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Pathophysiology

Modifiable factors  Cigarette smoking  Lifestyle  Dietary factors  Environmental & occupational exposure (radon, arsenic, & radiation  Second Hand Smoke (SHS)

Non-modifiable Factors  Genetic predisposition  Age 45 y/o and above  Sex M 90 % at risk

Inhalation of Carcinogens Transformation of epithelial cells in the tracheobronchial airways Carcinogens binds & damage the cell s DNA Alteration in both oncogenesis & tumor suppressor genes

Thickening of bronchial epithelium

mucous gland hypertrophy

alveolar cell ruptures

Malignant transformation from normal epithelium to invasive carcinoma

Persistent infection in pneumonitis distal to the tumor

FEVER

Impaired exchange of oxygen & carbon dioxide

Tumor cells grow & invade surrounding lung tissuechest, shoulder, arm, back pain

Limited expansion of the affected lobes of the lungs

Interfere gas exchange of O2 and carbon dioxide

Air obstruction

persitent cough, wheezing, stridor, dyspnea

cancerous cells invade local lymphnodes and thoracic duct

chest pain and tightness hoarseness dysphagia head and neck edema blood-tinged sputum anorexia

ASSESSMENT S> o> dyspnea >hemoptysis >wheezing >easy fatigue ability >anorexia Analysis Ineffective airway clearance r/t decrease energy

PLANNING Within 30min. to 1 hour of nursing intervention the patient will demonstrate skill in conserving energy while attempting to clear airway.

INTERVENTION >assess respiratory status at least 30 min according to established standards. >encourage to do deep breathing. >encourage patient to expectorate sputum. >administer oxygen as ordered.

RATIONALE > to detect early signs of compromise.

>promote lung expansion.

EXPECTED OUTCOME After 30 minutes to 1 hour of proper nursing intervention, the patient was able to demonstrate skill in conserving energy while attempting to clear airway. Goal was met.

>to remove pathogens & prevent spread of infection.

>to help relieve respiratory distress.

ASSESSMENT S> o> altered respiratory rate >nasal flaring >shortness of breath >easy fatigability Analysis: Ineffective breathing pattern related to use of accessory muscles

PLANNING Within 30 min of proper nursing intevention, the patient will achieve maximum expansion with adequate ventilation.

INTERVENTION >assist patient to comfortable position. >encourage to do deep breathing exercise. >administer oxygen as ordered.

RATIONALE >to promote comfort and lung expansion. >promote lung expansion.

EXPECTED OUTCOME After 30 minutes of proper nursng intervention , the patient achieved maximum lung expansin with adequate ventilation.

>supplemental oxygen help reduce hypoxemia and relieve respiratory distress. >this prevents fatigue and reduce oxygen demands.

>schedule necessary activities to provide period of rest .

ASSESSMENT S> o>irritable >nasal flaring >restlessness Analysis: Impaired gas exchange related to altered oxygen supply.

PLANNING Within 30 min of proper nursing intevention, the patient will be able to express feelings of comfort in maintaining air exchange.

INTERVENTION >assess and record pulmonary status every hour. >place patient iin positon that best facilitates lung expansion. >gve medications as ordered. >include periods of rest in care plan. >instruct patient relaxation technique

RATIONALE >to indicate or monitor if there is hypoxemia.

>to enhance gas exchange.

EXPECTED OUTCOME After 30 minutes of proper nursing intervetion the patient was able to express feelings of comfort in maintaining air exchange. Goal was met

>to improve oxygen.

>to reduce patients tissue oxygen demands. >reduce oxygen demand and energy. RATIONALE >to prevent musculoskeletal deformities. >to prevent skin breakdown by relieving pressure. >to prevent muscle atrophy EXPECTED OUTCOME After 30 minutes proper nursing intevention, the patients respiration remain within prescribed range. Goal was met.

ASSESSMENT S> o>weakness >muscle atrophy >easy fatigue ability Analysis: Activity intolerance related to imbaance between oxygen supply and demand

PLANNING Within 30 min of proper nursing intevention, the patient respiration will remain within prescribed range.

INTERVENTION >assist patient to comfortable position. >turn patient side to side every 2hours. >unless contraindicated, perform ROM exercises every morning. >assess patients physiologic response to increased activity. >provide emotional support & offer positive feedback

>monitor vital signs to assess tolerance for increased activity. >offering emotional support will enhance patientselfesteem and motivation

ASSESSMENT S> o> altered immune function >malnutrition >tissue destruction Analysis: Risk for infection related to surgical procedure done.

PLANNING Within 2-3 hours of proper nursing intevention, the incision site wll remain free signs and symptoms of infection.

when patient displays initiative INTERVENTION >instruct patient to wash hands before and after providing wound dressing. >monitor WBC count as ordered. >encourage patient to eat nutritious foods rich in vit. C and protein such as orange,meat if not contraindicated.

RATIONALE >handwashing is the single best way to prevent spread of pathogens.

EXPECTED OUTCOME After 2-3hours of proper nursing intervention, ,the incision siteremain free from signs and symptoms of infection.

>elevated total WBC count indicates infection. >for wound healing and repair.

>help patient turn every 2hours. >encourage fluid intake 1.5-2L/day unless contraindicated.

>to prevent skin breakdown and venous stasis. >to help eliminate mucus secretions.