Far Eastern University Institute of Nursing
A Case Presentation Nursing Process: Lung Cancer Submitted by: Udani, Celine S. Umali, Kimberlyn J. BSN – 135 Gropu 139 - B
I. Biographic Data Name: MNC Address: Southern Leyte Age: 52 years old Marital status: Married Room and bed: F7 Chief complaint: Hemoptysis Attending Physician:
II. Nursing History A. Past Health History 1. Childhood Illness He had asthma when he was still a toddler. But it did not persist any longer especially when he turned 12. 2. Immunizations He had a complete immunization.
He has not taken any medicine when the persistent pain of his leg has become. The doctor presently ordered a medicine (written at the medications below) and he just brought it a while ago. 7. Foreign travel (when, length of stay) There is no stated foreign travel.
B. History of Present Illness This is a case of a 52y/o, male, married, Filipino, who came in due to hemoptysis. The client stated that he was already experiencing an on and off cough for several weeks prior the hemoptysis.
C. Family History Their family has a history of PTB on paternal side.
III.
Patterns of Functioning A. Psychological Health 1. Coping Pattern Whenever he has problem, he walks alone and think about it. He likes to share it to his friends and seek advice. He somewhat feel relieved after
Analysis: Communication can be a transmission of feelings or a more personal and social interaction between people. Self-concept develops as a result of social interaction with others. (Kozier &Erb’s Fundamental of Nursing Eight Edition Volume two. Self-concept , page 1003.) 3. Cognitive Pattern He finished until first year college with a course of mechanical engineer. He is well mannered and literate. He loves reading informational books, like reader’s digest whenever he is free. Interpretation: Even if he didn’t finished his study, he is determined to study to learn more and add more knowledge. Analysis: Cognition is greatly affected by education. Those who study and develop their skills have better cognitive performances because they have been provided with different information and chances to develop their self. Perception is affected by the sensory diseases. Presence of any sensory abnormalities affects or halters perception that would affect proper communication. (Black, Medical Surgical Nursing7th edition, page 1880). Cognition involves a person’s intelligence, perceptual ability and ability to process information. It represents a progression of mental abilities from illogical to logical thinking, from simple to complex problem solving and from concrete to abstract ideas. (Kozier et.al, Fundamentals of Nursing 7 th ed. Page 359). 4. Self-Concept He always tries to look on a better side whenever he has problems, like being in the hospital. Instead of thinking that he is ill, he thinks that at least when he is in the hospital he can relax. He feels good about himself as long as he is
withdrawal and depression are common. (Kozier et.al, Fundamentals of Nursing 7 th ed. Pages 957-962). 5. Emotional Patterns As for his emotions, he is still the same ill or healthy. He is friendly and laughs with his friends. He always tries to think of happy thoughts. Interpretation: He has a good coping mechanisms that helps him reduce emotional stress. Analysis: Emotion-focused coping includes thoughts and actions that relieve emotional distress. (Kozier &Erb’s Fundamental of Nursing Eight Edition Volume one. Stress and Coping, page 1068.) 6. Family Coping Patterns He is open to his family. Whenever they have problems they talk about it immediately and try to resolve it. They never make it a big deal as long as it can be resolved. The family is open to each other. Interpretation: Communication to one another is a good way to solve the problem that is being misunderstand. Analysis: Family coping mechanisms are the behaviors families used to deal with stress or changes imposed from either within or without. Internal resources, such as knowledge, skills, effective communication patterns, and a sense of mutuality and purpose within the family are the one mostly utilized by the family to assist them in their problemsolving process. B. Socio-Cultural Pattern
Interpretation: His relation lasts because of his good way of thinking things as well as protecting his family and providing their needs. Securing and assuring himself in doing activities is a good way to avoid further accident. Analysis: Culture is a complex whole in which each part is related to every other part. It is learned, and the capacity to learn culture is genetic, but the subject matter is not genetic and must be learned by each person in his or her own family. (Kozier &Erb’s Fundamental of Nursing Eight Edition Volume one. Culture and Heritage, page 315.) Children and adults in healthy, functional families receive support, understanding, and encouragement as they progress through predictable developmental stages, as they move in or out of the family unit, and as they establish new family units. (Kozier &Erb’s Fundamental of Nursing Eight Edition Volume one. Promoting Family Health, page 429.) People are becoming increasingly aware of their environment and how it affects their health and level of wellness. (Kozier &Erb’s Fundamental of Nursing Eight Edition Volume one. Health Wellness and Illness, page 301.) The economic resources needed by the family are secured by adult members. (Kozier &Erb’s Fundamental of Nursing Eight Edition Volume one. Promoting Family Health, page 429.)
C. Spiritual Pattern 1. Religious Beliefs and Practices He attends mass twice a month. He do fasting and things a Roman Catholic does.
Spiritual well-being is manifested by a generally feeling of being alive, purposeful and fulfilled. People nurture or enhance their spirituality in many ways. Some focus on development of the inner self or world; others focus on the expression of their spiritual energy with others or outer world. Relating to one’s inner self or soul may be achieved through conducting an inner dialogue with a higher power or with one’s self through prayer or medications. The expression of a person’s spiritual energy to others is manifested in loving relationship with and service to others, joy and laughter and participation in religious services and associated fellow gatherings and activities and by expression of compassion, empathy, forgiveness and hope. (Kozier et.al, Fundamentals of Nursing 7 th ed. Pages 996).
IV.Activities of Daily Living ADL
1. Nutrition
Before Hospitalization
During Hospitalization
Breakfast: Dried fish, hotdog, coffee, a cup of rice Lunch: Fish, a cup of rice, a glass of water Dinner: Fish, a cup of rice, a glass of water
Breakfast: Bread, rice, ham, hardboiled egg sausage, coffee Lunch: Vegetable, 2 cups of rice, meat, a glass of water Dinner: Fish, Vegetable, 2 cups of rice, a glass of water.
*client
*client said that he eat
said
that
he
eat
4am.
at 3am. Takes a 3-hournap every afternoon.
Interpretation and Analysis: His fluid intake should increase, because increasing fluid intake could help him to excrete some toxic materials in his body. V. Physical Assessment
General Appearance 1. Posture/Gait
2. Skin color
3. Personal Hygiene/ Grooming
Norms
Actual Findings
Interpretation and Analysis
Relaxed, erect posture; coordinated movement
Relaxed
Normal
Varies from light to deep brown
Deep brown, uniform except in areas exposed to the sun; areas of lighter pigmentation (palms, lips, nail beds)
Neat, clean
Neat and clean
Normal
Normal
4. Blood Pressure 5. Weight 6. Height
130/90mmHg
Body Part Norms (Technique used) SKIN Inspect for skin Varies from light color and to dark brown uniformity of color.
Actual Findings
Interpretation and Analysis
Brown
Normal
EYES Shiny, smooth, Inspect the pink or red palpebral conjunctiva for color, texture, and presence of lesions
Pink palpebral conjunctiva
Normal
(-) nasoaural discharge
Normal
NOSE Inspect for any deviations in shape, size or color and flaring or discharge from the nares. TONSILS
Symmetric and straight; no discharge or flaring; uniform color
JOINTS Inspect joint for swelling.
bowel sounds
(-) cyanosis
No swelling
Swelling with discharges (pus)
It might have infection. S/S of infection are swelling, discharges , pain, and redness
VI. Laboratory and Diagnostic Examinations Results Date
Procedure
Norms
Result
09-23-10
Cytology Report
No mass and malignant cells on lungs
Mass on upper lobe of left lung. Many malignant celss. Consistent with a nonkeratinizing squamous cell carcinoma.
09-06-10
CT scan of the chest
No mass and malignant cells on lungs
Large pulmonary solid mass in the left upper lobe consistent
Interpretation and Analysis ___________
___________
Chemistry (all in normal range unless indicated)
Uric Acid
umol/L
Eto nb un lahat? VII. Generic / Trade Name Vitamin B complex
Medications, IV Infusions, Blood Transfusion, Treatment Given Dosage / Frequen cy 1 Tab OD
Classification
Indication
Contraindication
Side Effect
Nsg. Responsibilities
Vitamins minerals
Pernicious anemia CONTRA:hypersensitiv e to vitamin B12 or cobalt. -early Leber’s disease
-should not be used in hypersensitivity to any of the vitamins, containing in the preparation, as well as in patients with 2-nd or 3-rd degree arterial hypertension.
CV: peripheral vascular thrombosis, heart failure. GI: transient diarrhea. Respi: pulmonary edema. Skin: itching, transitory exanthema, urticaria. Other: anaphylaxis, anaphylactoid reactions with parenteral administration, pain or burning at
BEFORE:
and
Action: A coenzyme that stimulate metabolic function and is needed for cell replication, hematopoiesis, and nucleoprotein and myelin synthesis.
-Determine reticulocyte count, hct, Vit.B12, iron, folate levels before beginning therapy. -Obtain a sensitivity test history before administration -Avoid I.V. administration bec. faster systemic elimination will reduce effectiveness of vitamin. DURING:
ol
OD
Action: -structural isomer of hyp oxanthine (a naturally occurring purin e in the body) and is an enzyme inhibitor, inhibiting xant hine oxidase
of the signs and symptoms of primary and secondary gout. -management of patients with leukemia, lymphoma, and malignancies that result in elevation of serum and uric acid.
-contraindicated with allergy to allopurinol, blood dyscrasias. -use cautiously with liver disease, renal failure.
drowsiness, peripheral neuropathy, neuritis, paresthesias. Dermatologic: rashesmaculopapular, scaly or exfoliativesometimes fatal. GI: nausea, vomiting, diarrhea, abdominal pain, gastritis, hepatomegaly, hyperbilirubinemi a, cholestatic jaundice. GU: exacerbation of gout and renal calculi, renal failure. Hematologic: Anemia, leukopenia, agranulocytosis, thrombocytopenia , aplastic anemia, bone marrow depression.
Yung mv+eea dq Makita sa drug buk..aun.. wg n ntn isali un.heheh..
-Take the drug after meal. -avoid over the counter medications. -drink 2.5-3 liters of fluids per day while on this drug. -report rash, unusual bleeding or bruising, fever, chills, gout attack; numbness or tingling; flank pain, skin rash.
for cell growth, differentiation and survival
-second-hand smoker
of LUNG CANCER
Protooncogenes= normal gene that becomes oncogene (mutated Modifiable: genes)
-environmental and occupational exposures. Non-Modifiable:Kelangan dagdag ntn 2 sa cues.gawan •Age nlng ntn.
• Lifestyle Loss (Smoking) of •
smoke
PATHOPHYSIOLOGY
• Gender
heterozygosit y (LOH) in a Environmental
• Genetics
cell represents • Occupation the loss of normal function of one allele of a gene in which the other allele was already inactivated.
Carcinogenics agent will enter the respiratory tract
It will attack the epithelial cells/ lining of the lungs
Mutations in the K-RAS proto oncogenes will contribute to develop non-small cancer cells
-dietary deficits -respiratory diseases
Pathophysiology Lung cancers arise from a single transformed epithelial cell in the tracheobronchial airways. A carcinogen (cigarette smoke, radon gas,and other occupational and environmental agents) binds to a cell’s DNA and damages it.This damage results in cellular changes, abnormal cell growth, and eventually a malignant cell. As the damaged DNA is passed on to daughter cells, the DNA undergoes further changes and becomes unstable. With the accumulation of genetic changes, the pulmonary epithelium undergoes malignant transformation from normal epithelium to eventual invasive carcinoma.Squamous cell carcinoma is more centrally located and arises more commonly in the segmental and subsegmental bronchi in response to repetitive carcinogenic exposures. Adenocarcinoma is the most prevalent carcinoma of the lung for both men and women; it presents more peripherally as peripheral masses or nodules and often metastasizes. Large cell carcinoma (also called undifferentiated carcinoma) is a fast-growing tumor that tends to arise peripherally. Bronchioalveolar cell cancer arises from the terminal bronchus and alveoli and is usually slower growing as compared to other bronchogenic carcinomas. Small cell carcinomas arise primarily as a proximal lesion or lesions but may arise in any part of the tracheobronchial tree. (pde nman na ung diagram na ginwa mo, ok lng kht d muna mglead sa death kc buhay pa nman pt. ntn.hehe..) IX.Ecologic Model A. Hypothesis
B. Pre-Disposing Factors C. Ecologic Model D. Analysis E. Conclusion and Recommendations
xa maxadong umiinom ng h2o •
•
•
•
•
Fatigue -nahihirapan xa sa paghinga kya napapagod xa Imbalanced nutrition: Less than body requirements Impaired physical mobility Ineffective airway clearance Risk for infection -wla nman xang operation and malinis nmn xa sa katawan xe naliligo dn
XI. Nursing Care Plan NURSING DIAGNOSIS
ANALYSIS
GOALS AND OBJECTIVES
INTERVENTI ONS
Pcnd nlng skn qng anung ncp gagawin, aq nlng gagawa..
RATIONALE
EVALUATION
XII.
Discharge Plan
Treatment for lung cancer may include surgery, chemotherapy, radiation therapy, or a combination of these. M – Medications to take at home • Continue Taking medications as prescribed by the doctor. Use laxatives or stool softener if advised (after surgery). Ask your doctor before taking any vitamins (after radiation therapy). • •
E – Exercise (After a Surgery) Rest when you are tired. Don’t worry if you are fatigued. Fatigue and weakness are normal for a few weeks • after having a lung removed. • Limit your activity to short walks. Gradually increase your pace and distance as you feel able. • Avoid strenuous activities; don’t lift anything heavier than 10 pounds for 4–6 weeks. • Avoid sitting with your legs down for long periods of time. (After Chemotherapy) • Try to exercise. Exercise keeps you strong and keeps your heart and lungs active. Walk as much as you can without becoming dizzy or weak. T – Treatments (After a Surgery) • Leave the small white strips (Steri-Strips) over your incision in place for 7–10 days after your surgery. Always keep your incision clean and dry. Shower as needed. Wash your incision gently with mild soap and warm water and pat dry. Avoid scrubbing your incision. • •
(After Chemotherapy) Follow doctors prescriptions and orders. •
H – Health Teachings (After a Surgery) Lie on the side of your surgery, with your good lung up (toward the ceiling). Call your doctor if you are coughing up brownish sputum or blood. Lie on the side of your operation with your good lung up while you wait for help. • •
•
• •
Learn to check your own pulse. Keep a record of your results. Ask your doctor which pulse rates mean that you need medical attention. Check your temperature every day for 7 days after your surgery. Use your incentive spirometer 5 times a day for the first 2 weeks you are home.
(After Chemotherapy) Brush your teeth with a soft-bristle toothbrush after every meal. Don’t use dental floss if your platelet count is below 50,000. Your doctor or nurse will tell you if this is the case. Use an oral swab or special soft toothbrush if your gums bleed during regular brushing. • If you can’t tolerate regular methods, use salt and baking soda to clean your mouth. Mix 1 teaspoon(s) of salt and 1 teaspoon(s) of baking soda into an 8-ounce glass of warm water. Swish and spit. Use moisturizing soap. Treatment can make your skin dry. Apply moisturizing lotion several times a day to help relieve dry skin. • •
•
• •
(After Radiation Therapy)
•
Don’t scrub or use soap on the treated area. Ask your therapy team which lotion to use. Avoid sun on the treated area. Ask your therapy team about using a sunscreen. Don’t remove ink marks unless your radiation therapist says it’s okay. Don’t scrub or use soap on the marks w hen you wash. Let water run over them and pat them dry. Protect your skin from heat or cold. Avoid hot tubs, saunas, heating pads, and ice packs. Wear soft, loose clothing to avoid rubbing your skin.
•
If your mouth or throat becomes dry or sore, sip cool water. Ice chips may also help.
• • • •
•
O – Out patient follow up Make a follow up check up as instructed by your health care team D – Diet (After a Surgery) Avoid constipation. Eat fruits, vegetables, and whole grains. Drink 6 to 8 glasses of water a day, unless directed otherwise. Use a laxative or a mild stool softener if your doctor says it’s okay. • • •
(After Chemotherapy) Remember, many patients feel sick and lose their appetites during treatment. Eat small meals several times a day to keep your strength up.
• • •
Choose bland foods with little taste or smell if you are reacting strongly to food. Be sure to cook all food thoroughly. This kills bacteria and helps you avoid infection. Eat foods that are soft. Soft foods are less likely to cause stomach irritation.
(After Radiation Therapy) Eat foods high in protein and calories. Drink plenty of water and other fluids, unless directed otherwise. • •
