321 -Exam 1- P. 31-38

Front 1

Voice Rehabilitation

-when having supraglottic surgery or radical neck, they will need an alternative means of communication

true or false

Back 1

true

Front 2

Voice Rehabilitation

-if patient has a total laryngectomy, they will have no natural voice

true or false

Back 2

true

Front 3

-what should you say if you can’t understand someone who doesn’t have an alternate means of communication?

Back 3

it is your problem and it is not his problem.. so you need to say “I’m sorry I’m having a difficult time understanding you, if you could repeat it and talk slower I will get it”. just remember it is not their fault. they might not mind writing but that can get old too. so saying you write it out is not that answer.

Front 4

Esophageal speech- is attempted by most patients who have a total laryngectomy.

-what is it

Back 4

sound can be produced this way by “burping” the air swallowed or injected into the esophageal pharynx and shaping the words in the mouth. the voice produced is a monotone and it can not be raised or lowered and carries no pitch.

Front 5

Esophageal Speech / Total Laryngectomy

what is a negative outcome that happens from this speech

Back 5

intestinal bloating as a result of swallowing air for esophageal speech

Front 6

what is the electrolarynx?

Back 6

a mechanical device that may be used by the pt who cannot attain esophageal speech.


•they are battery powered devices placed against the side of the neck or cheek
•the air inside the mouth and throat is vibrated and the pt moves their lips and tongue.
•the quality of speech that is generated with this is robot like and does not sound natural

Front 7

Care of trach: a surgical incision into the trachea for the purpose of establishing an airway

make sure they kno how to suction and clean around the trach. usually trachs are disposable (get a new one when changing the whole thing) inner cannulas can be used a couple times.

when do you know when to suction

Back 7

when audible or noisy secretions, crackles, or wheezes are heard on auscultation or when restlessness, increased HR or RR or when mucus in the artificial airway is present. other indicators are pt requests or an increase in the peak airway pressure on the ventilator.

Front 8

suctioning (adverse outcomes)

Back 8

-hypoxia,
-tissue trauma,
-infection,
-bronchospasm
-cardiac dysrthymias

Front 9

suctioning
-what do you tell the pt about SOB and coughing?

Back 9

that the sensations such as shortness of breath and coughing are to be expected but that any discomfort will be very brief

Front 10

suctioning
-how can you prevent hypoxia?

Back 10

by hyperoxygenating the pt with 100% oxygen for 30 seconds to 3 minutes (at least three hyperinflations)

Front 11

suctioning
-what do you lubricate the catheter with before insertion?


-when do you apply suction?

Back 11

lubricate the catheter with sterile water or saline before insertion.


apply suction only during the withdrawal of the catheter

Front 12

suctioning
-do not apply suctiong during insertion (true or false)


-never suction longer than how many seconds?

Back 12

true



never suction longer than 10-15 sec

Front 13

suctioning
-how do you withdraw the catheter?

Back 13

withdraw the catheter and begin to apply suction.


use intermittent suction and a twirling motion of the catheter during withdrawal to prevent grabbing of the mucosa

Front 14

suctioning
-hyperoxygenate for how long?

Back 14

1-5 min or until the pts HR and O2 status are WNL

Front 15

suctioning
-repeat up to how many times?

Back 15

3

Front 16

suctioning
-sterile or clean technique

Back 16

• in the hospital, use sterile technique. at home, use clean technique when suctioning because the number of organisms in the home envt is lower than in the hospital

Front 17

suctioning
-cleaning the inner cannula?

Back 17

remove and clean the inner cannula and use a half strength hydrogen peroxide to clean the cannula and sterile saline to rinse it. if the cannula is disposable, remove the cannula and replace it with a new one

Front 18

Discharge Teaching - Safety for Trach Care

they need to cover the trach (ex: cover when outside so u don’t get a bug in there) so nothing gets in it and to help keep out pollutants.

Back 18

:)

Front 19

Discharge Teaching - Safety for Trach Care

cover it with gauze, trach covers, light scarfs – cover the airway with cotton or foam to protect it during the day. covering the permanent opening filters the air entering the stoma, keeps humidity in the air, and enhances appearance.

Back 19

:)

Front 20

Discharge Teaching - Safety for Trach Care

they have to have a smoke detector

Back 20

(if you can’t smell, you can’t smell smoke)

Front 21

Discharge Teaching - Safety for Trach Care

what about water?

Back 21

they need to keep water out of their trach (showering is ok but they need to have a trach bib – hard plastic bib that prevents water from getting in – or they can use a shower shield to prevent water from entering the airway) they shouldn’t go swimming

Front 22

Discharge Teaching - Safety for Trach Care


•children:

Back 22

they have to play, so you have to be really careful and make sure it is covered and protected so they can’t shove things down into the trach. let them outside in the sandbox, just protect it. let them take a bath and splash around, just have a little water in the tub

Front 23

Discharge Teaching - Safety for Trach Care

if it is really dry out (middle of winter) what 2 things should they do?

Back 23

use a humidifier (keep air moist) and drink lots of water.

the normal airway goes through the mouth and nose and that humidifies it. with a trach, we have a direct route from the outside down the trach into the lungs, so think about the protection.

drink a lot of fluids to keep airways moist.

Front 24

Discharge Teaching - Safety for Trach Care

-teach the pt to increase humidity in the home.

Back 24

instruct him or her to instill normal saline into the artificial airway 10-15 days or as prescribed.

Front 25

Discharge Teaching - Safety for Trach Care

the tracheostomy tube bypasses the nose and mouth, which normally humidify, warm, and filter air before it reaches the lower respiratory tract. if humidification and warming are not adequate, tracheal damage can occur.

thick, dried secretions can :

Back 25

occlude the airways

Front 26

Discharge Teaching - Safety of Trach

if a person is sick, what should you encourage them to do

Back 26

push fluids so the airways don’t become dry.

Front 27

Care of Trach

-make sure they keep it clean and gently remove crusties

Back 27

(can use hydrogen peroxide)

Front 28

laryngeal cancer w/ a trach

-when can they expect to return back to work

Back 28

1-2 months after surgery unless the CA is what is preventing them from going back to work

Front 29

living with a trachea

body image disturbance
-always a problem. some people don’t like to talk about things, they try to hide the trach

how would you know if someone is coping?

Back 29

as long as they are going out in the public and interacting, they are getting involved in the care of the trach – they are accepting the body image change (if someone says you do it, or have home health keep coming that is a problem)

Front 30

-routine post op care / trachea

immediately after surgery, focus on what??

confirm what?


how often should you do a thorough respiratory assessment?

Back 30

ensuring a patent airway.

confirm the present of bilateral breath sounds.

conduct a thorough respiratory assessment q2h

Front 31

assess the stoma how often for s/s of infection, such as:

4

Back 31

once a shift


purulent drainage
redness
pain
swelling

Front 32

tracheostomy dressings may be used to keep the stoma clean and dry.

these dressing resemble a 4x4 gauze pad with an area removed to fit around the tube. if these dressings are not available, what should you use?

Back 32

fold standard sterile 4x4s to fit around the tube. DO NOT CUT the dressings because small bits of gauze could be aspirated through the tube. change these dressings often b/c moist dressings provide a medium for bacterial growth

Front 33

how does subcutaneous emphysema occur in a pt with a trachea?

what 2 s/s resemble this?

Back 33

occurs when there is an opening or tear in the trachea and air escapes into fresh tissue planes or the neck.

air can progress throughout the chest and other tissues into the face.

if the skin is puffy and you can feel a crackling sensation, notify Dr immediately

Front 34

Trach care: keep head of bed elevated for at least ___min after eating to prevent aspiration

Back 34

30

Front 35

Trach vent
-a device that is helpful to facilitate what?

-what does the valve allow the patient to do?

-what does the valve do on exhalation?

Back 35

-a speech for the pt with a tracheotomy is a special one way value that fits over the tube

-the valve allows the pt to breathe in through the tracheotomy tube


-on exhalation, the valve closes so that air is forced through the vocal cords, allowing speech.

Front 36

Trachea
-body image disturbance

what should you help the patient do?

Back 36

set realistic goals, starting with involvement in self care

Front 37

Trach vent

what’s the purpose of it?



-speech therapy assists with this

Back 37

so they can talk, filters the air, and you use it if they can breath on their own. it goes over the trach and they learn how to change airflow because airflow is going up, which allows them to form sounds/verbalize. they can also help them eat.



-people complain that they are SOB and secretions

Front 38

Asthma, unlike COPD is an intermittent disease with reversible airflow obstruction and wheezing

true or false

Back 38

true

Front 39

Asthma

does it affect the airways or alveoli?

Back 39

ONLY the airways

Front 40

During an asthma attack, muscle surrounding the bronchial tubes tighten (what is this known as?), narrowing the air passage and interrupting the normal flow of air into and out of the lungs. airflow is further interrupted by an increase in mucous secretion, forming mucous plugs, and the swelling of bronchial tubes.

Back 40

bronchospasms

Front 41

Asthma

airway obstruction can occur in 2 ways

Back 41

1) inflammation (obstructs the inside of the airways)

2) airway hyperresponsiveness ( bronchial linings overreact to various triggers, causing smooth muscle spasms that severely constrict the airway. mucosal edema and thickened secretions further block the airways)

Front 42

Asthma

What is the key event in triggering an asthma attack?

Back 42

inflammation of the mucous membranes lining the airways

Front 43

asthma

inflammation occurs in response to the presence of specific allergens (cold or dry air, microorganisms, aspirin)


airway hyperresponsiveness can occur with

Back 43

exercise, upper respiratory illness

Front 44

-the pt with asthma usually has a pattern of episodes of (4) characteristics

Back 44

-dyspnea (SOB),
-chest tightness,
- coughing,
-wheezing,
-increased mucous production

Front 45

-during an acute episode of an asthma attack, the most common s/s are (2)

Back 45

an audible wheeze and increased RR.

the wheeze is loud on exhalation.

Front 46

-the pt may use accessory muscles to help breathe during an asthma attack.

true or false

Back 46

true

Front 47

-the pt with long standing severe asthma may have a barrel chest, caused by ?

Back 47

air trapping

Front 48

Asthma
-examine the mucosa and nail beds for what?

-POX shows what?

-what happens to the HR

Back 48

-cyanosis


-POX shows hypoxemia (poor blood oxygen levels) related to the degree of dyspnea



-tachycardia

Front 49

Tests used to diagnose asthma are:


what do they evaluate?

Back 49

Pulmonary function tests (PFTs)



---they evaluate lung mechanics, gas exchange, and acid base disturbance through spirometric measurements, lung volumes, and ABG values

Front 50

asthma
-what drugs can cause an attack?

Back 50

beta blockers

ASA

NSAIDS

Front 51

asthma

-what disease can cause an attack?

Back 51

GERD (you can aspirate gastric acids that are working the way up which can cause the aspiration)

Front 52

Patient education of Asthma

teach the pt to assess symptom severity at least twice daily with what?

Back 52

a peak flowmeter and adjust drugs to manage inflammation and bronchospasms

Front 53

Patient education with asthma

avoid envt triggers such as smoke, fireplaces, dust, mold, weather changes such as warm to cold



avoid medications that could trigger asthma

Back 53

:)

(ASA, NSAIDS, beta blockers)

Front 54

Patient education with asthma


if you experience symptoms of exercise induced asthma, what should you tell them to do?

Back 54

use your bronchodilator inhaler 30 min before exercise to prevent or reduce bronchospasms

Front 55

Asthmatic Drug Therapy
- Two categories of drugs:

Back 55

1) Anti-inflammatory (glucocorticoids)


2)Bronchodilators (beta 2 agonist)

Front 56

Asthmatic Drug Therapy

Anti-inflammatory
VS
Bronchodilator

which should you take first?

Back 56

bronchodilator beacuse it will provide better absorption of the glucocorticoid because it opens the airway

Front 57

Asthmatic Drug Therapy

Anti-inflammatory
&
Bronchodilator

when they are combined together, it means what

Back 57

maintenance

Front 58

Asthmatic Drug Therapy

-when Anti-inflammatory and bronchodilators are used separate, you know it is used when

Back 58

during an acute attack

Front 59

Bronchodilators
•have no effect on inflammation but what do they do?

Back 59

increase bronchiolar smooth muscle relaxation

they stimulate beta 2 adrenergic receptors to relax the smooth muscle, producing dilatation

Front 60

Bronchodilators

SE:

Back 60

tachycardia,
anxiety,
irritability,
angina pain
tremors

Front 61

Bronchodilators

____________________ provide rapid but short term relief. these inhaled drugs are useful when an attack begins (rescue drug) or as premedication when the patient is about to begin an activity that is likely to induce an asthma attack.

Back 61

Short acting beta 2 agonists

Front 62

Asthma Drug Therapy
Short acting beta 2 agonists

examples include: (rescue or maintence)
albuterol (Proventil) –
salmeterol (Serevent) –
Levalbuterol –
terbutaline (Brethaire) –

Back 62

examples include:
•albuterol (Proventil) –rescue
•salmeterol (Serevent) –maintenance
•Levalbuterol – rescue
•terbutaline (Brethaire) – rescue


-when inhaled from either a metered dose inhaler or a dry powder inhaler, the drug is delivered directly to the site of action and systemic effects are minimal

Front 63

Asthma Drug Therapy

Anti-Inflammatory (Glucocorticoids)

how do they help?

Back 63

these help improve bronchiolar airflow by decreasing the inflammatory response of the mucous membranes in the airways.

they do NOT cause bronchodilation

•decreases inflammation, edema, and vascular permeability

Front 64

Asthma Drug Therapy

examples include:
•fluticasone (Flovent) -maintenance
•budesonide (Pulmicort) -maintenance


what kind of drug are they?

Back 64

Anti-Inflammatory (Glucocorticoids)

Front 65

Asthmatic Drug Therapy

Other drug classes are cholinergic antagonists, also called anticholinergic drugs

what do they do?

Back 65

blocks the parasympathetic nervous system, allowing the sympathetic nervous system to dominate, resulting in bronchodilation and decreased pulmonary secretions

Front 66

Drug Therapy

examples include:
•ipratropium (Atrovent)
•tiotropium (Spiriva) – long acting agent

Back 66

cholinergic antagonists, also called anticholinergic drugs

Front 67

Exercise/Activity

•regular exercise is recommended for asthma therapy

•some asthma pts may need to pre-medicate with what before beginning an activity ?

Back 67

inhaled bet agonists (SABA)

Front 68

Asthma CM

restlessness
-lung sounds?

-abdominal sounds?

Back 68

wheezes or crackles / absent or diminished lung sounds
-prolonged exhalation

hyperresonance

Front 69

Asthma CM

-RR? (2)

Back 69

tachypnea and hyperventilation

Front 70

Asthma CM

-HR?

Back 70

tachycardia

Front 71

Which of the following are precipitating factors that may induce an asthma attack?

Back 71

a.allergen inhalation (animal dander, dust mites, pollens, molds, cock roaches)
b.air pollutants (exhaust fumes, perfume, cigarette smoke, aerosol spray, oxidants, sulfur dioxide)
c.viral upper respiratory infections
d.sinusitis and nasal problems
e.exercise, especially in cold dry air
f.drugs (ASA, NSAIDS, β adrenergic blockers)
g.occupational exposure (metal salts, wood and vegetable dust, chemicals and plastics,)
h.food additives (sulfites, tartrazine)
i.hormones/menses
j.GERD
k.emotional stress

Front 72

if a patient is experience an asthma attack, what position do you want them to be in

Back 72

high- fowlers (orthopenic position) or tripod

Front 73

if a 6 month old was having an asthma attack, what position would you want them to be in

Back 73

an infant car seat

Front 74

The following nursing diagnoses are developed. Which of the nursing diagnoses would be of priority?


-Potential ineffective airway clearance R/T bronchoconstriction, edema, tachypnea
-Impaired gas exchange R/T bronchoconstriction
-Ineffective breathing pattern R/T increased airway resistance from bronchospasm, edema, mucus
-Anxiety R/T dyspnea
-Risk for infection R/T retained secretions
-Fatigue/activity intolerance R/T persistent cough and increase in work of breathing
-Knowledge deficit R/T causal factors and self-care measures

Back 74

-Impaired gas exchange R/T bronchoconstriction (not getting enough O2)


(always pick actual over potential.. follow airway, breathing, circulation)for a code situation, it is circulation, airway, breathing……sometimes you look at your priorities and what you can do fastest)

Front 75

pt has a fracture femur and just came back from surgery…what is most important assessment? airway or circulation?

Back 75

circulation

Front 76

The physician orders an albuterol HHN (hand held nebulizer). This medication will:

a.cause bronchodilation within minutes
b.decrease inflammation
c.cause bronchodilation over 12 hours
d.block the action of acetylcholine
e.block action of leukotrienes

Back 76

A

C is wront because it lasts 3-4 hours
D- anticholingers such as Spirivia block Ach

Front 77

-why did the phyisician order a HHN instead of a inhaler?

Back 77

it provides deeper penetration

Front 78

a patient says they feel jumpy, and that their heart is beating fast. the symptoms of irritability and tachycardia is a side effect of?

Back 78

β2 agonists

(cuz part of the beta 1 gets stimulated) you get a cross over effect

Front 79

-albuterol:teaching

maintenance or rescue inhaler,

can cause an increase in HR, you want to shake it/go back and forth to mix the solution,

do they have a spacer? (the tube that u put the canister into. they were developed to get more of the medication),

carry it with you all the time.

wait how long between puffs of Albuterol.

do not take more than prescribed

Back 79

rescue, lasts 3-4 hours
a minute

Front 80

albuterol: teaching

-how to care for the equipment?

Back 80

wash it once a day… oral care is important

Front 81

prednisone: teaching

what kind of drug is it?

what about a fever?

what will it do to BS?

what disease can it cause?

what time of the day should they take it and why?

Back 81

anti-inflammatory (suppresses immune system),

they may not develop temperature (99.9 is a concern) because they suppress the immune response.

can raise BS. do not stop suddenly (they will taper down).


-when someone is started on steroids or immunosuppressant’s, they test for TB. TB can lie
dormant in your body and be activated


-steroids can cause diabetes

-steroids can cause ulcers. take in the morning with food.

-steroids can cause a pseudo-cushing effect (that effect looks like a moon face, weight gain, weight distribution, large trunk)

-can cause acne.

Front 82

What health promotion and maintenance strategies is the most important to tell to include w/ regards to asthma?


a. use the albuterol prior to exercise
b. avoid triggers of an asthma attack
c. drink plenty of fluids
d. avoid being around sick people
e. use the peak flow meter to check if the medications are working during an asthma attack

Back 82

a. use the albuterol prior to exercise
b. avoid triggers of an asthma attack
c. drink plenty of fluids
d. avoid being around sick people
e. use the peak flow meter to check if the medications are working during an asthma attack