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NURS 347 EXAM 2 > Upper Respiratory Problems ( larynx & Trachea ) > Flashcards

Upper Respiratory Problems ( larynx & Trachea ) Flashcards

1
Q

Problem of the larynx and trachea

A
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2
Q

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

A

Medical Emergency because we are blocking the airway

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3
Q

What’s the difference between airways of an adult and a child?(5)

A

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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4
Q

Airway obstruction can be from? And example

A

Foreign body’s
Marbles

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5
Q

What are the manifestations of airway obstruction ? (10)
( Chat stops using super nasal warming remedies to catch cold )

A

Choking
Stridor
Use of accessory muscles
Suprasternal & intercostal retractions
Nasal flaring
Wheezing
Restlessness
Tachycardia
Cyansois
Change in LOC

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6
Q

Why do we hear a stridor sound in airway obstruction ?

A

Because the body is trying to get air passed the foreign object or around it

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7
Q

Airway obstruction is what type of assessment and why? And how long do you have ?

A

Immediate assessment because it’ll cause brain damange or death in 3-5mins

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8
Q

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?

A

Tracheostomy

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9
Q

What is a tracheostomy ?

A

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

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10
Q

Tracheostomy surgically created stoma ( opening ) to?(5)

A

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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11
Q

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

A

Any secretions, obstruction or fluids

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12
Q

Cricothyrotomy is what?

A

Emerrgently surgically in OR or percutaneosuly at bedside

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13
Q

What are some things you need to perform a tracheostomy? (7)

A

Cannula ties & obturator
Water soluble lubricant
Saline nebulae
Scissors
Gauze for wound care
Nezt size smaller
Precut clean gauze

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14
Q

What are some extra things you may need in the room when preforming a tracheostomy? (7)

A

Good light source
Sterile water & container
Manual resuscitation bag kit
Towel for positioning
Oximeter
Oxygen
Suction machine/ Cather

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15
Q

What are the advantages of tracheostomy over endotracheal tube ?4)

A

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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16
Q

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

A

Coughing

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17
Q

What’s the most important piece of a tracheostomy tube? And how does it work?

A

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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18
Q

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

A

In order to inflate the cuff

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19
Q

Tracheostomy tube is with what 2 things?

A

Cuff and pilot balloon

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20
Q

Fenestrated tracheostomy tube is what 3 things?

A

Cuff
Inner cannula
Decannulation plug

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21
Q

Speaking tracheostomy tube is what 2 things?

A

Cuff
Two external tubing

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22
Q

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

A

Filled cuff

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23
Q

Uncuffed tracheostomy tube is what?

A

Long term

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24
Q

Tracheostomy are normally ___ in place and secured the first time

A

Sutured

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25
Q

The nurse wants to Monitor what for nursing management of Tracheostomy? (3)

A

Vital signs
SpO2
Mechanical ventilator settings

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26
Q

What are the 3 nursing management for tracheostomy? For post procedure care

A

Obturator removed ( keep at bedside )
Cuff ( balloon ) inflated
Confirm placement

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27
Q

How will we confirm the placement of a tracheostomy ? (4)

A

Auscultation for air entry
Tidal CO2 capnography
Passage of suction catheter
Chest X-ray

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28
Q

We usually give a tracheostomy tube what? And why?

A

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

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29
Q

Whenever our trache is put in, there is usually what exam taken afterwards so we can see the lungs are properly inflating ?

A

X-Ray

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30
Q

Can you mechanically ventilation a patient through a tracheostomy?

A

Yes

31
Q

The patient will make a lot of secretions due to mechanical ventilation from a tracheostomy, in which we will need a what?

A

A suction machine to remove all that fluid and secretions

32
Q

What are the nursing managements for a tracheostomy & example each one (5)

A

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

33
Q

What’s a closed suctioning tracheotomy?

A

Catheter into the ventilator circuit

34
Q

What are the two biggest nursing managements (2)

A

Prevent dislodgment
Accidental dislodgment

35
Q

What are the 4 things we can do to help prevent dislodgment for a tracheostomy?

A

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

36
Q

What are the 5 things we can do to help with accidental dislodgment in a tracheostomy?

A

Call for help
Assess for respiratory distress
- insert hemostat in opening and spread
- Insert suction catheter
- cover stoma with gauze

37
Q

Can tracheostomy be chronic and what does that mean?

A

Yes
Trache is in there for a long period of time

38
Q

We want to teach patient/caregiver of a chronic care of tracheostomy to?

A

Observe tracheostomy site for signs and symptoms of infection

39
Q

We want to perform tracheostomy care for chronic care if tracheostomy how ? (4)

A

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 )

40
Q

Chronic care tracheostomy cleaning is sterile or no? And avoid what?

A

Yes sterile in order to avoid
Skin breakdown

41
Q

What do we use to make a patient speak with a tracheostomy tube?

A

Passy-Muir value

42
Q

How does a passy Muir value work?
Steps (4) ( fenestrated tracheostomy tube )

A

Remove inner cannula
May deflate cuff
Place cap on tube
Allows exhaled air to flow over vocal

43
Q

What is a fenestrated tracheostomy tube?

A

Air passes from lungs through opening in tracheostomy into upper airway

44
Q

Fenestrated tracheostomy tube has two pigtail tubings, how does that work? (3)

A

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

45
Q

We want to put a cap on a tracheostomy tube in order to avoid what?

A

Things going inside and prevent infections

46
Q

When assessing a patient who has a Fenestrated tracheostomy tube, we want to asses a patient of any what?

A

Respiratory distress

47
Q

How do place a cap on a trache? (3)

A

Remove inner cannula
Deflate cuff
Place cap on tube

48
Q

Speaking valves what is it?

A

Thin diaphragm that opens on inspiration and closes on expiration

49
Q

What is going over the vocal cords during exhalation for a speaking valve?

A

Air flow

50
Q

Speaking value
We want to ensure cuff is deflated and or use what?

A

Use a uncuffed tube

51
Q

Lastly for a speaking value, we want to evaluate a patient ability to what?

A

Tolerate

52
Q

What is decannulation ?

A

Removal of tracheostomy tube from trachea

53
Q

When we have decannulation, epithelia tissues form in what time and opening closes in what days?

A

24-48 hours
4-5 days

54
Q

What is the 4 criteria for patient of decannulation?

A

Hemodynamically stable
Stable intact respiratory drive
Adequately exchanges air
Independently expectorates

55
Q

We will put a little red button over the trachea in order to help promote?

A

Healing and avoiding infections during healing

56
Q

Prior to decannulation we will what to the patient? (7)
( what we will do )

A

Explain procedure
Monitor VS
suction tracheostomy & mouth
Remove tapes/ties
Remove sutures
Deflate cuff
Remove in smooth motion

57
Q

After removal of decannulation we will what ?(5)

A

Apple sterile occlusive dressing
Monitor bleeding
Monitor respiratory status
Apply alternate 02 device
Patient education
-with coughing, swallowing and speaking

58
Q

Monitor respiratory status isn’t like 5mins when removing the trachea it’s a how long procedure?

A

24-48 hours

59
Q

Head and neck cancer

A
60
Q

Head and neck cancer structure include? (8)

A

Nasal cavity
Paranqsal sinuses
Nasopharynx
Oropharynx
Larynx
Oral cavity
Salivary glands

Squamous cells in mucosal surfaces

61
Q

What is the etiology with head and neck cancer? ( cause main )

A

Smoking (85%)

62
Q

What’s the age of head and neck cancer?

A

Over 50

63
Q

Risk factors if head and neck cancer?(3) and explain the exposures ( 6)

A

HPV
excess alcohol
Exposure to : sun, asbestos, industrial carcinogens, marijuana, radiation to head and neck and poor oral hygiene

64
Q

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)

A

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

65
Q

What are some late signs of manifestations for head and neck cancer? (6)

A

Unintentional weight loss!!!
Difficult with chewing
Swallowing
Moving tongue or jaw
Breathe
Airway obstruction

66
Q

Unintentional weight loss is the big one because the cancer cells are?

A

Taking up all the glucose because they rapid replicating cells
Body isn’t able to supply muscle and fat with sugar

67
Q

What’s the nursing implementation of head and neck? (3)

A

Avoid tobacco
Good oral hygiene
Safe sex to prevent HPV

68
Q

HPV is the only vaccine that helps against what?

A

Cancer

69
Q

What are some acute care implementation of head and neck cancer? (3)

A

Explain treatment
Psychological impact
- body change, loss of voice, extrenal feeding
Support systems
- loss of employment

70
Q

What is the nursing implementation of head and neck cancer in post operative?

A

Airway management
Vital signs
Bleeding
Wound drain care
Skin flaps
NGT
Nutrition
Communication
Psychological issue
Pain control
TRACH care
Suction
Fluids
Hydration

71
Q

We may want to include these 3 things in head and neck cancer implementations which are ?

A

Radiation therapy
Stoma care
Psychosocial needs
- depression body image sexuality

72
Q

Radiation therapy can cause what 4 things for neck and head cancer?

A

Dry mouth ( xerostomia )
Oral mucositis
Skin care
Fatigue

73
Q

When giving radiation therapy we want to make sure they have good what?

A

Oral hygiene

74
Q

Ambulatory care for nursing implementation (4)

A

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

NURS 347 EXAM 2 (7 decks)

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