INTRODUCTION

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 day—the 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 interests—it'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 lung’s 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:

 Squamous cell carcinoma or epidermoid carcinoma. As the most common type of NSCLC
and the most common type of lung cancer in men, squamous cell carcinoma forms in the
lining of the bronchial tubes.
 Adenocarcinoma. As the most common type of lung cancer in women and in nonsmokers,
adenocarcinoma forms in the mucus-producing glands of the lungs.
 Bronchioalveolar carcinoma. This type of lung cancer is a rare type of adenocarcinoma that
forms near the lungs' air sacs.
  Large-cell undifferentiated carcinoma. A rapidly growing cancer, large-cell
undifferentiated carcinomas form near the outer edges or surface of the lungs.
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
What causes cancer?
Cancer is ultimately the result of cells that uncontrollably grow and do not die. Normal cells in
the body follow an orderly path of growth, division, and death. Programmed cell death is called
apoptosis, and when this process breaks down, cancer begins to form. Unlike regular cells,
cancer cells do not experience programmatic death and instead continue to grow and divide. This
leads to a mass of abnormal cells that grows out of control. Lung cancer occurs when a lung
cell's gene mutation makes the cell unable to correct DNA damage and unable to commit suicide.
Mutations can occur for a variety of reasons. Most lung cancers are the result of inhaling
carcinogenic substances.

Smoking
 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 asbestos-
related 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
 Radon gas is a natural radioactive gas that is a natural decay product of uranium. Uranium
decays to form products, including radon, that emit a type of ionizing radiation. Radon gas is a
known cause of lung cancer, with an estimated 12% of lung-cancer deaths attributable to radon
gas.
Lung diseases
 The presence of certain diseases of the lung, notably chronic obstructive pulmonary
disease (COPD), is associated with an increased risk (four- to six-fold the risk of a nonsmoker) for
the development of lung cancer even after the effects of concomitant cigarette smoking are
excluded. Pulmonary fibrosis (scarring of the lung) appears to increase the risk about seven-fold,
and this risk does not appear to be related to smoking.
Prior history of lung cancer
 Survivors of lung cancer have a greater risk of developing a second lung cancer than the
general population has of developing a first lung cancer. Survivors of non-small cell lung
cancers (NSCLCs)have an additive risk of 1% to 2% per year for developing a second
lung cancer. In survivors of small cell lung cancers (SCLCs, see below), the risk for
development of second lung cancers approaches 6% per year.

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.

How is lung cancer diagnosed and staged?

Physicians use information revealed by symptoms as well as several other procedures in order to
diagnose lung cancer. Common imaging techniques include chest X-rays, bronchoscopy (a thin
tube with a camera on one end), CT scans, MRI scans, and PET scans.
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 gamma-
rays 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 chemical-
induced 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.
 PATIENT’S PROFILE

 Name: F.C
 Age:81 years old
 Gender: Male
 Birthday: September 4, 1933
 Birthplace: Esteban, Ilocos Sur
 Address: Trancoville, Baguio City, Benguet
 Nationality: Filipino
 Civil Status: Widowed
 Religion: Roman Catholic
 Occupation: Retired Revenue Officer
 Chief Complaint: Difficulty of Breathing
 Assessment: Lung cancer, COPD
 Attending Physician: Dr. Felina Adefuin
 Date Admission: August 31,2014
 Time of Admission :4:37 A.M
 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: 110/80 mmHg

Temperature 36.6 Celsius
Cardiac Rate 105 cpm
Respiratory Rate 24 bpm
O2 sat: 86%
weight 33.5 kg.
Height 5’2”

(+) decrease breath (+) crackles

sounds bibasal

Assessment: Lung Cancer, COPD

Plan: Admission
 NURSING HISTORY

 History of Past Illness

 According to patient F.C, he don’t remember receiving any immunizations as a

child, he commented that immunization injections has never been a fad in the
early years. Patient F.C. recalls that whenever he suffers from illnesses such as
fever, colds and bodily pains he used to self medicate by taking pain relievers
such as Paracetamol for fever and eventually his stamina regains. In his late 30’s
he was diagnosed with tuberculosis. According to him before he was diagnosed
with the disease, he have been constantly coughing out with whitish phlegm
sleepless nights, loss of stamina, and chest pain that took him two months before
consulting a physician. What took more of his attention was his phlegm has been
progressed with spitting out with blood. He then had his sputum examined and
chest x ray as advised .Result shown that he incurred the disease, he then advised
by the physician to take the 6six month treatment course. Upon the advice, he
completed the course and eventually declared TB free henceforth. He had a
cataract operation on both eyes last 3 years ago. He doesn’t remember any serious
illnesses and major operations except for the latter.
.
 History of Present Illness
 Three months before the diagnosis has made, the patient can still roam around the
house can even perform self care activities but with assistance. Due to untreated
cough with whitish phlegm, easy fatigability intermittent fever and chest pain that
doesn’t 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

 Family Health History

 According to the patient, his parents and grandparents died of old age. In a brood
of 8 only 3 of them are alive. His eldest brother t died due to hypertension, his
eldest sister died of breast cancer, his other sister died of cholera and his older
 brother died of lung cancer their youngest has recently died of car accident. Just a
year ago, his wife died of pneumonia. The patient further mentioned that most of
his children were all healthy other than his eldest son who has been suffering from
heart ailment since childhood.

 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.
 Gordon’s Functional Pattern

1) Health Perception/Health Management

 Patient perceives health as wealth.”Ti salun-at ket kayamanan’’ as he verbalized.
When further explored what he means by that he gives his state of health as an
example. States that when he was younger and still strong he doesn’t mind any
bodily pains. He claims that he used to walk a kilometer everyday from home
going to work and vice versa and take it as a form of exercise. Though he is aware
of the risks and disadvantages of cigarette smoking he did not stop until 3 years
ago and now he is harvesting the effects of his vices. He also states that he is a
social drinker and denies of using prohibited drugs. He rates his general health
these days as 3 out of 10 being 10 as the healthiest state and 0 as in the
debilitating state. ‘Ganito ang tumatanda, madaming iniinda na sakit’’. Further
mentioned that six months ago he fell from a chair but did not tell anyone. Since
he was diagnosed with lung cancer, he thinks that his health is deteriorating each
day. ‘Dati kaya ko pang mglakad lakad sa veranda ng bahay, ngayon madali na
akong hapuin, konting lakad lang napapagod na agad ako’’. Patient states that he
believes in traditional medicines such as the use of herbal medicines, and quack
doctors. Sometimes he takes oregano for colds. Now that he is the hospital he
believes that he is in good hands and will be given the best care by the hospitals’
staff.

2) Nutritional/Metabolic Pattern
 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 doesn’t have problems with swallowing only that
sometimes his satiety is not fulfilled because he can’t taste the food well. ‘Bassit
lang ti kankanek ittan, awan unay ganas ku nga mangan.Narigat ti mangan nga
nakapustisu hanan mu nga maenjoy’’he 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 doesn’t have problems with urination , he
described that his urine is dark yellow and approximately 30-45 ml per
voiding mentions that he doesn’t 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 doesn’t have the energy to move
around the hospital’s 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 doesn’t stop and being disturbed by nurses and doctors
coming in out of his room to check him out.

6) Cognitive/Perception
 Patient F.C doesn’t 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
doesn’t 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 don’t stop being a father even you’re 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 haven’t 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 don’t
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
doesn’t 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 don’t question God of his current
state and doesn’t 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 REFERENCE ANALYSIS

VALUES
WBC 9.0x103/L 4.0-10 normal
RBC 3.87x106/L 4.0-5.50  d/t anemia and chemotherapy

Hemoglobin 117 g/L 120-160  d/t anemia, chemotherapy

Hematocrit 0.350 g/L .400-.500  d/t anemia, chemotherapy
Platelet count 259 x103L 150-450 normal
WBC Differential
Count
Neutrophils .51 .40-.70 normal
Lymphocytes .46 .20-.40  d/t infection
Eosinophils .03 .00-.06 normal
Stabs .00 .00-.04 normal
Atypical Cells .00 .00 normal
Blood Type
MCV 90.4m3 82.0-95.0 normal
MCH 30.2 Pcg 27.0-31 normal
MCHC 334 g/L 320-360 normal
***manually verified
Date: August 31,2014

TEST NAME REF. VALUES ANALYSIS

PROTHROMBIN TIME(PT)

RESULT 12.9 seconds 10.3-13.1 sec normal

% activity 80.0 %

INR 1.08

METHOD : Scattered light detection

 CLINICAL CHEMISTRY

Date: August 31,2014

Analyte Results Normal Range Analysis

Creatinine 1.46 mg/dl .70-1.20  possible kidney failure

Date: August 31, 2014

Analyte Results Normal Range Interpretation

Sodium 133 135-148 mmol ,due to lung cancer

Potassium 3.6 3.5-5.5mmol normal

Method: Ion Selective Electrode

GRAM STAIN

Date: August 31,2014

Specimen: Sputum

Result: smear shows occasional gram-positive cocci in short stains. Moderate

pus cells and rare epithelial cells noted.

Normal: few to no white blood cells and no bacteria. Presence may denote
infection

sample.Ba
 ABG’S

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 

Acute metabolic alkalosis

HCO3 21 mEq/L 22-26 mEq/L slightly low

pH 7.48 7.35-7.45

PCO2 39 mmHg
 CHEST X RAY STUDIES

Date: august 31, 2014

DR
INTERPRETATION

A well defined homogenous dense opacity is seen in the left upper lobe
with the deviation of the trachea to the right.

Lamellated homogenous opacity obscuring the left costophrenic sulcus.

The heart is not enlarged by C-T ratio.

The right costophrenic sulci are intact.

Right midclavicular deformity probably old fracture.

IMPRESSION:

UPPER LOBE MASS WITH PLEURAL EFFUSSION, LEFT

CONSIDER OLD CLAVICULAR RIGHT.
Date: September 1,2014

INTERPRETATION

Comparison was made with a previous study dated August 31, 2014. There is
internal clearing of the left sided pleural effusion post thoracenthesis with
minimal residual blurring of the left costophrenic sulcus.

The left upper lobe mass and associated mass effects are unchanged.

The heart is not enlarged by CT ratio.

The rest previous findings are unchanged.

 DRUG STUDY

1. Clarithromycin

Dose/Route/Frequency: 500/tab 1 tab OD

Brand Name: Biaxin, Biaxin XL

Pregnancy Category: B

Drug class: Macrolide antibiotic

Therapeutic actions: Clarithromycin prevents bacteria from growing by interfering with

their protein synthesis. Clarithromycin binds to the subunit 50S of the bacterial ribosome and
thus inhibits the translation of peptides. Clarithromycin has similar antimicrobial spectrum as
erythromycin but is more effective against certain gram-negative bacteria,
particularly Legionella pneumophila. Besides this bacteriostatic effect, clarithromycin also has
bactericidal effect on certain strains such as Haemophilus influenzae, Streptococcus
pneumoniae and Neisseria gonorrhoeae

Indications: used to treat pharyngitis, tonsillitis, acute maxillarysinusitis, acute bacterial

exacerbation of chronic bronchitis, pneumonia (especially atypical pneumonias associated
with Chlamydia pneumoniae or TWAR), skin and skin structure infections. In addition, it is
sometimes used to treat Legionellosis, Helicobacter pylori, and Lyme disease. Besides this
bacteriostatic effect, clarithromycin also has bactericidal effect on certain strains such as
Haemophilus influenzae, Streptococcus pneumoniae and Neisseria gonorrhoeae

Contraindication: Clarithromycin should be used with caution if the patient has liver or kidney
disease, certain heart problems (e.g., QT prolongation or bradycardia), or an electrolyte
imbalance (e.g., low potassium or sodium levels).
· used in HIV patients due to significant interaction with HIV drugs.
· not to be used in pregnant patients.
· cause serotonin syndrome symptoms when taken in conjunction with buspirone (Buspar).
· Clarithromycin almost doubles the level of carbamazepine in serum by reducing its clearance
inducing toxic symptoms of Carbamazepine

Adverse effects: · Gastrointestinal: diarrhea, nausea, extreme irritability, abdominal pain and
vomiting, facial swelling.Headaches, hallucinations (auditory and visual), dizziness/motion
sickness, rashes, alteration in senses of smell and taste, including a metallic taste that lasts the
entire time one takes it. Dry mouth, panic and / or anxiety attacks and nightmares have also been
 reported albeit less frequently. In more serious cases it has been known to
cause jaundice, cirrhosis, and kidney problems including renal failure. Uneven heartbeats, chest
pain, and shortness of breath

Nursing Considerations:
 Culture infection before therapy.
 Do not cut or crush, and ensure that patient does not chew ER tablets.
 Monitor patient for anticipated response.
 Administer without regard to meals; administer with food if GI effects occur
 .Administer drug with food if GI effects occur
 Do not let patient drink grapefruit juice while taking this drug.

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 β-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, ß-adrenergic agents, ß-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)
 4. NEUROBION (Vitamin B-complex)

Dosage/frequency: 1 cap OD

Pregnancy Category: A

Drug class: Vitamins and Minerals

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

Dosage/frequency:1 sachet of Acetylcysteine (Fluimucil) 100 mg, 3 times a day..

Brand name: Fluimucil granules and tablet

Pregnancy Category: B

Drug class: antedotes, mucolytics

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 aren’t recommended because output is too small and particle size too
large.

 Drug is physically or chemically incompatible with tetracycline, erythromycin

 Watch out for hypoxia

 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 Mechanism and pathophysiology

Primary lung lesion symptoms

Cough (50-70%)  Presence of a mass irritates the cough receptors in the airway
 More common in squamous cell carcinoma andSCLC (more commonly
found in the central airways)
 Obstruction from central airway could also lead to post-obstructive
pneumonia and distal atelectasis

Weight loss (46%)  Cancer induced lipolysis and proteolysis leads to loss of adipose and
skeletal muscle. Protein synthesis is also reduced via a number of
mechanisms.

Hemoptysis (25-50%)  Tumour in the central airway

 Blood vessels resulting from tumour-induced angiogenesis are leaky and
tortuous, predisposing them to easy rupture and causing hemoptysis
Symptoms Mechanism and pathophysiology

Dyspnea (25%)  Extrinsic or intraluminal airway obstruction

 Activation of mechanoreceptors and chemoreceptors in lungs due to
cachexia or hypoxemia/acidosis

Chest pain (20%)  Tumour involving pleural surface causing pleuritic chest pain

Mediastinal0 involvement

Superior vena cava  Obstruction of superior vena cava by the tumour

syndrome  More common in SCLC (central tumour)
 2-4% of lung cancer patients develop it at some point

Pericardial effusion  Tumours can at times infiltrate into the pericardium or press on the heart
causing pericardial effusion


Pleural effusion  Benign pleural effusion may be due to lymphatic obstruction, post-
 Chest pain obstructive pneumonitis, or atelectasis
 Dyspnea  Malignant pleural effusion occurs when malignant cells are present in
pleural fluid

Dysphagia  Enlargement of the subcarinal lymph nodes compressing on the middle

third of the esophagus

Pancoast tumour (superior
sulcus tumour)
 Shoulder or arm pain
 Weakness, atrophy,
numbness of ipsilateral
hand
 Horner syndrome
o Ptosis
o Miosis
o Anhidrosis
 Tumour originates in the apical portion of the lung
 Occurs in 5% of non-small cell lung cancer
 Invasion of brachial plexus causes pain and muscle wasting of arm and
hand
 Invasion of superior cervical sympathetic ganglion leads to Horner
syndrome:
o Loss of sympathetic control of Muller muscle that elevates the upper
eyelid leads to partial ptosis
o Loss of sympathetic drive of iris dilator muscle leads
to miosis (excessive constriction of the pupil)
Symptoms
Paraneoplastic syndromes: symptoms in cancer patients not attributable to tumour compression or invasion
Ectopic Cushing syndrome
 See Adrenal
cortex chapter in
Endocrinology
Syndrome of inappropriate
antidiuretic hormone
production (SIADH)
 See Hyponatremia in
Nephrology for details
Hypercalcemia
Hypertrophic
osteoarthropathy and digital
clubbing
Distant metastasis
Metastatic sites include
brain, bone, liver and
adrenal glands
Mechanism and pathophysiology
o Anhidrosis (lack of sweating) caused by impingement of sweat gland
fibres arising from cervical sympathetic ganglion
 Phrenic nerve involvement can lead to unilateral diaphragm paralysis
 Recurrent pharyngeal nerve involvement can lead to voice hoarseness
 Ectopic secretion of adrenocorticotrophic hormone (ACTH) → adrenal
cortisol secretion → weight gain, hypertension, hypokalemia, muscle
weakness
 Most common form of ectopic secretion in lung cancer, especially SCLC
 Ectopic secretion of ADH → retain free water in collecting ducts
 Euvolemic hyponatremia and concentrated urine
 Mild symptoms include headache and weakness, severe symptoms include
altered mental status, seizures, respiratory depression, and death
 Common in SCLC
 Increased secretion of PTHrP → acts like parathyroid hormone to increase
bone resorption and renal calcium reabsorption → hypercalcemia
 Associated with squamous cell carcinoma
 Associated with NSCLC, especially the adenocarcinoma type
 Periosteal proliferation of the tubular bones characterized by (i) painful
symmetrical arthritis of the ankles, knees, wrists and elbows, and (ii)
digital clubbing.
 Mechanism is due to secretion of various factors including VEGF, PDGF,
and prostaglandin E2.
 Frequently asymptomatic however 33% of patient presents with symptoms
relating to distal metastasis
 PATHOPHYSIOLOGY of LUNG CANCER

MODIFIABLE FACTORS NON MODIFIABLE OTHER FACTORS

-Smoking (62 yrs smoker)2/3 packs FACTORS
-Previous lung disease
per day -Age (81 years old)
-Exposure to chemicals -Past Cancer treatment
-Fam .Hx (Lung ca)
-2nd hand smoking -Gender (male)
Air Pollution

Inhalation of irritants /carcinogenesis

-
enters the lungs and maj. bronchi

Irritation and obstruction of -Nagging

cough, SOB
airways
,wheezing

carcinogenesis

SCLC NSCLC

Central Tumor
Peripheral Tumor
 Primary lung lesion Mediastinal
involvement Paraneoplastic
syndromes

Wt.loss hemop dyspnea Chest

cough
tysis pain

SVC Dysphagia
Pericardial Pains and Horner’s
symptoms
effusion weakness,atr Syndrome
ophy of
arms and
shoulders

SIADH hypercalcem Hypertrophic

ia osteoarthropathy
Ectopic
and digital
Cushing
clubbing
Syndrom
e
 Assessment Diagnosis Planning Implementation Evaluation

Intervention Rationale

Subjective Data: Ineffective At the end of 8 Auscultated chest for character Noisy respirations, rhonchi, At the end of the 8
‘haan lang met nga airway clearance hours, the patient of breath sounds and presence and wheezes are indicative of hours duty ,the
agsarsardeng ti related to will demonstrate of secretions. retained secretions or airway patient verbalized ‘
uyek kun’’.as increased patent airway, with Mejo nabawasan na
obstruction.
amount or
verbalized by the fluid secretions eas ang pagubo ko ’
viscosity of
patient secretions ily expectorated Assist client with and provide Upright position favors
RR=19
as evidenced by instruction in effective deep maximal lung expansion
changes in rate breathing, coughing in upright CR=95
Objective data: and depth of position (sitting),
respiration O2 sat-94%
RR=27 bpm Abnormal breath Increased amounts of
Observed amount and colorless (or blood-streaked)
CR=105 cpm sounds character of sputum. or watery secretions are
Dyspnea
(+) rhonchi upon normal initially and should
auscultation decrease as recovery
progresses. Presence of thick,
+crackles tenacious, bloody, or purulent
sputum suggests development
O2 sat-86
of secondary problems—for
example, dehydration,
pulmonary edema, local
hemorrhage, or infection—

Encouraged oral fluid intake,
at least 2,500 mL/day
Assisted client with postural
drainage as indicated.
Administered bronchodilators,
expectorants, and analgesics,
as indicated.
that require correction or
treatment
Adequate hydration aids in
keeping secretions loose and
enhances expectoration
Improves lung expansion and
ventilation and facilitates
removal of secretions
Relieves bronchospasm to
improve airflow. Expectorants
increase mucus production
and liquefy and reduce
viscosity of secretions,
facilitating removal.
ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION EVALUATION

INTERVENTION RATIONALE

Subjective: Acute pain r/t At the end of 30 At the end of

irritation of tissue minutes, the 30 mins.
“Nasakit ti barukung endings patient will patient
ku pati agituy sakak”, report relief from verbalized that
as verbalized by the pain as pain scale
patient. manifested by: decreased
from 7 to 3

Pain scale of 7/10 No facial

Decrease in pain grimace noted
scale from 8/10
to 4/10
Objective:

Absence of facial
Facial grimace grimace
Guarding behavior Positioned the patient To provide non
comfortably pharmacologic
Exertional discomfort Absence of management of
guarding pain
In fetal position behavior
Encouraged deep To alleviate
breathing feelings of pain
Encouraged adequate To prevent fatigue
rest periods
To assess
Performed pain congruency with
assessment each time verbal reports of
pain occurs pain

Noted every time pain To rule out

occurs worsening of
condition

Administered
analgesics as ordered To maintain
acceptable level of
pain
Encouraged quiet and To conserve
restful atmosphere energy or lower
tissue oxygen
demand
 ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION EVALUATION

Subjective: INTERVENTION RATIONALE

‘Haan nak nga Imbalanced Nutrition: Less At the end of Monitors daily food Identifies nutritional
unay nga than 4 weeks the intake and have client keep strengths and
makapang Body Requirements related patient will food diary, as indicated. . deficiencies.
pangan,awan to hyper metabolic state progressively
unay ganas ku’’ gains weight
as verbalized by at 1 per Measured height, weight,
and skin fold thickness, or Measurements fall
the patient. week
other anthropometric below minimum
Objective: measurements, as standards, client’s chief
appropriate. source of stored energy,
Weight=32 kg fat tissue, is depleted

Height=5’2’’ Assess skin and mucous Helps in identification

membranes for pallor, of protein-calorie
BMI=12.9 delayed wound healing, malnutrition, especially
and enlarged parotid weight
Dry skin
glands.

Encourage client to eat Metabolic tissue and

high-calorie, nutrient-rich needs are increased as
diet, with adequate fluid to eliminate waste
intake. Encourage use of products. Supplements
supplements and frequent, can play an important
smaller meals spaced role in maintaining
throughout the day. adequate caloric and
protein intake.

Create pleasant dining

atmosphere; encourage Makes mealtime more
client to share meals with enjoyable, which may
family and friends. enhance intake
 ASSESSMENT DIAGNO PLANNING IMPLEMENTATION EVALUATION
SIS

Subjective Data Impaired At the end of 8 hour INTERVENTION RATIONALE At the end of the
Gas shift the patient will shift, the patient’s
“Nahihirapan Exchange demonstrate respiratory rate
Monitored and
akong huminga as To obtain baseline data
R/T improved ventilation recorded vital signs decreased from 26
verbalized by the Alveolar – and adequate bpm to 19 bpm
patient” Capillary oxygenation of Monitored respiratory rate, To assess for rapid or
Membrane tissue depth and rhythm shallow respiration that
Changes occur because of
Objective data hypoxemia and stress

Use of accessory Assessed pt’s general To note for etiology

condition precipitating factors that
muscle for
breathing can lead to impaired gas
exchange
restlessness
Auscultated breath sounds, To note for etiology
RR= 26 bpm note areas of precipitating factors that
decreased/adventitious can lead to impaired gas
Presence of breath sounds as well as exchange
rhonchi upon fremitus
auscultation
Elevated head of the pt. To enhance lung
expansion
 To evaluate degree of
Noted for presence
compromise
of cyanosis

Encouraged To promote optimum

frequent position chest expansion
changes and
deep-breathing exercises

Provided supplemental To correct/ improve

oxygen at lowest existing deficiencies

Review laboratory results To determine pt’s

oxygenation status

Provide health teaching on To empower SO and pt

how to alleviate pt’s
condition

Administer prescribed For the pharmacological

medications as ordered management of the
patient’s condition

.
 Assessment Diagnosis Planning Implementation Evaluation

INTERVENTION RATIONALE

Activity At the end of 4 Establish Rapport To gain clients participation

Subjective data:
days the patient and cooperation in the nurse
‘Nanghihina Intolerance
will report patient interaction
ako,dati kayak o measurable
Monitor and recorded Vital To obtain baseline data
pang maglakad increase in
Signs
activity
lakad sa veranda
intolerance Assess patient’s general To note for any
ng bahay condition abnormalities and
ngayon parang deformities present within
the body
araw araw
Adjust client’s daily activities
nauubusan ako and reduce intensity of level. To prevent strain and
overexertion
ng lakas’ as
verbalized by Instruct client in unfamiliar
the patient activities and in alternate ways
of conserve energy. Encourage To relax the body
patient to have adequate bed
rest and sleep

Provide the patient with a

calm and quiet environment
To provide relaxation
Assist the client in ambulation
Note presence of factors that
could contribute to fatigue
Ascertain client’s ability to
stand and move about and
degree of assistance needed or
use of equipment
Give client information that
provides evidence of daily or
weekly progress
Encourage the client to
maintain a positive attitude
Assist the client in a semi-
fowlers position
Elevate the head of the bed
Assist the client in learning
and demonstrating appropriate
safety measures. Instruct the
SO not to leave the client
unattended
To prevent risk for falls that
could lead to injury
Fatigue affects both the
client’s actual and perceived
ability to participate in
activities
To determine current status
and needs associated with
participation in needed or
desired activities
To sustain motivation of
client. To enhance sense of
well being
To promote easy breathing
To maintain an open airway
to prevent injur
 Assessment Diagnosis Planning Implementation Evaluation

INTERVENTION RATIONALE

Activity At the end of 3 Established Rapport To gain clients participation

Subjective data:
days the patient and cooperation in the nurse
‘Nanghihina Intolerance
will report patient interaction
ako.dati kayak o measurable
Monitored and recorded Vital To obtain baseline data
pang maglakad increase in activity
Signs
intolerance
lakad sa veranda
Assesed patient’s general To note for any abnormalities
ng bahay condition and deformities present
ngayon parang within the body
araw araw
Adjusted client’s daily To prevent strain and
nauubusan ako activities and reduce intensity overexertion
of level.
ng lakas’ as
verbalized by the Discontinue activities that To conserve energy and
cause undesired psychological promote safety
patient
changes

Instruct client in unfamiliar To relax the body

activities and in alternate ways
of conserve energy

Encourage patient to have To provide relaxation

adequate bed rest and sleep
Provide the patient with a calm
and quiet environment
Assist the client in ambulation
Note presence of factors that
could contribute to fatigue
Ascertain client’s ability to
stand and move about and
degree of assistance needed or
use of equipment
Give client information that
provides evidence of daily or
weekly progress
Encourage the client to
maintain a positive attitude
Assist the client in a semi-
fowlers position
Elevate the head of the bed
Assist the client in learning and
demonstrating appropriate
safety measures. Instruct the
SO not to leave the client
unattended
To prevent risk for falls that
could lead to injury
Fatigue affects both the
client’s actual and perceived
ability to participate in
activities
To determine current status
and needs associated with
participation in needed or
desired activities
To sustain motivation of
client. To enhance sense of
well being
To promote easy breathing
To maintain an open airway
to prevent injury