Nursing care

Symptom management case study Essay
Symptom Management for NSCLC Patients

The case study is about a 72-year old female patient (Jane) that has been diagnosed with
non-small cell lung cancer (NSCLC). The woman has three adult children that don live with her.
Unfortunately her husband passed away and she has no one to take care of her. It is for this
reason that Jane needs nursing care.
Non-Small Cell Lung Cancer
Most of the patients that have been diagnosed with this illness have smoked in sometime
in their past or are smoking. However, some of the other factors that result in the development of
NSCLC include; radon (a radioactive gas commonly found in rocks and soil), air pollution,
radiation therapy to the chest, asbestos, and HIV/AIDS (Kitchens, Kessler & Konkle, 2013, Pg.
89). It is also hereditary.
Symptoms of NSCLC
Mostly, lung cancer cells do not cause symptoms until they have spread many organs.
However, symptoms have been detected in NSCLC. Patients with NSCLC have the following
symptoms;

 A persistent cough that keeps worsening
 Pain in the chest. The pain gets worse when the patients breathe deeply, cough or
laugh (Giaccone, 2012, Pg. 37).
 Hoarseness
 LOSE weight as well as appetite.
 Cough up rust-colored sputum or blood

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 Have short breath
 Fatigue
 Have recurrent infections of bronchitis and pneumonia
 Wheezing
NSCLC begins severe and spreads to other body organs. At this stage, the patients
experience pain the bone, neurologic changes such as headaches, numbness of the arms,
problems in balancing, and dizziness (Leary, 2011, Pg. 45). When NSCLC affects the liver, the
patients’ skin becomes yellow (jaundice). When NSCLC affects the lymph nodes and the skin,
lumps start developing on the body surface. Most of these conditions are likely to be caused by
other conditions apart from NSCLC.
Consequences of the Symptoms to the Patient and the Family
When serious disease or disability strikes a person, the whole family is affected by the
illness process as well as the entire health care experience. In the case study, Jane’s illness
disrupts her whole family. Her illness has made her sons change their lifestyle and take on some
role functions of Jane, which in turn has affected their normal role functioning. For instance, the
eldest son, who is also a father of two, has been forced to take leaves to console his mum. His
sons have also been forced to arrange for their parents care.
Jane’s illness has also caused additional strain due to economic problems and
interruptions. NSCLC requires expensive therapy procedures and costly medications too.
However, on a positive note, Jane’s illness has brought her family close together. She has had the
opportunity to re-unite with her sons who have been busy all through. The sons have been forced
to adjust their priorities and forgo some plans to just take care of their ailing mum. They also live
in fear of their mum passing on.

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To Jane NSCLC has caused her to undergo immense suffering. She feels a lot of pain that
causes deep sorrow. She has lost her weight and has no appetite; she even sometimes regrets and
feels as if she is a nuisance to her sons by making them visit her every now and then to confirm
how she is fairing. NSCLC is a life-threatening disease; its symptoms have trouble Jane to a
point that she feels that she should just rest in peace instead of going through intense suffering.
This has led to Jane being assigned counseling officers to encourage her and let her know that
there are some patients that were in the same condition that she is in but have then recovered and
resumed their normal duties.
Goals of Care
Every person and every illness is peculiar. After patients such as Jane have been
diagnosed with NSCLC, nursing care is aimed at;

 Relieving pain and other NSCLC associated symptoms
 Addressing patients’ spiritual as well as emotional concerns of the patient and
their families.
 Coordination of care
 Improving the patients’ quality of life during their illness.
For instance, a palliative care nurse has been assigned to Jane. The nurse prescribes
medications and other therapies to help treat Jane’s pain, shortness of breath, constipation, and
other symptoms. Jane also has a social worker who has been charged with the responsibility of
acting as Jane’s advocate on her behalf and family. She also has a chaplain who offers her
spiritual support and aids her in exploring her values and beliefs. The care is also aimed at
updating Jane’s family on her progress and necessary medical information.
Nursing Care Plan for NSCLC Patients

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Nursing care for patients suffering from lung cancer deals with comprehensive supportive
care and educating patients on how to reduce the complications they are experiencing with an
aim of speeding recovery from radiation, surgery, and chemotherapy (Almeida & Barry, 2011,
Pg.67). The following are nursing’s care plans for patients with lung cancer;
(I)Impaired Gaseous Exchange
Impaired gas exchange is associated with a change in the supply of oxygen and a
decreased oxygen carrying capacity of the blood. Patients present with cyanosis, restlessness,
dysnea, and hypercapnia (Kumar & Eng, 2014, Pg. 26). Nursing care plan is provided to the
patients with these symptoms with an aim of improving ventilation and sufficient oxygenation of
body tissues. The care plan also targets freeing symptoms of respiratory.
Nursing Interventions
-To achieve the above patient outcomes, nurses should examine respiratory rate, depth, and ease
of respirations. They should also monitor accessory muscles, variations in the color of the
mucous membrane, pursed-lip breathing, and cyanosis (Lam & Cavallari, 2013, Pg. 73). Patients
may have an increased respiration as a result of pain or as a compensatory mechanism that is
triggered in order to accommodate the loss of lung tissue.
-Nurses should also auscultate the patient’s lungs to examine movement of air or abnormal
breath sounds.
-Restlessness and variation in mentation or consciousness should also be investigated. This
procedure may demonstrate high levels of hypoxia and mediastinal shift complications that could
be accompanied with tachycardia (Newman, 2010, Pg. 851).

  • Evaluation of the patients’ response to an activity. Nurses should allow patients to have rest
    periods and reduces activities to promote patient tolerance. Surgery and increased consumption

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of oxygen can lead to dysnea. However, patients should participate in early mobilization to aid in
preventing pulmonary complications as well as obtain efficiency in their circulatory and
respiratory systems.

  • Finally, nurses should monitor and record ABGs and levels of hemoglobin (In Matzo, & In
    Sherman, 2015, Pg. 143). Low partial oxygen concentration and high carbon dioxide may
    necessitate the need for ventilator support.
    (ii)Impaired Airway Clearance
    Can be linked to restricted chest movement, fatigue, and increased secretion of mucous in
    the airway. Patients present with dysnea, abnormal sounds of breath, and ineffective cough
    (Kumar & Eng, 2014, Pg. 243). Nurses provided care that is aimed at clearing these abnormal
    sounds and decreasing secretions.
    Some of the interventions that are involved include;
  • Observing the amount and appearance of sputum and other aspirated secretions. Initially,
    increased amounts of watery, colorless or blood streaked secretions are normal (Davey,
    2012, Pg. 67). However, such secretions should decrease as the patient progresses with
    recovery.
  • Patients should be encouraged to have oral fluid intake of approximately 2500mL/day
    within tolerance of the cardiac activity. This is because adequate hydration helps in
    keeping secretions loose and also promotes expectoration.
  • Clinicians administered bronchodilators, analgesics, and expectorants. This will aid in
    improving airflow, increase production of mucous, liquefy, and reduce viscosity of
    secretions.
    (III)Acute Pain

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The pain may be due to surgical incision, disruption of nerves, and tissue trauma. Chest
tubes and invasion of NSCLC into the pleura may also be a cause of pain (In Palmer, In
Brown & In Hobson, 2013, Pg. 56). Clinicians will learn that patients are experiencing pain
when the patients have verbal discomfort, guard the area that is affected, are restless or have
changes in blood pressure and respiratory rate.
Nursing Care Interventions
-Care providers should evaluate the patients’ verbal and non-verbal pain cues whereby
discrepancy between non-verbal and verbal cues would indicate the degree of pain.

  • They should encourage measures that minimize pain such as changing the patient’s
    position, supporting them with pillows, and back rubbing patients.
    Barriers of NSCLC Symptom Management
    Poly-pharmacy
    Studies have shown that cancer is associated with 13% increase in medical use (Jeremić,
    2011, Pg. 92). Some of the factors that result in poly-pharmacy include age-related physiologic
    changes and multiple chronic conditions. When cancer patients take multiple drugs, adverse drug
    reactions take place. This poses as one of the biggest threat in management of cancer patients.
    Frailty among older patients who might have experienced loss of organ function and general
    decline of overall health is also a barrier in management. Frail patients require careful
    considerations of appropriate non-pharmacologic and pharmacologic approaches.
    To aid in tackling some of these barriers care providers may use non-pharmacologic
    practices such as acupuncture, Tai Chi, yoga or acupressure which have been reported to have
    tremendous positive effect in cancer survivors (Ellis, Calne & Watson, 2011, Pg. 231).

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References

Giaccone, G. (2012). Systemic treatment of non-small cell lung cancer. Oxford: Oxford
University Press.
Kitchens, C. S., Kessler, C. M., & Konkle, B. A. (2013). Consultative hemostasis and
thrombosis. Philadelphia, PA: Elsevier/Saunders.
Ellis, H., Calne, R., & Watson, C. (2011). Lecture Notes: General Surgery. New York, NY: John
Wiley & Sons.
Perry, M. C., Doll, D. C., & Freter, C. E. (2012). Chemotherapy source book. Philadelphia:
Wolters Kluwer/Lippincott Williams & Wilkins.
In Palmer, K. T., In Brown, I., & In Hobson, J. (2013). Fitness for work: The medical aspects.
Jeremić, B. (2011). Advances in radiation oncology in lung cancer. Berlin: Springer.
Rohde, G., & Subotic, D. (2013). Complex Pleuropulmonary Infections: European Respiratory
Monograph 61. Sheffield: European Respiratory Society.
Sinclair, A. J., Morley, J. E., & Vellas, B. (2012). Pathy’s Principles and Practice of Geriatric
Medicine. New York, NY: John Wiley & Sons.
Taktak, A. F. G., & Fisher, A. C. (2012). Outcome prediction in cancer. Amsterdam: Elsevier.
Davey, P. (2012). Medicine at a Glance. New York, NY: John Wiley & Sons.
In Matzo, M., & In Sherman, D. W. (2015). Palliative care nursing: Quality care to the end of
life.
Kumar, D., & Eng, C. (2014). Genomic Medicine: Principles and Practice. Oxford: Oxford
University Press.
Lam, Y.-W. F., & Cavallari, L. H. (2013). Pharmacogenomics: Challenges and Opportunities in
Therapeutic Implementation. Burlington: Elsevier Science.

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Roth, J. A., Cox, J. D., & Hong, W. K. (2011). Lung Cancer. New York, NY: John Wiley &
Sons.
Small cell lung cancer: New insights for the healthcare professional (2011 edition). (2012). S.l.:
Scholarly Editions.
Newman, W. G. (2010). Pharmacogenetics: Making cancer treatment safer and more effective.
Dordrecht: Springer.
Almeida, C., & Barry, S. (2011). Cancer: Basic Science and Clinical Aspects. New York, NY:
John Wiley & Sons.
Pass, H. I., Pass, H. I., & International Association for the Study of Lung Cancer. (2010).
Principles and practice of lung cancer: The official reference text of the IASLC.
Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Leary, A. (2011). Lung cancer: A multidisciplinary approach. Chichester, West Sussex, UK:
Wiley-Blackwell.

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