Diagnostics
Pulse Oximetry- what does it measure? When should you report a SpO2 reading?
Non-invasive monitors arterial oxygen saturation
Device attaches to earlobe, pinna of ear, fingertip, toe, forehead, bridge of nose
Detects blood in the capillaries
Nursing: Make sure the fingernail is clean of polish. Report to MD is consistently under 95%
Specifics lifestyle choices or exposure linked to Larynx Cancer
Tobacco products(cigarette, cigar, pipe, smokeless tobacco)
Excessive alcohol use
Lack of fruits and vegetables in diet
GERD
HPV and Hpylori
Environmental polluntants- asbestos, paint fumes,wood or coal dust, (911 workers/survivors)
Age related changes for respiratory disorders
Decreased immune system
Decreased cough reflex & increased risk of aspiration
Osteoporosis- kyphosis, which impinges lung expansion
Decreased elasticity in lungs affecting ventilation and lung function
Total body water decreases to 50%-dehydration, thick mucus
Decreased response to hypoxemia and hypercapnia
Atelectasis
Sarcoidosis
Incomplete expansion or collapse of alveoli. Usually reversible
Causes- Post op or being bed bound
Treatment= Incentive spirometry
Turn, deep breath and cough
Sarcoidosis= Granulomas in the lungs and lymph nodes. Fibrotic tissue changes.
African Americans 20-30 years old
ARDS
Acute respiratory distress syndrome= Acute lung injury from sepsis, major trauma, major surgery
Pulmonary edema and lung stiffness
Severe hypoxemia
Treat the underlying cause
Co2 Monitoring- what does it measure? How?
Capnography
Monitor adequacy of ventilation
Can be part of an oxygen delivery system measuring end-tidal Co2
Bedside by nurse
Which tumor cell is most common with Larynx cancer?
Squamous cell carcinoma
Grows from the lining of the respiratory tract- mets to the lungs is common
Restrictive verses Obstructive disease
Restrictive - decreased lung compliance (inability of the lung tissue to expand). Arthritis, kyphosis, and scoliosis decrease the size of the chest cavity.
Obstructive- can't move the air into and out of the lungs. Asthma, emphysema, chronic bronchititis and COPD.
Lung Cancer-etiology
Patho
90% cigarette smoking
Adenocarcinoma, squamous cell carcinoma, and large cell carcinoma 85%
Chronic irritation of the epithelial tissue
S/Sx of ARDS
Treatment
Nursing
Dyspnea, tachypnea, tachycardia and hypoxemia.Respiratory alkalosis.
Ventilatory support- nutritional support (enteral)
Prone positioning
ABG - what is it? Who can do it?
Arterial Blood Gas
Determines CO2 and oxygen exchange across the alveolar membrane
Determine acid-base balance within the body
Determines hypothermia
Respiratory or RN does this blood draw
Signs and Symptoms of Larynx Cancer
Persistent hoarseness
Sore throat
Consistent pain in or around the ear when swallowing
Difficulty swallowing
Dry persistent cough for no known reason
Blood in phlegm or saliva that is persistent
Lumps or knots on the neck -enlargement of the cervical lymph nodes
Five A's for helping your patient quit smoking
Ask- tobacco use
Advise- health benefits of quitting
Assess-readiness to quit
Assist-creating a quitting plan
Arrange- follow up
Lung cancer S/Sx
Cough and some wheezing
Pain or discomfort in the chest when a tumor grows
Fatigue, anorexia, and weight loss
Respiratory failure
The result of insufficient O2 or excessive CO2. Acute or chronic
Pneumonia or PE = Fluid fills the alveoli and interferes with gas exchange
Restlessness, agitation, confusion, diaphoresis, retraction of the accessory muscles, cyanosis
Sputum Analysis
Examine the lower respiratory tract sputum for bacteria, bacilli, or malignant cells. Determine C&S for antibiotics.
Nursing: It is best to obtain sputum in the morning before eating or mouth care. The specimen will be expectorated into a sterile container.
How to diagnosis Larynx Cancer?
Larynoscope- visulizes the larynx with a CT or PET scan
MRI
Tissue sample of the tumor
Suctioning
Sterile suction kit
Have a buddy with you.
Deliver oxygen before and during the procedure as needed
This prevents desaturation
Treatment for Lung Cancer
Early is better
Chemo/rads
Pneumonectomy= removal of entire lobe
Lobectomy for SCLC
Thoracic Surgery
Opening the chest wall and entering the pleural cavity
Post op= positioning, turning, coughing, deep breathing, chest tubes
Early ambulation and pain management
Monitor for s/sx of pneumothorax, hemothorax and CREPITUS
Gastric distention and ileus
Can lay on operative side or back
PFTs
Pulmonary Function Test
Integrity of the mechanical function and gas exchange of the lungs. The volume of air the lungs can hold. The rate of flow of air in and out of the lungs. Elasticity.
Emphysema, COPD, Asthma
Nursing: Patient breathes in as much air as possible and then breathes out as much air as possible. No smoking 4-6 hours before the test. No eating 1-2 hours before test. The patient may be very fatigued after test.
Treatment of Larynx Cancer
Can be outpatient-Radiation & Chemotherapy
Brachytherapy(internal radiation)
Laryngectomy- full or partial. Partial still have vocal cords
Tracheostomy with total laryngectomy No voice box, trach is permanent
Adventitious sounds
Wheezes-whistling, musical, high-pitched
Crackles-sounds like rubbing hairs between the fingers close to the ear
Pleural friction-grating or scratchy
Stridor-high pitched sound (croaking)
Explain pneumothorax
Pneumo= Injury to chest wall. Partial or total collapse of the lungs. Space within the pleural membranes is air tight with negative pressure. Allows for the tidal movements of air in and out of the lungs. If there is a break in the seal then the air rushes in and collapses the lungs.
Spontaneous= rupture of the alveoli
Tall, thin and smokers are prone to spontaneous pneumo. Also after scuba diving, flying and mountain climbing- why?
Mechanical Ventilation
Check alarms
Keep tubing clear of pooled water
Check the tubing for tension or stretching
Monitor for s/sx of pneumothorax, gastric distention, impaired cardiac output
Increased higher pressure alarms
Thoracentesis
Remove pleural fluid and/or obtain for diagnostics
Nursing: Consent. Position is sitting, leaning over the bedside table. Monitor respirations.
Complications: Rapid breathing, cyanosis, hemoptysis, changes in breath sounds, and tachycardia - REPORT IMMEDIATELY.
Nursing for Laryngectomy
Maintaining a patent airway- MONITOR FOR HEMMORRHAGE
Need to suction if unable to cough- patient will suffocate
Suctioning is a strict sterile technique
Lung sounds
INSTRUCT UAP TO REPORT COUGHING EPISODES OR GURGLING SOUNDS
Factors that increase risk for respiratory infection
Age older than 65
Cigarette smoking
Living in nursing home or ALF
Congenital or Cardiovascular disease
Chronic respiratory disorders
Chronic renal disease
DM
Comprised immune response
Explain Hemothorax
Blood within the pleural cavity caused by laceration of the lung,heart or blood vessels in the thorax
Partial or total collapse of the lung, mediastinal shift and impaired venous return of the heart
Treatment is thoracostomy and chest tube
Pulmonary Fibrosis
Environmental pollutants, medications, interstitial lung disease
S/Sx= exertional dyspnea, nonproductive cough, inspiratory crackles, and clubbed fingers