NR 324 Week 2 Upper Respiratory System

NR 324 Week 2 Upper Respiratory System

Name

Chamberlain University

NR-324 Adult Health I

Prof. Name

Date

Introduction

When caring for a patient with a tracheostomy, the primary focus is on maintaining airway patency and ensuring adequate breathing. This makes the assessment of the patient’s respiratory rate and oxygen saturation critical. Other evaluations, such as electrolyte levels, daily weights, speech, swallowing, pain, and mobility, while important, are secondary to the immediate need to ensure the patient’s airway and respiratory status are stable.

Before performing tracheostomy cannula care, particularly for a patient who has undergone reconstructive surgery for invasive head and neck cancer, the nurse should assess the quality of breath sounds. Auscultating the patient’s lung sounds is a priority, as it helps determine whether there are secretions that need to be cleared to prevent aspiration. While it is important to assess the patient’s level of consciousness, gag reflex, and tracheostomy cuff pressure, these are not the most immediate concerns in this situation.

NR 324 Week 2 Upper Respiratory System: Influenza Vaccination and Tracheostomy Care

When administering seasonal influenza vaccinations to residents of long-term care facilities, it is important to be aware of contraindications. A history of a severe allergic reaction, such as anaphylaxis, particularly one related to egg allergies, is a contraindication to receiving the vaccine. Other factors, such as advanced age or a history of chronic respiratory illnesses like chronic obstructive pulmonary disease (COPD), do not preclude the administration of the vaccine.

In the care of a stable patient with a tracheostomy, tasks such as suctioning the oropharynx can be delegated to unlicensed assistive personnel (UAP) if they have been properly trained. However, more complex tasks, such as assessing the need for suctioning, evaluating swallowing ability, and maintaining appropriate tracheostomy cuff pressure, should be performed by a registered nurse (RN) or licensed practical nurse (LPN).

NR 324 Week 2 Upper Respiratory System: Acute Sinusitis and Laryngeal Cancer

When assessing whether a patient’s upper respiratory infection (URI) has progressed to acute sinusitis, the nurse should check for maxillary pain or pressure, a specific clinical indicator of this condition. Although coughing and fever may be present, they are non-specific and not reliable indicators of sinusitis. Additionally, a history of allergies, such as a dust allergy, may contribute to upper respiratory tract irritation, but this alone does not confirm a diagnosis of acute sinusitis.

In reviewing a patient’s medical history with laryngeal cancer, the nurse should expect to find a history of chronic alcohol and tobacco use, as these are the leading risk factors for head and neck cancers. Additional risk factors include exposure to industrial carcinogens, radiation therapy, poor oral hygiene, and even sun exposure.

Delegation of Tasks and Medication Education

For patients with a permanent tracheostomy, the delegation of certain tasks is important. UAPs can be tasked with providing oral care using a toothbrush and tonsil suction tube, but more specialized care such as suctioning the tracheostomy or inspecting the stoma site for signs of skin breakdown must be performed by a registered nurse due to the skills and assessments required.

Patient education is also key when teaching about medications like budesonide intranasal spray, which is used for managing seasonal allergic rhinitis. Patients should be instructed to use the medication daily throughout the pollen season, even if they are asymptomatic, as this prevents inflammation and controls symptoms effectively. The medication does not provide immediate relief, nor does it affect liver function or significantly increase the risk of serious infections.

NR 324 Week 2 Upper Respiratory System: Postoperative Care and Emergency Response

Airway patency remains the highest priority when caring for patients postoperatively, especially following laryngectomy. The nurse must ensure that the airway is clear and unobstructed to maintain oxygenation and breathing. While monitoring patient comfort, incisional drainage, and vital signs is important, these assessments follow the priority of maintaining a patent airway.

In an emergency situation, such as when a patient expels their tracheostomy tube by coughing shortly after insertion, the nurse’s immediate priority is to maintain the airway. This can be achieved by using a sterile hemostat to keep the airway open until a new tracheostomy tube can be inserted. Temporary ventilation with an Ambu bag may be necessary if the patient experiences respiratory distress.

Table: Key Nursing Interventions for Tracheostomy Care and Respiratory Assessment

References

American Nurses Association. (2020). Nursing: Scope and Standards of Practice (4th ed.). Silver Spring, MD: American Nurses Association.

NR 324 Week 2 Upper Respiratory System

National Institutes of Health. (2021). Tracheostomy care guidelines. National Institute of Health. https://www.nih.gov/tracheostomy-care-guidelines

World Health Organization. (2022). Seasonal Influenza Vaccination Guidelines. WHO. https://www.who.int