Head and Neck Cancer Management Study Guide

Acid-Base Imbalances and Regulation Mechanisms

An overview of acid-base imbalances, pH regulation, and the roles of buffer, respiratory, and renal systems.

• Acid-base imbalance
• pH
• Hydrogen ions
• Buffer systems
• Carbonic acid-bicarbonate system
• Respiratory regulation
• Renal regulation
• Hyperventilation
• Hypoventilation
• Hyperkalemia

Acid-Base Imbalance and ABG Interpretation

An overview of acid-base imbalances, arterial blood gas (ABG) interpretation, and physiological compensation mechanisms.

• Arterial Blood Gas (ABG) interpretation
• Respiratory acidosis
• Respiratory alkalosis
• Metabolic acidosis
• Metabolic alkalosis
• Respiratory compensation
• Renal compensation
• Full compensation
• Partial compensation
• Carbonic acid excess
• Bicarbonate deficit

Respiratory System Structures and Functions

The respiratory system facilitates gas exchange by transferring oxygen and carbon dioxide between the atmosphere and blood through the upper and lower respiratory tracts.

• Upper respiratory tract
• Lower respiratory tract
• Gas exchange
• Alveoli
• Surfactant
• Pulmonary circulation
• Bronchial circulation
• Thoracic cage
• Diaphragm

Physiology and Control of Respiration

Physiology of respiration involves oxygenation, ventilation, diffusion, and the control of respiration via chemoreceptors and mechanical receptors.

• Oxygenation
• Partial pressure of oxygen (PaO2)
• Arterial oxygen saturation (SaO2)
• Diffusion
• Ventilation
• Compliance
• Resistance
• Medulla
• Chemoreceptors
• Mechanical receptors
• Respiratory defense mechanisms

Respiratory System Assessment and Gerontologic Considerations

Assessment of the respiratory system involves collecting subjective data through health history and objective data while considering gerontologic effects of aging.

• Gerontologic considerations
• Respiratory assessment
• Subjective data
• Health history
• Structural changes of aging
• Respiratory control

Respiratory System Physical Assessment Techniques

A guide to physical examination, inspection, palpation, percussion, and auscultation for respiratory assessment.

• Physical examination components
• Inspection of respiratory distress
• Thoracic abnormalities (pectus carinatum, pectus excavatum)
• Palpation of trachea and expansion
• Percussion for lung density
• Auscultation of breath sounds
• Adventitious breath sounds

Acute Respiratory Failure and Mechanisms

Acute Respiratory Failure involves inadequate oxygenation, ventilation, or both, resulting from hypoxemic or hypercapnic mechanisms.

• Acute Respiratory Failure (ARF)
• Hypoxemic respiratory failure
• Hypercapnic respiratory failure
• V/Q mismatch
• Diffusion impairment
• Alveolar hypoventilation
• Hypoxemia
• Hypercapnia
• PaO2
• PaCO2

Clinical Manifestations of ARF and ARDS

Clinical manifestations of hypoxemia and hypercapnia including respiratory, cardiovascular, and central nervous system changes.

• Hypoxemia manifestations
• Hypercapnia manifestations
• Respiratory compensation
• Clinical assessment of breathing patterns
• Auscultation of breath sounds

Upper Respiratory Problems and Management

• Deviated Septum
• Nasal Fracture
• Epistaxis
• Allergic Rhinitis
• Septoplasty
• Rhinoplasty
• CSF leak
• Periorbital ecchymosis
• Immunotherapy

Upper Respiratory Obstruction and Inflammation

This topic covers nasal polyps, pharyngitis, tonsillitis, laryngeal polyps, laryngitis, and airway obstruction.

• Nasal polyps
• Acute Pharyngitis
• Peritonsillar Abscess
• Laryngeal Polyps
• Acute Laryngitis
• Airway Obstruction

• Upper Respiratory Obstruction and Inflammation

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Head and Neck Cancer Management

Clinical manifestations, diagnostic studies, staging, and interprofessional care for head and neck cancer involving squamous cells in mucosal surfaces.

• Squamous cell carcinoma
• TNM staging
• Leukoplakia
• Erythroplakia
• Laryngoscopy
• Electrolarynx
• Transesophageal puncture (TEP)
• Esophageal speech
• Oral mucositis
• Xerostomia
• Skin flaps
• Tracheostomy care

• Head and Neck Cancer Management

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Procedures and Management for Supporting Ventilation

Artificial airways, chest tube drainage, and surgical thoracic approaches are utilized to support ventilation and manage pleural space issues.

• Endotracheal tube indications
• Nasotracheal tube usage
• Tracheostomy for long-term ventilation
• Bronchoscopy and Thoracentesis
• Chest tube drainage sizes
• Pleural drainage system compartments
• Water-seal chamber tidaling
• Suction control chamber types
• Flutter or Heimlich valve function
• Subcutaneous emphysema assessment
• Thoracotomy surgical approaches
• VATS minimally invasive procedure
• Postoperative respiratory management

• Procedures and Management for Supporting Ventilation

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Endotracheal Intubation Procedures and Management

Procedures for endotracheal intubation including preparation, rapid sequence intubation, placement confirmation, and post-intubation monitoring.

• Endotracheal (ET) Intubation Procedure
• Rapid Sequence Intubation (RSI)
• Preoxygenation
• Placement Confirmation
• Post-intubation Assessment
• Risks of Oral ET Intubation

Tracheostomy and Supporting Ventilation

A surgically created stoma used to establish a patent airway, bypass upper airway obstruction, and facilitate secretion removal or mechanical ventilation.

• Tracheostomy
• Cricothyroidotomy
• Trach tube components
• Cuffed vs cuffless tubes
• Fenestrated tubes
• Mechanical ventilation weaning

• Tracheostomy and Mechanical Ventilation Support

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Nursing Management of Tracheostomy Patients

Comprehensive nursing care including tracheostomy insertion, post-procedure monitoring, decannulation procedures, and long-term management for patients requiring mechanical ventilation.

• Tracheostomy cuff pressure
• Accidental decannulation
• Decannulation procedure
• Passy-Muir valve
• Home mechanical ventilation
• Stoma care
• Suctioning protocols
• Trach tie replacement

• Nursing Management of Tracheostomy Patients

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Upper Respiratory Infections and Management

An overview of upper respiratory infection, acute viral rhinopharyngitis, influenza, and sinusitis including manifestations, diagnostics, and management.

• Upper Respiratory Infection (URI)
• Acute Viral Rhinopharyngitis
• Influenza
• Sinusitis
• Symptom Management
• Viral Transmission
• Influenza Vaccine
• Sinusitis Classification

Respiratory Assessment and Diagnostic Procedures

Diagnostic procedures including bronchoscopy, lung biopsy, thoracentesis, and pulmonary function tests are used to obtain specimens, measure lung volumes, and evaluate respiratory disease.

• Bronchoscopy
• Bronchoalveolar lavage (BAL)
• Lung Biopsy
• Thoracentesis
• Pulmonary Function Tests (PFTs)
• Spirometry
• Pneumothorax monitoring

Obstructive Pulmonary Diseases: Bronchiectasis and Cystic Fibrosis

An analysis of the etiology, pathophysiology, clinical manifestations, and management of bronchiectasis and cystic fibrosis.

• Bronchiectasis
• Cystic Fibrosis
• CFTR protein mutation
• Mucociliary mechanism impairment
• Sweat chloride test
• Pancreatic insufficiency
• Pulmonary hypertension
• Airway clearance techniques

Clinical Manifestations and Management of COPD

Clinical manifestations, complications, diagnostic studies, and interprofessional care for patients with chronic obstructive pulmonary disease.

• Hypoxemia
• Hypercapnia
• Cor pulmonale
• Pulmonary hypertension
• Acute exacerbations
• Spirometry
• Bronchodilators

Lower Respiratory Tract Infections and Pneumonia

This topic covers acute bronchitis, pertussis, and various classifications and manifestations of pneumonia.

• Acute Bronchitis
• Pertussis
• Pneumonia Classifications
• Aspiration Pneumonia
• Opportunistic Pneumonia
• Pneumocystis jiroveci pneumonia (PJP)
• Community-acquired pneumonia (CAP)
• Hospital-acquired pneumonia (HAP)
• Ventilator-associated pneumonia (VAP)
• Necrotizing pneumonia

Clinical Management of Lower Respiratory Problems

Clinical problems involving impaired respiratory function, infection, fluid imbalance, activity intolerance, and altered body temperature require specific implementation strategies for acute and ambulatory care.

• Impaired respiratory function
• Health promotion
• Acute care implementation
• Ambulatory care implementation
• Infection control
• Pneumonia risk reduction
• Ventilator-associated pneumonia (VAP) prevention
• Aspiration awareness
• Expected respiratory outcomes

Tuberculosis Etiology, Pathophysiology, and Manifestations

Tuberculosis is caused by Mycobacterium tuberculosis, a gram-positive, aerobic, acid-fast bacillus that spreads via airborne droplets.

• Mycobacterium tuberculosis
• Latent TB infection (LTBI)
• Multidrug-Resistant Tuberculosis (MDR-TB)
• Extrapulmonary TB
• Miliary TB
• Pott’s disease

Diagnostic Studies for Tuberculosis

Diagnostic studies for tuberculosis include the Tuberculin skin test, Interferon-γ release assays, chest x-ray, and bacteriologic studies.

• Tuberculin skin test (TST)
• Mantoux test
• Purified protein derivative (PPD)
• Induration
• Interferon-γ (INF-gamma) release assays (IGRAs)
• QuantiFERON-TB Gold In-Tube (QFT-GIT)
• T-SPOT.TB
• Chest x-ray findings
• Bacteriologic studies
• Sputum culture

Management of Lower Respiratory Disorders

This content covers the diagnosis, drug therapy, and nursing management of tuberculosis, atypical mycobacteria, pulmonary fungal infections, lung abscesses, restrictive respiratory disorders, atelectasis, pleurisy, and pleural effusion.

• Active TB disease
• Latent tuberculosis infection (LTBI)
• Multidrug-resistant TB (MDR-TB)
• Directly observed therapy (DOT)
• Mycobacterium bovis (BCG vaccine)
• Atypical Mycobacteria
• Pulmonary Fungal Infections
• Lung Abscess
• Restrictive Respiratory Disorders
• Atelectasis
• Pleurisy
• Pleural Effusion

Lower Respiratory Disorders and Chest Trauma

This topic covers diffuse parenchymal lung disease, including Idiopathic Pulmonary Fibrosis and Sarcoidosis, alongside chest trauma such as fractured ribs and flail chest.

• Diffuse parenchymal lung disease
• Interstitial Lung Disease (ILD)
• Sarcoidosis
• Chest trauma
• Blunt and penetrating trauma
• Fractured ribs
• Flail chest
• Paradoxical movement

Pneumothorax and Pleural Effusion

• Tension pneumothorax
• Hemothorax
• Chylothorax
• Spontaneous pneumothorax
• Iatrogenic pneumothorax
• Mediastinal shift
• Needle decompression
• Chest tube with water-seal drainage

Lower Respiratory Disorders and Management

Clinical manifestations, diagnostics, and interprofessional care for pulmonary edema, pulmonary embolism, pulmonary hypertension, environmental lung diseases, lung transplants, and lung cancer.

• Pulmonary Embolism (PE)
• Venous Thromboembolism (VTE)
• Pulmonary Hypertension
• Cor Pulmonale
• Pneumoconiosis
• Hypersensitivity Pneumonitis
• Lung Transplantation
• Lung Cancer Etiology

Pathophysiology and Management of Lung Cancer

Primary lung cancers include non–small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLC) which arise from mutated epithelial cells.

• Non–small-cell lung cancer (NSCLC)
• Small-cell lung cancer (SCLC)
• Squamous cell carcinoma
• Adenocarcinoma
• Large-cell carcinoma
• Hemoptysis
• Lung biopsy
• Staging
• Surgical therapy
• Radiation therapy
• Chemotherapy
• Targeted therapy
• Immunotherapy
• Airway obstruction

Respiratory Assessment and Oxygenation Monitoring

• Hypoxia assessment
• Oximetry (SaO2 and SpO2)
• Arterial blood gases (ABG)
• Venous O2 saturation (ScvO2 and SvO2)
• Capnography (PtCO2 and PetCO2)
• Oxygenation and acid-base balance

Management of Acute Respiratory Failure

Nursing and interprofessional management of acute respiratory failure involves oxygen therapy, patient positioning, effective coughing, and drug therapy to correct hypoxemia.

• Acute Respiratory Failure (ARF) management
• Oxygen therapy goals
• Non-invasive ventilation
• Mechanical ventilation
• V/Q mismatching
• Patient positioning for respiratory expansion
• Augmented coughing (quad coughing)
• Bronchodilators and corticosteroids
• Chronic hypercapnia in COPD

Acute Respiratory Distress Syndrome Pathophysiology

• Acute Respiratory Distress Syndrome (ARDS)
• Direct lung injury
• Indirect lung injury
• Injury or exudative phase
• Reparative or proliferative phase
• Fibrotic or fibroproliferative phase
• Refractory hypoxemia
• V/Q mismatch
• Surfactant dysfunction
• Lung compliance

ARDS Progression and Diagnostic Studies

Acute Respiratory Distress Syndrome (ARDS) progresses from subtle initial presentations to severe respiratory failure characterized by refractory hypoxemia and diffuse bilateral infiltrates.

• ARDS progression
• Refractory hypoxemia
• PaO2/FiO2 ratio
• Clinical manifestations
• Arterial Blood Gas (ABG) alterations
• Chest X-ray findings

Complications of ARDS and ARF

Complications of ARDS include MODS, sepsis, respiratory issues, GI dysfunction, renal injury, cardiac dysrhythmias, and hematologic disorders.

• MODS
• Sepsis
• Barotrauma
• Ventilator-associated pneumonia
• Acute kidney injury
• Venous thromboembolism
• GI ulcers
• Pulmonary fibrosis

ARDS Management and Supportive Therapies

Best practices for ARDS include mechanical ventilation, prone positioning, and extracorporeal membrane oxygenation.

• ARDSNet protocol
• Low tidal volume ventilation
• Permissive hypercapnia
• Positive end expiratory pressure (PEEP)
• Prone positioning
• Continuous lateral rotation therapy (CLRT)
• Extracorporeal membrane oxygenation (ECMO)
• Extracorporeal CO2 removal (ECCO2R)
• Supportive therapy

Supporting Ventilation and Airway Clearance

Methods for supporting ventilation include diaphragmatic breathing, pursed-lip breathing, airway clearance techniques, and chest physical therapy.

• Diaphragmatic breathing
• Pursed-lip breathing (PLB)
• Airway clearance techniques (ACTs)
• Chest Physical Therapy (CPT)
• Postural drainage
• Percussion
• Vibration
• Airway clearance devices

Supporting Ventilation and Oxygen Therapy

Oxygen therapy is a common treatment for hypoxemia and hypoxia that requires an HCP order to meet individual physiological needs.

• Hypoxemia and hypoxia
• Fraction of inspired oxygen (FIO2)
• Low-flow and high-flow systems
• Oxygen toxicity
• Absorption atelectasis
• CO2 Narcosis
• Artificial Airways
• Nasopharyngeal airway
• Oropharyngeal airway
• Endotracheal tube

Noninvasive and Mechanical Ventilation Support

Noninvasive ventilation and mechanical ventilation provide respiratory support through continuous positive airway pressure, bi-level positive airway pressure, or positive pressure ventilation.

• Noninvasive Ventilation (NIV)
• Continuous Positive Airway Pressure (CPAP)
• Bi-level Positive Airway Pressure (Bi-PAP)
• Inspiratory Positive Airway Pressure (IPAP)
• Expiratory Positive Airway Pressure (EPAP)
• Mechanical Ventilation
• Negative Pressure Ventilation
• Positive Pressure Ventilation (PPV)
• Volume Ventilation
• Pressure Ventilation

Mechanical Ventilation Settings and Modes

This topic covers ventilator settings, Positive End Expiratory Pressure (PEEP), and various modes of mechanical ventilation including full support, partial support, and spontaneous breathing.

• Ventilator Settings
• Positive End Expiratory Pressure (PEEP)
• Work of Breathing (WOB)
• Assist-control (AC)
• Pressure-control (PC)
• Synchronous intermittent mandatory ventilation (SIMV)
• Pressure support (PS)
• Continuous positive airway pressure (CPAP)

Artificial Airway Management and Ventilator Support

Nursing responsibilities include maintaining correct tube placement, proper cuff inflation, tube patency, and monitoring alarm systems during artificial airway management.

• Artificial Airway Management
• Endotracheal Tube (ET) Placement
• Cuff Inflation
• Suctioning Indications
• Closed Tracheal Suction System
• Suctioning Complications
• Alarm Fatigue
• Analgesia and Sedation
• Neuromuscular Blocking Agents (NMBAs)
• Capnography (EtCO2)
• Oral Care
• Rescue Therapies (ECMO, Proning, Pulmonary Vasodilators)
• Aspiration Risk
• Barotrauma and Volutrauma
• Ventilator-Associated Pneumonia (VAP)

Ventilator Support and Weaning Protocols

Clinical strategies for VAP prevention, managing unplanned extubation, and the processes for weaning from and performing extubation.

• VAP Prevention
• Unplanned Extubation
• Weaning from PPV
• Spontaneous Awakening Trials (SATs)
• Spontaneous Breathing Trials (SBTs)
• Extubation Procedure
• Respiratory Assessment

Asthma Characteristics, Risk Factors, and Triggers

Asthma is a diverse disease characterized by bronchial hyperreactivity with reversible expiratory airflow limitation.

• Bronchial hyperreactivity
• Reversible expiratory airflow limitation
• Atopy
• Exercise-induced bronchospasm (EIB)
• Airway hyperresponsiveness
• Bronchoconstriction

Pathophysiology of Obstructive Airway Inflammation

Persistent and variable inflammation of airways leads to bronchoconstriction, hyperresponsiveness, and edema of airways.

• Airway inflammation
• Early-phase response
• Late-phase response
• Inflammatory mediators
• Airway remodeling
• Bronchoconstriction
• Smooth muscle hypertrophy

Clinical Manifestations and Classifications of Asthma

Asthma manifestations include wheezing, cough, dyspnea, and chest tightness, ranging from mild attacks to life-threatening acute respiratory failure.

• Asthma attack manifestations
• Wheezing severity
• Silent chest
• Hyperventilation and respiratory alkalosis
• Cough variant asthma
• Asthma severity classifications
• Airway remodeling
• Acute respiratory failure (ARF)

Asthma Management and Pharmacological Interventions

Clinical management of asthma through diagnostic studies, stepwise drug therapy, and emergency treatment for status asthmaticus.

• Status Asthmaticus
• Peak Expiratory Flow Rate (PEFR)
• Spirometry
• Inhaled Corticosteroids (ICS)
• Short-acting β-Adrenergic Agonists (SABAs)
• Long-acting β2-Adrenergic Agonist Drugs (LABAs)
• Leukotriene receptor antagonists (LTRAs)
• Fraction of exhaled nitric oxide (FENO)

Inhalation Devices for Asthma Drug Delivery

Inhalation devices including Metered dose inhalers, Dry powdered inhalers, and Nebulizers deliver asthma medications for faster action and fewer systemic side effects.

• Metered dose inhalers (MDI)
• Dry powdered inhaler (DPI)
• Nebulizers
• Spacer or holding chamber
• Hand-breath coordination
• Breath activated medication
• Fine mist conversion
• Asthma triggers and irritants

Management of Acute Asthma Attacks

Management strategies for asthma involving acute care goals, severity assessment, and asthma action plans.

• Acute asthma attack management
• Mild to moderate asthma attacks
• Severe acute asthma attack
• Peak Expiratory Flow Rate (PEFR)
• Asthma action plan
• Hypoxemia correction
• Silent chest sign
• Ambulatory care

Chronic Obstructive Pulmonary Disease Overview

Chronic Obstructive Pulmonary Disease is a progressive lung disease characterized by persistent airflow limitation and enhanced chronic inflammatory response.

• Chronic Obstructive Pulmonary Disease (COPD)
• Airflow limitation
• Chronic inflammation
• Alpha-1 Antitrypsin Deficiency (AATD)
• Pathophysiology
• Air trapping
• Pulmonary hypertension
• FEV1/FVC ratio
• Clinical manifestations

Management and Treatment of COPD

Comprehensive strategies for managing COPD through drug therapy, respiratory care, nutrition, surgical interventions, and acute care implementation.

• LABA
• ICS
• Triple therapy
• Pursed-lip breathing
• Diaphragmatic breathing
• Airway clearance techniques
• Lung volume reduction surgery (LVRS)
• Bronchoscopic lung volume reduction (BLVR)
• Pulmonary rehabilitation
• Acute exacerbations