2. Lung Cancer
   • Pathophysiology: squamous cell carcinoma: undifferentiated, pleomorphic in appearance; accounts for 45-60% of all lung cancer; small-cell (oat-cell) carcinoma: small, dark cells located between cells of mucosal surfaces; characterized by early metastasis and poor prognosis; large-cell (giant-cell) carcinoma: located in the peripheral areas of the lung, has poor prognosis; adenocarcinoma: found in men and women; not necessarily related to smoking.
   • Risk factors:
     1. Heavy cigarette smoking, 20 years smoking history.
     2. Exposure to certain industrial substances, such as asbestos.
     3. Increased incidence in women during the last decade of life.
   • Annual incidence: 178,100 new cases; 160,400 estimated deaths.
   • Assessment:
     1. Subjective data:
        • Dyspnea.
        • Pain: on swallowing; dull and poorly localized chest pain, referred to shoulders.
        • Anorexia.
        • History of cigarette smoking over a period of years; recurrent respiratory infections with chills and fever, especially pneumonia or bronchitis.
     2. Objective data:
        • Wheezing; dry to productive persistent cough; hemoptysis, hoarseness.
        • Weight loss.
        • Positive diagnosis: cytology report of cells from bronchoscopy.
        • Chest pain.
        • Signs of metastasis.
   • Analysis/nursing diagnosis:
     1. Ineffective breathing pattern related to pain.
     2. Impaired gas exchange related to tumor growth.
     3. Pain related to disease progression.
     4. Fear related to uncertain future.
     5. Powerlessness related to inability to control symptoms.
     6. Knowledge deficit related to disease and treatment.
   • Nursing care plan/implementation:
     1. Goal: make patient aware of diagnosis and treatment options.
        • Allow time to talk and to discuss diagnosis.
        • Patient makes informed decision regarding treatment.
     2. Goal: prevent complications related to surgery for patient who is diagnosed early and for whom surgery is an option: wedge or segmental resection, laser therapy, lobectomy, or pneumonectomy are usual procedures.
        • See Nursing care plan/implementation for the patient having thoracic surgery.
        • Monitor vital signs, including accurate respiratory assessment for respiratory congestion, blood loss, infection.
        • Assist patient to deep breathe, cough, change position.
     3. Goal: assist patient to cope with alternative therapies when surgery is deemed not possible.
        • Radiation: megavoltage x-ray, cobalt - usual form of radiation.
        • Chemotherapy:
          1. Cisplatin and VP-16 with irradiation has become standard form of induction chemotherapy. Cyclophosphamide (Cytoxan), doxorubicin (Adriamycin), CCNU, methotrexate, vincristine sulfate (Oncovin) are the other drugs given for lung cancer.
          2. See Nursing care plan/implementation for the patient having chemotherapy.
     4. Goal: health teaching.
        • Encourage patient to stop smoking to offer best possible air exchange.
        • Encourage high-protein, high-calorie diet to counteract weight loss.
        • Force fluids, to liquefy secretions so they can be expectorated.
        • Encourage adequate rest and activity to prevent problems of immobility.
        • Desired effects and side effects of medications prescribed for therapy and pain relief.
        • Coping mechanisms for maximal comfort and advanced disease.
   • Evaluation/outcome criteria:
     1. Copes with disease and treatment.
     2. Side effects of treatment are minimized by proper nursing management.
     3. Acid-base balance is maintained by careful management of respiratory problems.
     4. Patient is aware of the seriousness of the disease.