| cancer of the larynx （喉頭がん） |
＜risk factor＞ smoking, alcohol ＜early symptom＞ hoarseness lasting longer than 2W lump in the neck persistent sore throat cough ＜late symptom＞ dysphagia, hemoptysis pain, airway obstruction ＜治療＞ 手術・・laryngectomy OP後ND・・Impared verbal communication R/T inability to speak OP後・・ ・pt may eat any food that can be chewed and swallowed comfortably, but may not to be able taste and smell ・no longer breathing through the nose←keep humidity + intake fluidに注意する |
| lung cancer （肺がん） |
＜risk factor＞ smoking, ＜手術＞ pneumonectomy・・・removal of an entire lung lobectomy・・・removal of one lobe partial lobectomy・・・removal of one or more segments of a lung lobe wedge resection・・・removal of a wedge shaped section of lung tissue |
| pneumonia （肺炎） |
＜risk factor＞ age, smoking, upper respiratory tract infection malnutrition, immunosuppression, chronic illness ＜胸痛＞ ・caused by friction between the pleural layers more severe on inspiration + coughing ・pain is sharp, not mild ＜how to reduce chest pain＞ to splint the rib cage when coughing ＜hypoxiaになると・・・＞ irritability, anxiety, restlessness ↓ confused, combative ↓ coma ＜goal＞ to perform ADL without dyspnea |
| tuberculosis （結核） |
＜risk factor＞ age,urban poor, immunodeficiency, minority group ＜high risk area＞ inner-core residential area of large city ＜symptom＞ BW↓, anorexia, fatigue, low-grade fever, night sweats ＜検査＞ sputum specimen (using "acid-fast staining" technique) 「Montoux test」（皮内注射）・・・（+）だとかつて結核菌に接触したことがあるということ ＊resistanceができたというわけではない ＜how to spread＞ by airborne droplet nuclei ＊退院へむけてのpriority careは病気のことについての教育をすることが重要 ＊再発はphysicalやemotionalなストレスが引き金になることあり |
| COPD(chronic obstructive pulmonary disease) （慢性閉塞性肺疾患） |
＜risk＞ ・smoking ・exposure to environmental pollutants ・chronic asthma ＜所見＞ ・anteroposterior chest diameter (because air is trapped in the overextended alveoli) ・developed neck muscles (because their increased use in the work of breathing) ・distended neck veins (as a symptom of the heart failure) ・diminished chest excursion ＜呼吸症状＞ ・breath sounds are deminished ・expiration becomes prolonged ・感染が伴っていたら・・coarse crackles rhonchi ＜呼吸方法＞ pursed-lip breathing →to promote CO2 elimination to conserve energy ＜もしPaCO2があがっていたら・・＞ ・flushing due to vasodilation ・pt becomes drowsy and lethargic ＜ゴール＞ to manage the signs of the disease process so as to maintain the clients functional ability |
| asthma （喘息） |
＜症状＞ ・wheezing, chest-tightness, 呼吸数↑ ・呼吸性アシドーシスがおこる ＜accute attack＞・・・precipitating factor・・viral respiratory infections ・dyspnea, hypoxemia, nasal flaring, fatigue, diminished or absent breath sounds ＜ケア＞ ・administer bronchodilators ・intravenous coricosteroids or theophylline ＜ゴール＞ ・breath sound is clear! ＜退院教育＞ ・peak flow numbers syould be monitored daily, usually in the morning (before taking medication) ＊喘息患者はリスクがあるためpneumonia vaccine(Pneumovax)を受けたほうがいい |
| ARDS(acute respiratory distress syndrome) （急性呼吸窮迫症候群） |
＜原因＞ ・gram-negative septic shock ・gastric content aspiration ＜症状＞ early： hypoxia not responsive to oxygen therapy late：carbon dioxide↑, metabolic acidosis PaCO2↑, PaO2↓ ＜risk factor＞ hypovolemic shock （ARDSを招かないように十分にfluid replacement careを行う） ＜ケア＞ ・endotracheal intubation, mechanical ventilation |
| pnemothorax （気胸） |
・lung has collapsed and in not functioning ＜症状＞ diminished or absent breath sounds over the affected lung sudden sharp chest pain P↑, R↑, anxiety, restlessness ＜ケア＞ 胸腔ドレーン挿入 →to remove air and fluid, to re-expand the lung |