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University of Calgary
NURS 287
Rick Nilson

INFECTIOUS LUNG DISEASES  Cigarette smoking is the most important risk factor in the development of lung cancer. Smoking is responsible for approximately 80% to 90% of all lung cancers.  Primary lung cancers are often categorized into two broad subtypes: non–small cell lung cancer (80%) and small cell lung cancer (20%).  CT scanning is the single most effective noninvasive technique for evaluating lung cancer. Biopsy is necessary for a definitive diagnosis.  Staging of non–small cell lung cancer is performed according to the TNM staging system. Staging of small cell lung cancer by TNM has not been useful because the cancer is very aggressive and always considered systemic.  Treatment options for lung cancer include: o Surgical resection is the treatment of choice in non–small cell lung cancer Stages I and II, because the disease is potentially curable with resection. o Radiation therapy used with the intent to cure may be moderated in the individual who is unable to tolerate surgical resection due to comorbidities. It may also be used as adjuvant therapy after resection of the tumor. o Chemotherapy may be used in the treatment of nonresectable tumors or as adjuvant therapy to surgery in non–small cell lung cancer.  The overall goals of nursing management of a patient with lung cancer will include (1) effective breathing patterns, (2) adequate airway clearance, (3) adequate oxygenation of tissues, (4) minimal to no pain, and (5) a realistic attitude toward treatment and prognosis. PNEUMOTHORAX  Refers to air in the pleural space. As a result of the air in the pleural space, there is partial or complete collapse of the lung.  Types of pneumothorax include: o Closed pneumothorax has no associated external wound. The most common form is a spontaneous pneumothorax, which is accumulation of air in the pleural space without an apparent antecedent event. o Open pneumothorax occurs when air enters the pleural space through an opening in the chest wall. Examples include stab or gunshot wounds and surgical thoracotomy. o Tension pneumothorax is a pneumothorax with rapid accumulation of air in the pleural space causing severely high intrapleural pressures with resultant tension on the heart and great vessels. It may result from either an open or a closed pneumothorax. o Hemothorax is an accumulation of blood in the intrapleural space. It is frequently found in association with open pneumothorax and is then called a hemopneumothorax. o Chylothorax is lymphatic fluid in the pleural space due to a leak in the thoracic duct. Causes include trauma, surgical procedures, and malignancy.  Treatment depends on the severity of the pneumothorax and the nature of the underlying disease. FLAIL CHEST  Results from multiple rib fractures, causing an unstable chest wall. The diagnosis of flail chest is made on the basis of fracture of two or more ribs, in two or more separate locations, causing an unstable segment.  Initial therapy consists of airway management, adequate ventilation, supplemental oxygen therapy, careful administration of IV solutions, and pain control.  The definitive therapy is to reexpand the lung and ensure adequate oxygenation. CHEST TUBES AND PLEURAL DRAINAGE  The purpose of chest tubes and pleural drainage is to remove the air and fluid from the pleural space and to restore normal intrapleural pressure so that the lungs can reexpand.  Chest tube malposition is the most common complication.  Routine monitoring is done by the nurse to evaluate if the chest drainage is successful by observing for tidaling in the water-seal chamber, listening for breath sounds over the lung fields, and measuring the amount of fluid drainage. CHEST SURGERY  Thoracotomy (surgical opening into the thoracic cavity) surgery is considered major surgery because the incision is large, cutting into bone, muscle, and cartilage. The two types of thoracic incisions are median sternotomy, performed by splitting the sternum, and lateral thoracotomy.  Video-assisted thoracic surgery (VATS) is a thorascopic surgical procedure that in many cases can avoid the impact of a full thoracotomy. The procedure involves three to four 1- inch incisions made on the chest that allow the thorascope (a special fiberoptic camera) and instruments to be inserted and manipulated. PLEURAL EFFUSION  Pleural effusion is a collection of fluid in the pleural space. It is not a disease but rather a sign of a serious disease.  Pleural effusion is frequently classified as transudative or exudative according to whether the protein content of the effusion is low or high, respectively. o A transudate occurs prim
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