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Nur 336 > Respiratory - Unit 3 - Pulmonary cancer, chest trauma/surgery > Flashcards

Respiratory - Unit 3 - Pulmonary cancer, chest trauma/surgery Flashcards

1
Q

Does pulmonary cancer have a good cure rate?

A

Sadly, no - 90% or more is malignant.

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2
Q

Does pulmonary cancer metastasize quickly?

A

YES - very quickly.

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3
Q

Is pulmonary cancer the leading cause of cancer death?

A

YES

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4
Q

What are some pulmonary cancer risk factors?

A

CIGARETTE SMOKING = #1 (10x more likely in smokers and African Americans) environmental smoke, air pollution, occupational factors, radon, vitamin A deficiency

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5
Q

What are some diagnostic tests for pulmonary cancer?

A

Chest X-Ray, sputum, CT/MRI of chest, bronchoscopy w/biopsy, lung biopsy

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6
Q

What are some symptoms of pulmonary cancer?

A

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.

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7
Q

What surgeries might be done for pulmonary cancer? (4 types)

What are the priority nursing interventions for these surgeries?

A

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.

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8
Q

Will a patient have a chest tube with a pneumonectomy?

A

NOPE - just the others. No need for a chest tube when there’s no lung!

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9
Q

What are some problems with radiation therapy for a lung cancer patient?

A

Pneumonitis (alveoli wall inflammation), fatigue, discomfort, nutrition, skin integrity, knowledge deficit

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10
Q

Chemotherapy - never used for lung cancer patients. T/F?

A

FALSE - it is the treatment of choice.

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11
Q

What are some nursing considerations for chemo treatment?

A

Decreased immunity, sickness, fatigue, SOB, stomatitis

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12
Q

What are some complications of pulmonary cancer?

A

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)

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13
Q

What is pleurisy? What’s the onset?

A

Inflamed intrapleural space with an abrupt onset.

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14
Q

What causes pleurisy?

A

Viral, bacterial, surgical

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15
Q

What are some symptoms of pleurisy?

A

Non-specific pain with INSPIRATION, deep breathing, laughing, coughing, pleural rub on inspiration

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16
Q

How do we treat pleurisy?

A

Analgesics, heat to chest, antibiotics if bacterial

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17
Q

What is pleural effusion?

A

Fluid or blood in pleural space (up to 5L)

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18
Q

What causes pleural effusion?

A

Lung cancer, CHF, liver or kidney failure, pleural inflammation (viral or bacterial)

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19
Q

What are symptoms of pleural effusion?

A

Asymptomatic if

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20
Q

How do we treat pleural effusion?

A

Treat underlying condition, thoracentesis, chest tube

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21
Q

What are some complications of pleural effusion?

A

Atelectasis/depends on underlying condition

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22
Q

With a chest tube, what does fluid movement with inspiration indicate?

A

Tidaling - test tube is patent!

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23
Q

25% of traumatic deaths result from chest injuries. T/F?

A

True

24
Q

What is a pulmonary contusion?

A

Bruising of lung tissue.

25
Q

What is a pneumothorax?

A

Air in pleural space.

26
Q

What is a hemothorax?

A

Air and blood in pleural space

27
Q

What is a rib fracture?

A

sharp, knife-like pain.

28
Q

What is flail chest?

A

Loss of fixation of chest wall.

29
Q

What is tracheobronchial trauma?

A

Mediastinal shift

30
Q

What is crepitus?

A

Subcutaneous emphysema w/ pneumothorax - it’s like rice krispies.

31
Q

Chest Trauma - what is A-J (all the common ones) ?

A 
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
32
Q

What is a pneumothorax?

A

collapsed lung by trauma or similar circumstances - air becomes trapped and it collapses.

33
Q

What are the four types of pneumothorax?

A

Spontaneous/Closed/Tension/Open

34
Q

What’s a hemothorax?

A

Collection of blood in the space between the lung and the pleural cavity

35
Q

What’s a closed pneumo?
Tension pneumo?
Open?

A

Closed = air in between visceral - can’t escape.
Tension = air increases but can’t escape.
Open would be like someone was stabbed

36
Q

What are some symptoms of a pneumo?

A

Increasing dyspnea, increasing restlessness/agitation, asymmetrical chest movement, crepitus, hyper resonance, etc

37
Q

How do we treat a pneumo?

A

O2, chest tubes, pain control, antibiotics, open - occlude open wound

38
Q

If there’s a pneumothorax, where’s the chest tube placed?

A

Higher

39
Q

If there’s a hemothorax, where’s the chest tube placed?

A

Lower

40
Q

Why is a chest tube used to treat a hemo/pneumo?

A

Remove air or fluid/re-expand lung

41
Q

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?

A

True

42
Q

What are the three chambers of a chest tube system?

A

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)

43
Q

100-200 cc per hour after heart surgery in a chest tube. T/F?

A

True!

44
Q

Chest surgery - more than 100 cc/hr of drainage? What do we do?

A

REPORT IT

45
Q

If the drainage system bubbles after surgery, is that okay?

A

Yes, but not if it happens suddenly and hours after

46
Q

What are some chest tube assessment things?

A

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.

47
Q

What are some rules for a closed chest drainage system?

A

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

48
Q

What’s the heimlich valve?

A

The duck bill valve - keeps air (that shouldn’t be there!!) from coming into your chest.

49
Q

What’s a flail chest?

A

loss of fixation of a portion of the chest wall from multiple fractured ribs so the chest moves freely in that area.

50
Q

What are some symptoms of flail chest?

A

Dyspnea, hypoxia, sharp knife-like pain, crepitus, chest wall hematoma and edema, hemoptysis, absent breath sounds

51
Q

How do we treat flail chest?

A

Stabilize area with chest binder, CMV/O2, pain control/anesthetic blocks, chest tubes if pneumo is present.

52
Q

Are patients with flail chest prone to developing pneumonia?

A

YES

53
Q

What’s a VAT?

A

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.

54
Q

Should we keep an extra trach at the bedside for a patient who has a trach?

A

YES - in case something goes wrong.

55
Q

What are some benefits to a trach?

A

Less damage, client comfort, able to eat/talk.

56
Q

If you have to suction a patient, do you need to give them O2?

A

Yes - hyper-oxygenate them!

57
Q

What are signs your patient needs to be suctioned?

A

Excessive cough, decreased O2, congestion, frothy sputum, etc.

Nur 336 (26 decks)

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