upper respiratory

Question 1

epistaxis: cause

Answer 1

irritation, trauma, infection, foreign body, tumor
systemic (disease): htn/blood dyscrasias (problem with blood like thin - first thought if on anticoag)
systemic treatment: chemo/anticoag (protamine sulfate = heparin, warfarin = vit K)

Question 2

epistaxis: nc - anterior

Answer 2

pinch below bony prominence
upright, lean forward (asp if backwards, breathe via mouth), reassure/calm, lateral P/ice - vasoconstrict, nasal tampons, teach not to blow nose (or anything that would increase ICP)

Question 3

epistaxis: nc - posterior

Answer 3

emergency/hospital (cant pinch), posterior packing (balloon cath = tamponade - P to obstruct capillaries and stop bleed)
assess resp
humidification, O2, bedrest, pain control, oral care
teach: saline spray/humidification, avoid aspirin/NSAIDS (thin blood), avoid strenuous activities

Question 4

osa

Answer 4

apneas (stop breathing), hypopneas (slow breathing), and/or resp effort related arousal S caused by repetitive collapse of upper airway during sleep -> mandible drops back and blocks airway, not aware of this when aslpee

Question 5

osa: rf

Answer 5

oa, M, obese (neck circumference impedes airway), nasopharyngeal structural anomalies, smoking* (less est rf)

Question 6

osa: cm

Answer 6

daytime sleepiness, snoring, choking, gasping during sleep, morning HA (bc lack of sleep)
probably unaware - talk to SO

Question 7

osa: pa findings

Answer 7

obesity, large neck/waist
s/s of complications: motor vehicle crash (tired), neuropsych dysfunction (emotional status bc lack of rem sleep), htn (esp in lungs - fluid backup bc dont breathe), heart fail, metabolic S

Question 8

osa: polysomnography

Answer 8

diagnose
sleep test

Question 9

osa: tm

Answer 9

cpap (most used)
bipap
weight reduction and exercise, avoid OH and smoke, sleep on side, sleep hygiene, oral appliances (mild-mod, less clunk - pull mandible forward), sx (tissue removal or shrinkage, jaw repositioning, implant, tracheostomy)

Question 10

osa: cpap

Answer 10

simple and cheap
doesnt augment ventilation other than to maintain upper airway patency
educate on use! many non-comp
improve oxygenation of spont breathing pt
for nocturnal ventilation to prevent upper airway obstruction

Question 11

osa: bipap

Answer 11

2 pressures (inhale and exhale - COPD)
P less on exhale so easier to breathe out
for nocturnal ventilation in pt with NM disease, chest wall deformity, osa and copd
prevent intubation

Question 12

trach: shiley

Answer 12

plastic, disposable inner cannula, cuff, obturator, flange = face plate

Question 13

trach: jackson

Answer 13

reusable, obturator, no cuff, trach care

Question 14

trach dislodgment and decannulation

Answer 14

obturator at bedside -> outer cannula -> extend neck and open tissue, insert outer cannula/obturator -> remove obturator immediately bc will obstruct airway -> check breath sounds -> secure trach

Question 15

pharyngitis

Answer 15

inflammation of pharynx or tonsils
viral mostly, bacteria (abx) = group A strep (mostly kids), fungal (thrush - nystatin swish and swallow, on abx, candida albicans)
streptococcal: sidden sore throat with tonsillar hypertrophy and erythema, tender lymphadenopathy and fever

Question 16

pharyngitis: distinguish btw causative agent

Answer 16

hard with only S
rapid strep antigen testing for all pt w/o overt viral features = rhinorrhea, cough, oral ulcers, ulcers, d, conjunctivitis

Question 17

pharyngitis: treat S

Answer 17

local soothing: warm/cool fluids and analgesics/antipyretics

Question 18

head and neck cancer

Answer 18

body image and airway!, tobacco, men, > 50, HPV if <50, most have locally advanced disease at diagnosis

Question 19

head and neck cancer: tm

Answer 19

Sx (1st): vocal cord stripping, laryngectomy (always tracheostomy, cant talk), lymph node removal (metastasize, high [] of nodes in neck), neck dissection (into muscles))
radiation, chemo (or combo)
-ectomy = removal
-ostomy = opening: sputum come out of stoma when coughing with tracheostomy

Question 20

head and neck cancer: neck dissection

Answer 20

remove all tissue on side of neck from mandible to clavicle (muscle, nerve, salivary and major blood vessels -> jp drain)
will have trach

Question 21

head and neck cancer: laryngectomy

Answer 21

no voice box
artificial larynx: electrolarynx, easy to use, can use asap, sound robotic, provide vibration
TE voice restoration: hands free, procedure , valve
esophageal speech: PE vibrates, oral air into esophagus and expelled past PE, hands free and no extra device, lots of learning, quality of speech not great

Question 22

head and neck cancer: post op

Answer 22

airway!, trach collar with o2 and humidification, pulmonary toilet, stoma care, paint management, PT, SLP
secretions -> oral and tracheal, blood tinged 1-2 days bc trauma
nutrition -> tube placement maybe before sx (malN - usually havent felt like eating)