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Upper Respiratory ProblemsMedical Surgical Nursing

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What interventions can be used for a patient who is unable to speak due to a tracheostomy?
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Encourage written and nonverbal comunication techniques with others, listen attentively, use a picture board
What should be monitored to detect early signs of infection related to a tracheostomy?
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-warmth, redness at the insertion site -absolute granulocyte count, WBC count and differential results -assess for sputum changes, fever, pain, malaise, chilling or lethargy
A ______ tracheostomy tube allows a patient to speak, spontaneously breathe through the larynx, and cough up secretions while the tube is in place.
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Fenestrated
You have a patient who needs a trach tube. When selecting the appropriate one, you note that the patient can swallow without risk of aspiration but requires suctioning for secretion removal and uses a ventilator while sleeping. Based on this, you select a _________ trach tube.
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Fenestrated
What is the specifc order for preparing a fenestrated tube in a patient that has just been assessed for aspiration risks and determined to have none?
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Remove the inner cannula Deflate the cuff Place decannulation cap over the tube (Otherwise respiratory distress may develop)
What is the major drawback of use of a fenestrated trach tube?
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The potential for development of tracheal polyps from tracheal tissue granulating in the fenestrated openings
When using a tracheostomy tube with two pigtail tubings, which one is connected to the air source...the one connected to the cuff, or the one that is just above the cuff?
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The one just above the cuff
What needs to be done in order for a client to use a speaking tracheostomy valve?
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A cuffless tube must be in place, or the cuff of the tracheostomy should be deflated (patient has to be able to tolerate w/o aspiration)
What are the indicators that a tracheostomy can be removed?
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The patient can adequately exchange air and cough up secretions on their own
When does epithelial tissue begin to cover the stoma after a tracheostomy has been removed?
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Within 24-48 hours, it completely closes within several days
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Once a tracheostomy is removed, what teaching points should be covered with the patient?
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-How to change the dressing, it needs to be changed if it is soiled or wet -How to splint the stoma when the patient wants to cough, swallow or speak
T/F People who talk too much can irritate their vocal cords so much that they develop laryngeal polyps.
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True
What is the most common symptoms of a laryngeal polyp?
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Hoarseness
How are laryngeal polyps treated?
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Voice rest and lots of fluids, if they are so big they are causing dyspnea or stridor, they will need to be surgically removed
Head and neck cancers arise from mucosal surfaces and are usually ________ cell in origin.
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Squamous
Most head and neck cancers occur in people with what risk factors? (5)
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-over 50 -chronic smoker -chronic drinker -male -diet low in fruits and vegetables -past HPV infection
T/F Oral pain when eating acidic foods can be a late sign of cancer in the oral cavity.
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True, it presents as a painless growth, ulceration or change in denture fit
Cancers of the oropharynx, hypopharynx, and supraglottic larynx are almost always _________ carcinoma.
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Squamous cell
What are the possible early signs (if any) of cancers in the oropharynx, hypopharynx or supraglottic larynx?
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Unilateral sore throat or otalgia (ear pain) Hoarseness Lump in the throat Change in voice quality
When should a lump in the neck or hoarseness be evaluated by a medical professional?
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If it persists longer than 2 weeks
What are the late signs of head and neck cancers?
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Pain, dysphagia, decreased mobility of the tongue, airway obstruction, and CN neuropathies
  
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