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52 Cards in this Set
- Front
- Back
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Squamous cell carcinoma
Def |
is centrally located and arise in segmental and subsegmental bronchi in response to carcinogens
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Adenocarcinoma
Def |
is most prevalent & presents more peripherally as masses or nodules & is prone to metastisis
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Large Cell Ca:
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fast-growing tumor that is peripheral
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Bronchioalveolar Ca
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arises from terminal bronchi & alveoli & is slower growing
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Small Cell Ca:
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arises as a proximal lesion in any part of tracheobronchial tree * most commonly seen in smokers
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Stage of tumor refers to
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size, location, whether lymph nodes are involved, and mets
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Calculate Pack year hx
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# packs per day x # of years smoked
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Risk for Ca determined by
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pack years, age of initiation, depth of inhilation and tar/nicotine levels in cigarettes.
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Risk Factors for Bronchogenic Carcinoma: Environmental & Occupational Exposure
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•Motor vehicle emissions
•Pollutants from refineries & manufacturing plants •Incidence greater in urban areas as a result of pollutant buildup •Radon: colorless, odorless gas found in soil & rocks; seeps into homes thru ground rock -high levels associated with lung Ca especially when combined with smoking •Chronic exposure to industrial carcinogens: arsenic, asbestos, mustard gas, chromates, nickel, oil, & radiation •OSHA laws to control exposure help decrease risk somewhat |
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Risk Factors for Bronchogenic Carcinoma: Genetics & Dietary Factors
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•Familial predisposition
•Incidence in close relatives 2-3x that of general population regardless of smoking status •Risk higher if diet low in fruits & veggies •Carotenoids: Beta Carotene & Vitamin A may be important in reducing risk •Vitamin E, Selenium, Vitamin C, Fat & Retinoids(Vit. A derivatives) may have preventive role |
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Clinical Manifestations of Bronchogenic Ca
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•Insidious & asymptomatic until late in course
•Cough or change in chronic cough •Wheezing -20% of pts. •Dsypnea/stridor •Dysphagia •Weakness, anorexia, weight loss •Fatigue •Hemoptysis •Fever •Unresolved, repeated URIs •Chest or shoulder pain-chest wall or pleural involvement •CP, tightness, hoarseness •Head & neck edema •Pericardial or pleural effusion |
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Common Sites of Metastasis for Bronchogenic Ca
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•Lymph Nodes
•Bone •Brain •ContralateralLung (opposite) •Adrenal Glands •Liver |
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Nursing Assessment of the Client with Lung Cancer
•General Data |
Fever
neck and axillary lymphadenopathy paraneoplastic syndromes(a disease or consequence as a result of cancer in the body e.g. CushingsSyndrome, Hypercalcemia, anemia) |
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Nursing Assessment of the Client with Lung Cancer
•Integumentary: |
–Jaundice(liver mets); edema of neck and face(SVC syndrome), digital clubbin
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Nursing Assessment of the Client with Lung Cancer
Respiratory: |
–Wheezing, hoarseness, stridor, unilateral diaphragm paralysis, pleural effusions(late signs)
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Nursing Assessment of the Client with Lung Cancer
•CV: |
–Pericardial effusion, cardiac tamponade, dysrhthmias(late signs)
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Nursing Assessment of the Client with Lung Cancer
•Neuro: |
–Gait disturbances(brain mets)
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Nursing Assessment of the Client with Lung Cancer
•Musculoskeletal: |
–Pathologic fractures, muscle wasting
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Interventions for Bronchiogenic Ca
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Based on tumor size and mets
•Surgical resection-treatment of choice for early-stage non-small cell tumors without mets |
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Lobectomy:
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single lobe removed
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Bilobectomy:
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two lobes of lung removed
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Pneumonectomy:
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removal of entire lung
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Segmentectomy:
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a segment of the lung is removed
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Wedge Resection:
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removal of a small, pie-shaped areas of the segment -not a curative resection
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Chest wall resection
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with removal of cancerous lung tissue for cancers that have invaded the chest
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Closed-chest drainage (chest tube with underwater seal drainage): Indications and usage
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–After all forms of chest surgery except pneumonectomy
–Promotes evacuation of air and fluid from the pleural space to permit full lung reexpansion –Prevents mediastinal shift by equalizing pressures on both sides of the thorax |
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Closed-Chest Drainage
•Assessment: |
–Amount & type of chest drainage
–Water-seal function (bubbling, suction pressure, amount of water in seal chamber) –Adequacy of breath sounds & RR –O2 saturation |
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Radiation Therapy
Indications |
•Radiation therapy (RT)-useful for neoplasms that cannot be surgically resected but are responsive to RT
•RT may be used to reduce tumor size, make a tumor operable, or relieve pressure on organs •May control spinal cord mets or superior vena caval compression •Prophylactic brain RT to treat microscopic mets to brain •RT relieves cough, CP, DOE, hemoptysis, bone & liver pain -weeks to months |
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Complications of RT:
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esophagitis, pneumonitis, radiation lung fibrosis
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Lung Ca Interventions :Chemotherapy
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•Alters tumor growth patterns, treats distant mets, often an adjunct to surgery or radiation
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Treatment-Related Complications: Chemotherapy
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•Diminished cardiopulmonary function, fibrosis, pericarditis
•Pulmonary toxicity secondary to chemo •Airway clearance is key-TCDB, Chest PT •Assessment of gas exchange as tumor enlarges •Decrease dyspnea with promotion of lung expansion •Pulmonary rehab programs •Relieving fatigue enhances |
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Causes of Laryngeal CA
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•Tobacco
•Alcohol •Exposure to asbestos, mustard gas, wood, leather, & metals •Straining the voice •Chronic laryngitis •Riboflavin deficiency •Family predisposition |
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Laryngeal CA
Risk Factors |
•Occupational exposures: petroleum products, sawdust, asbestos, mustard gas, and other inhaled noxious fumes
•Chronic laryngitis and voice abuse |
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Laryngeal CA
Clinical Manifestation |
•Hoarseness
•Pain •Burning in throat when drinking or citrus juice •Dysphagia •Dyspnea •Foul breath •Weight loss •Throat pain •Neck mass •Aspiration during swallowing |
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Tumor ablation
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–removal while sparing undiseased tissue when possible
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Total laryngectomy: for large glottictumors/fixation of the vocal cords
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–When larynx removed, trachea is sutured to the neck and a permanent tracheostomyis created –therefore the ability to speak is lost and so is the sense of smell (air no longer enters the nose during breathing)
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guidelines the need to remove secretions is evidenced by:
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–coarse or “noisy” breath sounds
–↑ peak inspiratory pressures during volume controlled ventilation –patients inability to generate cough –visible secretions in the airway –suspected aspiration –↑ work of breathing –deterioration of ABGs –restlessness –Feeling of secretions in chest (tactile fremitus) –CXR shows atelectasisor consolidation |
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Larygeal CA
Potential Post-surgical Complications |
•Airway obstruction
•Hemorrhage •Carotid artery rupture •Fistula formation |
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Postoperative Care
Laryngeal Ca |
•Respiratory assessment, including trach tube care
•Maintain semi-Fowler’s or Fowler’s position •Suctioning as needed •CPT, ultrasonic nebulizers •Oxygen therapy •Adequate nutrition •Wound drains/dressing care Assess: ABC’s •Status •Physical •Psychosocial •Comfort •Nutritional status •Ability to swallow •Respiratory status –Function –Airway patency –Lung sounds –Oxygen saturation |
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Clinical Manifestations of ARDS
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•Restlessness
•Change in LOC •Dyspnea –usually the earliest sign •Tachypnea •Accessory muscle use/retractions •Flaring of nares(nostrils) These signs typically appear 12-24 hours after initial injury to capillaries |
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Clinical Manifestations of ARDS
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•Progressive deterioration of lung function
•Injury to alveolar epithelium and pulmonary microvasculature •Arterial hypoxemia (PaO2 less than 50mHg) –resistant to O2therapy •Decreased lung compliance and volumes •NO indication of left ventricular failure Alkalosis initially with low CO2levels (hypocapnia) and hypoxemia •Decreased platelet count •CXR shows consolidation about 24 hrs. after initial injury “ground glass” characteristics |
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PACO2
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35-40
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PAO2
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80-100
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HCO3
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22-36
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PH
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7.35-7.45
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•-Time cycled vent
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terminates orcontrol inspiration after a preset time. Pure time cycling is rarley used for adults.(Newborns/Infants)
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Pressure cycled vent
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delivers a flow of air(inspiration) inil it reaches a preset pressure and cycles off, and expiration ocurs passivley. Inteded for short term use
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Volume cycled vent
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Most commonly used + presure vents today. Volume of air is regulated, Volume of air to be delievered with each inspirtion is preset.
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Complications Related to Mechanical Ventilation
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•Hypotension& Fluid retention
•Barotrauma& ARDS •Stress Ulcers & Malnutrition •Infection •Ventilator dependence |
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Criterial for a
vent weaning trial |
•Respiratory Criteria
•-RR < 38 breaths/min •-Tidal Volume > 325ml •-FiO2 < 50 Criteria for a Weaning Trial •Other Criteria to consider: •-Improvement, correction of active disease process •-Nutritional & fluid status •-Stable cardiac, renal & cerebral status •-Afebrile |
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Consider rentubating if
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RR>30
Increased PaC02 abnormal breathing pattern dysrythmias diaphoresis anxiety dyspnea |
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Nursing careArtificial Airway
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Secure tube -placement mustbe verified –how?
•**Check for end-tidal CO2** •Check for bilateral breathe sounds •Check symmetry of chest expansion •Chest X-ray must be done Also check for air emerging from the ET tube •Ensure humidification •Check cuff for proper inflation pressure •Elevate HOB to ease respiratory effort •Sedation sometimes needed: •*pancuronium(Pavulon) *vecuronium(Norcuron) •*succinylcholine(Anectine) –paralyzing agents |
