Exam 2 Key Concept Guide
Neck cancer
a) The cancer begins as a loss of CELLULAR REGULATION when the mucosa is chronically
irritated and becomes tougher and thicker (squamous metaplasia)
b) Head and neck cancers can affect breathing, eating, facial appearance and speech.
c) They are usually squamous cell carcinomas and are slow-growing tumors that are generally
curable when diagnosed and treated early on.
d) These lesions may then be seen as white, patchy lesions (leukoplakia) or red, velvety
patches (erythroplakia)
e) They typically metastasize to the lymph nodes, muscle and bone.
f) Hoarseness, lump in neck or mouth sores
g) *suspicious *Causes include; tobacco, alcohol, voice abuse, chronic laryngitis, exposure to
chemicals, poor hygiene, long-term GERD and oral infections with human papillomavirus.
h) Pt may have foul breath, weakened immune system, white patch and jaw pain.
i) Diagnosed by a physical examination, x-ray with barium swallow or a panorex x-ray.
j) Nursing- impaired gas exchange from tumor or edema, nutrition deficit and aspiration risk.
a. The first priorities after head and neck surgery are airway maintenance and GAS
EXCHANGE.
b. Immediately following surgery the patient will likely need ventilator assistance and a
tracheostomy collar following vent weaning. (coughing and deep breathing to clear
secretions), alternative ways to communicate and nutrition are of importance.
Radiation therapy
a) Most patients have hoarseness, dysphagia, skin problems, impaired taste, and dry mouth for
a few weeks after radiation therapy.
a. Hoarseness may become worse during therapy.
i. Reassure the patient that voice improves within 4 to 6 weeks after
completion of radiation therapy.
b) Urge him or her to use voice rest and alternative means of communication until the effects
of radiation therapy have passed.
c) Collaborate with the speech and language pathologist to help the patient communicate.
d) Most patients have a sore throat and difficulty swallowing during radiation therapy to the
neck.
a. Gargling with saline or sucking ice may decrease discomfort.
b. Mouthwashes and throat sprays containing a local anesthetic agent such as lidocaine
or diphenhydramine can provide temporary relief.
c. Analgesic drugs may be prescribed.
e) Skin irritation may occur and avoiding sun exposure and use mild soap such as dove.
f) Mouth may become dry (xerostomia) usually long term and may become permanent.
, a. dental caries, increased risk for oral infections, bad breath, and taste changes.
Fluoride treatments, increasing fluid intake, and humidification and artificial saliva
sprays are interventions.
Extra information �- aspiration can not occur following surgery after a total laryngectomy because the
airway is completely separated from the esophagus.
multidimensional nursing strategies
a) Semi-fowlers/high-fowlers to promote adequate gas exchange, alternative communication
methods, speech therapy, language pathology, respiratory therapy, nutrition emphasis (likely
a feeding tube is placed while healing from surgery)
sinus cancer
a) the onset of sinus cancer is slow and symptoms resemble those of sinusitis. Including
persistent nasal obstruction, drainage, blood discharge, and pain that persists after
treatment of sinusitis.
b) Lymph node enlargement can occur on the side with the mass.
c) MAintain a patent airway, monitoring for hemorrhage, providing wound care, assessing
nutrition status and performing a tracheostomy if needed. Assess the patient for pain and
infection
Nasal fracture
a) interfere with gas exchange.
b) If there is no displacement of bone or cartilage, treatment may not be needed.
c) Displacement can cause airway obstruction, cosmetic deformity and is a potential for
infection.
d) Blood or clear fluid rarely drains from the nose following a simple nasal fracture
a. it is an indication of a serious injury (skull fracture).
b. Closed reduction is performed using local or general anesthesia within the first 24
hours and that involves moving the bones by palpation. After 24 hours this is difficult
because of edema and scar formation.
e) Simple fractures do not require surgery. Pain relief and cold compresses to decrease
swelling.
Post-rhinoplasty care
a) reduction and surgery may be needed for fractures that don’t heal properly or severe ones.
, b) Rhinoplasty is reconstruction of the nose.
c) Pt returns from surgery with packing in the nose to control bleeding and therefore cannot
breathe from the nose.
d) After surgery observe for edema and bleeding, checking VS every 4 hours. Remain in semi-
fowlers position and change positions slowly. Use cold compresses to nose and eyes to
reduce swelling and bruising. Drink at least 2,500ml of fluid per day to prevent bleeding use
the Valsalva maneuver, no sniffing or blowing of the nose and do not sneeze with the mouth
closed for the first few days. Avoid products containing ASPIRIN and antibiotics may be
prescribed to prevent infection. Use of humidifier is recommended to prevent mucosal
drying.
e) Edema can last for weeks and the final result will be in 6-12 months.
Priority nursing intervention s/p MVA: Remember ABC’s
COPD:
a) Consist of lung diseases that block the airflow making it difficult to breathe.
a. These conditions are emphysema and chronic bronchitis.
b) Symptoms of COPD include Obstructive sleep apnea (breathing disruption that lasts at least
10 seconds and occurs at least five times per hour), Shortness of breath, especially during
physical activities, Wheezing, Chest tightness, A chronic cough that may produce mucus
(sputum) that may be clear, white, yellow or greenish, Frequent respiratory infections, Lack
of energy, Unintended weight loss (in later stages), Swelling in ankles, feet or legs
a. During sleep the muscles relax and the tongue and neck structures are displaced
resulting in an upper airway obstruction. Apnea decreases gas exchange, increases
carbon dioxide levels and decrease the ph. After 10 seconds or longer, the sleeper
awakens to correct the obstruction. As a result, the sleeper may have excessive
daytime sleepiness, inability to concentrate and irritability.
b. Sleep study is the most accurate test.
c. Changes in sleeping position or weight loss may correct mild sleep apnea and
promote gas exchange.
d. Position fixing devices may prevent subluxation of the tongue. Non-invasive positive
pressure ventilation may be needed to hold open the upper airways
c) Most common cause is upper airway obstruction by the soft palate or tongue.
d) Factors include obesity, a large uvula, short neck, smoking, enlarged tonsils or adenoids and
oropharyngeal edema.
e) Long term effects include stroke, risk for hypertension, cognitive deficits, weight gain,
diabetes and pulmonary and cardiovascular disease.
Ineffective airway clearance for a client with pneumonia
Neck cancer
a) The cancer begins as a loss of CELLULAR REGULATION when the mucosa is chronically
irritated and becomes tougher and thicker (squamous metaplasia)
b) Head and neck cancers can affect breathing, eating, facial appearance and speech.
c) They are usually squamous cell carcinomas and are slow-growing tumors that are generally
curable when diagnosed and treated early on.
d) These lesions may then be seen as white, patchy lesions (leukoplakia) or red, velvety
patches (erythroplakia)
e) They typically metastasize to the lymph nodes, muscle and bone.
f) Hoarseness, lump in neck or mouth sores
g) *suspicious *Causes include; tobacco, alcohol, voice abuse, chronic laryngitis, exposure to
chemicals, poor hygiene, long-term GERD and oral infections with human papillomavirus.
h) Pt may have foul breath, weakened immune system, white patch and jaw pain.
i) Diagnosed by a physical examination, x-ray with barium swallow or a panorex x-ray.
j) Nursing- impaired gas exchange from tumor or edema, nutrition deficit and aspiration risk.
a. The first priorities after head and neck surgery are airway maintenance and GAS
EXCHANGE.
b. Immediately following surgery the patient will likely need ventilator assistance and a
tracheostomy collar following vent weaning. (coughing and deep breathing to clear
secretions), alternative ways to communicate and nutrition are of importance.
Radiation therapy
a) Most patients have hoarseness, dysphagia, skin problems, impaired taste, and dry mouth for
a few weeks after radiation therapy.
a. Hoarseness may become worse during therapy.
i. Reassure the patient that voice improves within 4 to 6 weeks after
completion of radiation therapy.
b) Urge him or her to use voice rest and alternative means of communication until the effects
of radiation therapy have passed.
c) Collaborate with the speech and language pathologist to help the patient communicate.
d) Most patients have a sore throat and difficulty swallowing during radiation therapy to the
neck.
a. Gargling with saline or sucking ice may decrease discomfort.
b. Mouthwashes and throat sprays containing a local anesthetic agent such as lidocaine
or diphenhydramine can provide temporary relief.
c. Analgesic drugs may be prescribed.
e) Skin irritation may occur and avoiding sun exposure and use mild soap such as dove.
f) Mouth may become dry (xerostomia) usually long term and may become permanent.
, a. dental caries, increased risk for oral infections, bad breath, and taste changes.
Fluoride treatments, increasing fluid intake, and humidification and artificial saliva
sprays are interventions.
Extra information �- aspiration can not occur following surgery after a total laryngectomy because the
airway is completely separated from the esophagus.
multidimensional nursing strategies
a) Semi-fowlers/high-fowlers to promote adequate gas exchange, alternative communication
methods, speech therapy, language pathology, respiratory therapy, nutrition emphasis (likely
a feeding tube is placed while healing from surgery)
sinus cancer
a) the onset of sinus cancer is slow and symptoms resemble those of sinusitis. Including
persistent nasal obstruction, drainage, blood discharge, and pain that persists after
treatment of sinusitis.
b) Lymph node enlargement can occur on the side with the mass.
c) MAintain a patent airway, monitoring for hemorrhage, providing wound care, assessing
nutrition status and performing a tracheostomy if needed. Assess the patient for pain and
infection
Nasal fracture
a) interfere with gas exchange.
b) If there is no displacement of bone or cartilage, treatment may not be needed.
c) Displacement can cause airway obstruction, cosmetic deformity and is a potential for
infection.
d) Blood or clear fluid rarely drains from the nose following a simple nasal fracture
a. it is an indication of a serious injury (skull fracture).
b. Closed reduction is performed using local or general anesthesia within the first 24
hours and that involves moving the bones by palpation. After 24 hours this is difficult
because of edema and scar formation.
e) Simple fractures do not require surgery. Pain relief and cold compresses to decrease
swelling.
Post-rhinoplasty care
a) reduction and surgery may be needed for fractures that don’t heal properly or severe ones.
, b) Rhinoplasty is reconstruction of the nose.
c) Pt returns from surgery with packing in the nose to control bleeding and therefore cannot
breathe from the nose.
d) After surgery observe for edema and bleeding, checking VS every 4 hours. Remain in semi-
fowlers position and change positions slowly. Use cold compresses to nose and eyes to
reduce swelling and bruising. Drink at least 2,500ml of fluid per day to prevent bleeding use
the Valsalva maneuver, no sniffing or blowing of the nose and do not sneeze with the mouth
closed for the first few days. Avoid products containing ASPIRIN and antibiotics may be
prescribed to prevent infection. Use of humidifier is recommended to prevent mucosal
drying.
e) Edema can last for weeks and the final result will be in 6-12 months.
Priority nursing intervention s/p MVA: Remember ABC’s
COPD:
a) Consist of lung diseases that block the airflow making it difficult to breathe.
a. These conditions are emphysema and chronic bronchitis.
b) Symptoms of COPD include Obstructive sleep apnea (breathing disruption that lasts at least
10 seconds and occurs at least five times per hour), Shortness of breath, especially during
physical activities, Wheezing, Chest tightness, A chronic cough that may produce mucus
(sputum) that may be clear, white, yellow or greenish, Frequent respiratory infections, Lack
of energy, Unintended weight loss (in later stages), Swelling in ankles, feet or legs
a. During sleep the muscles relax and the tongue and neck structures are displaced
resulting in an upper airway obstruction. Apnea decreases gas exchange, increases
carbon dioxide levels and decrease the ph. After 10 seconds or longer, the sleeper
awakens to correct the obstruction. As a result, the sleeper may have excessive
daytime sleepiness, inability to concentrate and irritability.
b. Sleep study is the most accurate test.
c. Changes in sleeping position or weight loss may correct mild sleep apnea and
promote gas exchange.
d. Position fixing devices may prevent subluxation of the tongue. Non-invasive positive
pressure ventilation may be needed to hold open the upper airways
c) Most common cause is upper airway obstruction by the soft palate or tongue.
d) Factors include obesity, a large uvula, short neck, smoking, enlarged tonsils or adenoids and
oropharyngeal edema.
e) Long term effects include stroke, risk for hypertension, cognitive deficits, weight gain,
diabetes and pulmonary and cardiovascular disease.
Ineffective airway clearance for a client with pneumonia
