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Bronchoscopy
Pre & Post Care
Bronchoscopy - direct visualization of larynx, trachea and bronchi through bronchosope (fiber optic)
- Pre Care
- *Assess for pregnancy and hypersensitivity to anestetic
- *Instruct - no eat for drink 8-12 hrs before
- *Vital Signs
- * Administer ordered meds
- Post Care
- *Assess for complications - laryngeal edema, bronchospasm, pneumothorax (air in thorax), cardiac dysryhthmias, bleeding
- *Look for respiratory distress - dyspnea, decreased breath sounds, low O2 sat
- *Assess gag reflex before food or drink
- *Instruct - no smoke 6-8 hrs after
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Sputum
How to Obtain Sample
Proper Suctioning procedure
- How to obtain sample
- -early morning is best -secretions pool overnight
- -fluid before helps liquify secretions
- 1. Provide mouth care
- 2. Instruct to breath deeply several time
- 3. Cough deeply & expectorate into container
- 4. Label & send to lab
- Proper suctioning
- 1. Provide mouth care
- 2. Use sterile mucous trap - aseptic technique - attach trap between suction catheter & tubing
- 3. Preoxygenate as needed
- 4. No suction during insertion - suction for no longer than 10 seconds while withdrawing
- 5. Clear suction catheter with normal saline
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Acute Rhinitis
Acute Rhinitis = common cold (inflammation of nasal cavity)
- URI, viral contagious, infectious disease
- Spread by airborne droplet sprays by infected person: breathing, talking, coughing, sneezing orby direct hand contact
- S/S: Red, swollen (boggy) nasal membranes with congestion or coryza (clear watery discharge)
- Low grade fever, muscle aches, HA, Sneezing / coughing
- TX: rest, fluids, warm salt water gargles
- Frequent handwashing
- Analgesics, decongestants & antihistamines
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Chronic (Allergic) Rhinitis
- Seasonal vs. Perennial
- S/S: nasal inflammation with coryza (perfuse nasal drainage)
- Watery eyes, itching, sneezing
- Bronchospasm, stridor/wheezes
- TX: ****Management:
- Nasal decongestant sprays are not recommended more than 5 days due to rebound effect
- Oral decongestants & antihistamines
- Nasal corticosteroids (Flonase, Beconase,Rhinocort)
- Cromolyn – mast cell stabilizer/antihistamine
- Allergen desensitization/allergy shots
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Influenza
- Contagious, viral respiratory disease
- short incubation 18 to 72 hours
- Most deaths occur >60 years of age with underlying disease (cardiac, plum., diabetic)
- Avian “Bird” Flu (H5N1) SE Asia
- S/S: Fatigue, malaise, muscle ache
- Fever/Chills
- Coryza discharge & sore throat
- Cough (dry then productive)
- Substernal burning
- TX: Deaths preventable if vaccination (flu shot)
- OTC analgesics (Tylenol)
- Prophylaxis Amantadine or Rimantadine up to 48 hrs.
- Antiviral agents (Relenza, Tamiflu, Ribavirin)
- Antitussives for cough
- Most common complication=pneumonia
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Sinusitis
S/S & Tx
Inflammation of sinus mucous membranes
- S/S: moving head pain- worse in morning - lessens throughout day as sinuses drain
- HA / sinus tenderness /pain cheeks or teeth
- Fever
- Nasal congestion/discharge with N/V or bad breath
- Sinus x-rays opaque instead of translucent with air
- TX: Antibiotics x 10 days
- Decongestant sprays (Pseudoephedrine)
- Mucolytics like Guaifenesin to liquefy secretions
- Steam or saline nose drops
- Surgery- NS irrigation with 16 ga. Needle
- Endoscopic sinus surgery with drainage window/antrectomy
- Sphenoethmoidectomy esp. if polyps
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Sinusitis
Nursing Care
Postop Nursing Dx
- Nursing Care:
- Heath Promotion
- *prevent sinusitis by promoting nasal drainage
- -encourage increased fluid intake
- -us of nasal decongestants as needed
- *patient with URI blow nose with both nares open
- *saline spray can promote drainage and reduce risk of obstriction and infection
Postop Nursing Dx:
- Pain - assess pain, use analgesics as needed
- - apply ice packs to nose
- - Fowler's or high-Fowlers for 24 to 48 hours (elevation minimizes swelling and promotes comfort)
- Imbalanced Nutrition: Less than Body Requirements
- -clear liquid diet progressing to soft foods - ensure
- -monitor I & O and weight
- -Elevate HOB during meals
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Pharyngitis/ Tonsillitis
70% viral; 15-20% beta-hemolyticstreptococcal (strep throat), chlamydia,or gonorrhea
- S/S: If tonsils, then red or pus & edematous
- Sore throat/unable to swallow (dysphagia)
- Fever/malaise/myalgia (muscle pain)
- Enlarged lymph nodes
- TX: Antibiotics x 10 days (PCN, erythromycin) Anti-pyretics (not ASA if surgery) & analgesics
- Warm saline gargles or ice collar
- Needle aspiration (I&D) or tonsillectomy
- Complications are rheumatic fever or acute glomerulonephritis
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Laryngeal Infections:
Epiglottitis
Laryngitis
- Epiglottitis
- H. influenza
- S/S: red, swollen epiglottis blocks airway, dysphagia,drooling, sore throat
TX: IV antibiotics,Decadron, freq.oximeters, maintainairway, No tongueblades
Laryngitis
Viral URI or stress voice
S/S: hoarseness oraphonia, sore throat,dry cough
TX: voice rest, avoid ETOH & tobacco,steam or warm gargles, antiseptic throat lozenges
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Epistaxis
- Nose Bleed
- Anterior - most common
- Posterior
- TX:
- -anterior -pressure on septum, ice packs, vasoconstrictors,
- nasal packing -nasal tampon or 0.25 inch petroleum gauze left in for 24 to 72 hours
- -posterior- nasal packing - left in for 2 to 5 days ,balloon catheter -inserted, inflated, left in place 2 to 3 days surgery - preferred to posterior packing - cauterize the vessel
- Nursing Care for Nasal Packing
- Monitor 02 sat
- VS
- Inspect mouth and oropharynx
- Elevate HOB
- Deep, slow breathing thourgh mouth
- Check for blood at back of mouth and frequent swallowing
- Cold compress to nose
- rest
- adequeate oral fluid intake
- frequent oral hygiene
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Broken Nose
Rhinoplasty
postop care
S/S: black eyes/periorbital ecchymosis, crepitus,epistaxis, nose deformed, rhinorrhea for CSF
TX: maintain airway,ice for swelling,rhinoplasty or septoplasty coughing, straining
- Rhinoplasty - surgical reconstruction of nose
- postop care - nasal packing left in plase for up to 72 hrs
- -temp plastic splint molded to shape of nose is removed in 3 to 5 days
- -ice packs - comfort & reduce swelling
- - Elevate HOB
- - No blow nose for 48 hrs after packing removed
- - avoid vigorous coughing or straing at stool
- - clean teeth pfrequently
- -increase fluid intake
- -bruising around eyes and nose will last for several days
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Obstructive Sleep Apnea
- Intermittent absence of air flow thru mouth/nose during sleep (tongue & soft palate block pharynx)
- Risk factors: males>females, middle age, obesity, largeneck size, ETOH or CNS depressants
- S/S: Diagnosis by sleep study (polysomnography, EEG) Loud, cyclic snoring with periods of apnea Choking/gasping/thrashing around during sleep
- Frequent awakening, insomnia, excessive daytime sleepiness, depression or impaired intellect
- Morning headaches (hypercapnia, vasodilation)
- TX: Wt. reduction & ETOH abstinence
- nCPAP=Nasal Continuous Positive Airway Pressure;nasal mask to prevent airway collapse
- BiPAP=Bilevel Positive Airway Pressure (higher pressure on inspiration, tolerated better)
- Surgery:tonsils/adenoids, uvulopalatropharyngoplasty
Machines dry mucous membrane - use in-line humidifier or room hymidifier
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Laryngeal Tumors:
Benign Polyps
Malignant Cancer of Larynx
Benign Polyps (papillomas) – bilat. wart-like growths on vocal cords, HPV, hoarseness or breathy tone;
TX: corticosteroids to shrink or polypectomy
- Malignant Cancer of Larynx: (squamous cell)
- Risk factors: males>females; > 50 years old,tobacco, alcohol, exposure to chemicals, African Amer.
- S/S: Early detection important
- Painless growth in mouth
- Ulcer that does not heal/change in denture fit
- Hoarseness or change in voice
- Lump in neck
- Dyspnea and/or dysphagia
- Pain is a late symptom (sometimes earache)
DX: by biopsy (TNM grading)
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Areas of Larynx Cancer (3)
Glottis/vocal cords – 60%, hoarseness or change in voice, well differentiated & slow growing with late metastasis as limited lymphatic supply
Supraglottis/false vocal cords – 35%,dysphagia, lump in throat, halitosis, early metastasis as rich lymphatic supply
Subglottis/below vocal cords – 5% asymptomatic til tumor obstructs airway
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Nursing Interventions of radiation Tx of larynx
- Nurse can suggest interventions to reduce side effects:
- Dry mouth (xerostomia)
- -Medication to increase production of saliva (Salagen) pilocarpine hydrochloride
- -Squirt or water bottle
- -Increase fluid intake
- -Chewing sugarless gum or candy
- -Nonalcoholic mouth rinse
- -Artificial saliva
- -Avoid commercial mouthwashes and hot or spicy foods because they are irritating
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Surgeries for Larynx CA
Cordectomy-superficial tumor involving one cord; voice rest
Hemilaryngectomy-removal of one vocal cord part larynx; temporary tracheostomy-voice preserved but quality is breathy and hoarse
Total laryngectomy- perm. separate trachea &esophagus so no aspiration; stoma or trach
Radical neck-+ lymph nodes but no metastasis; tissue from mandible to clavicle so deformity
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Laryngectomy Post-op nursing care
- -monitor airways and respiratory status
- -Encourage deep breath & cough
- -Elevate HOB
- -Humidification of inspired gasses
- -Adequate fluid intake
- -Suction using sterile technique
- -Trach care PRN
- -Teach to protect stoma from particles in air by cover with gauze or stoma protector
- -instruct to support head when moving in bed
- -call light in reach- answer call light promptly
- -Encourage family member presence
- -Spend time with pt
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Care of pt with new tracheostomy
- Care should be taken not to dislodge during the first few days when stoma is not mature (healed)
- Replacement tube of equal or lesser size is kept at the bedside
- Tracheostomy ties are not changed for at least 24 hours after insertion
- First tube change is performed by the physician usually no sooner than 7 days
- Accidentally dislodged-replace it immediately.
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Client teaching - Trach care
- Tube should be changed approximately once a month
- When a tracheostomy has been in place for several months, the tract will be well formed
- Teach the patient to change the tube using clean technique at home
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Trach stoma care
- Washed daily
- Scarf, crocheted shield to protect
- Plastic collar when bathing
- Swimming contraindicated
- Oral intake in dry weather
- Medic Alert bracelet
- Decreased smell and taste (smoke/carbon monoxide detectors should be used in home)
- -humidifier to add humidity to inspired air
- -increase fluid intake (moist mucosa)
- -remove secretions around stoma to prevent skin breakdown
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Trach suctioning
- Assess need to suction
- Explain procedure to patient
- Check suction source (neg. 80-120 mm Hg)
- Sterile technique
- Preoxygenate (100% vent. or MRB, or 3-4 deep breaths) Insert without suction on
- Withdraw catheter in rotating manner applying pressure intermittently
- Limit suctioning to 10 seconds
- Re-oxygenate, repeat suctioning if needed
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Acute Bronchitis
Acute inflammation of bronchi (v. COPD)
- S/S: paroxysms of cough (dry then productive)
- Pleuritic substernal chest pain
- Moderate fever
- General malaise
- TX: Broad spectrum antibiotic (50% bacterial)
- Increase fluids to thin secretions
- Antipyretics (ASA, Tylenol); analgesics
- Antitussive (Robitussin) esp. at night for rest
- Smoking cessation
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Pneumonia
- Acute inflammation of lung parenchyma (functioning part of the lung)
- Caused by:
- Bacteria
- Viruses
- Mycoplasma
- Fungi
- Parasites
- Chemicals (irritating gases or aspiration of gastric contents)
- The normal protective mechanisms of the respiratory system are unable to adequately protect against the affecting agent
- Antigen-antibody response with organisms releasing endotoxins that damage bronchial & alveolar membranes resulting in inflammation & edema
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Risk factors for Pneumonia
- ↓ Decreased Consciousness (depresses cough & epiglottal reflexes)
- Intubation(interferes with cough & normal mucus production)
- Air pollution / Smoking
- Viral URI (influenza, cytomegalovirus, adenovirus)
- Changes of Aging
- Chronic Diseases(leukemia, alcoholism, DM, COPD) Altered Oro-Pharyngeal Flora(secondary to antibiotic therapy)
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Classifications of Pneumonia
- infectous
- noninfectous
- community acquired
- hospital acquired
- opportunistic
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Community acquired pneumonia
- Streptococcus Pneumoniae (#1) - 66% gram +
- Haemophilus Influenzae (#2)
- Mycoplasma Pneumoniae - "walking pneumonia"
- Respiratory viruses (Influenza)
- Chlamydia Pneumoniae
- Legionella Pneumophila
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Hospital acquired Pneumonia
- Staphylococcus Aureus G(+)
- Pseudomonas Aeruginosa G(-) difficult to get out
- Klebsiella G(-)
- Escherichia coli (E-Coli) enteric G(-)
G(-) tend to be more damaging to lung fields due to acidotic pH
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OPPORTUNISTIC PNEUMONIA
- Opportunistic Pneumonia due to altered immune system esp. HIV/AIDS
- Pneumocystis carinii
- Mycobacterium tuberculosis
- Cytomegalovirus (CMV)
- Fungi
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Pneumonia lung patterns
- Lobar pneumonia - entire lobe- exudate in alveoli -consolidation of lung tissue occurs
- Bronchopneumonia - patchy consolodation- exudate in bronchi & bronchioles
- Interstitial pneumonia - inflammatory response in interstitum (CT)
Miliary pneumonia -immunocomprimised - inflammatory lesions as pathogen spreads to lungs via bloodstream
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Acute bacterial pneumonia
Streptococcus pneumoniae (community acquired)
- Sudden onset
- Chills/fever
- Tachycardia & tachypnea
- Productive cough (purulent or rust-colored)
- Pleuritic chest pain (worse with coughing &deep resp.) Pulmonary consolidation
- Dullness of percussion
- ↑ fremitus
- Bronchial breath sounds - (abnormal in LL)
- Crackles/Rhonchi
- Elderly with fever, tachypnea &altered mentation (agitation)
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Primary atypical pneumonia
- Mycoplasma Pneumoniae or Viral; “Walking” Pneumonia)
- -community acquired
- More gradual onset
- Dry hacking nonproductive cough
- Headache
- Myalgia (muscle aches)
- Sore throat (pharyngitis)
- Lack of alveolar exudate & consolidation
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LEGIONNAIRE’S DISEASE
- Legionella Pneumophila
- Gradual onset (2-10 days after exposure)
- Fever/chills
- Dry cough
- Dyspnea
- Headache
- Muscle aches (myalgias & arthralgias)
- Anorexia & diarrhea
- VERY sick (high mortality)
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ASPIRATION PNEUMONIA
- Aspiration of gastric contents into lung resulting in chemical & bacterial pneumonia
- Acid pH causes severe inflammatory response
- Pulmonary edema
- Respiratory failure
- Lung abscess/gangrene
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DIAGNOSTIC TESTS FOR PNEUMONIA
- Sputum
- Gram Stain
- Culture & Sensitivity
- CBC (leukocytosis & shift left, immature)
- ABG’s with paO2 < 70 – 80% (hypoxemia)
- Pulse Oximeter < 95%
- Chest x-ray (fluid, atelectasis, consolidation)
- Bronchoscopy to remove sputum
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COMPLICATIONS OF PNEUMONIA
- Atelectasis - collapsed or nonfunctioning portion
- Lung abscess/empyema - puss is lung
- Pleurisy/pleural effusion - pleural inflammation
- Pericarditis/endocarditis - inflammation of smooth muscle
- Meningitis - bacterial infection of meningies (covers brain)
- Peritonitis - inflammation of peritoneum
- Respiratory failure or ARDS
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Prevention of pneumonia
- vaccination recommended for
- -over age 65
- -those with cardiac, respiratory conditions, diabetes mellitus, alcoholism, other chronic diseases
- -immunocompromised
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PNEUMONIA MEDICAL INTERVENTIONS
- Antibiotics
- Antipyretics
- Bronchodilators
- Steroids
- Oxygen therapy
- Chest physiotherapy - percussion & vibraton
- Fluids (3L/day)
- Expectorants/Mucomyst
- Immunizations for pneumococcal &influenza
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NURSING INTERVENTIONS FOR PNEUMONIA
- Push Fluids/monitor IV’s
- Monitor VS esp. respirations
- Provide humidified O2
- Postural Drainage - positioning to promote drainage
- Suction PRN
- Encourage Rest
- Administer Meds (antibiotics,bronchodilators)
- High Fowlers to present aspiration
- Check gag reflex
- Do not overmedicate with Narcotics
- Client Education
- Teach prevention
- Emphasize need to finish all meds
- Adequate rest
- Encourage vaccine
- Deep breathing exercises(X 6 wk after Hosp. Discharge)
- Return to M.D. if fever, SOB,dyspnea, sleepiness, confusion
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Postural drainage
uses gravity to facilitate removal of secretions from a particular lung segment
pt is positioned with the segment to be drained superior to or above th trachea or mainstream bronchus
required various positions
Broncodilators adminsitered prior to postural drainage
-perform before meals to avoid nausea & vomiting
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Medications for Pneumonia
- Broad spectrum antibiotic
- -macrolides
- -PCN
- -Cephalosporin (2nd or 3rd gen)
- -fluoroquinolone
- Bronchodilators
- -sympathomimetic drugs - albuterol
- -metaproterenol - alupent
- -methylxanthines - theophylline (needs blood test for toxicity)
- Liquify Secretions
- -acetylcysteine -Mucomyst
- -potassium iodide
- -guaifenesin (mucinex)
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MYCOBACTERIUM TUBERCULOSIS = “TB”
Chronic pulmonary and extrapulmonary infectious disease acquired by inhalation of a dried-droplet nucleus containing a tuberclebacillus
- Airborne - from a person who expels the organism while:talking,coughing,singing,sneezing
- TB Pathophysiology:
- Macrophages Tubercle
- granulomas Caseation
- necrosis Calcification
- fibrosisReactivation
Private room & HEPA filtered respirator
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Risk factors for TB
- Close contact
- IV drug users
- Alcoholics
- Living in crowded,substandard housing
- Immigrants from areas with high incidence
- Medically underserved
- Institutionalized
- Health care workers
- Immunocompromised
- Preexisting medicalconditions:diabetes, chronic renal failure, silicosis,malnourishment
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S/S TB
- low grade fever
- fatigue
- anorexia
- weight loss
- night sweats
- chest pain
- persistent cough(purulent to bloodtinged/rusty)
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PPD/Mantoux test
PPD - purified protein derivitive of tuberculin - attracts macrophages to area - inflammatory response
results read in 48 to 72 hours & recorded as diameter of induration (raised area, not erythema)
<5mm Negative Response
- 5-9mm Negative for most people but pos for ppl
- - - in close contact with infective TB
- - - abnormal CXR
- - - HIV
- - - organ transplant
- 10 - 15mm Negative for most - pos for ppl
- - -birth in high-incidence country
- - - African Am, Hispanic, Asian
- - - Injected drug use
- - - residence of care facilities
> 15mm - positive for all ppl
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TB MEDICATIONS
- (MIN. 6 MONS.)
- Prophilactic - INH can be used alone (min 6 mo)
- Active infection - concurrent use of at least to antibiotics
- INH/Isoniazid - used prophilactally -use vit B6 & monitor liver function
- -peripheral neuropathy
- -hepatitis
- Rifampin - dont skip doses - contact lenses should not be worn (will be discolored)
- -heptitis
- -color body fluids orange-red
- Pyrazinamide (PZA) - monitor uric acid levels & avoid other hepatotoxins ASA & ETOH
- -Hyperuricemia
- -Hepatotoxicity
- Ethambutol (EMB) - monitor visual acuity
- -optic neuritis
- Streptomycin - autiometric examination & monitor renal function (BUN & CRE)
- -ototoxicity, vertigo
- -nephrotoxicity
- Calmette-Guerin (BCG) vaccine =3rd world countries to reduce symptoms of TB - PPD will be positive - CXR to rule out
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RISK FACTORS FOR LUNG CA
- Smoking
- *80-90% of lung CA due to smoking
- *Causes changes in bronchial epithelium
- *More men then women
- *More African Americans/Blacks
- *Cigs contain 43 known carcinogens
- *Dose response relationship
- Age > 50 years
- Ionizing Radiation
- Inhaled Irritants (asbestos, radon, nickel,iron, uranium, hydrocarbons, arsenic, &air pollution)
- Genetic predisposition
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SIGNS & SYMPTOMSOF LUNG CA
- Early Signs & Symptoms
- Usually non-specific & occur late after metastasis Chronic cough
- Chest pain
- SOB
- Wheezing
- Hemoptysis
- Later S & S
- Anorexia
- Wt. loss
- Fatigue
- N & V
- Hoarseness
- Dysphagia
- Very Late S & S
- Mediastinal involvement
- Bone metastasis
- Brain metastasis
- Liver metastasis
- Neuromuscular
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RESP. NURSING DIAGNOSES
- Ineffective breathing pattern R/T hypo or hyperventilation.
- Ineffective Airway Clearance R/T accumulation of secretions.
- Impaired Gas Exchange
- Altered Tissue Perfusion R/T Hypoxemia
- Activity Intolerance/Fatigue R/T Hypoxemia, COPD
- Acute pain R/T Inflammation or Chronic Pain R/T Lung Cancer
- Risk for Infection R/T Spread of TB
- Knowledge Deficit R/T TB Medications
- Fear/Anxiety R/T Suffocation and Inability to Breath
- Ineffective Therapeutic Regimen Management R/T TB Medications
- Decisional Conflict R/T Smoking
- Hyperthermia R/T Pneumonia
- Anticipatory Grieving R/T Cancer DX.
- Compromised Individual or Family Coping R/T Role Relationship Changes
- Imbalanced Nutrition, Less than Required
- Low self esteem R/T Interstitial Pulmonary
-
Chest tubes after lung CA surgery
- closed drainage system
- -monitor q hour, then q 2 to 4 or 8 hrs as indicated
Notify healthcare porvider if chest tube output exceeds 70 mL / hour or is bright red, warm, and free flowing (indicates intrathoradcic hemorrhage)
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MEDICAL CARE OF LUNG CA
- Chemotherapy (combination chemo esp. small cell due to rapid growth of lung CA & dissemination)
- Radiation (cure vs. palliative)
- Surgical Intervention (small cell usually metastasized – no surgery) - non-small cell - surgery only real chance for cure
- Pain management
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ASTHMA
- Chronic inflammatory disorder with obstruction of airways and episodes of wheezing, SOB, tight chest, & coughing
- 11 million asthma attacks per yr. in US
- Increased since 1980s & now stable
- ANA controls smooth muscles of airway
- Parasympathetic/cholinergic-bronchoconstrict Sympathetic/beta adrenergic-bronchodilate
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ASTHMA PATHOPHYSIOLOGY
- Early Phase: stimulus/trigger causes release of chemical mediators (histamine, prostaglandins,& leukotrienes) Increase parasympathetic system causing bronchoconstriction & spasm
- Increase capillary permeability with edema & mucusproduction
Late Phase: 4-12 hrs. after trigger, basophils & eosinophils activated with increased bronchoconstriction, air trapping and decreased oxygen exchange resulting in resp. alkalosis
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ASTHMA SIGNS & SYMPTOMS
- Chest tightness
- Wheezing,
- Dyspnea
- Cough / cough-variant asthma
- Nasal flaring
- Tachypnea with prolonged expiration
- Tachycardia
- Use of accessory muscles & intercostal retractions Restless, anxiety/feeling of suffocation
-
ASTHMA – DANGER SIGNAL !
Signs of Impending Respiratory Failure
Decreased Breath Sounds Decreased wheezing
-
ASTHMA DIAGNOSTIC TESTS
- Pulmonary Function Tests before & after bronchodilator therapy
- Increased residual volume (RV)
- Decreased vital capacity (VC)
Bronchial Provocation
- ABG’s –Early resp. alkalosis due to hyperventilation & use of accessory muscles
- Later resp. acidosis due to exhaustion & hypoventilation
Skin Testing to ID specific allergens
- Peak Expiratory Flow Rate (PEFR) meter
- green 80-100%
- Yellow 50 -80 %
- Red <50 %
-
ASTHMA MEDICAL MANAGEMENT
- Bronchodilators (used for acute asthma - stimulate sympathetic receptor & cause smooth mucle relaxation)
- Sympathomimetics
- *Epinephrine; Isuprel
- *Metered-Dose Inhalers (Salmeterol, Albuterol) *Terbutaline (Brethine)
- Xanthine Derivatives
- *Aminophylline IV
- *Theophylline PO
- Anticholinergics (Atropine, Combivent)
- Anti-inflammatory agents (prevent & treat acute episodes- decrease release of inflammatory mediators so decrease inflammatory response and airway edema)
- Corticosteroids (Decadron, Azmacort, AeroBid)
- Mast cell stabilizers (Nasalcrom/Cromolyn &Nedocromil)
- Leukotriene modifiers (blocks effects leukotrienes (bronchoconstrictors) which participate in inflammatory respnse )
- (Accolate, Zyflo, Singulair)maintenance & not acute attack; hepatotoxic
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