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40 Cards in this Set
- Front
- Back
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Lung Cancer
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#1 cancer killer of men and women
Primarily affects pts. 60-70 yr old 5% under age 40 Cigarette smoke is #1 cause Adenogin carcinoma is most common |
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Where does lung cancer like to metastasize?
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Liver, bone, brain and in adrenal glands. May do a PET scan to detect sites.
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Pathophysiology of lung cancer
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Arise from a single transformed epithelial cell in the tracheobronchial tree (airway)- the carcinogen material attaches itself to the cell and causes that transformation in the DNA of the cell and turns off at automatic stop order, typical and then we have increase in the number of cells. (hyperplasia) This is term we use for cancer cells, so we have hyperplasia of the tissues.
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Hyperplasia
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Increased NUMBER of cells
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Hypertrophy
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Increase in the size of EXISTING cells.
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Small cell ( classification of lung cancer)
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15-20% of tumors
Spreads quickly, fast- growing Arises from major bronchi and spreads along bronchial walls. They are called bronchogenic tumors=starts in major branches of bronchial tree Lots of secretions, blood tinge sputum |
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Non-small cell (classification of lung cancer)
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80-85% of tumors
metastasizes easier Rises in peripheral masses or nodules into lung field Looks like snowball on CXR Most are adenocarcinoma, some may be squamous cells May have persistent cough for years |
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Risk factors of Lung Cancer
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Smoking #1
2nd hand smoke Environmental-Radon #1, industrial carcinogens, arsenic Genetic predisposition |
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Clinical Manifestations of lung cancer
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#1 = cough or change in chronic cough
Hemoptysis-blood tinge sputum Dry, persistent cough 20% have wheezing |
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Diagnostics of lung cancer
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CXR- cotton ball effect (non-small cell)
CT scan- identify small nodules Sputum- rarely diagnostic |
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Definitive Diagnosis
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Fine needle aspiration and biopsy for non- small cell.
Bronchoscopy for small cell. |
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Medical management of lung cancer
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Surgery is #1 choice- to excise tumor, lobe or whole lung. (pneumonectomy)Radiation- Done pre-op to decrease size of tumor
Chemotherapy- can cause pneumonitis, used to decrease size. Palliative therapy- help with pain, decrease stress on other organs. |
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Nursing Management of lung caner
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Relieve breathing problems
Deal w/ n/v assoc with chemo and radiation Turn, cough, deep breath Suctioning Humidified oxygen Chest physiotherapy Bronchodilators- albuterol Reduce fatigue Lots of psychological support |
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What are complications of radiation?
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Collateral damage of pulmonary fibrosis- destroys other lung tissue and turns it into scar tissue; pericarditis (corpulmonale) a loss of right ventricular function because of lung pathology. ARDS can cause corpulmonale by increasing pulmonary artery pressures and cause right sided failure.
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Definition of Pulmonary Embolism
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Obstruction of a section of pulmonary artery or one of its branches by a thrombus, comes from right side of heart.
Usually start in lower extremity |
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Risk Factors of PE
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Venous stasis- slowing of blood flow in vein (prolonged sitting)
Hypercoagulability- due to release of tissue thromboplastin; injury, tumor, increased platelet ct Venous Endothelial- thrombophlebitis, vascular disease, foreign bodies Certain disease states- ht disease, trauma, postop |
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Other predisposing conditions of PE
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age, obesity, pregnancy, oral contraceptive use, hx of previous thrombophlebitis, constrictive clothing, varicose veins, spinal cord injuries, COPD, diabetes
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Patho of Pulmonary Embolism
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Increased platelet clumping on valves in deep veins.
Clot forms small piece of clot breaks off moves through right side of ht occludes pulmonary artery or its branches |
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More Patho of PE
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If thrombus obstructs pulm artery we have alveolar dead space(no perfusion around alveolar)
Air is getting into alveoli sac but no blood to get oxygen in to, so problem with perfusion. The area thats ventilated receives little or no blood flow then gas exchg is impaired. All depends on how big clot as to how much lung capacity is diminished Rt side has to work harder to pump blood against embolism |
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Cor pulmonale
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failure of rt ventricle due to lung issues
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Clinical Manifestations of PE
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Most frequent symptom is dyspnea
" " sign is tachypnea Chest pain- sudden onset Tachycardia SOA, Anxiety, apprehension low grade fever impending sense of doom |
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Diagnostics of PE
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D-dimer tells if pt is at risk for developing blood clot
CAT scan V/Q scan pulmonary angiography EKG venous dopplers |
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Medical management of Emergency situation of PE
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Anti-coag immediately, heparin drip
Thrombolytics if w/in 6hr - into rt side of ht Surgery- throbectomy done if large clots cut off circulation IVC filter collects clots- surgical procedure, like an umbrella, expands and catches clots. Done on venous side of vena cava |
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Nursing management of PE
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Active ROM, early ambulation
watch for signs of DVT; unilateral swelling, redness,warm Patent airway, use incentive spirometer Medication is heparin #1, narcotic analgesics for chest pain. |
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Discharge instructions for PE
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Target INR=2.0-3.0 for PE, will need to ck 1x/ wk then q 2wks as it stabilizes
No dangling legs, constrictive clothing |
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How to prevent and report DVT and PE
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Be able to describe these things;
Underlying process Need for continued anticoagulant therapy, SE of coagulation like bruising/bleeding ie. no sharps, no aspirin while on warfarin, avoid laxatives (effects vit k), report dark tarry stools S/S of lower extremity compromise such as swelling or calf pain When to contact HC provider Ways to prevent PE; no legs crossed, drink fluids to avoid hemoconcentration esp. in warm weather, wear stockings |
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Oxygen Therapy
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Changes in respiratory rate or pattern:
Hypoxemia= low O2 sat of blood Hypoxia= low O2 at tissue level ( poor gas exchange, cardiovascular disease) |
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Types of Hypoxia
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Hypoxemic hypoxia- dec. O2 level in blood resulting in dec. O2 diffusion in tissues. Causes are hypoventilation, high altitiudes, PE, atelectasis.
Circulatory hypoxia- resulting in inadequate capillary circulation. Caused by dec. cardiac ouput, shock, cardiac arrest. Annemic Hypoxia- decrease in hemoglobin concentration. Histotoxic hypoxia- toxc substance like cyanide, interferes with tissues ability to use oxygen. |
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Oxygen Toxicity
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occurs when to high a concentration of oxygen (greater than 50% is administered for longer than 48hr.
*** Restlessness, substernal discomfort and fatigue 2hr on 100% 6hr on 80% 48 hr on 50% |
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Oxygen devices
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Low flow- contribute ox to room air
>Cannula 1-2L- mucosal drying >Oropharyngeal catheter 1-6 L chg frequently to alternate nostril >Mask, simple 6-8 L >Mask, partial rebreather 8-11 >Mask, non-rebreather 12L- pt will suffocate if you put to low of air on them High flow- deliver total amt of inspired air >Transtracheal cath 1/4-4L req. surgical intervention and regular cleaning >Mask, venturi 4-6L*** most accurate >Mask, aerosol 8-10L >Trach collar 8-10L >T-piece 8-10L >Face tent 8-10L |
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Negative Pressure Ventilators
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Adjust the neg and pos pressure and the volume controls how much ventilatory effort. Machine can provide some or all.
Can adjust how much lung is inflated |
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Positive pressure Ventilators
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inflates lungs by excerting pos pressure on the airway, pushing air in, forcing alveoli to expand during inspiration
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Volume Control ventilators
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Control- every respiration is provided by the ventilator
volume control- mainly use Assist control- detects if certain amt of time has gone between resp, it will assist SIMV- synchronized intermittent mandatory ventilation, synchronized and helps with own resp. PEEP- positive and expiratory pressure, can use less supplemental oxygen CPAP-continuous pos. airway pressure. |
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CPAP
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Gas exchg. takes place during first third of expiration. Same thing as pursed lip breathing. Slows down pressure and increased expiration to provide gas exchg. Keeps alveoli sacs open.
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Endotracheal Intubation
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Nasal or oral
soft cuff- inflates to create a seal, occludes trachea and becomes airway Prevents tracheal necrosis Prevents aspiration Tracheostomy- cuffed, fenestrated or cuffless |
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Care of endotracheal intubation
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Daily cleaning- sterile in hospital, clean technique at home
Change ties daily Place new ties before removing old ones |
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Nursing Process for ventilated pt.
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>Alarms on at all times
>Empty tubing of accumulated water >Enhance gas exchg. by positioning, turning, incentive spirometer, ABG's >Promote airway clearance- humidified air to thin secretions. >prevent infection >Communication >monitor cardiac function >Mobility- ROM |
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Nutrition for ventilated pt
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^ protein 25% total calories
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How do you prep for weaning from ventilator
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ABG's, CPAP trial, bedside pulmonary function
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Complications of ventilated pts
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monitor chest tubes for pneumothorax
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