Med-Surg: Chapter 26: Lung Cancer Flashcards
Epidemiology
- second most common cancer in both men and women
- number one cancer killer in the US for both men and woman
- survival rates based on the stage of the disease
- major cause and most preventable is smoking
Pathophysiology
the uncontrolled growth of abnormal cells in the lungs causes lung cancer
Two types of Lung Cancer
- non-small cell
- small cell
Non-small cell cancer
-represents 85% of lung cancers >consists of 3 types of cells: -squamous-cell carcinoma -adenocarcinoma -large-cell carcinoma
Small-cell cancer
“oat-cell” cancer
- represents 15% of lung cancer
- grows quickly and metastasizes to other organs in the body
- survival statistics poor
Diagnosis
- Chest x-ray
- Computed tomography (CT) scan of the chest
- Sputum for cytology
- Bronchoscopy
- Positron Emission tomography (PET) scans
- Bone scans and Abdominal scans
- Mediastinoscopy
What would a chest x-ray or CT scan show?
-a pulmonary lesion
What would a cytology test on sputum identify?
-specific tumor cells
Bronchoscopy
allows direct visualization of the tissues to aid in diagnosis
-is the assessment of the larger airways, the trachea and bronchi, through a scope inserted through the mouth or nose
Mediastinoscopy
allows direct visualization of the tissues to aid in diagnosis
- surgical procedure that allows for direct visualization of the mediastinum
- a scope is inserted through an incision in the chest that allows direct examination and collection of samples for biopsy
Why are Bone scans and Abdominal scans performed?
to look for metastatic lesions
Positron Emission Tomography (PET) scans
used to identify change’s in the body’s metabolism and function rather than structure
-PET scan can detect areas of increased metabolic activity as occurs with rapidly dividing cancer cells
Treatment for Lung Cancer is Based on?
is interprofessional and is dependent on the type, size, location, and stage of the tumor
Non-surgical Treatments
- combination of radiation and chemotherapy
- pain management
Non-Surgical Treatment: Chemotherapeutic Agent
the chemotherapeutic agent used to treat lung cancer is dependent on the type and/or size of the tumor
- may be used in conjunction with surgery
- may be the primary treatment option for more advanced cancers or if the patient is too ill for surgery
Non-Surgical Treatment: Radiation Therapy
in situations where surgery is not an option
-can be used palliatively to relieve symptoms or for pain control
Pain Control
major component in lung cancer management
>Pain relief ladder
-Step 1: use of nonopioid analgesics (acetaminophen or NSAIDs) for mild to moderate pain
-Step 2: moderately potent opioid (codeine, hydrocodone, and oxycodone) plus a nonopioid for persistent pain or pain not controlled by step 1
-Step 3: use of stronger opioids (morphine, fentanyl) plus a nonopioid for uncontrolled or severe pain
>the use of adjuvant or additional medications is important to consider at all levels of treatment to relieve patient anxiety
>pain medication needs to be administered around the clock to avoid peaks of pain
When should pain medication be administered?
around the clock
-to avoid peaks of pain
Pain Control Relief Ladder Steps
> Step 1:
-use of non-opioid analgesics (acetaminophen or NSAIDs) for mild to moderate pain
> Step 2:
-moderately potent opioid (codeine, hydrocodone, and oxycodone) plus a non-opioid for persistent pain or pain not controlled by step 1
> Step 3:
-use of stronger opioids (morphine, fentanyl) plus a non-opioid for uncontrolled or severe pain
Palliative Care Services
appropriate to consider with the diagnosis of a life-threatening illness like lung cancer
- palliative care improves the quality of life of patients and families
- provides pain relief
- can help in the management of other distressing and debilitating symptoms such as SOB, nausea, and vomiting
Surgical Management
preferred treatment if there is no metastasis -used for non-small-cell tumors >Types: -Lobectomy -Pneumonectomy -Wedge Resection
Lobectomy
the removal of an entire lobe of the lung
Pneumonectomy
removal of the entire lung
Wedge Resection
the removal of a small section of a lobe of the lung
Chemotherapy and Surgery
- chemotherapy may be administered before (prior) to surgery to reduce the size of the tumor and aid in resection; neoadjuvant therapy
- can be used as an adjuvant therapy (after) surgery to kill any remaining cancer cells
Radiation and Surgery
radiation can be used to shrink the tumor before (prior) to surgery or after surgery to kill any remaining cancer cells
Patient with lung cancer presents with the following characteristics as a result of abnormal cell growth and tumors in the lungs causing impaired chest movement and air exchange; usually occur in late stages
- persistent cough
- dyspnea (difficulty or labored breathing)
- wheezing
- hemoptysis (blood in mucus)
- chest pain
- frequent episodes of pneumonia or bronchitis
Nursing Diagnoses
- ineffective gas exchange r/t disruption of pulmonary cells secondary to lung cancer
- anxiety r/t the inability to breathe effectively
- activity intolerance r/t fatigue and dyspnea
Nursing Interventions: Assessments
> Oxygen Saturation
- decreased SpO2 is due to poor gas exchange
- SpO2 less than 90% = oxygenation problems
> Temperature
-increased = signs of infection
> Breath Sounds
- presence of wheezes may = airway obstruction
- Rhonchi = increased secretions in the upper airways
> Cough
- indicates an irritation of the tracheobronchial tree
- presence of hemoptysis = rupture of small blood vessels
> Pain
-pain increases respiratory rate; anxiety decreases quality of life
> Appetite/Weight
- appetite may be decreased b/c of side effects of chemotherapy or loss of energy due to increased work of breathing
- monitoring weight helps identify nutritional deficiencies
Focused Post-operative Assessment
> Vital Signs
-hypotension and/or tachycardia may = excessive blood or fluid loss
> Breath Sounds
-diminished or absent may = postoperative atelectasis
> Suture Line
-reddened, warm to touch, and/or draining thick, yellow drainage = infection
> Chest Tube
- monitor amount and color of chest tube drainage; excessive bloody drainage may = a bleed within the chest; cloudy may = infection
- monitor water-seal chamber; persistent bubbling in the water-sea chamber = an air leak in the chest tube system
Nursing Actions
> Provide Oxygen
-increase the SpO2 to 90%
> Administer Medications as ordered
- Pain medications/ Anti-anxiety medications: pain and anti-anxiety medications provide relief from both pain and anxiety, allowing better relaxation, increased expansion of the lungs to improve oxygenation, and improve quality of life
- Bronchodilators: bronchodilators, bronchial smooth muscle relaxants, open the airway and decrease the work of breathing
> Provide small, frequent meals with dietary supplements
- small, frequent meals avoid excessive pressure on the diaphragm associated with a large meal
- dietary supplements increase nutritional caloric intake, providing energy for the work of breathing
> Position- Semi-fowler’s
-increases oxygenation by allowing full lung expansion
Focused Post-operative Actions
> Maintain a closed chest tube system
-closed system prevents any inadvertent air leaks
> Never clamp the chest tube
-may result in increased air or fluid in the pleural space, worsening the pneumothorax, and may lead to a tension pneumothorax
Teaching
> Breathing techniques
- help to increase the clearance of sputum and reduce the sense of breathlessness
- pursed-lip breathing encourages the exchange of oxygen and carbon dioxide
> Pacing activities
-pacing conserves energy and decreases the work of breathing
> Smoking Cessation Program
-smoking cessation can change the course of the disease process
> Nutritional Needs
-small, frequent meals decrease the work of breathing with less impact on the diaphragm
> Medication Regimen
-knowledge regarding medications and their use, such as proper use of inhalers, increases the ability to manage the disease
> Use of pain medications around the clock
-improves patient comfort and quality of life by maintaining a level of pain control rather than suffering peaks of discomfort
Evaluating Care Outcomes
> a well-managed patient with lung cancer has:
- the pain under control
- sufficient appetite and weight
- adequate oxygenation
> positive outcomes are achieved through
- around-the-clock pain medication
- small, frequent meals
- appropriate use of oxygen and bronchodilators
> regular provider follow-up and palliative care referrals are essential to maintaining an optimal quality of life
Lung Cancer: Risk Factors, S/S, Metastasis
> Risk Factors:
- asbestos
- coal
- soot
- tar
- pollution
- tobacco
- wood dust
> S/S:
- chronic cough
- hemoptysis
- dyspnea
- chest discomfort
- weight loss
- paraneoplastic syndromes
> Metastasis:
-brain, bone, adrenal gland, contralateral lung
