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Upper Respiratory tract infections (Pneumothorax (presence/ accumulation…
Upper Respiratory tract infections
common cold
URTIs that is caused by virus (e.g. rhinoviruses)
S/S: low-grade fever, nasal congestion, rhinorrhea(running nose), sneezing, cough, chills, sore throat
Management
Symptomatic therapy
adequate fluid intake
rest
nonsteroidal anti-inflammatory drug (NSAIDs) to relieve pain & aches
prevention of virus transmission
acute pharyngitis (inflammation of pharynx; the back portion of the throat)
can be vital (influenza virus), bacterial(group a beta-hemolytic streptococcus) / fungal infection
S/S: sore throat, red pharyngeal membrane, fever, malaise
Management
accurate diagnosis: obtain throat swab for culture to determine the cause
viral infection: supportive and comfort measure
bacteria infection: antibiotics
fungal infection: antifungal agents
analgesic for sore throat
symptomatic therapy include: bed rest, adequate fluid intake, ensure the patient to complete a full course of antibiotics
infection control & client education
viral & bacterial pharyngitis: droplet spread
good handwashing, hygiene technique, use o mask, avoid sharing eating utensils
Laryngitis (inflammation of larynx/ result of voice abuse (edema of vocal cords caused by the chronic irritation of infection)/ associated with gastroesophageal reflux (reflux larngitis)
caused by virus/ bacteria
S/S: Hoarseness of voice, cough, sore throat
Management: resting the voice, if it is bacterial infection-> follow the antibiotic regime, use of mucolytic, symptomatic measure such as elevate the head of bed to minimize reflux, avoid eating/ drinking before going to sleep
influenza (highly infectious viral disease)
caused by various types of influenza viral strain
mode of transmission: mainly by droplet, sneezing, nasal secretion
S/S: fever, headache, muscle ache, runny nose, cough, sore throat
management
influenza vaccination
adequate rest; well balanced diet with plenty of water
maintain good personal hygiene (cover nose when sneezing & coughing, put on mask)
maintain good indoor ventilation
Pneumothorax (presence/ accumulation of air in the pleural space -> causing disruption of the negative pressure -> lung collapse)
aim -> restore the negative pressure in the pleural cavity
Hemothorax (collection of blood in the pleural space -> also disrupt the negative pressure and cause lung collapse)
3 types
Spontaneous pneumothorax
air enter the pleural space through a broncholeural fistula/ a bleb
traumatic pneumothorax
air enters the pleural space because of trauma (e.g. rib fracture, stab wound/ invasive thoracic procedure e.g. thoracentesis)
often accompanied by hemothorax
tension pneumothorax
air is drawn and trapped in pleural space in each breath
tension of the affected pleural space cause lung collapse -> heart & great vessels and trachea shift to the unaffected side (mediastinal shift)
S/S
Pain & chest disccomfort
dyspnea
anxious/ restlessness
tachycardia
may develop central cyanosis (due to severe hypoxemia)
diagnostic & assessment
history taking & s/s
physical exam
CXR
Management (goal: to evacuate air/ blood from pleural space to restore the negative pleural pressure
open sucking wound -> cover the wound with pressure applied
(pressure dressing)
emergency thoracentesis (chest tapping)/ chest drain tube placement
hemothorax: insert in 4th/ 5th ICS at the mid axillary line
pneumothorax: insert near the 2nd ICS
therapeutic tx; oxygen therapy, pulse oximetry monitoring, IV therapy, blood transfusion (if excessive bleeding), prescribe of antibiotics, no airplane flight for 6 wks, surgical intervention such as pleurodesis
chest drain management
blunt trauma
major problem: Hypoxemia & hypovolaemia
dont only focus on obvious injuries, assessment of airway obstruction, tension/ open pneumothorax.....
CXR
ECG
Physical exam: inspection of airway, thorax, neck veins/ sob, RR, depth, chest symmetric movement, breath sounds, tracheal shift, subcutaneous emphysema, vital signs, pain management
Fractured ribs
at the point of maxima applied force/ the weakest point (the costochondral joint
never pull a penetrating object out the chest -> the object may preventing bleeding/ air enter the pleural space
localizing pain & tenderness over the fractured area upon inspiration & palpation, shallow respirations
pain control, care must be taken to avoid oversedation & suppression of respiratory drive
flail chest
(when three/more adjacent ribs are fractured at two/ more sites with free-floating rib segments) usually a complication of blunt chest trauma
ventilatory support
clear secretion & control pain