Epistaxis
What is an epistaxis
nose bleed
Risks for head and neck cancer
What changes with air circulation after surgery?
Before surgery, the nose helps filters out the air that is inhaled.
After surgery all the air you breathe goes in and out of the stoma, bypassing natural filtration of the nose
Types of lung cancer (3) and risk of cancer (1)
1. small cell, 2.non small cell (most pop), 3. mixed
Risks: smoking
Anticoagulant- Lovanox, Coumadin, Heparin
Thromb- TPA
The difference between an anterior and posterior nose bleed?
Anterior is random, posterior is very dangerous difficulty breathing
Warning signs of head/ neck cancer
pain is late symptom, lump, difficulty swallowing, tongue color changes, oral bleeding, numbness lips, mouth, face, dentures do not fit, burning sensation, persistent unilateral ear pain, sore throat, weight loss, lymph nodes
Pre-op check list
Self care of airway
Alternate form of communication
Suctioning
Pain control - WATCH RR
Nutritional support- G tube before surgery
Community acquired Pneumonia vs hospital
Community 14 days not in hospital or LTC
Hospital- 48 hours after admission or within 14 days of leaving hospital
Labs to monitor with TB pt
ALT and AST due to Rifampin medication taken
2- 10 weeks of tx, watch for resistance
How do you treat an anterior bleed?
Have pt sit up right and lean forward
Diagnostics
laryngeal scope/mirror, CT scan, MRI, biopsy
Post op check list
Vent assist- if needed
Collar for humidity
Secretions- 2 days blood tinged
Suctioning
Carotid- graft monitor every hr 72 hrs
Monitor drains
What is a late sign of lung cancer?
Changes in sputum is a late change- but often the first sign/symptom noticed from pt (red)
Cough, horseness, SOB, weight loss, Pleural effusion- all hard to detect because masked by smoking
What does the RN assess when caring for a pt with a chest tube?
First after xray confirm- establish lung expansion, set up Atrium and connect to drainage system (sterile), fit dressings around chest tube, and make sure all connections are set for chest tube
Causes of epistaxis?
trauma, HTN, low humidity, upper resp infections, allergies, sinusitis, foreign bodies, chemical irritants(drugs), decongestant nasal spray, tumor, clotting disorders
Tx
Radiation- make sure to rest voice, pain control, saline gargle and rinse, soft clothing, dry mouth make sure to tell pt risk for dental caries
Chemo- added with radiation
Monitor for bleeding
Monitor infection
Baseline and cont labs
Skin asmt
Pain mgmt
Nutrition- aspiration risk
Complication of pneumonia?
Sepsis, changes in LOC, increased HR, decreased BP, temperature (know if pt is immunocomp), serum lactate is elevated, elevated WBC, CBC diff
Parts to assess with chest tube:
Tidel: ball moving up and down
No tidel= lung healed or blockage in chest tube
Cough: bubbling in chamber= airleak
Dressing: drainage?
Connections: all placed properly
Watch for subcutaneous emphysema: sounds like rice crispies on chest of pt
Atrium bubbling and loud= chest tube out
How to treat posterior bleeding
Packed, balloons, gels tampons, hospitalization, monitor O2 sat, airway, pain meds, risk for infection, NO EXCESS USE of nasal contestants
What is a laryngectomy
Major surgery that is done to remove your voice box, or larynx. Your larynx is the part of your throat that contains your voice box. It's located at the upper end of your windpipe (trachea). Your larynx is important for breathing, swallowing, and speaking
Expected vital signs post op: BP, RR, O2 sat
All low : bp low, rr low, o2 sat low
Role of RN during thoracentisis? Bronchoscopy?
Thor- Label and send fluids, baseline asmt, post asmt, baseline breath sounds
Bronchoscopy- Assess for risk of aspiration, numbing of airway paralytic- ABC, gag reflex is absent at baseline?
Influenza complications (4), vaccine info, med to tx, signs in older adult
1.Pneumonia ,2.Fever ,3.Crackles ,4.Base in lungs diminished
Vaccine- covers 2-3 strains
Med- Tamiflu given 48 hrs of first s/s
Sign in older adult- might only have confusion like UTI