NUR 2502 MDC III – Examination Blue Print – Exam 2
Disorders to Review:
● Head/sinus/neck cancer
o Squamous cell carcinoma and slow growing
▪ treatable at early stage
▪ Begins with mucosa that is chronically irritated, becoming tougher than thicker
▪ Leukoplakia (white patchy) and erythroplakia (red,velvety) lesions
▪ Risk factors: tobacco and alcohol use
● voice abuse, chronic laryngitis, exposure to chemical or dusts, poor oral hygiene, long-
term GERD, and oral HPV
o Clinical manifestations
▪ lumps in mouth, throat, neck
▪ Difficulty swallowing
▪ color changes in mouth or tongue
▪ Oral lesion or sore that does not heal in 2 weeks.
▪ Persistent, unilateral ear pain
▪ persistent/unexplained oral bleeding
▪ Numbness or mouth, lips, or face
▪ Change in fit of dentures
▪ hoarseness or change in voice quality
▪ persistent/recurrent sore throat
▪ shortness of breath
▪ anorexia and weight loss
▪ burning sensation when drinking citrus or hot liquids
o Nursing interventions
▪ psychosocial-assess support systems and coping mechanisms
▪ laboratory assessment
● CBC, urinalysis, blood chemistries, kidney and liver function tests, HPV
▪ Imaging assessment
● x rays, CT, mri
▪ other diagnostic
● laryngoscopy, biopsy
▪ the priority interprofessional collaborative problems for patients with head and neck cancer
include
● potential for airway obstruction
● potential for aspiration
● Anxiety
● decreased self esteem
o Therapies
▪ radiation therapy
▪ chemotherapy
▪ cordectomy
▪ laryngectomy
● post op care for laryngectomy
o FIRST! airway maintenance and gas exchange
o wound, flap, reconstructive tissue care
o hemorrhage
o wound breakdown
o pain management
o nutrition
o speech and language habilitation
, ● Nasal/Facial fracture
o Clinical manifestations
▪ displacement of bone or cartilage can cause airway obstruction of cosmetic deformity; potential
source if infection
▪ CSF may indicate skull fracture
o Nursing interventions
▪ nasal reduction
▪ rhinoplasty
● observe for edema and bleeding
● check vital signs every 4 hours
● semi-fowler’s position
● cool compress to reduce swelling
● Limit valsalva- don't sniff upward or blow nose, laxatives or stool softeners to ease bowel
movements
● avoid aspirin and NSAIDs
● edema and bruising last for weeks
▪ nasal-septoplasty
● Epistaxis
o Clinical manifestations
▪ nosebleed is a common problem
▪ cauterization of affected capillaries may be needed nose is packed
o Nursing interventions
▪ assess for respiratory distress, tolerance of packing or tubes
▪ humidification, oxygen, bedrest, antibiotics, pain medications
● COPD
o Clinical manifestations
▪ may be absent in early phases
▪ May vary depending on underlying disease process
▪ Hypoxia
▪ barrel chest
▪ Cyanosis
▪ Clubbing
▪ Cough/ sputum production
▪ Dyspnea
▪ Lung sounds-hyper-resonany to percussion, wheezes/crackles
▪ Tripod position: In tripod position, one sits or stands leaning forward and supporting the upper
body with hands on the knees or on another surface
▪ Weight loss
▪ Fatigue
▪ Anxiety
o Complications:
▪ Hypoxemia/tissue anoxia
▪ Acidosis
● Increased CO2
● Decreased PO2
● Decreased pH
▪ Respiratory infections
● Due to increased mucus
▪ Heart failure/dysrhythmias
▪ respiratory failure
o Nursing interventions
▪ GOAL: improve airflow and prevent progression
● Support with coping, teaching pt to be a partner in COPD management
Disorders to Review:
● Head/sinus/neck cancer
o Squamous cell carcinoma and slow growing
▪ treatable at early stage
▪ Begins with mucosa that is chronically irritated, becoming tougher than thicker
▪ Leukoplakia (white patchy) and erythroplakia (red,velvety) lesions
▪ Risk factors: tobacco and alcohol use
● voice abuse, chronic laryngitis, exposure to chemical or dusts, poor oral hygiene, long-
term GERD, and oral HPV
o Clinical manifestations
▪ lumps in mouth, throat, neck
▪ Difficulty swallowing
▪ color changes in mouth or tongue
▪ Oral lesion or sore that does not heal in 2 weeks.
▪ Persistent, unilateral ear pain
▪ persistent/unexplained oral bleeding
▪ Numbness or mouth, lips, or face
▪ Change in fit of dentures
▪ hoarseness or change in voice quality
▪ persistent/recurrent sore throat
▪ shortness of breath
▪ anorexia and weight loss
▪ burning sensation when drinking citrus or hot liquids
o Nursing interventions
▪ psychosocial-assess support systems and coping mechanisms
▪ laboratory assessment
● CBC, urinalysis, blood chemistries, kidney and liver function tests, HPV
▪ Imaging assessment
● x rays, CT, mri
▪ other diagnostic
● laryngoscopy, biopsy
▪ the priority interprofessional collaborative problems for patients with head and neck cancer
include
● potential for airway obstruction
● potential for aspiration
● Anxiety
● decreased self esteem
o Therapies
▪ radiation therapy
▪ chemotherapy
▪ cordectomy
▪ laryngectomy
● post op care for laryngectomy
o FIRST! airway maintenance and gas exchange
o wound, flap, reconstructive tissue care
o hemorrhage
o wound breakdown
o pain management
o nutrition
o speech and language habilitation
, ● Nasal/Facial fracture
o Clinical manifestations
▪ displacement of bone or cartilage can cause airway obstruction of cosmetic deformity; potential
source if infection
▪ CSF may indicate skull fracture
o Nursing interventions
▪ nasal reduction
▪ rhinoplasty
● observe for edema and bleeding
● check vital signs every 4 hours
● semi-fowler’s position
● cool compress to reduce swelling
● Limit valsalva- don't sniff upward or blow nose, laxatives or stool softeners to ease bowel
movements
● avoid aspirin and NSAIDs
● edema and bruising last for weeks
▪ nasal-septoplasty
● Epistaxis
o Clinical manifestations
▪ nosebleed is a common problem
▪ cauterization of affected capillaries may be needed nose is packed
o Nursing interventions
▪ assess for respiratory distress, tolerance of packing or tubes
▪ humidification, oxygen, bedrest, antibiotics, pain medications
● COPD
o Clinical manifestations
▪ may be absent in early phases
▪ May vary depending on underlying disease process
▪ Hypoxia
▪ barrel chest
▪ Cyanosis
▪ Clubbing
▪ Cough/ sputum production
▪ Dyspnea
▪ Lung sounds-hyper-resonany to percussion, wheezes/crackles
▪ Tripod position: In tripod position, one sits or stands leaning forward and supporting the upper
body with hands on the knees or on another surface
▪ Weight loss
▪ Fatigue
▪ Anxiety
o Complications:
▪ Hypoxemia/tissue anoxia
▪ Acidosis
● Increased CO2
● Decreased PO2
● Decreased pH
▪ Respiratory infections
● Due to increased mucus
▪ Heart failure/dysrhythmias
▪ respiratory failure
o Nursing interventions
▪ GOAL: improve airflow and prevent progression
● Support with coping, teaching pt to be a partner in COPD management
