Head and Neck

What is an epistaxis 

nose bleed 


Risks for head and neck cancer 

tobacco, alcohol, poor nutrition, voice abuse, poor oral hygiene, long term GERD, oral infection with HPV

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 

Pulmonary embolism- difference between anticoagulant vs. thromblytics medications 

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 


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 



laryngeal scope/mirror, CT scan, MRI, biopsy


Post op check list 

Vent assist- if needed 

Collar for humidity 

Secretions- 2 days blood tinged 


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 



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 

General post op checklist 

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 

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