Oxygenation

Topic

Coal Worker’s Chest Tumor Blunt trauma

Pneumoconiosis
 • This is commonly known
as "black lung disease,"
occurs when coal dust is
Coal Workers inhaled.
Pnemoconiosi
• Over time, continued
s exposure to the coal dust
causes scarring in the
lungs, impairing your
ability to breathe.
Considered an
occupational lung disease,
it is most common among
coal miners.
Clinical Manifestation

Cough Rusty or gray sputum.

Fever Tachypnea
Weight loss Hypoxemia
Dyspnea Shaking chills
Chest pain Fast heartbeat.
Fatigue and weakness.
 Pathophysiology
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 Nursing Management

• Avoid dust and other airborne irritants

• Oxygen therapy
• Monitor the flow of oxygen and the amount given
• Monitor signs of oxygen toxicity (Coughing; Chest pain; Trouble breathing; Dizziness;
Blurred vision; Nausea;Muscle twitching in face and hands)
• Educate patient to adopt a healthy lifestyle – smoking cessation, weight loss, nutritious food,
plenty of exercise and sleep
• Teach deep breathing to help pt learn ways to breathe better
• Manage pain:
• Assess for the presence of pain, the scale, and intensity of pain
• Teach the client about pain management and relaxation with distraction
• Assess pain-reduction measures
• Provide analgesics as indicated
• Educate patient about preventive measures
• Wearing a mask
• Removing dust from skin and clothing
• Washing hands and face frequently
• Stopping tobacco use
• Seeing physician for regular checkups, including chest X-rays.
1. Inhaled medication such as a Medical
• bronchodilator - open up the
airway if patient have trouble Managements
breathing
• corticosteroid - can curb airway
inflammation

2. If tests show low levels of

oxygen in the blood, the physician
may suggest patient to get
supplemental oxygen therapy.
 Chest Tumor

• Primary and secondary chest wall tumors are distinguished by whether

they are malignant (cancerous) or benign (non-cancerous) (metastatic).

• Osteochondromas and chrondromas are the most prevalent benign

tumors. Tumors of the chest wall can form in the bones, soft tissues, and
cartilage of the chest cavity, which houses the heart, lungs, and other
organs. These tumors are frequently malignant and have invaded or
metastasized from surrounding thoracic malignancies in more than half
of cases.

• Tumors of the chest wall often present as painful, rapidly developing,

and palpable lumps. Surgery is frequently required, and plastic surgery
restoration may be required to restore a normal appearance.
 Clinical Manifestation

Malignant
Benign
· Cough
· Dyspnea · A lump or bump protruding
· Hemoptysis from the chest
· Chest or shoulder pain · Pain
· Swelling · Muscle atrophy
· Impaired movement
· A lump or bump protruding
from the chest
 Pathophysiology
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Nursing Management

Nursing care includes

strategies to ensure relief
of pain and discomfort
and to prevent
complications.
1.Managing Symptoms

The nurse instructs the patient and
family about the potential side effects
of the specific treatment and strategies
to manage them.

Symptoms such as:
• Dyspnea
• Fatigue
• Nausea and vomiting
• Anorexia
• Nausea and vomiting
 Eat foods that are bland, soft, and easy-to-digest
 Eat dry foods
 Slowly sip liquids throughout the day.
 Eat 5 or 6 small meals every day instead of 3 large meals.
 Sip on only small amounts of liquid during meals to avoid feeling full or
bloated.
 Sit up or lie with the head raised for one hour after eating.
 Do not eat or drink anything until the vomiting stops.
 Drink small amounts of clear liquids after vomiting stops.

• Anorexia
 Eat foods that are high in protein and calories. (Beans, Chicken, Fish, Meat,
Yogurt, Eggs)
 Sip only small amounts of liquids during meals
 Drink milkshakes, smoothies, juices, or soups if patient do not feel like
eating solid foods
 Eat small meals and healthy snacks often throughout the day
 Eat larger meals when patient feel well and are rested, and when patient
feel hungriest
2.Relieving Breathing Problems

Airway clearance techniques are key to

maintaining airway patency through the removal
of excess secretions. This may be accomplished
through:

• deep-breathing exercises
• chest physiotherapy
• directed cough
• Suctioning

 Adminster bronchodilator medications to
promote bronchial dilation

 Nursing measures focus on decreasing

dyspnea by encouraging the patient:
• to assume positions that promote lung
expansion
• to perform breathing exercises for lung
expansion and relaxation

 Patient education about energy conservation

and airway clearance techniques
3.Reducing Fatigue

 Nursing strategies to promote energy

conservation and reduce fatigue:

• Assesses physiologic and psychological

stressors that can contribute to fatigue
• Prioritize sleep
• Promote sufficient nutritional intake
• Encourage an exercise conditioning program
as appropriate
• Provide comfort such as judicious touch or
massage, and cool showers

• Teach energy conservation methods:

a. Organization and time management
b. Setting priorities, and clustering care to
use available energy to complete desired
activities
4.Providing Psychological Support

 The nurse must help the patient and family

deal with the following:

i. The poor prognosis and relatively rapid

progression of this disease.

ii. Informed decision making regarding the

possible treatment options.

iii. Methods to maintain the patient’s quality of

life during the course of this disease.

iv. End-of-life treatment options

 Medical
It is important to discuss
the goals of lung cancer Managements
treatment with the doctor.
Some treatments may be
used to control the cancer.
Others are used to improve
quality of life and/or
reduce symptoms. These
treatments may be used
alone or in combination.
 Chemotherapy and targeted
therapies
•. This is the drugs that are
Medical
designed to kill rapidly Managements
growing cells, such as cancer
cells. Chemotherapy may be
injected directly into a vein
(by IV, or intravenously) or
given through a catheter,
which is a thin tube placed
into a large vein and kept
there until it is no longer
needed. Some chemotherapy
drugs are taken orally in pill
form.
• The newer class of drugs Targeted agents Medical
. that are designed to act
against specific Managements
weaknesses in cancer cells
or surrounding supportive
tissues, such as blood
vessels. These drugs can
also be taken orally or by
IV. They are most effective
in cancers with specific
changes in their genes or
cell receptors.
 Radiation Therapy Medical
•. This is a high energy X-ray Managements
that kills cancer cells. It can
be used as a primary
treatment with or without
surgery. It often can play
an important role in
advanced cancer patients
by providing relief from
pain, blockage of the
airways, shortness of
breath or coughing.
• This is considered the “gold
standard” for treating
Surgery
Medical
. early-stage lung cancer.
Removing the tumor and Managements
surrounding lung tissue
gives the best chance for
cure for patients whose
disease is localized and to
be performed by
specialized thoracic
surgeons with particular
expertise in treatment of
lung cancer and other
chest malignancies.
Trained thoracic surgeons may perform video-assisted thoracic surgery (VATS) and
VATS lobectomy routinely as well as robotic surgery. Surgical resection of lung
cancer is generally performed as:

Lobectomy
Limited resection
Removal of a defined
An operation to remove section of the lung, (there
only a small portion of are three lobes of the lung
the lung is called a on the right and two on the
segmental or wedge left), is a lobectomy.
resection.
Trained thoracic surgeons may perform video-assisted thoracic surgery (VATS) and
VATS lobectomy routinely as well as robotic surgery. Surgical resection of lung
cancer is generally performed as:

Pneumonectomy

The removal of an entire

lung is called a
pneumonectomy.
 • It refers to injury of the body by
forceful impact with a dull object.
Blunt With blunt force trauma, there can
be internal organ injuries that are

Trauma not immediately visible. Common

organs that are affected include the
spleen, liver, and small intestine.
Injuries to internal organs can lead
to hemorrhage and sudden drop in
blood pressure. If not diagnosed
promptly, this can lead to
hypovolemic shock.

• The formation of blood clots is a

common occurrence with blunt
trauma injuries, and, in most cases,
is not cause for concern. If more
severe blood clots, such as a deep
vein thrombosis, forms, medical
attention may be required
 Clinical Manifestation
• Pt with rib fracture:
• Pt with sternal fracture:
• Anterior chest pain
• overlying tenderness
• ecchymosis
• crepitus
• swelling
• chest wall deformity
• severe pain
• point tenderness
• muscle spasm over area of fracture
(aggravated by coughing, deep
breathing and movement)
• area around fracture may be
bruised
• Pt avoid sighs, deep breaths,
coughing, movement
• Pt breathes in shallow manner
 Pathophysiology
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 Nursing Management
1. Monitor respiratory rate, depth, and character
• Patients with rib fractures tend to take more frequent, shallow breaths instead of
steady, deep breaths. This is typically due to the pain of inspiration.
• Shallow breaths can lead to atelectasis and pneumonia.

2. Monitor SpO2 and ABG if available

• Patients with pulmonary contusions are at risk for developing excessive fluid and
swelling within their lungs. This can impair oxygenation and gas exchange. Often
this condition is worse on days 2-4, so we must monitor for possible
decompensation.

3. Auscultate the patient’s lungs

• Crackles or wheezes may be heard with pulmonary contusions or if the patient
develops pneumonia.
• Diminished breath sounds may be an initial indicator of the development of
atelectasis

4. Administer supplemental O2 as needed

• Patients are at risk for impaired oxygenation. We should support them with
supplemental oxygen as needed, starting with the least invasive method (nasal
cannula).
 Nursing Management
5. Administer analgesics
• Pain can cause the patients to take more shallow breaths, which can
lead to atelectasis. Addressing their pain can make it easier for them to
take deep breaths and perform chest expansion exercises.

6. Educate the patient on the use of a pillow for splinting

• Splinting can help decrease the pain associated with deep breathing
and coughing, especially for patients with rib fractures.

7. Educate the patient on chest expansion exercises:

• Incentive Spirometry
• Turn, Cough, Deep Breathe
-Incentive Spirometry and Deep breathing/coughing can help to open any
collapsed alveoli and prevent further atelectasis. Incentive spirometry
should be done every hour while awake.

8. Advocate for higher level of care if patient decompensating

• Patients with pulmonary contusions may decompensate on days 2 – 4. If
you feel your patient is getting worse, call a Rapid Response and
advocate to get them transferred to a higher level of care if appropriate.
 Medical Management

• An airway is immediately established with oxygen support and, in some

cases, intubation and ventilatory support.

• Re-establishing fluid volume and negative intrapleural pressure and

draining intrapleural fluid and blood are essential.

• Ensuring an adequate airway and ventilation; stabilizing and reestablishing

chest wall integrity; occluding any opening into the chest (open
pneumothorax); and draining or removing any air or fluid from the thorax
to relieve pneumothorax, hemothorax, or cardiac tamponade.

• Hypovolemia and low cardiac output must be corrected. Many of these

treatment efforts, along with the control of hemorrhage, are carried out
simultaneously at the scene of the injury or in the emergency department.
THANK YOU
any questions ?