Respiratory (continued) – Pneumonia & Lung Cancer – Flashcards
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what do cancer pt's often have multiple episodes of prior to diagnosis?
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pneumonia
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what is atelectasis?
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- collapse of alveoli
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What may cause a person to have atelectasis? (6)
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- COPD - High BMI - Procedure/surgery - post anesthesia - Pain - inhibit deep breathing - Decreased level of consciousness - Lack of mobility
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Clinical manifestations of atelectasis: (7)
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- cough - sputum - pleural pain - infection - fever (low-grade) - dyspnea - tachycardia
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ventilation / perfusion ratio:
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a measurement used to assess the efficiency and adequacy of the matching of two variables: "V" - ventilation - the air that reaches the alveoli. "Q" - perfusion - the blood that reaches the alveoli.
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describe the cough associated with atelectasis: what does it lead to?
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- dry initially, then productive --> good environment for bacterial growth --> pna
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Good V/Q ventilation/perfusion if...
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- alveoli are fully inflated - capillaries are open and perfusing - good oxygenation back and forth - "air goes in & out, blood goes round & round"
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V/Q Mismatch - NEED TO LISTEN TO RECORDING!
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- when one of the two variables changes with a matching change in the other variable - ??? - low blood perfusion & high ventilation = high O2 - high blood perfusion & low ventilation = low O2 --> hypoxemia
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what does bronchitis do to the airways? resulting in?
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- narrows airway - decreased O2 in alveoli that cannot be perfused into the capillary walls
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what occurs if large areas of the lungs are affected by atelectasis?
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respiratory distress, anxiety, hypoxia
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atelectasis is an airless condition caused by _______, obstruction to airways, or _______.
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atelectasis is an airless condition caused by __hypoventilation__, obstruction to airways, or __compression__.
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what effect can anxiety have on respiratory distress?
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it can cause a cascade of worsening effects
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Pathogens that can cause pna: (3)
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- pseudomonas - staph aureus - e-coli
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Most common community acquired pna?
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staph aureus
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Pneumonia: (5)
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- inflammation w/in alveolar space - fluid spread of infection - alveolar wall thickening --> pleuritis - lung stiffness/atelectasis - hypoxia
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What is the difference between community acquired and hospital acquired pna?
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- Hospital-acquired pna or nosocomial pna refers to any pna contracted by a pt in a hospital at least 48-72 hours after being admitted. - Community-acquired pna develops in people with limited/no contact with medical settings.
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CURB 65
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Clinical presentation of pna - criteria used to determine if pt w/ pna requires hospital admitance: - Confusion - Urea nitrogen (BUN) (>7 mmol/l) - Respiratory rate (>=30bpm) - Systolic blood pressure (=65y/o)
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How long should CURB 65 symptoms be present to determine if someone needs to be admitted to the hospital?
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5 days
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BUN
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blood urea nitrogen: - break down of protein in urine
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what can elevate a BUN? (2)
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- fever & inflammation process of pna --> dehydration - kidney perfusion/function issues --> elevates BUN
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what type of BUN do you have with: (high or low) - liver failure - kidney function issues
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- liver failure - low BUN - kidney function issues - high BUN
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why might a person get confused with pna?
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lack of O2 to brain
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why does a person w/ pna RR increase?
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they are dyspnic, working harder to breath, using accessory muscles, resulting in increased RR
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Risk factors for pna: (5) What commonality do these risk factors have? What does it put the pts at risk for?
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- ETOH - HIV/AIDS - Respiratory Failure - Diabetes - COPD - All of these disorders have a compromised immune system -- at risk for opportunistic infection
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Nursing plan of care for pna: (8)
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- positioning - mobilization - postural drainage - fluids/humidification - breathing exercises - incentive spirometry - nutrition - chest percussion
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Other than position, name a couple ways to promote drainage from the respiratory system: (2)
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- cupping / percussion - vibrations
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What is the purpose of cupping / percussion & how do you perform it?
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- helps break up thick fluids in the lungs - either you or someone else claps a hand on your ribs while you are lying down - do this w/ or w/o clothing on your chest - Form a cup shape with your hand and wrist. - Clap your hand and wrist against your chest (or have someone clap your back, if your doctor tells you to). - You should hear a hollow or popping sound, not a slapping sound. - Do not clap so hard that it hurts.
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incentive spirometry: - what is it? - what does it mimic? - objective? - maintains/prevents?
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- sustained maximal inspiration (SMI) - designed to mimic natural sighing or yawning by encouraging the patient to take long, slow, deep breaths - accomplished by using a device that provides patients with visual when they inhale at a predetermined flowrate or volume and sustain the inflation for a minimum of 3 seconds - objectives: to increase transpulmonary pressure and inspiratory volumes, improve inspiratory muscle perfor-mance, and re-establish or simulate the normal pattern of pulmonary hyperinflation. - when repeated on a regular basis, airway patency may be maintained and lung atelectasis prevented and reversed
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medical management of pna: overall (3)
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- labs - supportive treatments - medication
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medical management of pna: labs (3)
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- chest x-ray - sputum culture & sensitivity
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medical management of pna: supportive treatments (6)
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- fluids - oxygen (for hypoxia) - antipyretics - antitussives - decongestants - antihistamines
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medical management of pna: medication (1) how determined?
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- antibiotics (for bacterial infections, not viruses) - determined by gram stain results
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How should antibiotics be used w/ pna: - prior to culture results - post culture results
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- prior: start pt on a broad spectrum antibiotic - post: Gram stain results will dictate the type of pna & sensitivity test will determine the best antibiotic to use to treat a bacterial pna. If viral pna, discontinue antibiotics.
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best way to obtain a sputum sample:
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- obtain 1st thing in A.M., sit pt. in upright position, rinse mouth out, take cpl deep breaths, cough & spit into specimen cup - want sputum from deep lungs, not back of throat.
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Pneumonia Discharge Criteria: (7)
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(opposite of CURB 65) - Normal mental status - NOT confused - Urea BUN (normal range, 8-20) - Resp Rtae (90 mmHg) - O2 Sats (>90%) - Afebrile (<37.8'C, <100'F) - Tolerating liquids
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What could sun downing in an elderly patient, whom does not normally suffer from this mean?
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possible pna
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What symptom might an elderly person suspected of having pna be missing?
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fever - it's hard for them to reach high fevers, so they may have an infection with far lower temperatures
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Who discovered TB? When?
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Robert Koch, 1882
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How is TB spread?
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aerosolization air droplet --> sputum going out highly infectious
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What is TB a defining illness of?
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HIV/AIDS
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What populations wont CDC treat for TB? Why?
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- alcoholics - d/t decreased liver function - Med ADR - also decreases liver function
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Medication Treatment for TB:
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- isoniazid (INH) + rifampin (combination) - pyrazinamide (if resistant) - streptomycin (if resistant)
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isoniazid (INH): - ADR's - what helps?
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- peripheral neuropathy - vitamin B6 helps - decreases liver function
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rifampin: - ADR
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- bright orange secretions
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Why is TB treated with multi-drug therapy?
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multiple drugs are more likely to kill all TB bacteria
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2 reasons for bacteria strains of TB to develop resistance?
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- infected w/ resistant strain at a high load - don't follow regimen therapy for full 6 months, or take incorrectly
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What tests are done to monitor TB to see if bacteria has resolved?
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chest x-ray sputum samples
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mantoux test
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tuberculin skin test - 1st get injection - 2nd go back 72 hrs later to have test read - rxn: palpable, raised, hardened area = + TB test
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Symptoms of TB:
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- cough - non-productive - low grade fever - weight loss - fatigue - HIV related illness & extrapulmonary disease (b/c immunocompromised)
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TB Nursing Plan of Care:
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- PPE/Isolation (negative flow room, full gear, N95 mask) - Multiple medication regimen (6-12 mos)
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2 phases of TB medication regimen:
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- initial tx phase: high dose of isoniazid (INH) & rifampin in rounds 1x/day - continuous/maintenance phase: after initial tx, every other day
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how long until TB patient is non-infectious?
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after 2-3 weeks of continual med therapy
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ways to prevent spread of TB:
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- take all meds (avoid resistant strains) - always cover mouth (elbow) - dont go to work or school - isolation - fresh air - air out room
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how can you NOT get TB infection?
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hand shakes, toilet seats, sharing utensils
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single largest cause of cancer mortality in US?
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lung cancer
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high incidence of lung cancer in what populations
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black females, native americans, and alaskans
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when are people usually diagnosed with lung cancer
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advanced stages, hard to detect
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etiology of lung cancer: (6)
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- smoker - environmental smoke - lung disease - previous lung cancer - family hx - gender (women who smoke)
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if no other cause can be identified, what is most likely cause of lung cancer?
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environment (radon, asbestos, silicone, coal, diesel exhaust, other chemicals/minerals)
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Nursing care for lung cancer: preventative
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lifestyle changes smoking cessation
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START =
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- smoking cessation tool - "Set a quit date, Tell a friend, Anticipate and plan, Talk to your doctor"
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smoking cessation tools:
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- SSRI - seratonin reuptake inhibitor - journaling - hypnosis - nicotine patches - drugs to help with cessation
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2 drugs to help with smoking cessation: ADR's
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- chantix - buspar - repetitive thoughts, suicidal ideations, depression
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recognizing symptoms of lung cancer
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- usually no sx's till advanced - persistent, dry cough - constant chest pain - increases w/ deep inspiration - blood tinged sputum - repeat pna, bronchitis - swelling of neck & face - loss of appetite (weight loss - 30-50lbs in 2-3 mos) - fatigue - pleural effusion
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diagnosis of lung cancer:
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- chest x-ray, CT scan - MRI (with PET - sugary soln, CA lights up) - sputum analysis - thorocentesis - biopsy w/ needle to culture - blue-light broncoscopy (tube into lungs to get tissue) - go through mediastinum for tissue - DNA in blood/bronchial cells
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only way to make a TRUE diagnosis
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thoracentesis
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most common site for lung cancer
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right side, hialar region
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confirmation of lung cancer
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- mediastinoscopy - needle biopsy - surgical biopsy - blood tests (looking for metastasis) - CBC (immunosupressed) look at immune status - Chemistry (renal or liver panel)
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2 main types of lung cancer (%) (spread rate)
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- NSCLC - non-small cell lung cancer - (80%) slow growth - SCLS - small cell lung cancer - (20%) aggressive, (aka oat cell)
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staging lung cancer: SCLC & NSCLC
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SCLC - limited (to lobe/area) --> extensive (metastasis) NSCLC - TNM (tumor node metastasis
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treatment for lung cancer:
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-utilized solo or in combo: - surgery - chemo - radiation therapy - external beam or brachytherapy - photodynamic therapy - type of radiation
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pneumonectomy
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surgical removal of a lung
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lobectomy
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- surgical removal of just one lobe of a lung
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segmentectomy
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surgical removal of a segment of lung as a wedge resection
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what treatment is #1 for SCLC & NSCLC
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- SCLC - chemo - NSCLC - surgery
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complications of lung cancer
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development of pleural effusion
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pleural effusion
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collection of fluid b/t the parietal and visceral pleura, inhibiting air exchange and oxygenation
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Treatment for pleural effusion:
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- thoracentesis - to drain fluid out
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post thoracentesis tx complication: what is done about it?
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multiple effusions or rebound effect need chest tube
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chest tube complications:
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- cough - hypotension (if pull out too much fluid) - re-expansion pulmonary edema - tracheal deviation (pressure from deflated lung)
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how do you position a pt. w/ a recently removed lung?
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- position on affected side so good lung is up - may be painful to incision - want to promote lung drainage from good lung to keep airways open
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What is the most common surgery for a apparently curable tumor of the lung?
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lobectomty
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what can a patient do while coughing and deep breathing to alleviate pain?
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splinting
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quad coughing
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give pt bear hug, they breath in big, squeeze when they exhale to assist dislodgment of secretions
