumococcal vaccine
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Inhaled corticosteroid adverse effects
Thrush
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MDI use
- Hold upright, shake, pump 2 sprays if haven’t used in 3 days,
- hold 1-2 inches away or use spacer chamber, breath slowly in, press
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Pleurisy characteristics
- inflamed pleural membrane rub together during respiration so, intensified in inspiration
- Sharp, knifelike pain on one side
- deep breathing, coughing or sneezing worsens pain
- SOB, anxiety
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Pneumonia nursing care
- ADEQUATE HYDRATION (thins and loosens pulmonary secretions)
- HOB raised
- rest periods
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Priority pneumonia intervention
Primary goal is to get crap out of lungs
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smoking patho effects
- Destroys ciliary cells that protect airways by preventing irritants and foreign material. When smoking damages this cleansing mechanism airflow is obstructed and air becomes trapped behind the obstruction.
- The alveoli distends which diminishes lung capacity.
- Smoking irritates the goblet cells and mucus glands, increasing mucous production, causing more irritation, infection, and damage to the lungs.
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TB teaching
- airborne transmission-person to person
- Risk increases with Overcrowding, substandard housing, inadequate Healthcare
- Diagnosed with a PPD test and chest x-Ray, and sputum culture for AFB
- Symptoms are low-grade fever, fatigue, night sweats, cough, weight loss.
- TB is curable. Must manage long term treatment, and adhere to regimen.
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Intraoperative hypothermia risk
- Elderly and people with low BMIs at greatest risk
- May use warmed IV fluids
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Intraoperative latex allergy
- THIS IS PRIORITY ASSESSMENT - High risk for anaphylaxis during surgery
- Need to ID before pt arrives in OR
- Also need to inform anesthesia
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Intraoperative malignant hyperthermia s/s
- Inherited muscle disorder, chemically induced by anesthetic agents
- must ID pt's at risk
- 1st sign is increased HR
- Mortality 50%
- increased HR >150, later signs of oliguria, hypotension and elevated temperatures.
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Post op complication prevention
- Priority: assess airway and breathing
- get up and moving as soon as possible
- use of incentive spirometer
- TCDB (turn, cough, deep breath)
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Postop hypoxia s/s
- first sign may be anxiety
- confusion & restlessness
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Postop PACU d/c criteria
- Aldrete score - must score 8+ for discharge
- Stable BP
- Sufficient oxygen
- Adequate respiratory function
- Oriented
- No evidence of hemorrhage
- Pain managed
6 considerations
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Postop vomiting
- Turn to side to allow vomitus to escape from side of mouth
- antiemetic
- cool cloth, fan
- distraction
- crackers & caffeine
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Preop consent criteria
- Surgeon's responsible to provide clear/simple explanation
- NURSE CLARIFIES INFORMATION
- If pt wants more info, notify surgeon
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preop consent emergent
- gives permission to operate as a life saving measure W/O pt's informed consent.
- Every effort must be made to contact family
- Can be phone, fax, or other electronic means
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Preop smoking cessation
stop 4-8 weeks before surgery
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NSAIDs and physiology of pain
- Patients feel different degrees of pain from similar stimuli because of neurochemicals
- NSAIDs block prostaglandins which cause pain
- NSAIDs can be given instead of opioid analgesia to prevent sedation (and inability to cough-pt’s need to cough after surgery to prevent atelectasis)
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Analgesia dosing in older adults
- Elderly have slower metabolism and excretion
- start low and go slow
- risk of more drug interactions because of chronic illnesses and other meds
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Chronic pain syndrome sequelae
- (sequelae is condition that is consequence of previous injury/illness)
- Pts become tolerant of pain meds
- Can cause: depression, no work, cost of medications, Lack of mobility, decreased social life, weight loss or weight gain, decreases immune system and recovery, increases cost in healthcare
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Opioid priority assessment
- Respiratory depressionconstipation
- decreases blood pressure
- level of sedation, nausea
- vomiting
- pruritis
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Opioids in cancer pain
- Use in cancer patients with mild to severe pain plus nonopioid and adjuvant therapy
- Increase doses with cancer
- Relieve their pain level, deliver in timely manner, may need different analgesics along with opioids as to control pain and prevent overdosing
- When selecting opioids be careful of what kind of cancer patients have
- Titration starting at a low dose to decrease adverse effects & prevent hypotension. Take a stool softener
- educate patient and family to correct fears and misconceptions about opioid use and to take an active role in managing pain.
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Outcome planning with chronic pain
- Pain goa l-a tolerant pain level to perform ADLs (Comfort level goals)
- Able to sleep and work
- Absence of constipation
- Exhibits normal vital signs, mental status
- Understands alternatives to medications
- Determine functional level of pain, usually 3-5
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Poorly managed pain sequaelae
- inadequate pain management leads to diminished quality of life, characterized by:
- distress & suffering
- anxiety & fear
- immobility
- isolation
- depression
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Preventative approach to pain control
- distraction
- guided imagery
- breathing exercises
- hot/cold therapy
- relaxation
- massage therapy (skin stimulation)
- Teach not to wait too long before taking meds or pain becomes harder to control.
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Tolerance recognition
over time patients are likely to become tolerant of the dosage, same dose has less therapeutic effect.
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Treatment of neuropathic pain
- Adjuvant and analgesic agents such as antidepressants, anticonvulsants and local anesthetics, but there is a wide variability in terms of efficacy and adverse effects
- NSAIDs like Celebrex
- Lidocaine patch 5% is often used for well-localized types of neuropathic pain, such as postherpetic neuralgia
- A relatively new pain management technique uses an in dwelling catheter-continuous peripheral nerve block (peri neural anesthesia)-ropivacaine or bupuvacaine usually.
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B cells physiologic processes
- type of lymphocytes
- Differentiating into plasma cells-immunoglobulins (protein molecules-humoral immunity)
- send antibodies/immunoglobulins to site of infection
- T-cells fight against foreign pathogens and go to site of infection. Attack directly. 3rd responder in chain
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B12 deficiency risks
- (megaloblastic, MCV elevated)
- Risks include:
- Bariatric surgery
- Crohn’s disease
- ileal resection
- gastrectomy and gastric surgeries
- vegetarians
- alcoholism
- inadequate dietary intake
- lack of intrinsic factor
- use of proton pump inhibitors (need acid to absorb vitamin B12)
- metformin use.
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Band cells function
- Band cells have a single lobe nucleus; it is a slightly immature neutrophil.
- The nucleus of the mature neutrophil has many lobes, 2-5.
- Twice size of erythrocytes.
- It’s a granulocyte
- They increase number during infection. Increase in number is a “left shift”. Neutrophils are first response.
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hematopoiesis physiology
- Erythrocytes, leukocytes and platelets
- Process of the body of replenishing the supply of blood cells
- Primary site of production is in the bone marrow when adult
- When in embryonic develop and in other conditions spleen and liver is a site of hematopoiesis.
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Kidney's function in RBC production
produces erythropoietin which stimulates RBC production
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Megaloblastic anemia causes
- B12 and folic acid deficiency
- Makes abnormally large red cells
- hyperplasia (increase in number of myeloid stem cells in the bone marrow)
- The abnormal cells are destroyed in the bone marrow
- The ones that do leave are fewer in number (panocytosis).
- Erythrocytes are abnormally shaped (poikilocytosis)
- MCV elevated >110 mcm3.
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RBC physiology
- Mature RBC have no nuclei
- Transports O2 using hemoglobin between lungs and tissues
- Reticulocytes are immature RBCs
- RBCs shrink as they age.
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RBC production and nutrition
- Important Nutrition for production?
- B vitamins, iron, vitamin A.
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polycythemia
- an abnormally increased concentration of hemoglobin in the blood, through either reduction of plasma volume or increase in red cell numbers
- It may be a primary disease of unknown cause, or a secondary condition linked to respiratory or circulatory disorder or cancer.
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Therapeutic phlebotomy rationale
- when having polycythemia.
- Hematocrit (HCT): Polycythemia is considered when the hematocrit is greater than 48% in women and 52% in men.
- Hemoglobin (HGB): Polycythemia is considered when a hemoglobin level of greater than 16.5g/dL in women or hemoglobin level greater than 18.5 g/dL in men.
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The criterion for anemia is met when the total RBC count, both young and old cells, it...
- MEN: below 4.5 million
- WOMEN: below 4 million
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A high MCV and a low MCH would grossly classify an anemia as...
macrocytic & hypochromic
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A pt is admitted to rule out a "GI bleed," and a physician has ordered a transfusion.
What MCV/RBC would make you question and hold the transfusion?
- MCV/RBC equals 12.0
- <13 may not be losing blood or need iron, it leads to beta-thalassemia minor
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An elderly woman is admitted with "altered mental status"
she has decreased vibration sensation in feet and yellow/blue color blindness.
CBC finding that might support your belief that pt has b12 deficit is
A high MCV
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A diabetic has a blood sugar level of 783, which causes excess sugar to move into RBC and make them swell
BCB would reflect this as...
Increased MCH and RDW
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A test tube of blood removed from a centrifuge shows 4.5 cm of sediment and 5.5 cm of clear fluid.
What is the Hct
45%
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What would you expect the approx Hgb to be from a tube with 4.5 cm sediment and 5.5 cm clear fluid
15%
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You admit a trauma pt with possible internal injuries. What finding would cause you to suspect an acute hemorrhage, such as ruptured spleen or aortic dissection
A normal CBC
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A physician orders iron sup for pt with extremely low Hgb and Hct. You expect an order for packed red cells. What CBC values do you suppose the physician saw that probably influenced the decision
A low MCV and low MCH
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On admission 2 days ago, pt had normal CBC. Yesterday showed decreased Hct. Today, it's normal again. WhY?
He began IV fluids and was overloaded with fluid when the second CBC was drawn
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3 or 8 pts assigned to you are anemic, with similar Hgb and Hct levels.
One is being detoxified from ETOH abuse, 2nd is post op from hysterectomy, 3rd is elderly man w hx of ulcers.
In order, how would you expect their anemias to be classified, based on MCV
Macrocytic, normocytic, and mirocytic
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A physician determines cause of pt anemia was bone marrow suppression secondary to drug reaction. Drug is held. what would provide first indication that dx is correct (out of those listed)
increasing RDW
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