Respiratory - Students

Respiratory Disorders Overview

Cancer of the Larynx

  • Prevalence: Accounts for about half of all head and neck cancers with approximately 12,410 new cases and 3,760 deaths annually.

  • Demographics: Most common in individuals over age 65, with a predominance in men (four times more likely).

  • Risk Factors: Various factors contributing to the development of laryngeal cancer.

Clinical Manifestations

  • Early Symptoms:

    • Hoarseness

    • Persistent cough

    • Sore throat with pain and burning sensation

    • Presence of a lump in the neck

  • Later Symptoms:

    • Dysphagia (difficulty swallowing)

    • Dyspnea (difficulty breathing)

    • Unilateral nasal obstruction

    • Persistent hoarseness and ulceration

    • Foul breath

Assessment and Diagnostics

  • Methods:

    • Comprehensive history and physical examination

    • Laryngoscopy and fine-needle aspiration (FNA) biopsy

    • Barium swallow study, endoscopy, and imaging (CT, MRI, PET scans)

  • Tumor Grading and Staging: Utilized TNM system to grade and stage tumors.

Medical Management

  • Stages I and II:

    • Treatments include radiation therapy, cordectomy, endoscopic laser excision, and partial laryngectomy.

  • Stages III and IV:

    • More aggressive treatments involving radiation therapy, chemotherapy, chemoradiation, or total laryngectomy.

Total Laryngectomy

  • Procedure: Complete removal of the larynx, along with associated structures (hyoid bone, epiglottis, etc.).

  • Consequences: Results in loss of voice and necessitates the use of a laryngectomy tube but allows for normal swallowing.

Changes in Airflow Post-Laryngectomy

  • Understanding how airflow is modified post-surgery:

    • Air enters through the neck stoma instead of the nasal cavity, affecting speech and mouth airflow.

Preoperative Assessment for Laryngectomy

  • Considerations: Includes health history, physical assessment, nutritional status, and labs.

  • Focus Areas: Communication abilities, coping skills, and education to reduce anxiety before the procedure.

Postoperative Care for Laryngectomy

  • Airway Management: Ensuring a patent airway and controlling secretions, with patients monitored in a Fowler’s position.

  • Pain Management: Caution with opioids and managing potential respiratory problems.

  • Communication Alternatives: Implementing alternative methods for communication post-surgery.

  • Nutrition: NPO for at least 7 days post-op, with IV fluids, TPN, and enteral feedings as necessary.

  • Complications: Awareness of complications such as respiratory distress, hemorrhage, infection, and tracheostomal stenosis is crucial.

Atelectasis

  • Definition: Closure or collapse of alveoli due to various causes including hypoventilation and obstruction.

  • Symptoms: Insidious onset, dyspnea, cough, non-productive sputum, and in severe cases, central cyanosis.

  • Diagnosis: Predominantly identified via chest X-ray showing patchy infiltrates.

Management of Atelectasis

  • Prevention Strategies: Frequent mobilization, deep breathing exercises, use of incentive spirometry, and nebulizers.

  • Management Techniques: Positive end-expiratory pressure (PEEP), chest physiotherapy, bronchodilators, or bronchoscopy as needed.

Acute Respiratory Distress Syndrome (ARDS)

  • Overview: This is a life-threatening condition characterized by lung alveoli filling with fluid, leading to severe respiratory distress.

  • Clinical Manifestations: Symptoms include severe dyspnea, intercostal retractions, and crackles upon auscultation.

  • Risk Factors and Diagnostics: Requires several diagnostics including blood cultures and chest X-rays.

Pulmonary Emboli (PE)

  • Definition: Obstruction of the pulmonary artery, significant as a leading cause of sudden death in patients.

  • Clinical Manifestations: Varying symptoms depending on the embolism's size and location—dyspnea, tachycardia, and anxiety are common.

  • Diagnostic Tools: Chest X-ray, ECG, and D-dimer among others to assess embolism presence.

Prevention and Management of PE

  • Preventive Measures: Encourage leg exercises, ambulation, and the use of compression devices.

  • Emergency Medical Management: Involves administering oxygen, IV fluids, and possibly thrombolytic therapy.

Pulmonary Tuberculosis (TB)

  • Overview: A contagious disease primarily affecting the lungs, caused by Mycobacterium tuberculosis, with significant global health implications.

  • Risk Factors: Strong links to poverty, overcrowding, and inadequate healthcare, leading to high rates of infection.

  • Clinical Manifestations: Low-grade fever, persistent cough, night sweats, and potential hemoptysis.

Diagnostics for Tuberculosis

  • Testing Methods: Skin tests, sputum analysis, and chest X-rays to identify active or latent infections.

  • Treatment: Multi-drug antibiotic regimens lasting from 6 to 12 months are essential for complete recovery.

Lung Cancer

  • Statistics: A leading cause of cancer-related deaths in the U.S. with over 85% attributed to smoking.

  • Types: Classified into Small Cell and Non-Small Cell Lung Cancer with varying treatment protocols.

  • Symptoms: Many patients are asymptomatic until later stages, but common symptoms include chronic cough, dyspnea, and chest pain.

Medical Management of Lung Cancer

  • Treatment Regimens: Surgical intervention, radiation, chemotherapy, and newer therapies such as immunotherapy based on type and stage.

Chest Trauma

  • Types: Blunt and penetrating trauma leading to significant respiratory complications including pneumothorax.

  • Pneumothorax: Defined and differentiated into various types with respective clinical implications and management protocols.