Adult3

Respiratory

Assessment

UpperAirwayStructure
a. Nose: Inspection tiltheadbackswelling,polyps,deviatedseptum
b. Sinuses:Palpation,w/light(willlightuporsolid=infectionorblood)
c. Pharynx: Inspectionahhhulcerations,redness,puspockets,
swallowing,cantheytalk?Anythingabnormal
d. Mouth: sameaspharynxteeth
e. Trachea: midline(massorgrowthpushingitoffmidline)
i. Signofiflungshavetensionpneumo:canpushovertracheaor
hematoma

Lower:&breathingpatterns
1) Chestconfiguration
a. BarrelchestedCOPD(hyperinflatelungs)1:2ratio
b. FunnelchesteddepressioninlowerportionofsternumRickets&
marphanssyndrome(tall)
c. Pigeonchestedbowedoutshallowbreathingsetupforpneumonia
d. KyphoscliosiselevationofscapulaandcorrespondingSshapedspine
1. severebirthdefects
2) BreathingPatterns/RespiratoryRate
a. Normalbreathingpattern=Eupnea(1218)
b. Bradypneaslow<10/min regular
c. Tachypneafast>24/min regular
d. Hyperventilation=rapid,shallowbreaths (Kausmauls=diabetic
ketoacidosisfast,deep)
e. Hypoventilation=slow,shallowbreaths
1. bag
2. chinlift,jawthrust,nasopharyngealtrumpet&thenbag
(openairway)
f. Apnea=cessationofbreathing
g. CheynesStokes=irregularshallowbreathsfollowedbydeepbreaths
followedbyapnea
h. BiotsRespirations=34breathsfollowedby1minuteofapnea

3) ThoracicPalpation
a. Respiratoryexcursionwatch,expansion(range&symmetry)
b. Tactilefremitusvibrate(haveptsayhownowbrowncowor99to
createresonanceinlungsmakefluidvibrate)

4) ThoracicPercussion
a. Shouldsoundhollowiffluidinthere=dull,thudCOPD=tympanic
b. Diaphragmexcursion(4a)percussdiaphragm(normalonbottom,flat
 asgoingup=obstruction=fluidinlungsCHF,pneumonia,lung
cancertypeptscantellhowmuchfluidsareinlungs

5) ThoracicAuscultationairintobronchialtree&lungstructures
a. Breathsounds21.4p.481****
i. Wheezehighpitched,musicalnotesnarrowingairways=
asthma,chemicalexposure
ii. Ralecracklespneumonia,bronchitis,CHF,pulmonary
fibrosis
iii. Frictionrubs2piecesofpaper&rubagainsteachother
1. pleuritis (lungsrubbingalongribsnolubricants)
iv. Vocalsoundsifyoucanspeak,youaregettingair

Physicalassessmentofbreathingability
1) Tidalvolumevolumeofeachbreath
a. Spirometer,Wrightpeakmeter
2) Vitalcapacitymaximumbreathbreathing&exhalingthroughspirometer
a. Age,sex,weight,race(dependentupon)
b. Males,younger,caucasian=largercapacity
3) MinuteVentilationtidalvolume+respiratoryrate
a. Detectrespiratoryfailure
4) InspiratoryForceevaluateseffortptismakingduringinspiration
a. UseonunconsciousptDeterminesifsomeoneneedstobeintubatedor
not

DiagnosticEvaluation
1) PulmonaryFunctionTests:testslungcapacity(dysfunction)measures
breathingcapacity,howmuchin&out,vitalcapacity
1. Canpurgewholesystemwithnitrogen&seehowwellyoureoxygenate
youbodywithO2howwellyouperfuse(perfusion)
2. COPD,surgicalcandidates,CHF,Pulmonaryfibrosis,asthmatics
2) BloodGas

RespiratoryAcidosis
Symptoms:
Rapid,shallowrespirations
Dyspnea
Disorientation
Muscleweakness

LungpHpCO2Lung

Typicallydrawnradially/brachialarterialblood
Allenclampradial&ulnararteriesfor30secondsuntilfingersblanche
 collateralcirculationchanceofsplittingarteryin1/2orhitnerve
Bloodpressurewillfillsyringeupifpullsyringe,hugeriskofcollapsingartery
&suckingneedlethrough

- Iflongerthan5minutes,putbloodgasonice
- BloodgasmeasuresO2andCO2inblood(CO2verytoxictobodytriggers
tobreathe)
- ProcessinwhichO2isexchangedfromairtotissueandCO2to?
3stepprocess:
1. Mechanicalventilationexchangeofairbetweenatmosphere&alveoli
Candependonairpressurevariances(sealevel,mountain),resistancetoairflow
(asthmatics),lungcompliancyhowwell/easyitcanblowupandletdownCOPD=
stifflung
2. Diffusionexchangeofo2andco2betweenalveoli&capillarieshappensin
lungsalveoliargassescrossmembranesintocapbeds
3. Transportation:O2movingintocells&CO2movedoutofcellscirculation
throughbody

Measure:pHofblood normal=7.35to7.45
CO2=3540
Bicarb2226 neutralizes
O2sat80100
RespiratoryAcidosisseeabove
- COPD,pneumonia,asthmatics,drugoverdose,sedatives,anyconditionthat
obstructsairway

RespiratoryAlkalosis Symptoms
Tinglingofextremities
Confusion
Deep,rapidbreathing
Seizures

pH pCO2

Overexcitement,hyperventilation,extremefeversletbreatheintopaperbag
nonrebreatherw/2L

MetabolicAcidosiskidneys Symptoms
Disorientation,
Kussmaulrespirations,
Muscletwitching
ChangesinLOC

pH HCO3

Renaldisease,diabeticketoacidosis,losingtoomuchbase(drugodaspirin)
helpbyhydration,oxygenatenasalcannulatotubing,bicarb(sodium
bicarbonate(1mgto1kg)doesnotcrossblood/brainbarrier

Metabolicalkalosis Symptoms
Nausea&vomiting
Diarrhea
Restlessness
Slowrespiration
Dysrhythmias, (useofdiuretics)

pH HCO3

Howtotellifsomeoneisinoneofthesestates:

Normalvaluesinonecolumn phhigh=alkalosis/acidosis
CO2/Bicarb

Pulseoximetryoxygenlevelsintissues(finger,forehead,ear)
SmokeinhalationCO2bindstoreceptorsitestricksintothinkingtheresO2
therefalsesenseofsecurity(says100%whenonly80%) Satprobesworthless
measures
Bound&unboundhemoglobin&CO2willbind

Cultureslung,nasal lungcoughintosterilecontainerorhypertonicsaline
throughnebulizer sputumculture

Remember: ROME RespiratoryOpposite,MetabolicEqual

AcuteRespiratoryDistressSyndrome(ARDS)

1. Definition
a. Asuddenandprogressive(shock)pulmonaryedemacharacterizedby
crackles
b. WillnotrespondtoO2
c. Decreasedlungcompliancestiff(willnotexpand)

Inabsenceofleftsidedheartfailure,ptexhibits:
Sudden&progressivepulmonaryedema
bilateralinfiltrates (xray=whitelung)fluid,blood,pus
asdiseasegetsworse,progressivelygoesfrombottomtotop
 HypoxemiarefractorytoO2
Reductioninlungcompliance

2. Pathophysiology seepaper
i. Kidneysnoperfusion=notpeeing
ii. Liver**decreasedbloodflowimpairliversabilityto
carryonmetabolicfunctionsbodywillnotgetanyenergytodo
anytypeofworktogetbetterimportantformedsliverdetoxes
andbreakdownsmanymedsadjustdosagesonmeds
iii. GIstressulcersbloodydiarrheahaveportionsof
intestinesremovedduetonecroizetissues
iv. DICSpiderveins,throwingupblood,bloodfromrectum,
eyes,ears
v. Usuallydiefrommultisystemorganfailure

- Injurytoalveolarcapmembranep.544smoking,injury,pneumonia,
- Ascapmembranestartspopping,airleaksout=crackles,
- Secretions&inflammationoflungsnarrowairway
- Decreasedlungcompliance
- Severehypoxemia

3. ClinicalManifestations
a. Rapidonsetofseveredyspnea
b. cyanotic
c. shortofairanxious,tripoding,sniffing(donotlayflat)
- giveO2,breathingtreatment(bronciahldilators),steroids(decreaseinflammation),
antianxietymed(ativan),turnlightsdown,bereassuring,smoothpurposeful
movements
- labs=ABGwithO2(toseeiftrulyhaverefractoryO2)
- xray,ECG,Cardiacenzymes,angioCT,liverfunctiontests,
- arterialhypoxemiadespiteO2

4. AssessmentandDiagnosticFindings
a. Rapid,shallowbreathing intercostalretractions
b. Changeinmentalstatus

5. MedicalManagement
a.Mechanicalventilation
i. O221%(RA)to100% Crankedupto100%andO2satstill
80%
1. AnyO2over80%=freeradicalswilldamagelungs&
makethemstuff
 2. 100%for2hrs80%for68hrsanythingafterthatwill
damagelungsandmakethemnoncompliant
b. Ventcancontrol,rate,volume,(weightx10perkg),peep(positiveend
expiratorypressure)minimalamtofpressuretokeeplungsexpandedand
adheretosideofchest(sowontcollapse)

#1thingtreattheproblemex:septicantibioticssupportivecare
turn,suction,deepbreatheorsignonventilatorsuctionbecausecantcoughupwhen
onvent(q2h)
Body=normalpeep5ml ifgohigheronpeep,diaphragmgodownandlungsgoup,
eventuallylungswillpopiftoomuchpeep(compliancyissuestobeginwith
overinflate&putconstantpressureon
- Complicationsofpeep
a. poppingalung/lungcollapsenobreathsoundsunequalrise&fallof
chesttrachealdeviationtensionpneumopushesover=CO,
b/p,extremelytachycardic,
Fixneedlecompression(14gaugemidclavicular,2ndintercostalsspace)putin
middle(toolowhitmammaryartery=surgery)putchesttubesin

Acauseofattack=pneumothorax

Bronchodilators

PharmacologyInterleukinI(lungcompliances)&neutrophilinhibitors(inflammation
process)inflammationresponsew/steroidstohelpdilatebronchialtreebetter,
Surfactantsurfacetensiononlungs
pulmonaryvasodilatorsgetmorebloodflowtolungssotheycancarryO2torestof
bodybetter
Treatsepsis

Nutritionalaspectstomachisnotgettinganyblood&liverisntgettinganyblood
necessarytobreakdownmanufactureenzymes
TPA,tubefeedings
Nutritionalsupport
Getawayfromgastriculcers
3545kcal/Kil

6. Nursingmanagement

- Generalconsiderations:closemonitoring,watchneurologicalstatus,HighFowlers
ifanxious,calmdown,turndownlights,etc.
- Considerventilation ifpeepistobeused,physiologicalpeep=5ml ifon
vent,unnaturalbreathingpattern
a. Ifcantsedateenough,paralyzethemsoventcanworkPavulon(1mg
perkg)Cantblinkeyesdryoutsomoisturizeandclose(tapedown)
SCDpumpsorpassiveROMlyingtherecancauseDVT
 o Turnq2h
o Maybeparalyzedbutmaystillfeelpainandhearyouversed,
ativan,valium,morphine(b/p,pulsetotellifanxious)
o Pain

PulmonaryEmbolism
1. Definitioninfectionofpulmonaryarteryoroneofitsbranches
Anythingthatobstructspulmonaryarteryoroneofitsbranches
thrombusrsideheart
o Emboli,fat,amnioticfluid,bone,sepsis,airfrompressureinjectors
airbag(insalinebag)
o Systemsproblem=catheterfitsonb/Pcuffairtokillsomeone=
60cc ifdidnotprimetubing,60lbsofpressure&will
pushbloodbackupintobag
o Airembolitrapsinatriumlayonside

Obstructionofpulmonaryarteryorbranchbyathrombus
Willoriginateinvenoussystemorrsideofheart

Riskfactors:venousstasis,hypercoagulability,venousendothelialdisease,certain
diseasestates(burns,justgivebirth,postop,DVT,afib,50years+,certaintypes
oftumors,longimmobilization(fracturedhipsurgery) p.548

2. Pathophysiology
i. SeepaperPE=gardenhosehastopump5Lofbloodthrubody
ii. Kinkarteryengorge&backuppumppressuresohigh
canthandleitthendecompensate=co=death

3.Clinicalmanifestations
iii. Mostcommon: dyspnea,tachypnea(rapid&hurt)
iv. Duration&intensitydependsonsize&extentex:distal
notdomuchsaddlePEwherebranchestolungs=die
v. Chestpainmimicattack pleureticinnature
vi. Anxiety,cough,fever,diaphoresis,ptosis,syncopy,
apprehension
vii. Occursfromonsetofchestpaintildie=1hour
viii. Typicallychestpain,soa,diaphoratic3040minbeforecall
ambulance
4. Assessment&diagnosticfindings
 a. Deathiscommonw/infirsthour
b. DVTcloselyassociatedwithPE
i. Dontoccurinsamespot*** w/1bloodclot,probablyhavemore
ii. Actgoofycheckheadforclot
c. Xraymightshowsomethingtypicallywilllooknormal
o Atelectasisinlungs(deadspace)elevateddiaphragmon
affectedside
o Notclearcutsign
d. EKGkinkinpartialblockage=strainonheart=willshowinEKG
prolongedPRintervalsascompression

Dependentonsize&areaofthrombus
Calfhumans+dopplar&bloodflowstudies
Lungpulmonaryangiography
- Chestxray
- ABGs O2,Co2
- v/qscan

Earlyrecognition
- Rightsideshortestpathwayinto
- IVrightsidefordye(pulmonaryangiography)

5. Prevention
- #1getup&walkingaftersurgery
- Activeexercise,avoidstasis
- TEDhose
- Heparin(Lovenox),Coumadin,aspirin, Coumadin5daystobuildup
totherapeuticlevelsinbody heparin1/2lifeveryshort
Warfarin(Coumadin)getsblooddrawnallthetimePTT,INR
betweentherapeuticdose&toxicdose=1%(narrowmargin)Warfarinbindsto
albuminsonutritionalstatusveryimportantifeatingwell,subtherapeutic
albumininknockingoutWarfarin,noteatingwell,gotoxic Coumadin
5000usubqLovenox40mg
- passiveROM,bloodthinners,legpumps

6. MedicalManagement

- EmergencyO2,bigIV,minimalof2,AGB&DDimer(factorthatshows
bloodhasclotted),co=b/ptreathypotensionalbutamine(makes
poundharder,b/pbysqueezingheart,fluids(dopamine=peripheral)
EKG,urinarycatheter(ifpeeing,profusingkidneys=ifprofusingkidneys,
profusingbrain withbackingupinblood,getdysrhytthmias
(Cardizem)booksaysdigitalishelpsregularbeat(liningducksupina
row)beatmoreeven,moreregular,diureticsfluidinlungshelppreload
andafterload(nitratesnitroglycerinesublingual)
- Thrombolyticsclotbustersurokinase,streptokinase,tKase,retovase,
 enzymesthatdissolvefibrinogen(dissolvesclot)maycauseCVA,dissolve
freshsurgical&IVclot,bestcasescenariodissolveclot&functionreturned
toandlungsguidelinesofwhethertousethrombolyticsornot
(Pharmacologic)
- Surgicalmanagement
i. feedasmallcatheteringrointhroughhearttowherePEisat&snareit
ii. PEthrombus(saddle)lessthan12hoursold
iii. waterjetgentlybustawayclot
- Greenfieldfilterthighandpermanentfilterplaced(hxofthrowingDVT),
letsbloodflowthroughandcatchesclot(coumadinrestoflifeforprevention)

PEnottreated=40%chancewilldie treated=4%mortalityrate
Heparin=cheap

Emergency,General,Pharmacologic,Surgical

NursingManagement

1. MinimizeriskofPEIDriskfactorsp.54823.8
2. Prevention activemovement,dontcrosslegs,0constrictiveclothing,dont
danglelegsoversideofbed
3. AssessmentHomanssign
4. Monitoringhaveptonheparinhospitalprotocolblooddrawq46hourstosee
ifthinnedouttoomuch
5. SystemsproblemheparindropsetIVpumpfor6hoursandthenwillgooff
&notmissblooddrawalwaysdoublecheckothersdrugcalculations
6. Painhurtslongactingpainmanagement=morphine,hydromorphone,Diludid
(dilatevenoussystemforpain&bloodflow)
7. ManagingO2deadspaceinlungs(duetobloodclot)doesnotoxygenate
loadupRBCtocarryO2tobody(donttrustfingermonitor)
- Relievinganxietyanswerquestions,knowwhathappeningtothem
8. ComplicationsARDS,cardiogenicshock,death(bluefromnipplelineup)will
dieinstantly

PostOperativeCareMonitoringpulmonarypressures
Providecomfort
Promotehowtopreventinfutureassess,assess,assess

BluntChestTrauma

1. Commoncauses
a. Mechanicalredistributionofenergyintothebody
b. Carwrecks
c. Fall
d. Bicycle/motorcycles
2. Pathophysiology
a. Energyistransferredintothechestdontcareaboutbrokenbonesbut
careaboutorgansthatlieunderneaththestructures
1. ex:brokensternum,bruisesheart,asgetsbigger&
bigger,messesupbothelectrical&mechanicalfunctionof

2. Ribscanpunctureorlungs
3. Problems:hypoxemia,hypovolemia,cardiacfailure
Hypoxemiacollapsedlungcantmaintainmechanical
integritytensionpneumo(2ndintercostals)shoveseverything
overandleadstocardiacfailurekinksoffcandeviate
trachea
Hypovolemiatearinchest,anterioraorticaneurysm,(tbone
shearsvesseloff)canbleedtodeathinsecondsrib
puncturespulmonaryvein
Cardiacfailure/cardiactamponadefluidinsac&crowds,
heartgetssmalleruntilcantbeat
3. Assessment&diagnosticfindings
a. Paramedicstellwhatexactlyhappenedatscene
b. Mechanismofinjury
c. LOCheadinjurypatternsheadbleeds
d. Estimatedbloodloss
e. DrugsorETOHonboard?
f. Whatdidparamedicsdoenroute?Intubate,IV,medications(narcotics)
4. MedicalManagement
a. Aggressivetreatment ABCairwaytubebreathingbagcardiac
CPR treatproblemwhatsgoingtokillthemfirst
b. Bluntchesttrauma&deadcrackchestopen,cardiactamponade,cut
sackopentoreleasetorestartcardiacfunction
c. Lungcollapsedchesttube 4th5th=bloodhigher=air
d. LoosestoomuchbloodgiveOtypeblood
5. SternalandRibFractures
a. Clinicalmanifestations
i. Mostcommoncauseofsternum=steeringwheel
ii. 50%ofallbrokensternumsdieliesunderneath
sheeramounttobreakisenormous&thentransferredto
iii. Ifnotdie,bruisedgraduallydevelopovercourseof
hourstodaysdysrhythmias,blooddisplacingtissue=
tachycardic,dropinb/pasinflammationgetslarger,decreasing
spacethatbloodcanpump
b. Assessment&DiagnosticFindings
i. Mostcommonproblem: pain
ii. Howtotellifbreakribbonycrepitus(ricekrispiesunder
skin),bruise,swelling,possiblechestwalldeformity(ifin2
places,freefloatinglossofstructuralintegrity)
a. Shallowbreathing
 b. cangetpneumonaARDS
Assessment:breathsounds
Inabilitytotakedeepbreath
Crackling/gratingsoundsiftakeadeepbreath
Sternumcardiaccontusion
Ribspulmonarycontusion
Chestxray,ABG(white=bloodpooling),pulseoximetry,EKG(bothand
lungs),aslungswells,vascularresistance
c. MedicalManagement
i. Paincontrol
ii. Fixatorsonsternumifpushingagainstheart
iii. Turn,cough,deepbreathe
iv. Nerveblocks

6. FlailChest
a. Pathophysiology3ormoreribfracturesat2ormoreplaceschestwall
losesabilitytostabilizeitselfparadoxical:whenchestmovesin&
sucksout chestexpandingitsucksin&breathinitgoesout
b. Withdamage,lungsmakemoresecretionsAtelectasis,respiratory
acidosisCO2
c. Medicalmanagement
i. Suction
ii. O2
iii. Paincontrol
iv. TCDBandambulate
v. IS
vi. Intubate
Howcanyoutelliftheventilatorisdoingagoodjob?O2sats,ABG,centralcyanosis,if
notparalyzedAgitated,anxious,pulserate,ifnotenoughO2(hypoxicsquirm)

7. PulmonaryContusion
a. Pathophysiology abnormalaccumulationoffluidininterstitialand
interaveloarspacesleaveproteinwhichleadstobloodloss,edema,and
cellulardebrispulmonaryresistance,moresusceptibletohypoxemia
&_____________________
b. Lungsgethurt,leadfluid,inflammationvascularresistance,abilityto
blowoffCO2andoxygenatethelung
c. Clinicalmanifestations
i. Tachypnea
ii. Tachycardia
iii. Chestpain
 iv. Bloodtingedsputum
v. Severefrankblood
vi. Crackles
vii. Severehypoxemia
viii. Respiratoryacidosis
d. AssessmentandDiagnosticFindings
i. Changemaynotbefor12days
ii. Xray,O2sat,
e. MedicalManagement
i. Maintainairway
ii. Provideo2
iii. Paincontrol
iv. IVfluids
v. Prophylacticantibiotics

PenetratingChestTraumaknife&gunclub

1. Commoncures
2. MedicalManagement
a. ABC
b. Chesttube>1500cctoORw/fluids
c. Aggressivetreatment
3. Pneumothorax
a.Whenthelungisexposedtoatmosphericpressure,itcollapses(holeinlung)
b.Simple&Tension
Simplespontaneousinnature,mostcommonassociatedwithblebon
lung(outpouchingoflungtissue) ex:herniaofthelungweakenedpieceof
lungtissuepronetopoppingwhenpops,lungdeflateemphesemainterstitial
lungdiseasemoresusceptible
Tensionsuckingchestwoundstraumaticknife&gun,ribfractures,
wherethingsarepushedovercanputneedleinthemaircomesin&not
allowedtoescapeasaircomesincreatesmorepressure&pusheseverything
over=cardiacfailure,airhunger,deviatetrachea,pain
4. ClinicalManifestations
a. Physicalexamhollow/tympanic(airinthere)percussiondull=blood
5. MedicalManagement
a. Chesttubeair=2ndintercostalsspaceblood=4th5thintercostals
space
6. TensionPneumothorax subcategoryoftraumatic
a. Definition airsuckedin&trappedpusheseverythingover
b. ClinicalManifestations sameasabove
c. MedicalManagement SAA

LaryngealCancer
 1. Definitioncanceraroundthelarynxandvoicebox(tumorinsidioustakes
time)
a. Smokerschewingtobacco
b. Asbestosormustardgasexposure
c. Menmorethanwomen
d. Singersstrainvocalcords/voice
2. ClinicalManifestations
a. #1hoarsenessmorethan2weeksduetotumor
b. cough
c. lumpsinneck
d. harsh,raspyvoice
i. tumorimpedesactionofvocalcords
e. Dyspnea
f. Foulbreath
3. Assessment&DiagnosticFindings
a. Biopsy
b. CT,bronchioscope(visualinspectionoftumor&vocalcords)thrunose
c. Palpationoflymphnode,thyroidglandenlarged
4. MedicalManagement
a. Surgery stage1mostsurvivablestage4worst
b. Partial: earlystages1&2partiallyremovethetumor
i. Radiationtherapyvoiceraspy&keepairway

UnderPartial:
c. Supraglottic:removefalsevocalcords(glottis)&hyoidbone
i. riskforaspiration
ii. temporarytrachnotaste,nomoisture(crustycritters),air
particlesfromairgetsuckedintolung(nofilter)setupfor
infectionstonsofsecretionsdryoutcleanout&suction
humidifiedO2
iii. Forgagreflexsemisoftfoods,thickenedliquids
chanceofaspiration
d. Hemilaryectomy: 1/2tumorgoesbeyondvocalcordslimitedto
subglotticareassomevocalcordsremoved,havetrach&NG, will
neverspeaknormallyagain(rough,raspy,hardtounderstand)
mostcommonproblem:dontgetallcancerout&havetogo
backandgettotal

e. Total: cancerisbeyondthevocalcordsremovalofhyoidbone,cricoid
cartilage,epiglottis,and23ringsoftrachea
i. radicalneckstripalllymphnodesout,bluntdissection
ii. permanentstomalotsofinflammationJPdrainspull
outifbelow3060cc/daysetupforARDS
- highriskforaspirationoffoods
Radiation: forstage12 knocksoutmucousreduction(drymouth)
- Speechtherapy:learnhowtospeakagain
- Esophagealspeech:belchingwords(belchingtechnique)
- Mechanicalvoicebox
- Tracheoesophagealpuncturespecialtypeoftrach
manipulate&vibrateartificialvoicebox

NursingProcessofthePatientundergoingLaryngectomy

1. Teachtheptbeforesurgery
2. OneofptsbiggestconcernsHowwill&Italk&Fear
3. Explainsurgery&whattoexpectafterwards
4. TCDB,IS dobeforesurgeryreturndemonstration(havethemshowus)
effectivenesslistentolungs
5. Reduceanxiety&depression
a. Havethemtalktosomeonewhoshadthesurgerydone&their
experiences
b. answerquestionshonestly
c. maintainandairway semifowlersposition
restlessness,shallowrespirations,pulse,cyanotic
6. Fix:TCDB,O2suction(painmedbefore)
- cleanstomadaily
- humiditysowontdryinsidestoma&lung
- canttalkotherwaysofcommunication:calllight,magic
board,pictures
- setupbeforesurgery
- adequatenutritionwillnoteatordrinkfor14daysthen
thickenedfood
o NG,TPN
- ARDSneed3545calories
- Avoidsweetsincreasesaliva(&decreaseappetite)
- Keepextrastomainroom

LungCancer(BronchogenicCarcinoma)

1. Definition#1cancerinmen&womenduetosmokingtransformedepithelial
cells&squamouscellschangefastgrowingtumorstages14
Riksfactors: 2ndhandsmoke,chemical/occupationalexposure,genetic/dietary
2. Pathophysiology
3. ClassificationandStaging
4. RiskFactors
5. ClinicalManifestations
a. Cough,wheezes,weightloss,fluidbuiltupincavity(candrainoff
w/needle)
 6. Assessment&DiagnosticFindings
a. Chestxray(whitecottonballs),CTvascularityofit,size,sputum
samples,aspiration
7. MedicalManagement
1.surgery
2.radiation
3.chemo
4.palliativecare
8. TreatmentRelatedComplications
RadiationN/V,weightloss,pulmonaryfibrosis,pericarditis,respiratory
failure, radiationscarslungs
9. NursingManagement
1.supportivecare(n/v,anorea,antiemetics,ngtube,caloricintake)
managesymptoms relievebreathingproblemssdeepbreathing,
suction,O2
2.reducefatigue
3.psychsupport

ThoracicSurgeries

1. TypesofProcedures
Pneumoectomyremovaloftotallung
1. Diaphragmgoesup,heartgoesover,otherlung
hyperinflates cavityfillswithfluidcuttidal
volumesofventby1/2
Lobectomyremovalof1lobe(segment/wedge)
f. Smallhyperinflationofsamesidelung,diaphragmgoesupabit

1. PreoperativeManagement p.625
a. AssessmentandDiagnosticFindings
i. Breathingpatterns
ii. Howmanypillowsdoyousleeponpernight
iii. Cardiopulmonaryfunction
iv. Psychstatus
b. PreoperativeNursingManagement
1.Packyear howmanypacksperdayx#yearssmoked=packyear
givesindicationofhowmuchdamagedonep.627
2.Improveairway
- stopsmoking
- humidifiedO2
- teachIS
- TCDB
- Diaphragmbreathe
- Relieveanxiety
 2. PostoperativeManagement
Airway:TCDB,chesttube,paincontrol,ambulate,prophylactic
antibiotic,teachofsymptomsgotodoctor canliveoffof1/4of
lung

ChestDrainage
1. TraditionalWaterSeal
2. DrySuctionWaterSeal
3. DrySuctionwithOnewayvalvesystem
4. NursingProcessforaPatientUndergoingThoracicSurgery
1.
2.
3.
4.
5.

Physicalassessmentofbreathingability

Diagnosticevaluation

I. Pulmonaryfunctiontests
II. Arterialbloodgases
III. Pulseoximetry
IV. Cultures
V. SputumCultures

ImagingStudies
1. Chestxrays
2. computedtomography(CT)
3. magneticresonanceimaging(MRI)
4. fluoroscopicstudies
5. pulmonaryangiography
6. radioisotopediagnosticprocedures(lungscan)

Endoscopicprocedures
i. Bronchoscopy
i. Nursinginterventions
ii. Thorascoy
i. Nursinginterventions
 iii. Thoracentesis
iv. Biopsy
i. Pleuralbiopsy
ii. Lungbiopsy
1. Nursinginterventions
v. LymphNodeBiopsy
1. Nursinginterventions

RespiratoryPharmacology
I. Bronchodilators
II. Corticosteroids
III. Expectorants
IV. Coughsuppressants
V. Antibiotics
VI. Mucolytics
VII. Decongestants
VIII. Antitussive

OxygenTherapy
1. Indications

2. CautionsinOxygenTherapy
1.
2.
3.

3. MethodsofOxygenAdministration
1.
2.

4. Ventilators
1.
2.

5. NursingProcessforaptonaventilator
1.
2.
3.
4.
5.