Adenocarcinomaof the lungNiccole CouseUniversity of South FloridaCollege of Nursing
Introduction(Eldridge, 2010a)• Adenocarcinoma refers to a cancer thatoriginates in glandular tissue of theepithelium.• It ...
Pathopysiology(Eldridge, 2010a)• Adenocarcinoma progresses in 4 stages1. Cancer is confined in the lung with no spread2. C...
Diagnosis(Eldridge, 2010a)• Determined by biopsy• Detected on– X-ray– Chest CT scan– Bronchoscopy– PET scan– Sputum cytology
Risk Factors• Smoking (tobacco and marijuana) (Fayed, 2006)– 15% of smokers develop lung cancer– 80% of lung cancer cases ...
Signs and Symptoms(Spiro, S. G., Gould, M. K., & Colice, G. L., 2010)• Early– Fatigue– Shortness of Breath– Back/chest ach...
Assessment(Spiro et al., 2010)• History:– Persistant cough, hemoptosis, dyspnea, chest pain, anorexia,weight loss• Oxygena...
Treatments• Surgery – lobectomy, pneumonectomy• Chemotherapy ( Einhorn, 2008)– Carboplatin & Paclitaxel• inhibits DNA synt...
Treatments – nursing considerations(Van Leeuwen, Poelhuis-Leth, & Bladh, 2012)• Surgery –– HOB at 30-45degrees– Increase f...
Treatments – nursing considerations(Fauci, Braunwald, Kasper, Hauser, Longo, Jameson, & Loscalzo, 2012)• Chemotherapy– Hai...
Treatments – nursing considerations(Edlridge, 2012b)• Radiation– Skin irritation– Hair loss– Dry cough/shortness of breath...
Treatments – nursing considerations(Eldridge, 2012b)• Radiation– Pulmonary fibrosis• Scar tissue formation– Cardiac toxici...
Prognosis(Bianchi, Nuciforo, Vecchi, Bernard, Tizzoni, Marchette, Buttitta, Felicioni, Nicassio, & Di Fiore, 2007)• Overal...
Nursing Diagnosis(Ackley & Ladwig, 2011)• Ineffective gas exchange• Activity Intolerance• Fear• Disturbed body image
Clinical Example80 year old Female. Lifetime never smoker.HPI: In 2007 she had a chest X-ray and her Dr. noticed a“nodule”...
Clinical Example• Positive Diagnosis: via biopsy after abnormalXray• Positive Risk Factors: Non smoker, female,family hist...
NCLEX style question• A female client is newly diagnosed withadenocarcinoma of the lung. She asks “Howcan I have lung canc...
NCLEX style question• A female client is newly diagnosed withadenocarcinoma of the lung. She asks “Howcan I have lung canc...
NCLEX style question• Which of the following indicate stage 4metastasis1. Jaundiced skin2. Seizures3. Palpable supraclavic...
NCLEX style question• Which of the following indicate stage 4metastasis1. Jaundiced skin2. Seizures3. Palpable supraclavic...
ReferencesAckley, B. J., & Ladwig, G. B., (2011) Nursing Diagnosis Handbook: An Evidence-BasedGuide to Planning Care ( 9th...
ReferencesEldridge, L., (2012a) Lung Adenocarcinoma: symptoms, treatments, and prognosis.About.com Guide. Retrieved from:h...
ReferencesSpiro, S. G., Gould, M. K., & Colice, G. L., (2010) Initial Evaluation of the Patient WithLung Cancer: Symptoms,...
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Case study adenocarcinoma of the lung

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Case study adenocarcinoma of the lung

  1. 1. Adenocarcinomaof the lungNiccole CouseUniversity of South FloridaCollege of Nursing
  2. 2. Introduction(Eldridge, 2010a)• Adenocarcinoma refers to a cancer thatoriginates in glandular tissue of theepithelium.• It is a non-small cell cancer– These are the most common types of lung cancer• It is the most common cancer effecting non-smokers and women.– 2nd most common overall
  3. 3. Pathopysiology(Eldridge, 2010a)• Adenocarcinoma progresses in 4 stages1. Cancer is confined in the lung with no spread2. Cancer has spread within the lung and may beaffecting lymphnodes.3. Cancer has spread to nearby tissues or the otherlung.4. Cancer has spread to another part of the body.
  4. 4. Diagnosis(Eldridge, 2010a)• Determined by biopsy• Detected on– X-ray– Chest CT scan– Bronchoscopy– PET scan– Sputum cytology
  5. 5. Risk Factors• Smoking (tobacco and marijuana) (Fayed, 2006)– 15% of smokers develop lung cancer– 80% of lung cancer cases are smokers• Female– Females are about 3X more likely (Gaspirino,2010)• Radon Exposure (Fayed, 2006)• Family History (Fayed, 2006)• Inflammatory lung diseases (Fayed, 2006)– Tuberculosis and pneumonia
  6. 6. Signs and Symptoms(Spiro, S. G., Gould, M. K., & Colice, G. L., 2010)• Early– Fatigue– Shortness of Breath– Back/chest ache• Late– Chronic cough****– Fatigue– Dyspnea– Back/chest pain– Hemoptosis– Weight loss
  7. 7. Assessment(Spiro et al., 2010)• History:– Persistant cough, hemoptosis, dyspnea, chest pain, anorexia,weight loss• Oxygenation:– Nail angle – clubbing– Wheezing• Assess for metastasis:– Lymph nodes: Supraclavicular node• enlarged in 20% of metastasis– Liver – common site• LFT – often not effected until late, jaundice, weakness, weight loss– Intracranial – 10%• Headaches, nausea, vomiting, seizures, confusion, personality changes
  8. 8. Treatments• Surgery – lobectomy, pneumonectomy• Chemotherapy ( Einhorn, 2008)– Carboplatin & Paclitaxel• inhibits DNA synthesis causing death of rapidly dividingsells (Deglin, Vallerand, & Sanoski , 2012)– Bevacizumab• Inhibits new blood vessel growth causing decreasedmetastasis (Deglin, Vallerand, & Sanoski , 2012)• Radiation (Eldridge, 2012b)
  9. 9. Treatments – nursing considerations(Van Leeuwen, Poelhuis-Leth, & Bladh, 2012)• Surgery –– HOB at 30-45degrees– Increase fluid intake– Monitor Airway– Suction airway as needed– Cough and deep breathing– Monitor oxygen saturation– Pain management– Chest tube monitoring– Early ambulation
  10. 10. Treatments – nursing considerations(Fauci, Braunwald, Kasper, Hauser, Longo, Jameson, & Loscalzo, 2012)• Chemotherapy– Hair loss– Healthy tissue necrosis– Immunodepression– Anemia
  11. 11. Treatments – nursing considerations(Edlridge, 2012b)• Radiation– Skin irritation– Hair loss– Dry cough/shortness of breath• Lowered surfactant – steroids may be given– Fatigue– Esophagitis• Dysphagia, heartburn– Radiation pneumonitis• Inflammation – 5-15% - treated with steroids
  12. 12. Treatments – nursing considerations(Eldridge, 2012b)• Radiation– Pulmonary fibrosis• Scar tissue formation– Cardiac toxicity– Secondary cancers• Appear 5-10 years after treatment– Leukemia, breast, and lung cancers most common
  13. 13. Prognosis(Bianchi, Nuciforo, Vecchi, Bernard, Tizzoni, Marchette, Buttitta, Felicioni, Nicassio, & Di Fiore, 2007)• Overall: 15% survive 5 years– Often due to late diagnosis– Inoperable• Stage 1 detection: 30-60% survive 5 years
  14. 14. Nursing Diagnosis(Ackley & Ladwig, 2011)• Ineffective gas exchange• Activity Intolerance• Fear• Disturbed body image
  15. 15. Clinical Example80 year old Female. Lifetime never smoker.HPI: In 2007 she had a chest X-ray and her Dr. noticed a“nodule” in her right lower lobe. He decided to monitor itfor any changes before attempting any surgicalprocedures. At a recent check-up, her Dr. noticed changesin the nodule and decided to biopsy the node and somesurrounding lymph nodes. When a few biopsy resultscame back positive for cancer, her Dr. referred her to aspecialist who operates out of Sarasota MemorialHospital for the removal of her right lower lobe of thelung.
  16. 16. Clinical Example• Positive Diagnosis: via biopsy after abnormalXray• Positive Risk Factors: Non smoker, female,family history, inflammatory lung disease(asthma and tuberculosis)• Positive Symptoms: none• Treatment: lobectomy possible chemotherapy• Prognosis: Good
  17. 17. NCLEX style question• A female client is newly diagnosed withadenocarcinoma of the lung. She asks “Howcan I have lung cancer? I never smoked!”What is an appropriate response to thepatients concerns?a) You must have been exposed to cigarette smokeat some point.b) You don’t have to lie about smoking.c) Adenocarcinoma is the most common lungcancer in non-smoking persons.d) It’s O.K. Everything will be fine!
  18. 18. NCLEX style question• A female client is newly diagnosed withadenocarcinoma of the lung. She asks “Howcan I have lung cancer? I never smoked!”What is an appropriate response to thepatients concerns?a) You must have been exposed to cigarette smokeat some point.b) You don’t have to lie about smoking.c) Adenocarcinoma is the most common lungcancer in non-smoking persons.d) It’s O.K. Everything will be fine!
  19. 19. NCLEX style question• Which of the following indicate stage 4metastasis1. Jaundiced skin2. Seizures3. Palpable supraclavicular lymph nodes4. Chronic cougha) 1,2,3b) 2,3c) 1,4d) 1,2
  20. 20. NCLEX style question• Which of the following indicate stage 4metastasis1. Jaundiced skin2. Seizures3. Palpable supraclavicular lymph nodes4. Chronic cougha) 1,2,3b) 2,3c) 1,4d) 1,2
  21. 21. ReferencesAckley, B. J., & Ladwig, G. B., (2011) Nursing Diagnosis Handbook: An Evidence-BasedGuide to Planning Care ( 9th edition). St. Louis, MO: Mosby Inc.Bianchi, F., Nuciforo, P., Vecchi, M., Bernard, L., Tizzoni, L., Marchette, A., Buttitta, F.,Felicioni, L., Nicassio, F., & Di Fiore, P. P., (2007) Survival Prediction of Stage 1Lung Adenocarcinomas by expression of 10 genes. The Journal of ClinicalInvestigation, 117(11).Doi: 10.1172/JCI32007Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2030461/Deglin, J.D., Vallerand, A. H., & Sanoski, C. A., (2012) Davis Drug Guide.. Nursing Central.Einhorn, L. H., (2008) First-Line Chemotherapy for Non–Small-Cell Lung Cancer: Is There aSuperior Regimen Based on Histology? Journal of Clinical Oncology, 26(21).Doi: 10.1200/JCO.2008.17.2056Retrieved from: http://jco.ascopubs.org/content/26/21/3485.full
  22. 22. ReferencesEldridge, L., (2012a) Lung Adenocarcinoma: symptoms, treatments, and prognosis.About.com Guide. Retrieved from:http://lungcancer.about.com/od/typesoflungcancer/a/Lung- Adenocarcnoma.htmEldridge, L., (2012b) Side Effects of Radiation Therapy for Lung Cancer. About.comGuide. Retrieved from:http://lungcancer.about.com/od/treatmentoflungcancer/a/radsideeffects.ht mFauci, A., Braunwald, E., Kasper, D., Hauser, S., Longo, D., Jameson, L., & Loscalzo, J.,(2012) Harrison’s Manual of Medicine, Nursing CentralFayed, L., (2006) Causes and Risk Factors for Lung Cancer. About.com Guide. Retrievedfrom: http://cancer.about.com/od/lungcancer/p/lungcancercause.htmGasperino, J., (2010) Gender is a Risk Factor for Lung Cancer. Medical Hypothesis,76(3). Retrieved from:http://www.sciencedirect.com.ezproxy.lib.usf.edu/science/article/pii/S0306 987710004433
  23. 23. ReferencesSpiro, S. G., Gould, M. K., & Colice, G. L., (2010) Initial Evaluation of the Patient WithLung Cancer: Symptoms, Signs, Laboratory Tests, and ParaneoplasticSyndromes. CHEST Journal, 132(3).Doi: 10.1378/chest.07-1358Retrieved from:http://chestjournal.chestpubs.org/content/132/3_suppl/149S.fullVan Leeuwen, A. M., Poelhuis-Leth, D. J., & Bladh, M. L., (2012) Diseases andDisorders. Nursing Central
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