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Question 1

Explain penetrating chest trauma?

Answer 1

Open pneumothorax (sucking chest wound). Hemothorax. Tracheobronchial injury. Pulmonary contusion. Diaphragm rupture. Mediastinal injury.

Question 2

Explain blunt (non-penetrating) trauma?

Answer 2

Fractured ribs. Flail chest. Closed pneumothorax. Tension pneumothorax. Tracehobronchial injury. Diaphragm rupture. Mediastinal injury. Pulmonary contusion.

Question 3

Common thoracic injury, often associated with flail chest.

Answer 3

Pulmonary contusion. Most often follows injuries caused by rapid deceleration during MVAs. Potentially lethal injury.

Question 4

How does a pulmonary contusion results in increased secretions?

Answer 4

Hemorrhage and edema in and between alveoli. Decreased lung movement. Decreased gas exchange. Bronchial mucosa irrigation. Increased secretions.

Question 5

Explain pulmonary contusion?

Answer 5

Injury to lung parenchyma (mild, moderate, severe). Interstitial hemorrhage with resulting alveolar collapse, atelectasis, and consolidation in uninjured areas. Edema in and around are of initial injury. Ventilation decreases, until hypoxia .

Question 6

Diagnostics and manifestations of pulmonary contusion?

Answer 6

CXR, chest CT
May be asymptomatic initially. Increasing dyspnea and tachypnea. Increasing restlessness. Crackles, wheezes, decreased breath sounds. Hemoptysis. Changes in sensorium due to hypoxia.

Question 7

Results from direct blunt trauma, such as blows, crushing injuries, strain from severe coughing, or sneezing spells.

Answer 7

Rib fracture. If splintered or displaced, may cause pneumothorax or hemothorax. Ribs 4-10 most commonly involved; often benign and treated conservatively.

Question 8

S/s of a rib fracture?

Answer 8

Pain at the site of injury, increasing on inspiration. Localized tenderness and crepitus on palpation. Splinting of the chest. Shallow breathing.

Question 9

Diagnostics and treatment of a rib fracture

Answer 9

CXR. chest CT

Nonspecific treatment. Pain control, promote adequate ventilation. Surgery is pretty rare.

Question 10

Fractured ribs and/or sternum in numerous places: loss of chest stability. Indication of severe chest trauma.

Answer 10

Flail chest. Thoracic injury with paradoxical motion of the chest wall segments. Often from direct impact, high speed mechanism of injury (MVA or severe fall)

Question 11

Explain flail chest.

Answer 11

Fx of consecutive ribs in greater than or equal to 2/3 places. Chest wall no longer provides the support needed for normal ventilation. Results in paradoxical breathing. Atelectasis, hypoxemia. Increased work of breathing. Hypercapnia, respiratory acidosis, always involves pulmonary contusion. Bruising of the skin over the injury.

Question 12

S/s of flail chest?

Answer 12

Severe chest pain, paradoxical breathing, oscillation of mediastinum, increasing dyspnea. Rapid, shallow respiration’s, tachycardia, hypotension, accessory muscle breathing, restlessness, anxiety, decreased breath sounds, cyanosis.

Question 13

Treatment for a flail chest?

Answer 13

Supportive. Pain control, promote ventilation, humidified O2, incentive spirometry, turn cough deep breathe, early ambulation, mechanical ventilation

Question 14

Complications of a flail chest?

Answer 14

Pneumothorax, hemothorax, pneumonia, ARDS, shock

Question 15

Air in the space between the lung and the chest wall. Spontaneous or chest injury related.

Answer 15

Pneumothorax. Open or closed. Diagnosed with CXR.

Question 16

S/s of a pneumothorax?

Answer 16

Small/slow developing. Asymptomatic maybe. When large/rapidly developing: pleuritic pain, tachypnea, increasing restlessness. Deviation of trachea. Absence of chest movement on the affected side. Crepitus. Decreased breath sounds on the affected side.

Question 17

Air enters the pleural space on inspiration but cannot leave it on expiration. Accumulating air increases positive pressure in chest cavity.

Answer 17

Tension pneumothorax. Results in lung collapse on affected side. Tracheal shift toward the unaffected side. Respiratory and circulatory function are compromised.

Question 18

Causes of tension pneumothorax?

Answer 18

Blunt chest trauma. Mechanical ventilation with positive end-expiratory pressure (PEEP). Chest tubes. Central line insertion.
Emergency; can quickly be fatal.

Question 19

S/s of tension pneumothorax?

Answer 19

Respiratory distress, agitation, tracheal deviation, asymmetry of the thorax, BS on affected side, distended neck veins, cyanosis, hyperresonance on affected side, diminished heart sounds, hypotension, tachycardia, shock, ineffective ventilation, subcutaneous emphysema

Question 20

Interventions for a chest pneumothorax?

Answer 20

Defect in the chest wall covered with sterile nonporous dressing. Chest tube. Semi-fowler’s. Administer O2. Vitals. Monitor for cardiac dysrhythmia, palpate for subq emphysema, support ventilation

Question 21

Blood in the pleural space. Chest trauma, blunt or penetrating.

Answer 21

Hemothorax. Pulmonary contusions or lacerations. May stem from the heart, great vessels, or intercostal arteries.

Question 22

S/s of a hemothorax?

Answer 22

Respiratory distress. s/s of blood loss. Bs diminished. Dull sounds percussion. CXR, thoracentesis

Question 23

Treatment for a hemothorax?

Answer 23

Chest tubes, IV fluids, blood transfusions, vitals, cardiac monitor, I+O, possible open thoracotomy

Question 24

What’s the purpose of a chest tube?

Answer 24

Removes unwanted materials (air, fluid) from the pleural cavity allowing the lung to re-expand. Must also prevent air from being pulled into the chest cavity.

Question 25

Etiology of carcinoma of the larynx?

Answer 25

Increasing in incidence. Greater in men and those older than 65. Associated with smoking, alcohol abuse, chronic laryngitis, coal abuse, and family history.

Question 26

S/s of carcinoma of the larynx?

Answer 26

Persistent hoarseness. With or without eat pain and dysphagia. Persistent cough and sore throat. Pain and/or burning in the throat.

Question 27

How to diagnose carcinoma of the larynx?

Answer 27

Direct/indirect fiberoptic laryngoscopy. X-rays, r/o lung or other metastasis. Barium swallow to determine the extent of the tumor and evaluate swallowing. Biopsy to confirm and laryngoscopy ID of the mass if found. CT/MRI to r/o metastatic to lymph nodes or other structures. Nuclear imaging for metastasis.

Question 28

Treatment for carcinoma of the larynx?

Answer 28

Surgical resection, radiation, chemo.
Resection includes hemilaryngectomy, supraglottic laryngectomy, subtotal laryngectomy, total laryngectomy, radical neck dissection

Question 29

What is a hemilaryngectomy?

Answer 29

Vertical partial laryngectomy. Half of the larynx is removed. Temp tracheotomy, no swallowing for 7-10 days. Swallowing is not a long-term problem. Voice quality is adequate for communication.

Question 30

What is a supraglottic laryngectomy?

Answer 30

Horizontal partial laryngectomy. Cancer above the cords. Voice quality not affected. May be 2-3 weeks before oral feedings are resumed. Postop danger of aspiration. Temp tracheotomy.

Question 31

Explain a total laryngectomy?

Answer 31

Used in advanced cases. Larynx and the surrounding tissues are removed. Permanent tracheotomy. Permanent loss of voice. No trouble with swallowing.

Question 32

Radical neck dissection?

Answer 32

Only done if the risk of metastasis to the neck is high. Causes atrophy of the trapezius muscle. Shoulder droops on the side of surgery.

Question 33

Preoperative nursing care for issues with carcinoma of the larynx?

Answer 33

Prepare them for voice changes, swallowing problems, trach and the care involved, diet changes. How the pt will communicate.

Question 34

Postoperative nursing care for carcinoma of the larynx?

Answer 34

Airway! Trach tube for 5-10 days for partial (cuffed tube initially then changed to uncuffed). Extra trach tube available. Sterile suctioning, O2, humidification. Incentive spirometer. Watch for dyspnea due to edema, secretions. Monitor for signs of aspiration.

Question 35

Post-op care of a radial neck dissection?

Answer 35

Semi-fowlers (3-45 degrees), neck flexed (minimize suture tension). OOB first post-op day. Drain wounds to prevent fluid accumulation. Max 300 mL in the 1st 16 hours. Monitor for air leaks and infection.

Question 36

Nutrition for post-op carcinoma of the larynx? Communication and other issues?

Answer 36

NG tube, hyperalimentation until able to swallow. Monitor for signs of aspiration. Adequate fluids to keep secretions thin. Protein needed for wound healing. Body image.
Speech therapy, new techniques may be utilized.

Question 37

Etiology of lung cancer?

Answer 37

Primary of metastatic. 90% attributed to smoking. Radon gas, occupational and environmental agents, asbestos exposure.
staged by the TNM system

Question 38

What are the 4 histologic types of lung cancer?

Answer 38

Small cell (10-15%)
Non-small cell (85-90%) including:
Epidermoid (squamous) 25-30%
Adenocarcinoma 40%
Large cell 10-15%

Question 39

Pulmonary manifestations of lung cancer?

Answer 39

Hoarseness, cough, sputum production, hemoptysis, shortness of breath, change in endurance, unilateral where, friction rub, chest discomfort.

Question 40

Non-pulmonary signs of lung cancer?

Late signs?

Answer 40

Muffled heart sounds, dysrhythmias, cyanosis, clubbing of fingers
Fatigue, weight loss, anorexia, dysphagia, n/v

Question 41

Diagnosis of lung cancer?

Answer 41

CXR, CT, MRI, PET, thoracentesis, bronchoscopy/needle biopsy, thorascopy, mediastinoscopy, surgical tipsy, sputum cytology, ABG, PFT

Question 42

Interventions for lung cancer?

Answer 42

Chemo, radiotherapy, surgical management including:

Thoracotomy with tumor removal. Lobectomy (most common for small, potential curable tumors). Pneumonectomy.

Question 43

These syndromes are most commonly associated with small-cell lung cancer.

Answer 43

Adrenocorticotropic hormone (ACTH)- Cushing’s syndrome
FSH- Gynecomastia
ADH- SIADH; (weight gain, general edema, dilution of serum electrolytes (esp Na))
PTH- Hypercalcemia
Ectopic insulin-Hypoglycemia