A CASE PRESENTATION ON LUNG CANCER

Presented to the faculty of the School of Nursing

Adventist Medical Center College
Brgy. San Miguel, Iligan City

In Partial Fulfillment
Of the requirements for the Degree
BACHELOR OF SCIENCE IN NURSING

Cheryl C. Padura
Trisha C. Mangubat
Muhammmad Alnashry B. Sarip
Earl Juffeny M. Etulle
Kea R. Alinas
Marwah C. Najeeb
Omaima M. Mocsana
Omerah S. Mimbalawag
Jan Mikee Afable
John Arthur Undag

March 21, 2018

 TABLE OF CONTENTS

I. TITLE PAGE

II. TABLE OF CONTENTS i

III. LIST OF TABLES ii

IV. LIST OF FIGURES iii

V. OBJECTIVES

General Objective
Specific Objectives
VI. DEFINITION OF TERMS

VII. INTRODUCTION

VIII. NURSING HEALTH HISTORY

Vital Information
History of Present Health Concern
Past Health History
Family Health History (genogram) 11
Physical Examination and Review of Systems 12-14
Gordon’s Functional Health Patterns Assessment 15-17
Diagnostic test 18-20
IX. NORMAL ANATOMY AND PHYSIOLOGY 21-22

X. CONCEPT MAPPING 23-24

XI. NURSING CARE PLAN 25-30

XII. DISCHARGE PLAN 31-37

XIII. REFERENCES 38
 LIST OF TABLES

TABLES PAGES

1 Physical Examination and Review of System (PEROS) 12-14

2 Gordon’s Assessment of Client Dauntless 15-17

3 Normal Anatomy and Physiology 21-22

4 Diagnostic tests

5 Drug study
 LIST OF FIGURES

FIGURES PAGE

1 Genogram Showing the Family History of Client Dauntless 11

2 Concept Mapping 23-24

 OBJECTIVES

General Objective:

At the end of one and a half hour case presentation, the listeners will be able to ask

questions, give suggestions and comments about the case presented in order to enhance their

critical thinking and skills in handling patients with such case in the clinical area.

Specific Objectives:

At the end of one and a half hour case presentation

The presenters will be able to:

1. Discuss the study lung cancer to gain better understanding about the disease and be

equipped with competence in dealing with related situations in the future;

2.Trace the pathophysiology and present it through a schematic diagram, explain the risk

factors and manifestations of a patient diagnosed with lung cancer;

3. Discuss the systems involved in the development of lung cancer in the human anatomy

and physiology;

4. Formulate specific, measurable, attainable, realistic, and time-bounded nursing care

plans with corresponding rationales for each of the nursing interventions; and

5. Present a discharge plan for the patient and justify the prognosis of a patient diagnosed

with lung cancer.

The students will be able to:

1. Acquire understanding about the etiology, nursing responsibilities, possible

complications of lung cancer;

 2. Gain knowledge about the disease process, risk factors, clinical manifestations and the

disease management of lung cancer;

3. Identify problems, develop a teaching plan and strategies appropriate for the goal

attainment for a client that manifests or is diagnosed with lung cancer;

4. Develop and establish interpersonal relationship with fellow audiences while the case

is ongoing; and

5. Ask sensible questions related to the case presentation about lung cancer.
 DEFINITION OF TERMS

Anasarca. A medical condition characterized by widespread swelling of the skin due to

effusion of fluid into the extracellular space.
According to Brunner and Suddarth, Anasarca is a severe generalized edema that can occur as a
result of increased capillary fluid pressure, decreased capillary oncotic pressure, or increased
interstitial oncotic pressure, causing expansion of the interstitial fluid compartment. p.250-251

Ascites. Refers to abnormal accumulation fluid in the abdominal (peritoneal) cavity. The
most common cause of ascites is cirrhosis of the liver.
According to Brunner and Suddarth, Ascites is a type of edema in which fluid accumulates in the
peritoneal cavity: it results from nephrotic syndrome, cirrhosis, and some malignant tumors. p.250-
251.
Atherosclerosis. A major cause of abdominal aortic aneurysm and is the most common
kind of arteriosclerosis, or hardening of the arteries. This disease process can be seen in any blood
vessel in the body and is the cause of coronary artery disease, stroke, and peripheral arterial disease
(PAD). According to Guyton and Hall, Atherosclerosis is a condition where the arteries become
narrowed and hardened due to a buildup of plaque around the artery wall. p.863

Community Acquired Pneumonia. A common disease with a reducing incidence. It

usually occurs in children or the elderly, or in people with an underlying pathology. This type of
pneumonia is often a complication of viral respiratory disease such as influenza. According to
Brunner and Suddarth, CAP occurs either in the community setting or within the first 48 hours
after hospitalization or institutionalization. The need for hospitalization for CAP depends on the
severity of the pneumonia. p. 574

Extravasation. The leakage of medication from the veins into the subcutaneous tissues.
According to Schulmeister, Extravasation is similar to infiltration, with an inadvertent
administration of vesicant or irritant solution or medication into the surrounding tissue. p.331

Infiltration. It occurs when I.V. fluid or medications leak into the surrounding tissue.
Infiltration can be caused by improper placement or dislodgment of the catheter. Patient movement
can cause the catheter to slip out or through the blood vessel lumen.
According to Schulmeister, Infiltration is characterized by edema around the insertion site, leakage
of IV fluid from the insertion site, discomfort and coolness in the area of infiltration, and a
significant decrease in the flow rate. When the solution is particularly irritating, sloughing of tissue
may result. p.28

Left atrial enlargement (LAE) or left atrial dilation. Refers to enlargement of the left
atrium (LA) of the heart, and is a form of cardiomegaly.
According to Guyton and Hall, both mitral stenosis and mitral regurgitation, it's more difficult for
the left atrium to pump blood into the left ventricle. This can lead to an increase in pressure in the
left atrium, which in turn leads to enlargement. p.865

Left ventricular hypertrophy. An enlargement and thickening (hypertrophy) of the walls

of your heart's main pumping chamber (left ventricle). Left ventricular hypertrophy can develop
in response to some factor such as high blood pressure or a heart condition that causes the left
ventricle to work harder.
According to Guyton and Hall, Left Ventricular Hypertrophy is a term for a heart's left pumping
chamber that has thickened and may not be pumping efficiently. Sometimes problems like aortic
stenosis or high blood pressure overwork the heart muscle. p.865

Lung Cancer. Also known as lung carcinoma, is a malignant lung tumor characterized by
uncontrolled cell growth in the tissues of the lung. According to Brunner and Suddarth, Lung
cancer that begins in the lungs and is one of the most cancers in the world. p.676
Pleural effusion. Sometimes referred to as “water on the lungs,” is the build-up of excess
fluid between the layers of the pleura outside the lungs.
According to Loscalzo, Pleural Effusion is a collection of fluid in the pleural space, is rarely a
primary disease process: it is usually secondary to other disease. p.598
Figure 1

GENOGRAM DIAGRAM

Figure 1. Genogram showing the Family History of Client X44

 Table 1

Physical Examination and Review of System (PEROS)

AREA ASSESSED SUBJECTIVE OBJECTIVE FINDINGS PROBLEM IDENTIFIED

FINDINGS
General Health Patient is non-  Unconscious,  Ineffective
Survey responsive, incoherent, non- breathing
“nanghihina responsive, very pattern
siya” as weak, poorly  Imbalanced
verbalized by the nourished nutrition
significant other  Vital signs  Impaired gas
(ranged): exchange
T: 36.0 – 38.4  Activity
P: 110 - 180 intolerance
R: 20 - 50  Risk for infection
BP: 100/70 –
180/110
Integumentary “wala kaming  Senile, poor  Risk for impaired
System nakitang rashes turgor, warm to skin integrity
sa kanyang touch  Impaired tissue
balat, biglaan integrity
ang kanyang  Ineffective
pagbawas ng thermoregulation
timbang” as  Self-care deficit
verbalized by the
significant other
HEENT “hindi siya  Dry lips, dry  No problem
 Head nagsusuot ng conjunctivae fixed identified
and salamin, dilated pupil
Face nakakarinig din
 Eyes naman siya ng
 Ears maayos, bungi
 Nose siya kasi nawalan
 Oral siya ng mga
Cavity ngipin” as
verbalized by the
significant
others
 Neck “ wala naman  Supple, negative  No problem
kaming nakita na for identified
namaga yung lymphadenopathy
leeg niya” as
verbalized by the
significant
others
Respiratory “naninigarilyo  Positive for  Impaired gas
System siya parati” as ronchi, positive exchange
verbalized by the for crackles both  Ineffective
significant upper and lower breathing
others lung fields pattern
Cardiovascular “hindi naman  Tachycadic  Risk for cardiac
System siya arrest
nagrereklamo na
may sakit sya sa
dibdib” as
verbalized by the
significant other
Breast and Axilla  No lumps  No problem
palpated identified
Gastrointestinal  Flat, Hypoactive  Imbalanced
System and the bowel sounds, nutrition: less
abdomen soft than body
requirements
Genitourinary/  Patient is in  Risk for infection
Reproductive catheter
System (indwelling)
 No unusual odor
Musculoskeletal  Weakness on all  Risk for activity
System extremities intolerance
 Patient is  Impaired physical
unconscious mobility
 Fatigue
 Risk for injury
Neurologic System  Ate che, wala sa 
notes ni ate
bambs about diri
and di ko
kapataka input
diri og stuff kay
wa ko kita sa
result sa mga test
Lymphatic/  And also diri te 
Hematologic
System
Endocrine System  EPPP, Weakness  Impaired tissue
on both integrity
extremities, more  Risk for infection
profound on the
right side non-
cyanotic nail beds
 Table 2

Gordon’s assessment on patient X44

 Table 3

NORMAL ANATOMY AND PHYSIOLOGY

Normal Anatomical Structures with their Descriptions and Functions

Anatomical structure Description

Brain It contributes to homeostasis by receiving sensory input, integrating new and stored
information, making decisions and executing responses through motor activities. (Tortora
& Derrickson, 2011, p. 527)
Thalamus Measures about 3 cm in length and makes up 80% of the diencephalon. It is the major
relay stationfor most sensory impulses that reach the primary sensory areas of the
cerebral cortex from the spinal cord and brain stem. In addition, the thalamus contributes
to motor functions by transmitting information from the cerebellum and basal nuclei to
the primary motor area of the cerebral cortex. The thalamus also relays nerve impulses
between different areas of the cerebrum and plays a role in the maintenance of
consciousness. ( Tortora & Derrickson, 2011, p. 543)
Cerebrospinal fluid It is a clear, colorless liquid composed primarily of water that protects the brain and
(CSF) spinal cord from chemical and physical injuries. It has three basic functions; mechanical
protection, homeostatic function and circulation ( Tortora & Derrickson, 2011, p. 531 )
Arteries It carries air throughout the body. The wall of an artery has the three layers of a typical
blood vessel, but has a thick muscular-to-elastic tunica media. Due to their plentiful
elastic fibers, arteries normally have high compliance, which means that their walls
stretch easily or expand without tearing in response to a small increase in pressure. The
brain receives blood via internal carotid and vertebral arteries.
( Tortora & Derrickson, 2011, p. 805)
Lungs This are paired cone-shaped organs of the thoracic cavity.The lungs' main function is to
help oxygen from the air we breathe enter the red cells in the blood. Red blood cells then
carry oxygen around the body to be used in the cells found in our body. The lungs also
help the body to get rid of CO2 gas when we breathe out. (Tortora & Derrickson, 2011,
p. 929)
Alveoli It is a cup-shaped outpouching lined by simple squamous epithelium and supported by a
thin elastic basement membrane; an alveolar sac. It is where exchange of O2 and CO2
takes place. (Tortora & Derrickson, 2011, p. 932-934)
Bronchi Also called as the windpipe. This are the main passageway into the lungs. When someone
takes a breath through their nose or mouth, the air travels into the larynx. The next step is
through the trachea, which carries the air to the left and right bronchus. The bronchi
become smaller the closer they get to the lung tissue and are then considered
bronchioles.(Tortora & Derrickson, 2011, p. 928-929)
 Figure 2

Concept Map
 Table 4

Diagnostic test
 Table 5

Drug study
 Table 6

Nursing Care Plans

Health Education Plan