Chapter 22: Management of Patients With Upper Respiratory Tract Disorders

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 was chewing ice chips all day long." "I used my voice in excess over the weekend." "I smoke a pack of cigarettes a day."

"I was chewing ice chips all day long." Chewing ice chips, a form of pica if in excess, is not likely to cause laryngitis. Allergies, smoking, and excessive use of the voice causing straining are frequent causes.

An obese male is being evaluated for OSA. 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 OSA is a breathing cycle characterized by periods of breathing cessation for: 6 seconds with 3 episodes/hour. 10 seconds with 5 episodes/hour. 4 seconds with 2 episodes/hour. 8 seconds with 4 episodes/hour.

10 seconds with 5 episodes/hour. OSA is characterized by frequent and loud snoring, with breathing cessation for 10 seconds or longer, for at least five episodes per hour, followed by abrupt awakening with a loud snort as the blood oxygen level drops. Symptoms typically progress with weight gain, aging, and during the transition to menopause for women.

A surgeon completes a total laryngectomy. Postoperatively, the nurse explains to the patient's family that: 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. One vocal cord was removed along with a portion of the larynx.

A permanent tracheal stoma would be necessary. A total laryngectomy will result in a permanent stoma and total loss of voice. A partial laryngectomy involves the removal of one vocal cord. The voice is spared with the supraglottic laryngectomy. Removal of a portion of the vocal cord occurs with a hemilaryngectomy.

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? Take aspirin for nasal discomfort. Decrease the amount of daily fluids. Administer normal saline nasal drops as ordered. Avoid sports activities for 6 weeks.

Avoid sports activities for 6 weeks. The nurse instructs the client to avoid sports activities for 6 weeks. There is no indication for the client to refrain from taking oral fluids. 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. The client does not need to use nasal drops when nasal packing is in place.

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

Continuous positive airway pressure (CPAP) 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. BiPAP ventilation offers independent control of inspiratory and expiratory pressure while providing pressure support ventilation. 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.

Select the nursing diagnosis that would warrant immediate health care provider notification. Deficient fluid volume related to decreased fluid intake and increased fluid loss secondary to diaphoresis associated with a fever Ineffective airway clearance related to excessive mucus production secondary to retained secretions and inflammation Deficient knowledge regarding prevention of upper airway infections, treatment regimens, the surgical procedure, or postoperative care Acute pain related to upper airway irritation secondary to an infection

Ineffective airway clearance related to excessive mucus production secondary to retained secretions and inflammation Ineffective airway clearance can lead to respiratory depression, which necessitates immediate intervention.

A patient comes to the clinic with a cold and wants something to help relieve the symptoms. What should the nurse include in educating the patient about the uncomplicated common cold? (Select all that apply.) Inform the patient that the virus is contagious for 2 days before symptoms appear and during the first part of the symptomatic phase. Suggest that the patient take adequate fluids and get plenty of rest. Inform the patient that taking an antihistamine will help to decrease the duration of the cold. Tell the patient to take prescribed antibiotics to decrease the severity of symptoms. Inform the patient about the symptoms of secondary infection.

Inform the patient that the virus is contagious for 2 days before symptoms appear and during the first part of the symptomatic phase. Suggest that the patient take adequate fluids and get plenty of rest. Inform the patient about the symptoms of secondary infection. Colds are highly contagious because virus is shed for about 2 days before the symptoms appear and during the first part of the symptomatic phase. Management consists of symptomatic therapy that includes adequate fluid intake, rest, prevention of chilling, and the use of expectorants as needed. The nurse instructs the patient about methods to treat symptoms of the common cold and provides both verbal and written information to assist in the prevention and management of URIs.

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? Liberally season foods. Initiate enteral feedings. Offer plenty of thin liquids. Encourage sweet foods.

Initiate enteral feedings. 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.

The nurse is caring for a client diagnosed with enlarged adenoids. What condition is produced by enlarged adenoids? Hardened secretions Erosion of the trachea Incrusted mucous membranes Noisy breathing

Noisy breathing Enlarged adenoids may produce nasal obstruction, noisy breathing, snoring, and a nasal quality to the voice. Incrustation of the mucous membranes in the trachea and the main bronchus occurs during the postoperative period following a tracheostomy. The long-term and short-term complications of tracheostomy include airway obstruction. These are caused by hardened secretions and erosion of the trachea.

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 Vocal cord stripping Partial laryngectomy Cordectomy

Partial laryngectomy 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.

You are performing a preoperative assessment on a client who is scheduled for a tonsillectomy. Why would you ask the client about the use of herbal supplements? They lower high-density lipoprotein levels. They produce anorexia. They impair the immune system. They prolong bleeding.

They prolong bleeding. The nurse must find out the bleeding tendencies of clients scheduled for tonsillectomy and adenoidectomy. Therefore, the nurse asks the clients about any recent use of herbal supplements. The nurse must ask about the use of these supplements because they may prolong bleeding. A client may experience anorexia because of a diminished sense of taste and smell following a laryngectomy. Similarly, excess zinc impairs the immune system and lowers the levels of high-density lipoproteins. These symptoms are not caused by herbal supplements.

Another term for clergyman's sore throat is aphonia. atrophic pharyngitis. hypertrophic pharyngitis. chronic granular pharyngitis.

chronic granular pharyngitis. In chronic granular pharyngitis, also referred to as clergyman's sore throat, the pharynx is characterized by numerous swollen lymph follicles. Aphonia refers to the inability to use one's voice. Atrophic pharyngitis is characterized by a membrane that is thin, white, glistening, and at times wrinkled. Hypertrophic pharyngitis is characterized by general thickening and congestion of the pharyngeal mucous membrane.

A client is being seen by the physician because of an unrelenting headache, facial tenderness, low-grade fever, and dark yellow nasal discharge. The client reports seeming to develop sinus infections "all the time." Which factor may predispose the client to sinusitis? interference with sinus drainage more than 8 hours of sleep per night excessive protein intake increased exposure to the health care environment

interference with sinus drainage The principal causes are the spread of an infection from the nasal passages to the sinuses and the blockage of normal sinus drainage. Interference with sinus drainage predisposes a client to sinusitis because trapped secretions readily become infected. Client with persistent sinus infections may have allergies, nasal polyps, or a deviated septum. Eating a well-balanced diet that includes but does not rely exclusively on protein is a measure that may help reduce incidences of sinusitis. Getting plenty of rest is a measure that may help reduce incidences of sinusitis. Increased exposure to the health care environment is not a specific cause of sinusitis, which is more commonly caused by allergies or blockage of the nasal passages.

You are speaking at a local PTO meeting about upper respiratory infections. Which preventive factor for rhinitis should you teach the attendees? Avoid carbonated fluids. Get adequate rest and sleep. Use a straw to drink fluids. Avoid clearing the throat.

Get adequate rest and sleep. Teaching clients about upper respiratory infections helps prevent them and reduce potential complications. The best prevention for rhinitis is to maintain a healthy life-style with adequate rest and sleep, proper diet, and moderate exercise. The nurse instructs clients who have undergone tonsillectomy and adenoidectomy to drink fluids without a straw, avoid clearing the throat, and avoid carbonated fluids. These instructions are not relevant for clients with rhinitis.

A female patient with obstructive sleep apnea (OSA) has been recommended a continuous positive airway pressure (CPAP) machine for the treatment of her health problem. The nurse's priority for patient education should be: The need to use inhaled corticosteroids and bronchodilators each night prior to applying CPAP The need to have continuous pulse oximetry in place while the CPAP machine is in use The importance of complying with CPAP despite the inconvenience associated with its use The importance of participating in daily physical exercise when using CPAP on a regular basis

The importance of complying with CPAP despite the inconvenience associated with its use Although CPAP is effective in management of OSA, patient compliance with the treatment continues to be a major concern. Nursing interventions aimed at increasing compliance are consequently a priority. Steroids, bronchodilators, and pulse oximetry are not normally necessary. Daily exercise is beneficial but the promotion of compliance is a priority for patients using CPAP.

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

d) Hypercapnia Repetitive apneic events result in hypoxia and hypercapnia, which triggers a sympathetic response (increased heart rate and decreased tone and contractility of smooth muscle).

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

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

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

sit upright, leaning slightly forward. 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.

A client has been diagnosed with acute rhinosinusitis caused by a bacterial organism. What antibiotic of choice for treatment of this disorder does the nurse anticipate educating the client about? Cefuroxime Clarithromycin Cephalexin Amoxicillin-clavulanic acid

Amoxicillin-clavulanic acid Treatment of acute rhinosinusitis depends on the cause; a 5- to 7-day course of antibiotics is prescribed for bacterial cases. Antibiotics should be administered as soon as the diagnosis of ABRS is established. Amoxicillin-clavulanic acid ( Augmentin) is the antibiotic of choice. Other antibiotics prescribed previously to treat ABRS, including cephalosporins such as cephalexin (Keflex), cefuroxime (Ceftin), cefaclor (Ceclor), and cefixime (Suprax), trimethoprim-sulfamethoxazole (Bactrim, Septra), and macrolides such as clarithromycin (Biaxin) and azithromycin (Zithromax), are no longer recommended because they are not effective in treating antibiotic-resistant organisms that are now more commonly implicated in ABRS.

A patient playing softball was hit in the nose by the ball and has been determined to have an uncomplicated fractured nose with epistaxis. The nurse should prepare to assist the physician with what tasks? Administering nasal lavage Applying nasal packing Preparing the patient for a septoplasty Applying steroidal nasal spray

Applying nasal packing A nasal fracture very often produces bleeding from the nasal passage. As a rule, bleeding is controlled with the use of packing.

You are caring for a client who is 42-years-old and status post adenoidectomy. You find the client in respiratory distress when you enter their room. You ask another nurse to call the physician and bring an endotracheal tube into the room. What do you suspect? Edema of the upper airway Post operative bleeding Infection Plugged tracheostomy tube

Edema of the upper airway An endotracheal tube is inserted through the mouth or nose into the trachea to provide a patent airway for clients who cannot maintain an adequate airway on their own. The scenario does not indicate infection, post operative bleeding, or a plugged tracheostomy tube.

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? Aphonia following a football game Epistaxis, twice last week Laryngitis following a cold Hoarseness for 2 weeks

Hoarseness for 2 weeks Persistent hoarseness, especially of unknown cause, can be a sign of laryngeal cancer and merits prompt investigation. Epistaxis can be from several causes and has occurred infrequently. Aphonia and laryngitis are common following the noted activity.

What is the most commonly prescribed treatment for the common cold? Decongestants Antihistamines Expectorants Antitussives

Antihistamines Antihistamines are the first group of medications recommended for treating sneezing, pruritus, rhinorrhea, and nasal congestion associated with the common cold.

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

Drainage is <30 mL/day for 2 consecutive days. Drains are removed when secretions are minimal, which usually is less than 30 mL for 48 straight hours.

A client is scheduled for endotracheal intubation prior to surgery. What can the nurse tell this client about an endotracheal tube? "The ET tube will maintain your airway while you're under anesthesia." "The ET tube will be inserted through an opening in your trachea." "The ET tube will be connected to a negative-pressure ventilator." "The ET tube will remain in place for at least a day postsurgery."

"The ET tube will maintain your airway while you're under anesthesia." An endotracheal tube provides a patent airway for clients who cannot maintain an adequate airway on their own. Tracheostomy tubes are inserted into a surgical opening in the trachea, called a tracheotomy. Clients receiving endotracheal intubation for the purpose of general anesthesia should not require long-term placement of the ET tube. Positive-pressure ventilators require intubation and are used for clients who are under general anesthesia. They are also used for clients with acute respiratory failure, primary lung disease, or who are comatose.

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 HSV-1 is transmitted primarily by direct contact with infected secretions. The incubation period is about 2 to 12 days. The time periods of 20 to 30 days, 1 to 3 months, and 3 to 6 months exceed the incubation period.

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

Amoxicillin 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.

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? Restrict fluid intake. Position the patient in the side-lying position. Apply pressure to the convex of the nose. Apply an ice pack.

Apply an ice pack. 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. Applying direct pressure is not indicated in this situation.

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

Emotional support 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. It does not require a referral for counseling or vocational training. It also does not require family counseling.

Your client has a history of hoarseness lasting longer than 2 weeks. The client is now complaining of feeling a lump in their throat. What would you suspect this client has? Cancer of the tonsils Laryngeal cancer Laryngeal polyps Cancer of the pharynx

Laryngeal cancer Later, the client notes a sensation of swelling or a lump in the throat, followed by dysphagia and pain when talking. Hoarseness is not indicative of pharyngeal cancer; laryngeal polyps; or cancer of the tonsils.

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

c) Polycythemia d) Insomnia e) Loud snoring

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

Cocaine use Using nasally inhaled illicit drugs, such as cocaine, increases the risk of epistaxis (nosebleed) because of the increased vascularity of the nasal passages. A dry environment (not a humidified one) increases the risk of epistaxis. Hypertension, not hypotension, increases the risk of epistaxis. A history of nasal surgery doesn't increase the risk of epistaxis.

A patient has had a laryngectomy and was able to retain his airway, with no difficulty swallowing. There is no split of thyroid cartilage. The nurse would record this type of laryngectomy as which of the following? Total laryngectomy Partial laryngectomy Supraglottic laryngectomy Hemilaryngectomy

Partial laryngectomy In a partial laryngectomy, a portion of the larynx is removed, along with one vocal cord and the tumor; all other structures remain. The airway remains intact, and the patient is expected to have no difficulty swallowing. During a supraglottic laryngectomy, a tracheostomy is left in place until the glottic airway is established. Hemilaryngectomy is done by splitting the thyroid cartilage of the larynx in the midline of the neck, and the portion of the vocal cord is removed with the tumor. During a total laryngectomy, a complete removal of the larynx is performed, including the hyoid bone, epiglottis, cricoids cartilage, and two or three rings of the trachea.

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? In 1 week when the patient no longer has serous drainage When the drainage tube comes out 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 patient has less than 30 mL for 2 consecutive days Wound drains, inserted during surgery, may be in place to assist in removal of fluid and air from the surgical site. Suction also may be used, but cautiously, to avoid trauma to the surgical site and incision. The nurse observes, measures, and records drainage. When drainage is less than 30 mL/day for 2 consecutive days, the physician usually removes the drains.

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

"I should become involved in a weight loss program." Obesity and decreased pharyngeal muscle tone commonly contribute to sleep apnea; the client may need to become involved in a weight loss program. Using an inhaler won't alleviate sleep apnea, and the physician probably wouldn't order an inhaler unless the client had other respiratory complications. A high-protein diet and sleeping on the side aren't treatment factors associated with sleep apnea.

A homeless client with streptococcal pharyngitis is being seen in a clinic. The nurse is concerned that the client will not continue treatment after leaving the clinic. Which of the following measures is the highest priority? Provide the client with oral penicillin that will last for 5 days. Provide emphatic oral instructions for the client. Administer one intramuscular injection of penicillin. Ask an accompanying homeless friend to monitor the client's follow-up.

Administer one intramuscular injection of penicillin. If a nurse is concerned that a client may not perform follow-up treatment for streptococcal pharyngitis, the highest priority is to administer penicillin as a one-time injection dose. Oral penicillin is as effective and less painful, but the client needs to take the full course of treatment to prevent antibiotic-resistant germs from developing. The nurse should provide oral and written instructions for the client, but this is not as high a priority as administering the penicillin. Having a homeless friend monitor the client's care does not ensure that the client will follow therapy.

A nurse is caring for a client experiencing laryngeal obstruction. What clinical finding should lead the nurse to anticipate mechanical ventilation for the client? Diminished breath sounds throughout Retractions in the neck during inspiration Rhonchi in the bronchial region Crackles in the base of the lungs

Retractions in the neck during inspiration The nurse anticipates mechanical ventilation if the client is having neck retractions during inspiration. Rhonchi in the bronchial region is heard lower in the airways and crackles are heard in the base of the lungs. Diminished breath sounds that occur throughout are indicative of airway obstruction, not laryngeal swelling.

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? Edema of the upper airway Plugged tracheostomy tube Postoperative bleeding Infection

Edema of the upper airway With severe respiratory distress in a status post adenoidectomy client, the nurse would suspect an airway issue related to edema of the upper airway. The scenario does not indicate infection, postoperative bleeding, or a plugged tracheostomy tube.

You are doing preoperative teaching with a client scheduled for laryngeal surgery. What should you teach this client to help prevent atelectasis? Encourage deep breathing every 2 hours. Monitor for signs of dysphagia. Caution against frequent coughing. Provide meticulous mouth care every 4 hours.

Encourage deep breathing every 2 hours. The nurse should encourage a client undergoing laryngeal surgery to practice deep breathing and coughing every 2 hours while the client is awake. These measures prevent atelectasis and promote effective gas exchange. Monitoring for signs of dysphagia and providing meticulous mouth care every 4 hours are the interventions related to the client's caloric intake.

A 60-year-old man has been diagnosed with obstructive sleep apnea (OSA) based on his clinical symptoms and polysomnographic findings. What intervention should the nurse perform to assist this patient in the management of his health problem? Encouraging the patient to adopt a later bedtime and earlier rising hour Teaching the patient deep breathing and coughing exercises to perform before going to bed Encouraging the patient to avoid alcohol and hypnotic medications Teaching the patient strategies for waking himself up when he experiences an apneic spell

Encouraging the patient to avoid alcohol and hypnotic medications Treatments for OSA are varied but include weight loss and avoidance of alcohol and hypnotic medications initially. Patients are not normally able to awaken themselves during apneic periods. Deep breathing exercises and changes to sleeping times are not known to improve the signs and symptoms of OSA.

Which is a priority nursing intervention that the nurse should perform for a client who has undergone surgery for a nasal obstruction? Apply a warm pack postoperatively Apply pressure to the convex portion of the nose Provide a splint postoperatively Ensure mouth breathing

Ensure mouth breathing For a client who has undergone surgery for a nasal obstruction, it is important for the nurse to emphasize that nasal packing will be in place postoperatively, necessitating breathing through the mouth. The nurse applies an ice pack to reduce pain and swelling and not a warm pack. The nurse recommends the use of a splint and the application of pressure to the convex portion of the nose in case of a nasal fracture.

A client reports nasal congestion, sneezing, sore throat, and coughing up of yellow mucus. The nurse assesses the client's temperature as 38°C The client states this is the third episode this season. The highest priority nursing diagnosis is Deficient knowledge related to prevention of upper respiratory infections Ineffective airway clearance related to excess mucus production Acute pain related to upper airway irritation Deficient fluid volume related to increased fluid needs

Ineffective airway clearance related to excess mucus production All the listed nursing diagnoses are appropriate for this client. Following Maslow's hierarchy of needs, physiological needs are addressed first and, within physiological needs, airway, breathing, and circulation are the most immediate. Thus, ineffective airway clearance is the priority nursing diagnosis.

A nurse is providing discharge teaching for a client who had a laryngectomy. Which instruction should the nurse include in her teaching? "Swimming is good exercise after this surgery." "Keep the humidity in your house low." "Wear a tight cloth at the stoma to prevent anything from entering it." "Cover the stoma whenever you shower or bathe."

"Cover the stoma whenever you shower or bathe." The nurse should instruct the client to gently cover the stoma with a loose plastic bib, or even a hand, when showering or bathing to prevent water from entering the stoma. The client should cover the stoma with a loose-fitting, not tight, cloth to protect it. The client should keep his house humidified to prevent irritation of the stoma that can occur in low humidity. The client should avoid swimming, because it's possible for water to enter the stoma and then enter the client's lung, causing him to drown without submerging his face.