Far Eastern University

Institute of Nursing

A Case Presentation
Nursing Process: Lung Cancer
Submitted by:

Udani, Celine S.

Umali, Kimberlyn J.

BSN – 135

Gropu 139 - B

Submitted to:

Prof. Gulapa RN MAN

, 2010

Nursing Process
I. Biographic Data

Name: MNC

Address: Southern Leyte

Age: 52 years old

Marital status: Married

Room and bed: F7

Chief complaint: Hemoptysis

Attending Physician:

II. Nursing History

A. Past Health History

1. Childhood Illness

He had asthma when he was still a toddler. But it did not persist any
longer especially when he turned 12.

2. Immunizations

He had a complete immunization.

3. Allergies

He has no medication allergies but he has an allergy on sea foods such

as shrimp and crabs.

4. Accidents

He had a vehicular accident last December 2009. He was driving a car

and the suddenly he bumped in a 10-wheeler trucked which had
caused him to have an implant on his left leg.

5. Hospitalization

He has no previous hospitalization except to the accident that he had

into last December.

6. Medications used or currently taken

 He has not taken any medicine when the persistent pain of his leg has
become. The doctor presently ordered a medicine (written at the
medications below) and he just brought it a while ago.

7. Foreign travel (when, length of stay)

There is no stated foreign travel.

B. History of Present Illness

This is a case of a 52y/o, male, married, Filipino, who came in due to

hemoptysis. The client stated that he was already experiencing an on and
off cough for several weeks prior the hemoptysis.

C. Family History

Their family has a history of PTB on paternal side.

III. Patterns of Functioning

A. Psychological Health

1. Coping Pattern
Whenever he has problem, he walks alone and think about it. He likes to
share it to his friends and seek advice. He somewhat feel relieved after
sharing it to others. He always tries to feel positive.

Interpretation: He looks for an alternative way of dealing with any

stress and tries to be optimistic.

Analysis: Coping mechanisms which are behaviors used to decrease

stress and anxiety. Many coping behaviors are learned, based on one’s
family past experiences, and socio-cultural influences and
expectations.
(Fundamentals of Nursing 5th edition by Taylor, page 855)

2. Interaction Pattern
He has many friends at work and he knows all his neighbors in Leyte. He has
never encountered any major problem with his friends or many as long as he
remembers. He is always in good terms with them. He loves socializing with
people and he always laughs and tells fun stories.

Interpretation: Interacting with people makes you aware of what

kind of person who you are, whether you are good or bad. In his case,
he had never encounter any major problem with his friends and it
signifies that he is a good individual.
 Analysis: Communication can be a transmission of feelings or a more
personal and social interaction between people. Self-concept develops
as a result of social interaction with others. (Kozier &Erb’s
Fundamental of Nursing Eight Edition Volume two. Self-concept, page
1003.)

3. Cognitive Pattern
He finished until first year college with a course of mechanical engineer. He is
well mannered and literate. He loves reading informational books, like
reader’s digest whenever he is free.

Interpretation: Even if he didn’t finished his study, he is determined

to study to learn more and add more knowledge.

Analysis: Cognition is greatly affected by education. Those who study

and develop their skills have better cognitive performances because
they have been provided with different information and chances to
develop their self. Perception is affected by the sensory diseases.
Presence of any sensory abnormalities affects or halters perception
that would affect proper communication. (Black, Medical Surgical
Nursing7th edition, page 1880).
Cognition involves a person’s intelligence, perceptual ability and ability
to process information. It represents a progression of mental abilities
from illogical to logical thinking, from simple to complex problem
solving and from concrete to abstract ideas. (Kozier et.al,
Fundamentals of Nursing 7th ed. Page 359).

4. Self-Concept
He always tries to look on a better side whenever he has problems, like being
in the hospital. Instead of thinking that he is ill, he thinks that at least when
he is in the hospital he can relax. He feels good about himself as long as he is
with his family and with God.

Interpretation: He is a positive thinker and it can help him to reduce

the pain and sufferings that he might encounter.

Analysis: Self concept is one’s mental image of oneself. A positive self

concept is essential to a person’s mental and physical health.
Individuals with a positive self concept are better able to develop and
maintain interpersonal relationship and resist psychological and
physical illness.
Self concept involves all of these self perceptions, that is, appearance,
values and beliefs that influences behaviors and that are referred to
when using the words I or me. Body image is ho the person perceives
the size, appearance and functioning of the body. If a person’s body
image closely resembles one’s ideal body, the individual is more likely
to think positively about the physical and non-physical concept of self.
Self concept is also affected by role-strains. People undergoing
role-strains are frustrated because they feel or made to feel
inadequate or unsuited to a role.
Illness and trauma can also affect the self-concept. People
responds to different stressors such as illness and alterations in
function related to aging in a variety of ways: acceptance, denial,
 withdrawal and depression are common. (Kozier et.al, Fundamentals
of Nursing 7th ed. Pages 957-962).

5. Emotional Patterns
As for his emotions, he is still the same ill or healthy. He is friendly and
laughs with his friends. He always tries to think of happy thoughts.

Interpretation: He has a good coping mechanisms that helps him

reduce emotional stress.

Analysis: Emotion-focused coping includes thoughts and actions that

relieve emotional distress. (Kozier &Erb’s Fundamental of Nursing
Eight Edition Volume one. Stress and Coping, page 1068.)

6. Family Coping Patterns

He is open to his family. Whenever they have problems they talk about it
immediately and try to resolve it. They never make it a big deal as long as it
can be resolved. The family is open to each other.

Interpretation: Communication to one another is a good way to solve

the problem that is being misunderstand.

Analysis: Family coping mechanisms are the behaviors families used

to deal with stress or changes imposed from either within or without.
Internal resources, such as knowledge, skills, effective communication
patterns, and a sense of mutuality and purpose within the family are
the one mostly utilized by the family to assist them in their problem-
solving process.

B. Socio-Cultural Pattern

1. Cultural pattern
He belongs to no tribe. They celebrate fiestas, Christmas, mourning of the
dead and anything that a Roman Catholic does.

2. Significant Relationship
He is 30 years happily married, and has 3 children.

3. Recreational Patterns
He loves to read informational books like Reader’s Digest. He plays sports
like basketball before, but doesn’t now because of his fracture on his right
leg from a motor accident before, he is afraid that it might get injured
again. He goes to mass twice a month or whenever he feels so.

4. Environmental Pattern
He lives near seaside. Their house is just right with the size of his family,
they have two rooms and good ventilation since it is seaside.

5. Economic
He is already independent financially. He has work and supports his
children with their studies. He earns well, enough for their living but not
for luxury.
 Interpretation: His relation lasts because of his good way of thinking
things as well as protecting his family and providing their needs.

Securing and assuring himself in doing activities is a good way to avoid

further accident.

Analysis: Culture is a complex whole in which each part is related to

every other part. It is learned, and the capacity to learn culture is
genetic, but the subject matter is not genetic and must be learned by
each person in his or her own family. (Kozier &Erb’s Fundamental of
Nursing Eight Edition Volume one. Culture and Heritage, page 315.)
Children and adults in healthy, functional families receive support,
understanding, and encouragement as they progress through
predictable developmental stages, as they move in or out of the family
unit, and as they establish new family units. (Kozier &Erb’s
Fundamental of Nursing Eight Edition Volume one. Promoting Family
Health, page 429.)
People are becoming increasingly aware of their environment
and how it affects their health and level of wellness. (Kozier &Erb’s
Fundamental of Nursing Eight Edition Volume one. Health Wellness
and Illness, page 301.)
The economic resources needed by the family are secured by adult
members. (Kozier &Erb’s Fundamental of Nursing Eight Edition Volume
one. Promoting Family Health, page 429.)

C. Spiritual Pattern

1. Religious Beliefs and Practices

He attends mass twice a month. He do fasting and things a Roman Catholic
does.

2. Values and Valuing

Whenever there are Christian events, like Holy week, he participates in the
activities like fasting. He does not believe in ghosts and elementals for he
knows that God is always there to guide and protect him. He seldom reads
the bible and does not always pray the rosary but he respects and obeys the
rule of God and continues to be a good Christian.

Interpretation: Whether he attends mass for only two times a month

doesn’t mean that he is not as religious as other people was, because
he believes of god’s existence and it is enough to be a good Christian.
Also, he knows god’s rules and obeys it.

Analysis: Spiritual well-being is the condition that exists when the

universal spiritual needs for meaning and purpose, love and belonging,
and forgiveness are met. O’ Briens conceptual model of spiritual well-
being in illness identified three empirical referents of spiritual well-
being: personal faith, religious practice and spiritual contentment.
Spiritual beliefs are of special importance to nurses because of the
many ways they can influence a patient’s level of health and self-care
behaviors. (Kozier et.al, Fundamentals of Nursing 7th ed. Pages
975,979).
 Spiritual well-being is manifested by a generally feeling of being
alive, purposeful and fulfilled. People nurture or enhance their
spirituality in many ways. Some focus on development of the inner self
or world; others focus on the expression of their spiritual energy with
others or outer world. Relating to one’s inner self or soul may be
achieved through conducting an inner dialogue with a higher power or
with one’s self through prayer or medications. The expression of a
person’s spiritual energy to others is manifested in loving relationship
with and service to others, joy and laughter and participation in
religious services and associated fellow gatherings and activities and
by expression of compassion, empathy, forgiveness and hope. (Kozier
et.al, Fundamentals of Nursing 7th ed. Pages 996).

IV. Activities of Daily Living

ADL Before Hospitalization During Hospitalization

1. Nutrition Breakfast: Breakfast:

Dried fish, hotdog, coffee, a Bread, rice, ham, hard-
cup of rice boiled egg sausage, coffee
Lunch: Lunch:
Fish, a cup of rice, a glass Vegetable, 2 cups of rice,
of water meat, a glass of water
Dinner: Dinner:
Fish, a cup of rice, a glass Fish, Vegetable, 2 cups of
of water rice, a glass of water.

*client said that he eat *client said that he eat

snack once a day and snack once a day and
drinks more water in drinks more water in
between. A total of 5 between. A total of 5
glasses of water a day all in glasses of water a day all
all. in all.

2. Elimination He defecates once a day and He defecates once a day

he urinates 4-5x a day. and he urinates 4-5x a
day.

3. Exercise He exercises regularly for 1 He walks up and down the

hour a day every morning. stairs for 20 mins a day.
He takes a bath once a day He takes a bath once a day
4. Hygiene and brushes his teeth twice and brushes his teeth twice
a day. a day.

He does not smoke nor He does not smoke nor

5. Substance Use takes any illegal drugs. takes any illegal drugs.

6. Sleep and Rest He usually sleeps at around He usually sleeps at

10pm and wakes up at around 7pm and wakes up
 4am. at 3am. Takes a 3-hour-
nap every afternoon.

Interpretation and Analysis: His fluid intake should increase, because

increasing fluid intake could help him to excrete some toxic materials in his body.

V. Physical Assessment

Norms Actual Interpretation

Findings and Analysis
General Appearance
1. Posture/Gait Relaxed, erect Relaxed Normal
posture;
coordinated
movement

2. Skin color Varies from light Deep brown,

to deep brown uniform except Normal
in areas exposed
to the sun;
areas of lighter
pigmentation
(palms, lips, nail
beds)

3. Personal Hygiene/ Neat, clean Neat and clean Normal

Grooming

4. Age Logical The client can Normal

Appropriateness sequence; makes answer all the
senses; questions well
has sense of
reality

5. Verbal Behavior Understandable, The client is Normal

moderate pace; understandable
exhibits thought and exhibits
association thought

6. Non-verbal Cooperative The client is Normal

Behavior Appropriate to cooperative and
the situation. appropriate to
No distress the situation
noted.

Measurement
1. Temperature 36.0 °C Normal
2. Pulse Rate 70bpm
3. Respiratory 18cpm
Rate
 4. Blood Pressure 130/90mmHg
5. Weight
6. Height

Body Part Norms Actual Findings Interpretation

(Technique and Analysis
used)
SKIN
Inspect for skin Varies from light Brown Normal
color and to dark brown
uniformity of
color.

EYES Shiny, smooth, Pink palpebral Normal

Inspect the pink or red conjunctiva
palpebral
conjunctiva for
color, texture,
and presence of
lesions

NOSE
Inspect for any Symmetric and (-) nasoaural Normal
deviations in straight; discharge
shape, size or no discharge or
flaring; uniform
color and flaring
color
or discharge
from the nares.

TONSILS
Inspect the size Pink and smooth; (-) Normal
of the tonsils, no discharge of tonsilopharyngeal
color and normal size or not congestion
discharge. visible

THORAX
Inspect the Anteroposterior to Symmetrical chest Normal
shape, and transverse expansion, (-)
symmetry diameter is ratio retraction
of 1:2
Chest symmetric

Auscultate the Clear breath Clear breath Normal

thorax sounds sounds, (-)
murmur, normal
rate regular rhythm
ABDOMEN
Inspect, palpate Flat, rounded Flat, soft abdomen, Normal
and ausculate (convex), or (-) tenderness;
the abdomen scaphoid normoactive bowel
(concave); Audible sounds, (-) edema,
 bowel sounds (-) cyanosis
JOINTS
Inspect joint for No swelling Swelling with It might have
swelling. discharges (pus) infection. S/S of
infection are
swelling,
discharges , pain,
and redness

VI. Laboratory and Diagnostic Examinations Results

Date Procedure Norms Result Interpretation

and Analysis
09-23-10 Cytology Report No mass and Mass on upper ___________
malignant lobe of left
cells on lung. Many
lungs malignant
celss.
Consistent
with a non-
keratinizing
squamous cell
carcinoma.
CT scan of the
09-06-10 chest No mass and Large ___________
malignant pulmonary
cells on solid mass in
lungs the left upper
lobe
consistent
with
bronchogenic
neoplasm.
Within normal
09-09-10 Hematolgy
Section: range.
Prothrombin 10.6-13.6 11.4 sec.
time sec.

Thromboplastin 25.3-32.2 27.5

time sec.

Clotting time 2-7 min. 2 min. 5 sec.

Bleeding time 2-4 min. 1 min. 45 sec.

Hematology Monocytes 0.02-0.10 0.12

(all in normal
range unless MCH 27-31 32.8
indicated)

Blood 202-416 780 umol/L

 Chemistry (all Uric Acid umol/L
in normal
range unless
indicated)

Eto nb un lahat?

VII. Medications, IV Infusions, Blood Transfusion, Treatment Given

Generic Dosage Classification Indication Contraindication Side Effect Nsg. Responsibilities

/ Trade /
Name Frequen
cy
Vitamin B 1 Tab Vitamins and Pernicious -should not be CV: peripheral BEFORE:
complex OD minerals anemia used in vascular
-Determine
CONTRA:- hypersensitivity to thrombosis,
hypersensitiv any of the heart failure. reticulocyte
e to vitamins, GI:
Action: vitamin B12 containing in the transient count, hct, Vit.B12, iron,
A coenzyme or cobalt. preparation, as diarrhea. folate levels before
that -early well as in patients Respi:
stimulate Leber’s with 2-nd or 3-rd pulmonary beginning therapy.
metabolic disease degree arterial edema.
-Obtain a sensitivity test
function and is hypertension. Skin:
needed for cell itching, transitory history before
replication, exanthema,
hematopoiesis, urticaria. administration
and Other: -Avoid I.V. administration
nucleoprotein anaphylaxis,
and myelin anaphylactoid bec. faster systemic
synthesis. reactions with elimination will reduce
parenteral
administration, effectiveness of vitamin.
pain or
burning at DURING:
injection site
-Don’t give large doses of
vitaminB12 routinely;
drug is lost through
excretion.
- Don’t mix parenteral
preparation in same
syringe with other drugs.

AFTER:
-Protect Vit.B12 from
light. Don’t refrigerate or
freeze.
-Monitor patient for
hypokalemia for first 48
hours, as anemia correct
itself. Give potassium
supplements, as needed

Allopurin 300mg Antigout drug -management CNS: headache, Teaching points:

ol OD of the signs drowsiness, -Take the drug after
and peripheral meal.
symptoms of neuropathy, -avoid over the counter
Action: primary and neuritis, medications.
-structural secondary paresthesias. -drink 2.5-3 liters of
isomer of hyp gout. Dermatologic: fluids per day while on
oxanthine (a -management rashes- this drug.
naturally of patients maculopapular, -report rash, unusual
occurring purin with scaly or bleeding or bruising,
e in the body) leukemia, exfoliative- fever, chills, gout attack;
and is lymphoma, sometimes fatal. numbness or tingling;
an enzyme and GI: flank pain, skin rash.
inhibitor, malignancies nausea, vomiting,
inhibiting xant that result in diarrhea,
hine oxidase elevation of -contraindicated abdominal pain,
serum and with allergy to gastritis,
uric acid. allopurinol, blood hepatomegaly,
dyscrasias. hyperbilirubinemi
-use cautiously a, cholestatic
with liver disease, jaundice.
renal failure. GU: exacerbation
of gout and renal
calculi, renal
failure.
Hematologic:
Anemia,
leukopenia,
agranulocytosis,
thrombocytopenia
, aplastic anemia,
bone marrow
depression.

Yung mv+eea dq Makita sa drug buk..aun.. wg n ntn isali un.heheh.. 

VIII. Pathophysiology

NOTES: Modifiabl
e risk
K-Ras- factors
 for cell smoke
growth, PATHOPHYSIOLOGY
differentiation -second-hand
and survival of LUNG CANCER smoker

Proto- -environmental
oncogenes= and
normal gene occupational
that becomes exposures.
oncogene Non-Modifiable:Kelangan
(mutated dagdag ntn 2
Modifiable:
genes) sa cues.gawan
•Age
nlng ntn.
• Lifestyle
Loss (Smoking)
of
heterozygosit • Gender -dietary deficits
• Environmental
y (LOH) in a
cell • Genetics -respiratory
diseases
• Occupation
represents
the loss of
normal
function of
one allele of
a gene in
which the Carcinogenics agent
other allele will enter the
was already
inactivated.
respiratory tract

It will attack the epithelial cells/

lining of the lungs

Mutations in the K-RAS proto oncogenes

will contribute to develop non-small
cancer cells

Proto-oncogenes will turn into

oncogenes

Chromosomal damage can lead

to heterozygosity

Can cause inactivation of tumor

suppressor genes

NSCC will proliferate due to

inhibition of tumor supressor
genes

Formation of tissue mass leading to

manifestations of sign & symptoms like; chest
pain, dyspnea and productive cough.
Pathophysiology
Lung cancers arise from a single transformed epithelial cell in the tracheobronchial
airways. A carcinogen (cigarette smoke, radon gas,and other occupational and
environmental agents) binds to a cell’s DNA and damages it.This damage results in cellular
changes, abnormal cell growth, and eventually a malignant cell. As the damaged DNA is
passed on to daughter cells, the DNA undergoes further changes and becomes unstable.
With the accumulation of genetic changes, the pulmonary epithelium undergoes malignant
transformation from normal epithelium to eventual invasive carcinoma.Squamous cell
carcinoma is more centrally located and arises more commonly in the segmental and
subsegmental bronchi in response to repetitive carcinogenic exposures. Adenocarcinoma is
the most prevalent carcinoma of the lung for both men and women; it presents more
peripherally as peripheral masses or nodules and often metastasizes. Large cell carcinoma
(also called undifferentiated carcinoma) is a fast-growing tumor that tends to arise
peripherally. Bronchioalveolar cell cancer arises from the terminal bronchus and alveoli and
is usually slower growing as compared to other bronchogenic carcinomas. Small cell
carcinomas arise primarily as a proximal lesion or lesions but may arise in any part of the
tracheobronchial tree.

(pde nman na ung diagram na ginwa mo, ok lng kht d muna mglead sa death kc
buhay pa nman pt. ntn.hehe..)

IX. Ecologic Model

A. Hypothesis

B. Pre-Disposing Factors

C. Ecologic Model
D. Analysis
E. Conclusion and Recommendations

X. Prioritized List of Nursing Problems

Nursing Problems Cues Ranking Justification

Identified
• Acute pain- example >this nursing
palabasin nlng diagnosis needs
ntn na immediate attention
sumasakit because it is an actual
dibdib nya pag problem and if this
umuubo problem will be
xa.hehe addressed first there is
an increase of possibility
• Anxiety of preventing and
-nde to pde xe eliminating further
positive problems.
thinker xa.

• Deficient fluid
volume
-pde to xe d
 xa maxadong
umiinom ng
h2o

• Fatigue
-nahihirapan
xa sa paghinga
kya
napapagod xa

• Imbalanced
nutrition: Less
than body
requirements

• Impaired
physical
mobility

• Ineffective
airway
clearance

• Risk for
infection
-wla nman
xang operation
and malinis
nmn xa sa
katawan xe
naliligo dn
nmn xa.
 XI. Nursing Care Plan

NURSING ANALYSIS GOALS AND INTERVENTIONS RATIONALE EVALUATION

DIAGNOSIS OBJECTIVES

Pcnd nlng skn qng anung ncp gagawin, aq nlng gagawa..

XII. Discharge Plan

Treatment for lung cancer may include surgery, chemotherapy, radiation therapy, or a combination of these.

M – Medications to take at home

• Continue Taking medications as prescribed by the doctor.
• Use laxatives or stool softener if advised (after surgery).
• Ask your doctor before taking any vitamins (after radiation therapy).

E – Exercise
(After a Surgery)
• Rest when you are tired. Don’t worry if you are fatigued. Fatigue and weakness are normal for a few weeks
after having a lung removed.
• Limit your activity to short walks. Gradually increase your pace and distance as you feel able.
• Avoid strenuous activities; don’t lift anything heavier than 10 pounds for 4–6 weeks.
• Avoid sitting with your legs down for long periods of time.

(After Chemotherapy)
• Try to exercise. Exercise keeps you strong and keeps your heart and lungs active. Walk as much as you can
without becoming dizzy or weak.

T – Treatments
(After a Surgery)
• Leave the small white strips (Steri-Strips) over your incision in place for 7–10 days after your surgery.
• Always keep your incision clean and dry.
• Shower as needed. Wash your incision gently with mild soap and warm water and pat dry. Avoid scrubbing
your incision.

(After Chemotherapy)
• Follow doctors prescriptions and orders.

H – Health Teachings
(After a Surgery)
• Lie on the side of your surgery, with your good lung up (toward the ceiling).
• Call your doctor if you are coughing up brownish sputum or blood. Lie on the side of your operation with your
good lung up while you wait for help.
 • Learn to check your own pulse. Keep a record of your results. Ask your doctor which pulse rates mean that
you need medical attention.
• Check your temperature every day for 7 days after your surgery.
• Use your incentive spirometer 5 times a day for the first 2 weeks you are home.

(After Chemotherapy)
• Brush your teeth with a soft-bristle toothbrush after every meal.
• Don’t use dental floss if your platelet count is below 50,000. Your doctor or nurse will tell you if this is the
case.
• Use an oral swab or special soft toothbrush if your gums bleed during regular brushing.
• If you can’t tolerate regular methods, use salt and baking soda to clean your mouth. Mix 1 teaspoon(s) of salt
and 1 teaspoon(s) of baking soda into an 8-ounce glass of warm water. Swish and spit.
• Use moisturizing soap. Treatment can make your skin dry.
• Apply moisturizing lotion several times a day to help relieve dry skin.

(After Radiation Therapy)

• Don’t scrub or use soap on the treated area.
• Ask your therapy team which lotion to use.
• Avoid sun on the treated area. Ask your therapy team about using a sunscreen.
• Don’t remove ink marks unless your radiation therapist says it’s okay. Don’t scrub or use soap on the marks when you
wash. Let water run over them and pat them dry.
• Protect your skin from heat or cold. Avoid hot tubs, saunas, heating pads, and ice packs.
• Wear soft, loose clothing to avoid rubbing your skin.
• If your mouth or throat becomes dry or sore, sip cool water. Ice chips may also help.

O – Out patient follow up

Make a follow up check up as instructed by your health care team

D – Diet
(After a Surgery)
Avoid constipation.
• Eat fruits, vegetables, and whole grains.
• Drink 6 to 8 glasses of water a day, unless directed otherwise.
• Use a laxative or a mild stool softener if your doctor says it’s okay.

(After Chemotherapy)
Remember, many patients feel sick and lose their appetites during treatment. Eat small meals several times a
day to keep your strength up.
• Choose bland foods with little taste or smell if you are reacting strongly to food.
• Be sure to cook all food thoroughly. This kills bacteria and helps you avoid infection.
• Eat foods that are soft. Soft foods are less likely to cause stomach irritation.

(After Radiation Therapy)

• Eat foods high in protein and calories.
• Drink plenty of water and other fluids, unless directed otherwise.