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Medical Surgical Nursing - Ch 26


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True or False?

A major deviation in the nasal septum that causes obstruction of nasal airflow is usually corrected by a __RHINOPLASTY__.

A major deviation in the nasal septum that causes obstruction of nasal airflow is usually corrected by a NASAL SEPTOPLASTY.
True or False?

In the pt who has suffered a major frontal blow with a nasal fx, the nurse should monitor for __LEAKAGE OF CEREBROSPINAL FLUID__.
True or False?

Preop teaching for the pt planning an elective rhinoplasty for cosmetic effects includes informing the pt to avoid __ASPIRIN-CONTAINING PRODUCTS__ for 2 weeks before and immediately following the surgery.
True or False?

__PERENNIAL__ rhinitis usually occurs as an allergic response when pollen counts are high in spring and fall.

SEASONAL rhinitis usually occurs as an allergic response when pollen counts are high in spring and fall.
True or False?

Nasal polyps are a complication of long-term __ALLERGIC RHINITIS__.
A pt develops epistaxis upon removal of a nasogastric tube. The nurse should:
a. pinch the soft part of the nose
b. position the pt on the side
c. apply an ice pack to the forehead
d. have the pt hyperextend the neck
a. Direct pressure on the entire soft lower portion of the nose for 10-15 minutes is indicated for epistaxis, in addition to sitting the pt upright, leaning forward, to prevent swallowing of blood. Ice compresses to the nose may be used in addition to having the pt suck ice to constrict the nasal vessels.
When caring for a pt hospitalized with posterior nasal packing for control of epistaxis, the nurse:
a. monitors for hypoxemia and hypercapnia
b. cleans the nares and applies petroleum jelly
c. expects the pt to have a low grade fever
a. After packing of the posterior nasopharynx, some pts experience a decrease in PaO2 and an increase in PaCO2 because of impaired respiration, and the nurse should monitor respiratory rate and rhythm and SpO2. The nares are cleaned and petroleum jelly is applied after the packing is removed. A low-grade fever may be an indication of infection and is not expected, and NSAIDs should not be used because their antiplatelet effects may prolong bleeding.
The nurse teaches the pt with allergic rhinitis that the most effective way to decrease allergic symptoms is to:
a. undergo weekly immunotherapy
b. identify and avoid triggers of the allergic reaction
c. use cromolyn nasal spray prophylact
b. The most important factor in managing allergic rhinitis is identification and avoidance of triggers of the allergic reactions. Immunotherapy may be indicated if specific allergens are identified and cannot be avoided. Drug therapy is an alternative to avoidance of the allergens, but long-term use of decongestants may cause rebound nasal congestion.
During assessment of the pt with a viral URI, the nurse recognizes that antibiotics may be indicated based on the finding of:
a. fever
b. cough and sore throat
c. purulent nasal discharge
d. dyspnea and purulent sputum
d. Dyspnea and purulent sputum in a pt who has a viral URI indicate lower respiratory involvement and a possible secondary bacterial infeciton. Bacterial infections are indications for antibiotic therapy, but unless symptoms of complications are present, injudicious administration of antibiotics may produce resistant organisms. Elevated temp, purulent nasal drainage, cough, sore throat, and myalgia are common symptoms of viral rhinitis and influenza.
A 36 yr old pt asks the nurse if an influenza vaccine is necessary every year. The best response by the nurse is:
a. "Only HCP in contact with high-risk pts should be immunized each year"
b. "Annual vaccination is not necessary b
d. The influenza vaccine is recommended for individuals at increased risk for influenza-related complications, such as those age 50 and older, residents of long-term care facilities, adults with chronic diseases, health care workers, and providers of care to at-risk persons. It is also recommended for any person wishing to reduce chances of acquiring influenza. Antiviral agents will help reduce the duration and severity of influenza in those at high risk, but immunization is the best control.
An advantage of a tracheostomy over an endotracheal tube for long-term management of an upper airway obstruction is that a tracheostomy:
a. is safer to perform in an emergency
b. allows for more comfort and mobility
c. has a lower risk of
b. With a tracheostomy rather than an endotracheal tube, pt comfort is increased because there is no tube in the mouth, and because the tube is more secure, mobility is improved. It is preferable to perform a tracheotomy in the operating room because it requires careful dissection, but it can be performed with local anesthetic in ICU or in an emergency. With a cuff, tracheal pressure necrosis is as much a risk with a tracheostomy tube as with an endotracheal tube, and infection is also as likely to occur since the defenses of the upper airway are bypassed.
If a tracheostomy tube has an inner cannula, it is designed to:
a. allow the pt to speak
b. facilitate suctioning of secretions from the tube
c. promote cleaning of mucus from the inside of the tube
d. increase the volume of air that
c. An inner cannula is a second tubing that fits inside of the outer tracheostomy tube and can be removed and cleaned of mucus that has accumulated on the inside of the tube. Many tracheostomy tubes today do not have inner cannulas because if humidification is adequate, accumulation of mucus should not occur.
Nursing care of the pt with a cuffed tracheostomy tube in place includes:
a. changing the tube q3d
b. recording cuff pressure q8h
c. performing mouth care q12h
d. assessing ABGs q8h
b. Cuff pressure should be monitored q8h to ensure that an air leak around the cuff does not occur and that the pressure is not too high to allow adequate tracheal capillary perfusion. Tracheostomy tubes are not usually changed sooner than 7 days after a tracheotomy. Mouth care should be performed a minimum of q8h and more often as needed to remove dried secretions. ABGs are not routinely assessed with tracheostomy tube placement unless symptoms of respiratory distress continue.
In the event that a tracheostomy tube becomes dislodged, the nurse should immediately:
a. notify the physician
b. attempt to replace the tube
c. place the pt in high Fowler's position
d. ventilate the pt with a manual resucitation bag
b. If a tracheostomy tube is dislodged, the nurse should immediately attempt to replace the tube by grasping the retention sutures (if available) and spreading the opening. The obturator is inserted in the replacement tube, water-soluble lubricant is applied to the tip, and the tube is inserted in the stoma at a 45-degree angle to the neck. The obturator is immediately removed to provide an airway. If the tube cannot be reinserted, the physician should be notified, and the pt should be assessed for the level of respiratory distress, positioned in semi-Fowler's position, and ventilated with an MRB only if necessary until assistance arrives.
To determine when the pt with a tracheostomy tube can effectively swallow, the nurse deflates the cuff and:
a. checks for a gag reflex at the back of the tongue with a tongue blade
b. asks the pt to drink 30 ml of milk and suctions the tube for
d. If colored secretions are coughed or suctioned from the trachea after the pt has attempted to swallow colored water, it indicates that swallowing is not functional and aspiration has occurred. Uncolored water is not discernable as aspirate, and aspiration of small amounts may not cause any respiratory symptoms. The presence of a gag reflex does not ensure that a pt can adequately swallow with a tracheostomy tube in place, and no fluids except clear liquids should be used to assess aspiration risk.

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