Upper Respiratory: 220 Test II

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mthompson17
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Upper Respiratory: 220 Test II
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2014-02-23 16:50:31
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upper respiratory nursing
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220 test II: Upper Respiratory: Vickers
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  1. Gerontologic changes in respiratory system?
    • 1. decreased response to hypoxia & hypercapnia
    • 2. decreased lung compliance
    • 3. decreased alveoli
    • 4. decreased immunity
    • 5. decreased cilia & cough force
    • 6. decreased sensation in pharynx
  2. 3 things that can interfere with pulse ox"
    • 1. dark skin
    • 2. cold skin
    • 3. decreased circulation
  3. How is smoking Hx measured?
    pack years - packs/day X # of years
  4. Purpose of surfactant?
    decreases amnt of pressure needed to inflate lungs
  5. Causes of atelectasis?
    trauma, diseases (COPD, pneumonia), surgery, anything that decreases ability to take a deep breath
  6. Pleuracy?

    Tx?
    inflammation of parietal pleura

    antiinflammatory med:  ibu
  7. Why does O2 go from alveoli to blood
    partial pressure of O2 is greater in alveoli than in blood --> diffusion
  8. What occurs in the alveoli of pt with COPD/emphysema?
    alveoli collapse & trap CO2, lungs lose elasticity & compliance --> less O2 exchanged & retain CO2
  9. 2 ways O2 exists in blood?
    carried in water & combined with HgB
  10. Oxygenation of tissues depends on what 2 things?
    O2 picked up in lungs & how well HgB gives up the O2 when gets to the tissues
  11. Why is PaO2 >60mmHg OK & need 95% O2sat?
    Lg drop in PaO2 has little effect on O2sat:  drop from 100 to 60 only decreases O2 sat by 7%  (from 100 to 93%)

    Increasing PaO2 above 60 has little effect on HgB saturation
  12. What happens to O2 at the tissues?
    HgB releases O2 to the tissues because diffusion:  PaO2 of blood is >60 & PaO2 of tissues is 30-40  --> desaturated HgB can now pick up more O2 at lungs
  13. Effects of pH & CO2 on oxy-HgB curve?
    • alkalosis - left shift 
    • acidosis - right shift

    H+ ions compete with O2 molecules for HgB binding - more H+ = less O2 picked up in lungs & more O2 dropped in tissue

    CO2 increases H+ ions & also competes with O2 for HgB:  low PaCO2:  left shift; high PaCO2:  right shift
  14. Effect of temperature on oxy-HgB curve?
    elevated temp will denature bond b/t HgB & O2 --> less O2 picked up in lungs & more dropped off to tissues
  15. Shift to the left on oxyhemoglobin curve?

    3 causes of L shift?
    picks up O2 more readily in lungs but delivers it less readily to the tissues 

    • 1. alkalosis
    • 2. hypothermia
    • 3. decrease in PaCO2
  16. Right shift on oxy-HgB curve?
    decreased O2 picked up in the lungs & increased O2 delivered to tissues

    • 1. acidosis
    • 2. hyperthermia/fever
    • 3. increased PaCO2
  17. PaO2?
    amnt of O2 in plasma
  18. SaO2?
    amnt of HgB saturated with O2
  19. What det if HgB combines with or releases O2?
    depends on PaO2 surrounding it
  20. HgB affinity for O2 decreased by ___, ____, & ____.
    • 1.hyperthermia
    • 2. increased PaCO2
    • 3. decreased pH/acidity
  21. Hct?
    ratio of RBC to plasma
  22. Sputum Studies?
    1. C&S:  takes 48-72h for results

    can determine type of bacteria, ABX to use, abnormal cells
  23. When should sputum for sputum test be collected?
    early am after mouth care b/c secretions collect during night
  24. Pre CXR?
    pt should undress to waist, put on a gown, and remove metal b/t neck & waste
  25. Pre-CT?
    considerations for contrast dye:  check BUN & creatinine, allergy to shellfish/iodine, hydrate before & after to excrete contrast, may cause flushing

    will need to lie still
  26. MRI considerations?
    same as for CT but iodine-based dye is not used

    No metal, PPM, or ICD
  27. Ventilation-perfusion (V/Q lung scan)?
    assess ventilation & perfusion of lungs - IV radioisotope to assess perfusion & inhale radioactive gas to assess ventilation - outlines alveoli
  28. If VQ scan shows ventilation without perfusion what is indicated?
    PE
  29. Considerations for ventilation-perfusion/VQ scan?
    Undress to waste, put on gown, & remove metal from neck to waste

    no post care
  30. Pulmonary angiogram?
    contrast medium injected through catheter into pulmonary artery or R side of heart
  31. Considerations for pulmonary angiogram?
    • same as for CXR
    • 1. check pressure dressing after procedure
    • 2. monitor BP, pulse, circulation distal to injection site
  32. Positron emission tomography (PET)?
    IV radioactive glucose shows increased uptake of glucose in malignant lung cells
  33. Considerations for PET?
    • same as for CXR
    • 1. no precautions afterward
    • 2. encourage fluids to excrete radioactive subsance
  34. Bronchoscopy?

    Uses?
    flexible scope 

    • 1. Dx
    • 2. biopsy & specimen collection
    • 3. assessment of changes
    • 4. suction mucous plugs
    • 5. lavage lungs
    • 6. remove foreign objects
  35. Bronchoscopy considerations?

    Before & after
    • 1 NPO for 6-12h 
    • 2. signed consent
    • 3. sedative if ordered

    • After:
    • 1. NPO until gag returns
    • 2. monitor for laryngeal edema
    • 3. monitor for recoverly from sedatives
    • 4. blood-tinged mucus is normal
    • 5. if biopsy was done monitor for hemorrhage and pneumothorax
  36. Mediastinoscopy?
    scope inserted through small incision in suprasternal notch & advanced into mediastinum to inspect & biopsy lymph nodes to Dx some cancers:  lung Ca etc
  37. How are lung biopsies obtained?
    transbronchial or perfutaneous biopsy or via transthoracic need aspiration
  38. Considerations for bronchoscopy biopsy?
    same as bronchoscopy
  39. Considerations for lung biopsy if open lung biopsy is done?
    same as for thracotomy
  40. Considerations with biopsy via needle aspiration?
    • 1. check breath sounds q4h for 24h 
    • 2. check incision site for bleeding
    • 3. CXR to check for pneumothorax
  41. Biopsy done via Video-assisted thrascopic surgery (VATS) consideration?
    performed in OR under general anesthetic

    Monitor as for bronchoscopy after procedure
  42. Thoracentesis uses?
    • 1. obtain specimen of leural fluid for Dx
    • 2. remove pleural fluid
    • 3. instill medication
  43. What is always done after thoracentesis?  Why?
    CXR to check for pneumothorax
  44. Pre, during, & post thoracentesis?
    • 1. Explain & get consent
    • 2. usually done in pt room - pt upright with elbows on overbed table & feet supported
    • 3. instruct not to cough or talk
    • 4. observe for s/s of hypoxia & pneumothrax ^& verify breath sounds in all fields after procedure
    • 5. encourage deep breaths to expand lungs
    • 6. take labeled specimens to lab
  45. Pulmonary function tests?  PFT
    eval lung function - use spirometer to assess air mvmt as pt performs prescribed resp maneuvers
  46. Considerations with PFT?
    • 1. avoid scheduling immediately after mealtime
    • 2. avoid admin of inhaled bronchdilator 5 h before
    • 3. explain procedure
    • 4. assess for respiratory distress before & report
    • 5 provide rest after procedure
  47. Who performs PFT?

    What pt get it?

    How is it performed?
    resp therapist

    COPD & asthma

    inhale in device and shows how lungs functioning
  48. Is SaO2 a reliable indicator of ventilation if pt is on O2?
    no
  49. How are throat cultures obtained?
    swab throat for strep, miningitis, etc
  50. Test to Dx PE?
    VQ lung scan
  51. Therapeutic level of theophylline?
    10-20
  52. Does O2 therapy require an order?
    yes
  53. RDP
    respiratory driven protocol
  54. O2-induced hypoventilation?
    too much O2 for COPD pt can cause them to stop breathing
  55. O2 toxicity s/s?
    lethargy
  56. 2 causes of deviated septum?
    congenital & trauma
  57. 7 S/S of deviated septum?
    • 1. nasal obstruction
    • 2. snoring
    • 3. noisy/difficult breathing
    • 4. HA
    • 5. epistaxis
    • 6. post-nasal drip
    • 7. sinusitis
  58. Nursing intervention if observe clear fluid coming from nose with deviated septum?
    test for glucose/CSF
  59. Mgmt of deviated septum?
    will have surgery:  resection, septoplasty, &/or rhinoplasty
  60. 2 surgical complications when correcting deviate septum?
    septal tearing, depression in bridge of nose (saddle)
  61. Unilateral, bilateral, & complex nasal fractures?
    unilateral - little or no displacement

    bilateral - nose has flattened look

    complex - shattered frontal bones
  62. Mgmt of nasal fractures?
    splinting, manual/surgical reduction, nasal packing, antibiotics, pain mgmt
  63. Tx that may be used to decrease bleeding and provide structure in pt with nasal fracture?
    nasal tampon
  64. Priorities with nasal fracture?
    • 1. airway & bleeding (swallowing)
    • 2. avoid further trauma
    • 3. oral care
  65. How may reduction of nasal fracture be done?
    open or closed - open done in surgery
  66. When is the best time to do nasal realignment?
    7 d after injury
  67. 3 nursing interventions for nasal fracture?
    • 1. ice
    • 2. upright position
    • 3. no head tilt
    • 4. tell pt not to take ASA or NSAIDs for 2 wks prior to surgery
  68. S/S of nasal fracture?
    • 1. epistaxis may be only one
    • 2. decreased ability to breathe through one side of nose
    • 3. edema, bleeding, hematoma
    • 4. raccoon eyes
  69. Rhinoplasty?
    surgical reconstruction of the nose
  70. Critical aspect of preparation for rhinoplasty?
    pt expectations
  71. Immediate postop care of nasal surgery pt?
    • 1. maintain airway
    • 2. resp status
    • 3. pain mgmt
    • 4. bleeding & infection
    • 5. edema
    • 6. pt teaching
  72. Why may epistaxis be an otolaryngeal emergency?
    can hemorrhage or compromise airway
  73. Bleeding, common pt, cause in anterior and posterior epistaxis?
    anterior- mild to mod bleeding usually in children & YA; caused by trauma or infection:  usually preceded by an event:  picking, sneezing, nose blowing, etc

    posterior - more severe bleeding & occurs more commonly in the elderly, not r/t trauma & occurs spontaneously; HTN, ASCVD, ETOH, abuse
  74. 4 complications of epistaxis?
    • 1. blood loss
    • 2. hypoxemia
    • 3 infection
    • 4. shock
  75. Mgmt of anterior epistaxis?
    • 1. sit up straight or lean forward
    • 2. pinch nose
    • 3. ice or eat ice
    • 4. pack with guaze - may stay in for 2-3 days & pt take out
  76. Why may a pt be hospitalized with epistaxis?
    if have packed posterior bleed
  77. Consideration with nasal packing?
    very uncomfortable for the pt
  78. Teaching with epistaxis & nasal packing?
    • 1. if swallowing a lot or tampon is getting saturated need to call
    • 2. avoid trauma
    • 3. no ASA or NSAIDs
  79. 2 main priorities with nasal packing?
    airway & bleeding
  80. Causes of allergic rhinitis?
    pet saliva, dust mites, cockroaches, viruses (cold, flu)
  81. Intermittent allergic rhinitis?
    s/s present <4d a week or <4wks/year
  82. Persistent allergic rhinitis?
    s/s >4d/wk or >4wks/year
  83. Nursing interventions for allergic rhinitis?
    • 1. pt keep allergy journal
    • 2. living conditions:  environment, pets
    • 3. alleviate s/s:  antihistamines, intranasal corticosteroids, leukotriene receptor antagonists, immunotherapy
  84. 2 actions of 1st gen antihistamines?
    • 1. constricts nasal mucosa
    • 2. dries out the body
  85. Nursing interventions with antihistamines?
    • 1. teach to increase fluids
    • 2. fall risk - sedating
    • 3. no alcohol or sedatives
  86. Consideration with pseudophed?
    watch for increased HR, BP, & palpitations
  87. AE of anithistamines?
    sedation/stimulation, GI & GU changes, palpitations, tachycardia
  88. Teaching for 2nd gen antihistamines?
    Do not take with alcohol, sedatives, or MAOIs
  89. AE of intranasal corticosteroids?
    localized fungal infection with candida
  90. Teaching for pt with intranasal corticosteroid?
    • 1. begin 2 wk before pollen season starts & use throughout
    • 2. use on regular basis - not prn
    • 3. D/C if nasal infection occurs
  91. Leukotriene receptor antagonists action?
    inhibit airway edema & bronchoconstriction & decrease inflammation
  92. 3 leikotriene antagonists/inhibitors?
    • 1. accolate
    • 2. singulair
    • 3. zyflo
  93. Main AE of leukotriene receptor antagonits?
    • 1. altered liver function
    • 2. can interfere with theophylline & coumadin
    • 3. accolate - flu-like syndrome
  94. Acute Viral rhinitis?
    common cold caused by adenovirus in upper resp
  95. How is acute viral rhinitis/cold spread?
    spread via droplet & contact while person is breathing, talking, sneezing, or coughing
  96. Droplet precautions?
    surgical mask, gloves, gown, may need face shield or goggles
  97. How long can adenovirus survive on inanimate objects?
    up to 3 days
  98. What people are at increased risk for getting acute viral rhinitis?
    fatigue, phys & emot stress, & compromised immune system
  99. Nursing interventions for acute viral rhinitis?
    • 1. rest
    • 2. fluids to liquify secretions & proper diet
    • 3. antipyretics & analgesics
    • 4. Avoid crowded situations
    • 5. frequent hand wahsing & avoiding hand to face contact
    • 6. antihistamines or decongestants
    • 7. s/s of secondary bacterial infection
  100. Effects of antihistamines & decongestants on acute viral rhinitis?
    decrease postnasal drip, cough, nasal obstruction, & discharge
  101. Teaching r/t intranasal decongestant sprays?
    should be used for no more than 3 days to prevent rebound congestion
  102. S/S of secondary bacterial infection with acute viral rhinitis?
    • 1. temp >38
    • 2. purulent nasal exudate
    • 3. tender, swollen glands
    • 4. sore, red throat
  103. Consideration for pt recieving allergy shots?
    keep pt for observation X 20 min after shot in case of allergic reaction
  104. S/S of flu?
    • abrupt onset & lasts 7d
    • 1. HA
    • 2. myalgias
    • 3. fever & chills
    • 4. cough
    • 5. sore throat
  105. Complications of flu?
    pneumonia - dyspnea and diffuse crackles
  106. Why does pneumonia occur in elderly with the flu?
    airways don't expand as well & less forceful cough & less immunity
  107. How is flu virus spread?
    droplet contact and inhalation
  108. S/S of development of pneumonia with flu pt?
    will start to get better then develop worsening cough & purulent sputum
  109. Tx for pneumonia?
    ABX
  110. Mgmt of flu?
    relieve s/s & prevent secondary infection
  111. Dx of flu?
    nasopharyngeal or throat swab - can get results from rapid flu test in 15min
  112. Nursing interventions for flu?
    • 1. antivirals
    • 2. same as for colds
  113. Antiviral meds for flu?
    TypeA:  rimantidine & amantadine

    Type A & B:  tamiflu, relenza, virazole
  114. When should antivirals for flu be given?
    w/in 24 to 48 h of s/s
  115. 2 types of flu vaccine?

    When should flu vaccines be given and to whom?

    What ppl should not get the flu vaccine?
    inactivated:  injection, 6mo & older,

    live attenuated:  nasal spray for health ppl 2-49

    everyone >6mo old should get vaccine:  only healthy, nonpregnant ppl can get nasal

    best if given in the fall

    CI:  Hx of Guillain-Barre & hypersensitivity to eggs
  116. Flu vaccine is routine for what group of ppl?
    ppl 50 and up
  117. 4 things that make sinusitis worse?
    • 1. smoking
    • 2. frequent nasal sprays & inhalers
    • 3. allergies
    • 4. asthma
  118. S/S of sinusitis?
    • 1. pain over affected sinus
    • 2. purulent nasal drainage
    • 3. nasal congestion &/or obstruction
    • 4. fever & malaise
    • 5. HA - recurrent & change with position
  119. Do pt with sinusitis have fever?
    rarely
  120. Nursing interventions for sinusitis?
  121. 1. Teach about ways to reduce inflammation, infection, & allergy control
    • 2.6 to 8 oz of fluid
    • 3. nasal cleaning:  blowing nose, steam, saline irrigation
  122. Tx of sinusitis?
    • 1. ABX
    • 2. intranasal steroids
    • 3. analgesics
    • 5. antihistamines
    • 6. saline
    • 7. decongestions:  promote drainage
    • 8. surgery
    • 8. mucolytics:  mucinex
    • 9. can use steam to loosen:  shower
  123. Why should antihistamines be used cautiously with sinusitis?
    they dry the mucous membranes and make secretions more viscous
  124. How to make at home nasal saline solution?

    How to admin it?
    mix 1/4 tea salt in 8oz tap water & may add pinch of baking soda

    2-4 sprays at least tid
  125. Nasal polyps causes?
    • 1. recurrent swelling of nasal & sinus mucous membranes
    • 2. chronic allergic rhinitis
    • 3. asthma
  126. S/S of nasal polyps?
    • 1. smooth, pale tumor
    • 2. nasal obstruction
    • 3. sinusitis
    • 4. nasal discharge
    • 5. speech distortion
  127. Tx of nasal polyps?
    will Tx with corticosteroid to shrink them

    if become symptomatic:surgical removal
  128. Nursing mgmt of pt after sinusitis surgery?
    • 1. first priority is airway & breathing
    • 2. apply ice
    • 3. upright
    • 4. give ABX & pain meds
    • 5. teach home:  s/s of infection & bleeding
    • 6. don't blow nose, cough forcefully; sneeze with mouth open
  129. Number one priority with nasal polyps?
    airway - can obstruct
  130. Complications of foreign body obstruction?
    can cause infection or obstruction
  131. S/S of foreign body obstruction?
    • 1. inflammation
    • 2. purulent, foul-smelling discharge
  132. How are foreign body obstructions removed?
    remove from nose through route of entry

    may sneeze with other nostril occluded
  133. What not to do with foreign body obstruction?
    Do not irrigate or push backward
  134. How is pharyngitis spread?
    droplet transmission
  135. What puts pt at risk for fungal pharyngitis?
    ABX use, inhaled corticosteroids, immunosuppressed ppl, HIV
  136. S/S of pharyngitis?
    • 1. sore throat
    • 2. dry hacking cough
    • 3. red, edematous plaques with drainage
    • 4. anterior cervical node edema
    • 5. fever
  137. 2 complications of untreat strep?
    • 1. rheumatic heart disease
    • 2. glomerulonephritis
  138. Tx for yeast pharyngitis?
    nystatin swish and swallow
  139. Goals of Tx for pharyngitis?
    • 1. infection control
    • 2. s/s relief
    • 3. prevention of complications:  airway obstruction
  140. Prevention of pharyngitis?
    rinse out mouth with water after using inhaled corticosteroids
  141. Nursing interventions for viral pharyngitis?
    • 1. increase fluids
    • 2. cool, bland liqueids & gelatin (non-irritating)
    • 3. humidity
    • 4. rest
  142. Nursing mgmt of bacterial pharyngitis?
    • 1. beta strep culture of throat
    • 2. ABX
  143. Grade 4 tonsils with pharyngitis?

    What will this pt sound like?

    Complication that occur r/t to this?
    touch together & can obstruct airway

    sound like have sleep apnea

    can cause cor pulmonale if occur chronically
  144. Complication of pharyngitis?
    peritonsillar abscess
  145. Laryngitis causes?
    URI, GERD, CA, tumors, & inhalation of irritants/pollutants
  146. Peritonsillar abscess cause?
    pharyngitis invades tonsils
  147. S/S of peritonsillar abscess?
    • precipitated by sore throat:
    • 1. edema
    • 2. copious pus
    • 3. high fever & chills
    • 4. severe leukocytosis
    • 5. "hot potato voice"
    • 6. severe pain:  can't swallow
    • 7. bad breath & foul taste
  148. Priority with peritonsillar abscess?

    6 Interventions?
    • 1. throat culture & C&S
    • 2. Tx s/s - throat pain, etc
    • 3. humidify
    • 4. avoid aggravating:  smoking
    • 5. I&D
    • 6. tonsillectomy
  149. Causes of partial airway obstruction?
    • 1. aspiration or foreign body
    • 2. laryngeal edema/stenosis or tracheal stenosis
    • 3. CNS depression:  drugs, etc
    • 4. allergic:  anaphylaxis
  150. 6 s/s of airway obstruction?
    • 1. stridor/wheezing
    • 2. use of accessory mucles
    • 3. retratction
    • 4. restlessness
    • 5. tachycardia
    • 6. cyanosis
  151. What is a major s/s of hypoxia and/or obstruction?
    restlessness
  152. Tx of airway obstruction?
    • keeping/getting the airway patent:
    • 1. heimlich
    • 2. cricothyroidectomy
    • 3. ET - may be able to remove foreign body while intubating
    • 4. tracheostomy
  153. 4 indications for a tracheostomy?
    • 1. if need long-term ventilation
    • 2. bypass upper airway obstruction
    • 3. facilitate removal of secretions
    • 4. permit oral intake & speech
  154. How are tracheostomies usually performed?
    in OR under general anesthesia - may be at bedside with local anesthesia in ermergencies
  155. Advantages of tracheostomy over ventilator?
    • 1. less damage to airway long-term
    • 2. pt can eat
    • 3. more mobility
    • 4. more comfort
  156. Priority with trach pt?

    What should be monitored?
    AIRWAY:  keep obturator at bedside

    swallowing, aspiration risk, & airway integrity
  157. When will trach with inflated cuff be used?
    if pt at risk for aspiration or needs ventilator
  158. How should trach cuff be deflated
    • 1.Assess pt for ability to handle secretions have pt cough up secretions if possible & suction secretions above the cuff to prevent aspiration
    • 2. deflate during exhalation to propel secretions toward mouth
    • 3. have pt cough and suction after deflation also
    • 4. reinflate cuff during inspiration
  159. How long does it take the tracheostomy to heal?
    5 to 7 days
  160. 3 precautions used during healing of tracheostomy?
    • 1. have replacement tube of equal or lesser size in case of decannulation in the room
    • 2. do not change ties for the first 24h
    • 3. MD will do the first tube change - usually no sooner than 7 days after surgery
  161. Action if the trach tube comes out?
    immediately try to replace it with the obturator

    may also use a suctin catheter to open the airway & insert the trach tube through it
  162. Actions if trach tube comes out and cannot be replaced?
    • 1. assess level of resp distress
    • 2. semi-fowler's until assistance arrives
    • 3. if progresses to resp arrest:  cover stoma with sterile dressing & bag pt
  163. What type of O2/air do trach pt need?
    need humidified air b/c bypass upper airway
  164. How often should trach tube changes be done?
    approx once per month after first change done
  165. What type of trach tube may be used to allow speech in pt that is not at risk for aspiration?
    fenestrated
  166. What is the speaking valve for trachs called?
    passey muir
  167. Procedure for trach suctioning?
    • 1. Assess O2, HR< rhythm to est baseline
    • 2. provide pre-O2 & gather all necessary sterile supplies
    • 3. limit suction time to 10 seconds
    • 4. auscultate to assess changes in lung sounds
    • 5. record time, amnt, & character of secretions & response to suctioning
    • 6. return O2 concentration to prior setting
  168. How often should nurse assess need for suctionig for trach pt?
    q 2 h and prn
  169. When can trach be removed?
    when pt can exchange air & expectorate secretions
  170. Teaching for pt with removed trach?
    • cover with occlusive dressing & do not get water in it
    • splint when speaking, swallowing, & coughing
  171. Consideration with cuffless trach?
    aspiration risk
  172. Purpose of fenestrated trach tube?

    What pt cannot use it?
    allows speech

    pt at risk for aspiration
  173. How is need to suction determined?
    pt need or to get sputum sample
  174. 7 complications of trach suctioning?
    • 1. hypoxia
    • 2. atelectasis
    • 3. tissue damage
    • 4. violent cough, vomit, aspiration
    • 5. airway spasms
    • 6. dysrhythmias
    • 7. increased ICP
  175. How long does it take a removed tracheostomy to close?
    24 to 48 h
  176. Number one risk with removed trach?
    aspiration
  177. Cause of lyrangeal polyps?
    vocal abuse or irritation
  178. Number s/s of laryngeal polyps?
    hoarseness
  179. Tx of laryngeal polyps?
    • 1. complete voice rest
    • 2. speech therapy after voice rest to prevent reoccurence
    • 3. surgical or laster removal
    • 4. I&D
    • 5. tonsillectomy for repeated episodes
  180. 2 complications of laryngeal polyps?
    • 1. endocarditis
    • 2. renal damage if not Tx
  181. Dx of laryngeal polyps?
    will be biopsied for cancer
  182. Risk factors for head & neck cancer?
    • 1. men
    • 2. prolonged use of tobacco & alcohol
    • 3. chronic laryngitis
    • 4. voice abuse
    • 5. family Hx
    • 6. HPV
  183. S/S of head & neck cancer?
    • not obvious
    • 1. hoarseness
    • 2. change in mouth (lesions) or fit of dentures
    • 3. unilateral sore throat or ear pain
    • 4. lump in throat or change in voice quality
    • 5. leukoplakia (white patch) or erythroplakia (red patch)
  184. Late s/s in head and neck cancer?
    • 1. pain
    • 2. dysphagia
    • 3. decreased mobility of the tongue
    • 4. airway obstruction
    • 5. cranial nerve neuropathies
    • 6. dyspnea & cough
    •  7. heomptysis
    • 8. weight loss
    • 9. enlarge lymph nodes
  185. Dx of head & neck cancer?
    biopsy, MRI, CT, laryngoscopy
  186. Tx of head and neck cancer?
    radiation, chemo, & surgeries
  187. 3 important priorities with laryngetctomy surgery?
    swallowing, airway, obstruction, & talking
  188. Important consideratin if pt has total laryngectomy & radical neck dissection?
    will never speak normally again
  189. What is primary action if pt with a tracheostomy is in respiratory distress?
    suction
  190. Considerations for pt after neck surgeries for cancer (laryngectomy)?
    • 1. will initially have parenteral then enteral feeding b/c throat will be too swollen to eat
    • 2. speech changes should be expected - may be lost
    • 3. maintain patent airway- may be compromised by edema
    • 4. will have trach & may have drains in place
    • 5. semi-fowlers
    • 6. monitor vs, hemorrhage, & resp status
    • 7. immediately after surgery will need frequent suctioning
    • 8. humidifier should be used
    • 9. teach pt to use extremeities to assist with support & mvmt of the head
    • 10. should exercise affected area to prevent frozen shoulder
    • 11. voice prosthesis teaching
    • 12. stoma care & teaching
  191. Nursing interventions for nutrition after laryngectomy & other neck surgeries?
    • 1. assess swallowing
    • 2.adust feeding according to GI s/s
    • 3. when pt can swallow give small amnts of water
  192. Considerations for pt undergoing radiation?
    • 1 need protein for tissue repair
    • 2. antiemetics or analgesics before meals
    • 3. bland foods
    • 4. increase caloric intake with powders, gravies, sauces
    • 5. dry mouth
    • 6. stomatitis
    • 7. only use prescribed skin products
    • 8. avoid sun & use sunblock
  193. Interventions for dry mouth?
    • 1. salagen -increases secretions
    • 2. increasing fluid intake
    • 3. chewing sugarless gum/candy
    • 4. using nonalcoholic mouth rinses
    • 5. always carry a water bottle
    • 6. aritificial saliva
  194. Interventions for stomatitis?
    • 1. soft, bland foods
    • 2. sucking on ice chips
    • 3. avoid commerial mouthwashes & hot foods
    • 4. mix equal parts of antacid, diphenhydramine, & topical lidocaine & rinse mouth
  195. What position should a pt be in who has had larygectomy or other neck surgery?
    upright position
  196. Stoma care in post-laryngectomy or neck surgery pt?
    • 1. wash area around stoma qd with moist cloth
    • 2. cover stoma when coughing & when it could get stuff in it:  make-up
    • 3. wear a plastic collar when taking a shower
    • 4. admin humidification
    • 5. high fluid intake
    • 6. wear medic alert bracelet
    • 7. install smoke & carbon monoxide detectors r/t decrease sense of smell
  197. Common psych issue with ppl who have undergone laryngectomy or have trach?
    depression
  198. Obstructive sleep apnea?  (OSA)
    repetitive cessation of airflow during sleep
  199. Cause of OSA?
    • 1. small pharyngeal airway
    • 2. hormonal imblance
    • 3. altered neural control of respiratory muscles
  200. Dx of sleep apnea?
    Diagnostic Sleep Polysomnography - sleep study
  201. Nonsurgical mgmt of sleep apnea?
    • 1. avoid sedatives, no ETOH 3-4h before sleep
    • 2. control excessive weight
    • 3. oral appliance
    • 4. CPAP, BiPaP
  202. 3 surgeries for sleep apnea?
    • 1. UPP or UP3
    • 2. GAHM
    • 3. LAUP
  203. s/s of sleep apnea?
    • 1. irritable
    • 2. can't concentrate
    • 3. daytime sleepiness
    • 4. bloodshot eyes
    • 5. snoring, gasping, snorting,
    • 6. witnessed episodes
    • 7. weight loss

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