Upper Respiratory Problems ( larynx & Trachea ) Flashcards by Brina Quintanilla Reyes

Problem of the larynx and trachea

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Airway obstruction it’s a what type of emergency and why?

Medical Emergency because we are blocking the airway

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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 )

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Airway obstruction can be from? And example

Foreign body’s
Marbles

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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

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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

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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

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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

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What is a tracheostomy ?

Surgical created Stoma ( opening into the airway from the exterior part of the neck )

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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

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When you open the stoma from the tracheostomy you want to remove?(3)

Any secretions, obstruction or fluids

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Cricothyrotomy is what?

Emerrgently surgically in OR or percutaneosuly at bedside

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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

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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

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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

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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

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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

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What is the function of the pilot ballon for a tracheostomy tube?

In order to inflate the cuff

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Tracheostomy tube is with what 2 things?

Cuff and pilot balloon

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Fenestrated tracheostomy tube is what 3 things?

Cuff
Inner cannula
Decannulation plug

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Speaking tracheostomy tube is what 2 things?

Cuff
Two external tubing

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Tracheostomy tube is with foam is known as what type of cuff?

Filled cuff

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Uncuffed tracheostomy tube is what?

Long term

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Tracheostomy are normally ___ in place and secured the first time

Sutured

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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