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Cough, Vomiting & Syncope

Cough, Vomiting & Syncope. UNIT –II COMMON SIGNS & SYMPTOMS. Topics: Cough, vomiting and syncope Prepared by, Mrs. Anju Ullas Lecturer Dept. of Medical Surgical Nursing Yenepoya Nursing College. Learning objectives. Students will be able to:

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Cough, Vomiting & Syncope

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  1. Cough, Vomiting & Syncope

  2. UNIT –IICOMMON SIGNS & SYMPTOMS Topics: Cough, vomiting and syncope Prepared by, Mrs. AnjuUllas Lecturer Dept. of Medical Surgical Nursing Yenepoya Nursing College

  3. Learning objectives Students will be able to: • Define cough, vomiting and syncope the electrolyte imbalance. • List down the types of cough • explain its causes, pathophysiology, clinical manifestations, diagnostic evaluation , complications and management of cough, vomiting and syncope.

  4. Cough Meaning A cough is a common reflex action that clears the throat from mucus or foreign irritants.

  5. A cough that lasts for less than three weeks is an acute cough. • A cough that lasts between 3 and 8 weeks, is a subacute cough. • A persistent cough that lasts more than eight weeks is a chronic cough.

  6. Causes • Clearing the throat • Respiratory infection – cold and flu • Smoking • damage to the vocal cords • bacterial infections such as pneumonia, whooping cough, • pulmonary embolism • Gastroesophageal reflux disease • Medications – Enelapril, lisinopril

  7. Types of cough • Dry cough • Wet cough • Stress cough • Barking cough • Whooping cough

  8. Non pharmacological Treatment • Keep hydrated by drinking plenty of water. • Elevate the head with extra pillows when sleeping. • Gargle hot salt water regularly to remove mucus and soothen the throat. • Avoid irritants, including smoke and dust. • Add honey or ginger to hot tea to relieve cough and clear airway.

  9. Pharmacological management • Steam Inhalation • Oral Antiobiotics • For 3 days • Cefotaxim, Amoxicillin, ciprofloxacin • 500mg, two times a day • Cough lozenges. • Cough syrup

  10. nasal inhalers like ipratropium bromide (Atroven) • cough syrup - diphenhydramine (Benadryl) 

  11. Nursing Management Nursing diagnosis • Ineffective airway clearance related to secretion as evidenced persistent cough.

  12. Nursing Interventions • Auscultate breath sounds  • Monitor respiratory patterns, including rate, depth, and effort. • Monitor blood gas values and pulse oxygen saturation. • Position client to optimize respiration (e.g., head of bed elevated 45 degrees and repositioned at least every 2 hours).

  13. Encourage client to use incentive spirometer. • Observe sputum, noting color, odor, and volume • Breathing and coughing exercises • Provide oral care every 4 hours • Provide chest physiotherapy and suctioning • Encourage activity and ambulation • Encourage fluid intake • Administer medications and oxygen.

  14. Vomiting Vomiting is a forceful expulsion of stomach contents

  15. Causes • Eating too much food or drinking • food poisoning • indigestion • infections • motion sickness • pregnancy-related morning sickness • headaches • anesthesia • chemotherapy

  16. Vomiting emergencies • vomits for more than one day • suspects food poisoning • has a severe headache accompanied by a stiff neck • has severe abdominal pain • Blood in the vomits

  17. Colour • Bright red -bleeding from the esophagus • Dark red vomit with liver-like clots -profuse bleeding in the stomach • Coffee-ground-like vomit – minor bleeding in the stomach • Yellow vomit - bile, indicating that the pyloric valve is open and bile is flowing into the stomach from the duodenum

  18. Complications • abdominal pain • fever • Light-headedness • dry mouth • decreased urination • fainting • confusion • vomiting blood • Dehydration

  19. Management • Identify the cause • Anti emetics • Increase the fluid intake • ORS • Blood transfusion

  20. Nursing management Assessment • History collection –feeling of nausea, characteristics of vomitus • Physical examination- assess abdomen, auscultate all four quadrants • Monitor and document vital signs • Assess skin turgor and oral mucous membranes for signs of dehydration.

  21. Monitor BP for orthostatic changes  • Assess color and amount of urine. Report urine output less than 30 ml/hr for 2 consecutive hours. • Note presence of nausea, vomiting and fever. • Monitor serum electrolytes and urine osmolality, and report abnormal values.

  22. Nursing diagnosis • Deficient fluid volume related to vomiting as evidenced by decresed skin turgor/ increased weight loss/dry mucus membrane

  23. Nursing interventions • Urge the patient to drink adequate amount of fluid. • Aid the patient if he or she is unable to eat without assistance, and encourage the family to assist with feedings, as necessary. • Emphasize importance of oral hygiene. • Provide comfortable environment  • Maintain intake output chart

  24. Provide measures to prevent excessive electrolyte loss  • Administer blood products if prescribed

  25. Syncope

  26. Definition SYNCOPEis defined as ‘sudden andtransientlossofconsciousness which is secondaryto period of cerebralischemia’’

  27. Predisposingfactor NONPSYCHOGENIC Sitting in an upright position orstanding Hunger Exhaustion Poor physical condition Male sex Hot,humid,crowded environment Ageb/w16-35 PSYCHOGENIC Anxiety Emotional stress Unwelcomenews Pain(sudden and unexpected) Sight of blood orof surgical Dentalinstruments

  28. Pathophysiology stress release ofcatecholamine change of tissue perfusion ,decrease peripheralvascularresistance,increase bloodflow Pooling of blood

  29. decrease in circulatory volume decrease in cerebral bloodflow SYNCOPE decrease in bloodpressurecompensatory mechanismareactivated

  30. Classification STRUCTURA L CARDIO-PUL MANARY DISEASE CARDIAC ARRHYTHMIAS NEURALLY MEDIATED ORTHOSTATIC CEREBRO-VAS CULAR

  31. Clinical manifestation PRESYNCOPE SYNCOPE POSTSYNCOPE

  32. PRESYNCOPE EARLYSYMPTOMS Feelingof warmth Loss of colour:pale orashen grey skintone Heavy perspiration Complaint of feeling bador faint Nausea Blood pressure aprox .At baseline tachycardia LATE SYMPTOMS Pupillarydilatation Yawning Hyperpnea coldness in hands and feet Hypotension Bradycardia Visualdisturbances Dizziness Loss ofconsciousness

  33. SYNCOPE • Breathing irregular;jerky,gasping • Pupil dilate,death likeappears • Bradycardiya • Pulse weakand • Decreased bloodpressure.

  34. POSTSYNCOPE • Pallor,nausea,weakness.sweatingfrom few min. to manyhrs. • Short period of mentalconfusion • Disorientation • Blood pressure andheart rate-normal • Tendency of secondattack • if allowed to stand or sit toosoon

  35. Familyhistory • Sudden unexplaineddeath • Deafness • Arrhythmias • Congenital heartdisease • Seizures • Metabolic disorders • Myocardial infarction at youngage

  36. History • Time andday • Activities preceding (recurrent/at rest, exercise associated, onstanding) • Prodromes, associatedsymptoms • Duration ofLOC • Injuries • Medications,ingestions • CardiacHistory

  37. M a n a g e m e n t

  38. Presyncope • Procedure should bestopped • P-Patient placed into the supineposition with the legs slightlyelevated

  39. A- airway • B- breathing • C- circulation • D- drugs

  40. Syncope • Step 1:- Assessconsciousness • Step 2:-Call forassistence • Step 3:-Position the patient:- placingthe patient in supineposition • Step 4:-Assess and openairway • Step 5:-Assess airway potencyand breathing • Step 6:-Assesscirculation

  41. IF THE PATIENT CONTINUES TOREMAIN UNCONSCIOUS SUMMON MEDICAL ASSISTANCEIMMEDIATELY

  42. Step 8:-Administeroxygen • Step 9:-Monitor vitalsigns • Step 10:-provide definitivemanagement • Step 11:-delay patientrecovery

  43. Definitivemanagement • Loosening ofclothes • Respiratory stimulant:-aromaticammonia • Cold towel on patient’sforehead. • Blanketplaced • If bradycardia persist:-anticholinergics atropine-0.5mg or max 3mg

  44. Postsyncope • Patient should not be subjectedto additional dental care. • The possibilities of second episodeof syncope during this period oftime. • Prior to dismissal ,the doctor should determine fromthe patientwhat the primary precipitating event was and what other factors may have been presentsuch as hunger orfear.

  45. Precaution • Controlling the predisposingfactors before the patient enters the treatmentarea • It should be made certain that the patient has eatenrecently • a comfortableenvironmentaltemperatureand humidity • Stress reduction modalities can beemployed • Sedation through variety ofdrugs • Reducing anxiety • Proper positioning and receiving supplemental oxygen

  46. Treatment • Immediately stop any dental treatment goingon • Loosen tightclothing • Place the patient in head low position With lower limbelevated • (trendelenburgposition) • monitorpulse • If pulse isnormal • Sprinkle coldwater • Carry a gauge dipped in aromatic spirit of ammonia close to patients nostrils • Ifbradycardia • Injection of atropine 6mgi.v. • Injection of mephentramine 10-30 mgi.m. • If patient is still not responding support respiration(start • oxygen)

  47. Prevention • Proper positioning ofpatient

  48. Relief ofanxiety. • Everypotentialpatientmust be recognised andevaluatedfor the presence ofdental anxiety • Collect medical history

  49. Nursing interventions • Prevent injury • Educate patient to change positions slowly • Reevaluate medications, review any that may cause syncope • Monitor for changes in level of consciousness. • Promote adequate fluid intake

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