Special Care Client

C. Curran DH2
2/1/16
Lung Cancer and Complicating Factors Thereafter
My patient is a 74 year old female who recently had a portion of one of her left lung
lobes removed due to cancer. She was very sick in March 2015 and thought she just had a virus
of some sort. When she began having more severe symptoms and extreme difficulty breathing
she thought it was time to go to the emergency room. She then found out she had early stage
non-small cell lung cancer. Non-small cell lung cancer is a disease in which malignant cells form
in the tissues of the lung. There are several types of non-small cell lung cancer. The cancer cells
of each type grow and spread in different ways. The specific kind my patient had was squamous
cell carcinoma. This type of cancer begins in squamous cells, which are thin, flat cells. This is
also called epidermoid carcinoma. Smoking cigarettes, pipes, or cigars is the most common
cause of lung cancer. The earlier in life a person starts smoking, the more often a person smokes,
and the more years a person smokes, the greater the risk of lung cancer. If a person has stopped
smoking, the risk becomes lower as the years go by. Unfortunately my patient smoked a pack of
cigarettes a day for over 35 years. She did however quit in late 2004.
Sometimes lung cancer does not cause any signs or symptoms. It may be found during a
procedure such as a chest x-ray that is being done for another condition. Signs and symptoms
include: chest discomfort or pain, a cough that doesnt go away or gets worse over time,
difficulty breathing, wheezing, blood in mucus coughed up from the lungs, hoarseness, loss of
appetite, weight loss for no known reason, feeling very tired, trouble swallowing, and swelling in
the face and/or veins in the neck. Luckily my patient did exhibit symptoms of a terrible cough

that only worsened over time, trouble breathing, and fatigue. This led her to seek treatment and
the doctors were able to find the cancer in the early stages. If she would not have had any
symptoms, the cancer may not have been detected in time to treat it. Upon describing her
symptoms and their duration, a chest x-ray was performed. This is one of the ways of diagnosing
lung cancer. When the chest x-ray was positive for lung cancer a CT scan was performed to
confirm the diagnosis. In July, 2015 surgery was performed to remove a portion of her lower left
lung lobe which is called a segmentectomy or wedge resection. Tests had to be done prior to
surgery to ensure that surgery would leave my patient with enough healthy lung tissue. If surgery
can be done, as it could in this case, it provides the best chance to cure early stage non-small cell
cancer.
Activity should be limited for 1-2 months following surgery and the patient may
experience shortness of breath after surgery. My patient currently states that she experiences
breathing difficulties and has coughing fits. She is currently prescribed Spiriva, which is a
bronchodilator. This helps her breathe. I advised my patient to bring her Spiriva with her to our
hygiene appointment in case she begins coughing uncontrollably or has difficulties breathing
during treatment. Due to my patients breathing difficulties and persistent cough I am going to
have to position my patient upright for our appointment and give her multiple breaks. I am also
going to have to refrain from using the ultrasonic to minimize a buildup of fluids in her throat
and allow her to breathe through her mouth because she also stated that she does not breathe
through her nose, she has always breathed completely through her mouth.
As well as the ultrasonic being contraindicated due to her breathing difficulties my
patient also has a pace maker that was placed after she had a heart attack due to a clogged artery
in 1998. The ultrasonic unit transmits electrical impulses and could cause electromagnetic

interference, which could cause the pacemaker to malfunction. Due to the coronary artery
disease my patient is taking Provastin which is an antilipidemic used to reduce the amount of fat
in the blood vessels. When my patient had a heart attack she also found out she had high blood
pressure and was prescribed Losartan and Cavedilol to treat it and thus help prevent a future
heart attack. Both of these medications have the risk of orthostatic hypotension, but since I will
not be placing my patient in the supine position and I will be giving her multiple breaks, I do not
feel like this will be an issue. My patients blood pressure is being controlled with her medication
and was 131/82 at our evaluation appointment.
Along with surgery my patient had to undergo four months of chemotherapy.
Chemotherapy can cause many oral complications, especially mucositis. I will be sure to
examine and question my patient about any signs of oral complications related to her
chemotherapy. My patients last chemotherapy treatment was Dec. 7th, 2015. Because her last
treatment was so recently and chemotherapy weakens the immune system, a medical consult was
needed to assess the patients need for premedication. Her oncologist sent the consult back with
the okay to proceed with treatment without the need for premedication and with no other
restrictions.
My patient will continue to be under the care of her oncologist for frequent check-ups
and CT scans to ensure that the cancer has not spread and does not come back in her lungs. I read
a horrifying piece of information from the National Cancer Institute stating for most patients
with non-small cell lung cancer, current treatments do not cure the cancer. They recommend
seeking clinical trials to aid in a better prognosis. I hope that my patients cancer does not come
back.

Resources:

National Cancer Institute. (May, 2015). Non-Small Cell Lung Cancer Treatment. Retrieved
from:http://www.cancer.gov/types/lung/patient/non-small-cell-lung-treatment-pdq
American Cancer Society. (March, 2015). Surgery for Non-Small Cell Lung Cancer. Retrieved
from: http://www.cancer.org/cancer/lungcancer-non-smallcell/detailedguide/non-small-cell-lungcancer-treating-surgery
National Institute of Dental and Craniofacial Research. (July, 2014). Dental Provider's Oncology
Pocket Guide. Retrieved from:
http://www.nidcr.nih.gov/oralhealth/Topics/CancerTreatment/ReferenceGuideforOncologyPatien
ts.htm