NUR2502 Exam 2 Focused Review
· Neck cancer- s/s, nursing interventions, teaching regarding treatment
· S/S: leukoplakia (white, patchy lesions), erythroplakia (red, velvety lesions), lumps in
mouth/throat/neck, difficulty swallowing and chewing, foul breath, epistaxis (nose
bleeds), oral lesion or sore throat that doesn’t heal in 2 wks, persistent/unilateral ear pain,
persistent/unexplained oral bleeding, numbness of mouth/lips/face, jaw pain, change in fit
of dentures, voice hoarseness, SOB, burning sensation when drinking citrus or hot liquids
· Nursing interventions: fowlers or semi fowlers, monitor for hemorrhage after surgery,
wound flap/reconstructive tissue care, prevent wound breakdown, admin opioid
analgesics, feeding tube, teach how to minimize anxiety, monitor for resp. distress
· Teaching about tx:
o radiation s/e: dry mouth (increased risk for dental cavities, infections, bad breath),
hoarseness of voice, skin irritation, difficulty swallowing, impaired taste; avoid
exposing area to sun, heat/cold, abrasive actions (shaving)
o laryngectomy or cordectomy: need feeding tube sort-term, alt. means of
communication, self mgmt of airway, tracheostomy may be temp. or permanent,
stoma care
· Nasal fractures- s/s, treatments, nursing interventions, post-operative care and teachings
· S/S: deviation, misaligned bridge, change in nasal breathing, crepitus on palpitation,
bruising, pain, blood or clear drainage from nose (CSF may indicate skull fracture)
· Tx: closed reduction (move bone back into place), rhinoplasty, nasoseptoplasty
· Nursing interventions: semi-fowlers, maintain airway
· Post-op care and teaching: observe for edema and bleeding, cool compress to reduce
swelling, analgesics, change drip pad as needed, don’t sniff upward or blow nose, stool
softeners to ease bowel mvmts so pt doesn’t strain, avoid aspirin and NSAIDs, let pt
know edema and bruising is expected and can last for weeks, drink adequate fluids, use
of humidifier
· Rhinosinusitis- s/s, diagnosis, treatment
· Sinus infection
· S/S: nasal swelling, congestion, headache, facial pressure, pain, tenderness, low-grade
fever, cough, purulent or bloody nasal drainage (everything is inflammed)
· Diagnosis: CT scan, physical exam and if has s/s for 10 days (to make sure it's not a virus
bc viruses last 7-10 days) OR is sick, gets a little better, and then s/s get worse
· Tx: broad spectrum abx, analgesics, decongestants, intranasal steroid spray, steam
humidification, hot/wet packs over sinuses, nasal saline irrigations, increased fluids
· Differentiating CSF from nasal drainage
· CSF has glucose and yellow halo when dried
· COPD and oxygen
· Be careful not to give too much O2 for too long, bc it can take away the hypoxic drive to
breathe, expect them to have lower O2 sat and that’s okay 88-93%
· Obstructive sleep apnea- s/s, treatment, nursing interventions
· S/S: excessive daytime sleepiness, inability to concentrate, irritability
, · Tx: change sleep position, positive pressure ventilation (CPAP), surgical: adenoidectomy,
uvulectomy, uvulopalatopharyngoplasty (removes excess tissue in throat)
· Nursing interventions: encourage weight loss, smoking cessation, raise HOB when
sleeping or lateral position
· Non-invasive ventilation techniques
· Uses positive pressure to keep alveoli open and improve gas exchange w/o intubation
· CPAP and BiPAP
o BiPAP has 2 pressure settings: the prescribed pressure for inhalation, and a lower
pressure for exhalation; allows pt to get more air in and out of the lungs
· Can deliver oxygen or room air
· Epistaxis- treatment, nursing interventions
· Nosebleed; posterior nasal bleeding is an emergency because we cant readily access the
back of the nose
· Tx: cauterization of affected capillaries, nose is packed
· Nursing interventions: have pt lean forward and pinch bridge of nose, assess for resp.
distress, humidification, O2, bedrest, abx, analgesics
· Asthma- etiology, s/s, treatments, nursing interventions, education
· Chronic, reversible airway obstruction resulting in inflammation and bronchoconstriction
(affects airway only, not alveoli)
· Etiology: general irritants, exercise, upper respiratory illness, aspirin/NSAIDs, GERD
· S/S: audible wheeze, increased RR, increased cough, use of accessory muscles, “Barrel
chest”, tachycardia, chest pain, color changes
▪ Difficulty talking,
▪ Nasal flaring
▪ Using inhaler and not getting better, >50%
o Resp. Acidosis, decreased PaO2, increased PaCO2 during an attack
· Tx: bronchodilators- albuterol (cause smooth muscle relaxation, no role in inflammation;
give 5 min before other meds), anticholinergics- ipratropium/tiotropium (increases
bronchodilation and decreases secretions), anti-inflammatories- corticosteroids/
leukotriene modifiers (only controller drugs, not for relief), Exercise, O2 therapy if O2
sats are low, mag sulfate
o Drugs for asthma:
▪ Controlled therapy: inhaled corticoid steroid is drug of choice:
· Considerations: rinse their mouth to avoid thrush, hyperglycemia, tachy,
· If pt comes into the ER, has drug tx but HR is still high, do not give
breathing tx
o Give the medication some time, get hr down a bit
· Bronchodilator should be given 5 mins before corticoid steroid
o Steroids are not a priority drug
▪ O2 and breathing tx are reliever drugs
· Steroids are controller drugs
▪ Do not give Beta blockers, NSAIDs, or Aspirin to asthmatic pt
·
· Nursing interventions: obtain a baseline PFT, improve air flow and gas exchange with
exercise/activity, relieve symptoms, O2 therapy during an acute attack
▪ Tripod position
· Neck cancer- s/s, nursing interventions, teaching regarding treatment
· S/S: leukoplakia (white, patchy lesions), erythroplakia (red, velvety lesions), lumps in
mouth/throat/neck, difficulty swallowing and chewing, foul breath, epistaxis (nose
bleeds), oral lesion or sore throat that doesn’t heal in 2 wks, persistent/unilateral ear pain,
persistent/unexplained oral bleeding, numbness of mouth/lips/face, jaw pain, change in fit
of dentures, voice hoarseness, SOB, burning sensation when drinking citrus or hot liquids
· Nursing interventions: fowlers or semi fowlers, monitor for hemorrhage after surgery,
wound flap/reconstructive tissue care, prevent wound breakdown, admin opioid
analgesics, feeding tube, teach how to minimize anxiety, monitor for resp. distress
· Teaching about tx:
o radiation s/e: dry mouth (increased risk for dental cavities, infections, bad breath),
hoarseness of voice, skin irritation, difficulty swallowing, impaired taste; avoid
exposing area to sun, heat/cold, abrasive actions (shaving)
o laryngectomy or cordectomy: need feeding tube sort-term, alt. means of
communication, self mgmt of airway, tracheostomy may be temp. or permanent,
stoma care
· Nasal fractures- s/s, treatments, nursing interventions, post-operative care and teachings
· S/S: deviation, misaligned bridge, change in nasal breathing, crepitus on palpitation,
bruising, pain, blood or clear drainage from nose (CSF may indicate skull fracture)
· Tx: closed reduction (move bone back into place), rhinoplasty, nasoseptoplasty
· Nursing interventions: semi-fowlers, maintain airway
· Post-op care and teaching: observe for edema and bleeding, cool compress to reduce
swelling, analgesics, change drip pad as needed, don’t sniff upward or blow nose, stool
softeners to ease bowel mvmts so pt doesn’t strain, avoid aspirin and NSAIDs, let pt
know edema and bruising is expected and can last for weeks, drink adequate fluids, use
of humidifier
· Rhinosinusitis- s/s, diagnosis, treatment
· Sinus infection
· S/S: nasal swelling, congestion, headache, facial pressure, pain, tenderness, low-grade
fever, cough, purulent or bloody nasal drainage (everything is inflammed)
· Diagnosis: CT scan, physical exam and if has s/s for 10 days (to make sure it's not a virus
bc viruses last 7-10 days) OR is sick, gets a little better, and then s/s get worse
· Tx: broad spectrum abx, analgesics, decongestants, intranasal steroid spray, steam
humidification, hot/wet packs over sinuses, nasal saline irrigations, increased fluids
· Differentiating CSF from nasal drainage
· CSF has glucose and yellow halo when dried
· COPD and oxygen
· Be careful not to give too much O2 for too long, bc it can take away the hypoxic drive to
breathe, expect them to have lower O2 sat and that’s okay 88-93%
· Obstructive sleep apnea- s/s, treatment, nursing interventions
· S/S: excessive daytime sleepiness, inability to concentrate, irritability
, · Tx: change sleep position, positive pressure ventilation (CPAP), surgical: adenoidectomy,
uvulectomy, uvulopalatopharyngoplasty (removes excess tissue in throat)
· Nursing interventions: encourage weight loss, smoking cessation, raise HOB when
sleeping or lateral position
· Non-invasive ventilation techniques
· Uses positive pressure to keep alveoli open and improve gas exchange w/o intubation
· CPAP and BiPAP
o BiPAP has 2 pressure settings: the prescribed pressure for inhalation, and a lower
pressure for exhalation; allows pt to get more air in and out of the lungs
· Can deliver oxygen or room air
· Epistaxis- treatment, nursing interventions
· Nosebleed; posterior nasal bleeding is an emergency because we cant readily access the
back of the nose
· Tx: cauterization of affected capillaries, nose is packed
· Nursing interventions: have pt lean forward and pinch bridge of nose, assess for resp.
distress, humidification, O2, bedrest, abx, analgesics
· Asthma- etiology, s/s, treatments, nursing interventions, education
· Chronic, reversible airway obstruction resulting in inflammation and bronchoconstriction
(affects airway only, not alveoli)
· Etiology: general irritants, exercise, upper respiratory illness, aspirin/NSAIDs, GERD
· S/S: audible wheeze, increased RR, increased cough, use of accessory muscles, “Barrel
chest”, tachycardia, chest pain, color changes
▪ Difficulty talking,
▪ Nasal flaring
▪ Using inhaler and not getting better, >50%
o Resp. Acidosis, decreased PaO2, increased PaCO2 during an attack
· Tx: bronchodilators- albuterol (cause smooth muscle relaxation, no role in inflammation;
give 5 min before other meds), anticholinergics- ipratropium/tiotropium (increases
bronchodilation and decreases secretions), anti-inflammatories- corticosteroids/
leukotriene modifiers (only controller drugs, not for relief), Exercise, O2 therapy if O2
sats are low, mag sulfate
o Drugs for asthma:
▪ Controlled therapy: inhaled corticoid steroid is drug of choice:
· Considerations: rinse their mouth to avoid thrush, hyperglycemia, tachy,
· If pt comes into the ER, has drug tx but HR is still high, do not give
breathing tx
o Give the medication some time, get hr down a bit
· Bronchodilator should be given 5 mins before corticoid steroid
o Steroids are not a priority drug
▪ O2 and breathing tx are reliever drugs
· Steroids are controller drugs
▪ Do not give Beta blockers, NSAIDs, or Aspirin to asthmatic pt
·
· Nursing interventions: obtain a baseline PFT, improve air flow and gas exchange with
exercise/activity, relieve symptoms, O2 therapy during an acute attack
▪ Tripod position
