Respiratory2 Flashcards
Explain penetrating chest trauma?
Open pneumothorax (sucking chest wound). Hemothorax. Tracheobronchial injury. Pulmonary contusion. Diaphragm rupture. Mediastinal injury.
Explain blunt (non-penetrating) trauma?
Fractured ribs. Flail chest. Closed pneumothorax. Tension pneumothorax. Tracehobronchial injury. Diaphragm rupture. Mediastinal injury. Pulmonary contusion.
Common thoracic injury, often associated with flail chest.
Pulmonary contusion. Most often follows injuries caused by rapid deceleration during MVAs. Potentially lethal injury.
How does a pulmonary contusion results in increased secretions?
Hemorrhage and edema in and between alveoli. Decreased lung movement. Decreased gas exchange. Bronchial mucosa irrigation. Increased secretions.
Explain pulmonary contusion?
Injury to lung parenchyma (mild, moderate, severe). Interstitial hemorrhage with resulting alveolar collapse, atelectasis, and consolidation in uninjured areas. Edema in and around are of initial injury. Ventilation decreases, until hypoxia .
Diagnostics and manifestations of pulmonary contusion?
CXR, chest CT
May be asymptomatic initially. Increasing dyspnea and tachypnea. Increasing restlessness. Crackles, wheezes, decreased breath sounds. Hemoptysis. Changes in sensorium due to hypoxia.
Results from direct blunt trauma, such as blows, crushing injuries, strain from severe coughing, or sneezing spells.
Rib fracture. If splintered or displaced, may cause pneumothorax or hemothorax. Ribs 4-10 most commonly involved; often benign and treated conservatively.
S/s of a rib fracture?
Pain at the site of injury, increasing on inspiration. Localized tenderness and crepitus on palpation. Splinting of the chest. Shallow breathing.
Diagnostics and treatment of a rib fracture
CXR. chest CT
Nonspecific treatment. Pain control, promote adequate ventilation. Surgery is pretty rare.
Fractured ribs and/or sternum in numerous places: loss of chest stability. Indication of severe chest trauma.
Flail chest. Thoracic injury with paradoxical motion of the chest wall segments. Often from direct impact, high speed mechanism of injury (MVA or severe fall)
Explain flail chest.
Fx of consecutive ribs in greater than or equal to 2/3 places. Chest wall no longer provides the support needed for normal ventilation. Results in paradoxical breathing. Atelectasis, hypoxemia. Increased work of breathing. Hypercapnia, respiratory acidosis, always involves pulmonary contusion. Bruising of the skin over the injury.
S/s of flail chest?
Severe chest pain, paradoxical breathing, oscillation of mediastinum, increasing dyspnea. Rapid, shallow respiration’s, tachycardia, hypotension, accessory muscle breathing, restlessness, anxiety, decreased breath sounds, cyanosis.
Treatment for a flail chest?
Supportive. Pain control, promote ventilation, humidified O2, incentive spirometry, turn cough deep breathe, early ambulation, mechanical ventilation
Complications of a flail chest?
Pneumothorax, hemothorax, pneumonia, ARDS, shock
Air in the space between the lung and the chest wall. Spontaneous or chest injury related.
Pneumothorax. Open or closed. Diagnosed with CXR.
S/s of a pneumothorax?
Small/slow developing. Asymptomatic maybe. When large/rapidly developing: pleuritic pain, tachypnea, increasing restlessness. Deviation of trachea. Absence of chest movement on the affected side. Crepitus. Decreased breath sounds on the affected side.
Air enters the pleural space on inspiration but cannot leave it on expiration. Accumulating air increases positive pressure in chest cavity.
Tension pneumothorax. Results in lung collapse on affected side. Tracheal shift toward the unaffected side. Respiratory and circulatory function are compromised.
Causes of tension pneumothorax?
Blunt chest trauma. Mechanical ventilation with positive end-expiratory pressure (PEEP). Chest tubes. Central line insertion.
Emergency; can quickly be fatal.
S/s of tension pneumothorax?
Respiratory distress, agitation, tracheal deviation, asymmetry of the thorax, BS on affected side, distended neck veins, cyanosis, hyperresonance on affected side, diminished heart sounds, hypotension, tachycardia, shock, ineffective ventilation, subcutaneous emphysema
Interventions for a chest pneumothorax?
Defect in the chest wall covered with sterile nonporous dressing. Chest tube. Semi-fowler’s. Administer O2. Vitals. Monitor for cardiac dysrhythmia, palpate for subq emphysema, support ventilation
Blood in the pleural space. Chest trauma, blunt or penetrating.
Hemothorax. Pulmonary contusions or lacerations. May stem from the heart, great vessels, or intercostal arteries.
S/s of a hemothorax?
Respiratory distress. s/s of blood loss. Bs diminished. Dull sounds percussion. CXR, thoracentesis
Treatment for a hemothorax?
Chest tubes, IV fluids, blood transfusions, vitals, cardiac monitor, I+O, possible open thoracotomy
What’s the purpose of a chest tube?
Removes unwanted materials (air, fluid) from the pleural cavity allowing the lung to re-expand. Must also prevent air from being pulled into the chest cavity.
Etiology of carcinoma of the larynx?
Increasing in incidence. Greater in men and those older than 65. Associated with smoking, alcohol abuse, chronic laryngitis, coal abuse, and family history.
S/s of carcinoma of the larynx?
Persistent hoarseness. With or without eat pain and dysphagia. Persistent cough and sore throat. Pain and/or burning in the throat.
How to diagnose carcinoma of the larynx?
Direct/indirect fiberoptic laryngoscopy. X-rays, r/o lung or other metastasis. Barium swallow to determine the extent of the tumor and evaluate swallowing. Biopsy to confirm and laryngoscopy ID of the mass if found. CT/MRI to r/o metastatic to lymph nodes or other structures. Nuclear imaging for metastasis.
Treatment for carcinoma of the larynx?
Surgical resection, radiation, chemo.
Resection includes hemilaryngectomy, supraglottic laryngectomy, subtotal laryngectomy, total laryngectomy, radical neck dissection
What is a hemilaryngectomy?
Vertical partial laryngectomy. Half of the larynx is removed. Temp tracheotomy, no swallowing for 7-10 days. Swallowing is not a long-term problem. Voice quality is adequate for communication.
What is a supraglottic laryngectomy?
Horizontal partial laryngectomy. Cancer above the cords. Voice quality not affected. May be 2-3 weeks before oral feedings are resumed. Postop danger of aspiration. Temp tracheotomy.
Explain a total laryngectomy?
Used in advanced cases. Larynx and the surrounding tissues are removed. Permanent tracheotomy. Permanent loss of voice. No trouble with swallowing.
Radical neck dissection?
Only done if the risk of metastasis to the neck is high. Causes atrophy of the trapezius muscle. Shoulder droops on the side of surgery.
Preoperative nursing care for issues with carcinoma of the larynx?
Prepare them for voice changes, swallowing problems, trach and the care involved, diet changes. How the pt will communicate.
Postoperative nursing care for carcinoma of the larynx?
Airway! Trach tube for 5-10 days for partial (cuffed tube initially then changed to uncuffed). Extra trach tube available. Sterile suctioning, O2, humidification. Incentive spirometer. Watch for dyspnea due to edema, secretions. Monitor for signs of aspiration.
Post-op care of a radial neck dissection?
Semi-fowlers (3-45 degrees), neck flexed (minimize suture tension). OOB first post-op day. Drain wounds to prevent fluid accumulation. Max 300 mL in the 1st 16 hours. Monitor for air leaks and infection.
Nutrition for post-op carcinoma of the larynx? Communication and other issues?
NG tube, hyperalimentation until able to swallow. Monitor for signs of aspiration. Adequate fluids to keep secretions thin. Protein needed for wound healing. Body image.
Speech therapy, new techniques may be utilized.
Etiology of lung cancer?
Primary of metastatic. 90% attributed to smoking. Radon gas, occupational and environmental agents, asbestos exposure.
staged by the TNM system
What are the 4 histologic types of lung cancer?
Small cell (10-15%) Non-small cell (85-90%) including: Epidermoid (squamous) 25-30% Adenocarcinoma 40% Large cell 10-15%
Pulmonary manifestations of lung cancer?
Hoarseness, cough, sputum production, hemoptysis, shortness of breath, change in endurance, unilateral where, friction rub, chest discomfort.
Non-pulmonary signs of lung cancer?
Late signs?
Muffled heart sounds, dysrhythmias, cyanosis, clubbing of fingers
Fatigue, weight loss, anorexia, dysphagia, n/v
Diagnosis of lung cancer?
CXR, CT, MRI, PET, thoracentesis, bronchoscopy/needle biopsy, thorascopy, mediastinoscopy, surgical tipsy, sputum cytology, ABG, PFT
Interventions for lung cancer?
Chemo, radiotherapy, surgical management including:
Thoracotomy with tumor removal. Lobectomy (most common for small, potential curable tumors). Pneumonectomy.
These syndromes are most commonly associated with small-cell lung cancer.
Adrenocorticotropic hormone (ACTH)- Cushing’s syndrome
FSH- Gynecomastia
ADH- SIADH; (weight gain, general edema, dilution of serum electrolytes (esp Na))
PTH- Hypercalcemia
Ectopic insulin-Hypoglycemia
