Lung & Laryngeal CA Student 2022 PDF

Cancer of the Larynx & Cancer of the Lung Chris Garrison, PhD, RN, CNE, CHSE Objectives Learners will be able to:  Identify risk factors for the development of cancer of larynx and lung as well as strategies for prevention.  Construct a nursing plan of care for a client...

Cancer of the Larynx & Cancer of the Lung Chris Garrison, PhD, RN, CNE, CHSE Objectives Learners will be able to:  Identify risk factors for the development of cancer of larynx and lung as well as strategies for prevention.  Construct a nursing plan of care for a client with a laryngectomy, a radical neck dissection, or a thoracotomy.  Develop a plan to assist the laryngectomy patient with speech and communication.  Manage the care of a patient with a chest tube Cancer of the Larynx Risk Factors:  Tobacco  Alcohol  Asbestos/Chemicals/Fumes Symptoms:  Hoarseness  Sore Throat  Neck Mass  Lymphadenopathy 5 Year Survival  32% to 90%  55% have lymph node involvement Cancer of the Larynx Medical Management Diagnosis:  Laryngoscopy & biopsy Surgery  Vary in amount of tissue removed Radiation  Can be used pre or post surgery  Alternative to surgery in early stage Chemotherapy Radiation to Head & Neck Mucositis Xerostomia Loss of Taste Dysphagia Skin Reactions Total Laryngectomy Indications:  Spread beyond the vocal cords  Recurrence after radiation Complete removal of larynx, epiglottis, partial removal of trachea Permanent airway alteration Loss of normal speech Differences Between Tracheostomy and Laryngectomy Stoma is sole route of airflow Oxygen delivery Intubation Clinical Judgment Laryngectomy Patient  What are they at risk for?  What assessments would you do? Airway Issues Loss of upper airway function  Need for humidification Trach collar Humidifier Stoma Covers Management of secretions  Sterile Suctioning  Pulmonary Toilet Equipment at bedside  Laryngectomy tube  Suction  Ambu Bag Stoma Cover Speech & Communication Plan for communication post-operatively  Writing  PictureBoard  Gestures Tracheoesophageal Voice Prosthesis Electrolarynx Electrolarynx Laryngectomy Patient Education Protect Stoma Humidification Medic-Alert Bracelet New Voice or Lost Cord Club Tips from Former Smokers Terrie Tips from former smokers Radical Neck Dissection Indicated for mets to lymph nodes in neck  Frequent occurrence with laryngeal cancer Resection of lymph nodes, muscle, part of thyroid, parathyroids, salivary glands.  Modified may retain some of these structures Critical Thinking Questions What is the number one nursing priority in the post-op care of a radical neck dissection? What needs to be at the bedside? Assessing Oxygenation Subjective Vitals SpO2 or ABG Color LOC Respiratory Cardiac Periphery Radical Neck Dissection Nursing Care Laryngectomy Tube Dressing/Incision Care Pain Management Aspiration Risk Nutritional Support  May receive tube feeding NPO for 7 days post-op Communication Observation for Complications:  Airway/Breathing  Hemorrhage  Nerve Damage  Hypocalcemia Radical Neck Dissection Nursing Diagnoses  Ineffectiveairway clearance  Impaired verbal communication  Pain  Imbalanced nutrition  Risk for aspiration  Disturbed body image Radical Neck Dissection Nursing Diagnoses  Ineffectiveairway clearance  Impaired verbal communication  Pain  Imbalanced nutrition  Risk for aspiration  Disturbed body image Case Study Robert is a 60 year old male with a 40 pack-year history of smoking. He was diagnosed with cancer of the larynx with metastasis to cervical lymph nodes. He underwent a total laryngectomy with modified radical neck dissection. He is out of the OR in the PACU and is about to be transferred to the surgical intensive care unit (SICU) PMH includes HTN and COPD Case Study What supplies need to be ready at the bedside before he arrives? What medication should be readily available? What is he at risk for? What are your priority assessments when he arrives? Lung Cancer Leading cause of cancer death 5 Year survival rate 13% Carcinogens  Tobacco smoke  Asbestos  Radon Lung Cancer Cell Type  Small Cell (20%) Not surgically resectable Paraneoplastic syndromes  SIADH  Cushing’s  Lambert-Eaton Syndrome  Non-Small Cell (80%) Lung Cancer Screening Issues  CXR not effective  CT New Recommendations Clinical Manifestations  Persistent cough  Later: dyspnea, hemoptysis, pleural effusion, pain Low Dose CT Screening Lung Cancer Diagnosis:  Bronchoscopy  Biopsy  CT/MRI  PET scan Bronchoscopy with Biopsy Bronchoscopy Direct visualization of airways  Allows for biopsy Pre-procedure  Consent  NPO  Medications Analgesics Anticholinergics Post-procedure  V/S  Respiratory  NPO until gag Medical Treatment Surgery  Open Thoracotomy or Video-Assisted Thoracoscopic Surgery (VATS)  Best chance of cure if tumor is resectable  Wedge Resection  Lobectomy  Pneumonectomy Positioning Lay on surgical side Chemotherapy Clinical Judgment Thoracotomy Patient  What are they at risk for?  What assessments would you do? Lobectomy Thoracotomy Pre-Operative Teaching Pain Management Plan Incentive Spirometer/TCDB Possible Ventilator Chest Tube Expectation for Early Mobilization Answer Questions Address Anxiety Chest Tube Inserted in pleural space Purpose  Evacuate air or fluid 3 Chamber system  Drainage, water seal, suction Assessment  Vitals  SpO2  Pulmonary  COCA Notify surgeon if drainage > 100 mL/hour in immediate post-op period  Pain Troubleshooting/Complications  Air leak  Disconnection  Tube dislodgment  Subcutaneous emphysema Chest Tube Assessment & Management Chest Tube Video Types of Chest Tube Systems 3 Chamber wet system 3 Chamber dry system Heimlich Valve PleurX tube Targeted Therapy pembrolizumab (Keytruda®)  PD-1 Inhibitors  Inhibits an enzyme that inactivates t-cells  Allows t-cells to destroy cancer cells  Indicated for metastatic NSCLC with progression after platinum-based chemotherapy  Can cause immune-mediated inflammation in multiple organs Pneumonitis, Hepatitis, Colitis, Encephalitis, Iritis Next Gen Bow Tie Item Complete the diagram by dragging (or selecting) The nurse is caring for a 68 year old client on from the choices below to specify which POD #1 after right upper lobe lobectomy for lung potential complication the client is most likely cancer experiencing, two assessment findings that support that condition, and two potential Nurses Note: interventions to treat the condition. V/S 100.6, 100, 24, 142/90 Intervention SpO2 86% on O2 at 2L by NC Assessment Alert but confused to time and place Complication Lungs with diminished breath sounds throughout and fine crackles at bases bilaterally. Assessment Intervention Surgical dressing changed. Incision line approximated with slight erythema and small amount of serous drainage. Chest tube with 30 mL of serosanguineous drainage in past 8 hours. Tidaling noted in water seal chamber with intermittent bubbling.  Next Gen Bow Tie Item Complete the diagram by dragging (or selecting) from the choices below to specify which potential complication the client is most likely experiencing, two assessment findings that support that condition, and two potential interventions to treat the condition. Assessments Complication Interventions Incision Surgical Site Antibiotics Infection Temperature Atelectasis Incentive Spirometer Lung Sounds Chest Tube Air Acetaminophen leak SpO2 TCDB Chest Tube Clamp tube Assessment NCLEX Question The nurse is assessing a patient’s chest tube and notes some bubbling in the suction chamber. Which of the following actions is most appropriate?  A. Document the finding as expected  B. Decrease the wall suction  C. Assess the system for air leaks  D. Both B + C NCLEX Question A patient with a laryngectomy tube has a continuous pulse ox monitor. The SpO2 drops from 95-89%. Identify appropriate nursing actions. (Select all that apply)  A. Assess breath sounds  B. Perform suctioning  C. Change the frequency of Albuterol treatments  D. Reposition the patient  E. Check the oxygen flow rate and connections NCLEX Question The nurse is preparing to receive a patient from the PACU after a total laryngectomy. What supplies should the nurse have available at the bedside? (Select all that apply)  A. An oxygen mask  B. A suction canister  C. A laryngectomy tube  D. A communication board  E. An electrolarynx NCLEX Question A patient is post-op day #1 after a total laryngectomy. He indicates that he feels numbness and tingling in his lips and fingers. Which lab result is most important for the nurse to check?  A. Serum calcium  B. Serum Potassium  C. Serum Sodium  D. Serum Phosphorus NCLEX Question Which of the following patients should the nurse assess first?  A. A patient with lung cancer who has complained of dyspnea and fatigue for the past 12 hours  B. A patient who is 24 hours post-op after a lobectomy and has 175 mL of serosanguineous drainage in the chest tube collection device.  C. A patient who is 4 hours post-op after total laryngectomy and has bright red drainage on the surgical dressing  D. A patient with cancer of the larynx who is undergoing radiation therapy and is complaining of severe throat pain and dysphagia NCLEX Question Which of the following interventions would be most effective in decreasing the incidence of lung cancer?  A. Smoking cessation programs  B. Chest X-ray screening programs  C. Distributing radon detectors in high risk areas  D. Educating smokers to be evaluated for a persistent cough