Lung Cancer and Pneumothorax/ Hemothorax

Question 1

Lung Cancer

Answer 1

Treatments are to meet unique needs of each person

Vary with the type of lung cancer a person has

Question 2

Staging

Answer 2

Will determine survival
Will determine options for treatment
- Specifically if treatment is for cure or palliation

Question 3

Small Cell Lung Cancer

Answer 3

Treatment based on stage of cancer
PT overall health
Options
- Chemotherapy
- Radiation
- Surgery: rarely used because metastases has usually occurred by diagnosis

Question 4

Non- Small Cell Lung Cancer: Treatment Options

Answer 4

Surgery 
- Wedge resection: remove tumour and margin of healthy tissue
- Lobectomy: Remove lobe with tumour
- Pneumonectomy: Removal of whole lung
Radiation
-  With chemo for inoperable tumour
- Prior to surgery to shrink tumour
- Alone
- Palliative to provide comfort

Question 5

Care of Cancer Patients

Answer 5

No matter where the cancer is, caring for clients with cancer is similar
Monitoring side effects of treatment
Managing pain
Helping family deal with decisions
Giving patients as much control as possible

Question 6

Client with Pneumothorax

Answer 6

Treatment dependent upon severity of the problem

• Small ones: may involve several x-rays to monitor resolution without intervention
• Symptomatic requires insertion of chest tubes (thoracostomy)

Question 7

Therapeutic Modalities

Answer 7

Thoracentesis
Thoracotomy
Chest tube

Question 8

Thoracentesis

Answer 8

Needle insertion into pleural space to aspirate the air
- Positioning important: post on unaffected side for an hour
- Assessing respiratory system for any complications post
Emergency treatment for tension pneumothorax
- Insertion of large bore needle to relieve pressure on mediastinum

Question 9

Thoracostomy

Answer 9

Placement of closed-chest catheter to allow lungs to re-expand

• Chest tube under “water seal” or closed drainage system; low-suction applied to re-establish negative pressure in pleural space
• Heimlich (one-way valve) may also be inserted

Question 10

Pleurodesis

Answer 10

Creation of adhesions between parietal and visceral pleura to prevent recurrent pneumothorax

• Instillation of chemical agent (doxycycline) to cause inflammation and scarring
• Surgery: surgical creation of adhesions or partially excise parietal pleura

Question 11

Pneumothorax: Nursing Care

Answer 11

Assessment of respiratory status and pain
Impaired gas exchange
Risk for injury: maintenance of chest tube keeping drainage system lower than the chest; especially during ambulation
- Accidental removal of chest tube, need to cover with an occlusive dressing, vaseline gauze
Altered comfort
Continuing care
- Avoid smoking
- Follow-up care and monitoring

Question 12

Client with Pneumothorax: Home Care

Answer 12

Risk of occurrence 40-50% after single episode of spontaneous pneumothorax
May be advised to avoid change in altitude
Avoid contact sports
Seek medical assistance if manifestations occur

Question 13

Client with Hemothorax: Treatment

Answer 13

Rib fracture: adequate analgesia, rib belt, binders, taping

Flail chest and pulmonary contusion: often requires intubation and mechanical ventilation; intensive care management

Question 14

Client with Hemothorax: Nursing Diagnoses

Answer 14

Acute pain
Ineffective airway clearance
Impaired gas exchange: hyperoxygenation prior to suctioning; fluid management to control pulmonary edema

Question 15

Client with Hemothorax: Home Care

Answer 15

Rib fractures are often managed at home
Significant pulmonary contusion can result in long-term insufficiency requiring home health referral
Client and family education regarding care of chronic respiratory problem