X
|
STUDENT DIGITAL NEWSLETTER ALAGAPPA INSTITUTIONS |
|
Henry J. Kaminski, M.D.
After each position change arthritis in my back treatment generic arcoxia 120 mg amex, the nurse encourages the patient to breathe deeply and cough diet untuk rheumatoid arthritis cheap 90mg arcoxia amex. If the patient is too weak to cough effectively arthritis knee weight loss purchase arcoxia 90 mg with amex, the nurse may need to remove the mucus by nasotracheal suctioning (see Chap arthritis pain toes cheap arcoxia 90 mg online. It may take time for secretions to mobilize and move into the central airways for expectoration. Thus, it is important for the nurse to monitor the patient for cough and sputum production after the completion of chest physiotherapy. The effectiveness of oxygen therapy is monitored by improvement in clinical signs and symptoms, and adequate oxygenation values measured by pulse oximetry or arterial blood gas analysis. It is important to instruct outpatients not to overexert themselves and to engage in only moderate activity during the initial phases of treatment. An increased respiratory rate leads to an increase in insensible fluid loss during exhalation and can lead to dehydration. Therefore, it is important to encourage increased fluid intake (at least 2 L/day), unless contraindicated. Fluids with electrolytes (commercially available drinks, such as Gatorade) may help provide fluid, calories, and electrolytes. The patient also needs informa- · Continuing symptoms after initiation of therapy Shock Respiratory failure Atelectasis Pleural effusion Confusion Superinfection Planning and Goals the major goals for the patient may include improved airway patency, rest to conserve energy, maintenance of proper fluid volume, maintenance of adequate nutrition, an understanding of the treatment protocol and preventive measures, and absence of complications. The nurse encourages hydration (2 to 3 L/day) because adequate hydration thins and loosens pulmonary secretions. A highhumidity facemask (using either compressed air or oxygen) delivers warm, humidified air to the tracheobronchial tree, helps to liquefy secretions, and relieves tracheobronchial irritation. Lung expansion maneuvers, such as deep breathing with an incentive spirometer, may induce a cough. The nurse encourages the patient to per- Chapter 23 Management of Patients With Chest and Lower Respiratory Tract Disorders 531 tion about factors (both patient risk factors and external factors) that may have contributed to developing pneumonia and strategies to promote recovery and to prevent recurrence. If hospitalized for treatment, the patient is instructed about the purpose and importance of management strategies that have been implemented and about the importance of adhering to them during and after the hospital stay. Explanations need to be given simply and in language that the patient can understand. Because of the severity of symptoms, the patient may require that instructions and explanations be repeated several times. The patient is monitored for changes in physical status (deterioration of condition or resolution of symptoms) and for persistent recurrent fever, which may be due to medication allergy (signaled possibly by a rash); medication resistance or slow response (greater than 48 hours) of the susceptible organism to therapy; superinfection; pleural effusion; or pneumonia caused by an unusual organism, such as P. Failure of the pneumonia to resolve or persistence of symptoms despite changes on the chest x-ray raises the suspicion of other underlying disorders, such as lung cancer. As described earlier, lung cancers may invade or compress airways, causing an obstructive atelectasis that may lead to a pneumonia. In addition to monitoring for continuing symptoms of pneumonia, the nurse also monitors for other complications, such as shock and multisystem failure, atelectasis, pleural effusion, and superinfection, which may develop during the first few days of antibiotic treatment. The nurse reports signs of deteriorating patient status and assists in administering intravenous fluids and medications prescribed to combat shock. Intubation and mechanical ventilation may be required if respiratory failure occurs. Shock is described in detail in Chapter 15, and care of the patient receiving mechanical ventilation is described in Chapter 25. Atelectasis and Pleural Effusion the patient is assessed for atelectasis, and preventive measures are initiated to prevent its development. If pleural effusion develops and thoracentesis is performed to remove fluid, the nurse assists in the procedure and explains it to the patient. After thoracentesis, the nurse monitors the patient for pneumothorax or recurrence of pleural effusion. Superinfection the patient is monitored for manifestations of superinfection (ie, minimal improvement in signs and symptoms, rise in temperature with increasing cough, increasing fremitus and adventitious breath sounds on auscultation of the lungs). These signs are re- ported, and the nurse assists in implementing therapy to treat superinfection. Confusion the patient with pneumonia is assessed for confusion and other more subtle changes in cognitive status. Confusion and changes in cognitive status resulting from pneumonia are poor prognostic signs. Confusion may be related to hypoxemia, fever, dehydration, sleep deprivation, or developing sepsis. Patient education is crucial regardless of the setting, and the proper administration of antibiotics is important. In some instances, the patient may be initially treated with intravenous antibiotics as an inpatient and then be discharged to continue the intravenous antibiotics in the home setting. It is important that a seamless system of care be maintained for the patient from hospital to home; this includes communication between the nurses caring for this patient in both settings. In addition, if oral antibiotics are prescribed, it is important to teach the patient about their proper administration and potential side effects. The nurse encourages breathing exercises to promote secretion clearance and volume expansion. Often improvement in chest x-ray findings lags behind improvement in clinical signs and symptoms. Smoking inhibits tracheobronchial ciliary action, which is the first line of defense of the lower respiratory tract. Smoking also irritates the mucous cells of the bronchi and inhibits the function of alveolar macrophage (scavenger) cells. The patient is instructed to avoid stress, fatigue, sudden changes in temperature, and excessive alcohol intake, all of which lower resistance to pneumonia. The nurse reviews with the patient the principles of adequate nutrition and rest, because one episode of pneumonia may make the patient susceptible to recurring respiratory tract infections. Continuing Care Patients who are severely debilitated or who cannot care for themselves may require referral for home care. The nurse stresses to the patient and family the importance of monitoring for complications. The nurse encourages the patient to obtain an influenza vaccine at the prescribed times, because influenza increases susceptibility to secondary bacterial pneumonia, especially that caused by staphylococci, H. The nurse also encourages the patient to seek medical advice about receiving the vaccine (Pneumovax) against S. Study Sample and Design this was a descriptive study; a self-report questionnaire was mailed to a random sample of 4,000 members of the Oncology Nursing Society. The response rate was 38%, with 1,508 completed questionnaires available for analysis. Subjects were asked to identify those interventions related to tobacco use that they used in their clinical practice. Findings the majority of respondents were female (98%), with an average age of 44 years. Overall, the sample was characterized as experienced nurses, with average number of years in nursing at 18 ± 9. Sixtyfour percent of the respondents assessed and documented smoking status in their clinical patients and 38% assessed readiness to quit. The most frequent barriers cited included perceived lack of patient motivation (74%), time (52%), and skills to provide a cessation intervention (53%). Nursing Implications Nurses have frequent contacts with active smokers in the inpatient and outpatient setting and could have a tremendous impact on smoking prevention and cessation. Even in this sample of oncology nurses, few provided smoking cessation interventions on a regular basis. Nurses need a heightened awareness of the importance of smoking cessation and the potential impact they may have on this growing problem. Demonstrates improved airway patency, as evidenced by adequate oxygenation by pulse oximetry or arterial blood gas analysis, normal temperature, normal breath sounds, and effective coughing 2. Rests and conserves energy by limiting activities and remaining in bed while symptomatic and slowly increasing activities 3.
A mastectomy to treat recurrent breast cancer after primary lumpectomy and radiation is an example of salvage surgery sarcoid arthritis definition generic 60mg arcoxia free shipping. In addition to the use of surgical blades or scalpels to excise the mass and surrounding tissues arthritis relief from pain purchase arcoxia 60 mg line, several other types of surgical interventions are available rheumatoid arthritis in fingers joints discount 60mg arcoxia mastercard. Chemosurgery uses combined topical chemotherapy and layer-by-layer surgical removal of abnormal tissue arthritis in small fingers arcoxia 90 mg low price. Laser surgery (l ight amplification by stimulated emission of radiation) makes use of light and energy aimed at an exact tissue location and depth to vaporize cancer cells. This type of radiation has such a dramatic effect on the target area that the changes are considered to be comparable to more traditional surgical approaches (International Radiosurgery Support Association, 2000). If Chapter 16 necessary, a plan for postoperative rehabilitation is made before the surgery is performed. The growth and dissemination of cancer cells may have produced distant micrometastases by the time the patient seeks treatment. Therefore, attempting to remove wide margins of tissue in the hope of "getting all the cancer cells" may not be feasible. This reality substantiates the need for a coordinated multidisciplinary approach to cancer therapy. Once the surgery has been completed, one or more additional (or adjuvant) modalities may be chosen to increase the likelihood of destroying the cancer cells. However, some cancers that are treated surgically in the very early stages are considered to be curable (eg, skin cancers, testicular cancers). Recent developments in the ability to identify genetic markers indicative of a predisposition to develop some types of cancer may play a role in decisions concerning prophylactic surgeries. Some controversy, however, exists about adequate justification for prophylactic surgical procedures. Because the long-term physiologic and psychological effects are unknown, prophylactic surgery is offered selectively to patients and discussed thoroughly with the patient and family. Preoperative teaching and counseling, as well as long-term follow-up, are provided. Patients are instructed about possible reconstructive surgical options before the primary surgery by the surgeon who will perform the reconstruction. Reconstructive surgery may be indicated for breast, head and neck, and skin cancers. Providing the patient and family with opportunities to discuss these issues is imperative. The needs of the individual must be accurately assessed and validated in each situation for any type of reconstructive surgery. Combining other treatment methods, such as radiation and chemotherapy, with surgery also contributes to postoperative complications, such as infection, impaired wound healing, altered pulmonary or renal function, and the development of deep vein thrombosis. In these situations, the nurse completes a thorough preoperative assessment for all factors that may affect patients undergoing surgical procedures. The patient undergoing surgery for the diagnosis or treatment of cancer is often anxious about the surgical procedure, possible findings, postoperative limitations, changes in normal body functions, and prognosis. The patient and family require time and assistance to deal with the possible changes and outcomes resulting from the surgery. The nurse provides education and emotional support by assessing patient and family needs and exploring with the patient and family their fears and coping mechanisms, encouraging them to take an active role in decision making when possible. When the patient or family asks about the results of diagnostic testing Palliative Surgery When cure is not possible, the goals of treatment are to make the patient as comfortable as possible and to promote a satisfying and productive life for as long as possible. Whether the period is extremely brief or lengthy, the major goal is a high quality of life- with quality defined by the patient and family. Honest and informative communication with the patient and family about the goal of surgery is essential to avoid false hope and disappointment. Palliative surgery is performed in an attempt to relieve complications of cancer, such as ulcerations, obstructions, hemorrhage, pain, and malignant effusions (Table 16-5). Reconstructive Surgery Reconstructive surgery may follow curative or radical surgery and is carried out in an attempt to improve function or obtain a more desirable cosmetic effect. The patient and family may also ask the nurse to explain and clarify information that the physician initially provided but that they did not grasp because they were anxious at the time. It is important for the nurse to communicate frequently with the physician and other health care team members to be certain that the information provided is consistent. Postoperative teaching addresses wound care, activity, nutrition, and medication information. Patients and families are also encouraged to use community resources such as the American Cancer Society or Make Today Count for support and information. Certain chemicals, including chemotherapy agents, act as radiosensitizers and sensitize more hypoxic (oxygen-poor) tumors to the effects of radiation therapy. External Radiation If external radiation therapy is used, one of several delivery methods may be chosen, depending on the depth of the tumor. Depending on the amount of energy they contain, x-rays can be used to destroy cancerous cells at the skin surface or deeper in the body. Kilovoltage therapy devices deliver the maximal radiation dose to superficial lesions, such as lesions of the skin and breast, whereas linear accelerators and betatron machines produce higher-energy x-rays and deliver their dosage to deeper structures with less harm to the skin and less scattering of radiation within the body tissues. This energy is produced from the spontaneous decay of naturally occurring radioactive elements such as cobalt 60. The gamma rays also deliver this radiation dose beneath the skin surface, sparing skin tissue from adverse effects. Some centers nationwide treat more hypoxic, radiation-resistant tumors with particle-beam radiation therapy. This type of therapy accelerates subatomic particles (neutrons, pions, heavy ions) through body tissue. This therapy, which is also known as high linear energy transfer radiation, damages target cells as well as cells in its pathway. More than half of patients with cancer receive a form of radiation therapy at some point during treatment. Radiation therapy may also be used to control malignant disease when a tumor cannot be removed surgically or when local nodal metastasis is present, or it can be used prophylactically to prevent leukemic infiltration to the brain or spinal cord. Palliative radiation therapy is used to relieve the symptoms of metastatic disease, especially when the cancer has spread to brain, bone, or soft tissue, or to treat oncologic emergencies, such as superior vena cava syndrome or spinal cord compression. Two types of ionizing radiation-electromagnetic rays (x-rays and gamma rays) and particles (electrons [beta particles], protons, neutrons, and alpha particles)-can lead to tissue disruption. Therefore, those body tissues that undergo frequent cell division are most sensitive to radiation therapy. These tissues include bone marrow, lymphatic tissue, epithelium of the gastrointestinal tract, hair cells, and gonads. Slower-growing tissues or tissues at rest are relatively radioresistant (less sensitive to the effects of radiation). A radiosensitive tumor is one that can be destroyed by a dose of radiation that still allows for cell regeneration in the normal tissue. In theory, therefore, radiation therapy may be enhanced if more oxygen can be delivered to tumors. In addition, Internal Radiation Internal radiation implantation, or brachytherapy, delivers a high dose of radiation to a localized area. The specific radioisotope for implantation is selected on the basis of its half-life, which is the time it takes for half of its radioactivity to decay. This internal radiation can be implanted by means of needles, seeds, beads, or catheters into body cavities (vagina, abdomen, pleura) or interstitial compartments (breast). Brachytherapy may also be administered orally as with the isotope I 131, used to treat thyroid carcinomas. In these malignancies, the radioisotopes are inserted into specially positioned applicators after the position is verified by x-ray. Patients are maintained on bed rest and log-rolled to prevent displacement of the intracavitary delivery device. An indwelling urinary catheter is inserted to ensure that the bladder remains empty.
Buy arcoxia 60 mg on-line. Truth about Rheumatoid Arthritis Diet Treatment with Dr McDougall.
Syndromes
References