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RESPIRATORY NEOPLASMS 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 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 MEDICAL DIAGNOSIS 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 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 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 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. 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 (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 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 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 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