Laryngectomy test 1

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Author:
juliemarie
ID:
236409
Filename:
Laryngectomy test 1
Updated:
2013-09-23 23:21:46
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Laryngectomy Tracheostomy SLP
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Description:
fundamentals of the management of laryngectomy and tracheostomy
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  1. The upper respiratory tract extends from the _______ to the inferior border of the _______ at the ________ cartilage.
    • nose
    • larynx
    • cricoid
  2. The upper respiratory tract contains (3):
    • Nasal cavity
    • oral pharynx
    • larynx
  3. The lower respiratory tract includes (3):
    Trachea, bronchi and lungs
  4. How might you observe the upper respiratory tract?
    Through a fiberoptic endoscopic evaluation (flexible scope is inserted through nose)
  5. How might you observe the lower respiratory tract?
    Bronchoscopy (must be asleep)
  6. vital functions of the nose (3):
    secondary functions (2):
    • Filter the air
    • Warm the air
    • humidify the air
    • adds resonance to speech
    • contains olfactory nerves for taste and smell
  7. In the nasal cavity there are ____ that line and filter. The bony structures of the nose are called _______ which cause turbulence and resistance to airflow (aiding the in filtering). Blood supply to these structures aid in _______.
    • cilia
    • turbinates
    • warming the air
  8. The _____ and ______ separate the nasal and oral cavities. 

    The oral cavity begins at the ____ and ends at the ______ ______. It aids in ________ (5)
    • Hard palate
    • soft palate
    • lips
    • faucial arches
    • mastication, digestion, swallowing, resonance, articulation
  9. The tongue asserts the _______ impact on moving air. It functions in (3). The intrinsic muscles of the tongue control _______ and the extrinsic muscles control the __________
    • largest
    • chewing, bolus movement, speech production
    • fine motor movements
    • gross motor movements (attach tongue to other structures)
  10. Saliva is secreted by 3 glands:
    Serves as 3 agents:
    Helps in digestion and coats articulators
    • Sublingual, submandibular, and parotid glands
    • antibacterial, antifungal, antiviral
  11. What is Xerostomia?
    extreme dry mouth (common in trach patients)
  12. The pharynx is a ______ ______ that is used for ______ and ________. The ________ tubes are also connected to the pharynx.
    • muscular tube
    • breathing 
    • swallowing
    • eustachian
  13. In the pharynx, breathing functions and swallowing functions are separated in the ___________. NG/OG tubes pass this area to reach the _________.
    • Hypopharynx
    • esophagus
  14. The Gag reflex is _____ _______ of a safe swallow.
    not determinate
  15. Major functions of the Larynx (3):
    • Airway protection (folds)
    • Phonation
    • pressure valving (cough)
  16. The cough has 4 phases
    • Irritation by stimulus
    • Deep inspiration
    • compression (contraction of muscles)
    • Expulsion (vocal folds open and pressure is released)
  17. The cough facilitates:
    defecation, vomiting, and heavy lifting
  18. Can intubated patients cough?
    No!
  19. The larynx is suspended by the ______ _____ and is supported by the _______ and ________ cartilages and the __________.
    • Hyoid bone
    • Cricoid, thyroid
    • arytenoids
  20. The cricoid cartilage is ______ shaped and forms the ____ of the trachea and the _____ or the larynx.
    • Ring
    • Top
    • Base
  21. The thyroid cartilage is _____ shaped, the anterior prominence forms the ______ ______
    • Shield
    • Adam's apple
  22. The cricothyroid joint:
    Lengthens and shortens the vocal folds
  23. The arytenoids:
    rest on cricoid cartilage and have two processes for muscle attachment
  24. Cricoarytenoid joint:
    • Allows arytenoids to rock/glide 
    • abduct/adduct vocal folds
  25. Subglottic
    Glottic
    Supraglottic
    • below vocal folds
    • true vocal folds
    • above vocal folds (laryngeal ventricle specifically)
  26. Intrinsic Muscles of the larynx serve in:
    Finer adjustments needed for vocal fold movement (abduct, adduct, lengthen, shorten, alter tension)
  27. The true vocal folds are large muscles called _________ there are internal and external. The internal muscles are the ______________.
    • Thyroarytenoids
    • true vocal folds
  28. The vocal folds are ________ to damage during __________ __________ ___________ and some __________.
    • Susceptible
    • airway management procedures
    • surgeries
  29. Laryngeal movements are secondary to _______ _______ movement.
    hyoid bone
  30. Extrinsic muscles of the larynx (3):
    THese muscles are responsible for changes in the __________ of the larynx during speech and voice production
    • Raise, lower, stabilize
    • positioning
  31. The intrinsic and extrinsic muscles of the larynx allow for _______.
    Valving
  32. Intubated/trached patients do not have the _______ ________ from foreign bodies of the upper airway, nor do they have access to the structures for ______  and ________.
    • Added protection
    • speech 
    • swallowing
  33. The lower airways consist of the ________ and the _________ _________, and is divided into two zones:
    • trachea 
    • descending airways
    • conductive 
    • respiratory
  34. trachea is made up ____________ _______ that expand and flex due to the ____________ _________ in between the rings.
    • Cartilaginous rings
    • fibroelastic membrane
  35. trachea diameter changes with _________ and ___________. Dilation occurs with ___________ and constriction occurs with ___________.
    • Inspiration 
    • Expiration
    • Inspiration
    • Expiration
  36. In an adult: 
    Diameter:
    Length: 
    Number of rings:
    • 1.5-2.5
    • 10-12 cm
    • 16-20
  37. cells in the trachea excrete _________ which functions as a __________ and __________ mechanism.
    • mucous
    • protective 
    • cleansing 

    (goblet cells)
  38. _______ is the place of bifurcation for the trachea, it is also the place for eliciting a _______ ________. The trachea divides into left and right.
    • The Carina
    • Cough reflex
  39. The left mainstem bronchi (which branches from the trachea) has a ______ degree angle
    45-55
  40. The right mainstem bronchi (which branches from the trachea) has a ________ degree angle. And has a ________ diameter than the left bronchi.
    • 20-30
    • wider
  41. Which lung is easier to aspirate into?
    The right (less of an angle, so more of a straight shot for food/liquid)
  42. The bronchi divide into lobar and segmental groups. 
    Bronchi - ______ - _______ _________ - _________ _____ _____
    • Bronchioles
    • terminal bronchioles
    • alveolar air sacs
  43. Conductive zone: 
    _____ sweep debris at a a rate of _____-______ tpm. This moves debris to the upper airway where it can be ______ more effectively. ________ paralyzes these ______.
    • Trachea to the terminal bronchioles 
    • cilia
    • 1000-1500
    • coughed
    • Tobacco smoke 
    • cilia
  44. The respiratory zone includes:
    It functions in:
    Bronchioles, alveolar ducts, alveolar sacs, pulmonary capillaries 

    The delivery of oxygen and the removal of carbon dioxide
  45. The thoracic cavity contains:
    The thorax _______
    The thoracic cavity is divided by ________ which contains:
    • 12 thoracic vertebrae, sternum, rib cage
    • protects
    • the mediastinum
    • the heart, blood vessels, nerves, and esophagus
  46. ribs attach to _______ and the ______ except for the ________ ribs
    • vertebrae 
    • sternum
    • floating
  47. The Heart

    Deoxygenated blood returns via the ______ _______ heart pumps blood to lungs via ________ ________ where it is then _____________ and heads back to the heart to be dispersed by the _______
    • vena cava
    • pulmonary artery
    • oxygenated
    • aorta
  48. right lung has __ lobes
    left lung has __ lobes
    • 3
    • 2
  49. Surfactant is a ________ that maintains ________ ________ aiding the lungs so they don't __________
    • lubricant
    • surface tension
    • collapse
  50. Atelectasis is:
    THe collapse of the alveolar air sacs
  51. Lungs are housed in _______ _______ 
    and similarly _______ ________ lines the thorax
    • visceral pleurae 
    • Parietal pleurae
  52. ________ pressure allows the visceral and parietal pleurae to stick together, in this way they are connected, which is called _______ __________. A __________ occurs when the airtight seal between pleurae is broken (resulting in _______ ________)
    • negative
    • pleural linkage
    • pneumothorax 
    • lung collapse
  53. respiratory musculature

    allows thorax to move _______ and ________
    What is the major muscle of inspiration?
    This muscle separates the ________ and _______
    • anteriorly, laterally
    • the diaphragm 
    • thorax, abdomen
  54. contracting and flattening the diaphragm _________ the volume of the thorax and _________ the volume of the abdomen.
    • increases
    • compresses
  55. Contraction of _________ muscles ________ thoracic volume by _________ the ribs
    • (external) intercostal 
    • increases
    • elevating
  56. Accessory muscles to expiration: 
    these are active during ________ expiration
    • Rectus abdominis 
    • interanal/external obliques
    • transversus abdominis 
    • forced
  57. Accessory muscles to inspiration: 
    These muscles are activated when normal recoil of the lungs is not functional, for example:
    • Sternocleidomastoid
    • scalene
    • pectoralis major musles 
    • emphysema 
    • asthma
    • dysfunctional diaphragms
  58. Vagus Nerve

    (3) branches:
    recurrent laryngeal nerve: intrinsic laryngeal muscles (except for the cricothyroid), provides sensory innervation to sublottic region 

    Superior laryngeal nerve: cricothyroid movement and supraglottic sensation

    Pharyngeal: motor innervation of the pharynx/soft palate. Facilitates speech and swallowing
  59. Since the diaphragm is innervated by the phrenic nerves (c3, c4, c5) then a high SCI will most likely result in the need for ____________
    ventilation
  60. Ois carried in ____ _____ _____ whose main component is ____________.
    • red blood cells 
    • hemoglobin
  61. At the _______ _________ gas exchange takes place as _____ enters the alveoli and is exhaled from the body by the lungs
    • alveolar capillaries
    • CO2
  62. Quiet Breathing: 
    Forced Breathing:
    Speech Breathing:
    • active inspiration, passive expiration
    • active inspiration, active expiration
    • active inspiration, active expiration (against added resistance of vocal folds)
  63. Tidal Volume:
    Volume of air inhaled and exhaled during normal quiet breathing
  64. Inspiratory Reserve volume:
    amount of air that can be inhaled beyond a normal tidal inspiration
  65. Expiratory reserve volume:
    amount of air that can be exhaled beyond a normal tidal expiration
  66. Residual Volume:
    Volume of air that remain in the lungs beyond a maximum forced expiration (prevents lung collapse)
  67. Functional Residual capacity:
    volume of air that remains in the lungs beyond a normal tidal expiration
  68. vital capacity:
    amount of air which can be maximally expelled from the lungs after a maximum inspiration
  69. Minute Volume:
    amount of air that is inspired and expired per minute
  70. What is the normal respiration rate?
    12-20 breaths per minute
  71. Pulmonary function tests involve a ____________
    spirometer
  72. Pressure and flow

    1. Diaphragm contracts: 
    2. Alveolar pressure becomes ________
    3. When the flow of air into the lungs stops: 
    4. ventilation is the:
    • 1. alveolar pressure drops 
    • 2. negative
    • 3. alveolar pressure becomes positive
    • 4. constant adjusting system of flow and pressure
  73. In speech breathing, the inspiratory cycle is _______ compared to the expiratory cycle
    shorter (quick inhalation, slow exhalation). Longer phrases need larger volume. Shorter phrases need less volume with more frequent inhalations
  74. Respiratory is located in the __________ _________ of the brainstem. The _________ is the major control center, balancing _____ and ____
    • Reticular formation
    • medulla
    • CO2 and O2
  75. Regulation of breathing requires _______ ________ of the _________ makeup of the blood. Chemoreceptors detect low __ in blood.
    • constant analysis 
    • chemical 
    • O2
  76. Arterial blood gases:
    measures the levels of acids and bases
  77. __________ ___ are the main base in the blood, when it combines with ______ ____ it forms carbonic acid. Carbonic acid is another way in which ___ is carried through the blood.
    • bicarbonate ions
    • hydrogen ions
    • CO2
  78. Respiratory system regulates ____ ______
    Renal system regulates amount of _________ in the blood
    • CO2 levels
    • bicarbonate
  79. Hyperventilation:
    lungs provide too much ventilation and eliminate too much CO2 from the body
  80. Hypoventilation:
    Inadequate ventilation and the body retains CO2
  81. Obstructive Diseases:

    (Can't get air out)
    Chronic Obstructive pulmonary disease: 
    Chronic Bronchitis:
    • irreversible airway obstruction caused by damage to lung tissue 
    • The presence of a productive cough for a minimum of 3 months a year for 2 consecutive years

    caused by chronic inhalation of irritants, bronchoconstriction, cyanosis, increased respiratory efforts, wheezing, increased secretions
  82. Obstructive Diseases Cont: 
    Emphysema:
    • Deterioration of lung tissue (alveolar walls)
    • loss of elastic recoil
    • dyspnea
    • use of accessory muscles for inspiration
    • work of breathing increased
  83. Restrictive Lung Diseases

    Reduced lung volumes (can't get air in)
    Reduced lung compliance (lungs can't fully expand) 
    Examples:
    • Scleroderma 
    • systematic lupus
    • arthritis 
    • scoliosis
    • intersitial fibrosis
  84. Pneumonia
    • Acute infection and inflammation involving the gas exchange regions of the lungs. 
    • Fever, shortness of breath
    • can be viral or bacterial
  85. Aspiration pneumonia
    • Common in dysphagia 
    • severe aspiration can cause cardiopulmonary arrest 
    • repeated aspirations can result in decreased lung compliance
  86. Neuromuscular Disease: ALS
    • UMN and LMN affected
    • hypoventilation (weakened muscles/diaphragm paralysis)
    • progressive deterioration occurs
    • intact eye muscles and cognition
    • Needs: AAC, PEG, Trach/Vent
    • Breathing difficulties/aspiration leading cause of death
  87. Neuromuscular Disease: Multiple Sclerosis
    • Demyelinating disease 
    • deterioration - speech, swallowing, cognitive-linguisitic, physical-motor 
    • respiratory issues
    • pharyngeal dysphagia 
    • silent aspiration
  88. Neuromuscular Disease: Muscular Dystrophy
    • Hereditary
    • progressive muscle deterioration
    • affects striated muscles (heart, diaphragm)
    • atelectasis 
    • pneumonia
  89. Neuromuscular Disease: Gillian-Barre Syndrome
    • acute onset, rapid deterioration 
    • may see complete recovery 
    • speech/swallowing problems when respiratory involvement is present 
    • (viral infection, surgery, immunization, immunologic disorder)
  90. Neuromuscular Disease: Stroke
    • can have a brainstem stroke
    • this can cause respiration problems 
    • mechanical ventilation may be needed in this instance
    • anarthria and dysphagia 
    • some may require trach for pulmonary hygiene 
    • AAC
  91. Neuromuscular Disease: Poliomyelitis
    • severe muscle weakness
    • associated respiratory failure
    • postpolio syndrome includes respiratory insufficiency, progressive muscle weakness, dysphagia
  92. Neuromuscular Disease: Spinal Cord Injury
    • above the 4th cervical vertebrae: respiratory musculature nonfunctional with partial or full paralysis of diaphragm
    • below the 4th cervical vertebrae: spares diaphragm, muscles of inspiration and expiration are impaired
    • quadriplegic patient is unable to use forced breathing (ineffective cough)
  93. Cardiopulmonary Conditions: 
    successful gas exchange is dependent on circulation of blood to the alveoli
    • Efficient circulation is often impaired in cardiovascular conditions either because blood is not circulating or because intravascular fluids congest the lungs (pulmonary adema)
    • could effect either or both ventricles of the heart
    • congestive heart failure: occurs when heart cannot pump out sufficient amounts of blood, and fluid collects in the lungs
  94. Adult respiratory distress syndrome:
    • damage to the area of oxygen transfer, results in severe impairment of the gas exchange function 
    • fluid leakage into alveoli 
    • loss of surfactant
    • severe atelectasis 
    • Hypoxemia: deficiency of oxygen in arterial blood
    • Hypoxia: lack of oxygen at level of the body (brain damage)
    • Increased Work of Breath (WOB)

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