Nursing 211

N211: Health Differences Across the Lifespan I

3.20 Lung Cancer Lung Cancer is the leading cause of death from malignancy, with a five-year survival rate of less than 15%. Greater than 90% of lung cancers originate in the bronchus epithelium. Cigarette smoking is the leading cause; cancer risk increases with length of smoking exposure. Contributing factors include inhaled environmental substances such as air pollution, arsenic, asbestos, iron, radon and aromatic hydrocarbons. Tumor growth commonly begins in the bronchus then migrates to the upper lobes of the lungs. Tumor type includes small cell and non-small cell. Metastasis occurs in direct contact and transport in blood and lymph’s. Nursing Assessment Includes dry, hacking cough, with cough turning productive as disease progresses; hoarseness, dyspnea, hemoptysis with rust colored or purulent sputum; pain in the chest area; diminished breath sounds, occasional wheezing. Diagnostics Include chest x-ray will be abnormal showing a mass. Positive sputum for cytology reveals tumor cells. Bronchoscopy with mediastinoscopy, biopsy, pulmonary function studies and pulse oximetry with arterial blood gases are performed. Nursing Diagnosis • Ineffective breathing pattern related to pain, restrictive respiratory tract • Ineffective airway clearance related to inability to cough effectively due to pain. • Impaired gas exchange related to air and fluid collection in lungs and pleural space. • Anxiety and knowledge deficit related to feelings of dyspnea, and diagnosis • Impaired nutrition Nursing Interve tions Include placing client in semi-fowlers position; teach pursed lip breathing to improve gas exchange. Teach relaxation techniques; administer oxygen as indicated by pulse oximetry or ABGs. Decrease pain to a manageable level by administering analgesics as needed. . Administer antiemetics prior to chemotherapy. Elevate head of bed and place pillows under arms to decrease work of breathing. Splint incision to facilitate breathing. Humidify oxygen to loosen secretions. Encourage increased fluid intake. Monitor chest drainage post-operatively. Monitor respiratory rate, depth and pattern. Allow clients and family to express feeling regarding disease. 3.21 Bladder Cancer Bladder Cancer is most common in individuals over the age of 50 and three times more common in men as in women. Risk factors include cigarette smoking and exposure to certain carcinogens such

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