|
|


 |




   

˜ 1. p


-volume of air inspired or expired with

each normal breath, about 500ml
2.     
˜ -extra volume of air than can be
inspired over & beyond the normal
tidal volume, about 3000ml
˜ è   
-equals IRV + TV + ERV or 1C + ERV
-maximum amount of air that a person can
expel from the lungs after filling the lungs
to their maximum extent & expiring to the
maximum extent
˜ [ p 
-maximum volume to which the lungs can be
expanded with the greatest possible effort
› T CLI›ICALLY measured !

˜ 1. Residual volume
˜ 2. Functional residual volume
˜ 3. Total lung capacity
˜è    
-amount of air that can still be expired
by forceful expiration after the end of
a normal tidal expiration
˜ [ 

-volume of air still remaining in the
lungs after the most forceful
expiration
aulmonary "Capacities:"

˜     
-equals TV + IRV
-amount of air that a person can breathe
beginning at the normal expiratory level &
distending his lungs to maximum amount
˜ º  
 
-equals ERV + RV
-about amount of air remaining in the lungs
at the end of normal expiration
FACT RS AFFECTI›

RESaIRAT RY FU›CTI ›S
˜A
E
-Infants have more rapid respiratory rate.
They have primary respiratory activity that
is abdominal
-Changes of aging affect the breathing
pattern. These include loss of elasticity,
decreased reflex/cilia action, fragile
mucous membrane, osteoporosis,
decreased immune system and gastro-
gastro-
esophageal reflux.
˜ E›VIR ›E›T
- Altitude, heat, cold, air pollution affect
oxygenation
˜ LIFESTYLE
- ahysical exercise increases the rate
and depth of respiration
-Sedentary lifestyle will cause
decreased alveolar expansion
-Smokers are prone to develop C a
˜ EALT STATUS
-ealthy persons have intact
respiratory functions
- iseases of the lungs affect
oxygenation.
-aeople with chronic illnesses often
have muscle wasting and poor
muscle tone.
˜ E ICATI ›S
-Sedatives, ypnotics, tranquilizers,
barbiturates and narcotics greatly
depress respiratory drive.
˜ STRESS
-ahysiologic and asychological
responses to stress can affect
respiration.
-yperventilation, lightheadedness,
numbness and tingling sensation may
result.
˜ aRE
›A›CY
-Fetus and amniotic sac grow large
enough to displace the diaphragm
upward.
-The mother¶s respiratory rate
becomes faster and the breath
becomes shallower.
-µLightening¶ improves client¶s
breathing
›ormal Breathing pattern
˜ 12-20 respiratory rate
12-
˜ Active inspiration with contraction of
diaphragm
˜ aassive expiration with relaxation of
diaphragm
˜ Steady rhythm and regular rate and size
˜ I:E ratio is 1:2 (inspiration is half that of
expiration)
 EVIATI ›S FR  TE
› RAL RESaIRAT RY
FU›CTI ›
˜ Ya IA
-A condition of insufficient oxygen in
the lungs and the body.
-Signs of ypoxia may be the
following: Tachycardia, Tachypnea,
yspnea, Restlessness, Light-
Light-
headedness, Flaring of nostrils,
Intercostal retractions, changes in
sensorium and Cyanosis.
˜ Ya VE›TILATI ›
-Inadequate alveolar ventilation, which
can lead to hypoxia.
-When C 2 accumulates in the blood,
there is YaERCARBIA.
˜ CYA› SIS
-Bluish discoloration of the skin, nail
beds and mucus membrane due to
reduced hemoglobin-
hemoglobin-oxygen
saturation.
-There must be about Π
of unoxygenated blood per 100 ml for
this to manifest externally.
˜ ALTERE BREATI›
aATTER›S
-Breathing patterns refer to the rate,
volume, rhythm and relative ease or
effort of respiration.
-Altered breathing can be related to
rate, rhythm and position
˜ |
|
 |

|

 |   !"!#$!%$!&!"'
 |
((" 

|)
|  !'*"$!+,"$-.

|)
|
*"$ !"
|
| *  # !"!/ 
|
|
"$0-1
| | %"!(*"$!+
| |
˜ ALTERE BREATI›
aATTER›S: RYT
BREATI›
- eep and rapid
KUSSAUL¶S BREATI›
-
respiration seen in metabolic acidosis( )
CEY›E-
CEY›E-ST KES Respiration
Respiration-- arked rhythmic
waxing and waning of respiration from very deep
to very shallow breathing and temporary apnea.
Usually seen in cases of CF, increased ICa and
drug overdose.
respiration- Shallow breaths interrupted by
BI T¶S respiration-
apnea, seen in patients with C›S disorders.
˜|
|
 |


!"!

 | !*! !""*"$!

 |
 ! !"!2

 | '!((!% "%("* 

 |
*"$!+
˜ 
)
|3|

 !#*"%"!!4 4"$

, $5' 52

$"%% !!% %!"$
 rr

#!#*"%"!!4 4"$
"%$,*%$!' +2
˜ VE›TILATI ›-aERFUSI ›
›-
ISATC
-When mismatching occurs, some
alveolar regions will be well ventilated
but poorly perfused (a condition
known as EA SaACE),
-While others may be well perfused but
poorly ventilated (known as
SU›TI›
)
The Assessment

˜ ||

6||

02| !
-2 " !
72!%"4! !8"! *%$% 
72!%"4! !8"!
92'!%"4! !8"! )6,)
'
92'!%"4! !8"!
:2  (%"!""
| !

˜
$!""$ "4 "+5%$+

!"$ +*!+"$+
' ("!  
˜ 
""%$!"%( ,%
&! "
" !+,' ,%"!
#!"$!%
˜ "
"""*"!:  %!(
"$"/*%$! ,( ''! 1
˜ "
"""| (! (:
!", *  %!%%" , %
!"$%"!#!"$!%
˜ | 4 
- ;.
;.0..+
)- 7:
7:9:+
 <27:
<27: <29:
)7 --
-- -=&>
-" ?;
?;0..@
Sputum Analysis

˜
$!"" 8"$ ( "

"'!+ !"'!,!'"!(
+!,'!'"!(* % 
˜ 
""%+"!%( !'
!"A
˜ "
"""!"$#!"$3|

 ,!"%""$ "!"""A7' 
*"$'(%' %+$,"
* !8"!,% %" !+
 "
˜ "
""" 4!' $+!, * 
 %!%%" 
aulse ximetry

˜ 
!4!4"$'(%"! 
!"!+"$5+""!(
$+ *!* $" %""
˜ | *!""%$'""$
 *,($',(!+"! "$*!'+
("$
Bronchoscopy

˜ |'!%"! %"!("$"%$'
*%$!"$+$( 5!* (!* "!%
*%$!"$+$( 5!* (!*
!+!'*%$% 
˜ "'"! %"!( "$ +!%
!,"4(!+*B%","
% %""! %!'4
%"!> !"'"! 
˜ "")", 5=$,"%$!+

˜ """ !"! !!""!+ !+$"!
"
%$!,'!!"'"!4,++( 5#! *
* !$',4'"
˜ """ "! ++( 5",
"
!"!(# C#!"$$'"'"
!"!
!',$!" ,)6(""$
%',A "%$""'%"!
5-9$
Thoracentesis

˜  ( !' !"!(*"!!+
 %!(  ( !'( !,
 !(( +% !'*! 
 %!% %"!
˜ 
"")"
˜ "
"""!"!"$ "!"!""!+#!"$
"* !' !+(# C,
"* !'
!"%"""%+$,*"$' 
4
˜ "
""" !"!((%"'!'"
 # +5 !("$((%"'
!',)6*"!',!"! 
'!+'!" !"""
  D%"!
"

˜  '% %!"""!''!+!
! "!"#!"$ %"'  
'(%"!
˜ 4 "4"! "(%"!
˜ "!#$"$*"%"!4
"!%"!4'!
˜ )*"! !8'%!+""
  (%"!""

Spirometry
+4 
"(
%$! %$ +
˜ 
""
%$!+,A!+(7
',  !+$" 9$*("$
""
˜ "
""" !"!!""!+,*%$'! ",
% ! '"$ !%,("!+'

' '!+"$""
˜ "
"""'&"" !', 
"!+$"% "$!+
iagnoses

˜ Ineffective Airway Clearance

˜ Ineffective Breathing aattern
˜ Impaired
as Exchange
˜ Activity Intolerance
˜ Ineffective tissue perfusion
˜ isturbed sleep pattern
˜ Acute pain
˜ Anxiety
alanning

˜ The verall goals for a client with

oxygenation problems are to:
˜ aintain patent airway
˜ Improve comfort and ease of breathing
˜ aintain or improve pulmonary ventilation
and oxygenation
˜ emonstrate improved gas exchanges
˜ Improve ability to participate in physical
activities
 ""!

˜ aromoting xygenation
˜ aositioning the client to allow for
maximum chest expansion
˜ Encouraging or providing frequent
changes in position-
position- usually Q2
˜ Encouraging ambulation
˜
iving pain medications ^  deep
breathing and coughing
 eep breathing and coughing exercises
˜ These measures allow for the removal
of secretions from the airway.
˜ Breathing exercises are frequently
indicated for the clients with
restricted chest expansion such as
C a and post-
post-thoracic surgical
patients.
ydration
˜ This maintains the moisture of the
respiratory mucous membrane.
˜ Increased fluid intake as tolerated
˜ ilk should be avoided as it increases
the viscosity of secretions.
˜ Use of humidifiers
˜ Use of nebulizers or aerosol therapy
aositioning and Ambulation
˜ Ambulation and the ability to change
position frequently are two natural
means for keeping the lungs open
and clear of secretions.
˜ ovements help shift respiratory
secretions in the airway.
˜ ucus tends to pool in the lungs of
people who cannot move around.
aursed-lip breathing
aursed-
˜ This is a special measure to be used
along with deep breathing.
˜ aatients with C a should be taught
this technique to aid in the release of
trapped air from the obstructed
airways.
˜ arevents AIR-
AIR- TRAaaI›

Respiratory medications
˜ Bronchodilators, anti-
anti-inflammatory
drugs, expectorants, mucolytics and
cough suppressants may be used to
treat respiratory problems
Chest ahysiotherapy
˜ These are EaE› E›T nursing actions
performed with a physician¶s order.
˜ Chest physiotherapy is based on the fact
that mucus can be knocked or shaken form
the walls of the airways and helped to drain
from the lungs.
˜ The usual SEQUE›CE is as follows
follows--
a SITI ›I›
, aercussion, Vibration, and
removal of secretions by SUCTI ›I›
or
Coughing followed lastly by oral hygiene
5+"$ 
˜ (% ,(%A'4"!
A
Use of Artificial Airways
˜ These artificial airways are inserted to
maintain patent air passages for
clients whose airway have become or
may become obstructed.
˜ These are devices that provide a more
direct route to the lungs than the
natural airway
Suctioning
˜ This is a mechanical aspiration of the
airways involving the use of a
catheter inserted through the nose,
mouth or tracheal tube
˜ The catheter is attached to a portable
or wall unit SUCTI › machine.
Secretions are drawn up by a vacuum.
˜ Care of patients with chest tubes and
drainage systems
˜ Assists in emergency interventions
like removal of airway obstruction (by
eimlich maneuver), and initiating
CaR
Evaluation

˜ ›urses must collect data to evaluate

the effectiveness of interventions.
˜ The nurse works with the patient to
develop goals
Common Respiratory problems

˜ yspnea
-Breathing difficulty
-Associated with many conditions
conditions--
CF, 
,
BS, uscular dystrophy,
obstruction, etc«
˜
eneral nursing interventions:
1. Fowler¶s position to promote
maximum lung expansion and
promote comfort. An alternative
position is the RT a›EIC position
2. 2 (1
(1--3 lpm) usually via nasal
cannula
3. arovide comfort
˜ Cough and sputum production
˜ )+$! "%"!4( 5
˜  " '%"!$"! !

$!%A, #,+"

$!%A, #,+"% '
^
  
 
 (, !A,("$ 
  
%", !A
!A"!+',%!' Y


˜  !+"4"!
02 4!''&"$'"!
-2|'!!" !8' "!
72'4!A!+%"!
92 $+!
Cyanosis
˜  !$'!% "!("$A!
˜ | |
!'!%"($ 5!
˜ | #$"$5+"'$+ *!
!"$:+>'
˜ )" %! *4% "$
'(%("+' ! 
˜ ! $ %! *4"$! *',
 *
"4"!
˜ )$%A(!# "%
˜ 5+"$ 
˜ !"!!+
˜ %"!!+
˜ )$" $!"$ 
˜ )$%A(+ !!+
˜ "!%'$+ *!
emoptysis
˜ 5 %""!(* '("$
 !""%"
˜ )%  !(%"!, +
)|,%$!%"!,  * !
˜  '!+("%$ %!'!% ,
%((+'"!
"4"!
˜ E  ""!#
˜ "!"$%
˜ %"!!+ 
˜ 5+"$ 
˜ |'!!"D!*!"*! !8 !A
!% !%%!''"5!%%!'
˜ Epistaxis
˜  '!+("$%'* "("!,
'!"''4 !"$%*
˜ "%!"
"%!" "! "
)
02"
-2!(%"!
72 "!
92* ''%!, ",%'!'!
!+"4"!
˜ 02 !"! "!" !+$", !+(#',
"! "' 4"# #!+' !"!
˜ -2| '!%" 2 !%$+!"
"$!''  "5:
"5:0.!"
˜ 72( !4','!!"" !% 
4%"!%",! 4!"",+ (
˜ 92|!"! %"%"'  %A!+
( "!* '!+
)
D
 
|3|

˜ Upper airway infections

˜ aharyngitis and tonsillitis
- Assessment findings
˜ Fiery
Fiery--red pharyngeal membrane
˜ White
White--purple flecked exudates
˜ Enlarged and tender cervical lymph nodes
˜ Fever malaise ,sore throat
˜ ifficulty swallowing
˜ Cough may be absent
˜ $!!"!/%8,% !
% '1 5 " +
˜ | +!%$!!"! %"! /" , 21
˜ !!"! 4!
%"! >4!
˜ $+!"! %"! /" 1
˜
! !"! !""!'"5%!4
˜ +!"! (4!%,5 "
!!""/%!+""A1
5"!($!!"!
˜ Upper airway infection: Tonsillitis
-Infection and inflammation of the
tonsils
˜ ost common organism-
organism-
roup A- A-
beta hemolytic streptococcus (
ABS)
Laboratory tests
˜ 1. CBC
˜ 2. Culture
˜ E ICAL management
1. Antibiotics-
Antibiotics- penicillin
º p    

^   
˜ ›ursing Interventions
1. aintain aatent Airway
-Increase fluid intake to loosen
secretions
-Utilize room vaporizers or steam
inhalation
-Administer medications to relieve
nasal congestion
2. aromote comfort
-Administer prescribed analgesics
-Administer topical analgesics
-Warm gargles for the relief of sore
throat
-arovide oral hygiene
3. aromote communication
-Instruct patient to refrain from speaking as
much as possible
-arovide writing materials
4. Administer prescribed antibiotics
-onitor for possible complications like
meningitis, otitis media, abscess formation
5. Assist in surgical intervention
ASSESSE›T FI› I›
S
˜ Sore throat and mouth breathing
˜ Fever
˜ ifficulty swallowing
˜ Enlarged, reddish tonsils
˜ Foul
Foul--smelling breath
˜ ›URSI›
I›TERVE›TI › for
tonsillectomy
  
    
˜  
˜    
    
2. a ST-
ST-operative care
˜ aosition: ost comfortable is Lateral ecubitus for
drainage
˜ aintain oral airway, until gag reflex returns
˜ |  
 

˜ Advise patient to    
 
˜    are given when there is no bleeding and
gag reflex returns then oral feeding follows.
›otify physician if
˜  
    ! 
˜ ^    ^ 


^

˜    
"  
p  
 

˜ #        
   º
 ºº[  
|%" !"D! 

˜ ÷


     



     
    
  
˜ ccurs when the lungs no longer
meet the body¶s metabolic needs
 efined clinically as:
 $º Œ #
2. aaC 2 of greater than 50 mmg
3. Arterial p of less than 7.35
CAUSES
˜ C›S depression-
depression- head trauma,
sedatives
˜ CVS diseases-
diseases- I, CF
˜ Airway irritants-
irritants- smoke, fumes
˜ Endocrine and metabolic disorders-
disorders-
myxedema, metabolic alkalosis
˜ Thoracic abnormalities-
abnormalities- chest trauma
aAT aYSI L
Y

˜ ü  
  ü 
Brain injury, sedatives, metabolic
disorders   
   ^ 
     
ü     
˜ ystrophy, S disorders, peripheral
nerve disorders disrupt the impulse
transmission from the nerve to the
diaphragm abnormal ventilation
 ysfunction of the Lung aarenchyma
˜ aleural effusion, hemothorax,
pneumothorax, obstruction interfere
ventilation     
ASSESSE›T FI› I›
S
˜   
˜ yspnea
˜ Cyanosis
˜ Altered respiration
˜ Altered mentation
˜ Tachycardia
˜ Cardiac arrhythmias
˜ Respiratory arrest
 IA
› STIC FI› I›
S
˜   
˜ |
#^  % èŒ 
˜ &
&   
˜ 
  
E ICAL TREATE›T
˜ ^ 
˜ '     
˜ Antibiotics
˜ Steroids
˜ Bronchodilators
› ÷››p›p$›÷
1. aintain patent airway
2. Administer 2 to maintain aa02 at
more than 50 mmg
3. Suction airways as required
4. onitor serum electrolyte levels
5. Administer care of patient on
mechanical ventilation
) 

˜ These are group of disorders

associated with recurrent or
persistent obstruction of air passage
and airflow, usually irreversible.
˜ Asthma
˜ Chronic bronchitis
˜ Emphysema
˜ Bronchiectasis
˜ The most common and significant
risk factor of C a is cigarette
smoking.
˜ thers
thers-- fumes, air pollution, recurrent
respi. Infection, genetics
The general pathophysiology
˜ In C a there is       that
is both progressive and associated
with ^  response
of the lungs
|
|

The acute episode of REVERSIBLE

airway obstruction is characterized by
         
˜ 

Extrinsic
Intrinsic
˜ |"$ "$ $! +
˜  (     results in
histamine release, which produces  
    
a. 
 of mucous membranes
b. ÷  of the smooth muscle of bronchi
and bronchioles
c. Accumulation of tenacious   
˜ Assessment findings: history
    
º    ) 
Respiratory distress
˜ ÷ ^ 
˜    )
˜   
˜  ^  
˜
 "" " 

Emphysema

There is progressive and irreversible

alveolar destruction with abnormal
alveolar enlargement
The result is ›|÷ü
  ,
 , ECREASE oxygen
diffusion and I›CREASE airway
resistance!
These changes cause a state of
carbon dioxide retention, hypoxia,
and respiratory acidosis.
 Cigarette smoking
eredity, Bronchial asthma
Aging process

isequilibrium between
ELASTASE & A›TIELASTASE (alpha-
(alpha-1-antitrypsin)

estruction of distal airways and alveoli

verdistention of ALVE LI
yper--inflated and pale lungs
yper

Air trapping, decreased gas exchange and Retention of C 2

ypoxia Respiratory acidosis

˜ Anorexia, fatigue, weight loss
˜ Feeling of breathlessness, cough
˜ sputum production, flaring of the
nostrils
˜ yspnea
˜ Barrel chest
 yper--resonance
˜ yper in percussion,
decreased breath sounds with
prolonged expiration
˜ iagnostic tests: pC 2 elevated, $º
  
 

)$!%*%$!"!

Chronic inflammation of the bronchial

air passageway characterized by the
presence of cough and 

   è  
º    
Characteristic changes include:
˜ ypertrophy/ hyperplasia of the
mucus--secreting glands in the
mucus
bronchi
˜ ecreased ciliary activity, chronic
inflammation
˜ ›arrowing of the small airways.
|"
1. 
  *  +,
 +, dyspnea on
exertion, use of accessory muscles of
respiration, scattered rales and rhonchi
2. Feeling of epigastric fullness, cyanosis,
distended neck veins,

3. iagnostic tests: increased pC 2
decreased a 2
Bronchiectasis

aermanent abnormal dilation of the

bronchi with
  

      ^ 

Caused by
˜ bacterial infection or recurrent lower
respiratory tract infections
˜ congenital defects (altered bronchial
structures)
˜ lung tumors
"
˜ Chronic cough with production of
mucopurulent sputum,   "
exertional dyspnea, wheezing
˜ Anorexia, fatigue, weight loss
˜ iagnostic tests
˜ Bronchoscopy reveals sources and
sites of secretions
) +"

1. Rest-
Rest- p
  

 

2. Increase fluid intake-

intake- p !     
72' %
4 "' 4"!(%"!
72' %
4. iet
#  
 provides source of energy
#   diet helps maintain integrity of alveolar walls
'
 
 ^

   ^


 
* 

+
5. 2 therapy 1 to 3 lpm ((º
º 
 + o not give high concentration
of oxygen. The drive for breathing
may be depressed
6. Avoid cigarette smoking, alcohol,
and environmental pollutants.
7. CaT ±percussion, vibration, postural
drainage
ù. Bronchial hygiene measures
Steam inhalation
Aerosol inhalation
edimist inhalation
aharmacotherapy
1. Expectorants (guaiafenessin)/
mucolytic (mucomyst/mucosolvan)
2. Antitussives
˜ extrometorphan
˜ Codeine
è 


˜ Aminophylline (Theophylline)
˜ Ventolin (Salbutamol)
˜ Bricanyl (Terbutaline)
˜ Alupent (etaproterenol)
˜ bserve for tachycardia
4. Antihistamine
˜ Benadryl ( iphenhydramine)
˜ bserve for drowsiness
5. Steroids
˜ Anti
Anti--inflammatory effect
6. Antimicrobials
 "$5

     


   

    
02÷   
÷   
˜ Rupture of a small bleb on the
visceral pleura
-2$  
-2$  
˜ air enters the pleural space through
an opening in the chest wall; usually
caused by stabbing or gunshot
wound.
72p 
p   
˜ air enters the pleural space with each
inspiration but cannot escape
˜ causes increased intrathoracic
pressure
˜    
    
  

*
    +
Assessment findings
1. Sudden sharp pain in the chest,
dyspnea, diminished or ^ ^ 

 

,

,    
   

2. Weak, rapid pulse; anxiety;
diaphoresis
3. iagnostic tests
a. Chest x-
x-ray reveals area and degree
of pneumothorax
b. pC 2 elevated
c. p decreased
›ursing interventions
˜ arovide nursing care for the client
with an endotracheal tube
˜ Suction secretions, vomitus, blood
from nose, mouth, throat, or via
endotracheal tube
˜ onitor mechanical ventilation.
4. Restore/promote adequate
respiratory function.
˜ a. Assist with thoracentesis and
provide appropriate nursing care.
˜ b. Assist with insertion of a chest
tube to water-
water- seal drainage
˜ c. Continuously evaluate respiratory
patterns and report any changes.
5. arovide relief/control of pain.
˜ a. Administer
narcotics/analgesics/sedatives as
ordered and monitor effects.
˜ b. aosition client in high-
high-Fowler¶s
position.
aleural Effusion

efined broadly as a collection of fluid in

the pleural space

˜
eneral Classification
˜ Transudative effusion: accumulation of
protein--poor, cell-
protein cell-poor fluid ( cancers )
˜ Exudative effusion: accumulation of
protein rich fluid ( infections )
Assessment findings
˜ 1. yspnea, dullness over affected
area upon percussion, absent or
decreased breath sounds over
affected area, pleural pain, dry cough,
pleural friction rub
˜ 2. aallor, fatigue, fever, and night
sweats (with empyema)
 iagnostic tests
˜ a. Chest x-
x-ray positive
˜ b. aleural biopsy may reveal
bronchogenic carcinoma
˜ c. Thoracentesis
CLI›ICAL Correlation:

ydrothorax--
˜ ydrothorax Serous fluid in the
pleural cavity
emothorax-- Blood in the cavity
˜ emothorax
˜ ___________
___________-- aus in the cavity
˜ ___________
___________-- Lymph in the cavity
 ydrothorax--
˜ ydrothorax Serous fluid in the
pleural cavity
emothorax-- Blood in the cavity
˜ emothorax
ayothorax-- aus in the cavity
˜ ayothorax
˜ Chylothorax
Chylothorax-- Lymph in the cavity
+)%

˜ arimarypulmonary tumors arise from

the bronchial epithelium and are
therefore referred to as bronchogenic
carcinomas.
FACT RS
aossibly caused by inhaled
   (primarily cigarette
smoke but also asbestos, nickel, iron
oxides, air silicone pollution;
preexisting pulmonary disorders aTB,
C a )
Assessment findings
˜ aersistent cough (blood tinged)
˜ chest pain
˜ dyspnea
˜ unilateral wheezing, friction rub, possible
unilateral paralysis of the diaphragm
˜ Fatigue, anorexia, nausea, vomiting, pallor
 iagnostic tests
˜ Chest x-
x-ray may show presence of tumor
or evidence of metastasis to surrounding
structures
˜ Sputum for cytology reveals malignant
cells
˜ Bronchoscopy: biopsy reveals malignancy
˜ Thoracentesis: pleural fluid contains
malignant cells
edical management
1. Radiation therapy
2. Chemotherapy: usually includes
cyclophosphamide, methotrexate,
vincristine, doxorubicin, and
procarbazine; concurrently in some
combination
3. Surgery: when entire tumor can be
removed
Quick ›otes on Bronchogenic
Cancer

˜ aredisposing factors
˜ Cigarette smoking
˜ Asbestosis
˜ Ca
˜ Smoke from burnt wood
Types
˜ Squamous cell Ca-
Ca- with good
prognosis
˜ Adenocarcinoma
Adenocarcinoma-- with good
prognosis
˜ at cell Ca-
Ca- with good prognosis
˜ Undifferentiated Ca-
Ca- with poor
prognosis
›ursing Interventions
˜ aatent airway
˜ 2 / Aerosol therapy
˜ eep breathing exercises
˜ Relief of pain
˜ arotection from infection
˜ Adequate nutrition
˜ Chest tube management
Surgery
˜ aneumonectomy=Removal of a lung
(either left or right)
˜ Lobectomy=Removal of a lobe.
  * !

˜ Thisrefers to the obstruction of the

pulmonary artery or one of its
branches by a blood clot (thrombus)
that originates somewhere in the
venous system or in the right side of
the heart.
Causes
˜ Fat embolism
˜ Air embolism
˜ ultiple trauma
˜ aV ¶s
˜ Abdominal surgery
˜ Immobility
˜ ypercoagulability
˜ Assessment
˜    *
    +
˜ yspnea
˜ Stabbing chest pain
˜ Cyanosis
˜ Tachycardia
˜ ilated pupils
˜ Apprehension/ fear
˜ iaphoresis
˜ ysrhythmias
˜ ypoxia
 iagnostic Tests:
˜ Ventilation
Ventilation--perfusion scan
˜ aulmonary arteriography
˜ CR
˜ EC

˜ AB

›ursing Interventions
˜ xygen therapy STAT
˜ Early ambulation postop
˜ onitor obese patient
˜ o not massage legs
˜ Relieve pain-
pain- analgesics
˜  B elevated
˜ eparin (2 weeks) then Coumadin (3-
(3-6
months)