Transcript 15 L. Interventions for Clients with Lung Cancer

Lung Cancer
Etiology
Leading cause of cancer-related
deaths
 In 2002, 25% of all female deaths
were estimated to be due to lung
cancer
 Most commonly occurs in individuals
over 50 and with a history of
cigarette
 smoking
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Etiology
Smoking is responsible for 80 to 90%
of all lung cancers
 Tobacco smoke contains 60
carcinogens that interfere with cell
development
 Cigarette smoking causes a change in
bronchial epithelium
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Etiology
Lung cancer is related to total
exposure to cigarette smoke
measured by
 • Total number of cigarettes smoked
 • Age of smoking onset
 • Depth of inhalation
 • Tar and nicotine content
 • Use of unfiltered cigarettes
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Etiology
Environmental tobacco smoke (ETS)
inhaled by nonsmokers poses 35%
increased risk in developing lung
cancer
 Children are more vulnerable to ETS
than adults
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Etiology
Other carcinogens pose risk for
developing lung cancer
 • Asbestos
 • Radon
 • Nickel
 • Iron/iron oxides
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Etiology
Other carcinogens pose risk for
developing lung cancer
 • Uranium
 • Polycyclic aromatic hydrocarbons
 • Arsenic
 • Chromates
 • Air pollution
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Pathophysiology
90% of cancers originate from
epithelium of bronchus
 It takes 8 to 10 years for a tumor to
reach 1 cm; smallest lesion
detectable on x-ray
 Occur primarily on segmental bronchi
and upper lobes
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Pathophysiology
Pathologic changes in bronchial
system
 • Hypersecretion of mucus
 • Desquamation of cells
 • Reactive hyperplasia of basal cells
 • Metaplasia of normal respiratory
epithelium to stratified squamous
cells
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Pathophysiology
Primary lung cancers categorized
into two subtypes
 • Non-small cell lung cancer (NSCLC)
 • 82%
 • Small cell lung cancer (SCLC)
 • 18%
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Lung cancer pathology
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Types of Non-small cell (NSCLC)–82%
Squamous cell—32%
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usually undifferentiated
Invades surrounding tissue early then mets
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Adenocarcinoma- 40- 42%
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Increasing in women
Can appear in non smokers
Slow-growing –early invasion of the lymphatics
Large cell(undifferentiated) 12 %
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Lung cancer pathology
Lung Cancer Pathology Squamous
Cell
 Adenocarcinoma
 Large Cell Carcinoma
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Pathophysiology
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Lung cancers metastasize by direct
extension, blood circulation, and lymph
system
Common sites for metastatic growth
• Liver
• Brain
• Bones
• Lymph nodes
• Adrenal glands
Clinical Manifestations
Symptoms appear late in disease
 Depend on type of primary lung
cancer, location, and metastatic
spread
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Clinical Manifestations
Pneumonitis
 Persistent cough with sputum
 Hemoptysis
 Chest pain
 Dyspnea
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Clinical Manifestations
Later manifestations
 • Anorexia
 • Weight Loss
 • Fatigue
 • N/V
 • Hoarse voice
 • Unilateral paralysis of diaphragm
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Diagnostic Studies
Chest x-ray
 CT scan
 Magnetic resonance imaging (MRI)
 Positron emission tomography (PET)
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Diagnostic Studies
Diagnosis identified by malignant
cells
 Sputum specimens obtained for
cytologic studies
 • Fiberoptic bronchoscope
 • Mediastinoscopy
 • Video-assisted thoracoscopy (VATS)
 • Pulmonary angiography
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Diagnostic Studies
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Staging
• NSCLC staged according to TNM system
• T umor size, location, and degree of
invasion
• N ode indicates regional lymph node
involvement
• M etastasis represents presence/absence
of distant metastases
Staging non-small cell
Stage I-one lobe without lymph node
involvement
 Stage II- one lobe with involvement
of lymph node inside the lung
 Stage III- lung ca with lymph nodes
in the mediastinal region or outside
the chest
 Stage IV-spread outside of the chest
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Lung Cancer Staging
Diagnostic Studies
Staging
 • SCLC
 • Not been useful due to cancer
metastasized before diagnosis is
made
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Collaborative Care
Surgical Therapy
 • Surgical resection is
contraindicated for small cell
carcinomas
 • Squamous cell carcinomas are likely
treated with surgery
 • Usually stage I or II
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Surgical Management
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If complete resection is not possible,
removes the bulk of the tumor & risk of
metastatic extension
Thoracotomy (opening thoracic cavity) –
Pneumonectomy- remove all or part of
lung
Lobectomy-removes a lobe of the lung
Wedge resection or segmentectomyremoves a small part of a lobe of lung
Surgical Management
Following lobectomy for lung cancer, a
client receives a chest tube connected to a
three-chamber
 chest drainage system. The nurse observes
that the drainage system is functioning
correctly
 when she notes tidal movements or
fluctuations in which compartment of the
system as the client
 breathes?
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ANSWER
WATER-SEAL
 Fluctuations in the water-seal
compartment are called tidal
movements and indicates normal
 system function
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Preoperative Care
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Aimed at relieving anxiety & promoting
client participation
Encourage client to express fears &
concerns
Reinforces physician’s explanation of
procedure
Teach anticipated location of incision,if
known, shoulder exercises, and about
chest
tubes (except pneumonectomy)
Collaborative Care
Radiation therapy
 • Curative approach in individual with
resectable tumor and poor surgery
risk
 • Some cancer cells are more
radiosensitive than others
 • Used in combination with
chemotherapy
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Collaborative Care
Chemotherapy
 • Treatment of nonresectable tumors
or adjuvant to surgery in NSCLC with
distant metastases
 • Used in combination with multidrug
regimen
 • Improved survival rate with NSCLC
and SCLC
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Collaborative Care
Other therapies
 • Biologic therapy
 • Prophylactic cranial therapy
 • Bronchoscopic laser therapy
 • Phototherapy
 • Airway stenting
 • Cryotherapy
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Nursing Management
Nursing Assessment
Nursing Assessment
 Assess patient and family’s
understanding of diagnostic tests,
diagnosis, treatment
 options, and prognosis
 Assess level of anxiety
 Obtain subjective and objective data
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Nursing Management
Nursing Diagnoses
Ineffective airway clearance
 Anxiety
 Acute pain
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Nursing Management
Nursing Diagnoses
Imbalanced nutrition: less than body
requirements
 Ineffective health maintenance
 Ineffective breathing pattern
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Nursing Management
Planning
Overall goals
 • Effective breathing patterns
 • Adequate airway clearance
 • Adequate oxygenation of tissues
 • Minimal to no pain
 • Realistic attitude toward treatment
and prognosis
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Nursing Management
Nursing Implementation
Health Promotion
 • Avoid smoking
 • Promote smoking cession programs
 • Support education and smoking
policies
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Nursing Management
Nursing Implementation
Acute Intervention
 • Offer support during diagnostic
evaluation
 • Nutritional evaluation
 • Provide comfort
 • Teach methods to reduce pain
 • Educate indications for
hospitalization
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Nursing Management
Evaluation
Expected outcomes
 • Adequate breathing patterns
 • Minimal to no pain
 • Realistic attitude about prognosis
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Psychosocial Preparation
If CA resectable, encourage optimism
and gradual return to normal
 activities
 • If prognosis is poor, facilitate
expression of fears & concerns,
maintain
 open lines of communication & stress
quality of as defined by client
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Home Care Management
References to community agencies,
home health nursing or hospice
 Hospice provides physical and
psychological support to client &
family
 American Cancer Society
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