(relates to chapter 28 “nursing management: lower respiratory problems,” in the textbook) focus...

(Relates to Chapter 28 “Nursing Management:

Lower Respiratory Problems,” in the textbook)

Focus on Lung Cancer

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Lung CancerLeading cause of cancer-related deaths

Leading cause of death in women

Survival rates are lower than for most other cancers.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 2

Etiology Most important risk factor in 80% to 90% of all lung cancers is smoking. Contains 60 carcinogens that interfere with cell development

Causes a change in bronchial epithelium


EtiologyLung 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


EtiologyEnvironmental tobacco smoke (ETS) inhaled by nonsmokers poses 35% increased risk of developing lung cancer.

Children are more vulnerable to ETS than adults.


EtiologyOther carcinogens pose risk for developing lung cancer. Asbestos Radon Nickel Iron/iron oxides Uranium


EtiologyOther carcinogens pose risk for developing lung cancer. Polycyclic aromatic hydrocarbons

Arsenic Chromates Air pollution


PathophysiologyMost 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


PathophysiologyOccur primarily in segmental bronchi and upper lobes


Lung Cancer


Fig. 28-2. Lung cancer (peripheral adenocarcinoma). The tumor shows prominent black pigmentation,suggestive of having evolved in an anthracotic scar.

Lung Carcinoma


Fig. 28-3. Lung carcinoma. The gray-white tumor tissue is infiltrating the lung. Histologically this tumor wasidentified as a squamous cell carcinoma.

PathophysiologyPathologic changes in bronchial system Hypersecretion of mucus Desquamation of cells Reactive hyperplasia of basal cells

Metaplasia of normal respiratory epithelium to stratified squamous cells


PathophysiologyPrimary lung cancers categorized into two subtypes Non–small-cell lung cancer (NSCLC)80%

Small cell lung cancer (SCLC)20%


PathophysiologyLung cancers metastasize by Direct extension Blood circulation Lymph system


PathophysiologyCommon sites for metastatic growth Liver Brain Bones Scalene lymph nodes Adrenal glands


PathophysiologyParaneoplastic syndrome

Various systemic manifestations caused by factors produced by tumor cells

Commonly associated with SCLC


Clinical ManifestationsSymptoms appear late in disease.

Depend on type of primary lung cancer, location, and metastatic spread


Clinical ManifestationsPneumonitisPersistent cough with sputum (most common)

HemoptysisChest painDyspnea


Clinical ManifestationsLater manifestations

Anorexia Fatigue Nausea/vomiting Hoarse voice Unilateral paralysis of diaphragm

Dysphagia Superior vena cava obstruction


Diagnostic StudiesChest x-rayCT scanMagnetic resonance imaging (MRI)

Positron emission tomography (PET)

Diagnosis identified by malignant cells


Diagnostic StudiesSputum specimens obtained for cytologic studies Fiberoptic bronchoscope Mediastinoscopy Video-assisted thoracoscopy (VATS)

Pulmonary angiography


Diagnostic StudiesStaging

NSCLC staged according to TNM systemTT denotes tumor size, location, and degree of invasion.

NN indicates regional lymph node invasion.

MM represents presence/absence of distant metastases.


Diagnostic StudiesStaging

SCLCHas not been useful because cancer has metastasized before diagnosis is made


Diagnostic StudiesScreening

No current recommendations exist.

No difference in deaths between those screened and those who were not


Collaborative CareSurgical therapy

Surgical resection is contraindicated for small cell carcinomas.

NSCLC is likely treated with surgery.


Collaborative CareRadiation therapy

Used as curative therapy, palliative therapy, or adjuvant therapy

Primary therapy for those unable to tolerate surgery

Some cancer cells are more radiosensitive than others.

Stereotactic radiotherapy


Collaborative CareChemotherapy

Primary treatment for SCLCTreatment of nonresectable tumors or adjuvant to surgery in NSCLC


Collaborative CareBiologic and targeted therapy

Erlotinib (Tarceva): Blocks growth stimulating signals in NSCLC cells

Bevacizumab (Avastin): Inhibits angiogenesis


Collaborative CareOther therapies

Prophylactic cranial therapy Bronchoscopic laser therapy


Collaborative CareOther therapies

Photodynamic therapy Airway stenting Cryotherapy


Nursing ManagementNursing Assessment

Assess patient’s and family’s understanding of diagnostic tests, diagnosis, treatment options, and prognosis.


Nursing ManagementNursing Assessment

Assess level of anxiety.Obtain subjective and objective data.


Nursing ManagementNursing Diagnoses

Ineffective airway clearance

AnxietyAcute pain


Nursing ManagementNursing Diagnoses

Imbalanced nutrition: Less than body requirements

Ineffective health maintenance

Ineffective breathing pattern


Nursing ManagementPlanning

Overall goals Effective breathing pattern Adequate airway clearance Adequate oxygenation of tissues


Nursing ManagementPlanning

Overall goals Minimal to no pain Realistic attitude toward treatment and prognosis


Nursing ManagementNursing ImplementationHealth promotion

Avoid smoking. Promote smoking cessation programs.

Support education and smoking policies.


Nursing ManagementNursing ImplementationAcute intervention

Offer support during diagnostic evaluation.

Monitor for side effects. Provide comfort.


Nursing ManagementNursing ImplementationAcute intervention

Teach methods to reduce pain.

Educate indications for hospitalization.


Nursing ManagementNursing ImplementationAmbulatory and home care

Follow up carefully for manifestations of metastasis.

Educate patient on signs and symptoms of hemoptysis, dysphagia, chest pain, and hoarseness.

May need information about hospice


Case Study


Case Study62-year-old man is diagnosed with stage IIB small cell cancer of the lungs.

He has smoked 2 packs of cigarettes per day for past 40 years.


Case StudyHe is the sole income provider for his wife and two grandchildren.

He has not agreed to chemotherapy and radiation.


1. How can you attempt to determine the patient’s goals and understanding of the diagnosis?

2. What is the most important thing that can improve the patient’s outcome?

Discussion Questions


3. What can you do to help him with anticipatory guidance if he elects to get treatment?

Discussion Questions


(relates to chapter 28 “nursing management: lower respiratory problems,” in the textbook) focus...

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