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
Promote oxygenation by ensuring a patent airway!
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
Displacement of bone or cartilage can cause airway
obstruction or cosmetic deformity; potential source
of infection

CSF may indicate skull fracture

Interventions

Closed reduction

Rhinoplasty

Nasoseptoplasty
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Observe for edema and bleeding
 Check vital signs every 4 hours
 Change drip pad as needed

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Nosebleed is common problem
 Cauterization of affected capillaries may be needed;
nose is packed
 Posterior nasal bleeding is an emergency!
 Assess for respiratory distress, tolerance of packing
or tubes
 Humidification, oxygen, bedrest, antibiotics, pain
medications

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Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Benign, grapelike clusters of mucous membranes
and connective tissue
 Large polyps may obstruct nasal airway
 Manifestations:

Obstructed nasal breathing
Increased nasal discharge
 Change in voice quality


Most managed with inhaled steroids
 Polypectomy treatment of choice

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Tumors rare, can be benign or malignant
 Seen with exposure to dust from wood, textiles,
leather, as well as flour, nickel, chromium mustard
gas, radium
 Slow onset, manifestations resemble sinusitis

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Local lymph enlargement often occurs on side with
tumor mass
 Surgical removal is main treatment; may be
combined with radiation (IMRT)

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Priority action is airway assessment!
 Manifestations:







Stridor
Shortness of breath/dyspnea
Anxiety/restlessness
Hypoxia and hypercarbia
Decreased oxygen saturation
Cyanosis, loss of consciousness
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


I — nasoethmoid complex
fracture
II — maxillary and
nasoethmoid complex fracture
III — combination of I & II plus
orbital-zygoma fracture; often
called craniofacial disjunction
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Airway assessment
 Anticipate need for emergency intubation
 Tracheotomy
 Cricothyroidotomy
 Fixed occlusion
 Débridement

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Breathing disruption during sleep
 Excessive daytime sleepiness, inability to
concentrate, irritability
 Nonsurgical management—change of sleep
position, weight loss, positive-pressure ventilation
 Surgical management—adenoidectomy, uvulectomy
or uvulopalatopharyngoplasty

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Vocal cord paralysis
 Vocal cord nodules and polyps
 Laryngeal trauma

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Interruption in airflow through nose, mouth,
pharynx, or larynx
 Life-threatening emergency
 Early recognition essential in preventing further
complications, including respiratory arrest

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Assess cause of obstruction

Maintenance of patent airway and ventilation

Cricothyroidotomy

Endotracheal intubation (nasotracheal or orotracheal)

Tracheotomy
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May be caused by knife, gunshot, traumatic
accident
 Priority is to assess for and maintain patent
airway!
 Assess for other injuries: cardiovascular,
respiratory, intestinal, neurologic damage

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Assess carotid artery and esophagus
 Assess for cervical spine injuries, prevent excess
neck movement
 Obstruction can occur from initial injury or
resultant swelling

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


Usually squamous cell carcinoma and slow growing
Usually begins with mucous that is chronically
irritated, becoming tougher and thicker
Usually leukoplakia and erythroplakia lesions
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Lumps in mouth, throat, neck
 Difficulty swallowing
 Color changes in mouth or tongue
 Oral lesion or sore that does not heal in 2 weeks
 Persistent, unilateral ear pain

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Persistent/unexplained oral bleeding
 Numbness of mouth, lips, or face
 Change in fit of dentures
 Burning sensation when drinking citrus or hot
liquids

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Hoarseness or change in voice quality
 Persistent/recurrent sore throat
 Shortness of breath
 Anorexia and weight loss

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
Radiation therapy

Chemotherapy

Cordectomy

Laryngectomy
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Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
First priorities are airway maintenance and
ventilation!
 Wound, flap, reconstructive tissue care
 Hemorrhage
 Wound breakdown
 Pain management
 Nutrition
 Speech and language rehabilitation

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Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Home care management
 Teaching for self management:

Stoma care
 Communication
 Smoking cessation

Psychosocial preparation
 Health care resources

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The patient is a 58-year-old woman diagnosed with throat
cancer 1 week ago. She has come to the clinic today to discuss
surgical options with her health care provider. She is very
tearful and appears sad when the nurse calls her back to the
examination room.
Based on her diagnosis, which clinical manifestation will the
nurse likely observe in the patient?
A. Severe chest pain
B. Hoarseness
C. Low hemoglobin level (anemia)
D. Numbness and tingling of the face
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
When the nurse begins taking the patient’s history,
she says, “Did you know that I have throat cancer
and may not survive?” What is the nurse’s most
appropriate response?
A. “I am so sorry to hear this.”
B. “My mother had cancer, so I know how you must be
feeling right now.”
C. “I know you have been diagnosed with cancer. Tell me
why you think you may not survive.”
D. “I am sure that your cancer can be cured if you follow
your doctor’s advice.”
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The provider discusses radiation therapy with the patient
because her lesion is small and the cure rate is 80% or higher.
The patient asks if her voice will return to normal. What is the
nurse’s best response? (Select all that apply.)
A. “The more you use your voice, the quicker it will improve.”
B. “At first the hoarseness may become worse.”
C. “Your voice will improve within 4 to 6 weeks after
completion of the therapy.”
D. “You should rest your voice and use alternative
communication during the therapy.”
E. “Gargling with saline may help decrease the discomfort in
your throat.”
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After the radiation therapy begins, the patient visits
the clinic stating that her throat is sore, she is having
difficulty swallowing, and the skin on her throat is
red, tender, and peeling.
What strategies does the nurse recommend for these
discomforts?
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37
To prevent aspiration in a patient admitted for
treatment of neck and throat cancer, the nurse’s first
step should be to:
A. Encourage hydration with water and juices.
B. Encourage the patient to eat juicy fruits to address
the sensation of thirst.
C. Stop feeding the patient if coughing occurs.
D. Encourage the patient to sit in a chair for meals.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
A patient has been admitted to the ED after
experiencing a fall while rock climbing. He appears to
have several facial fractures. Which observed
assessment finding is most serious?
A. Malaligned nasal bridge
B. Clear fluid draining from one of the nares, testing
positive for glucose
C. Blood draining from one of the nares
D. Crackling of the skin (crepitus) upon palpation
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An important nursing intervention to prevent airway
obstruction in an older patient with dementia is:
A. Ensuring the patient is out of bed twice a day
B. Maintaining the head of bed greater than 45
degrees
C. Performing daily oral hygiene and removing
secretion buildup
D. Teaching the family to use oral suction for
excessive secretions
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