LAGUNA STATE POLYTECHNIC UNIVERSITY

MAIN CAMPUS
STA. CRUZ LAGUNA

COLLEGE OF NURSING
A/Y: 2010-2011

A CASE REPORT IN NURSING CARE MANAGEMENT – 102

LUNG CANCER

Prepared By:

BSN II – A

Group I

Presented To:

LSPU College of Nursing Clinical Instructors

March 04, 2011

 TABLE OF CONTENTS

I. Introduction

II. Patient’s Profile

III. Patient’s History

A. Present Health History

B. Past Health History

C. Family health History

D. Developmental History

E. Socio-economic History

F. Psychological Status

G. Socio-cultural History

H. Spiritual

I. Nutritional

J. Elimination

K. Exercise

L. Hygiene

M. Sleep

IV. Physical Assessment

V. Anatomy and Physiology

VI. Pathophysiology

VII. Diagnostic Procedures

 VIII. Medical Management

IX. Nursing Care Plans

X. Drug Study

XI. Nursing Management

XII. Recommendations

INTRODUCTION
Description of Health Condition

Lung Cancer is the leading cause of cancer death among men. It commonly occur in
individuals more than 50 years of age who have a long history of cigarette smoking. Non small
cell lung cancer (NSCLC) accounts for 80% of the primary lung cancers. Adenocarcinoma has
been associated with lung scarring and chronic interstitial fibrosis; is not related to cigarette
smoking, often has no manifestations until -widespread metastasis is present.

Source: Medical Surgical Nursing: Assessment and Management of Clinical Problems volume 1 by Lewis
p.578-585

Statistical Data

Lung cancer is currently responsible for 29% of cancer deaths in the United States. Even
though more women are diagnosed with breast cancer and more men with prostate cancers,
lung cancer remains the leading cause of cancer deaths for both men and women.

Source: http://lung cancer.about.com/od/whatislungcancer/a/lungcancerstats.htm

Here in the Philippines, lung cancer kills 80% of those diagnosed (8,518 or 14.2%
mortality among 10,643 or 17.4% incidence) of all those diagnosed with the disease compared
to 35% mortality among breast cancer. Every year, there are about 20,000 smoking related
deaths in the country.

Source: http:/www.tribuneonline..org/metro/20101212met5.html

Objectives
  To define what lung cancer, its pathophysiology is and enumerate the signs and
symptoms including its risk factors.
 To understand options in the different type of medical treatment necessary
 To learn new clinical skills, as well as sharpen our current clinical skills those are
required in the management of a terminally ill patient having lung cancer.
 To formulate and apply nursing care plan using the nursing process.
 To provide nursing care applicable to a terminally ill lung cancer patient.
 To help nursing students to avoid and quit smoking and be a model for others a a part of
the health care team.

SCOPE AND LIMITATION

Scope
This study covers and focuses on:

 A brief discussion of lung cancer and its pathophysiology

 Drug study that has been prescribed to and taken by the patient during
hospitalization at PPL-Bay, and we included medications that has been
prescribed by his previous consultation from other health care providers.
 Nursing Care Plan that covers action that would help the patient in his terminal
condition.

Limitation
 This study only covers the period of confinement of our patient that has been
hospitalized during our clinical exposure last February 13, 20011 during our 6-2
shift.
 All the laboratory exams of the patients that we had gathered were limited to the
laboratory results the patient presented to us during his confinement at PPL-Bay
during our shift.
 This study was only limited to Lung cancer, this is our main focus.

Background of the study

We decided to choose to present this case due to the complexity of the case, and our
eagerness to learn and explore new knowledge regarding lung cancer. Our group found this
case, uncommon and rare in any other cases that we handled. And we do believe that this can
be of great help in understanding and performing appropriate nursing interventions to the
patient. It is of great advantage that the patient also gains knowledge about this condition. Also,
we choose this case because we want to provide nursing care to a terminally ill client and also,
for those people who smoke to let them know the consequences of smoking.

Significance of the study

The study is done for the benefits of the following:

a. Student Nurse
 To impart to them the knowledge and understanding about lung cancer
and to have the appropriate and relevant nursing care that can be use for
this kind of condition.

b. Client and relatives

To have the necessary information and help them understand the
condition and its complications and how they can support and care for the
person having the disease.

c. Reader
For them to acquire and gain more knowledge about lung cancer, about its
signs and symptoms, cause, treatment regimen and necessary type of
management that can be use and necessary information on how to
prevent themselves in getting it.

II. PATIENT’S PROFILE

Name: Mr. XXX

Address: Brgy. Dila Bay, Laguna
Age: 66 years old
Date of Birth: May 28, 1944
Place of birth: Calauan, Laguna
Religion: Roman Catholic
Nationality: Filipino
Date of Admission: February 13, 2011
Time: 08:45 am
Admitting Diagnosis: Lung Cancer, Stage IV
Case Number: 25112
Admitting Physician: Dr. Giovanni Lagoc, MD

A. PRESENT HEALTH HISTORY

 2 yrs. prior to admission, the client quitted smoking and there he experience
withdrawal syndrome.
  8 months prior to admission around May 2010, he felt difficulty in sleeping,
night sweat, chest pain, difficulty in breathing and productive cough.

 7 months prior to admission around June 2010, he was advised to have chest
X-ray and after that he has been treated with RIPES for 6 months then after 6
months they complaint of feeling bad and the treatment given afforded no
relief.

 2 months prior to admission around December 2010, he complaint of difficulty

swallowing and sleeping accompanied by severe cough by then they
consulted a physician and after several test he was then diagnosed to have a
Lung cancer, stage 4.

 1 month prior to admission around January 2011, he complaint of difficulty

urinating and defecating, hoarseness, numbness in the left upper extremities.

 1 day prior to admission at February 20, 2011, he was admitted due to

productive cough, difficulty of breathing, chest pain, weakness, hoarseness,
pain in the right neck and numbness in the left upper extremeties.

B. PAST HEALTH HISTORY

He hadn’t experience any disease when he was a child even when he turned into
teenage life. But when he is at his adulthood stage of life he was exposed to measles by then
he doesn’t have any serious complications until he reaches the age of – where he experience
having severe cough that soon became his present condition, having lung cancer. One factor is
that when he started smoking when he was in grade 6, 1 stick per day and continued till he used
to smoke 1 pack per day. When he reaches the age of 63 he quitted smoking.

C. FAMILY HEALTH HISTORY

According to the patient, no one of the member of their family had cancer. His father
died due to diabetes mellitus and her mother had asthma. Her wife told us that their family is in
good health, and that this is the first time that someone had cancer in their family.

D. DEVELOPMENTAL HISTORY
 EXPERIENCE
Erik Erikson’s psychosocial
stages of development:
Integrity versus Despair
Sigmund Freud’s
psychosexual stages of
development:
Jean Piaget’s cognitive stages
of development:
Sources: Shaffer. David R. Developmental Psychology Theory Research and Application. California:
Brooke Cole Publishing Company, 1985
VERBALIZATION
“Tanggap ko na kung anu
mang ipagkaloob ng
maykapal, kunin man nya ako,
handa na ako.”, as verbalized
by the patient.
“Grade 6 ako unang
nanigarilyo, isang stick kada
isang araw hanggang sa
maging isang kaha na isang
araw.”, as verbalized by the
patient.
“Pareho kami nang asawa
kong gumagawa ng desisyon
tungkol sa mga problema man
na nararanasan naming sa
buhay.”, as verbalized by the
patient.
INTERPRETATIONS
Integrity;
As individuals approach the
end of life, they tend to take
stock of the years that have
gone before. Our client feels a
sense of satisfaction with his
accomplishments in life.
Oral Stage;
Freud believed that all human
beings pass through a series
of psychosexual stages; each
stage dominated by the
development of sensitivity in a
particular erogenous or
pleasure giving spot in the
body. Furthermore, each
stage poses for individual a
unique conflict that they must
resolve before they go to the
next higher stage. If
individuals are unsuccessful in
resolving the conflict, the
resulting frustration becomes
chronic and remains a central
feature of their psychological
make-up.
Formal Operational Period;
Individuals are capable of
systematic deductive
reasoning that permits them to
consider many possible
solutions to a problem and
pick the best action to take.

E. SOCIO ECONOMIC

A person who was diagnosed having a lung cancer must undergo certain procedures
that cost much to maintain living and prevent further complications. Given the privilege from
raising his children, patient XXX was being supported financially by her daughter working
abroad as a nurse. He receives ₱5000.00 monthly for the examinations and tests he must
undergo. His hospitalization and other needs such as medications, foods, and etc. are being
provided by his other relatives. Since he and his wife don’t have work, they are seeking for help
to sustaine their daily needs from their children and other relatives.
 F. PYCHOLOGICAL STATUS

• BEFORE THE ILLNESS

Patient XXX is fond of smoking and considers a cigarette as a part of his daily
life. He thought that he can’t live without a cigarette in his life and feels that his strength comes
from his vice.

Even being prohibited by his daughter which is a Nurse and his relatives, Patient
XXX can’t stop himself from smoking.

• WHEN DIAGNOSED / DURING ILLNESS

When patient XXX felt difficulty sleeping, swallowing and having productive
cough, her family consulted a Doctor for him. When being advised by the doctor to quit smoking,
he thought that he can successfully cease his smoking habit to relieve his feeling of ill. His first
time trying not to smoke made him realize that it is hard to turn his back in his daily habit and he
stated, “Tanggap ko na kung ano mang ipagkaloob sa akin ng panginoon” as verbalized by the
patient.

G. SOCIO – CULTURAL

One of patient XXX’s child was a Registered Nurse and it serves as a main factor
that influenced his health belief – to seek medical treatment. They first consulted a doctor when
he felt illness and preferred to Medical Management when it comes to his health. However, they
also believed in “faith healers”, as some of Filipino’s tradition.

H. SPIRITUAL

As Christians, patient XXX and his family was able to deal with God in their daily
lives. When he was diagnosed having a Lung Cancer, the family entrust patient XXX’s life on
God’s hand and prepared themselves to accept whatever will happen to patient XXX.

I. NUTRITIONAL
 BEFORE HOSPITALIZATION DURING HOSPITALIZATION
Breakfast Breakfast
2-3 cups of rice 2-3 tbsp. soup
1 med. size fried fish ½ glass of water
1 cup coffee
1-2 glasses of water
Lunch Lunch
2-3 cups of rice 3-4 tbsp. soup
1 ½ servings of vegetable ½ glass of water
1 med. size pork
2-3 glasses of water
Snack
4-5 pcs. Bread
1 glass of water
Dinner Dinner
2-3 cups rice 2-3 tbsp. soup
1 serving of vegetable ½ glass of water
2-3 glasses of water
He ate meals in a moderate manner- When he was diagnosed, the doctor
the usual meal for a sedentary man ordered a soft diet for him to take.
After few days, he was ordered to have
a diet as tolerated.

His usual oral fluid intake was about 6-7 At the hospital, Patient XX’s fluid and
glasses of water per day, with exception electrolytes was maintained through
to coffee and beverages. intravenous fluids and supported by oral
fluid intake.

Before the illness, patient XXX weighs Previously, patient XXX weighs about
at about 65 kilograms. 40 kilograms, due to his unusual eating
habits and having difficulty swallowing.

J. ELIMINATION

BEFORE HOSPITALIZATION DURING HOSPITALIZATION

 The patient defecates for at least 1-2
times a day.
 January 2011 the patient defecates
twice or thrice a week.
 The patient urinates approximately 4-6
times a day with no other problems in
voiding.
 Sometimes the patient defecate once a
day and sometimes none.
 February 2011, the patient has difficulty
in voiding, he defecates twice or thrice
a week.
 During his hospitalization, the patient
has difficulty in urinating. He uses adult
diaper, he consume 2 diapers per day.
K. EXERCISE
BEFORE HOSPITALIZATION
 The patient was able to ambulate
around their house and going to the
store without any assistance in his
side.
L. HYGIENE
BEFORE HOSPITALIZATION
 He takes a bath 1-2 times a day with
Luke warm water.
 He washes his hand before and after
eating.
 He brushes his teeth every after meal.
 He can change and wear clothes or
dress if ever he wants.
 He can trim nails by his self.
M. SLEEP
BEFORE HOSPITALIZATION
 He usually sleeps around ten o’clock in
the evening and awake at five o’clock
in the morning or earlier.
DURING HOSPITALIZATION
 The patient was able ambulate with
assistance in his side.
 The patient experience fatigue and
weakness due to decrease in
oxygen level in the body.
DURING HOSPITALIZATION
 His relative provides sponge bath to
him.
 He neglects to wash his hand before
and after eating.
 He brushes his teeth irregularly.
 His wife changes his cloth or any
available relatives.
 His relative is the one who trim his
nails.
DURING HOSPITALIZATION
 He had a difficulty in sleeping due to
the attacks of his condition including
coughing.
 He has a productive cough with clear
white sticky mucous secretions.
 The patient sleep five hours or less due
to ambiance of hospital.
IV. PHYSICAL ASSESSMENT

Area Methods Findings Interpretation & Reference

Integument - brown - normal, older person’s skin

becomes pale due to
• Skin - even in overall skin color decreased melanin
production and decreased
Inspection - presence of paleness of
dermal vascularity.
the skin
* Janet Weber, Jane H. Kelley; Health
Assessment in Nursing 3rd Edition ©
2007- Chapter 11 p. 166

- poor skin turgor - older person’s skin loses

its turgor because of a
- dry, warm decrease in elasticity and
collagen fibers. Also, their
skin may feel dryer because
Palpation
sebum production decrease
with age.
* Janet Weber, Jane H. Kelley; Health
Assessment in Nursing 3rd Edition ©
2007- Chapter 11 p. 171

• Hair - black to gray color - normal, gray or white hair

- well distributed in the scalp
and in the overall skin
Inspection
is also result as a person
ages because decrease in
or a lack of melanin
production.
* Rod R. Seeley, Trent
D. Stephens, Philip Tate; Essentials of
Anatomy and Physiology 6th Edition,
International Edition © 2007- Chapter
5 Integumentary System p.112

• Nails - pale nail beds -

- clubbing of nails - results from inflammatory

changes in the bones of the
Inspection fingers from prolonged
oxygen deficiency.

* The Respiratory System

Chapter 12 p. 283

Head - symmetrical skull and is - normal

appropriate in size
• Skull & Face Inspection - symmetrical facial
features
- no lumps or bumps on the
scalp
• Eyes & Vision - sclera is white - normal

- conjunctiva clear & pinkish

in color
Inspection - no blurring of vision

- pupils equally round,

ANATOMY AND PHYSIOLOGY

RESPIRATORY SYSTEM

 Respiration is necessary because all living cells of the body require oxygen and
produced carbon dioxide. The respiratory system assist in gas exchange and performs
other functions as well.

1. Gas Exchange

2. Regulation Of Blood pH
 3. Voice Production

4. Olfaction

5. Innate Immunity.

Nose
The nose consist of the external nose and the nasal cavity. The external nose is the
visible structure that performs a prominent feature of the face. Most of the external nose is
composed of hyaline cartilage, although the bridge of the external nose consist of bone. The
bone and the cartilage are covered by connective tissue and skin.
The nasal cavity extends from the nares to the choane. The nares or nostrils, are the
external openings of the nose and the choane are the openings into the pharynx. The nasal
septum is a partition dividing the nasal cavity into right and left parts. A deviated nasal septum
occurs when the septum bulges to one side of the other. The hard plate forms the floor of the
nasal cavity, separating the protects against abrasion. Two sets of tonsils, the palatine tonsil
and the lingual tonsils, are located near the opening between the mouth and the oropharynx.
The lingual tonsil is located on the surface of the posterior part of the tongue.
The laryngopharynx passes posterior to the larynx and extends from the tip of
epiglottis to the esophagus. It is lined with stratified squamous epithelium and ciliated columnar
epithelium.

NASAL CAVITY
The nasal cavity is lined with mucous membrane that warms and moistens the air as it
passes through: moisture protects the cilia.

The cilia propel the mucus towards the larynx.

The sinuses, reduce the weight of the skull, produce mucus, and influence voice quality.

PHARYNX
The pharynx is about 5 inches long and extends from the back of the mouth to the
esophagus. It serves as a passageway for the respiratory tract and the gastrointestinal system,
moving air to the lungs and food to the esophagus.

TONSILS
Tonsils, which part of Lymphatic system, are located in the pharynx: if they became
inflamed and enlarged, they may interfere with breathing.

LARYNX
The larynx is important to the formation of the sounds of speech. It sits between the
Pharynx and trachea. The vocal cords are located to the larynx.

TRACHEA
The trachea is made up of cartilage, smooth muscle , and connective tissues and is lined
at the mucous membrane.

BRONCHI
 The principal bronchi are further divided into smaller and smaller bronchi. When the
bronchi become inflammed, a condition results which is referred to as bronchitis [bronchi + -itis,
inflammation].
Further divisions of the bronchi eventually lead to tiny tubes, called bronchioles, which
lead to tiny air sacs known as alveoli. The alveoli are richly supplied with capillaries where the
exchange of gases takes place between the red blood cells and the air. When the alveoli
become inflammed due to an infection, a condition results which is referred to as pneumonia.

LUNGS
1. There are two lungs.
2. The airway passage of the lungs branch and decrease in size. The main bronchi
form the lobar bronchi, which go to each lobe of the lungs. The lobar bronchi form
the segmental bronchi, which go to each bronchopulmonary segment of the lungs.
The segmental bronchi branch many times to form bronchioles. The bronchioles
branch to form the terminal bronchioles, which give rise to the respiratory
bronchioles, from which alveolar ducts and respiratory bronchioles.

3. The epithelium from the trachea to the terminal bronchioles is ciliated to facilitate
removal of debris. Cartilage helps to hold the tube system open (from the trachea to
the bronchioles). Smooth muscle controls the diameter of the tubes(especially
bronchioles). The alveoli are formed by simple squamous epithelium, and they
facilitate diffusion of gases.
4. The components of the respiratory membrane include film of water, the walls of the
alveolus and the capillary, and an interstitial space. The respiratory membranes are
thin and have a large surface area that facilitates gas exchange.

PLEURAL CAVITIES
The pleural membranes surround the lungs and provide protection against function.

LYMPHATIC SUPPLY
The lung have superficial and deep lymphatic vessels.

LUNG RECOIL
1. The lung tends to collapse because of the elastic recoil of the connective tissue and
surface tension of the fluid lining the alveoli.
2. The lungs normally do not collapse because surfactant reduces the surface tension
of the fluid
lining the
alveoli
and
pleural
pressure
is less
than
alveolar
pressure.
GAS EXCHANGE
1. The respiratory membrane is all of the areas in which gas exchange between air and
blood occurs.
2. The dead space is the parts of the respiratory passageways in which gas exchange
between air and blood does not occur.

Breathing
The act of breathing is performed primarily by the diaphragm, a large muscle that
separates the thoracic cavity from the abdominal cavity. During inspiration (breathing in), the
diaphragm contracts, drawning downward, creating a vacuum in the thoracic cavity. This
vacuum inflates the lungs by drawing air into the body through the trachea, or windpipe. During
normal expiration (breathing out), the diaphragm relaxes allowing the air to flow out as the lungs
deflate, similar to the way an inflated balloon deflates when released.
 Reference:
 Essentials of Anatomy and Physiology Sixth Edition, 2007 – rod r. Seeley, Tient D. Stephens,
Philip Tale

 Essentials of Anatomy and Physiology Eight edition, 2006 – Marieb, Elaine N.

LABORATORY EXAMINATIONS

May 12, 2010

RADIOLOGIC FINDINGS
Impression:
 Minimal Kock’s infection, Right upper lobe.
 Interstitial pneumonitis Right hemithorax.
 Consolidation pneumonia Lingular zone.
 Please correlated clinically.

November 2, 2010
RADIOLOGIC FINDINGS

Impression:
 Follow up study since May 12, 2010 shows progression of the confluent opacities in the
Left perihilar area and Left lower lobe. Note of slight interval clearing of the Right upper
lobe infiltrated. No other interval changes seen.
 December 5, 2010
RADIOLOGIC FINDINGS
Impression:
 Consider moderate PTB disease, Right, activity undetermined clinical is suggested
 Intercurrent pneumonia, Left

December 13, 2010

CT-SCAN
Impression:
 Pulmonary mass lingular segment, with mediastinal and Left Hilar lymphadenopathy,
biopsy is suggested
 PTB of undetermined activity, Right upper lobe
 Atherosclerotic aorta

December 23, 2010

RADIOLOGIC FINDINGS
Impression:
 Resolving Pneumonia, Left Hilum.
 Unchanged right upper lobe PTB and left Hilar mass.
 Mild cardiomegallo.
 Atherosclerotic thoracic aorta.
 Degenerative osseous changes.
 December 23, 2010
FNAB
Impression:
 Positive for malignant cells.
 Non small cell compatible with adenocarcinoma.

MEDICAL MANAGEMENT

DATE TIME DOCTOR’S ORDER INTERPRETATION

2/ 13/11 8:45 am  admit  To monitor the condition of
the patient and for
implementation of proper
treatment.
 secure consent  It protects the client’s right
to self-determination.
 To inform the client on
what treatment or
procedure he/she might
be involved.
 TPR q shift & record  to know if there’s any
alteration on vital signs
 DAT if not dyspneic  to avoid aspiration
 IVF D5 NM 1L x 12  for replacement of fluid
hours and electrolyte loss
 O2 at 1-2 4m via  Decreases shortness of
nasal cannula breath. Nasal Cannula
delivers a relatively low
concentration of oxygen
which is 24% to 45% at
flow rates of 2 to 6 liters
per minute.
 moderate high back  it promotes total
rest expansion of the lung
  Nebulizaton with  salbutamol relieves nasal
salbutamol + congestion and reversible
ipratropium q 8 1 bronchospasm by relaxing
amp. the smooth muscles of the
bronchioles.
 ipratropium relieve any
reversible airways
blockage associated with
problems such as
repeated infections
affecting the airways.
 refer  For further studies of the
disease and for more
improved medical
management.

Meds:
 Dexamethasone 250  Dexamethasone reduces
g IV q8 the swelling, itching, and
redness that can occur in
these types of conditions.
This medication is a mild
corticosteroid.
 Assessment Diagnosis Planning Intervention Rationale Evaluation
S> “Naninikip and Impaired gas GOAL: INDEPENDENT:
dibdib ko” as exchange Adequate gas >Note respiratory rate, >Respiration may be After series of
verbalized by the related to exchange depth and ease of increase as a result of pain nursing
patient altered respiration. or as an initial intervention the
oxygen DESIRED Observe for the use of compensatory mechanism patient was
supply as OUTCOMES accessory muscle, pursed to accommodate for loss of able to
O> with non evidenced by After the nursing lip breathing, changes in lung tissue. Increased work demonstrate
productive cough clubbing of interventions, the skin or mucous of breathing and cyanosis improve
>with mucous fingers patient will be able membrane color. may indicate increasing ventilation and
secretions to : oxygen consumption and adequate
o Scant in a. Demonstrat energy expenditures and oxygenation.
amount e improved reduced respiratory reserve
and ventilation
o Clear, and >Maintain patent airway >Airway obstruction
thick, adequate impedes ventilation,
whitish oxygenation impairing gas exchange.
sputum . >Reposition frequently,
>use b. Participate placing patient in sitting >maximize lung expansion
sternocleidomast in treatment positions and supine to and drainage of secretions.
oid muscles and regimen side positions.
scaline muscles with in level
while breathing of ability or >encourage or assist with >promote maximal
>with clubbing of situation deep breathing exercises ventilation and oxygenation
fingers in both and pursedlift breathing and reduces or prevent
hands. as appropriate atelectasis
> RR= 12bpm
DEPENDENT
>Administer supplemental
oxygen via nasal cannula, >Maximizes available
partial rebreathing mask, oxygen, especially while
or high humidity face ventilation is reduced
mask as indicated. because of pain.
Oxygen saturation: 1-2
L/min

Reference:
 Nursing care PlansGuidelines for Individualizing Client Care across the life span Edition & - Marilyn E. Doenges
 Assessment Diagnosis Planning Intervention Rationale Evaluation
S>” nahihirapan Ineffective GOAL: Independent: After series of
akong huminga” as airway Effective airway >Auscultate chest for >noisy respiration, nursing
verbalized by the clearance clearance character of breath ronchi, and wheezes interventions,
patient related to sounds and presence are indicative of patient will
constriction of Desired Outcome: of secretions retained secretions demonstrate
the airway as After nursing and/or airway patent airway,
O > with non evidenced by intervention patient will obstruction will have
productive cough decreased be able to: expectorated
>with mucous respiratory a. Demonstrate >Observe amount and >presence of thick secretions and
secretions rate:12bpm and patent airway character of sputum and tenacious bloody decrease use of
o Scant in deep shallow b. Expectorate secretions. or purulent sputum accessory
amount breathing. secretions Investigate changes suggest development muscles while
and c. Clear breath as indicated of secondary breathing.
sounds problems
o Clear, thick, d. Decrease use of
accessory >encourage oral >adequate hydration
whitish
muscles for intake if not aids in keeping
sputum breathing contraindicated and secretions loose or
e. Demonstrate within cardiac enhance
>with crackles behavior to tolerance. expectorations
breath sounds improve or
heard on the maintain clear
second intercoastal airways Dependent: >relieves
spaces >Administer bronchospasms to
>with wheezing on bronchodilators, improve airflow.
the sixth expectorants and/ or Expectorants
intercoastal space analgesics as increases mucous
heard upon indicated production and liquefy
expiration and reduce viscosity
of secretions,
facilitating removal.
Alleviation or chest
discomfort promotes
cooperation and
breathing exercises
and enhances
effectiveness of
respiratory therapies.
 Assessment Diagnosis Planning Intervention Rationale Evaluation
S>” Hindi na ako Activity Goal: Independent: After nursing
makagawa ng intolerance Enhance activity >evaluate client’s >Establishes intervention patient will
datirating kong related to tolerance response to client’s be able to:
ginagawa ditto sa imbalance activities. capabilities or a. Participate in
bahay” as between oxygen Desired Outcome: needs and techniques to
verbalized by the Supply and After nursing facilitates choice enhance activity
patient. demand as interventions, patient of intervention tolerance
evidence by will be able to: b. Eliminate and
decreased a. Participate in >Note reports of >Symptoms may reduce factors
O>decreased physical activity & techniques to dysnea, increased be result of/or that contribute
physical activity easy fatigability enhance activity weakness or contribute to activity
> easy fatigability tolerance fatigue, and intolerance of intolerance
>body malaise b. Eliminate and changes in vital activity c. Demonstrate a
>RR; 12bpm reduce factors signs during and decrease in
>decrease depth that contribute after activities. psychological
of breathing activity signs or
>poor muscle tone tolerance >Encourage use >Reduces stress intolerance.
c. Demonstrate a of stress and excess
decrease in management and stimulation,
physiological diversional promoting rest
signs of activities as
intolerance appropriate.

>Assist and >Patient may be

encourage to comfortable with
assume head of bed
comfortable elevated, sleeping
position for rest in chair or leaning
and sleep. forward on
overbed table with
pillows support.
 >Encourage >Prevents
adequate fluid dehydration
intake (which increases
fatigue)

>Assist with self >weakness may

care needs when make ADLs
indicated and difficult to
ambulation complete or place
patient at risks for
injury during
activities.

Dependent: >Presence of
>Provide hypoxemia
supplemental reduces oxygen
oxygen as available for
indicated at 1- cellular uptake
2L/min. and contributes to
fatigue.

Reference:
 Nursing care PlansGuidelines for Individualizing Client Care across the life span Edition & - Marilyn E. Doenges
 DRUG NAME ACTION INDICATION CONTRAINDICATION ADVERSE NURSING
REACTION RESPONSIBILITIES

Date Ordered: >Stimulates > Relief and >Hypersensitivity to a >Fine skeletal >Assess cardio-
Beta2 receptors prevention of salbutamol, also to muscle tremor, respiratory function:
Feb.13 2011
of bronchioles by bronchospasm atrophine and its leg cramps, B/P, heart rate and
Generic Name: increasing the in patients with derivatives. >Cardiac palpitations, rhythm and breath
levels of cAMP reversible arrhythmia associated tachycardia, sounds
Nebulizaton with
which relaxes obstructive w/ tachycardia caused hypertension,
SALBUTAMOL + smooth muscles airway disease by digitalis intoxication. headache, >Monitor for
to produce or COPD nausea, evidence of allergic
ipratropium q 8 1
bronchodilation. >Inhalation and vomiting, reactions and
amp. treatment of dizziness, paradoxical
acute attack of hyperactivity, bronchospasm
Brand Name:
bronchospasm insomnia,
Activent >Prevention of
exercise –
Dosage and
induced
Frequency: bronchospasm
1Neb. 1amp every 8
hours.

Classification:
Symphatomimetics

Reference:
 PPD’s Nursing Drug Guide 2nd edition
 DRUG NAME ACTION INDICATION CONTRAINDICA ADVERSE NURSING
TION REACTION RESPONSIBILITIES

>Centrally acting >Tramadol is >Hypersensitivity >Vasodilation: >Assess patient’s pain

Date Ordered:
analgesic not used for >Acute Dizziness/vertigo, (location, type,
Feb.13 2011 chemically moderate to intoxication with headache, character) before
related to opioids severe pain. alcohol, somnolence, therapy and regularly
Generic Name:
but binds to mu- hypnotics, stimulation, thereafter to monitor
Tramadol opioid receptors centrally acting anxiety, drug effectiveness.
and inhibits analgesics, confusion, >Assess for
reuptake of opioids, or coordination hypersensitivity
Brand Name: norepinephrine psychotropic disturbance, reactions:pruritus,
and serotonin. agents. sleep disorders, rash and urticaria.
Dolotral
seizures. >Monitor for possible
Dosage and >Pruritus, drug induced adverse
sweating, rash. reactions: CNS:
Frequency:
>Visual stimulation, dizziness,
Classification: disturbances, dry vertigo, headache,
mouth. somnolence, anxiety,
Analgesics, Muscle
>Nausea, confusion,
Relaxants and diarrhea, coordination
constipation, disturbance, malaise,
Uricosurics
vomiting, euphoria,
Corticosteriods. dyspepsia, nervousness, sleep
abdominal pain, disorder, seizures.
anorexia,
flatulence.
 DRUG NAME ACTION INDICATION CONTRAINDICATION ADVERSE NURSING
REACTION RESPONSIBILITIES

Date Ordered: >Synthetic >Respiratory >systemic fungal >Thromboembolis > Obtain pt. history of
glucocorticoid diseases infection: IM injection m or fat embolism; underlying condition
Feb.13 2011
w/ marked anti- use in idiophatic thromboplebitis; before therapy.
Generic Name: inflammatory
thrombocytopenic necrotizing >Assess for possible
effect because
Dexamethasone of its ability to
purpura: angiitis; cardiac drug induced adverse
inhibit arrhythmias or reaction.
250 g IV q8
prostaglandin ECG changes. >Monitor renal status
Brand Name: synthesis, inhibit >vertigo and function.
Decilone migration of > headache >Assess mental
macrophages, >Impared wound status: Affect, mood,
Dosage and leukocytes and healing behavioral changes.
Frequency: fibroblasts at >visual acuity >Assess pt’s and
sites of >thoat irritation family’s knowledge on
inflammation, drug therapy.
Classification: phagocytosis
and lysosomal
Hormones and enzyme release.
related drugs. It can also
cause the
reversal of
increased
capillary
permeability.

Reference:
 PPD’s Nursing Drug Guide 2nd edition
 DRUG NAME ACTION INDICATION CONTRADICTION ADVERSE NURSING
REACTION RESPONSIBILITIES

Date Ordered: Chemically Acute Hyper sensitivity to Dryness of >Assess patient’s condition
related to exacerbations of soya lecithin or mouth, throat before and after drug
Feb. 13, 2011
atropine, it chronic related food products. irritation or therapy. Monitor peak
Generic Name: antagonizes obstructive Atropine or any cough. expiratory flow.
the effect of pulmonary anticholinergic >Monitor for evidence of
Nebulizaton
acetylcholine. disease (COPD). derivates. allergic reactions, paradoxic
with It causes a Used in bronchopspasm.
local and site conjunction w/ >Assess pt’ and family’s
salbutamol +
specific beta-adrenergic knowledge on drug therapy.
IPRATROPIUM bronchodilatat stimulant for >Inform pt. that drug is not
ion by acute asthmatic effective for treatment of
q 8 1 amp.
preventing the attacks. acute bronchopspasm.
Brand Name: increase in >Teach pt. the proper way of
intracellular drug administration.
Atrovent
cyclic
guanosine
mono-
Classification:
phosphate
Anticholinergic which
produced by
s
the interaction
of
acetylcholine
w/ the
muscarinic
receptors of
the bronchial
smooth
muscles.

Reference:
 PPD’s Nursing Drug Guide 2nd edition
NURSING MANAGEMENT

ACTION RATIONALE

>Assessed respiratory rate and depth >useful in evaluating the degree of respiratory
distress and /or chronicity of the disease
process .

>Auscultated chest , noting presence or >to identify etiology or precipitating factors

characteristic of breath sounds, presence of
secretions.

>Observed characteristics of cough >cough can be persistent but ineffected,

especially if client is elderly, acutely ill, or
debilitated.

>Performed physical and or psychological >to determine the extent of the limitation of the
assessment current condition.

>Encouraged adequate rest periods between >to limit fatigue

activities

>Established a minimum weight goal and daily >provides comparative baseline for
nutritional requirements effectiveness of therapy

>Give frequent oral care, remove expectorated >noxious tastes, smell and sights are prime
secretions promptly, provide specific container deterrents to appetite and can produce nausea
for disposal of secretions and tissue and vomiting with increase respiratory difficulty
RECOMMENDATIONS:
This case study has provided us with important information about the patient’s lung cancer
disease condition and its nursing care interventions prior to the treatments and medical
procedures done with the patient. In order to help managing or controlling present condition, the
group would like to recommend the following:

To the Patient:

Despite of his age and the severity of his condition, the patient cooperation and
willingness to prevent further complications related to his lung condition.

• The patient must be able to verbalize any problems and needs that he is
experiencing about his present condition and his perceptions about this event
happens in his manner of living .

• His capability on how he complies with therapeutic regimen that involve in his
managing complications on his condition.

• He must be open minded in the process of therapeutic regimen given to him to

relieve negative reaction occurring during the course of an illness and accepting
the fact about his situation.

To the Patient’s family:

The patient’s family is the one that can provide a great significant role in patient’s status
with regard to conditions.

• Family should available themselves to the patient to provide support and show
their concern to him. Help his to build strength and stabilized good outcome
about the patient’s status.

• Family also inspires patient to obtain stability as he experienced painful,

traumatic and extremely disturbing procedures. Also, it is important to them to
know the information about the patient’s condition so that they can act
appropriately according to the situation.

• Listening, touching, expressing sympathy, attending to the patients' wishes,

comforting, encouraging and being present with them are important in
accordance with the patient need of emotional incapability.

To our fellow Students:

However, it is important that may have a complete nursing care in the long run of
confinement of your patient, to begin with assessment, admission, and until the patient
recovered that includes discharge or may go order and follow-up consultations for further
studies in every actual goal and for proper nursing interventions in each occurring problems
connected on his condition and this can also provide us to become more aware of our health.