Welcome to Scribd, the world's digital library. Read, publish, and share books and documents. See more
Download
Standard view
Full view
of .
Look up keyword
Like this
1Activity
0 of .
Results for:
No results containing your search query
P. 1
Lung Cancer, Pneumonia, COPD

Lung Cancer, Pneumonia, COPD

Ratings: (0)|Views: 47|Likes:
Published by Kring-kring Gerenia

More info:

Published by: Kring-kring Gerenia on Feb 23, 2011
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as PDF, TXT or read online from Scribd
See more
See less

01/31/2013

pdf

text

original

 
1
KarissaDeniseH.Gerenia,BSNRN
CANCEROFTHELUNGS
Δ
 
Lungcancerdevelopswhengeneticmutationsoccurinanormalcellwithinthelung.Asaresult,thecellreproducesendlesslyandbecomesacancer.
Δ
 
Thereareusuallynosignsorearlysymptomsoflungcancer.
Δ
 
Aslungcancerstagesadvance,lungcancersymptomsmayincludecoughing,wheezing,shortnessofbreath,andbloodymucus.TypesofLungCancer1.
 
SmallCellLungCancer(
SCLC
)a.
 
20%ofalllungCab.
 
99%associationwithsmokingc.
 
ThemostaggressiveandrapidlygrowingofalllungCad.
 
Usuallymetastaticattimeofdiagnosise.
 
Paraneoplasticsyndromesarecommonf.
 
Surgicalresectionnothelpful2.Non-SmallCellLungCancer(N
SCLC
)a.
 
80%ofalllungCancersb.
 
SurgicalresectionhelpfulforstageIandIIc.
 
Combinationchemotherapyishelpfuld.
 
Radiationusedforcureifdiseaseisconfinedtothecheste.
 
Categorizedintothreetypes
ò
 
Squamouscellcarcinoma(alsocalledepidermoidcarcinoma),Adenocarcinoma,andLargecellcarcinoma
Squamouscellcarcinoma
I.
 
0%ofalllungCaII.
 
StronglyassociatedwithsmokingIII.
 
Slowergrowing,lessinvasiveIV.
 
Foundinbronchiandperipherallung
Adenocarcinoma
I.
 
30-35%ofalllungCaII.
 
IncidencesimilarforsmokersandnonsmokersIII.
 
MostcommonlungCainwomenIV.
 
MetastasisoccursearlyV.
 
Foundinperipherallungtissue
Largecellcarcinomas
I.
 
≈10%ofallLungCaII.
 
SometimesreferredtoasundifferentiatedcarcinomasIII.
 
SlowgrowingIV.
 
Foundinperipherallungtissue**Othertypesofcancerscanariseinthelung;thesetypesaremuchlesscommonthanNSCLCandSCLCandtogethercompriseonly5-10%oflungcancers:
ò
 
Bronchialcarcinoids
accountforupto5%oflungcancers.Thesetumorsaregenerallysmall(3-4cmorless)whendiagnosedandoccurmostcommonlyinpersonsunder40yearsofage.Unrelatedtocigarettesmoking,carcinoidtumorscanmetastasize,andasmallproportionofthesetumorssecretehormone-likesubstances.Carcinoidsgenerallygrowandspreadmoreslowlythanbronchogeniccancers,andmanyaredetectedearlyenoughtobeamenabletosurgicalresection.
ò
 
Cancersofsupportinglungtissuesuchassmoothmuscle,bloodvessels,orcellsinvolvedintheimmuneresponsecanrarelyoccurinthelung.Table2showshowtheTNMstaginginformationfitsintothenumberstagingsystem.
 
2
Pathophysiology:DiagnosticExams/LabTests:a.
 
Chestx-ray:lunglesions,cavitiesformedbysquamouscellcarcinoma,oralace-likepatternofcellsspreadingthroughthelungsb.
 
ComputedTomographyspecifically,low-dosespiral(orhelical)CTfordeterminingifandwherethecancerhasspreadc.
 
Positronemissiontomography(PET)candiagnoselungtumorsassmallas1centimeterwithveryhighaccuracy.PETisagoodimagingtechniqueforstaginglungpatientsthoughttohaveearlystagelungcancerafterothertesting.d.
 
MRI.FrequentlyusedinsteadofCTscanningtolocatebrainandbonetumorsthathavespreadfromthelung.e.
 
Thoracoscopy:diagnosingcancerintheouterareasofthelungs,orthoseinvolvingthepleuraf.
 
Bronchoscopy:locatecancerthatdevelopsinthecentralareasandmajorairwaysofthelung(usuallysquamousorsmall-cellcancer)g.
 
Cytologicexaminationofearlymorningsputumspecimen,orfluidfrompleuraleffusionthroughthroracentesis.Biologicmarkers(biomarkers):i.
 
Enzymesii.
 
Hormonesiii.
 
Amino-acidcompoundsiv.
 
Antigens(identifiedbyantibodiesthatspecificallytargetthem)v.
 
Growthfactorsvi.
 
OtherchemicalsPHYSICALASSESSMENT:Pulmonary1.
 
Chills,fever,andcough2.
 
Blood-tinged/purulentandcopioussputum3.
 
Hemoptysis(latercourseofthedisease)4.
 
Laboredorpainfulbreathingpatterns-Useofaccessorymuscles-Flarednares-Stridor-Asymmetricdiaphragmaticmovementoninspiration5.
 
Rapid,shallowbreathing6.
 
Dyspnea7.
 
Areasoftendernessormassesoverthechestwall8.
 
Increasedchestfremitus9.
 
Tracheamaybedisplaced10.
 
Dullorflatuponpercussionoverareaswithmasses11.
 
Breathsoundschangewiththepresenceoftumor:
-
 
Wheezes(partialobstructionofairflow)
-
 
Decreasedorabsentbreathsounds(completeobstruction)
-
 
Increasedloudness/soundintensityofthevoicewhilelisteningtobreathsounds(increaseddensityoflungtissuefromtumorcompression)
-
 
PleuralfrictionrubheardwheninflammationisalsopresentNonpulmonary1.
 
Muffledheartsounds(cardiactamponade)2.
 
Dysrythmias3.
 
Cyanosisoflipsandfingertips/clubbing4.
 
Thinningbones5.
 
Bonepain/pathologicfractures
Latemanifestations
:6.
 
Fatigue7.
 
Weightloss8.
 
Anorexia9.
 
Dysphagia10.
 
Nauseaandvomiting11.
 
Superiorvenacavasyndrome12.
 
Lethargyandsomnolence13.
 
Confusionandpersonalitychanges14.
 
Diminishedbowelandbladderfunction15.
 
Psychosocial:fear,anxiety,guiltandshame.INTERVENTIONSFORCARENonsurgicalManagement1.
Chemotherapy
.Itmaybeusedaloneorasadjuvanttherapyincombinationw/surgeryforNSCLC.Sideeffectsthatoccurwithchemotherapyforlungcancerincludealopecia,nauseaandvomiting,mucositis,immunosuppression,anemia,andthrombocytopenia.(table3chemo.agents)
 
3
Table3CommonChemotherapyAgentsforLungCa
GenericNameTradeName
CarboplatinParaplatinCisplatinPlatinolDocetaxelTaxotereGemcitabineGemzarPaclitaxelTaxolVinorelbineNavelbine*PemetrexedAlimta
NursingInterventions:
 
Reassureclientthathairlossistemporary(makeuseofwigs,scarves,turbans,andhats)
 
Administerantiemeticbefore&/therapyasordered
 
Frequentmouthassessmentandoralhygiene
 
Instructuseofsoft-bristledtoothbrush&avoidusingdentalfloss
 
Teachclient&familyprecautionstoreduceclient’schancesofdevelopinginfection2.
RadiationTherapy
.Besteffectivetreatmentforlocallyadvancedlungcancersconfinedtothechest.Usuallyperformeddailyfora5-to6-weekperiod.Sideeffectsincludeskinirritationandpeeling,fatigue,nausea,andtastechanges.Forsome,esophagitisandnarrowingofesophagus.-External-BeamRadiation-Brachytherapy
NursingInterventions:
 
Skincareontheradiation-treatedarea:instructclientnottowashoffthemarkingsthatoutlinetheareasforradiation
 
Avoiduseoflotion/ointmentsonskinofchestunlessradiologistsprescribethem
 
Instructclienttoavoiddirectexposuretosunlightduringtreatmentandatleast1yearafterradiationiscompleted
SURGICALMANAGEMENT
 
Thesurgicalremovalofanentirelobeorpartsofalungistheprimarytreatmentforeligiblepatientsintheearlystagesofcancer
 
Recurrenceishighaftersurgery,althoughthenewtumorisoftenoperable
 
StandardsurgicalproceduresincludeWedgeResectionorsegmentectomy,lobectomy,andpneumonectomy.
Preoperativecaregoal:relieveanxiety&promoteclient’scooperation
 
Encourageclienttoexpressfearandconcerns
 
Reinforcesurgeon’sexplanationofSxprocedure
 
Provideeducationr/twhatisexpectedafterSx
 
Teachabouttheprobablelocationofincision,howtoperformcoughing,DBE,shoulderexercises,andaboutchesttubeanddrainagesystem
Postoperativecare:
 
Maintainapatentairway,andmonitorchesttubestoreestablishnormalintrathoracicpressure
 
Monitorv/sandreportabnormalrespiration
 
Suctionpatientoftenandencouragecoughinganddeepbreathing
 
Monitorchestdrainage;keepchesttubespatentanddrainingeffectively;watchforairleaksandreportthemimmediately
 
Positionpatientonsurgicalsidetopromotedrainageandlungexpansion
 
AdequatehydrationINTERVENTIONSFORPALLIATION1.Supplementaloxygentherapyforhypoxemicclients2.Drugtherapy:
 
Bronchodilatorsandcorticosteroidstodecreasebronchospasm,inflammation&edema
 
Mucolytics
 
Appropriateantibiotictherapy3.Radiationtherapytorelievehemoptysis,obstructionofbronchiandgreatveins,dysphagia,andpainfrombonemetastasis4.Lasertherapytodebulkbronchialobstruction5.Dyspneamanagement:
 
Placeinsemi-fowler’sposition
 
Supplementaloxygen
 
Alternaterestandactivityperiods6.Painmanagement:
 
Pharmacologicmanagementwithopioiddrugsasoralorparenteralpreparations;analgesicsroundtheclock
 
Nonpharmacologicmeasures:positioning,hotorcoldcompresses,distractions,andguidedimagery
 
Reduceoreliminatefactorsthatprecipitatepain

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->