Chapter 27: Lung cancer Flashcards
Cite which type of cancer causes the most deaths in the US.
Lung cancer
List common causes of lung cancer
- Tobacco
*Smokeless tobacco
*Pipes
*Cigars
*Hookah
*Waterpipe
*Bidis
*Kreteks
Cite the 2 most common subtypes of lung cancer and compare their growth rates.
- Non-small cell lung cancer (NSCLC) (85%)
*Adenocarcinoma → Moderate
*Large cell (undifferentiated) → Rapid
*Squamous cell → Slow - Small cell lung cancer (SCLC) (15%)
*Small cell → Very rapid
Most common symptom and often the one that is reported first
persistent cough.
other common s/s (4)
*Wheezing
*Blood-tinged sputum
*Chest pain (localized or unilateral, mild to severe)
*Dyspnea
Later manifestations (nonspecific systemic symptoms): 12
*Anorexia
*N/V
*Fatigue
*Weight loss
*Hoarseness
*Dysphagia
*Unilateral paralysis of diaphragm
*Superior vena cava obstruction
*Palpable lymph nodes in neck
*Pericardial effusion
*Cardiac tamponade
*Dysrhythmias
Describe diagnostic tests used to diagnose lung cancer
- chest x-ray
then…
CT of chest
Sputum cytologic studies
Biopsy (CT-guided needle aspiration, bronchoscopy, mediastinoscopy, video-assisted thoracoscopic surgery (VATS)
Thoracentesis (to relieve pleural effusion)
Bone scans
CT of brain, pelvis, abdomen to look for mets
CBC w/differential
Chemistry panel
Liver function test
Renal function test
Pulmonary function test
MRI
PET scan
Understand why the TNM system of classification is used for non-small cell lung cancer but not very useful for small cell lung cancer.
*NSCLC: Under the TNM system, cancer is grouped into 4 stages with A or B subtypes. Patients with stages I, II, and IIIA may be surgical candidates. Stage IIIB or IV usually are inoperable and have a poor prognosis.
*SCLC: Staging of SCLC by TNM has not been useful because this cancer is AGGRESSIVE and IS ALWAYS CONSIDERED SYSTEMIC. The stages of SCLC are limited and extensive. Limited means that the tumor is only on 1 side of the chest and regional lymph nodes. Extensive SCLC means that the cancer extends beyond the limited stage. Most patients with SCLC have extensive disease at time of diagnosis.
Name the treatment of choice for lung cancer in stages I to III
Surgical resection
Describe why surgical interventions might not be done for lung cancer.
If the patient is unable to tolerate surgical resection because of comorbidities
Describe the indications and benefits of radiation therapy for treatment for lung cancer.
*May be given as curative therapy, palliative therapy (to relieve symptoms ), or adjuvant therapy in combo with surgery, chemo, or targeted therapy.
*May be used as primary therapy in a person who is unable to tolerate surgical resection because of comorbidities.
*Radiation therapy relieves symptoms of dyspnea and hemoptysis from bronchial obstructive tumors and treats superior vena cava syndrome.
*It can treat pain from metastatic bone lesions or brain metastasis.
*Radiation before surgery can reduce the tumor mass before surgical resection.
R/F of rad therapy
esophagitis, skin irritation, N/V, anorexia, and radiation pneumonitis.
Explain the importance of an airway stent and the rationale of its use with persons diagnosed with lung cancer
*Stents are used alone or in combo with other techniques for relief of dyspnea, cough, or respiratory insufficiency.
*he advantage of an airway stent is that it supports the airway wall against collapse or external compression and a delay extension of tumor into the airway lumen
Describe objective data found when performing a respiratory assessment on someone that has lung cancer: general
Fever, nose and/or throat infection, neck and axillary lymphadenopathy, paraneoplastic syndrome
Describe objective data found when performing a respiratory assessment on someone that has lung cancer: integ
Edema of neck and face, digital clubbing, jaundice
Describe objective data found when performing a respiratory assessment on someone that has lung cancer: resp
Wheezing, hoarseness, stridor, dyspnea on exertion, pleural effusions
Describe objective data found when performing a respiratory assessment on someone that has lung cancer: cardio
Pericardial effusion, cardiac tamponade, dysrhythmias
Describe objective data found when performing a respiratory assessment on someone that has lung cancer: neuro
Confusion, disorientation, unsteady gait
Describe objective data found when performing a respiratory assessment on someone that has lung cancer: musculoskeletal
Pathologic fractures, muscle wasting
Describe objective data found when performing a respiratory assessment on someone that has lung cancer: possible diagnostic findings
Observance of lesion on chest x-ray, CT scan, or PET scan. MRI findings of vertebral, spinal cord, or mediastinal invasion. Positive sputum oro bronchial washings for cytologic studies. Positive fiberoptic bronchoscopy and biopsy findings.
List 4 possible nursing diagnoses for the patient with lung cancer.
Impaired airway clearance
Impaired breathing
Impaired gas exchange
Anxiety
Cite the 5 overall goals of patients with lung cancer and appropriate nursing interventions to address these goals.
Adequate airway clearance
Effective breathing patterns
Adequate oxygenation of tissues
Minimal to no discomfort
A realistic outlook about treatment and prognosis
Describe the expected outcomes when caring for patients with lung cancer.
Have adequate breathing patterns
Maintain adequate oxygenation
Have minimal to no pain
Convey feelings openly and honestly, with a realistic attitude about prognosis
