LungC

ancer

Its not about smoking,

its about breathing

Patients profile

Occupation: Retired
Revenue Officer
Name: F.C
Chief Complaint:
Difficulty of
Age:81 years old
Breathing
Assessment: Lung
Gender: Male
cancer, COPD
Birthday: September
Attending
4, 1933
Physician: Dr.
Birthplace: Esteban,
Felina Adefuin
Ilocos Sur
Address: Trancoville, Date Admission:
August 31,2014
Baguio City, Benguet
Time of Admission :
Nationality: Filipino
4:37 A.M
Civil Status: Widowed

Admission
Subjective
Data
:

The patient is a diagnosed

case of non small lung
carcinoma stage 4 .Had onset
of DOB and chest pain, few
minutes prior to admission.2
days prior to admission,
patient was noted to have a
productive
cough
with
whitish
phlegm,
no
hemoptysis, no fever, no
vomiting, patient was noted
to have increase severity of
symptoms thus consult to E.R
and subsequent admission.

objective

BP:

110/80
mmHg
Temperature 36.6 Celsius
Cardiac
Rate
Respiratory
Rate
O2 sat:

105 cpm
24 bpm

weight

33.5 kg.

86%

Height
52
(+) decrease (+) crackles

Nursing
history

History of Past Illness

According to patient F.C, he dont remember

receiving any immunizations as a child, he
commented that immunization injections has never
been a fad in the early years. Patient F.C. recalls
that whenever he suffers from illnesses such as
fever, colds and bodily pains he used to self
medicate by taking pain relievers such as
Paracetamol for fever and eventually his stamina
regains. In his late 30s he was diagnosed with
tuberculosis. According to him before he was
diagnosed with the disease, he have been
constantly coughing out with whitish phlegm and
progressed, sleepless nights, loss of stamina, and
chest pain that took him two months before
consulting a physician. What took more of his
attention was his phlegm has been progressed with

History of Present Illness

Three months before the diagnosis has made, the patient can
still roam around the house can even perform self care activities
but with assistance. Due to untreated cough with whitish
phlegm, easy fatigability intermittent fever and chest pain that
doesnt seem to get away even with the intake of medicines; he
went to the local hospital for checkup. The attending physician
ordered several tests such as blood tests, chest x-ray and ct
scan and it was revealed that it is lung cancer. The family has
been shocked upon learning of the disease. They thought that it
was the recurrence of his tuberculosis. They even sought for a
second opinion at NKTI in Manila and it was confirmed that it is
lung cancer. According to the patient he has in and out of the
hospital. He was in a chemo treatment and just finished his first
chemo treatment last week. He was instructed by his physician
to have 4 cycles of treatment. His next cycle is due after a
week.
The patient is a diagnosed case of lung carcinoma, who had
onset of DOB few mins.PTA. Two days PTA, patient was noted to
have whitish phlegm, no hemoptysis, no vomiting, patient was
noted to have severity of symptoms thus increased severity of
symptoms thus, consulted to ER and subsequent admission

According to the patient, his

Familyand
health
parents
grandparents died
history
of
old age. In a brood of 8 only
3of them are alive. His eldest
brother died due to
hypertension, his eldest sister
died of breast cancer, his
other sister died of cholera
and his older brother died of
lung cancer their youngest has
recently died of car accident.
Just a year ago, his wife died
of pneumonia. The patient
further mentioned that most
of his children were all healthy
other than his eldest son who

Social

health

history

His children state that he has

been a good father and provider
to the family. He maintains a
good relationship towards his
neighbors, friends and former
colleagues he was a former
revenue officer they added. In
his younger years, his form of
recreation is going to a cockpit
fights every weekend. He was a
heavy smoker as what he
commented He started smoking
at the age of 16 with the
influence of his older brothers
and until then he could finish
two to three packs of cigarettes
a day. He was a complete sober

Laboratory
Findings

Hematology Report
TEST

RESULTS

REFERENCE VALUES

ANALYSIS

WBC

9.0x103/L

4.0-10

normal

RBC

3.87x106/L

4.0-5.50

due to anemia

Hemoglobin

117 g/L

120-160

due to anemia

Hematocrit

0.350 g/L

.400-.500

Due to anemia

Platelet count

259 x103L

150-450

normal

WBC
Differential
Count
Neutrophils

.51

.40-.70

normal

Lymphocytes

.46

.20-.40

Due to infection

Eosinophils

.03

.00-.06

normal

Stabs

.00

.00-.04

normal

Atypical Cells

.00

.00

normal

MCV

90.4m3

82.0-95.0

normal

MCH

30.2 Pcg

27.0-31

normal

MCHC

334 g/L

320-360

normal

Blood Type

PROTHROMBIN TIME(PT)

Date: August 31,2014
RESULT
ANALYSIS
12.9 sec

REF. VALUES
10.3-13.1 sec

% activity
80.0 %
INR
1.08
METHOD : Scattered light detection

(normal )

Clinical Chemistry

Date: August 31,2014

Analyte
Results
Normal Range
Analysis
Crea
1.46 mg/dl
.70-1.20
possible kidney failure
Sodium
133
135-148 mmol
due to lung cancer
Potassium
3. 6
3.5-5.5mmol
normal

Gram Stain

Date: August 31,2014

Specimen: Sputum
Result: smear shows occasional grampositive cocci in short stains. Moderate
pus cells and rare epithelial cells noted.
Normal: few to no white blood cells and
no bacteria. Presence may denote
infection

ABGs

Date: August 31,2014

RESULT
ANALYSIS
pH
7.48
slightly high
PCO2
39 mmHg
mmHg
normal
HCO3
28 mEq/L
mEq/L
slightly low

NORMAL
7.35-7.45
35-45
22-26

X-ray Studies
Date: August 31,2014

INTERPRETATION
A well defined homogenous dense
opacity is seen in the left upper lobe with
the deviation of the trachea to the right.
Lamellated
homogenous
opacity
obscuring the left costophrenic sulcus.
The heart is not enlarged by C-T ratio.
The right costophrenic sulci are intact.
Right midclavicular deformity probably
old fracture.

IMPRESSION:
UPPER LOBE MASS WITH PLEURAL
EFFUSSION, LEFT CONSIDER OLD
CLAVICULAR RIGHT

Date: September 1,2014

INTERPRETATION
Comparison was made with a
previous study dated
August 31,2014. There is
internal clearing of the left
sided pleural effusion post
thoracenthesis with
minimal residual blurring of
the left costophrenic
sulcus.
The left upper lobe mass and
associated mass effects
are unchanged.
The heart is not enlarged by
CT ratio.
The rest previous findings are
unchanged.

Gordons
Functional
Pattern


Health Perception/Health Management

Patient perceives health as wealth. Ti salun-at ket kayamanan

as he verbalized. When further explored what he means by
that he gives his state of health as an example. States that
when he was younger and still strong he doesnt mind any
bodily pains. He claims that he used to walk a kilometer
everyday from home going to work and vice versa and take it
as a form of exercise. Though he is aware of the risks and
disadvantages of cigarette smoking he did not stop until 3
years ago and now he is harvesting the effects of his vices. He
also states that he is a social drinker and denies of using
prohibited drugs. He rates his general health these days as 3
out of 10 being 10 as the healthiest state and 0 as in the
debilitating state. Ganito ang tumatanda, madaming iniinda na
sakit. Further mentioned that six months ago he fell from a
chair but did not tell anyone. Since he was diagnosed with
lung cancer, he thinks that his health is deteriorating each day.
Dati kaya ko pang mglakad lakad sa veranda ng bahay,
ngayon madali na akong hapuin konting lakad lang napapagod

Nutritional/Metabolic Pattern
No known allergies to foods or
medicines. At home he eats three
times a day and snacks in between
meals. His usual meal consists of
rice, with fish, or meat products or
poultry with the inclusion of
vegetables and fruits with each
meal. Typically he consumes 2- 3
liters of water every day. Upon rising
he takes a cup of coffee and at
bedtime he takes milk. He doesnt
have problems with swallowing only
that sometimes his satiety is not
fulfilled because he cant taste the
food well. Bassit lang ti kankanek
ittan,awan unay ganas ku nga
mangan.Narigat ti mangan nga
nakapustisu haan mu nga
maenjoyhe verbalized .

Upon admission the patient

weighs 38 kilograms, patient
states that he drastically lose
weight stating that about
two months ago he weighs 52
kilograms. When asked about
the hospital food he
comments that there were
restrictions to his food intake
these includes red meat and
four legged animals, raw
vegetables even fresh fruits
despite that he desire to eat
food that he likes the most
especially adobong baboy.

Elimination
Pattern

Before hospitalization,
patient F.C states that he
urinates about 5 to 7 times
a day. He states that he
doesnt have problems with
urination , he described that
his urine is dark yellow and
approximately 30-45 ml per
voiding mentions that he
doesnt notice blood on his
urine as well .He defecates
every other day and
described that his stool is
hard and dark brown

During hospitalization, he
was in a catheter and with
diapers. Patient F.C states
that he is uncomfortable
with the catheter and
diapers because he is not
used to it. S.O further
mentioned that his urine is
dark yellow and drains the
catheter bag whenever it is
half full. Patient F.C
complains of sweating and
feeling of hot sensation
despite of low temperature
of the room

Activity/Exercise Pattern

Before hospitalization
patient is capable of
providing self care activities
such as grooming, taking a
bath and going to the
bathroom. Due to history of
falls few months ago they
decided to hire for a private
nurse to look after him. S.O
states that the patient can
still roam around the house
and can even go for
shopping but with
assistance from them.

During hospitalization, patient

F.C stays most of the time in
bed due to easy fatigability.
His general appearance is
weak. He doesnt have the
energy to move around the
hospitals room or in the
hallway. He complains of joint
pains when asked to raise his
arms and legs. When asked to
for a hand grip the patient
demonstrates a weak hand
grip. The patient constantly
coughing up with whitish
phlegm.

Sleep- Rest Pattern

Before hospitalization,
patient is already having
sleepless nights. Haan nak
nga unay makaturug nu rabii
ta nakasaksakit ti likod ku
kin barukung ku.kin haan
nga agsardeng ti uyek ku
as verbalized by him. When
asked about his pain scale
he voiced out that it was
7.When asked about his
preferred position during
sleeping he prefers side lying
or on his back with 3 pillows
on his head

During
Hospitalization,
patient F.C states
that he is not
sleeping well. His
cough doesnt stop
and being disturbed
by nurses and
doctors coming in
out of his room to
check him out.

Cognitive/Perception Pattern
Patient F.C doesnt have a
problem with recent and remote
memories. His S.O states that
the patient has a sharp memory.
He is fond of telling stories about
his childhood memories. The
patient has no problems with
hearing abilities. He can even
hear whispers on a distance. The
patient wears reading glasses
and last checked up was last
year. When asked on decision
making he sees to it that he
doesnt jump too quickly and
need to think the pros and cons
of every situation.

During hospitalization, the

patient is well oriented to
date, time, place and
people around him. He can
easily grasps ideas and
questions being asked of
him. The patient managed
to read newspaper despite
his condition. Patient F.C
has a long span of
attention. He is a college
graduate and can speak
English, Tagalog, Ilocano
and Spanish fluently.

 During
Self Perception/Self Concept
hospitalization,
patient F.C
Patient feels good about his
maintains eye
achievements in life; he has
been a good provider to his
contact when being
family. He loves his family so
asked. His
much and would do anything
for them. He claims that he
attention span is
has raised his children well.
long but he is
All of them are successful. His
eldest son is a lawyer, his
easily disturbed by
second son is an Air force man
noises. Patient is
and his youngest daughter is
a doctor. He also voiced out
very much
that as a father, the success
assertive on his
of his children is also his
success.
answers during the
interview process
and maintains a

 During
hospitalization,
Role /Relationship
Pattern
Before hospitalization, Patient F.C lives
with his youngest daughter and two
private nurses who help him with his
needs. His 3 children are married and
only his youngest daughter is still single
His wife died a year ago and misses her
so much especially this time of sickness.
Nung buhay pa cya, kapag may sakit ako
hindi yun umaalis sa tabi ko. He clings
to the idea that one day they will meet
again in paradise. He always looks
forward for weekends because his
grandchildren and children in- laws
would come and visit him. Once a father
is a father he claimed. You dont stop
being a father even youre children are
married. Yung mga anak ko na may mga
importanteng desisyon na gagawin
kinukunsulta pa rin nila ako hanggang
ngayon. Upon learning of my illness my
children were so shocked and feel
saddened.

Patient F.C interacts

well with his private
nurses and his
children were present
and some of his
relatives even from far
places dropped at the
hospital to visit him.
He even added that
coming to the hospital
is like a reunion for
them because
relatives whom he
havent seen for long
came to see him in
the hospital.

Sexuality/Reproductive

Patient F.C was circumcised when he

was ten years old. He got married
when he was 21 years old and had
his first coitarche. They have 3
children and dont remember using
any family planning method. He
claims that at his age he is no
longer sexually active

Coping/Stress Tolerance

Since diagnosed with lung cancer their

family is even closer and holds on to each
other. I have already accepted my fate that
eventually we will die but my children
doesnt want to give up on me. They said
that they will give their best for me to be
well again. When caught in a stressful
situation he normally prays to God. His form
of destressors in this times is watching
television, reading and seeing his
grandchildren

Value/Belief Pattern

Patient F.C is a Roman Catholic. He states that

praying is very much important to his everyday life
.Despite of his condition, he dont question God of
his current state and doesnt lose his faith in Him.
Everything and every situation have reason why
we were put into it he comments. He goes to mass
on Sundays and any days of obligation even when
his wife died. He already surrendered everything to
God due to his state of condition he can no longer
go to church and watch mass on TV instead.

Drug
Study

Clarithromycin

Description: macrolide antibiotic

Generic Name: clarithromycin
Brand Name: Biaxin, BiaxinXL
Pregnancy Category C
Therapeutic actions: Inhibits protein synthesis in susceptible bacteria,
causing cell death.
Indications:
Treatment of URIs caused byStreptococcuspyogenes, S.pneumoniae
Treatment of LRIs caused byMycoplasmapneumoniae, S.pneumoniae,
Haemophilusinfluenzae, Moraxellacatarrhalis
Treatment of skin and skin-structure infections caused
byStaphylococcusaureus, S.pyogenes
Treatment of disseminatedmycobacterialinfections due
toMyobacteriumaviumandM. intracellular
Treatment of active duodenal ulcer associated withHelicobacter pyloriin
combination with proton pump inhibitor
Treatment of acuteotitismedia, acute maxillary sinusitis due
toH.influenzae, M.cararrhalis, S.pneumoniae
Treatment of mild to moderate community-acquired pneumonia in adults

 Contraindications and cautions:

Contraindicated with hypersensitivity
toclarithromycin, erythromycin, or
anymacrolideantibiotic.
Use cautiously with colitis, hepatic or renal
impairment, pregnancy, lactation.
Available forms
Tablets250, 500mg; granules for suspension
125, 250mg/5mL; ER tablets500mg

Metabolism:Hepatic; T1/2: 37 hr
Distribution:Crosses placenta; enters breast
milk
Excretion:Urine

Adverse effects
CNS:Dizziness, headache, vertigo, somnolence,
fatigue
GI:Diarrhea, abdominal pain, nausea,dyspepsia,
flatulence,
vomiting,melena,pseudomembranouscolitis
Other:Superinfections,increased PT, decreased
WBC
Interactions

Drug-drug: Increased serum levels

and effects
ofcarbamazepine,theophylline,lovast
atin,phenytoin
Drug-food: Food decreases the

Nursing considerations:
Assessment
History:Hypersensitivity toclarithromycin, erythromycin, or
anymacrolideantibiotic;pseudomembranouscolitis, hepatic or renal impairment,
lactation, pregnancy
Physical:Site of infection; skin color, lesions; orientation, GI output, bowel sounds,
liver evaluation; culture and sensitivity tests of infection, urinalysis, liver and renal
function tests
Interventions
Do not cut or crush, and ensure that patient does not chew ER tablets.
Monitor patient for anticipated response.
Administer without regard to meals; administer with food if GI effects occur.
Teaching points
Take drug with food if GI effects occur. Take the full course of therapy. Do not drink
grapefruit juice while taking this drug.
Shake suspension before use; do not refrigerate; do not cut, crush, or chew ER tablets;
swallow them whole.
You may experience these side effects: Stomach cramping, discomfort, diarrhea;
fatigue, headache (medication may be ordered); additional infections in the mouth or
vagina (consult with care provider for treatment).
Report severe or watery diarrhea, severe nausea or vomiting, rash or itching, mouth
sores, vaginal sores