Table of Contents

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Overview Pathophysiology Signs and Prevention Treatment Nursing Care
Symptoms and and Management
Screening Prognosis

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99% Match 2021 18+

Lung cancer begins when abnormal cells grow and multiply in an

uncontrolled way in one or both lungs.
Cancer that starts in the lungs is known as primary lung cancer. It
can spread to other parts of the body such as the lymph nodes,
brain, adrenal glands, liver and bones. When cancer starts in
another part of the body and spreads to the lungs, it is called
secondary or metastatic cancer in the lung
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TYPES OF LUNG CANCER

There are two main types of primary lung cancer, which are classified according to the type of cells affected.
Other types of cancer can also affect the lung area but are not considered lung cancer. These include tumours that start
in the space between the lungs (mediastinum) or in the chest wall.
1. Non-small cell lung cancer (NSCLC)
NSCLC makes up about 85% of lung cancers. It may be classified as:
• adenocarcinoma – begins in mucus-producing cells, more often found in the outer part of the lungs.
• squamous cell carcinoma – begins in thin, flat cells, most often found in the larger airways.
• large cell undifferentiated carcinoma – the cancer cells are not clearly squamous or adenocarcinoma.
2. Small cell lung cancer (SCLC)
- SCLC makes up about 15% of lung cancers. It tends to start in the middle of the lungs, and usually spreads more
quickly than NSCLC.
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Lung cancer mainly occurs in older people. Most people diagnosed with lung
cancer are 65 or older; a very small number of people diagnosed are younger
than 45. In its early stages, lung cancer doesn't typically have symptoms you can
see or feel. Early lung cancer does not alert obvious physical changes. Moreover,
patients can live with lung cancer for many years before they show any signs or
symptoms.

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The main symptoms of lung cancer include:

• a cough that doesn’t go away after 2 or 3 weeks
• a long-standing cough that gets worse
• chest-infections that keep coming back
• coughing up blood
• an ache or pain when breathing or coughing
• persistent breathlesness
• persistent tiredness or lack of energy
• loss of appetite or unexplained weight loss BA
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Less common symptoms of lung cancer include:

• changes in the appearance of your fingers, such as becoming more curved or
their ends becoming larger
• dysphagia
• wheezing
• a hoarse voice
• swelling of your face or neck
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• persistent chest or shoulder pain
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PREVENTION

Cigarette smoking is responsible for almost 90 percent of cases of lung cancer;

secondhand smoke exposure also increases risk. Environmental exposure to radon (a

colorless and odorless gas) is an important and modifiable risk factor for lung cancer

among both smokers and non-smokers. In addition, exposure to certain other

substances, such as asbestos, has been linked to the development of lung cancer.
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The best way to prevent lung cancer is to avoid smoking; don't start smoking,
or if you already smoke, quit. Some people believe that once they have smoked
for a long time, there is little point in quitting. However, studies have shown
that smokers who quit decrease their risk of lung cancer when compared with
those who continue to smoke. Smokers who quit for more than 15 years have
an 80 to 90 percent reduction in their risk of lung cancer compared with people
who continue to smoke. Quitting smoking can be challenging, but help is
available, and your health care provider can support you. If you live in an area
with high levels of environmental radon, you can buy a kit to test for the
presence of radon in your home.
If radon is present, it's possible to lower the level; radon treatment
("mitigation") professionals can provide guidance on the best way to do this.
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SCREENING
Screening is a way to detect a disease in its earliest stages, when it is more
likely to be treatable or curable. In order for experts to recommend routine
screening for any disease, it must be clear that the screening test is safe and
accurate, that screening can detect the disease in the early stages, and that
this can reduce the number of people who die from the disease. Screening
for lung cancer with low-dose computed tomography (CT) scan has been
shown to decrease the risk of death in people over age 55 years who are
heavy smokers or have a long history of smoking. However, quitting
smoking is even more important than screening because quitting smoking
will also reduce your risk of lung cancer, other cancers, heart disease, and
stroke.
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Screening is not recommended for everyone, but for some people with a heavy or
long smoking history, screening can save lives. If all of the following statements
apply to you, you may be a candidate for screening with low-dose CT scans:
●You are 50 to 80 years old
●You have smoked an amount that is equal to at least 1 pack a day for 20 years
(for example, 2 packs a day for 10 years)
●You still smoke now or quit smoking in the past 15 years
In addition to your smoking history, you should also consider your overall health
(and whether you are healthy enough to get treatment if you do develop lung
cancer) as well as the cost of screening. Insurance and Medicare payments for
screening change with time and clinical recommendations, so it is best to check
with your plan regarding payment. BA
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Benefits of screening — The main benefit of screening is that it increases the
chances of detecting lung cancer early, when it is generally easier to treat and
may be curable. This can lower your chances of dying from lung cancer.
Drawbacks of screening — One possible drawback of screening is the risk of
getting a "false positive" result. This is when a screening test finds something
that could be cancer, but ultimately turns out not to be cancer. False positives
can occur with screening with low-dose CT scans. In addition to being stressful,
this can lead to more imaging tests and/or a lung biopsy, which can be painful
and can sometimes leads to problems, such as bleeding or a collapsed lung.
Some people also worry about radiation exposure. However, the low-dose CT
scans used for lung cancer screening expose you to much less radiation than
regular CT scans. BA
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If you have a serious medical condition such as chronic lung, heart, or

other disease, the risks of lung cancer screening may outweigh the

benefits for you. If you are in generally good health, the decision to

screen will depend more on your personal values and preferences. Your

health care provider can help you figure out if screening is a good choice
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for you.
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LOW-DOSE CT SCAN — A large randomized trial (the National Lung Screening Trial [NLST]) in the
United States compared the benefits of screening by low-dose computed tomography (CT) scan
or standard chest X-ray in heavy smokers. Compared with chest X-ray, low-dose CT scan reduced
the risk of death from lung cancer by 20 percent and the overall risk of death by about 7
percent. However, nearly a quarter of the people who had yearly low-dose CT screening for
three years had an abnormal test, and more than 95 percent of the abnormal tests were "false
positive," meaning that they did not represent cancer.
Yearly screening with low-dose CT scan is now recommended by many organizations for current
or former smokers (who quit within the past 15 years) with a heavy or long smoking history.
Guidelines vary among organizations regarding the specific criteria they use, including age and
smoking history.
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CHEST X-RAY — There is no evidence that having an annual chest X-ray helps
extend life. In a large study comparing chest X-ray with low-dose CT for lung
cancer screening, only CT showed reduced the risk of death. Current expert
guidelines recommend against screening people who are at risk with chest X-
ray.
OTHER TESTS — Although low-dose CT scanning is the only recommended
method of lung cancer screening, experts are studying other tests that may
play a future role in lung cancer screening, including sputum tests, positron
emission tomography, bronchoscopy, breath testing, and blood tests.
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TYPES OF TREATMENT
1. Surgery
- Lung cancer surgery is an option for some patients depending on the type, location and stage of their
lung cancer and other medical conditions. If the patient’s cardiovascular status, pulmonary function, and
functional status are satisfactory, surgery is well tolerated. However, coronary artery disease, pulmonary
insufficiency and other comorbidities may contraindicate surgical intervention. The surgery is primarily
used for NSCLCs, because small cell cancer of the lungs grows rapidly and metastasizes early and
extensively. Lesions of patients with bronchogenic cancer are inoperable at the time of diagnosis.
- There are several types of lung resection that can be performed. The most common surgical
procedure for small, apparently curable tumor of the lung is lobectomy where you remove a single lobe of
the lung. Other types of Lung Resection are Bilobectomy, Sleeve resection, Pneumonectomy,
Segmentectomy, Wedge Resection and Chest Wall resection with removal of cancerous lung tissue.
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2. Radiation therapy
- Lung cancer radiation therapy uses powerful, high-energy X-rays to kill cancer cells or keep them from
growing. Radiation may come from outside the body (external) or from radioactive materials placed
directly inside the lung cancer tumor (internal/implant). External radiation is used most often. The
radiation is aimed at the lung cancer tumor and kills the cancer cells only in that area of the lungs.
Radiation can be used before lung cancer surgery to shrink the tumor or after surgery to kill any cancer
cells left in the lungs. Sometimes external radiation is used as the main type of lung cancer treatment. This
is often the case for people who may not be healthy enough to have surgery or whose cancer has spread
too far to have surgery. Radiation therapy for lung cancer also can be used to relieve symptoms caused by
the cancer, such as pain, bleeding or blockage of airways by the tumor.
- Sometimes patients with small cell lung cancer (SCLC) will get radiation to the brain. This helps to
lower the chances of the lung cancer spreading to the brain, which is common in SCLC. This is called
prophylactic cranial irradiation.
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3. Chemotherapy
- Chemotherapy is used to alter tumor growth patterns, treat distant metastases
or small cell cancer of the lung and as an adjunct to surgery or radiation therapy. It
may provide relief especially of pain but it does not cure the disease or prolong life
to any great degree and is accompanied by side effects.
- The choice of agent depends on the growth of the tumor cell and the specific
phase of the cell cycle that the medication affects. In combination with surgery,
chemotherapy may be given before surgery (neoadjuvant therapy) or after surgery
(adjuvant therapy). Chemotherapy is usually given by intravenous (IV) line. The
chemotherapy treatment for lung cancer is given in cycles. Each treatment period is
followed by a recovery period.
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4. Palliative therapy
- Palliative care, concurrent with standard oncologic care for lung cancer,
should be considered early in the course of illness for any patient with
metastatic cancer or high symptom burden. In lung cancer, palliative
therapy may include radiation therapy to shrink the tumor to provide pain
relief, a variety of bronchoscopic interventions to open narrowed bronchus
or airway, and pain management and other comfort measures. Evaluation
and referral for hospice care are important in planning for comfortable and
dignified end-of-life care for the patient and family.
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PROGNOSIS
The lung cancer five-year survival rate (18.6 percent) is lower than many
other leading cancer sites, such as colorectal (64.5 percent), breast (89.6
percent) and prostate (98.2 percent).
The five-year survival rate for lung cancer is 56 percent for cases detected
when the disease is still localized (within the lungs). However, only 16 percent
of lung cancer cases are diagnosed at an early stage. For distant tumors
(spread to other organs) the five-year survival rate is only 5 percent. More
than half of people with lung cancer die within one year of being diagnosed.
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NURSING ASSESSMENT
• Determine the client’s history regarding use of tobacco products.
• Determine the pack-year history, which is the number of packs of
cigarettes smoked per day times the number of years smoked.
• Evaluate the client’s use of tobacco products (cigars, pipes, and chewing
tobacco).
• Ask about exposure to second-hand smoke or occupational exposure to
carcinogens.
• Monitor for a cough that changes in pattern. BA
• Monitor nutritional status, weight loss, and anorexia
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NURSING DIAGNOSIS
• Impaired gas exchange related to altered oxygen supply.
• Ineffective breathing pattern related to decreased lung expansion
secondary to fibrotic condition in the lungs.
• Activity Intolerance related to decreased oxygenation.
• Acute pain related to disease process, surgical intervention, or
treatment effects.
• Chronic pain related to direct tumor involvement such as infiltration of
tumor into nerves, bones, or hollow viscus.
• Risk of infection. BA
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PLANNING
Desired Outcomes:
• Client will be able to keep a patent airway
• Client will remain free from pain.
• Client will remain free from infection.
• Client will be able to maintain within 10% of ideal body weight.
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NURSING INTERVENTIONS
Goal: To prepare client for surgery.
A. General preoperative preparations
1. Obtain client profile. Determine whether client is prepared for a procedure or
surgery.
 Older adult priority: older clients are at increased risk for developing
postoperative complications because of the decreased response of the immune
system (which delays healing), and the increased incidence of chronic disease.
 The older adult may require repeated explanation, clarification, and positive
reassurance. BA
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2. Conduct a preoperative interview
• chronic health problems and previous surgical procedures and
experiences
• Past and current drug therapy, including over-the-counter medications
(vitamins, herbal remedies, homeopathic medications).
• History of drug allergies and dietary restrictions.
• Client’s perception of illness and impending surgery
• Discomfort or symptoms client is currently experiencing.
• Religious affiliation.
• Family or significant others. BA
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3. Psychosocial needs: fear of the unknown is the primary

cause of preoperative anxiety.
4. Ask about the use of medications which may
predispose client to operative complications.
• Anticoagulants: potentiate bleeding
• ….
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5. Check results of routine diagnostic laboratory studies.
• CBC: serum electrolytes, coagulation studies, serum creatinine, BUN,
and fasting glucose.
• Urinalysis
• Chest X-ray
• ECG for clients over 40 years of age.
• Coagulation studies for clients with known problems to establish a
baseline.
6. Provide preoperative teaching: goal is to decrease the client’s anxiety
and prevent postoperative complications. BA
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7. Physical preparation of client:

• Skin preparation: purpose is to reduce bacteria on the
skin.
• Gastrointestinal preparation: Food and fluid restriction,
enemas or cathartics, promote sleep and rest.

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8. Legal implications
• Each surgical procedure must have the voluntary, informed, and written consent of the client or
the person legally responsible for the client.
• The physician gives the client full explanation of the procedure, including complications, risks,
and alternatives.
• Client’s informed consent record (permit must be signed by the client or guardian. A witness
signs to validate this is the client’s signature. The witness is frequently a staff nurse. Depending on
facility policy, the surgeon may also be required to sign the consent form.
 Nursing Priority: Determine that the client understands relevant information before
procedure/surgery; do not witness the client’s signature on an informed consent form until you
verify that the client has received relevant information.
• The signed consent record is part of the permanent chart record and must accompany the
client to the operating room. BA
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B. Improve quality of ventilation before surgery
1. No smoking
2. Bronchodilators
• Bronchodilators are a type of medication that make breathing easier by
relaxing the muscles in the lungs and widening the airways (bronchi).
3. Good pulmonary hygiene
• Pulmonary hygiene, previously known as pulmonary toilet, refers to
exercises and procedures that help to clear your airways of mucus and
other secretions. This ensures that your lungs get enough oxygen and your
respiratory system works efficiently. BA
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C. Discuss anticipated activities in the immediate postoperative period
- Goals: During the postoperative period, reestablishing the patient’s physiologic
balance, pain management and prevention of complications should be the focus of
the nursing care. To do these it is crucial that the nurse perform careful assessment
and immediate intervention in assisting the patient to optimal function quickly,
safely and comfortably as possible.
• Maintaining adequate body system functions.
• Restoring body homeostasis.
• Pain and discomfort alleviation.
• Preventing postoperative complications.
• Promoting adequate discharge planning and health teaching. BA
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The mnemonic "POSTOPERATIVE" may also be helpful:
• P - Preventing and/or relieving complications
• O - Optimal respiratory function
• S - Support: psychosocial well-being
• T - Tissue perfusion and cardiovascular status maintenance
• O - Observing and maintaining adequate fluid intake
• P - Promoting adequate nutrition and elimination
• A - Adequate fluid and electrolyte balance
• R - Renal function maintenance
• E - Encouraging activity and mobility within limits
• T - Thorough wound care for adequate wound healing
• I - Infection Control
• V - Vigilant to manifestations of anxiety and promoting ways of relieving it
• E - Eliminating environmental hazards and promoting client safety
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To PACU
Patient Care during Immediate Postoperative Phase:
Transferring the Patient to RR or PACU
D.Encourage ventilation of feelings regarding diagnosis
and impending surgery.
E. Establish baseline data for comparison after surgery
F. Orient client to the intensive care unit, if indicated
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Goal: To maintain patent airway and promote ventilation after thoracotomy
A. Removal of secretions from tracheobronchial tree, either by coughing or
suctioning.
B. Have client cough frequently, deep-breathe, and use incentive spirometer
- How to use the incentive spirometer
• Sit on the edge of your bed if possible, or sit up as far as you can in bed.
• Hold the incentive spirometer in an upright position.
• Place the mouthpiece in your mouth and seal your lips tightly around it.
• Breathe in slowly and as deeply as possible. Notice the yellow piston rising
toward the top of the column. The yellow indicator should reach the blue BA
outlined area.
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• Hold your breath as long as possible (at least for 5 seconds). Then exhale slowly
and allow the piston to fall to the bottom of the column.
• Rest for a few seconds and repeat steps one to five at least 10 times every hour.
• Position the yellow indicator on the left side of the spirometer to show your best
effort. Use the indicator as a goal to work toward during each slow deep breath.
• After each set of 10 deep breaths, cough to be sure your lungs are clear. If you
have an incision, support your incision when coughing by placing a pillow firmly
against it.
• Once you are able to get out of bed safely, take frequent walks and practice
coughing. You may stop using the incentive spirometer unless otherwise instructed by
your healthcare provider.
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C. Assess vital signs; correlate with quality of respirations.

D. Provide supplemental O2 as indicated
E. Control pain so that client can take deep breaths and cough
F. Do not position the client who has undergone a wedge
resection or lobe resection on the affected side for extended
periods of time; this will hinder the expansion of the lung
remaining on that side. If client is in stable condition, place in
semi-Fowler’s position to promote optimum ventilation
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Nursing Priority: Postoperative positioning of the
client who has had thoracic surgery is important
to remember, especially the client who has
undergone pneumonectomy
G. If the client who has undergone
pneumonectomy experiences increased dyspnea,
place him or her in semi-Fowler’s position. If
tolerated, positioning on the operative side is
recommended to facilitate full expansion of lung
on unaffected side. BA
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H. Encourage ambulation as soon as possible.
- the ‘out of bed’ strategy, with ambulation, immediately after surgery is
aimed to augment the pleural lymphatic drainage (3), cutting fluid loss
from drainages. It is known that ambulation also increases pulmonary
ventilation and reduces risk of post-operative atelectasis and pneumonia
I. Assess level of dyspnea at rest and with activity
J. Maintain water-sealed drainage system. The client who has
undergone pneumonectomy will not have chests tubes for lung
reexpansion because there is no lung left in the pleural cavity
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Goal: To assess and support cardiac function after thoracotomy

A. Monitor for dysrhythmias; assess adequacy of cardiac output
B. Evaluate urine output
C. Administer fluids and transfusions with extreme caution;
client’s condition is very conductive of development of fluid
overload
D. Evaluate hydration and electrolyte status
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Goal: To maintain normal range of motion and function of the affected shoulder after
thoracotomy
A. Exercises to increase abduction and mobility of the shoulders
B. Encourage progressive exercises
• Exercise Goals Slowly work up to walking at least 30 minutes, total, every day.
• Start by walking 3 times a day for about 5 minutes each time. Each week, increase the
total time you walk by about 3 minutes until you are walking for a total of 30 minutes a
day.
• Warm up and cool down for 5 minutes before and after you walk by doing exercises
(see exercise handout), or by walking more slowly.
• Remember to add in the time for your return trip. Do not walk until you are tired.BA
•
Exercise at a moderate level of effort (3 to 5 on a scale of 0 to 10)
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• Wear loose-fitting, comfortable clothes.
• Wait 1 hour after you eat to exercise.
• Walk on flat ground.
• It is OK to walk on a treadmill at a slow speed (3.0 mph or less).
Pay Attention to Your Body
Slow down if:
• Your body is working at more than a moderate level of effort (greater than 5 on a scale of 0
to 10).
• For more than 10 minutes after you STOP exercising, you are very short of breath or your
pulse is 20 beats per minute higher than when you started exercising.
• You cannot sleep, or you feel more tired than normal the day after you exercise.
• You have arthritis and it flares up, or you feel pain in your joints, heels, or calf muscles.BA
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• You have increased swelling in your legs or feet.
Do not exercise if:
• You have a cold, flu, or fever.
• You have diabetes and it is out of control.
• You feel extreme emotional stress or you are much more tired than
normal.
Call your doctor if:
• You have pain or pressure in your chest, arms, or throat.
• You are dizzy, lightheaded, have blurry vision, or feel faint. BA
• You are confused or suddenly clumsy.
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Goal: To assist client to understand measures to promote health after
thoracotomy
A. No more smoking; avoid respiratory irritants
B. Decreased strength is common
C. Continue activities and exercises
D. Stop any activity that causes shortness of breath, chest pain, or
undue fatigue
E. Avoid lifting heavy objects until complete healing has occurred
F. Return for follow-up care as indicated BA
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Water-sealed chest drainage
Chest drains also known as under water sealed drains
(UWSD) are inserted to allow draining of the pleural
spaces of air, blood or fluid, allowing expansion of the
lungs and restoration of negative pressure in the
thoracic cavity.
Purposes
1. To remove air and/or fluid from the pleural cavity
2. To restore negative pressure in the pleural cavity
and promote reexpansion of the lung
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Principle of Water-sealed chest drainage

The water seal (or dry seal on some
equipment) serves as a one-way valve; it
prevents air, under atmospheric pressure,
from reentering the pleural cavity. On
inspiration, air and fluid leave the pleural
cavity via the chest tube; the water or dry
seal keeps the air and fluid from
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reentering.
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Medications
Chemotherapy agents
• Chemotherapy is the treatment of choice for lung cancer. The purpose of these
medications is to destroy cancer cells, as well as healthy cells, to prevent DNA
formation. Platinum compounds such as cisplatin are commonly used.
- Nursing Considerations
• Watch the client for a decrease in immunity function
• Observe the client for nausea and vomiting
• Monitor the client for fatigue
• Assess the client for shortness of breath
• Assess the client’s throat and mouth for aphthous (cold sore) lesions BA
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- Client Education
• Encourage the client to inform the nurse if nausea and vomiting persists.
• Encourage the client to use frequent oral hygiene and use a soft-bristled
toothbrush. Advise the client to avoid alcohol-based mouthwashes
• Inform the client that hair loss (alopecia) occurs 7 to 10 days after
treatment begins. Encourage the client to select a hairpiece before
treatment starts.

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Opioid agonists (Pain medication)
• Morphine sulfate, oxycodone, and fentanyl are opioid agents used to
treat moderate to severe pain, caused by an illness. These medications act
on the mu and kappa receptors that help to alleviate pain.
• Activation of these receptors produces analgesia (pain relief), respiratory
depression, euphoria, sedation, and decrease in gastrointestinal motility.
• Use cautiously with clients who have asthma or emphysema due to the
risk of respiratory depression.

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- Nursing Considerations
• Assess the client’s pain every 4 hours
• Remind clients receiving the fentanyl patch that the initial patch takes
several hours to take effect. A short-acting pain medication will be
administered for breakthrough pain
• Watch the client for signs of respiratory depression, especially in older
adult clients. If respiration are 12/min or less, stop the medication and notify
the health care provider immediately.
• Monitor the client’s vital signs closely for signs of hypotension and
decreased respirations. BA
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• Observe the client for nausea and vomiting

• Assess the client’s level of sedation (drowsiness, level of
consciousness)
• Encourage fluid intake and activity related to a decrease
in gastric motility
• Monitor intake and output and for signs of fluid
retention. This is common in clients who have an enlarged
prostate. BA
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- Client Education
• Encourage the client to suck on hard candies to help with dry mouth
• Encourage the client to drink plenty of fluids to help prevent constipation
• Advise the client to increase fiber intake to help with constipation
• Advise the client to notify the nurse if nausea and vomiting persists.
• Advise the client to avoid driving while taking the medication
• Teach the client to use a patient-controlled analgesia (PCA) pump if
applicable. The client is the only person that is to push the medication
administration button. Reassure the client that the safety lockout mechanism
on the PCA prevents overdosing of medication BA
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Complications
Syndrome Of Inappropriate Antidiuretic Hormone (SIADH) Nursing Management
Nursing Diagnosis:
Excess fluid volume related to excessive amount of antidiuretic hormone secretion.
Patient Monitoring
1. Monitor pulmonary artery pressures and central venous pressure hourly (if available) or
more frequently to evaluate the patient’s response to treatment. Both parameters reflect the
capacity of the vascular system to accept volume and can be used to monitor fluid volume
status.
2. Monitor hourly intake and output, and determine fluid balance every 8 hours. Compare
serial weights and note rapid (0.5-1 kg/day) changes in weight, suggesting fluid imbalance.
3. Continuously monitor ECG for dysrhythmias resulting from electrolyte imbalance. BA
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Patient Assessment
1. Obtain VS every hour or more frequently until the patient’s condition is
stable.
2. Evaluate hydration status every 4 hours. Note skin turgor on inner thigh or
forehead, condition or buccal membranes, development of edema or crackles,
and complaints of thirst.
3. Assess for pressure ulcer development secondary to edematous state.
Diagnostic Assessment
Review serum sodium and potassium, serum osmolality, urine specific gravity,
and urine osmolality to evaluate the patient’s response to therapy. BA
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Patient Management
1. Restrict fluid as ordered, generally <500 mL/day in severe cases and 800 to
1000 mL/day in moderate cases.
2. Administer potassium supplements as ordered, assess renal function and
ensure adequate urine output before administering potassium.
3. As adjuncts to water restriction, demeclocycline may be ordered to inhibit
the renal response to ADH in patients with lung malignancies.
4. Avoid hypotonic enemas to treat constipation because water intoxication
can be potentiated.
5. Institute pressure ulcer prevention strategies. BA
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Superior vena cava syndrome
- Superior vena cava syndrome results from pressure placed on the vena cava by a tumor.
It is a medical emergency
Nursing Actions
- Monitor for signs
• Early signs include facial edema, edema in neck, nosebleeds, peripheral edema, and
dyspnea
• Late signs include mental status changes, cyanosis, hemorrhage, and hypotension
- Notify the health care provider immediately.
- Radiation and stent placement provide temporary relief. Prepare the client for the
procedure (informed consent, NPO if possible, client transport).
- Monitor the client’s status (vital signs, oxygenation) during and after the procedure.
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Pneumonia
- an increased work of breathing increases caloric demands.
- Proper nutrition aids in the prevention of secondary respiratory
infections.
- Encourage fluid intake of 2 to 3 L/day to promote hydration and
thinning of secretions, unless contraindicated due to another
condition.
- Provide rest periods for older adult clients who have dyspnea.
- Reassure the client who is experiencing respiratory distress.
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Collaborative care
- Nursing care
• Position the client to maximize ventilation (high-Fowler’s=90%)
• Encourage coughing or suction to remove secretions
• Administer breathing treatments and medications as prescribed
• Administer oxygen therapy as prescribed
• Monitor for skin breakdown around the nose and mouth from the oxygen device.
• Encourage deep breathing with an incentive spirometer to prevent alveolar collapse.
• Determine the client’s physical limitations and structure activity to include periods of
rest.
• Promote adequate nutrition