PrepU Chapter 22

supraglottic laryngectomy:

The voice is spared

Epistaxis treatment

To manage this condition, the nurse should apply direct continuous pressure to the nares for 5 to 10 minutes with the client's head tilted slightly forward.

The herpes simplex virus type 1 (HSV-1), which produces a cold sore (fever blister), has an incubation period of 2 to 12 days 20 to 30 days 1 to 3 months 3 to 6 months

2 to 12 days

a feeling of swelling at the back of the throat

A client finished a course of antibiotics for laryngitis but continues to experience persistent hoarseness. Which symptom would cause the nurse to suspect laryngeal cancer? a feeling of swelling at the back of the throat weight loss discomfort when drinking cold liquids headaches in the morning

Fever

A client has a red pharyngeal membrane, reddened tonsils, and enlarged cervical lymph nodes. The client also reports malaise and sore throat. The nurse needs to assess first for: Fever Headache Myalgias Nausea

Nuchal rigidity

A client has acute bacterial rhinosinusitis for several weeks despite treatment. The nurse observes for a possible complication of the infection by assessing for Hypertension Mild headache Nuchal rigidity Nausea

"Tell my wife about it, I do not want to touch it."

A nurse is evaluating teaching when discussing care of a new tracheostomy. Which statement, made by the client, indicates that the client does not accept the new tracheostomy? "I must carry tissues with me." "I must give up my love of pool aerobics." "I will not be able to have the tracheostomy removed." "Tell my wife about it, I do not want to touch it."

The nasal mucosa

A patient comes to the clinic complaining of a possible upper respiratory infection. What should the nurse inspect that would indicate that an upper respiratory infection may be present? The nasal mucosa The buccal mucosa The frontal sinuses The tracheal mucosa

partial laryngectomy/hemilaryngectomy: laryngofissure-thyrotomy

A patient is diagnosed as being in the early stage of laryngeal cancer of the glottis with only 1 vocal cord involved. For what type of surgical intervention will the nurse plan to provide education? Total laryngectomy Cordectomy Vocal cord stripping Partial laryngectomy

A permanent tracheal stoma would be necessary.

A surgeon completes a total laryngectomy. Postoperatively, the nurse explains to the patient's family that: One vocal cord was removed along with a portion of the larynx. The voice was spared and a tracheostomy would be in place until the airway was established. A permanent tracheal stoma would be necessary. A portion of the vocal cord was removed.

clients with laryngeal cancer

After an initial hoarseness lasting longer than a month, will feel a sensation of swelling or a lump in the throat or in the neck. Weight loss often occurs later in the progression due to reduced calorie intake as a result of impaired swallowing and pain. May report burning in the throat when swallowing hot or citrus liquids.

Laryngitis causes

Allergies, smoking, and excessive use of the voice causing straining are frequent causes.

laryngeal cancer is one of the most preventable types of cancer.

As part of a primary cancer prevention program, an oncology nurse answers questions from the public at a health fair. When someone asks about laryngeal cancer, the nurse should explain that: laryngeal cancer is one of the most preventable types of cancer. inhaling polluted air isn't a risk factor for laryngeal cancer. laryngeal cancer occurs primarily in women. adenocarcinoma accounts for most cases of laryngeal cancer.

total laryngectomy

Communication needs to be established using an alternate method. Not able to speak. The client typically has difficulty with swallowing due to edema in the immediate postoperative period. Alternate forms of nutrition are used. The tracheostomy cuff is often deflated for periods of time. The head of the bed is maintained in a semi-Fowler's position to decrease edema.

Emotional support

Malignancy of the larynx can be a devastating diagnosis. What does a client with a diagnosis of laryngeal cancer require? Emotional support Referral for counseling Family counseling Referral for vocational training

Responsible viruses include the adenovirus, influenza virus, Epstein-Barr virus, and herpes simplex virus.

Most cases of acute pharyngitis are caused by viral infection.

Viral infection

Most cases of acute pharyngitis are caused by which of the following? Viral infection Bacterial infection Fungal infection Systemic infection

Commonly contribute to sleep apnea

Obesity and decreased pharyngeal muscle tone the client may need to become involved in a weight loss program.

oxymetazoline sprays (Afrin)

Over-the-counter nasal treatment that may cause rebound congestion.

intervention laryngectomy

Postoperatively, the client may not be permitted to eat or drink for at least 7 days. Alternative sources of nutrition and hydration include IV fluids, enteral feedings through a nasogastric or gastrostomy tube, and parenteral nutrition. Once the client is permitted to resume oral feedings, thick liquids are offered; sweet foods are avoided because they cause increased salivation and decrease the client's appetite. The client's taste sensations are altered for a while after surgery because inhaled air passes directly into the trachea, bypassing the nose and the olfactory end organs. In time, however, the client usually accommodates to this change and olfactory sensation adapts; thus, seasoning is based on personal preferences.

Ineffective airway clearance is the nursing diagnosis of highest priority.

The client is postoperative immediately following a total laryngectomy. The client's respirations are 32 breaths/minute, shallow, and noisy. The tracheostomy pad is moist. Pulse oximetry is 88%. The client's eyes are wide open, and the client appears apprehensive. The client is receiving humidified oxygen. A priority nursing diagnosis is: ineffective airway clearance related to excess mucus production anxiety related to the effects of surgery and loss of voice ineffective breathing pattern related to inflammatory effects of surgery impaired gas exchange related to ventilation-perfusion inequality

Apply an ice pack.

The nurse is caring for a client admitted to the ED with an uncomplicated nasal fracture. Nasal packing has been put in place. Which intervention should the nurse include in the client's care? Apply an ice pack. Restrict fluid intake. Position the patient in the side-lying position. Apply pressure to the convex of the nose.

Transillumination of sinuses

The nurse is caring for a client in the physician's office with a potential sinus infection. The physician orders a diagnostic test to identify if fluid is found in the sinus cavity. Which diagnostic test, written by the physician, is specifically ordered for this purpose? CBC with differential Transillumination of the sinus Nasal culture Magnetic resonance imaging (MRI)

Edema of the upper airway

The nurse is caring for a client status post adenoidectomy. The nurse finds the client in severe respiratory distress when entering the room. What does the nurse suspect? Infection Postoperative bleeding Edema of the upper airway Plugged tracheostomy tube

Develop an alternate method of communication.

The nurse is caring for a client who had a recent laryngectomy. Which of the following is reflected in the nursing plan of care? Develop an alternate method of communication. Encourage oral nutrition on the second postoperative day. Maintain the client in a low-Fowler's position. Assess the tracheostomy cuff for leaks.

"You should try to reduce exposure to irritants and allergens."

The nurse is caring for a client with allergic rhinitis. The c;ient asks the nurse about measures to help decrease allergic symptoms. Which is the best response by the nurse? "You should try to reduce exposure to irritants and allergens." "Be sure to receive your influenza vaccination each year." "You need to see your ear, nose, and throat specialist monthly." "Take over-the-counter nasal decongestants when you experience symptoms."

When the patient has less than 30 mL for 2 consecutive days

The nurse is caring for a patient who had a total laryngectomy and has drains in place. When does the nurse understand that the drains will most likely be removed? When the patient has less than 30 mL for 2 consecutive days When the patient states that there is discomfort and requests removal When the drainage tube comes out In 1 week when the patient no longer has serous drainage

Test the nasal drainage for glucose.

When caring for a client with head trauma, a nurse notes a small amount of clear, watery fluid oozing from the client's nose. What should the nurse do first? Test the nasal drainage for glucose. Look for a halo sign after the drainage dries. Have the client blow his nose. Contact the physician.

Wound drains

When drainage is less than 30 mL/day for 2 consecutive days, the physician usually removes the drains.

Recommend guaifenesin. Provide warm salt-water gargles. Administer oral ibuprofen. Teach the client about handwashing.

Which of the following interventions would be helpful for a client reporting nasal congestion, sneezing, sore throat, and muscle aches? Select all that apply. Provide warm salt-water gargles. Administer oral ibuprofen. Teach the client about handwashing. Refer the client to a physician for antibiotic therapy. Recommend guaifenesin.

The client should seek medical assistance if swallowing :

is impaired to prevent aspiration.

Following Maslow's hierarchy of needs, airway clearance:

is the highest priority.

signs and symptoms of acute pharynigitis.

red pharyngeal membrane, malaise and sore throat ,reddened tonsils, and enlarged cervical lymph nodes ,fever higher than 39.3°C. headache, myalgias, and nausea. Findings will help to determine if the client requires antibiotic therapy.

CBC with differential can note an elevated

white blood cell count

total laryngectomy

will result in a permanent stoma and total loss of voice.

Clients may experience a morning headache

with obstructive sleep apnea(OSA)

Viral infection

x Most cases of acute pharyngitis are caused by which of the following? Viral infection Bacterial infection Fungal infection Systemic infection

Major goals of intubation are to improve

respirations and maintain a patent airway for gas exchange.

The adenoids or pharyngeal tonsils consist of

lymphatic tissue near the center of the posterior wall of the nasopharynx.

first sign of recurrence of rhinosinusitis to promote drainage of the sinus cavities and prevent bacterial infection.

take a decongestant (e.g., guaifenesin [Mucinex])

Laryngitis is common in older adults and may be secondary

the client has a medical history of GERD. Older adults are more likely to have impaired esophageal peristalsis and a weaker esophageal sphincter.

To prevent possible drug interactions,

the client is cautioned to read drug labels before taking any over-the-counter medication.

appropriate room assignment based on

the client's problems, safety, and risk for infection to others.

face mask

The nurse is caring for a respiratory client who uses a noninvasive positive pressure device. Which medical equipment does the nurse anticipate to find in the client's room? A ventilator A face mask A rigid shell A nasal cannula

Hoarseness for 2 weeks

The nurse is obtaining a health history from a client on an annual physical exam. Which documentation should be brought to the physician's attention? Epistaxis, twice last week Aphonia following a football game Hoarseness for 2 weeks Laryngitis following a cold

"I was chewing ice chips all day long."

The nurse is obtaining a health history from a client with laryngitis. Which causative factor, stated by the client, is least likely? "I have environmental allergies." "I smoke a pack of cigarettes a day." "I used my voice in excess over the weekend." "I was chewing ice chips all day long."

Avoid sports activities for 6 weeks.

The nurse is providing discharge instructions to a client who has nasal packing in place following nasal surgery. Which discharge instructions would be most appropriate for the client? Avoid sports activities for 6 weeks. Decrease the amount of daily fluids. Take aspirin for nasal discomfort. Administer normal saline nasal drops as ordered.

B

The nurse is to make a room assignment for a client diagnosed with an upper respiratory infection. The other clients with empty beds in the room are listed in the accompanying chart. The best room assignment for the new client would be with Client A B C D

drainage is blood tinged in the client nose.

The nurse, has a client with head trauma should look for a halo sign only if the

Gastroesophageal reflux disease (GERD)

A 76-year-old client presents to the ED reporting "laryngitis." The triage nurse should ask whether the client has a medical history that includes Gastroesophageal reflux disease (GERD) Chronic obstructive pulmonary disease (COPD) Congestive heart failure (CHF) Respiratory failure (RF)

Apply direct continuous pressure.

A client comes into the emergency department with epistaxis. What intervention should the nurse perform when caring for a client with epistaxis? Apply a moustache dressing. Provide a nasal splint. Apply direct continuous pressure. Place the client in a semi-Fowler's position.

"Gargle with a warm salt solution."

A client is being discharged from an outpatient surgery center following a tonsillectomy. What instruction should the nurse give to the client? "Gargle with a warm salt solution." "You may have a sore throat for 1 week." "You are allowed to have hot tea or coffee." "Decrease oral intake if increased swallowing occurs."

Saline lavages to the nares

A client is experiencing acute viral rhinosinusitis. The nurse is providing instructions about self-care activities and includes information about Cold compresses to the sinus cavities Use of a dehumidifier Saline lavages to the nares Administration of oral antibiotics

sit upright, leaning slightly forward

A client with thrombocytopenia, secondary to leukemia, develops epistaxis. The nurse should instruct the client to: lie supine with his neck extended. sit upright, leaning slightly forward. blow his nose and then put lateral pressure on his nose. hold his nose while bending forward at the waist.

can note bacteria in the nares.

A nasal culture

guaifenesin

A nurse is teaching a client with recurrent rhinosinusitis. What medication will the nurse instruct the client to take at the first sign of symptoms? guaifenesin acetaminophen oxymetazoline nasal spray naproxen

Group A, beta-hemolytic streptococcus

A patient comes to the clinic and is diagnosed with tonsillitis and adenoiditis. What bacterial pathogen does the nurse know is commonly associated with tonsillitis and adenoiditis? Gram-negative Klebsiella Pseudomonas aeruginosa Group A, beta-hemolytic streptococcus Staphylococcus aureus

Amoxicillin/Clavulanate:

Antibiotics should be administered as soon as the diagnosis of ABRS is established. Amoxicillin-clavulanic acid is the antibiotic of choice. For clients who are allergic to penicillin, doxycycline or respiratory quinolones, such as levofloxacin or moxifloxacin, can be used. Other antibiotics previously prescribed to treat ABRS, including cephalosporins such as cephalexin and cefuroxime, are no longer recommended because they are not effective in treating antibiotic-resistant organisms that are now more commonly implicated in ABRS.

interventions related to the management of a client with a nasal obstruction:

Application of a moustache dressing or a drip pad to absorb drainage, application of a nasal splint, and placement of the client in a semi-Fowler's position.

Contains glucose

Because cerebrospinal fluid (CSF) testing nasal drainage for glucose helps determine whether it's CSF. A client with a suspected CSF leakage shouldn't blow his nose; doing so could increase the risk of injury. The nurse should contact the physician after completing the assessment.

a form of pica

Chewing ice chips, if in excess, is not likely to cause laryngitis.

total laryngectomy interventions

Client must understand that the natural voice will be lost but special training can provide a means for communicating. The client needs to know that until training is started, communication will be possible using the call light, through writing, or using a special communication board. The use of an electronic device is a long-term postoperative goal. The speech therapist will evaluate the client before surgery and establish a method of immediate postoperative communication.

may transmit infection to susceptible people?

Client with an upper respiratory infection

Hypercapnia

During assessment of a patient with OSA, the nurse documents which of the following characteristic signs that occurs because of repetitive apneic events? Pulmonary hypotension Hypercapnia Systemic hypotension Increased smooth muscle contractility

Symptoms of laryngeal cancer

Earlier, the patient may complain of a persistent cough or sore throat and pain and burning in the throat, especially when consuming hot liquids or citrus juices. Later symptoms include dysphagia, dyspnea, unilateral nasal obstruction or discharge, persistent hoarseness, persistent ulceration, and foul breath.

The nurse is caring for a client diagnosed with rhinosinusitis. The physician has ordered the client to receive four sprays of budesonide (Rhinocort) in each nostril every morning. The nurse informs the client that a common side effect of this medication is: Headache Epistaxis Arthralgia Watery eyes

Epistaxis

Acute Tonsillitis

Infection of the adenoids frequently accompanies

The nurse is caring for a client who underwent a laryngectomy. Which intervention will the nurse initially complete in an effort to meet the client's nutritional needs? Initiate enteral feedings. Offer plenty of thin liquids. Encourage sweet foods. Liberally season foods.

Initiate enteral feedings.

the most preventable types of cancer;

Laryngeal cancer is one of it can be prevented by abstaining from excessive drinking and smoking. Inhaling noxious fumes, such as in polluted air, is a risk factor for laryngeal cancer. Roughly 80% of laryngeal cancer cases occur in men.

Dysphagia Dyspnea Persistent hoarseness

Late symptoms of laryngeal cancer include which of the following. Select all that apply. Dysphagia Dyspnea Persistent hoarseness Sore throat Burning in throat

total laryngectomy

Loss of the ability to speak normally is a devastating consequence of surgery and is certain. Issues with self-esteem and deficient knowledge are possible, but less certain. Infection is a risk, but not a certainty.

Common signal of throat cancer

Persistent hoarseness may which is associated with tobacco use. Although straining the voice may cause hoarseness, it wouldn't cause hoarseness lasting for 1 month.

sign of laryngeal cancer and merits prompt investigation

Persistent hoarseness, especially of unknown cause, can be a. Epistaxis can be from several causes and has occurred infrequently. Aphonia and laryngitis are common following the noted activity.

Hemilaryngectomy or vertical laryngectomy

Removal of a portion of the vocal cord occurs .

obstructive sleep apnea (OSA), signs and symptoms of OSA

Signs and symptoms include excessive daytime sleepiness, frequent nocturnal awakening, insomnia, loud snoring, morning headaches, intellectual deterioration, personality changes, irritability, impotence, systemic hypertension, dysrhythmias, pulmonary hypertension, corpulmonale, polycythemia, and enuresis.

thrombocytopenia, secondary to leukemia, develops epistaxis

Sitting upright and leaning slightly forward avoids increasing vascular pressure in the nose and helps the client avoid aspirating blood. Lying supine won't prevent aspiration of the blood. Nose blowing can dislodge any clotting that has occurred. Bending at the waist increases vascular pressure in the nose and promotes bleeding rather than halting it.

Wound drains

Suction also may be used, but cautiously, to avoid trauma to the surgical site and incision.

Sinus Infection (Sinusitis)

The nurse in the ICU is caring for a client with a nasotracheal tube. Because of the tube placement, the nurse understands that the client is at risk for developing sinus infection. severe epistaxis. subperiosteal abscess. orbital cellulitis.

clients with allergic rhinitis

The nurse instructs : to avoid or reduce exposure to allergens and irritants, such as dusts, molds, animals, fumes, odors, powders, sprays, and tobacco smoke. Receiving an influenza vaccination each year is recommended for clients with infectious rhinitis.

Auscultate lung sounds.

The nurse is caring for the client in the intensive care unit immediately after removal of the endotracheal tube. Which of the following nursing actions is most important to complete every hour to ensure that the respiratory system is not compromised? Obtain vital signs. Monitor heart rhythm. Auscultate lung sounds. Assess capillary refill.

"You can use writing or a communication board to communicate."

The nurse is discussing immediate postoperative communication strategies with a client scheduled for a total laryngectomy. What information will the nurse include? "After surgery you will have a sore throat, but you will be able to speak." "You can use writing or a communication board to communicate." "After surgery you will have to use an electric larynx to communicate." "A speech therapist will evaluate you and recommend a system of communication after surgery."

Wound drains, inserted during surgery, may be in place to assist in removal of fluid and air from the surgical site.

The nurse observes, measures, and records drainage.

Squamous cell carcinoma

accounts for most cases of laryngeal cancer.

Medications that the client may take later in the illness for pain relief

acetaminophen (Tylenol) and nonsteroidal antinflammatory drugs, such as naproxen (Aleve).

Saline lavages are used for

acute rhinosinusitis and relieve symptoms, reduce inflammation, clear nasal passages of stagnant mucus, and reduce the development of opportunistic infections. Other methods that promote drainage of the sinuses are humidifying the air, not dehumidifying it, and warm compresses, not cold compresses, to the sinus cavities. Because this infection is viral, antibiotics are not indicated.

To assess the client's risk for throat cancer,

ask about smoking habits.

CPAP is the most effective treatment for OSA

because the positive pressure acts as a splint, keeping the upper airway and trachea open during sleep. To use CPAP, the patient must be breathing independently. Mechanical ventilation is not the most effective treatment for OSA. Administration of low-flow nasal oxygen at night can help relieve hypoxemia in some patients but has little effect on the frequency or severity of apnea.

Clients with a malignancy of the larynx require:

emotional support before and after surgery and help in understanding and choosing an alternative method of speech.

Common side effects of budesonide (Rhinocort) include

epistaxis, pharyngitis, cough, nasal irritation, and bronchospasm.

chronic rhinitis: inspects the nasal mucosa

for abnormal findings such as increased redness, swelling, exudate, and nasal polyps, which may develop in The mucosa of the nasal turbinates may also be swollen (boggy) and pale bluish-gray. The nurse palpates the frontal and maxillary sinuses for tenderness, which suggests inflammation, and then inspects the throat by having the patient open the mouth wide and take a deep breath.

Frequently occurring bacterial pathogens include the most common organism

group A, beta-hemolytic streptococcus

Repetitive apneic events result in

hypoxia and hypercapnia, which triggers a sympathetic response (increased heart rate and decreased tone and contractility of smooth muscle).

Late complications of radiation therapy

include laryngeal necrosis, edema, and fibrosis.

BiPAP ventilation offers

independent control of inspiratory and expiratory pressure while providing pressure support ventilation.

Transillumination and x-rays of the sinuses

may show a change in the shape of or confirms that there is fluid in the sinus cavity.

clinical manifestation of hemorrhage related to carotid artery rupture:

monitors vital signs for changes, particularly increased pulse rate, decreased blood pressure, and rapid, deep respirations. Cold, clammy, pale skin may indicate active bleeding.

A rigid shell is used with a

negative pressure chamber and is not frequently used today

Potential complications of acute bacterial rhinosinusitis :

nuchal rigidity and severe headache. Hypertension may be a result of over-the-counter decongestant medications. Nausea may be a result of nasal corticosteroids.

treatment of a client with epistaxis determines on

severity and location of bleeding.

Tonsillectomy Interventions

A warm saline solution will help with removal of thick mucus and halitosis. It will be a gentle gargle, because a vigorous gargle may cause bleeding. A sore throat may be present for 3 to 5 days. Hot foods should be avoided.

Do you smoke cigarettes, cigars, or a pipe?"

A client seeks care for hoarseness that has lasted for 1 month. To elicit the most appropriate information about this problem, the nurse should ask which question? "Do you smoke cigarettes, cigars, or a pipe?" "Have you strained your voice recently?" "Do you eat a lot of red meat?" "Do you eat spicy foods?"

type of ventilation does not require intubation or a ventilator.

A face mask or other nasal devices are found in the client's room as this

LARYNGEAL NECROSIS

A late complication of radiation therapy is pain. laryngeal necrosis. xerostomia. dysphasia.

"I should become involved in a weight loss program."

A nurse is caring for a client who has a history of sleep apnea. The client understands the disease process when he says: "I need to keep my inhaler at the bedside." "I should eat a high-protein diet." "I should become involved in a weight loss program." "I should sleep on my side all night long."

Discharge instructions after nasal surgery:

The nurse instructs the client to avoid sports activities for 6 weeks. Mouth rinses help to moisten the mucous membranes and to reduce the odor and taste of dried blood in the oropharynx and nasopharynx. The client should take analgesic agents, such as acetaminophen or NSAIDs (i.e., ibuprofen or naproxen), to decrease nasal discomfort, not aspirin.

Polycythemia, Insomnia, Loud snoring

The nurse is assessing a client for obstructive sleep apnea (OSA). Which are signs and symptoms of OSA? Select all that apply. Polycythemia Evening headaches Loud snoring Pulmonary hypotension Insomnia

Increased risk of epistaxis (nosebleed)

Using nasally inhaled illicit drugs, such as cocaine, because of the increased vascularity of the nasal passages. A dry environment (not a humidified one) Hypertension, increases the risk of epistaxis.

Swimming

When the nurse gives a client and family instructions after laryngeal surgery, which does the nurse indicate should be avoided? Hand-held showers Wearing a scarf over the stoma Swimming Coughing

Cocaine use

Which assessment finding puts a client at increased risk for epistaxis? Use of a humidifier at night Hypotension Cocaine use History of nasal surgery

Increased pulse rate

Which clinical manifestation of hemorrhage is related to carotid artery rupture? Increased pulse rate Increased blood pressure Shallow respirations Dry skin

Use enteral feedings after the procedure

Which intervention regarding nutrition is implemented for clients who have undergone laryngectomy? Use enteral feedings after the procedure Recommend the long-term use of zinc lozenges Offer plenty of thin liquids when intake resumes Season food to suit an increased sense of taste and smell

Amoxicillin

Which is the antibiotic of choice used to treat acute bacterial rhinosinusitis (ABRS)? Amoxicillin Levofloxacin Keflex Ceftin

impaired verbal communication

Which nursing diagnosis is most likely for a client who has just undergone a total laryngectomy? impaired verbal communication deficient knowledge risk for infection risk for chronic low self-esteem

Continuous positive airway pressure (CPAP)

Which of the following is the most effective treatment for obstructive sleep apnea (OSA)? Continuous positive airway pressure (CPAP) Bilevel positive airway pressure (BiPAP) Mechanical ventilation Oxygen by nasal cannula

Drainage is <30 mL/day for 2 consecutive days.

Wound drains, inserted during the laryngectomy, stay in place until what criteria are met? The stoma is healed, about 6 weeks after surgery. The surgical site is dry with encrustations. Drainage is <30 mL/day for 2 consecutive days. The patient is able to assist with his own suctioning.

partial laryngectomy (laryngofissure-thyrotomy):

involves the removal of one vocal cord. A partial laryngectomy (laryngofissure-thyrotomy) is often used for patients in the early stages of cancer in the glottis area when only one vocal cord is involved.

Regular auscultation of the lung fields

is essential in confirming that air is reaching the lung fields for gas exchange.

Following a nasal fracture:

the nurse applies ice and encourages the client to keep the head elevated. The nurse instructs the client to apply ice packs to the nose to decrease swelling. The packing inserted to stop the bleeding may be uncomfortable and unpleasant, and obstruction of the nasal passages by the packing forces the client to breathe through the mouth. This, in turn, causes the oral mucous membranes to become dry. Mouth rinses help to moisten the mucous membranes and to reduce the odor and taste of dried blood in the oropharynx and nasopharynx.

With severe respiratory distress in a status post adenoidectomy client

the nurse would suspect an airway issue related to edema of the upper airway.

A nasal cannula is not used with

the positive pressure device.

follow Maslow's hierarchy of needs and ABCs (airway, breathing, circulation)

to determine highest priority.

HSV-1 is

transmitted primarily by direct contact with infected secretions. The incubation period is about 2 to 12 days.

laryngeal surgery postoperative instructions:

water should not enter the stoma because it will flow from the trachea to the lungs. avoid swimming and to use a handheld shower device when bathing. wear a scarf over the stoma to make the opening less obvious. cough every 2 hours to promote effective gas exchange.

Wound drains, inserted during the laryngectomy are removed:

when secretions are minimal, which usually is less than 30 mL for 48 straight hours.