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Clients with Health Challenges - N3600 > Problems of Oxygenation - Part 2 > Flashcards

Problems of Oxygenation - Part 2 Flashcards

1
Q

What are the different types of LC?

A

Non-small cell LC
- squamous, adenocarcinoma, large cell LC
Small cell LC
- small cell LC

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2
Q

How is LC diagnosed?

A

Usually through imaging - CT, MRI or PET scan

Can also do a lung scan, pulmonary angiography (dye), fine needle aspiration and bronchoscopy/mediastinoscopy

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3
Q

What are the different treatments for LC?

A 
Thoracotomy
Lobectomy, pneumonectomy
radiation
Chemo
Biological therapy
phototherapy
Cryotherapy
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4
Q

Describe the indication or contraindication for the following LC treatments.
Surgery
Radiation
Chemo

A

Surgery - not for small cell as there is widespread metastasis

Radiation - used in combination with surgery and chemo for palliation

Chemo - improved survival in NSCLC

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5
Q

Tissue is destroyed by freezing via bronchoscope

A

Cryotherapy

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6
Q

Describe how phototherapy works.

A

IV injection of Phtofrin, concentrates in tumour cells. 48 hours later, laser light applied and a toxic oxygen form destroys tumour cells.
Necrotic tissue is then removed by bronchoscope.

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7
Q

What are some examples of biologica therapies?

A

IFNs, ILs (interleukins), Monoclonal Abs, Hematopoeitic GFs (growth factors)

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8
Q

Interferes with cancer cell’s ability to metastatize or differentiate, or restore hosts immune mechanism

A

Biological therapy

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9
Q

Where does a bronchoscope go?

A

Through nose, into bronchus

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10
Q

Blockage of an artery in the lungs by a substance that has traveled from elsewhere in the body via the bloodstream.

A

Pulmonary embolism

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11
Q

Symptoms of PE?

A

SOB, chest pain (esp. when breathing in) and hemoptysis

symptoms of a leg clot may also be present - red, warm, swollen and painful leg

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12
Q

What are signs of PE?

A

Low SpO2, tachypnea, tachycardia, mild fever

Severe cases - very low BP, sudden death, loss of consciousness

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13
Q

PE usually results from what?

A

A blood clot in the leg that travels to the lung

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14
Q

phenomenon that is experienced by the individual affected by the disease; subjective

A

symptom

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15
Q

phenomenon that can be detected by someone other than the individual affected by the disease; objective

A

sign

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16
Q

When a person has a PE, where are they sent?

A

ICU - high risk of coding (respiratory arrest)

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17
Q

What is Virchow’s triad?

A

Signs that predispose a person to blood clots. these are:

  • Venous stasis
  • Hypercoaguability
  • Venous endothelial disease
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18
Q

What are certain disease states that predispose a person to PE?

A

post-op/postpartum, heart disease, diabetes, COPD

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19
Q

If smoking and over ___, doctors will not give what to patients? Why?

A

35, oral contraceptives

Because there is a higher risk for developing blood clots

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20
Q

What used to be a very serious risk factor that contributed to DVT in the older days?

A

Pantyhose

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21
Q

How is PE diagnosed?

How is it treated?

A

Dx = based on S&S in combination with test results

Tx - heparin(ize), thrombolytics, CXR, VQ scan, D-dimer test

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22
Q

A lung ventilation/perfusion scan, measures air and blood flow in lungs. most often used to help diagnose/rule out a pulmonary embolism.

A

VQ scan

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23
Q

Blood test to rule out presence of a thrombus. Measures a fibrin degradation product (or FDP), a small protein fragment present in the blood after a blood clot is degraded by firbinolysis. Released after a blood clot breaks up.

A

D-dimer test

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24
Q

What are conditions in which the D-dimer test is used to help rule out the presence of a thrombus?

A

Stroke, DVT, PE

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25
Q

What is injected in a VQ scan?

A

A dye

26
Q

What does the D-dimer test look for?

A

The fibrin degradation product, FDP.

27
Q

Nursing management of PE:

  • How does one minimize the risk of PE?
  • What are some ways in which low mobility patients may be prevented from developing PE or DVT?
  • Daily evaluations of what should be done for pts at high risk for PE?
A

Minimize risk - identify pts at high risk for PE

Preventing thrombus formation:

  • Ambulation and leg exercises
  • do not cross legs
  • rest feet on floor rathen than dangled
  • short term IV/central line placement

Daily evaluations of extremities for pain, temperature, redness and inflammation

28
Q

If we are unable to ambulate pts at risk for PE, what do we do?

A

ROM exercises - only need subtle changes/
Pts can also just change bed position q20 minutes
If pts are unable to do this (e.g. sedated) - order a dynamic surface

29
Q

__% of seniors are at risk for PE.

Long term _____ ______ will promote the development of clotting.

A

40

central lines

30
Q

When we put a person on a blood thinner, what value do we look for?

A

INR - time it takes for clotting to occur - if INR is high, tell doc to hold the blood thinner

31
Q

Nursing management of PE

  • Managing pain?
  • Managing O2 therapy
A

Managing pain

  • semi-fowlers (no more than 30°) for comfort, but NOT high fowlers as this can decrease circulation to lower limbs, and increase pressure trauma over coccyx
  • Frequent repositioning and administration of opiates

O2 therapy
- assess for hypoxemia, monitor O2 sats, encourage DB and C

32
Q

What are some complications of PE?

A

Cardiogenic shock (perform cardiac assesment) or right ventricular failure

33
Q

What is an important aspect of patient teaching for discharge after PE?

A

Elevate foot of bed to promote venous return

Isometric exercises

34
Q

What is some post-op care for PE patients?

What are some teaching points?

A 
Monitor: 
Respiratory status
Urinary output
vascular access sites
BP

Teaching: Elevate FOB, isometric exercises, compression stockings, ambulation, minimize sitting

35
Q

What is the purpose of elevating the FOB for PE patients?

A

Promotes venous return

36
Q

Air in the pleural space resulting in complete or partial lung collapse. Occurs from blunt trauma to chest wall.

A

Pneumothorax

37
Q

Pneumothorax with no external wound.

A

Closed pnuemothorax

38
Q

Also known as a sucking chest wound. Here, air enters through an opening in the chest wall.

A

Open pneumothorax

39
Q

What is the treatment for pneumothorax (open)?

A

Cover wound with a vented dressing, do not remove impaled object.

40
Q

When would be put a chest tube in?

A

If fluid accumulates around the lung

41
Q

When is a chest tube taken out?

A

The nurse will measure the amount of drainage, if it is below 50 mL in 24 hours (variable) - will call physician to pull it out.

42
Q

Medical term for a collapsed lung.

A

atelectasis

43
Q

Medical emergency in which there is rapid accumulation of air with high intrapleural pressures. Will see severe respiratory distress, tachycardia and hypotension, mediastinal displacement and trachea shift.

A

Tension pneumothorax

44
Q

Blood in the intrapleural space

A

Hemothorax

45
Q

Lymphatic fluid in pleural space

A

Chylothorax

46
Q

Resulting from multiple rib fractures, causing chest wall instability.

A

Flail chest - medical emergency!

47
Q

Describe the breathing pattern one observes when a person has flail chest.

A

Get paradoxical breathing - uneven breathing (i.e. one lung up, other down)

48
Q

Describe, in layman terms, a tension pneumothorax.

A

Occurs when fluid around the collapsed lung pushes everything over towards the other lung.

49
Q

Lung anatomy:

  • Lungs covered with ______ pleura
  • Anterior chest wall lined with membrane called _______ pleura
  • The space in between the pleura is filled with _______ fluid; it is called the __________ space
  • ________ intrapleural pressure must be maintained for the lungs to expand
  • _____ leaks are absorbed, but large leaks require the insertion of a _______ ______
A 
visceral
parietal
lubricating; intrapleural
negative
small; chest tube
50
Q

What is the purpose of a chest tube?

A

To provide negative intrapleural pressure

The purpose is NOT to drain fluid out of the long, although it does this through NEGATIVE PRESSURE

51
Q

Describe the placement of a chest tube.

A

Catheter inserted into the 2nd intercostal space to remove air
8th or 9th intercostal space to drain fluid or blood

52
Q

What is the chest drainage system that we use in Ontario?

A

Pleur-Evac chest tube drainage system

53
Q

Chest tubes - Nursing care
- Closed chest tube systems must always be placed how?
How are chest tubes placed?

A

Closed chest tube systems must always be placed lower than the patient’s chest

Chest tubes must be placed upright on floor or hung from bed

54
Q

In the event that a chest tube unit must be raised above the patient’s chest, what is done?

A

The tube is double clamped in this instance

55
Q

Chest tubes nursing care:

  • Follow orders about positioning, if client can lie on operative side, ensure they are not _____ or _______ the tube
  • Loop tubing on the bed so it falls directly to the drainage device and has no ________ loops
  • recheck the tubes each time client is __________
A

kinking or compressing
dependent
repositioned

56
Q

The dressing over top of the chest tube is changed at what frequency?

A

q72 hours

57
Q

Describe the components of respiratory assessment (esp. for high risk patients).

A 
Monitor breath sounds and equality
Respiration rate, pattern, and effort
Heart rate
Chest pain
Oxygen saturation
S&S of pneumothorax (respiratory distress, tracheal deviation, dyspnea)
58
Q

Assess Chest tube insertion site

  • What do we look for regarding the dressing?
  • Dressing change frequency?
  • Look for the presence of? (Will mark border)
A

Is the dressing clean, dry, intact
Document any drainage on/around the dressing
Change dressing minimally q72h
Look for presence of subcutaneous emphysema - mark and document borders and assess frequently for any increase in size

59
Q

Puffed up appearance and “crackling”under the skin caused by air leaking into the SQ tissue

A

SQ emphysema

60
Q

In what case would SQ emphysema cause a change in the position of a chest tube?

A

If there is a lot of crackling - will pull it out and place in a new spot

61
Q

Assess chest drainage (chest tube)

  • Measure and record _______ and _______ of drainage
  • _______ drainage or sudden ______ should be reported
  • Normally, chest drainage is _______ immediately following surgery, but this should not continue beyond a few _____
  • if the fluid level is not changing, check tubes for ______
A

characteristics and amount
excessive, increase
bloody, hours
patency

Clients with Health Challenges - N3600 (22 decks)

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