Class notes
Medical Surgical Nursing 1
- Course
- Institution
Respiratory, immunology, autoimmune, hematology, cancer, urinary , reproductive
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Disorders of the Upper AirwayRhinosinusitis: Inflammation of paranasal sinuses (sinus infection)
Causes: prolonged cold, swimming/ diving, tooth infection, enlarged adenoids
-Thick yellow/ green mucus
-Facial pain/ fullness
-Headache
-Fever
Complications: Bacterial meningitis (assess for nuchal rigidity), osteomyelitis, abcesses
Treatment: Antibiotics (if bacterial)- amoxicillin, saline lavage, intranasal steroids, warm
compress, humidifierLook
Acute pharyngitis: Inflammation of back of throat, can be viral or bacterial
-Fiery red throat
-White spots/exudate in throat (bacterial)
-Swollen tonsils
-Fever
-Pain
Complications:Rheumatic fever, scarlet fever, mastoiditis, peritonsillar abscess,
glomerulonephritis
Treatment: Antibiotics, saltwater gargle, tonsillectomy, NSAIDS, soft and cold fluids
Rhinitis: Inflammation/ irritation to mucous membranes of nose
Causes: Cold, allergy, asthma, infection, OTC meds, nasal decongestants
-Rhinorrhea(runny nose)
-Itchy eyes
-Sore throat
-Sneezing
-If from allergies = not contagious
Viral rhinitis: (common cold) 7-10 day duration
-Congestion
-Low grade fever
-Mucus
-Halitosis
-Sore throat
Complication: URI, sinusitis
Treatment: Antihistamines, nasal sprays, steroids, fluids, rest
,Laryngitis: inflammation of larynx and vocal cords, viral or bacterial
-Aphonia (hoarseness)
-Morning dry throat, can be sore
Causes: beta blockers, ace inhibitors, anaphylaxis, GERD
Complication: Laryngeal obstruction **Airway management w/ tracheostomy if needed**
Laryngeal Cancer:
-Aphonia (Hoarseness) > 2 weeks
-Dysphagia
-Coughing, can be bloody
Dx: biopsy
Treatment: laryngectomy, radiation, chemotherapy
Causes: smoking, alcohol use, older age, industrial pollutants
*Laryngectomy*- removal of larynx (voice box)
-Requires permanent tracheostomy
-Requires alternative to speech, ex. electrolarynx
-Not an aspiration risk!
POST OP: airway management, stoma care, cover during showers, soft foods
-May be started on enteral or parenteral nutrition
Peritonsillar Abscess (quinsy): Complication of sore throat, can be bacterial or viral.
Collection of purulent exudate between tissue and tonsillar capsule.
-Rancid breath
-Severe sore throat
-Inflamed tonsil w/ abscess
-Trismus
-Dysphagia
-Fever
-Odynophagia (painful swallowing)
-Otalgia (ear pain)
Complications: Spread to neck and chest, edema causing airway obstruction,
mediastinitis, intracranial abscess, empyemas
Treatment: Antibiotics, steroids, needle aspiration, KEEP TRACHEOSTOMY AT
BEDSIDE!
,Tonsillitis/Adenoiditis: Inflammation of tonsils or adenoids can be viral or bacterial
-Common complication of group A strep
-Sore throat
-Fever
-Snoring
-Halitosis
-Mouth breathing
-Otitis media
-Enlarged lymph nodes
Complications: Airway obstruction r/t bleeding or edema
Treatment: Tonsillectomy, soft/cold foods, no red foods, assess gag reflex, refrain from
coughing, alkaline washes
Tonsillectomy: sore throat, minor ear and neck pain, vomiting in FIRST 24 hours post op
are expected. STILL ASSESS PATIENT!
Immediate postoperative period: prone, with the patient’s head turned to the side to
allow drainage from the mouth and pharynx. The nurse must not remove the oral airway
until the patient’s gag and swallowing reflexes have returned.
Post op complications: ear pain, bleeding, throat pain, fever
Nurse should have at the bedside: light, mirror, gauze, curved hemostats, and a waste
basin.
Teaching: avoid hot, spicy/ acidic foods, dairy products. Avoid smoking and heavy lifting
for 10 days! Hemorrhage can occur up to 8 days post op tonsillectomy (teach for signs)
Central sleep apnea: Nervous system immaturity, ex; prematurity, neurological
disorders, or trauma (brain isn’t sending signals)
Obstructive Sleep apnea: Muscles of tongue/ mouth occlude airway
Risk factors: obesity, men, elderly, alcohol use, postmenopausal, sleeping on back
3 S’s: snoring, sleeping during daytime, significant other (first to realize)
-Snoring
-Waking with chest pain
-Early morning headaches (hypoxia)
-Excessive daytime sleepiness, mood changes
-Fatigue
-Low O2, high CO2 (hypercapnia)
Dx: sleep studies, breathing cessation >10 seconds 5X per hour
Treatment: tonsillectomy if they are cause, sleep in high fowlers/side sleeping, CPAP,
lose weight, smoking cessation
, Deviated septum: protruding of cartilage to one side
Nasal polyps: can be considered precancerous, surgical removal is necessary
Nasal fracture: related to trauma to face
-Swelling
-Bruising
-Asymmetrical nose
Dx: with X-ray
Risks: CSF leak from break in cribriform plate, confirm with halo test - halo will form on
sheet
Tx: ice pack, head elevated, packing
*If patient has nasal packing, instruct them to mouth breathe*
Epistaxis: Nose bleeds
Causes: picking, dryness, trauma, HTN (posterior bleed), thrombocytopenia,
anticoagulant use
Treatment: Sit upright with head tilted forward (prevent aspiration), pinch the soft outer
portion of the nose against the midline septum for 5 or 10 minutes continuously. Nasal
packing (instruct mouth breathing), balloon, cauterization, avoid blowing nose,
phenylephrine
Tracheostomy care/suctioning:
-Suction no more than 10-15 seconds, can cause hypoxia induced cardiac arrhythmias
-Use continuous suction 100-150 mmhg, intermittently suction when withdrawing
-Insert catheter 6 inches or until meet resistance, withdrawal 0.5 inches and suction
-Assess lung sounds, pulse ox, effort, chest rise/rall, labored or shallow breaths
-Assess mucus color, amount, consistency
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