Treatment & Nursing Care

Cards (31)

  • 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 ~ 710 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 36 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 36 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