management of patients with upper airway problems Flashcards
name some upper airway infections
- rhinitis (viral)
- rhinosinusitis (acute/chronic)
- pharyngitis (sore throat)
- tonsilitis/adenoiditis
- peri-tonsillar abscess
- laryngitis
whats some obstruction/trauma that can happen with the upper airway
- OSA
- epistaxis (nose bleed)
- nasal obstruction (polyps, deviated septum, fracture)
- fracture of nose
- laryngeal obstruction (food, dentures, tumor)
- cancer
what are some indications of need of oxygen therapy
- change in resp pattern
- hypoxemia
- hypoxia
- CNS changes (mental status, agitation, disorientation, confusion, lethargy)
- dyspnea, changes in HR, dysrhythmias, diaphoresis
what are some symptoms of longstanding hypoxia
fatigue, drowsiness, apathy, inattentiveness
is oxygen therapy considered a medication
yep
what are some complications of oxygen therapy
- oxygen toxicity
- suppression of ventilation
- combustible and tubing is source of bacterial cross infection
what are some signs of oxygen toxicity
- irritability
- agitiation
- coughing and dyspnea
- leads to cell damage (alveoli) and death
- muscle twitching
- tinnitus
- may cause seizures
name some noninvasive respiratory therapies
- oxygen therapy
- incentive spirometer (deep breathing can be used if unable to participate)
- small volume nebulizer
- chest physiotherapy
what may be included in chest physiotherapy
- postural drainage
- chest percussion/vibration
- pulmonary rehabilitaion
what may be used for airway management
- endotracheal intubation
- tracheostomy
- mechanical ventilation
describe tracheotomy
surgical procedure in which an opening is made into the trachea
describe tracheostomy
the actual opening from a tracheotomy
what are some used of a tracheostomy
- bypass an upper airway obstruction
- removal of tracheobronchial secretions
- long term use of mechanical ventilation
- prevent aspiration of oral or gastric secretions
- surgical procedures done for cancer
what are some different types of tracheostomies
- standard, inner, and outer cannula, cuffed
- talking/fenestrated: allows speech
- metal
whats included in nursing care of tracheostomy
- patency of airway
- infection prevention
- prevent accidental decannulation
- keep trach secure with strao or twill tape
- sterile while in hospital/clean care at home
- monitor pulse ox (gove O2 before and between suction attempts)
how often should you perform trach care
at least Q8hrs
what should you NOT do with a trach
- do NOT attempt to change or remove until stoma is established >96hours
- do NOT instill NS into trach to stimulate cough
what is obstructive sleep apnea
- recurrent episodes of upper airway obstruction and a reduction in ventilation during sleep
- air flow blocked by anatomical structures, soft tissue
- increased risk for HTN, MI, stroke
- higher incidence in men
what is central apnea
- dysfunction in respiratory control center
- neural cause
what are some risk factors for OSA
- obesity
- male
- postmenopausal
- advanced age
- stop bang questionairre
describe the patho of OSA
pharynx -> compressed by soft tissues and surround structures -> tone is reduced during sleep -> upper airway collapse -> repeated apneic events -> hypoxia and hypercapnia -> triggers sympathetic response
what does OSA increase the risk of
- CV problems (HTN, MI, CHF, arrhythmias, strokes, pulmonary hypertension)
- accidents
- increased insulin resistance
- imparied social interactions
- more sudden deaths between midnight and 6am
what is the treatment for OSA
- weight loss
- airway support = airflow keeps airway open (BiPAP and CPAP)
- dental appliance to reposition jaw and keep airway open
- meds liek CNS depressants to decrease daytime sleepiness (modafinil)
- surgery (remove part of soft tissue, soft palate, uvula or tongue)
- sleep positioning (sleep on side)
