Upper and Lower Respiratory Disorders

• What are the risk factors for laryngeal cancer?

  • Prolonged use of tobacco and alcohol 
  • Exposure to chemicals, toxins, or HPV ~ oral sex 
  • Family predisposition 
  • Vocal straining or chronic laryngitis  
• What are the risk factors for lung cancer?

  • Smoking** (biggest) 
  • Family Hx 
  • Pre-existing lung disease  
  • Environmental/occupational exposure  
• What are the risk factors for the development of pulmonary embolism?

  Virchow’s Triad: 

  • Sluggish blood flow/venous stasis (immobility) 
  • Damage to blood vessels (trauma) [fractures, pregnancy, childbirth, surgery etc.] 
  • Hypercoagulability [meds like BC, estrogen; a-fib = hypercoagulability state] 
• What are risk factors for a pneumothorax?

  Simple (spontaneous): d/t rupture of lung bleb (blister)  

  Traumatic: d/t rib fractures, blunt or penetrating trauma  
• What are risk factors for chest trauma involving rib fractures?

  Penetrating: stab, GSW 

  Blunt: MVA fall  
• What are some assessment findings seen in laryngeal cancer?

  Supraglottic: dysphagia/odynophagia, lump in throat or neck, wt loss 

  Glottic: persistent hoarsness or change in voice quality, throat pain or burning 

  Subglottic: persistent cough, dyspnea  
• What are the primary symptoms of lung cancer?

  Primary Sx.  

  • New or change in cough** key 
  • Change in sputum color or volume; recurrent respiratory infection 
  • Breath sounds diminished, wheezing 
  • Dyspnea  
• What are the symptoms of metastasis in lung cancer?

  • Dull, aching chest or shoulder pain 
  • Hoarseness and/or dysphagia 
  • Non-specific signs: fatigue, anorexia, wt loss 
  • Findings specific to organ of metastasis  
• How would you diagnose a pulmonary embolism?

  • (+) Elevated D-Dimer ~ for high suspicion 
  • CT pulmonary angio ~ gold standard or spiral CT 
  • VQ scan 
  • ABGs: respiratory acidosis w/ hypoxia 
  • Increased Troponin, EKG, echo 
  • U/S for lower extremities
• What are some respiratory symptoms seen for a patient experiencing a pulmonary embolism?

  Respiratory Sx 

  • Dyspnea, tachypnea, SPO2 < 94% on RA and anxiety 
  • Pleuritic chest pain ~ sudden onset sharp pain w/ inspiration; can be midsternal and mistaken as angina  
  • Diminished breath sounds affected area, possibly crackles  
  • Hemoptysis  
• What cardiac symptoms would be seen for a patient experiencing a pulmonary embolism?

  Cardiac Sx 

  • VS: tachycardia, possibly hypotension, distended neck veins  
  • EKG changes possible  
• What kind of symptoms would you see in a patient with pneumothorax?

  • Pleuritic chest pain  
  • Respiratory distress ~ could be minimal or cyanotic w/ accessory use dependency = dyspneic and anxious  
  • Diminished breath sounds ---> crepitus  
  • Asymmetrical chest wall expansion  
• How would you differentiate between a tension pneumothorax and a regular pneumothorax?

  • Trachea deviated to one side and heart sounds deviated to one side  
  • Hypotension  
• What assessment findings would be seen in a patient with simple rib fractures?

  • Shallow, splinted respirations 
  • Chest wall pain w/ palpation 
  • Pain increases w/ moving, coughing, DB ~ pleuritic chest pain  
  • Possible bruising, crepitus over the area 
  • Possible chest wall deformity  
• What assessment findings may be seen in a patient with flail chest?

  • Paradoxical chest wall motion
  • Hypotension
• What is paradoxical chest wall motion?

  • Paradoxical chest wall motion ~ when the flail segment moves opposite to the rest of the chest = results in decreased amount of air able to be inspired and exhaled  
  • Leads to hypoxia and respiratory distress  
• A patient comes in with a change in their cough, diminished breath sounds, and dyspnea. The patient report having a recurrent respiratory infection. What condition will this patient likely be diagnosed with?

  primary symptoms of lung cancer