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RESPIRATORY NEOPLASMS
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th
Brunner 13 ed., pages:
 557 – 568 **
 605 – 610 **
 Ch.35 p. 981
Objectives: Explain common respiratory disorders across the lifespan
3) Obstructive
a. Asthma
b. Emphysema
c. COPD
d. Cystic fibrosis
e. Croup
f. Pulmonary embolus
g. Neoplasms
h. Sleep apnea
Describe nursing responsibilities related to treatment modalities in the care of clients
experiencing respiratory disorders across the lifespan.
5. Nursing Responsibilities Related to
Treatment Modalities
A. Drug Therapy
1) Classification
a. Bronchodilators
b. Decongestants
c. Antihistamines
d. Expectorants
e. Anti-tussives
f. Antibiotics
g. Anti-tuberculin
h. Anticoagulants
i. Antileukotrienes
j. Mast cell stabilizers
k. Vaccinations
i. Influenza
ii. Pneumonia
l. Chemotherapeutic agents
2) Dosage, route, time
3) Action
4) Expected Therapeutic Effect
5) Contingencies
6) Expected Therapeutic Outcome
7) Common Side Effects
8) Nursing Implications
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C. Surgery/Procedures
1) Types
a. Thoracotomy
b. Laryngectomy
c. Radical neck resection
e. Chest tubes
d. Vena cava umbrella
2) Brief Description of
Procedure
3) Rationale
4) Nursing Implications
5) Lifespan
Considerations
6) Cultural
Considerations
7) Discharge Planning
8) Home Management
9) Community Referral
 CANCER OF THE LARYNX
Incidence
Risk factors
Categories
 Supraglottic:
 Glottic:
 Subglottic:
 UPPER RESPIRATORY SYSTEM
 EARLY SYMPTOMS
Hoarseness
Persistent cough
Sore throat or pain, burning in
throat
Lump in neck
 LATER SYMPTOMS
Dysphagia
Dyspnea
Unilateral nasal obstruction or discharge
Persistent hoarseness,
Persistent ulceration,
Foul breath
 GENERALIZED SYMPTOMS
Weight loss
Debilitation
Lymph adenopathy
Radiation of pain to ear
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MEDICAL DIAGNOSIS
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MEDICAL TREATMENT
Diagnosis
Tumors staged
CT, MRI, PET
Radiation therapy
Chemotherapy
Surgery
 Partial laryngectomy
 Supraglottic laryngectomy
 Hemilaryngectomy
 Total laryngectomy
http://youtu.be/jb2JXJF_b4E
 CHANGES IN AIRFLOW WITH TOTAL LARYNGECTOMY
 NURSING PROCESS – CARE OF A CLIENT WITH A TOTAL LARYNGECTOMY ASSESSMENT
Health history
Assess history of alcohol abuse
Physical assessment
Nutritional status
Assess literacy, hearing, visual ability; may impact communication
Assess learning needs
Assess patient, family coping, support systems
 POTENTIAL COMPLICATIONS
Respiratory distress
Hemorrhage
Infections
Wound breakdown
Aspiration
Tracheal stenosis
 NURSING PROCESS - PLANNING
Adequate level of knowledge (patient, family)
Reduction of anxiety
Maintenance of patent airway
Effective means of communication
Attaining optimum hydration, nutrition
 PLANNING
Improved body image, self-esteem
Self-care management
Absence of complications
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 PREOPERATIVE TEACHING
Instruction regarding type of procedure, resultant changes (changes in speech,
permanent loss of speech, changes in airway)
Include instruction regarding tubes used postoperatively (drainage tubes, feeding
tubes), provide general preoperative teaching to prevent postoperative complications
 PREOPERATIVE TEACHING
Include planning for postoperative communication, long-term speech rehabilitation
Utilize collaborative approach
Include physician, speech therapy, dietary, social work, clinical nurse specialist, others
as required
 ANXIETY AND DEPRESSION
Allow asking of questions, provide information
Permit verbalization of feelings
Interventions to reduce anxiety, promote comfort
Reassuring manner
Stay with patient during episodes of anxiety
Relaxation techniques
 MAINTAINING A PATENT AIRWAY
Semi Fowler’s or position to decrease edema
Monitor for signs, symptoms of respiratory distress
Tracheostomy or laryngectomy tube assessment, care
Care of stoma
Suctioning
Humidification of air
Patient teaching
 COMMUNICATION
Plan communication preoperatively
Immediate postoperative communication
 Magic slate
 Communication board
 Speech rehabilitation
http://youtu.be/R4azcU6i2IE
 TEP VOICE PROSTHESIS
 POTENTIAL FOR ASPIRATION
Keep HOB elevated during, after tube feedings
Check gastric residual when administering tube feedings
When patient begins oral feeding, maintain upright bed position during, after feedings
Swallowing maneuvers to prevent aspiration
Use of thickened liquids
 CLASSIC RADICAL NECK DISSECTION
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http://youtu.be/a3Zj1pHJ2Ck
 NURSING PROCESS – CARE OF THE PATIENT WITH A RADICAL NECK DISSECTION ASSESSMENT
Assess knowledge.
Assess for risks for potential complications.
Postoperatively, the patient will need careful monitoring and assessment.
 Airway and breathing
 Pain
 Potential bleeding and wound drainage system
 Other
 POTENTIAL COMPLICATIONS
Hemorrhage
Chyle fistula
Nerve injury
 NURSING PROCESS – PLANNING: Major Goals
patient participation in the treatment plan
maintenance of respiratory status
attainment of comfort
absence of infection
viability of graft
 NURSING PROCESS – PLANNING: Major Goals
maintenance of adequate nutrition and fluid intake
effective coping strategies
effective communication
maintenance of neck and shoulder motion
absence of complications
 MAINTAINING THE AIRWAY
Frequent assessment
Place in Fowler’s position
Encourage coughing and deep breathing
If patient has a tracheostomy provide tracheostomy care as required.
 PATIENT EDUCATION
Patient should be aware of the extent and nature of the surgery and what to expect in
the postoperative period.
Patient and family will require postoperative teaching related to self-care and home
management.
 Sign and symptoms to report
 Wound care, dressings and drains if present
 PATIENT EDUCATION
 Diet and medications
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 Exercises and activity
Speech therapy, support resources, and follow-up care.
 IMPAIRED TISSUE INTEGRITY
Suctioning should be done with great care to protect suture lines.
Support the head and neck when moving the patient.
Assess wound drain system and empty as required.
Assess dressings, wound, and graft condition
 IMBALANCED NUTRITION
Consider patient preferences and cultural considerations in food selection.
Provide oral care before and after eating.
Nasogastric or gastrostomy feedings may be required.
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LUNG CANCER
CLASSIFICATION
Small cell lung cancer (SCLC)
Non-small cell lung cancer (NSCLC)
 Squamous cell (almost all malignant
tumors of the larynx)
 Adenocarcinoma
 Large cell carcinoma
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(undifferentiated carcinoma)
 Bronchoalveolar cell
 RISK FACTORS
Tobacco smoke
Secondhand smoke
Environmental and occupational exposure
Genetics
 CLINICAL MANIFESTATIONS
Signs & symptoms depend on
 Location and size of tumor
 Degree of obstruction
 Existence of metastases
Cough
Dyspnea
 CLINICAL MANIFESTATIONS
Hemopytosis
Chest or shoulder pain/tightness
Fever
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Symptoms of pleural or pericardial effusion
 COMMON SITES OF METASTASES
Lymph nodes
Bone
Brain
Contralateral lung
Adrenal glands
Liver
 DIAGNOSTIC FINDINGS
Surgical biopsy
Chest x-ray
CT of the chest
MRI
Fiberoptic bronchoscopy
Fine-needle aspiration
Endoscopy with esophageal ultrasound
Pet scan
 MEDICAL MANAGEMENT
Surgical management
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Lobectomy
 Bilobectomy
 Sleeve resection
 Pneumonectomy
 Segmentectomy
 Wedge resection
 Chest wall resection
 MEDICAL MANAGEMENT
Radiation therapy
Chemotherapy
Palliative therapy
http://youtu.be/Z3pnbPFkqzs
 TREATMENT-RELATED COMPLICATIONS
Respiratory failure
Surgical complications
Prolonged mechanical ventilation
Radiation therapy complications
Pneumonitis
Pulmonary toxicity
 NURSING MANAGEMENT
Respiratory distress and hypoxia
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Relieving breathing problems
Reducing fatigue
Providing psychological support
Post-operative teaching
Reducing anxiety and fear
Nutrition and hydration
Promoting self-care management
 GERONTOLOGIC CONSIDERATIONS
Functional status
Comorbid conditions
Nutritional status
Cognition
Concomitant medications
Psychological and support system