Lewis Ch 27

What is Chemotherapy?

(e.g., cisplatin (Platinol), and cetuximab (Erbitux)), a targeted therapy used in combination with radiation therapy for patients with unresectable cancers.

What should nursing planning in regards to head and neck cancer include?

1. Have a patent airway, 2. no spread of cancer, 3. no complications related to therapy, 4. adequate nutritional intake, 5. minimal to no pain, 6. the ability to communicate, 7. an acceptable body image.

What are the simple first aid measures to control Epistaxis?

1. keep the patient quiet; 2. place the patient in a sitting position; 3. apply direct pressure by pinching the entire soft lower portion of the nose for 10 to 15 minutes; 4. partially insert a small gauze pad into the bleeding nostril, and apply digital pressure if bleeding continues; and 5. obtain medical assistance if bleeding does not stop.

How long does a Rapid Flu Test take?

15 min.

What is a Peritonsillar Abcess?

A complication of acute pharyngitis or acute tonsilitis when bacterial infection invades one or both tonsils. Tonsils may enlarge and affect airway patency. High fever, leukocytosis, hot potato voice, and chills. AB IV therapy is given along with needle aspiration or incision and drain of abscess.

What is a Deviated Septum?

A deflection of the normal straight nasal septum. Trauma to the nose and congenital disproportion a condition in which the size of the septum is not proportional to the size of the nose, are the most common causes.

What is a sign of diptheria?

A gray-white false membrane termed a pseudomembrane, often covering the oropharynx, nasopharynx, laryngopharnyx and may extend to the trachea.

What is an Blom-Singer Prosthesis?

A soft plastic device inserted into a fistula made between the esophagus and the trachea. The puncture may be created at the time of surgery or after. This prosthesis allows air from the lungs to enter the esophagus by way of the tracheal stoma. A one way valve prevents aspiration of food or saliva. To speak the patient manually blocks the stoma. Speech is produced by the air vibrating against the esophagus and is formed into words by moving the tongue and lips. If a valves in place pt does not need to cover stoma.

What is a tracheotomy?

A surgical incision into the trachea for the purpose of establishing an airway.

When initially teaching a patient the supraglottic swallow following a radical neck dissection, with which food or fluid should the nurse begin? A.Cola B.Applesauce C.French fries D.White grape juice

A.Cola When learning the supraglottic swallow, it may be helpful to start with carbonated beverages because the effervescence provides clues about the liquid's position. Thin, watery fluids should be avoided because they are difficult to swallow and increase the risk of aspiration. Nonpourable pureed foods, such as applesauce, would decrease the risk of aspiration, but carbonated beverages are the better choice with which to start.

The school nurse is providing information to high school students about influenza prevention. What should the nurse emphasize in teaching to prevent the transmission of the virus (select all that apply)? A.Cover the nose when coughing. B.Obtain an influenza vaccination. C.Stay at home when symptomatic. D.Drink non-caffeinated fluids daily. E.Obtain antibiotic therapy promptly.

A.Cover the nose when coughing. B.Obtain an influenza vaccination. C.Stay at home when symptomatic. Covering the nose and mouth when coughing is an effective way to prevent the spread of the virus. Obtaining an influenza vaccination helps prevent the flu. Staying at home helps prevent direct exposure of others to the virus. Drinking fluids helps liquefy secretions but does not prevent influenza. Antibiotic therapy is not used unless the patient develops a secondary bacterial infection.

The nurse is scheduled to administer seasonal influenza vaccinations to the residents of a long-term care facility. What would be a contraindication to the administration of the vaccine to a resident? A.Hypersensitivity to eggs B.Age greater than 80 years C.History of upper respiratory infections D.Chronic obstructive pulmonary disease (COPD)

A.Hypersensitivity to eggs Although current vaccines are highly purified, and reactions are extremely uncommon, a hypersensitivity to eggs precludes vaccination because the vaccine is produced in eggs. Advanced age and a history of respiratory illness are not contraindications for influenza vaccination.

The nurse notices clear nasal drainage in a patient newly admitted with facial trauma, including a nasal fracture. What should the nurse do first? A.Test the drainage for the presence of glucose. B. Suction the nose to maintain airway clearance. C.Document the findings and continue monitoring. D.Apply a drip pad and reassure the patient this is normal.

A.Test the drainage for the presence of glucose. Clear nasal drainage suggests leakage of cerebrospinal fluid (CSF). The drainage should be tested for the presence of glucose, which would indicate the presence of CSF. Suctioning should not be done. Documenting the findings and monitoring are important after notifying the health care provider. A drip pad may be applied, but the patient should not be reassured that this is normal.

What are Acute Pharyngitis?

Acute inflammation of the pharyngeal walls. May include tonsils, palate and uvula. Viral accounts for 70% of cases. Acute follicular pharyngitis (strep throat) results from streptococcal invasion and accounts for 5 - 15%. Fungal pharyngitis, esp candidiasis can develop as well.

What happens during Allergic Rhinitis?

After exposure, mast cells and basophils release histamine, prostaglandins and leukotrienes, which cause the early symptoms of sneezing, itching, rhinorrhea, and moderate congestion. Two to 4 hours after exposure, there is an infiltration of inflammatory cells into the nasal tissue causing and maintaining the inflammatory response.

What are examples of antivirals that can be used to treat and prevent influenza?

Amantadine (Symmetrel) or rimantadine (Flumadine). Zanamivir (Relenza) and oseltamivir (Tamiflu) are used to prevent and treat influenza.

What antigen is produced in Allergic Rhinitis?

Antigen specific immunoglobulin E (IgE).

What are Head and Neck Cancers?

Arise from mucosal surfaces and are typically squamous cell carcinomas. This category of tumors includes the paranasal sinuses, the oral cavity, and the nasopharynx, oropharynx, and larynx.

When caring for a patient who is 3 hours postoperative laryngectomy, what is the nurse's highest priority assessment? A.Patient comfort B.Airway patency C.Incisional drainage D.Blood pressure and heart rate

B.Airway patency Remember the ABCs with prioritization. Airway patency is always the highest priority and is essential for a patient undergoing surgery surrounding the upper respiratory system. Comfort, drainage, and vital signs follow the ABCs in priority.

A patient is being discharged from the emergency department after being treated for epistaxis. In teaching the family first aid measures in the event the epistaxis would recur, what measures should the nurse suggest (select all that apply)? A.Tilt patient's head backwards. B.Apply ice compresses to the nose. C.Tilt head forward while lying down. D.Pinch the entire soft lower portion of the nose. E.Partially insert a small gauze pad into the bleeding nostril.

B.Apply ice compresses to the nose. D.Pinch the entire soft lower portion of the nose. First aid measures to control epistaxis include placing the patient in a sitting position, leaning forward. Pinching the soft lower portion of the nose or inserting a small gauze pad into the bleeding nostril should stop the bleeding within 15 minutes. Tilting the head back or forward does not stop the bleeding, but rather allows the blood to enter the nasopharynx, which could result in aspiration or nausea/vomiting from swallowing blood. Lying down also will not decrease the bleeding.

A patient whose tracheostomy was inserted 30 minutes ago is recovering in the postanesthesia recovery unit when he coughs and expels the tracheostomy tube. How should the nurse respond? A.Suction the tracheostomy opening. B.Maintain the airway with a sterile hemostat. C.Use an Ambu bag and mask to ventilate the patient. D.Insert the tracheostomy tube obturator into the stoma.

B.Maintain the airway with a sterile hemostat. As long as the patient is not in acute respiratory distress after dislodging the tracheostomy tube, the nurse should use a sterile hemostat to maintain an open airway until a sterile tracheostomy tube can be reinserted into the tracheal opening. The tracheostomy is an open surgical wound that has not had time to mature into a stoma. If the patient is in respiratory distress, the nurse will use an Ambu bag and mask to ventilate the patient temporarily.

Which task can the registered nurse (RN) delegate to unlicensed assistive personnel (UAP) in the care of a stable patient who has a tracheostomy? A.Assessing the need for suctioning B.Suctioning the patient's oropharynx C.Assessing the patient's swallowing ability D.Maintaining appropriate cuff inflation pressure

B.Suctioning the patient's oropharynx Providing the individual has been trained in correct technique, UAP may suction the patient's oropharynx. Assessing the need for suctioning should be performed by an RN or licensed practical nurse, whereas swallowing assessment and the maintenance of cuff inflation pressure should be performed solely by the RN.

What are Nasal Polyps?

Benign mucous membrane masses that form slowly in response to repeated inflammation of the sinus or nasal mucosa. Usually appear as bluish, glossy projections in the naris, and can exceed the size of a grape.

What are indications for a tracheostomy?

Bypass of an upper airway obstruction, facilitate removal of secretions, permit long term mechanical ventilation, and permit oral intake and speech in the patient who requires long term mechanical ventilation.

A patient with a history of tonsillitis complains of difficulty breathing. Which patient assessment data warrants emergency interventions by the nurse? A.Bilateral erythema of especially large tonsils B.Temperature 102.2° F, diaphoresis, and chills C.Contraction of neck muscles during inspiration D.β-hemolytic streptococcus in the throat culture

C.Contraction of neck muscles during inspiration Contraction of neck muscles during inspiration indicates that the patient is using accessory muscles for breathing and is in serious respiratory distress. The reddened and enlarged tonsils indicate pharyngitis. The increased temperature, diaphoresis, and chills indicate an infection, which could be β-hemolytic streptococcus or fungal infection, but not an emergency situation for the patient.

The patient has been diagnosed with head and neck cancer. Along with the treatment for the cancer, what other treatment should the nurse expect? A.Nasal packing B.Epistaxis balloon C.Gastrostomy tube D.Peripheral skin care

C.Gastrostomy tube Because 50% of patients with head and neck cancer are malnourished before treatment begins, many patients need enteral feeding via a gastrostomy tube because the effects of treatment make it difficult to take in enough nutrients orally, whether surgery, chemotherapy, or radiation is used. Nasal packing could be used with epistaxis or with nasal or sinus problems. Peripheral skin care would not be expected because it is not related to head and neck cancer.

What is the priority nursing assessment in the care of a patient who has a tracheostomy? A.Electrolyte levels and daily weights B.Assessment of speech and swallowing C.Respiratory rate and oxygen saturation D.Pain assessment and assessment of mobility

C.Respiratory rate and oxygen saturation The priority assessment in the care of a patient with a tracheostomy focuses on airway and breathing. These assessments supersede the nurse's assessments that may also be necessary, such as nutritional status, speech, pain, and swallowing ability.

What is an Airway Obstruction?

Can be complete or partial. Complete is a medical emergency. Partial may occur as a result of aspiration of food or a foreign body, as well as laryngeal edema following extubation, laryngeal or tracheal stenosis, CNS depression, and allergic reactions.

What are the clinical manifestations of Acute Pharyngitis?

Can range from scratchy throat to pain so severe that swallowing is difficult. Both viral and strep can appear as red and edematous pharynx, with or without patchy yellow exudates. Appearance is not always diagnostic. Cultures or a rapid strep direct management.

What is Acute Viral Rhinitis?

Common cold or acute coryza is caused by an adenovirus that invades the upper respiratory tract and often accompanies an acute upper respiratory infection (URI).

What is Brachytherapy?

Concentrated and localized method of delivering radiation that involves placing a radioactive source into or near the tumor. The goal is to deliver high doses of radiation to the target area while limiting exposure of surrounding tissues.

What can predisposes patients to Epistaxis?

Conditions that prolong bleeding time or alter platelet count, patients that take aspirin or NSAIDs. Elevated blood pressure.

What are the various surgical procedures for Head and Neck cancer?

Cordectomy, hemilaryngectomy, supraglottic laryngectomy, radical neck dissection, and a modified neck dissection.

A patient had an open reduction repair of a bilateral nasal fracture. The nurse plans to implement an intervention that focuses on both nursing and medical goals for this patient. Which intervention should the nurse implement? A.Apply an external splint to the nose. B.Insert plastic nasal implant surgically. C.Humidify the air for mouth breathing. D.Maintain surgical packing in the nose.

D.Maintain surgical packing in the nose A goal that is common to nursing and medical management of a patient after rhinoplasty is to prevent the formation of a septal hematoma and potential infections resulting from a septal hematoma. Therefore the nurse helps to keep the nasal packing in the nose. The packing applies direct pressure to oozing blood vessels to stop postoperative bleeding. A medical goal includes realigning the fracture with an external or internal splint. The nurse helps maintain the airway by humidifying inspired air because the nose is unable to do so following surgery because it is swollen and packed with gauze.

The patient seeks relief from the symptoms of an upper respiratory infection (URI) that has lasted for 5 days. Which patient assessment should the nurse use to help determine if the URI has developed into acute sinusitis? A.Coughing B.Fever, chills C.Dust allergy D.Maxillary pain

D.Maxillary pain The nurse should assess the patient for sinus pain or pressure as a clinical indicator of acute sinusitis. Coughing and fever are nonspecific clinical indicators of a URI. A history of an allergy that is likely to affect the upper respiratory tract is supportive of the sinusitis diagnosis but is not specific for sinusitis.

The patient has decided to use the voice rehabilitation that offers the best speech quality even though it must be cleaned regularly. The nurse knows that this is what kind of voice rehabilitation? A.Electromyograph B.Intraoral electrolarynx C.Neck type electrolarynx D.Transesophageal puncture

D.Transesophageal puncture The transesophageal puncture provides a fistula between the esophagus and trachea with a one-way valved prosthesis to prevent aspiration from the esophagus to the trachea. Air moves from the lungs, vibrates against the esophagus, and words are formed with the tongue and lips as the air moves out the mouth. The electromyography and both electrolarynx methods produce low-pitched mechanical sounds.

How do you help a patient cope with sexuality after a head and neck surgery?

Discussion regarding sexuality and encouraging patient to discuss this problem with their partner. Allow the patient to plan how to communicate with their sexual partner and offer support and guidance to the sexual partner. Helping the patient see sexuality involves more than appearance may relieve anxiety.

How often should you check drainage systems and what for with a Radical Neck Surgery?

Drainage should be serosanguineous and gradually decrease in volume over 24 hours, monitor patency every 4 hours to ensure proper removal of serious drainage.

What are the late clinical manifestations of Head and Neck Cancers?

Easily detectable signs and symptoms including pain, dysphagia, decreased mobility of the tongue, airway obstruction and cranial nerve neuropathies. There maybe thickening of the normally soft and pliable oral mucosa. Leukoplakia (white patch) or erythroplakia (red patch) may be seen and should be noted for later biopsy.

How are Nasal Polyps treated?

Endoscopic or laser surgery can remove nasal polyps, but recurrence is common. Topical or systemic corticosteroids may slow polyp growth.

What are Nursing Considerations for Sinusitis?

Environment control of allergies and appropriate drug therapy. Antibiotics if post 7 days. Amoxicillin is the first drug of choice for 10 - 14 days. After that broader spectrum may be used. Nasal decongestants should not be used for more then 3 days. Antihistamines should be used with caution. Increase fluid intake. Saline nasal spray.

What are the recommendations for flu vaccines?

Everyone 6 months of age and older should get a flu vaccine. More effective when given in the fall. Advocate for vaccination in older then 50 years, give high priority to hcp because they can transmit to high risk persons.

What is Influenza?

Flu. Virus classified into types A, B, and C. Only A and B cause significant illness in humans. Type A, is most common. Usually abrupt with systemic symptoms of cough, fever, and myalgia often accompanied by a headache and sore throat. Milder symptoms similar to cold may occur. Dyspnea and diffuse crackles are signs of pulmonary complications. Symptoms usually subside in 7 days.

What are postoperative procedures for the patient with a Laryngectomy?

Frequent suctioning via the laryngectomy tube.

What is a Radical Neck Dissection?

Frequently accompanies a total laryngectomy to decrease lympathic spread. Involves wide excision of the lymph nodes and their lymphatic channels. Sternocleidomastoid muscle, and other closely associated muscles, internal jugular vein, mandible, submaxillary gland, part of the thyroid and parathyroid gland and spinal accessory nerve may need to be removed or transected.

What is the inactivated Influenza vaccine?

Given by injection, approved for use in people 6 months or older. Can be used in people at increased risk: people of any age with chronic medical conditions, residents of nursing homes and ltc facilities. People who are immunocompromised, pregnant women.

What is the live attenuated influenza vaccine (LAIV)?

Given by nasal spray. Approved for health people ages 2 - 49. Given to nonpregnant health people.

What is a electrolarynx?

Hand-held battery powered device that creates speech by the use of sound waves.

What should the Nurse Assessment include with Head and Neck Cancer in regards to Subjective Data in Functional Health Patterns?

Health perception health management: does not participate in preventive health measures, long history of alcohol and tobacco use. Nutrition metabolic: mouth ulcer that does not heal, change in fit of dentures, change in appetite, weight loss, swallowing difficulty. Activity Intolerance: fatigue. Cognitive Perceptual: Sore throat, pain on swallowing, referred ear pain.

What are Interventions for an Airway Obstruction?

Heimlick manuever, cricoidthyroidotomy, endotracheal intubation, and tracheostomy.

How do you help a patient cope with depression after a head and neck surgery?

Help them talk through their feelings, conveying acceptance, and helping the patient regain an acceptable self concept. Sometimes psychiatric referral is appropriate.

What should the Nurse Assessment include with Head and Neck Cancer in regards to Objective Data in Respiratory System?

Hoarseness, change in voice quality, chronic laryngitis, nasal voice, palpable neck mass and lymph nodes, tracheal deviation, dyspnea, stridor (late sign).

What are findings that indicate Acute Sinusitis?

Hyperemic and edematous mucosa, a discolored purulent nasal drainage, enlarged turbinates, and tenderness over the involved front and/or maxillary sinuses. Some patients have recurrent headaches that change in intensity of position.

If simple first aid measures are not effective to treat Epistaxis, what is the medical management?

Identification of the bleeding site and application of a vasoconstrictive agent, cauterization, or anterior packing by a health care provider. Pledgets (nasal tampons) impregnated with anesthetic solution and or vasoconstrictive agents such as lidocaine for 10 - 15 min. Silver nitrate may be use to cauterize after the bleeding has stopped.

What are Nursing Considerations for Allergic Rhinitis?

Identifying and avoiding triggers. Medication therapy.

What are the two types of flu vaccines?

Inactive and live, attenuated.

What are Nursing Diagnosis examples in relation to a patient having a total laryngectomy and/or radical neck surgery?

Ineffective airway clearance, risk for aspiration, risk for infection, anxiety.

What are Nursing Considerations for Acute Pharyngitis?

Infection control, symptomatic relief, and prevention of secondary complications. AB for strep. Nystatin (Mycostatin) for Candida infection. Increase fluid intake. Cool bland and gelatin will not irritate the pharynxx; citrus juices are often irritating.

What is Sinusitis?

Inflammation of the sinuses. Develops when inflammation or hypertrophy of the mucosa narrows or blocks the ostia (exit). The secretions that accumulate behind the obstruction a rich medium for bacterial, viral, and fungi growth that can cause infection.

What does assessment involve in Acute Sinusitis?

Inspection of the nasal mucosa and palpation of the sinus points for pain.

What is stoma care postoperatively to head and neck surgery?

Instruct on stoma care. Pt should wash the area daily with a moist cloth. If tube in place must remove entire tube at least once, as well as inner cannula. A scarf, loos shirt or crocheted shield can be used to shield stoma. Cover stoma when coughing. Plastic collar taking shower. Swimming is contraindicated.

What nursing implementation is there for radiation therapy?

Interventions to reduce side effects of radiation therapy. Dry mouth is most common. Pilocarpine hydrochloride (Salagen) is often effective and should be started before and cotinue for 90 days. Increase fluids, chew sugarless gum or sugarless candy, use nonalcoholic mouth rinses and artificial saliva. Carry water. Take frequent rests, regular exercise. Eat soft bland food if irritation occurs. Do not use lotions 2 hours before treatment. avoid all exposure to sun.

What is a Supraglottic Laryngectomy?

Involves removing structures above the true cords - the false cords and the epiglottic. The patient is left high risk of aspiration following surgery and requires a temp tracheostomy.

What is Esophageal Speech?

Involves swalloing air, trapping it in the esophagus and releasing it to create sound. The air causes vibration of the pharyngoesophageal segment and sound which is similar to a belch.

What are diagnostic studies for Head and Neck Cancers?

Laryngoscopy. CT scan or MRI. PET. Multiple biopsy specimens to determine extent.

What is Chronic Sinusitis?

Lasting longer then 3 weeks. A persistent infection usually associated with allergies and nasal polyps. Usually results from repeated episodes of acute sinusitis that results in irreversible loss of the normal ciliated epithelium lining the sinus cavity.

What are the advantages to a Tracheostomy?

Less risk of long term damage to the airway compared with an endotracheal tube, patient comfort may be increased because no tube is present in the mouth, the patient can eat with a tracheostomy because the tube enters the lower airway. Traceostomy tube is more secure, patients mobility is increased.

What is important postpoeratively for the patient receiving surgery for Head and Neck Cancer?

Maintenance of a patent airway is essential, inflammation of the surgical area may compress the trachea, a tracheostomy tube will be in place. Semi folwers to decrease edema and limit tension on suture lines. Monitor VS. Check drains (Hemovac, Jacson-Pratt).

What nursing interventions are there during the immediate post operative period after nasal surgery?

Maintenance of the airway, assessment of the respiratory status, pain management, and observation of the surgical site for bleeding, infection and edema. Teaching is also important.

What should the Nurse Assessment include with Head and Neck Cancer in regards to Objective Data in Possible Diagnostic Findings?

Mass on direct or indirect laryngoscopy; tumor on soft tissue x-ray, CT, MRI, positive biopsy.

What is choice of treatment for head and neck cancer determined?

Medical history, extent of disease, age, cosmetic considerations, urgency of treatment, and patient choice.

What is a Modified Neck Dissection?

Modified by sparing as many structures as possible to limit disfigurement and functional loss. Dissection of the major cervical lymphatic vessels and lateral cervical space with preservations of nerves and vessels, including the sympathetic and vagus nerves, spinal accessory nerves and internal jugular veins.

What is Cetuximab used for?

Monotherapy for treatment of squamous cell cancer of the head and neck that has metastasized following standard chemotherapy.

What surgery may be required for Sinusitis?

Nasal endoscopic surgery to relieve blockage caused by hypertrophy or septal deviation.

What are clinical manifestations of Nasal Polyps?

Nasal obstruction, nasal discharge (usually clear mucus) and speech distortion.

What drugs are possible for Medication Therapy with Allergic Rhinitis and Sinusitis?

Nasal spray corticosteroids, nasal spray mast cell stabilizer, leukotriene receptor antagonists (LTRAs) and inhibitors, anticholinergic nasal sprays, antihistamines first generation and second generation, decongestants oral and topical.

How do antivirals work on Influenza?

Neuraminidase inhibitors that prevent the virus from budding and spreading to other cells.

What are the findings of Chronic Sinusitis?

Nonspecific symptoms. Patient is rarely febrile. May be facial or dental pain, nasal congestion and increased drainage, severe pain and purulent drainage are usually absent. Some symptoms mimic those seen with allergies.

What is Epistaxis?

Nosebleed - caused by trauma, foreign bodies, topical corticosteroid use, nasal spray abuse, street drug use, anatomic malformation, allergic rhinitis, and tumors.

If medical management does not work for Epistaxis what is the final method of intervention?

Packing may be used. May consist of traditional vaseline ribbon gauze, a prefabricated nasal sponge (Merocel), or an epistaxis balloon (Rhino).

What is Nutritional Therapy with A Radical Neck Surgery?

Parenteral fluids are given for the first 24 - 48 hours. Enteral nutrition is usually given via a nasogastric, nasointestinal or gastrostomy tube. Observe for tolerance of feedings. Anticipate swallowing problems. Supraglottic swallow.

What is a Cordectomy?

Partial removal of one vocal cord - used when there is a superficial tumor involving one cord.

What should the Nurse Assessment include with Head and Neck Cancer in regards to Subjective Data in Imporant Health Information?

Past Health: family history, tobacco use, alcohol use, poor intake of fruits and vegetables. Medications: prolonged use of OTC meds for sore throat and decongestants.

What preoperative care should be given to the patient before Surgery for Head and Neck Cancer?

Physical preparation, with emphasis on oral hygiene. Explanation and emotional support are of special significance and should include postoperative measure relating to communication and feeding. Explain surgical procedure to pt and family.

What is an artificial larynx?

Place against the neck rather then the mouth. The device is used after surgical healing is complete and there is no edema remaining. With experience normal sounding speech can be obtained. Voice pitch is low and sounds mechanical.

What are Laryngeal Polyps?

Polyps that develop on the vocal cords from vocal abuse or irritation. Most common symptom is hoarseness. Treated with voice rest and adequate hydration. Surgical removal may be indicated which may cause dyspnea and stridor.

What do patients who are stage 1 or 2 have the option to undergo with Cancer treatment?

Radiation therapy or surgery with the goal of cure.

What are the different treatments for head and neck cancer?

Radiation therapy, surgery, chemotherapy, targeted therapy, and combinations.

What are the primary nursing measures for Influenza?

Relief of symptoms and prevention of secondary infection. Bedrest, fluid, gargles, antihistamines, antipyretics.

What is a hemilaryngectomy?

Removal of one vocal cord or part of a cord and requires a temporary tracheostomy.

What is the Nursing Considerations for Acute Viral Rhinitis?

Rest, fluids, proper diets, antipyretics and analgesics are recommended. Complications can occur. AB if symptoms remain post 7 days. Relieving annoying symptoms. Use of decongestion spray no more than 3 days. Teach symptoms of secondary bacterial infection such as higher than 100.4 fever.

What is Acute Sinusitis?

Results from an URI, allergic rhinitis, swimming or dental manipulation all of which cause inflammatory changes and retention of scretions. Follows viral rhinitis, symptoms worsen after 5 - 7 days and are worse then original rhinitis.

What can inadequate treatment of acute streptococcal pharyngitis result in?

Rheumatic heart disease or glomerulonephritis.

What are the Clinical Manifestations of Acute Sinusitis?

Significant pain over affected sinus, purulent nasal drainage, nasal obstruction, congestion, fever, and malaise. The patient looks and feels sick.

What are the early clinical manifestations of Head and Neck Cancers?

Signs and symptoms vary with tumor location. Cancer of the oral cavity may be a painless growth in the mouth, an ulcer that does not heal, or a change in the fit of dentures. Cancers of the oropharynx, hypopharynx and supraglottic larynx are usually squamous cell carcinoma. Usually diagnosed in late stage. Pt may complain of persistant unilateral sore throat or otalgia (ear pain). Hoarseness may be a symptom of early laryngeal cancer. A lump in throat or voice quality longer than 2 weeks.

What is an effective way to remove foreign bodies from the upper respiratory tract?

Sneezing with the opposite nostril closed is often effective. Avoid irrigating the nose or pushing the object backwards can cause aspiration or airway obstruction.

What are the clinical manifestations of Allergic Rhinitis?

Sneezing, watery itchy eyes, and nose, altered sense of smell, and thin watery nasal discharge that can lead to a more sustained nasal congestion. In chronic exposure headache, congestion, pressure, nasal polyps, and postnasal drip are common cause of cough. May cause snoring by congestion.

What are the different tracheostomys?

Standard surgical tracheostomy usually performed in the OR under general anesthesia. Percutaneous tracheostomy bedside in emergency situations under local anesthesia and some sedation/analgesia.

What are the most common bacterial causes of bacterial sinusitis?

Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

What are symptoms of a Airway Obstruction?

Stridor, use of accessory muscles, suprasternal and intercostal retractions, wheezing, restlessness, tachycardia and cyanosis.

What is a Rhinoplasty?

Surgical reconstruction of the nose, performed for cosmetic reasons or to improve airway function with trauma or developmental deformities result in nasal obstruction.

What do you teach to a patient after Nasal Packing?

Teach about home-care before discharge. Instruct the patient to avoid vigorous nose blowing, strenuous activity, lifting, and straining for 4 - 6 weeks. Teach the patient to sneeze with the mouth open and to avoid the use of aspirin containing products or NSAIDS.

What is important teaching following a neck dissection?

Teach the patient to use upper extremities to assist with support and movement of the head. Pt should begin an exercise program to maintain strength and movement in the affect shoulder and neck. Without exercise, patient will be left with a frozen shoulder and limited ROM.

What should the nurse teach in acute intervention?

Teach the pt and family about the type of therapy to be performed and care required. Assessment of concerns is integral.

What is a total laryngectomy?

The entire larynx and preepiglottic region are removed and a permanent tracheostomy is performed.

What is Allergic Rhinitis?

The reaction of nasal mucosa to a specific antigen. Can be intermittent (less than 4 days a week, or less than 4 weeks per year) or persisent (more than 4 days a week and for more then 4 weeks a year). Usually occur in the spring and fall and caused by allergy to pollen from trees, flowers or grasses.

How are Head and Neck Cancers Stages determined?

The stage of the disease is determined based on tumor size (T), number and location of involved nodes (N), and extent of metastasis (M). TNM staging classifies diseases as stage 1 to stage 4 and guides treatments.

What is a tracheostomy?

The stoma (opening) that results from the tracheotomy.

What are the clinical manifestations of Acute Viral Rhinitis?

Tickling, irritating, sneezing, or dryness of the nose or nasopharynx followed by copious nasal secretions, some nasal obstruction, watery eyes, elevated temperatures, general malaise, and headache.

What are risk factors for Head and Neck Cancers?

Tobacco, alcohol, diet poor in fruits and vegetables, marijuana, voice abuse, chronic laryngitis, industrial chemicals, neglect of oral hygiene, and infection by the human papillomavirus (HPV). Men are more likely as well.

What should the Nurse Assessment include with Head and Neck Cancer in regards to Objective Data in the Gastrointestinal System?

White (leukoplakia) or red (erythoplakia) patches inside mouth, ulceration of mucosa, asymmetric tongue, exudate in mouth or parhynx, mass or thickening of mucosa.

What is a sign of a Candida albicans infection of the pharynx?

White, irregular patches.

6. When planning health care teaching to prevent or detect early head and neck cancer, which people would be the priority to target (select all that apply) a. 65-year-old man who has used chewing tobacco most of his life b. 45-year-old rancher who uses snuff to stay awake while driving his herds of cattle c. 78-year-old woman who has been drinking hard liquor since her husband died 15 years ago d. 21-year-old college student who drinks beer on weekends with his fraternity brothers e. 22-year-old woman who has been diagnosed with human papilloma virus (HPV) of the cervix

a. 65-year-old man who has used chewing tobacco most of his life b. 45-year-old rancher who uses snuff to stay awake while driving his herds of cattle c. 78-year-old woman who has been drinking hard liquor since her husband died 15 years ago e. 22-year-old woman who has been diagnosed with human papilloma virus (HPV) of the cervix Rationale: Eighty-five percent of head and neck cancers are caused by tobacco use. Excessive alcohol consumption is also a major risk factor. Head and neck cancers in people younger than 50 years of age have been associated with human papilloma virus (HPV) infection. Sun exposure, especially to the oral cavity, is also a risk factor.

4. The best method for determining the risk of aspiration in a patient with a tracheostomy is to a. consult a speech therapist for swallowing assessment. b. have the patient drink plain water and assess for coughing c. assess for change of sputum color 48 hours after patient drinks small amount of blue dye. d. suction above the cuff after the patients eats or drinks to determine presence of food in trachea.

a. consult a speech therapist for swallowing assessment. Rationale: The ability to swallow secretions without aspiration has traditionally been evaluated with the use of blue dye. A teaspoon of water colored with blue dye is swallowed by the patient. Respiratory secretions are then monitored for 24 hours for appearance of the dye, which would indicate aspiration. Recent studies, however, do not support the sensitivity of this test. It is therefore no longer recommended. Instead, clinical assessment by a speech therapist, videofluoroscopy, or fiberoptic endoscopic evaluations of swallow are recommended. Patients should begin swallowing with thickened liquids, not plain water. Ability to swallow should be assessed with the cuff deflated, inasmuch as cuff inflation may interfere with swallowing ability.

8. When using a prosthesis for transesophageal speech, the patient a. places a vibrating device in the mouth. b. blocks the stoma entrance with a finger. c. swallows air using a Valsalva maneuver. d. places a speaking valve next the stoma

b. blocks the stoma entrance with a finger. Rationale: To use a prosthesis for transesophageal speech, the patient manually blocks the stoma with a finger. Air moves from the lungs through the prosthesis, into the esophagus, and out the mouth. Speech is produced by the air vibrating against the esophagus and is formed into words by movement of the tongue and lips.

5. Which nursing action would e of highest priority when suctioning a patient with a tracheostomy? a. Auscultating lung sounds after suctioning is complete. b. Providing a means of communication for the patient during the procedure. c. Assessing the patient's oxygenation saturation before, during and after suctioning. d. Administering pain and/or antianxiety medication 30 minutes before suctioning.

c. Assessing the patient's oxygenation saturation before, during and after suctioning. Rationale: A patient with a tracheostomy is at risk for hypoxemia after suctioning. Therefore, it is imperative to monitor the patient's oxygen status before, during, and after suctioning. Remember the protocol for airway, breathing, and circulation (ABCs) when prioritizing.

3. A patient is seen at the clinic with fever, muscle aches, sore throat with yellowish exudates, and headache. The nurse anticipates that the collaborative management will include (select all that apply) a. antiviral agents to treat influenza. b. treatment with antibiotics starting ASAP. c. a throat culture or rapid strep antigen test d. supportive care, including cool, bland liquids. e. comprehensive history to determine possible etiology.

c. a throat culture or rapid strep antigen test. d. supportive care, including cool, bland liquids. e. comprehensive history to determine possible etiology. Rationale: The goals of nursing management are infection control, symptom relief, and prevention of secondary complications. Medications are not prescribed until the etiology is known. Unnecessary use of antibiotics leads to the development of antibiotic-resistant organisms. A thorough history and a throat culture help identify the cause. The nurse should encourage the patient with pharyngitis to increase fluid intake. Cool, bland liquids and gelatin do not irritate the pharynx; citrus juices are often irritating.

7. While in the recovery room, a patient with a total laryngectomy is suctioned and has bloody mucus with some clots. Which nursing interventions would apply? a. Notify the physician immediately. b. Place the patient in the prone position to facilitate drainage. c. Instill 3 mL of normal saline into the tracheostomy tube to loosen secretions. d. Continue your assessment of the patient, including O2 saturation, respiratory rate, and breath sounds.

d. Continue your assessment of the patient, including O2 saturation, respiratory rate, and breath sounds. Rationale: Immediately after surgery, the patient with a laryngectomy requires frequent suctioning by means of the laryngectomy tube. Secretions typically change in amount and consistency over time. Secretions may initially be copious and blood-tinged secretions and then diminish and thicken. Normal saline bolus through the tracheostomy tube is not recommended to assist with removal of thickened secretions because it causes hypoxia and damage to the epithelial cells.

2. A patient with allergic rhinitis reports sever nasal congestion; sneezing; and watery, itchy eyes and nose at various times of the year. To teach the patient to control these symptoms, the nurse advises the patients to a. avoid all intranasal sprays and oral antihistamines. b. limit the usage of nasal decongestant spray to 10 days. c. use oral decongestants at bedtime to prevent symptoms during the night. d. keep a diary of when the allergic reaction occurs and what precipitates it.

d. keep a diary of when the allergic reaction occurs and what precipitates it. Rationale: An important intervention involves identifying and avoiding triggers of allergic reactions. The nurse should instruct the patient to keep a diary of times when the allergic reaction occurs and of the activities that precipitate the reaction. To prevent rebound nasal congestion, decongestant sprays should not be used for more than 3 days.

1. A patient was seen in the clinic for an episode of epistaxis, which was controlled by placement of anterior nasal packing. During discharge teaching, the nurse instructs the patient to a. use aspirin for pain relief. b. remove the packing later that day. c. skip the next dose of antihypertensive medication d. avoid vigorous nose blowing and strenuous activity.

d.avoid vigorous nose blowing and strenuous activity. Rationale: The nurse should teach the patient about home care before discharge: to avoid vigorous nose blowing, strenuous activity, lifting, and straining for 4 to 6 weeks; to sneeze with the mouth open; and to avoid the use of aspirin-containing products or nonsteroidal antiinflammatory drugs (NSAIDs).