Lung Cancer

      
Also called bronchogenic cancer. It is a malignant tumor of the lung arising within the bronchial wall or epithelium. Bronchogenic cancer is classified according to cell type: epidermoid (squamous cell most common), adenocarcinoma, small cell (oat cell) carcinoma, and large cell (undifferentiated) carcinoma. The lung is also a common site of metastasis from cancer elsewhere in the body through venous circulation or lymphatic spread. The primary predisposing factor in lung cancer is cigarette smoking. Lung cancer risk is also high in people occupationally exposed to asbestos, arsenic, chromium, nickel, iron, radioactive substances, isopropyl oil, coal tar products, and petroleum oil mists. Complications include superior vena cava syndrome, hypercalcemia (from bone metastasis), syndrome of inappropriate antidiuretic hormone (SIADH), pleural effusion, pneumonia, brain metastasis, and spinal cord

compression. 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 pleural effusion) on examination. DIAGNOSTIC EVALUATION Chest X-ray may be suspicious for mass; CT or position emission tomography scan will be better visualize tumor. Sputum and pleural fluid samples for cytologic examination may show malignant cells. Fiberoptic bronchoscopy determines the location and extent of the tumor and may be used to obtain a biopsy specimen. Lymph node biopsy and mediastinoscopy may be ordered to establish lymphatic spread and help plan treatment. Pulmonary function test, which may be combined with a split-function perfusion scan, determines if the patient will have adequate pulmonary reserve to withstand surgical procedure.

 

PHARMACOLOGIC INTERVENTIONS Expectorants and antimicrobial agents to relieve dyspnea and infection. Analgesics given regularly to maintain pain at tolerable level. Titrate dosages to achieve pain control.

Chemotherapy using cisplatin in combination with a variety of other agents and immunotherapy

treatments may be indicated. SURGICAL INTERVENTIONS

    

Resection of tumor, lobe, or lung. THERAPEUTIC INTERVENTIONS Oxygen through nasal cannula based on level of dyspnea. Enteral or total parenteral nutrition for malnourished patient who is unable or unwilling to eat. Removal of the pleural fluid (by thoracentesis or tube thoracostomy) and instillation of sclerosing agent to obliterate pleural space and fluid recurrence. Radiation therapy in combination with other methods. NURSING INTERVENTIONS

1. 2. 3. 4. 5. 6. 7. 8. 9.

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). Teach breathing retraining exercises to increase diaphragmatic excursion and reduce work of breathing. Augment the patients ability to cough effectively by splinting the patients chest manually. Instruct the patient to inspire fully and cough two to three times in one breath. Provide humidifier or vaporizer to provide moisture to loosen secretions. Teach relaxation techniques to reduce anxiety associated with dyspnea. Allow the severely dyspneic patient to sleep in reclining chair. Encourage the patient to conserve energy by decreasing activities. 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. 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 patients sense of control. 13. Teach the patient to use prescribed medications as needed for pain without being overly concerned about addiction.