Review of Respiratory system
What are symptoms of respiratory distress?
SOB when speaking
Tachypnea
Adventitious breath sounds
Intercostal or sternal retractions
Cyanosis
Diaphoresis
Nasal flaring
Decreased LOC
Agitation/apprehension/anxiety
What are the risk factors?
Smoking-- its the greatest risk
Radon
Exposure to substances that are carcinogenic
Asbestos -Beryllium
Chromium-Coal distillates- Cobalt
Iron Oxide-Mustard Gas-Petroleum distillates-Nickel-Radiation-Tar-Uranium
Air pollution w/ Hydrocarbons
Family or personal history of lung cancer (Genetic component)
Over the age of 65
What are the treatments for lung cancer (types)?
Non-Small Cell:
Surgery: can provide a cure
Chemotherapy
Radiation
Most cases need more than surgery
Small Cell:
Chemotherapy
Radiation(monitor for surnburn with radiation)
(Rarely produce long term survival; 5 yr. survival up to 14%)
Chest tubes:
Nurses must check the chest tube site, assessing for s/sx of local infection at the site, crepitus, and any problems with the chest tube system.
Provider needs to be alerted if drainage is more than 100-150mL
Or when they stand up and they have a high amount of output= known as “dumping”
What is it?
Its an inherited autosomal recessive disorder affecting many organs, lethally impairing pulmonary function.
-Blocked chloride transport, producing thick mucus with low water content
-Mucus plugs up glands, causing atrophy and organ dysfunction
What is the goal treatment for CF?
There is no cure for CF, but tx can ease sx's and reduce complications.
Goals of treatment include:
Preventing and controlling infections that occur in the lungs
Removing and loosening mucus from the lungs
Treating and preventing intestinal blockage
Providing adequate nutrition
How do you promote optimal breathing?
Postitoning
C & DB
Abdominal breathing
Pursued-lip breathing
I.S
Fluid intake
Humidification
Postural drainage
Percussion and vibration
Types of Lung cancers? Which is the most aggressive?
Non-Small Cell:grouped together because the approach to diagnosis and treatment is similar for all of these cancers.
Small Cell:The most aggressive. Median survival from diagnosis to death only 2-4 months. More likely that it is widely disseminated by the time of diagnosis.
What is the treatment of choice for the lung cancer types?
SCLC: Chemotherapy
NSCLC: Chemo is used alone or combined with surgery
What are the diagnostic tests?
Sweat Test: detects abnormal concentration in sweat (increased level of sodium 2 – 5 x’s)
Duodenal Analysis: of secretions for detection of pancreatic enzymes reveals extent of pancreatic involvement
Stool analysis: analyzed for fat & lack of trypsis
PFT & Chest x-ray
ABG’s
CF tx dependent on sx's
Respiratory
-antibiotics
-mucus-thinning meds/treatments
-anti-inflammatory
-bronchodilator
-chest physiotherapy-
-GI
-pancreatic enzymes
-vitamins
-diet
Lung transplant consideration, however, R side of heart tends to enlarge because the congestion in the lungs increases pressure in the pulmonary artery & R ventricle. Signs of heart failure seen
Lung transplantation
Does not cure
Extends life by 1 to 15 years
Transplant rejection rate is high
Patient at continued risk for lethal pulmonary infections
If heart failure is occurring they are unable to receive a lung transplant
What are interventions for abnormal resp assessments?
Check for airway obstruction; proper positioning of patient
Suctioning
Administering oxygen
Using mechanical ventilation
Have I.V. access
Incentive spirometer, cough and deep breathing
Calm environment
Ongoing assessment
Respiratory rate
Lung sounds
Skin color
Pulse oximeter
Changes in mentation
What are lung cancer manifestations?
The majority of patients are asymptomatic during the early stages
As the tumor grows clues emerge:
Persistent cough, chills or fever
Dyspnea
Chest pain
Blood-streaked or rusty sputum
Frank hemoptysis(Bright red blood)
Wheezing
Recurrent pneumonia, pleural effusions, bronchitis
Hoarse voice from laryngeal nerve involvement
Weight loss
What are the side effects of chemo treatments?
Fatigue
Alopecia
Myelosupression-Bone marrow suppression
Peripheral neuropathy
Mucositis
N/V(Zofran used prior to and after chemotherapy)
Thrombocytopenia(decreased platelets)
Anemia
Neutropenia(dereased WBC's)
What are the clinical manifestations in childhood?
10-15% of newborns with CF have meconium ileus (pancreatic enzymes lacking, obstructing intestine)
Failure to grow
Clubbing
Persistent cough
Poor nutritional status(you aren’t able to absorb)
Large frequent BM( nothing is being absorbed=fast passage)
Large protuberant abdomen may develop
Jaundice
Salt depletion
Multiple respiratory infections
Ineffective airway clearance
Altered oxygenation
Anticipatory grieving
Risk for compromised family coping R/T chronic illness in a child
Risk for impaired skin integrity R/T acid stools
Imbalanced nutrition, < body requirements R/T inability to digest fat
Nursing care is similar to client with COPD
What are the levels for the ABG's?
pH: 7.35
pCO2: 35-45
HCO3:21-28
PaO2: 80-100 (less than 80 is hypoxia)
Heart Sounds –muffled by tumor
Dysrhythmias d/t hypoxia
Loss of Bone density-pathological fractures
Wt Loss, anorexia
Dysphagia, N/V
Superior Vena Cava Syndrome(swelling in face, neck, trunk & AMS)
Change in Bowel or Bladder tone
Psychosocial-fear r/t dyspnea
What are nursing diagnoses?
Impaired gas exchange
Activity intolerance
Imbalanced Nutrition
Pain
Grieving
Risk for infection
Risk for injury
Self care deficit
Spiritual distress
What are clinical manifestations in adults?
Frequent cough
Reoccurring bronchiolitis, bronchitis, pneumonia
Distal intestinal obstruction
Anorexia
Vomiting
Protein and fat malabsorption
Male sterile
Female delayed menarche(lack of menstruation)
Life expectancy 30 – 35 years, most die of lung complications
Non-pulmonary symptoms
Abdominal distention
GERD, rectal prolapse, foul-smelling stools, steatorrhea
Malnourishment, vitamin deficiencies
Pulmonary symptoms
Respiratory infections
Chest congestion and sputum production
Decreased pulmonary function
Limited exercise tolerance
What are CF airway clearance methods?
Mechanical mobilization (chest physiotherapy or the vest (high frequency chest compression)) used 1-3x a day and postural drainage
Clapping: Clapping with the cupped hand on the chest wall over the section of the lungs to be drained starts vibrations which are transmitted to the air passages (bronchi), stimulating the movement of secretions. These vibrations may help to remove secretions sticking to the walls of the air passages.
Aerosol therapy with antibiotics, bronchodilators, and mucolytics.:
Frequent hospitalizations to treat pulmonary infections (oral, IV and nebulized antibiotics might be used)
May be prescribed an oral drug for suppressive therapy or aerosolized tobramycin
Bronchodilators (Albuterol)
Flutter valve:
The Flutter valve works when you exhale through the device. Your exhaled air moves a steel ball inside the valve. The ball moves up and down inside the device quickly causing a flutter effect, which increases pressure slightly. The increased pressure and vibration from the ball moving breaks secretions up. The increased pressure also helps to hold the airways open making the secretions easier to cough out.
What affects ventilation and respiration?
uChanges in volume and capacity
Air pressures
Oxygen (O2)
Carbon Dioxide (CO2)
Airway resistance
Lung compliance
Elasticity
Alveolar surface tension
Affected by gender, age , weight & health
What are lung cancer diagnosis?
Chest X-ray reveals a tumor
CT scan to detect and stage disease
Bronchoscopy to biopsy tumor
Thoracoscopy-done through small chest incisions
Mediastinoscopy
Metastasis: lymph node biopsy, MRI, PET scan
What are radiation therapy side effects?
Fatigue
Skin reactions(sunburn)
Esophagitis
Pneumonitis
Pericarditis
What is the organ involvement for the pancreas and lung?
Pancreas:
Enzyme secretions so thick ducts are plugged
Back-pressure on acinar cells atrophy – no longer able to produce enzymes
0 enzymes = unable digest fat, protein & some sugars
BM’s: large, bulky, greasy , foul odor (steatorrhea)
Abdominal distention – signs of malnutrition
Fat-soluble vitamin deficiencies
Tx: Pancrealipase(Kalydeco)"pancreatic enzymes"- Taken every single time they eat(even with snacks) to help with digestion
Lung:
Thickened mucous pools in bronchioles
Pockets of infection(high risk)in secretions (staphylococus aureus, psudomonas aerginosa, H. inflluenzae
Secondary emphysema
Bronchiectasis , pneumonia, atelectasis
Clubbed fingers, diameter of chest enlarged
CF nursing care teaching
Inhaler and nebulizer use
Chest physiotherapy
Medications-mucolytics, antibiotics, steroids
Nutrition-pancreatic enzymes( TAKE anytime they are eating-also snacks)
How to prevent infection
Recognition of complications
Isolation in hospital(protective precautions)