-↑ breathing, HR

-stridor

-nasal flaring

-inability to lie down

-agitation

-retractions

-use of accessory muscles

-wheezing

-diaphoresis

-cyanosis

-protect the airway at all times

-adequately ventilate and oxygenate

-high fowler's position

-bubbling noises on inspiration/expiration

-↑ secretions

-sputum

-vomiting

-non-productive cough

-explain procedure, even if pt is unconscious

-explain short rests between periods of suctioning

-explain that they will feel the need to sneeze, cough, or gag

-adult: 12-18 French

-frail adult/child: 8-10 French

1) wash hands

2) open equipment

3) turn on suction and check that it works

4) put on PPE

5) assemble tubing/catheter

6) slide catheter into nose, down into oropharynx (DO NOT OCCLUDE SUCTION PORT WHEN INSERTING CATHETER)

7) occlude suction port for <10 seconds

8) remove catheter and flush with NS

9) wait 30 seconds before suctioning again

10) document

-larger tongue 

-obligated nasal breathers for first year of life 

-hard to see larynx 

-angled vocal chords 

-epiglottis is ohmega shaped and angled away from trachea 

-narrowest part of infant's larynx is cricoid cartilage

-smaller lung volume

-softer ribs

-weaker muscles

-thin chest wall

-abdominal breathers

-vocal chords are perpendicular to trachea

-epiglottis is broader, parallel to trachea

-narrowest part of larynx is the glottis opening (vocal chord)

-fully developed cricoid cartilage occurs at 10-12 years old

-basilar skull fracture

-CSF leak

-pO2 <55 on supplemental O2

-respiratory acidosis and ↓ LOC

-respiratory rate >35-40 or <10 breaths per minute

-↑ use of accessory muscles

-metabolic acidosis

-for infants/young children

-lifts epiglottis and exposes the opening

-be careful to avoid pressure on teeth and gums

-after placement, check breath sounds bilaterally and check neck sounds (no air should be able to go around the blade)

-for older children/adults

-size depends on body mass and anesthesiologists preference

-after placement, check breath sounds bilaterally and check neck sounds (no air should be able to go around the blade)

-rate: pre-set, minimum number of breaths delivered to pt

-tidal volume: volume delivered with every mechanical breath

-presure support: pressure delivered with each inspiration

-antihistamines, anticholinergics, sedatives

-H2 blockers ↓ gastric acid

-compete with histamine for unoccupied receptors, cannot push histamine off of receptors when already bound

-prevent vasodilation, ↑ secretions, and ↑ capillary permeability

-better in prevention, than treatment

-also for motion sickness, sleep disorders

-palliative, not curative

-Bendaryl (diphenhydramine) is sedating

-Claritin (loratadine), Allegra (fexofenadine), Zyrtec (cetirizine) are non-sedating, have a longer duration of action

-take with meals to ↓ GI upset

-delayed onset, but prolonged action

-less potent

-no rebound congestion

-adrenergics

-Dristan, Tylenol Cold, Sudafed

-prompt onset

-more potent

-can cause rebound congestion

-adrenergics and steroids

-andrenergics constrict small blood vessels→tissues shrink→nasal secretions can drain better

-steroids turn off immune system cells, anti-inflammatory→less inflammation=less congestion

-can cause HTN, palpitations, CNS stimulation

-avoid caffeine

-used to stop or reduce non-productive coughing

-perform respiratory and cough assessments

-avoid liquids for 30-35 mins after taking chewable tablets or lozenges

-have a direct action on medulla

-codeine, hydrocodone

-side effects: sedation, N/V, lightheadedness, constipation

-numb stretch receptors in respiratory tract

-Nyquil, Robitussin

-side effects: dizziness, drowsiness, N/V

-thin secretions

-reflief of non-productive coughs

-use with caution in elderly and pts with asthma

-↑ fluids to help thin secretions

-long term:

*antileukotrienes

*inhaled steroids

*long acting beta agonists

*cromoglycate (Intal)

-short term/quick relief:

*IV corticosteroids

*short acting beta agonists

*theophylline

xanthine derivatives

(bronchodilator)

-caffeine, theophylline

-relax smooth muscles of airways, cause CNS stimulation

-used for prevention

-slow onset

-have a diuretic effect

-side effects: N/V, anorexia, GERD during sleep, ↑ HR, ↑ urination

-caution with cardiac disease

beta-agonists

(bronchodilators)

-sypathomimetics

-used during asthma attacks, quickly ↓ constriction

-epinephrine

-used for prevention and acute attacks

-side effects: ↑ or ↓ BP, headaches, tremor

-adequate fluid intake

-avoid excessive heat, caffeine

-bind to ACh receptors, prevent ACh from binding

-Atrovent used for respiratory disease: slow/prolonged action, prevents bronchoconstriction, not used for acute attacks

-side effects: dry mouth, GI upset, headache, coughing, anxiety

-new asthma medications

-montelukast (Singulair)

-histamines enter body→leukotrienes are secreted, causing immune response→inflammation, bronchoconstriction, ↑ mucus

-prevent action of leukotrienes

-prevention and chronic treatment of asthma, not for acute attacks

-side effects: headache, nausea, diarrhea, liver dysfunction

-improvement seen in 1 week after administration

-anti-inflammatory

-used for chronic asthma, not acute attacks

-oral or inhaled

-may take several weeks before effects are seen

-Inhaled:

*budesonide (Pulmicort), fluticasone (Flovent)

*side effects: coughing, dry mouth, yeast infection

*contraindicated in pts with fungal infections or immunocompression

*gargle and rinse mouth with water after inhaling to prevent fungal infections

*must be weaned off

-oral:

*prednisone

-cromoglycate (Intal)

-used for prevention, not acute asthma attacks

-prevent exercise-induced bronchospasm

-side effects: cough, sore throat, rhinitis, bronchospasm, taste changes, headache

-effects may not be seen for up to 4 weeks

-inflammation of the nasal cavities

-most common upper respiratory infections

-can be acute or chronic

-allergic rhinitis:

*hay fever

*caused by sensitivity to allergens

-vasomotor rhinitis:

*unknown cause

-atrophic rhinitis:

*changes in mucous membranes of nose

-droplets from sneezing and coughing

-direct contact

-boosts immune system

-don't use longer than 2 weeks, if used over 8 weeks→over-stimulation of immune system can cause immunosuppression

-don't use if pregnant or breastfeeding

-inflammation of mucous membranes/sinuses, caused by immune response trying to fight the infection

-usually follows URIs

-caused by: strep, staph, etc.

-hard to treat in immunosuppressed pts

-air filled cavities in face

-lined with cilia to move stuff out

-usually sterile

-lower O2 content than inspired air

-maxillary area: pain over cheek and upper teeth

-ethmoid area: pain between and behind eyes

-frontal area: pain in forehead

-sinusitis for >6 months

-causes: smoking, allergies, habitual use of nasal sprays or inhalants

-s/s: pain/tenderness at sinus area, pressure, headache, fever, purulent drainage, bad breath

-symptoms worse in AM, but better as day goes on

-drugs: antibiotics for 10-14 days, nasal sprays, antihistamines, saline nose drops, warm steam, guaifenesin

-accute inflammation of pharynx 

-common 

-usually viral, but can be bacterial (strep most common bacterial cause)

-strep pharyngitis:

*sudden onset of high fever, severe sore throat, dysphagia, swollen lymp nodes

-viral pharyngitis:

*gradual onset, low grade fever, sore throat, mild hoarseness, headache, runny nose

-acute inflammation of palatine tonsils

-sometimes viral, but usually from strep (bacterial)

-most common in late fall and spring (cold weather)

-very contagious, spread by droplets

-incubation is a few hours to days (viruses for 2-3 days)

-symptoms gone in 3-10 days

-s/s: bright red/swollen tonsils, sore throat, dysphagia, fever

-sudden onset of hematuria, proteinuria, HTN, and edema within 7-10 days after infection

-diagnosis: throat swab, rapid strep test

-CBC levels: WBCs ↓ if viral, ↑ if bacterial

-possible tonsillectomy required for chronic infections

-removal of tonsils

-ice collar and acetaminophen (not aspirin) for pain control

-ice cold fluids, no milk products, avoid spicy/hot/acidic/rough foods

-inflammation of larynx

-common (especially in winter)

-causes: excessive use of voice, change in temperatures, exposure to allergens/irritants

-s/s: hoarseness, loss of voice, sore throat, dry/harsh cough

-treatment: chloraseptic spray, inhaled steam

-caused by anaphylaxis, foreign object, aspiration (main cause)

-pt can't talk, cough, breathe

-s/s: hoarness, SOB, rapid onset of dyspnea, respiratory arrest, cyanosis, distress (look of terror)

-treatment: epi-pen needed ASAP, corticosteroids, ice pack

-drugs: Benadryl, Zantac, Solumedrol

-causes: edema, general anesthesia, suctioning, inhaled irritants

-treatment: O2, neuromuscular blocking agent, ventilation, tracheotomy

-benign: papillomas, nodules, polyps

-malignant: squamous cell carcinomas

-can metastasize anywhere

-↑ risk for men, over 55, smokers

-treatment: radiation, chemotherapy, surgery

-most cancerous tumors start in the glottis→1st s/s is hoarseness

-nosebleed

-anterior nosebleeds usually r/t trauma, posterior nosebleeds usually r/t secondary issues (HTN)

-treatment: apply pressure by pinching nose for 5-10 mins, apply ice pack, sitting position, lean forward

-drugs: topical vasoconstrictors, silver nitrate, lidocaine, antibiotics

-nasal tampon

-nasostat: soft balloon filled with air to apply pressure

-petroleum gauze

-keep pt calm, anxiety causes bleeding to ↑

-nose is #1 facial bone broken

-s/s: pain, bleeding, swelling, deformity

-treatment: control bleeding, cold compress, re-break nose 7-10 days after original fracture happened, acetaminophen