Respiratory Malignancies Flashcards
Risk Factors for Head and Neck Cancer
List 11
- Smoking
- Alcohol
- HPV
- Gender: Men 2-3x more common
- Age
- Poor oral Hygiene
- Occupational hazards
- Marijuana use
- GERD
- Poor nutrition: weakens immune system
- Weakened immune system
In young adult population, main risk factor is
HPV
A patient with a history of heavy alcohol use and newly diagnosed with head and neck cancer is admitted for surgery, what should the nurse monitor for?
Alcohol withdrawal
8 S/S of Head and Neck Cancer
- Ear pain (otalgia)
- Nose bleeds (epistaxis)
- Coughing up blood (hemoptysis)
- Difficulty swallowing (dysphagia)
- Difficulty breathing (dyspnea)
- White, patchy lesions (Leukoplakia)precancerous (does not heel after 2 weeks)
- Red, patchy lesions (Erythroplakia)
- Weight loss
Difinitive Dx study for Head & Neck Cancer
Biopsy
If patient has an ENDOSCOPY for dx studies, what should be monitored after procedure before allowing the patient to eat or drink.
Gag reflex- to prevent aspiration
System used by healthcare providers to determine cancer stage
TNM staging system
TNM stands for
- Tumor: size of tumor
- Node: Number and location of involved lymph nodes
- Metastasis: Extent of metastasis (has it spread)
3 main treatments for Head and Neck Cancer
- Chemotherapy & Targeted Therapy
- Radiation
- Surgery
Preferred treatments for Head and Neck cancer
Radiation + Chemo
(chemo on its own does not cure)
Review:
larynx is essential for
normal breathing
protecting the airway
producing sound (speech)
Surgical Treatment:
HIGHEST risk with Partial Laryngectomy
risk of aspiration
- important parts of the throat that prevent food and liquids from entering the airway are removed. Since the airway is still connected to the mouth, there’s a higher risk of aspiration.
Which of the following surgical procedures results in no risk for aspiration?
A) Partial laryngectomy
B) Total laryngectomy
C) Tracheostomy
D) Esophagectomy
B) Total laryngectomy
-Since a total laryngectomy removes the entire larynx, separating the airway from the digestive tract, there is no risk for aspiration. (Separates esophagus and trachea)
Surgical Treatment:
What senses are LOST with a TOTAL Laryngectomy?
List 3
- Normal speech ability is lost
- Sense of smell: air no longer passes thru the nose when breathing, disrupting ability to smell
- Sense of taste
After a total laryngectomy, what type of airway management will a patient require?
permanent tracheostomy
- creates a NEW airway for breathing, as the removal of the larynx eliminates the normal route for air passage through the mouth and nose.
Surgical removal of lymph nodes and surrounding tissues in the neck to eliminate cancerous cells.
Radical Neck Dissection
What are the potential complications of a radical neck dissection that can affect a patient’s physical abilities and appearance?
Complications may include:
* difficulty lifting and turning the head
* shoulder drop on the affected side
* significant physical deformity
Radiation Therapy:
Involves delivering high-energy radiation beams from OUTSIDE the body directly to the tumor.
External beam
Radiation Therapy:
Involves placing radioactive sources directly INSIDE or very close to the tumor.
Internal implants (brachytherapy)
2 types of Internal Implants (brachytherapy)
- temporary
- permanent
Which type of the 2 types of Radiation Therapy is the patient radioctive
Internal implants (brachytherapy)
Review from N2:
2 types of brachytherapy based on the form of the radioactive material
-
sealed (or solid) brachytherapy
-seeds, applicators -
unsealed (or liquid) brachytherapy
-injected,oral: systemically
Type of Brachytherapy where patient emits radiation but NONE in EXCRETIONS (waste products)
Sealed
Type of Brachytherapy where Patient AND Exretion are radioactive
Unsealed
Nursing Responsibilities for Patients receiving Brachytherapy tx.
List 5
- Private Room for Pt
- Limit visits 10-30 mins
- Visitors sit 6 ft away from pt
- No small children or pregnant women
- Assess fistulas or necrosis of adjacent tissue
- Monitor for S/S: burning, excessive perspiration, cills/fever, N/V, diarrhea
Chemo and Radiation (both) are used for which stages of cancers (all cancers)?
III & IV (3/4)
Used with chemotherapy for patients with late-stage head and neck cancer
Targeted Therapy & Immunotherapy
Targeted Therapy & Immunotherapy:
These patients are at high risk for
infection
Fever that is an EMERGENCY situation for chemo patients
Fever of 100.4 F
know
With Head and Neck Cancers we are more concerned with:
List 4
- Airway
- Breathing
- Bleeding
- Infection
Can head and Neck cancers be prevented?
Most can!
* stop tobacco and alcohol
* poor oral hygiene
* HPV infection
Head & Neck Cancer:
Nursing Management for Acute Care
- Teach about the type of treatment pre-op.
- Prepare them to deal with the psychological impact of cancer
- Alteration in physical appearance
- Possible need for enteral feedings
- Potential for altered methods of communication
- Assessment of the support system ( social service)
Post-Op Care for Airway Management
- Inflammation may compress the trachea
- Semi-Fowler’s position to decrease edema
- Frequent suctioning via tracheostomy for patients with laryngectomy
- Adequate fluids to keep secretions thin and mucous membranes moist **
Post-Op Wound Care:
first dressing change after surgery typically performed by
surgeon
*Post-Op: Nutrition *
What clinical indicator suggests that a patient may begin enteral or oral feeding after surgery?
The return of bowel sounds.
What are important considerations for pain control in patients who may not be able to speak?
- Administer analgesic drugs as needed to manage pain effectively.
- Use visual cues, such as the FACES pain scale, to help assess pain levels
- Text-to-speech apps
- Keyboard-based communication
High Mortality, Low cure rates
What cancer am I?
Lung cancer
What is the primary risk factor for developing lung cancer?
smoking
What are the other 2 causes of Lung Cancer
- Radon: gas emitted from soil
- Occupational and environmental causes (industrial pollutants, firefighters, coal miners)
Why is the prognosis for lung cancer generally poor?
due to late diagnosis and the frequent presence of metastasis at the time of detection.
Most Common S/S of Lung cancer
Chronic cough or Bloody cough
Early S/S of Lung Cancer
- Bone pain: due to mestastasis near spine, rib cage, pelvis
- Wheezing sound
- raspy, hoarse voice
- SOB
- Difficulty Swallowing: metastasis tumors can hit nerves near esophagus
2 Late S/S of Lung Cancer
- Unexplained Weight Loss
- Nail Clubbing
DX study that is DEFINITIVE for Lung Cancer
Biopsy
What is the relationship between lung cancer and superior vena cava syndrome?
Lung cancer can cause superior vena cava syndrome (SVCS)
* when a tumor compresses or invades the superior vena cava, leading to obstructed blood flow
What symptoms might indicate the presence of superior vena cava syndrome in a lung cancer patient?
- Facial swelling or puffiness.
- Neck swelling or distention.
- Shortness of breath or difficulty breathing.
- Headaches or dizziness.
- Prominent veins in the neck or chest
2 Treatments for Superior Vena Cava syndrome (SVC)
- Radiation therapy with or without chemotherapyis the mainstay of treatment for most patients.
- Intravascular stents are proven to be safe and effective and allow the most rapid resolution of symptoms
What are key components of respiratory status and care for a patient after lung cancer surgery?
List 5
- Assessment of respiratory status.- IMPORTANT
- Proper positioning to facilitate breathing.
- Use of an incentive spirometer
- “turning, coughing, and deep breathing” (TCDB) techniques.
- Effective chest tube management to ensure proper drainage and lung expansion.
How does effective pain control contribute to preventing hypoventilation in patients?
- When a patient has pain, it can be uncomfortable to take deep breaths or cough.
- If the pain isn’t managed well, the patient might avoid taking deep breaths
- When they’re not in pain, they’re more likely to take deep breaths and cough when necessary.
Repeted:
Lung Cancer- POST OP
No. 1 Emergency Symptom
Fever 100.4 F or greater.
* Most reliable indicator for infection!!
* check WBC!!!!
IMPORTANT
What role does early ambulation play in post-surgery recovery?
Helps prevent DVT and PE, improves circulation, and accelerates recovery.
Treament for Lung cancer leads to several common symptoms.
List 5
- Fatigue
- Nausea/Vomiting
- Anorexia
- Cachexia: wasting of body due to severe chronic illness
- Rashes
- Alopecia (hair loss)
A condition characterized by the collapse or partial collapse of the lung or a section (lobe) of the lung.
Atelectasis
Early signs of Atelectasis
- Decreased breath sounds
- Low grade fever
Late signs of Atelectasis
- cyanosis
- intercostal retractions
Nutrition needed for Lung Cancer patients
high-calorie
high-protein
