NR 324 Week 2 Upper Respiratory System

Student Name

Chamberlain University

PSYC-290 Lifespan Development

Prof. Name

Date

Introduction

Caring for a patient with a tracheostomy requires careful attention to maintaining a patent airway and supporting adequate ventilation. For this reason, continuous monitoring of respiratory rate and oxygen saturation remains the nurse’s highest priority. Although assessments such as electrolyte balance, daily weights, swallowing ability, speech, mobility, and pain levels are important in overall care, they are secondary to the immediate concern of ensuring airway stability and effective breathing.

Before performing tracheostomy cannula care, especially in patients recovering from reconstructive surgery following invasive head and neck cancer, the nurse must prioritize auscultation of breath sounds. Evaluating lung sounds provides critical information about the presence of retained secretions that may cause aspiration or respiratory obstruction. While assessing the patient’s neurological status, gag reflex, and tracheostomy cuff pressure is beneficial, these factors are not as urgent as ensuring clear airways and stable respiratory patterns.

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

When administering the seasonal influenza vaccine to residents in long-term care facilities, contraindications must be carefully assessed. A documented history of severe allergic reactions, such as anaphylaxis to egg proteins or vaccine components, is a strict contraindication. In contrast, conditions such as advanced age or chronic illnesses like chronic obstructive pulmonary disease (COPD) do not prevent vaccination and, in fact, highlight the importance of immunization for vulnerable populations.

For patients with tracheostomies, delegation of responsibilities should be guided by patient stability and staff competence. For example, trained unlicensed assistive personnel (UAP) may perform basic tasks such as oropharyngeal suctioning in stable patients. However, more advanced responsibilities—including determining suctioning needs, evaluating swallowing capability, or monitoring tracheostomy cuff pressure—should remain within the scope of practice of registered nurses (RNs) or licensed practical nurses (LPNs) due to the complexity of clinical judgment required.

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

In differentiating acute sinusitis from a simple upper respiratory infection (URI), specific clinical indicators such as localized maxillary pain or facial pressure are more reliable than general symptoms like fever or cough. Although allergies, such as dust sensitivity, may predispose an individual to respiratory irritation, they do not independently confirm a diagnosis of sinusitis.

For patients with laryngeal cancer, the nurse reviewing medical history should anticipate risk factors such as chronic alcohol consumption and tobacco use, which remain the most significant contributors to head and neck malignancies. Additional risks include occupational exposure to industrial carcinogens, prior radiation therapy, poor oral hygiene, and even environmental factors like excessive sun exposure. Recognizing these risks can improve early detection and patient education.

Delegation of Tasks and Medication Education

Delegating tasks appropriately is crucial for patients with a permanent tracheostomy. For example, UAPs may assist with routine oral hygiene using a toothbrush and suction tube. However, specialized procedures, such as tracheostomy suctioning or stoma site assessment for potential skin breakdown, require the clinical expertise of a nurse due to the complexity and risk involved.

Medication education is another cornerstone of nursing practice. When teaching a patient about intranasal budesonide spray, used to manage seasonal allergic rhinitis, it is essential to stress consistent daily use throughout the allergy season—even in the absence of symptoms. This prevents inflammatory responses and ensures long-term symptom control. Patients should also be informed that budesonide does not offer immediate relief, does not significantly affect hepatic function, and carries minimal risk of serious infection when used correctly.

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

In postoperative patients, particularly following laryngectomy, ensuring airway patency is the primary nursing responsibility. While comfort measures, wound drainage assessment, and vital sign monitoring are all important, they are secondary to the life-preserving function of maintaining a clear airway.

In emergencies, such as accidental expulsion of a tracheostomy tube shortly after insertion, the immediate response must focus on preserving airway patency. A sterile hemostat can be used to keep the stoma open while a replacement tube is prepared. If the patient demonstrates signs of respiratory distress, temporary ventilation with a manual resuscitation device (Ambu bag) may be required until definitive airway management is restored.

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.

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

World Health Organization. (2022). Seasonal influenza vaccination guidelines. https://www.who.int