Upper Respiratory Problems ( larynx & Trachea ) Flashcards
Problem of the larynx and trachea
Airway obstruction it’s a what type of emergency and why?
Medical Emergency because we are blocking the airway
What’s the difference between airways of an adult and a child?(5)
A child airway has more space for an obstruction to go down into the lungs compared to an adult
Takes less time
Prominent occiput
- lay child on their back & back of the head drops drop down & chin drops to chest
Tongue is larger in kids
Larynx sits higher
Narrow portion at cricoid ring
( firm cartilage, holds shape of airway )
Airway obstruction can be from? And example
Foreign body’s
Marbles
What are the manifestations of airway obstruction ? (10)
( Chat stops using super nasal warming remedies to catch cold )
Choking
Stridor
Use of accessory muscles
Suprasternal & intercostal retractions
Nasal flaring
Wheezing
Restlessness
Tachycardia
Cyansois
Change in LOC
Why do we hear a stridor sound in airway obstruction ?
Because the body is trying to get air passed the foreign object or around it
Airway obstruction is what type of assessment and why? And how long do you have ?
Immediate assessment because it’ll cause brain damange or death in 3-5mins
In the event of that you have an airway that’s completely blocked and can’t get disloged of a forgein body or just not breathing well, you can do a what?
Tracheostomy
What is a tracheostomy ?
Surgical created Stoma ( opening into the airway from the exterior part of the neck )
Tracheostomy surgically created stoma ( opening ) to?(5)
Establish a patent airway
Bypass an upper airway obstruction
Facilitate secretion removal
Permit long term mehcnical ventilation
Facilitate weaning from mechanical ventilation
When you open the stoma from the tracheostomy you want to remove?(3)
Any secretions, obstruction or fluids
Cricothyrotomy is what?
Emerrgently surgically in OR or percutaneosuly at bedside
What are some things you need to perform a tracheostomy? (7)
Cannula ties & obturator
Water soluble lubricant
Saline nebulae
Scissors
Gauze for wound care
Nezt size smaller
Precut clean gauze
What are some extra things you may need in the room when preforming a tracheostomy? (7)
Good light source
Sterile water & container
Manual resuscitation bag kit
Towel for positioning
Oximeter
Oxygen
Suction machine/ Cather
What are the advantages of tracheostomy over endotracheal tube ?4)
Easier to keep clean
Better oral and bronchial hygiene
Patient comfort increased
Less risk of long term damage to vocal cords
When a patient has a tracheostomy, we want to ensure that they have it wrapped around there with with strap holds, but also to be careful when ? Because it can come out
Coughing
What’s the most important piece of a tracheostomy tube? And how does it work?
Obturator & rounded tip
Firm, will sit inside the trachea in order for it to be firm when you’re inserting it into the ostomy tube
Rounded tip in order to prevent damage to the airway
What is the function of the pilot ballon for a tracheostomy tube?
In order to inflate the cuff
Tracheostomy tube is with what 2 things?
Cuff and pilot balloon
Fenestrated tracheostomy tube is what 3 things?
Cuff
Inner cannula
Decannulation plug
Speaking tracheostomy tube is what 2 things?
Cuff
Two external tubing
Tracheostomy tube is with foam is known as what type of cuff?
Filled cuff
Uncuffed tracheostomy tube is what?
Long term
Tracheostomy are normally ___ in place and secured the first time
Sutured
The nurse wants to Monitor what for nursing management of Tracheostomy? (3)
Vital signs
SpO2
Mechanical ventilator settings
What are the 3 nursing management for tracheostomy? For post procedure care
Obturator removed ( keep at bedside )
Cuff ( balloon ) inflated
Confirm placement
How will we confirm the placement of a tracheostomy ? (4)
Auscultation for air entry
Tidal CO2 capnography
Passage of suction catheter
Chest X-ray
We usually give a tracheostomy tube what? And why?
Smaller or bigger
Because if the trache comes out, and we want to reinsert their may be inflammation, we may not be able to use the same size in
Whenever our trache is put in, there is usually what exam taken afterwards so we can see the lungs are properly inflating ?
X-Ray
Can you mechanically ventilation a patient through a tracheostomy?
Yes
The patient will make a lot of secretions due to mechanical ventilation from a tracheostomy, in which we will need a what?
A suction machine to remove all that fluid and secretions
What are the nursing managements for a tracheostomy & example each one (5)
Monitor complications
- bleeding , airway obstruction, infection
Assess site and latency at least every shift
- cleaning up blood and secretions to avoid clogging & choking
Monitor cuff inflation pressure : 20-25cm H20
- to prevent dislodge
Humidified air
- thins secretions & reduce mucous plugs
Tracheostomy care per agency policy
What’s a closed suctioning tracheotomy?
Catheter into the ventilator circuit
What are the two biggest nursing managements (2)
Prevent dislodgment
Accidental dislodgment
What are the 4 things we can do to help prevent dislodgment for a tracheostomy?
Watch when turning and repositioning
Keep replacement tube if equal and or smaller size at bedside
Do not change trachea tapes for at least 24 hours
HCP performs first tube change but not sooner than 7 days after placement
What are the 5 things we can do to help with accidental dislodgment in a tracheostomy?
Call for help
Assess for respiratory distress
- insert hemostat in opening and spread
- Insert suction catheter
- cover stoma with gauze
Can tracheostomy be chronic and what does that mean?
Yes
Trache is in there for a long period of time
We want to teach patient/caregiver of a chronic care of tracheostomy to?
Observe tracheostomy site for signs and symptoms of infection
We want to perform tracheostomy care for chronic care if tracheostomy how ? (4)
Clean inner cannula
Suction
Change tracheotomy tapes
Tube change monthly after 1st tube then change every 1-3 months
(Clean technique is used at home )
Chronic care tracheostomy cleaning is sterile or no? And avoid what?
Yes sterile in order to avoid
Skin breakdown
What do we use to make a patient speak with a tracheostomy tube?
Passy-Muir value
How does a passy Muir value work?
Steps (4) ( fenestrated tracheostomy tube )
Remove inner cannula
May deflate cuff
Place cap on tube
Allows exhaled air to flow over vocal
What is a fenestrated tracheostomy tube?
Air passes from lungs through opening in tracheostomy into upper airway
Fenestrated tracheostomy tube has two pigtail tubings, how does that work? (3)
One connects to cuff for inflation
Other connects to opening just above cuff
When second tube is connected to low flow air source ; this permits speech
We want to put a cap on a tracheostomy tube in order to avoid what?
Things going inside and prevent infections
When assessing a patient who has a Fenestrated tracheostomy tube, we want to asses a patient of any what?
Respiratory distress
How do place a cap on a trache? (3)
Remove inner cannula
Deflate cuff
Place cap on tube
Speaking valves what is it?
Thin diaphragm that opens on inspiration and closes on expiration
What is going over the vocal cords during exhalation for a speaking valve?
Air flow
Speaking value
We want to ensure cuff is deflated and or use what?
Use a uncuffed tube
Lastly for a speaking value, we want to evaluate a patient ability to what?
Tolerate
What is decannulation ?
Removal of tracheostomy tube from trachea
When we have decannulation, epithelia tissues form in what time and opening closes in what days?
24-48 hours
4-5 days
What is the 4 criteria for patient of decannulation?
Hemodynamically stable
Stable intact respiratory drive
Adequately exchanges air
Independently expectorates
We will put a little red button over the trachea in order to help promote?
Healing and avoiding infections during healing
Prior to decannulation we will what to the patient? (7)
( what we will do )
Explain procedure
Monitor VS
suction tracheostomy & mouth
Remove tapes/ties
Remove sutures
Deflate cuff
Remove in smooth motion
After removal of decannulation we will what ?(5)
Apple sterile occlusive dressing
Monitor bleeding
Monitor respiratory status
Apply alternate 02 device
Patient education
-with coughing, swallowing and speaking
Monitor respiratory status isn’t like 5mins when removing the trachea it’s a how long procedure?
24-48 hours
Head and neck cancer
Head and neck cancer structure include? (8)
Nasal cavity
Paranqsal sinuses
Nasopharynx
Oropharynx
Larynx
Oral cavity
Salivary glands
Squamous cells in mucosal surfaces
What is the etiology with head and neck cancer? ( cause main )
Smoking (85%)
What’s the age of head and neck cancer?
Over 50
Risk factors if head and neck cancer?(3) and explain the exposures ( 6)
HPV
excess alcohol
Exposure to : sun, asbestos, industrial carcinogens, marijuana, radiation to head and neck and poor oral hygiene
What the manifestations can vary in head and neck cancer but they include? (13)
(LT, ST, WRP, CIV, H, EP, RIE, S/LIN, CC, CUB, SIJ, UIM)
Lump in thorat
Sore throat ( pharyngeal )
White/red patches
Change in voice
Hoarseness greater than 2 weeks
Ear pain
Ringing in ears
Swelling/lump in neck
Constant cough
Cough up blood
Swelling in jaw
Ulcers in mouth
What are some late signs of manifestations for head and neck cancer? (6)
Unintentional weight loss!!!
Difficult with chewing
Swallowing
Moving tongue or jaw
Breathe
Airway obstruction
Unintentional weight loss is the big one because the cancer cells are?
Taking up all the glucose because they rapid replicating cells
Body isn’t able to supply muscle and fat with sugar
What’s the nursing implementation of head and neck? (3)
Avoid tobacco
Good oral hygiene
Safe sex to prevent HPV
HPV is the only vaccine that helps against what?
Cancer
What are some acute care implementation of head and neck cancer? (3)
Explain treatment
Psychological impact
- body change, loss of voice, extrenal feeding
Support systems
- loss of employment
What is the nursing implementation of head and neck cancer in post operative?
Airway management
Vital signs
Bleeding
Wound drain care
Skin flaps
NGT
Nutrition
Communication
Psychological issue
Pain control
TRACH care
Suction
Fluids
Hydration
We may want to include these 3 things in head and neck cancer implementations which are ?
Radiation therapy
Stoma care
Psychosocial needs
- depression body image sexuality
Radiation therapy can cause what 4 things for neck and head cancer?
Dry mouth ( xerostomia )
Oral mucositis
Skin care
Fatigue
When giving radiation therapy we want to make sure they have good what?
Oral hygiene
Ambulatory care for nursing implementation (4)
Tracheostomy care - suction, skin care, NGT, enteral feelings
Medic alert - heck breather
Safety - smoke and CO detactors; loss of smell
Resume exercise, recreation sexual activity, employment when able
