Week 6: Lung Cancer: lower respiratory disorder

Question 1

What is Lung Cancer?

Answer 1

uncontrolled growth of abnormal cells in the lungs causes lung cancer

Question 2

2 Major types of Lung Cancer

Answer 2

1. Non-small-cell cancer

2. Small-cell cancer

Question 3

Non-small cell cancer

Answer 3

• represents 85% of lung cancers
• consists of 3 types of cells; squamous cell-carcinoma, adenocarcinoma, and large-cell carcinoma
• the 5-year survival rate for those diagnosed with non-small-cell cancer if diagnosed in the early stage is good

Question 4

Small-cell cancer

Answer 4

(oat-cell cancer)

• represents 15% of lung cancers
• grows quickly and metastasizes to other organs in the body
• independent of the stage at diagnosis, survival statistics are poor; only 5 to 10% of those developing small-cell cancers survive for 5 years

Question 5

Clinical Manifestations

Answer 5

not evident early in the disease but become apparent as disease advances
-new cough that does not go away or changes in chronic cough
-hemoptysis (blood in sputum)
-SOB
-wheezing
-hoarseness
-chest pain
-headache and bone pain may also be present
-weight loss is common
>as disease progresses, symptoms worsen

Question 6

Diagnosis

Answer 6

made through several methods:

• chest x-ray
• CT scan of the chest
• sputum for cytology
• bronchoscopy
• PET scans
• bone scans and abdominal scans
• mediastinoscopy

Question 7

A chest x-ray or CT scan of the chest may identify?

Answer 7

a pulmonary lesion

Question 8

A cytology test on sputum may identify?

Answer 8

specific tumor cells

Question 9

Bronchoscopy or mediastinoscopy are performed for?

Answer 9

direct visualization of the tissues to aid in diagnosis of lung cancer
-Bronchoscopy is the assessment of the larger airways, the trachea and bronchi, through a scope inserted through the mouth or nose
Mediastinoscopy is a surgical procedure that allows for direct visualization of the mediastinum, a scope is inserted through an incision in the chest that allows for direct examination and collection of samples for biopsy

Question 10

Bronchoscopy

Answer 10

the assessment of the larger airways, the trachea and bronchi, through a scope inserted through the mouth or nose

Question 11

Mediastinoscopy

Answer 11

a surgical procedure that allows for direct visualization of the mediastinum
-a scope is inserted through an incision in the chest that allows for direct examination and collection of samples for biopsy

Question 12

Bone Scans and Abdominal Scans are performed for?

Answer 12

to look for metastatic lesions

Question 13

PET scan is used for?

Answer 13

to identify changes in the body’s metabolism and function rather than structure
-can detect areas of increased metabolic activity as occurs with rapidly dividing cancer cells

Question 14

Treatment for Lung Cancer is based on what?

Answer 14

is interprofessional and is dependent on the type, size, location, and stage of the tumor

Question 15

The components of non-surgical treatment

Answer 15

• typically consists of a combination of radiation and chemotherapy
• pain management

Question 16

Chemotherapeutic Agent

Answer 16

is dependent on the type and or/size of the tumor
-may be used in conjunction with surgery or may be the primary treatment option for more advanced cancers or if the patient is too ill for surgery

Question 17

Radiation therapy

Answer 17

• have great versatility
• in situations where surgery is not an option, radiation can be used
• can also be used palliatively to relieve symptoms or for pain control
• also used to shrink the tumor prior to surgery or after surgery to kill any remaining cancer cells

Question 18

Pain Control

Answer 18

• major component in lung cancer management
• a pain relief ladder developed by the World Health Organization is helpful as a guideline for pain control
• the use of adjuvant or additional medications is important to consider at all levels of treatment to relieve patient anxiety
• pain medication needs to be administered AROUND THE CLOCK rather than on demand to avoid peaks of pain

Question 19

Palliative Care Services

Answer 19

are appropriate to consider with the diagnosis of life-threatening illness like lung cancer

• improves the quality of life of patients and their families
• provides pain relief
• helps in the management of other distressing and debilitating symptoms such as SOB, nausea, and vomiting

Question 20

Surgical Management

Answer 20

preferred treatment if there is no metastasis
-used for non-small-cell tumors
-several types of surgery depending on size and tumor site
>lobectomy
>pneumonectomy
>wedge resection

Question 21

Surgical Management: Lobectomy

Answer 21

removal of entire lobe of lung

Question 22

Surgical Management: Pneumonectomy

Answer 22

removal of entire lung

Question 23

Surgical Management: Wedge resection

Answer 23

removal of a small section of a lobe of the lung

Question 24

Chemotherapy

Answer 24

• may be administered prior to surgery to reduce the size of the tumor and aid in resection
• the administration of a chemotherapeutic agent in an effort to shrink the tumor prior to surgery is a type of neoadjuvant therapy
• can be used as an adjuvant therapy after surgery to kill any remaining cancer cells

Question 25

Chemotherapy and Radiation can be used as what types of therapy?

Answer 25

- neoadjuvant therapy (effort to shrink he tumor prior to surgery) - adjuvant therapy (after surgery to kill any remaining cancer cells)

Question 26

Nursing Interventions: Assessment

Answer 26

Assess: - oxygen saturation (decreased SpO2 is due to poor gas exchange) - temperature (increased = infection) - breath sounds (presences of wheezes = airway obstruction, rhonchi= increased secretions in upper airway) - cough - pain - appetite/weight

Question 27

Nursing Intervention: focused post-op assessment

Answer 27

- Vital signs (hypotension and/ or tachycardia may indicate excessive blood or fluid loss - breath sounds (diminished or absent =post-op atelectasis) - suture line (a suture line that is reddened, warm to touch, and/or draining thick, yellow drainage may indicate infection) - chest tube; monitor amount and color of chest tube drainage (excessive bloody drainage may indicate a bleed within the chest. cloudy drainage may indicate infection) - monitor water-seal chamber in chest tube (persistent bubbling in the water-seal chamber indicates an air leak in the chest tube system)

Question 28

Nursing Interventions: Actions

Answer 28

-provide oxygen -administer medications as ordered (pain medications/ anti-anxiety meds provide relief from both pain and anxiety, allowing better relaxation, increased expansion of the lungs to improve oxygenation, and improved quality of life -bronchodilators (bronchial smooth muscle relaxants, open the airway and decrease work of breathing) -provide small, frequent meals with dietary supplements (small, frequent meals avoid excessive pressure on the diaphragm associated with a large meal. dietary supplements increase nutritional caloric intake, providing energy for the work of breathing) -position semi-fowlers (increases oxygenation by allowing full lung expansion) -focused post-op actions >maintain a closed chest tube system (prevents inadvertent air leaks) >never clamp the chest tube (may result in increased air or fluid in the pleural space, worsening the pneumothorax, and may lead to tension pneumothorax)

Question 29

Client Education

Answer 29

- breathing techniques (pursed-lip breathing encourages exchange of O2 and CO2) - pacing activities (conserves energy and decreases work of breathing) - smoking cessation - nutritional needs (small, frequent meals decrease the work of breathing with less impact on the diaphragm) - medication regimen - use of pain medications around the clock