MDC 3 Exam 2 1. Respiratory Changes Made with Aging - · Alveolar surface area decreases · Decreased elasticity of the lungs · Muscle atrophy · Increased pulmonary vascular resistance · Effectiveness of cilia decrease · Sedentary lifestyle contributes to breathlessness 2. Oxygen Hemoglobin Dissociation Curve Conditions that shift to the right require more CO2 - · Fever · Increased CO2 concentration · Acidosis · Hypoxia 3. Oxygen Hemoglobin Dissociation Curve Conditions that shift the curve to the left require less CO2 - · Decreased temperature · Decreased CO2 concentration · Alkalosis 4. Assessment: Respiratory - · Smoking history · History of pre existing respiratory issues · Cough · Sputum · Chest pain · Dyspnea · Orthopnea · Inspection o Skin o Rate, rhythm, depth of breaths, symmetry, use of accessory muscles, tripod position, pursed lips o Barrel Shape chest o Retractions · Palpation o Crepitus "Subcutaneous emphysema · Percussion · Auscultation o Fine crackles o Coarse crackles o Wheeze o Rhonchi o Pleural Friction Rub · Cyanosis, pallor · Clubbing · Pale nail beds · Weight loss · General appearance · Endurance · Anxiety 5. Assessment Diagnostic Test - · Hemoglobin, White blood cells · ABG's · Sputum · Chest x ray · Chest CT · Oximetry · PFT's · Bronchoscopy 6. Thoracentesis - · Needle aspiration of pleural fluid or air from pleural space · Fluid is often drained to relive compression and improve breathing · Instill drugs for loculated pleural effusions · Can be done at bedside with US guidance and local anesthetic Chest x ray after to rule out pneumothorax 7. Lung Biopsy - · Obtain tissue for analysis · Can be done with fluoroscopy guidance and local anesthetic in radiology or open biopsy in OR 8. Head and Neck Cancer: What is it - · Loss of cellular regulation after chronic irritation · Usually in mucous membranes and skin · Slow growing · Curable when diagnosed early · Fatal 2 years after diagnosed if untreated · Metastasizes to lymph nodes, muscle, bone and eventually distant sites like lung and liver 9. Etiology of Head and Neck Cancer - · Tobacco · Alcohol · Chronic laryngitis · Exposure to chemicals or dust · Poor oral hygiene · Long term GERD · Oral infection with HPV virus 10. Assessment of Head and Neck Cancer - · Difficulty speaking · Hoarseness - early sign · Shortness of breath - early sign · Oral sores · Swallowing difficulty · Lumps in neck · Pain