I.

Introduction

Lung cancer is a disease of uncontrolled cell growth in tissues of the lung. This
growth may lead to metastasis, which is the invasion of adjacent tissue and infiltration
beyond the lungs. Lung cancer affects almost 1.35 million people worldwide and it is
responsible for the 1.3 million cancer-related deaths annually. The most
common symptoms are shortness of breath, coughing (including coughing up blood), and
weight loss.

The main types of lung cancer are small cell lung carcinoma and non-small cell
lung carcinoma. This distinction is important, because the treatment varies; non-small
cell lung carcinoma (NSCLC) is sometimes treated with surgery, while small cell lung
carcinoma (SCLC) usually responds better to chemotherapy and radiation.

Worldwide, lung cancer is the most common cancer in terms of both incidence
and mortality (1.35 million new cases per year and 1.18 million deaths). The population
segment most likely to develop lung cancer is over-fifties who have a history of smoking.
It is the leading cancer-related cause of death. In contrast to the mortality rate in men,
which began declining more than 20 years ago, women's lung cancer mortality rates have
been rising for over the last decades, and are just recently beginning to stabilize. Among
lifetime nonsmokers, men have higher age-standardized lung cancer death rates than
women.

Not all cases of lung cancer are due to smoking, but the role of passive smoking is
increasingly being recognized as a risk factor for lung cancer—leading to policy
interventions to decrease undesired exposure of nonsmokers to others' tobacco smoke.
Emissions from automobiles, factories, and power plants also pose potential risks.

Lung cancer incidence is currently less common in developing countries. With

increased smoking in developing countries, the incidence is expected to increase in the
next few years, notably in Asia Pacific Region. According to the Philippine Cancer
Society, approximately 17,238 new local cases were diagnosed in the recent years and
almost 9,000 of these cases are men under 50 years of age. Lung cancer incidence has an
inverse correlation with sunlight and UVB exposure. One possible explanation is a
preventative effect of vitamin D

From the 1950s, the incidence of lung adenocarcinoma cancer started to rise
relative to other types of lung cancer. This is partly due to the introduction of filter
cigarettes. The use of filters removes larger particles from tobacco smoke, thus reducing
deposition in larger airways. However the smoker has to inhale more deeply to receive
the same amount of nicotine, increasing particle deposition in small airways where
adenocarcinoma tends to arise.

Smoking, particularly of cigarettes, is by far the main contributor to lung

cancer. Across the developed world, almost 90% of lung cancer deaths are caused by
smoking. Among male smokers, the lifetime risk of developing lung cancer is 17.2%;
among female smokers, the risk is 11.6%. This risk is significantly lower in nonsmokers:
1.3% in men and 1.4% in women. Cigarette smoke contains over 60 known
carcinogens, including radioisotopes from the radon decay sequence, nitrosamine,
and benzopyrene. Additionally, nicotine appears to depress the immune response to
malignant growths in exposed tissue.

The length of time a person smokes, as well as rate of smoking increases the
person's chance of developing lung cancer. In the case of Mr. D.S.M. , he has been
smoking cigarettes for 31 years which indicates that him having lung cancer was very
feasible. If a person stops smoking, this chance steadily decreases as damage to the lungs
is repaired and contaminant particles are gradually removed. In addition, there is
evidence that lung cancer in never-smokers has a better prognosis than in smokers, and
that patients who smoke at the time of diagnosis have shorter survival times than those
who have quitted.

We have chosen Lung Cancer as our case because it is progressive, lethal, and has
a very significant correlation with smoking which, in our society, is very common
especially with teenagers and college students. We would like to enlighten ourselves and
our fellow students in the fatal consequences of smoking to our body through this case.
http://www.cnetwork.org.ph/media.asp?section=news&id=48
II. Personal Data

Name: Mr. D.S.M.

Age: 61 years old
Address: Wawa, Abucay, Bataan.
Birth date: November 3, 1948
Place of Birth: Tortugas, Balanga City, Bataan
Sex: Male
Civil Status: Married
Nationality: Filipino
Religion: Roman Catholic
Chief Complaint: DOB (Difficulty of Breathing) one month prior to admission
Date of Admission: 8:55 am, November 14, 2009
Attending Physician: Dr. Joseph Malixi
Admitting Diagnosis: CHF (Congestive Heart Failure)
III. Personal-Social History

Mr. D.S.M. is the third of the five children of Mr. and Mrs. M. Mr. D.S.M.
has been happily married for forty years and gave rise to his six children. Presently, he
and his wife are staying with their youngest daughter’s house together with her own
family.

Mr. D.S.M., was a very lively and outgoing type of person. When he was just a
little boy, he recalls that when school was over, he goes near the river with his friends, to
try and catch some fish with makeshift spears and if they give it to their mothers to be
dinner. Also, Mr. D.S.M. was able to recollect that in his teenage years, he goes with his
friends headed for other towns to go and meets some girls. And at the age of 17, he was
able to learn to drink alcoholic beverages. As he remembers, he was able to consume 3 to
4 bottles of 500 ml beer and a bottle of hard liquor every time he drinks with his friends.

Mr. D.S.M. learned how to fish from his father when he was 15 years old;
according to him he was enforced to carry the tradition of being a fisherman in their
family. He refused to go along with his father’s plans for him becoming a fisherman, he
insisted that he wanted to finish college to be something else, somebody that doesn’t
involve fishes and fishing, he wanted to become a teacher. But to become a teacher, he
needs to work before he could even enter college. He became a welder for 8 months, but
hard labor and exhaustion from working made him realize that being a welder isn’t worth
any more his time. This is also the reason why he was not able to enter college. So when
he was 30 years old, his father gave him a boat and used it to catch fish in the waters of
Abucay. At age 30 also, he stopped drinking alcohol but started smoking. His daughter
claimed that her father can sometimes consume one pack of cigarette in a day. He had
been a fisherman for 15 years. At the age of 45, he stopped fishing because he
experienced pain on the knees.

Since he doesn’t work anymore, he spends most of his time at home. He was the
one to take care of his grandchildren when his daughter is not around. Mr. D.S.M. usually
eats four times a day and is fond of eating fatty and salty foods. His favorite food is
“sinigang na baboy”. After eating in the morning, he usually go outside their house to see
his friends. He sometimes go to his other daughter’s house in also in Abucay. In the
afternoon, he takes a nap for at least two hours. In the evening, he watches television for
a while. he goes to bed early but falls asleep at around twelve midnight. He usually wakes
up at five in the morning.
IV. Present Medical History

Prior to admission, Mr. DSM was experiencing difficulty of breathing with

productive cough that is recurrent for 1 month; it is also accompanied by chest pain. This
is the cause of his sleep disturbances. His daughter also noticed some changes in his skin
color that looked pale and his fingers including his nails are somewhat pale and bluish in
color also. There is also swelling in his lower extremities. November 13, 2009, he
consulted a urologist (Dr. Felizaedo Angulo) through OPD section. He undergone
urinalysis and the doctor said he is negative of urinary tract infection. he was suggested to
undergo a cardio clearance and was referred to Dr. Honesto del Rosario. Because he
doesn’t have enough money at that time, he was not able to comply. Instead, he just went
to Bataan General Hospital for cardio clearance hoping that it would be a lot cheaper. But
the admitting physician (Dr. Malixi) suggested admitting him for further observation.
November 14, 2009 at around 8:55 in the morning the patient was admitted in the
Medical Ward under the care of Dr. Joseph Malixi.
Upon admission he was given an IV fluid of D5W infusing at the left hand
regulated at 10-11 gtts/ min and an O2 inhalation via nasal cannula at 1-2 lpm.
V. Past Medical History

According to Mr. DSM, he didn’t know if he was completely immunizes when he

was still a child. He had chickenpox, mumps and measles when he was in his elementary
years. He was circumcised at the age of 12. He claimed that he doesn’t get seriously sick.
He only had colds, cough and fever when he was still young. He has never been
hospitalized.

At the age of forty five, he said that he experienced having knee joint pains. This
is the reason why he stopped from fishing. He never sought any medical advice. When in
pain, he will just apply liniment like efficascent oil and just take some medications like
mefenamic acid like dolfenal and alaxan to ease the pain. Sometimes this medication
work but they also fail often. When this happens and he doesn’t have anything to do, he
will just consult a hilot to massage the area.

He also told us that two years ago (2008), he experienced painful urination and
always felt like he could not empty his bladder when he urinates for a week. He said that
he had dark yellow, concentrated urine but also decided not to seek any medical advice.
He tried to drink buko juice as what others tell him to do but it did not work. When he
could no longer tolerate the condition and started having fever and flank pain for two
days, he fainted. This is when he also consulted an urologist (Dr. Felizardo Angulo) and
he was diagnosed with severe urinary tract infection. The doctor gave him medication but
he cannot recall the name of the drugs.
VI. Family Medical History

Mr. DSM’s family has history of many diseases like cardiac arrest, ulcer,
hypertensive, arthritis, rheumatic heart disease and cancer.

Mr. DSM’s grandfather died because of cardiac arrest at the age of 64. His
grandmother died of unknown cause/disease. His father died with ulcer at the age of 79
and his older brother died at the age of 58 because of ulcer also. His other brother is
hypertensive. His aunt acquired cervical cancer and died at the age of 50. Mr. DSM’s
mother is still alive and is hypertensive. His younger sister, Marina Flores was admitted
in the same hospital one day before he was admitted because of rheumatic heart disease.
VII. Theoretical Framework

Theory of Lydia Hall (Care, Cure, Core Theory)

Lydia Hall’s model for nursing provides a framework to encourage open

communication between patients and nurses. The model has three interrelated circles that
represent medical and clinical management nurses give to patients.

The care circle is the intimate care nurses provide to patients to assist in bathing,
dressing and assistance with daily activities. The disease management and treatment of
the patient is addressed in the cure circle of the framework. The core circle symbolizes
the emotional and social structure of the patient. The model is not static, but rather the
patient can be in an individual circle or the circles can overlap depending on the needs of
the patient during management of their disease. Patients who have their care, cure, and
core needs met have improved self-esteem and awareness of the importance of disease
management and improved quality of life. The care, cure, core model provides an
opportunity for patients to develop trust and communicate their fears and concerns in
relation to disease management.

The care model dominates when nurses provide hands on care to patients with
lung cancer. Hands on care for patients produce an environment of comfort and trust and
promotes open communication between nurses and patients. Open communication
encourages expressions of thoughts and fears and decreases anxiety. Patients develop
feelings of security and verbalize concerns of disease management, emotional, and/or
social issues in relation to the lifestyle changes they are experiencing secondary to lung
cancer.

The cure model dominates when nurses perform physical assessments and care
management plans for lung cancer patients. During this phase, nurses assess patients’
ability to perform activities of daily living based on physical changes that occur during
walking, talking or bathing. Nurses monitor patients fatigue level, respiratory status,
blood pressure and oxygen saturation to determine patients’ tolerance level and need for
supplemental oxygen.

The core model of the framework dominates when nurses and patients are able to
discuss emotional concerns and distress to physical and mental changes due to patients’
disease process. Patients address emotional concerns and distress due to their perceived
ability or inability to manage their disease, living alone, and general fear of their disease
process. These emotions and concerns effect compliance to the medical plan and quality
of life. An essential role of nurses in the healthcare plan is to assist with management of
lung cancer patients by providing medical, physical, and social care.

• We also chose the theory of Lydia Hall which is The Care, Cure, Core
Theory because we believe that as nurses, we should provide medical,
physical and social care to the patient. Since his condition is lung cancer
and we know that chances of survival from this is very low, nurses should
play an important role to at least make the patient feel better. We should
care for them physically by assisting them in doing light activities to avoid
aggravation of the condition. We should also be sure that all the doctor’s
orders are done carefully to make patient feel that he is given enough
attention. We chose this theory because it also teaches us on how we can
show empathetic support to the patient and to his family.
VIII. Patterns of Daily Living

Activities Before Hospitalization During Hospitalization

NUTRITION According to his daughter,

a. height and weight he eats abundantly four
BMI times a day. He eats all
=wt. (kg) / ht (meter) 2 types of food especially
=70 kg. / (1.7 m) 2 those that are salty like
=24.22 chicharon and fatty foods
like sinigang na baboy. He
b. times (meals) can consume three cups of
c. frequency (feeding) rice per meal. He drinks 8-
d. how much food 10 glasses of water per day
e. intake and output and can consume 2-3 cups
f. IV fluids given of coffee and 1-2 bottles of
soda per day.
During hospitalization, the
patient is in low salt low fat
diet as ordered by the
doctor. He was given an
intravenous fluid of D5W
one liter to run for 24 hours
and is regulated at 10-11
gtts/min. due to
hospitalization, the patient
loses his appetite. He was
also instructed to control his
fluid intake to at least 1 liter
for the whole day to prevent
aggravation of his edema.

ELIMINATION
• Bowel The patient has regular During hospitalization the
a. color bowel movement. He patient was not able to
b. odor defecates once a day. He defecate.
c. amount has hard, yellowish stool
d. consistency with distinct odor.
e. frequency

HYGIENE
a. skin care The patient said that he During hospitalization,
b. hair care takes a bath everyday and since the patient is unable to
c. oral care brushes his teeth at least take a bath, he just received
d. eye care three times a day. He cleans sponge bath and changes his
e. ear care his ears once a week. He clothes after every session.
f. nose care cuts his nails when they
appeared long already.
BATHING
g. perineal-genital care
h. foot care
i. nail care
RECREATION The patient spends much of The patient spends his time
his time at home since he is in the hospital by chatting
jobless. He watches TV and with his relatives and to
takes care of his other patients.
grandchildren. He takes a
nap every afternoon or
whenever he feels he wants
to do so. He stands by
outside their house and chat
with his friends when he is
not busy
IX. Physical Assessment

DAY 1
(November 14, 2009)

3:00 P.M 4:00 P.M.

BP - 110/80 mmHg BP - 130/100 mmHg

Temp.-37ºC Temp.-37.2ºC
PR-89 PR-90
RR-26 RR-25

6:00 P.M. 8:00 P.M.

BP-120/90 mmHg BP-110/90 mmHg

Temp.-36.8ºC Temp.-37.3ºC
PR-98 PR-81
RR-32 RR-27
 INTAKE OUTPUT
TIME IVF ORAL TOTAL URINE STOOL
3:00-4:00 50 cc 120 cc 170 cc 25 cc -
4:00-6:00 70 cc 240 cc 310 cc 60 cc -
6:00-8:00 80 cc 100 cc 180 cc 40 cc -
200 cc 460 cc 660 cc 125 cc 0

Part Technique Findings Analysis

SKIN
Color Inspection Pale Decrease blood supply
Turgor Palpation Wrinkled skin As person ages the
skin’s turgor
decreases because of
the decrease activity
of subcutaneous
glands w/c results in
dry wrinkled skin.
Moisture Palpation Dry Poor hygiene
Texture Palpation Rough Because of decrease
skin turgor.
NAILS and
FINGERS
Appearance Inspection Dirty Poor hygiene
Inspection Pale to bluish Poor Blood Supply
Capillary Refill Inspection 2-3 sec. Normal
BODY HAIR
Appearance Thin and Minimal Normal
Black
HEAD
Shape Inspection Round Normal
FACE
Appearance Inspection Symmetrical face Normal
HAIR
Color Inspection Gray Hair Loss of melanin in
hair shaft w/c causes
graying.

Appearance Inspection Shiny and Oily Poor Hygiene

SCALP
Appearance Inspection Without Dandruff Normal
Palpation No lesions or deformities Normal
Texture Palpation Smooth but oily Poor hygiene
EYES
Sclera Inspection Clear or white Normal

Iris Inspection Brown Normal

Conjunctiva Inspection Pale Decrease RBC w/
laboratory test of
3,120,000 cubic mm.
EARS
Symmetry Inspection Symmetrical Normal
Appearance Inspection Without Cerumen Normal
NOSE
Nares Inspection Symmetrical with presence Normal
of hair
Septum Located at the midline Normal
X. Laboratory/ Diagnostic Exam
MOUTH
Lips Inspection Dark outer and inner lips Because of prolonged
Diagnostic/ smoking. Analysis and
Lab Procedures Date OrderedDry Indications/ Poor Hygiene
Results Normal Values Interpretation
Teeth Inspection No dentures Normal
Purposes
Absence of some teeth Aging
Hematology Nov. 14, 2009 The CBC is used for
Yellowish Because of nicotine
• WBC the following 6,000 mm3 5,000-10,000 mm3 • Within normal values.
from the cigarette
Gums Inspection purposes:
Dark red-violet Vitamin C deficiency
Tongue Inspection Presence of more thantest
•as a preoperative pink 3,120,000
Normalmm3 4,600,000–6,200,000 mm3
• RBC • Decreased level of RBC is associated
Mucosa Inspection Pinkish, symmetrical Normal
to ensure both with decrease level of hemoglobin and
NECK
Appearance Inspection adequate oxygen
Symmetrical Normal oxygen transport from the lungs to the
Adam's Apple
carrying is at theand
capacity center Normal tissues. Because of this, organs may fail
Jugular veins are not distended Normal
homeostasis. to function properly.
THORAX
Appearance Inspection Symmetrical Normal
Sound Auscultation Presence of Adventitious
•to identify persons Because of productive
Breath
whosounds
may have an 8.7cough.
mg/dL 13-18 mg/dL • Decreased of it may cause inadequacy
• Hgb
Absence of Extra Heart sounds Normal
infection. of oxygen in blood circulating around
BACK
Appearance Inspection Symmetrical Normal the body. When this happens, tissue
Absence of Bedsores
•to diagnose anemia. Normal
may die and organs will function
ABDOMEN
Appearance Inspection Symmetrical Normal improperly
•to identify acute and
Sounds Auscultation Presence of illness,
chronic Bowel Sounds Normal
UPPER
bleeding tendencies,
EXTREMITIES
Appearance Inspection Symmetrical Normal
With Scars Normal
No Wounds Normal
Presence of IV at left dorsal Medical Intervention
 and white blood cell
disorders such as 27% Male: 40-50% • Since there is water retention,
Hct leukemia. Female: 37-47% hematocrit level decreases and it is
being diluted by the body fluids
•to monitor treatment especially water. Patient will be at risk
for anemia and other of having anemia because of this.
blood diseases. 30.1% 25-33%
Lym
Hematology

Date ordered: Nov. 14, 2009

TESTS NORMAL VALUES RESULTS INTERPRETATION ANALYSIS

BUN 10-20 mg/dL 17 mg/dl Normal level

Reduced blood flow to the kidney
CREATININE 0.7 – 1.4 mg/dl 2.8 mg/dl Above normal level due to shock, dehydration,
congestive heart failure,
atherosclerosis, or complications
of diabetes
Kidney isn’t properly fixing
SODIUM 135 – 145 mEq/L 207.4 Above normal level therefore, excretion, absorption,
and filtration is impaired causing
increased levels of waste materials
inside the body including
creatinine.
Potassium decreases because
POTASSIUM 3.5– 5.0 mEq/L 3.22 Below normal level sodium increases.

CHLORIDE 95 – 103 mEq/L 103.0 Within normal level

Lipid Profile

Date ordered: November 14, 2009

 XI. Anatomy and Physiology

Introduction.
The respiratory system includes tubes that remove particles from incoming air and

TESTS NORMAL VALUES RESULTS INTERPRETATION ANALYSIS

FBS 64 – 100 mg/dL 5.09 Within normal level

Due to impaired HDL

CHOLESTEROL < 200 mg/dL 314 Above normal level
& LDL ratio.

TRIGLYCERIDE 100 – 200 mg/dL 380 Above normal level Increased of it is

caused by obesity,
alcohol use and stress.

HDL 30 – 75 mg/dL 52.2 Within normal level

There is a very high

LDL 66 – 178 mg/dL 328.96 Above normal level
risk of developing a
heart disease
transport air to and from lungs and the air sacs where gases are exchange. Respiratory is
the entire process of gas exchange between the atmosphere and body cells.
Respiratory is biological system for all organisms that involve gas exchange.
Body tissues received the oxygen by respiratory system and the rate of oxygen is
increased during exercise.

ORGANS OF THE RESPIRATORY SYSTEM

Organs of the Respiratory System.
The organs of the respiratory system can be divided into two groups. The upper
respiratory tract includes the nose, nasal cavity, and pharynx and the lower respiratory
tract includes the larynx, trachea, bronchial tree and lungs.

THE UPPER RESPIRATORY THE LOWER RESPIRATORY

NOSE LARYNX

NASAL CAVITY BRONCHIAL TREE

PHARYNX LUNGS
NOSE.

Bone and cartilage support nose internally. Its two nostrils are openings through
which air can enter and leave the nasal cavity. Many internal hairs guard the nostril for
preventing entry large particles carried in the air.

NASAL CAVITY
 The nasal cavity is a hollow space behind the nose. The nasal septum, composed
of bone and cartilage, divides the nasal cavity into right and left portions. Nasal conchae
are bones that curl out from the lateral walls of the nasal cavity on each side, dividing the
cavity into passageways. Nasal conchae also support the mucous membrane that line the
nasal cavity and help increase its surface.

The mucous membrane filters, warms, and moistens incoming air. Ciliary action carries
particles trapped in mucus to the pharynx, where they are swallowed.

PHARYNX.

The pharynx or throat is behind the oral cavity, the nasal cavity and the larynx. It
is a passageway for food travelling from the oral cavity to the esophagus and for air
passing between the nasal cavity and the larynx. It also helps produce the sounds of
speech.

Pharynx are consists 3 parts. Those are nasopharynx, oropharynx and laryngopharynx.
LARYNX.

The larynx is an enlargement in the airway at the top of the trachea and below the
pharynx. It is composed of muscles and cartilages and is lined with mucous membrane.

The larynx contains the vocal cords, which vibrate from side to side and produce
sounds when air passes between them. Inside the larynx, two pairs of horizontal vocal
folds. The upper folds are called false vocal cords and the lower folds are called true
vocal cords.
The glottis and epiglottis help prevent foods and liquids from entering the trachea.

TRACHEA.

The trachea is a flexible cylindrical tube about 2.5 cm in diameter and 12.5cm in
length. It extends downward anterior to the esophagus and into the thoracic cavity, where
it splits into right and left bronchi.
 A ciliated mucous membrane with many goblet cells lines the trachea’s inner
wall. This membrane filters incoming air and moves entrapped particles upward into the
pharynx, where the mucus can be swallowed.
The cartilaginous rings prevent the trachea from collapsing and blocking the air-
way. The soft tissues that complete the rings in the back allow the nearby esophagus to
expand as food moves through it to stomach

BRONCHIAL TREE.

The bronchial tree consists of branched airways leading from the trachea to the
microscopic air sacs in the lungs. Its branches begin with the right and left primary
bronchi, which arise from trachea at the level of fifth thoracic vertebra. Each primary
bronchus divides into secondary bronchi, which in turn branch into tertiary bronchi and
then into finer and finer tubes.
 Among the smaller tubes are bronchioles that continue to divide, giving rise to
terminal bronchioles, respiratory bronchioles and finally to very thin tubes called
alveolar ducts. These ducts lead to thin-walled outpouchings called alveolar sacs.
Alveolar sacs lead to smaller microscopic air sacs called alveoli.
XIII. Pathophysiology

Non-Modifiable:
Modifiable:
•Age
• Lifestyle (Smoking)
• Gender
• Environmental
• Genetics
• Occupation

Carcinogenics agent will

enter the respiratory
tract

It will attack the epithelial cells/

lining of the lungs

Mutations in the K-RAS proto oncogenes will

contribute to develop non-small cancer cells

Proto-oncogenes will turn into

oncogenes

Chromosomal damage can lead to

heterozygosity

Can cause inactivation of tumor

suppressor genes

NSCC will proliferate due to

inhibition of tumor supressor genes

Formation of tissue mass leading to manifestations of

sign & symptoms like; chest pain, dyspnea and
productive cough.
XIII. Nursing Care Plan
Nursing Care Plan # 1

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

S> “Nahihirapan Ineffective airway Short-term Goal: Independent: Goal met.
akong huminga.” as clearance r/t over  After 30mins-1hr >Monitor respirations R: To monitor airway
claimed. secretion of mucous as of nursing and breath sounds. clearance or The patient’s RR
evidence by productive consideration, accumulation of decreased from 32bpm
O> Weak and pale cough pt’s RR will dec. secretions. to 29bpm and was able
 with RR of 32 from 32bpm to at >Encourage deep to demonstrate
bpm: tachypneic least 28bpm. breathing and cough R: To promote good behaviors of improved
 with productive  After 30mins. of exercise. circulation and airway clearance.
cough noted nursing expectoration
 with nasal flaring consideration, pt. >Position the client
noted will demonstrate according to comfort R: To maintain open
 with use of behaviors to airway
accessory noted improve airway Dependent”
clearance. >administer O2
inhalation
R: To improve
patient’s oxygenation
 Nursing Care Plan # 2

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

S> “Parang ang bigat Fluid volume excess r/t After 8 hours of Independent: Goal partially met.
ng paa ko.” as claimed. compromised nursing intervention,  Elevate edematous R: to reduce tissue
regulatory mechanism the pt. will have a extremities and perfusion and risk of Patient was able to
O> weak and pale in as evidenced by stabilized fluid volume change position skin great barrier stabilize fluid volume
appearance edema. as evidenced by frequently. breakdown as evidenced by vital
> edema on both balanced I & O and  Set an appropriate signs within client’s
lower extremities vital signs within rate of oral fluid R: to prevent picks or normal limits.
 lab: serum clients normal limits intake throughout valleys in fluid level
sodium= 24-hour period. and thirst.
507.4mEq/l
 grade 3 pitting  Instruct patient to
bipedal edema increase protein
 redness on soles intake R: To increase oncotic
of the feet  Monitor I & O pressure
 weight= 70 kg
R: to evaluate level of
cardiac functioning
and the degree of fluid
and electrolyte
imbalance
 Weigh daily or on a
regular schedule, as R: it is a more
indicated sensitive indicator of
fluid balance and
provides as
comparative baseline.
 Nursing Care Plan # 3
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
S> “Hinahapo ako”, as Fatigue r/t decrease After 8 hours of giving Independent: Goal met. Patient
claimed. hemoglobin level as nursing intervention,  Monitor assess R: to evaluate fluid reported improvement
evidence by CBC the pt., will report vital signs status and in sense of energy.
O > weak and pale in results of hgb. (mg./dL) improved sense of cardiopulmonary
appearance energy. response to activity
> with RR of 32 bpm
> with hgb results of  Encourage R: to promote energy
8.7mg/dL nutritionally consumption through
dense easy to foods.
prepare foods.

 Encourage use R: to conserve energy

of assistive and avoid any
devices. possible accident

Dependent
• Administer O2 R: To improve
inhalation as patient’s oxygenation
ordered by the
admitting
physician
 Nursing Care Plan # 4

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

S> “Nahihirapan Impaired gas exchange Within 3-4 hours of Independent: Goal met.
akong huminga.” as r/t damaged lung proper nursing  Monitor vitals R: serves as
claimed. capillary sac secondary interventions the patient signs specially baseline data After 3-4hrs of nursing
to lung cancer will demonstrate RR, BP and PR. intervention, the pt. was
O> weak and pale in improved ventilation  instruct patient able to demonstrate
appearance and adequate to avoid improved ventilation
> RR of 32bpm; oxygenation and remain activities that R: to prevent and adequate
Tachypneic free from signs and increases further imbalance oxygenation and remain
>Decrease RBC symptoms of cardiac work between O2 free from signs and
with values of 3.12x12/L respiratory distress. load demand and supply symptoms of
>Decrease Hgb with  position into respiratory distress.
values of 8.7mg/dL After 8hours of nursing semi-Fowlers
>with use of intervention, the position R: to promote lung Goal partially met.
accessory muscle noted patient’s RR will expansion and
>with nasal flaring decrease from 32 Dependent: proper ventilation After 8hours of nursing
noted breaths per minute to at  administer O2 intervention, the
>with capillary refill least 28 breaths per inhalation patient’s RR decreased
of 4-5secs. minute. R: to promote good from 32 breaths per
respiration and to minute to 27 breaths per
sustain O2 demand. minute.
 Nursing Care Plan # 5

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

S> “Hindi ako Anxiety r/t perceived Within the shift, the • Encourage R: To identify Goal partially met.
mapakali, baka threat of death. patient will identify and verbalization of contributing factors
mamatay ako sa sakit express feelings freely feelings. related to anxiety. The patient was able to
ko.” as verbalized. and will show positive identify and express
outlook towards reality • Encourage asking R: To give information feelings freely.
O>poor eye contact after a series of nursing questions in relation and avoid
>restlessness interventions. to current health misconceptions
>irritability status.
>increase RR
• Provide calm, fresh, R: To promote
and peaceful relaxation
environment.

• Assist to engage R: To reduce guilt

spiritual growth feelings of guilt and
activities and allow conflicts to move
forgiveness to heal forward towards
past hurts. resolution

• Provide
opportunities to R: To enhance sense of
make decisions. control
 XIV. Drug Study
ACTUAL ADVERESE
GENERIC NAME ACTION INDICATION CONTRAINDICATION SIDE EFFECTS EFFECT NURSING CONSIDERATION

GENERIC NAME • Anuria vertigo, Dizziness, • To prevent nocturia, give

• acute
Furosemide >inhibits • hepatic coma & precoma dizziness, Headache preparation in the morning and
pulmonary edema
reabsorption of 20 • severe hypokalemia &/or headache, food to prevent G.I upset.
• hypertension
BRAND NAME to 30% of sodium hyponatremia paresthesia, • Watch for signs of hypokalemia
Lasix and chloride at the • hypovolemia w/ or w/o orthostatic • inform patient of possible need
CLASSIFICATION ascending limb of hypotension hypotension, for potassium or magnesium
Diuretics (loop) loop of Henle thrombophlebitis, rich foods or supplements
• Hypersensitivity to
DOSAGE It increases abdominal pain, • Instruct patient to rise slowly
furosemide or sulfonamides
potassium
Adult: hypokalemia, when rising to prevent dizziness
excretion and
20mg, 1 ampule plasma volume anemia because of sudden BP decrease
promoting renal
od muscle spasm
excretion of water,
sodium and
chloride,
magnesium,
hydrogen and
calcium.
 ACTUAL ADVERESE
DRUG NAME ACTION INDICATION CONTRAINDICATION SIDE EFFECTS EFFECT NURSING CONSIDERATION

GENERIC NAME An analgesic that • Acute alcohol headache • Assess type, location, duration
Indicated for
Tramadol HCl binds to mu- intoxication Frequent: of pain. Effect of medication is
moderate to
opioid receptors • Concurrent use of centrally Dizziness, vertigo, reduced if full pain recurs
moderately
BRAND NAME and inhibits acting analgesics, hypnotics, nausea, before next dose
severe pain
Ultram reuptake of opioids, or psychotrophic constipation, • Monitor pulse
norepinephrine drugs hypersensitivity to headache, • Assess with ambulation if
Classification and serotonin. opioids. somnolence dizziness, vertigo occurs. Dry
Analgesic Reduces the Occasional: crackers, cola may relieve
intensity of pain Vomiting, nausea.
Dosage,frequency, stimuli reaching pruritus, CNS • Palpate bladder for urinary
route, sensory nerve Stimulation ( such retention.
Adults/Elderly: endings. as nervousness,
• Monitor patient’s bowel activity
50mg, 1ampule, IV q8 Therapeutic anxiety, agitation,
and stool consistency
effect: Alters the
for severe pain. tremor, euphoria,
perception and • Advise pt. to avoid alcohol and
emotional response mood swings, and
OTC medications. Since it may
to pain.
hallucinations)
cause drowsiness, dizziness and
asthenia,
blurred vision
diaphoresis,
• Avoid tasks that require
dyspepsia, dry
alertness, motor skills until
mouth diarrhea
response to drug is established.
Rare:
• Inform physician if severe
Malaise,
constipation, difficulty
vasodilation,
breathing, excessive sedation,
anorexia,
seizures, muscle weakness,
flatulence, rash,
tremors, chest pain, palpitations
blurred vision,
occur.
urine retention, or
urinary frequency,
 Republic of the Philippines
BATAAN PENINSULA STATE UNIVERSITY
Balanga Campus
Don M. Banzon Ave. Poblacion, City of Balanga, Bataan
(047) 237 – 3003 (047) 237 – 5477
COLLEGE OF NURSING AND MIDWIFERY

LUNG CANCER
A Case Study

Presented to the Faculty of

College of Nursing and Midwifery

BATAAN PENINSULA STATE UNIVERSITY

In Partial Fulfillment

For the Requirement in the Degree of

BACHELOR OF SCIENCE in NURSING

Submitted by:
Group 23 (ThFS group)

Group Members
Analyn Austria
Mary Rose Cabais
Diane Joy Calpo
Carmela Cando
Irish Cortez
Adrian Van Dionila
Alvin Kenneth Duran
Gayfee Gabriel
Karen Gonzales
Leomar Gonzales
Jessica Hermedia
Karleen Inieto
Kristine Jimenez
Febe Anne Lalic

JANUARY 15, 2010