Upper Respiratory ( Nac 1)

Front 1

Upper Respiratory consists of

Back 1

Nose
Nostrils
Nasal Cavity
Mouth
Pharynx
Larynx

Front 2

Structural Disorders of the Upper Respiratory System

Back 2

Deviated Septum
Nasal Fracture
Rhinoplasty
Epistaxis
Rhinitis
Influenza
Sinusitis
Polyps
Pharyngitis
Peritonsillar Abscess
Sleep Apnea
Head and Neck Cancer

Front 3

Epistaxis
(def)

Back 3

Nose Bleed

Front 4

Anterior Epistaxis occurs most in

Back 4

Children and Young Adults

Front 5

Anterior Epistaxis often stops

Back 5

Spontaneously
-self-treated

Front 6

Posterior Epistaxis occurs most in

Back 6

Adults
-may require attention to stop

Front 7

Treatment for Posterior Epistaxis

Back 7

-cauterization
-nasal packing

Front 8

First Aid for Epistaxis

Back 8

1- Place pt in sitting position with head tilted forward to prevent aspiration and swallowing of blood
2- Hold nose firmly and continuously for 10-15 minutes with 4x4- Apply continuous external pressure from both sides
3- Have pt breath and spit through mouth
4-Cold packs to bridge of nose or back of neck (vesoconstriction)
5- Observe for 45-60 minutes after bleeding stops

Front 9

Epistaxis Prevention

Back 9

-Keep fingernails short and discourage nose picking
-Use humidifier if indoor drying effect occurring
-Quit smoking
-Open mouth when sneezing

Front 10

Influenza causes _________ deaths per year in the U.S.

Back 10

20,000

Front 11

Two types of Influenza Virus

Back 11

Type A
Type B
-many different strains within each

Front 12

S/S of Influenza

Back 12

1- chills
2- fever
3- aches & pains
4- headache
5- cough
6- runny nose
7- sore throat
8- nausea/ vomiting
9- malaise & weakness

Front 13

Prevention of Influenza

Back 13

Vaccination is the best way to avoid contracting influenza especially to vulnerable population

*Those with egg allergies can't take the flu shot

Front 14

Those at risk for influenza

Back 14

-immunosuppressed
-young
-old
-HCP
-Pregnant women

Front 15

Incubation period of influenza lasts ______ to ______ days

Back 15

1 to 4 days

Front 16

Symptoms of flu begin around the ______ day

Back 16

5th

Front 17

Complications of the flu can result in ___________

Back 17

pneumonia (from stasis sputum)

Front 18

Treatment of flu

Back 18

-Rest
-Increase fluid intake (gatorade, sprite)
-Treat symptoms
-Anti-virals (Tamiflu)
-Antibiotics if secondary bacterial infection present (i.e. pneumonia)

Front 19

Sinusitis
(def)

Back 19

develops when the ostia (exit) from the sinuses are narrowed or blocked by inflammation or hypertrophy (swelling) of the mucosa

Front 20

About _____ to ______ million people each year develop symptoms of sinusitis

Back 20

10 to 15 million

*One of the most common medical conditions

Front 21

Sinusitis may occur in any of the (4) sinuses

Back 21

1- Maxillary
2- Ethmoid
3- Frontal
4- Sphenoid

Front 22

Acute S/S of Sinusitis

Back 22

1- Usually results in pain, tenderness, and swelling over the affected sinus
2- Yellow or green pus may discharge from the nose
3- Fever and chills
4- Assess fro any changes in vision or swelling around the eyes

Front 23

Chronic S/S of Sinusitis

Back 23

1- Nasal obstruction
2- Nasal congestion
3- Post-nasal drip
4- May have colored d/c and decreased sense of smell
5- Generalized malaise

Front 24

Sinusitis Treatment

Back 24

1- Remove cause if caused by allergens
2- Improve sinus drainage and treatment of symptoms
3- Treat infection with antibiotics
4- Surgery if all else fails from chronic sinusitis

Front 25

(2) Ways to improve sinus drainage

Back 25

1- Use of decongestants, corticosteroids, and mucolytics

2- Steam vaporizer hot shower

Front 26

Treating infection with antibiotics:
Acute treat within _____ to _____ days

Chronic treat within _____ to _____ weeks

Back 26

Acute 10-14

Chronic 4-6 weeks

Front 27

Chronic Sinusitis:Surgical procedures

Back 27

1- Caldwell- Luc (Maxillary sinusitis)

2- Functional Endoscopic Sinus Surgery ( F.E.S.S)

Front 28

Obstructive Sleep Apnea (OSA)
(def)

Back 28

caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep

Front 29

S/S of Sleep Apnea

Back 29

-Daytime sleepiness
-Loud snoring
-Observed episodes of breathing cessation during sleep (how often/how long)
-Abrupt awakenings accompanied by shortness of breaths
-Awakening with a dry mouth or sore throat (breath thru mouth)
-Morning headache (lack of sleep)
-Difficulty staying asleep (insomnia)

Front 30

Diagnosis of OSA

Back 30

1- Confirmed by sleep studies (monitor thru the night)

2- Requires documentation of multiple episodes of apnea

Front 31

Treatment of Mild OSA

Back 31

1- Behavior modifications
i.e. sleep on side, not back

2- Oral Appliances (bring the mandible and tongue forward)

Front 32

Treatment for moderate to severe OSA

Back 32

1- CPAP (delivers air)
2- Surgery

Front 33

More than ______ Americans will develop cancer of the head and neck

Back 33

55,000
*Most incidences of head and neck cancer are preventable

Front 34

This year _______ will die from head and neck cancer

Back 34

13,000

Front 35

Risk Factor for Laryngeal Cancer

Back 35

1- Tobacco and alcohol use (Doubles chances)
2- Marijuana use
3- Voice abuse (singers)
4- Chronic laryngitis
5- Exposure to industrial chemicals or hardwood dust
6- Increased in males 3x, . age 50
7- HPV

Front 36

Many cancers of larynx and some of the hypopharynx can be found early. Cancer that forms on the vocal cords are often found at an early stage because they cause _________

Back 36

hoarseness

Front 37

Diagnosis of Laryngeal Cancer

Back 37

1- Physical exam
2- Indirect laryngoscopy
3- Direct laryngoscopy
4- CT Scan
5- Biopsy

Front 38

Direct Laryngoscopy
(def)

Back 38

A tubular endoscope that is inserted into the larynx through the mouth and used for observing the interior of the larynx.

Front 39

Treatment for Laryngeal Cancer

Back 39

1- Radiation
2- Chemotherapy
3- Surgery

Front 40

Radical Neck Dissection
(def)

Back 40

-Involves the removal of the cervical nodes from the clavicle to the mandible, the sternomastoid, the internal jugular vein and the accessory nerve. It results in the significant co-morbidity for the patient leading to shoulder pain and drop reduced of upper limb movement and poor cosmesis.

Front 41

Modified Radical Neck Dissection (def)

Back 41

Involves the removal of the cervical lymph nodes from the clavicle to the mandible.

-Usually the accessory nerve is preserved reducing limb disability for the patient

Front 42

Selective Neck Dissection
(def)

Back 42

Involves preserving one or more of the lymph nodes

Front 43

Nutritional Therapy for Throat/Neck Surgery

Back 43

1- NPO: usually 7-10 days after surgery
2- Enteral Tube Feeding (PEG)
3- When able to swallow, diet will be progressed as tolerated. Enteral tube will be removed when nutritional needs can be met by oral diet (sit up and monitor eating)

Front 44

(2) Reasons for NPO 7 to 10 days after Throat/Neck surgery

Back 44

1- To allow mucosal suture line and surgical sites to heal by preventing stress or pressure during eating or swallowing

2- Reduce risk of infection

Front 45

Nursing Diagnosis for Laryngeal Cancer

Back 45

1- High risk for ineffective breathing pattern related to impaired airway from disease process
2- Risk for aspiration related to edema, anatomic changes, or altered of protective oropharyngeal reflexes
3- Anxiety r/t fear of the unknown
4- Body image disturbances related to tumor and treatment modalities
5- Pain
6- Altered nutrition
7- Impaired verbal communication
8- Altered cerebral tissue perfusion
9- Impaired tissue integrity
10- Impaired skin integrity
11- Ineffective individual coping
12- Impaired social interaction
13- Impaired adjustment
14- Knowledge deficit

Front 46

Non-surgical Treatments for Head/ Neck Cancer

Back 46

1- Radiation Therapy
2- Chemotherapy

Front 47

Radiation Therapy

Back 47

-Skin problems, looks like sunburn
-Dry mouth (may persist and even be permanent)
-Sore throat
-Worsening of hoarseness, especially at beginning
-Difficulty swallowing
-Decreased taste
-Fatigue
-Difficulty breathing

Front 48

Chemotherapy

Back 48

-Nausea and vomiting- Loss of appetite (give antiemetic 1st)
-Loss of hair
-Mouth sores
-Decreased blood count (CBC count low: need blood transfusion)
-Increased susceptibility of infection

Front 49

Pre-Operative Head/Neck Surgery Care Teachings

Back 49

-Implications of surgery
-Airway, permanent tracheostomy self-care
-Methods of communication
-Suctioning
-Pain control methods
-Critical care environmental
-Nutritional support, feeding tubes
-Discharge needs

Front 50

Post-Operative Head/Neck Surgery Care Teaching

Back 50

-Nutritional Support
-Comfort levels, pain management
- Communication needs
-Psychological adjustments
-Out of bed 2nd post op day

Front 51

Complications of Head/Neck Surgery

Back 51

-Airway obstruction
-Hemorrhage
-Stoma Care (opening of the trach)
-Tumor recurrence

Front 52

Speech options for throat cancer

Back 52

1- Esophageal Speech
2- Artificial Larynx/ Electrolarynx (talking thru vibration)
3- Tracheoesophageal Speech (prosthetic put thru trach: push on it to talk)

Front 53

Impact of a Larygectomy

Back 53

-Patients' partners and family members frequently experience high levels of stress the first year following laryngectomy
-A significant number of patients d not return to work postlaryngectomy
-Assessment of continued harmful behaviors (i.e. tobacco and alcohol use), with particular attention to risk for alcohol
-Depression is prevalent postoperatively

Front 54

GOAL for: Potential for ineffective airway clearance R/T: Presence of tracheostomy tube, difficulty expectorating sputum

Back 54

-Maintain a clear, patent airway throughout hospitalization as evidence by:
*Clear breath sounds
*Respiratory rate: 16-20 breaths/minute
*Unlabored respirations
*Absence of stridor

Front 55

GOAL for: Potential for ineffective airway clearance R/T: Neck Dissection

Back 55

Effectively clear his/her airway by coughing prior to discharge

Front 56

GOALl for: Potential for ineffective airway clearance R/T: Laryngectomy

Back 56

Arrange for home suction machine and humidifier through special work services

Front 57

INTERVENTION for: Potential for ineffective airway clearance R/T: Presence of tracheostomy tube, difficulty expectorating sputum

Back 57

-Position the pt in semi-fowlers to prevent and forward flexion of the neck to reduce edema
-Observe for hypoxia
-Keep laryngectomy tube clean
-Watch for stridor

Front 58

GOAL for: Alteration in Verbal Communication R/T: Use of artificial airway

Back 58

-Learn and use an effective communication system immediately post-op and throughout hospitalization

Front 59

INTERVENTIONS for: Alteration in Verbal Communication R/T: Use of artificial airway

Back 59

-Maintain call bell within reach of patient at all times
-Label call system at nurse's station so they know the pt cant speak
-Answer call system promptly and in person
-Observe pt hourly
-Provide materials for communication
-Ask questions that require short answers
-Encourage all health care personnel and caregivers to use same techniques
-Ensure follow up with Speech Therapist regarding alternate speech devices

Front 60

Types of materials a pt can use to communicate with use of an artificial airway

Back 60

-pencils and paper
-picture board
-magic slate (dry erase board)

Front 61

Assessment for Facial Injuries

Back 61

1- Ensure adequate airway including bleeding that could occlude the airway
2- Cervical spine precautions c-spine immobilization by hard cervical collar until c-spine injury can be excluded
3- Control bleeding by careful direct pressure
4- Continue assessment to prevent increasing injury
5- Protect any open wounds to prevent infection

Front 62

The presence of glucose in fluid from facial injuries suggests ________ fluid

Back 62

CSF

Front 63

What is the primary concern with all facial/neck trauma victims

Back 63

Cervical-spine injury

Front 64

Cervical-Spine Stabilization should be implemented for pt's with

Back 64

1- injury above clavicle or head injury resulting in unconscious state
2- Any injury produced by high speed

Front 65

S/S of Cervical-Spine Stabilization

Back 65

-Neurologic deficit
-Neck pain

Front 66

A _______ tear or _______ ________ fracture can let ______ fluid leak from the skull into the ears, nose or eyes

Back 66

1-Meningeal tear
2-Basal Skull fracture
3-CSF

Front 67

Characteristics of CSF fluid

Back 67

-Typically clear
-May be blood-tinged or pink
-Glucose present

Front 68

Rhinorrhea
(def)

Back 68

Leaking of CSF from the nose

Front 69

Otorrhea
(def)

Back 69

Leaking of CSF from the ear

Front 70

Halo Sign
(def)

Back 70

Blood that collects in the center and yellow fluid encircles

Front 71

CSF leaks may be caused by damage to the _______ ________

Back 71

dura mater

Front 72

Intervention for CSF leak

Back 72

cover with loose gauze

Front 73

Serious facial traumas are often caused by:

Back 73

MVA's
Fights
Sporting Activities

Front 74

Trauma to the face can include injury to the:

Back 74

Nose
Eyes
Cheek (Maxillary)
Jaw (Mandible
Teeth

Front 75

Treatment Strategies for facial injuries

Back 75

1- Begin administration of 0.9% NaCl with 14 or 16 bore IV to prevent hypotension
2- Assess for presence of leaking CSF form the ears, nose or eyes (DON'T Occlude the drainage to keep from infection)
3- Apply cool packs to reduce edema

Front 76

Stabilization of Mandible Fractures

Back 76

with arch bars placed across the upper and lower teeth and wired together

Front 77

Following the stabilization (wiring) of a mandible fracture, the pt should be placed on a _________ ______ diet

Back 77

clear liquid

Front 78

_______ ________ should be at the pt's bed side at all times following a mandible stabilization

Back 78

wire cutters

*If the pt begins vomiting, cut the wires immediately to protect the airway

Front 79

Stabilization of Maxillary Fractures

Back 79

May be integrated with an arch bar across the upper teeth to stabilize any fractured teeth

Front 80

Possible airway obstruction may include interruption of airflow through the:

Back 80

Nose
Mouth
Pharynx
Larynx

Front 81

AIRway Management

Back 81

1- Assess for airway obstruction
2-Improve Airway Through Maneuvers
3-Remove Debris/Suction
4-Airway Adjuncts

Front 82

Assessment for airway obstruction for

Back 82

-Difficulty breathing
-Patient conduct
-Abnormal sounds

Front 83

A pt with airway obstruction may appear

Back 83

anxious or combative

Front 84

Maneuvers to improve/establish airway

Back 84

-Chin lift
-Jaw thrust

Front 85

The chin lift method should only be implemented in the absence of ____________

Back 85

Trauma

Front 86

Airway Adjuncts include

Back 86

Nasal Airway (Primary)
Oral Airway

Front 87

Hypoxia that occurs during suctioning may cause the HR to ________ in adults

Back 87

Increase

Front 88

Hypoxia that occurs during suctioning may cause the HR to _______ in infants and children

Back 88

Decrease

Front 89

HR decrease during suctioning may be due to

Back 89

Stimulation of posterior pharynx

Front 90

Nasophyrangeal Airway

Back 90

Keeps Tongue forward to prevent occlusion of the airway

Front 91

Insertion of Nasophryangeal Airway

Back 91

1-Lubricate
2-Insert along floor of nasal cavity
3-If resistance met, use back and forth motion
4-Don't force (use other nostril if necessary)
5-If pt gags, withdraw slightly

Front 92

Insertion of Phryngeal Airway

Back 92

1-Measure
2- Confirm pt is unconscious
3-Insert, rotate 180 degrees as inserting

Front 93

Endotracheal Tube (Intubation)
(def)

Back 93

a procedure by which a tube is inserted through the mouth down into the trachea (the large airway from the mouth to the lungs)

*Most often put in during code situation

Front 94

Tracheostomy
(def)

Back 94

the surgical procedure that creates a tracheostomy

Front 95

Indications for Tracheostomy

Back 95

1-Bypass acute upper airway obstruction
2-Maintain an open airway
3-Remove secretions more easily
4-Oxygenate and/or improve mechanical ventilation on a long term basis