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59 Cards in this Set
- Front
- Back
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COPD
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Emphysema
Chronic Brinchitis |
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Upper Respiratory Disorder
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Rhinitis
Sinusitis Pharyngitis Tonsillitis |
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Lower Respiratory Disorders
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COPD
Pulmonary Hypertension Pneumonia Pulmonary Embolsim |
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Larynx
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Vocalization
Connectys pharynx to trachea Facilitates coughing |
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Laryngitis Nursing Interventions
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Rest voice
2-3 L fluid intake Throat lozenges Antibiotic (if bacterial) Education |
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Obstructive Sleep Apnea
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Cessation of breathing during sleep
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Types of sleep apnea
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Obstructive
Central Mixed |
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Prevalency of Sleep Apnea
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men, overweight, smokers
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Definition of sleep apnea
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frequent and loud snoring (or lack of snoring) with breathing lapses greater than 10 seconds that occurs more than 5 times per hour
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Symptoms of obstructive sleep apnea
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headaches
sore throat irritability napping during the day |
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Causes of sleep apnea
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- throat muscles and tongue relax more than normal and occlude airway
- tonsils and adenoids are large - overweight - shape of head and neck |
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Treatment of Sleep apnea
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CPAP (continuous positive airway pressure)
BiPAP (two different levels of pressure for inspiration and expiration) Surgers (move jaw forward) |
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Nursing Treatment
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Education
Administration of oxygenation |
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Cancer of the Larynx warning signs
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pain
lump in throat Dysphagia Changes in oral mucosa Unexplained oral bleeding Weight loss Sore throat |
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Assement of Laryngeal Cancer
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Health history
inspect and palpate neck (swelling of lymph nodes) Psychosocial assessment - depression, support, resources, anxiety Lab assessment Diagnostic Testing |
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Nursing DX for Laryngeal Cancer
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Risk for aspiration r/t
Anxiety r/t Disturbed body image r/t |
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Goals and outcomes for Laryngeal Cancer
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Primary - Adequate ventilation and oxygenation
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NI for Non-Surgical Interventions for Laryngeal Cancer
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Assess Resp system and status
Pulse ox Blood Gasses (best indicator of gas exchange) High Fowlers Position |
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NI for Radiation Therapy for Laryngeal Cancer
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- Sore throat (Gargle with saline, Ice chips, Pain medication, Localized Anesthetic)
- Skin care - Dry mouth (increase fluid intake, artificial saliva |
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NI for Chemotherapy for Laryngeal Cancer
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No questions on the test
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Surgical Options for Laryngeal Cancer
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Individualized and dependent upon location of tumor and advancement of cancer
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Cordectomy
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Removal fo the vocal cords
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Partial Laryngectomy
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Removal of tumor, portion of larynx and vocal cord
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Supraglottic Laryngectomy
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Removal of the hyoid bone, glottis, false cords
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Hemilaryngectomy
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Removal of tumor, one true and one false vocal cord
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Total Larngectomy
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Advanced cancer, all portions of the larynx are removed
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Radical Neck Dissection
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Removal of tumor, lymph nodes, sternocleidomastoid muscle, juglar vein,s oft tissue and spinal accessory nerve
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Nursing Care Post-op
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monitor airway, vitals, hemodynamics, comfort
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NI Post Op for Laryngeal Cancer Operation - Airway
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Ventilation
Trach mask with humidified oxygen cough and deep breath Suction (as necessary) Suture line care with 1/2 strength hydrogen peroxide |
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NI Post Op for Laryngeal Cancer Operation - Wound
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Monitor for infection
Monitor for hematoma Monitor for carotid hemorrhage |
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NI Post Op for Laryngeal Cancer Operation - Pain
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Opioid analgesics (morophine)
NSAIDS (for mild pain) Tricyclic Antidepressants (nerve pain) |
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NI Post Op for Laryngeal Cancer Operation - Nutrition
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- J or G tube, NG tube 10-14 days post op.
- IV fluids - Assess gag reflex and ability to swallow prior to removing NG tube. |
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Can aspiration occur in client swith a total laryngectomy?
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No. there is no connection. The trach will take the place of the patients airway.
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Types of speach after laryngeal surgery
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Esophageal
Mechanical Tracheoesophageal fistula |
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Tracheostomy Definition
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Surgical incision made into the trachea for the purpose of airway establishment
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Reasons for Tracheostomy
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airway obstruction
airway protection secretion management sleep apnea Prolonged intubation airway burns |
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Complications of a Tracheostomy
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Obstruction
Dislodgement Pneumothorax (air in the airway) Subcutaneous Emphysema Bleeding Infection (Biggest Problem |
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NI for pt with Tracheostomy
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Presvent tissue damage
Humidification and warming Suctioning (hypoxia, tissue trauma, infection, vagal stimulation, bronchospasm) Assess need for suctioning prior to care |
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NDX for pt with tracheostomy
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Inneffective airway clearance
Risk for infection Risk for aspiration Impaired verbal communication Knowledge deficit Anxiety |
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NI Aspiration
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High fowlers position
Avoid eating when fatigued Chin to chest to aid swallowing Semi-solid foods |
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NI for ineffective airway clearance
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Positionchange
Humidification Hydration Suction |
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Acute Laryngeal Edema
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Inflammation, injury and anaphylaxis
Acute onset of SOB Respiratory arrest can occur Intubation is difficult |
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Med for actte Laryngeal Edema
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Epinephrine and corticosteroids
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Laryngospasm
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results from general anesthesia inhalation
Hyopocalcemia |
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NI for laryngospasm
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Establish airway, 200% oxygen
Paralysis and ventilate if necessary |
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Laryngeal Paralysis
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Results from neck surgery, tumors, CVA's
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S/s of Laryngeal Paralysis
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hoarseness
aspiration si very common |
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Lung Cancer
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Nost notable cause of cancer related deaths, increasing in women, most related to corcoinogenic chemicals
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Pathophysiology of Lung Cancer
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Exposure to carcinogenic agent
Transformation fo epithelial cell Transferring of damaged DNA to subsequent cells Shift from health functioning pulmonary epithelial tissue to carcinoma |
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Risk factors for Lung Cancer
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Tobacco smoke, 2nd hand smoke, exposure to environmental pollutants, genetics, gender, dietary
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Clinical Assessment findings for Lung Cander
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Often asymptomatic. S/S dependent on location of tumor, size, level of obstruction, degree of mets,
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Most common symptom of Lung Cancer
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Cough or change in cough
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other S/s of Lung Cancer
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Wheezing
Hemoptysis Fever Pain |
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DX Lung Cancer
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Chest X-ray
CT-Scan Bronchoscopy Needle Aspiration Atelectasis |
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NI focus for Lung Cancer Pt
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Maintain patent airway (deep breathing, coughing, chest PT, suctioning)
Ensure adequate gas exchange (oxygen, high fowlers position, enery conservation) |
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Classic warning sign of laryngeal cancer
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persistent hoarsness
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Nursing care of the client iwth a tracheostomy tube includes
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Using hyperoxygenation and sterile technique when suctioning the client
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The client is scheduled for a radical neck dissection. the nurse knows that hte surgeon will remove
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All of the lymph nodes from teh ramus to the jaw
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The nurse is caring for a client diagnosed with stage IV lung cancer which has reponded poorly to chemotherapy. What would be a priority NDX?
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Coping ineffective r/t poor response to therapy
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