Treatment & Nursing Care

• What are some pre-op treatment plans for a patient having surgery for laryngeal cancer?


  • Risk for ineffective airway:  
  • Assess patency ~ secretions or swelling that potentially is blocking airway? 
  • Position for comfort 
  • Nutrition less than body requirements  = Check albumin lvls, high protein diet  
  • Altered communication = Develop communication plan 
  • Fear and grieving = Address psychosocial needs  
• What are some nursing actions to manage post-op laryngeal CA surgery for ineffective airway clearance?

  • Humidified O2 ~ loosens secretions 
  • HOB up = decreases swelling ~ edema could cause trach ties to become too tight 
  • Suction carefully ~ avoid trauma to surgical lines placed  
  • May need oral suction d/t inability to swallow own secretions 
  • Monitor resp. Effort and pulse ox 
  • Trach care 
  • Prevent atelectasis  
  • Support head
• What are some nursing actions to manage post-op laryngeal cancer surgery for impaired swallowing?

  • Position to protect airway 
  • Swallow eval before resuming oral intake  
  • Have suction ready during initial feeding ~ for partial laryngectomy  
• What are some nursing actions to manage post-op laryngeal cancer surgery for a patient with nutrition less than body requirements?

  • NPO w/ tube feeds ~ 7 – 10 days  
  • Monitor albumin; weekly weights  
  • Taste/smell altered a few days  
  • Trismus possible (inability to open mouth fully) ~ may need splints to help 
• What are some nursing actions to manage post-op laryngeal cancer surgery for a patient with a risk for hemorrhage?

  • Monitor post op drains 
  • Monitor infection, skin graft integrity  
  • If skin graft ~ assess temp, CRT, color and drainage 
  • Flap cyanotic/white = inadequate blood supply 
  • Erythema = infection 
  • Head position should be straight or towards the operation side to prevent tension on flap 
  • Position flap so it is not dependent and no applied pressure on graft from trach ties  
• What is the treatment for a malignant Pleural Effusion in lung cancer?

  Tx: Remove effusion 

  • Thoracentesis ~ ultrasound guided = pt will leave w/ indwelling pleural catheter to prevent re-accumulation  
  • Long term chest tube drain = Indwelling pleural catheter 
  • Pleur-X Drainage system 
  • Rocket IPC drain  
• What is the treatment of choice for NSCLC?

  Surgical Resection

  • Thoracotomy – incision of chest wall 
  • Pneumonectomy – removal of entire lung  
  • Lobectomy – removal of a single lobe  
  • Post: pt will have 2 CTs; one to remove air and the other for fluid 
  • Wedge resection – removal of a section of lung tissue by VAT (video-assisted) or thoracotomy 
  • Used for small well-defined tumors 
  • Can be done w/ local anesthesia/IV sedation for high-risk for anesthesia 
• How is radiation used in the treatment for lung cancer?

  • Radiation ~ used for non-resectable tumors 
  • Helps decrease pressure on vital structures = improve quality of life  
  • Used to debulk tumors pre-op for comfort 
• How is chemotherapy used in the treatment for lung cancer?

  • Chemo: tx of choice for small cell cancer; adjunctive to surgery/radiation 
  • Used for bone pain; superior vena cava syndrome, brain metastasis but does not cure or prolong life  
• What are types of care besides surgery, chemo, and radiation is needed for lung cancer?

  Palliative care: 5 year survival = hospice advance directive discussion 
• What are some nursing actions to manage post-op thoracic surgery for a patient with impaired gas exchange?

  • O2 and semi/high Fowler’s
  • Turn q2h if chest tube ~  
  • check orders for positioning pneumonectomy pt = on back or w/ good lung up 
  • Can turn to either side w/ thoracotomy  
  • Monitor pulse ox and resp effort  
  • Encourage DB&C, IS 
  • Activity: OOB as much as possible  
  • Monitor Function of CT 
• How would a nurse manage pain for a post-op thoracic surgery patient?

  • Monitor effect on mental status = do not want pt to be sleeping all the time = increase risk for atelectasis and decreased CO 
  • Monitor effect on respiratory effort
• How would a nurse manage the risk of decreased cardiac output for a post-op thoracic surgery client?

  • Monitor for pulmonary edema
  • Monitor for arrhythmias [d/t hypoxia] , esp a-fib [d/t pulmonary hypotensive effects] 
• What other nursing diagnoses might a nurse monitor post-op thoracic surgery client?

  • Activity intolerance [d/t reduced gas exchange and CO] 
  • Space activities 
  • Gradual increase in activity  
  • Impaired physical mobility  
  • ROM to affected arm = prevent ankylosis (frozen shoulder) 
  • Grieving 
• What type of teaching should the nurse provide a patient post-op thoracic surgery?

  • Sx to report to MD [persistent SOB; worse than normal fever; increased pain; other s/s of infection] 
  • Activity Guidelines [ROM for shoulder exercises; no lifting > 20 lbs until MD clearance approved; rest periods [profound fatigue for 4 mo post op] 
  • Lung protective strategies  
  • Referrals for smoking cessation = continue DB&C; get immunizations and avoiding people w/ upper respiratory infections and smokers  
• How does a nurse assist during thoracentesis?

  • Record amount & describe fluid 
  • Position pt post-procedure 
  • Monitor VS 
  • Look for s/s of pneumothorax ~ do post procedure x-ray to ensure lung has re-expanded and no pneumothorax 
• What is a indwelling pleural catheter and how does it work?

  Pleural Effusion treated with a indwelling pleural catheter 

  • Pt connected to vacuum bottle when getting ready to drain = NOT connected all the time 
  • When ready to Drain there is no special position needed when suction is on 
  • As lung re-expands; catheter remains in lung and capped when not in use 
• What is the nursing role during the care of an indwelling pleural catheter?

  • Drainage orders 
  • Infection prevention = single use bottles! 
  • Home care teaching  
• What is some post-procedure care provided for patients after the insertion of a IVC filter?

  Surgical Intervention for PE ~ for high risk patients [unable to take anticoagulants or high chance of PE reoccurrence   

  • Monitor insertion site ~ s/s infection/bleeding 
  • Check peripheral pulses = ensure perfusion is maintained  
  • Monitor urine output b/c filter can migrate 
  • Monitor VS ~ [dropping BP = something is wrong; embolectomy if not IVC] 
• After a pulmonary embolism, what kind of medication education will a nurse give to a patient?

  • anticoagulants 3 – 6 mo minimum  
  • Bleeding precautions
  • Warfarin education if indicated  
• What are bleeding precautions?

  Increased HR, decreased BP, bruising, petechiae, hematomas, black tarry stools 
• What type of warfarin education might a nurse provide for their client?

  • P: prevention of thrombus & PE, of thrombotic events for a-fib 
  • T: bleeding precautions 
  • Pregnancy is contraindicated  
  • Avoid aspirin  
  • No concurrent use of other anticoagulants and NSAIDs 
  • If possible avoid concurrent use of phenobarbital, carbamazepine, phenytoin, oral contraceptives, and vitamin K 
  • Avoid foods high in vitamin K (dark leafy greens)  
• What are some nursing actions for the administration of warfarin?

  • Monitor VS 
  • Obtain PT (18-24sec) and monitor lvls and INR (2-3) 
  • Antidote: vitamin K 
• What are some interventions for flail chest causing hypoxemia?

  • Mechanical ventilation ~ provided for internal stabilization of the chest and correct hypoxemia  
  • Surgical stabilization  
• What are some interventions for Simple Rib Fractures?

  usually, pt sent home if nothing else is happening; takes 3 – 6 wks to heal; typically surgical stabilization NOT needed 

  • Use of a binder or rib belt to support the chest wall to reduce pain but not always b/c it inhibits inspiration  
  • Pain = #1 problem  
  • Impaired gas exchange = risk for or actual  
  • Biggest risk if atelectasis ---> IS or other deep breathing exercises 
• What are nursing interventions for a patient with pneumothorax experiencing impaired gas exchange?

  • Oxygen by NRB mask = give 100% ---> reinflates lung and treats hypoxia done regardless of if not hypoxic  
  • HOB elevated (if BP permits); promote oxygenation; cannot do if CO is a problem  
  • Chest tube to drain air/blood, and restore negative pressure  
• What kind of emergent management is needed for a pneumothorax?

  • Emergent management: decompression by insertion of large bore needle in 2nd ICS ==> if suspected tension pneumo.. MD does this ~ helps urgently release/relieve pressure = will hear a “whoosh” sound 
  • If open pneumo, apply occlusive dressing taped on 3 sides ~ lets air out but not in to avoid increase in pressure 
• What type of medication treatment is used for a PE?

  • Anticoagulants: prevents clotting 
  • Heparin transitioning to oral anticoagulants
  • Enoxaprin for low-risk patient
  • Thrombolytics for massive PE
• Heparin

  • Antidote = protamine sulfate  
  • Given IV to prevent clot from getting larger or new clots; does not dissolve clot 
  • Maintain APTT 1.5 - 2.5 
  • High alert med; second nurse check 
  • Bleeding Precautions 
• Enoxaprin for low-risk patient 

  • Observe for bleeding: increased HR, decreased BP, bruising, petechiae, hematomas, black tarry stools 
  • Avoid aspirin
• How will you treat a patient experiencing an acute pulmonary embolism?

  Impaired gas exchange 

  • Bedrest in high fowler’s  
  • Titrated O2 to pulse ox value  
  • HFNC (warm/humidified) or Bipap as needed 

  Risk for decreased CO  

  • Monitor VS & heart rhythm (dysrhythmias) & massive PE [use fluids w/ caution]

  Pain ~ give morphine