Competency Appraisal II

LUNG/BRONCHOGENIC CANCER

PREPARED BY: CARIDO, ARNIE JUDE ARQUIZA, KEVIN BESARES, ALYANNA MARIZ AL-MUJIL, FATIMA NORYL KRISHNA AMBALI, CECILLE ABUBAKAR, NUSHAIBA BERMEJO, ROSE MAR AMAN, HANISA LADJAHIRAN, ALHAMBRA SAKILI, SALWA SULAIMAN, NURSHEEMA LARRACOCHEA, VINCENT VILLAREAL, VHANESSA AUSTERO, SHEENA MARY MAY

SUBMITTED TO: Rina Fernandez, RN, MN
BSN IV-C WMSU | LUNG CANCER 1

LUNG CANCER    Also called bronchogenic cancer Is a disease of uncontrolled cell growth in tissues of the lung which may lead to metastasis Is the most common cause of cancer-related death in men and women, is responsible for 1.3 million deaths worldwide annually, as of 2004

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Types of lung cancer Doctors divide lung cancer into two major types based on the appearance of lung cancer cells under the microscope. The doctor makes treatment decisions based on which major type of lung cancer one has. The two general types of lung cancer include: Small cell lung cancer Small cell lung cancer occurs almost exclusively in heavy smokers and is less common than non-small cell lung cancer. > Stages of small cell lung cancer     Limited. Cancer is confined to one lung and to its neighboring lymph nodes. Extensive. Cancer has spread beyond one lung and nearby lymph nodes, and may have invaded either lungs, more-remote lymph nodes, or other organs, such as the liver or brain.
BSN IV-C WMSU | LUNG CANCER 2

Non-small cell lung cancer Non-small cell lung cancer is an umbrella term for several types of lung cancers that behave in a similar way. Non-small cell lung cancers include squamous cell carcinoma, adenocarcinoma and large cell carcinoma. > Stages of non-small cell lung cancer  Stage I. Cancer at this stage has invaded the underlying lung tissue but hasn'tspread to the lymph nodes. Stage II. This stage cancer has spread to neighboring lymph nodes or invadedthe chest wall or other nearby structures. Stage IIIA. At this stage, cancer has spread from the lung to lymph nodes inthe center of the chest. Stage IIIB. The cancer has spread locally to areas such as the heart, bloodvessels, trachea and esophagus — all within the chest — or to lymph nodes in the area of the collarbone or to the tissue that surrounds the lungs within the rib cage (pleura). Stage IV. The cancer has spread to other parts of the body, such as the liver, bones or brain.

Signs and Symptoms          dyspnea(shortness of breath) hemoptysis(coughing up blood) chroniccoughingor change in regular coughing pattern wheezing chest painor pain in the abdomen cachexia(weight loss),fatigue, and loss of appetite dysphonia(hoarse voice) clubbingof the fingernails (uncommon) dysphagia(difficulty swallowing)

BSN IV-C WMSU | LUNG CANCER

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Causes      Smoking Radon Gas Asbestos Viruses Particulate Matter

Risk Factors        Smoking Exposure to secondhand smoke Exposure to radon gas Exposure to asbestos and other chemicals Family history of lung cancer Excessive alcohol use Certain lung diseases

Complications       Shortness of breath Hemoptysis (coughing up blood) Pain Pleural effusion (fluid in the chest) Metastasis Death

Screening Screening refers to the use of medical teststo detect disease in asymptomatic people.Possible screening tests for lung cancer includechest radiographor computed tomography(CT). As of December 2009, screening programs for lung cancer have notdemonstrated any benefit.

BSN IV-C WMSU | LUNG CANCER

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Tests and Diagnosis    Imaging tests – x-ray Sputum cytology Biopsy

Treatment and Drugs  Surgery – Wedge resection to remove a small section of lung that contains thetumor along with a margin of healthy tissue – Segmental resection to remove a larger portion of lung, but not an entirelobe – Lobectomy to remove the entire lobe of one lung – Pneumonectomy to remove an entire lung Chemotherapy – uses drugs to kill cancer Radiation Therapy – Radiation therapy uses high-powered energy beams, such asX-rays, to kill cancer cells. – External beam radiation Radiation therapy directed at the lung cancer from outside the body – Brachytherapy Radiation put inside needles, seeds or catheters and placed inside the body near the cancer Targeted Drug Therapy – Targeted therapies are newer cancer treatments that work by targeting specific abnormalities in cancer cells. Targetedtherapy options for treating lung cancer include: – Bevacizumab (Avastin). Bevacizumab stops a tumor from creating a new blood supply. Blood vessels that connect to tumors can supply oxygen andnutrients to the tumor, allowing it to grow. Bevacizumab is usually used incombination with chemotherapy and is approved for advanced andrecurrent nonsmall cell lung cancer. Bevacizumab carries a risk of bleeding, blood clots and high blood pressure. – Erlotinib (Tarceva). Erlotinib blocks chemicals that signal the cancer cells to grow and divide. Erlotinib is approved for people with advancedand recurrent non-small cell lung cancer that haven't been helped bychemotherapy. Erlotinib side effects include a skin rash and diarrhea. BSN IV-C WMSU | LUNG CANCER 5

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Prevention There's no sure way to prevent lung cancer, but you can reduce your risk if you:        Don't smoke Stop smoking Avoid secondhand smokeTest your home for radon Avoid carcinogens at work Eat a diet full of fruits and vegetables Drink alcohol in moderation, if at all Exercise

Assessment   New or changing cough, dyspnea, wheezing, excessive sputum production,hemoptysis, chest pain (aching, poorly localized), malaise, fever, weight loss,fatigue, or anorexia. Decreased breath sounds, wheezing, and possible pleural friction rub (with pleuraleffusion) on examination.

Nursing Interventions

1. Elevate the head of the bed to ease the work of breathing and to prevent fluid collection in upper body (from superior vena cava syndrome). 2. Teach breathing retraining exercises to increase diaphragmatic excursion and reduce work of breathing. 3. Augment the patient’s ability to cough effectively by splinting the patient’s chest manually. 4. Instruct the patient to inspire fully and cough two to three times in one breath. 5. Provide humidifier or vaporizer to provide moisture to loosen secretions. 6. Teach relaxation techniques to reduce anxiety associated with dyspnea. Allow the severely dyspneic patient to sleep in reclining chair. 7. Encourage the patient to conserve energy by decreasing activities.

BSN IV-C WMSU | LUNG CANCER

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8. Ensure adequate protein intake such as milk, eggs, oral nutritional supplements; and chicken, fowl, and fish if other treatments are not tolerated – to promote healing and prevent edema. 9. Advise the patient to eat small amounts of high-calorie and high-protein foods frequently, rather than three daily meals. 10. Suggest eating the major meal in the morning if rapid satiety is the problem. 11. Change the diet consistency to soft or liquid if patient has esophagitis from radiation therapy. 12. Consider alternative pain control methods, such as biofeedback and relaxation methods, to increase the patient’s sense of control.13.Teach the patient to use prescribed medications as needed for pain without being overly concerned about addiction.

BSN IV-C WMSU | LUNG CANCER

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