Adult Health I Chapter 9

What agent is associated with abuse of nasal decongestants?

Vasomotor responses

Another term for the common cold

Viralrhinitis

Name the three most common techniques of alaryngeal communication.

Wound infection from the development of a pharyngocutaneous fistula, a salivary leak, stomal stenosis, and dysphagia secondary to pharyngeal and cervical esophageal structure.

Acute pharyngitis of a bacterial nature is most commonly caused by:

a group A, beta-hemolytic streptococci

Angioedema as a risk factor that leads to laryngeal obstruction is usually caused by:

a history of airway problems

Gillberta, a 14-year-old high school student, is sent with her mother to the emergency department of a local hospital for uncontrolled epistaxis. The nurse expects that emergency medical treatment may include insertion of a cotton pledget moistened with:

a topical anesthetic

decrease in arterial oxygen tension in the blood

hypoxemia

inflammation of the larynx

laryngitis

__________ fracture is the most common fracture in the body.

nasal

Assessment of a patient admitted for laryngeal carcinoma includes:

palpation of the neck for swelling

inflammation of the throat; usually viral or bacterial in origin

pharyngitis

Another term for excessive nasal drainage

rhinorrhea

The most likely causative organisms for the common cold are _______.

rhinoviruses

Jerome, a 52-year-old widower, is admitted for a laryngectomy owing to a malignant tumor. Before developing a care plan, the nurse needs to know whether Jerome's voice will be preserved. The surgical procedure that would not damage the voice box is a:

supraglottic laryngectomy

To assess for an upper respiratory tract infection, the nurse should palpate:

the frontal and maxillary sinuses; the trachea; the neck lymph nodes

To assess for an upper respiratory tract infection, the nurse should inspect:

the nasal mucosa

Brenda, a 64-year old with a long-term history of smoking, recently retired from the chemical laboratory department of a large company. After months of complaining of a persistent cough, sore throat, pain, and burning in the throat, Brenda was admitted to the hospital with a diagnosis of cancer of the larynx. The nurse advises Brenda to be vigilant about her follow-up care because the highest risk for laryngeal cancer is in the first ______ to _____ years.

2 to 3

Brenda, a 64-year old with a long-term history of smoking, recently retired from the chemical laboratory department of a large company. After months of complaining of a persistent cough, sore throat, pain, and burning in the throat, Brenda was admitted to the hospital with a diagnosis of cancer of the larynx. The nurse advises Brenda that the likelihood of lymph node involvement is less than _____ %. Without lymph node metastasis, recovery is expected in ______% of patients.

60%; 75 to 95%

The primary goal in the rehabilitation of the laryngectomy patient is to _______.

Establish an effective means of communication

True or False. High pressure can increase the risk for aspiration pneumonia.

False

True or False. Sleep apnea is more prevalent in women, especially those who are older and overweight.

False

True or False. When using an in-line suction device, the patient is disconnected from the ventilator.

False

List the clinical manifestations that are used to diagnose obstructive sleep apnea.

Frequent loud snoring and breathing cessation for 10 seconds or longer with five or more episodes per hour. This is followed by awakening abruptly with a loud snort when the blood oxygen level drops.

Name five symptoms that require further attention in a patient with a urinary tract infection.

High fever, increasing shortness of breath, confusion, increasing weakness, and malaise

A nurse takes the initial history of a patient who is being examined for cancer of the larynx. Select the sign that is considered an early clinical indicator.

Hoarseness of more than 2 week's duration

What agent is associated with pregnancy?

Hormonal triggers

During assessment of a patient with obstructive sleep apnea, the nurse documents which of the following characteristic signs that occurs because of repetitive apneic events?

Hypercapnia

A nurse determines that an individual had an obstructed airway. Select the first action the nurse would take to clear the airway.

Hyperextend the neck by placing one hand on the forehead and the fingers of the other hand underneath the jaw, and lift upward and forward.

List at least four signs of postoperative infection of a total laryngectomy that the nurse should monitor for.

Increase in temperature, tachycardia, purulent drainage, odor, redness or tenderness at the surgical site, and increased white blood cells.

The nurse advises a patient who sustained a fractured nose during an automobile accident that surgery will be necessary. Due to significant facial edema, surgery would be scheduled:

Within 1 week

The most common bacterial pathogen associated with tonsillitis and adenoiditis is:

group A, beta-hemolytic streptococcus

Isabel, a 14-year-old girl, has just undergone a tonsillectomy and adenoidectomy. The staff nurse assists her with transport from the recovery area to her room.The nurse assesses Isabel's postoperative vital signs and checks for the most significant postoperative complication of:

hemorrhage

Isabel, a 14-year-old girl, has just undergone a tonsillectomy and adenoidectomy. The staff nurse assists her with transport from the recovery area to her room. On the basis of knowledge about tonsillar disease, the nurse knows that Isabel must have experienced symptoms that required surgical intervention. Clinical manifestations may have included:

hypertrophy of the tonsils, repeated attacks of otitis media, and suspected hearing loss secondary to otitis media.

A decreased sense of smell

hyposmia

impairment of the sense of smell

hyposmia

As a general rule, the cuff on an endotracheal or tracheostomy tube should be __________.

inflated

Jerome, a 52-year-old widower, is admitted for a laryngectomy owing to a malignant tumor. Jerome is scheduled for a total laryngectomy. Preoperative education includes:

informing him that there are ways he will be able to carry on a conversation without his voice; making sure that he knows he will require a permanent tracheal stoma; reminding him that he will not be able to sing, whistle, or laugh

Nursing measures associated with the uncomplicated common cold include:

informing the patient about the symptoms of secondary infection, the major complication of a cold; suggesting adequate fluid intake and rest; teaching people that the virus is contagious for 2 days before symptoms appear and during the first part of the sympomatic phase

__________ cuff pressure can increase the risk for aspiration pneumonia.

low

A complication of acute pharyngitis can be:

mastoiditis; otitis media; peritonsillar abscess

A patient with a total laryngectomy would no longer have:

natural vocalization; protection of the lower airway from foreign particles; a normal effective cough

The major risk factor for obstructive sleep apnea is ________.

obesity around the neck that narrows and suppresses the upper airway

Isabel, a 14-year-old girl, has just undergone a tonsillectomy and adenoidectomy. The staff nurse assists her with transport from the recovery area to her room. Isabel is to be discharged the same day of her tonsillectomy. The nurse makes sure that her family knows how to:

offer her soft foods for several days to minimize local discomfort and supply her with necessary nutrients

A local complication of acute rhinosinusitis

osteomyelitis

Isabel, a 14-year-old girl, has just undergone a tonsillectomy and adenoidectomy. The staff nurse assists her with transport from the recovery area to her room. The nurse maintains Isabel in the recommended postoperative position of:

prone with her head on a pillow and turned to the side

List four possible complications following a laryngectomy that the nurse needs to asses for.

protriptyline (Triptil)

Brenda, a 64-year old with a long-term history of smoking, recently retired from the chemical laboratory department of a large company. After months of complaining of a persistent cough, sore throat, pain, and burning in the throat, Brenda was admitted to the hospital with a diagnosis of cancer of the larynx.The nurse knows that Brenda's stage I cancer will most likely be treated by:

radiation therapy or surgery

Jerome, a 52-year-old widower, is admitted for a laryngectomy owing to a malignant tumor. The nurse knows to assess for the most common postoperative complications of a total laryngectomy of:

respiratory distress, hypoxia, hemorrhage, infection, wound breakdown, and aspiration

List five common complications of pharyngitis.

rhinosinusitis, otitis media, peritonsillar abscess, mastoiditis, and cervical adenitis

If untreated, chronic rhinosinusitis can lead to severe complications. List them.

severe orbital cellulitis, subperiosteal abscess, cavernous sinus thrombosis, meningitis, encephalitis, and ischemic infarction.

Jerome, a 52-year-old widower, is admitted for a laryngectomy owing to a malignant tumor. Jerome needs to know that the laryngectomy tube will be removed when:

the stoma is well healed

indwelling tube inserted directly into the trachea to assist with ventilation

tracheostomy tube

surgical opening into the trachea

tracheotomy

surgical removal of the uvula, tonsils, and part of the soft palate to create a larger posterior oropharynx as treatment for obstructive sleep apnea

uvulopalatopharyngoplasty

The most common cause of laryngitis is:

viral

A term for dry mouth

xerostomia

dry oral cavity resulting from decreased function of salivary glands

xerostomia

The nurse expects that emergency medical treatment for epistaxis may include insertion of a cotton pledget moistened with:

Epinephrine

Jerome, a 52-year-old widower, is admitted for a laryngectomy owing to a malignant tumor. Postoperative nutrition is usually maintained by a way of nasogastric catheter. The nurse needs to tell Jerome that oral feedings usually begin after:

1 week

An obese male is being evaluated for obstructive sleep apnea. The nurse asks the patient's wife to document the number and frequency of incidences of apnea while her husband is asleep. The nurse tells the wife that a characteristic indicator of obstructive sleep apnea is a breathing cycle characterized by periods of breathing cessation for:

10 seconds with 5 episodes per hour

Surgical reduction of nasal fractures is usually performed how long after the fracture?

3 to 7 days

The health care provider diagnosed a patient with subacute rhinosinusitis. The nurse knows that the inflammatory process had existed or:

6 weeks

A surgeon completes a total laryngectomy. Postoperatively, the nurse explains to the patient's family that:

A permanent tracheal stoma would be necessary

Explain why the patient with a total laryngectomy secrets excessive amounts of mucus.

Air passes directly into the trachea without being warmed and moistened by the upper respiratory mucosa, and the tracheobronchial tree compensates by secreting excessive amounts of mucus. The patient will have frequent coughing episodes and may develop a brassy-sounding, mucus-producing cough.

What agent is associated with air pollution?

Allergic irritants

What agent is associated with seasonal pollens?

Allergic irritants

About 60% of cases of acute rhinosinusitis are caused by bacterial organisms. The antibiotic of choice is:

Amoxil

Describe a cordectomy, which is used to treat laryngeal cancer while preserving the voice.

An excision of the vocal cord performed via transoral laser and used for confined lesions involving the middle third of the vocal cord. The probability of poor voice quality is related to the extent of tissue removed.

The nurse practitioner treats a patient diagnosed with a common cold by recommending the most common treatment. What is that treatment?

Antihistamines

The nurse should advise the patient who has nasal packing for epistaxis that the packing can be left in place:

Anywhere from 2 to 6 days

Select the nursing diagnosis that would warrant immediate health care provider notification.

Ineffective airway clearance related to excessive mucus production secondary to retained secretions and inflammation

What agent is associated with chronic sinusitis?

Infectious stimulants

What agent is associated with tuberculosis?

Infectious stimulants

Gillberta, a 14-year-old high school student, is sent with her mother to the emergency department of a local hospital for uncontrolled epistaxis. Describe what the school nurse should tell Gillberta to manage the bleeding site while being transported to the hospital.

Should sit upright with her head tilted forward to prevent swallowing and aspiration of blood. She should also pinch the soft outer portion of the nose against the midline spectrum for 5 to 10 continuous minutes

The nurse is responsible for monitoring indicators of potential complications post laryngectomy. Which of the following indicators would be of concern?

Somnolence and hypotension; tachycardia and tachypnea; impaired swallowing; a tracheostomy cuff pressure greater than 20 mm Hg.

The most common form of cancer of the larynx is:

Squamous cell carcinoma

Bacterial infection occurs in about 70% of those who have acute rhinosinusitis. The nurse is aware that the least common bacteria is:

Staphylococcus aureus

Name four bacterial organisms that account for more than 60% of all cases of acute rhinosinusitis.

Staphylococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, and Moraxella catarrhalis

Once the patient has been cleared for oral feedings, post laryngectomy, the nurse knows to prepare:

Thick liquids that are easy to swallow

List the five primary reasons for a tracheostomy.

To bypass an upper airway obstruction, to allow removal of tracheobronchial secretions, to permit the long-term use of mechanical ventilation, to prevent aspiration of oral or gastric secretions in the unconscious or paralyzed patient and to replace an endotracheal tube.

Explain why topical nasal decongestants should be used with caution.

Topical therapy delivers medication directly to the nasal mucosa but its overuse can produce rhinitis medicamentosa, or an increase in the severity or duration of rhinitis that results from prolonged use of decongestant nasal spray or rebound rhinitis.

True or False. Patients receiving tube feedings are positioned with the head of the bed at 30 degrees or higher during feedings.

True

True or False. The primary concern of CSF rhinorrhea is the complication of meningitis.

True

Hemorrhage of the nose is termed __________.

epistaxis

List three types of alaryngeal communication.

esophageal speech, an artificial larynx, and tracheoesophageal puncture.

A 13-year-old soccer player presents to the emergency room with a fractured nose.The patient's mother is given which of the following postdischarge instructions?

Check for any unusual changes in breathing during the first 48 hours; observe for any clear drainage from either nostril; elevate the head of the bed for sleeping during the first week; restrict from sports activities for 6 weeks

What agent is associated with sarcoidosis?

Chronic inflammation

List five potential complications of an upper airway infection.

Complications ma include sepsis, a peritonsillar abscess, otitis media, sinusitis, and menigitis

Wound drains, inserted during the laryngectomy, stay in place until what criteria are met?

Drainage is less than 30 mL per day for 2 consecutive days

Describe the specific nursing actions necessary to prevent complications associated with an endotracheal or tracheostomy tube.

Early complications include bleeding, pneumothorax, air embolism, aspiration, subcutaneous or mediastinal emphysema, recurrent laryngeal nerve damage, and posterior tracheal wall penetration. Long-term complications include airway obstruction from accumulation of secretions or protrusion of the cuff over the opening of the tube, infection, rupture of the innominate artery, dysphagia, tracheoesophageal fistula, tracheal dilation, and tracheal ischemia and necrosis. Tracheal stenosis may develop after the tube is removed

Describe vocal cord stripping, used to treat laryngeal cancer while preserving the voice.

Involves removal of the mucosa at the edge of the cord using an operating microscope. It is used to treat dysplasia, hyperkeratosis, and leukoplakia and is often the curative treatment for this classification of lesions.

What agent is associated with cerebrospinal fluid?

Mechanical causes

What agent is associated with deviated septum?

Mechanical causes

What agent is associated with hypertrophied turbinates?

Mechanical causes

Explain how continuous positive airway pressure (CPAP) works as a treatment of obstructive sleep apnea (OSA).

Provides positive pressure to the airways throughout the respiratory cycle, preventing collapse. An air pressure source generates the air flow, generally ranging from 20 to 60 liters per minute. It is used with a leak-proof mask to keep alveoli open, thereby preventing respiratory failure. Is the most effective treatment for obstructive sleep apnea because the positive pressure acts as a splint, keeping the upper airway and trachea open during sleep. To use, the patient must be breathing independently.

Describe the symptoms of acute bacterial rhinosinusitis.

Purulent nasal drainage accompanied by nasal obstruction or a combination of facial pain, pressure, or a sense of fullness referred to collectively as facial pain-pressure-fullness, or both. The facial pain-pressure-fullness may involve the anterior face or the periorbital region. The patient may also report cloudy or colored nasal discharge, congestion, blockage, or stuffiness as well as localized or diffuse headache.

The nurse assesses a patient for possible acute pharyngitis. Which of the following clinical manifestations are consistent with this diagnosis?

Red pharyngeal membranes; swollen lymphoid follicles; white-purple exudates on the back of the throat; a temperature greater than 100.4 degrees Fahrenheit

Which of the following health care teaching points would a nurse cover when talking to a patient with rhinosinusitis?

Report the symptoms of a secondary infection, the major complication of a cold; increase fluid intake and rest as much as possible; be aware that the virus is contagious for 2 days before symptoms appear and during the first part of the symptomatic phase

inflammation of the mucous membranes of the nose; may be infectious, allergic, or inflammatory in origin

Rhinitis

Explain how rhinitis can lead to rhinosinusitis.

Rhinitis causes the nasal passages to become inflamed, congested, and edematous. The swollen conchae block the sinus openings and cause sinusitis.

drainage of a large amount of fluid from the nose

Rhinorrhea

The most serious complication of a tonsillectomy is:

hemorrhage

cold sore; cutaneous viral infection with painful vesicles and erosions on the tongue, palate, gingiva, buccal membranes, or lips

herpes simplex

Acyclovir, an antiviral agent, is recommended for:

herpes simplex infection

Nursing suggestions for a patient with acute or chronic rhinosinusitis include:

adequate fluid intake; increased humidity; local heat applications to promote drainage

Patient education for a laryngectomy includes:

advising that large amounts of mucus an be coughed up through the stoma; cautioning about preventing water from entering the stoma; telling the patient to expect a diminished sense of taste and smell

An early sign of cancer of the larynx in the glottic area (66% of cases) is:

affected voice sounds

alternative modes of speaking that do not involve the normal larynx; used by patients whose larynx has been surgically removed

alalaryngeal communication

A preventable cause of death in severe anaphylaxis

angioedema

Gillberta, a 14-year-old high school student, is sent with her mother to the emergency department of a local hospital for uncontrolled epistaxis. The nurse can advise the other that nasal packing used to control bleeding can be left in place:

anywhere from 2 to 6 days.

A term used to describe the complete loss of voice

aphonia

An obstructive sleep disorder

apnea

cessation of breathing or airflow for at least 10 seconds

apnea

Nursing management for a patient with acute pharyngitis includes:

applying an ice collar for symptomatic relief of a severe sore throat; encouraging bed rest during the febrile stage of the illness; suggesting a liquid of soft diet during the acute stage of the disease

Nursing intervention for a patient with a fractured nose includes:

applying cold compresses to decrease swelling and control bleeding; assessing respirations to detect any interference with breathing; observing for any clear fluid drainage from either nostril

Jerome, a 52-year-old widower, is admitted for a laryngectomy owing to a malignant tumor. Postoperative nursing measures to promote respiratory effectiveness include:

assisting with turning and early ambulation; positioning Jerome in semi- to high-Fowler's position; reminding Jerome to cough and take frequent deep breaths.

Chronic laryngitis is marked by persistent __________.

hoarseness

Symptoms of laryngitis include:

hoarseness, aphonia, and severe cough

Airway clearance in a patient with an upper airway infection is facilitated by:

humidifying inspired room air; positional drainage of the affected area; administering prescribed vasoconstrictive medications

Health teaching for viral rhinitis, or common cold, includes advising the patient to:

blow his or her nose gently to prevent spread of the infection; blow through both nostrils to equalize the pressure; rest, to promote overall comfort

Potential complications of enlarged adenoids include:

bronchitis; nasal obstruction; acute otitis media

Severe carbon dioxide retention

hypercapnia

A lethal complication of wound breakdown is:

carotid artery rupture

Gillberta, a 14-year-old high school student, is sent with her mother to the emergency department of a local hospital for uncontrolled epistaxis. Initial nursing measures in the emergency department that can be used to stop the nasal bleeding include:

compressing the soft outer portion of the nose against the midline septum continuously for 5 to 10 minutes; keeping Gilberta in an upright position with her head tilted forward to prevent swallowing and aspiration of blood, telling Gilberta to breathe through her mouth and to refrain from talking.

To correctly perform the Heimlich maneuver, a person should forcefully apply pressure against the victim's:

diaphragm

difficulty swallowing, causing the patient to be at risk for aspiration

dysphagia

Difficulty in breathing

dyspnea