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Respiratory Upper

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mattisensept's version from 2017-09-18 23:50

Section 1

Question Answer
Structure less recoil & compliance, increased AP diameter, fewer functioning alveoli,
defense mechanisms less cell mediated immunity, specific antibodies & alveolar macrophage function. decreased cilia function & cough force
respiratory controlreduced capacity to react to hypoxemia & hypercapnia
therefore... decreased wall movement, excurstion, vital capacity, cough, antibodies, breath sounds, clearance of secretions
result is...less oxygenation, more secretions, more infections, can't clear them or fight them, less ability to compensate for O2 changes and pH changes quickly
basic respiratory functionsventilation and oxygenation
usually a problem with...ventilation that leads to an oxygenation problem
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structural and traumatic disorders of the nose

Question Answer
potential complicationsbreathing obstruction. edema, dry mucosa, epistaxis, mucous blockage (infection)
NM-assessbreath though both nostrils, edema, bleeding, hematoma, hemorrhage?, clear fluids (CSF)
NM-goalsreduce edema, prevent complications
NM-actionselevate HOB x 48--> reduce swelling, nasal packing (1 day), ice (reduce edema & bleeding), continue to monitor
Epistaxis-interventionskeep pt quiet, sitting position, direct pressure, ice compression, small gauze pad into nostril
If interventions infective--> vasoconstrictor agents, cauterize, anterior or posterior packing for min 3 days
Rhinoplasty-interventionselevate HOB, restrict things that can contribute to bleeding, pt. should not change packing
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inflammation and infection

Question Answer
inflammation & infection -manifestationsnasal congestion, sneezing, watery/itchy eyes, altered smell, water discharge, H/A, congestion, pressure, nasal polyps
txtylenol, fluids, pharm
do not use decongestantsfor more than 3 days, rebound vasodilation and congestion
teachingavoidance of triggers, corticosteroids (inhaled have minimal systemic effects), wash hangs, monitor sputum
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influenza

Question Answer
influenza rate225,000 hospitalized, 20,000 deaths/year
who dies?most are elderly w/underlying heart/lung disease, many could be prevented if vaccinated
what are the groups at risk?>50 yr old, chronic cardiac or pulmonary, hospitalization, LTC recipients, immunocompromised, pregnancy,
live/attenuated vaccine2-49 yrs, intra-nasally
manifestationsrapid onset--> cough, fever, myalgia, HA, sore throat
complicated/not complicated subside within a week, older will have symptoms for weeks
can lead to... pneumonia, exacerbated cough, purulent sputum, tx w/antibiotics
nursing roleencourage vaccination, vaccine in fall,
contradictedallergy to eggs
those that can transmit to high-riskhealth care workers
if flu occurstreat symptoms
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obstruction

Question Answer
nasal polyps benign mucous membrane masses, bluish, glossy, pt may fear malignancy
txendoscopic/laser sx
prognosisprobably recur--> corticosteroids may slow growth
forign bodiesanything that fits
manifestationsclear discharge & local inflammation
txremove via point of entry, sneeze, do not push or irrigate (aspiration), refer if not resolves
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moving down the throat, pharynx

Question Answer
acute pharyngitisacute inflammation of pharyngeal walls, viral (70%), bacterial or fungal
acute follicular pharyngitis (step)in about 15-20%
fungal candid--> prolonged antibiotic or corticosteroid use. esp. if immunocompromised
manifestations red and edematous, maybe patchy yellow exudates, white--> candida,
tx completely.. so that it does not lead to rheumatic heart disease
mangementinfection control, symptomatic relief, prevent secondary infections, fluid (citrus can irritate), treat w/antibiotics or nystatin (fungal--> swish and swallow)
peritonsillar abscess (PA)complication of acute pharyngitis or acute tonsillitis, bacteria invade 1 or both tonsils, could threaten airway
PA- S&Shi gever, leukocytosis, chills
PA-txantibiotics, needle aspiration, I&D, tonsillectomy
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obstructive sleep apnea

Question Answer
Description partial or complete obstruction w/sleep, tongue & soft palate fall backward & partially or complete obstruct
last for 15-90 seconds
what is happening?severe hypoxemia (reduced PaO2) & hypercapnia (increased PaCO2), causes pt to wake
manifestations frequent awakenings, loud snoring, morning HA (hypercapnia, irritability, male impotence
diagnosispolysomnography (during sleep) all systems monitored, must have multiple episodes, in lab or home
management avoid sedative & alcohol, weight loss, oral appliance (mandible & tongue forward), CPAP or BiPAP. possible sx (remove tissue)
partial airway obstruction (PAO)aspiration, laryngeal edema
PAO S&Sstridor, accessory muscles, retractions, wheeze, restless, tachy, tachypnea &cyanosis
complete airway obstructionmedical emergency, be aware of epiglottis in children
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tracheostomy

Question Answer
definitionsx incision into trachea to establish stoma that establishes patent airway, usually done in ER
indicationsbypass upper airway obstruction, facilitate removal of secretions, long-term mechanical ventilation, permit oral intake and speech in patient that requires long-term mechanical ventilation
Advantages over endotracheal tubemore stability, less risk of long-term damage to airway, less risk of damaged vocal cords, comfort increased, hygiene improved, pt. can eat as tube enters lower airway, increased mobiity
obturator use of insertion of cannula, then removed, keep at bedside
outer cannulastability and remains
inner cannulaairway and may be disposable
trache care-teachingexplain its purpose, inform on inability to speak while inflated cuff is used
tubes contain a faceplate or flangerests on the neck between clavicles & outer canula
tube w/inflated cuff is used for risk pf aspiration or in mechanical ventilation, inflate cuff w/ min volume to create an airway seal, should not exceed 20mm Gh or 25 cm H2O
higher pressure compress tracheal capillaries, limit blood flow, predispose to tracheal necrosis
minimal leak techniquesinfalte cuff w/ min amount of air to form seal; withdraw 0.1 ml of air, monitor pressure daily as the underlying tissue may dilate over time and pt. becomes @ risk for complications of higher pressures
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trache care

Question Answer
how to suction STERILE--> pre-oxygenate (max 30 sec), insert 5-6 inc w/o suction, suction w/withdrawl (no longer than 15 seconds)
not too many passes if possibleleads to hypoxoia, if no problems, 2 is usually good
potential for dislodgement retention sutures (free ends taped to skin and leave accessible in case tube is dislodges, most dangerous 5-7 days
precautions to prevent dislodgment replacement tube @ bedside, do not change ties for 24 hrs, physician preforms first rube change (usually after 7 days)
accidental dislodgment immediately call for help!!
options to replace trache spread the opening w/ hemostat, insert a replacement tube w/obtutator, and remove obtutator, insert a suction cath to allow passage of air and guide insertion of replacement tube
if tube cannot be replacedassess level of respiratory distress, position in semi-fowlers position, severe distress may profess to respiratory arrest
until help arrivescover stoma w/sterile dressing and ventilate with bag-mask ventilation until help arrives
first thing to do if dislodgment occurs grasp the retention sutures to spread the tracheostomy opening
after first tube changeshould be changes once a month
once tube has been placed for several monthshealed tract will be well formed
patient can be taught to change tube using clean technique at home
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trache care cntd

Question Answer
nursing diagnosis examplesineffective airway clearance, impaired verbal communication, risk for infection, imbalances nutrition, impaired swallowing, ineffective therapeutic regimen management, hypoxemia
inflated cuffinterferes w/normal function of muscles used to swallow
clinical assessment for swallowing ability and aspiration riskby speech therapist, videofloroscopy, fiberoptic endoscopy
if no risk for aspiration..leave cuff deflated or replace w/ cuffless tube
fenestrated trache tubeair passes from lungs through openings in trach into upper airway, must not be @ risk for aspiration, remove inner cannula, deflate cuff, and place cap on tube, assess pt. for any respiratory distress
speaking tracheostomy tubecan be used on pt. @ risk for aspiration, two pigtail tubings, one connects to cuff for inflation, other connects to opening just above cuff,
when second tube is connected to low-flowair source, this permits speech
decannulationwhen pt can adequately exchange air and expectorate, stoma closed w/tape & covered w/occlusive dressing, instruct pt. to splint stoma w/fingers when coughing, swallowing or speaking, tissue forms in 24-48 hrs, opening will close in several days
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head and neck cancer

Question Answer
typically it issquamous cell carcinoma
can involve the sinuses, oral cavity, larynx, nasopharynx, oropharanyx, pharanyx
disabilitydisfigure and voice loss
who is at riskmen 2X women, over 50 yr, tobacco & alcohol
manifestations-oral cavity EARLYpainless growth, non-healing ulcer, change in denture fit, citric acid irritation
manifestations-oral cavity LATEpain, dysphagia, decreased tongue mobility, airway obstruction, thickened oral mucosa, leukoplakia, erythroplakia
laryngeal EARLYhoarseness, change in voice quality, lump
Tside of the primary tumor
Nthe degree to which regional lymph nodes are involves
Mthe absence or presence of distant metastases
stage 1 cancerssmall, localized and usually curable
stage 2 & 3 typically are locally advanced and or have spread to local lymph nodes
stage 4usually metastic and generally considered inoperable
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head and neck cancer cntd

Question Answer
In stage 1 or 2 radiation therapy and sx offer a possible cure, zerostomia (dry mouth, frequent and annoying)
Chemo can be used in conjunction w/other therapies
some very extensive sxpermanent hole in throat, need training before speaking is restored --> total laryngectomy, radial neck dissection, modified neck dissection
post opelevate HOB 24 hrs, semi fowlers (reduce edema and pressure on suture line) frequent suctioning,
possible forceful cough dislodges tubeFIRST- attempt to reinsert obturator, airway must be opened up, everything else comes second
nutritional therapy TPN for short time, then need tube feeding
nursing-feeding--> monitor feedings, swallowing, teaching
goalspatent airway, no therapy-related complications, adequate nutritional intake, ability to communicate, accept body image
diagnosisanxiety, ineffective airway clearance, ineffective tissue perfusion, imbalances nutrition, impaired vernal communication, disturbed body image, acute pain
helpless ness.. be present, involve pt. in care, try to get pt to take a part in their own care
total necks.. discharge teaching can resume normal activities, avoid smoke and carbon monoxide, never occlude the decanulation can, medic alert
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