Chapter 29: Disorders of the nose, sinuses, and larynx.

A patient who has just had a nosebleed successfully stopped using gauze packing will be sent home from the emergency department. Which statement by the patient indicates a need for further teaching about self-care at home?

"I should not blow my nose for the next 6 hours."

The supervising RN asks the graduate nurse how to prevent aspiration when the patient with a recent partial laryngectomy eats. Which response by the graduate nurse indicates a need for further instruction?

"I will encourage the patient to use a straw for liquids."

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."

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

Airway assessment

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

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

Which factors can increase the risk for head and neck cancer? Select all that apply.

Chronic voice abuse and related laryngitis Tobacco and alcohol use alone or in combination

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

An emergency nurse is preparing to care for a patient arriving by ambulance after a motor vehicle crash. The patient has severe facial and neck injuries and emergency airway measures are taken. Which type of airway does the nurse prepare for?

Cricothyroidotomy

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 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

A patient comes to the emergency department (ED) with a bruised and swollen nose after being hit with a baseball 2 days ago. X-ray reveals a displaced fracture of the nose. Which order does the nurse anticipate implementing?

Excessive swallowing

What differentiates cerebrospinal fluid leakage from normal nasal secretions?

Glucose content

Which is an orbital-zygoma fracture?

Le fort III

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

Maintaining a patent airway

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

A newly hired RN with no previous emergency department (ED) experience has just completed a 1-month orientation. Which of these patients would be most appropriate to assign to this nurse?

Patient on warfarin with epistaxis with profuse bleeding

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

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

Stool softener

Which principles guide the nurse's teaching of a patient who has had surgical repair after facial trauma? Select all that apply.

Titanium plates are permanent and do not interfere with future MRI studies. Patients with immunosuppression or history of alcohol abuse may not heal as well. Wire cutters must always be readily available if inner maxillary fixation was used.

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

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.

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

Oxygenation

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.

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

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

Tachypnea

A patient who is about to undergo a supraglottic partial laryngectomy asks the nurse what the surgeon will remove during this procedure. The nurse explains to the patient that the surgeon will remove which structures?

The hyoid bone, false cords, and the epiglottis

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 Wood particles

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

Normal lifestyle and functional ability must be preserved.

A postoperative patient develops stridor and becomes short of breath immediately following a thyroidectomy. What action does the nurse take?

Notify the Rapid Response Team.