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Respiratory Disorders 2


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Chronic Brinchitis
Upper Respiratory Disorder
Lower Respiratory Disorders
Pulmonary Hypertension
Pulmonary Embolsim
Connectys pharynx to trachea
Facilitates coughing
Laryngitis Nursing Interventions
Rest voice
2-3 L fluid intake
Throat lozenges
Antibiotic (if bacterial)
Obstructive Sleep Apnea
Cessation of breathing during sleep
Types of sleep apnea
Prevalency of Sleep Apnea
men, overweight, smokers
Definition of sleep apnea
frequent and loud snoring (or lack of snoring) with breathing lapses greater than 10 seconds that occurs more than 5 times per hour
Symptoms of obstructive sleep apnea
sore throat
napping during the day
Causes of sleep apnea
- throat muscles and tongue relax more than normal and occlude airway
- tonsils and adenoids are large
- overweight
- shape of head and neck
Treatment of Sleep apnea
CPAP (continuous positive airway pressure)
BiPAP (two different levels of pressure for inspiration and expiration)
Surgers (move jaw forward)
Nursing Treatment
Administration of oxygenation
Cancer of the Larynx warning signs
lump in throat
Changes in oral mucosa
Unexplained oral bleeding
Weight loss
Sore throat
Assement of Laryngeal Cancer
Health history
inspect and palpate neck (swelling of lymph nodes)
Psychosocial assessment - depression, support, resources, anxiety
Lab assessment
Diagnostic Testing
Nursing DX for Laryngeal Cancer
Risk for aspiration r/t
Anxiety r/t
Disturbed body image r/t
Goals and outcomes for Laryngeal Cancer
Primary - Adequate ventilation and oxygenation
NI for Non-Surgical Interventions for Laryngeal Cancer
Assess Resp system and status
Pulse ox
Blood Gasses (best indicator of gas exchange)
High Fowlers Position
NI for Radiation Therapy for Laryngeal Cancer
- Sore throat (Gargle with saline, Ice chips, Pain medication, Localized Anesthetic)
- Skin care
- Dry mouth (increase fluid intake, artificial saliva
NI for Chemotherapy for Laryngeal Cancer
No questions on the test
Surgical Options for Laryngeal Cancer
Individualized and dependent upon location of tumor and advancement of cancer
Removal fo the vocal cords
Partial Laryngectomy
Removal of tumor, portion of larynx and vocal cord
Supraglottic Laryngectomy
Removal of the hyoid bone, glottis, false cords
Removal of tumor, one true and one false vocal cord
Total Larngectomy
Advanced cancer, all portions of the larynx are removed
Radical Neck Dissection
Removal of tumor, lymph nodes, sternocleidomastoid muscle, juglar vein,s oft tissue and spinal accessory nerve
Nursing Care Post-op
monitor airway, vitals, hemodynamics, comfort
NI Post Op for Laryngeal Cancer Operation - Airway
Trach mask with humidified oxygen
cough and deep breath
Suction (as necessary)
Suture line care with 1/2 strength hydrogen peroxide
NI Post Op for Laryngeal Cancer Operation - Wound
Monitor for infection
Monitor for hematoma
Monitor for carotid hemorrhage
NI Post Op for Laryngeal Cancer Operation - Pain
Opioid analgesics (morophine)
NSAIDS (for mild pain)
Tricyclic Antidepressants (nerve pain)
NI Post Op for Laryngeal Cancer Operation - Nutrition
- J or G tube, NG tube 10-14 days post op.
- IV fluids
- Assess gag reflex and ability to swallow prior to removing NG tube.
Can aspiration occur in client swith a total laryngectomy?
No. there is no connection. The trach will take the place of the patients airway.
Types of speach after laryngeal surgery
Tracheoesophageal fistula
Tracheostomy Definition
Surgical incision made into the trachea for the purpose of airway establishment
Reasons for Tracheostomy
airway obstruction
airway protection
secretion management
sleep apnea
Prolonged intubation
airway burns
Complications of a Tracheostomy
Pneumothorax (air in the airway)
Subcutaneous Emphysema
Infection (Biggest Problem
NI for pt with Tracheostomy
Presvent tissue damage
Humidification and warming
Suctioning (hypoxia, tissue trauma, infection, vagal stimulation, bronchospasm)
Assess need for suctioning prior to care
NDX for pt with tracheostomy
Inneffective airway clearance
Risk for infection
Risk for aspiration
Impaired verbal communication
Knowledge deficit
NI Aspiration
High fowlers position
Avoid eating when fatigued
Chin to chest to aid swallowing
Semi-solid foods
NI for ineffective airway clearance
Acute Laryngeal Edema
Inflammation, injury and anaphylaxis
Acute onset of SOB
Respiratory arrest can occur
Intubation is difficult
Med for actte Laryngeal Edema
Epinephrine and corticosteroids
results from general anesthesia inhalation
NI for laryngospasm
Establish airway, 200% oxygen
Paralysis and ventilate if necessary
Laryngeal Paralysis
Results from neck surgery, tumors, CVA's
S/s of Laryngeal Paralysis
aspiration si very common
Lung Cancer
Nost notable cause of cancer related deaths, increasing in women, most related to corcoinogenic chemicals
Pathophysiology of Lung Cancer
Exposure to carcinogenic agent
Transformation fo epithelial cell
Transferring of damaged DNA to subsequent cells
Shift from health functioning pulmonary epithelial tissue to carcinoma
Risk factors for Lung Cancer
Tobacco smoke, 2nd hand smoke, exposure to environmental pollutants, genetics, gender, dietary
Clinical Assessment findings for Lung Cander
Often asymptomatic. S/S dependent on location of tumor, size, level of obstruction, degree of mets,
Most common symptom of Lung Cancer
Cough or change in cough
other S/s of Lung Cancer
DX Lung Cancer
Chest X-ray
Needle Aspiration
NI focus for Lung Cancer Pt
Maintain patent airway (deep breathing, coughing, chest PT, suctioning)
Ensure adequate gas exchange (oxygen, high fowlers position, enery conservation)
Classic warning sign of laryngeal cancer
persistent hoarsness
Nursing care of the client iwth a tracheostomy tube includes
Using hyperoxygenation and sterile technique when suctioning the client
The client is scheduled for a radical neck dissection. the nurse knows that hte surgeon will remove
All of the lymph nodes from teh ramus to the jaw
The nurse is caring for a client diagnosed with stage IV lung cancer which has reponded poorly to chemotherapy. What would be a priority NDX?
Coping ineffective r/t poor response to therapy

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