Gas Exchange: Lung Cancer Flashcards
What are the three types of non-small-cell carcinoma?
- adenocarcinoma
- squamous cell carcinoma
- large-cell carcinoma (bronchiolar or alveolar)
What type of carcinomas are the majority of bronchogenic carcinomas?
small-cell carcinomas
Describe small-cell carcinomas
metastasis early, mainly via lymph; prognosis poor
Where are adenocarcinomas typically found and what happens with metastasis?
they are usually found in the peripheral bronchi and metastasis occurs before they are found
Where are squamous cell carcinomas typically found and what population typically get them?
Typically found in the bronchial epithelium and spread via direct extension; usually a cigarette smoker
What does T stand for?
Primary Tumor
What does TX stand for?
Primary tumor cannot be assessed
What does TO stand for?
No evidence of primary tumor
What does T1, 2, 3 stand for?
increasing size/local extent of tumor
What does M stand for?
Distant Metastasis
What does MX stand for?
No Assessment
What does M0 stand for?
No distant Metastasis
What does M1 stand for?
Distant metastasis
What does N stand for?
Regional Lymph nodes
What does NX stand for?
Regional lymph nodes cannot be assessed
What does N0 stand for?
no regional lymph node metastasis
What does N 1, 2, 3 stand for?
increasing involvement of lymph node
What are the risk factors for lung cancer?
- incidence increases with age
- commonly over age 50
- Cigarette smoking most significant cause of lung cancer (approximately 90% of cases related to smoking)
- Exposure to ionizing radiation
- Inhaled irritants
- Radon exposure (pit mines, quarries)
What inhaled irritants are usually seen?
Mesotheliomas (chlorine, ozone, sulfur dioxide, asbestos)
What are some ways to prevent lung cancer?
- refraining or stopping smoking (quitting before age 40 important)
- Prevent environmental and occupational exposure to known carcinogens (radon, asbestos)
What will happen to your lungs the minute you stop smoking and what is the goal of smoking cessation?
The minute you quit smoking, your lung function will improve. The goal of smoking cessation is to improve lung function.
What does OSHA do with regard to work-related exposure to irritants?
OSHA has protections to prevent illness/exposure
What are the s/s of lung cancer?
- pneumonitis that fails to resolve
- pleural effusion w/ SOB
- Cough or increased cough w/ sputum
- hemoptysis
- Wheezing or dyspnea
- Chest pain
- Late: anorexia; fatigue; weight loss; pain
- Recurrent PNA
- Voice hoarseness
Which of the clinical manifestations are early signs?
- SOB
- Cough
- Hemoptysis
Which of the clinical manifestations are late signs?
- chest pain
- worsening SOB
- Wheezing
- Increased hemoptysis
What are the symptoms of brain metastasis (cancer has spread to the brain)?
- confusion
- ataxic
- trouble finding words
What are the symptoms of bone metastasis?
Fractures, pain
What diagnostic tests are usually used to confirm lung cancer?
- chest x-ray
- sputum specimen
- bronchoscopy
- computed tomography
- cytological examination, biopsy
- Serum lab studies
- Tuberculin test
- Pulmonary function test/ABGs
After surgery what should a nurse do?
do a thorough lung assessment; if lung sounds are decreased, call the provider!
What is pleurodesis?
when doxycycline is injected into the pleural space which leads to an inflammatory reaction promoting scarring to prevent fluid buildup
What is the preferred treatment for localized tumors with no metastases?
surgery
What types of surgery are available for lung cancer?
- lobectomy
- pneumonectomy (total lung removal)
- segmentectomy
- wedge resection
Before surgery what should a nurse allow a patient/family to do?
allow privacy to “come to grips” with reality; nurse stays nearby to answer any questions
What pharmacologic therapies may be used to treat lung cancer?
- combination chemotherapy
- bronchodilators to reduce airway obstruction
- analgesics to manage pain
- Oxygen therapy (make sure pt is on O2 if hypoxic)
If a patient is increasingly short of breath when on O2 what should the nurse do?
increase O2 flow
What is the pharmacologic treatment of choice for small-cell carcinomas?
Combination chemotherapy
What are some common side effects of chemotherapeutic agents?
- pain
- nausea
- infection
- alopecia (hair loss)
- loss of appetite
- loss of weight
What things can help a patient better tolerate chemotherapeutic agents?
- antiemetics (Reglan, Benadryl, Zofran)
- given over longer time with continuous infusion and small amounts
- Marinol: Marijuana like pill
- Marijuana Oil/THC
What are some oncologic emergencies?
- Superior Vena Cava Syndrome
- Spinal Cord Compression
- Hypercalcemia
- Pericardial effusion/Cardiac tamponade
- Disseminated Intervascular Coagulation
- SIADH
Describe the symptoms of superior vena cava syndrome
increasing dyspnea as well as increasing edema of the face and arms
What happens during cardiac tamponade?
the pericardial sac of the heart has excess fluid/blood causing decreased pumping ability and a cardiac emergency
What would be the intervention for a cardiac tamponade?
Aspirate fluid/blood from the pericardial sac
Why does Superior Vena Cava Syndrome occur?
The superior vena cava gets blocked by cancer causing fluid to backup which leads to increased edema
What are the 3 D’s of Beck’s triad for a cardiac tamponade?
- Distant heart sounds
- Distended jugular veins
- Decreased arterial pressure
What may radiation be used for and how may it be delivered?
- used alone or in combination with surgery, chemotherapy
- maybe either cure or symptom relief
- may be delivered by external beam, intraluminal radiation, and brachytherapy
What is a side effect of radiation?
Burns: need to treat this side effect
What are the nursing care concerns for oncology?
- infection
- skin integrity
- Nutrition
- Pain control
- Psychological adjustment (cure sometimes, relieve often, comfort always)
- body image
Why can body image be an issue for oncology patients?
external scars from surgery and radiation burns change a patients body image
If a patient is fearful/afraid what question should a nurse ask him about?
What is causing the most fear right now?
What assessments should a nurse look for respiratory function?
- look to see if they are using accessory muscles
- look to see if they are cyanotic
- look at current O2 sats
When assessing smoking history what questions should you ask?
- how many packs per day
- how many packs per year
- How many years of smoking
What are some interventions for palliation?
1. oxygen therapy 2 Drug therapy 3. Radiation therapy 4. Thoracentesis and pleurodesis 5. Dyspnea management 6. Pain management 7. Hospice Care
What are some interventions to counteract dyspnea?
- High Fowler’s
- cluster cares
- O2 therapy
If the patient has a poor prognosis and has a DNR what should the patient make sure they keep their DNR?
keep one on their front door, the fridge, and next to the bed
What does chest percussion help with?
Loosening secretions and increasing the ability to cough them up.
If a patient is bed-bound what are some important nursing interventions?
- turn every 2 hours
2. cough and deep-breathe
What do we want the patient to do about their emotions and concerns?
verbalize understanding of them
What are some nursing interventions to promote effective cardiorespiratory function?
- suction airway as needed
- administer supplemental oxygen as needed
- assess and document respiratory status at least every 4 hours
- elevate the head of the bed to 60 degrees
- assist the client to turn, cough, and deep breathe
- Work with RT and use analgesia or sedation to synchronize respirations if a patient is on mechanical ventilation
If the ventilator is doing most of the work for the patient what should the nurse discuss with the family?
Discuss with the family what they want to do next. Take the patient off the ventilator or not
What are the interventions to effectively manage pain?
- assess and document pain using scale
- provide analgesics as needed
- maintain 24-hour medication schedule
- Provide or assist with comfort measures
- Assist client/family to plan activities to distract from pain
- Provide physical and emotional support by spending time with the client and allowing family members to stay with the client
- Pre-medicate to tolerate interventions
What are some nursing interventions to manage fatigue and activity intolerance?
- plan rest periods (cluster care)
- Assist postoperative client to increase activities gradually
- teach measures to conserve energy
- Administer oxygen as prescribed
- encourage maintenance of physical activity to tolerance
- Allow family members to assist
- Provide reassurance and emotional support
How can a nurse help a patient conserve their energy?
- take things slower (Pace and space)
- space out activities to allow for rest
- When moving from the bed to the chair or chair to the bed, move slow and easy, sit on the edge of the bed for a minute or two, move to the chair, catch their breath, and so forth
What are the nursing interventions to promote healthy grieving?
- spend time with the client and family
- Answer questions honestly
- Do not deny probably outcome of disease
- Encourage expression of feelings/fears
- discuss advanced directives such as DNR orders or durable powers of attorney
- Help the patient and family to do as much as they can before the death (funeral plans, patient’s will in order, etc.)
