Gas Exchange Exemplars Flashcards

Flashcards on Gas Exchange Exemplars focusing on Laryngeal Cancer, Lung Cancer, Thoracic Trauma, Pulmonary Embolus (PE), and Chronic Obstructive Pulmonary Disease (COPD).

Laryngeal Cancer

Tumor that grows in the larynx; good prognosis if diagnosed early; risk factors include smoking, alcohol, voice abuse, and chemical exposure.

Early stage cues for Laryngeal Cancer

Lump in neck, sore throat, hoarseness.

Late stage cues for Laryngeal Cancer

Pain, dysphagia, airway obstruction, SOB, weight loss, unilateral ear pain, numbness.

Diagnostic tests for Laryngeal Cancer

Laryngoscope to visualize and biopsy tumor, X-rays, CT scan, MRI to determine metastatic sites.

Lab assessments for Laryngeal Cancer

Electrolytes, HCT, BUN; HCT may be affected if nutritional and hydration status is poor.

Treatments for Laryngeal Cancer

Radiation, chemo, biotherapy, laser surgery, surgery, or a combination, depending on tumor type, size, location, and patient preference.

Partial Laryngectomy

Only one vocal cord or no vocal cords are removed; patient can speak and breathe normally.

Total Laryngectomy with Radical Neck Dissection

Entire larynx/vocal cords removed; permanent stoma created; requires alternate method to talk.

Maintaining Patent Airway After Laryngectomy

Suction; lots of blood-tinged secretions post-op.

Post-Op Laryngectomy Care

Midline/HOB elevated, suture lines/stoma care, flap checks, NPO for 24-48 hours then tube feed, re-learn how to swallow, physio, emotional support.

Options for Voice Restoration After Total Laryngectomy

Electrolarynx, esophageal speech, transesophageal puncture with prosthetic voice device.

Stoma Care After Laryngectomy

Cover for protection, clean/suction/humidification.

Environmental Hazards/Safety Considerations After Laryngectomy

Smoke detectors, medic alert bracelet, capability of family/patient to handle emergency, when to seek help.

Psychological Support needed after Laryngectomy

Altered body image, different sounding speech, mucous from stoma embarrassing, cannot laugh or cry.

Risk Factors for Lung Cancer

Cigarette smoking is the #1 cause, 2nd hand smoke, environmental carcinogens, asbestos, air pollution.

Common Cues for Lung Cancer

Persistent cough, wheezing, chest pain, hoarseness, weight loss, dyspnea.

Diagnostics for Lung Cancer

CT scan (most effective noninvasive method), sputum for cytological studies, biopsy of cancer cells or pleural fluid is definitive.

Surgical Treatments for Lung Cancer

Wedge resection, segmental resection, pneumonectomy, lobectomy.

Radiation therapy for lung cancer

High-energy rays or particles targeted to kill cancer cells.

Chemotherapy approach for lung cancer

Drugs that work systemically to kill Ca cells.

Biologic /Targeted therapy for lung cancer

Drugs work to disrupt cancer cell division and modify the relationship between host and tumor.

Post-Op Care for Thoracotomy

Monitor respiratory status and treat hypoxia with O2 as needed; monitor chest tube and collection device.

Positioning and interventions post thoracotomy

Semi-Fowler's or up in chair as soon as possible, DB&C/incentive spirometry, encourage early mobility, optimal pain management (PCA).

Discharge Teaching After Lung Cancer Surgery

Signs and symptoms of progression, recurrent disease, safe use of home oxygen, smoking cessation, palliation, pain management.

Flail Chest

Results from multiple rib fractures, causing instability of the chest wall.

Cues for Flail Chest

Paradoxical chest movement (sucked in during inspiration, bulges out during expiration).

Treatment for Flail Chest

Oxygen, pain control, DB&C; severe cases may require ICU and intubation.

Pneumothorax

Presence of air in the pleural space, causing loss of negative pressure and lung collapse.

Open Pneumothorax

Pleural cavity exposed to outside air, such as from a penetrating wound.

Closed Pneumothorax

Caused by injury to lungs from broken ribs or medical procedures.

Cues for Small Pneumothorax

Mild tachycardia and dyspnea.

Cues for Large Pneumothorax

Respiratory distress, shallow/rapid respirations, dyspnea, air hunger, decreased oxygen saturation, no breath sounds on auscultation.

Hemothorax

Accumulation of blood in the pleural space from trauma or medical procedures.

Tension Pneumothorax

Rapid accumulation of air in pleural space (air enters but does not exit), causing mediastinal shift.

Cues for Tension Pneumothorax

Respiratory distress, shallow/rapid respirations, dyspnea, air hunger, decreased oxygen saturation, hypoxemia, no breath sounds, inadequate cardiac output, potentially death.

Treatment for Pneumothorax/Hemothorax/Tension Pneumothorax

Chest tube drain placed in pleural space, needle venting may be done as a life-saving measure.

Pulmonary Embolus (PE)

Blockage of pulmonary vessels by thrombus (commonly a DVT that breaks off), solid/fatty deposit, or air.

Risk Factors for PE

Prolonged immobility, surgery, pregnancy, obesity, advancing age, smoking, estrogen therapy, heart failure.

Cues for PE

Sudden onset of dyspnea, sharp/stabbing chest pain, apprehension, restlessness, cough, hemoptysis, ↑RR, ↑HR, ↓O2 sats.

Lab assessments and diagnostics for PE

Spiral CT with contrast dye to view blood vessels, D-dimer (increases with fibrinolysis).

Drug Therapy for PE

Fibrinolytics (tPA/Altaplase) to dissolve the clot, anticoagulants (heparin, LMWH, warfarin, DOACs) to prevent future clots.

General Nursing Care for PE

Position to optimize ventilation, O2 therapy, IV line for drugs and fluids, emotional support, monitoring.

Surgical Therapy for PE

Embolectomy (surgical removal of embolus) or inferior vena cava filter (traps emboli).

COPD

Airflow limitations (emphysema) and airflow obstruction (bronchitis).

Risk Factors for COPD

Cigarette smoking, occupational chemicals/dust, recurring infection, heredity, asthma, aging.

Cues for COPD

Easily fatigued, frequent respiratory infections, use of accessory muscles, orthopnea, wheezing, pursed-lip breathing, chronic cough, barrel chest, dyspnea, prolonged expiratory time.

ABG findings for COPD

Hypoxemia (low PAO2), hypercapnia (increased PAC02).

CBC findings for COPD

Increased WBC (if infection present), increased HGB and HCT (polycythemia).

Diagnostics for COPD

Pulmonary function tests (spirometry measures inhalation and exhalation effectiveness).

Drug Therapy for COPD

Long-term control therapy with inhaled drugs (short and long-acting) and prompt treatment with A/B for infections.

Pursed Lip Breathing

Inhale slowly through nose, pucker lips, exhale longer than inhale, cough after 3rd breath.

Diaphragmatic Breathing

Breath from abd while keeping chest still.

Positioning and Fluids for COPD

Upright position (tripod if possible), elevating HOB allows for lung expansion, fluids to thin secretions.

O2 Therapy for COPD

Sats should be between 88-92% or as prescribed, should be humidified, various methods of delivery.

Nutritional and Hydration Therapy for COPD

Rest before eating, prepare small meals, high-calorie/high-protein foods, drink at least 2L/day.

Exercise Therapy for COPD

Start slowly and increase gradually, walk daily until symptoms limit exercise.

Pulmonary Rehab Programs for COPD

Involve education and monitored exercise; psychosocial support is important.

Lung Volume Reduction Surgery (LVRS)

Removal of hyperinflated lung tissues, results in increased FEV and improved oxygenation.

Lung Transplant

Less common due to cost and scarcity, difficult course of antirejection drugs.

What is COPD acute exacerbation

acute exacerbation is a worsening of symptoms and decrease in ability to do ADLs.

Prevention of COPD exacerbations

Avoid crowds, up-to-date pneumonia and flu vaccines, avoid triggers, stay indoors when air quality is poor.

Action for Acute Exacerbation of COPD

Increase inhaled bronchodilators, antibiotics if infection is present, oral systemic steroids, oxygen, promote rest, ventilation and intubation if acute respiratory failure.

Pathophysiology of COPD Cor Pulmonale

Pulmonary vasoconstriction, vasoconstriction, Reduction of pulmonary vascular bed.

Management strategies for Depression and Anxiety associated with COPD

Support groups, counselling, meditation, hypnosis therapy etc to help.

COPD: Discharge Teaching

Pace and plan ADLs with rest periods, encourage smoking cessation, promote hand hygiene.