Adult Health Exam 2
What is obstructive sleep apnea? - ANS sleep-related breathing disorder with apneic periods that last for
10 seconds or more at least 5 times an hour while asleep. When those with OSA are symptomatic, it is
referred to as obstructive sleep apnea syndrome (OSAS).
What are s/s of OSA and interventions? - ANS Excessive daytime sleepiness, inability to concentrate,
irritability, fatigue, headaches, waking with gasping or choking, depression, and memory problems
Changes in sleep position, HOB elevated, weight loss, positive pressure ventilation, and surgical
management are uvulopalatopharyngoplasty
What is epistaxis and why is posterior bleeding more serious? - ANS Epistaxis common problem because
of the many capillaries within the nose. IT results from loss of tissue integrity from trauma to nasal
mucosa, hypertension, and NG tubes. Bleeding can occur from the anterior or posterior part of the nose.
Older adults tend to bleed from the posterior part of the nose, this is an emergency.
Posterior nasal bleeding is harder to control and creates a greater risk for airway compromise. Posterior
packing with epistaxis catheters or gel tampons are placed through the nose to stop bleeding. Airway
can be obstructed if the packing dislodges resulting in reduced gas exchang.
What are some interventions to prevent epistaxis from occurring and at home teaching? - ANS
Humidification, oxygen, bed rest, antibiotics, and pain management (NSAIDS and aspirin should be
avoided for risk of bleeding) instead of using opioids however these gag reflexes should be monitored
hourly with continuous pulse ox
At-home teaching: packing should be removed at 1-3 days; apply petroleum jelly to nares, use saline
nasal sprays for moisture, and avoid vigorous nose blowing (do not blow nose for 24 hours after
bleeding), if bleeding occurs tell patient to lean forward to prevent blood from entering the larynx and
possible aspiration
,What are the key assessment signs for nasal fracture and what are the interventions? - ANS Nasal
fractures may result in loss of tissue integrity and may interfere with gas exchange. For assessment
document any problems like deviation, change in nasal breathing or crepitus on palpation, bruising or
pain, blood or clear fluid (CSF). CSF is a serious concern and could indicate a serious injury like a skull
fracture. If CSF is suspected a glucose test can be performed, as it will test positive for glucose.
Interventions: closed reduction within first 24 hours, if after surgery may have to wait because of excess
edema
Explain post-op care and complications that can occur because of a nasal fracture - ANS After surgery
patient will have packing in noses, as long as packing is correctly in place the patient should not be able
to breathe through their nose. A dressing or drip pad is folded under nose.
- Check vital signs every four hours
- Instruct patient to stay in semi fowlers position and move slowly
- After the gag reflex has returned encourage fluid intake
- Avoid forceful coughing or straining during bm
- DO not sniff upward or blow nose and do not sneeze with mouth closed for first few days
- Avoid aspirin and NSAIDs
Complications: assess how often the patient swallows after surgery because repeated swallowing could
indicate posterior nasal bleeding
Explain the causes for head and neck cancer & assessment findings - ANS Head and neck cancers are
generally squamous cell carcinomas, slow-growing tumors that begin when the mucosa is chronically
irritated and as a result, become tougher and thicker. Eventually, genes controlling cell growth are
damaged and allow for an excess of malignant cells. Initial lesions first appear as white patchy lesions
(leukoplakia) or red velvety patches (erythroplakia). The two biggest risk factors for developing head &
neck cancer are alcohol and cigarette use. Also, exposure to chemicals or dust, GERD, oral infection with
HPV.
Assessment findings:
, pain
lump in mouth, throat, neck
Difficulty swallowing
changes in color of tongue or mouth
oral lesions that take long to heal
oral bleeding
change in voice quality
What are the top nursing priorities for head and neck cancer? - ANS Potential for airway obstruction
Potential for aspiration
Anxiety for decreased self esteem
Explain both a partial and total laryngectomy - ANS Both a laryngectomy and the nose help to filter the
air that is inhaled. After the surgery, all the air you breathe goes in and out of the stoma bypassing the
natural filtration of nose. A partial laryngectomy results in normal or hoarse voice quality, with a
temporary tracheostomy. A total laryngectomy results in no natural voice, with a permanent
laryngectomy stoma created in the neck. After surgery, patients may need mechanical ventilation
Explain post-op care and complications for a laryngectomy - ANS Monitor airway patency, v/s should be
monitored hourly for first 24 yours after surgery, hemodynamic status, nutrition (NG is placed during
surgery for nutritional support. Aspiration cannot occur after a total laryngectomy because airway is
separate from esophagus)
Complications are airway obstruction, hemorrhage, wound breakdown
Explain ways to promote communication for a patient that has had a total laryngectomy - ANS The
patient used an artificial larynx and may eventually learn esophageal speech. Mechanical devices or
tracheoesophageal puncture (TEP) may also be used. Esophageal speech is attempted by most patients,
where sound is produced by burping the air swallowed. Mechanical devices or electro-larynx is used for
communication and are battery-powered devices that are placed on the side of neck or cheek that
What is obstructive sleep apnea? - ANS sleep-related breathing disorder with apneic periods that last for
10 seconds or more at least 5 times an hour while asleep. When those with OSA are symptomatic, it is
referred to as obstructive sleep apnea syndrome (OSAS).
What are s/s of OSA and interventions? - ANS Excessive daytime sleepiness, inability to concentrate,
irritability, fatigue, headaches, waking with gasping or choking, depression, and memory problems
Changes in sleep position, HOB elevated, weight loss, positive pressure ventilation, and surgical
management are uvulopalatopharyngoplasty
What is epistaxis and why is posterior bleeding more serious? - ANS Epistaxis common problem because
of the many capillaries within the nose. IT results from loss of tissue integrity from trauma to nasal
mucosa, hypertension, and NG tubes. Bleeding can occur from the anterior or posterior part of the nose.
Older adults tend to bleed from the posterior part of the nose, this is an emergency.
Posterior nasal bleeding is harder to control and creates a greater risk for airway compromise. Posterior
packing with epistaxis catheters or gel tampons are placed through the nose to stop bleeding. Airway
can be obstructed if the packing dislodges resulting in reduced gas exchang.
What are some interventions to prevent epistaxis from occurring and at home teaching? - ANS
Humidification, oxygen, bed rest, antibiotics, and pain management (NSAIDS and aspirin should be
avoided for risk of bleeding) instead of using opioids however these gag reflexes should be monitored
hourly with continuous pulse ox
At-home teaching: packing should be removed at 1-3 days; apply petroleum jelly to nares, use saline
nasal sprays for moisture, and avoid vigorous nose blowing (do not blow nose for 24 hours after
bleeding), if bleeding occurs tell patient to lean forward to prevent blood from entering the larynx and
possible aspiration
,What are the key assessment signs for nasal fracture and what are the interventions? - ANS Nasal
fractures may result in loss of tissue integrity and may interfere with gas exchange. For assessment
document any problems like deviation, change in nasal breathing or crepitus on palpation, bruising or
pain, blood or clear fluid (CSF). CSF is a serious concern and could indicate a serious injury like a skull
fracture. If CSF is suspected a glucose test can be performed, as it will test positive for glucose.
Interventions: closed reduction within first 24 hours, if after surgery may have to wait because of excess
edema
Explain post-op care and complications that can occur because of a nasal fracture - ANS After surgery
patient will have packing in noses, as long as packing is correctly in place the patient should not be able
to breathe through their nose. A dressing or drip pad is folded under nose.
- Check vital signs every four hours
- Instruct patient to stay in semi fowlers position and move slowly
- After the gag reflex has returned encourage fluid intake
- Avoid forceful coughing or straining during bm
- DO not sniff upward or blow nose and do not sneeze with mouth closed for first few days
- Avoid aspirin and NSAIDs
Complications: assess how often the patient swallows after surgery because repeated swallowing could
indicate posterior nasal bleeding
Explain the causes for head and neck cancer & assessment findings - ANS Head and neck cancers are
generally squamous cell carcinomas, slow-growing tumors that begin when the mucosa is chronically
irritated and as a result, become tougher and thicker. Eventually, genes controlling cell growth are
damaged and allow for an excess of malignant cells. Initial lesions first appear as white patchy lesions
(leukoplakia) or red velvety patches (erythroplakia). The two biggest risk factors for developing head &
neck cancer are alcohol and cigarette use. Also, exposure to chemicals or dust, GERD, oral infection with
HPV.
Assessment findings:
, pain
lump in mouth, throat, neck
Difficulty swallowing
changes in color of tongue or mouth
oral lesions that take long to heal
oral bleeding
change in voice quality
What are the top nursing priorities for head and neck cancer? - ANS Potential for airway obstruction
Potential for aspiration
Anxiety for decreased self esteem
Explain both a partial and total laryngectomy - ANS Both a laryngectomy and the nose help to filter the
air that is inhaled. After the surgery, all the air you breathe goes in and out of the stoma bypassing the
natural filtration of nose. A partial laryngectomy results in normal or hoarse voice quality, with a
temporary tracheostomy. A total laryngectomy results in no natural voice, with a permanent
laryngectomy stoma created in the neck. After surgery, patients may need mechanical ventilation
Explain post-op care and complications for a laryngectomy - ANS Monitor airway patency, v/s should be
monitored hourly for first 24 yours after surgery, hemodynamic status, nutrition (NG is placed during
surgery for nutritional support. Aspiration cannot occur after a total laryngectomy because airway is
separate from esophagus)
Complications are airway obstruction, hemorrhage, wound breakdown
Explain ways to promote communication for a patient that has had a total laryngectomy - ANS The
patient used an artificial larynx and may eventually learn esophageal speech. Mechanical devices or
tracheoesophageal puncture (TEP) may also be used. Esophageal speech is attempted by most patients,
where sound is produced by burping the air swallowed. Mechanical devices or electro-larynx is used for
communication and are battery-powered devices that are placed on the side of neck or cheek that
