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41 Cards in this Set
- Front
- Back
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Obstructive Sleep Apnea (OSA) is a _____ or _____ obstruction during sleep. This deprives a patient of adequate _____. The patient experiences hypo___ and hyper_____ during sleep. What are some risk factors?
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Obstructive Sleep Apnea (OSA) is a partial or complete obstruction during sleep. This deprives a patient of adequate rest. The patient experiences hypoxemia and hypercapnia during sleep. Risk factors include male gender, age > 65, obesity, smoking, and craniofacial abnormalities.
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Craniofacial abnormalities that contribute to OSA include a narrow pallate or other throat problems that cause a poor opening. The tongue falls back into the throat and causes obstruction. _____ is just a small obstruction. What are the clinical manifestations of OSA?
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Snoring is just a small obstruction.
smoking snoring (complaints from partner) insomnia excessive daytime sleepiness irritability headaches mood/ personality changes |
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Apnea is the cessation of spontaneous respirations lasting longer than ___ seconds.
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10
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_______ is a condition characterized by shallow respirations (30-50% reduction in airflow
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hypopnea
(lewis p. 121) |
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What are the complications of OSA?
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impaired memory & concentration
Depression Impotence (men) HTN Right sided Heart Failure dysrhythmias- (heart issues due to chronic hypoxia) |
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A dx of OSA is made on the basis of PSG- polysomnography ( sleep study) . The patient's chest and abdominal movement, oral airflow, nasal airflow, SpO2, ocular movement and heart rate and rhythm are monitored. Progression through each sleep stage is determined by monitoring ____ waves using an EEG. A diagnosis of sleep apnea requires documentation of apneic events (no airflow or resp. effort) or hypopnea of at least __ seconds duration. Mild OSA is defined as __ - ___ events/h and severe OSA is defined as > ___ events/h.
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A dx of OSA is made on the basis of PSG- polysomnography ( sleep study) . The patient's chest and abdominal movement, oral airflow, nasal airflow, SpO2, ocular movement and heart rate and rhythm are monitored. Progression through each sleep stage is determined by monitoring brain waves using an EEG. A diagnosis of sleep apnea requires documentation of apneic events (no airflow or resp. effort) or hypopnea of at least 10 seconds duration. Mild OSA is defined as 5-10 events/h and severe OSA is defined as > 15 events/h.
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What is the nursing management of OSA?
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no alcohol or sedatives prior to sleep (depresses respirations)
lose weight (if overweight) Oral appliance Surgery to relieve obstructions (UPPP or GAHM) |
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UPPP is a uvulopalatopharngoplasty, basically like a ________ where excess _____ is removed. GAHM is genioglossus advancement hyaloid myotomy surgery. It involves cutting the chin bone and advancing the chin forward. This procedure results in forward advancement of the tongue, thereby reducing the chance of base of tongue collapse.
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UPPP is a uvulopalatopharngoplasty, basically like a tonsilectomy where excess tissue is removed.
GAHM is genioglossus advancement hyaloid myotomy surgery. It involves cutting the chin bone and advancing the chin forward. This procedure results in forward advancement of the tongue, thereby reducing the chance of base of tongue collapse. |
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How sleep apnea occurs: The patient is predisposed to OSA has a small pharyngeal airway. During sleep, the pharyngeal muscles relax, allowing the airway to close. Lack of airflow results in repeated apneic episodes. With ____, Continuous Positive Airway Pressure splints the airway open, preventing airflow obstruction. BIPAP is bilevel positive airway pressure. It involves more _____ on inspiration, less on _____. The drawbacks are that it is very loud, and not a very sexy apparatus! This is also an alternative before someone is _______. CPAP is usually tried first and it is cheaper than surgery.
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How sleep apnea occurs: The patient is predisposed to OSA has a small pharyngeal airway. During sleep, the pharyngeal muscles relax, allowing the airway to close. Lack of airflow results in repeated apneic episodes. With CPAP, Continuous Positive Airway Pressure splints the airway open, preventing airflow obstruction. BIPAP is bilevel positive airway pressure. It involves more pressure on inspiration, less on expiration The drawbacks are that it is very loud, and not a very sexy apparatus! This is also an alternative before someone is intubated.
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Tracheostomy is indicated for many things. It can be used to bypass upper airway ______. It facilitates removal of _______. It is useful for long term mechanical _______. It permits oral ____ and ____ in patients requiring long term mechanical ventilation.
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Tracheostomy is indicated for many things. It can be used to bypass upper airway obstruction. It facilitates removal of secretions (for patient with poor cough ability etc). It is useful for long term mechanical ventilation. It permits oral intake and speech in patients requiring long term mechanical ventilation.
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Advantages of a tracheostomy include less risk of long term ____ to the airway, increased ____, patient can eat, and increased discomfort/comfort because tube is more secure compared to ET if on long term mech. ventilation. Usually a person with a trach is started with an ___ tube because of some sort of respiratory compromise.
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Advantages of a tracheostomy include less risk of long term damage to the airway, increased comfort, patient can eat, and increased mobility because tube is more secure compared to ET if on long term mech. ventilation. Usually a person with a trach is started with an ___ tube because of some sort of respiratory compromise. (FYI- Some patients can't eat with a trach and some can)
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The natural response to waking up with an ET tube in place is to wrip that thing out! Very awkward, uncomfortable, patient can't "breathe" normally, not in control of breaths. If you see any sign of patient waking up "coming to" then ask for a percent drip, give them the ______.
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sedative
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See trach care 27-6 27-7 and lewis page 542 and review lecture notes page 2-5 (upper resp)
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....
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Cancer of the head and neck is rare but very _____. Usually this cancer is is seen in patients over 50 y (90%) Does it affect males or females more often? What are the 2 major risk factors?
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Cancer of the head and neck is rare but very disfiguring. Affects males more than females
2 major risk factors: prolonged use of alcohol prolonged use of tobacco |
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What are the signs of oral cancer?
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painless growth
ulcer that doesn't heal white/red patches on tongue pain aggravated by acidic foods (late sign) |
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Laryngeal cancer has a good prognosis if found early. If found in late stage, only treatment is ______. We hope to avoid finding it this late. The tx is very disfiguring, many social consequences (lose their voice, etc)
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Laryngeal cancer has a good prognosis if found early. If found in late stage, only treatment is surgery. We hope to avoid finding it this late. The tx is very disfiguring, many social consequences (lose their voice, etc)
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S/S of laryngeal cancer
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unilateral sore throat or otalgia
hoarseness/change in voice lump in throat late stages:pain, dysphagia, decreased mobility of tongue, airway obstruction Remember- sore throat is usually bilateral due to a microoganism, but laryngeal cancer is a sore throat just on one side (something's not right) |
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Diagnosing laryngeal cancer involves a _______ with ____. Management involves either ____ if stage 1 or 2, or ____. Chemotherapy is also a treatment option. The main goal of treating is to avoid disfigurement, preserve vocal cord function, and just get rid of the lesion/growth. Many of the surgeries will require a temporary _____.
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Diagnosing laryngeal cancer involves a laryngoscopy with biopsy.
Management involves either radiation if stage 1 or 2 or surgery. Chemotherapy is also a treatment option. The main goal of treating is to avoid disfigurement, preserve vocal cord function, and just get rid of the lesion/growth. Many of the surgeries will require a temporary tracheostomy. |
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Management of laryngeal cancer depends on the extent of the cancer which is determined by...
Also important is the patient's medical history (often poor due to lifetime of drinkin/smokin), cosmetic considerations, urgency, and patient's choice. |
T (tumor size)
N (# of nodules) M (metastasis) these aspects are similar for all cancers |
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One treatment option for treating laryngeal cancer is ________. This is an advanced cancer treatment. Radioactive seeds or sources are placed in or near the tumor itself, giving a high radiation dose to the tumor while reducing the radiation exposure in the surrounding healthy tissues. The term "brachy" is Greek for short distance._________ is radiation therapy given at a short distance: localized, precise, and high-tech
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brachytherapy
brachytherapy |
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__________ is a surgery to treat laryngeal cancer. It involves going in transorally and taking out the lesion.
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cordectomy
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A supraglottic laryngectomy involves removing structures above the ____ cords-- the false vocal cords and the epiglottis. The patient is at high risk of _____ following surgery and requires a temporary ______. Both a hemilaryngectomy (one cord removed) and a supraglottic laryngectomy allow the ___ to be preserved, but quality is breathy and hoarse.
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A supraglottic laryngectomy involves removing structures above the true cords-- the false vocal cords and the epiglottis. The patient is at high risk of aspiration following surgery and requires a temporary trach. Both a hemilaryngectomy (one cord removed) and a supraglottic laryngectomy allow the voice to be preserved, but quality is breathy and hoarse.
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Advanced lesions in a laryngeal cancer are treated by a total laryngectomy, in which the entire larynx and preepiglottic region are removed and a ____ tracheostomy is performed. ______ neck ______ frequently accompaines total laryngectomy to decrease risk of lymphatic ______. Depending on extend of involvement, extensive dissection and reconstruction may be performed, involving the removal of many tissues such as the mandible, associated muscles, internal jugular vein, etc.
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Advanced lesions in a laryngeal cancer are treated by a total laryngectomy, in which the entire larynx and preepiglottic region are removed and a permanent tracheostomy is performed. Radical neck dissection frequently accompanies total laryngectomy to decrease risk of lymphatic ______. Depending on extend of involvement, extensive dissection and reconstruction may be performed, involving the removal of many tissues such as the mandible, associated muscles, internal jugular vein, etc. (this is from the book, don't stress too much!)
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A modified neck dissection is performed whenever possible and is an alternative to the radical. It is not as extensive. The choice of surgery is determined by the extend the cancer has _____. In this surgery, the entire _____ and pre-epiglottic region is removed. It involves a _____ tracheostomy. Will the patient be able to speak?
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A modified neck dissection is performed whenever possible and is an alternative to the radical. It is not as extensive. The choice of surgery is determined by the extend the cancer has spread. In this surgery, the entire larynx and pre-epiglottic region is removed. It involves a permanent tracheostomy. No voice.
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See nursing assessment table 27-9 and nursing diagnosis 27-2
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...look at care plans
anticipate needs for some of these nursing dx |
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Planning for a patient with laryngeal cancer or a cancer of the head or neck involves goals of having no _________, maintaining a patent _____, providing adequate ______, minimal to no ______, providing a means for ______, and promoting acceptable body ___.
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Planning for a patient with laryngeal cancer or a cancer of the head or neck involves goals of having no complications, maintaining a patent airway, providing adequate nutrition, minimal to no pain, providing a means for communication, and promoting acceptable body image.
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In the acute interventions for radiation therapy for laryngeal cancer, monitor and try to prevent or control ____ mouth, f______, s______, and skin ______.
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In the acute interventions for radiation therapy for laryngeal cancer, monitor and try to prevent or control dry mouth, fatigue, stomatitis, and skin irritation.
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For surgical intervention for laryngeal cancer, monitor what 3 things? Keep ___ ____ at bedside just in case of laryngeal _____ closes airway.
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airway
pain nutrition trach tray edema (some swelling is to be expected) |
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Patients who lose their voice after tx for laryngeal cancer need to see a speech therapist to discuss voice restoration options. There are also support groups available in some areas. The most commonly used voice prosthesis is the ____-_____ prosthesis. This soft plastic device is inserted into a ____ made between the esophagus and trachea. This can be done during or after surgery depending on the Dr's preference. It has to be blocked off to speak (unless a valve is placed then don't have to) The prosthesis must be ____ regularly and replaced when blocked with ___. Voice will never sound natural, but now at least the patient has one.
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Patients who lose their voice after tx for laryngeal cancer need to see a speech therapist to discuss voice restoration options. There are also support groups available in some areas. The most commonly used voice prosthesis is the Blom-Singer prosthesis. This soft plastic device is inserted into a fistula made between the esophagus and trachea. This can be done during or after surgery depending on the Dr's preference. It has to be blocked off to speak (unless a valve is placed then don't have to) The prosthesis must be cleaned regularly and replaced when blocked with mucous. Voice will never sound natural, but now at least the patient has one.
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A ___-____ is an artificial larynx plastic tube in mouth that creates vibrations, the patient sounds like a ______. It won't work until the edema subsides.
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A Cooper- Rand is an artificial larynx plastic tube in mouth that creates vibrations, the patient sounds like a robot. It won't work until the edema subsides.
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An ______ is a hand-held, battery-powered device that creates speech with the use of sound waves.
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electrolarynx
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To create the most normal sound when using the Cooper-Rand artificial larynx, the patient should...
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1. avoid using the tongue to hold the tube in place
2. compress the tone generator for short intervals and speak in phrases, rather than full sentences 3 speak using large movements of the lips, tongue, and jaw rather than keeping the mouth partially closed 4 talk face to face with the listener 5 practice, because development of skill takes time (lewis p. 541- don't stress on it) |
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An artificial larynx is placed against the ____ rather than the _____. This device is used after surgical healing is complete and no edema is remaining. With experience, patient can learn to move the lips in ways that create normal-sounding speech. With both devices (electrolarynx & Cooper-Rand), voice pitch is ____ and the sound is ____.
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An artificial larynx is placed against the neck rather than the mouth. This device is used after surgical healing is complete and no edema is remaining. With experience, patient can learn to move the lips in ways that create normal-sounding speech. With both devices (electrolarynx & Cooper-Rand), voice pitch is low and the sound is mechanical.
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See figure 27-13
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...
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________ speech involves swallowing air, trapping it in the esophagus, and releasing it to create sound. The air causes vibration of the pharyngoesophageal segment and sound (similar to a ____).
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Esophageal speech involves swallowing air, trapping it in the esophagus, and releasing it to create sound. The air causes vibration of the pharyngoesophageal segment and sound (similar to a burp or belch).
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It is important to discuss stoma care, depression, and sexuality with patients after laryngeal surgery. What are some considerations for stoma care?
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Keep clean
Taught how to do trach care, after a while they won't need O2 support Need to cover cough so it doesn't get in people's faces! Cover stoma during shaving Swimming is a bad idea Cover during makeup application, avoid powders They can shower if they cover it up (use plastic collar) |
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What are some other nursing considerations in regard to people with stomas regarding sense of smell and humidification? These patients should wear a.....
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initially, humidification administered via a tracheostomy mask.
After discharge- the patient can use a bedside humidifier. High oral fluid intake, esp. in dry weather Sense of smell is limited- install smoke/ carbon monoxide detectors Sense of smell effects sense of taste- it's all about the presentation of food, select nutritious colorful foods etc |
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As patient with tracheostomy regains ability to swallow, may need ____ tube first. The patient may also want reconstructive surgery. ______ is very important and interventions are often needed to encourage this. Patients may even learn ___ language as an alternative to an artificial larynx.
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NG
nutrition sign language |
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Home care for stoma care is a ____ procedure because it's their own germs in their home environment.
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clean
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What are some goals you evaluate for for a patient with laryngeal stoma?
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Demonstrates effective airway clearance and normal breath sounds
Able to swallow oral food without aspiration No infection Acknowledges changes in body image Verbalizes decreased anxiety related to treatments Reports satisfactory pain relief Maintains body weight Communicates basic needs Demonstrates satisfactory care of tubes and incisions and verbalizes knowledge of speech rehabilitation, complications and treatment plan |
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See case study-
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last page of powerpoint
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