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Ch31 Upper Resp Prob
YJ
| Question | Answer |
|---|---|
| What does the upper airway structures include? | The nose, sinuses, oropharynx, larynx, and trachea. |
| What is a closed reduction? | THe manipulation of the bones by palpation to position then in proper alignment. Done with fracture to the nose. |
| After 24 hours, the fracture is... | more difficult to reduce because of edema and scar formation. |
| What is rhinoplasty? | A surgical reconstruction of the nose for cosmetic purposes and to improve airflow. |
| After rhinoplasty... | Instruct the patient to stay in a semi-Flwler's position and to move slowly. |
| Nasoseptoplasty (AKA submucous resection SMR) | may be needed to straighten a deviated septum when chronic symptoms (stuffy nose, snoring, sinusitis) or discomfort occurs. |
| What is Epistaxis? | AKA nosebleed is a common problem because of the many capillaries within the nose. |
| Posterior nasal bleeding is an emergency... | because it cannot be easily reached and the patient may lose a lot of blood quickly. |
| Emergency care of a patient with an anterior nosebleed includes... | position the patient upright and leaning forward to prevent blood from entering the stomach and possible aspiration. Also instruct pt. not to blow the nose for several hours after the bleeding stops. |
| Oral care and hydration are important because.. | of mouth breathing. |
| Petroleum jelly can be applied to the nares... | for lubrication and comfort. |
| What are nasal polyps? | Benign, grapelike clusters of mucous membrane and connective tissue. They often occur bilaterally. |
| How are nasal polyps caused? | By irritation to the nasal mucosa or sinuses. allergies, or infection (chronic sinusitis). |
| What are manifestations of nasal polyps? | Obstructed nasal breathing, a change in the character of nasal discharge, and a change in speech quality. |
| What is the choice of treatment for nasal polyps? | Surgery. Surgical removal called POLYPECTOMY. |
| The onset of sinus cancer is slow, and manifestations resemble sinusitis. | Thus the patient may have advanced disease at diagnosis. |
| Manifestations of nasal or sinus cancer include... | Persistant nasal obstruction, drainage, bloody discharge, and pain that does not improve after treatment of sinusitis. |
| Local lymph node enlargement ... | often occur on the side with tumor mass. |
| Radiation therapy... | is the main treatment for nasopharyngeal cancers. If radiation therapy is not successful, surgical removal of the cancer is performed. |
| Mandibular (lower jaw) fractures... | can occur at any point on the mandible and are the most common facial fractures. |
| Manifestations of airway obstruction include... | stridors, SOB, dyspnea, anxiety, restlessness, hypoxia, hypercarbia. decreased oxygen saturation, cyanosis, and loss of consciousness. |
| What is hypercarbia? | Elevated blood levels of carbon dioxide. |
| What is tracheotomy? | The surgical incision into the trachea to create an airway. |
| What is cricothyroidotomy? | The creation of a temporary airway by making a small opening in the throat between the thyroid cartilage and the cricoid cartilage. |
| Tracheotomy and cricothyroidotomy are used when... | the need for emergency intubation. |
| What is fixed occlusion? | The wiring the jaws together in the mouth closed position. Helps stabilize the fractured segment and allow the teeth to heal in proper alignment. Pt. can have for 6-10 weeks. |
| What is Bonesource? | Microplating surgical systems. These shaping plates hold the bone fragments in place until new bone grows. Bone cells grow into BonseSource and re-matrix into a stable bone support. |
| What is sleep apnea? | A breathing disruption during sleep that lasts at least 10 seconds and occurs a minimum of 5 times in an hour. |
| What is the most accurate test for sleep apnea? | Polysomnography-performed during an overnight sleep study. |
| People with narcolepsy (uncontrolled daytime sleep) can take what med? | Modafinil (Attenace, Provigil). It promotes daytime wakefulness for people with narcolepsy from sleep apnea. |
| How can vocal fold (cord) paralysis occur? | May result from injury, trauma, or disease that affects the larynx, laryngeal nerves, or vagus nerve. |
| When only one vocal cord has paralysis... | the airway remains patent but the voice is affected. |
| Manifestations of bilateral vocal cord paralysis are... | include hoarseness; a breathy, weak voice, and aspiration of food. |
| What are nodules? | enlarges, fibrous tissues caused by infectious processes or overuse of the voice. Occur where vocal cords touch during speech. |
| What are vocal cord polyps? | Chronic, edematous masses. Occur in smokers, people with allergies, or if live in dry climates. |
| Main manifestations of nodules and polyps are... | painless hoarseness because of the loss of coordinated closure of the vocal cords. |
| Treatment includes... | not speaking, especially not whispering, and avoiding heavy lifting. Humidifying inspired air may soothe the vocal cords and prevent overdrying. |
| Laryngeal trauma occurs with | a crushing or direct blow injury, fracture, or injury such as that induced by prolonged endotracheal intubation. |
| manifestation of laryngeal include | difficulty breathing (dyspnea), inability to produce sound (aphonia), hoarseness, and subcutaneous emphysema (air present in the subcutaneous tissue). sometimes Bleeding from the airway (hemoptysis) |
| Upper airway obstruction is a life-threatening emergency in which airflow is | interrupted through the nose, mouth, pharynx, or larynx. |
| A patient with a partial obstruction may have only subtle or general manifestations such as | diaphoresis, tachycardia, and elevated blood pressure. |
| What is a cricothyroidotomy? | A stab wound at the cricothyroid membrane between the thyroid cartilage and the cricoid cartilage ring. |
| Endotracheal intubation is performed | by inserting a tube into the trachea via the nose (nasotracheal) or mouth (orotracheal). |
| Tracheotomy is a | surgical procedure and takes about 5-10minutes. it is for a patient that cannot be easily intubated with an endotracheal tube. Can establish an airway in less than 2 minutes! |
| Patients receiving mechanical ventilation for upper airway obstruction or respiratory failure may | require a tracheostomy after 7 or more days of continuous oral or nasal intubation. |
| How to perform an abdominal thrust maneuver (formerly known as the Heimlich maneuver). | Person sitting or standing, place your fist between the persons lower rib cage and navel. Wrap the palm of your hand around your fist. A quick inward, upward thrust expels the air remaining in the lungs, and with it the foreign body. |
| Performing an abdominal thrust maneuver with the unconscious victim lying supine. | Straddle the victims thighs with your legs. Place on hand on top of the other, with the heel of the bottom hand just above the victim's navel. Quickly thrust inward and upward, toward the victim's head. |
| Esophagus injury may occur with | neck trauma. Assess for chest pain and tenderness, oral bleeding, and crepitus (crackling sounds when palpating the skin). |
| Head and neck cancer can disrupt | breathing, eating, facial appearance, self-image, speech, and communication. |
| Untreated cancer of the head and neck is | fatal disease within 2 years of diagnosis. It is curable when treated early. |
| Most head and neck cancers (80%) are | squamous cell carcinomas of the mucosa that are slow growing, taking several years to develop. |
| The growth and spread (metastasis) of head and neck cancer | first occur into nearby structures, such as lymph nodes, muscle, and bone. |
| The two most important risk factors of head and neck cancer are | tobacco and alcohol use especially in combination. Other risk factors include voice abuse, chronic laryngitis, exposure to industrial chemicals or hardwood dust, and poor oral hygiene. |
| How to calculate the patient's smoking history. | Calculate the number of packs smoked per day times the number of years the patient has smoked (pack-years). |
| With laryngeal cancer, | painless hoarseness may occur because of tumor size and an inability for the vocal cords to come together for normal speech (phonation). Lesions of the vocal cords are the earliest form of laryngeal cancer. |
| Diagnostic test for head and neck cancer include | CBC, bleeding times, urinalysis, and blood chemistries. |
| Warning signs of head and neck cancer. | Pian, lump in the mouth, throat or neck, diff. swallowing, SOB, anorexia and weight loss, oral lesion or sore that does not heal in 2 weeks, persistent or unexplained oral bleeding, numbness of the mouth, lips or face. Persistent, unilateral ear pain |
| more warning signs of head and neck cancer | hoarseness or change in voice quality. persistent or recurrent sore throat, burning sensation when drinking citrus juices or hot liquids, change in the fit of dentures, color changes in the mouth or tongue to red, white, gray, dark brown, or black |
| Radiation therapy for treatment of small cancers in specific locations | has a cure rate of at least 80%. |
| What is xerostomia? | Dry mouth |
| Chemotherapy can be used | alone or in addition to surgery or radiation for head and neck cancer. |
| The major types of surgery for laryngeal cancer include | cord stripping, removal of a vocal cord (cordectomy) |
| What is Valsalva maneuver | holding your breath or "bearing down"/ |
| Surgical procedures for Laryngeal cancer | Laser surgery, transoral cordectomy, laryngofissure, supraglottic partial laryngectomy, hemilaryngectomy or vertical laryngectomy, & total laryngectomy. |
| Laser surgery consists of | tumor being reduced or destroyed by laser beam through laryngoscope. Normal/hoarse voice after. |
| Transoral cordectomy is | tumor (early lesion) resected through laryngoscope. normal/hoarse voice after procedure. Has high cure rate. |
| Laryngofissure is | No cord is removed (early lesion) Normal voice. Has high cure rate. |
| Supraglottic partial laryngectomy | hyoid bone, false cords, and epiglottis removed. Neck dissection on affected side performed if nodes involved. Normal/hoarse voice after. |
| Hemilaryngectomy or vertical laryngectomy | One true cord, one false cord, and one half of thyroid cartilage removed. Hoarse voice after. |
| Total laryngectomy | Entire larynx, hyoid bone, strap muscles, one or two tracheal rings removed. Nodal neck dissection if nodes involved. NO NATURAL VOICE LEFT |
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wvc
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