Exam 3- ARDS, Mechanical Ventilation, Pulmonary Edema, Larnyx Cancer Flashcards
What accounts for half of all head and neck cancers?
Larynx Cancer
In which age group is larynx cancer most common?
People older than 65
How much more common is larynx cancer in men compared to women?
Four times more common
What type of carcinoma is laryngeal cancer classified as?
Squamous cell carcinoma
What percentage of all laryngeal cancers present with involved lymph nodes at diagnosis?
55%
When does recurrence of laryngeal cancer typically occur after diagnosis?
2-3 years
What are common clinical manifestations of laryngeal cancer?
- Horsness
- Persistent cough or sore throat
- Pain and burning in the throat (especially w hot liquids and citrus juices)
- Lump in neck
Name the later symptoms of laryngeal cancer.
- Dysphasia
- Dyspnea
- Unilateral nasal obstruction or discharge
- Foul breath
- Persistent ulceration
What diagnostic procedures are used for laryngeal cancer assessment?
- Laryngoscopy
- Fine-needle aspiration (FNA) biopsy
- Barium swallow
- Endoscopy
- CT or MRI scan
- Positron emission tomography (PET) scan
What is the medical management for early-stage laryngeal tumors?
- External beam radiation
- Conservation surgery (vocal cord stripping or cordectomy)
What is a total laryngectomy?
Surgical removal of the entire larynx
What are the side effects of radiation therapy for laryngeal cancer?
- Mucositis
- Ulceration of mucous membranes
- Pain
- Xerostomia (dry mouth)
- Loss of taste
- Dysphasia
- Fatigue
- Skin reactions
What is esophageal speech?
A method where air is compressed into the esophagus and expelled to produce sound
Tracheoesophageal puncture?
Most widely used, most resembles normal speech. Valve is places into the stoma to divert air into the esophagus and out the mouth
What does mechanical ventilation improve?
Gas exchange and decreases the work of breathing
What causes low tidal volume alarms in mechanical ventilation?
Leaks via disconnection, cuff leaks, tube displacement
What does the I:E ratio represent in mechanical ventilation?
Duration of inspiration to expiration
What is PEEP in mechanical ventilation?
Positive end-expiratory pressure applied at the end of expiration
What are the types of ventilators?
- Volume-Cycled Ventilators
- Pressure-Cycled Ventilators
- High-Frequency Oscillatory Support Ventilators
- Noninvasive Positive-Pressure Ventilation (CPAP and BiPAP)
What are risk factors associated with acute respiratory failure?
- Atelectasis
- COPD
- Cystic fibrosis
- HF
- Pneumonia
- Pneumothorax
- Pulmonary embolism
What is the difference between acute and chronic respiratory failure?
- Acute: Sudden, often due to CNS or pulmonary dysfunction
- Chronic: Insidious deterioration, often due to COPD
What are some clinical manifestations of acute respiratory failure?
- Restlessness
- Confusion
- Lethargy
- Fatigue
- Headache
- Use of accessory muscles
- resp distress
- tachycardia
- dysrhythmias
What lab values indicate acute respiratory failure?
PH <7.35, CO2 > 50, PaO2 < 50
What causes Acute Respiratory Distress Syndrome (ARDS)?
- Pneumonia
- Shock
- Sepsis
- Drug overdose
- Aspiration
- Trauma
- inhalation of chemicals
- pancreatitis
What are common diagnostics for ARDS?
- ABGs
- Chest X-ray (you will see bilateral infiltrates)
- BNP to rule out heart issues
What is a major treatment for ARDS?
- correcting underlying cause
- O2 supplementation
- mechanical ventilation
What is pulmonary edema?
Fluid accumulation in the lungs
What distinguishes cariogenic from non-cariogenic pulmonary edema?
- Cariogenic: Related to heart issues
- Non-Cariogenic: Damage to the capillary lining
What is a common symptom of pulmonary edema?
Extreme hypoxia even with high oxygen levels
High Pressure alarms due to… (two PB sandwiches can make you SCK)
increased pressure aka
P1- pulmonary edema
P2- pneumothorax
B1- bronchospasm
B2- biting
S- secretions
C- cough
K- kink
Tidal Volume Vt
volume of gas delivered with each breath
FiO2 is…
The fraction of inspired oxygen, o2 concentration of air being delivered to the pt
RA is 21% FiO2, 1 L is 24% and each L after that goes up by 4%
AC is
Assist control - vent is doing the work but the pt can take their own breath
Nursing care (ventilation)
Manual resuscitation bag with reintubation equipment at bed side with two different tube sizes
Regularly assess pts level of consciousness vitals breath sounds pulse ox and ABGs
Suction oral and tracheal suggestions as needed
Reposition ET tube every 24 hours to prevent skin break down
Frequent oral care
Monitor for complications such as ventilator associated pneumonia
Post ventilation encourage pts to take deep breaths and cough, and use IS
Volume-Cycled Ventilators –
delivers a preset volume of air with each inspiration, once that inspiration is delivered it cycles off and expiration happens passively
Pressure-Cycled Ventilators-
it delivers a flow of air until it reaches a preset pressure and then it cycles off and expiration occurs
High-Frequency Oscillatory Support Ventilators-
these types of ventilators deliver high respiratory rates (180-900 Breaths/min) with a very low tidal volume
Ventilation Perfusion Ratios
A= Normal Ratio: 1:1
B= Blockage of some kind keeping blood from being oxygenated
C= dead space within capillaries- ventilation exceeds profusion- no blood is getting to the alveoli
D= blockage in alveoli and capillary- no ventilation or profusion
ARDS characteristics
- sudden and progressive pulmonary edema
- increasing bilateral infiltrates on chest x-ray
- hypoxemia unresponsive to oxygen supplementation (regardless of the amount of PEEP)
- absence of an elevated left atrial pressure
- Leads to increased alveolar dead space
- Very difficult to ventilate
(Resembles pulm edema)
Pathophysiology of ARDS
Alveolar damage leads to pulmonary edema, causing them to be extremely hypoxia, unresponsive to increased O2 etc.
Medications for ARDS
paralytic, sedatives, analgesics, nitric oxide (helps with V:P ratio), vasopressors, inotropes, steroids
Non-Cariogenic pulmonary edema direct causes
damage from chest trauma, smoking, infection, or aspiration
Tx: treat the cause, and manage symptoms
Non-Cariogenic pulmonary edema indirect causes
damage from sepsis or burns (pancreatitis can be something that sets off the inflammatory process)
Tx: treat the cause, and manage symptoms
With pulmonary edema pts will be extremely _______________ even with ______________, ________________, and ______________
Hypoxic; High O2; High PEEP; High FiO2
Signs and symptoms of ARDS
- Dyspnea
- Rapid and shallow breathing
- Substernal retractions
- Tachycardia
- Cyanosis or pallor
- Crackles in lungs
Treatment of Acute Respiratory Distress syndrome
- O2 therapy
- Mechanical ventilation
- chest physiotherapy
- BiPAP and CPAP
- Bronchodilators
- corticosteroids
- antibiotics
- inotropic agents such as digoxin
- vasopressors and diuretics
ARDS Patho
An injury (direct or indirect) to the lungs that results in systemic inflammation which increases the permeability of the alveoli, allowing fluid to get in and collect in the lungs making it increasingly difficult to breath.
