Lung Cancer: Pathophysiology, Nursing Diagnosis and Interventions

The estimated new cases of lung cancer in 2017 was 222,500 (Lung Cancer, 2017). Lung cancer is the leading cause of cancer related deaths world-wide (Liao et al., 2014). Over 86% of lung cancers are attributed to smoking (Danson et al., 2015). Other risk factors to lung cancer are exposure to asbestos, secondhand smoke and a family history of lung cancer. However, there is still a high incidence in lung cancer for those who have never smoked or even been exposed to smoke (Grossman, 2014, p.945). This paper will discuss the pathophysiology of lung cancer, and the significant nursing diagnoses and interventions that should be fulfilled to help support patients who have been diagnosed with lung cancer.

Pathophysiology of Lung Cancer

Lung cancer is very complex and has many different ways of manifesting and evolving. Around 95% of lung tumors are carcinomas (Grossman, 2014, p. 945). Additionally, the lungs also are the most frequent body site for metastasis of other cancers. The lung tumors start as a small mucosal lesion that may form as intraluminal masses that invade the bronchial mucosa and infiltrate the peribronchial connective tissue. The tumor can also form large bulky mass that extends into the adjacent lung tissue (Grossman, 2014, p.945). Lung cancer is subdivided into four major categories, squamous cell carcinoma, adenocarcinoma, small cell carcinoma and large cell carcinoma (Grossman, 2014, p. 945). The staging of lung cancer is based on the TNM system, T for primary tumor, N for number of regional lymph nodes and M for distant metastasis (Ignatavicius, 2016, p. 574). To be able to stage and treat lung cancer, it is classified as small cell (SCLC) or non-small cell (NSCLC) lung cancer. SCLC have a distinct cell type, which are round, oval cells that grow in clusters that do not show a glandular or squamous organization. The SCLC are very malignant, and spread very easily, especially to the brain (Grossman, 2014, p. 945). Small cell lung cancers have been found to have a manifestation of neuroendocrine markers, which hint that they come from neuroendocrine cells of the bronchial epithelium (Grossman, 2014, p. 945).

The SCLC are associated with paraneoplastic syndromes, including inappropriate antidiuretic hormone secretion, Cushing's syndrome and the Eaton-Lambert syndrome of neuromuscular disorder (Grossman, 2014, p. 945-946). The NSCLC include the squamous cell carcinoma, adenocarcinoma, and large cell carcinomas, and these can also have the capacity to produce paraneoplastic syndromes (Grossman, 2014, p. 946). Squamous cell carcinoma originates in the central bronchi and spreads centrally to major bronchi and hilar lymph nodes (Grossman, 2014, p. 946). Adenocarcinoma is the most common type of lung cancer for women and nonsmokers. They originate in the bronchiolar or alveolar tissues (Grossman, 2014, p. 946). Large Cell Carcinomas start in the periphery of the lung and then invade the subsegmental bronchi and the larger airways (Grossman, 2014, p. 947). Lung cancer becomes noticeable when it affects the lung and related structures, the spread and metastasis, and the paraneoplastic effects that include the endocrine, neurologic and connective tissue function (Grossman, 2014, p. 947). The symptoms of lung cancer can include a cough, shortness of breath, hoarseness, wheezing, pain, and weight loss (Grossman, 2014, p. 947). Some complications that can arise from lung cancer include shortness of breath, coughing up blood which indicates that the cancer has spread to the blood vessels, pleural effusion which is fluid building up in the chest, and pain when the cancer has invaded the pleura (Mayo Clinic, 2018).

Nursing Diagnosis

There are many important nursing diagnoses for lung cancer. The first would be impaired gas exchange, related to ventilation-perfusion imbalance, alveolar-capillary membrane changes. This is evidenced by dyspnea, abnormal skin color, hypoventilation and restlessness and arterial blood gases demonstrating hypoxia (Doenges, 2013 p. 359). A second priority nursing diagnosis would be ineffective airway clearance, related to smoking, retained secretions and a foreign mass in the airway. This is evidenced by shortness of breath, adventitious breath sounds, hoarseness, and excessive sputum (Doenges, 2013 p. 49). A third priority nursing diagnosis is acute pain, related to chemical agent's secondary to chemotherapy. This is evidenced by self-report of pain using a numeric ranging scale, appetite change, hopelessness, vomiting, and restlessness (Doenges, 2013 p. 591).

Nursing Interventions

Incorporating supportive and comforting nursing interventions to lung cancer patients can improve their experience during their diagnosis. Quality of life has been identified as one of the most crucial indicators of cancer prognosis and factors related to the duration of survival for patients with lung cancer (Liao 2014). Treatments for lung cancer can include, surgery, radiation therapy, chemotherapy, drug therapy, palliative care and immunotherapy (Mayo Clinic 2018).

For impaired gas exchange maintaining adequate oxygenation is important. It is crucial to assess the patient's respirations, rate and rhythm as well as auscultating lung sounds. Observing these will provide insight if there is adequate gas exchange and determine how air is moving in and out of the lung fields. Noting the breath sounds can determine if there is an obstruction or presence of secretions (Doenges, 2013 p. 360). Elevating the head of the bed and providing supplemental oxygen can improve ventilation and increase gas exchange and oxygen diffusion (Doenges, 2013 p. 361). Many interventions are involved when maintaining a clear airway. Encouraging rest periods and limiting activities to an acceptable respiratory tolerance for the patient to prevent any fatigue, allows for the airway to remain clear without any secretions or inflammation (Doenges, 2013 p. 52). It is important to also note if there are any secretions and provide suction if needed to clear airway and eliminate excessive sputum blocking the airway (Doenges, 2013 p. 50-51). Another key factor is to encourage the patient to take deep breaths and cough every hour to improve the ability to mobilize and remove secretions (Doenges, 2103 p. 51). Administering bronchodilators such as albuterol can relieve bronchospasm and improve airflow (Doenges, 2013 p. 51).

Pain is common in patients with cancer and is the symptom most feared by them (Simoff et al., 2013). An intervention for acute pain is to assess an acceptable pain level for the patient and administer analgesics to maintain an acceptable level of comfort for the patient. Understanding the patient's perception of pain can help dose medication and manage how pain medication can help improve function for the patient (Doenges, 2013 p. 592). Another option for alleviating pain would be the use of non-pharmacological and complementary therapies, breathing exercises or guided imagery (Doenges,2013 p. 594). A study done by Naja et al., used non-pharmacological therapies including herbal remedies and vitamins like gaviola seeds, avocado mix, cherimoya and herbs such as, shita, A'landa, and also spiritual healing in forms of prayer, visiting sanctuaries and blessings (Naja et al., 2017). The use of non-pharmacological pain management can help the patient relieve pain without the effects of opioid medication (Doenges, 2013 p. 592).

Conclusion

In conclusion, lung cancer is a very aggressive form of cancer and is the cause of many deaths across the United States. Being able to educate the public about the causes of lung cancer and the risk factors, such as smoking can help decrease the incidence. When patients are diagnosed with lung cancer being able to provide comfort, adequate oxygenation and pain relief are the key to helping these patients be able to function and continue their quality of life.

References

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