RespiratoryDisorders for lung cancer disease

Lung Disorder stages

1. Respiratory DisordersRespiratory Disorders
Nursing 203Nursing 203

5. Pulmonary EdemaPulmonary Edema
Medical emergency!Medical emergency!
Abnormal accumulation of fluid in the lung(s)Abnormal accumulation of fluid in the lung(s)
Causes: LV failure, rapid administration of IVF’s Causes: LV failure, rapid administration of IVF’s
Clinical Manifestations:Clinical Manifestations:
–Increasing respiratory distress/ dyspnea, air hungerIncreasing respiratory distress/ dyspnea, air hunger
–Anxious/agitated/confusion Anxious/agitated/confusion
–Cough/Frothy pink sputumCough/Frothy pink sputum
–Crackles/ RalesCrackles/ Rales
–TachycardiaTachycardia
–Jugular vein distentionJugular vein distention

6. –Diagnostic Findings:Diagnostic Findings:
Chest X-ray show increased interstitial markingsChest X-ray show increased interstitial markings
ABGs show increasing hypoxia ABGs show increasing hypoxia
BNP Elevated BNP Elevated

7. Medical ManagementMedical Management
GOAL: Correct underlying disorderGOAL: Correct underlying disorder
Medications:Medications:
–Oxygen/ Endotracheal intubationOxygen/ Endotracheal intubation
–MorphineMorphine
–Diuretics (Lasix is DOC)Diuretics (Lasix is DOC)
–Vasodilators (Nitroglycerin)Vasodilators (Nitroglycerin)
–DobutamineDobutamine
–Milrinone Milrinone
–Digoxin Digoxin
–Nesritide ( Natrecor)Nesritide ( Natrecor)

8. Hemodynamic monitoring:Hemodynamic monitoring:
–Arterial lineArterial line
–Central venous pressure (CVP)Central venous pressure (CVP)
–Swan-Ganz (PAP monitoring)Swan-Ganz (PAP monitoring)

9. Nursing ManagementNursing Management
Assist with intubation (if necessary), monitor Assist with intubation (if necessary), monitor
mechanical ventilation mechanical ventilation
Administer oxygen by mask (40-60%)Administer oxygen by mask (40-60%)
HOB elevated, legs dangling if possibleHOB elevated, legs dangling if possible
Administering and monitoring medicationsAdministering and monitoring medications
Provide psychological supportProvide psychological support
CVP/ hemodynamic monitoringCVP/ hemodynamic monitoring
Vital signs frequentlyVital signs frequently

10. Nursing Management Nursing Management
ContinuedContinued
Low-Na+ dietLow-Na+ diet
Fluid restrictionsFluid restrictions
Strict I&O’sStrict I&O’s
Daily weightsDaily weights
Home Care Home Care

11. Adult Respiratory Distress Adult Respiratory Distress
SyndromeSyndrome
Also called ARDSAlso called ARDS
Characterized by sudden progressive Characterized by sudden progressive
pulmonary edemapulmonary edema
Increasing bilateral infiltratesIncreasing bilateral infiltrates
Hypoxemia regardless to oxygen therapy Hypoxemia regardless to oxygen therapy
Decreased lung complianceDecreased lung compliance

12. PathophysiologyPathophysiology
Result of inflammatory trigger that Result of inflammatory trigger that
damages/collapses alveolar interstitial damages/collapses alveolar interstitial
spacesspaces
Direct injury to lungsDirect injury to lungs
–Trauma, Smoke inhalationTrauma, Smoke inhalation
–Aspiration, infectionAspiration, infection
–DIC, DIC,
IndirectIndirect
–ShockShock
–Major surgeryMajor surgery

13. Clinical ManifestationsClinical Manifestations
Severe dyspnea occurring 12-48 after insultSevere dyspnea occurring 12-48 after insult
Arterial hypoxemia regardless of O2 amountArterial hypoxemia regardless of O2 amount
Lungs are “Stiff”Lungs are “Stiff”
Assessment findingsAssessment findings
Diagnostic findingsDiagnostic findings

14. Medical ManagementMedical Management
Identify and treat underlying causeIdentify and treat underlying cause
Intubation/Mechanical ventilationIntubation/Mechanical ventilation
–Will see PEEPWill see PEEP
–Goal: PaO2 > 60mm Hg or O2 sat 90%Goal: PaO2 > 60mm Hg or O2 sat 90%
–Hemodynamic monitoringHemodynamic monitoring
–MedsMeds
Human recombinant interleukin-1 receptor antagonistHuman recombinant interleukin-1 receptor antagonist
Neutrophil inhibitorsNeutrophil inhibitors
Surfactant, Surfactant,
Pulmonary vasodilatorsPulmonary vasodilators
CorticosteroidsCorticosteroids
Nutritional support: 35-45kcal/kg/dayNutritional support: 35-45kcal/kg/day

15. Nursing ManagementNursing Management
Monitor and implement medical plan of careMonitor and implement medical plan of care
Patient positioningPatient positioning
Psychological supportPsychological support
Ventilator considerations Ventilator considerations
–Do not turn off alarmsDo not turn off alarms
–HypotensionHypotension
–Fighting ventilatorFighting ventilator
–Suction frequentlySuction frequently
–Bite blockBite block
–SedationSedation
–Neuromuscular blockadeNeuromuscular blockade

16. Pulmonary EmbolismPulmonary Embolism
Thrombi most often arise from deep veins in Thrombi most often arise from deep veins in
the legs, the right side of the heart or pelvic the legs, the right side of the heart or pelvic
area and travel to the pulmonary circulation.area and travel to the pulmonary circulation.
Can also be air, fat, amnioticCan also be air, fat, amniotic
Medical Emergency!Medical Emergency!
Risk Factors:Risk Factors:
–Immobility, bed-rest, history of previous DVT, Immobility, bed-rest, history of previous DVT,
pre-post op, trauma, pregnancy, obesity, BC pre-post op, trauma, pregnancy, obesity, BC
pillspills

17. Assessment FindingsAssessment Findings
Severity of symptoms depend on the size and Severity of symptoms depend on the size and
location location
Acute onset of Acute onset of chest painchest pain, , dyspnea,dyspnea, tachypneatachypnea
Anxious, feelings of impending doomAnxious, feelings of impending doom
TachycardiaTachycardia
Rales / Crackles / Diminished breathe sounds/ Rales / Crackles / Diminished breathe sounds/
coughcough
Death can occur within 1 hr of onset of symptomsDeath can occur within 1 hr of onset of symptoms
May have history of DVTMay have history of DVT

18. Diagnostic FindingsDiagnostic Findings
Ventilation-Perfusion (V-Q) scanVentilation-Perfusion (V-Q) scan
Pulmonary angiographyPulmonary angiography
CXRCXR
ABGsABGs
Peripheral vascular studiesPeripheral vascular studies

19. PreventionPrevention
Active leg exerciseActive leg exercise
Early ambulationEarly ambulation
Pneumatic/elastic compression stockingsPneumatic/elastic compression stockings
Avoid sitting/ leg crossing Avoid sitting/ leg crossing
Teach signs/symptoms of DVT/PETeach signs/symptoms of DVT/PE
Low dose anticoagulant for those Low dose anticoagulant for those
undergoing surgeryundergoing surgery

20. Medical ManagementMedical Management
Emergency managementEmergency management
–Stabilize Cardiopulmonary systemStabilize Cardiopulmonary system
Nasal oxygenNasal oxygen
ABGsABGs
IVIV
Lung perfusion scan or spiral CT scanLung perfusion scan or spiral CT scan
Continuous cardiac monitoring/Vital Continuous cardiac monitoring/Vital
signs/Hemodynamic monitoringsigns/Hemodynamic monitoring
–Treat hypotension using Dobutamine or Treat hypotension using Dobutamine or
DopamineDopamine

21. Medical Management Cont..Medical Management Cont..
IV morphineIV morphine
Compression stockingsCompression stockings
Anticoagulants Anticoagulants
–Heparin bolus/dripHeparin bolus/drip
–Low molecular weight heparin (Lovenox)Low molecular weight heparin (Lovenox)
–CoumadinCoumadin
ThrombolyticsThrombolytics
–Urokinase, streptokinase, alteplase, Urokinase, streptokinase, alteplase,
reteplase,tPAreteplase,tPA

22. Medical Management Cont…Medical Management Cont…
Surgical management if PE is severeSurgical management if PE is severe
–Embolectomy Embolectomy
–Umbrella filter (Greenfield filter)Umbrella filter (Greenfield filter)

23. Nursing ManagementNursing Management
Minimize the risk of PEMinimize the risk of PE
–Always suspect PEAlways suspect PE
Prevent formation of thrombusPrevent formation of thrombus
–Major nursing responsibilityMajor nursing responsibility
–Leg exercise, early ambulationLeg exercise, early ambulation
–No sitting or lying for long period of timeNo sitting or lying for long period of time
–Legs should not be in a dependent positionLegs should not be in a dependent position
–Monitor IV sitesMonitor IV sites

24. Nursing Management Cont..Nursing Management Cont..
Monitoring anticoagulant/thrombolytic therapyMonitoring anticoagulant/thrombolytic therapy
–During infusion—bedrest, vital signs, O2 sats, limit During infusion—bedrest, vital signs, O2 sats, limit
invasive procedures, monitor PT, and PTT, monitor for invasive procedures, monitor PT, and PTT, monitor for
bleeding…bleeding…
Pain managementPain management
 Anxiety managementAnxiety management
Monitor for complicationsMonitor for complications
–Cardiogenic shockCardiogenic shock
–Right ventricular failureRight ventricular failure
–Education Education

25. Chest Trauma: BluntChest Trauma: Blunt
More common, harder to determine extentMore common, harder to determine extent
Cause: Sudden compression or positive Cause: Sudden compression or positive
pressure to the chest wallpressure to the chest wall
MVA, steering wheel, seat belt, falls , bicycle crashesMVA, steering wheel, seat belt, falls , bicycle crashes
TypesTypes
Fractured sternal and ribs, flail chest, pulmonary Fractured sternal and ribs, flail chest, pulmonary
contusioncontusion

26. Chest Trauma: PenetratingChest Trauma: Penetrating
Cause: A foreign object enters the chest Cause: A foreign object enters the chest
wallwall
–Gunshot and stabbings (most common)Gunshot and stabbings (most common)

27. PathophysiologyPathophysiology
Why is it life-threatening?Why is it life-threatening?
HypoxemiaHypoxemia
HypovolemiaHypovolemia
Cardiac failureCardiac failure

28. AssessmentAssessment
Assessment immediately--- When, how Assessment immediately--- When, how
injury occurred?injury occurred?
–LOC, other injuries, EBL, Drugs or ETOH LOC, other injuries, EBL, Drugs or ETOH
involved, pre-hospital treatmentinvolved, pre-hospital treatment
How is the airway?How is the airway?
–Inspect airway, thorax, neck veins, and Inspect airway, thorax, neck veins, and
breathing breathing
–AuscultationAuscultation
–PalpationPalpation

29. Assessment Cont..Assessment Cont..
Vital signs and skin colorVital signs and skin color
Labs (CBC, clotting studies, type and cross, Labs (CBC, clotting studies, type and cross,
Lytes, ABG’s Lytes, ABG’s
CXR, CT scan/ EKGCXR, CT scan/ EKG

30. Medical ManagementMedical Management
Establish/secure airwayEstablish/secure airway
–Intubation/VentilationIntubation/Ventilation
Re-establish chest wall integrity Re-establish chest wall integrity
–Occluding open chest wounds Occluding open chest wounds
–Correct fluid volume and negative intrapleural Correct fluid volume and negative intrapleural
pressure or drain intrapleural fluidpressure or drain intrapleural fluid
Control bleedingControl bleeding

31. Sternal And Rib FracturesSternal And Rib Fractures
Rib fractures most common type of chest trauma Rib fractures most common type of chest trauma
Most are benign but can be life-threatening Most are benign but can be life-threatening
55
thth
– 9 – 9
thth
most common site most common site
Usually heal in 3-6 weeks Usually heal in 3-6 weeks
Conservative treatmentConservative treatment
–Pain controlPain control
–Avoid excessive activityAvoid excessive activity
–Deep breathing exerciseDeep breathing exercise
–Rib belt Rib belt
–Surgical if gross deformity onlySurgical if gross deformity only

32. Flail ChestFlail Chest
CAUSATIVE: BLUNT CHEST TRAUMA CAUSATIVE: BLUNT CHEST TRAUMA
OFTEN ASSOCIATED WITH MULTIPLE OFTEN ASSOCIATED WITH MULTIPLE
RIB FRACTURESRIB FRACTURES
PATHOPHYSIOLOGYPATHOPHYSIOLOGY
“ “PARADOXICAL MOVEMENT”PARADOXICAL MOVEMENT”
RESULT: HYPOXEMIA, RESPIRATORY RESULT: HYPOXEMIA, RESPIRATORY
ACIDOSIS, HYPOTENSION, THEN ACIDOSIS, HYPOTENSION, THEN
METABOLIC ACIDOSISMETABOLIC ACIDOSIS

33. TREATMENT GOALSTREATMENT GOALS
CONTROL PAINCONTROL PAIN
CLEAR SECRETIONSCLEAR SECRETIONS
VENTILATORY SUPPORTVENTILATORY SUPPORT
TREATMENT DEPENDS ON DEGREE OF TREATMENT DEPENDS ON DEGREE OF
RESPIRATORY DYSFUNCTIONRESPIRATORY DYSFUNCTION

34. Treatment Cont..Treatment Cont..
CLEAR AIRWAY: COUGH AND DEEP CLEAR AIRWAY: COUGH AND DEEP
BREATH, POSITIONING, SUCTIONING BREATH, POSITIONING, SUCTIONING
SECRETIONSSECRETIONS
VENTILATORY SUPPORT: PULMONARY VENTILATORY SUPPORT: PULMONARY
PHYSIOTHERAPY, EMDOTRACHEAL PHYSIOTHERAPY, EMDOTRACHEAL
INTUBATION, MECHANICAL INTUBATION, MECHANICAL
VENTILATIONVENTILATION

35. NURSING INTERVENTIONSNURSING INTERVENTIONS
MONITOR ABG’SMONITOR ABG’S
PULMONARY FUNCTION MONITORINGPULMONARY FUNCTION MONITORING
PULSE OXIMETRYPULSE OXIMETRY
PAIN ASSESSMENT/CONTROLPAIN ASSESSMENT/CONTROL
SERIAL CHEST X-RAYSSERIAL CHEST X-RAYS

37. PNEUMOTHORAXPNEUMOTHORAX
PNEUMOTHORAX: ACCUMULATION OF AIR OR PNEUMOTHORAX: ACCUMULATION OF AIR OR
GAS IN THE PLEURAL CAVITY, RESULTING IN GAS IN THE PLEURAL CAVITY, RESULTING IN
COLLAPSE OF THE LUNG ON THE AFFECTED COLLAPSE OF THE LUNG ON THE AFFECTED
SIDESIDE
““BREACH IN PARIETAL OR VISCERAL BREACH IN PARIETAL OR VISCERAL
PLEURA=EXPOSURE TO POSTIIVE PLEURA=EXPOSURE TO POSTIIVE
ATMOPSHERIC PRESSURE”ATMOPSHERIC PRESSURE”

38. TYPES OF PNEUMOTHORAXTYPES OF PNEUMOTHORAX
SPONTANEOUS (OR SIMPLE)SPONTANEOUS (OR SIMPLE)
TRAUMATIC TRAUMATIC
TENSIONTENSION

39. SPONTANEOUS SPONTANEOUS
PNEUMOTHROAXPNEUMOTHROAX
ETIOLOGYETIOLOGY
1.1.RUPTURE OF A BLEBRUPTURE OF A BLEB
2.2.RUPTURE OF A BRONCHOPLEURAL FISTULARUPTURE OF A BRONCHOPLEURAL FISTULA
3.3.RUPTURE OF AIR FILLED BLISTER IN A RUPTURE OF AIR FILLED BLISTER IN A
HEALTHY PERSONHEALTHY PERSON
MAY BE ASSOCIATED WITH SEVERE MAY BE ASSOCIATED WITH SEVERE
EMPHYSEMA OR INTERSTITIAL LUNG DISEASEEMPHYSEMA OR INTERSTITIAL LUNG DISEASE

40. TRAUMATIC PNEUMOTHORAXTRAUMATIC PNEUMOTHORAX
WOUND IN THE CHEST WALL ALLOWS WOUND IN THE CHEST WALL ALLOWS
AIR TO ESCAPE; ENTERS THE PLEURAL AIR TO ESCAPE; ENTERS THE PLEURAL
SPACESPACE
CAUSES: BLUNT TRAUMA, CAUSES: BLUNT TRAUMA,
PENETRATING CHEST TRAUMA, PENETRATING CHEST TRAUMA,
ABDOMINAL TRAUMA, DIAPHRAGMATIC ABDOMINAL TRAUMA, DIAPHRAGMATIC
TEARS, INVASIVE THORACIC TEARS, INVASIVE THORACIC
PROCEDURES, PROCEDURES,

41. HEMOTHORAXHEMOTHORAX
COLLECTION OF BLOOD IN THE COLLECTION OF BLOOD IN THE
PLEURAL SPACE RESULTING FROM PLEURAL SPACE RESULTING FROM
TORN INTERCOSTAL VESSELS, TORN INTERCOSTAL VESSELS,
LACERATIONS OF THE GREAT VESSELS LACERATIONS OF THE GREAT VESSELS
AND LACERATION OF THE LUNGSAND LACERATION OF THE LUNGS
HEMOPNEUMOTHORAX: AIR AND HEMOPNEUMOTHORAX: AIR AND
BLOODBLOOD

42. SUCKING CHEST WOUND SUCKING CHEST WOUND
(OPEN PNEUMOTHORAX)(OPEN PNEUMOTHORAX)
TYPE OF TRAUMATIC PNEUTHORAXTYPE OF TRAUMATIC PNEUTHORAX
ALLOWS AIR TO PASS FREELY IN AND ALLOWS AIR TO PASS FREELY IN AND
OUT OUT
RUSH OF AIR THROUGH THE HOLE RUSH OF AIR THROUGH THE HOLE
PRODUCES A SUCKING SOUNDPRODUCES A SUCKING SOUND
CONSEQUENCE: MEDIASTINAL CONSEQUENCE: MEDIASTINAL
FLUTTERFLUTTER

43. CLINICAL MANIFESTATIONCLINICAL MANIFESTATION
PLEURITIC PAIN PLEURITIC PAIN
TACHYPNEATACHYPNEA
ANXIETYANXIETY
DYSPNEA WITH AIR HUNGERDYSPNEA WITH AIR HUNGER
USE OF ACESSORY MUSCLESUSE OF ACESSORY MUSCLES
DECREASED OR ABSENT BREATH SOUNDS; DECREASED OR ABSENT BREATH SOUNDS;
DECREASED MOVEMENT IN THE AFFECTED DECREASED MOVEMENT IN THE AFFECTED
SIDESIDE
SUBCUTANEOUS EMPHYSEMASUBCUTANEOUS EMPHYSEMA

44. MANAGEMENTMANAGEMENT
GOAL: EVACUATE THE AIR OR BLOOD GOAL: EVACUATE THE AIR OR BLOOD
FROM THE PLEURAL SPACEFROM THE PLEURAL SPACE

PNEUMOTHORAX: SMALL CHEST PNEUMOTHORAX: SMALL CHEST
TUBE/2TUBE/2
NDND
ICS ICS
HEMOTHORAX: LARGE CHEST HEMOTHORAX: LARGE CHEST
TUBE/2ND OR 5TUBE/2ND OR 5
THTH
ICS ICS
SUCTION: 20mm HG SUCTIONSUCTION: 20mm HG SUCTION

45. MANAGEMENTMANAGEMENT
ANTIBIOTIC THERAPYANTIBIOTIC THERAPY
HEIMLICH HEIMLICH
CHEST TUBE TO WATER SEAL CHEST TUBE TO WATER SEAL
DRAINAGEDRAINAGE
EMERGENCY THORACOTOMYEMERGENCY THORACOTOMY

46. NURSING CARE OF CHEST NURSING CARE OF CHEST
DRAINAGE SYSTEMDRAINAGE SYSTEM
Fill the water seal with sterile water to the specified levelFill the water seal with sterile water to the specified level
Fill the suction control chamber with sterile water to the Fill the suction control chamber with sterile water to the
20-cm level20-cm level
Attach CT’s to collection chamber and tape Attach CT’s to collection chamber and tape
Suction: dry system turn regulator dial to 20cm H2OSuction: dry system turn regulator dial to 20cm H2O
Suction: wet system turn on suction unit until steady Suction: wet system turn on suction unit until steady
bubbling appears in suction control chamberbubbling appears in suction control chamber

IMMEDIATE PETROLATUM GAUZEIMMEDIATE PETROLATUM GAUZE

48. INTERVENTIONS/CHEST TUBE INTERVENTIONS/CHEST TUBE
DRAINAGEDRAINAGE
MARK DRAINGE FROM CT MARK DRAINGE FROM CT
CHECK FOR KINKS, LOOP IN CT’SCHECK FOR KINKS, LOOP IN CT’S
WHAT’S “MILKING THE TUBES”WHAT’S “MILKING THE TUBES”
WHAT IS “TIDALING”WHAT IS “TIDALING”
OBSERVE FOR “AIR LEAKS”OBSERVE FOR “AIR LEAKS”
DO NOT CLAMP THE CT FOR TRANSPORTDO NOT CLAMP THE CT FOR TRANSPORT
INCENTIVE SPIROMETER/COUGH AND DBINCENTIVE SPIROMETER/COUGH AND DB
OBSERVE AND REPORT CHANGE IN STATUSOBSERVE AND REPORT CHANGE IN STATUS

49. CHEST TUBE REMOVALCHEST TUBE REMOVAL
VALSALVA MANEUVER PER CLIENTVALSALVA MANEUVER PER CLIENT
CHEST TUBE CLAMPED/QUICKLY CHEST TUBE CLAMPED/QUICKLY
REMOVED REMOVED
PRESSURE DRESSING TO CT SITEPRESSURE DRESSING TO CT SITE

50. TENSION PNEUMOTHORAXTENSION PNEUMOTHORAX
AIR ENTERS WOUND IN THE CHEST AIR ENTERS WOUND IN THE CHEST
WALL AND BECOMES TRAPPEDWALL AND BECOMES TRAPPED
WITH EACH BREATH, TENSION WITH EACH BREATH, TENSION
INCREASES IN THE PLEURAL SPACEINCREASES IN THE PLEURAL SPACE
LUNG COLLASPESLUNG COLLASPES
MEDIASTINAL STRUCTURES SHIFT TO MEDIASTINAL STRUCTURES SHIFT TO
THE OPPOSITE SIDETHE OPPOSITE SIDE

51. TENSION PNEUMOTHORAXTENSION PNEUMOTHORAX

52. CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS
PROFUSE DIAPHORESISPROFUSE DIAPHORESIS
AGITATIONAGITATION
AIR HUNGERAIR HUNGER
CENTRAL CYANOSISCENTRAL CYANOSIS
TACHYCARDIA/HYPOTENSIONTACHYCARDIA/HYPOTENSION
EMERGENCY!!EMERGENCY!!

53. TENSION PNEUMOTHORAX TENSION PNEUMOTHORAX
MANAGEMENTMANAGEMENT
SUPPLEMENTAL OXYGENSUPPLEMENTAL OXYGEN
MONITOR PULSE OXIMETRYMONITOR PULSE OXIMETRY
DECOMPRESSIONDECOMPRESSION
CHEST TUBE MAINTENANCECHEST TUBE MAINTENANCE

54. PLEURAL EFFUSIONPLEURAL EFFUSION
COLLECTION OF FLUID IN THE PLEURAL COLLECTION OF FLUID IN THE PLEURAL
SPACE, USUALLY SECONDARY TO SPACE, USUALLY SECONDARY TO
OTHER DISEASESOTHER DISEASES
CAUSES: HEART FAILURE, TB, CAUSES: HEART FAILURE, TB,
NEOPLASTIC TUMORS, PE, NEOPLASTIC TUMORS, PE,
CONNECTIVE TISSUE DISEASECONNECTIVE TISSUE DISEASE
CLEAR, BLOODY OR PURULENTCLEAR, BLOODY OR PURULENT
TRANSUDATE VS.EXUDATETRANSUDATE VS.EXUDATE

57. CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS
DYSPNEADYSPNEA
PLEURITIC CHEST PAINPLEURITIC CHEST PAIN
DECREASED OR ABSENT BREATH SOUNDSDECREASED OR ABSENT BREATH SOUNDS
DIAGNOSTIC FINDINGS: TRACHEAL DIAGNOSTIC FINDINGS: TRACHEAL
DEVIATION,CHEST X-RAY, CHEST CT, DEVIATION,CHEST X-RAY, CHEST CT,
THORACENTESIS (CONFIRMS DX)THORACENTESIS (CONFIRMS DX)
PLEURAL FLUID ANALYASISPLEURAL FLUID ANALYASIS
PLEURAL BIOPSYPLEURAL BIOPSY

58. EFFUSION TREATMENTEFFUSION TREATMENT
THORACENTESISTHORACENTESIS
PLEURODESISPLEURODESIS
CHEST TUBESCHEST TUBES
SURGICAL PLEURECTOMY WITH SURGICAL PLEURECTOMY WITH
CATHERTER INSERTIONCATHERTER INSERTION
PLEUROPERITONEAL SHUNTPLEUROPERITONEAL SHUNT

59. PAIN MANAGEMENTPAIN MANAGEMENT
PAIN NFUSION PUMP (OPIOIDS)PAIN NFUSION PUMP (OPIOIDS)
THORACIC EPIDURAL BLOCKTHORACIC EPIDURAL BLOCK
INTERCOSTAL NERVE BLOCKINTERCOSTAL NERVE BLOCK
INTERMITTANT ANALGESICINTERMITTANT ANALGESIC
INTRAPLEURAL ADMINISTRATION OF INTRAPLEURAL ADMINISTRATION OF
OPIOIDSOPIOIDS

60. CANCERS OF THE RESPIRATORY CANCERS OF THE RESPIRATORY
SYSTEMSYSTEM
LARYNGEAL CANCERLARYNGEAL CANCER
LUNG CANCERLUNG CANCER
TUMORS OF THE MEDIASTINUMTUMORS OF THE MEDIASTINUM

61. CANCER OF THE LARYNXCANCER OF THE LARYNX
RISK FACTORS RISK FACTORS
CARCINOGENS (MULTIPLE)CARCINOGENS (MULTIPLE)
HX OF ETOH ABUSEHX OF ETOH ABUSE
STRAINING THE VOICE STRAINING THE VOICE
FAMILIAL TENDENCYFAMILIAL TENDENCY
CHRONIC LARYNGITISCHRONIC LARYNGITIS
GENDER, AGE, RACEGENDER, AGE, RACE
NUTRITIONAL DEFICIENCIESNUTRITIONAL DEFICIENCIES

62. CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS
HOARSENESS>3 WEEKSHOARSENESS>3 WEEKS
LUMP IN THE THROATLUMP IN THE THROAT
PAIN OR BURNING SENSATIONPAIN OR BURNING SENSATION
DYSPHAGIADYSPHAGIA
DYSPNEADYSPNEA
COUGHCOUGH
ENLARGED CERVICAL NODESENLARGED CERVICAL NODES

63. PATHOPHYSIOLOGYPATHOPHYSIOLOGY
INTRINSIC TUMOR: LOCATED ON THE INTRINSIC TUMOR: LOCATED ON THE
TRUE VOCAL CORD (USUALLY DOES TRUE VOCAL CORD (USUALLY DOES
NOT SPREAD)NOT SPREAD)
EXTRINSIC TUMOR: LOCATED ON EXTRINSIC TUMOR: LOCATED ON
OTHER PART OF THE LARYNX (TENDS OTHER PART OF THE LARYNX (TENDS
TO SPREAD EARLY)TO SPREAD EARLY)
SUPRAGLOTTIS, GLOTTIS, SUBGLOTTISSUPRAGLOTTIS, GLOTTIS, SUBGLOTTIS

64. DIAGNOSTIC TESTDIAGNOSTIC TEST
LARYNGOSCOPYLARYNGOSCOPY
LARYNGEAL TOMOGRAPYLARYNGEAL TOMOGRAPY
CT SCAN / MRICT SCAN / MRI
CHEST X-RAYCHEST X-RAY
BIOPSYBIOPSY

65. STAGING LARYNGEAL CASTAGING LARYNGEAL CA
TNM CLASSIFICATION SYSTEM: TNM CLASSIFICATION SYSTEM:
METHOD USED TO CLASSIFIY HEAD METHOD USED TO CLASSIFIY HEAD
AND NECK TUMORS. DEVELOPED BY AND NECK TUMORS. DEVELOPED BY
THE AMERICAN JOINT COMMITTEE ON THE AMERICAN JOINT COMMITTEE ON
CANCERCANCER
“ “CLASSIFICATION OF THE TUMOR CLASSIFICATION OF THE TUMOR
SUGGEST TREATMENT MODALITIES” SUGGEST TREATMENT MODALITIES”
(Pg. 507; chart 22-6)(Pg. 507; chart 22-6)

66. PROGNOSIS OF LARYNGEAL PROGNOSIS OF LARYNGEAL
CANCERCANCER
TUMOR SIZETUMOR SIZE
CLIENT’S AGE AND GENDERCLIENT’S AGE AND GENDER
GRADE AND DEPTH OF TUMORGRADE AND DEPTH OF TUMOR
INITIAL DIAGNOSIS OR A RECURRENCEINITIAL DIAGNOSIS OR A RECURRENCE

67. LARYNGEAL CANCER LARYNGEAL CANCER
TREATMENTSTREATMENTS
RADIATION THERAPYRADIATION THERAPY
GOAL OF TREATMENTGOAL OF TREATMENT
CRITERIA FOR RADIATIONCRITERIA FOR RADIATION
BENEFITSBENEFITS
COMPLICATIONSCOMPLICATIONS

68. SURGICAL MANAGEMENT OF SURGICAL MANAGEMENT OF
LARYNGEAL CANCERLARYNGEAL CANCER
LARYNGECTOMYLARYNGECTOMY
PARTIAL LARYNGECTOMYPARTIAL LARYNGECTOMY
SUPRAGLOTTIC LARYNGECTOMYSUPRAGLOTTIC LARYNGECTOMY
HEMILARYNGECTOMYHEMILARYNGECTOMY
TOTAL LARYNGECTOMYTOTAL LARYNGECTOMY
RADICAL NECK DISSECTIONRADICAL NECK DISSECTION

71. NURSING INTERVENTIONSNURSING INTERVENTIONS
MONITOR AND MANAGE POTENTIAL MONITOR AND MANAGE POTENTIAL
COMPLICATIONS: RESPIRATORY COMPLICATIONS: RESPIRATORY
DISTRESS, HEMORRHAGE INFECTION, DISTRESS, HEMORRHAGE INFECTION,
WOUND BREAKDOWNWOUND BREAKDOWN
MAINTAIN PATENT AIRWAYMAINTAIN PATENT AIRWAY
TRACHEOSTOMY/STOMA CARETRACHEOSTOMY/STOMA CARE
ALTERNATIVE MEANS OF ALTERNATIVE MEANS OF
COMMUNICATION: COMMUNICATION:

72. NURSING INTERVENTIONSNURSING INTERVENTIONS
REDUCING ANXIETYREDUCING ANXIETY
PROMOTE ADEQUATE NUTRITIONPROMOTE ADEQUATE NUTRITION
HYGIENE AND SAFETY MEASURESHYGIENE AND SAFETY MEASURES
REFERRAL TO SUPPORT GROUPSREFERRAL TO SUPPORT GROUPS
RESTORING SPEECH AFTER RESTORING SPEECH AFTER
LARYNGECTOMYLARYNGECTOMY

73. LUNG CANCERLUNG CANCER
NUMBER ONE CANCER KILLER IN NUMBER ONE CANCER KILLER IN
UNITED STATESUNITED STATES
OCCURRENCE (60-70YR OLD)OCCURRENCE (60-70YR OLD)
SURVIVAL RATE LOWSURVIVAL RATE LOW
85% CAUSED BY INHALATION OF 85% CAUSED BY INHALATION OF
CARCINOGENIC CHEMICALSCARCINOGENIC CHEMICALS

74. LUNG CANCERLUNG CANCER
SMALL CELL CARCINOMASMALL CELL CARCINOMA
LARGE CELL CARCINOMALARGE CELL CARCINOMA
BRONCHIOALVEOLAR CELL CANCERBRONCHIOALVEOLAR CELL CANCER
ADENOCARCINOMAADENOCARCINOMA
SQUAMOUS CELL CARCINOMASQUAMOUS CELL CARCINOMA

75. RISK FACTORSRISK FACTORS
TOBACCO SMOKETOBACCO SMOKE
SECOND-HAND SMOKESECOND-HAND SMOKE
ENVIRONMENTAL AND OCCUPATIONAL ENVIRONMENTAL AND OCCUPATIONAL
EXPOSUREEXPOSURE
GENETICSGENETICS
 DIETARY FACTORSDIETARY FACTORS

76. CLINICAL MANIFESTATIONCLINICAL MANIFESTATION
COUGH OR CHANGE IN A CHRONIC COUGH OR CHANGE IN A CHRONIC
COUGHCOUGH
WHEEZING, DYSPNEA, HEMOPTYSISWHEEZING, DYSPNEA, HEMOPTYSIS
REPEATED, UNRESOLVED URI’SREPEATED, UNRESOLVED URI’S
CHEST PAIN, TIGHTNESS, CHEST PAIN, TIGHTNESS,
HOARSENESS, WEIGHT LOSS, FEVERHOARSENESS, WEIGHT LOSS, FEVER

77. DIAGNOSTIC FINDINGSDIAGNOSTIC FINDINGS
CHEST X-RAYCHEST X-RAY
C.T. CHESTC.T. CHEST
FIBEROPTIC BRONCHOSCOPY WITH FIBEROPTIC BRONCHOSCOPY WITH
BRONCHIAL WASHINGSBRONCHIAL WASHINGS
BRONCHOSCOPIC BIOPSYBRONCHOSCOPIC BIOPSY
POSITRON EMISSION TOMOGRAPHYPOSITRON EMISSION TOMOGRAPHY
MAGNETIC RESONANCE IMAGINGMAGNETIC RESONANCE IMAGING

78. LUNG CA TREATMENTLUNG CA TREATMENT
SURGICAL INTERVENTIONSURGICAL INTERVENTION
CHEMOTHERAPYCHEMOTHERAPY
RADIATION THERAPYRADIATION THERAPY
PALLIATIVE THERAPYPALLIATIVE THERAPY
“ “TREATMENT DEPENDS ON SIZE, TREATMENT DEPENDS ON SIZE,
LOCATION AND TYPE OF CANCER, AS LOCATION AND TYPE OF CANCER, AS
WELL AS OVERALL HEALTH”WELL AS OVERALL HEALTH”

79. TREATMENT TERMINOLOGYTREATMENT TERMINOLOGY
SURGICAL: LOBECTOMY, SURGICAL: LOBECTOMY,
BILOBECTOMY, PNEUMONECTOMYBILOBECTOMY, PNEUMONECTOMY
WEDGE RESECTIONWEDGE RESECTION
RADIATION: EXTERNAL, RADIATION: EXTERNAL,
BRACHYTHERAPYBRACHYTHERAPY
CHEMOTHERAPY: ALKYLATING AGENTS, CHEMOTHERAPY: ALKYLATING AGENTS,
CISPLATIN, PACLITAXEL, VINBLASTINE, CISPLATIN, PACLITAXEL, VINBLASTINE,
ETOPOSIDEETOPOSIDE

82. NURSING MANAGEMENTNURSING MANAGEMENT
STRATEGIES FOR SYMPTOMS OF STRATEGIES FOR SYMPTOMS OF
DYSPNEA, FATIGUE, NAUSEA AND DYSPNEA, FATIGUE, NAUSEA AND
VOMITINGVOMITING
RELIEVING BREATHING PROBLEMSRELIEVING BREATHING PROBLEMS
PSYCHOLOGICAL SUPPORTPSYCHOLOGICAL SUPPORT