Upper Respiratory: 220 Test II
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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
3 things that can interfere with pulse ox"
- 1. dark skin
- 2. cold skin
- 3. decreased circulation
How is smoking Hx measured?
pack years - packs/day X # of years
Purpose of surfactant?
decreases amnt of pressure needed to inflate lungs
Causes of atelectasis?
trauma, diseases (COPD, pneumonia), surgery, anything that decreases ability to take a deep breath
inflammation of parietal pleura
antiinflammatory med: ibu
Why does O2 go from alveoli to blood
partial pressure of O2 is greater in alveoli than in blood --> diffusion
What occurs in the alveoli of pt with COPD/emphysema?
alveoli collapse & trap CO2, lungs lose elasticity & compliance --> less O2 exchanged & retain CO2
2 ways O2 exists in blood?
carried in water & combined with HgB
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
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
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
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
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
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
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
amnt of O2 in plasma
amnt of HgB saturated with O2
What det if HgB combines with or releases O2?
depends on PaO2 surrounding it
HgB affinity for O2 decreased by ___, ____, & ____.
- 2. increased PaCO2
- 3. decreased pH/acidity
ratio of RBC to plasma
1. C&S: takes 48-72h for results
can determine type of bacteria, ABX to use, abnormal cells
When should sputum for sputum test be collected?
early am after mouth care b/c secretions collect during night
pt should undress to waist, put on a gown, and remove metal b/t neck & waste
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
same as for CT but iodine-based dye is not used
No metal, PPM, or ICD
Ventilation-perfusion (V/Q lung scan)?
assess ventilation & perfusion of lungs - IV radioisotope to assess perfusion & inhale radioactive gas to assess ventilation - outlines alveoli
If VQ scan shows ventilation without perfusion what is indicated?
Considerations for ventilation-perfusion/VQ scan?
Undress to waste, put on gown, & remove metal from neck to waste
no post care
contrast medium injected through catheter into pulmonary artery or R side of heart
Considerations for pulmonary angiogram?
- same as for CXR
- 1. check pressure dressing after procedure
- 2. monitor BP, pulse, circulation distal to injection site
Positron emission tomography (PET)?
IV radioactive glucose shows increased uptake of glucose in malignant lung cells
Considerations for PET?
- same as for CXR
- 1. no precautions afterward
- 2. encourage fluids to excrete radioactive subsance
- 1. Dx
- 2. biopsy & specimen collection
- 3. assessment of changes
- 4. suction mucous plugs
- 5. lavage lungs
- 6. remove foreign objects
Before & after
- 1 NPO for 6-12h
- 2. signed consent
- 3. sedative if ordered
- 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
scope inserted through small incision in suprasternal notch & advanced into mediastinum to inspect & biopsy lymph nodes to Dx some cancers: lung Ca etc
How are lung biopsies obtained?
transbronchial or perfutaneous biopsy or via transthoracic need aspiration
Considerations for bronchoscopy biopsy?
same as bronchoscopy
Considerations for lung biopsy if open lung biopsy is done?
same as for thracotomy
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
Biopsy done via Video-assisted thrascopic surgery (VATS) consideration?
performed in OR under general anesthetic
Monitor as for bronchoscopy after procedure
- 1. obtain specimen of leural fluid for Dx
- 2. remove pleural fluid
- 3. instill medication
What is always done after thoracentesis? Why?
CXR to check for pneumothorax
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
Pulmonary function tests? PFT
eval lung function - use spirometer to assess air mvmt as pt performs prescribed resp maneuvers
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
Who performs PFT?
What pt get it?
How is it performed?
COPD & asthma
inhale in device and shows how lungs functioning
Is SaO2 a reliable indicator of ventilation if pt is on O2?
How are throat cultures obtained?
swab throat for strep, miningitis, etc
Test to Dx PE?
VQ lung scan
Therapeutic level of theophylline?
Does O2 therapy require an order?
respiratory driven protocol
too much O2 for COPD pt can cause them to stop breathing
O2 toxicity s/s?
2 causes of deviated septum?
congenital & trauma
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
Nursing intervention if observe clear fluid coming from nose with deviated septum?
test for glucose/CSF
Mgmt of deviated septum?
will have surgery: resection, septoplasty, &/or rhinoplasty
2 surgical complications when correcting deviate septum?
septal tearing, depression in bridge of nose (saddle)
Unilateral, bilateral, & complex nasal fractures?
unilateral - little or no displacement
bilateral - nose has flattened look
complex - shattered frontal bones
Mgmt of nasal fractures?
splinting, manual/surgical reduction, nasal packing, antibiotics, pain mgmt
Tx that may be used to decrease bleeding and provide structure in pt with nasal fracture?
Priorities with nasal fracture?
- 1. airway & bleeding (swallowing)
- 2. avoid further trauma
- 3. oral care
How may reduction of nasal fracture be done?
open or closed - open done in surgery
When is the best time to do nasal realignment?
7 d after injury
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
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
surgical reconstruction of the nose
Critical aspect of preparation for rhinoplasty?
Immediate postop care of nasal surgery pt?
- 1. maintain airway
- 2. resp status
- 3. pain mgmt
- 4. bleeding & infection
- 5. edema
- 6. pt teaching
Why may epistaxis be an otolaryngeal emergency?
can hemorrhage or compromise airway
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
4 complications of epistaxis?
- 1. blood loss
- 2. hypoxemia
- 3 infection
- 4. shock
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
Why may a pt be hospitalized with epistaxis?
if have packed posterior bleed
Consideration with nasal packing?
very uncomfortable for the pt
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
2 main priorities with nasal packing?
airway & bleeding
Causes of allergic rhinitis?
pet saliva, dust mites, cockroaches, viruses (cold, flu)
Intermittent allergic rhinitis?
s/s present <4d a week or <4wks/year
Persistent allergic rhinitis?
s/s >4d/wk or >4wks/year
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
2 actions of 1st gen antihistamines?
- 1. constricts nasal mucosa
- 2. dries out the body
Nursing interventions with antihistamines?
- 1. teach to increase fluids
- 2. fall risk - sedating
- 3. no alcohol or sedatives
Consideration with pseudophed?
watch for increased HR, BP, & palpitations
AE of anithistamines?
sedation/stimulation, GI & GU changes, palpitations, tachycardia
Teaching for 2nd gen antihistamines?
Do not take with alcohol, sedatives, or MAOIs
AE of intranasal corticosteroids?
localized fungal infection with candida
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
Leukotriene receptor antagonists action?
inhibit airway edema & bronchoconstriction & decrease inflammation
3 leikotriene antagonists/inhibitors?
- 1. accolate
- 2. singulair
- 3. zyflo
Main AE of leukotriene receptor antagonits?
- 1. altered liver function
- 2. can interfere with theophylline & coumadin
- 3. accolate - flu-like syndrome
Acute Viral rhinitis?
common cold caused by adenovirus in upper resp
How is acute viral rhinitis/cold spread?
spread via droplet & contact while person is breathing, talking, sneezing, or coughing
surgical mask, gloves, gown, may need face shield or goggles
How long can adenovirus survive on inanimate objects?
up to 3 days
What people are at increased risk for getting acute viral rhinitis?
fatigue, phys & emot stress, & compromised immune system
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
Effects of antihistamines & decongestants on acute viral rhinitis?
decrease postnasal drip, cough, nasal obstruction, & discharge
Teaching r/t intranasal decongestant sprays?
should be used for no more than 3 days to prevent rebound congestion
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
Consideration for pt recieving allergy shots?
keep pt for observation X 20 min after shot in case of allergic reaction
S/S of flu?
- abrupt onset & lasts 7d
- 1. HA
- 2. myalgias
- 3. fever & chills
- 4. cough
- 5. sore throat
Complications of flu?
pneumonia - dyspnea and diffuse crackles
Why does pneumonia occur in elderly with the flu?
airways don't expand as well & less forceful cough & less immunity
How is flu virus spread?
droplet contact and inhalation
S/S of development of pneumonia with flu pt?
will start to get better then develop worsening cough & purulent sputum
Mgmt of flu?
relieve s/s & prevent secondary infection
Dx of flu?
nasopharyngeal or throat swab - can get results from rapid flu test in 15min
Nursing interventions for flu?
- 1. antivirals
- 2. same as for colds
Antiviral meds for flu?
TypeA: rimantidine & amantadine
Type A & B: tamiflu, relenza, virazole
When should antivirals for flu be given?
w/in 24 to 48 h of s/s
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
Flu vaccine is routine for what group of ppl?
ppl 50 and up
4 things that make sinusitis worse?
- 1. smoking
- 2. frequent nasal sprays & inhalers
- 3. allergies
- 4. asthma
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
Do pt with sinusitis have fever?
Nursing interventions for sinusitis?
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
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
Why should antihistamines be used cautiously with sinusitis?
they dry the mucous membranes and make secretions more viscous
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
Nasal polyps causes?
- 1. recurrent swelling of nasal & sinus mucous membranes
- 2. chronic allergic rhinitis
- 3. asthma
S/S of nasal polyps?
- 1. smooth, pale tumor
- 2. nasal obstruction
- 3. sinusitis
- 4. nasal discharge
- 5. speech distortion
Tx of nasal polyps?
will Tx with corticosteroid to shrink them
if become symptomatic:surgical removal
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
Number one priority with nasal polyps?
airway - can obstruct
Complications of foreign body obstruction?
can cause infection or obstruction
S/S of foreign body obstruction?
- 1. inflammation
- 2. purulent, foul-smelling discharge
How are foreign body obstructions removed?
remove from nose through route of entry
may sneeze with other nostril occluded
What not to do with foreign body obstruction?
Do not irrigate or push backward
How is pharyngitis spread?
What puts pt at risk for fungal pharyngitis?
ABX use, inhaled corticosteroids, immunosuppressed ppl, HIV
S/S of pharyngitis?
- 1. sore throat
- 2. dry hacking cough
- 3. red, edematous plaques with drainage
- 4. anterior cervical node edema
- 5. fever
2 complications of untreat strep?
- 1. rheumatic heart disease
- 2. glomerulonephritis
Tx for yeast pharyngitis?
nystatin swish and swallow
Goals of Tx for pharyngitis?
- 1. infection control
- 2. s/s relief
- 3. prevention of complications: airway obstruction
Prevention of pharyngitis?
rinse out mouth with water after using inhaled corticosteroids
Nursing interventions for viral pharyngitis?
- 1. increase fluids
- 2. cool, bland liqueids & gelatin (non-irritating)
- 3. humidity
- 4. rest
Nursing mgmt of bacterial pharyngitis?
- 1. beta strep culture of throat
- 2. ABX
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
Complication of pharyngitis?
URI, GERD, CA, tumors, & inhalation of irritants/pollutants
Peritonsillar abscess cause?
pharyngitis invades tonsils
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
Priority with peritonsillar abscess?
- 1. throat culture & C&S
- 2. Tx s/s - throat pain, etc
- 3. humidify
- 4. avoid aggravating: smoking
- 5. I&D
- 6. tonsillectomy
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
6 s/s of airway obstruction?
- 1. stridor/wheezing
- 2. use of accessory mucles
- 3. retratction
- 4. restlessness
- 5. tachycardia
- 6. cyanosis
What is a major s/s of hypoxia and/or obstruction?
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
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
How are tracheostomies usually performed?
in OR under general anesthesia - may be at bedside with local anesthesia in ermergencies
Advantages of tracheostomy over ventilator?
- 1. less damage to airway long-term
- 2. pt can eat
- 3. more mobility
- 4. more comfort
Priority with trach pt?
What should be monitored?
AIRWAY: keep obturator at bedside
swallowing, aspiration risk, & airway integrity
When will trach with inflated cuff be used?
if pt at risk for aspiration or needs ventilator
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
How long does it take the tracheostomy to heal?
5 to 7 days
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
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
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
What type of O2/air do trach pt need?
need humidified air b/c bypass upper airway
How often should trach tube changes be done?
approx once per month after first change done
What type of trach tube may be used to allow speech in pt that is not at risk for aspiration?
What is the speaking valve for trachs called?
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
How often should nurse assess need for suctionig for trach pt?
q 2 h and prn
When can trach be removed?
when pt can exchange air & expectorate secretions
Teaching for pt with removed trach?
- cover with occlusive dressing & do not get water in it
- splint when speaking, swallowing, & coughing
Consideration with cuffless trach?
Purpose of fenestrated trach tube?
What pt cannot use it?
pt at risk for aspiration
How is need to suction determined?
pt need or to get sputum sample
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
How long does it take a removed tracheostomy to close?
24 to 48 h
Number one risk with removed trach?
Cause of lyrangeal polyps?
vocal abuse or irritation
Number s/s of laryngeal polyps?
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
2 complications of laryngeal polyps?
- 1. endocarditis
- 2. renal damage if not Tx
Dx of laryngeal polyps?
will be biopsied for cancer
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
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)
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
Dx of head & neck cancer?
biopsy, MRI, CT, laryngoscopy
Tx of head and neck cancer?
radiation, chemo, & surgeries
3 important priorities with laryngetctomy surgery?
swallowing, airway, obstruction, & talking
Important consideratin if pt has total laryngectomy & radical neck dissection?
will never speak normally again
What is primary action if pt with a tracheostomy is in respiratory distress?
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
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
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
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
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
What position should a pt be in who has had larygectomy or other neck surgery?
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
Common psych issue with ppl who have undergone laryngectomy or have trach?
Obstructive sleep apnea? (OSA)
repetitive cessation of airflow during sleep
Cause of OSA?
- 1. small pharyngeal airway
- 2. hormonal imblance
- 3. altered neural control of respiratory muscles
Dx of sleep apnea?
Diagnostic Sleep Polysomnography - sleep study
Nonsurgical mgmt of sleep apnea?
- 1. avoid sedatives, no ETOH 3-4h before sleep
- 2. control excessive weight
- 3. oral appliance
- 4. CPAP, BiPaP
3 surgeries for sleep apnea?
- 1. UPP or UP3
- 2. GAHM
- 3. LAUP
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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