LUNG CANCER

INTRODUCTION
 INTRODUCTION

Lung cancer is a disease of uncontrolled cell growth in tissues of the lung. This growth may lead
to metastasis, which is the invasion of adjacent tissue and infiltration beyond the lungs. The vast
majority of primary lung cancers are carcinomas of the lung, derived from epithelial cells. Lung
cancer, the most common cause of cancer-related death in men and women, is responsible for 1.3
million deaths worldwide annually, as of 2004.The most common symptoms are shortness of
breath, coughing (including coughing up blood), and weight loss.

The main types of lung cancer are small cell lung carcinoma and non-small cell lung carcinoma.
(NSCLC) is sometimes treated with surgery, while small cell lung carcinoma (SCLC) usually
responds better to chemotherapy and radiation. The most common cause of lung cancer is long-
term exposure to tobacco smoke. The occurrence of lung cancer in nonsmokers, who account for
as many as 15% of cases,is often attributed to a combination of genetic factors, radon gas,
asbestos, and air pollution including secondhand smoke.

For small cell lung carcinoma, prognosis is also generally poor. The overall five-year survival for
patients with SCLC is about 5%.Patients with extensive-stage SCLC have an average five-year
survival rate of less than 1%. The median survival time for limited-stage disease is 20 months,
with a five-year survival rate of 20%.

According to data provided by the National Cancer Institute, the median age of death for cases of
lung cancer in the United States is 70 years, and the median age is 71 years.

In the Philippines, “forty-three Filipinos die of lung cancer everyday, making the disease the
most prevalent of cancers in the country.” The Cancer Network (C-Network),said more than
17,000 new cases are diagnosed every year… of which 15,695 are expected to succumb to the
disease which has a survival rate of only 5.28 percent.

Worldwide, lung cancer is the most common cancer in terms of both incidence and mortality
(1.35 million new cases per year and 1.18 million deaths), with the highest rates in Europe and
North America. The population segment most likely to develop lung cancer is over-fifties who
have a history of smoking. Lung cancer is the second most commonly occurring form of cancer
in most Western countries, and it is the leading cancer-related cause of death.
Clinical Abstract

This is a case of L.I. Cortez, 58 years old, male, EDF, Filipino, Roman Catholic from
Cavite who was admitted for the 1st time at Armed Forces of the Philippines Medical Center in
V.Luna last August 20, 2010 due to weakness of both lower extremities. His condition started 1
month prior to admission when the client experienced on and off back pain until 6days prior to
admission when he noted sudden weakness of both lower extremities causing the client’s
immobility.

He sought consultation at private physician wherein he was given pain relievers, Vitamin
B complex, and Prednisone. However, weakness persisted and now noted numbness up to the
hypogastric area. Hence, he was transferred to Armed Forces of the Philippines Medical Center
and was subsequently admitted.

The client was previously diagnosed with PTB last 2009 and was managed only for 5
months, Initial workups were done including Chest CT-scan revealing pulmonary mass, MRI of
the thoracic spine was also done showing a possible cancer metastasis vs. infectious process
which is positive for malignant cells consistent with a mixed carcinoma.
I. BIOGRAPHIC DATA:

Name: L.I.C

Address: Tamacan, Amadeo, Cavite

Age: 58 Gender: Male Religious Affiliation: Roman Catholic

Marilat Status: Married Occupation: Body Guard

Room and Bed: Pulmonary Ward, Cubicle D-Bed #8

Chief Complaint: Generalized weakness of lower extremeties

Initial Diagnosis: PTB CAT II

Provisional Diagnosis: Lung Ca metastasized to the spine

Attending Physician: Dr.Sabal/CPT CABANAG MC

II. NURSING HISTORY

A. Past Health History

The client has complete childhood immunizations but he cannot recall what those
immunizations he received. His Childhood illnesses are chicken pox, and mumps only. No
known allergies.

The client was hospitalized last 1985 due to multiple gunshot, 4 bullets hit his body 2 on
the lower extremities, one on the abdomen and one on the chest. Because of his condition, he
was seriously illed and was monitored in the ICU with Chest Tube Thoracotomy. Second
hospitalization was when he acquired PTB, he was admitted in the hospital for 1 week and was
discharged with home medications for self treatment, his Anti TB drugs (MyrinP) should be
taken for 6months treatment but he was only able to finish 5months of it. After his 5months
treatment, there was no consultation since then.

No history of any foreign travel.

B. History of Present Illness

1 month prior to admission, the client experienced on and off back pain and sudden
weight loss so he consulted a private hospital. Diagnostic work ups was made wherein Acid Fast
Bacilli smear revealed a (-)negative result, an Acid Fast Bacilli culture was also done but has not
yet released. The client was discharged thereafter and no medications given.

As the client experienced continuous on and off back pain until 6days before he was
admitted, he then experienced weakness, and numbness in his both lower extremities so he
consulted again his private physician. After the consultation, his physician gave him some
medications to manage the pain, Vitamin B complex and Prednisone for inflammation.
Moreover, he was referred to AFPMC for better management of his condition.

Upon the admission in AFPMC, the client has experiencing difficulty in ambulation he
cannot walk and feels nothing from his lower extremities; he was given medications such as
Tramadol 50mg/cap every 6 hours, Dolcet 1 tab every 6 hours, Vitamin B complex once a day
and Prednisone 50mg/tab BID. Laboratory work ups was also done such as Cytologic screening,
MRI of the Thoracic spine, chest CTscan, Hematology, Urineflow cytometry and Sputum
culture. These diagnostic exams revealed his diagnosis of having SCLC (Small cell lung
carcinoma)in the lungs and a possible malignant cells that metastasized to his spine.

C. Family History

The client’s family history has hypertension from his mother side and PTB from his
father. Moreover, 6 of his sibling has 4 male and 2 female, 1 among the male is also a PTB
patient but was already treated.
III. PATTERNS OF FUNCTIONING

A. Psychological Health

Coping Patterns

The client is very open with his family. Especially when in times of problems. He solves
problems together with his wife and siblings, they talks about the problem and prays to God. He
even said “sa oras ng problema kelangan may karamay ka, mas madali ka makakapag isip pag
ganon” he even believed that to cope up from the problems, there should be someone who can
counsel him and help him to solve the problems. He don’t treat problems seriously but rather he
just believed that it will just pass and will be solved soon.

Interpretation: The client's coping pattern shows how a normal person reacts in different
situations. Coping strategy is a natural or learned way on how a person responds to a changing
environment or in a specific problem or situation.

Analysis: Can reflect on the past and current experiences and can imagine, anticipate, plan and
hope. (Medical and Surgical Nursing by Udan 2009)
Coping may be described as dealing with problems and situations or contending with
them successfully. It also varies among individuals and is often related to the individual’s
perception of the stressful events. Successful coping requires the person to deal effectively with
stressful events and minimize distress associated with them those results in adaptation. (Kozier
et. Al FON 7th ed. P. 1020).

Interaction Patterns

The client interacts most often with his family, they have good relationship at home, they
are open to each other and can express their feelings. He also socialize with his neighbors, and
make some happy times with them, they just drink alcohol and he considered this as their
bonding. The client also has a good relationship with everybody even in his place of work
because he considered that a good personality will make him a well being. As he said “mas
masarap mabuhay ng maraming kasundo, madami kang malalapitan sa oras ng problema”. He is
very open with to everyone.

Intepretation: The client is able to mingle with the people around him. He has no difficulty in
interacting with people from his family up to his work place and possesses a good attitude in
interacting with everyone.
Analysis: Socialization can be defined simply as the process by which people learn
to become members of the groups and society and learn the social rules, defining
relationships into which they will enter. Socialization involves learning to behave, feel,
and see the world in a manner similar to other person occupying the same role as
oneself. (Fundamentals of Nursing by Kozier and Erbs 8th edition, p17)

Adherence is the extent to which an individual’s behavior (for example taking

medications, following diets or making lifestyle changes) coincides with medical or
health advice. (Fundamentals of Nursing 8th edition Vol. 1 by Kozier and Erb, p.304)

Cognitive Pattern

The client doesn’t have any problem in hearing and vision, he can still read newspaper
without eyeglasses and hear sounds clearly but he admitted that he has some memory problems,
as he quoted “nagiging makakalimutin na yata ako, dahil na rin siguro ito sa katandaan ko”. He
doesn’t consult any physician regarding his memory condition.

Interpretation: The client has no problem in terms of his cognition except for some memory
problems as related with aging.

Analysis: An individual’s senses are essential for growth, development and survival. Sensory
stimuli give meaning to events in the environment. Any alteration in people’s
functions can affect their ability to function within the environment. (Fundamentals of Nursing
8th edition Vol. 2 by Kozier and Erb, p.939)

Self-Concept
The client perceives a healthy person as somebody who can function well and do his job.
Someone who is not only disease free but also spiritually healthy. According to him, he was in a
very good condition when he was working before, he even rated his health status before as 8 out
of 10 it is because he can work well and fulfill his responsibilities as a breadwinner of the family.
But when he was hospitalized he said that he is not functional anymore, he even quoted “Hindi
ko na kaya magtrabaho dahil sa karamdaman ko” and his son also added “Dati malakas si tatay,
nagoovertime pa nga yan sa pag tatrabaho eh (as bodyguard), pero ngayong nasa ospital na sya
palala ng palala ang kalagayan nya”. The client cannot anymore support the needs of his family,
despite the fact that he cannot anymore fulfill his responsibilities; he cannot also take care of
himself. The client feels hopeless because of his condition, he feels useless and will die soon
because he know his condition is hard to treat, he said “ganon naman talaga ang buhay ng tao,
Masaya nakong nakita kong may mga pamilya na ang mga anak ko bago ako mamatay”. He also
thinks that hospital is just helping him to prolong his life.
When in times of sickness,the client practices self treatment. He do not seek medical attention
from any institutions. When the client becomes sick he just take self prescribed medications such
as paracetamol for fever, neozep for colds and solmux for cough. He cannot recall the dosages
but he said “effective rin naman kahit ako na ang gumamot sa sarili ko, mas makakamura pako”.
He also drinks 8-10 glasses a day and believes in herbal medications, he sometime uses Oregano
and Lagundi for treating his cough. Moreover, if these herbal medicines are not available, it is
the time he will take some medicines.
The client has vices; he is a 45pack/year smoker and an occasional drinker of almost 5 bottles in
one sitting. According to him he cannot stop drinking alcohol because it is his form of
socialization with his neighbors. Also, his smoking habit makes him comfortable and relaxed
that’s why it is indispensable for him.

Interpretation: The client has a positive self-concept in life. He wants to be a person who helps
most especially his family and relatives.

Analysis: Self concept is one's mental image of oneself. A positive self concept is essential to a
person's mental and physical health. Individuals with a positive self concept are better able to
develop and maintain interpersonal relationship and resist psychological and physical illness.
(Fundamentals of Nursing 7th edition Volume 1 Kozier and Erb, p. 957)

Emotional Patterns
The client sometimes becomes emotional every time he thinks that there might be no
more chance for him to recover. He considered that his condition might be the cause of his vices.
He is even aware that time will come a disease will progress and this will make him payoff for
everything he abused in himself. As he said “matanda narin ako at sandali nalang rin ako sa
mundo, sa tuwing naiisip ko ang kakalagayan ko ay nalulungkot ako, marahil kabayaran na ito sa
kapabayaan ko sa sarili ko” He even accepted the fact that soon he will die.

Interpretation: The client experiences sadness because of his current condition. Despite of that,
he remains calm and accepts any posible scenario that may occur.

Analysis: Acceptance is when a person agrees to experience a situation, to follow a process or

condition (often a negative or uncomfortable situation) without attempting to change it, protest,
or exit. (Fundamentals of Nursing 6th edition by Potter and Perrry p. 357)
Sexuality
The client has no regret when it comes to his masculinity, He is a typical man who
socialize with male friends, a man who planned to have a family and a man who still finds
chicks. As he said “minsan nambababae ako”. He said that it is a part of his social life but he
doesn’t find any other woman. Although he said that he sometimes finds chick, it is just a form
of his pakikisama with his friends that sometimes they go to Bars to have some bondings.
Moreover, his wife trusts him and he make it the point that there’s no other woman who can own
his heart. He is very honest to his wife.

Interpretation: The client together with his friends goes to bar as a past time from their work. It
also serves as their bonding moment. Though admitted that sometimes he sees other woman
aside her wife, their trust with each other is essential in preserving their relationship.

Analysis: According to Sigmund Freud's psychosexual development, the genital stage is

characterized by energy directed toward full sexual maturity and function and development of
skills needed to cope with the environment. (Introduction to Psychology 4th edition)

Family Coping Pattern

The client build a good relationship with his family, they solve problems together and
they also spend time together. Sometimes after going to church they also go to malls and eat in a
restaurant. His family is also god fearing, when in times of problem they can cope up and trust
everything to God. As he said “si Bro na ang bahala, basta ginagawa mo ang tama nandyan sya
at tutulungan ka nya.
Intepretation: The patient is very much connected to his family. He doesn’t have any
problem in terms of family bonding. Their family is able to manage or to solve their

problems by having an open communication.

Analysis: The middle adult becomes more altruistic and concept of service to others and love
and compassion gain prominence.

B. SOCIO-CULTURAL PATTERNS
Cultural Patterns
The client also practices some cultural events and beliefs. Together with his relatives,
they also spend fiestas yearly. They prepare foods during fiestas and invites everyone to eat at
their home. Everyone who is related to their family are invited. Also, he believe to some cultural
practices during holy days.
Interpretation: The client exercises or demonstrates the culture they grew up with. They are
also engage into fiestas which is a traditional Filipino culture.

Analysis: Different people have different outlooks in life and vary greatly upon geographical
domain. (Introduction to Psychology by Atkinson et. al.)

Recreation Pattern
The client doesn’t have any recreational activities. He is also busy in work and family so
he considered his recreation as exercising during mornings. As he said “wala narin naman akong
pinagkakaabalahang ibang bagay, malimit kasama ko ang pamilya at trabaho lang ang ginagawa
ko. He stays with his family and fulfills his responsibility as a father.

Interpretation: The client spends most of his time at work and considers exercise as a form of
his recreational activity.

Analysis: Recreation is any activity performed during one's leisure or free time. Recreational
activities are often done for amusement, enjoyment or pleasure and are considered to be fun.
Recreational activities serve as a preventive measures againts deep depression of certain
individual that may affect his/her emotional and mental health.

Economic
The client says that sometimes his income is not enough to sustain their needs, he is the
only who is working for the family and there comes a time that they sometimes ask their
relatives for money. He said “nangungutang nalang kami minsan sa mga kamag-anak at sa
tindahan. Minsan naman may nagbibigay ng kahit ano, maswete nalang kung laging ganon”. The
client doesn’t want to open regarding his monthly income he just said “ayos lang, minsan sapat
at minsan kulang pero hindi nagiging sobra”.

Intepretation: The client's income are sometimes not enough to sustain their needs but finds a
way on how to handle when situations like that arises.

Analysis: Having an adequate income will support the family's need for their everyday living
especially for their essential needs regarding health.
Religious Beliefs and Practices
The client doesn’t have any religious practice he exercised, but he has a good faith in
God, He trusts God for everything he has. Even though he has a serious disease condition he still
believes that God will make a way to recover him. In spite of his acceptance that soon he might
die, he still believe to God because for him “Hindi nya tayo bibigyan ng problemang hindi natin
makakayanan”. He has a good fighting spirit and trusts everything to his own creator.
Interpretation: The client believes in God and that he entrusts everything in him.
Analysis: The late-aged adult person tends to be less dogmatic about religious belief as religion
may offer more comfortable than before
Spiritual development of Fowlers at Paradoxical Consolidative wherein awareness of truths
varies from a variety of viewpoint.
IV. ACTIVITIES OF DAILY LIVING

ADL Before Before Interpretation and

Hospitalization Hospitalization Analysis
1. Nutririon The client is fond of During hospitalization The client's diet is
eating rice together the client is fond of composed of a
with viand of eating soft foods, balanced diet. His diet
vegetables and fishes. sometimes he do not is the same before and
He also prefer eating eat because he loses during hospitalization
fried foods because it his appetite since he but losses his appetite
is easier to prepare was admitted. because of his
and takes less time to condition. A person
cook, He eats 3 times should continue to eat
a day together with a healthy diet,
his family. The following the
ingredients are bought recommended
by his wife in a wet portions of the food
market near their groups, with special
home and is prepared attention to protein,
at home. calcium, and limiting
cholesterol intake.
Two to three liters of
fluid should also be
included in the diet.
( Fundamentals of
Nursing 8th ed by
Kozier & Erb, p 1243)
2. Elimination The client has a During hospitalization, The client's condition
normal elimination the client wasn’t able to hinders him to urinate
pattern before move himself to the CR freely that made him
hospitalization; he has because he cannot urinate through the aid
anymore ambulate due of a foley catheter.
regular bowel
to weakness of his lower Normal fecal
movements during extremities. The client characteristics: adult:
mornings, semi solid was on Foley catheter brown in color, aromatic
in form but dark in and diaper. And upon odor, affected by food
color. On the other assessment his urine is type, soft cylindrical in
hand, his urine pattern orange in color and his shape. Frequencies
is normal of at least 5 feces were dark brown varies: daily or 2 to 3
urinations per day, the in color. times a week.
consistency and color (Fundamentals of
is also normal. The Nursing by Potter and
client said that he Perry p. 1453)Color:
Normal urine ranges
doesn’t have any
from pale, straw color to
difficulty when it amber depending on its
comes to his concentration. Urine is
elimination pattern, usually more
 the client is satisfied concentrated in the
every time he excrete morning or with fluid
his wastes. volume deficits. as the
person drinks fluids,
urine becomes
concentrated.
3. Exercise The client doesn’t have During hospitalization, The clients physical
any form of exercise but the client cannot activity is getting a little
he considered walking anymore do any form bit inactive since he
everyday as part of his exercise; even any does not have a routine
exercise. He walks of activity hinders him exercise not like before.
approximately 2 from moving because of Pain, weakness and
kilometers from home pain he feels. Every compromised
to his place of work. time he moves he feels ambulation hinders
With this kind of pain in his left chest and client to do much
everyday activity, the makes it hard for him to movement. Lack of
client believes that talk. physical activity can
walking makes him contribute to health
stronger because it problems. the
exercises his feet. recommendation of 30
minutes per day
moderate exercise can
be done all at one time
or broken down into 10
minutes segment thrice
a day (Nutrition and
Diet Therapy by Ruth
A. Roth and Carolynn E.
Townsend p. 22)
4. Hygiene The client has a good In hospital, the client The client can no longer
hygiene when he was cannot anymore perform practice what he does
still in good condition; any form of hygienic because his conditions
he takes a bath 2x a day practices. He cannot prevents him from it.
during morning before take a bath and even bed bath is being done
going to work and when brush his teeth. This is for him.
he arrived from work. because of his condition Measure for personal
While he take a bath he that prevents him from cleanliness and
also brushes his teeth 2x doing his everyday grooming called
a day. For him, a hygiene maintenance. personal hygiene,
person’s personality promote physical and
also reflects from psychological well-
his/her hygiene. being. various studies
have confirmed that
improved personal
hygiene practices reduce
illness rates (Larson and
Aiello 2001)
5. Substance Used The client is aware of The client cannot The client is smoking
the possible harmful anymore smoke and and drinking. This factor
effects of smoking but drink inside the hospital may contribute in
he did not take this as having certain illnesses.
 risk for his life. He also because all that he done The respiratory system
worked in a paint inside the hospital was is also affected by
factory in Cavite which monitored by the health cigarette smoking.
also increase the risk of care providers. He Nicotine increases the
acquiring the disease. cannot anymore smoke blood pressure, and
He is a smoker who can and he also promised to causes vasoconstriction
tolerate 45sticks per day himself that when he and in areas where
and minimum of 25pcs recovered he will not vessels already are
per day (according to smoke anymore. narrowed by
him) The client also atherosclerosis tissue
drinks alcohol but it`s oxygenation can be
occasionally only, he impaired. Alcohol is a
consumes 5bottles in respiratory depressant,
one sitting. Also, the slowing respirations. (
client admitted that he Kozier and Erbs
used drug when he was Fundamentals of
a teenager, as he Nursing 8th ed p. 1409
verbalized “gumamit p. 1415)
ako ng shabu nung
kabataan ko”
6. Sleep and Rest The client has a Normally, when the The client has been
good sleeping client sleeps there’s experiencing difficulty
pattern; he sleeps no factors that affects in sleeping during
for almost 6-8 his sleeping pattern, episodes of pain and
hours a day. The shortness of breath.
he was able to sleep
only time he sleeps Sleeping can be altered
continuously but 1
is during night and if the client feels pain in
doesn’t take naps,
month prior to his body. Adults need 7
according to him admission, when he to 9 hours of sleep at
he feels satisfied started experiencing night ( National Sleep
every time he on and off back pain, Foundation) Any illness
wake up in the the client cannot that causes pain,
morning. The anymore sleep well. physical discomfort or
environment where He also said mood problems such as
he sleeps is “Magmula ng anxiety or depression
conducive for the nagkaroon ako ng can result to sleep
family. They sleep problem. Presence with
pananakit ng likod
with kulambo, an such alterations may
hindi na ako
electric fan and have trouble falling
nakakatulog ng asleep. ( Fundamentals
foam. The client
maayos, palaging pa of Nursing by Potter and
sleeps with his wife
while his youngest
putol putol ang Perry p. 1262)When
son has his own pagtulog ko”. And people obtain proper
room. because of that, he sleep, they feel that their
also believed that one energy has been
of the factors why he restored. (Fundamentals
experienced sudden of Nursing by Potter and
weight loss is due to Pery p. 1258)
lack of sleep.
 When the client is in
the hospital, we
wasn’t able to sleep
well because he feels
shortness of breath, on
and off back pain and
worried why his lower
extremities became
numbed. Since then,
he always feels lack
of sleep and
uncomfortable.

7. Sexual Activity The client has sexual No sexual activity. Sex is a need that must
activity before, he make be satisfied in order to
love with his wife for at maintain well-being.
least once a week. Sexual need do varies
Moreover, even he person to person with
sometimes find chicks different personality and
he doesn’t have sex with characteristics that
other partners. greatly influence his
behavior regarding sex.
Some internal and
external factors that may
affect the sexual
behavior of a person
such as place, age, time
etc.
V. PHYSICAL ASSESSMENT

Measurements
Findings Norms Interpretation
Temperature 36.6 Celsius 36.5-37.4o Celsius Normal
Pulse rate 94 bpm 60-100 beats/min Normal
Respiratory rate 28 cpm 14-20 cpm Tachypnea
Blood pressure 120/80 mmHg 90-120/60-90 Normal

Body Parts
Has thick black and
gray hair equally
Clean scalp without
distributed, thin, clean
any presence of
and smooth scalp
dandruff,
Head without any presence Normal
normocephalic,
of dandruff and lice.
symmetrical, no
No presence of any
lesions tenderness.
depression and
tenderness
Looks restless, weak
A restless behavior is
and responds seldom.
caused by some
Has guarding
alterations in human
behavior in his chest No signs of distress
Face body functions.
and relaxed.
Which this can be a
Skin is moist, no
sign of a health
superficial blood
condition.
vessels, no lesions,
Skin lacks color
showing generalized
paleness,
Cold Clammy Skin,
Varies from light to
Poor skin turgor, No Skin paleness or lack
deep brown; from
masses, no facial of skin color shows
ruddy pink to light
asymmetry, skin is signs of inadequate
pink;
moist, no superficial tissue perfusion.
Generally uniform
Skin blood vessels, no
except in areas
lesions. Gunshot wounds are
exposed to the sun; no
Uniform temperature caused by a bullet that
abrasions or other
upon palpation. strike the skin
lesions, uniform in
integrity
temperature
There’s a presence of
4 gunshot Wound in
the chest and both
legs.
Nails Nails are pink, Nails are pink in normal
smooth, no lesions, color, smooth in
 and with normal nail
folds.
texture, and has a
capillary refill of 2-3
2.3 seconds of
seconds.
capillary refill.

No presence of lies in No presence of lies in

Scalp the head, with lesions the head, clean, Normal
and wounds without any lesion
Appearance: not The client doesn’t
Eyes Sunken eyes
sunken have enough sleep.
Can hear sounds in
Sound is heard in both
both ears.
ears or is localized at
Symmetrical on both
the center of the head,
sides, same size and
Ears symmetry in shape Normal
shape, patent ear
and position, patent,
holes and no presence
no swelling and
of any swellings and
discharge.
discharge.
No discharge, distinct
no nasal flaring,
borders, no nasal
Nose symmetrical in shape Normal
discharge and nasal
with distinct borders,
flaring
no presence of lesions
Flat, round (convex),
Abdominal contour Scaphoid, Normal
or scaphoid (concave)
Breathes freely with
symmetrical lung Crackles are heard
expansion, no chest Symmetrical when an obstructed
retractions, vesicular expansion upon airway suddenly
Chest / Lungs
breath sounds, respiration, no chest opens and the
resonant in percussion retractions pressures on either
crackles on both lung side of the obstruction
lobes.
No evidence of No evidence of
Enlargement of liver
enlargement of liver enlargement of liver Normal
or spleen
or spleen or spleen
Bowel sounds are Audible bowel
Bowel sounds,
heard; absence of the sounds; Absence or
vascular sounds, and
vascular sounds and arterial bruits; Normal
peritoneal friction
peritoneal friction absence of friction
rubs
rubs rub
Light palpation in Relaxed, flubby and No tenderness; Normal
the four quadrants soft abdomen with relaxed abdomen with
 smooth, consistent smooth, consistent
tension tension
Can move his upper
extremities freely but
No resistance of
cannot stay strong
extremities can be
upon resistance, no
caused by weakness
gross deformities, has Able to move the
or any complications
Range of Motions positive weakness on certain part of the
in human skeletal
the lower extremities, body
system
(+) loss of range of
motion in lower
extremities
VI. Laboratory and Diagnostic Examinations Results

1. CYTOLOGY REPORT- September 13, 2010

Specimen: FNAB, mass, lower lobe, left lung

- There’s a mixture of malignant epithelial cells w/ enlarged nuclei and ample cytoplasms and
cells with small to intermediate-sized nuclei showing fine chromatin & scanty cytoplasms, the
morphological features compatible w/ a neuroendocrine neoplasm also noted are stripped nuclei
mixed w/ strands of a crust artifact.

Diagnosis: (+)positive for malignant cells consistent w/ a mixed carcinoma.

2. MRI OF THE THORACIC SPINE

Impression:

1. Lytic lesions at T3 & T4 with right para-vertebral and epidural mass component causing spinal
cor and nerve roots compression consistent with tumor metastases.

2. Secondary diffuse thoracic spinal cord edema.

3. Left pulmonary solid mass (bronchogenic neoplasm) w/ pleural effusion.

3. CT-Scan of the CHEST

Impression:

1. Pulmonary solid mass, posterior left upper lobe and superior left lower lobe consistent w/ a
bronchogenic neoplasm

2. Secondary metastases to the mediastinal lymph nodes.

3. Chronic Koch’s infection, both upper lobes w/ minimal left basa; pleural effusion.
4. HEMATOLOGY

Hemoglobin – 112.0

Hematocrit- 0.32

RBC- 3.88

WBC-15.31

Differential Count

Creatinine- 73.4

Na- 132.3

K-4.02

Uric Acid- 562.8 (normal value: 214-488)

5. URINEFLOW CYTOMETRY

Physical Exam

Color-Light Yellow

Clarity-turbid

Specific Gravity- 1.015

Chemical Analysis
pH-7.0

Protein- +1

Glucose- (-)

Leukocytes- +3

Nitrites- (-)

Ketones- (-)

Urobilinogen- +1

Bilirubin- (-)

Microscopic Analysis

RBC-160

WBC-1859

EC-3

CAST-1

BACT-1033
IX. ECOLOGIC MODEL

A. Hypothesis

Cancer is the general name given to a large group of diseases characterized by

uncontrolled growth and spread of abnormal cells, proliferation and metastasis.

In the case of our patient, he has Lung Cancer stage 4 in wherein it metastasis to his
spine. The cause may probably due to his lifestyle wherein he is a smoker of 4 pack years.
Environmental factors may have been involved where he works as a guard in a paint factory.

B. Predisposing

1. Host

- 58 years old
- Male
- Filipino
- Smoker of 4 pack years
- History of Pulmonary Tuberculosis
- Stress

2. Agents

- Chemical: Exposure to carcinogens

3. Environment

- Air Pollution
C. Ecologic Model

AGENT

Environme
nt HOST

D. Analysis

The agent-host-environment model is primarily used in predicting illness rather than promoting
wellness, although identification of risk factors that result from the interactions of agent, host and
environment are helpful in promoting and maintaining health. Because each of the agent-host-
environment factors constantly interacts with each other, health is an ever changing state. Health
is seen when all three elements are in balance while illness is seen when one, two or all three
elements are not in balance. Specifically, based on our assessment, there is a significant quantity
of factors that predispose to our client to have lung cancer which are mainly due to host factors.

V. Conclusion

We therefore conclude that the host factors of the patient have mostly contributed to the illness to
progress. His age, sex and lifestyle are significant factors in the development of the disease.
VI. Recommendation

Due to the irreversible condition of the patient, the nurse’s role is to lead the client in a dignified
death.

- Continue medication (Analgesics)

- Support from the family members
- Keep the client comfortable, lessen stress in the environment. (noise, temperature, etc.)

Reference: Fundamentals of Nursing by Kozier and Erbs 7th ed.

Far Eastern University
 CASE
PRESENTATION
Armed Forces of the Philippines Medical Center

Submitted By:

GROUP9/BSN103
Abacan, Ergie Kenneth

Acio, Eliza Anne

Acosta, Anjonette

Agbannawag, Jan Derick

Aguilar, Jordan

Agustin, Jericson

Alagao, Tisha Mae Kennen

Alcasid, Timothy Glenn

Alonzo, Denice

Alumisin, Shamira Monique

Arevalo, Abigail

Armamento, Joana Marie

 Submitted To:

Ma’am Aireen Gulapa RN,MAN