upper respiratory

Question 1

which of these are risk factors for head and neck cancers

50 years or older
live in the city
non smoker/non drinker
prolonged user of tobacco/alcohol
healthy diet
diet poor in fruits and veggies
HPV infection

Answer 1

50 years or older
prolonged user of tobacco/alcohol
diet poor in fruits and veggies
HPV infection

Question 2

laryngeal cancer (glottic, supraglottic and subglottic)

Answer 2

glottic (true vocal cords–radiation)
supraglottic (above vocal cords–radiation, partial laryngectomy)
subglottic (below vocal cords–total laryngectomy, mets common)

Question 3

patient teaching for radiation site skin care

Answer 3

use prescribed lotions and creams (but NOT within 2 hours of tx)
apply with a patting (DON’T RUB)
avoid temperature extremes, rough/tight clothing, rubbing/scratching treated area

Question 4

surgeries

Answer 4

radical (en bloc) neck dissection
all tissue on the side of the neck from jawbone to collarbone is removed. everything is gone.

complications: airway obstruction, hemorrhage (expect blood tinged secretions for 1st 48 hours), carotid artery rupture, fistua

post op care: surgical site: wound drain–> expect small to moderate serosanguineous dressing

Question 5

what to know about trachs and trach care

Answer 5

DON’T change the trach ties
keep obturator and a tube of equal size/smaller size at the bedside
tapes/ties not changed for 24 hours

tube changing=us=sterile
patient=clean (their germs to their germs)

suction to remove secretions
inner cannula care
clean around stoma
change ties

Question 6

accidental dislodgement of trach?

Answer 6

Priority is to immediately replace tube and MAINTAIN the AIRWAY

so…grab sutures and pull open quickly, stick new tube and obturator in. If no tube, use a suction catheter to keep it open until you can stick a tube in, then take cath out.

cannot replace tube after multiple attempts?
call for help, assess respiratory distress of patient, cover site with a sterile dressing, and ventilate with a bag-mask over nose and mouth until help arrives

Question 7

patient teaching and processes regarding decannulation

Answer 7

when pt. can exchange air and manage secretions
stoma closed with gauze, covered with tape
(tissue should start growing back in 24 hours)