Inpatient surgical and possibly subacute units.
- Psychosocial aspects of care
- Radical neck surgery: laryngectomy (postoperative care)
- Surgical intervention
- Patient Assessment Database (Preoperative)
- Findings depend on type, duration of cancer, and extent of metastasis.
Fatigue, inability to maintain usual routine, dyspnea with activity
Lassitude (usually in advanced stage)
- Jugular venous distention (JVD) (with vena caval obstruction)
- Heart sounds: Pericardial rub (indicating effusion)
- Clubbing of fingers
- Frightened feelings, fear of outcome of surgery
- Denial of severity of condition/potential for malignancy
- May exhibit: Restlessness, insomnia, repetitive questioning
- Intermittent diarrhea (hormonal imbalance, SCLC)
- Increased frequency/amount of urine (hormonal imbalance, epidermoid tumor)
- Weight loss, poor appetite, decreased food intake
- Difficulty swallowing
- Thirst/increased fluid intake
- Thin, emaciated, or wasted appearance (late stages)
- Edema of face/neck, chest, back (vena caval obstruction); facial/periorbital edema (hormonal imbalance, SCLC)
- Glucose in urine (hormonal imbalance, epidermoid tumor)
- Chest pain (not usually present in early stages and not always in advanced stages), which may/may not be affected by position change
- Shoulder/arm pain (particularly with large cell or adenocarcinoma)
- Bone/joint pain: Cartilage erosion secondary to increased growth hormones (large cell carcinoma or adenocarcinoma)
- Intermittent abdominal pain
- Distraction behaviors (restlessness, withdrawal)
- Guarding/protective actions
- Mild cough or change in usual cough pattern and/or sputum production
- Shortness of breath
- Occupational exposure to pollutants, industrial dusts (e.g., asbestos, iron oxides, coal dust), radioactive material
- Hoarseness/change in voice (vocal cord paralysis)
- History of smoking
- Dyspnea, aggravated by exertion
- Increased tactile fremitus (indicating consolidation)
- Brief crackles/wheezes on inspiration or expiration (impaired airflow)
- Persistent crackles/wheezes; tracheal shift (space-occupying lesion)
- Fever may be present (large cell carcinoma or adenocarcinoma)
- Bruising, discoloration of skin (hormonal imbalance, SCLC)
- Gynecomastia (neoplastic hormonal changes, large cell carcinoma)
- Amenorrhea/impotence (hormonal imbalance, SCLC)
- Familial risk factors: Cancer (especially lung), tuberculosis
- Failure to improve
- Discharge plan
- DRG projected mean length of inpatient stay: 9.9 days
- Assistance with transportation, medications, treatments, self-care, homemaker/maintenance tasks.
- Refer to section at end of plan for postdischarge considerations.
- Fiberoptic bronchoscopy: Allows for direct visualization, regional washings, and cytologic brushing of lesions (large percentage of bronchogenic carcinomas may be visualized).
- Chest x-ray (PA[posteroanterior] and lateral), chest computed tomography (CT): Outlines shape, size, and location of lesion. May reveal mass of air in hilar region, pleural effusion, atelectasis, or erosion of ribs or vertebrae.
- Positron emission tomography (PET): Useful diagnostic tool in early detection of cancer, allowing measurement of differential metabolic activity in normal and diseased tissues.
- Magnetic resonance imaging (MRI) scan: May be used in combination or instead of CT scans to determine tumor size/location and for staging.
- Cytologic examinations (sputum, pleural, or lymph node): Performed to assess presence/stage of carcinoma, and may identify tumors of the bronchial wall.
- Needle or tissue biopsy: May be performed on scalene nodes, hilar lymph nodes, or pleura to establish diagnosis.
- Mediastinoscopy: Used for staging of carcinoma and to examine for metastasis.
- Pulmonary function studies and ABGs: Assess lung capacity to meet postoperative ventilatory needs.
- Skin tests, absolute lymphocyte counts: May be done to evaluate for immunocompetence (common in lung cancers).
- Bone scan; CT scan of brain, liver; gallium scan of liver, spleen, bone: Used to detect metastasis.
- Maintain/improve respiratory function.
- Control/alleviate pain.
- Support efforts to cope with diagnosis/situation.
- Provide information about disease process/prognosis and therapeutic regimen.
- Oxygenation/ventilation adequate to meet individual activity needs.
- Pain controlled.
- Anxiety/fear decreased to manageable level.
- Free of preventable complications.
- Disease process/prognosis and planned therapies understood.
- Plan in place to meet needs after discharge.