Phenylephrine: Medical Information PDF

**Phenylephrine - found in just about every decongestant you can buy; now deemed no more effective than a placebo** - Found in dayquil, nyquil, robitussin, benadryl, sudafed - Also used to make crystal meth Epistaxis - **A nose bleed!** - This is a common problem because of the many cap...

**Phenylephrine - found in just about every decongestant you can buy; now deemed no more effective than a placebo** - Found in dayquil, nyquil, robitussin, benadryl, sudafed - Also used to make crystal meth Epistaxis - **A nose bleed!** - This is a common problem because of the many capillaries within the nose  - Teach the patient:  - **Do not blow nose for 24 hrs** - **Seek medical attention if bleeding continues** - **Direct lateral pressure 5-15 min ** - **Do not lean back; lean forward** - **A posterior bleed is significantly more serious than a anterior bleed b/c it can't be easily reached and can cause further complications ** - Treatment for a posterior nosebleed:  - **Nose packing** (with nose tubes or tampons that have epinephrine on them) - After removal of tubes or packing to treat a posterior nosebleed, teach the patient to **avoid vigorous nose blowing, take tylenol for pain, no strenuous exercise, and it's okay to use saline nasal spray after healing ** - If a patient has clear fluid coming from one or both nares after a nasal fracture: - **Filter paper testing should be done to differentiate normal drainage from CSF** - If it's CSF, this could indicate a serious injury  - Treatment for a nasal fracture/facial trauma: - Rhinoplasty (aka a nose job) - Teach the patient: - **Stay in a semi-Fowler's position** - **Do not sniff upward or blow the nose** - **No forceful coughing** - **No straining for BM (can give stool softeners to help with this)** - **Can use cool compress on the nose/eyes/face ** - Be aware for **[repeated swallowing]** - **Repeated swallowing can indicate continuous bleeding on the posterior side of the nose and can lead to other complications ** - **Look in the back of the throat to see if there's any bleeding** - **Expected: bloody nasal discharge ** Facial Trauma/Skull Fractures - **[Priority for pt w/ facial trauma: airway assessment for gas exchange ]** - Common assessment findings often associated with skull fractures and brain trauma - **Battle sign** - **extensive bruising behind the ears**; also indicates a basilar skull fracture (most serious and most common type of skull fracture) - **Raccoon eyes** (periorbital bruising) - Positive Halo sign on filter paper  - Cushing's triad (possible but not as common) - **Fixed occlusion**: **stabilization of a fractured jaw by tightening the mouth shut with wires, allowing the teeth to heal in proper alignment ** - Teachings: - **Teach to have wire cutters with them at all times for whatever situations or emergencies may arise** - **Do NOT use a toothbrush; use an irrigation device like a waterpik to prevent messing up the wires ** - **How to live on a liquid diet** - **Collaborate with dietitian nutritionist to come up with ways to still receive proper nutrition at this time ** Laryngeal trauma - Injury to the voicebox, in the upper airway area - Can be a blunt or penetrating trauma or just a very direct hit to the area - **Immediate symptoms:** - **Subcutaneous emphysema** - **Inability to produce sound (aphonia)** - **Difficulty breathing ** - **Hoarseness ** - Priority: protect and maintain the airway, treat the injuries, then restore the voice and swallowing - This type of trauma requires hospitalization (no matter the extent) - Treatment: - Vocal rest - Steroids  - Surgery if serious enough  Common Upper Respiratory Infections - **Sinusitis/rhinosinusitis - inflammation of tissues in the sinuses** - **For those who have chronic sinusitis, nasal decongestants should NOT be used daily; this can cause rebound congestion!** - **Instead, they can take intranasal steroids like fluticasone (flonase), or use a neti pot or humidifier** - **Nasopharyngitis - "common cold"; inflammation of nasal passages and pharynx** - **Interventions for children:** - **Adequate fluid intake** - **Suctioning PRN - probably for those who don't know how to blow their nose ** - **Elevate HOB** - **Use a humidifier ** - **Pharyngitis - inflammation of pharynx (sore throat)** - **Can confirm pharyngitis is strep throat by completing a [rapid strep test and throat culture]** - **Complications of untreated strep throat infection:** - **Acute glomerulonephritis** - **Scarlet fever** - **Rheumatic fever** - **Abscess** - **Ear infections ** - **Tx for strep throat infection:** - **Penicillin antibiotic** - **Cephalosporin antibiotics ** - **If someone is severely allergic to penicillin, DO NOT GIVE CEPHALOSPORIN ABX; WE GIVE THINGS LIKE AZITHROMYCIN (aka macrolides)** - **Children are considered infectious to others at the [onset of strep s/s and up to 24 hrs after initiation of oral antibiotics ]** - **Warm saline gargles** can provide relief - **Tonsillitis - inflammation of the tonsils** - Names of tonsils: - **Palatine** - most common; either side of throat and can be visualized by the naked eye  - **Lingual** - found in the base of the tongue; not as common  - **Pharyngeal** - aka adenoids (in upper part of throat near nose; can obstruct breathing) - **Swollen adenoids can often result in ear infections d/t close proximity to the eustachian tubes ** - **Tonsillectomy surgery usually includes the removal of palatine tonsils ** - Considered when: - **Massive enlargement that results in difficulty breathing or swallowing occurs** - 7 or more tonsillitis episodes in the previous year - 5 or more tonsillitis episodes in previous 2 years - 3 tonsillitis episodes in the previous 3 years  - Post op: - Once the child is awake, alert, and able to swallow, they can have ice chips to start with  - **Most obvious sign of bleeding post op: repeated swallowing ** - Teaching: - **Avoid coughing after surgery** - **It's okay to start soft foods post op day 1 or 2** - **Ice packs can be used to manage swelling and discomfort ** - **Adenoidectomy is removal of the pharyngeal tonsils ** - **Rhinitis - inflammation of the nasal mucous membrane** - Allergic rhinitis - involves allergies - **Antihistamines are best used prophylactically in this case** - **1st line: intranasal corticosteroids ** - **Nonpharmacological: nasal irrigation ** - Perennial - revolves around the seasons and irritants correlated to them - **Rhinorrhea - mucus (snot) dripping; "runny nose"** - In pediatrics: - **OTC cold and cough meds do NOT work for kids under 6** Adenovirus infections - **Viral nasopharyngitis - adenovirus infection of the upper respiratory tract** - **Signs: rhinorrhea, nasal congestion, pharyngitis ** Treatment for acetaminophen overdose - **Acetylcysteine** - **best if given within 8 hrs of ingestion but can be longer than that**; also known as mucomyst (given IV or nebulized; also given for overdose) - **Activated** **charcoal** - **can be used within 1 hr of overdose** **Fun fact:** non-opioid antitussives have a high risk of being abused by teens  - **Large amounts can distort awareness and alter time perception, cause hallucinations and euphoria** - Also known as: lean, skittles, black beauties, brownies, dextro, poor man's ecstasy, gel, skittling, syrup, velvet - Head & Neck Cancers  - Pathophysiology - Very complex, requiring interdisciplinary approachA diagram of the face of a person Description automatically generated - **Usually squamous cell carcinomas** - **Twice as common in men than women** - **Prognosis based on stage/time found and metastasis** - **Usually slow growing, with a high cure rate** - **Starts with the mucosal layers becoming chronically irritated, then damaged tissue builds up, and abnormal cancer cells collect there, building the tumor** - **First visual sign: lesions in mouth or around the mouth** - **Leukoplakia** - white patches in the mouth or around the mouth - **Erythroplakia** - red patches around the mouth or in the mouth; contained to one area; if mets, goes to lymph nodes, muscles, and/or bone  - Risk Factors - **Smoking/tobacco products (chewing, dip, pouches, etc)** - **Alcohol abuse and frequent drinkers** - **Voice abuse (yelling, screaming, singing, etc)** - **Chronic GERD** - **Chronic laryngitis or pharyngitis** - **Working in factories, around dust, around chemicals, around radiation** - **Poor oral hygiene** - **People w/ hx of HPV (moreso w/ oral HPV) - yet also has a higher cure rate** - Interdisciplinary Team - **Oncology team** - **Nutrition/dietary** - **Speech language pathology (for both talking and swallowing)** - **Respiratory therapy ** - **Spiritual care/healing arts** - **Dentist** - before, during, after; depends on procedures needing to be done   - **Counseling/psychiatry ** - **PT/OT** - **Wound care ** - Assessment - Obtain health hx - **Tobacco use (ppd hx = ppd X \# of yrs)** - **ETOH use (how often, how many drink)** - **Risk factors - hx of chronic infection** - **Any oral sores or lesions ** - **Any swallowing difficulties** - **Hx of HPV** - Assess for **[warning signs]** - **Pain in area and hasn't gone away ** - **Lump in mouth, throat, or neck area ** - **New onset of difficulty swallowing ** - **Any new color changes in oral mucosa ** - **Sores in the mouth that have been there for more than 2 weeks** - **Persistent and unexplained bleeding in the mouth ** - **Numbness of oral cavity, mouth, lips, neck area (r/t nerve damage or tumor putting pressure on nerves)** - **Sudden change in fit of dentures** - **Burning when drinking hot liquids or citrus drinks or juices (r/t open sores in mouth)** - **Persistent or recurrent sore throat ** - **New hoarseness in voice or change in voice quality (r/t tumor size and could be preventing vocal cords from working properly)** - **Any recent anorexia or weight loss ** - Diagnostics - Labs - **CBC** - WBC ct (leukopenia), plt ct (thrombocytopenia, chronic bleeding → anemia) - **BMP** - electrolytes (K+, Na+, Cl-), kidney and liver function (BUN, creatinine, AST, ALT, Alk Phos) - worry about dehydration  - **Bleeding times** (PT, PTT, INR) - **Urinalysis** (tells if there's dehydration, any urinary abnormalities or UTIs) - **Low albumin/protein if malnourished** (especially from ETOH abuse) - 3.4-5.4 - **Patients who have a lower albumin have an increased risk for complications and poorer prognosis** - Check liver and kidney fxn for ability to metabolize drugs and rule out mets - **AST, ALT, Alk Phos** - **Worry about nephrotoxicity and hepatotoxicity** - **Test for HPV** - **Can do a STD panel** - **Treatments can vary if HPV positive** - **Biomarker testing** - **EGFR (epidermal growth factor receptor)** - **HER-2 ** - **X-ray (sometimes w/ barium swallow)** - **Can show general tumor borders** - **Can show mets** - **CT w/ contrast** - **MRI** - **PET scan - most associated with cancer ** - **Bone scans** - **Endoscopic exam** - **Done under conscious sedation** - **Camera down the throat ** - **Biopsy ** - **Tells what type of cells are present, so staging the cancer can then take place ** - **ONLY fine needle biopsy for these types of cancer since it can spread easily with a bigger needle or open incision ** - **Worry about scar tissue, inflammation, infection if doing an open incision ** - Interventions - **Goal**: to remove or eradicate the cancer while preserving as much function as medically possible  - **Radiation therapy** - **Small cancers in specific locations**  - 40% cure rate - **Proton beam therapy ** - **Pinpoints the tumor to deliver radiation to the targeted area ** - **S/E: ** - **Hoarseness** - **Recommend vocal rest** - **Hoarseness will improve within 4-6 weeks generally** - **Sore throat** - **Can offer ice chips, throat lozenges, fluids** - **Can gargle w/ salt water ** - **Numbing sprays/chloraseptic sprays can help** - **Can get SLP involved** - **Dysphagia** - **Skin problems** - **Avoid the sun and extreme hot or cold temperatures** - **Don't shave face or neck** - **Wear loose clothing** - **Impaired taste** - **Dry mouth (xerostomia)** - **Inform the patient that sometimes goes away, sometimes it doesn't** - **Can offer ice chips, lozenges, fluids** - **Oral rinses, artificial saliva (spray or gel)** - **Humidifier in the room** - **Problems with chronic dry mouth: dental decay and infections ** - **Chemotherapy - refer to Canvas post ** - **Often given w/ radiation (chemoradiation)** - **Drugs will vary** - **Most regimens include cisplatin and 5-FU** - **May require some breaks due to increased S/E** - **Biotherapy (targeted therapy)** - **Epidermal growth factor receptor inhibitor (EGFRI)** - **EX: Cetuximab** - **May require some breaks due to increased S/E** - **Immunotherapy** - **Utilizes natural defenses** - **Treat recurrent or metastatic head and neck cancers** - **EX: Pembrolizumab (Keytruda), Nivolumab (Opdivo)** - **Surgery** - Determined by staging - **Laser or photodynamic therapy** - **Traditional surgery w/ resections** - **Laryngectomy** - **Tracheotomy** - **Oropharyngeal ** - **Laryngeal and lymph node cancers may vary ** - Surgical Care - Preoperative - **Teach family and patient about tumor** - **Self-mgmt of airway, suctioning, pain, critical care environment, nutrition, feeding tube, d/c planning** - **SLP should be involved to begin working on communication ** - Operative - Laryngectomy procedure - table 26.2 - **Total = no voice and permanent stoma** - **Partial = temporary trach ** - **Neck dissection = removal of lymph nodes, SCM muscle, jugular vein, CN11 and surrounding soft tissue** - **Often lasts 8+ hrs ** - Postoperative - **They will go to the ICU** - **Monitor airway q1h for 24 hrs** - **VS q1h for 24 hrs** - **Hemodynamic status - constant monitoring ** - Comfort level - Complications - Airway obstruction r/t secretions, not swallowing, hematoma formation - Hemorrhage - Carotid artery rupture - Wound breakdown - Tumor recurrence  - General anesthesia or surgery complications  - SERIOUS COMPLICATIONS - **Carotid leak** - ***[Continuous oozing of bright red blood]*** - **Can quickly rupture** - **Call rapid response team** - ***[DO NOT APPLY PRESSURE ]*** - **Carotid rupture ** - ***[Large amount of bright red blood spurts ]*** - ***[HOLD CONTINUOUS DIRECT PRESSURE TO THE SITE]*** - ***[SECURE AIRWAY]*** - **Emergently take to OR for carotid resection ** - ***[DO NOT LEAVE THE PATIENT ]*** - Postoperative Interventions  - Maintain airway and gas exchange - **May need mechanical ventilation** - **Begin to wean quickly, use a trach collar w/ O2 and humidity** - **[Expect blood tinged secretions for 1-2 days]** - Total laryngectomy - laryngectomy tube (care is similar to trach tube) or laryngectomy button - No risk for aspiration  - **Cough and deep breathe** - **Oral suctioning** - Prevent aspiration - Teach the supraglottic method of swallowing  - For anyone w/ a partial laryngectomy or base of tongue resection  A screenshot of a computer screen Description automatically generated - Wound management - Stoma care - **Clean w/ sterile saline** - **Suture line care q1-2 hrs during first few days, then q4h** - **Stoma should appear bright pink and shiny w/o crusts**  - Grafts or flaps - **Evaluate graft and donor site q1h for 72 hrs** - **Cap refill, color, drainage, doppler at donor site** - **Report any changes to surgeon immediately ** - **Positioning - flaps should never be dependent ** - Pain management - **PCA pump for first few days, then switch to PO if permitted ** - Nutrition - **Can have a taste and smell change, so a nutritional consult is beneficial to help pick out some foods that they can have or might want/tolerate ** - Communication  - **Promote** - **Find alternative methods for communication ** - **EX: communication board** - **Speech therapy ** - Total laryngectomy - can later on do an esophageal speech (electrolarynx - electric voice box) - Psychosocial support  - **Body image may be affected** - **Provide time and patience ** - **Monitor for s/s of distress (nonverbal)** - **Make realistic goals**  A screenshot of a computer Description automatically generated - Nursing interventions - **Monitor airway for any obstructions** - Talking, O2 saturation level, work of breathing/RR, ABG levels - **Position the patient in Fowler's or Semi-Fowler's** - **Promote clearing secretions** - Suction, deep breathing and coughing, aspiration precautions  - Care Coordination - Home care mgmt - **Usually d/c after 2 weeks ** - **Humidifier at home** - **Medical alert bracelet** - Self-mgmt education  - **Trach care** - **Stoma care ** - **Nutrition - tube feeding and how to do ** - **Communication methods** - **Can return to normal activity within 4-6 weeks ** - **Can wear a stoma guard/cover **  - **Psychological preparation** - **Safe and effective care environment ** A list of medical tests Description automatically generated