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95 Cards in this Set

  • Front
  • Back
Upper Respiratory consists of
Nose
Nostrils
Nasal Cavity
Mouth
Pharynx
Larynx
Structural Disorders of the Upper Respiratory System
Deviated Septum
Nasal Fracture
Rhinoplasty
Epistaxis
Rhinitis
Influenza
Sinusitis
Polyps
Pharyngitis
Peritonsillar Abscess
Sleep Apnea
Head and Neck Cancer
Epistaxis
(def)
Nose Bleed
Anterior Epistaxis occurs most in
Children and Young Adults
Anterior Epistaxis often stops
Spontaneously
-self-treated
Posterior Epistaxis occurs most in
Adults
-may require attention to stop
Treatment for Posterior Epistaxis
-cauterization
-nasal packing
First Aid for Epistaxis
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
Epistaxis Prevention
-Keep fingernails short and discourage nose picking
-Use humidifier if indoor drying effect occurring
-Quit smoking
-Open mouth when sneezing
Influenza causes _________ deaths per year in the U.S.
20,000
Two types of Influenza Virus
Type A
Type B
-many different strains within each
S/S of Influenza
1- chills
2- fever
3- aches & pains
4- headache
5- cough
6- runny nose
7- sore throat
8- nausea/ vomiting
9- malaise & weakness
Prevention of Influenza
Vaccination is the best way to avoid contracting influenza especially to vulnerable population

*Those with egg allergies can't take the flu shot
Those at risk for influenza
-immunosuppressed
-young
-old
-HCP
-Pregnant women
Incubation period of influenza lasts ______ to ______ days
1 to 4 days
Symptoms of flu begin around the ______ day
5th
Complications of the flu can result in ___________
pneumonia (from stasis sputum)
Treatment of flu
-Rest
-Increase fluid intake (gatorade, sprite)
-Treat symptoms
-Anti-virals (Tamiflu)
-Antibiotics if secondary bacterial infection present (i.e. pneumonia)
Sinusitis
(def)
develops when the ostia (exit) from the sinuses are narrowed or blocked by inflammation or hypertrophy (swelling) of the mucosa
About _____ to ______ million people each year develop symptoms of sinusitis
10 to 15 million

*One of the most common medical conditions
Sinusitis may occur in any of the (4) sinuses
1- Maxillary
2- Ethmoid
3- Frontal
4- Sphenoid
Acute S/S of Sinusitis
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
Chronic S/S of Sinusitis
1- Nasal obstruction
2- Nasal congestion
3- Post-nasal drip
4- May have colored d/c and decreased sense of smell
5- Generalized malaise
Sinusitis Treatment
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
(2) Ways to improve sinus drainage
1- Use of decongestants, corticosteroids, and mucolytics

2- Steam vaporizer hot shower
Treating infection with antibiotics:
Acute treat within _____ to _____ days

Chronic treat within _____ to _____ weeks
Acute 10-14

Chronic 4-6 weeks
Chronic Sinusitis:Surgical procedures
1- Caldwell- Luc (Maxillary sinusitis)

2- Functional Endoscopic Sinus Surgery ( F.E.S.S)
Obstructive Sleep Apnea (OSA)
(def)
caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep
S/S of Sleep Apnea
-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)
Diagnosis of OSA
1- Confirmed by sleep studies (monitor thru the night)

2- Requires documentation of multiple episodes of apnea
Treatment of Mild OSA
1- Behavior modifications
i.e. sleep on side, not back

2- Oral Appliances (bring the mandible and tongue forward)
Treatment for moderate to severe OSA
1- CPAP (delivers air)
2- Surgery
More than ______ Americans will develop cancer of the head and neck
55,000
*Most incidences of head and neck cancer are preventable
This year _______ will die from head and neck cancer
13,000
Risk Factor for Laryngeal Cancer
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
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 _________
hoarseness
Diagnosis of Laryngeal Cancer
1- Physical exam
2- Indirect laryngoscopy
3- Direct laryngoscopy
4- CT Scan
5- Biopsy
Direct Laryngoscopy
(def)
A tubular endoscope that is inserted into the larynx through the mouth and used for observing the interior of the larynx.
Treatment for Laryngeal Cancer
1- Radiation
2- Chemotherapy
3- Surgery
Radical Neck Dissection
(def)
-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.
Modified Radical Neck Dissection (def)
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
Selective Neck Dissection
(def)
Involves preserving one or more of the lymph nodes
Nutritional Therapy for Throat/Neck Surgery
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)
(2) Reasons for NPO 7 to 10 days after Throat/Neck surgery
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
Nursing Diagnosis for Laryngeal Cancer
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
Non-surgical Treatments for Head/ Neck Cancer
1- Radiation Therapy
2- Chemotherapy
Radiation Therapy
-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
Chemotherapy
-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
Pre-Operative Head/Neck Surgery Care Teachings
-Implications of surgery
-Airway, permanent tracheostomy self-care
-Methods of communication
-Suctioning
-Pain control methods
-Critical care environmental
-Nutritional support, feeding tubes
-Discharge needs
Post-Operative Head/Neck Surgery Care Teaching
-Nutritional Support
-Comfort levels, pain management
- Communication needs
-Psychological adjustments
-Out of bed 2nd post op day
Complications of Head/Neck Surgery
-Airway obstruction
-Hemorrhage
-Stoma Care (opening of the trach)
-Tumor recurrence
Speech options for throat cancer
1- Esophageal Speech
2- Artificial Larynx/ Electrolarynx (talking thru vibration)
3- Tracheoesophageal Speech (prosthetic put thru trach: push on it to talk)
Impact of a Larygectomy
-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
GOAL for: Potential for ineffective airway clearance R/T: Presence of tracheostomy tube, difficulty expectorating sputum
-Maintain a clear, patent airway throughout hospitalization as evidence by:
*Clear breath sounds
*Respiratory rate: 16-20 breaths/minute
*Unlabored respirations
*Absence of stridor
GOAL for: Potential for ineffective airway clearance R/T: Neck Dissection
Effectively clear his/her airway by coughing prior to discharge
GOALl for: Potential for ineffective airway clearance R/T: Laryngectomy
Arrange for home suction machine and humidifier through special work services
INTERVENTION for: Potential for ineffective airway clearance R/T: Presence of tracheostomy tube, difficulty expectorating sputum
-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
GOAL for: Alteration in Verbal Communication R/T: Use of artificial airway
-Learn and use an effective communication system immediately post-op and throughout hospitalization
INTERVENTIONS for: Alteration in Verbal Communication R/T: Use of artificial airway
-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
Types of materials a pt can use to communicate with use of an artificial airway
-pencils and paper
-picture board
-magic slate (dry erase board)
Assessment for Facial Injuries
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
The presence of glucose in fluid from facial injuries suggests ________ fluid
CSF
What is the primary concern with all facial/neck trauma victims
Cervical-spine injury
Cervical-Spine Stabilization should be implemented for pt's with
1- injury above clavicle or head injury resulting in unconscious state
2- Any injury produced by high speed
S/S of Cervical-Spine Stabilization
-Neurologic deficit
-Neck pain
A _______ tear or _______ ________ fracture can let ______ fluid leak from the skull into the ears, nose or eyes
1-Meningeal tear
2-Basal Skull fracture
3-CSF
Characteristics of CSF fluid
-Typically clear
-May be blood-tinged or pink
-Glucose present
Rhinorrhea
(def)
Leaking of CSF from the nose
Otorrhea
(def)
Leaking of CSF from the ear
Halo Sign
(def)
Blood that collects in the center and yellow fluid encircles
CSF leaks may be caused by damage to the _______ ________
dura mater
Intervention for CSF leak
cover with loose gauze
Serious facial traumas are often caused by:
MVA's
Fights
Sporting Activities
Trauma to the face can include injury to the:
Nose
Eyes
Cheek (Maxillary)
Jaw (Mandible
Teeth
Treatment Strategies for facial injuries
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
Stabilization of Mandible Fractures
with arch bars placed across the upper and lower teeth and wired together
Following the stabilization (wiring) of a mandible fracture, the pt should be placed on a _________ ______ diet
clear liquid
_______ ________ should be at the pt's bed side at all times following a mandible stabilization
wire cutters

*If the pt begins vomiting, cut the wires immediately to protect the airway
Stabilization of Maxillary Fractures
May be integrated with an arch bar across the upper teeth to stabilize any fractured teeth
Possible airway obstruction may include interruption of airflow through the:
Nose
Mouth
Pharynx
Larynx
AIRway Management
1- Assess for airway obstruction
2-Improve Airway Through Maneuvers
3-Remove Debris/Suction
4-Airway Adjuncts
Assessment for airway obstruction for
-Difficulty breathing
-Patient conduct
-Abnormal sounds
A pt with airway obstruction may appear
anxious or combative
Maneuvers to improve/establish airway
-Chin lift
-Jaw thrust
The chin lift method should only be implemented in the absence of ____________
Trauma
Airway Adjuncts include
Nasal Airway (Primary)
Oral Airway
Hypoxia that occurs during suctioning may cause the HR to ________ in adults
Increase
Hypoxia that occurs during suctioning may cause the HR to _______ in infants and children
Decrease
HR decrease during suctioning may be due to
Stimulation of posterior pharynx
Nasophyrangeal Airway
Keeps Tongue forward to prevent occlusion of the airway
Insertion of Nasophryangeal Airway
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
Insertion of Phryngeal Airway
1-Measure
2- Confirm pt is unconscious
3-Insert, rotate 180 degrees as inserting
Endotracheal Tube (Intubation)
(def)
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
Tracheostomy
(def)
the surgical procedure that creates a tracheostomy
Indications for Tracheostomy
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