Upper Respiratory Flashcards
Epistaxis (nosebleed) Causes
-Irritation, trauma, infection, foreign bodies, tumors
-Systemic disease
Hypertension/blood dyscrasias
-Anticoagulant therapy
-Systemic treatment
Chemotherapy/anticoagulants
Epistaxis Care Anterior - How to treat?
-Position upright/lean forward
-Reassure/calm
-Lateral pressure
-Ice
-Nasal tampons
-Teaching:
Avoid blowing nose
Epistaxis Care Posterior - How to Treat?
-Emergency/hospitalization
-Posterior packing (balloon catheters)
-Assess respiratory status
-Humidification, oxygen, bedrest, pain control, oral care
-Teaching:
Saline spray/humidification
Avoid aspirin/NSAIDS
Avoid strenuous activities
How to stop an anterior nose bleed
Lean forward-
Pinch to press both sides of your nose firmly against the septum.
-Hold continuously for 10 minutes.
What is Obstructive Sleep Apnea?
-obstructive apneas
-hypopneas
-respiratory effort-related arousals r/t repetitive
collapse of upper airway during sleep
OSA: Risk Factors
- Increased age
- Male
- Obesity
- Nasopharyngeal structural abnormalities
- Smoking (less est. risk factor)
OSA: Signs/Symptoms
- Daytime sleepiness
- Snoring, choking, gasping during sleep
- Morning headaches r/t lack of sleep
OSA: Physical Exam
- Obesity
- Large neck &/or waist circumference
OSA: Signs associated with complications
- Motor vehicle crashes
- Neuropsychiatric dysfunction
- Hypertension
- Heart failure
- Metabolic syndrome
OSA: Diagnostic Test
Polysomnography (Gold Standard)
OSA Treatment: Positive Airway Pressure Therapy
CPAP (most common)
Continuous Positive Airway Pressure
-Simplest to use, works well & is cheapest
-Only maintains upper airway patency
-Adherence estimated 20-40% non use
(patient teaching opportunity)
What is CPAP?
-For spontaneously breathing patients to improve
oxygenation
-For nocturnal ventilation to prevent upper airway
obstruction in patients with OSA
What is BiPAP (noninvasive)?
-2 pressures
one during inhalation – one during exhalation
-Nocturnal ventilation in patients with:
- neuromuscular disease
- chest wall deformity
- OSA & COPD
-To prevent intubationOSA Treatment
- Weight reduction & exercise
- Avoid alcohol and smoking
- Sleep on side
- Improved sleep hygiene
- Oral appliances (mild to moderate)
- Surgery
- Tissue removal or shrinkage
- Jaw repositioning
- Implant
- Tracheostomy
What are the two types of trachs?
-Shiley trach Disposable inner cannula Cuff Obturator -Jackson trach Reusable inner cannula No cuff Obturator
Tube Dislodgement & Accidental Decannulation: What to do
-Obturator taped at bedside AAT
-Insert obturator into outer cannula
-Extend neck & open tissue; insert outer
cannula/obturator
-Remove obturator immediately
-Check bilateral breath sounds
-Secure trach
Acute Pharyngitis: Defined
Inflammation of pharynx or tonsils
Viral Pharyngitis - s/s
-Viral difficult to distinguish viral from Bacterial - DO NOT GIVE ANTIBIOTICS -Viral symptoms - rhinorrhea - cough - oral ulcers - ulcers - diarrhea - conjunctivitis
Viral Pharyngitis Treatment
- Local soothing treatments of warm/cool fluids &
analgesics/antipyretics - DO NOT GIVE ANTIBIOTICS
Bacterial Pharyngitis - how to test for it
-10% of adult & 30% of childhood pharyngitis is caused
by group A strep
-Rapid streptococcal antigen testing is indicated in all
patients w/o overt viral features
Bacterial Pharyngitis Treatment
- Treat with:
- antibiotics
- Local soothing treatments (warm/cool fluids) &
analgesics/antipyretics
Fungal pharyngitis (Thrush)
- Caused by Candida albicans
Fungal Pharyngitis Treatment
- Treatment nystatin “swish & swallow” or “swish & spit”
- Local soothing treatments (warm/cool fluids) &
analgesics/antipyretics
Streptococcal pharyngitis - S/S
-Sudden onset of sore throat with tonsillar hypertrophy
& erythema
-Tender lymphadenopathy & fever
Streptococcal Pharyngitis Treatment
- Treat with antibiotics
- Local soothing treatments (warm/cool fluids) &
analgesics/antipyretics
Head and Neck Cancer Causes
-Tobacco use causes 85% of head & neck cancers
-Men > women; most often > 50 years old
-< 50 years old, often associated with HPV infection
-Most have locally advanced disease at time of
diagnosis
Head and Neck Cancer Treatment
- Surgery
- Radiation therapy
- Chemotherapy – or combination of all
Head & Neck Cancers: Types of Surgical Therapy
- Vocal cord stripping
- Laryngectomy
- Tracheostomy
- Lymph node removal
- Neck disection
Artificial larynx (electrolarynx) - how it works
- most common way to restore oral communication
- electronic, battery-powered device produces
vibrations transmitted through the neck/cheek/plastic
tube into the oral cavity. Sound is shaped by
movements of the tongue, jaw, lips, and pharynx.
Tracheoesophageal (TE) voice restoration
- most comparable to normal laryngeal speech in
quality, fluency, and ease of production - TE speakers more satisfied with their speech
- improved ability to communicate over the phone
- fewer limitations in their interactions with others
- include earlier use of the voice prosthesis for voice
rehabilitation - the procedure may be done with a total laryngectomy
procedure
Esophageal speech - what is it & advantages/disadvantages
- vibratory source is the pharyngoesophageal (PE)
segment - oral air that is introduced into the esophagus and
expelled past the PE - Advantages:
- Hands-free & no extra devices
- Disadvantages:
- Length of time that it takes to learn the technique
- Quality of speech not as good as other options
What is a Radical Neck Dissection?
- Removal of all tissue on side of neck - from mandible
to clavicle. - Includes muscle, nerve, salivary gland & major blood
vessels.
Radical Neck Dissection - Post OP Care
- Airway maintenance
- Trach collar w/ O2 & humidification
- Pulmonary toilet
- Secretions – oral (tonsil tip/Yankauer) & tracheal
- Normal: Blood-tinged sputum first 1-2 days
- Stoma care
- Pain management
- Nutrition – feeding tube placement, may start before
surgery - Physical therapy
- Speech therapy
