Med Surg 31 - Upper Respiratory - Disorders Upper Airway Obstruction

Terms in this set (10)

Sleep Apnea
breathing disruption during sleep that lasts at least 10 sec and occurs a minimum of five times in an hour; usually occurs from upper airway obstruction by soft palate or tongue which increases blood CO and decreases pH; causes sleeper to awaken after 10+ sec and occurs every 5+ min; this causes excessive daytime sleepiness, inability to concentrate, and irritability; contributing factors: obesity, large uvula, short neck, smoking, enlarged tonsils or adenoids, oropharyngeal edema
Sleep Apnea - Nursing Info
suspect for any person who has persistent daytime sleepiness or reports of "waking up tired", especially if snores heavy; perform complete health assessment;
Sleep Apnea - Intervention
Nonsurgical management: change in sleeping position or weight loss may reduce mild apnea, position-fixing devices may prevent subluxation of tongue, CPAP; severe apnea requires surgical removal of obstruction: adenoidectomy, uvulectomy or uvulopalatopharyngoplasty; meds can be used to help daytime wakefulness but not treat (modafinil (Attenace, Provigil)); poss tracheostomy needed in very severe
Upper Airway Obstruction
life-threatening emergency in which an interruption in airflow through the nose, mouth, pharynx, or larynx occurs; early recognition is essential to prevent further complications, including respiratory arrest
Upper Airway Obstruction - Causes
1) tongue edema (surgery, trauma, angioedema as an allergic response to a drug); 2) tongue occlusion (loss of gag reflex, loss of muscle tone, unconsciousness, coma); 3) laryngeal edema; 4) peritonsillar and pharyngeal abscess; 5) head and neck cancer; 6) thick secretions; 7) stroke and cerebral edema; 8) smoke inhalation edema; 9) facial, tracheal, or laryngeal trauma; 10) foreign-body aspiration; 11) burns of the head or neck area; 12) anaphylaxis
Upper Airway Obstruction - Nursing Info
essential to prevent partial obstruction from progressing to complete obstruction; partial obstruction produces subtle or general symptoms: diaphoresis, tachycardia, elevated blood pressure, persistent or unexplained symptoms; diagnostic procedures: chest or neck x-rays, laryngoscopic examination, computed tomography; observe for hypoxia and hypercarbia, restlessness, increasing anxiety, sternal retractions, and "seesawing" chest, abdominal movements, feeling impending doom; use pulse ox and continually assess stridor, cyanosis and LOC
Upper Airway Obstruction - Intervention
assess for cause of obstruction; if due to tongue falling back or excessive secretions, slightly extend pts head and neck and insert nasal/oral airway or use suctioning to remove obstruction; Some might need emergency procedures: cricothyroidotomy, endotracheal intubation, nasotracheal or orotracheal, tracheostomy
Upper Airway Obstruction - Intervention - Cricothyroidotomy
emergency procedure often performed outside hospital by emergency personnel; is a stab wound at the cricothyroid membrane between thyroid cartilage and the cricoid cartilage; any hollow tube can be placed through the opening to hold airway open until tracheotomy can be performed
Upper Airway Obstruction - Intervention - Endotracheal Intubation
performed by inserting a tube into trachea via the nose (nasotracheal) or mouth (orotracheal)
Upper Airway Obstruction - Intervention - Tracheostomy
surgical procedure and takes about 5-10 mins; pest performed in OR
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