Respiratory N172- Monitor/Manage/Teach

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foxyt14
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231215
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Respiratory N172- Monitor/Manage/Teach
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2013-09-08 19:45:26
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N172 Respiratory
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Respiratory....first 2 lectures
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  1. These chemoreceptors are found in the medulla and respond to changes in hydrogen ion concentration.
    Central Chemoreceptors
  2. These chemoreceptors are found in the carotid and aortic bodies and respond to decreases in:
    PaO2
    pH
    and increases in PaCO2
    Peripheral Chemoreceptors
  3. What do Central chemoreceptors stimulate?
    Increase in respiratory rate
  4. What do Peripheral chemoreceptors stimulate?
    the respiratory center
  5. What does a PFT do?
    it identifies if a person has an obstructive or restrictive defect with their lungs
  6. What does an increase in airway resistance indicate?
    Example....
    • Obstructive defect
    • COPD-hypersecretions, mucous
  7. What does a limitation in chest expansion indicate?
    Example....
    • Restrictive Defect
    • Asthma-narrowing of airway
  8. What do you tell a patient about prior to a PFT?
    Don't smoke 6-8 hrs before, and don't use your inhaler 4-6 hours before
  9. What PFT tells the amount of air that can ben quickly and forcefully exhaled after maximum inspiration?
    • Forced vital capacity
    • +80%
  10. What PFT tells the amount of air exhaled in the first second of Forced Vital Capacity?
    • Forced Expiratory volume in first second of expiration
    • (FEV1)
  11. What does the result of the FEV1 test tell you?
    it grades the severity of a persons airway obstruction
  12. What PFT will you use to differentiate a Obstructive from Restrictive defect?
    FEV1/FVC ratio
  13. What PFT will you perform when you want to monitor a persons bronchoconstriction with asthma?
    • PEFR
    • Peak Expiratory Flow Rate

    Maximum airflow rate during forced expiration
  14. When performing a PA for respiratory what do you inspect?
    • Respiratory rate, rhythm, quality, IE Ratio
    • Skin color
    • Shape of chest
  15. Where do you start auscultation of the lungs?
    What if they tire easily?
    Start at the apex....side to side and moving down.

    Start at bases....or divide it up and have breaks in between
  16. What changes does COPD cause in a persons thoracic cavity?
    Barrel chest from an in crease AP diameter related to chronic air trapping
  17. Ratio for normal inspiration : Expiration
    1 : 3
  18. Inspiration :  Expiration ratios for a person with:

    Asthma
    COPD
    Asthma....1:3 or 1:4....prolonged expiration

    COPD.....1 : 5
  19. Describe the normal sound heard over the lungs during percussion
    Resonance....low pitched
  20. Describe the sound heard over hyper-inflated lungs when performing percussion, like when a person has COPD and acute asthma when
    Hyperresonance.....Loud, low pitched
  21. Describe the sound heard over a gas filled stomach or intestine or pneumothorax when doing percussion
    Tympany.....loud drum
  22. Describe the noise you will hear when doing percussion over lungs with pneumonia
    Dull
  23. 3 Normal types/places of breath sounds and their ratios
    • Bronchovesicular 1:1
    • Bronchial 2:3
    • Vesicular 3:1
  24. Where do you hear Vesicular breath sounds and describe them.
    Heard over most lung fields...they are soft, low pitched and rustling sound
  25. Where do you hear Bronchovesicular breath sounds and describe them.
    Heard over the main bronchi...and they are loud and high pitched.  Sound like air blowing through a hollow pipe.
  26. Where do you hear Bronchial breath sounds and describe them.
    Over the trachea....and they are loud and high pitched.  Sound like air blowing through a pipe.
  27. What do you use "Egophony" to  diagnose?
    How do you do it?
    • Pneumonia and Pleural Effusion
    • While listening over the thorax, have the patient repeat the letter "e".  If it is heard as an "a", then they are positive for one of the above.
  28. What does "Whispered Pectoriloquy" diagnose and how do you do it?
    • Lung consolidation....Cancer (solid) and Pneumonia (fluid)
    • Have the patient whisper "1,2,3"...if it is heard through the stethoscope clearly/distinctly....then they have one of the two.
  29. Describe fine crackles...and what it means.
    High pitched sound heard before the end of inspiration (collapsed alveoli snap open).

    • Pneumonia
    • Early Pulmonary Edema
    • Atelectasis
    • Early CHF

    (Roll finger in hair by ears)
  30. Describe Coarse Crackles...and what does it mean.
    Series of long-duration, discontinuous low pitched sounds caused by air passing thru occluded mucous.

    • Pneumonia
    • Severe Congestion
    • COPD
    • Heart Failure
    • Pulmonary Edema
  31. Describe Rhonchi...and what does it mean.
    Continuous rumbling, snoring or rattling from obstruction of large airways with secretions.  Most prominent during expiration.

    • Pneumonia
    • COPD
    • Cystic Fibrosis
  32. Describe wheezes and what does it mean.
    High pitched squeak....first evident on expiration, but then evident on inspiration as obstruction increases.  Possibly audible without stethoscope.

    • Asthma (Bronchospasm)
    • COPD
    • Airway Obstruction
  33. Describe Stridor and what does it mean.
    Continuous musical sound as a result of a partial obstruction of the larynx or trachea.

    • Croup
    • Vocal Cord edema after extubation
    • Foreign body
  34. What do absent breath sounds mean?
    • Lobectomy
    • Pleural Effusion
    • Large atelectasis
  35. Describe Pleural Friction Rib...and what does it mean.
    Creaking or grating sound

    • Pneumonia
    • Pleurisy
    • Pulmonary Infarct
  36. Normal Lab Values for ABG's

    pH
    PaO2
    SaO2
    PaCO2
    HCO3
    • pH 7.35-7.45
    • PaO2 80-100 mmHg
    • SaO2 >95%
    • PaCO2 48-32 mmHg
    • HCO3 22-26
  37. Acid vs. Base
    Acid-low pH but high CO2 (hydrogen ions) (acidosis)

    Base-high pH low CO2 (hydrogen ions) (alkalosis)

    (hydrogen = acid)
  38. PaO2 <80mmHg=
    hypoxemia
  39. When we are in compensation for Respiratory Acidosis, what's the faulty system and what compensates?  Respiratory Alkalosis?
    • Respiratory
    • Metabolic Alkalosis

    • Respiratory
    • Metabolic Acidosis
  40. Describe compensation by Metabolic Alkalosis and Metabolic Acidosis.
  41. Describe compensation by Respiratory Acidosis and Respiratory Alkalosis.
  42. When we are in compensation for Metabolic Acidosis, what's the faulty system and what compensates?
    Metabolic Alkalosis?
    • Metabolic
    • Respiratory Alkalosis

    • Metabolic
    • Respiratory Acidosis
  43. How do I treat a person who is in Respiratory Acidosis? Respiratory Alkalosis?
    Increase their ventilation

    Decrease their ventilation
  44. How do I treat a person in Metabolic Acidosis?  Metabolic Alkalosis?
    Treat the problem and/or administer Sodium Bicarbonate (NaHCO3)

    Treat the problem, administer acid and/or dialysis
  45. Etiology of Respiratory Acidosis
    • Hypoventilation
    • Obstruction
    • COPD
    • Pulmonary Edema
    • Overdose (respiratory ctr depression)
  46. Symptoms of Respiratory Acidosis
    • Decreased mental status
    • Drowsiness
    • Tachy
    • Headache, weak, tremors
  47. Treatment for Respiratory Acidosis
    • TCDB
    • Aerosol Therapy/Suctioning
    • IPPB
    • IS
    • Pain Meds

    Artificial Airways/Mechanical Ventilation
  48. Etiology for Respiratory Alkalosis
    Hyperventilation due to anxiety, pain, fever or Pulmonary Embolism

    • Exercise
    • Mechanical Hyperventilation
  49. Treatment for Respiratory Alkalosis
    • Reassurance
    • Sedation/Pain Meds
    • Rebreathe CO2 (paper bag)
    • Reduce ventilator settings to decrease RR
  50. Etiology of Metabolic Acidosis
    • Low Base
    • Diarrhea, Renal Failure, Fistula, Pancreatic Drainage

    • Increased Acid
    • Alicylate OD
    • Sepsis
    • Shock
    • Starvation
  51. Treatment for Metabolic Acidosis
    • TREAT THE UNDERLYING CAUSE!!!
    • Monitor I&O and electrolytes
    • Correlate I&O with weight, VS, skin color, turgor and temp
    • Prevent Infection
    • Monitor arrhythmias
    • Protect from injury (seizures)
    • Monitor ABG's
    • In sever cases NaHCO3 may be ordered
  52. Etiology of Metabolic Alkalosis
    • Increased Base
    • NaHCO3 administration
    • Ingestion of Antacids (alkaloids)

    • Decreased Acids
    • Vomiting
    • N/G tube suctioning
    • Electrolyte Imbalance
  53. Symptoms of Respiratory Alkalosis
    • Increased Respiratory Rate
    • Cramps
    • Tetany
    • Paresthesias (tingly)
    • Seizures
  54. Symptoms of Metabolic Acidosis
    • Decreased Mental Status
    • Seizures
    • Fatigue
    • Hypotension
    • Anorexia/vomiting/Nausea
  55. Symptoms of Metabolic Alkalosis
    • Confusion
    • Hand Tremor
    • Light headedness
    • muscle twitch
  56. Treatment for Metabolic Alkalosis
    • TREAT THE UNDERLYING CAUSE
    • Monitor VS and electrolytes
    • Monitor I&O
    • Protect pt from injury
    • Admin Acid (Ammonium chloride)
    • Increase HCO3 excretion with Diamox
    • In sever cases dialysis may be ordered
  57. What drug will increase the excretion of HCO3 when a person is in Metabolic Alkalosis?
    Diamox
  58. When a person has COPD what will their ABG's looks like, how will the body compensate (2 ways)
    • Low pH <7.35
    • High PaCO2 > 48
    • High HCO3 >26

    • Compensated Respiratory Acidosis
    • Kidneys have kicked in to hold in or conserve HCO3 to help increase the pH back to a normal range
  59. What does a V/Q scan look for?

    Nursing Intervention?
    Assesses perfusion of the lung...or lack there of when a person has a pulmonary embolism

    minimal nursing intervention cuz it's like an x-ray
  60. What does a Bronchoscopy do?

    Nursing Interventions?
    It is used for diagnosis or treatment by a lighted scope being passed in to the bronchial tree.

    • NPO 6-12 hrs prior to test, and swallow eval done after test prior to food/fluids
    • HOB 30 degrees
    • Teach pt. may have a little blood, and a scratchy throat after
  61. Isotonic Solutions do what?

    Caution?
    Increases plasma volume.

    Since this solution doesn't cause a fluid shift in to other compartments, watch for HEMODILUTION (decrease in Hgb, Hct and Electrolytes)
  62. Hypotonic Solutions do what?

    Caution?
    They hydrate cells interstitial compartment...CELLS SWELL AND VESSELS Shrink

    It pulls fluid from the intravascular space to intracellular space.  Watch for HYPOTENSION, CEll and BRAIN EDEMA and DEATH
  63. Hypertonic Solutions do what?

    Caution?
    They hydrate and replace electrolytes.  Pulls ECF from interstitial space to intravascular space

    CELLS SHRINK and VESSELS SWELL.  Watch for Circulatory overload, irritation of vein walls and CELL DEHYDRATION
  64. What is a Thoracentesis used to do? 

    What are my nursing interventions?
    Removal of specimen for diagnosis, removal of pleural fluid or to instill medication

    Monitor pulse, color O2 saturation during procedure

    Apply dressing over the puncture site and position pt on unaffected side for 1 hr after.

    Recheck vital signs regularly after.
  65. What sort of respiratory condition will a person be in when they are experiencing an asthma attack?
    Respiratory Alkalosis initially....then Respiratory Acidosis.
  66. What is an asthma attack?
    Inflammation of the bronchials resulting in airflow obstruction caused by the inflammatory cascade.
  67. What's important to know about a person who has had an acute asthma attack?
    They are susceptible to another one for the next 4-10 hours that can be more severe and last longer
  68. Signs and Symptoms of an asthma attack
    • Dyspnea
    • Wheezing and Coughing...but not a good predictor of severity of their attack
    • Tight Chest
    • Prolonged Expiration
    • Use of Accessory Muscles
    • Increased RR
    • Severe Anxiety
    • Silent chest
    • Hypoxemia
  69. Signs of Hypoxemia
    • Restlesness
    • Inappropriate Behavior
    • Increased pulse and BP
  70. When percussing a person during an asthma attack what will I hear?
    Hyper-Resonance
  71. A person with Emphysema will be in Respiratory_____________ .  Compensated with ________________.
    Acidosis

    Metabolic Alkalosis
  72. What is Chronic Bronchitis?
    When a person has a chronic productive cough for 3 months in each of 2 consecutive hears.

    It is an inflammation of the Bronchi and Bronchioles due to chronic exposure to irritants
  73. 2 Types of COPD
    Chronic Bronchitis and Emphysema
  74. What is Emphysema?
    When a person has a loss of lung elasticity and hyperinflation of lung tissue.  It causes destruction of the alveoli leading to decreased surface are for gas exchange, carbon dioxide retention.
  75. How do you get COPD?
    Continued exposure to noxious particles causing an inflammation of the airways, hyperplasia of cells and increased production of mucous.
  76. What does hyperplasia of cells cause in a person with COPD?
    It reduces the diameter of their airway and increases the difficulty in clearing secretions.
  77. Signs and symptoms of COPD
    • Dyspnea upon exertion
    • Productive cough....mostly in the AM
    • Crackles/Wheezes
    • Rapid/Shallow Respirations
    • Barrel Chest
    • Thing Extremities
    • Clubbing
    • Pallor and Cyanosis
    • Decreased O2 Saturations
  78. When percussing a person with COPD what will I hear?
    Hyper-Resonance due to trapped air
  79. Car Pulmonale
    People with COPD get this....right sided heart failure
  80. When a person is in the late stages of COPD they will look like this....
    Super thin with enlarged neck muscles
  81. Nursing Interventions for a person with COPD
    • QUIT SMOKING!!!
    • Drug Therapy
    • O2 Therapy
    • Airway Clearance Techniques
    • Breathing Retraining
    • Weight Management
    • Good Fluid Intake
  82. What are Airway Clearance Techniques?
    • Teach Huff Coughing (Forced Expiratory Cough)
    • Chest Physiotherapy
  83. Examples of Breathing Retraining
    • Pursed Lip Breathing...prolongs exhalation and slows RR
    • Diaphragmatic Breathing....use of diaphragm and not accessory muscles
  84. What's the problem with weight and the person with COPD?
    They are underweight and this correlates to a poor prognosis.  Teach how to make eating less exhausting.
  85. Why increase fluids on a person with COPD?
    Cuz of the mucous accumulation...but not good if they have CHF or Renal failure too!!

    3L/Day
  86. When you inspect a person with COPD what are you looking at?
    • Respiratory Rate, rhythm, quality and IE Ratio
    • Skin Color
    • Shape of Chest
    • Use of Accessory Muscles?
  87. What is the minimum O2 saturation level for a person with COPD?
    90%
  88. When Auscultating a persons lungs with COPD what strategies do I use?
    If the patient tires easily start at the bases...or separate your listening with breaks in between
  89. What is postural drainage?
    A positioning technique that drains secretions from specific segments of the lung and bronchi into the trachea.

    • Put in different positions for 5 min each.
    • Do 1 hr before meals or 3 hours after
    • Side lying position if pt cant tolerate a head down position
    • Use aerosolized bronchidilators and hydration therapy prior to procedure
    • Do 2-4 times a day
  90. Cachexia
    • Loss of weight
    • Muscle Atrophy
    • Fatigue/Weak
    • Loss of appetite
  91. When should a person drink if they have COPD?
    between meals
  92. How do you evaluate a person with asthma?
    • Is the client able to.....
    • maintain adequate gas exchange
    • prevent acute attacks
    • have relief of symptoms
    • adhere to the medication regime
  93. How do you evaluate a person with COPD?
    • Is the client able to.....
    • maintain adequate gas exchange
    • be able to keep a patent airway
    • remain free from infection
    • maintain a healthy weight
  94. What's the Gold standard for care of a patient with COPD?
    • Prevention of disease progression
    • Relieve symptoms and improve exercise tolerance
    • Prevent and treat complications
    • Promote patient participation in care
    • Prevent and treat exacerbations
    • Improve quality of life and reduce mortality risk
  95. Why are the lungs a common site for both primary and secondary lung cancer?
    Venous return and lympathics bring tumor cells from distant sites in the body to the heart and pulmonary circulation which provides a hospitable environment for the tumor cell
  96. Assess for the risk of lung cancer is divided in to 3 categories
    • Smoker
    • Non smokers, but former smokers
    • True non smokers
  97. 10 years following cessation of smoking, lung cancer mortality is reduced...
    30-50%
  98. How do cigarettes cause cancer?
    The carcinogens inhaled are a lower airway irritant that changes bronchial epithelium
  99. Gender differences of lung cancer....
    • Higher incidence in men
    • More men die

    BUT....women smokers have a higher risk of developing LC than male smokers
  100. What lobes of the lungs does the cancer prefer?
    upper
  101. What is detected before the actual cancer in the lung?
    Metabolic changes....

    • Hypercalcemia
    • Anemia
    • SIADH
    • Leukocytosis
  102. SCLC occurs in people who....
    are smokers or have been exposed to environmental carcinogens.
  103. First sign of SCLC?  Prognosis
    Paraneoplastic Syndromes

    Less than 2 years to live.  Metastasizes early and grows FAST
  104. Staging of SCLC
    Limited...tumor is confined to the chest and regional lymph nodes

    Extensive....cancer has extended to the chest wall or to other parts of the body.
  105. If you have Extensive SCLC what is your estimated life span?
    7-10 months
  106. Whats the cancer most common in people who haven't smoked?
    NSCLC....most common in women
  107. How does somebody know that they have NSCLC?
    something else starts to bother them....cuz there are no clinical manifestations till it is widespread/metastasized

    OR

    Get a chest x ray for something else and see masses
  108. Once the lung cancer has spread....what will a person see that may alert them to something is wrong?
    • Persistent cough with sputum
    • Blood tinged Sputum
    • Chest pain
    • Dyspnea
    • Wheezes
  109. Late manifestations of lung cancer....
    • anorexia/weight loss
    • NVD
    • Hoarseness
    • Dysphagia
    • SVC Syndrome
    • Palpable Lymph nodes in the neck
  110. Heart conditions from late manifestations of lung cancer...
    • Cardiac Tamponade
    • Dysrhythmias

    Pericardial Effusion
  111. Where does lung cancer usually metastasize to?
    • long bones
    • vertebrae
    • liver
    • adrenals
    • BRAIN
  112. Collaborative management of a lung cancer patient?
    • ID risk factors and appropriate referrals for screening
    • Promote smoking cessation and healthy living
    • Nursing care related to chemo, targeted therapy, radiation and surgery
  113. General nursing care for patient with lung cancer
    • Provide support and reassurance
    • Care of the patient
    • Management of disease symptoms and side effects of treatments
    • Assess smoking cessation readiness
    • Patient teaching on pain management
    • Coping strategies
  114. What is the treatment of choice for people with Stage I and II NSCLC?
    Surgical Resection
  115. What are factors that effect survival for cancer?
    the size of the primary tumor and co morbidities
  116. Pneumonectomy
    removal of entire lung
  117. Lobectomy
    removal of one or more lobes of the lung
  118. Segmentectomy
    Removal of large portion of a lobe
  119. Wedge Resection
    removal of a small portion of a lobe
  120. Sleeve lobectomy
    removal of entire lobe and part of the bronchus
  121. Surgery is very rare for the patient with SCLC...in what case would you do surgery?
    when a patient has a solitary pulmonary nodule without metastases or regional lymph node involvement
  122. Preoperative care for lung cancer
    • What to expect post op ....
    • TCDB
    • IS
    • Pain meds
  123. How do you stage NSCLC?
    TNM staging system

    • T=tumor size, location and degree of invasion
    • N=regional lymph NODE involvement
    • M=presence or absence of distant metastases
  124. TNM for NSCLC assists with designation of....
    estimating disease progression and appropriate treatment
  125. When a person has a chest tube put in after surgery what is important?
    • XRAY to confirm placement
    • Note drainage
    • Palpate for Crepitus
    • Pain Management
  126. What are the potentials for complications after lung surgery?
    • VTE (Venous Thrombeo Embolism)
    • Pulmonary Edema
    • Cardiac Dysrhythmias
    • Hemorrhage
    • Hemothorax
    • Hypovolemic shock
  127. What's a Hemothorax?
    Accumulation of blood in the pleural space
  128. Hemoptysis
    Blood tinged sputum
  129. How do you manage pain for a person after surgery?
    If they have a PCA you can look at how many times they push the button in an hour, if it is excessive ask them how this approach is working.  May need to change it.
  130. If you see drainage around a chest tube or incision site....what do you note?
    Color and circle around the drainage stain so you can tell if it is getting larger
  131. Why will a person with a chest tube have MULTIPLE CHEST X RAYS?
    to check for placement....and to make sure they are progressing
  132. Primary treatment for SCLC
    Chemo
  133. When do you use chemo with NSCLC?
    as adjuvant therapy when a person has a non resectable tumor
  134. What does targeted therapy do for cancer?
    blocks the growth of molecules involved in tumor growth
  135. When is Radiation therapy used for lung cancer?
    • Treats both NSCLC and SCLC
    • Curative, palliative and adjuvant therapy
    • Used in combo with chemo
    • Used for patients that cant tolerate surgery
    • Pre-op to reduce the size of the tumor before surgery
  136. Name some complications of radiation therapy for lung cancer
    • esophagitis
    • skin irritation
    • radiation pneumonitis
  137. Palliation for lung cancer
    • treatment of dyspnea and pain
    • radiation therapy
    • laser therapy
    • Thoracentesis
    • Pleurodesis
  138. Where do laryngeal cancers usually metastasize to?
    • mucosa
    • muscle
    • bone
    • METS to lung and liver
  139. Risk factors for Head and Neck cancer
    • Poor diet in fruits and vegetables
    • HPV
    • 50+
    • Tobacco and alcohol
  140. Who usually identifies head and neck cancers?
    • Dentist.....
    • They should assess area under the tongue using a flashlight to visualize the area.  Also palpate for lumps
  141. What are the white and red patches called found in the mouth that are a sign of cancer?
    • Leukoplakia (white)
    • Erythroplakia (red)
  142. Clinical manifestations of cancer of the oral cavity
    • painless growth in the mouth
    • ulcer that doesn't heal
    • change in the fit of dentures
    • pain in the late stages cuz aggrevated by acidic foods
  143. Manifestations of cancers of oropharynx, hypopharynx and supraglottic larynx
    • C/o persistent unilateral sore throat
    • otalgia (ear pain)
    • hoarseness....that lasts longer than 2 weeks
    • lump in throat
  144. Late stages of head and neck cancers
    • Pain
    • dysphagia
    • decreased motility of the tongue
    • airway obstruction
    • cranial nerve neuropathies
  145. Brachytherapy
    placement of a radioactive source into or near the tumor.  The goal is to deliver high doses of radiation to the target area while limiting exposure of surrounding tissues
  146. Nursing Care for a patient who has had radiation treatment for head and neck cancer

    (Monitor)
    • Assess skin, mouth; area being radiated.
    • Check patients ability to swallow and communicate
    • Is there redness, skin irritation, swelling, dry mouth??
    • Bone pain?
    • Nausea
    • Fatigue
  147. After radiation treatment for Head and neck cancer when should you notify a doctor immediately?
    if you have a moist skin reaction
  148. After radiation what's the deal with the sun?
    No sun exposure for 1 YEAR after treatment is done!!!
  149. Fatigue is a common side effect of radiation...what should you teach the patient to do to manage this?
    • Frequent rest periods during the day
    • light exercise
  150. Xerostomia
    dry mouth
  151. How do you treat Xerostomia?
    • increase fluid intake
    • chew sugarless gum and candy
    • use nonalcoholic mouth rinses (baking soda too)
    • Brush teeth with soft tooth brush
    • Mouth rinses with 1/2 water and 1/2 NS
  152. What medication can increase saliva production?
    Salagen
  153. Stomatitis
    Inflammation of the mucous membrane in the mouth
  154. Cordectomy
    partial removal of one vocal cord when there is a superficial tumor
  155. Hemilaryngectomy
    removal of one vocal cord or part of a cord...requires a TEMPORARY Trach
  156. Supraglottic Laryngectomy
    removing structures above the true cords, the false vocal cords and epiglottis...requires a temporary tracheostomy
  157. What 2 surgeries will the patient receive a temporary Trach?
    Hemilaryngectomy and Supraglottic Laryngectomy
  158. What is the patient at high risk for with the supraglottic laryngectomy?
    high risk for aspiration  cuz it removes the epiglottis
  159. Which 2 surgeries allow the voice to be preserved, but the quality of the voice is breathy and hoarse?
    hemilaryngectomy and Supraglottic Laryngectomy
  160. Total Laryngectomy
    used for treatment of advanced lesions...removal of the entire larynx and pre-epiglottic region
  161. Which surgery requires a permanent tracheotomy?
    Total Laryngectomy
  162. When is a Radical Neck dissection performed?
    and what does it do?
    With a total laryngectomy

    Decreases the risk of lymphatic spread

    Other structures may be removed as well....thyroid, IJV, mandible....
  163. What's a modified neck dissection?
    Surgery that spares as many structures as possible
  164. Prior to having surgery on the head and neck make sure the patient visits....
    a dentist specializing in oncology
  165. Prior to surgery....who should the patient meet with besides the surgeon?
    Medical Oncologist Consultant
  166. What plans should be in place prior to head and neck surgery?
    • plan to prevent airway obstruction
    • hemorrhage
    • wound problems
  167. Prior to head and neck surgery it is the physicians responsibility to discuss
    • Risks of surgery
    • If trach is needed and for how long
    • complications?
    • Disfigurement?
    • Wound Problems
  168. Prior to radiation/surgery the patient should have a speech eval....why?
    • plan for voice restoration
    • swallow exercises
    • prevention of long problems with eating
  169. Head and Neck surgery Pre Op teaching....
    • deep breathing
    • pain management
    • communication
    • special breathing with Trach
    • Nutrition
    • ambulation
  170. Priorities or nursing care for a patient after head and neck surgery.....
    • Airway maintenance
    • Ventilation
    • Gas Exchange
    • Reconstructive tissue care
    • pain control
    • Nutrition
    • PT
    • Psych adjustment
  171. How may a person eat after head and neck surgery?
    • NG Tube
    • G Tube
    • PEG
    • TPN
  172. After head and neck surgery what do I check every 4 hours?
    Incision sites, dressings.....

    Color, amount, and drainage
  173. How is O2 delivered to a person with a trach?
    with a humidifier to prevent drying of secretions
  174. Things to assess after head and neck surgery...
    • auscultation of breath sounds
    • SPO2
    • communication
    • pain
    • ambulation
  175. What is the PT's main concern after head and neck surgery?
    providing patient with exercises to maintain strength and movement in the affected should and neck....to prevent development of frozen shoulder
  176. Should a person use the valsalva maneuver after head and neck surgery?
    NOT if they have a hole in their throat
  177. When a person has reconstruction after head and neck surgery what am I concerned with?
    Rejection of new tissues...any flaps/grafts
  178. Details of trach/stoma care.....
    • Patient/Family Education on care
    • Body image/emotional support
    • Trach Care
    • Caution when showering, shaving, applying makeup (Shield opening)
    • Bedside humidifier
    • Medic Alert Bracelet
  179. How do you shield a trach stoma for a shower?
    Use a....

    • manufacturers cover
    • dry cloth
    • childs bib with the plastic faced outward
  180. Bloom-Singer Prosthesis
    voice rehab....

    it is a soft plastic device inserted in to the fistula made btwn the esophagus and trachea

    Allows for air from the lungs to enter the esophagus by way of the stoma

    Speak manually by blocking stoma....words are formed by moving tongue and lips
  181. Electrolarynx
    voice rehab....

    it is a hand held batter powered device that speech is made by sound waves
  182. Cooper Rand device
    Voice Therapy....

    Special plastic tube placed in the corner of the mouth to create vibrations
  183. Artificial larynx
    voice therapy

    placed against the neck rather than in the mouth
  184. Esophageal speech
    speech therapy....

    method of swallowing, trap the air in the esophagus and release air to creat sound
  185. African Americans and respiratory disease process
    • highest mortality rates
    • highest incidence of lung cancer
    • most likely to die from lung cancer
  186. What is the prediction when you are diagnosed with asthma at an older age?
    you will have more complications due to your older immune system and comorbidities
  187. Why do people get chest tubes?
    • Pneumothorax (collapsed lung)
    • Hemothorax (blood in lungs)
    • Post op drainage
    • lung abscess
    • Pleural Effusion (fluid in lungs)
  188. What do you assess on a patient with a chest tube?
    • Any signs of resp. distress? (deviated trach?)
    • Is the dressing in tact? Crepitus?
    • Are there any kinks in the tubing?
    • Clots in tubing?
    • Is there the expected amount of drainage in the collection chamber?  type/color?
    • Does the water seal chamber have the correct water level?  Bubbling
    • Is the suction chamber suctioning at the prescribed amount?
  189. What does it mean when there are bubbles in the water seal chamber?

    Describe it.
    there is an air leak somewhere....

    You will see bubbles flowing from right to left in the chamber

    Rated by 0-5 (low to high)
  190. What's crepitus?
    leakage of air in to the subcutaneous tissues

    *monitor for discomfort and respiratory distress
  191. If a chest tube was just placed and a patient had a large pneumothorax....expect to see what in the chamber?
    air leak.....cuz air is being removed from the chest
  192. Patient teaching for a chest tube
    • IS q1-2
    • TCDB
    • OOB
    • Report pain and PQRST

    • *Report sudden pain or SOB
    • *report tube disconnection or dislodgement
    • * Report change in color of the drainage
  193. What do you do if a chest tube disconnects?
    • Get help from coworkers...bring supplies to you
    • Put patient in comfy position
    • Place end of tubing in to sterile water
    • Notify MD
    • Use standard precautions for body fluids
  194. What do you do if the chest tube gets dislodged?
    • Get help from co workers....bring supplies to you
    • Put patient in comfy position
    • Call MD
    • If necessary call Rapid Response
    • Assess exit site for drainage pain and bleeding
    • VS
    • Lungs sounds
    • Respirations

    Give MD SBAR when he calls  you back.  May need to put a sterile dressing over exit site
  195. Nursing care for a patient with a Trach
    • Teach
    • Emotional support about body image
    • Care

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