Module 4 Flashcards
(175 cards)
1
Q
The upper respiratory system contains
A
nose, sinuses, oropharynx, larynx, trachea
2
Q
What is epistaxis
A
a nosebleed
3
Q
Causes of epistaxis include
A
dry air
dry MM
trauma
picking nose
HTN
cocaine
NG tube
4
Q
Is an anterior or posterior nose bleed more common
A
anterior
5
Q
Which type of nosebleed is more dangerous - anterior or posterior
A
posterior
6
Q
Why is a posterior nose bleed more serious?
A
-cannot assess how much blood is there
-risk of aspiration
7
Q
Is a posterior nosebleed a medical emergency?
A
yes
8
Q
Anterior nose bleed interventions
A
-applying pressure (hand, ice) and tilting head forward
9
Q
Should patients with any type of epistaxis lean back to get it to stop
A
NO
10
Q
With proper interventions, anterior nose bleeds usually stop in
A
10 minutes
11
Q
If an anterior nosebleed does not stop in 20 minutes, the patient should?
A
present to the ER
12
Q
What type of intervention can be used for posterior and anterior nosebleeds?
A
nasal tampon insertion
13
Q
Nursing considerations for nasal tampon
A
-very uncomfortable
-patients become mouth breathers
(monitor their breathing)
14
Q
What is a nasal pressure tube?
A
inserted for posterior nose bleeds and uses balloons to hold pressure and stay in place
15
Q
What are complications of nasal pressure tubes?
A
- infection
- airway obstruction
- pressure injuries/tissue breakdown
16
Q
If posterior nosebleeds continue after interventions, what may need to be done?
A
cauterization
17
Q
What to do after an anterior or posterior nose bleed?
A
-saline nasal spray
-do not blow nose
-avoid anti-coags/NSAIDs
-avoid strenuous activity
18
Q
What is a displaced nose fracture
A
bones become out of alignment
19
Q
What is a non-displaced nose fracture?
A
bones remain in the correct spot
20
Q
If our patient has a nose fracture, we should also assess them for what two things?
A
- CSF leak
- skull fractures
21
Q
Indications of CSF leak
A
-leakage of clear yellow fluid (will have halos sign and glucose)
22
Q
Causes of nose fractures include?
A
blunt force/ trauma
23
Q
Nursing assessment during nose fracture
A
- airway and breathing
- patency
- bruising
- crepitus
24
Q
Why should we assess the back of our patients throat after a nose fracture
A
assess for posterior bleeding
25
What is crepitus also known as
subcutaneous emphysema
26
What is subcutaneous emphysema?
when air gets into the subcutaneous tissue
27
S/s of crepitus?
-feeling of a crackling sensation beneath the skin
-hearing crackles
28
Nursing interventions for subcutaneous emphysema?
-monitor
-mark the skin and keep track of spreading
29
When are we concerned about subcutaneous emphysema? Why?
-when it spreads to the neck
-it compress the trachea
30
What is a closed reduction for nose fracture?
when the bones are manipulated back into alignment
31
Closed reduction for nose fractures must be done within what time frame? why?
-24 hours
-once swelling is severe it will not work
32
Nursing consideration for closed reduction
-Pre-medicate for pain, sedative, anti-anxiety meds
33
What is a rhinoplasty
surgery on the bones of the nose
34
What is a nasoseptoplasty
surgery on the tissues of the nose/ septum
35
A patient following a rhinoplasty or nasoseptoplasty may have?
- splint
- mustache dressing
- nasal packing
36
Client education following surgery of the nose includes?
-do not bend over
-use cold compresses
-avoid sneezing
37
What position should patients be placed in postoperatively from nasal surgery?
-semi fowlers
(to reduce pressure and bleeding)
38
Following nasal surgery, the nurse should assess the client for? What does this indicate?
excessive swallowing ; this indicates the client is bleeding
39
Facial trauma includes fractures to these skull bones
-mandibular
-maxillary
-orbital
-nose lol
40
Assessment on patients with a skull fracture should include?
-ABCs
-neuro status
-cervical spine
-vision/ eye ROM
41
What respiratory sound is a medical emergency and we should monitor our patients for this if they have a skull fracutre>
stridor
42
What is a battle sign?
-area of bruising behind the ear
-associated with skull fractures and brain trauma
43
Should we assess patients with skull fractures for bleeding and CSF leakage?
Yes!
-assess nose, mouth, eyes, and ears for these
44
Is jaw stabilization a priority after facial trauma?
yes
45
46
What is an ORIF w/ plates or screws?
open reduction internal fixation
-in this case, the jaw has screws placed to maintain its alignment
47
Complications for clients with a wired jaw?
-they cannot talk
-they cannot eat
-they can hardly breathe
48
A major nursing consideration for patients with a wired jaw is
-oral care (use water picks at home)
49
Clients with their jaw wired require frequent _____ monitoring
airway
50
Can a client with a wired jaw have an NG tube placed?
No! (we actually avoid this in all facial trauma in most cases)
51
What type of diet is a client on when they have their jaw wired shut?
liquid diet
pureed foods
52
How do clients with their jaw wired shut receive their nutrition>
-straw or syringe in side of mouth
-temp PEG tube
-TPN
53
How long may a patient with their jaw wired shut require nutritional support
6-10 weeks
54
this interdisciplinary team member is crucial to have on board when a patient has a wired jaw
dietician!!
55
What to do if someone vomits/aspirates with their jaw wired shut?
-roll them on their side
-cut the wires
-ensure suction is available
56
What should be close to the patient at all times when their jaw is wired?
-wire cutters
-suction
57
The larynx is our
voice box
58
Causes of laryngeal trauma include>
-blunt force trauma
-intubation
-NG tube
-bronchoscopy
59
Why is an endotracheal tube the most common cause of laryngeal trauma
it is usually placed quickly and lasts the longest
60
Two largest assessment findings of laryngeal trauma include/
1. aphonia
2. subcutaneous emphysema
61
What is aphonia
loss of voice , hoarseness, etc
62
the risk of subcutaneous emphysema complications increases when it is near the trachea due to
-risk of airway compromise (it is closer to the trachea)
63
The nurse should frequently assess clients with laryngeal trauma for these complications?
1. stridor
2. tracheal deviation
3. bleeding
64
Does stridor warrant a rapid response
yes
65
the main intervention for laryngeal trauma is typically
surgery
66
Why do patients receiving laryngeal surgery have an extended intubation period?
-due to prolonged swelling of the airway
67
We should monitor postoperative patients from laryngeal trauma for?
-bleeding/ hematoma
-neck swelling
-tracheal deviation
68
Patients with laryngeal trauma sometimes require this form of ventilation instead>
tracheostomy tube
(if the swelling is too bad to get the ET tube down the neck)
69
Risks of head and neck cancer include
-tobacco
-alcohol use
-exposure to irritants
-poor oral hygiene
-long term Gerd
70
interprofessional collaboration for head and neck cancer usually includes
1. respiratory therapy
2. registered dietician
3. speech language pathologist
71
Assessment findings of head and neck cancer may include?
-cough
-difficulty swallowing
-lumps in neck
-neck swelling
-mouth sores that do not heal
-voice changes
-unilateral ear pain
72
Diagnostics for head and neck cancer include
-CT
-MRI
-PET
73
An unusual sign of head and neck cancer is
-change in the fit of dentures
74
Interventions for head and neck cancer include?
-radiation
-chemo
-biotherapy
-surgical intervetion
75
Examples of head and neck surgeries to treat their cancer
1. laryngectomy
2. radical neck
3. tracheotomy
4. orophayrngeal resection
5. cordectomy
76
After all surgical interventions for head and neck cancer, we are concerned for?
-nutrition
-breathing
-speaking
77
What is a laryngectomy?
removal of the voice box
78
What changes after a patient receives a laryngectomy?
-they cannot breathe through nose or mouth
-they cannot aspirate
79
What do we call patients with largyngectomys? This should be identified on their person while in the hospital
-neck breathers
80
Clients with largyngectomies are at an increased risk of _____ because?
infection ; they have a newly created stoma that leaves their respiratory tract exposed
81
What is removed during a radical next dissection?
-almost all lymph nodes
-spinal accessory nerve
-sternocleidomastoid muscle
-internal jugular vein
82
Patients that have had a radical neck dissection look similar to patients that have experienced
A stroke
83
Patients following a radical neck dissection have a hard time managing their
saliva ; they are likely to drool often on that side
84
Before any head or neck surgery, what must be obtain?
-NPO status
-informed consent
-pre op labs and meds
85
Before their surgery, we will educate clients with head and neck cancer about these major implications
1. their nutrition
2. how they will communicate
(get RD and SLP involved)
86
How will patients with head and neck surgeries for cancer get nutrition post opearatively
-temporary PEG/J tube (10 plus days(
87
Patients postoperatively from head and neck surgeries are sent to?
the ICU
-the have an extended intubation period
88
A client postoperatively from a laryngectomy will have this type of breathing tube
-largyngectomy tube
89
A largyngectomy stoma places the patient at risk for?
respiratory infections
90
a largyngectomy button allows for ?
speech
91
Why is bleeding a major concern postoperatively from head and neck cancer surgeries?
it is near the carotid artery
92
Signs that the carotid artery may be leaking includ
-neck swelling, ecchymosis
93
If we suspect that the carotid artery is leaking, do we touch it?
NO (this is to prevent rupture)
94
If we suspect the carotid artery is rupturing, do we touch it?
YES hold pressure
95
If we see neck swelling postoperatively, it is best to?
call a rapid response
96
Wound and tube care for a largyngectomy tube is very similar to
trach care
97
Communication from our clients in the beginning postoperative stages from head and neck surgery inlcludes
-writing on boards
98
What is a tracheoesophageal voice prosthesis (TEP)?
-when the trachea and esophagus have a little slit in between them that will allow air to go to the esophagus and produce sound
-uses a tep valve
99
What is an electrolarynx?
a device held under the chin that catches vibrations and makes noise when the patient speaks
100
What is esophageal speech?
when the SLP teaches a patient to swallow air and speak as they burp it back up
101
Is the esophageal speech technique tolerated well by patients
no
102
Can patients with a largyngectomy be intubated?
no ... it will notwork
103
What is pulmonary artery hypertension>
increased pressure inside lungs -> leads to restricted arteries --> blood cannot leave right side of heart and go to lungs
104
Pulmonary artery hypertension leads to this complication
right sided heart failure
105
Idiopathic/primary pulmonary artery hypertension causes
-just happens
-usually young women (20-40)
-familial component
106
Secondary causes of PAH include
-copd
-emphysema
-etc
107
What is the only 'cure' for PAH
lung transplant
108
How many classes are in PAH
4
109
Important about class 1 in PAH
usually has no symptoms
110
What class do symptoms of PAH become more apparent
class 3 - symptoms begin to appear at rest
111
Symptoms of PAH include
-fatigue
-dyspnea
-CP
-light headedness
112
Why is PAH often diagnosed late
the symptoms are so vague
113
Highlights of class 4 PAH includes
-dyspnea and fatigue at risk
-r sided heart failure symptoms
114
the diagnostic for right sided heart failure is
a right heart cath
115
Difference between left heart Cath and right heart cath
a right heart cath is used to diagnose right sided heart failure and goes through a VEIN
116
Does a left heart cath go through a vein>
NO!
117
Are the nursing interventions the same for left heart cath and right heart cath
-yes the same as we learned the first module
118
Why are patients with PAH placed on anticoagulants?
reduce risk of blood clot in the lungs
119
Why are patients with PAH placed on a calcium channel blocker
vasodilation
120
Should patients with PAH be placed on oxygen
yes - even at home
121
What additional combination of drugs should patients with PAH be placed on?
1. endothelin-receptor antagonists (macitentan)
2. prostacyclin agonists (epoprostenol, treprostinil)
3. guanlyate cyclase stimulators (riociguat)
122
endothelin receptor antagonist MOA
vessel relaxation
123
prostacyclin agonists MOA
non-systemic (selective) relaxation and dilation of pulmonary vessels
124
guanylate cyclase stimulators MOA
vessel relaxation and dilation
125
Risk of endothelin-receptor antagonists include?
hypotension , liver failure
126
Side effect of guanylate cyclase stimulators
peripheral edema, dizziness, headache
127
All 3 drugs in the combination regimen for PAH have a BBW for
birth defects!!!!!!!
128
What is a huge education point for patients with PAH
they are at risk for birth defects if they get pregnant and it is contraindicated
129
How are prostacyclin agents administered
-continuous IV infusion
130
How often do patients with prostacyclin agents need their medications?
-they need the continuous IV infusion 24 hours a day, 7 days a week, forever
131
What is the half life of prostacyclin agents
6 minutes
132
12 minutes without medication from prostacyclin agents can result in
severe cardiac events --> death
133
Why are prostacyclin agents so hard to maintain
1. different brands have different dosages
2. you must act quickly
3. must always have backup medication and supplies
134
What is idiopathic pulmonary fibrosis?
-restrictive lung disease of unknown cause
135
Other causes for pulmonary fibrosis include?
-smoking , inhalants, amiodarone
136
Pathophysiology of pulmonary fibrosis?
alveoli scar --> become thick and stiff --> reduces gas exchange
137
Is there a cure for pulmonary fibrosis
no, only lung transplant
138
The diagnosis of pulmonary fibrosis is the appearance of?
honey-comb pattern on CT
139
What medication should clients with idiopathic pulmonary fibrosis be placed on early in their diagnosis
-pirfendione anti-fibrotic agent
(used to delay fibrotic cell growth)
140
Why are patients with pulmonary fibrosis placed on oral, parenteral, or nebulizer morphine?
reduce the feeling of air hunger
141
Other medications clients with pulmonary fibrosis may be placed on include
corticosteroids , immunosuppressants
142
Who is most at risk for seasonal influenza
older adults, young children, immunocompromised , comorbidity patients
143
Symptoms of seasonal flu
fever, chills, body aches, congestion, n/v, sore throat
144
What is done to prevent the spread of the flu>
-hand hygiene
-vaccines
-wearing masks
145
What is a caveat to the influenza vaccine
they have to choose the one that they believe will be the most prevalent strain
146
Most of the time, the treatment for influenza is just to
let it run its course
(rest, fluids)
147
For those that are high risk, the seasonal influenza may be treated with
antivirals
148
What drugs are antivirals
end in -vir
149
Pandemic influenzas are almost all caused by
animals
150
symptoms of covid-19 include?
-fever
-chills
-cough
-SOB
-muscle aches
-ya know
151
those with covid-19 are at an increased risk of
blood clots
152
Prevention of the pandemic influenzas includw
-avoid public
-social distance
-vaccinating every year
-antivirals
-masking
-handwashing
-isolation
153
Treatment for pandemic influenzas includes
-antivirals (high risk)
-supportive care
154
Pulmonary tuberculosis is a viral or bacterial infection?
bacterial
-myobacterium tuberculossi
155
How is tuberculosis transmitted
airborne (talking, sneezing)
156
what is primary tuberculosis
the initial infection
157
what is secondary tuberculosis
when the dormant TB bacteria become active again
158
Who are those at risk of getting TB
-homeless, crowded living conditions
-elderly
-jails, prisons
159
Do most people with TB get very sick?
no
160
If someone has TB and a suppressed immune system, are they more at risk of getting very sick>
yes
161
What history questions should we ask someone to assess for TB
recent travel, if they are HIV positive, their living conditions
162
S/s of TB inlcud
-fatigue, fever, chills, night sweats, blood tinged productive cough, chest pain, crackles
163
The definitive diagnosis for TB is
a chest x-ray (will show active infection)
164
Does a TB skin test tell us if there is an active disease
no
165
If a TB skin test does come back positive, we should follow that up with?
a chest x-ray
166
To test for active TB, we should use these methods?
-chest x-ray
-sputum culture
167
What is a positive TB skin test result
10 mm with hardness of skin
168
What is a positive TB skin test result for an immunocompromised person
5 mm with hardness of skin
169
treatment of TB includes?
-airway managemnt
-fluids
-deep breathing
-incentive spirometer
-combination drug therapy
170
Combination drug therapy during the first 8 weeks of TB treatment includes
-isoniazid, rifampin, pyrazinamide, ethambutol
171
client education for the combination drug therapy of TB
-do not consume alcohol
-you will need LFTs
-rifampin reduces effectiveness of birth control
172
After first 8 weeks, drug therapy for TB changes to
18 weeks of INH and RG daily or BID
173
Drug therapy for TB may last up to
2 years
174
those on drug therapy for TB need a sputum culture q
2-4 weeks
175
When can patients with TB be taken off of drug therapy
after 3 negative sputum cultures in a row
