lung ca symptom mgmt

[onewithhospiceheart]

Have a new patient with lung ca...diagnosed 2 mths ago. Just discharged from hospital s/p pneumonia...was treated with vanco/levaquin. Was on 15L 02/face mask in hospital....discharged on 6L NC.

Now at home 1 day. Mildly sob, wheezy, has inhalers/nebs. Has started coughing with mild hemoptysis (new). Wondering what meds I should have on hand....has obvious anxiety....only meds doc sent patient home with was prednisone taper, continue po levaquin for 7 dys and 5 mg roxanol q1hr. Patient has no pain at this point. Also has buspar at home, 5 mg.....but it knocks pt out....took 2.5 mg and did better.

I know the morphine will help the patients anxiety/breathing/air hunger.....but wondering if I should get ativan to replace the buspar or just use the morphine? Also need atropine...?

Any other sx mgmt responses would be greatly appreciated...this is my first lung ca pt.

[leslie :-D]

definitely needs an anxiolytic.

lung ca pts are prone to panic attacks, r/t sob.

ativan et al, is just as important as the morphine.

also a circulating fan works wonders.

also, it's important to let him dictate the pace of any activities, including adl's and ambulating.

let him be in control.

while this should be with all pts, lung ca pts are very protective/anxious about any 'reserves' they may or may not have...so they need to be in control.

leslie

[leslie :-D]

I know the morphine will help the patients anxiety/breathing/air hunger.....but wondering if I should get ativan to replace the buspar or just use the morphine? Also need atropine...?

i didn't see your question about atropine.

personally, i don't like to give any 'drying' agents until the pt is semi or unconscious.

they do carry a serious risk of adverse effects, and shouldn't be given casually or liberally (unless unconscious).

let him expectorate the secretions if able, let him ambulate ad lib, and go about his business.

it's when the secretions can't move, that we start considering atropine, scope, etc.

that's how we use it...

not sure how other nurses do?

also, a cool room is preferable to a warm one.

warm environments can tend to feel stuffy, exacerbating perceptions of air hunger.

get the flow of air circulating...it really makes a difference...

even if it is psychological.

leslie

[hospicevet 20, ASN, RN]

I didn't see any reference to what kind of lung CA. Be aware that some kinds of lung CAs like to mets to the brain, and you may see some different symptoms than you would with another pulmonary process. I had a patient with lung CA that had horrible anxiety, regardless of what we used, ativan, haldol, morphine, everything in the toolkit. He committed suicide rather than continue that level of anxiety. Our whole team felt like we had completely failed him and his family. I'm encouraged to see you asking for help early on. Best of luck, and don't forget to trust your intuition.

[onewithhospiceheart]

Hi,

This patient has non small cell lung a with the tumor occluding the left lower lobe oriface. Don't know about mets....was to have a PET scan this coming week, but has decided against curative treatment, and against the PET scan. Just diagnosed within the last 2 months. This is an 82 year old gentleman...such a sweet man. He was terrified about coughing up the blood.

Thanks so much for the advice and tips, it is an immense help. :redbeathe

[onewithhospiceheart]

Hospicevet....how awful for you to have that patient commit suicide. I don't know what I would do in that situation. I hope that you and your team has come to terms with it, I am sure you tried your best. So sad.

[ErinS, BSN, RN]

Hospicevet- had the same thing happen to me. Younger man with lung ca, committed suicide the 3rd day on service. It was the most horrible thing that has happened so far to me in my entire career.

With my lung CA patients we talk at length from the start about why anxiety management is important, and why morphine works. Sometimes just having someone that can explain their feelings (when you can't breathe, you get anxious, and when you are anxious you can't breath, and it just gets worse) helps the anxiety. Morphine as a cough suppressant can be helpful for hemoptysis. Be careful with nebs- they can REALLY exacerbate anxiety.

It may be worth discussing the prednisone with md and pt, we often will continue low dose steroids. Also consider using a standard cough syrup, or even something strong. We use a lot of phenergan with codeine in the winter for cough suppressant. People love that medicine!

Hope this helps some. Also, we don't use buspar much.

[AtlantaRN, RN]

morphine nebs........