CASE STUDY IN LUNG CANCER BY; MAEDINE URBANO

8/12/2019 CASE STUDY IN LUNG CANCER BY; MAEDINE URBANO

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University of Perpetual Help System-DALTA Molino

Prepared by:

MAEDINE JOAN S.URBANO

Prepared by: MAEDINE JOAN S. URBANO BSN-4A Page 1


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BSN-4A



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INTRODUCTION

Background Study

I have chosen Lung Cancer as my case to be studied since I have personallyhandled this patient during our clinical duty in Perpetual Help Medical Center in Las

Pinas. Since lung cancer is very common disease now a days this case study will help

all nursing student to be familiar with the disease, etiology of the disease, common signs

and symptoms, complications and proper medical and nursing management needed for

this type of diseases.

Lung cancer also nown as carcinoma of the lung, is a disease characteri!ed by

uncontrolled cell growth in tissues of the lung . If left untreated, this growth can spreadbeyond the lung by process of metastasis into nearby tissue or other parts of the body.

Most cancers that start in the lung, nown as primary lung cancers, are carcinomas that

derive from epithelial cells.

Etiology

Cigarette smoking

Cigarette smo ing is the leading cause of lung cancer, accounting for about "#$of lung cancers. %is for lung cancer increases with the duration,intensity and depth of smo e inhalation.Second&hand 'passive( smo ing also causes lung cancer, but is less stronglyassociated compared to active smo ing.Cigarettes contain multiple carcinogens 'more than )*( that have been shown toinduce cancers in laboratory settings.

+icotine causes addiction to cigarette smo ing and is also a promoter forcarcinogenesis

Carcinogen nicotine does not initiate carcinogenesis, but it does promote initiatedcells by nicotinic cholinergic receptor signalling in the lungs. +icotine has beenshown to inhibit apoptosis, proliferate cells, and cause angiogenesis in lungtumours.

Environmental exposure

http://en.wikipedia.org/wiki/Cell_growthhttp://en.wikipedia.org/wiki/Tissue_(biology)http://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Metastasishttp://en.wikipedia.org/wiki/Carcinomashttp://en.wikipedia.org/wiki/Epitheliumhttp://en.wikipedia.org/wiki/Cell_growthhttp://en.wikipedia.org/wiki/Tissue_(biology)http://en.wikipedia.org/wiki/Lunghttp://en.wikipedia.org/wiki/Metastasishttp://en.wikipedia.org/wiki/Carcinomashttp://en.wikipedia.org/wiki/Epithelium


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- number of environmental ris factors have been identified, most of which relatesto occupational e posures such as asbestos, tar, soot, and a number of metalssuch as arsenic, chromium, and nic el.

-ir pollution has also been lin ed to increased ris of lung cancer.

enetics/here is an increased ris of lung cancer among first&degree relatives, indicating agenetic susceptibility.Candidate gene studies have identified several en!ymes in the cytochrome P&0#* system as ris factors for lung cancer. 1ne such gene is C2P3-3, whichcodes for aryl hydrocarbon hydro ylase. Certain alleles of C2P3-3 are thought toincrease the ris of lung cancer through increased metabolic activation ofprocarcinogens derived from cigarette smo e.

!ain types o" #ung Cancer

3. Small Cell #ung Carcinoma $SC#C%& previously nown as oat cell carcinoma. -

Small cell lung cancer is a neuroendocrine carcinoma that e hibits aggressive

behavior, rapid growth, early spread to distant sites, e 4uisite sensitivity to

chemotherapy and radiation, and fre4uent association with distinct paraneoplastic

syndromes

5. Non Small Cell #ung Carcinoma $NSC#C%& is the most common type of lung

cancer . It usually grows and spreads more slowly than small cell lung cancer .

T'ree common types o" NSC#C(

)denocarcinomas are often found in an outer area of the lung.

S*uamous cell carcinomas are usually found in the center of the lung

ne t to an air tube 'bronchus(.

#arge cell carcinomas can occur in any part of the lung. /hey tend to

grow and spread faster than the other two types .

http://emedicine.medscape.com/article/280744-overviewhttp://emedicine.medscape.com/article/280744-overviewhttp://www.nlm.nih.gov/medlineplus/ency/article/007270.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/007270.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000122.htmhttp://emedicine.medscape.com/article/280744-overviewhttp://emedicine.medscape.com/article/280744-overviewhttp://www.nlm.nih.gov/medlineplus/ency/article/007270.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/007270.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000122.htm


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Signi"icance o" Study

/his case study aims to identify and determine the general health problems and

needs of the patient with an admitting diagnosis of Lung Cancer. -s a nursing student Ican now formulate nursing care plan for the patient that would address this needs

effectively. /his would also e4uip nursing students with nowledge, s ills, and attitude to

manage patients with same disease.

oal

-t the end of this nursing case study, as a nursing student I will enhance my

understanding on the disease process of Lung Cancer, its nursing management and

paves a way to us student&nurses appreciate our roles of being health care providers in

the country6s 4uest for health progress and development.

Speci"ic O+,ectives(

-t the end of this case study, I will be able to

7efine Lung Cancer

7iscuss and interpret data gathered through theoretical analysis of +ursingHistory,

8ordon6s 33 9unctional Pattern, Physical -ssessment and Laboratory%esults.

/race the Pathophysiology of Lung Cancer.

Create effective and efficient nursing care plan re4uired by a patient with the above

mentioned disease process.

7iscuss the medications ta en by the client, its action, side effects and nursing

responsibilities



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-ealt' -istory

). Demograp'ic $ Biograp'ical Data%

Client6s Initial 8.%

8ender Male

-ge ## years old

%eligion Catholic

:sual Source of Care Hospital

7ate of -dmission 9ebruary 3", 5*30

-dmission; Initial 7iagnosis Lung Cancer

9inal 7iagnosis C-

B. Source and Relia+ility o" In"ormation

I collected and based my information in the patient6s chart, through interview and

laboratory e aminations.

C. Reason "or Seeking Care or C'ie" Complaints

Shortness of breath and easy fatigabilty.



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D. /resent -ealt' -istory

Patient is a diagnosed case of +on&small Cell Lung Cancer< s;p C/ ,

biopsy, right on -ugust 5*3=, s;p -MI on 9ebruary 5**# s;p C->8 ? 0 vessel

C-7 on March 5**#.

History of present Illness started 3 year P/C year 5*3=, when patient

e perienced persistent cough and intermittent symptoms of fever, shortness of

breath and easy fatigability. Moreover, loss of weight was also noted. Patient

sought consult wherein wor up was done and patient underwent C/&guide biopsy

of left lung on May 5*3=, with histopath said to reveal infection. Patient then too

anti&/> medications for = months. Symptoms were noted to be persistent during

this time. Patient again sought consult and C/ guided biopsy on the right lung on -ugust 5*3= was done which now revealed malignancy. Patient was advised

treatment options such as chemotherapy, radiotherapy and surgery however,

patient was lost to follow&up symptoms were still persistent and were later on

associated with right&sided chest pain radiating to bac . Patient was also noted to

have = pillow orthopnea. Severity of symptoms prompted consult at Cagayan de

1ro wherein was advised chemotherapy and radiotherapy hence transfer to

Perpetual Help Medical Center for further management.

/ast -ealt' -istory or /ast -ealt'

Patient 8.% Patient is a diagnosed case of +on&small Cell Lung Cancer< s;p C/ ,

biopsy, right on -ugust 5*3=, s;p -MI on 9ebruary 5**# s;p C->8 ? 0 vessel C-7 on

March 5**#. Patient sought consult wherein wor up was done and patient underwent

C/&guide biopsy of left lung on May 5*3=, with histopath said to reveal infection



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Be"ore -ospitali3ation During -ospitali3ation

-ccording to patient he defecates oncea day with semi& formed and brown incolor and being eliminated in morning.

She voids )&" times a daywith yellowish in color.

7uring our shift, the patient didn6t defecate.He has I9C connected to urine bag with =#*cc and yellow amber in color throughout the

shift.

)ctivity Exercise /attern

Be"ore -ospitali3ation During -ospitali3ation -ccording to the S1, the patient issometimes wal ing around their villagein Cagayan 7e 1ro but e perienced ofeasily shortness of breath andfatigability, so he prefer mostly to usedcar going to his destination. -bout hishygiene, they see to it that cleanlinessmust maintain to him.

/he patient6s 8CS is 33 'A0, D3c, M)( whichis in moderate scale or patient is stuporous./he S1 is advised to initiate passive range ofmotion for him to e ercise.

Sleep&Rest /attern


-ccording to the S1 her husbandcomplains of sleepless night, whenshortness of breath attac ed herhusband. He uses = pillows

orthopnea.

Patient is in moderate scale of 8CS, but canobeys commands.

Cognitive&/erceptual /attern


-ccording to the S1, her husband can /he patient responds to stimuli by means of



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still recogni!e people most specially hisrelatives. He can still communicate withpeople around him through writingbecause there was an endotracheal&tube attached via mechanical vent. Sohe was unable to produce sound.

nodding, calling out his name and obeyscommand.

Sel" perception4Sel" concept


-ccording to the S1, her husbandconsiders himself as a fulfilled man. hewas able to raise his child withunconditional love and support to alltheir needs and now they are allprofessionals with the help of theirfamily business that was handled by herhusband.

/he patient6s children are always in thehospital during visiting hours and I personallywitnessed how they care and love theirmother. /hey want to give the best medicalcare for him, which only proved how thesechildren love and appreciate their father

Role Relations'ip /attern


-ccording to the S1, he was a lovingfather and responsible to his children.He provides their needs and sees to itthat they are comfortable in their way oflife.

7ue to his condition, his children stated thatthey will do all their best to ta e care of theirfather. /hey will ma e sure to give bac thecare they have received from him.

Coping Stress /attern


Ehen her husband is tired, he drin s 7uring his present condition, he is in a



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alcoholic beverage and smo ecigarettes.

stressful state. His family is there to comfortand give him necessary needs Fust to showtheir love.

Sexual Reproduction /attern

/he patient is not now active in se ual intercourse because of easily gets tired and

shortness of breath attac s.

5alue Belie" /attern

He is a %oman Catholic and goes to church when he still can.

-. /'ysical )ssessment

0INDIN SNovem+er 678 692:

RE!)R;S

B#OOD /RESSURE 2694


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Eith I9Cconnected tourine bagdrainingyellow amber.

s command

>.Integu&mentary

a.( S in

Maputla angulay nya.J asverbali!ed bythe S1.

Dariesfrom lightto deepbrownest motorresponse in8CS is #, whichmeans obeyscommand formovement

d;t prolongedimmobility

@.Cardio&vascular

Eala namanpo syangcomplain namasa itJ asverbali!ed byS1.

>P 35*;"* mmHg

P% "*&3=* bpm

>P 35*;* mmHg

P% "bpm

+ormal9indings.



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'&( Chestpain

L.8astro&intestinal

Hindi na syama a ain sabibigJ as

verbali!ed bythe S1.

+ormalbowelsounds

heardevery #&5* sec.

8lobular

Soft Knon&tender

+8/ onleftnostril,

19continuous feeding

7iet

thepatientwas fedthrough

+8/ ./he dietwas 1953**@cal;dayand CA9B =#*cc0bananabasedplus =

scoops ofProsure.Continuousfeeding ?0hoursthen bestfor 0hours.

- person whocan6t have verymuch food at

one time needsto befed continuously. Somepeople are fedday and night.1thers are fedonly duringwa ing hoursor only at night.Start the

feedings at thesame hours.

M.

+eurologic

nag

rerespondnman sya, apagina ausapsiya,throughwriting asverbali!ed bythe S1

'&(

Sei!ures

'&(Paresthesia

-ble to

8CS of

33 'A3&none,D#&oriented,M)&obeyscommand(

d;t neurologic

deficit



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followscommand

I. #a+oratory

Electrocardiogram

D)TE RESU#T NOR!)# R)N E )N)#>SIS

5;3";30 Sinus

tachycardia

Left atrial

abnormality

Poor % wave

progression

+on&specific

S/&/ wave

changes

0.#*.#* 3* O

35;L

CT& ScanDate Result )nalysis

642ilateral

pulmonary

masses as

described above



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is atheromatous. Coronary arteries are

calcified.

/he left adrenal gland is prominent

Sternotomy wires are seen.

-E!)TO#O >

D)TE RESU#T NOR!)# R)N E )N)#>SIS64 694692 %>C& =."#

3*O35;L

0.#*&).** 3*O35;L Low %>C d;t chronic

anemia probably

secondary to

chronic diseaseHC/& *.== *.0* Q *.#0L d;t low %>C

productionH8>& 33* 35*.**&3)*.** g;L +ormalE>C& 5 .# 0.#*&3*.** ? 3*O ;L d;t heavy growth of

pseudomonas

Herginosa Isolated

and ' ( lebsiella

pneumoniaePlatelet & 3 279& 99 29 A4#

C'emistry Section

D)TE RESU#T NOR!)# R)N E )N)#>SIS64 694692 >:+& 5. =.5& .3 mmol;L

C%A-& 0) #"&33* umol;L lo?er muscle mass

caused by a disease,

such as muscular

dystrophy, or by

aging.Potassium& =.* =.#.3 mmol;L low potassium

(hypokalemia) refers



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to a lower than normal

level of potassium in

bloodstream maybe

d;t nutritional

deficiency

Immunology section

D)TE RESU#T NOR!)# R)N E )N)#>SIS64 2 42 Procalcitin level Q

*.3* ng;ml

R *.# ng;mL absence of bacteremia inadult patients withacute fever.

Bacteriology

D)TE RESU#T )N)#>SIS642=42 ramstain&

Pus cells& G5#;LP9

Apithelial cells R5#; LPH

8ram positive cocci 1CC-SI1+-L

8ram negative Short rods %are

ET)

)rterial +lood as

D)TE RESU#T NOR!)# R)N E )N)#>SIS64 6:4692 pH& .0 .=#& .0# al alosis

pC*5& 03 =*&0# mmH8 normalP*5&30= "*&3** mmHg abnormalHC*=& 5 55&5) mmol;L abnormal



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/)T-O/->SIO#O >


MODIFIABLE

-CIGARRETE SMOKING-DRINKS ALCOHOL-RESPIRATORY TRACTINFECTION-ENVIRONMENTAL

NON MODIFIABLE-AGE-GENDER-FAMILY HISTORY

EXPOSURE TO PATHOGENS

INFLAMMATION

BRADYKININ HISTAMIN

INC! CAPILLARY

FLUID " CELLULAR

HYPERSECRETION OF

PERSISTENT COUGH

SINGLE TRANSFORMED EPITHELIAL

CARCINOGEN BIND TO

ABNORMAL CELL GRO$TH

DNA CHANGES" ACCUMULATION OF GENTIC

PULMONARY EPITHELIUM

INVASIVE CARCINOMA

Non Small Cell #ung Carcinoma

%S&o'(n)*

* o+ ,') (&%o'(&o.n)


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F. /ro+lem #ist

). )ctual /ro+lem

/ro+lem No. /ro+lem Date Identi"ied2 I/. 0')1 g * )23& ng) 9ebruary 5) , 5*30

6 Ineffective airway Clearance 9ebruary 5) , 5*30

: Imbalanced +utrition 9ebruary 5) , 5*30

B. /otential /ro+lem2 %is for -spiration 9ebruary 5) , 5*30

6 %is for Pressure :lcer 9ebruary 5) , 5*30



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;. Disc'arge -ealt' Teac'ing /lans

M & -dvise the patient to continue the prescribed home medication ordered by thephysician.

A& Provide calm and safe environment. Prevent falls and eep your bathroom safe to use.

/ & -dvise the patient to avoid fatigue. Instruct to have enough rest at home.

H& Maintain good hygiene by ta ing a bath daily.

Chec every day for pressure sores at the heels, an les, nees, hips, tailbone, and elbows .

1 & Instruct to continue consulting to a doctor as ordered.

7 & Aat healthy foods such as fruits and vegetables. 9ollow low salt, low fat diet and 7M diet. 7rin plenty of water at least "&3* glasses of water a day.

S & -dvise family that patient needs continuous mechanical ventilation set up sincepatient cannot wean&off mechanical ventilation.

-dvise the family members to provide continuous moral support to the patient.

#. Summary o" Client1s Condition as o" #ast Day o" Contact7ate 9ebruary 5), 5*30

1n the last day of contact, Patient 8% was received in bed with mechanicalventilation support through endotracheal tube, his vital signs is strictly monitored every 3hour and with latest D;S as follows /emp.= . C, >P 35*; *mmHg, %% 3" cpm, H%.5bpm. Patient inta e and output is also on strict monitoring with total current output of="* cc. Continuous C>8 monitoring with 35 ** pm result of 3 mg;dl, no insulinprovided. +8/ continuous feeding is also provided. Current medications werecontinued. Patient 8% still stuporous, but can obey commands, 8CS of 33 'A3, D#, M)(.

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CASE STUDY IN LUNG CANCER BY; MAEDINE URBANO