Need nurses adwise for my assigment about lung cancer

leslie :-D · Oct 2, 2004

you are going to address the limitations of pt's breathing status and what are you going to do to facilitate better gas exchange. and how is it going to impact his adl's; activity intolerance?

the implications of his terminality; what does he want? chemo/rad or hospice?

are there any people he wants to see; issues he wants closure on?

what is his spirituality? is he distressed? does he accept his dx?

keeping him comfortable if he is on hospice.

getting him comfortable if he opts for chemo/rad txs;

i've seen too many ca pts that go through aggressive chemo txs only to have the remaining days of their lives impacted by the toxic se's of chemo. it's not pretty and it's not necessary. but the family often presses for such options.

there's a wealth of info out there for you to explore.

much luck to you.

leslie

flaerman · Oct 5, 2004

Greetings,

I am an RN with 19 years of experience and about 7 of those were doing Oncology full time. We treated a lot of lung cancer patients and sometimes there different treatments but it all depended on the staging. Some of our patients had surgical removal of the tumor and the affected lobe when it was more localized and then given chemo and radiation as an adjunct to kill off the rest of the cells. Some pt's got chemo and radiation, some just chemo, and some radiation(this was usually done as palliative to maybe shrink the tumor a little to improve their respiratory status. We even did some internal radiation on occasion when treatment called for it. Good respiratory assessment skills are necessary, and look at their history, had a nurse say that her pt did not have left sided breath sounds and it turned he'd had a left pneumonectomy so he wouldn't breath sounds. Respiratory treatments sometimes help and so does low Morphine. Assessment for dypnea on exertion and if it is present, how bad is it. These folks need help with ADL's and make sure that everything they may need is within easy reach for them. Chech their pulse oximetry, keep it above 90, where it isn't use supplemental oxygen to assist them. We used to have pt's that would need to go home with oxygen but whenever repsiratory would check their sats they would be 90 and higher. Here in the USA a lot insurances won't pay for O2 unless the sats are less then 90. What we would do then is walk them around or down the hallway with a pulse ox on the finger, when the sat dropped to 88, we documented that to help them get the oxygen for home use. If they are o2 dependent and going home, make sure their families bring in their O2 tanks prior to discharge. if O2 dependent and in hospital make sure they are O2 all the time, if they need to go to the bathroomyou can either use a portable tank or if they are awake and alert make sure their oxygen tubing is long enough for them to make it there. There was even a drug we gave that was only supposed to be a bone marrow protectant to give higher doses of chemo that we treated various pt's with, in our lung pateints we had some cases of complete disappearance of both tumors(verified by xray and CAT scans) and tumor markers from their blood during the 6 months we worked with the drug. One we stopped the drug everything returned. This drug was something called WR2721, it was experimental and seeking FDA(food and drug

administration) approval, we were the only team working with this that found those results, we notified the company and last I heard they were experimenting with a analog of the drug they were calling WR7 only for use on lung CA. When the disease progresses to to more terminal stage then comfort measures are important, assist with ADL's or just do them if pt's are unresponsive, support both patient and their families because this where it get hard for both. Morphine drips we used to use in the hospital setting and when it was getting near the end we would orders that would say to titrate to relief and I would do that, if the families would think their had breathing difficulty(and they will, increased resp distress that will even become a death rattle sound) I would up the drip and make sure they understood that as the drip went up the respirations would go down. As long as the families were OK with it and the pt was a DNR?No Code I was OK with it. Biggest thing you can do is support your patients and their families, they will remember you for this, as the disease progresses talk with about any feelings of fears they have and ask them if they have made final preparations(wills etc, burial arrangement). Look for any pt that either doesn't have families to visit or ones whose families won't and zero in on them because need the care and support that can only come from another human being, be that person. Some of my best and saddest moments were from my Oncology days and I wouldn't give them up or trade them for anything in the world.

Sorry that this got a little too wordy but it's still a strong topic for me and I hope something i have might help you. Good luck with school and in your future career and welcome aboard. Paul Ayres RN

ollikristiina · Oct 7, 2004

I want to thank you both for your replies. They were interesting and helpfull. :rotfl:

Take care Kristiina:p