The nurse is preparing a care plan for a patient recently diagnosed with non-small cell lung cancer (NSCLC) and underlying COPD. Which nursing intervention is most appropriate to address the patient's respiratory function considering their condition?

B) Educate the patient on energy conservation techniques and provide supplemental oxygen as needed.

A) Encourage the patient to engage in strenuous physical activity to improve lung capacity.

B) Educate the patient on energy conservation techniques and provide supplemental oxygen as needed.

C) Advise the patient to increase fluid intake to thin secretions and improve airway clearance.

D) Suggest the use of herbal supplements to enhance immune function and support respiratory health.

A patient with newly diagnosed non-small cell lung cancer (NSCLC) and underlying COPD is being evaluated for treatment options. The biopsy revealed the presence of EGFR mutations. Which intervention should the nurse prioritize when educating the patient about their treatment options?

A) Discuss the potential benefits and side effects of targeted therapy with EGFR inhibitors.

B) Explain the surgical resection procedure and its potential impact on lung function.

C) Provide information about chemotherapy and its systemic effects on the body.

D) Educate the patient on radiation therapy and its role in symptom management.

A patient with non-small cell lung cancer and liver metastases is experiencing increased fatigue, shortness of breath, and peripheral edema. The healthcare team must reconsider the treatment plan due to impaired liver function. As a nurse, what is the priority intervention to address the patient's current symptoms and improve quality of life?

C) Collaborate with the healthcare team for palliative care consultation

A) Administer diuretics to manage peripheral edema

B) Initiate high-flow oxygen therapy to improve oxygen saturation

C) Collaborate with the healthcare team for palliative care consultation

D) Educate the patient on dietary modifications to support liver function

A patient with non-small cell lung cancer (NSCLC) and a history of COPD presents with new symptoms, including peripheral edema, mild jaundice, and shortness of breath. The patient's liver function tests reveal elevated ALT and AST levels, and imaging confirms liver metastases. Considering the impaired liver function, what is the most appropriate nursing intervention to prioritize in this situation?

C) Collaborate with the healthcare team to modify the medication regimen.

A) Administer the prescribed chemotherapeutic agents as scheduled.

B) Increase the dose of bronchodilators to manage COPD symptoms.

C) Collaborate with the healthcare team to modify the medication regimen.

D) Encourage the patient to increase fluid intake to manage ascites.

A patient with advanced non-small cell lung cancer and a pleural effusion has a hemoglobin level of 9.2 g/dL. Despite adherence to diuretics, the patient presents with worsening dyspnea. Which nursing intervention is most appropriate to address the patient's current symptoms and improve quality of life?

D) Prepare the patient for pleural catheter insertion to facilitate drainage of pleural fluid

A) Increase the dosage of diuretics to reduce fluid overload

B) Administer supplemental oxygen to alleviate shortness of breath

C) Position the patient in a high Fowler's position and encourage deep breathing exercises

D) Prepare the patient for pleural catheter insertion to facilitate drainage of pleural fluid

A patient with metastatic non-small cell lung cancer presents with worsening shortness of breath and increased peripheral edema despite adherence to diuretics and supplemental oxygen therapy. A chest X-ray confirms a right-sided pleural effusion, and thoracentesis reveals malignant cells. What is the most appropriate nursing intervention to prioritize for this patient to address their respiratory distress?

C) Assist with pleural catheter insertion for ongoing drainage

A) Administer bronchodilators to improve airway patency

B) Encourage ambulation to enhance lung expansion

C) Assist with pleural catheter insertion for ongoing drainage

D) Increase the supplemental oxygen flow rate

A patient with metastatic disease is exhibiting signs of confusion, lethargy, hypotension, and tachycardia. Lab results show a drop in hemoglobin and elevated liver enzymes. Which nursing intervention should be prioritized to address the patient's immediate needs?

B) Prepare the patient for an immediate blood transfusion to address anemia.

A) Administer supplemental oxygen to improve oxygen saturation.

B) Prepare the patient for an immediate blood transfusion to address anemia.

C) Initiate fall precautions to prevent injury due to confusion and lethargy.

D) Schedule a consultation with palliative care for symptom management.

A patient with metastatic disease exhibits increasing confusion and lethargy, hypotension, tachycardia, elevated liver enzymes, and low hemoglobin levels. Which nursing intervention is the most appropriate to prioritize in this situation?

A) Administer a blood transfusion to address the anemia.

B) Increase the supplemental oxygen to improve oxygen saturation.

C) Initiate intravenous fluids to manage hypotension.

D) Consult with a gastroenterologist to investigate potential gastrointestinal bleeding.

A patient with advanced lung cancer has been diagnosed with esophageal varices due to portal hypertension from liver metastasis. Which nursing intervention is most appropriate to reduce the risk of variceal bleeding?

B) Administer prescribed beta-blockers to decrease portal pressure

A) Encourage a high-protein diet to support liver function

B) Administer prescribed beta-blockers to decrease portal pressure

C) Position the patient in a supine position to reduce abdominal pressure

D) Provide education on the importance of routine endoscopic surveillance

A patient with advanced lung cancer and liver metastasis has undergone an esophagogastroduodenoscopy (EGD) that confirmed esophageal varices. The healthcare team has initiated beta-blocker therapy to reduce portal pressure. Which nursing intervention is most important to monitor the effectiveness of the beta-blocker therapy?

A) Monitor the patient's heart rate and blood pressure regularly.

B) Assess the patient's skin and sclera for changes in jaundice.

C) Evaluate the patient's hemoglobin and hematocrit levels weekly.

D) Check the patient's stool for the presence of melena daily.

Lung canacer - Nursing Case Study

Pathophysiology

• Primary mechanism: Genetic mutations in lung epithelial cells, often triggered by carcinogens like tobacco smoke, lead to uncontrolled cellular proliferation. These mutations activate oncogenes and inactivate tumor suppressor genes, resulting in the formation of malignant tumors.

• Secondary mechanism: Angiogenesis, the process of new blood vessel formation, is stimulated by tumor cells to secure an adequate blood supply. This supports rapid tumor growth and facilitates metastasis, allowing cancer cells to spread to other parts of the body.

• Key complication: Metastasis is a critical complication, where cancer cells invade surrounding tissues and travel through the bloodstream or lymphatic system to distant organs, significantly impacting prognosis and treatment complexity.

Patient Profile

Demographics:

62-year-old male, retired construction worker

History:

• Key past medical history: Chronic obstructive pulmonary disease (COPD), hypertension, smoking history of 40 pack-years

• Current medications: Albuterol inhaler, Lisinopril, Aspirin

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Persistent cough and shortness of breath

• Key symptoms: Hemoptysis, chest pain, weight loss, fatigue, night sweats

• Vital signs: Blood pressure 150/95 mmHg, heart rate 105 bpm, respiratory rate 24 breaths per minute, temperature 100.4°F, oxygen saturation 88% on room air

Section 1

New Diagnostic Results:

Following the initial assessment, the healthcare team decided to conduct a series of diagnostic tests to further evaluate the extent and nature of the patient's lung cancer. A chest X-ray revealed a large mass in the right upper lobe, suggestive of a malignant tumor. A subsequent CT scan of the chest provided more detailed imaging, confirming the presence of a 4.5 cm mass with irregular borders and evidence of mediastinal lymphadenopathy, raising concerns for potential metastatic spread. A PET scan was also conducted, which highlighted increased metabolic activity not only in the primary lung lesion but also in the contralateral lung and liver, indicating possible metastasis.

A bronchoscopy with biopsy was performed to obtain tissue samples for histopathological examination. The pathology report identified the mass as non-small cell lung cancer (NSCLC), specifically adenocarcinoma, a subtype commonly associated with smoking and characterized by glandular differentiation. The biopsy also revealed the presence of EGFR mutations, which could influence targeted therapy options. Blood tests showed elevated levels of lactate dehydrogenase (LDH) and alkaline phosphatase, markers often associated with tumor burden and metastatic disease. These findings underscore the need for a multidisciplinary approach to determine the most appropriate treatment plan, considering the patient's underlying COPD and overall functional status.

The diagnostic results necessitate a comprehensive discussion with the patient regarding the prognosis and potential treatment pathways, including surgical resection, chemotherapy, radiation therapy, and targeted therapy. The presence of EGFR mutations opens the possibility for targeted drugs like gefitinib or erlotinib, which may offer a more tailored treatment approach. However, the patient's COPD and reduced pulmonary reserve pose significant challenges, requiring careful consideration of the risks and benefits of each treatment option. This diagnostic phase sets the stage for developing a personalized treatment strategy aimed at managing symptoms, slowing disease progression, and maintaining quality of life.

Section 2

As the healthcare team embarked on the treatment plan for the patient with non-small cell lung cancer (NSCLC), the patient began experiencing new complications. During a follow-up appointment, the patient reported increasing fatigue and shortness of breath, which were initially attributed to the progression of COPD. However, upon further examination, the patient displayed signs of peripheral edema and mild jaundice. Vital signs revealed a blood pressure of 145/90 mmHg, heart rate of 110 beats per minute, and oxygen saturation of 88% on room air, necessitating supplemental oxygen. These findings prompted additional laboratory tests and imaging to evaluate the underlying cause of these symptoms.

The lab results indicated a significant rise in liver enzymes, with ALT and AST levels elevated to 150 U/L and 180 U/L, respectively, suggesting hepatic involvement. A repeat CT scan of the abdomen confirmed the presence of liver metastases, and an ultrasound highlighted mild ascites. The patient's deteriorating condition, characterized by hepatic metastasis and impaired liver function, complicated the treatment landscape. With the liver's compromised ability to metabolize drugs, the healthcare team had to reconsider the use of certain chemotherapeutic agents and targeted therapies, including those aimed at EGFR mutations.

This development required a reassessment of the treatment strategy, emphasizing symptom management and supportive care to improve the patient's quality of life. Palliative care consultation was recommended to address the patient's physical, emotional, and spiritual needs. The team considered alternative therapeutic options that accounted for the patient's reduced liver function and ongoing respiratory issues. This phase of the patient's journey highlighted the importance of adapting treatment plans to evolving clinical situations and reinforced the need for continuous monitoring and multidisciplinary collaboration.

Section 3

As the patient's condition continued to evolve, the healthcare team focused on closely monitoring for any new complications. During a subsequent follow-up, the patient presented with worsening shortness of breath and increased peripheral edema despite adherence to prescribed diuretics and supplemental oxygen therapy. A thorough physical examination revealed decreased breath sounds in the lower lung fields and dullness to percussion, raising suspicion of a pleural effusion. Additionally, the patient's jaundice appeared more pronounced, and they reported a significant decrease in appetite and unintended weight loss.

New diagnostic tests were ordered to investigate these symptoms further. A chest X-ray confirmed the presence of a right-sided pleural effusion, and thoracentesis was performed to relieve the patient's respiratory distress and obtain fluid for analysis. The pleural fluid cytology revealed malignant cells, indicating further metastatic spread of the non-small cell lung cancer. Concurrently, the patient's complete blood count showed a declining hemoglobin level of 9.2 g/dL, suggesting anemia, which could be contributing to the fatigue and exacerbating the dyspnea.

In response to these findings, the healthcare team prioritized interventions to manage the pleural effusion and address the anemia. The patient underwent a pleural catheter insertion for ongoing fluid drainage, which provided symptomatic relief and improved respiratory function. Anemia management strategies were also implemented, including consideration for erythropoiesis-stimulating agents and dietary modifications to support nutritional intake. These interventions aimed to enhance the patient's quality of life while acknowledging the limitations imposed by the advancing disease and hepatic compromise. As the team continued to reassess the patient's status, they remained vigilant for further complications and explored additional supportive care measures to address the patient's complex needs.

Section 4

As the healthcare team continued to monitor the patient's response to the recent interventions, a change in patient status became apparent. Despite the relief provided by the pleural catheter, the patient began exhibiting signs of increasing confusion and lethargy. Vital signs indicated hypotension with a blood pressure reading of 90/60 mmHg, tachycardia with a heart rate of 112 beats per minute, and a slightly elevated respiratory rate of 24 breaths per minute. Oxygen saturation remained stable at 93% on supplemental oxygen, but the patient's mucous membranes appeared pale, further suggesting a worsening anemic state.

Concerned about the possibility of new complications, the team ordered a series of diagnostic tests. Repeat blood work revealed a further drop in hemoglobin to 8.6 g/dL, raising the suspicion of gastrointestinal bleeding or bone marrow suppression as potential contributors. A comprehensive metabolic panel indicated elevated liver enzymes, with an AST of 98 U/L and ALT of 76 U/L, alongside increased bilirubin levels, which were consistent with the advancing jaundice. The findings pointed towards progressive hepatic involvement, likely secondary to metastatic disease, contributing to the patient's declining condition.

Given these developments, the healthcare team shifted their focus to managing the new complications. A blood transfusion was considered to address the anemia more aggressively, while a consultation with a gastroenterologist was scheduled to evaluate the potential for gastrointestinal bleeding. Additionally, discussions were initiated regarding the incorporation of palliative care services to better support the patient's needs as the disease progressed. These steps underscored the importance of balancing aggressive symptom management with the patient's overall comfort and quality of life, all while preparing for the potential next stage of care.

Section 5

As the healthcare team proceeded with the blood transfusion to address the patient's anemia, there was a noticeable improvement in the patient's energy levels and mental status. The post-transfusion hemoglobin rose to 10.2 g/dL, which corresponded with a slight increase in blood pressure to 100/65 mmHg and a decrease in heart rate to 98 beats per minute. However, the patient's jaundice persisted, with the skin and sclera remaining a deep yellow, indicating ongoing hepatic involvement. Concurrently, the gastroenterologist's assessment raised concerns about a potential upper gastrointestinal bleed, given the patient's history and the presence of melena observed during a recent stool analysis.

Further diagnostic imaging, including an abdominal ultrasound, revealed hepatomegaly with multiple lesions suggestive of metastases, reinforcing the suspicion of liver impairment. An esophagogastroduodenoscopy (EGD) was performed, which confirmed the presence of esophageal varices, likely secondary to portal hypertension from liver metastasis, indicating a high risk for future bleeding episodes. This finding necessitated the initiation of beta-blocker therapy to reduce portal pressure and prevent further variceal bleeding, alongside continued monitoring of liver function tests.

The patient's response to interventions highlighted the complexity of managing multiple, interrelated complications in advanced lung cancer. The healthcare team recognized the critical need to maintain a balance between aggressive treatment and palliative care, ensuring the patient's comfort while addressing emergent issues. As the patient's condition stabilized temporarily, discussions with the patient and family about the future course of care and potential hospice involvement became increasingly important, setting the stage for ongoing decision-making and care planning.