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Prepared by:
Hira Devi Harmel
Roll no:12
BNS 2nd year
 LUNG CANCER
 Lung cancer is the type of cancer that begins in the lungs.
 Cancer starts when cells in the body begin to grow out of control
 Lung cancer begins in the lungs and may spread to lymph nodes or other organs in the
body, such as the brain, liver, adrenal gland and bones.
 Cancer from other organs also may spread to the lungs. When cancer cells spread from
one organ to another, they are called metastases.
 Lung cancer can arise in any part lungs but 90% to 95% of cancer of the lungs are arise
from the epithelial cells , the cells lining the larger and smaller airways (bronchi and
bronchioles)
 Lung cancer sometimes called bronchogenic carcinoma.
 Lung cancer is a very life threatening cancer and one of the most difficult cancer.
 conted…..

 Lungcancer is predominately a diseases of the elderly almost

70% of people diagnosed with lung cancer are over 65years age
while less than 3% of lung cancer occur in people under 45years
of age.
 Epidemiology
 Lung cancer is by far the leading cause of cancer death among both men and
women; about 1 out of 4 cancer deaths are from lung cancer. Each year, more
people die of lung cancer than of colon, breast, and prostate cancers combined.
 Lung cancer mainly occurs in older people. About 2 out of 3 people diagnosed with
lung cancer are 65 or older while less than 2% are younger than 45.
 The average age at the time of diagnosis is about 70 (American Cancer Society,
2017).
 contd….

 The American Cancer Society's estimates for lung cancer in the United States for
2017 (American Cancer Society, 2017) are:
 About 222,500 new cases of lung cancer(116,990 in men and 105,510 in women)
 About 155,870 deaths from lung cancer (84,590 in men and 71,280 in women)

 Lung cancer is a top 2nd cancer in Nepal.

 Lung Cancers Deaths in Nepal reached 2,235 or 1.41% of total deaths. The age
standardized death rate is 11.92 per 100,000 of population ranks Nepal #87 in the
world (WHO, 2014).
 Types of lungs cancer
Two main types of Lung Cancer:
It is classified according to cell type
1. Small Cell Lung Cancer (20-25% of all lung cancers)
2. Non Small Cell Lung Cancer (most common 80%):
 Squamous cell
 Adenocarcinoma

 Large cell carcinomas

 Small Cell Lung Cancer
 SCLC comprise about 20% of lung cancers and are the most
aggressive and rapidly growing of all lung cancers.
 SCLC are strongly related to cigarette smoking, with only 1% of these
tumors occurring in nonsmokers.
 It usually starts in the bronchi and then affects the whole lung.
 These cancers are sometimes called oat cell carcinomas.

 Non Small Cell Lung Cancer
 Most common lungs cancer accounting for about 80%of all
lung cancers.
 It can be divided into three main types that are named based
upon the type of cell found in the tumor:
 Squamous cell
 Adenocarcinoma
 Large cell carcinomas
Squamous cell

 account for about 30-40% of all lung cancer.

 Moderate to poor differentiation
 More common in males
 Mostly arise centrally in larger bronchi
 This types of cancer is often due to smoking.
 Stages

NSCLC are assigned a stage from I to IV in order of severity:

 Stage 1: Cancer is found in the lung, but it has not spread

outside the lung.

 Stage 2: Cancer is found in the lung and nearby lymph nodes.

 Stage 3: Cancer is in the lung and lymph nodes in the middle of the
chest.
o Stage 3A: Cancer is found in lymph nodes, but only on the same side of the
chest where growing. cancer first started
o Stage 3B: Cancer has spread to lymph on the opposite side of the chest or
to lymph nodes above the collarbone.
 Stage 4: Cancer has spread to both lungs, into the area around the
lungs, or to distant organs.
 Stages of small cell lung cancer
SCLC are staged using a two-tiered system
 Limited-stage (LS) SCLC refers to cancer that is confined to its area
of origin in the chest.
 In extensive-stage (ES) SCLC: The extensive stage means cancer has
spread:
• throughout one lung
• to the opposite lung
• to lymph nodes on the opposite side
 Risk factors
 Smoking
• 90% of lung cancers arising as a results of tobacco use.
 Passive smoking
• Inhalation of smoke by nonsmoker who share living or working quarters with
smoker.
 Asbestos fiber
• Workplace was a common source of exposure to asbestos fiber.
 Radon gas
• Radon gas is a natural radioactive gas that is a natural decay product of uranium
• Radon gas can travel up through soil and enter homes through gaps in the
foundation , pipes ,drains, or others openings.
 Familial predisposition
 Familial predisposition
• Individual genetic susceptibility
 Lung disease
• The presence of certain lung disease notably chronic obstructive
pulmonary disease(COPD) and scarring of lung disease.
 Air pollution
• Air pollution, polycyclic aromatic hydrocarbons (from incomplete combustion
of carbon based fuels, such as wood, coal, diesel, incense or tar) increase the
risk of lung cancer.
 Sign and symptoms

 No symptoms: In up to 25% of people who get lung cancer, the cancer is

first discovered on a routine chest X-ray or CT scan as a solitary small
mass. These patients with small, single masses often report no
symptoms at the time the cancer is discovered.
 contd…
 Symptoms related to the cancer: The growth of the cancer and invasion of
lung tissues and surrounding tissue may interfere with breathing, leading to
symptoms:
• Cough
• Shortness of breath
• Wheezing, chest pain
• Hemoptysis
• If the cancer has invaded nerves, for example, it may cause shoulder pain that
travels down the outside of the arm or paralysis of the vocal cords leading to
hoarseness.
 contd……….

• Invasion of the esophagus may lead to difficulty swallowing

• If a large airway is obstructed, collapse of a portion of the lung may
occur and cause infections (abscesses, pneumonia) in the obstructed
area.
 Contd….

 Symptoms of metastatic lung tumors depend on the location and size.

About of people with lung cancer have some symptoms or signs of
metastatic disease.

 Lung cancer most often spreads to the liver, the adrenal glands, the
bones, and the brain.

 Metastatic lung cancer in the liver usually does not cause symptoms, at
least up to the time of diagnosis.
 contd……….
 Metastatic lung cancer in the adrenal glands also typically causes
symptoms.
 Metastasis to the bones is most common with small cell cancers but
also occurs with other lung cancer types.
 Lung that has metastasized to the bone causes bone pain, usually in
the backbone (vertebrae), the thighbones, and the ribs.
 Lung cancer that spreads to the brain can cause difficulties with
vision, weakness on one side of the body and / or seizures.
 Diagnostic investigations
 History taking
 Physical examination
 Chest x-ray
 Magnetic resonance imaging (MRI) scans
 Positron emission tomography (PET )scanning
 Bone scan
 Sputum cytology
 contd………….

 Bronchoscopy
 Needle biopsy
 Thoracentesis
 Blood test: SGOP, SGPT, other cancer biomarker
such as CEA level
 Complication

 Shortness of breath
 Coughing up blood
 Pain
 Pleural effusion
 metastasis
 Management

1. Chemotherapy
2. Radiation therapy
3. Surgery (lung resection)

(Other types of treatment that are used to treat certain cancers are hormonal
therapy, biological therapy or stem cell transplant )
 Chemotherapy

Is used to alter tumor growth and to treat the patient with metastasis
Non small cell: two drug regimen:
Cis/Carbo platin + 1 other (Taxol/taxotere/Gemcitabine)
Small cell: Cisplatin/etoposide vOther drugs:
- Etoposide
- Paclitaxel
- Cyclophosphamide
- Doxorubicin
- Vinblastin
 Radiation treatment

• Useful in controlling the neoplasm that can not be surgically removed

• Used to reduce the size of the tumor

• May help to remove the symptoms like cough, chest pain, dyspnea and
hemoptysis etc.
 Surgical management
1. Lobectomy: a single lobe of lung is removed
2. Bilobectomy: 2 lobes of the lung are removed ( only on right side)
3. Sleeve resection: cancerous lobe is removed and segment of the main
bronchus is resected
4. Pneumonectomy: removal of entire lung
5. Segmentectomy: a segment of the lung is removed
6. Wedge resection: removal of a small pie shaped area of the segment
7. Chest wall resection with removal of cancerous lung tissue for cancers that
have invaded the chest wall
 Nursing assessment
1.Determine onset and duration of coughing, sputum production (purulent
vs. bloody), and degree of dyspnea
2. Auscultate breath sounds. Observe symmetry of the chest during
respiration
3. Take anthropometric measurements: weigh patient, review laboratory
tests and conduct appraisal of 24 hour food intake
4. Ask about pain, including location, intensity and factors influencing
pain
5. Monitor vital signs including oximetry
 Nursing diagnosis
 Ineffective airway clearance related to increased trachea bronchial
secretions and presence of tumor
 Ineffectivebreathing pattern related to decreased lung capacity and
presence of space-occupying lesion
 Impaired gas exchange related to tumor obstructing airflow
 Anxiety related to lack of knowledge of diagnosis or unknown prognosis
and treatments
 Grieving related to new cancer diagnosis, lack of knowledge about the
disease process, and therapeutic regimen
 Contd..

 Acutepain related to disruption of intercostal nerve as

evidence by verbal report of discomfort and guarding of chest
 Imbalance nutrition less than body requirement related to
poor appetite.
 Geriatric considerations
 Elevate the head of the bed to ease the work of breathing and to prevent fluid
collection in upper body (from superior vena cava syndrome).
 Teach breathing retraining exercises to increase diaphragmatic excursion and
reduce work of breathing.
 Augment the patient's ability to cough effectively by splinting the patient's chest
manually.
 Instruct the patient to inspire fully and cough two to three times in one breath.
 Provide humidifier or vaporizer to provide moisture to loosen secretions.
 Teach relaxation techniques to reduce anxiety associated with dyspnea. Allow the
severely dyspneic patient to sleep in reclining chair.
 Encourage the patient to energy by decreasing activities.
 Contd……

 Ensure adequate protein intake such a milk, eggs, oral nutritional supplements; and
chicken, fowl, and fish if other treatments are not tolerated - to promote healing
and prevent edema.
 Advise the patient to eat small amounts of high-calorie and high-protein foods
frequently, rather than three daily meals.
 Suggest eating the major meal in the morning.
 Change the diet consistency to soft or liquid if patient has esophagitis from radiation
therapy.
 Consider alternative pain control methods, such as biofeedback and relaxation
methods, to increase the patient's sense of control.
 Contd……….

 Teachthe patient to use prescribed medications as needed for pain

without being overly concerned addiction.
 Patient education
1.Teach patient to use NSAIDs or other prescribed medication, as
necessary for pain without being overly concerned about addiction
2. Help the patient realize that not every ache and pain is caused by
lung cancer
3. Radiation therapy may be used for pain control if tumor has spread to
bone, control of hemoptysis, bronchial obstruction or brain metastasis .
4. Advise the patient to report new or persistent pain; it may be caused
by other factors.
 Contd……..
5. Suggest talking to a social worker about financial assistance or other
services that may be needed
6. Facilitate referral to cancer support group or mental health
professional
7. Support patient and family to make decisions regarding long term care,
possibly pulmonary rehabilitations.
Asthma
 Asthma
 Asthma is reversible lung disease which is characterized by
chronic airway inflammation and increased airway hyper-
responsiveness leading to symptoms of wheeze, cough, chest
tightness and dyspnea.
 It is characterized by the presence of airflow obstruction over
short periods of time or irreversible with treatment.
 Asthma is common among person over age 65 and cause serious
health problems.
 Contd…………….
In another words, asthma is a disorder of the lungs that causes
intermittent symptoms. In the airways there is:
 Swelling or inflammation, specifically the airway linings
 Production of large amounts of mucus that is thicker than normal
 Narrowing because of muscle contractions surrounding the airways
 Factors that triggers asthma
 Airborne allergens, such as pollen, animal dander, mold, cockroaches and dust
mites
 Respiratory infections, such as the common cold
 Physical activity
 Cold air
 Air pollutants and irritants, such as smoke
 Certain medications, including beta blockers, aspirin, ibuprofen and naproxen
 Strong emotions and stress
 Sulfites and preservatives added to some types of foods and beverages,
including dried fruit, processed potatoes, beer and wine
 Risk factors
 Family history
 allergic condition such as atopic dermatitis or allergic
rhinitis (hay fever)
 Obesity
 Smoking and Passive smoking
 Exposure to secondhand smoke
 Having a pregnant mother who smoked while
 Exposure to exhaust fumes or other types of pollution
 Classification
Asthma is classified into four categories based upon frequency
of symptoms and objective measures, such as peak flow
measurements and/or spirometry results. These categories
are:
 Mild intermittent
 Mild persistent
 Moderate persistent
 Severe persistent.
 Mild Intermittent Asthma

 Symptomsoccur less than three times a week, and nighttime

symptoms occur less than two times per month.

 Lungfunction tests are greater than 80% of predicted values.

Predictions are often made on the basis of age, sex, and
height.

 No medications are needed for long-term control.

 Mild persistent asthma

 Symptoms occur three to six times per week.

 Lung function tests are greater than 80% of predicted values.

 Nighttime symptoms three to four times a month.

 Moderate persistent asthma

 Symptoms occur daily

 Nocturnal symptoms greater than five times per month.
 Asthmasymptoms affect activity, occur more than two times per week,
and may last for days
 Thereis a reduction in lung function, with a lung function test range of
60% to 80% of predicted values.
 Severe Persistent Asthma

 Symptoms occur continuously, with frequent nighttime asthma.

 Activities are limited.

 Lung function is decreased to less than 60% of predicted values.

 Symptoms
 Feeling short of breath
 Frequent coughing, especially at night
 Wheezing ( a whistling noise during breathing)
 Difficulty breathing
 Chest tightness
 Diagnostic investigations

 History Taking
 Physical Examination
 Blood test ( elevated eosinophil and IgE levels are highly suggestive of
atopy
 Pulmonary Function Test
. Methacholine Challenge Test
 Chest X-ray
Management

1. Non-pharmacological
2. Pharmacological
 Non -pharmacological

1. Reduce
2. Avoid 3. Avoid vehicle
exposure to
tobacco smoke emission
indoor allergens

4. Identify
5. Influenza
irritants and
vaccination
avoiding it
 Pharmacological management
Long-Term Control Medications
 Anti-inflammatory Drugs
 Corticosteroids
• inhaled (e.g., fluticasone)
• Oral (e.g., prednisone)
 Leukotriene modifiers (e.g., montelukast)
 Anti-IgE (omalizumab)

 Bronchodilators
• Long-acting inhaled B₂-adrenergic agonists (e.g., salmeterol)
• Long-acting oral B-adrenergic agonists (e.g., albuterol)
• Methylxanthines (e.g., theophylline)
 Contd…..

Quick-Relief Medications
 Bronchodilators

Short-acting inhaled B-adrenergic agonists (e.g., albuterol)

Anticholinergics (inhaled) (e.g., ipratropium)*

 Anti-inflammatory Drugs
Corticosteroids (systemic) (e.g., prednisone)+
 Special consideration for the treatment
of asthma in older adults
 Treatment can be complicated by the fact that so many older person take
multiple medications for other health problems.
 Asthma medications can react with these other treatments causing
unpleasant side effect .in addition other medications may worsen asthma
symptoms.
 In addition, many asthma medications come in the form of an inhaler. Using
an Inhaler requires a certain degree of coordination and dexterity. The
patient must press down quickly on the inhaler while drawing in a short, deep
breath.
 Older persons are more likely to have conditions such as arthritis, which
affects physical movement and coordination.
 These patients may find it more difficult to use inhalers properly in order to
receive the correct dose.
 Contd……..
 Treatment with oral medications can help older asthma patients avoid problems with
inhaler use.
 Short courses of oral steroids are helpful to treat acute asthma flares.
 Long-term oral steroid treatment is usually avoided in older asthma patients.
 Over time, oral steroids can cause severe side effects, such as weakening of bones,
ulcers and high blood pressure.
 Lifestyle changes can also reduce symptoms, especially if asthma is triggered by
allergies to substances in the environment or to certain foods (although often
quoted, food as the only of asthma in the elderly is extremely rare).
 Regular vaccinations for influenza and pneumonia are strongly recommended for
older adults with asthma
 Contd……..

 Elderly asthma patients should learn to identify and avoid asthma

triggers, monitor their breathing and seek medical attention quickly
when symptoms appear.
 Patients
also need a written emergency plan that they fully
comprehend.
Complication

 Pneumonia
 Atelectasis
 Respiratory failure
 Severe asthma attack( status asthmaticus)
 Nursing management

Nursing assessment
 Assess patient general condition
o Observe the patient and assess the rate, depth and character of
respirations.
o Assess for triggers of asthma that including Respiratory
infections ,Inhalation of irritating substance , Environmental
factors ,Emotional factors , Exercise and Aspirin and its derivatives.
o Assess the patient’s level of anxiety
 Contd………

 Ask about coughing, dyspnea, chest tightness, wheezing,

exertional changes, night time awakening with asthma.
 It is important to send diagnostic test to the diagnosis or
potential diagnosis, the treatment options and prognosis.
 Auscultate the chest for breath sounds or wheezing
 Nursing diagnosis

 Ineffective airway clearance related to excessive mucus production

 Anxiety related to fear of suffocating
 Difficulty in breathing related to narrowed airways
 Activity intolerance related to increased respiratory effort
 Acute pain related to lungs inflammation
 Deficient knowledge regarding treatment regimen
 Patient education
• Identify and avoid asthma triggers
• Instruct patient about medication regimen, completion of course of
antibiotic if prescribed
• Encourage patient to seek medical attention for shortness of breath and
worsening condition.
• Encourage mobilization of secretions through patient mobilization
(ambulation), hydration, chest physiotherapy and coughing
• If ordered, self-administer inhaled bronchodilator
• Caution patient on the use of over-the-counter cough suppressant
• Follow the asthma action plan it’s need to regular monitoring and
treatment