EXAM 2 STUDY GUIDE
Session Outline
Care of the Clients with Upper respiratory disorders:
I. Head and neck cancer
a. What it is:
i. Usually squamous cell carcinomas and are slow-growing tumors that are generally curable
when diagnosed and treated early. Typically metastasize into the lymph nodes, muscle, and
bone.
b. Diagnosis
i. CBC - detects presence of infection and anemia
ii. Bleeding time - performed to detect abnormalities in bleeding time due to liver involvement
iii. Liver function test - rule out spread of cancer to the liver
iv. Kidney function test - performed to rule out spread of cancer to kidneys
v. X-rays of skull, sinuses, neck, and chest - noninvasive to detect spread of cancer and the
presence of other tumors
vi. Computed tomography (CT) - noninvasive to evaluate the tumor’s exact location
vii. MRI - differentiate normal from diseased
viii. Bone scan - evaluate spread to bone
ix. Single-photon emission computerized tomography (SPECT) scan - noninvasive to locate
presence of additional tumors
x. PET-CT - presence of additional tumors
xi. Direct and indirect laryngoscopy - invasive - extent of tumor
xii. Tumor mapping- identify tumor location
xiii. Tumor biopsy- invasive - confirm diagnosis, identify type of tumor cells, location, and staging
c. Treatment
i. Radiation therapy
ii. Chemotherapy
iii. Biotherapy
iv. Laryngectomy (partial and total)
v. Tracheotomy
vi. Oropharyngeal cancer resection
vii. Transoral cordectomy
viii. Hospice
ix. Palliative care
d. Assessment findings
i. Weight loss
ii. Difficulty swallowing
iii. Pain
iv. Lump in the mouth, throat, or neck
v. Oral lesions that do not heal in two weeks
vi. Unexplained oral bleeding
vii. Numbness of the mouth, lips, or face
viii. Changes of the fit of dentures
ix. Ear pain
x. Hoarseness
xi. Persistent or recurrent sore throat
xii. Shortness of breath
e. Multidimensional care
i. Managing potential airway obstructions due to the presence of edema or a tumor
ii. Precautions to minimize risk of aspiration as these patients are at higher risk
iii. Provide adequate ventilation and oxygenation
1. Lack of adequate oxygen can lead to cell death or permanent organ damage
iv. Monitor ABG
1
, v. Assess respiratory depth and rate
vi. Monitor pulse oximetry
vii. Chemotherapy - monitor for potential side effects of treatment. Nausea and vomiting are
common side effects and can be managed with administration of antiemetics before and after
treatment
viii. Radiation therapy - will experience voice changes, sore throat, and skin irritation
1. Consult speech therapy to assist with patient communication
2. Manage sore throat (gargling with saline, sucking on ice, use of mouthwash and throat
sprays)
3. Refrain from being in sun and shaving
4. Wear protective clothing and gently clean skin with mild soap daily
ix. Post operative
1. Maintain patient airway by suctioning patient
2. Monitor for complications such as hemorrhage, airway obstruction, wound breakdown
and possible infection
3. Nutritional support - feeding tube generally inserted
4. Consult speech and language pathologist
x. Teaching patient and family
1. How to perform tracheostomy care
2. Administration of feeding
3. S/S of infection - fever, chills, redness, drainage at sites - instruct on when to follow
up with provider
II. Nasal and sinus cancer
a. Diagnosis
i. X-rays of the face - detect presence of cancer and other tumors
ii. CT - noninvasive to evaluate exact location
iii. MRI - noninvasive to differentiate normal from diseased tissue
iv. Biopsy - invasive to confirm diagnosis
b. Treatment
i. Surgical removal of the tumor
ii. Chemotherapy
iii. Radiation
iv. Hospice
v. Palliative care
c. Assessment findings
i. Nasal obstruction
ii. Drainage
iii. Bloody discharge
iv. Pain
v. Lymph node enlargement
d. Multidimensional care
i. Nausea and vomiting associated with chemotherapy (see above)
ii. Skin alterations with radiation therapy (see above)
iii. Administration of antiemetics
iv. Meticulous skin care
v. Provide wound care
vi. Assess and address nutritional needs
vii. Perform tracheostomy and oral care
III. Nasal fracture
a. Diagnosis
i. X-ray of the face - determine the presence of fracture
b. Treatment
i. Closed reduction
ii. Rhinoplasty
iii. Nasoseptoplasty
c. Assessment findings
2
, i. Bruising
ii. Pain
iii. Nasal deviation
iv. Crepitus
v. Blood or clear fluid draining from the nose
d. Multidimensional care
i. Closed reduction
1. Pain management
a. Pharmacological
b. Non-pharmacological
i. Application of cold compresses to reduce pain and swelling
ii. Undergoing surgical intervention
1. Maintain Semi-Fowler’s position to reduce swelling
2. Cold compresses to reduce pain and swelling
3. Educate patient not to cough forcefully or strain to prevent bleeding
a. First few days post op
4. Monitor nasal packing for increased bleeding
IV. Epistaxis
a. Diagnosis
i. X-rays - rule out disorders of the nose
b. Treatment
i. Capillary cauterization
ii. Silver nitrate
iii. Electrocautery
iv. Nasal packing
v. Epistaxis catheters
c. Assessment findings
i. Nasal bleeding/discharge
d. Multidimensional care
i. Management of bleeding by applying direct lateral pressure to the nose for 10 mins
ii. Application of cold compresses
iii. If bleeding doesn’t stop, nasal packing
iv. Implement standard precautions
v. Maintain an upright position - leaning forward to prevent aspiration
vi. Monitor BP - prevent hypertension which could increase bleeding
vii. Instruct pt. not to blow nose for 24 hours to prevent clot disruption
V. Facial trauma
a. Diagnosis
i. Xrays - noninvasive to determine extent of fracture
ii. CT - noninvasive to evaluate for head injury
iii. Cervical spine X-ray - noninvasive to assess for spinal injury
b. Treatment
i. Fixed occlusion
ii. Interfixation (ORIF)
iii. Inner maxillary fixation (IMF)
c. Assessment findings
i. Stridor
ii. Shortness of breath
iii. Dyspnea
iv. Anxiety
v. Restlessness
vi. Hypoxia
vii. Decreased oxygen saturation
viii. Cyanosis
ix. Loss of consciousness
x. Pain
3
Session Outline
Care of the Clients with Upper respiratory disorders:
I. Head and neck cancer
a. What it is:
i. Usually squamous cell carcinomas and are slow-growing tumors that are generally curable
when diagnosed and treated early. Typically metastasize into the lymph nodes, muscle, and
bone.
b. Diagnosis
i. CBC - detects presence of infection and anemia
ii. Bleeding time - performed to detect abnormalities in bleeding time due to liver involvement
iii. Liver function test - rule out spread of cancer to the liver
iv. Kidney function test - performed to rule out spread of cancer to kidneys
v. X-rays of skull, sinuses, neck, and chest - noninvasive to detect spread of cancer and the
presence of other tumors
vi. Computed tomography (CT) - noninvasive to evaluate the tumor’s exact location
vii. MRI - differentiate normal from diseased
viii. Bone scan - evaluate spread to bone
ix. Single-photon emission computerized tomography (SPECT) scan - noninvasive to locate
presence of additional tumors
x. PET-CT - presence of additional tumors
xi. Direct and indirect laryngoscopy - invasive - extent of tumor
xii. Tumor mapping- identify tumor location
xiii. Tumor biopsy- invasive - confirm diagnosis, identify type of tumor cells, location, and staging
c. Treatment
i. Radiation therapy
ii. Chemotherapy
iii. Biotherapy
iv. Laryngectomy (partial and total)
v. Tracheotomy
vi. Oropharyngeal cancer resection
vii. Transoral cordectomy
viii. Hospice
ix. Palliative care
d. Assessment findings
i. Weight loss
ii. Difficulty swallowing
iii. Pain
iv. Lump in the mouth, throat, or neck
v. Oral lesions that do not heal in two weeks
vi. Unexplained oral bleeding
vii. Numbness of the mouth, lips, or face
viii. Changes of the fit of dentures
ix. Ear pain
x. Hoarseness
xi. Persistent or recurrent sore throat
xii. Shortness of breath
e. Multidimensional care
i. Managing potential airway obstructions due to the presence of edema or a tumor
ii. Precautions to minimize risk of aspiration as these patients are at higher risk
iii. Provide adequate ventilation and oxygenation
1. Lack of adequate oxygen can lead to cell death or permanent organ damage
iv. Monitor ABG
1
, v. Assess respiratory depth and rate
vi. Monitor pulse oximetry
vii. Chemotherapy - monitor for potential side effects of treatment. Nausea and vomiting are
common side effects and can be managed with administration of antiemetics before and after
treatment
viii. Radiation therapy - will experience voice changes, sore throat, and skin irritation
1. Consult speech therapy to assist with patient communication
2. Manage sore throat (gargling with saline, sucking on ice, use of mouthwash and throat
sprays)
3. Refrain from being in sun and shaving
4. Wear protective clothing and gently clean skin with mild soap daily
ix. Post operative
1. Maintain patient airway by suctioning patient
2. Monitor for complications such as hemorrhage, airway obstruction, wound breakdown
and possible infection
3. Nutritional support - feeding tube generally inserted
4. Consult speech and language pathologist
x. Teaching patient and family
1. How to perform tracheostomy care
2. Administration of feeding
3. S/S of infection - fever, chills, redness, drainage at sites - instruct on when to follow
up with provider
II. Nasal and sinus cancer
a. Diagnosis
i. X-rays of the face - detect presence of cancer and other tumors
ii. CT - noninvasive to evaluate exact location
iii. MRI - noninvasive to differentiate normal from diseased tissue
iv. Biopsy - invasive to confirm diagnosis
b. Treatment
i. Surgical removal of the tumor
ii. Chemotherapy
iii. Radiation
iv. Hospice
v. Palliative care
c. Assessment findings
i. Nasal obstruction
ii. Drainage
iii. Bloody discharge
iv. Pain
v. Lymph node enlargement
d. Multidimensional care
i. Nausea and vomiting associated with chemotherapy (see above)
ii. Skin alterations with radiation therapy (see above)
iii. Administration of antiemetics
iv. Meticulous skin care
v. Provide wound care
vi. Assess and address nutritional needs
vii. Perform tracheostomy and oral care
III. Nasal fracture
a. Diagnosis
i. X-ray of the face - determine the presence of fracture
b. Treatment
i. Closed reduction
ii. Rhinoplasty
iii. Nasoseptoplasty
c. Assessment findings
2
, i. Bruising
ii. Pain
iii. Nasal deviation
iv. Crepitus
v. Blood or clear fluid draining from the nose
d. Multidimensional care
i. Closed reduction
1. Pain management
a. Pharmacological
b. Non-pharmacological
i. Application of cold compresses to reduce pain and swelling
ii. Undergoing surgical intervention
1. Maintain Semi-Fowler’s position to reduce swelling
2. Cold compresses to reduce pain and swelling
3. Educate patient not to cough forcefully or strain to prevent bleeding
a. First few days post op
4. Monitor nasal packing for increased bleeding
IV. Epistaxis
a. Diagnosis
i. X-rays - rule out disorders of the nose
b. Treatment
i. Capillary cauterization
ii. Silver nitrate
iii. Electrocautery
iv. Nasal packing
v. Epistaxis catheters
c. Assessment findings
i. Nasal bleeding/discharge
d. Multidimensional care
i. Management of bleeding by applying direct lateral pressure to the nose for 10 mins
ii. Application of cold compresses
iii. If bleeding doesn’t stop, nasal packing
iv. Implement standard precautions
v. Maintain an upright position - leaning forward to prevent aspiration
vi. Monitor BP - prevent hypertension which could increase bleeding
vii. Instruct pt. not to blow nose for 24 hours to prevent clot disruption
V. Facial trauma
a. Diagnosis
i. Xrays - noninvasive to determine extent of fracture
ii. CT - noninvasive to evaluate for head injury
iii. Cervical spine X-ray - noninvasive to assess for spinal injury
b. Treatment
i. Fixed occlusion
ii. Interfixation (ORIF)
iii. Inner maxillary fixation (IMF)
c. Assessment findings
i. Stridor
ii. Shortness of breath
iii. Dyspnea
iv. Anxiety
v. Restlessness
vi. Hypoxia
vii. Decreased oxygen saturation
viii. Cyanosis
ix. Loss of consciousness
x. Pain
3
