management of patients with upper airway problems

Question 1

name some upper airway infections

Answer 1

• rhinitis (viral)
• rhinosinusitis (acute/chronic)
• pharyngitis (sore throat)
• tonsilitis/adenoiditis
• peri-tonsillar abscess
• laryngitis

Question 2

whats some obstruction/trauma that can happen with the upper airway

Answer 2

• OSA
• epistaxis (nose bleed)
• nasal obstruction (polyps, deviated septum, fracture)
• fracture of nose
• laryngeal obstruction (food, dentures, tumor)
• cancer

Question 3

what are some indications of need of oxygen therapy

Answer 3

• change in resp pattern
• hypoxemia
• hypoxia
• CNS changes (mental status, agitation, disorientation, confusion, lethargy)
• dyspnea, changes in HR, dysrhythmias, diaphoresis

Question 4

what are some symptoms of longstanding hypoxia

Answer 4

fatigue, drowsiness, apathy, inattentiveness

Question 5

is oxygen therapy considered a medication

Answer 5

yep

Question 6

what are some complications of oxygen therapy

Answer 6

• oxygen toxicity
• suppression of ventilation
• combustible and tubing is source of bacterial cross infection

Question 7

what are some signs of oxygen toxicity

Answer 7

• irritability
• agitiation
• coughing and dyspnea
• leads to cell damage (alveoli) and death
• muscle twitching
• tinnitus
• may cause seizures

Question 8

name some noninvasive respiratory therapies

Answer 8

• oxygen therapy
• incentive spirometer (deep breathing can be used if unable to participate)
• small volume nebulizer
• chest physiotherapy

Question 9

what may be included in chest physiotherapy

Answer 9

• postural drainage
• chest percussion/vibration
• pulmonary rehabilitaion

Question 10

what may be used for airway management

Answer 10

• endotracheal intubation
• tracheostomy
• mechanical ventilation

Question 11

describe tracheotomy

Answer 11

surgical procedure in which an opening is made into the trachea

Question 12

describe tracheostomy

Answer 12

the actual opening from a tracheotomy

Question 13

what are some used of a tracheostomy

Answer 13

• 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

Question 14

what are some different types of tracheostomies

Answer 14

• standard, inner, and outer cannula, cuffed
• talking/fenestrated: allows speech
• metal

Question 15

whats included in nursing care of tracheostomy

Answer 15

• 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)

Question 16

how often should you perform trach care

Answer 16

at least Q8hrs

Question 17

what should you NOT do with a trach

Answer 17

• do NOT attempt to change or remove until stoma is established >96hours
• do NOT instill NS into trach to stimulate cough

Question 18

what is obstructive sleep apnea

Answer 18

• 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

Question 19

what is central apnea

Answer 19

• dysfunction in respiratory control center
• neural cause

Question 20

what are some risk factors for OSA

Answer 20

• obesity
• male
• postmenopausal
• advanced age
• stop bang questionairre

Question 21

describe the patho of OSA

Answer 21

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

Question 22

what does OSA increase the risk of

Answer 22

• CV problems (HTN, MI, CHF, arrhythmias, strokes, pulmonary hypertension)
• accidents
• increased insulin resistance
• imparied social interactions
• more sudden deaths between midnight and 6am

Question 23

what is the treatment for OSA

Answer 23

• 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)