Lung Cancer

Clinical Findings: Early-stage lung cancer is usually asymptomatic and is discovered from abnormal findings on
routine chest x-ray. Advancedstage lung cancer often manifests with persistent cough, chest pain, dyspnea, fatigue,
weight loss, hemoptysis, and hoarseness.

Etiology and Pathophysiology

 Altered DNA → alters cellular replication; may be primary or metastatic; often metastasizes to lymph nodes,
bone, brain before diagnosis
 Types: Adenocarcinoma, small cell (oat cell), large cell (undifferentiated), and squamous cell carcinoma

Risk Factors

 Smoking, heredity, ↓intake of fruits and vegetables, tar

 Exposure to asbestos or radon

Signs and Symptoms

 Dry, chronic cough; hoarseness, dyspnea, chest pain

 ↓Weight, lymphadenopathy
 Sputum positive for cytology
 Chest x-ray indicates lesion and possible effusion
 Biopsy indicates source (primary or secondary)

Treatment

 Lobectomy, pneumonectomy
 Chemotherapy, radiation, palliative care (↓pain)

Nursing

 Lobectomy: Manage chest tubes

 Pneumonectomy: Place on operative side
 Chemotherapy: Manage side effects; hospice prn

Pathophysiology

 Almost all lung cancers start in the epithelium of the lungs.

 In normal lungs, the epithelium lines and protects the tissue below it. However, when exposed to irritants or
carcinogens, the epithelium continually replaces itself until the cells develop chromosomal changes and
become dysplastic (altered in size, shape, and organization).
 Dysplastic cells don’t function well as protectors, so underlying tissue gets exposed to irritants and
carcinogens.
 Eventually, the dysplastic cells turn into neoplastic carcinoma and start invading deeper tissues.

Ineffective Airway Clearance - Related Factors Tracheal bronchial inflammation, edema formation, increased sputum
production Pleuritic pain Decreased energy, fatigue Aspiration - Defining Characteristics Changes in rate, depth of
respirations Abnormal breath sounds (rhonchi, bronchial lung sounds, egophony) Use of accessory muscles Dyspnea,
tachypnea Cough, effective or ineffective; with/without sputum production Cyanosis Decreased breath sounds over
affected lung areas Ineffective cough Purulent sputum Hypoxemia Infiltrates seen on chest x-ray film

Impaired Gas Exchange - Related Factors Alveolar-capillary membrane changes (inflammatory effects) Altered
oxygen-carrying capacity of blood/release at cellular level (fever, shifting oxyhemoglobin curve) Altered delivery of
oxygen (hypoventilation) Collection of mucus in airways Inflammation of airways and alveoli Fluid-filled alveoli -
Defining Characteristics Dyspnea, Tachypnea Pale, dusky, skin color Cyanosis Tachycardia Restlessness, irritability,
changes in mentation Hypoxemia Hypotension Disorientation
Ineffective Breathing Pattern - Related Factors Alteration of patient’s O2/CO2 ratio Anxiety Hypoxia Decreased lung
expansion Inflammatory process Pain - Defining Characteristics Changes in rate, depth of respirations Abnormal
breath sounds (rhonchi, bronchial lung sounds, egophony) Use of accessory muscles Dyspnea, tachypnea Cough,
effective or ineffective; with/without sputum production Cyanosis Decreased breath sounds over affected lung areas
Ineffective cough Purulent sputum Hypoxemia Infiltrates seen on chest x-ray film Reduced vital capacity

Hyperthermia - Related Factors Dehydration Infection Increased metabolic rate - Defining Characteristics Body
temperature above the normal range Hot, flushed skin Increased heart rate Increased respiratory rate