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207 Cards in this Set
- Front
- Back
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recurrent apnea during sleep
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obstructive sleep apnea
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deviated nasal septum, hypertrophy or turbinate bones, nasal polyps
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nasal obstruction
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what can nasal obstruction lead to
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freq infections leading to sinusitis
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location of this can make one susceptible to injury
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fx of nose
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what can fx of the nose result in (4)
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- hematoma
- infection - abscess - avascular/ septic necrosis |
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rupture of tiny, distended vesesl in mucous membrane in any area of the nose
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epistaxis
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common place for epistaxis
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anterior septum
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risk factors for epistxis (10)
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- local infection
- systemic infection - dry mucuos membranes - trauma - arteriosclerosis - HTN - tumor - thrombocytopenia - ASA use -liver disease |
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can result in obstruction of the airway
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epistaxis
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edema of mucous membrane can obsttruct narrow opening b/t glottis, occluding air flow (life threatening)
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laryngeal obstruction
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number of all head and neck cancers that involve the larynx
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1/2
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age for larynx Ca
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60-70
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larnyx Ca more frequent in whom
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4-5x greater in males
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% of lymph node involvement at time of presentation of larynx ca
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55%
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what do most larynx Ca arise from
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- surface epithelium (results in squamous cell) very invasive
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lifetime survival without lymphnode involvement
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75-95%
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when does larynx Ca usually reoccur
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2-3yrs and after 5 years recurrance is usually new primary malignancy
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risk factors for larynx Ca (8)
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- carcinogens
-tobacco - ETOH - asbestos - chemicals -straining voice - chronic laryngitis familial predisposition - riboflavin deficiency (vit B) |
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supraglottis
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above
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late Sx of larynx Ca (6)
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- dysphagia
- dyspnea - unilateral nasal obstruction/discharge - persistant hoarseness - persistant ulceration - foul breath |
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Sx if larnyx Ca metastasis (3)
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- cervical lymphadenoppathy
- wt loss - pain radiating to ear |
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manifestations of larynx Ca (6)
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- hoarseness >2wks if in glottis
- may sound harsh - raspy - lower pitch - persistant cough/sore throat - lump may be felt in neck |
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if larynx Ca is subglottic or supraglottic what happens
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voice changes may not be present as early Sx
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what occludes the airway in obstructive sleep apnea
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palate
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most common reason for seeking healthcare and for absences from school and work
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URI's
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% of URIs caused by virus
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90
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how can one dx larynx cancer (5)
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- Hx and Px
- laryngoscopy - CT - MRI - tissue sample |
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nsg mgnt for larnyx ca (4)
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- airway mgnt
- post op care - education - emotional support |
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medical mgnt for larnyx Ca (3)
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- cure (goal)
- preservation of useful voice - avoid permanent trach |
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what is prognosis of larynx ca r/t (5)
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-gender
-age -features of tumor -initial dx - recurrence |
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have a high risk of node involvement (spread quicker)
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supraglottic
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can shrink tumor
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radiation
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complete removal of larynx
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total laryngectomy
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when is total laryngectomy used (3)
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- advanced laryngeal Ca
- tumor extending beyond vocal cords -recurrance following high dose radiation |
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what does total removal of larynx include (8)
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- larynx
- hyoid bone - epiglottis - cricoid cartilage - 2-3 rings of trachea - tongue - pharyngeal wall - trachea preserved |
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what does total laryngectomy result in (3)
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- permanent trach
- normal swallowing - permanent loss of voice |
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why does one with a total larn need a permanent trach
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from lack of communication b/t upper resp and trachea
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can help restore loss of speach (3)
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- esophageal speech
- electric larynx - tracheoesophageal puncture |
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communication b/t trachea and esophagus to use tongue and mouth
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- tracheoesophageal puncture
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belch on command to move air and use mouth/tongue to form words
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esophageal speech
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transmits speech
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electric larynx
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what do goals for surgical mgnt include minimizing effects on (3)
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-speech
-swallowing - breathing |
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done in early phase and can sometimes treat if done early enough
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vocal cord stripping
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removal of mucosa edge of vocal cord
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vocal cord stripping
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what is vocal cord stripping used with (3)
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- dysplasia
- hyperderatosis - leukoplakia |
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excision of the vocal cord usually by laser
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cordectomy
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when is cordectomy used
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with lesions middle 1/3 of vocal cord
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with cordectomy, what is voice quality r/t
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extent of tissue removal
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microsurgery considered to be treatment of choice as improved outcomes w /fewer side effectts
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laser surgery
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what is laser surgery used for
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early tumors without large vascular involvement
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used in early stages in glottic area when only one vocal cord invol
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partial laryngectomy
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which type of surgical mgnt has a high cure rate
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partial laryngectomy
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what happens with parital laryngectomy (3)
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- portion of larynx, tumor, and 1 vocal cord removed
- airway intact - voice quality may change or may sound hoarse |
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strategies to prevent atelectasis (4)
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-frequent repositioning
- earliy mobilization - deep breathing/ IS - secretion mgnt |
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used to prevent atelectasis by keeping alveoli open
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TCDB
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mgnt of atelectasis (6)
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- improve ventilation and remove secretions
- same as prevention - PEEP (keeps airway open) - CPPB -secretion removal w/coughing/suctioning - intubation and mech vent |
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what is the goal with mgnt for atelectasis
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improve ventilation and remove secretions to get adequate gas exchange
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closure or colapse of alveoli
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atelectasis
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when is acute atelectasis seen (2)
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post-op or immobilized pts
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when is chronic atelectasis seen
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chronic airway obstruction
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S&S of atelectasis (4)
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- dyspnea
- cough - sputum production - resp distress (if large area) |
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what are the hallmarks of atelectasis (3)
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- tachypnea
-dyspnea - mild to mod hypoxia |
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what does collapse of alveoli cause
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no gas exchange
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acute inflammation of mucous membranes of trachea and bronchial tree
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acute tracheobronchitis
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what does Acute Trach often follow
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URI
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causes of acute trach(5)
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- strep pnemonaie
- H flu - mycoplasma pneumonaie - aspergillus (fungal) - inhalation of irritants |
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S&S of acute trach (6)
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- dry cough
- mucoid sputum - SOA - stridor -wheezing - purulent sputum |
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tx for acute trach (5)
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- fluids to thin secretions
- managed in home - tx symptoms - Abx depending on Sx - sputum culture |
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inflammation of lung parenchyma
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pneumonia
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what can pneumonistis inflammation of lung tissue predispose for
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microbial invasion
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causes of pnemonia (4)
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-bacterial
- mycobacteria - fungi -viruses |
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how can one get pneumonia other than organisms (4)
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- community acquired
- hospital acquired - immunocompromised host - aspiration |
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what type of pneumonia is common in immunocompromised
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fungal d/t decreased resistance
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more at risk for viral pneumonia
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children (uncommon in adults) atypical pneumonia
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how can one determine the type of pneumonia
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by finding out where they got it from (community, nsg home) and it helps dictate Abx to use
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causes lack of air in pneumonia
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density in lungs
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what does pneumonia affect (2)
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ventilation and diffusion
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what can exudate in alveoli block
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diffusion of 02 and C02
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occludes ventilation with pneumonia
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secretions and mucosal edema
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cause of arterial hypoxemia
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ventilation-perfusion mismatch
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prevention of pneumonia (6)
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-hand hygiene
- pneumococcal vaccine (>65) - staff education and infection prevention - infection/microbiologic survel - prevention of transmission - modifying host risk for infection |
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mgnt of pneumonia (7)
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- Abx (based on organism)
- blood cultures - tx prior to ID of organism based on where it was caught) - adjust Abx per ID - supportive w/ viral - hydration - mtr for S&S of shock and resp failure |
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interventions for pneumonia (5)
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- encourage fluid intake
- encourage CDB - CPT if needed - assess and eval of response to mgnt -bundle care to increase comfort and less stress |
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how can overtreatment of pneumonia occur
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by using broad spectrum ABX
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what should be done if no improvement of pneumonia within 48 hrs
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re-revaluate
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when are cultures done for Dx of pneumonia
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only when Abx is not working
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what can be done if nothing is working to treat pneumonia
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bronchoscopy
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why can one often not see sputum with pneumonia
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bc its too thick to move around
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Dx for pneumonia (4)
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-Hx
-exam -CXR (confirmation - cultures |
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S&S of pneumonia (8)
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- Ha
- low grade fever - pleuritic pain - mayalgia - rash - pharyngitis - mucoid/mucopurulent sputum - orthopnea |
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what can alter the S&S of pneumonia
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underlying conditions
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what is mucopurulent sputum
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thick
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what does pulmonary TB affect (5)
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- lung parenchyma
- meninges - kidneys -bones -lymph nodes |
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what is pulmonary TB
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an acid fast aerobid rod (affects lungs)
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how is pulm TB spread
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- airborne (talking,coughing, sneezing, laughing, singing)
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what happens to bacteria in pulm TB
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they become dormant
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what happens if bacteria calcify in pulm TB
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form collagenous scar
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results in bronchopneumonia (2-10wks after exposure)
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accumulation of exudate
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how does pulm TB take place
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inhaled mycobacteria settle in alveoli causing inflammatory response
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masses of live and dead bacilli surrounded by macrophages wall off becoming fibrous tissue mass
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Ghon tubercle (seen on xray)
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what can happen with the ghon tubercle (3)
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-calcify and form collagenous scar
-ulcerate reactivating disease - continued process spread to lungs |
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S&S of pulm TB (5)
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- low grade fever
- cough (prod-nonpro and may have hemoptysis) -night sweats - fatigue -wt loss |
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Dx of Pulm TB (4)
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-Tb skin test
- CXR - acid-fast bacillus smear - sputum culture |
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mgnt of pulm TB (2)
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- antiTB agents (6-12mths)
- prevent transmission |
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what are the antiTB agents (4)
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-isoniazid
-rifampin - pyrazinamide -ethambutol |
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what happens after one has a + TB skin test
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testing stops bc they will always remain + after
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necrosis of pulmonary parenchyma caused by microbial infection, usually aspiration of anaerobic bacteria
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lung abscess
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at risk for lung abscess (10)
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- impaired cough reflex
- swallowing difficulties - CNS disorders - drug addiction - alcoholism - esophageal disease - compromised immune func - no teeth -ng tube feeds - altered state of conscious |
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where can lung abscess be found
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in areas affected by aspiration (r/t gravity and positionin)
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Dx for lung abscess (3)
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- CXR
- sputum culture - bronchoscopy |
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tx of lung abscess (4)
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- IV abx
- CPT - drain of abscess - percutaneous catheter placement (long term drng) |
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seen on Px exam of lung abscess (3)
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- chest dullness on percussion
- decreased or absent sounds - intermittent pleural friction rub |
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inflammation of parietal visceral pleural membranes
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pleurisy
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what causes the pain in pleurisy
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severe sharp knifelike pain when membranes rub together during resps
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when can pleural friction rub be heard
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early on (once fluid accumulates its not heard)
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tx for pleurisy (3)
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- pain mgnt
- ID of underlying cause - supportive care |
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what are ones with pleurisy at high risk for
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atelectasis d/t not breathing affectively
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collection of fluid in pleural space
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pleural effusion
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what is pleural effusion usually secondary to (8)
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- heart failure
- TB - pneumonia - pulm infection - nephrotic syndrome - connective tissue disease - PE - neoplastic tumors |
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what do Sx depend on with pleural effusion
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- amt of fluid
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Dx for pleural Effusion (4)
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- CXR
- CT - thoracentesis - confirm presence of fluid |
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mgnt of pleural effusion (3)
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- ID of underlying cause
- thoracentesis - chest tube |
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what does pleural effusion do to the lungs
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decreases expanision
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accumulation of thick, purulent fluid in pleural space, often w/fibrin development and walled off area of infection
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empyema
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cause of empyema
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bacterial pneumonia or lung abscess
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S&S of empyema (8)
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- acute illness
- fever -night sweats - pleural pain - cough - dyspnea - anorexia - wt loss |
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Dx of empyema
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CT
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mgnt of empyema (2)
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drain pleural cavity
abx tx(4-6 wks) |
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what happens with larger empyema
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more resp compromise
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abnormal fluid accumulation in lung tissue, alveolar space, or both
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pulm edema
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what is pulm edema r/t
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abnormal cardiac function
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what happens with pulm edema (3)
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-back up of blood into pulm vasculature
- increased microvascular pressure - fluid leaks into interstitial space and alveoli |
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S&S of pulm edema (8)
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- dyspnea
-air hunger - central cyanosis - frothy secretion (blood tinged) - crackles in base - apices - hypoxemia -resp failure |
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most common cause of pulm edema
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CHF
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medical mgnt of pulm edema (4)
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- correct underlying cause
- medication to improve L vent function - diuretics (fluid restriction) - 02 (mech vent to expand alveoli) |
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nsg mgnt of pulm edema (3)
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- medication
-evaluate response - resp support |
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sudden, life threatening detoriation of gas exchange- failure of lungs to provide adequate oxygenation or ventilation of blood
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acute resp failure
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tx of acute resp failure (4)
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- correction of underlying problem
-restore adequate gas exchange in the lung - intubation - mech ventilation |
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S&S of progression with acute resp failure (7)
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- confusion
- diaphoresis - lethargy - tachycardia - tachypnea - central cyanosis - resp arrest |
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early S&S related to impaired oxygenation (7)
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- restlessness
- fatigue - Ha - dyspnea - air hunger - tachypnea - increased BP |
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oxygenation failure caused by what (4)
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- pneumonia
- ARDS - heart failure - PE |
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ventilatory failure caused by what (4)
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- CNS impairment( drug OD, head trauma, infections, hemorrhage, sleep apnea)
- neuromusc dysfunc - musculoske dysfunction - pulmonary dysfunction |
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what can cause CNS impairment (5)
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- drug OD
- head trauma - infections - hemorrhage - sleep apnea |
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causes of neuromuscular dysfunction (4)
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- MG
- GB - ALS - SCI |
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causes of musculoskeletal dysfunction (3)
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- chest trauma
- kyphoscoliosis - malnutrition |
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causes of pulmonary dysfunction (3)
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- COPD
- asthma - CF |
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things that can cause acute resp failure from post op period (4)
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- anesthesia
- analgesia - sedative agents - unmanaged pain |
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classification of acute resp failure
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- Pa02 <50
-PaC02 >50 -pH <7.35 |
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severe form of lung injury
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ARDS
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what happens with ARDS (5)
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- diffuse alveolar damage
- pulm edema - bilateral infiltrates - hypoxemia unresponsive to 02 - absence increased L atrial pressure |
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acute even of ARDS development
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over 4-48 hrs
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what causes injury to alveolar cap membranes in ARDS
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inflammatory triggers or cellular and chemical mediators
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what is seen upon Px exam with ARDs (5)
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- retractions
- crackles - dyspnea - hypoxemia - BNP levels |
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Dx for ARDS (3)
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- echo
- XRAY - pulm artery cath |
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mgnt for ARDs (8)
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- ID and tx underlying cause
- intubation and mech vent - circulatory support (3rd spacing) - adequate fluid volume - nutritional support - careful mtr and assessment - freq repositioning - control of anxiety |
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why is it important to control anxiety with ARDS
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to help decrease air hunger
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what does frequent repositioning do with ARDs
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helps reabsorption
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important with nutritional support in ARDs
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increase in protein
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what can increase vent pressure do with ARDs
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cause more damage
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obstruction of pulm artery or branch by thrombus or emboli
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Pulm embolism
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what does pulm embolism do (4)
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- increase in alveolar deadspace
- increased pulm vascular resistance - increased pulm arterial pressure - increased R vent work |
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what can increased right ventricular work do
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lead to right vent failure--- decreased cardiac output followed by decreased systemic BP and shock
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what does acute injury of ARDs progress to
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- fibrosing alveolitis and persistant severe hypoxemia
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what do S&S of PE depend on
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size of clot and location
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S&S of PE (10)
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- dyspnea
- tachypnea - chest pain - anxiety - fever - tachycardia - cough - diaphoresis - hemoptysis - syncope |
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what does obstruction of the pulmonary artery result in (6)
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- pronounced dyspnea
- sudden substernal pain - rapid and weak pulse - shock - syncope - sudden death |
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work up of PE includes (5)
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- CXR
- ECG - ABG - VQ scan/spiral CT - pulm angiography (best) |
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looks at the flow to the lungs
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VQ scan
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nonneoplastic alteration of lung from inhalation of mineral or inorganic dust
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pneumoconioses
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multisystem granulomatous disease with an unknown cause
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sarcoidosis
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thought to be the cause of sarcoidosis
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hypersensitivity exogenous agents
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what does pneumoconioses result in
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pulm fibrosis and parenchymal change
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mgnt for pneumoconioses
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not treatable once developed
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assessment and Dx of chest tumors (6)
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- CXR
- Ct scan - fiberoptic bronchoscopy (washing and biopsy of area) - fine needle aspiration (peripheral location) - scans to assess for metastasis - surgery |
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what type of scans can be done for chest tumors (4)
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- PET
- liver ultrasound - brain CT - MRI |
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mgnt of chest tumor (5)
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- cure if possible
- surgery - radiation - chemotherapy - palliative |
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may include radiation to shrink tumor for pain relief, bronchoscopic interventions
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palliative
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used to alter tumor growth, treat mets, adjunct to surgery or radiation
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chemo
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useful when resection not option. may be used to reduce size prior to surgery to relieve pressure from tumor (toxic to normal tissue)
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radiation
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mgnt for chest trauma (6)
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- airway/vent/oxygenation
- fluid support - reestablishing neg intrapleural pressure - rib fx - flail chest - drainage intrapleural fluid/blood |
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mild,moderate, severe damage to lung tissue resulting in hemorhage and edema
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pulm contusion
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sudden compression or positive pressure to chest wall
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blunt chest trauma
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can be alone or in combo with other trauma
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chest trauma
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causes hypoxemia from disruption of airway with chest trauma (5)
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- injury to parenchyma/rib cage/musculature
- collapsed lung - pneumothorax -hypovolemia - cardiac tamponade - |
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workup for chest trauma includes what (9)
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- CXR
- CT - CBC - clotting studies - type and cross - electrolytes - 02 sat - ABG - ECG |
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foreign object penetrates chest wall
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penetrating
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needs to be done with penetrating trauma
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occlude and stop the air from going in
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partial or visceral pleura is breached and pleural space exposed to positive atmospheric pressure
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pneumothorax
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spont', usually from rupture of bleb or bronchopleural fistula
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simple pneumo
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air escapes from laceration in lung itself, enters pleural space
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traumatic pneumo
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air drawn into pleural space from lacerated lung, or small opening or wound in chest wall
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tension pneumo
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what does tension pneumo result in
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shifting of mediastinum to unaffected side and collapse of lung
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drains air/ fluid around the heart
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pericardial tube
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what does staging of chest tumors refer to (4)
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- size
- location - lymph node involvement - any mets |
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classification of NSCLC (2)
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- 1- earliest w/ highest cure rate
- IV - designates mets spread |
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small cell types (2)
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- limited ( no mets/ lungs only)
- unlimited (spread) |
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% of lung cancer that has spread to lymphatics and other sites by time of Dx
|
70
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R/F for chest tumors (4)
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- tobacco smoke
- 2nd hand smoke - environmental/occupational hazards - genetics |
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leading cancer killers in the US
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lung or bronchus ca
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small cell lung Ca facts (3)
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- 15-20% of tumors
- most in major bronchi - spread by infiltration along bronchial wall |
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% of NSCLC
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80-
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most prevalent in lung 40%
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adenocarcinoma
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AKA undifferentiated, fast growing tumor
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large cell (15%)
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more centrally located, arises in segmental and subsegmental bronchi
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20-30%
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what are the most common sites of mets (6)
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- lymph nodes
- bone - brain - contralateral lung -adrenal glands - liver |
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what can indicate mets to the bone
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pain
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most freq Sx of chest tumor (4)
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-cough
-change in chronic cough - 65-75% present with cough - 25% with productive cough |
