INTRODUCTION
Our lungs fuel us with oxygen, the body's life-sustaining gas. They breathe in air, then extract the oxygen and pass it into the bloodstream, where it's rushed off to the tissues and organs that require it to function. Oxygen drives the process of respiration, which provides our cells with energy. The waste gas carbon dioxide is produced as a byproduct and disposed of when we exhale. Without this vital exchange our cells would quicly die and leave the body to suffocate. !ince the lungs process air, they are the only internal organs that are constantly exposed to the
The alveoli are where the crucial gas exchange taes place. The air sacs are surrounded by a dense networ of minute blood vessels, or cap illaries, which connect to the heart. Those that lin to the pulmonary arteries carry deoxygenated blood that needs to be refreshed. Oxygen passes through the incredibly thin walls of the alveoli into the capillaries and is then carried bac to the heart via the pulmonary veins . t the same time, carbon dioxide is removed from the blood through the same process of diffusion. This waste gas is expelled as we breathe out. The rate at which we breathe is controlled by the brain, which is quic qu ic to sense changes in gas ga s concentrations. This is certainly in the brain's interests+it's the body's biggest user of oxygen and the first organ to suffer if there's a shortage. In and Out
The actual ob of breathing is done mainly by the diaphragm , the sheet of muscles between the chest and abdomen. These muscles contract when we breathe in, expanding the lungs and drawing in air. We breathe out simply by b y relaxing the diaphragm0 the lungs deflate lie balloons. 1ungs are delicate organs and vulnerable to a range of illnesses. The most common of these in Western countries are bronchitis and emphysema , which are often caused by smoing. Tubes inside the lung become chronically inflamed, producing excess mucus. !moing can also lead to lung cancer, the world's maor cancer, which is diagnosed in $.& million people a year More about Lungs
abno rmal cells that start off in one or both lungs0 Lung cancer is the uncontrolled growth of abnormal usually in the cells that line the air passages. The abnormal cells do not develop into healthy lung tissue, they divide rapidly and form tumors. s tumors become larger and more numerous, they undermine the lung3s ability to provide the bloodstream with oxygen. Tumors that remain in one place and do not appear to spread are nown as 4benign tumors 5. Malignant tumors , the more dangerous ones, spread to other parts of the body either through the bloodstream or the lymphatic system. 6etastasis refers to cancer spreading beyond its site of origin to other parts of the body. When cancer spreads it is much harder to treat successfully. Primary lung cancer originates in the lungs, while secondary lung cancer starts somewhere else in the body, metastasi/es, and reaches the lungs. They are considered different types of cancers and are not treated in the same way. Statistics
ccording to the Wo World rld 7ealth Organi/ation W7O*, 8. million deaths globally each year are caused by cancer0 cancer canc er represents $9: of all global deaths. s seen below, lung cancer is by far the number one cancer iller. ;n the
Squamous cell carcinoma or epidermoid carcinoma. s the most common type of
?!"1" and the most common type of lung cancer in men, squamous cell carcinoma forms in the lining of the bronchial tubes. Adenocarcinoma. s the most common type of lung cancer in women and in
nonsmoers, adenocarcinoma forms in the mucus-producing glands of the lungs. ronchioalveolar carcinoma. This type of lung cancer is a rare type of adenocarcinoma that forms near the lungs' air sacs. Large!cell undi""erentiated carcinoma. rapidly growing cancer, large-cell undifferentiated carcinomas form near the outer edges or surface of the lungs.
!mall cell lung cancer !"1"* is characteri/ed b y small cells that multiply quicly and form large tumors that travel throughout the body. lmost lmost all cases of !"1" are due to smoing. Symptoms o" lung cancer are varied dependent upon the exact location of the tumor and the extent of its spread. person with lung cancer may ma y have the following inds of symptoms>
• ?o symptoms - @p to #=: of people who get lung cancer do not have any symptoms when the cancer is found. ;n these cases the cancer is first discovered on a routine chest routine chest A-ray or A-ray or computeri/ed tomography "T* scan performed scan performed for another reason.
• !ymptoms related to the cancer - The growth of the cancer and invasion of the lung and surroundings may lead to symptoms such as cough, shortness of breath, breath, whee/ing, whee/ing, chest pain, pain, and coughing up blood hemoptysis*. ;f the cancer has invaded nerves, it may cause shoulder pain that pain that travels down the outside of the arm called
;t is important always to consult a doctor if a p erson develops the symptoms associated with lung cancer, in particular> − new persistent cough or worsening of an existing chronic existing chronic cough − Blood in the sputum −
What causes cancer? "ancer is ultimately the result of cells that uncontrollably grow and do not die. ?ormal cells in the body follow an orderly path of growth, division, and death.
−
− Radon gas Radon gas is a natural radioactive gas that is a natural decay product o uranium. Uranium decays to orm products, including radon, that emit a type o ionizing radiation. Radon gas is a known cause o lung cancer, with an
Air pollution
− ir pollution from vehicles, industry, and power plants can raise the lielihood of developing lung cancer in exposed individuals. @p to $: of lung cancer deaths are attributable to breathing polluted air, and experts believe that prolonged ex posure to highly polluted air can carry a ris for the development of lung cancer similar to that of passive smoing.
%o& is lung cancer diagnosed and staged'
!tage ;;;a is when the cancer has spread to to lymph nodes around the trachea, chest wall, wall, and diaphragm, on the same side as the infected lung.
!tage ;;;b is when the cancer has spread to lymph nodes on the other lung or in the nec.
!tage ;H is when the cancer has spread throughout the rest of the bod y and other parts of the lungs.
!mall cell lung cancer has two stages> limited or extensive. ;n the limited stage, the tumor exists in one lung and in nearby lymph nodes. ;n the extensive stage, the tumor has infected the other lung as well as other organs in the bod y. %o& is lung cancer treated'
1ung cancer treatments depend on the type of cancer, the stage of the cancer how much it has spread*, age, health status, and additional personal characteristics. s there is usually no single treatment for cancer, patients often receive a combination of therapies and p alliative care. The main lung cancer treatments are surgery, chemotherapy, chemotherapy, andCor radiation. 7owever, there also have been recent developments in the fields of immunotherapy, hormone therapy, and gene therapy. Surgery
!urgery is the oldest nown treatment for cancer. ;f a cancer is in stage ; or ;; an d has not metastasi/ed, it is possible to completely cure a patient by surgically removing the tumor and the nearby lymph nodes. fter the disease has spread, however, it is nearly impossible to remove all of the cancer cells.1ung cancer cance r surgery is performed by a specially trained thoracic surgeon.
"hemotherapy utili/es strong chemicals that interfere with the cell division process - damaging proteins or D? - so that cancer cells will commit suicide. These treatments treatments target any rapidly dividing cells not ust cancer cells*, but normal cells usually can recover from any chemicalinduced damage while cancer cells cannot. "hemotherapy is considered systemic because its medicines travel throughout the entire body, illing the original tumor cells as well as cancer cells that have spread throughout the body. medical oncologist will usually prescribe chemotherapy drugs for lung cancer to be taen intravenously, but there are also drugs available in tablet, capsule, and liquid form. "hemotherapy treatment occurs in cycles so the b ody has time to heal between doses, and dosages are determined by the type of lung cancer, the type of drug, and how h ow the person responds to treatment. 6edicines may be administered daily, weely, or monthly, monthly, and can continue for months or even years. "ombination therapies often include multiple types of chemotherapy, and chemotherapy is also given as aduvant therapy as a complement to surgery and radiation. duvant therapy is designed to reduce the ris of cancer can cer recurrence after surgery and illing any cancer cells that exist after surgery. "hemotherapy can be given before surgery, called neo-aduvant therapy, to shrin tumors and to mae surgery more successful. "hemotherapy carries several common side effects, but they depend on the type of chemotherapy and the health of the patient. These include nausea and vomiting, vo miting, appetite loss, diarrhea, hair loss, fatigue from anemia, infections, bleeding, and mouth sores. 6any of these side effects are only temporarily felt during treatment, and several drugs exist to help patients cope with the symptoms.
cancer - most notably lung, throat, mouth, and liver cancer. Gven if you are a cu rrent tobacco user, quitting can still greatly reduce your chances of getting cancer. (he most important preventive measure you can ta#e to avoid lung cancer is to quit smo#ing . Juitting smoing will also reduce your ris of several other types o f cancer including esophagus, pancreas, larynx, and bladder cancer. ;f you quit smoing, you will usually reap additional benefits such as lower blood pressure, enhanced blood circulation, and increased lung capacity. Gxposure to tobacco smoe is not the only ris factor for lung cancer though. thoug h. Those who have come into contact with asbestos, radon, and secondhand smoe also have an increased ris of developing lung cancer. ;n addition, having a family member who developed lung cancer without being exposed to carcinogens could mean that you have a genetic predisposition for developing the disease, increasing your overall ris.
PA(I)*(+S P$O,IL)
?ame> E." E."
ge>($ years old
Kender> 6ale
Date dmission> ugust 9$,#%$&
Time of dmission >&>98 .6
A-MISSIO* -A(A Subective Summary: The patient is a diagnosed case of non small lung carcinoma stage & .7ad onset of DOB and chest pain, few minutes prior to admission.# da ys prior to admission, patient was noted to have a productive cough with whitish phlegm, no hemoptysis, no fever, no vomiting, patient was noted to have increase severity of symptoms
ssessment> 1ung "ancer, "O dmission dmission
*/$SI*0 %IS(O$1 %istory o" Past Illness
− ccording to patient E.", he don3t remember receiving any immuni/ations as a child, he commented that immuni/ation inections has never been a fad in the early years.
−
doesn3t seem to get away even with the intae of medicines0 he went to the local hospital for checup. The attending physician ordered several tests such as blood tests, chest x-ray and "T scan and it was revealed that it is lung cancer. The family has been shoced upon upo n learning of the disease. They thought that it was the recurrence of his tuberculosis. They even sought for a second opinion at ?MT; in 6anila and it was confirmed that it is lung cancer. 7e ust started his first first chemo therapy last two wees ago . 7e was instructed by his physician to have & cycles of treatment. 7is next cycle is due after a wee. The patient is a diagnosed case of lung carcinoma, which had onset of DOB few mins.
,amily %ealth %istory
− ccording to the patient, his parents and grandparents died of old age. ;n a brood of ( only 9 of them are alive. 7is eldest brother t died du e to hypertension, his eldest sister died of breast cancer, his other sister died of cholera and his older brother died of lung cancer their youngest has recently died of car accident. Nust a year ago, his wife died of pneumonia. The patient further mentioned that most of his children were all healthy other than his eldest son who has been suffering from heart ailment since childhood.
Social %istory
0ordon+s ,unctional Pattern
23 %ealth %ealth Perce Perceptio ption4% n4%ealt ealth h Manage Management ment −
When further explored what he means by that he gives his state of health as an example. !tates that when he was younger and still strong he doesn3t mind any bodily pains. 7e claims that he used to wal a ilometer everyday from home
?o nown allergies to foods or medicines. t t home eats three times a day and snacs in between meals. 7is usual meal consists co nsists of rice, with fish, meat products or poultry with the inclusion of vegetables and fruits with each meal. Typically Typically he consumes #- 9 liters of water every day. da y. @pon @pon rising he taes a cup of coffee and at bedtime he taes mil. 7e doesn3t have problems with swallowing only that sometimes his satiety is not fulfilled because he can3t taste the food well. Bassit lang ti anane ittan, awan unay ganas u nga mangan.?arigat ti mangan nga naapustisu hanan mu nga maenoy33he maenoy33he verbali/ed. @pon admission the patient weighs 9( ilograms, patient states that he drastically loses weight stating that about two months ago he weighs =# ilograms. When ased about the hospital food he comments that there were restrictions to his food intae these includes red meat and four legged animals, raw vegetables even fresh fruits despite that he desire to eat food that he lies the most especially 4adobong baboy5 63 )limi )liminat nation ion Patte Pattern rn Before hospitali/ation, patient E." states that he urinates about = to 8
times a day. 7e states that he doesn3t have problems with urination , he described that his urine is dar yellow and approximately 9%-&= ml per voiding mentions that he doesn3t notice blood on his urine as well .7e defecates defecates every other other day and described described that his stool stool is hard and dar brown During hospitali/ation, he was in a catheter and with diapers.
demonstrates a wea hand grip. The patient constantly coughing up with whitish phlegm. 93 Slee Sleep p 4$es 4$estt Patt Patter ern n − Before hospitali/ation, patient is already having sleepless nights.57aan na nga
−
unay maaturug nu rabii ta naasasait ti liod u in baruung u.in haan nga agsardeng ti uye u5 as verbali/ed by him. When ased about his pain scale he voiced out that it was 8.When ased about his preferred position during sleeping he prefers side lying or on his bac with 9 pillows on his head During 7ospitali/ation, patient E." states that he is not sleeping well in the hospital. 7is cough doesn3t stop and being disturbed by nurses and doctors coming in out of his room to chec him out.
3 Cogni Cognitiv tive4P e4Per erce cepti ption on −
−
states that the patient has a sharp memory. 7e is fond of telling stories about his childhood memories. The patient has no problems with he aring abilities. 7e can even hear whispers on a distance. The patient wears reading glasses and last checed up was last year. When ased on decision maing he sees to it that he doesn3t too easily and need to thin the pros and cons of each eac h situation. During hospitali/ation, the patient is well oriented to date, time, place and people around him. 7e can easily grasps ideas and questions being ased of him. The patient managed to read newspaper despite his condition.
much especially in this time of sicness. 3?ung buhay pa cya, apag may sait sait ao hindi yun umaalis u maalis sa tabi o33. o33. 7e clings to the idea that one day they will meet again in paradise. 7e always loos forward for weeends because his grandchildren and children in- laws would come and visit him. Once a father is a father he claimed. 2ou 2ou don3t stop being a father even you3re children are married3. 2ung 2ung mga ana o na, ung may ma y mga importanteng desisyon na gagawin inuunsulta pa rin nila ao hanggang ngaun33.@pon learning of my illness my children were so shoced and feel saddened. During hospitali/ation,
%)MA(OLO01 $)PO$(
Date> ugust 9$, #%$& ()S(
$)S/L(S
WB"
).%x$%9Cµ1
$),)$)*C) >AL/)S &.%-
%$A*AL1SIS
FB"
9.(8x$%Cµ1
&.%-=.=%
↓ dCt anemia and chemotherapy
7emoglobin 7ematocrit
$$8 gC1 %.9=% gC1 #=) x$%91
$#%-$% .&%%-.=%% $=%-&=%
↓ dCt anemia, chemotherapy ↓ dCt anemia, chemotherapy
normal
normal
Date> ugust 9$,#%$& ()S( *AM)
$),. >AL/)S
A*AL1SIS A*AL1SIS
$#.)
seconds
: activity
(%.% :
;?F
$.%(
/%H(* 0 1cattered light detection
Date>!eptember #,#%$&
$%.9-$9.$ sec
normal
CLI*ICAL C%)MIS($1
Date> ugust 9$,#%$& Analyte
"reatinine
$esults
$.& mgCdl
*ormal $ange
.8%-$.#%
Analysis
↑ possible idney failure failure
Date> ugust 9$, #%$& Analyte
$esults
*ormal $ange
Interpretation
!odium
$99
$9=-$&( mmol
↓,due to lung cancer
9.
Method: Ion Selective )lectrode
9.=-=.=mmol
normal
A0+S Date> ugust 9$,#%$& $)S/L(
*O$MAL
A*AL1SIS A*AL1SIS
p7
8.&(
8.9=-8.&=
slightly
<"O#
9) mm7g
9=-&= mm7g
normal
7"O9
#(mGqC1 # (mGqC1
∗cute metabolic alalosis
##-# mGqC1
↑
↑
C%)S( ? $A1 S(/-I)S
Date> august 9$, #%$& DF I*()$P$)(A(IO* well defined homogenous dense opacity is seen in the left upp er lobe with the deviation of the trachea to the right. 1amellated homogenous opacity obscuring the the left costophrenic sulcus. The heart is not enlarged by "-T ratio. The right costophrenic sulci are intact. Fight midclavicular deformity probably old fracture.
;6
Date> !eptember $,#%$& I*()$P$)(A(IO*
"omparison was made with a previous study dated ugust 9$, #%$&. There is internal clearing of the left sided pleural effusion post thoracenthesis with minimal residual blurring of the left costophrenic sulcus. The left upper lobe mass and associated mass effects are unchang ed. The heart is not enlarged by "T ratio. The rest previous findings are unchanged.
-ose4$oute4,requency > =%%Ctab $ tab OD rand *ame: Biaxin, Biaxin A1 Pregnancy Category: B -rug class: 6acrolide antibiotic
prevents bacteria from growing by interfering with (herapeutic actions: "larithromycin prevents bacteria their protein their protein synthesis. synthesis. "larithromycin binds to the subunit =%! of the bacterial ribosome ribosome and and thus inhibits the translation of peptides of peptides.. "larithromycin has similar antimicrobial spectrum as erythromycin but is more effective against certain gram-negative bacteria, particularly 1egionella particularly 1egionella pneumophila.. Besides this bacteriostatic effect, clarithromycin also has bactericidal effect on pneumophila certain strains such as 7aemophilus influen/ae, influen/ae, !treptococcus pneumoniae and pneumoniae and ?eisseria ?eisseria gonorrhoeae Indications: used to treat pharyngitis treat pharyngitis,, tonsillitis tonsillitis,, acute maxillarysinusitis maxillarysinusitis,, acute bacterial exacerbation of chronic bronchitis chronic bronchitis,, pneumonia pneumonia especially especially atypical pneumonias associated with "hlamydia pneumoniae or pneumoniae or TWF*, TWF*, sin and sin structure infections. ;n addition, it is sometimes used to treat 1egionellosis 1egionellosis,, 7elicobacter pylori, pylori, and 1ym 1ymee disease disease.. Besides this bacteriostatic effect, clarithromycin clarithromycin also has bactericidal effect on certain strains strains such as 7aemophilus influen/ae, influen/ae, !treptococcus pneumoniae and pneumoniae and ?eisseria ?eisseria gonorrhoeae Contraindication: "larithromycin should be used with caution if the patient has liver or idney disease, certain heart problems e.g., JT prolongation or bradycardia*, bradycardia*, or an electrolyte imbalance e.g., low potassium or sodium levels*.
"ulture
infection before therapy. Do not cut or crush, and ensure that patient does not n ot chew GF tablets. 6onitor patient for anticipated response. dminister without regard to meals0 administer with food if K; effects occur .dminister drug with food if K; effects occur Do not let patient drin grapefruit uice while taing this drug.
5. -uave avent neb -osage4"requency: 2 ampoule every ; hours rand name:
respiratory tract, in the form of bronchial smooth muscle relaxation, than isoproterenol at comparable doses while producing fewer cardiovascular effects. Indications: 6anagement of reversible bronchospasm associated with obstructive airway diseases eg, bronchial asthma*. Eor patients with chronic obstructive pulmonary disease "O
ssess lung sounds,
6. Calt Caltra rate te Plus lus rand name: "alcium "arbonate $ tab OD Pregnancy Category: " -rug class: "alcium salt (herapeutic Actions: Feduces total acid load in K; tract, elevates elev ates gastric p7 to reduce pepsin activity, strengthens strengthens gastric mucosal barrier, and increases esophageal sphincter tone Indications: cid indigestion, calcium supplement Contraindications: "ontraindicated in patients with ventricular fibrillation or hypercalcemia Adverse )""ects . . headache, headach e, irritability, weaness, weaness, nausea, constipation, con stipation, flatulence -rug Interactions: *ursing Considerations: Fecord amount and consistency of stools 6onitor calcium level Wa Watch tch out for evidence ev idence of hyercalcemia h yercalcemia ?H, ?H,headache, confusion and anorexia*
-rug class: Hitamins Hitamins and 6inerals
Therapeutic ctions> ?eurobion contains vitamins B$, B and B$# which act as co-en/ymes and accordingly constitute substances essential for the metabolism. Their role in the metabolism of peripheral and central nerve cells, as well as their concomitant cells, must be seen in correlation correlation with the maintenance of the structural and func tional properties of the nervous system.
;ndications> ?eurological and other disorders associated with disturbances of the metabolic functions influenced by B-complex vitamins, including diabetic neuropathy and alcohol peripheral neuritis. Treatment Treatment of neuritis and neuralgia of the spinal nerves, spinal facial facial paresis, cervical syndrome, low bac pain or ischialgia and herpes /oster.The vitamins B$, B and B$# are indispensable for a normal course of metabolism. ?eurobion coated tablets are prescribed in neuralgia and pain in the spinal region, "ontraindications> 7ypersensitivity to any of the active ingredients or excipients of ?eurobion. @se in children>?eurobion is contraindicated in the treatment of children due to the high content of its active ingredients. ;n application of solution for inection containing ben/ylalcohol, treatment of children 9 years should be avoided, due to the ris of fatal toxic reactions arising from exposure to ben/yl alcohol in excess of )% mgCg body weightCday, dverse Gffects. 7ypersensitivity reactions, such as sweating, tachycardia, and sin reactions with itching and urticaria may occur with tablets ver y rarely $C$%,%%%*. 7owever, for
*ursing Considerations
!tress importance the Hitamin Hitamin supplement. Teach Teach healthy dietary habits ;nstruct client not to tae folic acid to replace vitamin B$#, as it may accelerate
hematologic manifestations !ensitivity testsC intradermal test should be done for those those with possible sensitivity sensitivity
9. Pregab gabalin alin
-osage4"requency: rand name: Lyrica Pregnancy Category > " -rug class: anticonvulsant (herapeutic Actions: Treats fibromyalgia or nerve pain caused by certain conditions eg, shingles, diabetic nerve problems, spinal cord inury*. ;t is also used in combination with other medicines to treat certain types of sei/ures. ;t may also be used for other conditions as determined by your doctor.
!ee medical attention right away if any an y of these !GHGFG side effects occur> !evere allergic reactions rash0 hives0 itching0 difficulty breathing0 tightness in the chest0 swelling of the mouth, face, lips, throat, or tongue0 unusual hoarseness*0 burning, numbness, or tingling0 chest pain0 confusion0 fast or irregular heartbeat0 fever, chills, or persistent sore throat0 inability to control urination0 loss of coordination0 memory loss0 muscle aches, pain, tenderness, or weaness especially if this occurs with a fever or general feeling or discomfort*0 new or unusual sin sores0 new or worsening mental or mood changes eg, anxiety, depression, restlessness, irritability, irritability, panic attacs, feeling Ihigh,I behavior changes, chang es, suicidal thoughts or attempts*0 new or worsening sei/ures0 reddened, blistered, swollen, or peeling sin0 shortness of breath or whee/ing0 speaing problems0 sudden, unexplained weight gain0 swelling of the hands, feet, or anles0 tremor0 trouble sleeping0 trouble waling0 unusual bruising or bleeding0 severe or persistent tiredness or weaness0 vision vision changes.This medicine may cause di//iness, sleepiness, confusion or blurred vision and so may reduce your ability to drive or operate machinery safely. Do not drive or operate machinery mach inery until you now how this medicine affects you and you are sure it won't affect your performance. -rug Interactions: ngiotensin-converting en/yme "G* inhibitors e.g., enalapril* because the ris of angioedema may be increased. Ben/odia/epines e.g., lora/epam* or narcotic pain medicines e.g., oxycodone* because the ris of drowsiness may be increased. Thia/olidinedione antidiabetic agents e.g., rosiglita/one* because the ris of weight gain or swelling of the hands and feet may be increased *ursing Considerations:
;f you stop taing pregabalin for any an y reason, contact your doctor right away. awa y. Do not start taing it again unless your doctor tells you to. Discuss any questions or concerns with your doctor. ;f you develop new or o r worsening sei/ures, contact your doctor right away.
(herapeutic Actions > 6ucolytic that reduces the viscosity viscosity of pulmonary secretions secretions by splitting disulfide linages between mucoprotein molecular complexes. lso, restores liver stores of glutathione to treat acetaminophen toxicity Indications: Indications : Treatment of respiratory affections affections characteri/ed by thic and viscous hypersecretions> acute bronchitis, chronic bronchitis and its exacerbations0 pulmonary emphysema, mucoviscidosis and bronchieactasis. Contraindications : Mnown hypersensitivity h ypersensitivity to cetylcysteine. s cetylcysteine cetylcysteine Eluimucil* granules and tablets contain aspartame, it is contraindicated in patients suffering from phenyletonuria. Adverse )""ects 0 7ypersensitivity reactions have been reported in patients receiving cetylcysteine, including bronchospasm, angioedema, rashes and pruritus. Other adverse effects reported with cetylcysteine include nausea and vomiting, fever, syncope, sweating, arthralgia, blurred vision, disturbances of liver function. -rug Interactions: ?o cases of drug interactions are described in literature for ?" by oral use. *ursing Considerations: @se plastic, glass, stainless steel, or another nonreactive metal when giving by nebuli/ation. 7and-bulb nebuli/ers aren3t recommended because output is too small and particle si/e too large.
Indications: cute and long-term treatment of signs and symptoms of rheumatoid arthritis and osteoarthritis. Feduction of the number of colorectal polyps in familial adenomatous polyposisE<*6anagement polyposisE<*6anagement of acute pain. Treatment of primary primary dysmenorrheal. Contraindications Contraindications and cautions: "ontraindicated with allergies to sulfonamides, celecoxib, ?!;Ds, or aspirin0 significant significant renal impairment0 pregnancy0 lactation. @se cautiously with impaired hearing, hepatic and cardiovascular conditions. A-/L(S ;nitially, ;nitially, $%% mg 7eadache, di//iness, somnolence, insomnia, fatigue, tiredness, di//iness, tinnitus, ophthalmologic effects Dermatologic> Fash, pruritus, sweating, dry mucous membranes, stomatitis K;> ?ausea, abdominal pain, dyspepsia, flatulence, K; bleed 7ematologic> ?eutropenia, eosinophilia, leuopenia, pancytopenia, thrombocytopenia, agranulocytosis, granulocytopenia, aplastic anemia, decreased hemoglobin or hematocrit, bone marrow depression, menorrhagia Other>
%he symptoms produced produced $y the primary tumour tumour depend on its location &i.e., central vs peripheral+. Central tumours generally produce symptoms o cough, dyspnea, atelectasis, posto$structive pneumonia, wheezing, and hemoptysis4 whereas, peripheral tumours, in addition to causing cough and dyspnea, can lead to pleural e-usion and severe severe pain as a result o infltration o parietal pleura and the chest wall.
Symptoms
Mechanism and pathophysiology
Primary lung lesion symptoms 'ough &56#76"+
•
)resence o a mass irritates the cough receptors in the
•
airway ore common in s8uamous cell carcinoma and1'9'
•
&more commonly ound in the central airways+ ($struction rom central airway could also lead to post#o$structive pneumonia and distal atelectasis
Weight loss &:;"+ & :;"+
•
'ancer induced lipolysis and proteolysis leads to loss o adipose and skeletal muscle. )rotein synthesis is also reduced via a num$er o mechanisms.
Symptoms
Mechanism and pathophysiology
1uperior vena cava syndrome
• • •
($struction o superior vena cava $y the tumour ore common in 1'9' ¢ral tumour+ !#:" o lung cancer patients develop it at some point
)ericardial )ericardial e-usion e-usio n
•
%umours %umours can at times infltrate into the pericardium or press on the heart causing pericardial e-usion
• )leural e-usion 'hest pain • *yspnea •
• •
uid
*ysphagia
•
/nlargement o the su$carinal lymph nodes compressing on the middle third o the esophagus
)ancoast tumour &superior sulcus tumour+ 1houlder or •
• • •
%umour %umour originates in the apical portion o the lung (ccurs in 5" o non-small cell lung cancer nvasion o $rachial pleus causes pain and muscle wasting o arm and hand
Symptoms
Mechanism and pathophysiology
/ctopic 'ushing
•
syndrome 1ee Adrenal 1ee Adrenal • cortex chapter in /ndocrinology 1yndrome o
•
production &12*H+ 1ee Hyponatre • mia in mia in Aephrology or details Hypercalcemia
hormone &2'%H+ @ adrenal cortisol secretion @ weight gain, hypertension, hypokalemia, muscle weakness ost common orm o ectopic secretion in lung cancer, especially SCLC
•
/ctopic secretion o 2*H @ retain ree water in
• •
collecting ducts u!olemic hyponatremia and concentrated urine Mild symptoms include symptoms include headache and
•
weakness, severe symptoms include symptoms include altered mental status, seizures, respiratory depression, and death 'ommon in SCLC
inappropriate antidiuretic hormone
/ctopic secretion o adrenocorticotrophic
•
ncreased secretion o )%Hr) @ acts like parathyroid
•
hormone to increase $one resorption and renal calcium rea$sorption @ hypercalcemia 2ssociated with s"uamous cell carcinoma
PA(%OP%1SIOLO01 o" L/*0 CA*C)$
MO-I,IAL) ,AC(O$S ,AC(O$S -!moing # yrs smoer*#C9 pacs per day -Gxposure to chemicals -#nd hand smoing
*O* MO-I,IAL) ,AC(O$S
#2ge &F years old+ #Dam .H &9ung ca+ #Cender &male+
;nhalation of irritants Ccarcinogenesis enters the
lungs and maG.
;rritation and obstruction of airways
-?agging cough, !OB ,whee/ing
carcinogenesi
!"1"
"entral Tumor
A1'9'
)eripheral
OT7GF E"TOF! -
)rimary lung
cough
Wt.loss
Assessment
hemoptysi dyspnea s
-iagnosis
ediastin al
)araneoplastic syndromes
"hest pain
Planning !H" symptoms
Implementation Dysphagia
effusion
)valuation 7orner3s $ationale !yndrome
shoulders
!;D7
hypercalcemia
7ypertrophic osteoarthropathy and digital clubbing
Gctopic "ushing !yndrome
Subective -ata: haan lang met nga agsarsardeng ti uye un33.as verbali/ed by the patient
Obective data:
FFV#8 bpm "FV$%= cpm L* rhonchi upon auscultation Lcracles O# sat-(
t the end of ( uscultated chest for character ;neffective hours, the patient of breath sounds and presence airway clearance will demonstrate of secretions. related to patent airway, airway, with increased fluid secretions eas amount or ily expectorated ssist client with and provide viscosity of instruction in effective deep secretions breathing, coughing coughing in upright upright as evidenced by position sitting*, sittin g*, changes in rate and depth of respiration Observed amount and bnormal breath character of sputum. sounds Dyspnea
?oisy respirations, respirations, rhonchi, rhonchi, and whee/es are indicative of retained secretions or airway obstruction. @pright position favors maximal lung expansion
t the end of the ( hours duty ,the patient verbali/ed verbali/ed 6eo nabawasan n ang pagubo o 3 FFV$) "FV)= O# sat-)&:
;ncreased amounts of colorless or blood-streaed* or watery secretions are normal initially and should decrease as recovery progresses. progresses.
Gncouraged Gncouraged oral fluid intae, at least #,=%% m1Cday
dequate hydration aids in eeping secretions loose and enhances expectoration
ssisted client with postural drainage as indicated.
;mproves lung expansion and ventilation and facilitates removal of secretions
dministered bronchodilators, expectorants, and analgesics, as indicated.
ASS)SSM)*(
-IA0*OSIS
PLA**I*0
Felieves bronchospasm to improve airflow. Gxpectorants increase mucus production and liquefy and reduce viscosity of secretions, facilitating removal.
IMPL)M)*(A(IO*
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Subective:
4?asait ti baruung u pati agituy saa5, as verbali/ed by the patient.
%$cute pain rCt irritation of tissue endings
$A(IO*AL)
t the end of 9% minutes, the patient will report relief from pain as manifested by>
t the end of 9% mins. patient verbali/ed that pain scale decreased from 8 to 9 ?o facial grimace noted
Decrease in pain scale from (C$% to &C
%$Obective:
Eacial grimace
bsence of facial grimace
Kuarding behavior Gxertional discomfort ;n fetal position
bsence of guarding behavior
Gncouraged deep breathing Gncouraged adequate rest periods
To provide non pharmacologic pharmacologic management of pain To alleviate feelings of pain To prevent fatigue
?oted every every time pain occurs
To assess congruency with verbal reports of pain
To rule out worsening of condition
dministered analgesics as ordered To maintain acceptable level of pain
Gncouraged quiet and restful atmosphere
To conserve energy or lower tissue oxygen demand
ASSSSMN T
#IAGN$SIS
%LANNIN G
1u$Gective0 7aan na nga unay nga maapang pangan,awan pangan,awan unay ganas u33 as verbali/ed by the patient.
Obective>
IM%LMNTATI$N INTR&NTI$N
m$alanced Autrition0 9ess than
2t the end o : weeks the patient will progressive ly gains weight at per week
6onitors daily food intae and have client eep food diary, as indicated. .
6easured height, weight, and sin fold thicness, or other anthropometric measurements, as appropriate.
WeightV9# g 7eightV=3#33 B6;V$#.) Dry sin
RATI$NAL
;dentifies nutritional strengths and deficiencies.
6easurements 6easurements fall below minimum minimum standards, client3s chief source of stored energy, fat tissue, is depleted
ssess sin and mucous membranes for pallor, delayed wound healing, and enlarged parotid glands.
7elps in identification identification of protein-calorie protein-calorie malnutrition, especially weight
Gncourage client to eat high-calorie, high-calorie, nutrient-rich diet, with adequate fluid intae. Gncourage use of supplements and frequent, smaller meals spaced
6etabolic tissue and needs are increased as to eliminate waste products. !upplements !upplements can play an important
&AL'ATI$ N
throughout the day.
"reate pleasant dining atmosphere0 encourage client to share meals with family and friends.
role in maintaining maintaining adequate caloric and protein intae. intae.
6aes mealtime more enoyable, which may enhance intae
ASS)SSM)* (
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!ubective Data
;mpaire d Kas Gxchan ge FCT lveola r "apillar y 6embra ne "hanges
4?ahihirapan aong huminga as verbali/ed by the patient5
Obective data @se of accessory muscle for breathing restlessness FFV # bpm
t the end of ( hour shift the patient will demonstrate improved ventilation and adequate oxygenation of tissue
PlanningIMPL)MI) m* p( leA m(eInO ta*tion
I*()$>)*(IO*
6onitored and recorded vital signs
$A(IO*AL)
To obtain baseline data
6onitored respiratory rate, depth and rhythm To assess for rapid
ssessed pt3s general condition
or shallow respiration that occur because of hypoxemia and stress
To note for etiology precipitating factors uscultated breath sounds, that can lead to note areas of impaired gas decreasedCadventitious exchange breath sounds as well as fremitus To note for etiology precipitating factors Glevated head of the pt. that can lead to impaired gas exchange ?oted for presence presence of cyanosis To enhance lung expansion Gncouraged frequent position changes and deep-breathing exercisesTo evaluate degree of compromise
)>AL/A )( vaIlO uation *
t the end of the shift, the patient3s respiratory rate decreased from # bpm to $) bpm
how to alleviate pt3s condition
To correctC improve existing deficiencies
dminister prescribed To determine pt3s medications as ordered oxygenation status
Assessment
!ubective data> ?anghihina ao.dati aya o pang maglaad maglaad laad sa veranda ng bahay
-iagnosis
ctivity ;ntolerance
Planning .
. t the end of 9 days the patient will report measurable increase in activity intolerance
To empower !O and pt Implementation ;?TGFHG?T;O?
nauubusan ao ng laas3 as verbali/ed by the patient
$A(IO*AL)
Eor the Gstablished Fapport pharmacological pharmacologicalTo gain clients participation and cooperation in the nurse management of the patient interaction interaction patient3s condition 6onitored and recorded Hital !igns
To obtain baseline data
ssesed patient3s general condition
To note for any abnormalities and deformities present within the body
dusted client3s daily activities and reduce intensity of level.
To prevent strain and overexertion
Discontinue activities that cause undesired psychological changes
To conserve energy and promote safety safety
;nstruct client in unfamiliar activities and in alternate ways of conserve energy
To relax the body
Gncourage patient to have adequate bed rest and sleep
To provide relaxation
ngayon parang araw araw
)valuation
and quiet environment ssist the client in ambulation ?ote presence presence of factors that that could contribute to fatigue
To prevent ris for falls that could lead to inury
scertain client3s ability to stand and move about and degree of assistance needed or use of equipment
Eatigue affects both the client3s actual and perceived ability to participate in activities
Kive client information that provides evidence evidence of daily daily or weely progress
To determine current status and needs associated with participation in in needed or or desired activities
Gncourage the client to maintain a positive attitude
ssist the client in a semifowlers position Glevate the head of the bed
ssist the client in learning and demonstrating appropriate safety measures. ;nstruct the !O not to leave the client unattended
To sustain motivation of client. To enhance sense of well being To promote easy breathing To maintain an open airway
to prevent inury
