Respiratory DisordersRespiratory Disorders

Nursing 203Nursing 203

Pulmonary EdemaPulmonary Edema Medical emergency!Medical emergency! Abnormal accumulation of fluid in the lung(s)Abnormal accumulation of fluid in the lung(s) Causes: LV failure, rapid administration of IVF’s Causes: LV failure, rapid administration of IVF’s Clinical Manifestations:Clinical Manifestations:

– Increasing respiratory distress/ dyspnea, air hungerIncreasing respiratory distress/ dyspnea, air hunger– Anxious/agitated/confusion Anxious/agitated/confusion – Cough/Frothy pink sputumCough/Frothy pink sputum– Crackles/ RalesCrackles/ Rales– TachycardiaTachycardia– Jugular vein distentionJugular vein distention

– Diagnostic Findings:Diagnostic Findings: Chest X-ray show increased interstitial markingsChest X-ray show increased interstitial markings ABGs show increasing hypoxia ABGs show increasing hypoxia BNP Elevated BNP Elevated

Medical ManagementMedical Management GOAL: Correct underlying disorderGOAL: Correct underlying disorder Medications:Medications:

– Oxygen/ Endotracheal intubationOxygen/ Endotracheal intubation– MorphineMorphine– Diuretics (Lasix is DOC)Diuretics (Lasix is DOC)– Vasodilators (Nitroglycerin)Vasodilators (Nitroglycerin)– DobutamineDobutamine– Milrinone Milrinone – Digoxin Digoxin – Nesritide ( Natrecor)Nesritide ( Natrecor)

Hemodynamic monitoring:Hemodynamic monitoring:– Arterial lineArterial line– Central venous pressure (CVP)Central venous pressure (CVP)– Swan-Ganz (PAP monitoring)Swan-Ganz (PAP monitoring)

Nursing ManagementNursing Management Assist with intubation (if necessary), monitor Assist with intubation (if necessary), monitor

mechanical ventilation mechanical ventilation Administer oxygen by mask (40-60%)Administer oxygen by mask (40-60%) HOB elevated, legs dangling if possibleHOB elevated, legs dangling if possible Administering and monitoring medicationsAdministering and monitoring medications Provide psychological supportProvide psychological support CVP/ hemodynamic monitoringCVP/ hemodynamic monitoring Vital signs frequentlyVital signs frequently

Nursing Management Nursing Management ContinuedContinued

Low-Na+ dietLow-Na+ diet Fluid restrictionsFluid restrictions Strict I&O’sStrict I&O’s Daily weightsDaily weights Home Care Home Care

Adult Respiratory Distress Adult Respiratory Distress SyndromeSyndrome

Also called ARDSAlso called ARDS Characterized by sudden progressive Characterized by sudden progressive

pulmonary edemapulmonary edema Increasing bilateral infiltratesIncreasing bilateral infiltrates Hypoxemia regardless to oxygen therapy Hypoxemia regardless to oxygen therapy Decreased lung complianceDecreased lung compliance

PathophysiologyPathophysiology Result of inflammatory trigger that Result of inflammatory trigger that

damages/collapses alveolar interstitial damages/collapses alveolar interstitial spacesspaces

Direct injury to lungsDirect injury to lungs– Trauma, Smoke inhalationTrauma, Smoke inhalation– Aspiration, infectionAspiration, infection– DIC, DIC,

IndirectIndirect– ShockShock– Major surgeryMajor surgery

Clinical ManifestationsClinical Manifestations Severe dyspnea occurring 12-48 after insultSevere dyspnea occurring 12-48 after insult Arterial hypoxemia regardless of O2 amountArterial hypoxemia regardless of O2 amount Lungs are “Stiff”Lungs are “Stiff” Assessment findingsAssessment findings Diagnostic findingsDiagnostic findings

Medical ManagementMedical Management Identify and treat underlying causeIdentify and treat underlying cause Intubation/Mechanical ventilationIntubation/Mechanical ventilation

– Will see PEEPWill see PEEP– Goal: PaO2 > 60mm Hg or O2 sat 90%Goal: PaO2 > 60mm Hg or O2 sat 90%– Hemodynamic monitoringHemodynamic monitoring– MedsMeds

Human recombinant interleukin-1 receptor antagonistHuman recombinant interleukin-1 receptor antagonist Neutrophil inhibitorsNeutrophil inhibitors Surfactant, Surfactant, Pulmonary vasodilatorsPulmonary vasodilators CorticosteroidsCorticosteroids

Nutritional support: 35-45kcal/kg/dayNutritional support: 35-45kcal/kg/day

Nursing ManagementNursing Management Monitor and implement medical plan of careMonitor and implement medical plan of care Patient positioningPatient positioning Psychological supportPsychological support Ventilator considerations Ventilator considerations

– Do not turn off alarmsDo not turn off alarms– HypotensionHypotension– Fighting ventilatorFighting ventilator– Suction frequentlySuction frequently– Bite blockBite block– SedationSedation– Neuromuscular blockadeNeuromuscular blockade

Pulmonary EmbolismPulmonary Embolism Thrombi most often arise from deep veins in Thrombi most often arise from deep veins in

the legs, the right side of the heart or pelvic the legs, the right side of the heart or pelvic area and travel to the pulmonary circulation.area and travel to the pulmonary circulation.

Can also be air, fat, amnioticCan also be air, fat, amniotic Medical Emergency!Medical Emergency! Risk Factors:Risk Factors:

– Immobility, bed-rest, history of previous DVT, Immobility, bed-rest, history of previous DVT, pre-post op, trauma, pregnancy, obesity, BC pre-post op, trauma, pregnancy, obesity, BC pillspills

Assessment FindingsAssessment Findings Severity of symptoms depend on the size and Severity of symptoms depend on the size and

location location Acute onset of Acute onset of chest painchest pain, , dyspnea,dyspnea, tachypneatachypnea Anxious, feelings of impending doomAnxious, feelings of impending doom TachycardiaTachycardia Rales / Crackles / Diminished breathe sounds/ Rales / Crackles / Diminished breathe sounds/

coughcough Death can occur within 1 hr of onset of symptomsDeath can occur within 1 hr of onset of symptoms May have history of DVTMay have history of DVT

Diagnostic FindingsDiagnostic Findings Ventilation-Perfusion (V-Q) scanVentilation-Perfusion (V-Q) scan Pulmonary angiographyPulmonary angiography CXRCXR ABGsABGs Peripheral vascular studiesPeripheral vascular studies

PreventionPrevention Active leg exerciseActive leg exercise Early ambulationEarly ambulation Pneumatic/elastic compression stockingsPneumatic/elastic compression stockings Avoid sitting/ leg crossing Avoid sitting/ leg crossing Teach signs/symptoms of DVT/PETeach signs/symptoms of DVT/PE Low dose anticoagulant for those Low dose anticoagulant for those

undergoing surgeryundergoing surgery

Medical ManagementMedical Management Emergency managementEmergency management

– Stabilize Cardiopulmonary systemStabilize Cardiopulmonary system Nasal oxygenNasal oxygen ABGsABGs IVIV Lung perfusion scan or spiral CT scanLung perfusion scan or spiral CT scan Continuous cardiac monitoring/Vital Continuous cardiac monitoring/Vital

signs/Hemodynamic monitoringsigns/Hemodynamic monitoring– Treat hypotension using Dobutamine or Treat hypotension using Dobutamine or

DopamineDopamine

Medical Management Cont..Medical Management Cont.. IV morphineIV morphine Compression stockingsCompression stockings Anticoagulants Anticoagulants

– Heparin bolus/dripHeparin bolus/drip– Low molecular weight heparin (Lovenox)Low molecular weight heparin (Lovenox)– CoumadinCoumadin

ThrombolyticsThrombolytics– Urokinase, streptokinase, alteplase, Urokinase, streptokinase, alteplase,

reteplase,tPAreteplase,tPA

Medical Management Cont…Medical Management Cont… Surgical management if PE is severeSurgical management if PE is severe

– Embolectomy Embolectomy – Umbrella filter (Greenfield filter)Umbrella filter (Greenfield filter)

Nursing ManagementNursing Management Minimize the risk of PEMinimize the risk of PE

– Always suspect PEAlways suspect PE Prevent formation of thrombusPrevent formation of thrombus

– Major nursing responsibilityMajor nursing responsibility– Leg exercise, early ambulationLeg exercise, early ambulation– No sitting or lying for long period of timeNo sitting or lying for long period of time– Legs should not be in a dependent positionLegs should not be in a dependent position– Monitor IV sitesMonitor IV sites

Nursing Management Cont..Nursing Management Cont.. Monitoring anticoagulant/thrombolytic therapyMonitoring anticoagulant/thrombolytic therapy

– During infusion—bedrest, vital signs, O2 sats, limit During infusion—bedrest, vital signs, O2 sats, limit invasive procedures, monitor PT, and PTT, monitor for invasive procedures, monitor PT, and PTT, monitor for bleeding…bleeding…

Pain managementPain management Anxiety managementAnxiety management Monitor for complicationsMonitor for complications

– Cardiogenic shockCardiogenic shock– Right ventricular failureRight ventricular failure– Education Education

Chest Trauma: BluntChest Trauma: Blunt More common, harder to determine extentMore common, harder to determine extent Cause: Sudden compression or positive Cause: Sudden compression or positive

pressure to the chest wallpressure to the chest wall MVA, steering wheel, seat belt, falls , bicycle crashesMVA, steering wheel, seat belt, falls , bicycle crashes

TypesTypes Fractured sternal and ribs, flail chest, pulmonary Fractured sternal and ribs, flail chest, pulmonary

contusioncontusion

Chest Trauma: PenetratingChest Trauma: Penetrating Cause: A foreign object enters the chest Cause: A foreign object enters the chest

wallwall– Gunshot and stabbings (most common)Gunshot and stabbings (most common)

PathophysiologyPathophysiologyWhy is it life-threatening?Why is it life-threatening? HypoxemiaHypoxemia HypovolemiaHypovolemia Cardiac failureCardiac failure

AssessmentAssessment Assessment immediately--- When, how Assessment immediately--- When, how

injury occurred?injury occurred?– LOC, other injuries, EBL, Drugs or ETOH LOC, other injuries, EBL, Drugs or ETOH

involved, pre-hospital treatmentinvolved, pre-hospital treatment How is the airway?How is the airway?

– Inspect airway, thorax, neck veins, and Inspect airway, thorax, neck veins, and breathing breathing

– AuscultationAuscultation– PalpationPalpation

Assessment Cont..Assessment Cont.. Vital signs and skin colorVital signs and skin color Labs (CBC, clotting studies, type and cross, Labs (CBC, clotting studies, type and cross,

Lytes, ABG’s Lytes, ABG’s CXR, CT scan/ EKGCXR, CT scan/ EKG

Medical ManagementMedical Management Establish/secure airwayEstablish/secure airway

– Intubation/VentilationIntubation/Ventilation Re-establish chest wall integrity Re-establish chest wall integrity

– Occluding open chest wounds Occluding open chest wounds – Correct fluid volume and negative intrapleural Correct fluid volume and negative intrapleural

pressure or drain intrapleural fluidpressure or drain intrapleural fluid Control bleedingControl bleeding

Sternal And Rib FracturesSternal And Rib Fractures Rib fractures most common type of chest trauma Rib fractures most common type of chest trauma Most are benign but can be life-threatening Most are benign but can be life-threatening 55thth – 9 – 9thth most common site most common site Usually heal in 3-6 weeks Usually heal in 3-6 weeks Conservative treatmentConservative treatment

– Pain controlPain control– Avoid excessive activityAvoid excessive activity– Deep breathing exerciseDeep breathing exercise– Rib belt Rib belt – Surgical if gross deformity onlySurgical if gross deformity only

Flail ChestFlail Chest CAUSATIVE: BLUNT CHEST TRAUMA CAUSATIVE: BLUNT CHEST TRAUMA

OFTEN ASSOCIATED WITH MULTIPLE OFTEN ASSOCIATED WITH MULTIPLE RIB FRACTURESRIB FRACTURES

PATHOPHYSIOLOGYPATHOPHYSIOLOGY “ “PARADOXICAL MOVEMENT”PARADOXICAL MOVEMENT”RESULT: HYPOXEMIA, RESPIRATORY RESULT: HYPOXEMIA, RESPIRATORY

ACIDOSIS, HYPOTENSION, THEN ACIDOSIS, HYPOTENSION, THEN METABOLIC ACIDOSISMETABOLIC ACIDOSIS

TREATMENT GOALSTREATMENT GOALS CONTROL PAINCONTROL PAIN CLEAR SECRETIONSCLEAR SECRETIONS VENTILATORY SUPPORTVENTILATORY SUPPORT

TREATMENT DEPENDS ON DEGREE OF TREATMENT DEPENDS ON DEGREE OF RESPIRATORY DYSFUNCTIONRESPIRATORY DYSFUNCTION

Treatment Cont..Treatment Cont.. CLEAR AIRWAY: COUGH AND DEEP CLEAR AIRWAY: COUGH AND DEEP

BREATH, POSITIONING, SUCTIONING BREATH, POSITIONING, SUCTIONING SECRETIONSSECRETIONS

VENTILATORY SUPPORT: PULMONARY VENTILATORY SUPPORT: PULMONARY PHYSIOTHERAPY, EMDOTRACHEAL PHYSIOTHERAPY, EMDOTRACHEAL INTUBATION, MECHANICAL INTUBATION, MECHANICAL VENTILATIONVENTILATION

NURSING INTERVENTIONSNURSING INTERVENTIONS MONITOR ABG’SMONITOR ABG’S PULMONARY FUNCTION MONITORINGPULMONARY FUNCTION MONITORING PULSE OXIMETRYPULSE OXIMETRY PAIN ASSESSMENT/CONTROLPAIN ASSESSMENT/CONTROL SERIAL CHEST X-RAYSSERIAL CHEST X-RAYS

PNEUMOTHORAXPNEUMOTHORAX PNEUMOTHORAX: ACCUMULATION OF AIR OR PNEUMOTHORAX: ACCUMULATION OF AIR OR

GAS IN THE PLEURAL CAVITY, RESULTING IN GAS IN THE PLEURAL CAVITY, RESULTING IN COLLAPSE OF THE LUNG ON THE AFFECTED COLLAPSE OF THE LUNG ON THE AFFECTED SIDESIDE

““BREACH IN PARIETAL OR VISCERAL BREACH IN PARIETAL OR VISCERAL PLEURA=EXPOSURE TO POSTIIVE PLEURA=EXPOSURE TO POSTIIVE ATMOPSHERIC PRESSURE”ATMOPSHERIC PRESSURE”

TYPES OF PNEUMOTHORAXTYPES OF PNEUMOTHORAX SPONTANEOUS (OR SIMPLE)SPONTANEOUS (OR SIMPLE)

TRAUMATIC TRAUMATIC

TENSIONTENSION

SPONTANEOUS SPONTANEOUS PNEUMOTHROAXPNEUMOTHROAX

ETIOLOGYETIOLOGY1.1. RUPTURE OF A BLEBRUPTURE OF A BLEB2.2. RUPTURE OF A BRONCHOPLEURAL FISTULARUPTURE OF A BRONCHOPLEURAL FISTULA3.3. RUPTURE OF AIR FILLED BLISTER IN A RUPTURE OF AIR FILLED BLISTER IN A

HEALTHY PERSONHEALTHY PERSON

MAY BE ASSOCIATED WITH SEVERE MAY BE ASSOCIATED WITH SEVERE EMPHYSEMA OR INTERSTITIAL LUNG DISEASEEMPHYSEMA OR INTERSTITIAL LUNG DISEASE

TRAUMATIC PNEUMOTHORAXTRAUMATIC PNEUMOTHORAX WOUND IN THE CHEST WALL ALLOWS WOUND IN THE CHEST WALL ALLOWS

AIR TO ESCAPE; ENTERS THE PLEURAL AIR TO ESCAPE; ENTERS THE PLEURAL SPACESPACE

CAUSES: BLUNT TRAUMA, CAUSES: BLUNT TRAUMA, PENETRATING CHEST TRAUMA, PENETRATING CHEST TRAUMA, ABDOMINAL TRAUMA, DIAPHRAGMATIC ABDOMINAL TRAUMA, DIAPHRAGMATIC TEARS, INVASIVE THORACIC TEARS, INVASIVE THORACIC PROCEDURES, PROCEDURES,

HEMOTHORAXHEMOTHORAX COLLECTION OF BLOOD IN THE COLLECTION OF BLOOD IN THE

PLEURAL SPACE RESULTING FROM PLEURAL SPACE RESULTING FROM TORN INTERCOSTAL VESSELS, TORN INTERCOSTAL VESSELS, LACERATIONS OF THE GREAT VESSELS LACERATIONS OF THE GREAT VESSELS AND LACERATION OF THE LUNGSAND LACERATION OF THE LUNGS

HEMOPNEUMOTHORAX: AIR AND HEMOPNEUMOTHORAX: AIR AND BLOODBLOOD

SUCKING CHEST WOUND SUCKING CHEST WOUND (OPEN PNEUMOTHORAX)(OPEN PNEUMOTHORAX)

TYPE OF TRAUMATIC PNEUTHORAXTYPE OF TRAUMATIC PNEUTHORAX ALLOWS AIR TO PASS FREELY IN AND ALLOWS AIR TO PASS FREELY IN AND

OUT OUT RUSH OF AIR THROUGH THE HOLE RUSH OF AIR THROUGH THE HOLE

PRODUCES A SUCKING SOUNDPRODUCES A SUCKING SOUND CONSEQUENCE: MEDIASTINAL CONSEQUENCE: MEDIASTINAL

FLUTTERFLUTTER

CLINICAL MANIFESTATIONCLINICAL MANIFESTATION PLEURITIC PAIN PLEURITIC PAIN TACHYPNEATACHYPNEA ANXIETYANXIETY DYSPNEA WITH AIR HUNGERDYSPNEA WITH AIR HUNGER USE OF ACESSORY MUSCLESUSE OF ACESSORY MUSCLES DECREASED OR ABSENT BREATH SOUNDS; DECREASED OR ABSENT BREATH SOUNDS;

DECREASED MOVEMENT IN THE AFFECTED DECREASED MOVEMENT IN THE AFFECTED SIDESIDE

SUBCUTANEOUS EMPHYSEMASUBCUTANEOUS EMPHYSEMA

MANAGEMENTMANAGEMENT GOAL: EVACUATE THE AIR OR BLOOD GOAL: EVACUATE THE AIR OR BLOOD

FROM THE PLEURAL SPACEFROM THE PLEURAL SPACE PNEUMOTHORAX: SMALL CHEST PNEUMOTHORAX: SMALL CHEST

TUBE/2TUBE/2NDND ICS ICS HEMOTHORAX: LARGE CHEST HEMOTHORAX: LARGE CHEST

TUBE/2ND OR 5TUBE/2ND OR 5THTH ICS ICS SUCTION: 20mm HG SUCTIONSUCTION: 20mm HG SUCTION

MANAGEMENTMANAGEMENT ANTIBIOTIC THERAPYANTIBIOTIC THERAPY HEIMLICH HEIMLICH CHEST TUBE TO WATER SEAL CHEST TUBE TO WATER SEAL

DRAINAGEDRAINAGE EMERGENCY THORACOTOMYEMERGENCY THORACOTOMY

NURSING CARE OF CHEST NURSING CARE OF CHEST DRAINAGE SYSTEMDRAINAGE SYSTEM

Fill the water seal with sterile water to the specified levelFill the water seal with sterile water to the specified level Fill the suction control chamber with sterile water to the Fill the suction control chamber with sterile water to the

20-cm level20-cm level Attach CT’s to collection chamber and tape Attach CT’s to collection chamber and tape Suction: dry system turn regulator dial to 20cm H2OSuction: dry system turn regulator dial to 20cm H2O Suction: wet system turn on suction unit until steady Suction: wet system turn on suction unit until steady

bubbling appears in suction control chamberbubbling appears in suction control chamber IMMEDIATE PETROLATUM GAUZEIMMEDIATE PETROLATUM GAUZE

INTERVENTIONS/CHEST TUBE INTERVENTIONS/CHEST TUBE DRAINAGEDRAINAGE

MARK DRAINGE FROM CT MARK DRAINGE FROM CT CHECK FOR KINKS, LOOP IN CT’SCHECK FOR KINKS, LOOP IN CT’S

WHAT’S “MILKING THE TUBES”WHAT’S “MILKING THE TUBES”WHAT IS “TIDALING”WHAT IS “TIDALING”OBSERVE FOR “AIR LEAKS”OBSERVE FOR “AIR LEAKS”DO NOT CLAMP THE CT FOR TRANSPORTDO NOT CLAMP THE CT FOR TRANSPORTINCENTIVE SPIROMETER/COUGH AND DBINCENTIVE SPIROMETER/COUGH AND DBOBSERVE AND REPORT CHANGE IN STATUSOBSERVE AND REPORT CHANGE IN STATUS

CHEST TUBE REMOVALCHEST TUBE REMOVAL VALSALVA MANEUVER PER CLIENTVALSALVA MANEUVER PER CLIENT CHEST TUBE CLAMPED/QUICKLY CHEST TUBE CLAMPED/QUICKLY

REMOVED REMOVED PRESSURE DRESSING TO CT SITEPRESSURE DRESSING TO CT SITE

TENSION PNEUMOTHORAXTENSION PNEUMOTHORAX AIR ENTERS WOUND IN THE CHEST AIR ENTERS WOUND IN THE CHEST

WALL AND BECOMES TRAPPEDWALL AND BECOMES TRAPPED WITH EACH BREATH, TENSION WITH EACH BREATH, TENSION

INCREASES IN THE PLEURAL SPACEINCREASES IN THE PLEURAL SPACE LUNG COLLASPESLUNG COLLASPES MEDIASTINAL STRUCTURES SHIFT TO MEDIASTINAL STRUCTURES SHIFT TO

THE OPPOSITE SIDETHE OPPOSITE SIDE

TENSION PNEUMOTHORAXTENSION PNEUMOTHORAX

CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS PROFUSE DIAPHORESISPROFUSE DIAPHORESIS AGITATIONAGITATION AIR HUNGERAIR HUNGER CENTRAL CYANOSISCENTRAL CYANOSIS TACHYCARDIA/HYPOTENSIONTACHYCARDIA/HYPOTENSION

EMERGENCY!!EMERGENCY!!

TENSION PNEUMOTHORAX TENSION PNEUMOTHORAX MANAGEMENTMANAGEMENT

SUPPLEMENTAL OXYGENSUPPLEMENTAL OXYGEN MONITOR PULSE OXIMETRYMONITOR PULSE OXIMETRY DECOMPRESSIONDECOMPRESSION CHEST TUBE MAINTENANCECHEST TUBE MAINTENANCE

PLEURAL EFFUSIONPLEURAL EFFUSIONCOLLECTION OF FLUID IN THE PLEURAL COLLECTION OF FLUID IN THE PLEURAL

SPACE, USUALLY SECONDARY TO SPACE, USUALLY SECONDARY TO OTHER DISEASESOTHER DISEASES

CAUSES: HEART FAILURE, TB, CAUSES: HEART FAILURE, TB, NEOPLASTIC TUMORS, PE, NEOPLASTIC TUMORS, PE, CONNECTIVE TISSUE DISEASECONNECTIVE TISSUE DISEASE

CLEAR, BLOODY OR PURULENTCLEAR, BLOODY OR PURULENTTRANSUDATE VS.EXUDATETRANSUDATE VS.EXUDATE

CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS DYSPNEADYSPNEA PLEURITIC CHEST PAINPLEURITIC CHEST PAIN DECREASED OR ABSENT BREATH SOUNDSDECREASED OR ABSENT BREATH SOUNDS DIAGNOSTIC FINDINGS: TRACHEAL DIAGNOSTIC FINDINGS: TRACHEAL

DEVIATION,CHEST X-RAY, CHEST CT, DEVIATION,CHEST X-RAY, CHEST CT, THORACENTESIS (CONFIRMS DX)THORACENTESIS (CONFIRMS DX)

PLEURAL FLUID ANALYASISPLEURAL FLUID ANALYASIS PLEURAL BIOPSYPLEURAL BIOPSY

EFFUSION TREATMENTEFFUSION TREATMENT THORACENTESISTHORACENTESIS PLEURODESISPLEURODESIS CHEST TUBESCHEST TUBES SURGICAL PLEURECTOMY WITH SURGICAL PLEURECTOMY WITH

CATHERTER INSERTIONCATHERTER INSERTION PLEUROPERITONEAL SHUNTPLEUROPERITONEAL SHUNT

PAIN MANAGEMENTPAIN MANAGEMENT PAIN NFUSION PUMP (OPIOIDS)PAIN NFUSION PUMP (OPIOIDS) THORACIC EPIDURAL BLOCKTHORACIC EPIDURAL BLOCK INTERCOSTAL NERVE BLOCKINTERCOSTAL NERVE BLOCK INTERMITTANT ANALGESICINTERMITTANT ANALGESIC INTRAPLEURAL ADMINISTRATION OF INTRAPLEURAL ADMINISTRATION OF

OPIOIDSOPIOIDS

CANCERS OF THE CANCERS OF THE RESPIRATORY SYSTEMRESPIRATORY SYSTEM

LARYNGEAL CANCERLARYNGEAL CANCER

LUNG CANCERLUNG CANCER

TUMORS OF THE MEDIASTINUMTUMORS OF THE MEDIASTINUM

CANCER OF THE LARYNXCANCER OF THE LARYNX RISK FACTORS RISK FACTORS CARCINOGENS (MULTIPLE)CARCINOGENS (MULTIPLE) HX OF ETOH ABUSEHX OF ETOH ABUSE STRAINING THE VOICE STRAINING THE VOICE FAMILIAL TENDENCYFAMILIAL TENDENCY CHRONIC LARYNGITISCHRONIC LARYNGITIS GENDER, AGE, RACEGENDER, AGE, RACE NUTRITIONAL DEFICIENCIESNUTRITIONAL DEFICIENCIES

CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS HOARSENESS>3 WEEKSHOARSENESS>3 WEEKS LUMP IN THE THROATLUMP IN THE THROAT PAIN OR BURNING SENSATIONPAIN OR BURNING SENSATION DYSPHAGIADYSPHAGIA DYSPNEADYSPNEA COUGHCOUGH ENLARGED CERVICAL NODESENLARGED CERVICAL NODES

PATHOPHYSIOLOGYPATHOPHYSIOLOGY INTRINSIC TUMOR: LOCATED ON THE INTRINSIC TUMOR: LOCATED ON THE

TRUE VOCAL CORD (USUALLY DOES TRUE VOCAL CORD (USUALLY DOES NOT SPREAD)NOT SPREAD)

EXTRINSIC TUMOR: LOCATED ON EXTRINSIC TUMOR: LOCATED ON OTHER PART OF THE LARYNX (TENDS OTHER PART OF THE LARYNX (TENDS TO SPREAD EARLY)TO SPREAD EARLY)

SUPRAGLOTTIS, GLOTTIS, SUBGLOTTISSUPRAGLOTTIS, GLOTTIS, SUBGLOTTIS

DIAGNOSTIC TESTDIAGNOSTIC TEST LARYNGOSCOPYLARYNGOSCOPY LARYNGEAL TOMOGRAPYLARYNGEAL TOMOGRAPY CT SCAN / MRICT SCAN / MRI CHEST X-RAYCHEST X-RAY BIOPSYBIOPSY

STAGING LARYNGEAL CASTAGING LARYNGEAL CA TNM CLASSIFICATION SYSTEM: TNM CLASSIFICATION SYSTEM:

METHOD USED TO CLASSIFIY HEAD METHOD USED TO CLASSIFIY HEAD AND NECK TUMORS. DEVELOPED BY AND NECK TUMORS. DEVELOPED BY THE AMERICAN JOINT COMMITTEE ON THE AMERICAN JOINT COMMITTEE ON CANCERCANCER

“ “CLASSIFICATION OF THE TUMOR CLASSIFICATION OF THE TUMOR SUGGEST TREATMENT MODALITIES” SUGGEST TREATMENT MODALITIES” (Pg. 507; chart 22-6)(Pg. 507; chart 22-6)

PROGNOSIS OF LARYNGEAL PROGNOSIS OF LARYNGEAL CANCERCANCER

TUMOR SIZETUMOR SIZE CLIENT’S AGE AND GENDERCLIENT’S AGE AND GENDER GRADE AND DEPTH OF TUMORGRADE AND DEPTH OF TUMOR INITIAL DIAGNOSIS OR A RECURRENCEINITIAL DIAGNOSIS OR A RECURRENCE

LARYNGEAL CANCER LARYNGEAL CANCER TREATMENTSTREATMENTS

RADIATION THERAPYRADIATION THERAPY GOAL OF TREATMENTGOAL OF TREATMENT CRITERIA FOR RADIATIONCRITERIA FOR RADIATION BENEFITSBENEFITS COMPLICATIONSCOMPLICATIONS

SURGICAL MANAGEMENT OF SURGICAL MANAGEMENT OF LARYNGEAL CANCERLARYNGEAL CANCER

LARYNGECTOMYLARYNGECTOMY PARTIAL LARYNGECTOMYPARTIAL LARYNGECTOMY SUPRAGLOTTIC LARYNGECTOMYSUPRAGLOTTIC LARYNGECTOMY HEMILARYNGECTOMYHEMILARYNGECTOMY TOTAL LARYNGECTOMYTOTAL LARYNGECTOMY RADICAL NECK DISSECTIONRADICAL NECK DISSECTION

NURSING INTERVENTIONSNURSING INTERVENTIONS MONITOR AND MANAGE POTENTIAL MONITOR AND MANAGE POTENTIAL

COMPLICATIONS: RESPIRATORY COMPLICATIONS: RESPIRATORY DISTRESS, HEMORRHAGE INFECTION, DISTRESS, HEMORRHAGE INFECTION, WOUND BREAKDOWNWOUND BREAKDOWN

MAINTAIN PATENT AIRWAYMAINTAIN PATENT AIRWAY TRACHEOSTOMY/STOMA CARETRACHEOSTOMY/STOMA CARE ALTERNATIVE MEANS OF ALTERNATIVE MEANS OF

COMMUNICATION: COMMUNICATION:

NURSING INTERVENTIONSNURSING INTERVENTIONS REDUCING ANXIETYREDUCING ANXIETY PROMOTE ADEQUATE NUTRITIONPROMOTE ADEQUATE NUTRITION HYGIENE AND SAFETY MEASURESHYGIENE AND SAFETY MEASURES REFERRAL TO SUPPORT GROUPSREFERRAL TO SUPPORT GROUPS RESTORING SPEECH AFTER RESTORING SPEECH AFTER

LARYNGECTOMYLARYNGECTOMY

LUNG CANCERLUNG CANCER NUMBER ONE CANCER KILLER IN NUMBER ONE CANCER KILLER IN

UNITED STATESUNITED STATES OCCURRENCE (60-70YR OLD)OCCURRENCE (60-70YR OLD) SURVIVAL RATE LOWSURVIVAL RATE LOW 85% CAUSED BY INHALATION OF 85% CAUSED BY INHALATION OF

CARCINOGENIC CHEMICALSCARCINOGENIC CHEMICALS

LUNG CANCERLUNG CANCER

SMALL CELL CARCINOMASMALL CELL CARCINOMA LARGE CELL CARCINOMALARGE CELL CARCINOMA BRONCHIOALVEOLAR CELL CANCERBRONCHIOALVEOLAR CELL CANCER ADENOCARCINOMAADENOCARCINOMA SQUAMOUS CELL CARCINOMASQUAMOUS CELL CARCINOMA

RISK FACTORSRISK FACTORS TOBACCO SMOKETOBACCO SMOKE SECOND-HAND SMOKESECOND-HAND SMOKE ENVIRONMENTAL AND OCCUPATIONAL ENVIRONMENTAL AND OCCUPATIONAL

EXPOSUREEXPOSURE GENETICSGENETICS DIETARY FACTORSDIETARY FACTORS

CLINICAL MANIFESTATIONCLINICAL MANIFESTATION COUGH OR CHANGE IN A CHRONIC COUGH OR CHANGE IN A CHRONIC

COUGHCOUGH WHEEZING, DYSPNEA, HEMOPTYSISWHEEZING, DYSPNEA, HEMOPTYSIS REPEATED, UNRESOLVED URI’SREPEATED, UNRESOLVED URI’S CHEST PAIN, TIGHTNESS, CHEST PAIN, TIGHTNESS,

HOARSENESS, WEIGHT LOSS, FEVERHOARSENESS, WEIGHT LOSS, FEVER

DIAGNOSTIC FINDINGSDIAGNOSTIC FINDINGS CHEST X-RAYCHEST X-RAY C.T. CHESTC.T. CHEST FIBEROPTIC BRONCHOSCOPY WITH FIBEROPTIC BRONCHOSCOPY WITH

BRONCHIAL WASHINGSBRONCHIAL WASHINGS BRONCHOSCOPIC BIOPSYBRONCHOSCOPIC BIOPSY POSITRON EMISSION TOMOGRAPHYPOSITRON EMISSION TOMOGRAPHY MAGNETIC RESONANCE IMAGINGMAGNETIC RESONANCE IMAGING

LUNG CA TREATMENTLUNG CA TREATMENT SURGICAL INTERVENTIONSURGICAL INTERVENTION CHEMOTHERAPYCHEMOTHERAPY RADIATION THERAPYRADIATION THERAPY PALLIATIVE THERAPYPALLIATIVE THERAPY “ “TREATMENT DEPENDS ON SIZE, TREATMENT DEPENDS ON SIZE,

LOCATION AND TYPE OF CANCER, AS LOCATION AND TYPE OF CANCER, AS WELL AS OVERALL HEALTH”WELL AS OVERALL HEALTH”

TREATMENT TERMINOLOGYTREATMENT TERMINOLOGY SURGICAL: LOBECTOMY, SURGICAL: LOBECTOMY,

BILOBECTOMY, PNEUMONECTOMYBILOBECTOMY, PNEUMONECTOMY WEDGE RESECTIONWEDGE RESECTIONRADIATION: EXTERNAL, RADIATION: EXTERNAL,

BRACHYTHERAPYBRACHYTHERAPYCHEMOTHERAPY: ALKYLATING AGENTS, CHEMOTHERAPY: ALKYLATING AGENTS,

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