ASUHAN KEPERAWATAN PADA

PASIEN DENGAN KANKER PARU

ARIF SETYO UPOYO

 CAPAIAN PEMBELAJARAN
• Mampu menjelaskan definisi kanker paru
• Mampu menyebutkan penyebab dan dan faktor resiko
kanker paru
• Mampu menidentifikasi tanda dan gejala kanker paru
• Mampu menyebutkan pemeriksaan penunjang pada
kanaker paru
• Mampu menjelaskan penatalaksaan pada kanker paru
• Mampu melakukan pengkajian pada pasien dengan
kanker paru
• Mampu menyusun diganosa dan intervensi
keperawatan pada pasien dengan kanker paru
 DEFINITION
• Lung cancer is the uncontrolled growth of
abnormal cells.

• These cells develop into tumors and the tumors

disrupt the proper function of the lung.
CAUSES AND RISK FACTORS
OF LUNG CANCER
 THE FACTORS THAT INCREASE THE RISK OF
DEVELOPING LUNG CANCER INCLUDE:
• Smoking tobacco- is the predominant cause of Lung Ca and
accounts for 80% of all new cases in women and 90% in
men. Lung cancer is 10 times more likely to occur in
smokers than non-smokers.
• second-hand smoke- studies have shown that people who are
exposed to tobacco smoke in a closed environment (car,
house, building) are at inc’d risk of developing lung Ca than
those who are not exposed.
• Asbestos-Asbestos refers to a group of naturally occurring
minerals that are used in some industries. Asbestos fibers
have a tendency to easily shatter into small bits that can be
suspended in the air and adhere to clothes. In the event that
these asbestos particles are inhaled, they can enter into the
lungs, damaging cells, escalating the risk for lung cancer
development. Studies have revealed that workers exposed
to great amount of asbestos are 3 to 4 times more at risk of
developing lung cancer than those who work in asbestos free
environment.
• Arsenic - Arsenic can be found in both surface water and
groundwater sources, with levels generally higher in
groundwater and is known to be a human carcinogenic
(Health Canada, 2008)
 THE FACTORS THAT INCREASE THE RISK OF
DEVELOPING LUNG CANCER INCLUDE:
• Radon- Radon is gas that is undetectable, fragrance-free, and
tasteless radioactive gas that occurs naturally in soil and
rocks. It naturally occurs in can cause damage to the lungs
that may lead to lung cancer. People who work in mines may
be exposed to radon and, in some parts of the country, radon
is found in houses. Smoking increases the risk of lung cancer
even more for those already at risk because of exposure to
radon. A kit available at most hardware stores allows
homeowners to measure radon levels in their homes. The
home radon test is relatively easy to use and inexpensive.
Once a radon problem is corrected, the hazard is gone for
good.
• There are also various carcinogens identified in the
atmosphere from vehicle emissions and pollutants from
refineries and manufacturing plants. Evidence suggests that
the incidence of lung cancer is greater in urban areas as a
result of the buildup of these pollutants (Day et. al, 2010, p.
630).
 Some other risk factors are:
Marijuana
Pollution
Industry work
Lung Disease
Personal History
Diet
• Lung Diseases. Certain lung ailments, such as tuberculosis (TB), add to a
person's likelihood of developing lung cancer. Lung cancer tends to grow in
the regions of the lung that are scarred from TB. Other diseases such as
tuberculosis (TB) and some types of pneumonia often leave scars on the
lung. This scarring can increase the risk of developing lung cancer. People
with diseases from breathing in certain minerals also have a higher risk of
lung cancer.
• Personal History. A person who has a history of having lung cancer lung
cancer is more prone to develop lung cancer again compared with someone
who has never had lung cancer. Smoking cessation following a diagnosis of
lung cancer may stop the development subsequent lung cancer.
• Additionally, People who have had prior experiences with radiation therapy
on the chest at higher risk for lung cancer, especially if they smoke.
• Diet: Some reports propose that a diet low in fruits and vegetables may
amplify the risk of lung cancer in people who are exposed to environmental
tobacco smoke. It is believed that fruits and vegetables help protect against
lung cancer.
 TYPES OF LUNG CANCER
• Primary lung cancer starts in the lung itself. Primary
lung cancer is divided into small cell lung cancer and
non-small cell lung cancer, depending on how the
cells look under the microscope. Each type of
Primary lung cancer grows and spreads in different
ways.
• Secondary lung cancer is cancer that starts
somewhere else in the body (for example, the breast
or colon) and spreads to the lungs.
 TYPES OF LUNG CANCER
Two main Types of Lung Cancer:

Small Cell Lung Cancer (20-25% of all lung cancers)

Non Small Cell Lung Cancer (most common ~80%)

 Small Cell Lung Cancer

Small Cell Lung Cancer is the most aggressive form of lung cancer. It usually starts in the bronchi
which is problematic because post-pneumonia and atelectasis often occur.
These cancer cells are small and are considered to be quite aggressive in nature and they have a
large growth factor. Because of these reasons, at the time of diagnosis, (60% of the time), these
tumors have often metastasize to other parts of the body (brain, liver, and bone marrow) (Otto,
2001, p. 284).
 Non-small cell lung cancer

1. Squamous cell carcinoma

2. Adenocarcinoma
3. Large cell carcinomas
 Squamous cell carcinoma
• Moderate to poor differentiation
• makes up 30-40% of all lung cancers
• more common in males
• most occur centrally in the large bronchi
• Uncommon metastasis that is slow effects the liver, adrenal
glands and lymph nodes.
• Associated with smoking
• Not easily visualized on xray (may delay dx)
• Most likely presents as a Pancoasts tumor
 Adenocacinoma
• Increasing in frequency. Most common type of Lung cancer
(40-50% of all lung cancers).
• Clearly defined peripheral lesions (RLL lesion)
• Glandular appearance under a microscope
• Easily seen on a CXR
• Can occur in non-smokers
• Highly metastatic in nature
– Pts present with or develop brain, liver,
adrenal or bone metastasis
 Large cell carcinomas
• makes up 15-20% of all lung cancers
• Poorly differentiated cells
• Tends to occur in the outer part (periphery) of lung, invading
sub-segmental bronchi or larger airways
• Metastasis is slow BUT
• Early metastasis occurs to the kidney, liver organs as well as
the adrenal glands
 SIGNS AND SYMPTOMS
OF LUNG CANCER

• Sometimes lung cancer does not cause any symptoms and is

only found in a routine x-ray.
• If a person with lung cancer does have symptoms, they will
depend on the location of the tumour in their lung.
• It is also imperative to note that the same symptoms can be
caused by other conditions, so may not necessarily mean
cancer.
• Signs and symptoms also depend upon the location, size of
the tumor, degree of obstruction and existence of metastases
SIGNS AND SYMPTOMS OF LUNG CANCER

There are two types of signs and symptoms of

lung cancer:
1) Localized – involving the lung.
2) Generalized – involves other areas
throughout the body if the cancer has spread.
LOCALIZED SIGNS AND SYMPTOMS
Cough
Breathing Problems, SOB, stridor
Change in phlegm (sputum)
Lung infection, hemoptysis
Hoarseness, Hiccups
Wt loss
Chest Pain and tightness
Pancoats Syndrome
Horner’s Syndrome
Pleural Effusion
Superior Vena Cava Syndrome
Fatigue
 Generalized Signs and Symptoms
• Bone pain
• Headaches, mental status changes or neurologic
findings
• Abdominal pain, elevated liver function tests,
enlarged liver, gastrointestinal disturbances
(anorexia, cachexia), jaundice, hepatomegaly r/t liver
involvement
• Weight loss
 Early/late Signs and Symptoms
Of Lung Cancer
Early Signs Late signs

Cough/chronic cough Bone pain, spinal cord compression

Dyspnea Chest pain/tightness

Hemoptysis Dysphagia

Chest/shoulder pain Head and neck edema

Recurring temperature Blurred vision, headaches

Recurring respiratory infections Weakness, anorexia, weight-loss, cachexia

Pleural effusion

Liver metastasis/regional spread

 Diagnostic Tests
• CXR
• CT Scans
• MRI
• Sputum cytology
• Fibreoptic bronchoscopy
• Transthoracic fine needle aspiration
 Laboratory Tests
 Blood Tests
*CBC-to check red/white blood cell & platelets
-to check bone marrow and organ function
*Blood Chemistry Test-to assess how organs
are functioning such as liver and kidney

 Biopsy-to determine if the tumor is cancer or not

-to determine the type of cancer
-to determine the grade of cancer (slow
or fast)
 Endoscopy
• Bronchoscopy
• Mediastinoscopy
• VATS (video assisted thoracoscopic surgery)
Bronchoscopy
Mediastinoscopy
VATS (video assisted thoracoscopic
surgery)
 Nursing Management for post endoscopic
procedures

Bronchoscopy Mediastinoscopy VATS

Monitor V/S; NPO status Monitor VS; potential for Monitor V/S; potential for
maintained until return of bleeding, infection and bleeding, infection and
gag reflex. dyspnea; NPO status until dyspnea; NPO status until
return of gag reflex return of gag reflex
Fever up to 101F can be
expected afterwards
 Treatment

• Surgery

• Chemotherapy

• Radiation Therapy
 PENGKAJIAN KEPERAWATAN
• Keluhan : batuk, batuk darah, nyeri dada,
sesak nafas
• Riwayat : Perokok, perokok pasif, pekerjaan
beresiko
• Pemeriksaan fisik: IPPA ( bunyi nafas parau,
perkusi redup, ronkhi), penurunan BB
 Nursing Diagnoses
• Ineffective breathing pattern r/t loss of adequate ventilation
• Impaired gas exchange r/t excessive or thick secretions 2 to smoking; r/t
decreased passage of gases between alveoli of lungs and vascular system
• Chronic pain related to Stage IV NSCLC diagnosis as evidenced by client
reporting “pain in right chest and lower ribs”.
• Risk of infection related to altered immune system secondary to effects of
cytotoxic drugs.
• Risk for disturbed self concept related to changes in lifestyle.
• Nausea related to effects of chemotherapy as evidenced by
client reporting feeling nauseated.
• Risk for deficient fluid volume related to gastrointestinal fluid loss
secondary to vomiting.
• Fatigue related to chemotherapy secondary to stage IV NSCLC as
evidenced by client reporting he “ no longer has the energy to play with
his grandchildren or visit his friends”.
 Nursing Interventions
• Pain management, education to avoid concern about addiction,
pharmacological and non-pharmacological
• Elevate HOB, Teach breathing retraining exercises to increase
diaphragmatic excursion
• Splinting to aid in coughing
• Teach breathing exercises to ↑ diaphragmatic excursion Provide a
vaporizer (humidifier)
• Relaxation techniques to ↓ anxiety Encourage energy conservation
• Management o weakness, fatigue, wt loss, appetite loss, altered taste
• Encourage small amts of high-calorie
 Nursing pulmonary post-op
considerations/interventions
• Positioning in bed, Monitor V/S
• Prevention of respiratory complications
– Early ambulation, DB&C, incentive spirometer, managing dyspnea
Prevention of deep vein thrombosis
– Early ambulation
• Pain management
• Infection control
 Educating the patient

• Inform the patient what to expect, from administration of anesthesia to

thoracotomy and the likely use of chest tubes and a drainage system
postoperatively.
• Tell the patient about the administration of oxygen postoperatively and
the possible use of a ventilator.
• Explain the importance of frequent turning to promote drainage of lung
secretions.
• Instruct the proper use of an incentive spirometry and how to perform
diaphragmatic and pursed-lip breathing techniques.
• Teach the patient to splint the incision site with hands, a pillow or a folded
towel to avoid discomfort
 Prevention: Primary

• Avoid the use of tobacco smoke

• Personal and family are important risk factors
• Know environmental carcinogens that increase risk
• Chemoprevention:
– Consuming carotenoids, Vit A, retinoids Vit E, selenium, Vit C, fat
 Prevention: Secondary
• Aim is to early diagnose high risk populations
via screening
• CXR, MRI, CT scans, sputum cytology
 Prevention: Tertiary
• Targeted at people who survived a cancer
disease
• Assists them to retain an optimal level of
functioning regardless of their potential
debilitating disease
 Nurse’s Role with clients with lung cancer
• Coping with diagnosis
• Pre/post treatment education
• Education on managing breathlessness
• Referrals for ‘stop smoking advisor’
• Referring to services such as hospice care, dietitian, massage
therapy, counselors
• Advocate for appointments, scans etc.
• Educate client and family about disease process, treatment
options and S/E
• Provide resources for support groups and where information
and be sought
SELAMAT BELAJAR