Non-Small Cell Lung Cancer
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its the same essay you advertised dated 8 April 2014(symptom management case study)my case study is about a patient newly diagnosed non small cell lung ca .contact me on my email if need clarification,its more reliable,supported relevant evidence should be no more than 5 years.
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The case study is about a 72-year old female patient (Jane) that has been diagnosed with non-small cell lung cancer (NSCLC). The woman has three adult children that don live with her. Unfortunately her husband passed away and she has no one to take care of her. It is for this reason that Jane needs nursing care.
Non-Small Cell Lung Cancer
Most of the patients that have been diagnosed with this illness have smoked in sometime in their past or are smoking. However, some of the other factors that result in the development of NSCLC include; radon (a radioactive gas commonly found in rocks and soil), air pollution, radiation therapy to the chest, asbestos, and HIV/AIDS (Kitchens, Kessler & Konkle, 2013, Pg. 89). It is also hereditary.
Symptoms of NSCLC
Mostly, lung cancer cells do not cause symptoms until they have spread many organs. However, symptoms have been detected in NSCLC. Patients with NSCLC have the following symptoms;
- A persistent cough that keeps worsening
- Pain in the chest. The pain gets worse when the patients breathe deeply, cough or laugh (Giaccone, 2012, Pg. 37).
- Hoarseness
- LOSE weight as well as appetite.
- Cough up rust-colored sputum or blood
- Have short breath
- Fatigue
- Have recurrent infections of bronchitis and pneumonia
- Wheezing
NSCLC begins severe and spreads to other body organs. At this stage, the patients experience pain the bone, neurologic changes such as headaches, numbness of the arms, problems in balancing, and dizziness (Leary, 2011, Pg. 45). When NSCLC affects the liver, the patients’ skin becomes yellow (jaundice). When NSCLC affects the lymph nodes and the skin, lumps start developing on the body surface. Most of these conditions are likely to be caused by other conditions apart from NSCLC.
Consequences of the Symptoms to the Patient and the Family
When serious disease or disability strikes a person, the whole family is affected by the illness process as well as the entire health care experience. In the case study, Jane’s illness disrupts her whole family. Her illness has made her sons change their lifestyle and take on some role functions of Jane, which in turn has affected their normal role functioning. For instance, the eldest son, who is also a father of two, has been forced to take leaves to console his mum. His sons have also been forced to arrange for their parents care.
Jane’s illness has also caused additional strain due to economic problems and interruptions. NSCLC requires expensive therapy procedures and costly medications too. However, on a positive note, Jane’s illness has brought her family close together. She has had the opportunity to re-unite with her sons who have been busy all through. The sons have been forced to adjust their priorities and forgo some plans to just take care of their ailing mum. They also live in fear of their mum passing on.
To Jane NSCLC has caused her to undergo immense suffering. She feels a lot of pain that causes deep sorrow. She has lost her weight and has no appetite; she even sometimes regrets and feels as if she is a nuisance to her sons by making them visit her every now and then to confirm how she is fairing. NSCLC is a life-threatening disease; its symptoms have trouble Jane to a point that she feels that she should just rest in peace instead of going through intense suffering. This has led to Jane being assigned counseling officers to encourage her and let her know that there are some patients that were in the same condition that she is in but have then recovered and resumed their normal duties.
Goals of Care
Every person and every illness is peculiar. After patients such as Jane have been diagnosed with NSCLC, nursing care is aimed at;
- Relieving pain and other NSCLC associated symptoms
- Addressing patients’ spiritual as well as emotional concerns of the patient and their families.
- Coordination of care
- Improving the patients’ quality of life during their illness.
For instance, a palliative care nurse has been assigned to Jane. The nurse prescribes medications and other therapies to help treat Jane’s pain, shortness of breath, constipation, and other symptoms. Jane also has a social worker who has been charged with the responsibility of acting as Jane’s advocate on her behalf and family. She also has a chaplain who offers her spiritual support and aids her in exploring her values and beliefs. The care is also aimed at updating Jane’s family on her progress and necessary medical information.
Nursing Care Plan for NSCLC Patients
Nursing care for patients suffering from lung cancer deals with comprehensive supportive care and educating patients on how to reduce the complications they are experiencing with an aim of speeding recovery from radiation, surgery, and chemotherapy (Almeida & Barry, 2011, Pg.67). The following are nursing’s care plans for patients with lung cancer;
(I)Impaired Gaseous Exchange
Impaired gas exchange is associated with a change in the supply of oxygen and a decreased oxygen carrying capacity of the blood. Patients present with cyanosis, restlessness, dysnea, and hypercapnia (Kumar & Eng, 2014, Pg. 26). Nursing care plan is provided to the patients with these symptoms with an aim of improving ventilation and sufficient oxygenation of body tissues. The care plan also targets freeing symptoms of respiratory.
Nursing Interventions
-To achieve the above patient outcomes, nurses should examine respiratory rate, depth, and ease of respirations. They should also monitor accessory muscles, variations in the color of the mucous membrane, pursed-lip breathing, and cyanosis (Lam & Cavallari, 2013, Pg. 73). Patients may have an increased respiration as a result of pain or as a compensatory mechanism that is triggered in order to accommodate the loss of lung tissue.
-Nurses should also auscultate the patient’s lungs to examine movement of air or abnormal breath sounds.
-Restlessness and variation in mentation or consciousness should also be investigated. This procedure may demonstrate high levels of hypoxia and mediastinal shift complications that could be accompanied with tachycardia (Newman, 2010, Pg. 851).
– Evaluation of the patients’ response to an activity. Nurses should allow patients to have rest periods and reduces activities to promote patient tolerance. Surgery and increased consumption of oxygen can lead to dysnea. However, patients should participate in early mobilization to aid in preventing pulmonary complications as well as obtain efficiency in their circulatory and respiratory systems.
– Finally, nurses should monitor and record ABGs and levels of hemoglobin (In Matzo, & In Sherman, 2015, Pg. 143). Low partial oxygen concentration and high carbon dioxide may necessitate the need for ventilator support.
(ii)Impaired Airway Clearance
Can be linked to restricted chest movement, fatigue, and increased secretion of mucous in the airway. Patients present with dysnea, abnormal sounds of breath, and ineffective cough (Kumar & Eng, 2014, Pg. 243). Nurses provided care that is aimed at clearing these abnormal sounds and decreasing secretions.
Some of the interventions that are involved include;
- Observing the amount and appearance of sputum and other aspirated secretions. Initially, increased amounts of watery, colorless or blood streaked secretions are normal (Davey, 2012, Pg. 67). However, such secretions should decrease as the patient progresses with recovery.
- Patients should be encouraged to have oral fluid intake of approximately 2500mL/day within tolerance of the cardiac activity. This is because adequate hydration helps in keeping secretions loose and also promotes expectoration.
- Clinicians administered bronchodilators, analgesics, and expectorants. This will aid in improving airflow, increase production of mucous, liquefy, and reduce viscosity of secretions.
(III)Acute Pain
The pain may be due to surgical incision, disruption of nerves, and tissue trauma. Chest tubes and invasion of NSCLC into the pleura may also be a cause of pain (In Palmer, In Brown & In Hobson, 2013, Pg. 56). Clinicians will learn that patients are experiencing pain when the patients have verbal discomfort, guard the area that is affected, are restless or have changes in blood pressure and respiratory rate.
Nursing Care Interventions
-Care providers should evaluate the patients’ verbal and non-verbal pain cues whereby discrepancy between non-verbal and verbal cues would indicate the degree of pain.
– They should encourage measures that minimize pain such as changing the patient’s position, supporting them with pillows, and back rubbing patients.
Barriers of NSCLC Symptom Management
Poly-pharmacy
Studies have shown that cancer is associated with 13% increase in medical use (Jeremić, 2011, Pg. 92). Some of the factors that result in poly-pharmacy include age-related physiologic changes and multiple chronic conditions. When cancer patients take multiple drugs, adverse drug reactions take place. This poses as one of the biggest threat in management of cancer patients.
Frailty among older patients who might have experienced loss of organ function and general decline of overall health is also a barrier in management. Frail patients require careful considerations of appropriate non-pharmacologic and pharmacologic approaches.
To aid in tackling some of these barriers care providers may use non-pharmacologic practices such as acupuncture, Tai Chi, yoga or acupressure which have been reported to have tremendous positive effect in cancer survivors (Ellis, Calne & Watson, 2011, Pg. 231).
References
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Leary, A. (2011). Lung cancer: A multidisciplinary approach. Chichester, West Sussex, UK: Wiley-Blackwell.
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