Lung Cancer & Chest Tubes Flashcards
What are some risk factors for lung cancer ?
- smokers who are currently smoking
- non smokers who formerly smoked
- non smokers, especially those exposed to second-hand smoke
- inhaled carcinogens: asbestos, radon, chromates
- air pollution
- preexisting pulmonary disease: TB, pulmonary fibrosis, COPD
- risk factors as measured by number of cigarettes smoker in a lifetime
How do you calculate pack years ?
of packs per day X # of yrs smoker
What is curative therapy ?
meant to cure a illness or disease with the goal of a full recovery
What is adjunctive therapy ?
means another treatment used with a primary treatment to assist it
What is palliative therapy ?
provides symptom relief, comfort and support to the patient
- about improving quality of life
- can still seek curative tx
- at any stage of life
What is the pathophysiology of lung cancer ?
- lung cancer arises in the bronchial epithelial cells
- cells are slow growing (this is why it’s so hard to diagnose at an early stage)
- may take 8-10 yrs to grow a tumor 1 cm in size
- occurs primarily in the segmental bronchi and have a preference for the upper lobes
What are some clinical manifestations of lung cancer ?
- clinically silent for the majority of its course
- lung cancer is found on chest x-ray 10% of the time
- persistent cough that produces sputum
- blood tinged sputum
- dyspnea and wheezing
- weight loss and fatigue hoarseness
What are some non-invasive diagnostic studies ?
- chest x-ray
- CT scanning is the most effective non-invasive technique
- sputum cytology can identify malignant cells
- bone scans for metastasis
- PET scan
What are some invasive diagnostic studies ?
- biopsy is needed for definitive diagnosis
- fine needle aspirates
- bronchoscopies
- thoracentesis
- mediastinoscopy
- VAT thoracoscopy (video assisted thorascopy)
What are the types of lung cancers ?
- non small cell lung cancer (NSCLC)is about 80%
- adenocarcinoma 20-30%
- squamous cell carcinoma 30-40%
- large cell undifferentiated carcinoma 10%
- small cell 20%
For what stages of non-small cell lung cancer is surgery an option ?
- stage 1-3a
- 3a: surgery is sometimes an option, chemo and/or radiation therapy
What stages is surgery not an option for ?
stages 3b-4
- 4: metastasized
What are some characteristics of small cell lung cancer ?
- smoking related
- most malignant/worst prognosis
- may be associated with endocrine disorders
- SIADH: watch Na+
- chemotherapy
- radiation therapy
- surgery contraindicated: usually widespread metastasis at time of diagnosis
What are some surgical options ?
- lobectomy: removal of lung lobe
- pneumonectomy: removal of an entire lung
- segmental resection: removing a section of a lobe of the lung
- wedge resection: remove a wedge/lesion-shaped section of lung tissue
- exploratory thoracotomy
- VATS (video-assisted thoracoscopic surgery)
What is a thoracotomy ?
surgical procedure in which a cut is made between the ribs to see and reach the lungs or other organs in the chest or thorax
- Pre-op: NPO
- Post-op: pain meds or epidural, IS ambulation, O2 may or not be needed
- assessments: O2 sats, breath sounds, incision care, manage chest tubes if placed
- operative side up is best ventilation position
What is decortication ?
stripping of a fibrous membrane
What is a pleurodesis ?
instillation of a chemical into the pleural space causing pleura to stick together & prevent buildup of fluid or air in the space
What is a pneumothorax ?
the lungs remains expanded by the negative pressure in the lung lining or pleural space (air in the pleural space)
- when this becomes disrupted the lung will collapse
- chest tubes reestablish this negative pressure and reinflation of the lung
What is hemothorax ?
blood in the pleural space
What is the reason for a chest tube in tension pneumothorax ?
the air in the pleural space is increasing which shifts the vital organs
What is the reason for chest tubes in a pleural effusion ?
fluid in the pleural space that must be drained
What is the reason for a chest tube in empyema ?
purulent fluid gathers in the pleural space
What are some clinical manifestations of pneumothorax ?
- dyspnea
- absent breath sounds on affected side
- increased respiratory effort and rate
- may have tracheal deviation
- decreased O2 saturation
- rapid thread pulse
- decreased or asymmetrical BP
- subcutaneous emphysema
What is the procedure like for a chest tube ?
- inserted by medical professional trained in insertion
- elevated HOB 30 degrees if possible
- area cleansed and local anesthetic applied (lidocaine SQ)
- chest tubes are placed in between ribs forceful and it is painful
- CT is sutured in by HCP
- chest x-ray to verify correct placement
