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Our lungs fuel us with oxygen, the body's life-sustaining gas. They breathe in air, then extract the
oxygen and pass it into the bloodstream, where it's rushed off to the tissues and organs that
require it to function.
Oxygen drives the process of respiration, which provides our cells with energy. The waste gas
carbon dioxide is produced as a byproduct and disposed of when we exhale. Without this vital
exchange our cells would quickly die and leave the body to suffocate.
Since the lungs process air, they are the only internal organs that are constantly exposed to the
external environment. Central to the human respiratory system, they breathe in between 2,100
and 2,400 gallons (8,000 and 9,000 liters) of air each daythe amount needed to oxygenate the
2,400 gallons (9,000 liters) or so of blood that is pumped through the heart daily.
Intricate Construction
Our two lungs are made up of a complex latticework of tubes, which are suspended, on either
side of the heart, inside the chest cavity on a framework of elastic fibers. Air is drawn in via the
mouth and the nose, the latter acting as an air filter by trapping dust particles on its hairs. The air
is warmed up before passing down the windpipe, where it's divided at the bottom between two
airways called bronchi that lead to either lung.
Within the lungs, the mucus-lined bronchi split like the branches of a tree into tens of thousands
of ever smaller tubes (bronchioles), which connect to tiny sacs called alveoli. The average
adult's lungs contain about 600 million of these spongy, air-filled structures. There are enough
alveoli in just one lung to cover an area roughly the size of a tennis court.
The alveoli are where the crucial gas exchange takes place. The air sacs are surrounded by a
dense network of minute blood vessels, or capillaries, which connect to the heart. Those that link
to the pulmonary arteries carry deoxygenated blood that needs to be refreshed. Oxygen passes
through the incredibly thin walls of the alveoli into the capillaries and is then carried back to the
heart via the pulmonary veins. At the same time, carbon dioxide is removed from the blood
through the same process of diffusion. This waste gas is expelled as we breathe out.
The rate at which we breathe is controlled by the brain, which is quick to sense changes in gas
concentrations. This is certainly in the brain's interestsit's the body's biggest user of oxygen
and the first organ to suffer if there's a shortage.
In and Out
The actual job of breathing is done mainly by the diaphragm, the sheet of muscles between the
chest and abdomen. These muscles contract when we breathe in, expanding the lungs and
drawing in air. We breathe out simply by relaxing the diaphragm; the lungs deflate like balloons.
Lungs are delicate organs and vulnerable to a range of illnesses. The most common of these in
Western countries are bronchitis and emphysema, which are often caused by smoking. Tubes
inside the lung become chronically inflamed, producing excess mucus. Smoking can also lead
to lung cancer, the world's major cancer, which is diagnosed in 1.4 million people a year
More about Lungs
The lungs are two spongy organs on your chest. The left lung is divided into two lobes or
sections. The right lung is divided into three lobes. When you breathe in, the air enters your nose
or mouth and passes into your trachea or windpipe. The trachea divides into two bronchi, then
branches into smaller bronchioles. The bronchioles and in tiny air sacs alveoli and here the
oxygen in the air you inhale passes into the bloodstream and carbon dioxide from your body
passes out. The carbon dioxide from your body is expelled from your body when you exhale
your lungs are encased by pleura. A thin membrane to protect them and help them slide back and
forth as you breathe in and out underneath your lungs is the diaphragm, a smooth muscle that
helps your lungs expand and contract as you breath. Your lungs are connected to small
connections of the lymph nodes by way of lymphatic vessels. You have groups of this lymph
nodes in your lungs above your
collarbones and behind your breastbone as well as the other parts of your body. The lymphatic
vessels carry bacteria ,cancer cells and other unhealthy materials away from your lungs and other
organs in a clear fluid called lymph nodes. Lymph nodes filter material out of the lymph.
Lung cancer is the uncontrolled growth of abnormal cells that start off in one or both lungs;
usually in the cells that line the air passages. The abnormal cells do not develop into healthy lung
tissue, they divide rapidly and form tumors. As tumors become larger and more numerous, they
undermine the lungs ability to provide the bloodstream with oxygen. Tumors that remain in one
place and do not appear to spread are known as benign tumors.
Malignant tumors, the more dangerous ones, spread to other parts of the body either through
the bloodstream or the lymphatic system. Metastasis refers to cancer spreading beyond its site of
origin to other parts of the body. When cancer spreads it is much harder to treat successfully.
Primary lung cancer originates in the lungs, while secondary lung cancer starts somewhere
else in the body, metastasizes, and reaches the lungs. They are considered different types of
cancers and are not treated in the same way.
Statistics
According to the World Health Organization (WHO), 7.6 million deaths globally each year are
caused by cancer; cancer represents 13% of all global deaths. As seen below, lung cancer is by
far the number one cancer killer. In the Philippines lung cancer is the leading cancer deaths
reaching to 2.02% or 85818 .Among 192 countries, Philippines ranked as the 80th.Smoking as
the main culprit for lung Cancer, Philippine stands as the most number of smokers among South
east Asian nations with an estimated 17.3 million tobacco consumers.
Prognosis:
Survival rate of limited stage:5 years with treatment and 2 years without treatment
Survival rate for extensive stage:6-12 mos.with treatment and 2-4 mos.without treatment
How is lung cancer classified?
Lung cancer can be broadly classified into two main types based on the cancer's appearance
under a microscope: non-small cell lung cancer and small cell lung cancer. Non-small cell lung
cancer (NSCLC) accounts for 80% of lung cancers, while small cell lung cancer accounts for the
remaining 20%.
NSCLC can be further divided into four different types, each with different treatment options:
Small cell lung cancer (SCLC) is characterized by small cells that multiply quickly and form
large tumors that travel throughout the body. Almost all cases of SCLC are due to smoking.
Symptoms of lung cancer are varied dependent upon the exact location of the tumor and the
extent of its spread. A person with lung cancer may have the following kinds of symptoms:
No symptoms - Up to 25% of people who get lung cancer do not have any symptoms
when the cancer is found. In these cases the cancer is first discovered on a routine chest
X-ray or computerized tomography (CT) scan performed for another reason.
Symptoms related to the cancer - The growth of the cancer and invasion of the lung and
surroundings may lead to symptoms such as cough, shortness of breath, wheezing, chest
pain, and coughing up blood (hemoptysis). If the cancer has invaded nerves, it may
cause shoulder pain that travels down the outside of the arm (called Pancoast syndrome)
or paralysis of the nerves traveling to the vocal cords that leads to hoarseness. Invasion of
the esophagus may lead to difficulty swallowing (dysphagia). If a large airway is
obstructed, collapse of a portion of the lung may occur and cause infections (abscesses,
pneumonia) in the obstructed area.
Symptoms related to metastasis (spread to other organs) - Lung cancer that has spread to
the bones may produce excruciating pain at the sites of bone involvement. Cancer that
has spread to the brain may cause a number of neurologic symptoms that may
include blurred vision, headaches, seizures, confusion or altered thought processes, or
symptoms of stroke.
Paraneoplastic symptoms - Lung cancers frequently are accompanied by so-called
paraneoplastic syndromes that result from production of hormone-like substances by the
tumor cells that are released into the blood. A common paraneoplastic syndrome
associated with one type of lung cancer is the production of a hormone called
adrenocorticotrophic hormone (ACTH) by the cancer cells, leading to oversecretion of
another hormone, cortisol, by the adrenal glands (Cushing's syndrome).
Nonspecific symptoms - Nonspecific symptoms seen with many cancers, including lung
cancers, include weight loss, weakness, and fatigue.
It is important always to consult a doctor if a person develops the symptoms associated with lung
cancer, in particular:
A new persistent cough or worsening of an existing chronic cough
Blood in the sputum
Persistent bronchitis or repeated respiratory infections
Chest pain
Unexplained weight loss and/or fatigue
Breathing difficulties such as shortness of breath or wheezing
The incidence of lung cancer is strongly correlated with cigarette smoking, with about
90% of lung cancers arising as a result of tobacco use. The risk of lung cancer increases
with the number of cigarettes smoked and the time over which smoking has occurred;
doctors refer to this risk in terms of pack-years of smoking history (the number of packs
of cigarettes smoked per day multiplied by the number of years smoked). For example, a
person who has smoked two packs of cigarettes per day for 10 years has a 20 pack-year
smoking history. While the risk of lung cancer is increased with even a 10-pack-year
smoking history, those with 30-pack-year histories or more are considered to have the
greatest risk for the development of lung cancer. Among those who smoke two or more
packs of cigarettes per day, one in seven will die of lung cancer. Pipe and cigar smoking
also can cause lung cancer, although the risk is not as high as with cigarette smoking.
Thus, while someone who smokes one pack of cigarettes per day has a risk for the
development of lung cancer that is 25 times higher than a nonsmoker, pipe and cigar
smokers have a risk of lung cancer that is about five times that of a nonsmoker.
Passive smoking
Passive smoking or the inhalation of tobacco smoke by nonsmokers who share living or
working quarters with smokers, also is an established risk factor for the development of
lung cancer. Research has shown that nonsmokers who reside with a smoker have a 24%
increase in risk for developing lung cancer when compared with nonsmokers who do not
reside with a smoker. The risk appears to increase with the degree of exposure (number of
years exposed and number of cigarettes smoked by the household partner). An estimated
3,000 lung cancer deaths that occur each year in the U.S. are attributable to passive
smoking.
Asbestos fibers
Asbestos fibers are silicate fibers that can persist for a lifetime in lung tissue following
exposure to asbestos. The workplace was a common source of exposure to asbestos
fibers, as asbestos was widely used in the past as both thermal and acoustic insulation.
Today, asbestos use is limited or banned in many countries, including the U.S. Both lung
cancer and mesothelioma (cancer of the pleura of the lung as well as of the lining of the
abdominal cavity called the peritoneum) are associated with exposure to
asbestos. Cigarette smoking drastically increases the chance of developing an asbestosrelated lung cancer in workers exposed to asbestos. Asbestos workers who do not smoke
have a fivefold greater risk of developing lung cancer than nonsmokers, but asbestos
workers who smoke have a risk that is fifty- to ninety-fold greater than nonsmokers.
Radon gas
Air pollution
Air pollution from vehicles, industry, and power plants can raise the likelihood of
developing lung cancer in exposed individuals. Up to 1% of lung cancer deaths are
attributable to breathing polluted air, and experts believe that prolonged exposure to
highly polluted air can carry a risk for the development of lung cancer similar to that of
passive smoking.
Physicians will also conduct a physical examination, a chest examination, and an analysis of
blood in the sputum. All of these procedures are designed to detect where the tumor is located
and what additional organs may be affected by it.
Although the above diagnostic techniques provided important information, extracting cancer
cells and looking at them under a microscope is the only absolute way to diagnose lung cancer.
This procedure is called a biopsy. If the biopsy confirms lung cancer, a pathologist will
determine whether it is non-small cell lung cancer or small cell lung cancer.
After a diagnosis is made, an oncologist will determine the stage of the cancer by finding out
how far the cancer has spread. The stage determines which choices will be available for
treatment and informs prognosis. The most common cancer staging method is called the TNM
system. T (1-4) indicates the size and direct extent of the primary tumor, N (0-3) indicates the
degree to which the cancer has spread to nearby lymph nodes, and M (0-1) indicates whether the
cancer has metastasized to other organs in the body. A small tumor that has not spread to lymph
nodes or distant organs may be staged as (T1, N0, M0)
For non-small cell lung cancer, TNM descriptions lead to a simpler categorization of stages.
These stages are labeled from I to IV, where lower numbers indicate earlier stages where the
cancer has spread less. More specifically:
Stage I is when the tumor is found only in one lung and in no lymph nodes.
Stage II is when the cancer has spread to the lymph nodes surrounding the infected lung.
Stage IIIa is when the cancer has spread to lymph nodes around the trachea, chest wall,
and diaphragm, on the same side as the infected lung.
Stage IIIb is when the cancer has spread to lymph nodes on the other lung or in the neck.
Stage IV is when the cancer has spread throughout the rest of the body and other parts of
the lungs.
Small cell lung cancer has two stages: limited or extensive. In the limited stage, the tumor exists
in one lung and in nearby lymph nodes. In the extensive stage, the tumor has infected the other
lung as well as other organs in the body.
How is lung cancer treated?
Lung cancer treatments depend on the type of cancer, the stage of the cancer (how much it has
spread), age, health status, and additional personal characteristics. As there is usually no single
treatment for cancer, patients often receive a combination of therapies and palliative care. The
main lung cancer treatments are surgery, chemotherapy, and/or radiation. However, there also
have been recent developments in the fields of immunotherapy, hormone therapy, and gene
therapy.
Surgery
Surgery is the oldest known treatment for cancer. If a cancer is in stage I or II and has not
metastasized, it is possible to completely cure a patient by surgically removing the tumor and the
nearby lymph nodes. After the disease has spread, however, it is nearly impossible to remove all
of the cancer cells.Lung cancer surgery is performed by a specially trained thoracic surgeon.
After removing the tumor and the surrounding margin of tissue, the margin is further studied to
see if cancer cells are present. If no cancer is found in the tissue surrounding the tumor, it is
considered a "negative margin." A "positive margin" may require the surgeon to remove more of
the lung tissue.Surgery carries side effects - most notably pain and infection. Lung cancer
surgery is an invasive procedure that can cause harm to the surrounding body parts. Doctors will
usually provide several options for alleviating any pain from surgery. Antibiotics are commonly
used to prevent infections that may occur at the site of the wound or elsewhere inside the body.
Radiation
Radiation treatment, also known as radiotherapy, destroys or shrinks lung cancer tumors by
focusing high-energy rays on the cancer cells. This causes damage to the molecules that make up
the cancer cells and leads them to commit suicide. Radiotherapy utilizes high-energy gammarays that are emitted from metals such as radium or high-energy x-rays that are created in a
special machine. Radiation can be used as the main treatment for lung cancer, to kill remaining
cells after surgery, or to kill cancer cells that have metastasized.
Chemotherapy
Chemotherapy utilizes strong chemicals that interfere with the cell division process - damaging
proteins or DNA - so that cancer cells will commit suicide. These treatments target any rapidly
dividing cells (not just cancer cells), but normal cells usually can recover from any chemicalinduced damage while cancer cells cannot. Chemotherapy is considered systemic because its
medicines travel throughout the entire body, killing the original tumor cells as well as cancer
cells that have spread throughout the body.
A medical oncologist will usually prescribe chemotherapy drugs for lung cancer to be taken
intravenously, but there are also drugs available in tablet, capsule, and liquid form.
Chemotherapy treatment occurs in cycles so the body has time to heal between doses, and
dosages are determined by the type of lung cancer, the type of drug, and how the person responds
to treatment. Medicines may be administered daily, weekly, or monthly, and can continue for
months or even years.
Combination therapies often include multiple types of chemotherapy, and chemotherapy is also
given as adjuvant therapy as a complement to surgery and radiation. Adjuvant therapy is
designed to reduce the risk of cancer recurrence after surgery and killing any cancer cells that
exist after surgery. Chemotherapy can be given before surgery, called neo-adjuvant therapy, to
shrink tumors and to make surgery more successful.
Chemotherapy carries several common side effects, but they depend on the type of chemotherapy
and the health of the patient. These include nausea and vomiting, appetite loss, diarrhea, hair
loss, fatigue from anemia, infections, bleeding, and mouth sores. Many of these side effects are
only temporarily felt during treatment, and several drugs exist to help patients cope with the
symptoms.
Other lung cancer treatments
Researchers continue to search for ways to improve lung cancer treatments and find new
methods of treating the disease. Targeted therapies are designed to only treat cancer cells while
leaving alone normal and healthy lung cells. These include monoclonal antibodies that travel
directly to the cancer cells and release drugs or radiation, anti-angiogenesis agents that interfere
with the blood supply creation mechanism of cancer cells, and growth factor inhibitors that block
the effects of growth factors and disallow the cancerous cells to grow.
There is also some research in the area of lung cancer vaccines that first transform cancer cells so
they are no longer cancerous. However, the cells will exist such that the body's immune system
can recognize the cancerous cells as foreign and attack them. These targeted therapies are also
called immunotherapies because the treatment tweaks the body's natural immune responses.
How can lung cancer be prevented?
Cancers that are closely linked to certain behaviors are the easiest to prevent. For example,
choosing not to smoke tobacco or drink alcohol significantly lowers the risk of several types of
cancer - most notably lung, throat, mouth, and liver cancer. Even if you are a current tobacco
user, quitting can still greatly reduce your chances of getting cancer. The most important
preventive measure you can take to avoid lung cancer is to quit smoking.
Quitting smoking will also reduce your risk of several other types of cancer including esophagus,
pancreas, larynx, and bladder cancer. If you quit smoking, you will usually reap additional
benefits such as lower blood pressure, enhanced blood circulation, and increased lung capacity.
Exposure to tobacco smoke is not the only risk factor for lung cancer though. Those who have
come into contact with asbestos, radon, and secondhand smoke also have an increased risk of
developing lung cancer. In addition, having a family member who developed lung cancer without
being exposed to carcinogens could mean that you have a genetic predisposition for developing
the disease, increasing your overall risk.
PATIENTS PROFILE
Name: F.C
Gender: Male
Nationality: Filipino
ADMISSION DATA
Subjective Summary: The patient is a diagnosed case of non small lung carcinoma stage
4 .Had onset of DOB and chest pain, few minutes prior to admission.2 days prior to
admission, patient was noted to have a productive cough with whitish phlegm, no
hemoptysis, no fever, no vomiting, patient was noted to have increase severity of symptoms
thus consult to E.R and subsequent admission.
Objective Summary:
BP:
Temperature
Cardiac Rate
Respiratory Rate
O2 sat:
weight
Height
110/80 mmHg
36.6 Celsius
105 cpm
24 bpm
86%
33.5 kg.
52
(+) crackles
bibasal
NURSING HISTORY
doesnt seem to get away even with the intake of medicines; he went to the local
hospital for checkup. The attending physician ordered several tests such as blood
tests, chest x-ray and CT scan and it was revealed that it is lung cancer. The
family has been shocked upon learning of the disease. They thought that it was the
recurrence of his tuberculosis. They even sought for a second opinion at NKTI in
Manila and it was confirmed that it is lung cancer. He just started his first chemo
therapy last two weeks ago . He was instructed by his physician to have 4 cycles
of treatment. His next cycle is due after a week.
The patient is a diagnosed case of lung carcinoma, which had onset of DOB few
mins.PTA. Two days PTA, patient was noted to have whitish phlegm, no
hemoptysis, no vomiting, patient was noted to have severity of symptoms thus
increased severity of symptoms thus, consulted to ER and subsequent admission
Social History
His children state that he has been a good father and provider to the family. He maintains
a good relationship towards his neighbors, friends and former colleagues he was a
former revenue officer they added. In his younger years, his form of recreation is going
to a cockpit fights every weekend. He was a heavy smoker as what he commented He
started smoking at the age of 16 with the influence of his older brothers and until then he
could finish two to three packs of cigarettes a day. He was a complete sober for about 3
years now. Since his wife passed away a year ago his living situation as what he
described is that every weekends his children, children in-laws and grandchildren visit
him on weekends. He is living his youngest daughter and two private nurses who helps in
his needs.
No known allergies to foods or medicines. At home eats three times a day and
snacks in between meals. His usual meal consists of rice, with fish, meat products
or poultry with the inclusion of vegetables and fruits with each meal. Typically he
consumes 2- 3 liters of water every day. Upon rising he takes a cup of coffee and
at bedtime he takes milk. He doesnt have problems with swallowing only that
sometimes his satiety is not fulfilled because he cant taste the food well. Bassit
lang ti kankanek ittan, awan unay ganas ku nga mangan.Narigat ti mangan nga
nakapustisu hanan mu nga maenjoyhe verbalized.
Upon admission the patient weighs 38 kilograms, patient states that he drastically
loses weight stating that about two months ago he weighs 52 kilograms. When
asked about the hospital food he comments that there were restrictions to his food
intake these includes red meat and four legged animals, raw vegetables even fresh
fruits despite that he desire to eat food that he likes the most especially adobong
baboy
3) Elimination Pattern
Before hospitalization, patient F.C states that he urinates about 5 to 7
times a day. He states that he doesnt have problems with urination , he
described that his urine is dark yellow and approximately 30-45 ml per
voiding mentions that he doesnt notice blood on his urine as well .He
defecates every other day and described that his stool is hard and dark
brown
During hospitalization, he was in a catheter and with diapers. Patient F.C
states that he is uncomfortable with the catheter and diapers because he is
not used to it. S.O further mentioned that his urine is dark yellow and
drains the catheter bag whenever it is half full. Patient F.C complains of
sweating and feeling of hot sensation despite of low temperature of the
room.
4) Activity/Exercise Pattern
Before hospitalization patient is capable of providing self care activities such as
grooming, taking a bath and going to the bathroom. Due to history of falls few
months ago they decided to hire for a private nurse to look after him. S.O states
that the patient can still roam around the house and can even go for shopping but
with assistance from them.
During hospitalization, patient F.C stays most of the time in bed due to easy
fatigability. His general appearance is weak. He doesnt have the energy to move
around the hospitals room or in the hallway. He complains of joint pains when
asked to raise his arms and legs. When the patient asked to for a hand grip
demonstrates a weak hand grip. The patient constantly coughing up with whitish
phlegm.
5) Sleep /Rest Pattern
Before hospitalization, patient is already having sleepless nights.Haan nak nga
unay makaturug nu rabii ta nakasaksakit ti likod ku kin barukung ku.kin haan nga
agsardeng ti uyek ku as verbalized by him. When asked about his pain scale he
voiced out that it was 7.When asked about his preferred position during sleeping
he prefers side lying or on his back with 3 pillows on his head
During Hospitalization, patient F.C states that he is not sleeping well in the
hospital. His cough doesnt stop and being disturbed by nurses and doctors
coming in out of his room to check him out.
6) Cognitive/Perception
Patient F.C doesnt have a problem with recent and remote memories. His S.O
states that the patient has a sharp memory. He is fond of telling stories about his
childhood memories. The patient has no problems with hearing abilities. He can
even hear whispers on a distance. The patient wears reading glasses and last
checked up was last year. When asked on decision making he sees to it that he
doesnt too easily and need to think the pros and cons of each situation.
During hospitalization, the patient is well oriented to date, time, place and people
around him. He can easily grasps ideas and questions being asked of him. The
patient managed to read newspaper despite his condition. Patient F.C has a long
span of attention. He is a college graduate and can speak English, Tagalog,
Ilocano and Spanish fluently.
7) Self Perception/Self Concept
Patient feels good about his achievements in life; he has been a good
provider to his family. He loves his family so much and would do anything
for them. He claims that he has raised his children well. All of them are
successful. His eldest son is a lawyer, his second son is an Air force man and
his youngest daughter is a doctor. He also voiced out that as a father, the
success of his children is also his success.
During hospitalization, patient F.C maintains eye contact when being asked.
His attention span is long but he is easily disturbed by noises. Patient is very
much assertive on his answers during the interview process and maintains a
soft voice.
8) Role /Relationship
Before hospitalization, Patient F.C lives with his youngest daughter and two
private nurses who help him with his needs. His 2 children are married and only
his youngest daughter is still single His wife died a year ago and misses her so
much especially in this time of sickness. Nung buhay pa cya, kapag may sakit
ako hindi yun umaalis sa tabi ko. He clings to the idea that one day they will
meet again in paradise. He always looks forward for weekends because his
grandchildren and children in- laws would come and visit him. Once a father is a
father he claimed. You dont stop being a father even youre children are married.
Yung mga anak ko na, kung may mga importanteng desisyon na gagawin
kinukunsulta pa rin nila ako hanggang ngaun.Upon learning of my illness my
children were so shocked and feel saddened.
During hospitalization, Patient F.C interacts well with his private nurses and his
children were present and some of his relatives even from far places dropped at
the hospital to visit him. He even added that coming to the hospital is like a
reunion for them because relatives whom he havent seen for long came to see
him in the hospital.
9) Sexuality/Reproductive
Patient F.C was circumcised when he was ten years old. He got married when he
was 21 years old and had his first coitarche. They have 3 children and dont
remember using any family planning method. He claims that at his age he is no
longer sexually active.
10) Coping/Stress Tolerance
Since diagnosed with lung cancer their family is even closer and holds on to each
other. I have already accepted my fate that eventually we will die but my children
doesnt want to give up on me. They said that they will give their best for me to
be well again. When caught in a stressful situation he normally prays to God. His
form of destressors in this times is watching television, reading and seeing his
grandchildren
11) Value/Belief Pattern
Patient F.C is a Roman Catholic. He states that praying is very much important to
his everyday life .Despite of his condition, he dont question God of his current
state and doesnt lose his faith in Him. Everything and every situation have a
reason why we were put into it he comments. He goes to mass on Sundays and
any days of obligation even when his wife died. He already surrendered
everything to God due to his state of condition he can no longer go to church and
watch mass on TV instead.
HEMATOLOGY REPORT
Date: August 31, 2014
TEST
RESULTS
WBC
9.0x103/L
REFERENCE
VALUES
4.0-10
ANALYSIS
RBC
3.87x106/L
4.0-5.50
Hemoglobin
Hematocrit
Platelet count
WBC Differential
Count
Neutrophils
117 g/L
0.350 g/L
259 x103L
120-160
.400-.500
150-450
.51
.40-.70
normal
Lymphocytes
.46
.20-.40
d/t infection
Eosinophils
Stabs
.03
.00
.00-.06
.00-.04
normal
normal
Atypical Cells
Blood Type
MCV
MCH
MCHC
***manually verified
.00
.00
normal
90.4m3
30.2 Pcg
334 g/L
82.0-95.0
27.0-31
320-360
normal
normal
normal
normal
REF. VALUES
ANALYSIS
PROTHROMBIN TIME(PT)
RESULT
12.9
seconds
% activity
80.0 %
INR
1.08
10.3-13.1 sec
normal
Date:September 2,2014
TEST NAME
REF. VALUES
PROTHROMBIN TIME(PT)
RESULT
14.7 seconds
% activity
64.7 %
INR
1.21
10.3-13.1 seconds
INTERPETATION
CLINICAL CHEMISTRY
Date: August 31,2014
Analyte
Creatinine
Results
1.46 mg/dl
Normal Range
Analysis
.70-1.20
Results
Normal Range
Interpretation
Sodium
133
135-148 mmol
Potassium
3.6
3.5-5.5mmol
normal
GRAM STAIN
ABGS
Date: August 31,2014
RESULT
NORMAL
ANALYSIS
pH
7.48
7.35-7.45
slightly
PCO2
39 mmHg
35-45 mmHg
normal
HCO3
28mEq/L
22-26 mEq/L
IMPRESSION:
UPPER LOBE MASS WITH PLEURAL EFFUSSION, LEFT
CONSIDER OLD CLAVICULAR RIGHT.
DRUG STUDY
1. Clarithromycin
2. Duavent neb
Dosage/frequency: 1 ampoule every 8 hours
Brand name: Pratropium Bromide, Salbutamol sulfate
Pregnancy Category:C
Drug class: Belongs to the class of adrenergics in combination with anticholinergics used in the
treatment of obstructive airway diseases.
Therapeutic Actions: Ipratropium bromide is a quaternary ammonium compound with
anticholinergic (parasympatholytic) properties. Similar to atropine, it is a nonselective
competitive antagonist of muscarinic receptors present in airways and other organs. Ipratropium
bromide relaxes smooth muscles of bronchi and bronchioles by blocking acetylcholine-induced
stimulation of guanyl cyclase, thus reducing formation of cyclic guanosine monophosphate
(cGMP), a mediator of bronchoconstriction. Ipratropium generally exhibits greater
antimuscarinic activity of bronchial smooth muscle than on secretory (eg, salivary, gastric)
glands.
Ipratropium bromide is a potent bronchodilator, particularly in large bronchial airways; however,
some evidence suggests that it also has bronchodilator activity in small airways. Bronchodilation
results from relaxation of smooth muscles of the bronchial tree. The extent of bronchodilation
produced by ipratropium appears to be determined by the level of cholinergic parasympathetic
bronchomotor tone and by inhibition of bronchoconstriction resulting from neural reflex
activation of cholinergic pathways.
Salbutamol: Salbutamol stimulates adenyl cyclase, the enzyme which catalyzes the formation of
cyclic-3', 5'-adenosine monophosphate (cAMP) from adenosine triphosphate (ATP). The cAMP
thus formed mediates the cellular response eg, bronchial smooth muscle relaxation. In
vitro and in vivopharmacologic studies have demonstrated that salbutamol has a preferential
effect on -adrenergic receptors that are especially found in respiratory tract compared with
isoproterenol. Salbutamol has been shown in most controlled studies to have more effect on
respiratory tract, in the form of bronchial smooth muscle relaxation, than isoproterenol at
comparable doses while producing fewer cardiovascular effects.
Indications: Management of reversible bronchospasm associated with obstructive airway
diseases (eg, bronchial asthma).
For patients with chronic obstructive pulmonary disease (COPD) on a regular inhaled
bronchodilator who continue to have evidence of bronchospasm and who require a second
bronchodilator.
Contraindications: Hypersensitivity to soya lecithin or related food products e.g, soybeans or
peanuts; and to any component of Duavent or to atropine and its derivatives. Hypertrophic
obstructive cardiomyopathy or tachyarrhythmia.
Adverse Effects: Headache, pain, influenza, chest pain, nausea. Bronchitis, dyspnea, coughing,
pneumonia, bronchospasm, pharyngitis, sinusitis, rhinitis. Edema, fatigue, Hypertension,
dizziness, nervousness, paresthesia, tremor, dysphonia, insomnia, diarrhea, dry mouth,
dyspepsia, vomiting, arrhythmia, palpitation, tachycardia, arthralgia, angina, increased sputum,
taste perversion and UTI/dysuria. Allergic-type reactions.
Drug Interactions: Anticholinergic agents, -adrenergic agents, -receptor blocking agents,
diuretics. MAOIs and tricyclic antidepressants.
Nursing Considerations:
Assess lung sounds, PR and BP before drug administration and during peak of
medication. Observe for paradoxical spasm and withhold medication and notify physician
if condition occurs.
Administer PO medications with meals to minimize gastric irritation.
Extended-release tablet should be swallowed-whole. It should not be crushed or chewed.
If administering medication through inhalation, allow at least 1 minute between
inhalation of aerosol medication.
Advise the patient to rinse mouth with water after each inhalation to minimize dry mouth.
Instruct patients to avoid spraying the aerosol into the eyes since this may result in
precipitation or worsening of narrow-angle glaucoma, eye pain or discomfort, temporary
blurring of vision, visual halos or colored images in association of red eyes from
conjunctival and corneal congestion.
3. Caltrate Plus
Brand name: Calcium Carbonate 1 tab OD
Pregnancy Category: C
Drug class: Calcium salt
Therapeutic Actions: Reduces total acid load in GI tract, elevates gastric pH to reduce pepsin
activity, strengthens gastric mucosal barrier, and increases esophageal sphincter tone
Indications: Acid indigestion, calcium supplement
Contraindications: Contraindicated in patients with ventricular fibrillation or hypercalcemia
Adverse Effects. . headache, irritability, weakness, nausea, constipation, flatulence
Drug Interactions:
Nursing Considerations:
Record amount and consistency of stools
Monitor calcium level
Watch out for evidence of hyercalcemia (NV,headache, confusion and anorexia)
Therapeutic Actions: Neurobion contains vitamins B1, B6 and B12 which act as co-enzymes and
accordingly constitute substances essential for the metabolism. Their role in the metabolism of
peripheral and central nerve cells, as well as their concomitant cells, must be seen in correlation
with the maintenance of the structural and functional properties of the nervous system.
Indications: Neurological and other disorders associated with disturbances of the metabolic
functions influenced by B-complex vitamins, including diabetic neuropathy and alcohol
peripheral neuritis. Treatment of neuritis and neuralgia of the spinal nerves, spinal facial paresis,
cervical syndrome, low back pain or ischialgia and herpes zoster.The vitamins B1, B6 and B12
are indispensable for a normal course of metabolism. Neurobion coated tablets are prescribed in
neuralgia and pain in the spinal region,
Contraindications: Hypersensitivity to any of the active ingredients or excipients of
Neurobion. Use in children:Neurobion is contraindicated in the treatment of children due to the
high content of its active ingredients. In application of solution for injection containing
benzylalcohol, treatment of children <3 years should be avoided, due to the risk of fatal toxic
reactions arising from exposure to benzyl alcohol in excess of 90 mg/kg body weight/day,
Adverse Effects. Hypersensitivity reactions, such as sweating, tachycardia, and skin reactions
with itching and urticaria may occur with tablets very rarely (< 1/10,000). However, for
gastrointestinal complaints, such as nausea, vomiting, diarrhoea and abdominal pain the
frequency is unknown (i.e. cannot be estimated from the current data). For Neurobion injection,
anaphylactic shock, injection site reactions, individual cases of acne or eczema have been
reported very rarely after high parenteral doses of vitamin B12.
Drug Interactions: If you are taking this product under your doctor's direction, your doctor or
pharmacist may already be aware of any possible drug interactions and may be monitoring you
for them. Do not stop, start, or change the dosage of any medicine before checking with them
first.Before using this product, tell your doctor or pharmacist of all prescription and
nonprescription/herbal products you may use, especially of: altretamine, cisplatin, certain
antibiotics (e.g., chloramphenicol), certain anti-seizuredrugs (e.g., phenytoin), levodopa, other
vitamin/nutritional supplements.This product may interfere with certain laboratory tests (e.g.,
urobilinogen, intrinsic factor antibodies), possibly causing false test results. Make sure laboratory
personnel and all your doctors know you use this product.This document does not contain all
possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all
the products you use. Keep a list of all your medications with you, and share the list with your
doctor and pharmacist.
Nursing Considerations
Stress importance the Vitamin supplement.
Teach healthy dietary habits
Instruct client not to take folic acid to replace vitamin B12, as it may accelerate
hematologic manifestations
Sensitivity tests/ intradermal test should be done for those with possible sensitivity
5. Pregabalin
Dosage/frequency:
Brand name: Lyrica
Pregnancy Category: C
Drug class: anticonvulsant
Therapeutic Actions: Treats fibromyalgia or nerve pain caused by certain conditions (eg,
shingles, diabetic nerve problems, spinal cord injury). It is also used in combination with other
medicines to treat certain types of seizures. It may also be used for other conditions as
determined by your doctor. Pregabalin is an anticonvulsant and neuropathic pain agent. Exactly
how pregabalin works is not known. It is thought to bind to certain areas in the brain that help
reduce seizures, nerve pain, and anxiety.
Indications: used as an add-on therapy for adults with partial seizures with or without secondary
generalization. Nerve pain (peripheral and central neuropathic pain) in adults, for example due to
diabetic neuropathy, following shingles (post-herpetic neuralgia) or due to spinal cord injury.
Generalized anxiety disorder in adults.
Contraindications: Lyrica capsules contain lactose and are not suitable for people with rare
hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose
malabsorption. This medicine is not recommended for children and adolescents under 18 years of
age, because the manufacturer has not studied its safety and efficacy in this age group.
Adverse Effects: Blurred vision; changes in sexual function; constipation; dizziness;
drowsiness; dry mouth; headache; increased appetite; light-headedness; tiredness; trouble
concentrating; weakness; weight gain.
Seek medical attention right away if any of these SEVERE side effects occur:
Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest;
swelling of the mouth, face, lips, throat, or tongue; unusual hoarseness); burning, numbness, or
tingling; chest pain; confusion; fast or irregular heartbeat; fever, chills, or persistent sore throat;
inability to control urination; loss of coordination; memory loss; muscle aches, pain, tenderness,
or weakness (especially if this occurs with a fever or general feeling or discomfort); new or
unusual skin sores; new or worsening mental or mood changes (eg, anxiety, depression,
restlessness, irritability, panic attacks, feeling "high," behavior changes, suicidal thoughts or
attempts); new or worsening seizures; reddened, blistered, swollen, or peeling skin; shortness of
breath or wheezing; speaking problems; sudden, unexplained weight gain; swelling of the hands,
feet, or ankles; tremor; trouble sleeping; trouble walking; unusual bruising or bleeding; severe or
persistent tiredness or weakness; vision changes.This medicine may cause dizziness, sleepiness,
confusion or blurred vision and so may reduce your ability to drive or operate machinery safely.
Do not drive or operate machinery until you know how this medicine affects you and you are
sure it won't affect your performance.
Drug Interactions: Angiotensin-converting enzyme (ACE) inhibitors (e.g., enalapril) because
the risk of angioedema may be increased. Benzodiazepines (e.g., lorazepam) or narcotic pain
medicines (e.g., oxycodone) because the risk of drowsiness may be increased. Thiazolidinedione
antidiabetic agents (e.g., rosiglitazone) because the risk of weight gain or swelling of the hands
and feet may be increased
Nursing Considerations:
Pregabalin may cause drowsiness, dizziness, blurred vision, or light-headedness. These
effects may be worse if you take it with alcohol or certain medicines. Use pregabalin with
caution. Do not drive or perform other possibly unsafe tasks until you know how you
react to it.
Do not drink alcohol while you are taking pregabalin.
Check with your doctor before you use medicines that may cause drowsiness (eg, sleep
aids, muscle relaxers) while you are taking pregabalin; it may add to their effects. Ask
your pharmacist if you have questions about which medicines may cause drowsiness.
Pregabalin may reduce the number of clot-forming cells (platelets) in your blood. Avoid
activities that may cause bruising or injury. Tell your doctor if you have unusual bruising
or bleeding. Tell your doctor if you have dark, tarry, or bloody stools.
Do NOT take more than the recommended dose or use for longer than prescribed without
checking with your doctor.
Do not suddenly stop taking pregabalin or change your dose without checking with your
doctor. If you stop taking pregabalin suddenly, you may have headaches, nausea,
diarrhea, trouble sleeping, anxiety, or increased sweating. If you have epilepsy and you
stop taking pregabalin suddenly, you may have seizures more often. If you need to stop
taking pregabalin, your dose should be gradually reduced over a period of at least 1 week.
If you stop taking pregabalin for any reason, contact your doctor right away. Do not start
taking it again unless your doctor tells you to. Discuss any questions or concerns with
your doctor.
If you develop new or worsening seizures, contact your doctor right away.
Patients who take pregabalin may be at increased risk of suicidal thoughts or actions. The
risk may be greater in patients who have had suicidal thoughts or actions in the past.
Watch patients who take pregabalin closely. Contact the doctor at once if new, worsened,
or sudden symptoms (e.g., depressed mood; anxious, restless, or irritable behavior; panic
attacks; or any unusual change in mood or behavior) occur. Contact the doctor right away
if any signs of suicidal thoughts or actions occur.
Tell your doctor or dentist that you take pregabalin before you receive any medical or
dental care, emergency care, or surgery.
Diabetes patients - Monitor your skin closely for any new or unusual sores while you take
pregabalin.
In animal studies, birth defects were seen in the babies of male animals who were treated
with pregabalin. It is not known if this may also occur in humans. If you are planning to
father a child, discuss the possible risks with your doctor.
Use pregabalin with caution in the ELDERLY; they may be more sensitive to its effects.
Pregabalin should be used with extreme caution in CHILDREN; safety and effectiveness
in children have not been confirmed.
6. ACETYLCYSTEINE
Therapeutic Actions: Mucolytic that reduces the viscosity of pulmonary secretions by splitting
disulfide linkages between mucoprotein molecular complexes. Also, restores liver stores of glutathione to
treat acetaminophen toxicity
Indications: Treatment of respiratory affections characterized by thick and viscous
hypersecretions: acute bronchitis, chronic bronchitis and its exacerbations; pulmonary
emphysema, mucoviscidosis and bronchieactasis.
Contraindications: Known hypersensitivity to Acetylcysteine. As Acetylcysteine
(Fluimucil) granules and tablets contain aspartame, it is contraindicated in patients
suffering from phenylketonuria.
Adverse Effects : Hypersensitivity reactions have been reported in patients receiving
Acetylcysteine, including bronchospasm, angioedema, rashes and pruritus. Other adverse
effects reported with Acetylcysteine include nausea and vomiting, fever, syncope,
sweating, arthralgia, blurred vision, disturbances of liver function.
Drug Interactions: No cases of drug interactions are described in literature for NAC by
oral use.
Nursing Considerations:
Use plastic, glass, stainless steel, or another nonreactive metal when giving by nebulization.
Hand-bulb nebulizers arent recommended because output is too small and particle size too
large.
Drug is physically or chemically incompatible with tetracycline, erythromycin
7. Celebrex
Dosage:500 mg.BID,PO
Pregnancy Category C
Pregnancy Category D (third trimester)
Drug classes: NSAID, Analgesic (nonopioid),Specific COX-2 enzyme blocker
Therapeutic actions: Analgesic and anti-inflammatory activities related to inhibition of the
COX-2 enzyme, which is activated in inflammation to cause the signs and symptoms associated
with inflammation; does not affect the COX-1 enzyme, which protects the lining of the GI tract
and has blood clotting and renal functions.
Indications: Acute and long-term treatment of signs and symptoms of rheumatoid arthritis and
osteoarthritis. Reduction of the number of colorectal polyps in familial adenomatous
polyposis(FAP)Management of acute pain. Treatment of primary dysmenorrheal.
Contraindications and cautions: Contraindicated with allergies to sulfonamides, celecoxib,
NSAIDs, or aspirin; significant renal impairment; pregnancy; lactation.
Use cautiously with impaired hearing, hepatic and cardiovascular conditions.
ADULTS Initially, 100 mg PO bid
Adverse effects:
CNS: Headache, dizziness, somnolence, insomnia, fatigue, tiredness, dizziness,
tinnitus, ophthalmologic effects
Dermatologic: Rash, pruritus, sweating, dry mucous membranes, stomatitis
GI: Nausea, abdominal pain, dyspepsia, flatulence, GI bleed
Hematologic: Neutropenia, eosinophilia, leukopenia, pancytopenia,
thrombocytopenia, agranulocytosis, granulocytopenia, aplastic anemia, decreased
hemoglobin or hematocrit, bone marrow depression, menorrhagia
Other: Peripheral edema, anaphylactoid reactions to anaphylactic shock
Interactions: Increased risk of bleeding if taken concurrently with warfarin. Monitor patient
closely and reduce warfarin dose as appropriate
Nursing considerations:
Assessment
History: Renal impairment, impaired hearing, allergies, hepatic and CV
conditions, lactation
Physical: Skin color and lesions; orientation, reflexes, ophthalmologic and
audiometric evaluation, peripheral sensation; P, edema; R, adventitious sounds;
liver evaluation; CBC, renal and liver function tests; serum electrolytes
Interventions:
Administer drug with food or after meals if GI upset occurs.
Establish safety measures if CNS, visual disturbances occur.
Arrange for periodic ophthalmologic examination during long-term therapy.
If overdose occurs, institute emergency procedures\u2014gastric lavage, induction of
emesis, supportive therapy.
Provide further comfort measures to reduce pain (eg positioning, environmental
control), and to reduce inflammation (eg warmth, positioning, rest).
Take drug with food or meals if GI upset occurs.
Take only the prescribed dosage
The pathogenesis of lung cancer is like other cancers, beginning with carcinogen-induced
initiation events, followed by a long period of promotion and progression in a multistep
process. Cigarette smoke both initiates and promotes carcinogenesis. The initiation event
happens early on, as evidenced by similar genetic mutations between current and former smokers
(e.g. 3p deletion, p53 mutations). Smoking thus causes a field effect on the lung epithelium,
providing a large population of initiated cells and increasing the chance of transformation.
Continued smoke exposure allows additional mutations to accumulate due to promotion by
chronic irritation and promoters in cigarette smoke (e.g. nicotine, phenol, formaldehyde). The
time delay between smoking onset and cancer onset is typically long, requiring 20-25 years for
cancer formation. Cancer risk decreases after smoking cessation, but existing initiated cells may
progress if another carcinogen carries on the process.
SCLC and NSCLC are treated differently because they originate from different cells, undergo
different pathogenesis processes, and accumulate different genetic mutations.
The symptoms produced by the primary tumour depend on its location (i.e.,
central vs peripheral). Central tumours generally produce symptoms of
cough, dyspnea, atelectasis, postobstructive pneumonia, wheezing, and
hemoptysis; whereas, peripheral tumours, in addition to causing cough
and dyspnea, can lead to pleural effusion and severe pain as a result of
infiltration of parietal pleura and the chest wall.
Symptoms
Hemoptysis (25-50%)
Dyspnea (25%)
Mediastinal0 involvement
Symptoms
Pericardial effusion
Pleural effusion
Chest pain
Dyspnea
Dysphagia
Pancoast tumour
(superior sulcus
tumour)
Shoulder or
arm pain
Weakness,
atrophy,
numbness of
ipsilateral hand
Horner
syndrome
o
Ptosis
o
Miosis
o
Anhidros
is
Symptoms
Ectopic Cushing
syndrome
See Adrenal
cortex chapter in
Endocrinology
Syndrome of
inappropriate
antidiuretic hormone
production (SIADH)
See Hyponatre
mia in Nephrology
for details
Hypercalcemia
Hypertrophic
osteoarthropathy and
digital clubbing
Distant metastasis
Metastatic sites
include brain, bone,
liver and adrenal
glands
MODIFIABLE FACTORS
-Smoking (62 yrs smoker)2/3 packs
per day
-Exposure to chemicals
-2nd hand smoking
bronchi
-Nagging cough,
SOB ,wheezing
carcinogenesi
s
SCLC
Central Tumor
NSCLC
Peripheral
Tumor
OTHER FACTORS
-Previous lung disease
-Past Cancer treatment
Air Pollution
Primary lung
lesion
cough
Wt.loss
Assessment
hemoptysi dyspnea
s
Diagnosis
Mediastin
al
involveme
Paraneoplastic
syndromes
Chest pain
Planning
SVC symptoms
Implementation
Dysphagia
Pericardial
Intervention
effusion
Pains and
weakness,atrophy
of arms and
Evaluation
Horners
Rationale
Syndrome
shoulders
SIADH
hypercalcemia
Hypertrophic
osteoarthropathy and
digital clubbing
Ectopic
Cushing
Syndrome
Subjective Data:
haan lang met nga
agsarsardeng ti
uyek kun.as
verbalized by the
patient
Objective data:
RR=27 bpm
CR=105 cpm
(+) rhonchi upon
auscultation
+crackles
O2 sat-86
Ineffective
airway clearance
related to
increased
amount or
viscosity of
secretions
as evidenced by
changes in rate
and depth of
respiration
Abnormal breath
sounds
Dyspnea
At the end of 8
hours, the patient
will demonstrate
patent airway, with
fluid secretions eas
ily expectorated
Increased amounts of
colorless (or blood-streaked)
or watery secretions are
normal initially and should
decrease as recovery
progresses. Presence of thick,
tenacious, bloody, or purulent
sputum suggests development
of secondary problemsfor
example, dehydration,
pulmonary edema, local
hemorrhage, or infection
that require correction or
treatment
Administered bronchodilators,
expectorants, and analgesics,
as indicated.
ASSESSMENT
DIAGNOSIS
PLANNING
Relieves bronchospasm to
improve airflow. Expectorants
increase mucus production
and liquefy and reduce
viscosity of secretions,
facilitating removal.
IMPLEMENTATION
EVALUATION
INTERVENTION
Subjective:
Nasakit ti barukung
ku pati agituy sakak,
as verbalized by the
patient.
RATIONALE
At the end of 30
minutes, the
patient will
report relief from
pain as
manifested by:
At the end of
30 mins.
patient
verbalized that
pain scale
decreased
from 7 to 3
No facial
grimace noted
Decrease in pain
scale from 8/10
to 4/10
Objective:
Facial grimace
Absence of facial
grimace
Guarding behavior
Exertional discomfort
In fetal position
Absence of
guarding
behavior
To provide non
pharmacologic
management of
pain
Encouraged deep
breathing
To alleviate
feelings of pain
Encouraged adequate
rest periods
To prevent fatigue
Performed pain
assessment each time
pain occurs
To assess
congruency with
verbal reports of
pain
To rule out
worsening of
condition
Administered
analgesics as ordered
To maintain
acceptable level of
pain
To conserve
energy or lower
tissue oxygen
demand
ASSESSMEN
T
DIAGNOSIS
PLANNIN
G
Subjective:
Haan nak nga
unay nga
makapang
pangan,awan
unay ganas ku
as verbalized by
the patient.
Objective:
Weight=32 kg
Height=52
BMI=12.9
Dry skin
IMPLEMENTATION
INTERVENTION
Imbalanced Nutrition:
Less than
Body Requirements rel
ated to hyper
metabolic state
At the end
of 4 weeks
the patient
will
progressive
ly gains
weight at
1 per
week
RATIONALE
Measurements fall
below minimum
standards, clients chief
source of stored energy,
fat tissue, is depleted
Helps in identification
of protein-calorie
malnutrition, especially
weight
EVALUATIO
N
role in maintaining
adequate caloric and
protein intake.
Makes mealtime more
enjoyable, which may
enhance intake
Objective data
Use of
accessory
muscle for
breathing
restlessness
RR= 26 bpm
Presence of
rhonchi upon
auscultation
Impaire
d Gas
Exchan
ge R/T
Alveola
r
Capillar
y
Membra
ne
Changes
At the end of 8
hour shift the
patient will
demonstrate
improved
ventilation and
adequate
oxygenation of
tissue
PlanningIMPLEMENTATION
Implementation
INTERVENTION
Monitored and
recorded vital signs
RATIONALE
To obtain baseline
data
or shallow
respiration that
occur because of
hypoxemia and
stress
EVALUATIO
Evaluation
N
At the end of
the shift, the
patients
respiratory
rate decreased
from 26 bpm
to 19 bpm
Assessment
Subjective data:
Nanghihina
ako.dati kayak o
pang maglakad
lakad sa veranda
ng bahay
Diagnosis
Activity
Intolerance
Planning
.
.
At the end of 3
days the patient
will report
measurable
increase in activity
intolerance
To empower SO and
pt
Implementation
INTERVENTION
RATIONALE
For the
Established Rapport
pharmacologicalTo gain clients participation
and cooperation in the nurse
management of the
patient interaction
patients condition
Monitored and recorded Vital
Signs
To provide relaxation
ngayon parang
araw araw
nauubusan ako
ng lakas as
verbalized by the
patient
Evaluation
To sustain motivation of
client. To enhance sense of
well being
To promote easy breathing
To maintain an open airway