Respiratory - Unit 3 - Pulmonary cancer, chest trauma/surgery

Question 1

Does pulmonary cancer have a good cure rate?

Answer 1

Sadly, no - 90% or more is malignant.

Question 2

Does pulmonary cancer metastasize quickly?

Answer 2

YES - very quickly.

Question 3

Is pulmonary cancer the leading cause of cancer death?

Answer 3

YES

Question 4

What are some pulmonary cancer risk factors?

Answer 4

CIGARETTE SMOKING = #1 (10x more likely in smokers and African Americans) environmental smoke, air pollution, occupational factors, radon, vitamin A deficiency

Question 5

What are some diagnostic tests for pulmonary cancer?

Answer 5

Chest X-Ray, sputum, CT/MRI of chest, bronchoscopy w/biopsy, lung biopsy

Question 6

What are some symptoms of pulmonary cancer?

Answer 6

Persistent cough with or without blood, rust-streaked sputum, frank hemoptysis (coughing up blood), hoarseness, dyspnea, wheezing, pneumonia, chest pain or tightness, fatigue, anorexia/weight loss, etc.

Question 7

What surgeries might be done for pulmonary cancer? (4 types)

What are the priority nursing interventions for these surgeries?

Answer 7

Wedge Resection - tiny piece removed.

Segmentectomy (a segment is removed)

Lobectomy - a lobe is removed

Pneumonectomy - a whole lung is removed.

Interventions = O2, Pain, etc.

Question 8

Will a patient have a chest tube with a pneumonectomy?

Answer 8

NOPE - just the others. No need for a chest tube when there’s no lung!

Question 9

What are some problems with radiation therapy for a lung cancer patient?

Answer 9

Pneumonitis (alveoli wall inflammation), fatigue, discomfort, nutrition, skin integrity, knowledge deficit

Question 10

Chemotherapy - never used for lung cancer patients. T/F?

Answer 10

FALSE - it is the treatment of choice.

Question 11

What are some nursing considerations for chemo treatment?

Answer 11

Decreased immunity, sickness, fatigue, SOB, stomatitis

Question 12

What are some complications of pulmonary cancer?

Answer 12

Pleural effusion (dyspnea, cough, chest pain, fever, diminished breath sounds, anxiety), Hyperglycemia (stimulated by tumor), altered mental status (brain metastasis - which is usually caused by lung cancer 50% of the time)

Question 13

What is pleurisy? What’s the onset?

Answer 13

Inflamed intrapleural space with an abrupt onset.

Question 14

What causes pleurisy?

Answer 14

Viral, bacterial, surgical

Question 15

What are some symptoms of pleurisy?

Answer 15

Non-specific pain with INSPIRATION, deep breathing, laughing, coughing, pleural rub on inspiration

Question 16

How do we treat pleurisy?

Answer 16

Analgesics, heat to chest, antibiotics if bacterial

Question 17

What is pleural effusion?

Answer 17

Fluid or blood in pleural space (up to 5L)

Question 18

What causes pleural effusion?

Answer 18

Lung cancer, CHF, liver or kidney failure, pleural inflammation (viral or bacterial)

Question 19

What are symptoms of pleural effusion?

Answer 19

Asymptomatic if

Question 20

How do we treat pleural effusion?

Answer 20

Treat underlying condition, thoracentesis, chest tube

Question 21

What are some complications of pleural effusion?

Answer 21

Atelectasis/depends on underlying condition

Question 22

With a chest tube, what does fluid movement with inspiration indicate?

Answer 22

Tidaling - test tube is patent!

Question 23

25% of traumatic deaths result from chest injuries. T/F?

Answer 23

True

Question 24

What is a pulmonary contusion?

Answer 24

Bruising of lung tissue.

Question 25

What is a pneumothorax?

Answer 25

Air in pleural space.

Question 26

What is a hemothorax?

Answer 26

Air and blood in pleural space

Question 27

What is a rib fracture?

Answer 27

sharp, knife-like pain.

Question 28

What is flail chest?

Answer 28

Loss of fixation of chest wall.

Question 29

What is tracheobronchial trauma?

Answer 29

Mediastinal shift

Question 30

What is crepitus?

Answer 30

Subcutaneous emphysema w/ pneumothorax - it's like rice krispies.

Question 31

Chest Trauma - what is A-J (all the common ones) ?

Answer 31

``` A - Aortic Tear B - Bronchial Tear C - Cord Injury D - Diaphragmatic rupture E - Esophageal Injury F - Flail Chest G - Gas in chest (pneumothorax) H - Hemothorax I - Infarction J - HVD ```

Question 32

What is a pneumothorax?

Answer 32

collapsed lung by trauma or similar circumstances - air becomes trapped and it collapses.

Question 33

What are the four types of pneumothorax?

Answer 33

Spontaneous/Closed/Tension/Open

Question 34

What's a hemothorax?

Answer 34

Collection of blood in the space between the lung and the pleural cavity

Question 35

What's a closed pneumo? Tension pneumo? Open?

Answer 35

Closed = air in between visceral - can't escape. Tension = air increases but can't escape. Open would be like someone was stabbed

Question 36

What are some symptoms of a pneumo?

Answer 36

Increasing dyspnea, increasing restlessness/agitation, asymmetrical chest movement, crepitus, hyper resonance, etc

Question 37

How do we treat a pneumo?

Answer 37

O2, chest tubes, pain control, antibiotics, open - occlude open wound

Question 38

If there's a pneumothorax, where's the chest tube placed?

Answer 38

Higher

Question 39

If there's a hemothorax, where's the chest tube placed?

Answer 39

Lower

Question 40

Why is a chest tube used to treat a hemo/pneumo?

Answer 40

Remove air or fluid/re-expand lung

Question 41

To remove chest tube, have the patient full breathe in, hold breath, and remove + cover with gloved hand until covered with something permanent, T/F?

Answer 41

True

Question 42

What are the three chambers of a chest tube system?

Answer 42

Drainage (marks drainage) Suction (-20 to -10 cm H20) Water seal - either a dry system (uses a valve or air leak) or a WET system (uses water seal)

Question 43

100-200 cc per hour after heart surgery in a chest tube. T/F?

Answer 43

True!

Question 44

Chest surgery - more than 100 cc/hr of drainage? What do we do?

Answer 44

REPORT IT

Question 45

If the drainage system bubbles after surgery, is that okay?

Answer 45

Yes, but not if it happens suddenly and hours after

Question 46

What are some chest tube assessment things?

Answer 46

Fluid movement with inspiration (patency), assess for respiratory distress, air leaks, chest movement, crepitus, dressing, breath sounds and vital signs, fluid replacement, ROM and increase activity, pain control, etc.

Question 47

What are some rules for a closed chest drainage system?

Answer 47

Collection apparatus below chest level, coil tubing in bed, NO pins or clamps, assess patency, tape all connections, asepsis, I&O every 8 hours, suction should be at 10-20 Cm H20

Question 48

What's the heimlich valve?

Answer 48

The duck bill valve - keeps air (that shouldn't be there!!) from coming into your chest.

Question 49

What's a flail chest?

Answer 49

loss of fixation of a portion of the chest wall from multiple fractured ribs so the chest moves freely in that area.

Question 50

What are some symptoms of flail chest?

Answer 50

Dyspnea, hypoxia, sharp knife-like pain, crepitus, chest wall hematoma and edema, hemoptysis, absent breath sounds

Question 51

How do we treat flail chest?

Answer 51

Stabilize area with chest binder, CMV/O2, pain control/anesthetic blocks, chest tubes if pneumo is present.

Question 52

Are patients with flail chest prone to developing pneumonia?

Answer 52

YES

Question 53

What's a VAT?

Answer 53

Video Assisted Thoracic Surgery - view lung, biopsy, remove cancer nodes, blebs, pleurodesis (pleural space is artificially obliterted), treats pleural effusion, no chest tubes, short LOS, less post-op pain, etc.

Question 54

Should we keep an extra trach at the bedside for a patient who has a trach?

Answer 54

YES - in case something goes wrong.

Question 55

What are some benefits to a trach?

Answer 55

Less damage, client comfort, able to eat/talk.

Question 56

If you have to suction a patient, do you need to give them O2?

Answer 56

Yes - hyper-oxygenate them!

Question 57

What are signs your patient needs to be suctioned?

Answer 57

Excessive cough, decreased O2, congestion, frothy sputum, etc.