Lung Cancer

Most lung cancers are non-small cell lung cancer (NSCLC), which includes squamous, adeno, and large cell
carcinomas.

 Radiation
◦ Because external radiation commonly causes skin irritation, the nurse should wash the irradiated
area with water only and leave the area open to air. No soaps, deodorants, lotions, or powders
should be applied
 Remember therapeutic communication!!!!
 Hypoxia: decreased O2 in inspired air
 Hypoxemia: decreased O2 in the blood
 Hypercapnia: increased CO2 in the blood
 Hypocapnia: decreased CO2 in the blood

EXPECTED FINDI NGS

Clients can experience few manifestations early in the disease. Monitor for manifestations that often appear late
in the disease.
• Fatigue, weight loss, or anorexia
• Fever (pneumonitis or bronchitis that occurs with obstruction)
• Persistent cough, with or without hemoptysis (rust-colored or blood-tinged sputum)
• Hoarseness
• Altered breathing pattern: dyspnea, prolonged exhalation alternated with shallow breaths (obstruction),
rapid, shallow breaths (pleuritic chest pain, elevated diaphragm)
• Altered breath sounds (wheezing)
• Diminished or absent breath sounds (obstruction)
• Chest pain or tightness
• Chest wall masses
• Muffled heart sounds
• Pleural friction rub
• Clubbing of fingers
• Increased work of breathing (retractions, use of accessory muscle, stridor, nasal flaring)
• Decreased bone density
Assessment
• Skin color; LOC; mental status; respiratory rate, depth, effort, and rhythm; use of accessory
muscles; shape of the chest and symmetry of chest movements; finger clubbing
• Inspect nose, inflammation; tracheal symmetry
• Dyspnea, on inspiration, increased or more frequent cough, increased sputum production or
change in color/consistency of the mucus, wheezing, hemoptysis, SOB
• Cough, dyspnea, chest pain
• Hoarseness
• Hemoptysis
• Anorexia, weight loss
 • Weakness

Diagnostics

Chest radiography size, shape, and position of the lungs and other structures of the thorax (Looking at size. Not
looking at blood flow) Crushed glass may show advanced lesions and can show a lesion up to 2 years
before signs and symptoms appear;

Pulmonary Angiography: radioisotope study viewing arterial circulation of the lungs: PE

Lung scans: ventilation-perfusion scan (V-Q scan), the gallium scan, positron emission tomography (PET)
scan. Also SPEC. Is it in the lungs or spread.

Bronchoscopy: visualization of the larynx, trachea, and bronchi

Laryngoscopy, Mediastinoscopy, and Thoracoscopy: examination of pleural cavity

 Mediastinoscopy is used to evaluate enlarged ymph nodes identified on CT scans.

Thoracentesis: removal of excess air or fluid accumulates between visceral and parietal pleurae; must be
aspirated by inserting a needle into chest wall. {Removes fluid from pleural space} At risk for collapsed
lung.

Tissue biopsy of metastatic sites (including supraclavicular and mediastinal lymph nodes and pleura) is used to
assess disease extent. Based on histologic findings, staging describes the disease extent and prognosis
and is used to direct treatment.

Thoracentesis allows chemical and cytologic examination of pleural fluid.

Endoscopic thorascopy small incision to excise: NURSING ACTIONS

Keep client NPO after midnight.
Provide throat lozenges or sprays for report of a sore throat once the gag reflex returns following procedure.

Pleural Effusion: an abnormal volume of fluid collects in the pleural space

INTERVENETIONS
• Monitor Vital signs and pulse oximetry
• Monitor breathing patterns and breath sounds
• Decrease bronchospasms, inflammation and edema
• High calorie, high vitamin and protein diet – small frequent meals
• Fowler’s position to ease breathing.
• O2 with humidified air to loosen secretions.
• Activity as tolerated, rest periods and ROM
• Daily weights
• Skin care

Non-Surgical:
• Radiation therapy:
 o localized intrathoracic lung cancers and palliation hemoptysis, obstructions, dysphagia, and
pain.
• Chemotherapy for treatment of non- resectable tumors or as adjuvant therapy.

Surgical
• Laser Therapy: Relieves endobronchial obstruction
• Ablation Therapy destroys tumor
• Thoracentesis and Pleurodesis: removes pleural fluid and relieves hypoxia.
• Thoracotomy (opening into thoracic cavity) with pneumonectomy( lung removal)
• Thoracotomy with lobectomy: removal of one lobe for tumors confined to a single lobe.
• Thoracotomy wedge segmental resection: removal of lobe segment.
• Surgery is reserved for early stage lung cancer (I or II) with no metastasis.

Chest Drainage System

• Chest catheter placed in right pleural space and attached to Pleuro-Evac system with three chambers: (1)
drainage collection chamber from client, (2) the water-seal chamber, and (3) the suction control chamber
attached to source of suction and vented to room air.
Treatments:
• Chemotherapy drug combinations: Non-small cell: carboplatin (Paraplatin) or cisplatin (Platinol),
o Chemotherapy is the primary choice of treatment for lung cancers. It is often used in
combination with radiation and/or surgery. Platinum compounds, such as cisplatin, are
commonly used.
o ADVERSE EFFECTS: Nausea, vomiting, hair loss, mucositis, neutropenia, thrombocytopenia,
peripheral neuropathy
• Targeted drug therapy (in combination with chemotherapy) such as afatinib (Gilotrif),
• bevacizumab (Avastin)
• Immunotherapy, such as gefitinib (Iressa), erlotinib (Tarceva), crizotinib(Xalkori), PD-1/PD-L1
inhibitors; nivolumab (Opdivo) and pembrolizumab (Keytruda)
• Antiemetics, such as ondansetron hydrochloride (Zofran),
• Corticosteroids for brain metastasis and spinal cord compression (small-cell lung cancer)
• Analgesics
• Anti-anxiety medications
• Supplemental oxygen therapy
• Partial removal of lung (wedge resection, segmental resection, lobectomy, radical lobectomy)
• Total removal of lung (pneumonectomy, radical pneumonectomy)

• Radiation therapy is effective for lung cancer that has not spread beyond the chest wall and is used
as anadjuvant therapy.

Palliative procedures
Thoracentesis or pleurodesis to ease breathing
Laser therapy and photodynamic therapy can be used in treatment and palliative therapy to open airways
blocked by tumors.
Pericardiocentesis or pericardial window to improve cardiac function
Oxygen therapy to correct hypoxemia