Med-Surg: Chapter 26: Lung Cancer

Question 1

Epidemiology

Answer 1

• 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

Question 2

Pathophysiology

Answer 2

the uncontrolled growth of abnormal cells in the lungs causes lung cancer

Question 3

Two types of Lung Cancer

Answer 3

• non-small cell

- small cell

Question 4

Non-small cell cancer

Answer 4

-represents 85% of lung cancers
>consists of 3 types of cells:
-squamous-cell carcinoma
-adenocarcinoma
-large-cell carcinoma

Question 5

Small-cell cancer

Answer 5

“oat-cell” cancer

• represents 15% of lung cancer
• grows quickly and metastasizes to other organs in the body
• survival statistics poor

Question 6

Diagnosis

Answer 6

• 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

Question 7

What would a chest x-ray or CT scan show?

Answer 7

-a pulmonary lesion

Question 8

What would a cytology test on sputum identify?

Answer 8

-specific tumor cells

Question 9

Bronchoscopy

Answer 9

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

Question 10

Mediastinoscopy

Answer 10

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

Question 11

Why are Bone scans and Abdominal scans performed?

Answer 11

to look for metastatic lesions

Question 12

Positron Emission Tomography (PET) scans

Answer 12

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

Question 13

Treatment for Lung Cancer is Based on?

Answer 13

is interprofessional and is dependent on the type, size, location, and stage of the tumor

Question 14

Non-surgical Treatments

Answer 14

• combination of radiation and chemotherapy

- pain management

Question 15

Non-Surgical Treatment: Chemotherapeutic Agent

Answer 15

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

Question 16

Non-Surgical Treatment: Radiation Therapy

Answer 16

in situations where surgery is not an option

-can be used palliatively to relieve symptoms or for pain control

Question 17

Pain Control

Answer 17

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

Question 18

When should pain medication be administered?

Answer 18

around the clock

-to avoid peaks of pain

Question 19

Pain Control Relief Ladder Steps

Answer 19

> 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

Question 20

Palliative Care Services

Answer 20

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

Question 21

Surgical Management

Answer 21

preferred treatment if there is no metastasis
-used for non-small-cell tumors
>Types:
-Lobectomy
-Pneumonectomy
-Wedge Resection

Question 22

Lobectomy

Answer 22

the removal of an entire lobe of the lung

Question 23

Pneumonectomy

Answer 23

removal of the entire lung

Question 24

Wedge Resection

Answer 24

the removal of a small section of a lobe of the lung

Question 25

Chemotherapy and Surgery

Answer 25

• 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

Question 26

Radiation and Surgery

Answer 26

radiation can be used to shrink the tumor before (prior) to surgery or after surgery to kill any remaining cancer cells

Question 27

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

Answer 27

• persistent cough
• dyspnea (difficulty or labored breathing)
• wheezing
• hemoptysis (blood in mucus)
• chest pain
• frequent episodes of pneumonia or bronchitis

Question 28

Nursing Diagnoses

Answer 28

• 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

Question 29

Nursing Interventions: Assessments

Answer 29

> 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

Question 30

Focused Post-operative Assessment

Answer 30

> 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

Question 31

Nursing Actions

Answer 31

> 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

Question 32

Focused Post-operative Actions

Answer 32

> 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

Question 33

Teaching

Answer 33

> 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

Question 34

Evaluating Care Outcomes

Answer 34

> 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

Question 35

Lung Cancer: Risk Factors, S/S, Metastasis

Answer 35

> 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