Lung And Laryngeal Cancer

Question 1

Primary vs. Metastatic

Answer 1

Primary: starts in the lungs
Metastatic: comes from elsewhere in the body

Question 2

1) What is the leading cause of lung cancer?

2) Other risk factors

Answer 2

1) A history of Smoking for more than 20 years

2) Asbestos, beryllium, chromium, coal, cobalt, iron oxide, mustard gas, petroleum, radiation, air pollution, genetics

Question 3

1) Who should be screened for lung cancer?

2) Two types of lung cancer

Answer 3

1) Adults 55-77 with a Hx of smoking of quit less than 15 years ago should be screen annually
2) Small cell and Non small cell

Question 4

Types of Non Small cell lung cancer

Answer 4

• Epidermoid
• Adenocarcinoma
• Large cell

Question 5

Small Cell Lung Cancer

1) Growth
2) What is it associated with?
3) Treatment

Answer 5

1) Fast and aggressive
2) Smoking and paraneoplastic syndrome
3) Chemo and radiation. Surgery not helpful

Question 6

Epidermoid Carcinoma

1) What does it look like?
2) What is it associated with?
3) Growth
4) Where is it found?

Answer 6

1) Squamous cell
2) Smoking
3) Slow
4) The bronchi and peripheral tissues

Question 7

Adenocarcinoma

1) What group is it associated with?
2) Where is it found?

Answer 7

1) Nonsmokers and women

2) Peripheral lung tissue

Question 8

Tumor Grading

1) Gx
2) G1
3) G2

Answer 8

1) Can’t be determined
2) Tumor cells closely resemble normal cells
3) Tumor cells have some normal characteristics but also have malignant ones

Question 9

Tumor Grading

1) G3
2) G4

Answer 9

1) Tumor cells are poorly differentiated but tissue of origin can still be determined
2) Tumor cells have no normal characteristics and tissue of origin may not be established

Question 10

Tumor Staging

1) Tx
2) To
3) Tis
4) T1-4

Answer 10

1) Primary tumor can’t be assessed
2) No evidence of primary tumor
3) Carcinoma in situ: tumor is localized
4) Increasing size of tumor

Question 11

Node

1) Nx
2) No
3) N1-3

Answer 11

1) Regional lymph nodes can’t be assessed
2) No regional lymph node metastasis
3) Increasing involvement of regional lymph nodes

Question 12

1) Mx
2) Mo
3) M1

Answer 12

1) Distal metastasis can’t be assessed
2) No distant metastasis
3) Distant metastasis

Question 13

Pulmonary S&S of Lung Cancer

Answer 13

• Persistent Cough- most common symptom
• Hemoptysis
• SOB
• Unilateral wheeze
• Pain on inspiration
• Friction Rub
• Pleural Effusion
• Edema of face and neck
• Clubbing of fingers

Question 14

Dx Tests for Lung Cancer

Answer 14

• CXR
• CT Scan, MRI, PET
• Sputum collection
• Fiberoptic Bronchoscopy
• Thoracentesis
• Biopsy

Question 15

1) What is the first Dx test?
2) What does it show?
3) What is definitive for Dx?

Answer 15

1) CXR
2) White patches in the lungs
3) Biopsy

Question 16

What medications are used to treat lung cancer?

Answer 16

• Chemo- give the lowest dose possible
• Morphine for pain
• Bronchodilators open up the airways; Albuterol
• Mucolytics to help loosen secretions

Question 17

Tx for Lung Cancer

Answer 17

• Radiation
• Chemo
• Thoracentesis
• Surgery- lobectomy or pneumonectomy
• Pleurodesis

Question 18

Nursing Dx for Lung Cancer

Answer 18

• Impaired Gas Exchange
• Pain
• Activity intolerance
• Disturbed body image
• Knowledge deficit

Question 19

Risk Factors for Laryngeal Cancer

Answer 19

• Smoking
• Alcohol consumption
• Marijuana
• Poor oral hygiene
• HPV

Question 20

S&S of Laryngeal Cancer

Answer 20

• Hoarseness that lasts more than 2 weeks
• Erythroplakia and Leukoplakia
• Ear pain
• Ringing in the ears
• Swelling or lumps in the neck
• Constant coughing

Question 21

Dx Test for Laryngeal Cancer

Answer 21

• Fiberoptic laryngoscopy
• CXR
• Barium Swallow
• CT, MRI, SPEC, PET
• Biopsy

Question 22

Surgical Interventions for Laryngeal Cancer

Answer 22

• Hemilaryngectomy
• Subtotal laryngectomy
• Supraglottic laryngectomy
• Total/Partial laryngectomy
• Radical Neck Dissection
• Tracheostomy
• Neck dissection

Question 23

1) What position should patients be in post op?

2) What meds should be given before meals?

Answer 23

1) Semi Fowler

2) Anitemetics or analgesics

Question 24

Radiation Therapy

Side effects and treatments

Answer 24

• Dry mouth- increase fluids; mouth rinses; pilocarpine hydrochloride
• Oral mucositis: oral care
• Fatigue: walking 15-30mins a day

Question 25

Pts teaching for radiation

Answer 25

• Pts should always carry a water bottle

- Don’t use lotions within 2 hrs of Tx

Question 26

1) Tracheostomy

2) Function

Answer 26

1) Surgically created stoma in the trachea
2) Establish patent airway
Facilitate removal of secretions
Long term mechanical ventilation

Question 27

Tracheostomy

1) How should pt be positioned during procedure?
2) How to confirm placement?
3) What should stoma be cleaned with?

Answer 27

1) Supine
2) Auscultate the pts chest for air entry
3) Normal saline

Question 28

Tracheostomy

1) What should be done before suctioning?
2) What should be avoided for the first 24hrs?
3) Who should assess swallowing and risk for aspiration?

Answer 28

1) Give humidified air
2) Avoid changing tapes
3) Speech therapist

Question 29

What to do if tracheostomy tube becomes displaced?

Answer 29

• Call HCP
• Assess LOC, ability to breathe and for respiratory distress
• If respiratory distress, use hemostat to open up stoma
• If tube can’t be replaced, place pt in semi Fowlers

Question 30

Indications for suctioning

Answer 30

• Coughing
• Crackles/wheezes
• Increase in peak inspiratory pressure
• Restlessness/Agitation

Question 31

1) What is the priority during suctioning?

2) When should it be stopped?

Answer 31

1) Assess O2 before, during, and after

2) If pts becomes bradycardic, hypotensive, dysthymias, or decrease in SPO2