Lung Cancer NCM112A BSN3C G2 PDF

Western Mindanao State University College of Nursing LUNG CANCER Presented by | BSN 3C | Group 2 [S.Y. 2024-2025] NCM 112 Instructor | Sandra M. Covarrubias, RN, MN  PRESENTERS TANIA GYLE J. ABELLA, SN AZRAF BIN-SALI A. ABUBAKAR, SN...

Western Mindanao State University College of Nursing LUNG CANCER Presented by | BSN 3C | Group 2 [S.Y. 2024-2025] NCM 112 Instructor | Sandra M. Covarrubias, RN, MN  PRESENTERS TANIA GYLE J. ABELLA, SN AZRAF BIN-SALI A. ABUBAKAR, SN BERNADETTE T. ADIL, SN IRA CAIRE S. CABATO, SN HAIRANNIE A. DATU INDAL, SN AMIN C. KARANAIN, SN MANDIADI, XYVEE C. MIKEL VAL M. MIDEL, SN NURIEL AYNA K. SUHAILI, SN SHIRIN M. TAN, SN  TOPIC OUTLINE Definition Nursing Management for Post Endoscopic Procedure Types of Lung Cancer Post-Op Complications Cancer Staging System SCLC Tumor Size NSCL Nodal Involvement Types of NSCL Metastasis Causes & Risk Factors Staging Pathophysiology Medical Management Signs & Symptoms Surgical Treatment Diagnostic Test Radiation Treatment Laboratory Test Chemotherapy | Side Effects Complimentary Therapies Bronchoscopy Prognostic Factors Endoscopy Prevention Mediastinoscopy Nursing Assessment VATS Nursing Diagnoses/Interventions  LUNG CANCER Cancer refers to an abnormal growth of cells which tend to proliferate in an uncontrolled way and, in some cases, to metastasize (spread). Cancer is not one disease. It is a group of more than 100 different and distinctive diseases. Lung cancer is the most common cause of cancer death for men and women. Tobacco use accounts for 87% of lung cancer. Lung cancer affect primarily in 5 or 6th decade of life. In 70% of lung cancer patient, disease has spread to distant organs. Healthy Lung Tissue Diseased Lung Tissue  Types of Lung Cancer Small Cell Lung Cancer SCLC accounts for 20-25% of all lung cancers. Small Cell Lung Cancer is the most aggressive form of lung cancer. It usually starts in the bronchi then affects the whole lung. These cancer cells are small and considered to be quite aggressive in nature and they have a large growth factor. Because of these reasons, at the time of diagnosis, (60% of the time), the tumors have often metastasize to other parts of the body (brain, liver, and bone marrow).  Types of Lung Cancer Non Small Cell Lung Cancer NSCLC accounts for 80% of lung cancers. Considered as the most common type of lung cancer. NSCLC is any type of epithelial lung cancer other than small cell lung cancer. Non-small cell lung cancer usually grows and spreads more slowly than SCLC.  TYPES OF NSCL SQUAMOUS CELL carcinomas usually arise centrally in larger bronchi. Makes up 30-40% of all lung cancers Often linked with smoking More common to male Occur centrally in the large bronchi Associated with smoking Not easily visualized on x-ray  TYPES OF NSCL ADENOCARCINOMA formed from grandular structure in epithelial tissues, often found in periphery of the lungs Most common type of lung cancer (40-50%) Originates in glandular cells that produce mucus and line the alveoli A slower-growing cancer compared to other types of NSCLC. Can occur in non smokers More common to woman  TYPES OF NSCL LARGE CELL CARCINOMAS occur in any part of the lung and tend to grow and spread faster than the other two types. 15-20% of the lung cancer Poorly differentiated lung cancer Develop in both the central and peripheral regions of the lung. Known for being one of the more aggressive NSCLC CAUSES AND RISK FACTORS Smoking history Age Genetic disposition Pollution and occupational exposure Family history of Lung Diseases Diet  Pathophysiology Carcinogens Abnormal proliferation of Lung Cells (slowly). (Smoking, Occupational & Covers the Segmental Bronchi & Lobes of the Lung. Environmental Agents, Genetics) Non-specific Inflammatory changes hypersecretion of Binds with cell’s DNA & mucus, desquamation of cells Damage the Cells Lesions formation in Lung Tissues Cellular changes and (Bronchi, Bronchioles, Alveoli) Abnormal cell growth occur. Malignant transformation of BRONCHOGENIC pulmonary epithelial cells. CARCINOMA  Signs & Symptoms There are (2) Two Types of Signs and Symptoms of Lung Cancer: 1. LOCALIZED - involving the lung. 2. GENERALIZED - involves other areas throughout the body if the cancer has spread. Thus, also has EARLY or LATE Signs and Symptoms!  Signs & Symptoms LOCALIZED Cough Lung Fatigue Stridor Hemoptysis Infection Hoarseness, Hiccups Weight Chest Pleural Loss Pain Effusion  Signs & Symptoms GENERALIZED Mental Status Abdominal Bone Pain Weight Loss changes Pain Jaundice Elevated Liver Cachexia Anorexia Hepatomegaly Function Test  Signs & Symptoms EARLY LATE Cough or chronic cough Bone pain, spinal cord Dyspnea compression Hemoptysis Chest pain/tightness Chest or Shoulder Pain Dysphagia Recurring Temperature Head and Neck Edema Recurring Respiratory Infections Blurred vision, headaches Weakness Anorexia, Weight-loss Cachexia Pleural effusion Liver metastasis/regional spread  Diagnostic Tests Chest X-ray - Initial imaging to identify any visible masses CT Scan (Computed Tomography) - Provides detailed images of the lungs and other structures PET Scan (Positron Emission Tomography) - Assesses metabolic activity of suspicious areas, often combined with CT for better localization MRI (Magnetic Resonance Imaging) - Used if there is concern about brain or spinal metastasis  Laboratory Tests Sputum Cytology - Examines mucus from the lungs for cancer cells Biopsy - Tissue sample taken from the lung for pathology analysis Molecular Testing - Identifies specific mutations to guide targeted therapies Blood Tests - Often used to check overall health; can include complete blood count (CBC) and blood chemistry panels.  Endoscopy and VATS Endoscopy - A general term for inserting a flexible tube with a camera (endoscope) through a natural opening (like the mouth) to visualize internal organs, primarily the gastrointestinal tract, but can also be used in other areas depending on the site Bronchoscopy - A procedure where a flexible tube with a camera (bronchoscope) is inserted through the nose or mouth into the lungs to visualize the airways, collect tissue or mucus samples, and assess any abnormalities Mediastinoscopy - A surgical procedure in which a small incision is made at the base of the neck, and a scope is inserted to examine the mediastinum (area between the lungs) and biopsy lymph nodes to check for cancer spread  Endoscopy and VATS VATS (Video-Assisted Thoracoscopic Surgery) - A minimally invasive surgical technique where a camera and small instruments are inserted through small chest incisions, allowing visualization and removal of tissue or tumors in the lungs without a large incision  Nursing Management for Post-Endoscopic Procedures Monitor Vital Signs - Regularly check blood pressure, heart rate, respiratory rate, and oxygen saturation to identify any signs of respiratory distress, bleeding, or other complications. Assess for Complications - Watch for signs of bleeding (coughing up blood, tachycardia), perforation (sudden severe pain, abdominal tenderness), respiratory distress, or infection (fever, chills). Report any abnormalities promptly. Airway Management - Assess airway patency and monitor for gag reflex return, especially if sedation or local anesthetic was used. Keep the patient NPO (nothing by mouth) until gag reflex has fully returned to prevent aspiration.  Nursing Management for Post-Endoscopic Procedures Pain Management - Provide prescribed analgesics as needed and monitor for pain levels, as mild discomfort is common post-procedure. Educate the patient to report severe or worsening pain. Positioning - Keep the patient in a semi-Fowler’s position to aid breathing and minimize aspiration risk, especially if there is any residual sedation. Hydration and Nutrition - Once cleared to resume oral intake, begin with clear fluids and gradually advance to regular diet as tolerated. Ensure hydration to support recovery. Patient Education - Teach the patient about symptoms to watch for at home, such as bleeding, difficulty swallowing, chest pain, fever, or respiratory symptoms. Provide clear instructions on when to seek medical help.  TNM Staging system for Lung Cancer Stands for Tumor, Node, Metastasis T - describes the size of the tumour N - describes whether there are any cancer cells in the lymph nodes M - describes whether the cancer has spread to a different part of the body Used to provide a description of the anatomic extent of cancer that can be communicated to others, assist in treatment decisions, and indicate prognosis.  Tumor Size describes the size of the tumor Tx - The tumor size is unknown, or cancer cells are only found in sputum. T0 -The tumor is present only in the cells 36- 37/67 airway T1 - Tumors less than or equal to 3 cm or (≤3cm) T1A (≤1cm), T1B (>1-2cm), and T1C (>2-3cm) T2 - Tumor's size is 4-7 cm. - T2A (>3cm but ≤4cm), T2B (>4cm but ≤5cm) - atelectasis or pneumonitis T3 - Tumors greater than 7 cm or (>7cm) T4 - tumor that invades structures in the chest such as the heart, major blood vessels near the heart, the trachea, the esophagus.  Nodal Involvement refers to the status of lymph nodes near the tumor and is a major factor in prognosis and treatment. The current nodal classification system for lung cancer is based on the anatomical location of the involved lymph nodes: N0 -No nodes are involved. N1 - The tumor has spread to nearby nodes on the same side of the body. N2 - The tumor has spread to nodes farther away, but on the same side of the chest. N3 - The tumor has spread to lymph nodes on the other side of the chest from the original tumor, or has spread to nodes near the collarbone or neck muscles.  Metastasis describes whether the cancer has spread to a different part of the body MO - The tumor has not spread to distant regions. M1 M1a - The tumor has spread to the opposite lung, to the lung lining M1b - The tumor has spread to distant regions of the body, such as the brain or bones. Staging Stage 1. Tumor is small and localised to lung, no lymph node involvement A - Tumor 3 cm and invading surrounding local area Stage 2. A - Tumor 3 cm involving the bronchus and lymph nodes on the same side of chest and tissue of local organs. Stage 3. A - Tumor spread to the nearby structure and regional lymph nodes B - Tumor involving heart, trachea, esophagus, mediastinum and lymph nodes. Stage 4 - distant metastasis  Medical Management: Lung Cancer Three main cancer treatments 1. Lung resection - removal of a part or all of the lung; used to diagnose and treat lung disorders Lobectomy - single lobe of lung is removed. Bilobectomy - two lobes of the lung is removed, only on right side tumors Sleeve resection - cancerous lobe is removed and segment of the main bronchus is resected Pneumonectomy - removal of entire lung Segmentectomy - a segment of the lung is removed Wedge resection - a removal of a small, pie- shaped are of the segment Chest wall resection with removal of cancerous lung tissue - for cancers that have invaded the chest wall  Medical Management: Lung Cancer 2. Radiation therapy useful in controlling the neoplasm that can not be surgically removed reduce size of the tumor remove symptoms like cough chest pain, dyspnea, and hemoptysis  Medical Management: Lung Cancer 3. Chemotherapy use to alter tumor growth and treat patient with metastasis Non small cell Other drugs involved two drug regimen Etoposide Cis/Carbo platin + 1 Paclitaxel other (Taxol/ Cyclophosphamide Taxotere/ Doxorubicin Gemcitabine) Vinblastin Small cell Cisplatin/ Etoposide Side Effects of the treatments Surgery Radiation Chemotherpy Pain Fatigue Anemia, thrombocytopenia Hematoma Decreased nutritional intake Fatigue Hemorrhage Radiodermatitis Alopecia Decreased hematopoietic Altered respiratory function Cold, pale skin function Risk for atelectasis, Risk for pneumonitis, Peripheral Neuropathy pneumonia, hypoxia esophagitis, cough Risk for DVT Lung fibrosis Cognitive Changes Grief Immunosuppression  Medical Management: Lung Cancer Complementary Therapies for Chemotherapy To aid in alleviating the side effects of chemotherapy and improve patient’s quality of life Nutritional Support Physical Activity More protein and Aerobic Exercises calories Low intensity Meat, Fish, Eggs, ex. walking Dairy, Fats, Plant- based proteins Herbal Support Ginger Mind Body Therapies Moringa Tree Meditation Burdock Root Yoga Discuss with healthcare provider Tai Chi before taking any herbs  Prognostic Factors The best estimate on how a patient will do based on: Type of cancer cells Size or location of the tumor Stage of the cancer at the time of diagnosis Age of the person Gender Results of blod or other tests A persons specific response to treatment Overall health and physical condition  Prevention: Primary ✓ Avoid the use of tobacco smoke ✓ Know environmental carcinogens that increase risk ✓ Chemoprevention: Consuming Vit. A, Vit E, Vit C. Prevention: Secondary ✓ Aim is to early diagnose high risk populations via screening ✓ Chest X-ray, MRI, CT scans, sputum cytology  Prevention: Tertiary Targeted at people who survived a cancer disease Assist them to retain an optimal level of functioning regardless of their potential debilitating disease Nursing Assessment Subjective Data: Objective Data: Past health history Vitals monitoring Exposure to smoke, airborne carcinogens, any Respiratory: Assess for wheezing stridor, respiratory diseases and pollutants hoarseness, pleural effusion Nutritional habits CVS: Assess for cardiac tamponade, Symptoms like anorexia, nausea, vomiting, dysrhythmias, pericardial effusion cough and hemoptysis Findings: Chest X-ray, MRI scan, CT scan, CBC.  Lung Cancer Post-op complications Airway obstruction, dyspnea, hypoxemia, respiratory failure Anesthesia side effects (N/V) Bleeding (hypotension, cardiogenic shock) Cardiac dysthymias, CHF, fluid overload Fever, sepsis Pneumonia Pneumothorax (abnormal collection of air in the pleural space between the lung and the chest wall.) Pulmonary embolus (blockage of an artery in the lungs) Wound dehiscence (reopening of the wound) Prolonged hospitalization Death  Cancer Staging Systems The most common staging system for lung cancer is the TNM System developed by the International Union Against Cancer (UICC). Guides best course of treatment Estimates prognosis It is only useful in staging NSCLC, when surgery is considered. The TNM system is the most widely used cancer staging system. TNM can stage solid tumors. The TNM Classification is a system for classifying a malignancy. By this system, patient's clinical stage can be estimated by how far their cancer has spread.  NURSING MANAGEMENT Nursing Diagnosis Ineffective breathing pattern r/t loss of adequate ventilation as evidenced by overexertion of pt. during respiration Nursing Intervention Teach patient about deep breathing exercises Encourage alternating activity with rest periods Chest physiotherapy Suctioning Bronchodilator medication O2 administration, if required  NURSING MANAGEMENT Nursing Diagnosis Impaired gas exchange r/t to excessive or thick secretions or r/t to decreased passageway of gases between alveoli of lungs and vascular system as evidenced by decreased SPO2 level of pt. Nursing Intervention Instruct the patient to stop smoking Semi-fowler position Administered antibiotics as prescribed Adequate hydration Deep breathing exercises Nebulisation Suctioning, as required  NURSING MANAGEMENT Nursing Diagnosis Chronic pain r/t stage IV NSCLC diagnosis as evidenced by client reporting “pain in the right chest and lower ribs". Nursing Intervention Relaxation techniques Diversional therapy Frequent massage Encourage energy conservation Comfortable position Education to avoid concern about pharmacological and non-pharmacological therapies Medication, as prescribed  NURSING MANAGEMENT Risk for Infection Monitor the client temp. routinely Encourage the patient to do regular ADL like brushing, bathing, eating, toileting Provide a high calorie, high protein diet. Hand washing before and after taking food Antibiotics, as prescribed Risk of deficit fluid volume Encourage the patient to take fluids (2-3 1/day) Small frequent diet I/V fluid administration, if prescribed Intake-Output charting Administer skin care, apply hydrating lotion Weight recording  NURSING MANAGEMENT Risk for disturbed self concept related to changes in lifestyle Provide psychological support Encourage the family members in caring of the patient Encourage communication with the patient Diversional therapy Ask the client to identify personal strenght and talent.  REFERENCES Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 15TH EDITION Brunner, L. S., & Suddarth, D. S. (2010). Brunner & Suddarth’s textbook of medical- surgical nursing (12th ed.). Wolters Kluwer. Martel, J. (2023, March 8). Pharyngitis. Healthline. Retrieved from https://www.healthline.com/health/pharyngitis#treatment Pathania,.. (2018, March 21). Upper respiratory diseases [Slide show]. SlideShare. Retrieved from https://www.slideshare.net/slideshow/upper-respiratoey- diseases/91399634 Wikipedia contributors. (2024, June 9). [PHOTO] Streptococcal pharyngitis. Wikipedia. Retrieved from https://en.wikipedia.org/wiki/Streptococcal_pharyngitis Wolford, R. W., Goyal, A., Syed, S. Y. B., & Schaefer, T. J. (2023, May 1). Pharyngitis. StatPearls - NCBI Bookshelf. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK519550/