Lower Respiratory Disorders Flashcards

Question

Treatment of Lung Cancer

Answer 1

Radiation therapy Chemotherapy- Primary treatment for SCLC and adjuvant to surgery in NSCLC Surgery Segmental, “wedge” resection Lobectomy Pneumonectomy Immunotherapy – Can be used in people with NSCLC whose cancer starts growing again after chemo Pneumonectomy Chest tubes may, or may not be placed If placed, it is clamped & only released by surgeon to adjust volume of sero-sanguinous fluid allowed to fill space Daily CXR Position patient operative-side DOWN Pain management

Answer 2

Caused by air entering pleural cavity Positive pressure in pleural space causes lung to partially or fully collapse Increased air in pleural space equals reduced lung volume Open: opening in chest wall Penetrating trauma—sucking chest wound Closed: no external wound Suspect pneumothorax with chest wall trauma Manifestations Small pneumothorax Mild tachycardia and dyspnea Large pneumothorax Respiratory distress Absent breath sounds over affected area Diagnostic Study: Chest x-ray

Answer 3

Spontaneous—rupture of blebs Can occur in healthy or chronically ill persons (COPD, asthma, cystic fibrosis, pneumonia) Risk factors: Tall, thin, male, family history, or previous spontaneous pneumothorax Iatrogenic —medical procedures Biopsies, subclavian catheter insertion, ventilator, esophageal trauma Tension pneumothorax Accumulation of air in pleural space that cannot escape results in increased intrapleural pressure Causes mediastinal shift and hemodynamic instability: reduced venous return and reduced cardiac output Medical emergency – may be fatal if not corrected

Answer 4

Spontaneous—rupture of blebs Can occur in healthy or chronically ill persons (COPD, asthma, cystic fibrosis, pneumonia) Risk factors: Tall, thin, male, family history, or previous spontaneous pneumothorax Iatrogenic —medical procedures Biopsies, subclavian catheter insertion, ventilator, esophageal trauma Tension pneumothorax Accumulation of air in pleural space that cannot escape results in increased intrapleural pressure Causes mediastinal shift and hemodynamic instability: reduced venous return and reduced cardiac output Medical emergency – may be fatal if not corrected

Answer 5

Hemothorax Blood in pleural space Treat with chest tube Hemopneumothorax Blood and air in pleural space Chylothorax Lymphatic fluid in pleural space Treat conservatively or with Octreotide Refractory options: surgery or pleurodesis

Answer 6

Dependent on severity, underlying cause and hemodynamic stability Emergency treatment—Cover wound with dressing secured on 3 sides If impaled object in place, stabilize it with a bulky dressing but do not pull it out Treatments Chest tubes with water-seal drainage Other: partial pleurectomy, stapling, or pleurodesis Tension pneumothorax Needle decompression— immediate Chest tube and water-seal drainage Inspiration: pulls dressing against wound so air cannot enter pleural space Expiration: dressing pushes out and air escapes

Answer 7

Chest tubes Drain pleural space Reestablish negative pressure Allow lung to expand Small: air Medium: fluid Large: blood

Answer 8

Collection device for fluid, air, or blood from chest cavity Three basic compartments 1st compartment or collection chamber Fluid stays in; air vents to 2nd compartment 2nd compartment or water-seal chamber Contains 2 cm of water; acts as one-way valve; air goes in, bubbles out, but can’t go back to patient 3rd compartment or suction control chamber Uses column of water to control suction from regulator Bubbling in water-seal chamber Brisk at first, eventually disappears as lung expands Intermittent with exhalation, coughing, or sneezing Tidaling in water-seal chamber Fluctuation of water with pressure changes during respiration Disappears as lung re-expands If stops suddenly, check for occlusion Suction control chamber Wet suction Amount of water in chamber (20 cm) controls suction Excess suction from source vented Usual suction order = −20 cm H2O Adjust suction until gentle bubbling in third chamber Dry suction—no water (less noise) Dial regulator to pressure; visual alert

Answer 9

Drainage system Keep tubing loosely coiled Keep connections tight; taped Observe: tidaling, bubbling, air leak, fluid levels Patient’s clinical status Assess: Vital signs, lung sounds, pain Drainage amount Drainage site infection Subcutaneous emphysema Encourage: Deep breathing/Incentive spirometry Range-of-motion exercises Chest drainage Keep below chest Mark and measure drainage Report greater than 200 mL/hr in first hour and 100 mL/hr thereafter; replace unit when full Avoid overturning unit Breakage of unit Place distal end of chest tube in 2 cm water in sterile container; replace unit No milking or stripping chest tubes Dry suction chest drainage – Most common type Wet suction chest drainage Monitor: Water levels Suction at—20 cm H2O Gentle bubbling Chest tube dressings Change according to agency policy and procedure Petroleum gauze Aseptic technique Monitor for infection Document Clamping chest tubes Not advocated during transport or disconnection due to risk for tension pneumothorax May clamp briefly to change drainage unit

Answer 10

When lungs reexpanded and drainage minimal Premedicate prior to removal Valsalva maneuver during removal Apply occlusive dressing Chest x-ray Monitor for respiratory distress

Answer 11

Crackles (rales) Snorous Wheezes (rhonchi – low pitched) Sibilant Wheezes (high pitched) Stridor

Lower Respiratory Disorders Flashcards

(35 cards)