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Lung Cancer is the ____ cause of cancer deaths:

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Leading

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Smoking is responsible for __% of all lung cancers

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80-90

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Tobacco smoke contains # carcinogens.

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60

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When quoting smoking how many years does take to get to non-smokers cancer rate

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10-15 years

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Assessment of the risk of lung cancer is now divided into three categories:

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(1) smokers, people who are currently smoking; (2) nonsmokers, people who formerly smoked; and (3) never smokers.

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Lung cancer: Risk Factors are directly related to

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Total exposure to tobacco smoke: -Measured by total number of cigarettes smoked in a lifetime -Age of smoking onset -Depth of inhalation -Tar and nicotine content -Use of unfiltered cigarettes.

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Non-Tobbaco Related Lung Cancer Causes:

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Pollution Radiation: RADON Asbestos Exposure to industrial agents: - Ionizing radiation - coal dust - nickel - uranium - chromium - formaldehyde - arsenic

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CULTURAL & ETHNIC HEALTH DISPARITIES Lung Cancer

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African Americans: • Highest incidence of lung cancer • Are more likely to die from lung cancer than any other ethnic group • Higher rate of lung cancer among men than in other ethnic groups Whites • Second-highest death rate • Higher rate of lung cancer among women than in other ethnic groups Asian/Pacific Islanders and Hispanics • Lowest rates of lung cancer in both men and women Other • Regional variations among ethnic groups may be due to smoking prevalence, exposure to cancer-causing substances, and other factors. • Cigarette consumption has decreased dramatically in developed countries such as the United States and Canada. • Cigarette smoking is increasing in developing countries (e.g., nations in Africa, Asia, Latin America).

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Lung Cancer Men

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• More men than women are diagnosed with lung cancer. • More men than women die from lung cancer. • Male smokers are 10 times more likely to develop lung cancer than nonsmokers. • Men with lung cancer have worse prognosis • Lung cancer incidence and deaths are decreasing in men.

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Women: Lung Cancer

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• Lung cancer incidence and deaths are increasing in women. • Women develop lung cancer after fewer years of smoking • Women develop lung cancer at a younger age than men. • Women are more likely to develop small cell carcinoma than men. • Nonsmoking women are at greater risk of developing lung cancer than men. • Women with lung cancer live, on the average, 12 months longer than men.

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Most primary lung tumors are believed to arise from

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mutated epithelial cells.

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Once started, continued tumor development is promoted by

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epidermal growth factor.

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Lung Cancer cells grow

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slowly, taking 8 to 10 years for a tumor to reach 1 cm in size, the smallest lesion detectable on an x-ray.

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Lung cancers occur primarily in the

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segmental bronchi or beyond and have a preference for the upper lobes of the lungs

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Primary lung cancers are categorized into two broad subtypes

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Non-small cell lung cancer (NSCLC) (80%) Small cell lung cancer (SCLC) (20%).

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Lung cancers metastasize primarily by direct extension and via the blood and lymph system. The common sites for metastasis are the

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- liver - brain - bones - lymph nodes - adrenal glands.

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Lung Cancer: Symptoms

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Cough SOB Dyspnea Hoarseness Chest Pain

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Lung Cancer: Symptoms

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Decreased P02 Cyanosis - Clubbing Tachypnea Crackles Wheeze - Rhonchi Blood tinged Sputum

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Impact Of Smoking

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Risk Increased 10+ pack years Cigarette Smoking worse then Pipe or Cigar Carcinogens 70+ Damage and Loss of Cilia Smoking Cessation: Normal Lung Growth replaces damaged cells 15 years of smoking cessassation = Non-Smoker Passive Smoking - Living w/ smoker increases risk 24%

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Lung Cancer: Diagnostic Studies

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- Chest X-Ray - CT - MRI - Biopsy Bronchoschopy Needle Biopsy Open Biopsy (VATS) - Thoracenttesis

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Lung Cancer: Collaborative Therapy

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• Surgery • Radiation therapy • Chemotherapy • Biologic and targeted therapy • Prophylactic cranial radiation • Bronchoscopic laser therapy • Photodynamic therapy • Airway stenting • Cryotherapy

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Lung Cancer is the ___ Common cause of cancer

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2nd Prostate: Men Breast: Women

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Lung Cancers is the _____ cause of cancer deaths in men and Women

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Leading

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Average Age for Lung Cancer Dx:

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70

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Small-cell Lung Cancer

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Very Aggressive Seen more in smokers Causes 15% of Lung Cancers

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Non-Small Cell Lung Cancer

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Grows Slowly 85% of Lung Cancers

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Screening for Lung Cancer

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Screening for high-risk patients: This study showed a 20% decrease in deaths from lung cancer in patients who underwent screening with low-dose spiral CT scanning, compared with those who had chest x-rays.

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Only those patients who meet the following criteria should be considered for Lung Cancer screening:

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55 to 74 years old Current or former smokers with at least a 30 pack-year smoking history Former smokers who quit within the past 15 years, no history of lung cancer, not on home O2 therapy.

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Lung Cancer Treatments

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- Surgery - Chemo - Radiation

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Lung Cancer: Surgery for

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NSCLC

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Lung Cancers: Removing part of lobe

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Wedge Resections Segmental Resecstions

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Lung Cancer: Remove Whole Lobe

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Lobectomy

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Lung Cancer: Remove Whole Lung

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Pneumonectomy

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Complications of radiation therapy include

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Esophagitis Skin irritation Nausea and vomiting Anorexia Radiation pneumonitis

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Chemotherapy is the primary treatment for

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SCLC. In NSCLC, chemotherapy may be used in the treatment of nonresectable tumors or as adjuvant therapy to surgery.

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Nursing diagnoses: lung cancer

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•Ineffective airway clearance •Anxiety •Ineffective self-health management •Ineffective breathing pattern •Impaired gas exchange

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Thoracotomy

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surgical incision into the chest to gain access to the heart, lungs, esophagus, thoracic aorta, or anterior spine. The two most common approaches to a thoracotomy are the medial sternotomy and the lateral thoracotomy.

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The medial sternotomy involves

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splitting the sternum primarily used for surgery involving the heart.

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The lateral thoracotomy

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Incision can be done by posterolateral or anterolateral incision. Lewis, Sharon L.; Dirksen, Shannon Ruff; Heitkemper, Margaret M.; Bucher, Linda (2014-03-14). Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume (Page 548). Elsevier Health Sciences. Kindle Edition.

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The posterolateral incision is used for most surgeries involving

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the lung.

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The posterolateral incision is made from front to back at the level of the:

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fourth, fifth, or sixth intercostal space Strong mechanical retractors are used to separate the ribs.

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The anterolateral incision is made in the

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fourth or fifth intercostal space from the sternal border to the midaxillary line. This procedure is commonly used for surgery or trauma victims, mediastinal operations, and wedge resections of the upper and middle lobes of the lung.

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Thoracotomy (not involving lungs)

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Incision into thorax for surgery on other organs Hiatal hernia repair, open heart surgery, esophageal surgery, tracheal resection, thoracic aorta repair Postoperative care related to thoracotomy and to primary reason for surgical procedure; need chest tubes postoperatively.

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Video-assisted thoracoscopic surgery (VATS)

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VATS done under general anesthesia in operating room. Procedures performed using VATS include lung biopsy, lobectomy, resection of nodules, repair of fistulas Video-assisted technique with a rigid scope with a distal lens inserted into the pleura and image shown on a monitor screen. Allows surgeon to manipulate instruments passed into the pleural space through separate small intercostal incisions.

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NURSING ASSESSMENT Lung Cancer Subjective Data

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Important Health Information Past health history: Secondhand smoke, Airborne carcinogens Other pollutants Medications: Cough medicines or other respiratory medications Functional Health Patterns Health perception-health management: Smoking history, including amount per day and number of years family history of lung cancer frequent respiratory tract infections Nutritional-metabolic: Anorexia, nausea, vomiting, dysphagia (late); weight loss; chills Activity-exercise: Fatigue; persistent cough (productive or nonproductive); dyspnea at rest or with exertion, hemoptysis (late symptom) Cognitive-perceptual: Chest pain or tightness, shoulder and arm pain, headache, bone pain (late symptom)

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Lung Cancer: Objective Data

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General: Fever, neck and axillary lymphadenopathy, paraneoplastic syndrome (e.g., syndrome of inappropriate ADH secretion) Integumentary: Jaundice (liver metastasis); edema of neck and face (superior vena cava syndrome), digital clubbing Respiratory: Wheezing, hoarseness, stridor, unilateral diaphragm paralysis, pleural effusions (late signs) Cardiovascular Pericardial effusion, cardiac tamponade, dysrhythmias (late signs) Neurologic: Unsteady gait (brain metastasis) Musculoskeletal: Pathologic fractures, muscle wasting (late)

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Lung Cancer: Planning Goals

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Effective Breathing Patterns Adequate Airway Clearance Adequate Oxygenation of tissues Minimal to Low Pain Realistic Attitude about Treatment

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Lung Cancer: Health Promotion

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- Smoking Cessation

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CT: Nursing Responsibilieites

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Contrast medium IV. BUN and serum creatinine to assess renal function. Assess if patient is allergic to shellfish (iodine) Patient is well hydrated before and after procedure Warn patient that contrast injection may cause a feeling of being warm and flushed. Instruct the patient that he or she will need to lie still on a hard table and the scanner will revolve around the body with clicking noises.

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Ventilationperfusion (V/Q) scan

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Used to assess ventilation and perfusion of lungs. IV radioisotope given to assess perfusion. For the ventilation portion, the patient inhales a radioactive gas (xenon or krypton), which outlines the alveoli. Normal scans show homogeneous radioactivity. Diminished or absent radioactivity suggests lack of perfusion or airflow. Ventilation without perfusion suggests a pulmonary embolus.

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Ventilationperfusion (V/Q) scan: Nursing Responsibilities

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Same as for chest x-ray. No precautions needed afterward because the gas and isotope transmit radioactivity for only a brief interval.

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Bronchoscopy

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Flexible fiberoptic scope is used for diagnosis, biopsy, specimen collection, or assessment of changes. Suction mucous plugs, lavage the lungs, or remove foreign objects.

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Bronchoscopy: Nursing Responsibilities

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NPO 6-12 hr Give sedative if ordered. After procedure, keep patient NPO until gag reflex returns. Monitor for recovery from sedation. Blood-tinged mucus is not abnormal. If biopsy was done, monitor for hemorrhage and pneumothorax.

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Transthoracic needle aspiration (TTNA)

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- Lung Biopsy - Performed in the bronchoscopy suite - Under CT guidance in radiology department

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Transthoracic needle aspiration (TTNA): Nursing Responsibilities

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Check breath sounds q4hr for 24 hr and report any respiratory distress. Check incision site for bleeding. Chest x-ray should be done after TTNA or transbronchial biopsy to check for pneumothorax.

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Video-assisted thoracoscopic surgery (VATS)

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- Lung Biopsy - Performed in the bronchoscopy suite or OR

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Video-assisted thoracoscopic surgery (VATS): Nursing Responsibilities

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- Chest tube may be in postprocedure until lung has reexpanded. Monitor breath sounds to follow chest reexpansion. Encourage deep breathing for lung reinflation.

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Open Lung Biopsy

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- Performed in OR

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Obstructive Sleep Apnea

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- Partial or Complete upper airway obstruction during sleep

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Apnea

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Cessation of spontaneous respirations lasting longer than 10 seconds and occurs 5x an hour

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OSA is characterized by:

answer

Loud Snoring

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What needs to be done to Dx Sleep Apnea

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- Sleep Study

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OSA Causes:

answer

- Obesity - Age - Smoking Hx - Neck Size

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OSA: S/S

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- Tired During day - Morning Headache - Poor Concentration - Lack of Energy - Forgetfulness - Sexual Dysfunction - Depressed Mood - Irritability - Weight Gain

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OSA: Complications

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- HTN - R-Sided HF - Dysrhythmias

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OSA: Treatments

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Oral Appliance CPAP BiPAP Surgery

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OSA: BMI

answer

28+

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OSA: Age

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65+

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OSA: Neck Circumference

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17 inches

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OSA: Conservative Treatments

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- Side Sleeping - HOB Elevation - Avoid Alcohol and Sedative 4 hours before bed - Sleep Meds can make worse

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When Hospitalized be careful of:

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-Opioids - Sedation Meds

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OSA: Surgical Treatment Post-Op

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- Airway obstruction or hemorrhage occur most often in the immediate postoperative period. - Discharged home within 1 day. - Throat will be sore - May have a foul breath odor that may be reduced by rinsing with diluted mouthwash and then salt water after several days. - Snoring may persist until the inflammation has subsided.

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Pneumothorax

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Air entering pleural cavity

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Pneumothorax Manifestations:

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- Dyspnea, -Decreased movement of involved chest wall - Diminished or absent breath sounds on the affected side - Hyper resonance to percussion

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Pneumothorax Interventions

answer

- Chest Tube with flutter valve

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Simple Pneumothorax

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Small

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Spontaneous Pneumothorax

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No obvious cause

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What usually causes Sponatanues Pneumothorax:

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- Rupture of small blebs at apex of lungs

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What is a bleb:

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Air-Filled Blisters in visceral pleural layers Smoking increases Blebs

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Pneumothorax : Risk Factors

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- Tall and Skinny - Smoker - Male - Family Hx - Previous Pnemothorax

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Common Causes of Blebs:

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Spontaneous or Secondary Spontaneous Pneumothorax: from Lung Diseases

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Hemothorax

answer

blood in pleural space

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Hemothroax Manifestations

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- Dyspnea - Diminished or absent breath sounds - Dullness to percussion - Decreased Hgb - Shock depending on blood volume lost

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Hemothroax Interventions

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- Chest tube insertion with chest drainage system. - Autotransfusion of collected blood, - Treatment of hypovolemia as necessary.

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Open Pneumothorax

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air entering through opening in chest wall

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Small Pneumothorax: S/S

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- Mild Tachycardia - Dyspnea

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Large Pneumothorax: S/S

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- Respiratory Distress - Shallow, Rapid Respirations - Dyspnea - Air Hunger - O2 Desaturaton - Chest Pain - Cough

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Pneumothorax: Auscultation

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No Breath sounds over affected area

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Iatrogenic Pneumothorax is:

answer

laceration or puncture during medical procedures.

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Leading cause of iatrogenic pneumothorax.

answer

Transthoracic needle aspiration

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iatrogenic pneumothorax: Other causes

answer

- Subclavian catheter insertion - Thoracentesis - Pleural biopsy - Transbronchial lung biopsy - Barotrauma from excessive ventilatory pressure during manual or mechanical ventilation can rupture alveoli or bronchioles. - Esophageal procedures may also be involved in the development of a pneumothorax. - Tearing during insertion of a gastric tube can allow air from the esophagus to enter the mediastinum and the pleural space.

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Traumatic Pneumothorax

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- Open or Closed

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Traumatic Pneumothorax: Emergency Treatment

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- Cover Wound with Occulsive Dressing that is secure on 3 sides - Do not remove object - Stbilize impaled object with bulky dressing

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Thoracentesis:

answer

can be used to aspirate air in small Pneumothorax

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EPB: Lung Cancer Non-Pharm interventions

answer

- Exercise - Nutrition - Breathlessness and Pain Management - Progressive Muscle Relaxation - Foot Reflexology - Counseling Decrease Anxiety, Depression and breathlessness symptoms

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