Chapter 29

Which teaching by the student nurse to a patient who underwent a rhinoplasty may result in complications during the postoperative period?

"Apply a hot water bottle to the nose."

A patient has received packing for a posterior nosebleed. In reviewing the patient's orders, which order does the nurse question?

"Give ibuprofen 800 mg every 8 hours as needed for pain."

A patient underwent treatment for posterior nose bleeding. After 3 days, the patient's tubes and nasal packing are removed. The nurse is educating the patient on self-management to prevent further bleeding. Which statements made by the patient indicate a need for further teaching? Select all that apply.

"I will take aspirin as needed for pain." "I will apply thick coats of petroleum jelly every 2 hours."

A patient who had a rhinoplasty performed 1 day ago is to be discharged. Which instructions does the nurse include in discharge teaching? Select all that apply.

"Try to limit forceful coughing." "Laxatives may be taken to prevent straining." "Use cool compresses on your nose, eyes, and face." "Do not blow your nose for a few days after packing is removed."

A patient with seasonal allergies has developed vocal cord polyps and asks the nurse what can be done to treat this condition. What does the nurse suggest?

"Voice rest and avoiding heavy lifting are helpful."

A patient has been diagnosed with nasal fracture. What measure does the nurse plan to initiate immediately upon admission to prevent complications?

Assessment for an airway obstruction

The nurse is caring for a patient who has undergone a hemilaryngectomy for laryngeal cancer. Once a feeding tube has been placed and the patient's intestinal tract has recovered from the effects of anesthesia, which action by the nurse is appropriate for the next few days?

Ensuring an individualized nutrition plan is followed for calorie needs

Which is an orbital-zygoma fracture?

Le Fort III

Which principle about anterior versus posterior nasal bleeding must the nurse consider the priority?

Posterior bleeding is an emergency because it cannot be easily reached.

A new patient arrives in the medical-surgical unit with a flap after a total laryngectomy. The flap appears dusky in color. What should be the nurse's first action?

Use a Doppler to assess flow to the area.

What is the priority nursing action for patients who have experienced facial trauma?

airway assessment

Which two factors in combination are the greatest risk factors for head and neck cancer?

alcohol and tobacco use

Which principles guide the nurse's support of the patient and family after a complete surgical laryngectomy? Select all that apply.

aspiration cannot occur because the airway and esophagus have been completely separated; the impact on quality of life is often poorly addressed by health care providers in the hospital; with adequate speech and language training, communication can be understandable and meaningful; learning to swallow may be painful initially; persistence and emotional support are important.

What occurs during closed reduction?

bones are realigned by palpating under anesthesia

Patients with which risk factor warrant close monitoring for and education about cancers of the nose and sinuses?

chronic exposure to dust from wood, leather, or flour

A patient who has chronic exposure to textile dust is fearful about the risk for sinus cancer after a coworker developed the disease. To help assess risk, the nurse asks the patient about which other risk factor?

cigarette smoking

What are other normal findings in a patient who has undergone nasoseptoplasty?

ecchymosis and edema

Which measure aids in reducing anxiety in a patient with head and neck cancer who is scheduled for surgery?

encouraging the patient and family to discuss their fears

The nurse is assessing a patient who underwent nasoseptoplasty 24 hours ago. Which finding requires immediate intervention by the nurse?

excessive swallowing- can indicate posterior nasal bleeding

What differentiates cerebrospinal fluid leakage from normal nasal secretions?

glucose content

What is the best time to perform a closed reduction of a nasal fracture? Select all that apply.

just after injury; within 24 hours

A patient who works in a furniture and woodworking factory reports that he is worried about his health because two coworkers have been diagnosed with sinus cancer in the past year. The nurse tells the patient that his risk of sinus cancer may increase with chronic exposure to which elements? Select all that apply.

leather dust and wood particles

Which nursing action has the highest priority when caring for a patient with laryngeal trauma?

maintaining a patent airway

What is a Le Fort II fracture?

maxillary fracture and nasoethmoid complex fracture

What clinical manifestation related to respiratory difficulty does the nurse expect to observe in a patient who has experienced laryngeal trauma?

nasal flaring

Which condition is an indication for nasoseptoplasty?

nasal septum deviation

Which is considered the priority in treatment planning for patients with head and neck cancers?

normal lifestyle and functional ability must be preserved

Which nursing assessment has the highest priority when caring for a patient with facial trauma?

oxygenation

Which factors assist the nurse in determining if fluid leaking from the nose is cerebrospinal fluid (CSF) or normal nasal secretions? Select all that apply.

positive glucose test on a dipstick; yellow halo ring on filter paper as the fluid dries

What are the priority problems for patients with head and neck cancer? Select all that apply.

potential risk for airway obstruction; potential for aspiration due to anatomical changes; reduced self-concept related to tumor and treatment

Xerostomia is a condition associated with which of the following types of treatment?

radiation therapy

When teaching a patient who has undergone a rhinoplasty about home care, which medication does the nurse recommend?

stool softener

Why is it difficult to perform a closed reduction after 24 hours?

swelling and scars occur, making it harder to perform

Which clinical manifestation requires immediate action by the nurse for a patient with laryngeal trauma?

tachypnea

What should be avoided in a patient with vocal cord polyps?

whispering

When caring for a patient with head and neck cancer following a total laryngectomy 12 hours ago, which potential complications are important for the nurse to address? Select all that apply.

wound breakdown and hemorrhage; comfort and nonverbal communication; airway obstruction and inadequate oxygenation