GNRS 555-Case Study EXAM Upper
Respiratory Diseases Questions With Answers
Rated A+
• Mr. Davidson is a 24-year old boxer. He had a boxing game and received with a
nose injury. Due to heavy nosebleed, he was transferred to ER.
Health Assessment and Physical Exam:
Diagnostic Test:
Deviated septum is observed. X-ray is done to confirm the diagnosis.
• Patient is alert and oriented. He didn't lose his consciousness. The patient reports
severe nose pain. No other symptoms.
• Nursing Care:
• What should be your highest priority when you plan the care of this patient?
o Vent airway, BCs
• Which position should you assist the patient to and why?
o Up right position, head slightly forward
• How do you differentiate between anterior nasal bleeding and posterior nasal bleeding?
o Posterior: secondary to hypertension, older people, coughing, more dangerous, back of
throat
o Anterior: stops spontaneously, not life threatening, able to see
• What are some of the nursing interventions that can help control the bleeding of this
patient? Provide rationale.
o High fowlers, pinch nose, head tilt forward, acetaminophen, nasal sponges,
nasal packing, medication for pain, Tylenol (no NSAIDS)
GNRS 555-Case Study EXAM Upper
Respiratory Diseases Questions With Answers
Rated A+
, GNRS 555-Case Study EXAM Upper
Respiratory Diseases Questions With Answers
Rated A+
• What is the appropriate way to apply pressure to stop the epistaxis? How and for how long?
o Pinch nose against septum 10-15 mins, up right, lean forward, ice
• Would you insert gauze into the bleeding nostril in this case? Why?
o NO because patient has a fx. If stops in 10-15 mins then no gauze
• Considering the bleeding, what medications would be contraindicated?
o NSAIDS, (aleve, advil, ibuprofen) anticoagulants (warfarin, heparin, Lovenox)
▪ Heparin-IV, SC Lab: aPPT Need: sulfate
▪ Coumocin- PO Lab: PT, INR Need: vit K
▪ Lovenox-
• If you notice a clear liquid draining from the patient's left ear, what should you do next?
o Worried about CSF from skull fx, check fluid for glucose, send to lab
• What do you expect the vital signs of this patient to be? Explain.
o Increased HR, high RR, increase BP patient is in distress and anxious
• The ENT specialist applies nasal ointment that includes topical Lidocaine and
epinephrine. What are the indications and desired outcomes of these two
agents?
o Lidocaine pain, epi is vasoconstrictor
• The bleeding continues, so the ENT decides to use a Pledget (nasal tampon)
impregnated with cocaine. Why cocaine?
o Cocaine- potent anesthetic and vasoconstrictor
GNRS 555-Case Study EXAM Upper
Respiratory Diseases Questions With Answers
Rated A+
, GNRS 555-Case Study EXAM Upper
Respiratory Diseases Questions With Answers
Rated A+
• How long should the pledgets remain in the nose?
o 2-3 days
o Need ENT to place and remove pladget
• While the pledgets inside the nose, the patient needs to sneeze, what should tell the patient?
o Sneeze with mouth open
• Remember the pre-op management (consent, precautions (bleeding and infection), etc).
o Consent- patientneeds to consent unless unconscious
o Precautions- know about bleeding and risk infection
• Formulate a nursing diagnosis with highest priority post-op.
o Airway clearance effective
o Edema
• Sulfamethoxazole/Trimethoprim (Bactrim) antibiotic was prescribed for the
patient to take for 2 weeks. What teaching should you provide regarding the
indication and the administration of this antibiotic?
o Finish antibiotic in entirety
o Bactrim is for MRSA or staph infection
• During the rhinoplasty, packing is inserted and left for few days. What
teaching should you provide regarding the packing?
o No nose blowing, swimming, heavy lifting, strenuous activity
# 2: Allergic Rhinitis
GNRS 555-Case Study EXAM Upper
Respiratory Diseases Questions With Answers
Rated A+
, GNRS 555-Case Study EXAM Upper
Respiratory Diseases Questions With Answers
Rated A+
Mrs. Jones is a 32-year old who has a history of persistent allergic rhinitis.
• What is the difference between intermittent and persistent allergic rhinitis?
o Intermittent- >4 days a week or 4 months per year
o Persistent-symptoms present more than four days a week and for more than four
weeks per year
• What seasons of the year do allergies flare up? Why?
o Spring and fall
• What immunoglobulin rises when Mrs. Jones exposes to allergens?
o IgE
• What are the major chemical mediators that are released during exposure to allergens?
What are the major changes these mediators cause? How do these changes explain the
symptoms of sneezing, itching, and congestion?
o Prostaglandins, leukotrienes, histamines
▪ Release mediators,
Nursing Care:
• The best and most important step management of allergic rhinitis is to avoid
allergens. Teach the patient how to identify allergens. (Table 26-4)
• Mrs. Jones says "I want something to cure this allergy". How should you respond?
o We can manage symptoms, but not cure allergies
• Identify the connection between the chemical mediators that result from the
GNRS 555-Case Study EXAM Upper
Respiratory Diseases Questions With Answers
Rated A+
Respiratory Diseases Questions With Answers
Rated A+
• Mr. Davidson is a 24-year old boxer. He had a boxing game and received with a
nose injury. Due to heavy nosebleed, he was transferred to ER.
Health Assessment and Physical Exam:
Diagnostic Test:
Deviated septum is observed. X-ray is done to confirm the diagnosis.
• Patient is alert and oriented. He didn't lose his consciousness. The patient reports
severe nose pain. No other symptoms.
• Nursing Care:
• What should be your highest priority when you plan the care of this patient?
o Vent airway, BCs
• Which position should you assist the patient to and why?
o Up right position, head slightly forward
• How do you differentiate between anterior nasal bleeding and posterior nasal bleeding?
o Posterior: secondary to hypertension, older people, coughing, more dangerous, back of
throat
o Anterior: stops spontaneously, not life threatening, able to see
• What are some of the nursing interventions that can help control the bleeding of this
patient? Provide rationale.
o High fowlers, pinch nose, head tilt forward, acetaminophen, nasal sponges,
nasal packing, medication for pain, Tylenol (no NSAIDS)
GNRS 555-Case Study EXAM Upper
Respiratory Diseases Questions With Answers
Rated A+
, GNRS 555-Case Study EXAM Upper
Respiratory Diseases Questions With Answers
Rated A+
• What is the appropriate way to apply pressure to stop the epistaxis? How and for how long?
o Pinch nose against septum 10-15 mins, up right, lean forward, ice
• Would you insert gauze into the bleeding nostril in this case? Why?
o NO because patient has a fx. If stops in 10-15 mins then no gauze
• Considering the bleeding, what medications would be contraindicated?
o NSAIDS, (aleve, advil, ibuprofen) anticoagulants (warfarin, heparin, Lovenox)
▪ Heparin-IV, SC Lab: aPPT Need: sulfate
▪ Coumocin- PO Lab: PT, INR Need: vit K
▪ Lovenox-
• If you notice a clear liquid draining from the patient's left ear, what should you do next?
o Worried about CSF from skull fx, check fluid for glucose, send to lab
• What do you expect the vital signs of this patient to be? Explain.
o Increased HR, high RR, increase BP patient is in distress and anxious
• The ENT specialist applies nasal ointment that includes topical Lidocaine and
epinephrine. What are the indications and desired outcomes of these two
agents?
o Lidocaine pain, epi is vasoconstrictor
• The bleeding continues, so the ENT decides to use a Pledget (nasal tampon)
impregnated with cocaine. Why cocaine?
o Cocaine- potent anesthetic and vasoconstrictor
GNRS 555-Case Study EXAM Upper
Respiratory Diseases Questions With Answers
Rated A+
, GNRS 555-Case Study EXAM Upper
Respiratory Diseases Questions With Answers
Rated A+
• How long should the pledgets remain in the nose?
o 2-3 days
o Need ENT to place and remove pladget
• While the pledgets inside the nose, the patient needs to sneeze, what should tell the patient?
o Sneeze with mouth open
• Remember the pre-op management (consent, precautions (bleeding and infection), etc).
o Consent- patientneeds to consent unless unconscious
o Precautions- know about bleeding and risk infection
• Formulate a nursing diagnosis with highest priority post-op.
o Airway clearance effective
o Edema
• Sulfamethoxazole/Trimethoprim (Bactrim) antibiotic was prescribed for the
patient to take for 2 weeks. What teaching should you provide regarding the
indication and the administration of this antibiotic?
o Finish antibiotic in entirety
o Bactrim is for MRSA or staph infection
• During the rhinoplasty, packing is inserted and left for few days. What
teaching should you provide regarding the packing?
o No nose blowing, swimming, heavy lifting, strenuous activity
# 2: Allergic Rhinitis
GNRS 555-Case Study EXAM Upper
Respiratory Diseases Questions With Answers
Rated A+
, GNRS 555-Case Study EXAM Upper
Respiratory Diseases Questions With Answers
Rated A+
Mrs. Jones is a 32-year old who has a history of persistent allergic rhinitis.
• What is the difference between intermittent and persistent allergic rhinitis?
o Intermittent- >4 days a week or 4 months per year
o Persistent-symptoms present more than four days a week and for more than four
weeks per year
• What seasons of the year do allergies flare up? Why?
o Spring and fall
• What immunoglobulin rises when Mrs. Jones exposes to allergens?
o IgE
• What are the major chemical mediators that are released during exposure to allergens?
What are the major changes these mediators cause? How do these changes explain the
symptoms of sneezing, itching, and congestion?
o Prostaglandins, leukotrienes, histamines
▪ Release mediators,
Nursing Care:
• The best and most important step management of allergic rhinitis is to avoid
allergens. Teach the patient how to identify allergens. (Table 26-4)
• Mrs. Jones says "I want something to cure this allergy". How should you respond?
o We can manage symptoms, but not cure allergies
• Identify the connection between the chemical mediators that result from the
GNRS 555-Case Study EXAM Upper
Respiratory Diseases Questions With Answers
Rated A+
