Week 2 Powerpoint Respiratory Disorders

Lung cancer is

the most preventable cancer.

-Leading cause of cancer-related deaths in men & women- the deadliest of all cancers

-5 year survival rate @ 19%

Risk factors of Lung cancer

⎻ Cigarette smoking
⎻ Age 40 to 75

Lung Cancer Etiology & pathophysiology

⎻ Airway irritation & changes in bronchial epithelium

Morbidities

are health conditions or diseases that a person has, especially in addition to a main illness.

Primary types of Lung Cancer

⎻Non-small cell lung cancer (NSCLC)
⎻Accounts for up to ~85 to 90%of cases
⎻Squamous cell carcinoma,adenocarcinoma, large cellundifferentiated carcinoma

Lung Cancer Clinical manifestations

⎻Clinically silent for most individualsfor the majority of disease course
⎻Non-specific & appear late indisease

Lung Cancer Diagnostic studies

⎻Chest x-ray, CT, MRI, PET, cytology,biopsy
⎻Staging

Lung Cancer Nursing Assessment

general, weight, nutrition, Respiratory, Intergumentary

Primary: ABCs Oxygen, resp.

Assess, vitals signs and then safety

having cancer is a risk factor for developing a

blood clot

when patients start radiation therapy it is important to assess the

Integumentary system, skin break down.

(jaundice in Liver cancer)

lung cancer, lung assessment

crackles (in fluid) , reduced air entry, sides of consolidation

Lung Cancer Clinical Manifestations

Muscle wasting, Thin, Cough, SOB, Clinically silent for most individuals

Lung Cancer Nursing care

Oxygen therapy, emotional support, deep breathing & coughing, surgical care, post-
chemotherapy & radiation management
Pain & nausea control
Smoking cessation

Lung cancer tens to metastasize to the

brain and bone,

sometimes breast tissue

Cancer pts are typically on

Anticoagulant

Anticoagulant’s

blood thinner

metastasize

Cancer spreading to another site of the body

NSCLC

Non-small cell lung cancer

Encouraging ____ for someone with lung cancer will help get rid of secretions and help lower the risk for infections.

deep breathing and coughing

how do we care for someones skin when they are receiving radiation

keep it clean, check electrolytes , if itchy use a tropical steroid (unscented) (not on the day of the therapy )

Hydrate the skin, do not shave the skin where you are receiving radiation.

Opioid therapy is for

pain

(people who have cancer may be receiving this)

chemo and radiation are a type of

Palliative approach, but if can be curative

surgery for cancer is a

Removal approach / curative

Superior Vena Cava Syndrome (SVCS) happens

when the superior vena cava (SVC), the large vein returning blood from your head, arms, and chest to the heart, gets blocked or compressed, causing fluid backup and swelling in the face, neck, and upper body.

SVCS 1st things to do

semi flowers, v/s, oxygen, call HCP

most common cause of Superior Vena Cava Syndrome (SVCS)

lung cancer, lymphoma, and breast cancer

Supplemental Oxygen Therapy

• Generally reserved for oxygen saturation level of less than 92-90% on
room air
• May not always supplement in COPD

Types of non-invasive/low flow devices:

Nasal cannula, simple face mask, partial rebreather, non-rebreather

invasive/high flow devices:

• Airvo, Optiflow, BiPAP
• Artificial airway & bag-valve mask
• Mechanical ventilation & intubation

Radiation Therapy

⎻ High-energy beams applied to pre-marked
areas on the skin to damage cancer cells’
DNA and ability to divide & grow
⎻ Used as a curative approach in patients with
a surgically resectable tumor but considered
a poor surgical risk
⎻ SCLCs are radiosensitive, but prognosis is so
poor that radiation often does not
significantly improve mortality
⎻ Also done as a palliative procedure

Meds for Nausea

Ananasetron , gravel, haldol, dexamethasone

With Dexamethasone you are more

at risk for constipation

you should not put lotion on pre-radiation as

you could burn

radiation therapy improves survival when used in combination

with surgery and chemotherapy

Adenocarcinomas are the most

radioresistant type of cancer cell

nasal canula for someone who

just went to bathroom and is A LITTLE out of breath, or if O2 was a little low like 95-96

non-breather mask for someone who

is in respiratory distress

Chest trauma 2 general types

Blunt trauma or Penetrating trauma

Blunt trauma

⎻ Occurs when the body is struck by a blunt object

(could be like a car accident, from a sport something like a ball hitting you)

Penetrating trauma

⎻ Occurs when a foreign body impales or passes through the body
tissues

(could be a gun wound)

Pleura

is a double-layered membrane surrounding each lung, consisting of the visceral pleura (covering the lung) and the parietal pleura (lining the chest wall), separated by the pleural space containing lubricating fluid for smooth breathing

Pneumothorax

⎻ Presence of air in the
pleural space

Types of Pneumothorax

⎻ Closed pneumothorax
⎻ Open pneumothorax
⎻ Tension pneumothorax
⎻ Hemothorax
⎻ Chylothorax

Pneumothorax clinical manifestations

• Small: mild tachycardia &
dyspnea
• Large: respiratory distress

Pneumothorax Diagnostics

• Chest x-ray

Nursing care for Pneumothorax

Chest tube drainage

who is at risk for developing spontaneous pneumothorax

tall skinny males

spontaneous pneumothorax

happens when air leaks into the space between your lung and chest wall (pleural space) without injury, causing the lung to collapse, often due to ruptured air sacs (blebs)

tension pneumothorax is a

medical emergency

Red flag

clinical manifestations for pneumothorax

small- mild tachycardia + dyspnea

large- respiratory distress (Emergency)

with altered LOC or confusion we think

about Hypoxia

Hypoxia

a condition where the body or a specific region is deprived of adequate oxygen supply at the tissue level

chest tube care

basic wound/dressing care, keeping it generally covered.

keeping drain below the level of the patient, never above.

Suction may be in use.

With Pneumothorax

There is no breathing sounds on the effected side

Open Pueumothorax can turn into

tension and can collapse the uninfected lung

we do not want to see ___ in the chamber for the chest tube

bubbling

if chest tube falls out

we cover hole with moist dress, non- woven gauze.

3 sides taped down , to allow for some air to vent off, so we do not cause more risk for tension pneumothorax.

Flail Chest Results from

multiple rib fractures, causing
instability of the chest wall.

⎻ The affected flail area will move
paradoxically to the intact portion of the
chest during respiration

⎻ Overall, this prevents adequate
ventilation to the lung tissue in the
injured area

During inspiration of flail chest

the affected portion
is sucked in

During expiration of flail chest

The affected area
bulges out

Flail chest assessments

diagnostics & management

ABCs, ABGs, & adequate ventilation

Flail chest is a

severe, life-threatening chest injury where a segment of the rib cage breaks off, usually from significant blunt trauma, causing it to move independently and paradoxically (inward during inhalation, outward during exhalation), severely impairing breathing and oxygenation, often accompanied by underlying lung bruising (pulmonary contusion) and requiring urgent medical care for pain control, oxygenation, and potentially mechanical ventilation or surgery.

Pleural Effusion

⎻ Collection of fluid in the pleural space
⎻ Not a disease itself, but a sign of a
serious underlying condition

Pleural effusion is a common complication of

Lung cancer because of:

• Tumor blocks lymphatic drainage → fluid accumulates

• Cancer spreads to the pleura → ↑ capillary permeability

• Inflammation from the tumor

• Post-obstructive pneumonia

• Treatment effects (radiation/chemo)

When cancer cells are present in the fluid, it’s called a malignant pleural effusion

Transudative

⎻ Protein content of effusion is low,
where fluid movement is facilitated out
of the capillaries and into the pleural
space
⎻ Often associated with noninflammatory
conditions

Exudative

⎻ Protein content of effusion is high,
often occurring with inflammatory
reactions and increased capillary
permeability
⎻ Often associated with malignancies,
pulmonary infections, or GI diseases

pleural friction rub

a grating or squeaking sound heard with a stethoscope during breathing, caused by inflamed pleural layers rubbing together, often signaling conditions like pneumonia, pleurisy, or pulmonary embolism.

anytime there is fluid in a spot that it in not supposed to be there is an increase for

risk of infection

Pleural Effusion Clinical Manifestions

progressive dyspnea

Pleuritic chest pain

Absent or decreased breath sounds

Pleural Effusion Diagnostics

Chest X-rays & Throracentesis

Nursing care for pleural effusion

Remove the fluid

Treat the underlying cause

risk factors for DVTS and PE

went on a long trip (long flight), decreased mobility, broken leg, pregnancy, cancer,

DVT

Deep vein thrombosis, blood clot in a deep vein

PE

Pulmonary Embolism is a life threatening blockage in the lungs artery, often caused by DVT traveling to lung

Patient may say “ “ when having a pulmonary embolism

feelings of doom , anxiety

Most PEs stem from

DVTs in lower extremities

Hemoptysis

coughing up blood, bloody sputum

stroke should be treated within _hrs

4

Risk factor for taking anticoagulant therapy

Bleeding

Pulmonary Hypertension

⎻ Elevated pulmonary pressure resulting from an increase in
pulmonary vascular resistance to blood flow through small
arteries and arterioles
⎻ Can be primary or secondary to another condition
⎻ Primary: rare, cause unknown
⎻ Dietary suppressants, younger age, natal-sex
females
⎻ Secondary: caused by primary diseases like COPD,
pulmonary fibrosis, etc

Pulmonary Hypertension Nursing care

⎻ No cure
⎻ Vasodilator therapy, diuretics, anticoagulant therapy

Pulmonary Hypertension Clinical manifestations

⎻ Dyspnea on exertion, fatigue, exertional chest pain,
dizziness, exertional syncope

Pulmonary Hypertension Diagnostics

⎻ ECG, CXR, CT, echocardiogram, measurement of
pulmonary pressures

Acute Exacerbation of COPD

⎻ Sustained worsening of COPD symptoms
⎻ Related to severity of underlying airflow
obstruction
⎻ Infectious or non-infectious in nature
⎻ Infectious: viruses, H. influenzae, M.
catarrhalis, S. pneumoniae
⎻ Non-infectious: allergens, irritants, cold air,
pollution

Tazocin treats

Bacterial Infections (broad spectrum antibiotic) (covers gram neg and pos)

Tazocin is given

when a patient has a serious or suspected serious bacterial infection

Clinical manifestations of Acute Exacerbation of COPD

⎻ Dyspnea, cough, sputum

Acute Exacerbation of COPD diagnosis

⎻ CXR to assess for pneumonia, ABGs

Acute Exacerbation of COPD Nursing care

⎻ Nursing care
⎻ Supplemental oxygen with caution,
bronchodilators, antibiotics, corticosteroids
⎻ Prevention & education

Acute exacerbation of CODP may lead to ____ if untreated

Acute respiratory failure

Acute Respiratory Distress Syndrome and Acute Respiratory Failure

• Infectious or inflammatory process releases
cytokines and other substances that increase
tissue permeability
• Increased tissue permeability allows fluid to
leak into alveoli and leads to impaired gas
exchange that doesn’t improve with
supplemental oxygen

Acute Respiratory Distress Syndrome and Acute Respiratory Failure

Causes

• Direct (pulmonary causes)
• Pneumonia, aspiration, inhalation injury,
pulmonary contusion
• Indirect (systemic causes)
• Sepsis
• Trauma, burns
• Massive transfusions
• Pancreatitis

ARDS & ARF Clinical presentation:

Severe dyspnea and hypoxia that does
not resolve with oxygen therapy
Tachypnea
Bilateral infiltrates/opacities on chest x-
ray (pulmonary edema)
No evidence of cardiac failure

With ARDS + ARF management and nursing care ____ is very important

Intubate + mechanical ventilation

ARDS & ARF Management & nursing care:

Supportive care & resolve underlying
cause
Mechanical ventilation with lung
protection
• Higher PEEP to keep alveoli open
Prone positioning
Family support

ARDS & ARF has a

High Mortality Rate

Q: What does ARDS stand for?

A: Acute Respiratory Distress Syndrome — a life-threatening lung condition with rapid onset

Q: What is the basic pathophysiology of ARDS?

A: Injury to the alveolar-capillary membrane causes fluid leakage into alveoli → impaired gas exchange → severe hypoxemia.

Q: What causes ARDS?

A: Direct lung injury (pneumonia, aspiration, inhalation injury) or indirect (sepsis, trauma, pancreatitis)

Q: What is a key diagnostic hallmark of ARDS (not due to heart failure)?

A: Bilateral infiltrates on chest X-ray with severe hypoxemia (low PaO₂).