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Questions and Answers
What are the hallmark symptoms indicating the severity of atelectasis?
What are the hallmark symptoms indicating the severity of atelectasis?
Which of the following is NOT a recommended preventive measure for atelectasis?
Which of the following is NOT a recommended preventive measure for atelectasis?
What is a first-line treatment measure for managing atelectasis?
What is a first-line treatment measure for managing atelectasis?
What terminology describes inflammation of the lung parenchyma caused by various microorganisms?
What terminology describes inflammation of the lung parenchyma caused by various microorganisms?
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Which condition poses the biggest risk for microbial invasion in lung tissue?
Which condition poses the biggest risk for microbial invasion in lung tissue?
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What is the most common viral pathogen found in immunocompromised adults?
What is the most common viral pathogen found in immunocompromised adults?
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Which of the following is a common causative agent in hospital-acquired pneumonia?
Which of the following is a common causative agent in hospital-acquired pneumonia?
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Which factor is NOT a known predisposing factor for hospital-acquired pneumonia?
Which factor is NOT a known predisposing factor for hospital-acquired pneumonia?
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What often complicates ventilator-associated pneumonia?
What often complicates ventilator-associated pneumonia?
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Which surgical procedure involves complete removal of the larynx?
Which surgical procedure involves complete removal of the larynx?
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Which of these is NOT a clinical manifestation of pneumonia?
Which of these is NOT a clinical manifestation of pneumonia?
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What is a common nursing diagnosis for patients undergoing laryngectomy?
What is a common nursing diagnosis for patients undergoing laryngectomy?
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Which intervention is essential for managing postoperative anxiety in laryngectomy patients?
Which intervention is essential for managing postoperative anxiety in laryngectomy patients?
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What is one common pathogen associated with aspiration pneumonia?
What is one common pathogen associated with aspiration pneumonia?
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Which of the following treatment options may be used for early-stage tumors without lymph node involvement?
Which of the following treatment options may be used for early-stage tumors without lymph node involvement?
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What underlying condition can lead to pneumonia in immunocompromised patients?
What underlying condition can lead to pneumonia in immunocompromised patients?
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What is a significant change in communication for patients after a complete laryngectomy?
What is a significant change in communication for patients after a complete laryngectomy?
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What respiratory rate is often observed in severely ill pneumonia patients?
What respiratory rate is often observed in severely ill pneumonia patients?
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Which position should a patient be placed in post-anesthesia to enhance lung function?
Which position should a patient be placed in post-anesthesia to enhance lung function?
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What type of therapy is emphasized for enhancing communication post-laryngectomy?
What type of therapy is emphasized for enhancing communication post-laryngectomy?
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What might contribute to disturbed body image in laryngectomy patients?
What might contribute to disturbed body image in laryngectomy patients?
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What should a patient be advised to avoid while using oxygen?
What should a patient be advised to avoid while using oxygen?
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Which of the following should be encouraged to prevent bloating during meals?
Which of the following should be encouraged to prevent bloating during meals?
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What is a common chronic trigger for asthma symptoms?
What is a common chronic trigger for asthma symptoms?
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What is one recommended approach to improve breathing patterns in patients?
What is one recommended approach to improve breathing patterns in patients?
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Which symptom is most likely to indicate an asthma attack?
Which symptom is most likely to indicate an asthma attack?
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What is a dangerous health risk associated with rapidly worsening asthma symptoms?
What is a dangerous health risk associated with rapidly worsening asthma symptoms?
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Which of the following should be avoided before and after meals?
Which of the following should be avoided before and after meals?
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Which patient behavior is NOT a recommended self-care practice for asthma management?
Which patient behavior is NOT a recommended self-care practice for asthma management?
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What symptoms are commonly associated with tuberculosis (TB)?
What symptoms are commonly associated with tuberculosis (TB)?
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What size of induration in a tuberculin skin test is generally considered significant in individuals with normal immunity?
What size of induration in a tuberculin skin test is generally considered significant in individuals with normal immunity?
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Which of the following is NOT a first-line medication used in the treatment of pulmonary tuberculosis?
Which of the following is NOT a first-line medication used in the treatment of pulmonary tuberculosis?
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What does a nonsignificant (negative) result on a tuberculin skin test indicate?
What does a nonsignificant (negative) result on a tuberculin skin test indicate?
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Which vitamin is commonly administered with isoniazid during TB treatment?
Which vitamin is commonly administered with isoniazid during TB treatment?
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Why is patient education about adherence to the treatment regimen essential in managing TB?
Why is patient education about adherence to the treatment regimen essential in managing TB?
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What is the purpose of promoting airway clearance in a TB patient?
What is the purpose of promoting airway clearance in a TB patient?
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What is the typical duration for antituberculosis treatment in pulmonary TB?
What is the typical duration for antituberculosis treatment in pulmonary TB?
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Study Notes
Laryngeal Cancer
- Treatment options for laryngeal cancer include surgery, radiation therapy, and adjuvant chemoradiation therapy.
- Early-stage tumors and lesions without lymph node involvement may benefit from external-beam radiation therapy or conservation surgery.
- Stage III and IV tumors may require total laryngectomies with or without postoperative radiation therapy or chemotherapy.
Surgical Treatment
- Surgical treatment options include Vocal Cord Stripping, Cordectomy, Laser Surgery, Partial Laryngectomy, and Total Laryngectomy.
Nursing Diagnoses
- Deficient knowledge about the surgical procedure and postoperative course.
- Anxiety related to the diagnosis of cancer and impending surgery.
- Ineffective airway clearance related to excess mucus production secondary to surgical alterations in the airway.
- Impaired verbal communication related to anatomic deficit secondary to removal of the larynx and to edema.
- Imbalanced nutrition (less than body requirements) related to inability to ingest food secondary to swallowing difficulties.
- Disturbed body image and low self-esteem secondary to major neck surgery, change in appearance, and altered structure and function.
- Self-care deficit related to pain, weakness, fatigue, and musculoskeletal impairment related to surgical procedure and postoperative course.
Nursing Interventions
- Providing preoperative patient education: if a complete laryngectomy is planned, the patient must understand that their natural voice will be lost. Teach coughing and deep breathing exercises and assist with return demonstrations.
- Reducing anxiety: Address patient and family's fears and misconceptions, providing opportunities for open communication and discussion. Visits from previous laryngectomy patients can reassure patients about the possibility of rehabilitation.
Maintaining a Patent Airway
- Position the patient in the semi-Fowler or Fowler position post-anesthesia to promote lung expansion and decrease surgical edema.
- Tachypnea, dyspnea, and mild-to-moderate hypoxemia are hallmarks of the severity of atelectasis.
Atelectasis Prevention
- Frequent position changes, especially from supine to upright, to facilitate ventilation.
- Encourage early mobilization and ambulation.
- Encourage deep breathing and coughing for secretion mobilization.
- Educate on incentive spirometry technique.
- Judicious administration of prescribed opioids and sedatives.
- Perform postural drainage and chest percussion.
- Implement suctioning for tracheobronchial secretions removal.
Pneumonia
- Pneumonia is an inflammation of the lung parenchyma caused by various microorganisms, including bacteria, mycobacteria, fungi, and viruses.
- Pneumonitis is a more general term that describes an inflammatory process in the lung tissue that may predispose or place the patient at risk for microbial invasion.
- Pneumonia and influenza are the most common causes of death from infectious diseases in the United States.
- Cytomegalovirus is the most common viral pathogen in immunocompromised adults.
- Health Care–Associated Pneumonia: Causative pathogens are often MDR, making early antibiotic treatment crucial.
- Ventilator-Associated Pneumonia: A complication in up to 28% of patients requiring mechanical ventilation.
Hospital-Acquired Pneumonia (HAP)
- Predisposing factors: impaired host defenses, comorbid conditions, supine positioning and aspiration, coma, malnutrition, prolonged hospitalization, and metabolic disorders.
- Hospitalized patients are exposed to potential bacteria from other sources, such as respiratory therapy devices and equipment, and transmission of pathogens by healthcare personnel.
- Intervention-related factors: prolonged or inappropriate use of antibiotics and use of nasogastric tubes, etc.
- HAP is associated with a high mortality rate due to the virulence of the organisms, resistance to antibiotics, and the patient’s underlying disorder.
- Common organisms include Enterobacter species, Escherichia coli, Pseudomonas aeruginosa, methicillin-sensitive or methicillin-resistant Staphylococcus aureus (MRSA).
Pneumonia in the Immunocompromised Host
- Pneumocystis pneumonia (PCP), fungal pneumonias, and Mycobacterium tuberculosis are common in immunocompromised hosts.
- Pneumonia can occur due to immunosuppressive agents, chemotherapy, nutritional depletion, broad-spectrum antimicrobial agents, AIDS, genetic immune disorders, and long-term advanced life support technology.
- Higher morbidity and mortality rates in immunocompromised patients.
Aspiration Pneumonia
- Pulmonary consequences from entry of endogenous or exogenous substances into the lower airway.
- May occur in community or hospital settings.
- Common pathogens include anaerobes, S.aureus, Streptococcus species, and gram-negative bacilli.
Clinical Manifestations of Pneumonia
- Sudden chills and rapidly rising fever (38.5C to 40.5C [101F to 105F]).
- Pleuritic chest pain aggravated by respiration and coughing.
- Severely ill patients have marked tachypnea (25 to 45 breaths/min) and dyspnea; orthopnea when not propped up.
- Pulse rapid and bounding; may increase 10 beats/min per degree of temperature elevation (Celsius).
- Other signs: upper respiratory tract infection, headache, myalgia, rash, and pharyngitis; after a few days, mucoid or mucopurulent sputum is expectorated.
Clinical Manifestations of Tuberculosis
- Low-grade fever, cough, night sweats, fatigue, and weight loss.
- Nonproductive cough, which may progress to mucopurulent sputum with hemoptysis.
Assessment and Diagnostic Methods for Tuberculosis
- TB skin test (Mantoux test); QuantiFERON-TB Gold (QFT-G) test.
- Chest x-ray.
- Acid-fast bacillus smear.
- Sputum culture.
Tuberculin Skin Test
- Tubercle bacillus extract (tuberculin) is injected into the forearm's inner layer. 0.1 mL of PPD is injected, creating an elevated wound 6-10 mm in diameter.
- Test results are recorded 48 to 72 hours after injection.
- The size of the induration determines the significance of the reaction.
- 0 to 4 mm is not significant.
- 5 mm or greater may be significant in people considered at risk.
- 10 mm or greater is usually significant in people with normal or mildly impaired immunity.
- A significant reaction indicates past exposure to M.tuberculosis or vaccination with the bacille Calmette-Guérin (BCG) vaccine.
- A significant reaction does not necessarily mean active disease is present in the body.
- A nonsignificant (negative) skin test means the person’s immune system did not react to the test and that latent TB infection or TB disease is not likely.
Medical Management - Treatment of Tuberculosis
- Pulmonary TB is treated primarily with antituberculosis agents for 6 to 12 months.
- First-line medications: isoniazid or INH (Nydrazid), rifampin (Rifadin), pyrazinamide, and ethambutol (Myambutol) daily for 8 weeks and continuing for up to 4 to 7 months.
- Second-line medications: capreomycin (Capastat), ethionamide (Trecator), para-aminosalicylate sodium, and cycloserine (Seromycin).
- Vitamin B (pyridoxine) usually administered with INH.
Nursing Management of Tuberculosis
- Promoting airway clearance: Encourage increased fluid intake. Instruct about the best position to facilitate drainage.
- Advocating adherence to treatment regimen: Explain that TB is a communicable disease and that taking medications is the most effective way of preventing transmission. Instruct about the risk of drug resistance if the medication regimen is not strictly and continuously followed.
- Carefully monitor vital signs and observe for spikes in temperature or changes in the patient’s clinical status.
- Promoting activity and adequate nutrition: Plan a progressive activity schedule. Caution the patient that smoking with or near oxygen is extremely dangerous.
Nutritional Therapy
- A thorough assessment of caloric needs and counseling about meal planning and supplementation.
- Rest at least 30 minutes prior to eating.
- Use bronchodilator before meals.
- Select foods that can be prepared in advance.
- 5-6 small meals to avoid bloating.
- Avoid foods that require a great deal of chewing.
- Avoid exercises and treatments 1 hour before and after eating.
Nursing Management
- Achieving Airway Clearance: Chest physiotherapy with postural drainage, intermittent positive-pressure breathing, increased fluid intake.
- Improving Breathing Patterns: Inspiratory muscle training, diaphragmatic breathing, Pursed-lip breathing.
- Improving Activity Tolerance: Recommend use of walking aids, if appropriate, to improve activity levels and ambulation.
- Monitoring and Managing Complications: Monitor for cognitive changes, increasing dyspnea, tachypnea, and tachycardia. Encourage patient to be immunized against influenza and Streptococcus pneumonia.
- Teaching Patients Self-Care: Instruct patients to avoid extremes of heat and cold and air pollutants (eg, fumes, smoke, dust, talcum, lint, and aerosol sprays). High altitudes aggravate hypoxemia.
Asthma
- Chronic inflammatory disease of airways characterized by hyperresponsiveness, mucosal edema, and mucus production.
- Patients may experience symptom-free periods and acute exacerbations.
- Common chronic disease of childhood, can begin at any age.
- Risk factors include family history, allergy, and chronic exposure to airway irritants.
- Common triggers include airway irritants, exercise, stress, rhinosinusitis, medications, viral respiratory tract infections, and gastroesophageal reflux.
Clinical Manifestations of Asthma
- Cough (with or with out mucus production), dyspnea, wheezing (first on expiration, then possibly during inspiration as well), and chest tightness.
- Asthma attacks frequently occur at night or in the early morning.
- Expiration requires effort and becomes prolonged.
- As exacerbation progresses, central cyanosis secondary to severe hypoxia may occur.
- Additional symptoms, such as diaphoresis, tachycardia, and a widened pulse pressure, may occur.
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Description
This quiz covers the treatment options for laryngeal cancer, focusing on surgical approaches and nursing diagnoses associated with the condition. Participants will explore various treatments, including radiation and different surgical techniques, along with the challenges patients may face during recovery. Test your knowledge on this critical topic in oncology nursing.
