1	Respiratory Lecture #3 Dr. Kathleen Ethridge Northeast Texas Community College
2	Cancer of Lung A tumor arising from within the lung. It may respresent the primary site or may be metastatic
3	Lung Cancer Four major types Squamous cell (epidermoid) Adenocarcinoma Large cell Small cell (oat cell)
4	Overview Epidermoid or squamous cell slow growth rate arises from bronchial epithelium
5	Overview Adenocarcinoma slow growth rate strongly linked to cigarettes
6	Overview Large cell peripheral mass slow growth
7	Overview Small cell (Oat cell) Rapid growth poor prognosis
8	Warning Signs change in respirations cough that is persistent change in sputum weight loss chest pain recurring respiratory disorders such as pneumonia or bronchitis
9	Various Stages of Lung Cancer Staged by Tumor Node Metastasis This is the TNM classification system
10	Treatment Radiation Surgery Chemotherapy
11	Prepare for Surgery General preop preparations Improve quality of ventilation Discuss postop expectations Baseline data Consider emotional status
12	Pulmonary Resections Wedge Resection Lobectomy Segmental Resection Pneumonectomy
13	Chest Tube Drainage note: no chest tube with pneumonectomy one bottle system two bottle system three bottle system
14	Safety Keep the collection system below the client’s chest Do not clamp (unless ordered)
15	Removal Chest tube is usually removed 2 to 3 days after surgery.
16	Occupational Lung Diseases Respiratory irritation Occupational asthma Hypersensitivity pneumonitis Pneumoconioses
17	Restrictive Lung Diseases Disorders affecting lung volume and compliance Intrapulmonary Extrapulmonary
18	Scoliosis Restrictive disorder Alters the chest cage space Lung tissue may be compressed
19	Restrictive vs. Obstructive Disorders Obstructive Affect the patency or elasticity of airways Increase in airway resistance Restrictive Interfere in the chest wall movement
20	Lung Transplantation Improved significantly since 1980s End-stage lung disease
21	Pleural Effusion Accumulation of fluid in the pleural space Causes heart failure liver or renal failure infections or trauma impaired lymphatic system
22	Empyema and Decortication Empyema - collection of thick purulent fluid in the pleural space Decortication - procedure performed if the purulent fluid becomes solidified (fibrothorax), requires surgical removal
23	Respiratory Failure Two types: Hypoxemic Respiratory Failure Acute Ventilatory Failure
24	Endotracheal Tube Must have special training to intubate ET tube a long, slender, tube inserted into the trachea used for short-term management always confirm tube placement
25	Complications of Tracheal Suctioning Hypoxemia Dysrhythmias Bronchospasm Airway trauma Infection Atelectasis, lobar collapse
26	Mechanical Ventilation Volume -Cycled Ventilators Deliver a predetermined tidal volume A pressure limit is set
27	Types of Ventilators Most often used: volume-cycled ventilators Others pressure-cycled ventilators time-cycled ventilators
28	Ventilator Control Panel Many different models Display messages may differ in appearance
29	Modes of Ventilation Control Mode (machine-cycled ventilation) Assist/Control Intermittent mandatory ventilation (IMV) Synchronized intermittent mandatory ventilation (SIMV) Positive end-expiratory pressure (PEEP) High-frequency ventilation (HFV)
30	Weaning Modes Continuous positive airway pressure (CPAP) Pressure support
31	Alarms High-Pressure Alarms Low Pressure Alarms Oxygen Alarms
32	Safety If at any time you cannot quickly determine the problem, disconnect the patient and ventilate with resuscitation bag.
33	Nursing Care of the Ventilated Client Check all alarms each shift Resuscitation bag must be available Check ventilator settings and chart Assess client’s tolerance Consider client’s emotional status
34	Suctioning Endotracheal tube or Tracheal tube Sterile Suction Closed suction system
35	Adult Respiratory Distress Syndrome ARDS a sudden form of respiratory failure that progresses rapidly characterized by
36	Adult Respiratory Distress Syndrome Risk Factors Direct Pulmonary Trauma Indirect Pulmonary Trauma
37	Understanding ARDS
38	Chest Trauma Penetrating or crushing chest injuries may be life threatening.
39	Pneumothorax Closed pneumothorax presence of air in the pleural space Open Pneumothorax sucking chest wound
40	Tension Pneumothorax Open pneumothorax lets air into the pleural space
41	Flail Chest Occurs when two or more adjacent ribs are fractured at two or more sites During inspiration the detached part of the rib segment moves in a paradoxical manner (pulled inward) On expiration, the segment will be bulging outward The mediastinum shifts
42	Other Respiratory Disorders RSV (Respiratory Syncytial Virus) Inflammation of the bronchioles Transmitted by direct contact Treated with rest, fluids, high humidity, oxygen
43	The End