Week 6: Lung Cancer: lower respiratory disorder Flashcards
What is Lung Cancer?
uncontrolled growth of abnormal cells in the lungs causes lung cancer
2 Major types of Lung Cancer
- Non-small-cell cancer
2. Small-cell cancer
Non-small cell cancer
- represents 85% of lung cancers
- consists of 3 types of cells; squamous cell-carcinoma, adenocarcinoma, and large-cell carcinoma
- the 5-year survival rate for those diagnosed with non-small-cell cancer if diagnosed in the early stage is good
Small-cell cancer
(oat-cell cancer)
- represents 15% of lung cancers
- grows quickly and metastasizes to other organs in the body
- independent of the stage at diagnosis, survival statistics are poor; only 5 to 10% of those developing small-cell cancers survive for 5 years
Clinical Manifestations
not evident early in the disease but become apparent as disease advances
-new cough that does not go away or changes in chronic cough
-hemoptysis (blood in sputum)
-SOB
-wheezing
-hoarseness
-chest pain
-headache and bone pain may also be present
-weight loss is common
>as disease progresses, symptoms worsen
Diagnosis
made through several methods:
- chest x-ray
- CT scan of the chest
- sputum for cytology
- bronchoscopy
- PET scans
- bone scans and abdominal scans
- mediastinoscopy
A chest x-ray or CT scan of the chest may identify?
a pulmonary lesion
A cytology test on sputum may identify?
specific tumor cells
Bronchoscopy or mediastinoscopy are performed for?
direct visualization of the tissues to aid in diagnosis of lung cancer
-Bronchoscopy is the assessment of the larger airways, the trachea and bronchi, through a scope inserted through the mouth or nose
Mediastinoscopy is a surgical procedure that allows for direct visualization of the mediastinum, a scope is inserted through an incision in the chest that allows for direct examination and collection of samples for biopsy
Bronchoscopy
the assessment of the larger airways, the trachea and bronchi, through a scope inserted through the mouth or nose
Mediastinoscopy
a surgical procedure that allows for direct visualization of the mediastinum
-a scope is inserted through an incision in the chest that allows for direct examination and collection of samples for biopsy
Bone Scans and Abdominal Scans are performed for?
to look for metastatic lesions
PET scan is used for?
to identify changes in the body’s metabolism and function rather than structure
-can detect areas of increased metabolic activity as occurs with rapidly dividing cancer cells
Treatment for Lung Cancer is based on what?
is interprofessional and is dependent on the type, size, location, and stage of the tumor
The components of non-surgical treatment
- typically consists of a combination of radiation and chemotherapy
- pain management
Chemotherapeutic Agent
is dependent on the type and or/size of the tumor
-may be used in conjunction with surgery or may be the primary treatment option for more advanced cancers or if the patient is too ill for surgery
Radiation therapy
- have great versatility
- in situations where surgery is not an option, radiation can be used
- can also be used palliatively to relieve symptoms or for pain control
- also used to shrink the tumor prior to surgery or after surgery to kill any remaining cancer cells
Pain Control
- major component in lung cancer management
- a pain relief ladder developed by the World Health Organization is helpful as a guideline for pain control
- 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 rather than on demand to avoid peaks of pain
Palliative Care Services
are appropriate to consider with the diagnosis of life-threatening illness like lung cancer
- improves the quality of life of patients and their families
- provides pain relief
- helps 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
-several types of surgery depending on size and tumor site
>lobectomy
>pneumonectomy
>wedge resection
Surgical Management: Lobectomy
removal of entire lobe of lung
Surgical Management: Pneumonectomy
removal of entire lung
Surgical Management: Wedge resection
removal of a small section of a lobe of the lung
Chemotherapy
- may be administered prior to surgery to reduce the size of the tumor and aid in resection
- the administration of a chemotherapeutic agent in an effort to shrink the tumor prior to surgery is a type of neoadjuvant therapy
- can be used as an adjuvant therapy after surgery to kill any remaining cancer cells
Chemotherapy and Radiation can be used as what types of therapy?
- neoadjuvant therapy (effort to shrink he tumor prior to surgery)
- adjuvant therapy (after surgery to kill any remaining cancer cells)
Nursing Interventions: Assessment
Assess:
- oxygen saturation (decreased SpO2 is due to poor gas exchange)
- temperature (increased = infection)
- breath sounds (presences of wheezes = airway obstruction, rhonchi= increased secretions in upper airway)
- cough
- pain
- appetite/weight
Nursing Intervention: focused post-op assessment
- Vital signs (hypotension and/ or tachycardia may indicate excessive blood or fluid loss
- breath sounds (diminished or absent =post-op atelectasis)
- suture line (a suture line that is reddened, warm to touch, and/or draining thick, yellow drainage may indicate infection)
- chest tube; monitor amount and color of chest tube drainage (excessive bloody drainage may indicate a bleed within the chest. cloudy drainage may indicate infection)
- monitor water-seal chamber in chest tube (persistent bubbling in the water-seal chamber indicates an air leak in the chest tube system)
Nursing Interventions: Actions
-provide oxygen
-administer medications as ordered (pain medications/ anti-anxiety meds provide relief from both pain and anxiety, allowing better relaxation, increased expansion of the lungs to improve oxygenation, and improved quality of life
-bronchodilators (bronchial smooth muscle relaxants, open the airway and decrease 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-fowlers (increases oxygenation by allowing full lung expansion)
-focused post-op actions
>maintain a closed chest tube system (prevents 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 tension pneumothorax)
Client Education
- breathing techniques (pursed-lip breathing encourages exchange of O2 and CO2)
- pacing activities (conserves energy and decreases work of breathing)
- smoking cessation
- nutritional needs (small, frequent meals decrease the work of breathing with less impact on the diaphragm)
- medication regimen
- use of pain medications around the clock
