Respiratory - Unit 3 - Pulmonary cancer, chest trauma/surgery Flashcards
Does pulmonary cancer have a good cure rate?
Sadly, no - 90% or more is malignant.
Does pulmonary cancer metastasize quickly?
YES - very quickly.
Is pulmonary cancer the leading cause of cancer death?
YES
What are some pulmonary cancer risk factors?
CIGARETTE SMOKING = #1 (10x more likely in smokers and African Americans) environmental smoke, air pollution, occupational factors, radon, vitamin A deficiency
What are some diagnostic tests for pulmonary cancer?
Chest X-Ray, sputum, CT/MRI of chest, bronchoscopy w/biopsy, lung biopsy
What are some symptoms of pulmonary cancer?
Persistent cough with or without blood, rust-streaked sputum, frank hemoptysis (coughing up blood), hoarseness, dyspnea, wheezing, pneumonia, chest pain or tightness, fatigue, anorexia/weight loss, etc.
What surgeries might be done for pulmonary cancer? (4 types)
What are the priority nursing interventions for these surgeries?
Wedge Resection - tiny piece removed.
Segmentectomy (a segment is removed)
Lobectomy - a lobe is removed
Pneumonectomy - a whole lung is removed.
Interventions = O2, Pain, etc.
Will a patient have a chest tube with a pneumonectomy?
NOPE - just the others. No need for a chest tube when there’s no lung!
What are some problems with radiation therapy for a lung cancer patient?
Pneumonitis (alveoli wall inflammation), fatigue, discomfort, nutrition, skin integrity, knowledge deficit
Chemotherapy - never used for lung cancer patients. T/F?
FALSE - it is the treatment of choice.
What are some nursing considerations for chemo treatment?
Decreased immunity, sickness, fatigue, SOB, stomatitis
What are some complications of pulmonary cancer?
Pleural effusion (dyspnea, cough, chest pain, fever, diminished breath sounds, anxiety), Hyperglycemia (stimulated by tumor), altered mental status (brain metastasis - which is usually caused by lung cancer 50% of the time)
What is pleurisy? What’s the onset?
Inflamed intrapleural space with an abrupt onset.
What causes pleurisy?
Viral, bacterial, surgical
What are some symptoms of pleurisy?
Non-specific pain with INSPIRATION, deep breathing, laughing, coughing, pleural rub on inspiration
How do we treat pleurisy?
Analgesics, heat to chest, antibiotics if bacterial
What is pleural effusion?
Fluid or blood in pleural space (up to 5L)
What causes pleural effusion?
Lung cancer, CHF, liver or kidney failure, pleural inflammation (viral or bacterial)
What are symptoms of pleural effusion?
Asymptomatic if
How do we treat pleural effusion?
Treat underlying condition, thoracentesis, chest tube
What are some complications of pleural effusion?
Atelectasis/depends on underlying condition
With a chest tube, what does fluid movement with inspiration indicate?
Tidaling - test tube is patent!
25% of traumatic deaths result from chest injuries. T/F?
True
What is a pulmonary contusion?
Bruising of lung tissue.
What is a pneumothorax?
Air in pleural space.
What is a hemothorax?
Air and blood in pleural space
What is a rib fracture?
sharp, knife-like pain.
What is flail chest?
Loss of fixation of chest wall.
What is tracheobronchial trauma?
Mediastinal shift
What is crepitus?
Subcutaneous emphysema w/ pneumothorax - it’s like rice krispies.
Chest Trauma - what is A-J (all the common ones) ?
A - Aortic Tear B - Bronchial Tear C - Cord Injury D - Diaphragmatic rupture E - Esophageal Injury F - Flail Chest G - Gas in chest (pneumothorax) H - Hemothorax I - Infarction J - HVD
What is a pneumothorax?
collapsed lung by trauma or similar circumstances - air becomes trapped and it collapses.
What are the four types of pneumothorax?
Spontaneous/Closed/Tension/Open
What’s a hemothorax?
Collection of blood in the space between the lung and the pleural cavity
What’s a closed pneumo?
Tension pneumo?
Open?
Closed = air in between visceral - can’t escape.
Tension = air increases but can’t escape.
Open would be like someone was stabbed
What are some symptoms of a pneumo?
Increasing dyspnea, increasing restlessness/agitation, asymmetrical chest movement, crepitus, hyper resonance, etc
How do we treat a pneumo?
O2, chest tubes, pain control, antibiotics, open - occlude open wound
If there’s a pneumothorax, where’s the chest tube placed?
Higher
If there’s a hemothorax, where’s the chest tube placed?
Lower
Why is a chest tube used to treat a hemo/pneumo?
Remove air or fluid/re-expand lung
To remove chest tube, have the patient full breathe in, hold breath, and remove + cover with gloved hand until covered with something permanent, T/F?
True
What are the three chambers of a chest tube system?
Drainage (marks drainage)
Suction (-20 to -10 cm H20)
Water seal - either a dry system (uses a valve or air leak) or a WET system (uses water seal)
100-200 cc per hour after heart surgery in a chest tube. T/F?
True!
Chest surgery - more than 100 cc/hr of drainage? What do we do?
REPORT IT
If the drainage system bubbles after surgery, is that okay?
Yes, but not if it happens suddenly and hours after
What are some chest tube assessment things?
Fluid movement with inspiration (patency), assess for respiratory distress, air leaks, chest movement, crepitus, dressing, breath sounds and vital signs, fluid replacement, ROM and increase activity, pain control, etc.
What are some rules for a closed chest drainage system?
Collection apparatus below chest level, coil tubing in bed, NO pins or clamps, assess patency, tape all connections, asepsis, I&O every 8 hours, suction should be at 10-20 Cm H20
What’s the heimlich valve?
The duck bill valve - keeps air (that shouldn’t be there!!) from coming into your chest.
What’s a flail chest?
loss of fixation of a portion of the chest wall from multiple fractured ribs so the chest moves freely in that area.
What are some symptoms of flail chest?
Dyspnea, hypoxia, sharp knife-like pain, crepitus, chest wall hematoma and edema, hemoptysis, absent breath sounds
How do we treat flail chest?
Stabilize area with chest binder, CMV/O2, pain control/anesthetic blocks, chest tubes if pneumo is present.
Are patients with flail chest prone to developing pneumonia?
YES
What’s a VAT?
Video Assisted Thoracic Surgery - view lung, biopsy, remove cancer nodes, blebs, pleurodesis (pleural space is artificially obliterted), treats pleural effusion, no chest tubes, short LOS, less post-op pain, etc.
Should we keep an extra trach at the bedside for a patient who has a trach?
YES - in case something goes wrong.
What are some benefits to a trach?
Less damage, client comfort, able to eat/talk.
If you have to suction a patient, do you need to give them O2?
Yes - hyper-oxygenate them!
What are signs your patient needs to be suctioned?
Excessive cough, decreased O2, congestion, frothy sputum, etc.
