DESCRIPTION OF HEALTH CONDITION

Lung Cancer is the leading cause of

cancer death among men. It commonly occur
in individuals more than 50 years of age who
have a long history of cigarette smoking. Non
small cell lung cancer (NSCLC) accounts for
80% of the primary lung cancers.
Adenocarcinoma has been associated
with lung scarring and chronic interstitial
fibrosis; is not related to cigarette smoking,
often has no manifestations until -widespread
metastasis is present.
Source: Medical Surgical Nursing: Assessment and Management of Clinical Problems volume 1 by Lewis p.578-585
 STATISTICAL DATA
Lung cancer is currently responsible for 29% of
cancer deaths in the United States. Even though
more women are diagnosed with breast cancer and
more men with prostate cancers, lung cancer
remains the leading cause of cancer deaths for
both men and women.
Source: http://lung cancer.about.com/od/whatislungcancer/a/lungcancerstats.htm

Here in the Philippines, lung cancer kills 80% of

those diagnosed (8,518 or 14.2% mortality among
10,643 or 17.4% incidence) of all those diagnosed
with the disease compared to 35% mortality among
breast cancer. Every year, there are about 20,000
smoking related deaths in the country.
Source: http:/www.tribuneonline..org/metro/20101212met5.html
OBJECTIVES

To define what lung cancer, its pathophysiology is and

enumerate the signs and symptoms including its risk factors.

To understand options in the different type of medical

treatment necessary

To learn new clinical skills, as well as sharpen our current

clinical skills those are required in the management of a
terminally ill patient having lung cancer.

To formulate and apply nursing care plan using the nursing
process.

To provide nursing care applicable to a terminally ill lung

cancer patient.

To help nursing students to avoid and quit smoking and be

a model for others a part of the health care team.
SCOPE AND LIMITATION

SCOPE
This study covers and focuses on:
A brief discussion of lung cancer and its pathophysiology
Drug study that has been prescribed to and taken by the patient during
hospitalization at PPL-Bay, and we included medications that has been prescribed
by his previous consultation from other health care providers.
Nursing Care Plan that covers action that would help the patient in his terminal
condition.
LIMITATION
This study only covers the period of confinement of our patient that has been
hospitalized during our clinical exposure last February 13, 20011 during our 6-2
shift.
All the laboratory exams of the patients that we had gathered were limited to the
laboratory results the patient presented to us during his confinement at PPL-Bay
during our shift.
This study was only limited to Lung cancer, this is our main focus.
 BACKGROUND OF THE STUDY

We decided to choose to present this case due to the

complexity of the case, and our eagerness to learn and
explore new knowledge regarding lung cancer. Our group
found this case, uncommon and rare in any other cases that
we handled. And we do believe that this can be of great help
in understanding and performing appropriate nursing
interventions to the patient. It is of great advantage that the
patient also gains knowledge about this condition. Also, we
choose this case because we want to provide nursing care to
a terminally ill client and also, for those people who smoke to
let them know the consequences of smoking.
SIGNIFICANCE OF THE STUDY
The study is done for the benefits of the following:
a. STUDENT NURSE
To impart to them the knowledge and understanding
about lung cancer and to have the appropriate and relevant
nursing care that can be use for this kind of condition.
b. CLIENT AND RELATIVES
To have the necessary information and help them
understand the condition and its complications and how they can
support and care for the person having the disease.
c. READER
For them to acquire and gain more knowledge about
lung cancer, about its signs and symptoms, cause, treatment
regimen and necessary type of management that can be use and
necessary information on how to prevent themselves in getting it.
Name: Mr. XXX
Address: Brgy. Dila Bay, Laguna
Age: 66 years old
Date of Birth: May 28, 1944
Place of birth: Calauan, Laguna
Religion: Roman Catholic
Nationality: Filipino
Date of Admission: February 13, 2011
Time: 08:45 am
Admitting Diagnosis: Lung Cancer, Stage IV
Case Number: 25112
Admitting Physician: Dr. Giovanni Lagoc, MD
A. PRESENT HEALTH HISTORY
2 yrs. prior to admission, the client quitted smoking and there he experience
withdrawal syndrome.
8 months prior to admission around May 2010, he felt difficulty in sleeping, night
sweat, chest pain, difficulty in breathing and productive cough.
7 months prior to admission around June 2010, he was advised to have chest X-ray
and after that he has been treated with RIPES for 6 months then after 6 months they
complaint of feeling bad and the treatment given afforded no relief.
2 months prior to admission around December 2010, he complaint of difficulty
swallowing and sleeping accompanied by severe cough by then they consulted a
physician and after several test he was then diagnosed to have a Lung cancer, stage
4.
1 month prior to admission around January 2011, he complaint of difficulty
urinating and defecating, hoarseness, numbness in the left upper extremities.
1 day prior to admission at February 20, 2011, he was admitted due to productive
cough, difficulty of breathing, chest pain, weakness, hoarseness, pain in the right
neck and numbness in the left upper extremities.
B. PAST HEALTH HISTORY
He hadn’t experience any disease when he was a child
even when he turned into teenage life. But when he is at his
adulthood stage of life he was exposed to measles by then he
doesn’t have any serious complications until he reaches the
age of 65 where he experience having severe cough that soon
became his present condition, having lung cancer. One factor
is that when he started smoking when he was in grade 6, 1
stick per day and continued till he used to smoke 1 pack per
day. When he reaches the age of 63 he quitted smoking.
C. FAMILY HEALTH HISTORY
According to the patient, no one of the member of
their family had cancer. His father died due to diabetes
mellitus and her mother had asthma. Her wife told us that
their family is in good health, and that this is the first time
that someone had cancer in their family.
D. DEVELOPMENTAL HISTORY

EXPERIENCE VERBALIZATION INTERPRETATION

Erik Erikson’s “Tanggap ko na kung INTEGRITY;

Psychosocial Stages anu mang ipagkaloob As individuals
of Development: ng maykapal, kunin approach the end of
Integrity versus man nya ako, handa life, they tend to take
Despair na ako.”, as stock of the years
verbalized by the that have gone
patient. before. Our client
feels a sense of
satisfaction with his
accomplishments in
life.
 “Grade 6 ako unang nanigarilyo, ORAL STAGE;
Sigmund Freud’s Freud believed that all human
isang stick kada isang araw
beings pass through a series
Psychosexual Stages of hanggang sa maging isang kaha of psychosexual stages; each
Development: na isang araw.”, as verbalized by stage dominated by the
development of sensitivity in a
the patient. particular erogenous or
pleasure giving spot in the
body. Furthermore, each stage
poses for individual a unique
conflict that they must resolve
before they go to the next
higher stage. If individuals are
unsuccessful in resolving the
conflict, the resulting
frustration becomes chronic
and remains a central feature
of their psychological make-
up.

Jean Piaget’s Cognitive “Pareho kami nang asawa kong FORMAL OPERATIONAL
gumagawa ng desisyon tungkol PERIOD;
Stages of Development
sa mga problema man na Individuals are capable of
nararanasan naming sa buhay.”, systematic deductive reasoning
as verbalized by the patient. that permits them to consider
many possible solutions to a
problem and pick the best action
to take.

Sources: Shaffer. David R. Developmental Psychology Theory Research and Application. California: Brooke Cole Publishing
Company, 1985
E. SOCIO ECONOMIC
A person who was diagnosed having a lung cancer must
undergo certain procedures that cost much to maintain living and
prevent further complications. Given the privilege from raising his
children, patient XXX was being supported financially by her
daughter working abroad as a nurse. He receives ₱5000.00
monthly for the examinations and tests he must undergo. His
hospitalization and other needs such as medications, foods, and
etc. are being provided by his other relatives. Since he and his
wife don’t have work, they are seeking for help to sustained their
daily needs from their children and other relatives.
F. PYCHOLOGICAL STATUS
BEFORE THE ILLNESS
Patient XXX is fond of smoking and considers a
cigarette as a part of his daily life. He thought that he can’t live without a
cigarette in his life and feels that his strength comes from his vice.
Even being prohibited by his daughter which is a
Nurse and his relatives, Patient XXX can’t stop himself from smoking.

WHEN DIAGNOSED / DURING ILLNESS

When patient XXX felt difficulty sleeping, swallowing
and having productive cough, her family consulted a Doctor for him. When
being advised by the doctor to quit smoking, he thought that he can
successfully cease his smoking habit to relieve his feeling of ill. His first
time trying not to smoke made him realize that it is hard to turn his back in
his daily habit and he stated, “Tanggap ko na kung ano mang ipagkaloob
sa akin ng panginoon” as verbalized by the patient.
G. SOCIO – CULTURAL
One of patient XXX’s child was a Registered Nurse
and it serves as a main factor that influenced his health belief – to
seek medical treatment. They first consulted a doctor when he felt
illness and preferred to Medical Management when it comes to his
health. However, they also believed in “faith healers”, as some of
Filipino’s tradition.

H. SPIRITUAL
As Christians, patient XXX and his family was able
to deal with God in their daily lives. When he was diagnosed having a
Lung Cancer, the family entrust patient XXX’s life on God’s hand and
prepared themselves to accept whatever will happen to patient XXX.
I. NUTRITIONAL

BEFORE HOSPITALIZATION DURING HOSPITALIZATION

Breakfast Breakfast
2-3 cups of rice 2-3 tbsp. soup
1 med. size fried fish ½ glass of water
1 cup coffee
1-2 glasses of water

Lunch Lunch
2-3 cups of rice 3-4 tbsp. soup
1 ½ servings of vegetable ½ glass of water
1 med. size pork
2-3 glasses of water
Snack
4-5 pcs. Bread
1 glass of water
Dinner Dinner
2-3 cups rice 2-3 tbsp. soup
1 serving of vegetable ½ glass of water
2-3 glasses of water
He ate meals in a moderate manner- the When he was diagnosed, the doctor
usual meal for a sedentary man ordered a soft diet for him to take.
After few days, he was ordered to have
a diet as tolerated.

His usual oral fluid intake was about 6-7 At the hospital, Patient XX’s fluid and
glasses of water per day, with exception electrolytes was maintained through
to coffee and beverages. intravenous fluids and supported by
oral fluid intake.

Before the illness, patient XXX weighs at Previously, patient XXX weighs about
about 65 kilograms. 40 kilograms, due to his unusual eating
habits and having difficulty swallowing.
 J. ELIMINATION
J. ELIMINATION
BEFORE HOSPITALIZATION
 The patient defecates for at least 1-2
times a day.
 January 2011 the patient defecates twice
or thrice a week.
 The patient urinates approximately 4-6
times a day with no other problems in
voiding.
K. EXERCISE
BEFORE HOSPITALIZATION
 The patient was able to ambulate around
their house and going to the store
without any assistance in his side.
DURING HOSPITALIZATION
 Sometimes the patient defecate once a
day and sometimes none.
 February 2011, the patient has difficulty in
voiding, he defecates twice or thrice a
week.
 During his hospitalization, the patient has
difficulty in urinating. He uses adult
diaper, he consume 2 diapers per day.
DURING HOSPITALIZATION
 The patient was able ambulate with
assistance in his side.
 The patient experience fatigue and
weakness due to decrease in oxygen level
in the body.
L. HYGIENE

BEFORE HOSPITALIZATION DURING HOSPITALIZATION

 He takes a bath 1-2 times a day with
Luke warm water.
 He washes his hand before and after
eating.
 He brushes his teeth every after meal.
 He can change and wear clothes or
dress if ever he wants.
 He can trim nails by his self.
 His relative provides sponge bath to
him.
 He neglects to wash his hand before
and after eating.
 He brushes his teeth irregularly.
 His wife changes his cloth or any
available relatives.
 His relative is the one who trim his
nails.

M. SLEEP
BEFORE HOSPITALIZATION DURING HOSPITALIZATION

 He usually sleeps around ten o’clock in
the evening and awake at five o’clock in
the morning or earlier.
 He had a difficulty in sleeping due to the
attacks of his condition including
coughing.
 He has a productive cough with clear
white sticky mucous secretions.
 The patient sleep five hours or less due
to ambiance of hospital.
 AREA METHODS FINDINGS INTERPRETATION

Integument - brown -normal, older person’s skin

Skin - even in overall becomes pale due to
skin color decreased melanin
- presence of production and decreased
Inspection paleness of the dermal vascularity.
skin
* Janet Weber, Jane H. Kelley;
Health Assessment in Nursing 3rd
Edition © 2007- Chapter 11 p. 166

- poor skin turgor -older person’s skin loses

- dry, warm its turgor because of a
decrease in elasticity and
collagen fibers. Also, their
skin may feel dryer because
Palpation sebum production decrease
with age.

* Janet Weber, Jane H. Kelley;

Health Assessment in Nursing
3rd Edition © 2007- Chapter 11 p.
171
 Hair - black to gray color -normal, gray or white hair is
- well distributed in the also result as a person ages
scalp and in the overall because decrease in or a lack
skin of melanin production.

* Rod R. Seeley, Trent

D. Stephens, Philip Tate; Essentials
of Anatomy and Physiology 6th
Inspection Edition, International Edition © 2007-
Chapter 5 Integumentary System
p.112
 Nails - pale nail beds - may indicate hypoxia
Inspection

- lubbing of fingers - results from inflammatory

changes in the bones of the
fingers from prolonged oxygen
deficiency.
* The Respiratory System Chapter 12 p. 283

Head - symmetrical skull - normal

and is appropriate
Skull & Face in size
- symmetrical facial
Inspection features
- no lumps or bumps
on the scalp
 Eyes & - sclera is white - normal
Vision
- conjunctiva clear & pinkish in
color

- no blurring of vision

- pupils equally round, reactive to

light and accommodation
(PERRLA)
Inspection
- indicates a weakness in
one or more extraocular
- eyes did not converge muscles or dysfunction of
the cranial nerve that
innervates the particular
muscle.
* Janet Weber, Jane H. Kelley; Health
Assessment in Nursing 3rd Edition © 2007-
Chapter 13 p. 225

 Ears & - symmetrical ears and equal in - normal

Hearing size

- no build up of cerumen/ear wax

Inspection
- can hear whispered words at a
distance of 1 ft. in both ears

- no pain reported upon palpation

and no presence of swelling - normal

Palpation both ear auricles non tender

 Nose & - nose is symmetrical in shape and same - normal
Sinuses in color with face

Inspection - patient can breathe with one nostril and

the other is occluded

- no presence of discharge

- no presence of bumps and tenderness

- normal
Palpation no pain reported

- non tender sinuses

 Mouth - no presence of lesions - normal
&
Orophar - pink, moist oral mucosa
ynx - no dentures
- cough reflex is weaker - because of weakened
respiratory muscles
Inspection and decreased ciliary
movement.
- yellowish teeth with some tooth decays, - persons who smoke
and missing tooth may have yellow or
brownish teeth
* Janet Weber, Jane H. Kelley;
Health Assessment in Nursing 3rd
Edition © 2007 - Chapter 15 p. 281
Neck - symmetrical but weak in strength - normal

Neck Inspection - symmetrical movement of neck

muscles muscles

 Lymph lymph nodes are non palpable - normal

nodes
of the Palpation
neck
 Trachea trachea is in midline position - normal
Inspection

- coarse crackle heard in the -

tracheal site during early
Auscultation inspiration to early expiration

 Thyroid butterfly in shape, in midline - normal

gland position, non palpable lobes,
Palpation not enlarged, and rises as
patient swallows

Thorax & - symmetrical chest shape & - normal

Lungs size
Chest shape
& size - no barrel chest
- use of accessory muscles, - the use of accessory
(scalene and muscles facilitates
sternocleidomastoid) muscles inspiration of O2
while breathing
* Janet Weber, Jane H. Kelley; Health
Assessment in Nursing 3rd Edition ©
2007 - Chapter 16 p. 310

Inspection
- there are retractions of the - indicates an increased
intercostals spaces inspiratory effort. This may
be the result of an
obstruction of the
respiratory tract.
* Janet Weber, Jane H. Kelley; Health
Assessment in Nursing 3rd Edition ©
2007 - Chapter 16 p. 318
 - upon deep breathing
anterior thoracic expansion:
approx. 5 cm. ; posterior
thoracic expansion: approx.
6 cm.
- because of loss of the
accessory musculature in older
persons thoracic expansion
may be decreased although it
should still be symmetrical

- symmetrical expansion * Janet Weber, Jane H. Kelley; Health

Assessment in Nursing 3rd Edition © 2007 -
Chapter 16 p. 313
Palpation

- increased fremitus in - usually the result of

the upper region of the consolidation or bronchial
lungs obstruction
* Janet Weber, Jane H. Kelley; Health
Assessment in Nursing 3rd Edition ©
2007 - Chapter 16 p. 312

- dullness present - dullness is present when fluid

or solid tissue replaces air in
Percussion the lung or occupies the pleural
space as in tumor.
Breath sounds - coarse crackles heard in - inhaled air comes into contact
the 2nd L and R intercostals with secreations in the large
space during early bronchi
inspiration to early * Janet Weber, Jane H. Kelley; Health
expiration Assessment in Nursing 3 Edition © 2007 -
rd

Chapter 16 p. 317

- wheezing heard in the 6 th L - as air passes through

and R intercostals space constricted passages (caused
Auscultation
during expiration by swelling, secretions, or
tumor) a high-pitched, musical
sound is produced
* Janet Weber, Jane H. Kelley; Health
Assessment in Nursing 3rd Edition © 2007 -
Chapter 16 p. 317
Cardiovascular & - S1 corresponds with each carotid -
Peripheral pulsation. S2 immediately follows
Vascular System after S1
Heart (Sounds) Auscultation
- no extra heart sounds and
murmurs

 Central vessels - equal in pulse rate, rhythm of - normal

(carotid arteries carotid arteries, and amplitude of
& jugular vein) 2+

Palpation
- no bruits upon auscultation of
the carotid arteries

- jugular vein not distended

 Peripheral - uniform in color, presence of -Normal
Vascular pallor
system - capillary refill of nail beds is 3 there is slow capillary
(peripheral secs. nailbed refill with
pulses, veins, respiratory or
and cardiovascular diseases
perfusion) that cause hypoxia
* Janet Weber, Jane H.
Kelley; Health
Inspection Assessment in Nursing
3rd Edition - Chapter 11
p. 175
- peripheral pulses (radial, brachial, and -Normal
femoral) are equal in pulse rate and
rhythm
- pink coloration returns to palms in 4
secs. if ulnar artery is patent and 3secs.
if radial artery is patent.
 - bulging veins - normal findings in an
elderly person

* Janet Weber, Jane H. Kelley; Health

Assessment in Nursing 3rd Edition -
Chapter 30 p. 856

Breast & Axillae - breasts are relatively - normal

equal
Breast size, Inspection
symmetry &
contour/shape
- no presence of
hardness in any area
Palpation

 Nipples - nipples at same level - normal

size, shape, on chest, and of same
position, dark brown color, no
color, Inspection presence of lesions
discharge &
lesions
 Axillary, - enlarged, hard, non- - the left supraclavicular
subclavicul mobile left lymph node drains the
ar & supraclavicular lymph thorax, abdomen via thoracic
supraclavic node, approximately 2 duct. Common causes of
ular lymph cm. in diameter; no pain enlargement include
nodes Palpation reported lymphoma, thoracic cancer,
bacterial or fungal infection.
* Metastases in Supraclavicular Lymph
Nodes in Lung Cancer: Assessment with
Palpation, US, and CT. Radiology 2004;232:
75-80.
Abdomen: - sunken abdomen is - a scaphoid (sunken)
observed abdomen may be seen
Abdominal with severe wiehgt loss
contour,
symmetry * Janet Weber, Jane H. Kelley; Health
Assessment in Nursing 3rd Edition ©
2007 - Chapter 20 p. 441

- symmetrical, no presence of - normal

Inspection scars, lesions

- slight pulsation of - normal

abdominal aorta in the
epigastric region

- abdominal respiratory
movement is seen
- no palpable mass, no
pain reported
- no tenderness and is
soft
Palpation
- lower edge of liver is
palpable and is firm &
even; other organs non
palpable
 Bowel - normal bowel sounds: 5 -Normal
sounds times/min, heard in all four
quadrants
Auscultation
 Vascular - no bruits over abdominal aorta - normal
sounds & femoral arteries

- no friction rubs over area of

liver & spleen
Inspection - tympany is heard over
abdomen
- dullness over the liver and
spleen

Musculoskeletal - decreased muscle mass, tone, - several changes

System: and strength occur in aging skeletal
muscle that reduce
Muscle - rate of muscle strength is 4 – muscle mass. There is
active motion against some loss of muscle fiber &
resistance fast-twitch muscle
Inspection fibers as aging occurs.
The number of motor
neurons also decrease
* Rod R. Seeley, Trent
D. Stephens, Philip Tate;
Essentials of Anatomy and
Physiology 6th Edition,
International Edition © 2007-
Chapter 7 Muscular System p.194
 Bones - no deformities & fractures - normal

- exaggerated thoracic curve - an exaggerated

Inspection thoracic curve
(kyphosis) is common
with aging
 Joints - non tender joints - normal
- bilaterally equal decreased ROM - the ligament &
except R arm tendon surrounding a
joint shorten &
become less flexible
with age, resulting in a
decrease in ROM of
the joints.
Inspection * Rod R. Seeley, Trent
D. Stephens, Philip Tate;
Essentials of Anatomy and
Physiology 6th Edition,
International Edition © 2007-
Chapter 6 Skeletal System p.151

- Non tender joints -normal

Neurologic: - good grooming, dresses -normal

appropriately to weather
Mental status - speech is of appropriate age
Inspection and flows easily
- maintains eye contact, can
smile & frown appropriately
 Level of - awake, alert, and oriented to
conscious time, place, person, and
ness Inspection responds to stimuli –
Glascow coma Scale: score
of 15
Cranial nerves

 CN I - decreased sense of - elderly people experience only a

smell slight loss in the ability to detect
odors.

 CN II - can read a printed -normal

writing at 14 inches
without difficulty

Inspection
 CN III, - eyes did not converge - indicates a weakness in one or more
IV, & VI extraocular muscles or dysfunction of
the cranial nerve that innervates the
particular muscle.
* Janet Weber, Jane H. Kelley; Health Assessment in
Nursing 3rd Edition © 2007- Chapter 13 p. 225

- temporal and masseter

 CN V muscles contract - normal
bilaterally
- correctly identified sharp
and dull stimuli of an
object
 CN VII - can smile, frown, show - normal
yeeth, puff out his
cheeks, raise eyebrows.
These are all symmetrical
in movement.
- can hear whispered words at
a distance of 1 ft. in both
ears
 CN IX & X - uvula and soft palate rises bilaterally - normal
and symmetrical upon saying “ah”
- gag reflex is present

 CN XI - there is symmetric but weak -most of the loss of

contraction of the trapezius muscles strength in an elderly
upon shrugging of shoulders against is due to the loss of
resistance muscle fibers and the
loss of fast-twitch
muscle fibers.
* Rod R. Seeley, Trent
D. Stephens, Philip Tate;
Essentials of Anatomy and
Physiology 6th Edition,
International Edition © 2007-
Chapter 7 Muscular System
p.194

 CN XII - tongue movement is symmetrical and - normal

smooth and strength is bilateral

Reflexes
 Deep
tendon
reflex
 Biceps reflex - both elbows flexed and contraction - normal
of biceps muscle is felt
 Triceps - both elbows extended, triceps  Triceps reflex
reflex Inspection muscles contracts
 Patellar - knee extends, quadriceps contracts  Patellar reflex (knee-
reflex (knee- jerk reflex)
jerk reflex)

 Achilles - both foot has plantar flexion  Achilles reflex

reflex
 Motor - no tremors - normal
functions Inspection seen
- gait is slow - information on the position,
and has bent- tension, and length of tendons and
forward muscles also decreases, resulting
appearance in additional reduction in the
senses of movement, posture, and
position, as well as reduced
control and coordination of
movement
* Rod R. Seeley, Trent
D. Stephens, Philip Tate; Essentials of Anatomy
and Physiology 6th Edition, International
Edition © 2007- Chapter 8 Nervous System
p.237

- the surface area of the neuromuscular

junction decreases and, as a
result, action potentials in neurons
stimulate action potential
production in muscle cells more
slowly and fewer action potentials
are produced in the muscle fibers.
* Rod R. Seeley, Trent
D. Stephens, Philip Tate; Essentials of Anatomy
and Physiology 6th Edition, International
Edition © 2007- Chapter 8 Muscular System
p.194

- having - there is a general decline in the

difficulties of number of motor neurons. Muscle
rapid fibers innervated by the lost motor
alternating neurons are lost.
movements * Rod R. Seeley, Trent
D. Stephens, Philip Tate; Essentials of Anatomy
and Physiology 6th Edition, International
Edition © 2007- Chapter 8 Nervous System
p.237
 Sensory - decreased - as a result of decreases in the
functions light touch number of skin receptors, elderly
sensation people are less conscious of
- correctly something touching or pressing
identifies on the skin.
direction of * Rod R. Seeley, Trent
D. Stephens, Philip Tate; Essentials of Anatomy
Inspection movement of and Physiology 6th Edition, International
fingers & toes Edition © 2007- Chapter 8 Nervous System
p.237
with eyes is
closed

Genitals/Inguinal: - pubic hair is - normal findings in an elderly

Inspection thin. person
* Janet Weber, Jane H. Kelley; Health Assessment in
Nursing 3rd Edition - Chapter 30 p. 860-861
- penis and
testes size
decreased
Palpation - no swelling
and no masses

Rectum/Anus: - anus is darker - normal findings in an elderly

than the person
surrounding skin * Janet Weber, Jane H. Kelley; Health Assessment in
Inspection Nursing 3rd Edition - Chapter 30 p. 861

Others:
Senses - numbness in his - there is compression of the left
neck, left shoulder subclavian artery & brachial plexus
Inspection
and arm,
Mechanism of Breathing
 PREDISPOSING FACTORS PRECIPITATING FACTORS
-Gender -Smoking History: 53 pack-yrs. of
Age: 65 y/o smoking

Passage of Cigarette Smoke

to lower respiratory system

Nicotine Tars Carbon Monoxide

Ability to
Phagocytize
Goblet inhaled
Mucocilliary Clearance Ineffective Cough Impaired Alveolar
Cells Foreign
System Impairement Reflex Macrophages
Particles

Chronic irritation and exposure

of epithelial tissue to smoking

Exposure / inhalation of
↑ Vulnerability of epithelial tissue to
infected aerosol through droplet
irritants and carcinogens

Inhaled nuclei lodge in alveoli

Interruption of Normal cells

Binding of bacterial cell wall to

Activation of normal cancer cell macrophage

Primary growth of tumor in the

Spread of bacilli via lymphatic
epithelial tissue
system to upper lobes of the
lungs
- Desquamation of cells
-Hypersecretion of mucus
-Hyperplasia of the basal cells Tubercle bacilli replicates
-Metaplasia of normal slowly due to sensitivity to heat
Respiratory epithelium
 Failure of the immune system to Patient stopped for smoking 2
recognize cancer cell as foreign years ago (2008)
body

Progression and proliferation of Progression of tubercle bacilli

cancer cells

Formation of granuloma
Increased tumor size

Drainage of necrotic material

Obstruction of the Cancer cell into the tracheobronchial tree
bronchus due to detached from
tumor primary tumor
Scar formation

Tumor enlarges Migrate via lymph Full blown immunity of bacilli

through blood nodes or blood
vessels circulation
Active infection of Bacilli
-hemoptysis
Cancer cells -productive cough
established at -chest pain and tightness
secondary sites -night sweating
(May 2010)

FNAB Dec. 23, 2010

May 22, 2010
Non small cells lung
X-ray shows Koch’s infection
cancer
at right upper lobe
Positive for
Adenocarcinoma
 January 2011 May 2010
-hoarseness
Started anti-tubercular drugs
-dysphagia
for six months (May-Nov.
-Non- productive cough 2010)
-anorexia
-weight loss

Recurring of symptoms after 6

months of treatment
February13, 2011
-hoarseness
-dysphagia
-Non- productive cough
-numbness of the Left neck, shoulder & arm
Dec. 13, 2010
-dyspnea •Pulmonary mass
-wheezes on 6thth intercostal space
lingular segment, with
-crackles on trachea & 2ndnd intercostals space
mediastinal and Left
-palpable lymph node on left neck
Hilar lymphadenopathy,
biopsy is suggested
•PTB of undetermined
activity, Right upper
lobe

Dec. 23, 2010

Unchanged right upper lobe
PTB and left hilar mass
 May 12,
2010

RADIOLOGIC FINDINGS

IMPRESSION:
•Minimal Kock’s infection, Right upper lobe.
•Interstitial pneumonitis Right hemithorax.
•Consolidation pneumonia Lingular zone.
•Please correlated clinically.

November
2, 2010

RADIOLOGIC FINDINGS
 
IMPRESSION:

•Follow up study since May 12, 2010 shows progression of the

confluent opacities in the Left perihilar area and Left lower
lobe. Note of slight interval clearing of the Right upper lobe
infiltrated. No other interval changes seen.
 December 5, 2010

RADIOLOGIC FINDINGS
IMPRESSION:

•Consider moderate PTB disease, Right, activity undetermined

clinical is suggested
•Intercurrent pneumonia, Left

December 13, 2010

RADIOLOGIC FINDINGS

IMPRESSION:

•Pulmonary mass lingular segment, with mediastinal and Left

Hilar lymphadenopathy, biopsy is suggested
•PTB of undetermined activity, Right upper lobe
•Atherosclerotic aorta
 
 December 23, 2010

RADIOLOGIC FINDINGS

IMPRESSION:

•Resolving Pneumonia, Left Hilum.

•Unchanged right upper lobe PTB and left Hilar mass.
•Mild cardiomegallo.
•Atherosclerotic thoracic aorta.
•Degenerative osseous changes.

December 23, 2010

FNAB
IMPRESSION:

•Positive for malignant cells.

•Non small cell compatible with adenocarcinoma.
 
 DATE TIME DOCTOR’S ORDER INTERPRETATION
2/ 13/11 8:45 am  admit  To monitor the
condition of the
patient and for
implementation of
proper treatment.

 secure consent  It protects the

client’s right to
self-
determination.
 To inform the
client on what
treatment or
procedure he/she
might be involved.

 TPR q shift &  to know if there’s

record any alteration on
vital signs

 DAT if not  to avoid

dyspneic aspiration
DATE TIME DOCTOR’S ORDER INTERPRETATION
 IVF D5 NM 1L x 12  for replacement of fluid and
hours electrolyte loss

 O2 at 1-2 4m via  Decreases shortness of breath.

nasal cannula Nasal Cannula delivers a
relatively low concentration of
oxygen which is 24% to 45% at
flow rates of 2 to 6 liters per
minute.
 moderate high back  it promotes total expansion of the
rest lung
DATE TIME DOCTOR’S ORDER INTERPRETATION
 Nebulizaton with  salbutamol relieves nasal
salbutamol + congestion and reversible
ipratropium q 8 1 amp. bronchospasm by relaxing
the smooth muscles of the
bronchioles.
 ipratropium relieve any
reversible airways blockage
associated with problems
such as repeated infections
affecting the airways.
 refer  For further studies of the
disease and for more
improved medical
management.

Meds:

 Dexamethasone 250 g  Dexamethasone reduces

IV q8 the swelling, itching, and
redness that can occur in
these types of conditions.
This medication is a mild
corticosteroid.
Assessment Diagnosis Planning Interventions Rationale Evaluatio
n
S> “Naninikip and Impaired gas GOAL: INDEPENDENT> >Respiration may be After series of
dibdib ko” as exchange Adequate gas Note respiratory increase as a result of nursing
verbalized by the related to exchange rate, depth and pain or as an initial intervention
patient altered DESIRED ease of compensatory the patient
was able to
O> with non oxygen OUTCOMES respiration. mechanism to
demonstrate
productive cough supply as After the nursing accommodate for loss improve
With mucous evidenced by interventions, the >Observe for the of lung tissue. Increased ventilation
secretions: clubbing of patient will be use of accessory work of breathing and and adequate
• scant in fingers able to : muscle, pursed lip cyanosis may indicate oxygenation.
amount a.Demonstrate breathing, increasing oxygen
•Clear , thick improved changes in skin or consumption and
whitish sputum ventilation and mucous energy expenditures
>use adequate membrane color. and reduced respiratory
sternocleidomast oxygenation. reserve
oid muscles and b.Participate in
scaline muscles treatment >Maintain patent >Airway obstruction
while breathing regimen with in airway impedes ventilation,
>with clubbing of level of ability or impairing gas exchange.
>Reposition
fingers in both situation >maximize lung
frequently, placing
hands. expansion and drainage
patient in sitting
> RR= 12bpm of secretions.
positions and
supine to side
positions.
Assessment Diagnosis Planning Intervention Rationale Evaluation
s
>encourage or >promote
assist with maximal
deep breathing ventilation and
exercises and oxygenation
pursedlift and reduces or
breathing as prevent
appropriate atelectasis

DEPENDENT

>Administer >Maximizes
supplemental available
oxygen via nasal oxygen,
cannula, partial especially while
rebreathing ventilation is
mask, or high reduced
humidity face because of pain.
mask as
indicated.
Oxygen
saturation: 1-2
L/min
Assessmen Diagnosi Planning Interventions Rationale Evaluation
t s
S>”Nahihirapan Ineffective GOAL: Independent: After series of
akong airway Effective airway >Auscultate chest >noisy respiration, nursing
huminga” as clearance clearance for character of ronchi, and wheezes interventions,
verbalized by related to Desired breath sounds and are indicative of patient will
the patient constriction Outcome: presence of retained secretions demonstrate
O > with non of the airway After nursing secretions and/or airway patent airway,
productive as evidenced intervention >Observe amount obstruction will have
cough by patient will be and character of >presence of thick and expectorated
>with mucous decreased able to: sputum secretions. tenacious bloody or secretions and
secretions respiratory a.Demonstrate Investigate purulent sputum decrease use
oScant in rate:12bpm patent airway changes as suggest development of accessory
amount and and deep b.Expectorate indicated of secondary problems muscles while
shallow secretions >encourage oral >adequate hydration breathing.
oClear, thick, aids in keeping
breathing. c.Clear breath intake if not
whitish sputum sounds contraindicated and secretions loose or
d.Decrease use within cardiac enhance
>with crackles
of accessory tolerance. expectorations
breath sounds
heard on the muscles for Dependent:
second breathing >Administer
e.Demonstrate bronchodilators, >relieves
intercoastal
behavior to expectorants and/ bronchospasms to
spaces
improve or or analgesics as improve airflow.
>with wheezing
maintain clear indicated Expectorants increases
on the sixth
airways mucous production and
intercoastal
liquefy and reduce
space heard
viscosity of secretions,
upon expiration
facilitating removal.
Alleviation or chest
discomfort promotes
cooperation and
breathing exercises
and enhances
Assessment Diagnosis Planning Intervention Rationale Evaluation
s
S>” Hindi na ako Activity Goal: Independent: >Establishes After nursing
makagawa ng intolerance Enhance activity >evaluate client’s client’s capabilities intervention
related to response to or needs and patient will be able
datirating kong tolerance
imbalance activities. facilitates choice to:
ginagawa ditto sa between oxygen Desired Outcome:
of intervention Participate in
bahay” as Supply and After nursing     techniques to
verbalized by the demand as interventions, >Note reports of >Symptoms may enhance activity
patient. evidence by patient will be dysnea, increased be result of/or tolerance
O>decreased decreased physical able to: weakness or contribute to Eliminate and
activity & easy fatigue, and
physical activity a.Participate in intolerance of reduce factors that
fatigability changes in vital activity contribute activity
> easy fatigability techniques to
signs during and   intolerance
>body malaise enhance activity after activities.   Demonstrate a
>RR; 12bpm tolerance   >Reduces stress decrease in
>decrease depth b.Eliminate and >Encourage use of and excess psychological signs
of breathing reduce factors stress stimulation, or intolerance.
>poor muscle that contribute management and promoting rest
diversional
tone activity tolerance
activities as
c.Demonstrate a appropriate.
decrease in
physiological >Assist and >Patient may be
signs of encourage to comfortable with
intolerance assume head of bed
comfortable elevated, sleeping
position for rest in chair or leaning
and sleep. forward on
overbed table with
pillows support.
Assessment Diagnosis Planning Intervention Rationale Evaluation
s
>Encourage >Prevents
adequate fluid dehydration
intake (which increases
  fatigue)
   
   
>Assist with self >weakness may
care needs when make ADLs
indicated and difficult to
ambulation complete or
  place patient at
  risks for injury
  during activities.
   
   
Dependent: >Presence of
>Provide hypoxemia
supplemental reduces oxygen
oxygen as available for
indicated at 1- cellular uptake
2L/min. and contributes
to fatigue.
 CONTRAINDI- ADVERSE NURSING
DRUG NAME ACTION INDICATION CATION REACTION RESPONSIBILI
TIES

Date Ordered: >Stimulates >Hypersensitivit >Fine skeletal >Assess cardio-

> Relief and
Beta2 receptors y to a muscle tremor, respiratory
Feb.13 2011 prevention of
of bronchioles salbutamol, also leg cramps, function: B/P,
Generic Name: by increasing bronchospasm
to atrophine and palpitations, heart rate and
in patients with
Nebulizaton the levels of its derivatives. tachycardia, rhythm and
reversible
cAMP which >Cardiac hypertension, breath sounds
with obstructive
relaxes smooth arrhythmia headache, >Monitor for
SALBUTAMOL muscles to airway disease
associated w/ nausea, evidence of
or COPD
+ ipratropium q produce tachycardia vomiting, allergic
bronchodilation. >Inhalation caused by dizziness, reactions and
8 1 amp.
and treatment digitalis hyperactivity, paradoxical
Brand Name: intoxication. insomnia, bronchospasm
of acute attack
Activent of
Dosage and bronchospasm
Frequency:
1Neb. 1amp
every 8 hours.
Classification:
Symphatomim
etics
 CONTRAINDI- ADVERSE NURSING
DRUG NAME ACTION INDICATION CATION REACTION RESPONSIBI-
LITIES

>Centrally >Tramadol is >Hypersensitivit >Vasodilation: >Assess patient’s

Date Ordered:
acting analgesic used for y pain (location,
Dizziness/vertig
Feb.13 2011 type, character)
not chemically moderate to >Acute o, headache,
Generic Name: before therapy
related to severe pain. intoxication with somnolence,
and regularly
Tramadol opioids but alcohol, stimulation, thereafter to
binds to mu- hypnotics, anxiety, monitor drug
Brand Name:
opioid receptors centrally acting confusion, effectiveness.
Dolotral and inhibits analgesics, coordination >Assess for
Dosage and reuptake of opioids, or disturbance, hypersensitivity
Frequency: norepinephrine psychotropic sleep disorders, reactions:pruritus,
and serotonin. agents. seizures. rash and urticaria.
Classification: >Monitor for
>Pruritus,
Analgesics, possible drug
sweating, rash.
induced adverse
Muscle >Visual
reactions: CNS:
disturbances,
Relaxants and stimulation,
dry mouth. dizziness, vertigo,
Uricosurics >Nausea, headache,
Corticosteriods diarrhea, somnolence,
. constipation, anxiety,
vomiting, confusion,
dyspepsia, coordination
abdominal pain, disturbance,
anorexia, malaise,
euphoria,
flatulence.
nervousness,
sleep disorder,
seizures.
 NURSING
DRUG NAME ACTION INDICATION CONTRAINDIC ADVERSE RESPONSIBI-
ATION REACTION LITIES

Date Ordered: >Synthetic >Respiratory >systemic >Thromboembol > Obtain pt.

glucocorticoid w/ diseases fungal infection: ism or fat history of
Feb.13 2011
marked anti- IM injection use embolism; underlying
Generic Name: inflammatory
in idiophatic thromboplebitis; condition before
Dexamethason effect because of
thrombocytopeni necrotizing therapy.
its ability to inhibit
e 250 g IV q8 prostaglandin
c purpura: angiitis; cardiac >Assess for
Brand Name: synthesis, inhibit arrhythmias or possible drug
migration of ECG changes. induced adverse
Decilone
macrophages, >vertigo reaction.
Dosage and leukocytes and > headache >Monitor renal
Frequency: fibroblasts at sites >Impared status and
Classification: of inflammation, wound healing function.
phagocytosis and >visual acuity >Assess mental
Hormones and
lysosomal >thoat irritation status: Affect,
related drugs. enzyme release.
mood,
It can also cause
behavioral
the reversal of
increased
changes.
capillary >Assess pt’s
permeability. and family’s
knowledge on
drug therapy.
 NURSING
DRUG NAME ACTION INDICATION CONTRAINDIC ADVERSE RESPONSIBI-
ATION REACTION LITIES

Date Ordered: Chemically Acute Hyper sensitivity Dryness of >Assess

related to exacerbations to soya lecithin mouth, throat patient’s
Feb. 13, 2011
atropine, it of chronic or related food irritation or condition before
Generic Name: antagonizes the obstructive products. cough. and after drug
Nebulizaton effect of pulmonary Atropine or any therapy. Monitor
acetylcholine. It disease anticholinergic peak expiratory
with
causes a local (COPD). Used derivates. flow.
salbutamol + and site specific in conjunction >Monitor for
IPRATROPIUM bronchodilatatio w/ beta- evidence of
n by preventing adrenergic allergic
q 8 1 amp.
the increase in stimulant for reactions,
Brand Name: intracellular acute asthmatic paradoxic
Atrovent cyclic attacks. bronchopspasm
Classification: guanosine .
mono- >Assess pt’ and
Anticholinergic phosphate family’s
s which produced knowledge on
by the drug therapy.
interaction of >Inform pt. that
acetylcholine w/ drug is not
the muscarinic effective for
receptors of the treatment of
bronchial acute
smooth bronchopspasm
muscles. >Teach pt. the
proper way of
drug
administration.
 ACTION RATIONALE

>Assessed respiratory rate and depth >useful in evaluating the degree of

respiratory distress and /or chronicity of
the disease process .

>Auscultated chest , noting presence >to identify etiology or precipitating

or characteristic of breath sounds, factors
presence of secretions.

>Observed characteristics of cough >cough can be persistent but

ineffected, especially if client is elderly,
acutely ill, or debilitated.

>Performed physical and or >to determine the extent of the

psychological assessment limitation of the current condition.
 ACTION RATIONALE

>Encouraged adequate rest periods >to limit fatigue

between activities

>Established a minimum weight goal >provides comparative baseline for

and daily nutritional requirements effectiveness of therapy

>Give frequent oral care, remove >noxious tastes, smell and sights are
expectorated secretions promptly, prime deterrents to appetite and can
provide specific container for disposal produce nausea and vomiting with
of secretions and tissue increase respiratory difficulty
This case study has provided us with important
information about the patient’s lung cancer
disease condition and its nursing care
interventions prior to the treatments and
medical procedures done with the patient. In
order to help managing or controlling present
condition, the group would like to recommend
the following:
To the Patient:
Despite of his age and the severity of his condition, the patient
cooperation and willingness to prevent further complications
related to his lung condition.

•The patient must be able to verbalize any problems and

needs that he is experiencing about his present condition
and his perceptions about this event happens in his manner
of living .

•His capability on how he complies with therapeutic regimen

that involve in his managing complications on his condition.

•He must be open minded in the process of therapeutic

regimen given to him to relieve negative reaction occurring
during the course of an illness and accepting the fact about
his situation.
To the Patient’s family:
The patient’s family is the one that can provide a great
significant role in patient’s status with regard to conditions.
•Family should available themselves to the patient to provide
support and show their concern to him. Help his to build
strength and stabilized good outcome about the patient’s
status.

•Family also inspires patient to obtain stability as he

experienced painful, traumatic and extremely disturbing
procedures. Also, it is important to them to know the
information about the patient’s condition so that they can act
appropriately according to the situation.

• Listening, touching, expressing sympathy, attending to the

patients' wishes, comforting, encouraging and being present
with them are important in accordance with the patient need
of emotional incapability.
To our fellow Students:

However, it is important that may have a complete

nursing care in the long run of confinement of your
patient, to begin with assessment, admission, and
until the patient recovered that includes discharge or
may go order and follow-up consultations for further
studies in every actual goal and for proper nursing
interventions in each occurring problems connected
on his condition and this can also provide us to
become more aware of our health.
 “ COURAGE
gives you the urge
to
fight and
PREPARATION
gives you the chance
to win.”
GROUP 1… so happy
together!!!!