case pres lung cancer vluna[1]

8/7/2019 case pres lung cancer vluna[1]

1/19

Far Eastern University

Institute of Nursing

A Case PresentationNursing Process: Lung Cancer

Submitted by:

Udani, Celine S.

Umali, Kimberlyn J.

BSN 135

Gropu 139 - B


2/19

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.

3 All i


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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 PatternWhenever 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 aftersharing it to others. He always tries to feel positive.


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Analysis: Communication can be a transmission of feelings or a morepersonal and social interaction between people. Self-concept develops

as a result of social interaction with others. (Kozier &ErbsFundamental 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 iswell mannered and literate. He loves reading informational books, like

readers digest whenever he is free.

Interpretation: Even if he didnt finished his study, he is determinedto study to learn more and add more knowledge.

Analysis: Cognition is greatly affected by education. Those who studyand develop their skills have better cognitive performances because

they have been provided with different information and chances todevelop their self. Perception is affected by the sensory diseases.

Presence of any sensory abnormalities affects or halters perceptionthat would affect proper communication. (Black, Medical Surgical

Nursing7th edition, page 1880).Cognition involves a persons intelligence, perceptual ability and ability

to process information. It represents a progression of mental abilitiesfrom illogical to logical thinking, from simple to complex problem

solving and from concrete to abstract ideas. (Kozier et.al,Fundamentals of Nursing 7th 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 whenhe is in the hospital he can relax. He feels good about himself as long as he iswith his family and with God.


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withdrawal and depression are common. (Kozier et.al, Fundamentalsof Nursing 7th ed. Pages 957-962).

5. Emotional Patterns

As for his emotions, he is still the same ill or healthy. He is friendly andlaughs with his friends. He always tries to think of happy thoughts.

Interpretation: He has a good coping mechanisms that helps himreduce emotional stress.

Analysis: Emotion-focused coping includes thoughts and actions that

relieve emotional distress. (Kozier &Erbs Fundamental of NursingEight Edition Volume one. Stress and Coping, page 1068.)

6. Family Coping PatternsHe 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 itcan 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 usedto deal with stress or changes imposed from either within or without.

Internal resources, such as knowledge, skills, effective communicationpatterns, and a sense of mutuality and purpose within the family are

the one mostly utilized by the family to assist them in their problem-solving process.

B. Socio-Cultural Pattern

1. Cultural pattern

He belongs to no tribe. They celebrate fiestas, Christmas, mourning of the


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Interpretation: His relation lasts because of his good way of thinkingthings 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 isgenetic, but the subject matter is not genetic and must be learned by

each person in his or her own family. (Kozier &Erbs 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 throughpredictable developmental stages, as they move in or out of the family

unit, and as they establish new family units. (Kozier &ErbsFundamental 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 &ErbsFundamental 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 &Erbs Fundamental of Nursing Eight Edition Volumeone. 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 Catholicdoes.

2. Values and Valuing


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Spiritual well-being is manifested by a generally feeling of being

alive, purposeful and fulfilled. People nurture or enhance theirspirituality in many ways. Some focus on development of the inner self

or world; others focus on the expression of their spiritual energy withothers or outer world. Relating to ones inner self or soul may be

achieved through conducting an inner dialogue with a higher power or

with ones self through prayer or medications. The expression of apersons 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. (Kozieret.al, Fundamentals of Nursing 7th ed. Pages 996).

IV.Activities of Daily Living

ADL Before Hospitalization During Hospitalization

1. Nutrition Breakfast:Dried fish, hotdog, coffee, acup of rice

Lunch:Fish, a cup of rice, a glass

of waterDinner:

Fish, a cup of rice, a glassof water

*client said that he eat

snack once a day anddrinks more water in

Breakfast:Bread, rice, ham, hard-boiled egg sausage, coffee

Lunch:Vegetable, 2 cups of rice,

meat, a glass of waterDinner:

Fish, Vegetable, 2 cups ofrice, a glass of water.

*client said that he eat

snack once a day anddrinks more water in


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4am. at 3am. Takes a 3-hour-nap every afternoon.

Interpretation and Analysis: His fluid intake should increase, becauseincreasing fluid intake could help him to excrete some toxic materials in his body.

V. Physical Assessment

Norms Actual

Findings

Interpretation

and Analysis

General Appearance1. Posture/Gait

2. Skin color

3. Personal Hygiene/Grooming

4. Age

Appropriateness

Relaxed, erect

posture;coordinated

movement

Varies from light

to deep brown

Neat, clean

Logicalsequence; makes

Relaxed

Deep brown,

uniform exceptin areas exposed

to the sun;areas of lighter

pigmentation(palms, lips, nail

beds)

Neat and clean

The client can

answer all the

Normal

Normal

Normal

Normal


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4. Blood Pressure5. Weight

6. Height

130/90mmHg

Body Part

(Techniqueused)

Norms Actual Findings Interpretation

and Analysis

SKIN

Inspect for skincolor and

uniformity of

color.

EYESInspect the

palpebralconjunctiva for

color, texture,

and presence oflesions

NOSE

Inspect for any

deviations in

shape, size or

color and flaring

or discharge

from the nares.

TONSILSInspect the size

of the tonsils,

Varies from lightto dark brown

Shiny, smooth,pink or red

Symmetric andstraight;

no discharge orflaring; uniform

color

Pink and smooth;

no discharge of

Brown

Pink palpebralconjunctiva

(-) nasoauraldischarge

(-)

tonsilopharyngeal

Normal

Normal

Normal

Normal


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JOINTS

Inspect joint forswelling.

bowel sounds

No swelling

(-) cyanosis

Swelling withdischarges (pus) It might haveinfection. S/S of

infection areswelling,

discharges , pain,and redness

VI.Laboratory and Diagnostic Examinations Results

Date Procedure Norms Result Interpretationand Analysis

09-23-10

09-06-10

Cytology Report

CT scan of thechest

No mass and

malignantcells on

lungs

No mass and

malignantcells on

lungs

Mass on upper

lobe of leftlung. Many

malignant

celss.Consistent

with a non-keratinizing

squamous cellcarcinoma.

Large

pulmonarysolid mass in

the left upper

lobeconsistentwith

bronchogenic

___________

___________


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Chemistry (allin normal

range unlessindicated)

Uric Acid umol/L

Eto nb un lahat?

VII. Medications, IV Infusions, Blood Transfusion, Treatment Given

Generic/ TradeName

Dosage/Frequency

Classification Indication Contraindication Side Effect Nsg. Responsibilities

Vitamin Bcomplex

1 TabOD

Vitamins andminerals

Action:A coenzymethatstimulatemetabolic

function and isneeded for cellreplication,hematopoiesis,andnucleoproteinand myelinsynthesis.

PerniciousanemiaCONTRA:-hypersensitiv

e tovitamin B12or cobalt.-earlyLebersdisease

-should not beused inhypersensitivity toany of the

vitamins,containing in thepreparation, aswell as in patientswith 2-nd or 3-rddegree arterial

hypertension.

CV: peripheralvascularthrombosis,heart failure.

GI:transientdiarrhea.Respi:pulmonaryedema.

Skin:itching,transitoryexanthema,urticaria.Other:anaphylaxis,anaphylactoidreactions with

parenteraladministration,pain orburning atinjection site

BEFORE:

-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:

-Dont give large doses of

vitaminB12 routinely;


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ol OD

Action:-structuralisomer ofhyp

oxanthine (anaturallyoccurring purin

e in the body)and isan enzymeinhibitor,inhibiting xant

hine oxidase

of the signsandsymptoms of

primary andsecondarygout.-managementof patientswithleukemia,lymphoma,and

malignanciesthat result in

elevation ofserum anduric acid.

-contraindicatedwith allergy toallopurinol, blooddyscrasias.-use cautiouslywith liver disease,renal failure.

drowsiness,peripheralneuropathy,

neuritis,paresthesias.Dermatologic:rashes-maculopapular,scaly orexfoliative-sometimes fatal.GI:

nausea, vomiting,diarrhea,

abdominal pain,gastritis,hepatomegaly,hyperbilirubinemi

a, cholestaticjaundice.GU: exacerbationof gout and renalcalculi, renalfailure.Hematologic:

Anemia,leukopenia,agranulocytosis,thrombocytopenia, aplastic anemia,bone marrowdepression.

-Take the drug aftermeal.-avoid over the counter

medications.-drink 2.5-3 liters offluids per day while onthis drug.-report rash, unusualbleeding or bruising,fever, chills, gout attack;numbness or tingling;flank pain, skin rash.

Yung mv+eea dq Makita sa drug buk..aun.. wg n ntn isali un.heheh..

VIII. Pathophysiology

for cell smoke
http://en.wikipedia.org/wiki/Isomerhttp://en.wikipedia.org/wiki/Hypoxanthinehttp://en.wikipedia.org/wiki/Hypoxanthinehttp://en.wikipedia.org/wiki/Purinehttp://en.wikipedia.org/wiki/Purinehttp://en.wikipedia.org/wiki/Enzyme_inhibitorhttp://en.wikipedia.org/wiki/Enzyme_inhibitorhttp://en.wikipedia.org/wiki/Xanthine_oxidasehttp://en.wikipedia.org/wiki/Xanthine_oxidasehttp://en.wikipedia.org/wiki/Isomerhttp://en.wikipedia.org/wiki/Hypoxanthinehttp://en.wikipedia.org/wiki/Hypoxanthinehttp://en.wikipedia.org/wiki/Purinehttp://en.wikipedia.org/wiki/Purinehttp://en.wikipedia.org/wiki/Enzyme_inhibitorhttp://en.wikipedia.org/wiki/Enzyme_inhibitorhttp://en.wikipedia.org/wiki/Xanthine_oxidasehttp://en.wikipedia.org/wiki/Xanthine_oxidase


13/19

Modifiable:

Lifestyle (Smoking)

Environmental

Occupation

Non-Modifiable:

Age

Gender

Genetics

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

PATHOPHYSIOLOGY

of LUNG CANCER

for cell

growth,

differentiation

and survival

Proto-

oncogenes=

normal gene

that becomes

oncogene

(mutatedgenes)

Loss of

heterozygosit

y (LOH) in a

cellrepresents

the loss of

normal

function of

one allele of

a gene in

which the

other allele

was already

inactivated.

smoke

-second-hand

smoker

-environmental

and

occupational

exposures.

Kelangan

dagdag ntn 2sa cues.gawan

nlng ntn.

-dietary deficits

-respiratory

diseases
http://en.wikipedia.org/wiki/Cell_%28biology%29http://en.wikipedia.org/wiki/Allelehttp://en.wikipedia.org/wiki/Genehttp://en.wikipedia.org/wiki/Genehttp://en.wikipedia.org/wiki/Allelehttp://en.wikipedia.org/wiki/Cell_%28biology%29


14/19

PathophysiologyLung cancers arise from a single transformed epithelial cell in the tracheobronchial

airways. A carcinogen (cigarette smoke, radon gas,and other occupational andenvironmental agents) binds to a cells DNA and damages it.This damage results in cellular

changes, abnormal cell growth, and eventually a malignant cell. As the damaged DNA ispassed 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 cellcarcinoma 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 ariseperipherally. Bronchioalveolar cell cancer arises from the terminal bronchus and alveoli and

is usually slower growing as compared to other bronchogenic carcinomas. Small cellcarcinomas 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 kcbuhay pa nman pt. ntn.hehe..)

IX.Ecologic Model

A. Hypothesis

B. Pre-Disposing Factors

C. Ecologic Model

D. AnalysisE. Conclusion and Recommendations


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xa maxadongumiinom ng

h2o

Fatigue-nahihirapan

xa sa paghingakya

napapagod xa

Imbalanced

nutrition: Lessthan bodyrequirements

Impaired

physical

mobility

Ineffective

airwayclearance

Risk for

infection-wla nman

xang operationand malinis

nmn xa sakatawan xe

naliligo dnnmn xa.
http://nursing-concept.blogspot.com/2009/02/nursing-care-plans-for-risk-for.htmlhttp://nursing-concept.blogspot.com/2009/02/nursing-care-plans-for-risk-for.htmlhttp://nursing-concept.blogspot.com/2009/02/nursing-care-plans-for-risk-for.htmlhttp://nursing-concept.blogspot.com/2009/02/nursing-care-plans-for-risk-for.html


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XI.Nursing Care Plan

NURSINGDIAGNOSIS

ANALYSIS GOALS ANDOBJECTIVES

INTERVENTIONS RATIONALE EVALUATION

Pcnd nlng skn qng anung ncp gagawin, aq nlng gagawa..


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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. Dont 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; dont lift anything heavier than 10 pounds for 46 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 710 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 scrubbingyour 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 yourgood lung up while you wait for help.


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Learn to check your own pulse. Keep a record of your results. Ask your doctor which pulse rates mean thatyou 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.

Dont use dental floss if your platelet count is below 50,000. Your doctor or nurse will tell you if this is thecase.

Use an oral swab or special soft toothbrush if your gums bleed during regular brushing.

If you cant 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)

Dont 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.

Dont remove ink marks unless your radiation therapist says its okay. Dont scrub or use soap on the marks when 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 its okay.

(After Chemotherapy)Remember, many patients feel sick and lose their appetites during treatment. Eat small meals several times aday to keep your strength up.


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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.

case pres lung cancer vluna[1]

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