Interventions for Clients with Lung Cancer

1. Interventions for Clients with Lung Cancer

2. Benign Breast Disorders • • Fibroadenoma, most common cause of breast • masses during adolescence; may occur in • clients in their 30s • • Solid, slowly enlarging, benign mass; round, • firm, easily movable, nontender, and clearly • delineated from the surrounding tissue • • Usually located in the upper outer quadrant of • the breast

3. Fibrocystic Breast Disease • • Physiologic nodularity of the breast, most • common breast problem of women between 20 • and 30 years of age • • Stage 1: premenstrual fullness and tenderness, • symptoms occur on menstrual cycle • • Stage 2: multiple nodular areas in both breasts • (Continued)

4. Fibrocystic Breast Disease (Continued) • • Stage 3: microscopic or macroscopic cysts • associated with pain, tenderness, or burning • occurring in women between 35 and 55 years of • age

5. Collaborative Management • • Symptomatic management • • Hormonal manipulation • • Drug therapy: vitamins C, E, and B complex • • Diuretics • • Avoidance of caffeine • • Mild analgesics • (Continued)

6. Collaborative Management (Continued) • • Limited salt intake before menses • • Well-padded supportive bra • • Local application of heat or ice for pain relief

7. Ductal Ectasia • • Benign breast problem of women approaching • menopause caused by dilation and thickening of • the collecting ducts in the subareolar area • • Mass that is hard with irregular borders, tender • • Greenish brown nipple discharge, enlarged • axillary nodes and edema over the site of the • mass

8. Intraductal Papilloma • • Occurs most often in women 40 to 55 years of • age • • Benign process in the epithelial lining of the • duct, forming an outgrowth of tissue • (Continued)

9. Intraductal Papilloma (Continued) • • Trauma and erosion within the duct, resulting in • bloody or serous nipple discharge • • Diagnosis aimed first at ruling out breast cancer

10. Gynecomastia • • Benign condition of breast enlargement in men • • Can be a result of primary cancer such as lung • cancer • • Causes include: • – Drugs • – Aging • – Obesity • (Continued)

11. Gynecomastia (Continued) • – Underlying disease causing estrogen excess • – Androgen deficiency • – Breast cancer

12. Breast Cancer • • Types of breast cancer • • Complications include: • – Invasion of lymph channels causing skin • edema • – Metastasis to lymph nodes • – Bone, lungs, brain, and liver—sites of • metastatic disease from breast cancer • – Ulceration of overlying skin

13. Breast Cancer in Men • • Of all breast cancers, only 1% occurs in men. • • Breast cancer in men usually presents as a hard, nonpainful subareolar mass. • • Breast cancer in men is often a widely spread disease because it is usually detected at a later stage than in women.

14. Mammography • • Baseline screening mammography yearly at age • 40 is recommended. • • Barriers to mammography compliance can • involve factors such as fear. • • Increase compliance through education.

15. Breast Self-Examination • • The goal of screening for breast cancer is early • detection because breast self-examination • cannot prevent breast cancer. • • Early detection reduces mortality rate. • • Teach breast self-examination.

16. Breast Care • • Clinical breast examination • • Cancer surveillance • • Prophylactic mastectomy • • Chemoprevention

17. Pathologic Examination • • Key to diagnosis of breast cancer • • Presence or absence of estrogen receptors or • progesterone receptors • • S-phase index, or growth rate • • DNA ploidy • • Histologic or nuclear grade • • HER2/neu gene expression

18. Anxiety • • Interventions: • – Anxiety for the woman with breast cancer • begins the moment the lump is discovered. • – Level of anxiety may be related to past • experiences and personal associations with • the disease. • – Allow the client to ventilate feelings. • – Flexibility is the key to nursing care.

19. Potential for Metastasis • • For clients with late-stage breast cancer, • nonsurgical treatment may be the only • alternative; tumor may be removed with local • anesthetic, follow-up treatment with hormonal • therapy, chemotherapy, and sometimes • radiation. • (Continued)

20. Potential for Metastasis (Continued) • • For breast cancer at a stage for which surgery is • the main treatment, follow-up with adjuvant • radiation, chemotherapy, hormone therapy, or • targeted therapy is commonly prescribed.

21. Surgical Management • • Mass should be removed to reduce risk for local • recurrence; but controversy exists concerning • the best treatment. • • Axillary lymph nodes (dissection or removal) • • Sentinel lymph node biopsy • • Preoperative care • • Operative procedure

22. Postoperative Care • • Avoidance of using the affected arm for blood • pressure measurement, giving injections, or • drawing blood • • Monitoring of vital signs • • Care of drainage tubes • • Comfort measures • • Mobility and diet • • Breast reconstruction

23. Adjuvanat Therapy • • To decrease the risk of recurrence, adjuvant therapy consists of: • – Radiation therapy • – Chemotherapy • – Hormonal therapy • – Stem cell transplantation • – Targeted therapy