Lung Cancer & Thoracic Topics Flashcards
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Diagram of the Lungs
Assessing Lungs & Thorax
Care of the Patient with Lung Cancer
- Concepts of lung disorders
- Priority concepts
- Gas exchange
- Immunity
- Interrelated concepts
- Perfusion
- Cellular regulation
Lung Cancer Pathophysiology
- Leading cause of cancer deaths worldwide
- Poor long-term survival due to late-stage diagnosis
> Prognosis for advanced lung cancer is poor, about 6% when metastasized (distant) at diagnosis. Therefore, treatment is often palliative rather than curative
Bronchogenic carcinomas
Typically classified as
- SCLC
- NSCLC
Most primary lung cancers (primary meaning that the cancer started in the lungs rather than metastasized (or spread) from another site first) result from cellular regulation failure in the bronchial epithelial cells and are classified as bronchogenic carcinomas
- Lung cancer can spread or metastasize by direct extension or through the blood and lymph systems
> Tumors can then compress, invade, and/or block the airway and any other nerve, vessel, bone, tissue, etc.
Staging Lung Cancer
- Staged to assess size/extent of disease
- T-N-M system
Assessment
- History - risk factors
- Pulmonary and non-pulmonary manifestations
- Symptoms (subjective/objective)
- Psychosocial assessment
- Diagnostic assessment
Symptoms
- Hoarseness, change in respiratory pattern
- Persistent cough or change in cough
- Blood-streaked sputum; rust-colored or purulent sputum
- Frank hemoptysis; chest pain or tightness
- Shoulder, arm, or chest wall pain; recurring episodes of pleural effusion, pneumonia, or bronchitis
- Dyspnea; fever associated with 1 or 2 other signs
- Wheezing, weight loss, clubbing of the fingers
Assessment
- Psychosocial assessment
- Fear
- Guilt
- Shame
- Anxiety
Assessment/Diagnosis
- Diagnostic assessment
- Examination of cancer cells
- Cytological testing of sputum but may not always be present in sputum
- Cytology of pleural fluid if present
- X-rays of lesions
- Thoracoscopy and/or mediastinoscopy
- Needle biopsy, direct surgical biopsy, or pleural biopsy via thoracoscopy
- PFT’s, ABG’s, PET’s, etc. to determine extent of metastasis if present
Intervention - Nonsurgical Management
- Chemotherapy (especially for SCLC, also surgery too)
- Targeted therapy
- Radiation therapy (i.e. targeted agents for NSCLC) (best result = use radiation with chemo and surgery)
- Photodynamic therapy (involves ICU care for airway management; risks of hemorrhage, fistula, hemoptysis)
- Interventions have a curative or palliative focus
Surgical Management
- Lobectomy
- Pneumonectomy
- Segmentectomy
- Wedge resection
Chest Tube Drainage System
Interventions for Palliation
- Oxygen therapy
- Drug therapy
- Radiation therapy
- Thoracentesis and pleurodesis
- Dyspnea management
- Pain management
- Hospice care
Impact of Cancer on Physical Function
- Impaired immunity and clotting
> Can be affected by both the metastasis of cancer to the bone marrow, where blood cells are formed, but also as a side effect of the chemotherapy
> When white cell production or function is affected, immune system is impaired - Altered GI function
> Direct tumors in GI tract can block it and affect absorption and overall function
> Pressure can build in abdomen and make pts not feel hungry or not allow them to each much at a time
> We see N/V, cachexia; may need enteral or parenteral feeding
> Tumors can invade the liver and damage can lead to malnutrition and death
- Altered peripheral nerve function
> D/t tumor involvement and a side effect of chemo
> Is neurotoxic and can lead to damaged peripheral nerves, peripheral neuropathy, reducing sensory perception - Motor and sensory deficits
> When tumors invade spinal cord and brain - Cancer pain
- Altered respiratory and cardiac function
> Tumors invade the airways and cause obstruction. If in the lungs, lung capacity affected
> Chemo and radiation affect heart and lung function (dyspnea, hypoxia, decreased cardiac function and heart/valve disease)
Surgery as Cancer Treatment
- Oldest form of cancer treatment
- Prophylaxis
- Diagnosis
- Cure
- Control
- Palliation
- Assessing therapy effectiveness
- Reconstruction
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Purpose is to destroy cancer cells with minimal damaging effects of surrounding normal cells; maintain a safe environment
- Is a local treatment
- Uses ionizing radiation
__ is the amount of radiation absorbed
__ is the amount of radiation delivered
Radiation therapy
Radiation dose
Exposure
Side Effects of Radiation Therapy
- Acute and long-term site-specific changes
- Vary according to site
- Local skin changes and hair loss
- Altered taste sensations
- Fatigue
- Bone marrow suppression
Radiation Therapy - Interprofessional Collaborative Care
- Provide accurate information
- Do not remove temporary ink markings
- Avoid skin irritation
> Follow policy for skin care product use - Nutritional support consult
- Care for xerostomia (dry mouth), mouth sores
- Teach about risk for fractures
> For bone exposed to radiation - Exercise and sleep interventions for fatigue
Thoracic
- Assessments
- Surgeries
- Chest tube placement
- Nursing diagnoses
- Teaching
- Procedures
Assessment
- Reasons for surgery
> Relief of disease process
> Exploratory
> Emergent (i.e. chest trauma) - Preoperative concerns
> Optimal “pre-op” condition (functional reserves, alleviate pt anxiety)
> Survival - Physical assessment
> History
> Pre-op testing
> Physical exam
Nursing diagnoses
- Impaired airway clearance
- Impaired gas exchange
- Anxiety
- Fear
- Knowledge deficit
Pre-operative outcomes
- Improved airway clearance
- Teaching
- Decreasing anxiety/fear
- Improved knowledge
- Adequate gas exchange
Improved Airway Clearance
- Underlying reason for the surgery is often associated with increase in respiratory secretions
- Stop smoking
- Implement measures to reduce atelectasis and pneumonia (incentive spirometry, cough and deep breathing, frequent repositioning)
Teaching
- Pursed lip breathing/diaphragmatic breathing
- Incision splinting
- Humidification
- Postural drainage
- Antibiotics
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Is removal of (excess) fluid in the pleural space
Thoracentesis
Nursing Interventions
- Assure adequate consent
- NPO 6-8h prior to procedure
- Explain procedure
- Administer rx’s
- Monitor for return of gag reflex post procedure (! avoid aspiration)
- Monitor respiratory status
- Monitor VS
- Discharge instructions
Common Thoracic Surgeries
- Pneumonectomy (removal of whole lung)
- Lobectomy (a piece or lobe of the lung)
- Segmental resection (remove a segment of the lung)
- Wedge resection (pie-shaped piece removed)
Front or lateral incisions
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Is the presence of air or gas in the pleural space that causes the lung to collapse
Pneumothorax
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When air from a ruptured lung enters the pleural cavity without a means to escape
As air pressure builds up, the lung is compressed and all of the mediastinal tissues are displaced to the opposite side of the chest
Tension pneumothorax
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Blood fills the pleural cavity
Usually occurs because of chest surgery, trauma, or diagnostic procedures
* If blood continues to accumulate there, the lung is going to collapse
Minimal = <350mL
Moderate = 350-1500mL (treat with thoracentesis and chest tube drainage with underwater seal)
Massive = >1500mL (usually 2 chest tubes inserted and thoracotomy may be necessary to stop bleeding)
Hemothorax
The Need for Chest Tubes
- Chest surgery causes a pneumothorax on the operated side
- Atmospheric air rushes into the pleural space as the parietal pleura is incised
- The normally negative pressure in the pleural space changes to a positive pressure therefore collapsing the lung
