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When dealing with respiratory issues, what is the main nursing priority?
To promote oxygenation by maintaining a patent airway.
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Displacement of either the bone or cartilage of the nose that can cause airway obstruction or cosmetic deformity and is potential source for infection.
Fracture of the nose.
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In facial fracture, the presence of cerebrospinal fluid could indicate what?
a skull fracture
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How do can tell if a pt's fluid that is present is cerebrospinal?
Cerebrospinal fluid has glucose in it so you can test it using a dip stick. also, it dries with a yellow halo.
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What are the 3 types of interventions for a nasal fracture?
Rhinoplasty, Nasoseptoplasty, and closed redution.
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Intervention for a nasal fracture that involves manupulation of the bones by palpation to position them in proper alignment which is effective within the first 24 hours
Closed reduction
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Intervention for a nasal fracture that involves surgical reconstruction of the nose for cosmetic purposes and to improve airflow.
Rhinoplasty
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Intervention for a nasal fracture that involves submucous resection, this may be needed to straighten a deviated septum when chronic symptoms occur.
Nasoseptoplasty
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Term for Nose bleed, which is a common problem because of the many capillaries within the nose.
Epistaxis.
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What type of nosebleed is an emergency?
Posterior nose bleeding. It is an emergency becuase the it is not easy to get to and the pt may loose alot of blood.
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What is a good indicator that the pt is bleeding posteriorly?
Frequent swallowing.
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What are some interventions if a nosebleed does not respond to emergency care?
- - affected cappillaries are cauterized with silver nitrate or elecrocautery, and the nose is packed.
- - administer humidification, oxygen, bedrest, antibiotics, pain medicatinos.
- - epistaxis catheters and gel tampons.
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How often should the nurse check the pt's airway from posterior nasal packing placed after surgery or posterior nasal epistaxis.
Every hour
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What are benign grapelike clusters of mucous membrane and connective tissue which often occur bilaterally.
Nasal polyps. If they become to large, airway obstruction may result.
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Tumors of the nose and sinsuses are rare and be either benign or mailgnant. The onset is slow and the manifestations resemble what?
Sinusitis.
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Often what occurs with tumor mass with caner of the nose and sinuses?
Local lymph enlargement.
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What is the main therapy used for the treatment of nasopharyngeal caner (nose cancer)
Readiation therapy. Surgical removal is performed if radiation therapy is not successful.
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Is described by the specific bones, such as mandibular, maxillary, orbital, or nasal fractures, and the side of the face involved.
Facial trauma
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For faciala trauma, the most common are what type of fractures?
Mandibular jaw fractures.
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For a pt with facial trauma, what does the nurse need to anticipate?
Anticipate the need for emergency intubation, tracheotomy, or cricothyroidotomy.
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What is the priority for facial trauma patients?
To establish a patent airway.
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This type of facial trauma intervention involves wiring the patients jaws shut.
Fixed occlusion.
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For a pt with fixed occlusion, what does the nurse or the pt (when alone) need to have with them at all times?
wire cutters
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is a breathing disruption during sleep that lasts at least 10 seconds and occurs a minumum of 5 times an hour.
Sleep apnea.
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What is the most common cause of sleep apnea?
the most common for occurs as a result of upper-airway obstruction by the soft palate or tongue.
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What greatly increases the risk for sleep apnea?
obesity
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What are some symptoms of sleep apnea?
excessive daytime sleeepiness, inability to concentrate, and irritability.
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What are some nonsurgical methods to help sleep apnea.?
Change of sleep position, weight loss, positive ressure ventilation (C pap machine)
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What are some surgical interventions for sleep apnea?
adenoidectomy, uvulectomy, or uvulopalatopharyngoplasty. Some of these patients are on cardiac monitors as well.
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Prolonged intubation with an endotracheal tube may cause temporary or permanent __?
vocal cord paralysis.
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Why is a pt with vocal cord apralysis at risk ro aspiration?
because the airway may not close during swallowing. Therefore, pt should be taugh to hold their breath during swallowing.
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Life- threatening emergency in which an interruption in airflow through the nose, mouth, pharynx, or larunx occurs.
Upper airway obstruction
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why is early recognition essential in upper airway obstruction?
to prevent further complications, including respiratory arrest
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What is the first intervention for a pt with an upper airway obstruction?
Assessment for the cause of the obstruction.
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What does the second intervention include for a pt with an upper airway obstruction after assessment?
Maintenance of the patient airway and ventilation. This could be through a cricothyroidotomy, endotracheal intubation (naso or orotracheal), and tracheostomy
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What are enlarged fibrous tissues caused by infectious processes or overuse of the voice and often apper where the vocal cords touch during speech?
Nodules. People most affected are those who often speack loudly such as teachers, coaches, sports fans, and singers.
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These are chronic, edematous masses which occur most often in smokers, people with allergies, or those who live in dry climates.
Vocal cord polyps.
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What is the main symptom of nodules and polyps?
painless hoarseness because of the loss of coordinated closure of the vocal cords and vocal wave.
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this is a stab wound at the cricothyroid membrane between the thyroid cartilage and the cricoid cartilage ring performed in emergencies to open the airway.
Cricothyroidotomy
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A surgical incision into the trachea for the prupose of establishing an airway.
Tracheotomy. Use sterile technique when performing endotracheal or tracheal suctioning.
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Assess the new tracheostomy stoma at leas __ per shift for purulent drainage, redness, pain, swelling, as indicators for infection.
once
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for a tracheostomy tube, keep cuff pressure between __ and __ mm Hg to prevent tissue injury.
14 and 20 mm Hg
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What should the nurse use to ventilate the patient if the tracheostomy tube has dislodged or been decannulated.
Manual resuscitation bag.
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before delivering o2 to the pt, what should the nurse do to the o2?
warm and humidify it.
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What are some manifistations of laryngeal trauma?
Difficutly breathing, aphonia, hoarseness, and subcutaneous emphysema
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What is the priority nursing care for a pt with a neck injury?
assessing for and maintaining a patent airway.
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along with airway, what should you assess in a pt that has a neck injury?
assess the carotid artery and esophagus, cervicle spine injuries and prevent excess neck movement.
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Phonation is good indicator of laryngeal cancer, what is phonation?
an inability for the vocal cords to come together for normal speech.
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What is the earliest form of laryngeal cancer?
lesions on the vocal cord.
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Often, what does a psychcosocial assessment reveal about a pt who has head and neck cancer?
the pt has a long standing history of cigarette or alcohol use or both.
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What are some interventions for a person who has head and neck cancer?
Radiation therapy (may create dry mouth), chemotherapy, cordectomy (may remove one or both vocal cords), laryngectomy
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surgery performed for a pt who has head and neck cancer where the upper airway is separated from the throat and esophagus, and the trachea is brought out through the skin in the neck and sutured in place, creating a stoma.
laryngectomy. pt will have no natural voice.
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If prescribed, the pt should instill normal saline in the artificial airway __ to __ times a day?
10 to 15 times
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