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In the year 2000, the Philippines had a total number of 6,395 reported deaths that was

caused by cancer of the lungs, as documented by the DOH (Philippine Health Statistics 2000, DOH)

Slow-growing lung adenocarcinoma, in actuality, is the most common kind of lung cancer -

both in smokers and non-smokers, and in people under age 45. Adenocarcinoma makes up for

about 30 percent of primary lung tumors in male smokers and 40 percent in female smokers. For

non-smokers, these percentages approach 60 percent in males and 80 percent in females. This is

also more common in Asian populations. Although smoking frequently causes this type of cancer,

secondary risk factors include age, family history, and exposure to secondhand smoke, mineral and

metal dust, asbestos, or radon. Symptoms develop slowly as well. They include coughing, shortness

of breath, wheezing, chest pain and bloody sputum. Sometimes, this illness may appear at first to be

pneumonia or a collapsed lung.

Sometimes the spread of this cancer produces large amounts of fluid building up around the

lung. In this case, doctors perform Chest tube thoracostomy. It is done by placing a hollow plastic

tube between the ribs into the chest to drain fluid, blood, or air from the space around the lungs.

Pleural effusion, the term used to call the excess fluid that had accumulated in the pleural cavity,

which is the fluid-filled space that surrounds the lungs. The excess amount of this fluid affects the

lungs by limiting the expansion of the lungs thus, it impairs breathing.

The group chose Smokey Robinsonǯs case primarily because they would like to broaden

their knowledge on lung cancer.

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"  
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Personal Data:

Patients Name: #$ % 

Age: &'
Gender: 
Birth date: '()'(*(
Address:  )+) 
Nationality:   ! 
Religion [Domination]:    , # -
Civil Status:  
Educational Attainment: .  
Occupation:  
Weight: /0$ #

Clinical/ Admitting Data:

Date of admission: %()01'1

Time of admission: **1!#
Hospital: !2 # .! ,10'111*3(-
Ward [Room & Bed *1*
Numbers]:
Attending Physician: 42 5 642 


Chief complaint:   % 
Admitting and Final Æ 5 Æ
Diagnosis:
Vital signs on admission: 
Temperature: */7 
Pulse Rate: 8&+! 

Respiratory Rate: 0*! 

Blood pressure: '*19(1  #!

Surgical Procedure Done: 

%#

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*Pre-operation Diagnosis:  5  !   


:Surgeon:424242 


:Anesthesiologist42
Source of information:  ; "; " 




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4. 


The past illnesses that the patient has encountered in the past were not significant. Only

common minor illnesses such as fever, flu, and hyperacidity were experienced by the patient in his

lifetime. He did not experience severe, yet common diseases such as dengue and measles. Also, he

has no diabetes mellitus. He has no history of food and drug allergies or hypersensitivities. He

smoked an average of 15 cigarettes per day since high school. Also, he is a social drinker who only

drinks at parties or special events. A notable health condition that he experienced is bronchial

asthma. He coped with asthma by finding a comfortable position during asthma attacks and she did

not take any medications because those were not available yet. His asthma subsided when she was

about 40 years old. A significant disease that he encountered (and is still encountering) later on in

his life is hypertension. He was diagnosed after getting his routine blood pressure checkup. The

doctor advised him to avoid salty and fatty foods and he was also given medicine, specifically

amlodipine besylate(Norvasc).

Medications he took in her lifetime were not numerous, according to him. In fact, he said he

hardly ever took medications. Paracetamol was always his first choice whenever he encounters

fever and colds. He also took some Neozep and mefenamic acid in his lifetime. Also, the patient

noted that he had to comply with taking Norvasc for his hypertension.



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4.. 

The patientǯs hypertension is now held at bay by doing follow-up visits to the doctor, asking

for advices and of course, compliance with medications. He also minimized eating his favorite food,

which is pork, for the sake of improving his hypertensive state. He is currently in a pre-

hypertensive state with a blood pressure of 130/90 mmHg. The doctorǯs first impression with his

hypertension was that he was in Stage 2, thus we can say that his condition has significantly

improved.

The patientǯs lung cancer was diagnosed when he was having an onset of difficulty of

breathing for three days when he was on a vacation in Baguio last May 2009. As the days went by,

he noticed a progression of dyspnea. Initially, he thought that her asthma had recurred, which

prompted him to seek consultation on June 2009. After a series of diagnostic procedures, he was

then diagnosed of having lung cancer. The cancer was classified as adenocarcinoma, or a cancer

originating in the mucus producing glands in the lungs. It is known to be the most common cancer

of smokers.

On July 2, 2009, upon receiving the chest x-ray result, her physician, Dr. V.V. Villaflor III,

ordered a STAT chest tube thoracostomy. Dr. V.V. Villaflor III performed the procedure with the

help of Dr. GPV as the anesthesiologist.

. <
Æ  

Date of Assessment: February 11, 2010

Time of Assessment: 8:25 pm

Location of Assessment: Dagupan Doctorǯs Villaflor Memorial Hospital

Vital Signs

Temperature : 36 degrees Celsius

Pulse Rate: 87 Beats per Minute

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Respiratory Rate: 23 Cycles per Minute---Rapidc

Blood Pressure: 130/90 Millimeter per Mercury

 5

During assessment, the patient was eating on bed. There is a chest tube connected to a chest

tube drainage installed on the surgical site located at the 6th and 7th intercostal space of the left lung.

Patient is awake, conscious, coherent, and oriented to time, place, person and reason for admission.

He is calm and responsive. The patient has an endomorph type of body; with a height of 158.49

centimeters or 62.4 inches and with a weight of 62 kilograms or 136.4 pounds. Patient had already

done his general and oral hygiene and was dressed appropriately for the occasion.

c

His skin color is normal, appears thin and translucent, dry and flaky over the extremities.

Skin lost its elasticity and takes longer to return to its natural shape after being tented between the

thumb and finger. The palms and the soles are calloused. Wrinkles appear on the skin of the face

and neck. Freckles are also noted on the back of the hand. Incision site is 2 cm on the lateral thorax

on the 6th and 7th intercostal space of the left lung and the compact dressing appears to be fixed.

Hair is black, thin and fine textured but not evenly distributed on the scalp. No infection or dandruff

noted. Scalp is free of lesions. The hair of the eyebrows is coarse. Nails are pink, firm with capillary

refill of 2 seconds and without lesions or clubbing.

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Head is symmetrical, rounded normocephalic with smooth skull contour positioned at

midline and erect with no lumps or ridges. Facial movements are symmetrical and patient is able to

perform different kinds of facial expression effortlessly and without any obstructions.
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Patient uses corrective lenses when reading. Eyebrows are symmetrically aligned and with

equal movement with no presence of flakes, scars, or lesions. Darkened skin around the orbit of the

eye is noted. Skin folds of the upper lids are more prominent, and the lower lids sag. Eyes are dry

and lusterless and iris appears pale with brown discolorations. Conjunctivas of the eye are also

pale. Pupil reaction to light and accommodation is normally symmetrically equal, 2mm in size

diameter. Both eyes are coordinated; move in unison and with parallel alignment.


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The color of patientǯs ears is the same as her facial skin. The left and the right pinna are

symmetrical and are aligned with the inner canthus of the eye. There is no foul smelling serous or

purulent discharges noted. External canal is normally clear with minimal dry cerumen. The earlobe

is elongated and the skin of the ear is dry and less resilient. Upon palpation, auricles are mobile, and

non-tender; pinna recoils after it is folded. The patient was able to hear normal voice tones and is

able to hear ticking in both ears, as whispered same words on both ears with correct responses.


c

The nose is symmetric, straight, and uniform in color and no discharges or flaring noted. Air

moves freely as the patient breathes through the nares. Nasal mucosa is pink, clear and no lesions

noted. Nasal septum is intact and in midline. Upon palpation, no tenderness noted.

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Lips are dry, cracked and pale in color and with symmetry in contour. Patient is wearing

dentures and has an incomplete set of teeth. Gums are pinkish in color, dry and firm with yellow

discoloration of the enamel and dental carries was noted on both lower right and lower left of the

teeth. The tongue is normally in midline and was able to move freely, and the base has prominent

veins. The patient is able to swallow with no difficulty.

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The patientǯs uvula was located along the midline. The mucosa was pinkish in color and no

lesions or ulcerations noted. The tonsils were pink and smooth, no discharges or inflammation

noted.


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Neck can perform any range of motion without discomfort and with equal muscle strength

as the patient turns his head from left to right; up and down; and circular motion. Trachea was

located centrally in the midline of the neck, spaces are equal on both sides, and no deviation noted

on any part. No lymph nodes noted on any of the areas of the neck. Thyroid gland is not visible upon

inspection.  c c 
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The patientǯs thoracic curvature is accentuated, his chest was not symmetrical due to the

surgical site and the spine was vertically aligned from the neck to the buttocks. There was a full and

symmetric chest expansion. The anteroposterior diameter of the chest widens because of barrel-

chested appearance. Upon auscultation, no adventitious sounds can be heard.

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The patientǯs precordial area is flat; there was no lift or heaves. The point of maximal

impulse was located at the fifth left intercostals spaces or along the breast line in line with the

nipples. During palpation, the patientǯs carotid artery produces full pulsations with thrusting

quality.


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Patientǯs breasts were even. Skin was smooth and uniform in color with the abdomen.

During palpation, there were no tenderness, masses or nodules noted with the patientǯs axillary,

subclavicular and supraclavicular lymph nodes.

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Patientǯs abdomen is round, with silver white striae, symmetric contour, and no evidence of

enlargement of liver or spleen. Abdominal wall is slacker and thinner. The patientǯs abdominal girth

measures 34 inches or 74.8 centimeters. Skin returns quickly to its original shape when picked up

between two fingers and released. Growling sounds noted with fifteen (15) bowel sounds per

minute. No areas of tenderness or palpable organs noted upon palpation. Patient defecates once a

day, every morning.

  c

The patient declined to assess his genitals. However, according to the client there were no

discharges and pain during urination.

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Patientǯs peripheral pulses were symmetrical, strong, within normal rate, regular in rhythm

at 24 beats per minute. The patientǯs nails took 2 seconds for the capillary refill. The nails were

pinkish in color. Edema was not noted on the patientǯs upper extremity and lower extremities.

There are bilateral warmth on both arms and legs of the client.

The patient was able to perform range of motion without any discomfort, swelling,

deformity, or nodule on his upper and lower quadrants and on both upper and lower extremities.

Weakness and pain were noted at the upper left extremity of the patient near the incision or

surgical part. There is no missing finger or bone enlargement on the hands and wrists.

The back is also symmetrical with the spinal cord aligning from the neck down to the

buttocks. There were no deformities or abnormalities on the bone such as scoliosis, osteoporosis

and alike to be noted. There are also no lesions and the like noted on the back. Skin color at the back

and the extremities are similar with the rest of the body. Hip joints and thighs can perform range of

motion without any discomfort.


<
.<
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The lungs are a pair of cone-shaped breathing organs in the chest. The lungs bring oxygen

into the body as you breathe in. They release carbon dioxide, a waste product of the bodyǯs cells, as

you breathe out.

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Each lung has sections called lobes. The left lung has two lobes, while the right lung is

slightly larger and has three lobes. Two tubes called bronchi, lead from the trachea (windpipe) to

the right and left lungs. These bronchi are sometimes also involved in lung cancer disease process.

Tiny air sacs called alveoli and small tubes called bronchioles make up the inside of the

lungs. A thin membrane called the pleura covers the outside of each lung and lines the inside wall of

the chest cavity. This creates a sac called the pleural cavity. The pleural cavity normally contains a

small amount of fluid that helps the lungs move smoothly in the chest when you breathe.

Æ
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Cancer of the lung, like all cancers, results from an abnormality in the body's basic unit of

life, the cell. Normally, the body maintains a system of checks and balances on cell growth so that

cells divide to produce new cells only when needed.

There are two main types of lung

cancer, non-small cell lung cancer and small

cell lung cancer. First is the Non-small Cell

Lung Cancer. NSCLC accounts for about 80%

of lung cancers.

There are different types of NSCLC, including 1.  

c c   (also called

epidermoid carcinoma). This is the most common type of NSCLC. It forms in the lining of the

bronchial tubes and is the most common type of lung cancer in men. 2.   . This cancer

is found in the glands of the lungs that produce mucus. This is the most common type of lung cancer

in women and also among people who have not smoked. 3.   ! c  . This is a

rare subset of adenocarcinoma. It forms near the lungs' air sacs. Recent clinical research has shown

that this type of cancer responds more effectively to the newer targeted therapies, and 4. c

""c . This cancer forms near the surface, or outer edges, of the lungs. It can

grow rapidly.

The second type of lung cancer is the Small cell Lung Cancer. SCLC accounts for about 20% of

all lung cancers. Although the cells are small, they multiply quickly and form large tumors that can

spread throughout the body. Smoking is almost always the cause of SCLC.

 #

Like other cancers, adenocarcinoma is the growth of abnormal cells. These cancerous cells
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multiply out of control and form a tumor. As the tumor grows, it destroys parts of the lung.
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Eventually, the tumor's abnormal cells can spread (metastasize) to other parts of the body,

including the local lymph nodes in the chest and the central portion of the chest, called the

mediastinum; the liver; the bones; the adrenal glands; and other organs, including the brain.

When lung cancer metastasizes, the tumor in the lung is called the primary tumor, and the

tumors in other parts of the body are called secondary tumors or metastatic tumors. Tumors are

dangerous because they take oxygen, nutrients, and space from healthy cells, thus leading to the

destruction of the healthy and normal-functioning cells in our body.

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The test that
measures the
120Ȃ 160
Hemoglobin amount of '009Æ Normal
g/dL
hemoglobin per
liter of blood

Feb 10,
2010 The test
measures the
M: 42-52%
Hematocrit percentage of 3*? Normal
F: 37-47%
RBC in the total
blood volume

HIGH:
Conditions that
cause high WBC
values include
infection,
inflammation,
damage to body
tissues, severe
The test
physical or
measures all
emotional stress
0.5-10 leukocytes '*4/ =
WBC count (such as a fever,
X10^9/L present in 1 '1@(9Æ
injury, or surgery),
cubic millimeter
burns, kidney
of blood.
failure, lupus,
tuberculosis,
rheumaoid arthritis,
malnutrition,
leulemia, and
diseases such as
cancer.
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Monocytes have
phagocytic
action. It
removes dead or
injured cells, cell
fragments, and
Monocyte 2 Ȃ 10% 0? Normal
microorganism.
This test is done
to diagnose an
illness such as
inflammatory
diseases.
Eosinophils
initiate allergic
responses and
act against
Eosinophils 1 Ȃ 8% parasitic 0? Normal
infestation. The
test is use to
diagnose worm
infestation.
The test
measures the
4.0-5.0X circulating RBCs 34&*=
RBC count Normal
10^12/L in 1 cubic '1@'09Æ
millimeter of
blood.
The test
measures the
Thrombocytes 150- 300X amount of 0(1
Normal
10^9/L platelets that are ='1@(9Æ
important for
blood clotting.

The test
measures the
percentage of
Lymphocytes 20-40% the principal 01? Normal
component of
the bodyǯs
immune system.
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The
prothrombin
time is the time
it takes plasma
to clot after
Feb 10,
addition of
2010
Prothrombin 12-15 tissue factor. '043
Normal
time seconds This measures 
the quality of the
extrinsic
pathway (as well
as the common
pathway) of
coagulation.

The test is to
International know if there is a
Normalized 0.8Ȃ1.2 high chance of
141& Normal
Ratio bleeding or high
chance of blood
clot.

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   <
        
Generic Name
Theophylline
Brand Name Theocron
Classification Xanthine derivative; Pregnancy risk Category C

Indication and 5 mg/kg P.O., then 3 mg/kg q 6 hours for two doses. intenance dosage is 3
Dosage mg/kg q 8 hours 250 mg, 1 tab od @ hs

Mode of Action Inhibits Phosphodiesterase, the enzyme that degrades cAMP, resulting in
relaxation of smooth muscle of the bronchial airways and pulmonary blood
vessels.
Contraindication Contraindicated in patients hypersensitive to xanthine compounds (caffeine,
theobromine) and in those with active peptic ulcer or poorly controlled seizure
disorders.
Side/ Adverse  : restlessness, dizziness, insomnia, seizures, headache, irritability, muscle
Effects twitching.
#: palpitations, sinus tachycardia, arrhythmias, extrasystoles, flushing, marked
hypotension.
$: nausea, vomiting, diarrhea, epigastric pain.
à : urinary catecholamines
%
  : respiratory arrest, tachypnea
Nursing {c Dosage may need to be increased in cigarette smokers and in habitual
Responsibilities marijuana smokers because smoking causes drug to be metabolized faster.
{c Give the drug around the clock, using extended-release product at bedtime.
{c Monitor vital signs; measure and record fluid intake and output. Expect
improved quality of pulse and respirations.
{c Patients metabolize xanthenes at different rates; dosage is determined by
monitoring response, tolerance, pulmonary function, and drug level. Drug
levels range from 10 to 20 mcg/ml; toxicity may occur at levels above 20
mcg/ml.
{c ALERT: evidence of toxicity includes tachycardia, anorexia, nausea,
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vomiting, diarrhea, restlessness, irritability, and headache. If these signs

occur, check drug level and adjust dosage, as indicated.
{c Look alike-sound alike: donǯt confuse extended-release form with regular-
release form. Donǯt confuse Theolair with Thyrolar.
  
{c Supply instructions for home care and dosage schedule.
{c Warn patient not to dissolve, crush, or chew extended-release products.
Small children unable to swallow these can ingest (without chewing) the
contents of capsules sprinkled over soft food.
{c Tell patient to relieve GI symptoms by taking oral drug with full glass of
water after meals, although food in stomach delays absorption.
{c Warn patient to take drug regularly, only as directed. Patients tend to want
to take extra Dzbreathing pillsdz.
{c Inform elderly patient that dizziness is common at start of therapy.
{c Urge patient to tell prescriber about any other drugs taken. OTC drugs or
herbal remedies may contain ephedrine or theophylline salts; excessive
CNS stimulation may result.

c
c
Generic Name
Multivitamins + minerals
Brand Name Centrum®
Classification Vitamins &/or Minerals

Indication and Complete multivitamin & mineral formula.

Dosage Dosage: 1 tab/day

Mode of Action {c

Contraindication 1.c If the multivitamin supplement contains fluoride, check with doctor.
Patients should not use it if their drinking water contains more than 0.7
parts per million of fluoride.
2.c Contraindicated to patients if allergic to any ingredient in Centrum
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3.c Inform the doctor or pharmacist if the patient has any medical
conditions, especially if any of the following applies:
{c if patient is pregnant, planning to become pregnant, or are
breast-feeding
{c if patient is taking any prescription or nonprescription medicine,
herbal preparation, or dietary supplement
{c if patient has anemia, liver problems, or metabolism problems
Side/ Adverse No reported adverse effects at doses studied up to approximately 500 mg / day
Effects

Nursing 1.c Do not use supplements as a replacement for a diet rich in essential
Responsibilities vitamins and minerals. Encourage the patient to eat the right kind of
food for it contains many important ingredients not available in
supplements.
2.c Follow the dosing instructions on the bottle, or use as directed by your
doctor.
3.c Do not take more than suggested.
4.c If the patient forgot to take the multivitamins for a day, relieve possible
patient concerns by educating them or by resuming his/her regular
schedule the following day.
5.c Encourage the patient to store it out of the reach of children, at room
temperature, and keep tightly closed.
c c

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c Take pain medications as needed
c Inform client to take medications on time, or as directed for the full course of therapy,
even if feeling better. Inform the client about the possible side effects of the medication.
c Encourage the client to report or inform the physician if any of these side effects occur.
Inform and explain to the client in simple terms that other drugs, such as over the counter
drugs that he or she is taking, will probably have other effects with the medication given.
Moreover, emphasize the right timing or taking or the right time intervals of these drugs
to maximize its effects and avoid further complications.
c Provide information for better understanding regarding therapeutic regimen

= 

c Encourage early ambulatory.
c 

 

     
  
  


     

 
 
 
 


 

c Instruct the client to continue drug therapy as ordered.
c Inform the client as well as the family the dangers of non compliance to treatment
regimen.
c Discuss to the client the complication of the condition.
c Inform client to do exercises and stretches.
c Advise patients to wash their hands before touching incision sites.
c Instruct the patient to report to the physician promptly about any changes on health
condition.
c Encourage patient to strictly comply with the doctorǯs orders, especially in taking
prescribed medications
c Encourage the patient to have followed up visitations to the physician after discharge.
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.Æ..

 
c The incision area must be kept dry until the wound begins to heal and sponge baths are
recommended for the first day or two.

c  



   

    






c !


   
    

 


 
   


c Notify the physician on the following:

Àc fever and 


Àc redness, swelling, or bleeding or other drainage from the incision site(s)
Àc increased pain around the incision site(s)
Àc abdominal pain, cramping, or swelling
 


c Remind client on the arrangements to be made with the physician for follow-up check ups

c Follow-up check up regularly in order to monitor and properly manage patientǯs illness.

c Continue medication as ordered.

c Instruct to have a follow-up check-up or refer to the physician if the patient is

uncomfortable

c Instruct the client and significant others to report for any unusualities.

c  
 


  
" "
  

c The pathology results from patientǯs surgery should be available within one week after
your surgery.

c Follow-up appointments are generally made before surgery with the physician and a
nurse. The dressing will be changed or removed at patientǯs post-operative visit.



c Instruct client may resume his regular diet as soon as he can take fluids after recovering
from anesthesia.

c Encourage eight to 10 glasses of water and non-caffeinated beverages per day, plenty of
fruits and vegetables as well as lower fat foods.
29

c Encourage to eat high fiber foods such as fruits and vegetables.c

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