INTRODUCTION

Lung cancer is a disease of uncontrolled cell growth in tissues of the lung. This growth may lead to metastasis, invasion of adjacent tissue and infiltration beyond the lungs. The vast majority of primary lung cancers are carcinomas of the lung, derived from epithelial cells. Lung cancer, the most common cause of cancer-related death in men and the second most common in women, is responsible for 1.3 million deaths worldwide annually. The most common symptoms are shortness of breath, coughing (including coughing up blood), and weight loss. The main types of lung cancer are small cell lung carcinoma and non-small cell lung carcinoma. This distinction is important because the treatment varies; non-small cell lung carcinoma (NSCLC) is sometimes treated with surgery, while small cell lung carcinoma (SCLC) usually responds better to chemotherapy and radiation. The most common cause of lung cancer is long term exposure to tobacco smoke.[6] The occurrence of lung cancer in non-smokers, who account for fewer than 10% of cases, appears to be due to a combination of genetic factors, radon gas, asbestos, and air pollution, including secondhand smoke. This is the case of Mr. B.R., 18 years old, male, who was admitted to Mary Johnston Hospital because of joint pains. The group decided to chose this patient because we know that through studying the patients case, we will learn and at the same time enhance our knowledge and skills in rendering care to patients who are in need of prompt nursing interventions. In studying this case, the group came up with different nursing problems, such as:

DEMOGRAPHIC DATA
This is the data of R. B., 18 years old, male, Filipino, Methodist, born on July 14 1989, presently residing at #3 Pitugo Ext. Grp 1 area B, Brgy. Payatas QC, and was admitted Ferbruary 26, 2008 due to low back pain. Three months PTA, patients complained of low back pains, self medicated with alaxan and Mefenamic acid which offered temporary relief. Patient was then consulted at Fairview Hospital where urinalysis was done revealed normal results and the patient was sent home with pain relievers. Two months PTA, still with low back pains consulted to Orthopedic Center wher lumbosacral X-ray was done. Patient was diagnosed with HNP, LSSI with radiculopathy. Patient was given medications like Mefenamic acid, Lagiflex and Godapentin. Patient was then advised to undergoe PT. the patient had 10 sessions. One month PTA, still with low back pains and now with difficulty walking. Consulted at Orthopedic center where he was prescribed with Pregabalin (Lyrica), 50 mg/tab TID for 5 days, Celecoxib, 400 mg/cap OD x 7 days and Prednisone 5 mg/tab TID for 2 days. Persistence of low back pain, difficulty of walking, and now with pain and paresthesia in both lower extremitiesprompled then to seek consult and was subsequently admitted. Past Medical History: No PTB, no asthma, no HPN, no DM No allergy to foods or medicines Family History: Unremarkable S/P History: Patient is a non smoker and non alcoholic beverages drinker. Review of Systems: Unremarkable

PE: Conscious, coherent, ambulatory, afebrile V/S: BP: 110/70 mmHg HEENT: Anicteric sclerae, pinkish palpebral conjunctivae, no nasolacrimal discharges, non distended neck veins, no cervical lymphodenopathy. Chest Lungs: Symmetrical chest expansion, decreased breath sounds, right lung fields, decreased tactile, decreased vocal femitus right lung. Heart: Adynamic precordium, normal rate, regular rhythm, no murmur. Abdomen: Flat, soft, hypoactive bowel sounds, non tender. Extremities: Full and equal pulses on both lower and upper extremities. Neurologic: CNI : N/A CNII : pupils 2-3 mm EBRTI CN III IV VI : intact EOMs CN V : (+) corneal reflex CN VII : no facial asymmetry CN VIII : gross hearing intact CN IX X : (+) gag reflex CN XI : able to shrug shoulder CN XII: midline tongue Motor: s/s s/s s/s s/s Sensory 100 80 100 50 PR: 84 bpm RR: 24 cpm T: 37 C Skin: no jaundice, no pallor, no cyanosis

GORDONS FUNCTIONAL HEALTH PATTERN

I. HEALTH PERCEPTION AND HEALTH MANAGEMENT PATTERN Ang kalusugan ay mahalaga para mabuhay ang mga tao Nung sumasakit ang baywang ko, pumunta kami sa Fairview General Hospital at nagpacheck up. Wala naman silang nakita sa ihi ko kaya niresitahan lang ako ng gamot. Tapos hindi pa rin nawala yung sakit. Kumonsulta kami sa orthopedic center kasi baka sa buto naman ang problema tapos nagpatherapy ako. Pagkatapos ng 12 sessions ng therapy hindi pa rin nawala yung sakit kaya nagpatingin na kami ditto sa Mary Johnston. Currently under the service of Dr. R. II. NUTRITIONAL METABOLIC PATTERN Nakakakain naman ako pero hindi pokatulad dati na maganang Magana. Bihira ko lang po maubos yung pagkain ko eh. Eats 3x a day excluding snacks. On DAT diet. Maayos naman at malakas naman ako uminom ng tubig Consumes 1-2 liters of water a day. Hindi naman po ako nahihirapan sa paglunok at pagkain. III. ELIMINATION PATTERN Pawisin po ako kaya madalas lagging basa yung gown ko o kaya naman po ay yung damit at bed sheet ko. With Foley catheter to CDU bag draining yellowish urine on moderate amount. With right chest thoracostomy tube draining on 3 way bottle. Ang problema naman po sa akin ngayon ay yung pagdumi ko. Nakakaisang beses pa lang ako dumumi simula noong maadmit ako last February 26. Hindi po kasi ako masyado naggagagalaw. IV. ACTIVITY AND EXERCISE PATTERN Andito lang po ako sa higaan ko, hindi naman ako nagtatatayo kasi baka sumakit itong tubo ko. Cant turn himself on left lateral side and partially on right lateral side because of the CTT Has no regular bed exercises.

Pinapalakad lakad na nga po ako ng doctor ko eh kaso lang po kinakabahan pa rin po ako sa tubo baka sumakit o kung anong mangyari kaya hindi pa rin ako naglalakad. V. SLEEP AND REST PATTERN Hindi po ako makatulog disto sa ospital. Nahihirapan po ako kumuha ng tulog ko eh, hindi kop o alam kung bakit. Siguro halu-halo na rin po kung bakit hindi ako makatulog. Siguro po dahil sa sakit ng tubong nakakabit, o dahil po kinakabahan ako, o siguro po dahil hindi po ako sanay sa lugar na maraming tao, parang namamahay din po ako. Able to sleep for only 2-3 hours at night interruptedly Nakakatulog at nakakaidlip naman po ako sa maghapon ng mga 2-3 oras kaso lang po pagising gising din yun. VI. COGNITIVE PERCEPTUAL PATTERN March 3, 2005 na po ngayon. Sayang nga po patapos na sana yung isang semester ko nabitin pa. Oriented to date and time. Doesnt use eyeglasses nor hearing aids. Maayos naman po ang mata, tainga, pandama pati panlasa ko. VII. SELF CONCEPT AND SELF PERCEPTION PATTERN Nanghihinayang po ako dahill nagkasakit po ako tapos hindi kop o naipagpatuloy yung pagaaral ko. Kumikirot kirot pa rin po yung nasa tobo ko lalo nap o kapag gumagalaw galaw ako. With pain scale of 5. Pakiramdam ko rin po na ang hina hina at nanlalambot ako ngayon hindi po katulad ng dati na malakas pa ako. VIII. ROLE AND RELATIONSHIP PATTERN Youngest among 3 siblings. Hindi pa nga ako nadadalw ng mga classmate at kaibigan ko sa school kasi malayo sa kanila at hindi nila alam itong ospital.

Masayang masaya po ako kahit paano kasi nandiyan naman po ang mga magulang ko para mag alaga saakin. Had lots of friends and no enemy. IX. SEXUALITY AND REPRODUCTIVE PATTERN Circumcised Grossly male Dresses appropriately to gender. X. COPING STRESS TOLERANCE PATTERN Kapag nababagot na po ako dito sa higaan ko madalas po nilalaro ko na lang po ang cell phone ko o kaya naman po ay nagtitext na lang po ako. Kung minsan kapag wala naman po talagang magawa, natutulog na lang po ako. He also reads newspapers and magazines. XI. VALUE BELIEF PATTERN Hindi po ako regular na nagsisimba eh, paminsan minsan lang po. A Roman Catholic Prays everyday Seldomly reads his Bible. Hindi naman ako naniniwala sa mga pamahiin.

PHYSICAL EXAMINATION
VITAL SIGNS TEMP: 38 C PR: 75 bpm RR: 28 bpm BP: 110/70 mmhg GENERAL APPEARANCE Awake Coherent and conversant Not in CP distress Lying supine on bed Wearing gown HAIR Evenly distributed hair Black, straight Short-haired Dry hair uncut hair Without white hair (-) pediculosis (-) dandruff (-) lesions

EYES

Black pupils Clear, dark brown cornea Whitish sclerae Pale conjunctivae Teary-eyed With dark circles around the eyes Symmetrical eyes Eyeballs able to move freely

Head is centered Able to move neck and head without pain (-) lesions (-) pruritus (-) hypertrophy of the thyroid gland Equal lung expansion With right chest thoracostomy tube via 3-way bottle Deep breathing noted (-) DOB Fair complexion Intact chest wall Decreased abdominal sounds (-) abdominal pain (-) abdominal enlargement (-) lesions (-) masses Intact abdominal wall AND LOWER

CHEST AND LUNGS

NOSE Symmetrical nares (-) nasal flaring (-) discharges (-) bleeding Symmetrical to the outer canthus of the eyes Can hear well (-) discharges (-) lesions Pale and dry lips Pale tongue Pink gums (-) halitosis (-) tooth decay Not inflamed tonsils Trachea in midline

EARS

ABDOMEN

MOUTH

UPPER EXTREMITIES

Good skin turgor Complete set of fingers and nails Uncut finger and toenails With numbing felt on both lower extremities Flexible and movable legs and hands

NECK

With full ROM on both legs and arms (+) lesions

(+) scars Moist skin

RISK FACTORS
PASSIVE SMOKING Smoking, particularly of cigarettes, is far the main contributor to lung cancer. Smoking is estimated to account for 87% of lung cancer cases. Among men smokers, the lifetime risk of developing lung cancer is 17.2%. Cigarette smoke contains over 60 known carcinogens including radioisotopes from the radon decay and many more. Additionally, nicotine appears to depress the immune response to malignant growths in exposed tissue. The length lf time a person smokes as well as the amount smoked increases the risk of developing lung cancer. The inhalation of smoke from anothers smoke is a cause of lung cancer in non-smokers. Studies shows it have consistently shown a significant increase in relative risk among those who exposed to passive smoke. The patient is a non smokers, that is why passive smoking or the inhalation of smoke from other people trigger his body to developed lung cancer. GENETIC FACTORS Patients with history of lung cancer have a high risk of developing lung cancer. Researchers have discovered that an inherited genetic region on the human chromosome number 6 that is linked with lung and other tobacco related cancers. ENVIRONMENT The patient lives in a place where the garbage of a city dump in. we all know that living on this place can cause many diseases. The patient developed lung cancer due to his stay at this place. It is only risk factor but it can contribute in developing lung cancer. Asbestos is linked to increased risks of lung cancer. It was also studied that city air pollution was a bigger risk for lung cancer, yet the idea tat chemicals in the environment are a major cause of cancer persists. Although most cancers are believed to be caused by

lifestyle choices, such as what you eat, weather you maintain a healthy weight and weather you smoke.

LABORATORIES

A. Hematology Blood Component Hemoglobin Hematocrit Leukocytes Segmentars Lymphocytes Eosinophil ESR Result 123-decreased .38-decreased 12.8-increased .37-normal .25-normal .02-normal 48-increased Normal Values 140-170g/L .40-.50 5-10g/L .54-.75 .2-35 .01-.04 0-10mm/hr

Thrombocytes are adequate Normochromic, Normocytic INTERPRETATION: Hemoglobin is the main intracellular protein of the red blood cell. Its primary function is to transport oxygen to the cells and remove carbon dioxide from them for excretion by the lungs. Hemoglobin determinations are of greatest use in the evaluation of anemia, as the oxygen-carrying capacity of the blood is directly related to the hemoglobin level so a decreased hemoglobin level directly affects this oxygen-carrying capacity. Hemoglobin also functions as a buffer in the maintenance of acid-base balance, and inadequate hemoglobin in the blood impairs this role. The data above shows that the patient has decreased hemologin levels which implies decreased oxygen carrying capacity of the blood. The hematocrit (packed red cell volume) measures the proportion of red blood cells in a volume of whole blood. Normally, hemoglobin and hematocrit levels parallel each other and are commonly used together to express the degree of anemia. Decreased levels suggests anemia, fluid retention and hemorrhage. Leukocyte Count is the absolute number of WBC(s) circulating in a cubic millimeter of blood. White cells are produced in the red bone marrow and lymphatic tissue. After they are formed, they enter the blood, which transports them to the parts of the body where they are needed to (1) defend against invading organisms through phagocytosis and (2) produce or transport and distribute antibodies to help maintain immunity. The results above shows increased leukocyte count which is usually caused by conditions such as

infection, that stimulates the bone marrow to produce WBC(s) to fight off invading organisms. Segmentars, also called polymorphonuclear leukocytes or neutrophils has protective functions which includes phagocytosis. Foreign particles are degraded, and pyrogens are released that produce fever by acting on the hypothalamus to set the bodys thermostat at a higher level. The lab result shows no deviation from normal range. Lymphocytes functions protectively in antibody production and humoral immunity. The result shows normal lymphocyte count which indicates absence of viral, bacterial or hormonal disorders. Eosinophils play a role in allergic reactions, possibly inactivating histamine. The results indicate no deviation from normal limits which indicates no allergic reaction due to antigen-antibody reactions. Thrombocytes are adequate which means no deviation from the total number of circulating platelets in the patients system. It also indicates good adhesiveness or sticky quality of the platelets which allows them to clump together or aggregate and adhere to injured surfaces if such damage is present. The color of the erythrocytes and its size is within normal limits and as seen with the results, the findings are normochromic and normocyticno deviation from normal. ESR- erythrocyte sedimentation rate-increased levels may suggest presence ofd tuberculosis, acute and chronic inflammation, and anemia. B. Blood Chemistry Result 26-Feb-08 Creatinine 27-Feb-08 AST ALT Total CHON Albumin Globulin 29-Feb-08 LDH ALKP 54umol/L- LO 34u/L- normal 37u/L- normal 69g/L- normal 30g/L- LO 38g/L- HI 1397u/L- HI 187u/L- HI Normal Values 62-133 14-59 9- 72 63-82 35-50 23-35 313-618 38-126

INTERPRETATION: Creatinine is constantly released from muscle and excreted primarily by glomerular filtration with relatively no reabsorption and some secretion. Low blood creatinine levels can mean lower muscle mass caused by a disease, such as muscular dystrophy, or by aging. Low levels can also mean some types of severe liver disease or a diet very low in protein. Pregnancy can also cause low blood creatinine levels. Aspartate aminotransferase (AST), formerly called serum glutamic-oxaloacetic transaminase, or SGOT, is another enzyme necessary for energy production. It, too, may be elevated in liver and heart disease. In liver disease, the AST increase is usually less than the ALT increase. However, in liver disease caused by alcohol use, the AST increase may be two or three times greater than the ALT increase. Alanine aminotransferase (ALT), formerly called serum glutamate pyruvate transaminase, or SGPT, is an enzyme necessary for energy production. It is present in a number of tissues, including the liver, heart, and skeletal muscles, but is found in the highest concentration in the liver. Because of this, it is used in conjunction with other liver enzymes to detect liver disease, especially hepatitis or cirrhosis without jaundice. Additionally, in conjunction with the aspartate aminotransferase test (AST), it helps to distinguish between heart damage and liver tissue damage. Albumin is made mainly in the liver. It helps keep the blood from leaking out of blood vessels. Albumin also helps carry some medicines and other substances through the blood and is important for tissue growth and healing.

Albumin is tested to: Check how well the liver and kidney are working. Find out if your diet contains enough protein. Help determine the cause of swelling of the ankles (pedal edema) or abdomen (ascites) or of fluid collection in the lungs that may cause shortness of breath (pulmonary edema).

Decrease in albumin can cause edema to the patient because it is responsible for the oncotic pressure in the vascular system. Globulin is made up of different proteins called alpha, beta, and gamma types. Some globulins are made by the liver, while others are made by the immune system. Certain globulins bind with hemoglobin. Other globulins transport metals, such as iron, in the blood and help fight infection Globulin is tested to: Determine your chances of developing an infection. See if you have increased globulin levels are found in multiple myeloma and Waldenstroum's macroglobulinemia, two cancers characterized by overproduction of gammaglobulin from proliferating plasma cells. Increased globulin levels are also found in chronic inflammatory diseases such as rheumatoid arthritis, acute and chronic infection, and cirrhosisa rare blood disease, such as multiple myeloma or macroglobulinemia. ALP is generally part of a routine lab testing profile, often with a group of other tests called a liver panel. It is also usually ordered along with several other tests if a patient seems to have symptoms of a liver or bone disorder. High ALP usually means that the bone or liver has been damaged. Very high ALP levels suggests that the patients bile ducts are somehow blocked. Often, ALP is high in persons who have cancer that has spread to the liver or the bones. Lactate dehydrogenase (LDH) is a protein that normally appears throughout the body in small amounts. Many cancers can raise LDH levels, so it is not useful in identifying a specific kind of cancer. Measuring LDH levels can be helpful in monitoring treatment for cancer. Noncancerous conditions that can raise LDH levels include heart failure, hypothyroidism, anemia, and lung or liver disease. C. Arterial Blood Gas Analyses 26-Feb-08 Arterial Blood Gas 11PM 11:45PM Normal

pH 7.42- normal PCO2 37-normal PO2 129.2-increased HCO3 23.6- normal B.E. 0.4- LO O2Sat 98.6%- increased INTERPRETATION:

7.42- normal 37-normal 129.2-increased 23.6- normal 0.4- LO 98.6%- increased

Values 7.35 - 7.45 35 - 45 80 - 100 22 - 26 2 meq/L 97%

The ABG result shows there is a normal arterial blood gas. Wherein, all results had been compensated and the oxygen has good return to the body since there is more than adequate oxygen result. There is a balance exchange of gases in the body. While in Partial Oxygen measures, there is an increased pressure of oxygen dissolved in the blood and there is increased oxygen moving from the airspace of the lungs into the blood, it happens to compensate adequacy of oxygen saturation in the blood and the carbon dioxide as well. D. Urinalysis Urinalysis Color: Specific Gravity: Characteristic CHON: Reaction: Sugar: WBC: RBC: Epithelial Cells: Bacteria: Mucus: Other: INTERPRETATION: 27-Feb-08 Yellow 1.03 Slightly Turbid .30g/L 6 Trace 3-5/HPF 2-3/HPF Few Few Moderate Amorphous Materials: Few 28-Feb-08 Dark Yellow 1.025 Turbid 0.3 6 Negative 3-4/HPF 2-4/HPF Few Few Moderate

Slightly turbid appearance of urine is considered normal, however, turfbidity may suggest concentrated urine. While urines specific gravity is an indication of the kidneys ability to reabsorb water and chemicals from the glomerular filtrate. However, specific gravity is not a true measure of the number or concentration of particles but correlates well with osmolality. The result shows a normal specific gravity of the patients urine, this indicates that the kidney is able to concentrate or dilute urine and that the renal tubules are functioning well. Also, theres appropriate secretion of ADH by the posterior pituitary

gland and that it is in good functioning because it is the one which controls water reabsorption in the collecting ducts. Urine normally contains only a scant amount of protein which derives both from the blood and the urinary tract itself. Proteinuria may indicate serious renal or systemic disease, its detection on routine urinalysis must always be further evaluated for possible cause. Normally, glucose is virtually absent in the urine, the result is abnormal having a trace of sugar in the patients urine. Although nearly all glucose passes into the glomerular filtrate, most of it is reabsorbed by the proximal tubules through active transport mechanisms. In active transport, carrier molecules attach to molecules of other substances and transport them across membranes. Usually there are enough carrier molecules to transport all of the glucose from the renal tubules back to the blood. If plasma glucose levels are very high, however such that carrier mechanisms are overwhelmed, glucose will appear in the urine, the point which called renal threshold from 160-200 mg/ dl, depending on the individual. That is, the blood sugar must rise to its renal threshold level before glucose will appear in the urine. The most common cause of glycosuria is diabetes mellitus and perhaps this is the reason why there are trace of sugar in the patients urine. Only a few white blood cells are normally found in the urine, the above result is increased which generally indicate either renal or genitourinary tract infection. NURSING CONSIDERATION: A higher than normal number of leukocytes may be seen if the sample is contaminated with genital secretions, also, the nurse must carefully remind the patient not to allow samples to stand at room temperature for more than 1-2 hour for this too will give false result. The presence of Red Blood Cells in the urine which is called hematuria is abnormal because RBCs are too large to pass through the glomerulus, this condition indicates damage to the glomerular membrane or to the genitourinary tract. But there are some nonrenal disorders wherein hematuria occurs, this includes presence of tumor, blood cell infection and inflammation. Few epithelial cells in the urine are normal so as rare bacteria, unless bacteria in the urine are accompanied by excessive number of white blood cells, it may indicate an

infectious or inflammatory process. Amorphous materials as well are not of major clinical significance. E. PCR Test 5-Mar-08 PCR Test- NEGATIVE CHON Sugar LDh All substances are present at the pleural fluid INTERPRETATION: This process is artificial DNA replication, used to make copies of DNA that may be needed for genetic testing and other times when you lots of bits of one part of DNA. A powerful method for amplifying specific DNA segments which exploits certain features of DNA replication. For instance replication requires a primer and specificity is determined by the sequence and size of the primer. The method amplifies specific DNA segments by cycles of template denaturation; primer addition; primer annealing and replication using thermostable DNA polymerase. The degree of amplification achieved is set at a theoretical maximum of 2^N, where N is the number of cycles, eg 20 cycles gives a theoretical 1048576 fold amplification. F. Pleural Fluid AFB Smear 28-Feb-08 Pleural Fluid AFB Smear No Acid Fast Bacilli Seen The pleural fluid smear is a screening test for the presence of microorganisms or abnormal cells in pleural fluid in the space around the lungs .A sample of pleural fluid is examined under the microscope. The test is performed when infection of the pleural space is suspected, or when an abnormal collection of pleural fluid is noticed by chest x-ray. There were no organisms present in the pleural fluid such as Mycobacterium tuberculosis. G. Pleural Fluid Analysis 28-Feb-08 Specimen - Pleural Fluid Rivalta's Test Result Negative Normal Values

Ph Specific Gravity Glucose Total CHON LDH WBC Differential Count: Segmentars Lymphocytes

7.5-decreased 1.015-normal 5.0mmol/L 62g/L-increased 3,533u/L- increased 486x109/L-normal 0.54- increased 0.46- normal

7.65 less than 1.015 greater than 60 mg/dL less 3.0 g/dL less than or equal to 200 U/L less than 1000 per microliter less than 50% less than 50%

Pleural fluid analysis examines fluid that has collected in the pleural space. The pleura is a thin membrane that lines the outside of the lung and the inside of the chest cavity. The data above ruled out the diagnosis of exudative pleural effusion based on Lights criteria. Rivalta reaction is still used as a puncture fluid test for differentiation of exudate and transudate pleural effusion. H. Pleural Fluid Gram Stain and Pleural Fluid Culture and Sensitivity 28-Feb-08 Pleural Fluid Gram Stain WBC-positive No definite microorganism seen 3-Mar-08 Pleural Fluid Culture and Sensitivity No growth after 72 hours of incubation (3-1-08) INTERPRETATION The pleural fluid gram stain is one of the best techniques for the rapid diagnosis of bacterial infections. The test is performed when infection of the pleural space is suspected or when an abnormal collection of pleural fluid is noticed by chest x-ray. There were no microorganisms seen such as Mycobacterium tuberculosis. The patients pleural fluid is positive to WBC which may indicate presence of infection.

I. Others 2-Mar-08 AFP B-HCG Result >940- increased 84.91- increased Normal Values 0.0 11.3 IU/ml 0.0 - 5.0 mIU/ml

INTERPRETATION Alpha-fetoprotein is normally elevated in pregnant women since it is produced by the fetus. However, AFP is not usually found in the blood of adults. In men, and in women who are not pregnant, an elevated level of AFP may indicate liver cancer or cancer of the ovary or testicle. Noncancerous conditions may also cause elevated AFP levels. A high level of AFP may indicate a problem with the spinal cord, brain, or digestive system. HCG may indicate cancer in the testis, ovary, liver, stomach, pancreas, and lung. Marijuana use can also raise HCG levels.

PROCEDURES
I. CT Scan It is a special imaging procedure that uses the same X-rays as in a classic X-ray examination. CT images are much more precise, however. This is because a CT takes pictures of millimeter-thin layers of a selected region inside the body. The word tomography comes from the Greek and means depicting in layers or slices. Various types of tissue, such as bones, muscles and fat as well as possible changes in tissue, can be shown much more clearly by a CT than by a simple X-ray. Furthermore, the computer can subsequently dimensional image, which gives the physician an exact 3D picture of certain body regions. This can be necessary before sur4gery on a complicated fracture, for example. CT Scan of the Chest to include the thoracic spine (non-contrast enhance) Date: February 27, 2008 Results: Limited study due to lack of IV contrast. There is a heterogeneous mass lesion with calcification which appears to be in the right paratracheal space of the mediastinum displacing the trachea to the left and compressing the underlying right lung parenchyma as

well as the right bronchi. The right lung is opacified. Moderate amount of right side pleural effusion is present. There is pleural thickening in the right. A subcentimeter nodule is present in the superior segment of the lower lobe. There is no focal infiltrate and consolidation in left lung. Parenchymal fibrosis is seen in the left lower lobe. Heart is within normal size and configuration. Great vessels are unremarkable on the non-contrast exam. Esophagus shows no intraluminal defects. Walls are not thickened. Lytic change is seen in the right pedicle of T2 vertebral body. Hyppodense/lytic change is seen in L3 vertebral body . the rest of the thoracic and visualized lumbar vertebral bodies and posterior elements are unremarkable. The alignment and intervertebral disc spaces are unremarkable. There is a 1.2 cm hypodense structure in the right hepatic lobe and a 2.3 cm hypodense structure in the left hepatic lobe. Impression: 1. Limited study due to lacking of IV contrast. 2. Heterogenous mass lesion with calcification which appears to be in the right paratracheal space of the mediastinal mass region such as teratoma with additional malignant components is considered. Correlation with IV Chest CT Scan and tissue correlation is suggested. 3. Subcentimeter nodule, left lower lobe. 4. Moderate right side pleural effusion. 5. Pleural thickening, right. 6. Possible metastasis, right pedicles at T2 vertebral body. Possible lytic change, L3 vertebral body. 7. Hypodense structure in the liver. Metastasis is not ruled out. Correlation with contrast enhance abdominal CT is suggested. II. X -Rays It is electromagnetic radiation of extremely short wavelength (beyond the ultraviolet), with great penetrating powers in matter opaque to light. X-rays are used in diagnosis in the techniques of radiography and also in certain forms of radiography. Great

care is needed to avoid unnecessary exposure, because the radiation is harmful in large quantities. A. Chest AP Right Lateral DEC/TLS February 26, 2008 Results: There is hemogenous opaqcities of the right lung obscuring the left hemi diaphragm and sulcus. Hazy infiltrates are seen in the left lung base. Heart size cant be assessed. Impression: Massive pleural effusion Right Pneumonia, left Right lateral decubitus shows layering of fluid in its dependent portion. B. Chest AP CTT insertion February 27, 2008 Results: Follow up chest now shows CTT tube on the right. There is very minimal clearing of massive right side pleural effusion. The rest of findings are unchanged. Interpretation: The patient was diagnosed of having pleural effusion which revealed on the first x-ray result. The patient undergone CTT insertion thats why he still need to underwent Chest X-ray for the second time to determine if he tube is inserted at the right place. C. X-ray of Thoracolumbar spine: Lumbar spine is strengthened which can be due to muscle spasm. Vertebral body heights and intervertebral disc spaces are intact. III. CTT insertion

The pleural space normally contains a thin layer of lubricating fluid that allows frictionless movement of the lungs during respirations. An excess of fluid (hemothorax or pleural effusion), air (pneumothorax), or both in this space alters intrapleural pressure and causes partial or complete lung collapse. Chest tube insertion permits the drainage of air of fluid from the pleural space. Performed by the doctor with a nurse assisting, this procedure requires sterile technique. The insertion site varies, depending on the patients condition and the doctors judgment. For hemothorax or pleural effusion, the sixth to the eight intercostals spaces are common sites because fluid settles to the lower levels of the intrapleural space. For removal of both air and fluid, a chest tube is inserted into a high and low site. Following insertion, the chest tube is connected to a thoracic drainage system that provides for the drainage of air and/or fluid out of the pleural space, thus promoting lung expansion.

DRUG STUDY
1. MORIAMIN FORTE Classification: Multivitamins, Essential Amino acids, folic acid, 5 oxyanthranillic acid Action: It protects and enhances bodys immune system response against further infection Side Effects: without any known side effects. Why is it given?: Since the patient was experiencing lung cancer, the patient undergone immune system depression, this drug is given to enhance patients response. 2. DEXAMETHASONE SODIUM SUCCINATE 4MG TAB BID Brand Name: Dexamethasone Classification: An anti inflammatory Drug Action: Glucocorticoids, naturally occurring and synthetic, are adrenocortical steroids that cause varied metabolic effects. In addition, they modify the body's immune responses to diverse stimuli. Naturally occurring glucocorticoids (hydrocortisone and cortisone), which also have sodium-retaining properties, are used as replacement therapy in adrenocortical deficiency states. Their synthetic analogs including dexamethasone are primarily used for their anti-inflammatory effects in disorders of many organ systems. Adverse Effects: Allergic reactions: Anaphylactoid reaction, anaphylaxis, angioedema. Cardiovascular: Bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatory collapse, congestive heart failure, fat embolism, hypertension, hypertrophic

cardiomyopathy in premature infants, myocardial rupture following recent myocardial infarction (see WARNINGS, Cardio-renal), edema, pulmonary edema, syncope, tachycardia, thromboembolism, thrombophlebitis, vasculitis. Endocrine: Decreased carbohydrate and glucose tolerance, development of cushingoid state, hyperglycemia, glycosuria, hirsutism, hypertrichosis, increased requirements for insulin or oral hypoglycemic agents in diabetes, manifestations of latent diabetes mellitus, menstrual irregularities, secondary adrenocortical and pituitary unresponsiveness (particularly in times of stress, as in trauma, surgery, or illness), suppression of growth in pediatric patients. Fluid and electrolyte disturbances: Congestive heart failure in susceptible patients, fluid retention, hypokalemic alkalosis, potassium loss, sodium retention. Gastrointestinal: Abdominal distention, elevation in serum liver enzyme levels (usually reversible upon discontinuation), hepatomegaly, increased appetite, nausea, pancreatitis, peptic ulcer with possible perforation and hemorrhage, perforation of the small and large intestine (particularly in patients with inflammatory bowel disease), ulcerative esophagitis. Musculoskeletal: Aseptic necrosis of femoral and humeral heads, loss of muscle mass, muscle weakness, osteoporosis, pathologic fracture of long bones, steroid myopathy, tendon rupture, vertebral compression fractures. Contraindication: Hypersensitivity to corticosteroids Indication: Respiratory diseases: Berylliosis, fulminating or disseminated pulmonary tuberculosis when used concurrently with appropriate antituberculous chemotherapy, idiopathic eosinophilic pneumonias, symptomatic sarcoidosis. Why is it given?: The patient had lung cancer and experiencing difficulty of breathing, it will help tomopen airway by dilating bronchioles for more oxygen supply. It also prevents inflammation. 3. PARACETAMOL 500MG/TAB Q4 FOR FEVER Brand Name: Biogesic Classification: Antipyretic drug Action: It blocks the hypothalamus to secrete pyrogens a chemical mediator responsible for increasing thermoregulation. Indication: This drug is indicated to patient with fever and pain Contraindication: It is contraindicated to repeated administration in anemic patient, Cardiac, Pulmonary, Renal and hepatic disease. Side Effects: Skin rash and GI disturbances.

Why is it given?: Due to inflammatory responses, the patient experiencing fever, thus, using paracetamol will lower it. 4. NALBUPHINE 5MG Q6 FOR PAIN Brand Name: Nubain Classification: Opiate Analgesic Action: NUBAIN is a potent analgesic. Its analgesic potency is essentially equivalent to that of morphine on a milligram basis. Receptor studies show that NUBAIN binds to mu, kappa, and delta receptors, but not to sigma receptors. NUBAIN is primarily a kappa agonist/partial mu antagonist analgesic. Indication: NUBAIN is indicated for the relief of moderate to severe pain. NUBAIN can also be used as a supplement to balanced anesthesia, for preoperative and postoperative analgesia, and for obstetrical analgesia during labor and delivery. Contraindication: NUBAIN should not be administered to patients who are hypersensitive to nalbuphine hydrochloride, or to any of the other ingredients in NUBAIN. Side Effects: Nervousness, depression, restlessness, crying, euphoria, floating, hostility, unusual dreams, confusion, faintness, hallucinations, dysphoria, feeling of heaviness, numbness, tingling, unreality, Hypertension, hypotension, bradycardia, tachycardia, Depression, dyspnea, asthma. Why is it given?: The patient is experiencing severe bone pain, nalbuphine is given to reduce pain. 5. CIPROFLOXACIN Brand Name: Ciprobay Classification: Anti infective drugs Action: An antibiotics that prevent and blocks further bacterial and viral infection. Indication: Urinary Tract Infections, Lower Respiratory Tract Infections, Bone and Joint Infections Contraindication: Ciprofloxacin is contraindicated in persons with a history of hypersensitivity to ciprofloxacin, any member of the quinolone class of antimicrobial agents, or any of the product components. Concomitant administration with tizanidine is contraindicated. Side Effects: palpitation, atrial flutter, ventricular ectopy, syncope, hypertension, angina pectoris, myocardial infarction, cardiopulmonary arrest, cerebral thrombosis,

phlebitis, tachycardia, migraine, hypotension, restlessness, dizziness, lightheadedness, insomnia, nightmares, hallucinations, manic reaction, irritability, tremor, ataxia, convulsive seizures, lethargy, drowsiness, weakness, malaise, anorexia, phobia, depersonalization, depression, paresthesia, abnormal gait, grand mal convulsion, dyspnea, epistaxis, laryngeal or pulmonary edema, hiccough, hemoptysis, bronchospasm, pulmonary embolism. Why is it given?: A patient is at risk for infection, antibiotics is given to prevent entrance of microorganism that may lead to infection.

COURSE IN THE WARD

March 3, 2008 The patient was seen lying in supine position with ongoing IVF # 10 D5 NM 1L x 12 hours at 500 cc level and SD A # 7 D5 W 500 + 200 mg Tramadol x 24 hours at full level; inserted at right metacarpal vein and infusing well. He has right CTT connected to 3way bottle with no draining output. He also has patent and intact FC to CDU draining dark yellow urine at 200 cc level. He is in full diet + 2 egg whites TID. Ate, masakit yung sa may tubo ko saka yung likod ko masakit din, as stated. He is weak and pale looking, with pale lips and conjunctivae noted. Facial grimacing when moving and frequent touching of the back was also evident as observed. He had pain scale of 6 out of 10 where 10 is the highest and admitted that the pain he felt was tolerable. So Nalbuphine 50 mg q6h IV which is given PRN for pain was not given. The client was encouraged to do relaxation technique such as deep breathing. Touch therapy was also provided. The client was also encouraged to increase fluid intake as ordered. Spiritual care such as praying with the client was rendered. March 4, 2008 The patient was seen lying in supine position with ongoing IVF # 12 D5 NM 1L x 24 hours at 900 cc level inserted at right metacarpal vein and infusing well. The Tramadol drip was removed and replaced by Morphine Sulfate tablet p.o TID. He has right CTT connected to 3-way bottle with no draining output. He also has patent and intact FC to CDU draining dark yellow urine at 250 cc level. Namamanhid po yung dalawang paa ko at di kop o masyadong magalaw at maangat, as said. He is still weak and pale looking. He

has limited ROM and poor muscle tone at lower extremities. He cannot ambulate and cannot do ADLs alone. The client was encouraged to eat fruits and vegetables and foods rich in protein. He was also instructed to increase oral fluid intake. The relatives were also encouraged to exercise the feet of the client by doing passive ROM. They were also instructed to help the client in doing his ADL. Dr. M. R. ordered for the client to have thoracoscopy, biopsy and talc poundage tomorrow at 5:00 PM in OR. The relatives were informed by Dr. Q about the procedure but refused to sign until the oldest sibling arrived. March 5, 2008 The patient was seen lying in supine position with ongoing IVF # 12 D5 NM 1L x 24 hours at 900 cc level inserted at right metacarpal vein and infusing well. He has right CTT connected to 3-way bottle with no draining output. He also has patent and intact FC to CDU draining dark yellow urine at 100 cc level. Nagbabalat na yung likod nya, parang nagbibitak na, as said by the mother of the client. The client has dry and scaly skin at the back. He also doesnt ambulate or turn from side to side. He is still with limited ROM and dependent in doing ADLs. The client was turned from side to side. Back rub, tapotement and effleurage was rendered. The schedule for thoracoscopy, biopsy and talc poundage was deferred because the relatives refused to sign the consent due to financial constraints. March 6, 2008 The patient was received lying on bed on supine position, with ongoing IVF of #13 D5NM 1L x 24 hours at 300 cc level infusing well at right metacarpal vein. He has right CTT to 3 way bottle with no output draining. He also has a Foley Catheter to CDU, patent and intact with yellowish output of about 210 cc. The patient still complained with joint pains on the lower extremities, thus, health teachings regarding pain relief were rendered by the SN. Rest periods were provided during interventions, and the patient had some time to sleep at frequent intervals uninterruptedly. Patient was assisted to turn from side to side but still the patient cannot tolerate the turning schedules due to pain upon doing so. The patient was then encouraged to do some ROM exercises to facilitate good circulation. The patient is still for thoracoscopy and talc poundage but OR was deferred temporarily due to refusal of patients relatives to sign the written consent.

NURSING THEORY
LYDIA HALLS CORE, CARE, CURE IMOGENE KINGS GOAL ATTAINMENT THEORY The group utilized the theory of Lydia Hall which is the Core, Care, and Cure. This theory was used to further enhance the rendering of care to the patient. In this theory there had been a collaborative work done by the physicians, the nurses and the student nurses and as well as the patient himself. The core is the patient, wherein he is the center of both the cure and the care. The cure is when the physicians takes place. This is wherein they give medications and procedures for the patient, may it be invasive or non-invasive. While the nurses together with the student nurses are the care. This is the part wherein the core is being cared of, physically, mentally, emotionally, and spiritually. In here the student nurses focused more on the care of the patient but also assisted in delivering cure to the patient, by means of carrying out doctors order, giving medications and etc. The group incorporated the theory of Imogene king which is the goal attainment theory. The group also utilized this theory since the above theory that was mentioned was collaborative; which is composed of the patient, the physicians and the nurses and student nurses as well. In using this theory the student nurse together with the patient formulated a goal: and that is to help the patient recover from his condition and be able to continue his normal daily activities. The student nurses ensured that the patient is still asked for his preference and opinion in forming the said goal.

PROBLEM #
ASSESSMENT: Subjective: Sobrang sakit ng paa ko. Hindi ko na kaya! as stated

Paano ba mawawala to! as added Objective: -pale and weak looking -restless and irritable -with limited movements noted -with limited focus -poor eye contact noted -pale conjunctivae -teary eyed -with nasal flaring noted -dry, pale lips -with facial grimacing noted -with guarding behavior on lower extremities -with clenched fist noted -pain scale of 9 out of 10 Nursing Diagnosis Alteration in Comfort: Acute Pain related to nerve compression of both limbs Nursing Goal: At the end of 8 hours duty the patient will be able to verbalize decreased pain from 9 to 5 as manifested by less facial grimacing and guarding behavior through the use of relaxation skills and divertional activities to be taught by the student nurse after the hours of duty.

Nursing Interventions with Rationale: 1. Allowed patient to verbalize pain. R: Pain is subjective that can only be felt by the person affected.

2. Determined pain history, such as location, frequency, duration, intensity and relief measures used. R.: Information provides baseline data to evaluate need for or effectiveness of interventions. Pain of more than 6 mo duration constitutes chronic pain, which may affect therapeutic choices. Recurrent episodes of acute pain can occur within chronic pain, requiring increased level of intervention 3. Provided non-pharmacologic comfort measures such as repositioning, back rub and divertional activities such as listening to music and conversing about pleasant things. R: Promotes relaxation and helps refocus attention. 3. Encouraged use of stress management skills or complementary therapies such as guided imagery and therapeutic touch. R: Enables patient to participate actively in nondrug treatment of pain and enhances sense of control. Pain produces stress and, in conjunction with muscle tension and internal stressors, increase patients focus on self, which in turn increases the level of pain. 4. Taught to do deep breathing exercise and instructed to do it along with the other interventions when the pain starts. R: Increases lung expansion, reduces muscle tension, enhances circulation and decreases pain perception. 5. Regulated Tramadol drip timely and correctly. R: to ensure that the right amount of drug is given so as to help patient cope with the pain through pharmacologic approach. 6. Administered Nalbuphine (Nubain) 5 mg TIV as rescue pain management as ordered. R: To aid in controlling pain easier and faster. 7. Instructed relatives to stay with the patient at most times. R: To reduce anxiety and enhance patients coping skills which in turn, decreases pain. Evaluation: Goal Partially Met! At the end of 8 hours duty the patient was able to verbalize decreased pain from 9 to 6 as manifested by less facial grimacing and guarding behavior through the use of

relaxation skills and divertional activities taught by the student nurse after the 8 hours of duty.

PROBLEM #
ASSESSMENT Subjective:

Lagi lang siyang nakahiga. Hindi niya kayang tumagal ng nakatagilid kasi sumasakit yung tagiliran niya dahil sa tubo at nanghihina kasi siya. as stated by the relative Tuyo na nga likod niya at natatanggal na ang mga balat. As added by the relative Objective: -pale and weak looking -restless and irritable -with limited/ reluctance movements noted -with right CTT-3 way bottle -with fracture board under the mattress -stays confined on low fowlers position -facial grimacing noted on slight movements -with dry, scaly, blanching of skin on the back -redness noted on the sites affected Nursing Diagnosis: Impaired skin integrity: presence of reddened dry and scaly skin on the back related to prolonged bed rest and immobility Nursing Goal: At the end of 8 hours duty, the patient will be able to have improved skin integrity through participating in techniques to promote healing as manifested by decreased redness and scaly skin. Nursing Interventions with Rationale 1. Turned/ Repositioned patient at least every 2 hours. R: Promotes circulation and prevents undue pressure on skin and tissues. 2. Encouraged use of soft, loose cotton clothing. R: To promote comfort and maintain optimum circulation 3. Used preventive skin care devices such as pillows and padding. R: To avoid discomfort and skin breakdown 4. Kept patients skin dry and clean. R: These measures promote comfort and reduce risk of irritation and skin breakdown. 5. Protected bony prominences with pillows and padding.

R: Prominences have little subcutaneous fat and are prone to breakdown; using padding and pillows may help promote skin integrity. 6. Kept linen dry, clean and free from wrinkles or crumbs. R: Dry, smooth linens help prevent excoriation and skin breakdown. 7. Monitored nutritional intake and maintained adequate hydration. R: Anemia and low serum albumin which the patient has are associated with the development of pressure ulcers. Hydration helps maintain skin integrity. 8. Educated his family and the patient in preventive skin care and the essence of frequent repositioning. R: These measures encourage compliance with patients skin care regimen. Evaluation: Goal Met! At the end of 8 hours duty, the patient was able to show improved skin integrity through participating in techniques to promote healing as manifested by decreased redness and scaly skin.

PROBLEM #
ASSESSMENT: Subjective: Hindi na ako makatayo at makalakad sa sobrang sakit ng paa ko. As stated

Mas gusto ko pa itong nakahiga.as added Objective: -pale ands weak looking -with limited movements noted -able to do passive and active ROM exercise -poor muscle strength noted, RA: 5 LA: 5, RL:3 LL: 3 -poor muscle tone as observed -prefers to stay confined on low fowlers position -poor attention span -limited focus noted -facial grimacing noted on slight movements -guarding behavior noted on lower extremities Nursing Diagnosis: Impaired Physical Mobility related to generalized weakness and joint pains Nursing Goal: At the end of 8 hours duty, the patient will be able to achieve a slight increase in physical mobility and show no evidence of complications such as contractures and skin breakdown through patients willingness to participate in care. Nursing Interventions and Rationale: 1. Observed patients functional ability daily. R: Changes may indicate decline or improvement in underlying disorder. 2. Ensured patient comfort by padding extremities prone to skin breakdown and repositioned patient every 2 hours and provided meticulous skin care. R: These measures prevents skin breakdown. 3. Implemented ROM exercises from passive to active, every after pain medication. R: This prevents injury, joint contracture and muscle atrophy. 4. Encouraged patients active movement by using assistive devices and promoted joint rest between activities. R: To increase muscle tone and increase patients feelings of self-esteem

5. Promoted progressive mobilization to maximum, within the limits of patients tolerance for pain. R: This maintains muscle tone and prevents complications of immobility. 6. Discussed the use of distraction and other nonpharmacologic pain relief methods with patient. R: In addition to providing pain relief, nonpharmacologic techniques may help patient achieve a sense of control. 7. Encouraged nutritional intake. R: Necessary to meet energy needs for mobility. 8. Recommended scheduling activities for periods when patient has most energy and decreased pain. R: Prevents overexertion, allows for some activity within the patients ability. Evaluation: Goal Met! At the end of 8 hours duty, the patient was able to achieve a slight increase in physical mobility and show no evidence of complications such as contractures and skin breakdown through patients willingness to participate in care.

PROBLEM #
POST OPERATIVE Assessment

Subjective: Kakalagay lang ng tubo sa tagiliran ko kaya hirap akong huminga Parang hinahabol yung hiningastated by the client Objective: - Pale and weak looking - Restless and irritable - Nasal flaring noted - Mouth breathing noted - Pale and dry lips - Substernal muscles noted upon respiration - Retractions noted on inspiration - Crakles noted upon auscultation - With respiratory rate of 38bpm - With CTT to 3 way bottle draining Nursing Diagnosis: Ineffective breathing pattern related to altered physiology secondary to opening the pleural cavity. Nursing Goal: At the end of 8 hours of duty, the patient will achieve normal breathing pattern as evidenced by eupnea and a respiratory rate within the normal limits (14-24bpm) from a RR of 38 bpm. Nursing Interventions with Rationales: 1. Positioned the patient on semi fowlers with head elevated 30 to 40 degrees R: To improve movement of diaphragm 2. Looked and listened at the patients open mouth as he breathes. R: To look for evidences of obstruction 3. Auscultated chest for adequacy of air movement. R: To detect bronchospasm, consolidation. 4. Encouraged deep breathing exercises R. To expand the lungs for better gas exchange 5. Taught of effective coughing technique

R: To expectorate secretions and increase intrapleural pressure. 6. Administered oxygen therapy R: It decreases the ventilatory and myocardial work; warming and humidification of inspired gases prevents drying of secretions and loss of body heat. 7. Checked the chest drainage on frequent intervals note for the color of drain and the level of secretion. R: Chest tube must maintain a negative pressure to avoid mediastinal shift. Assessing for the color and drain is necessary to assess the effectiveness of the chest tube. 8. Milked the tubing in the direction of the drainage bottle as often as directed. R: To prevent the tubing becoming plugged with cloth and fibrin. It also provides patency which will facilitate prompt expansion of the lung and minimize complication. Evaluation Goal met! The patient achieved normal breathing pattern as evidenced by eupnea and a respiratory rate within the normal limits which is 24 bpm from 38 bpm.

PROBLEM #
ASSESSMENT: Subjective:

Marami pa rin po akong plema at inuubo po ako. Matagal na po ito. Di ko na po matandaan kung kailan nagsimula., as verbalized Objective: Nursing Diagnosis Ineffective airway clearance R/T decreased mucociliary action S/T present condition: lung cancer Nursing goal At the end of 8-hour duty, the patient will be able to demonstrate improved airway clearance as evidenced by clear breath sounds and will be able to expectorate at least 30 ml. of sputum after the interventions rendered by the student nurse. Nursing Intervention 1. Advised to perform deep breathing exercises. : Promotes mobilization of secretions for better lung expansion.\ 2. Encouraged to increase oral fluid intake up to 2L/day. : Fluids help decrease viscosity of sputum. 3. Instructed on proper coughing technique with upright position. :Upright position allows maximal lung expansion. Effective coughing helps avoid stress in coughing. 4. Provided mild bronchial clap. : Bronchial clap helps loosen secretions from the lung fields sfor easier expectoration. 5. Observed character of sputum upon expectoration Appears pale and weak-looking Teary-eyed With intermittent productive cough: sputum appears yellowish,thick and in very small amount With abnormal breath sounds: crackles heard upon auscultation With slight chest indrawing noted when coughing With RR=34

: Blood-streaked sputum indicates trauma in the bronchus or lungs and may promote development of secondary problems such as Pneumonia, etc. 6. Advised to rest every after cough for about 15 minutes. : To avoid overexhaustion in coughing 7. Auscultated breath sounds. : To determine if further interventions in removel of sputum is still needed. 8. Encouraged to increase intake of foods rich in Vitamin C such as oranges and calamansi juice. : Vitamin C helps boost immune system to avoid further respiratory problems that can occur which can cause further increase in sputum production. Evaluation Goal partially met! At the end of 8-hour duty, the patient was able to demonstrate slight improvement in airway clearance as evidenced by expectoration of approximately 10 to 20 cc of yellowish, non- blood streaked sputum after the interventions rendered by the student nurse.

PROBLEM #
ASSESSMENT: Subjective

Medyo kinakabahan ako sa gagawin sa akin sa operasyon. Di naman daw delikado pero unang beses ko lang kasi naranasan ang magpa-opera, as verbalized by patient. Objective Nursing Diagnosis ANXIETY Nursing goal At the end of 8-hour duty, the patient will be able to demonstrate decreased anxiety as evidenced by the client will appear calm before the procedure and verbalize decreased nervousness on the procedure after the interventions rendered by the student nurse. Nursing Interventions 1. Encouraged verbalization of feelings. : Support may enable patient to begin exploring and dealing with the reality of Cancer and its treatment. Patient may need time to begin to express their feelings. 2. Provided therapeutic touch. : Establishes trust and expresses support and empathy. 3. Provided opportunities to ask questions about the procedure and answered them honestly. procedure. : This will decrease misperception/ misinterpretations of the situation. This will also help in the psychological preparation of the patient. 4. Noted behaviors indicative of increased anxiety like restlessness, anger,. And crying episodes. Provided teachings on the advantages and disadvantages of the R/T POSSIBLE OUTCOME OF THE SURGICAL PROCEDURE: CLOSED THORACOSTOMY TUBE INSERTION Pale and weak-looking Appears nervous; mild anxiety noted Teary eyed Frequently asked questions Appears interested in knowing about the operation

: This will signal other necessary interventions appropriate for the situation such as pharmacotherapy. 5. Involved significant others in the teaching and support. : Family and close friends are effective in helping the patient cope with the procedure to be done if involved fully in the teachings. Evaluation Goal met! At the end of 8-hour duty, the patient was able to demonstrate decreased anxiety as evidenced by the client appeared calm before the procedure and verbalized decrease nervousness on the procedure after the interventions rendered by the student nurse.

PROBLEM #
ASSESSMENT: Subjective:

Marami pa rin po akong plema at inuubo po ako. Matagal na po ito. Di ko na po matandaan kung kailan nagsimula., as verbalized Objective: Nursing Diagnosis INEFFECTIVE AIRWAY CLEARANCE R/T DECREASED MUCOCILIARY ACTION SECONDARY TO PRESENT CONDITION: LUNG CANCER Nursing goal At the end of 8-hour duty, the patient will be able to demonstrate improved airway clearance as evidenced by clear breath sounds, noiseless respiration, and will be able to expectorate at least 30 ml. of sputum after the interventions rendered by the student nurse. Nursing Interventions 1. Advised to perform deep breathing exercises. : Promotes mobilization of secretions for better lung expansion. 2. Encouraged to increase oral fluid intake up to 2L/day. : Fluids help decrease viscosity of sputum. 3. Instructed on proper coughing technique with upright position. :Upright position allows maximal lung expansion. Effective coughing helps avoid stress in coughing. 4. Provided mild bronchial clap. : Bronchial clap helps loosen secretions from the lung fields sfor easier expectoration. 5. Observed character of sputum upon expectoration. Appears pale and weak-looking Teary-eyed With intermittent productive cough: sputum appears yellowish,thick and in moderate amount With abnormal breath sounds: crackles heard upon auscultation With slight chest indrawing noted when coughing With RR=

: Blood-streaked sputum indicates trauma in the bronchus or lungs and may promote development of secondary problems such as Pneumonia, etc. 6. Advised to rest every after cough for about 15 minutes. : To avoid over exhaustion in coughing 7. Auscultated breath sounds. : To determine if further interventions in removal of sputum is still needed. 8. Encouraged to increase intake of foods rich in Vitamin C such as oranges and calamansi juice : Vitamin C helps boost immune system to avoid further respiratory problems that can occur which can cause further increase in sputum production. Evaluation Goal partially met! At the end of 8-hour duty, the patient was able to demonstrate slight improvement in airway clearance as evidenced by noiseless respiration, and expectoration of 30 ml. of yellowish, non- blood streaked sputum after the interventions rendered by the student nurse.

PROBLEM #
Assessment: Subjective Objective Nahihirapan akong gumalaw kasi hinihingal ako, patient said

RR 38cpm Deep breathing noted Moist crackles heard on both lung fields upon auscultation Flaring of the nares noted. Pale and Dry Lips Tired and Weak-Looking Slightly Diaphoretic Lying in bed on a side-lying position Has difficulty assuming a standing position Has difficulty moving both the left and right extremities With a muscle strength of 3/5 for both left and right lower extremities

Nursing Diagnosis: Activity intolerance related to difficulty of breathing. Nursing Goal: At the end of 8 hours of duty, the patient will be able to report a measurable increase in activity tolerance as evidenced by being able to assume a standing position with less discomfort and preventing complications in the disease condition. Nursing Interventions with Rationale 1. Assess patients response to activity, such as increased BP of >140 in systolic and >90 in diastolic, elevated pulse of more than 20 bpm, dyspnea, chest pain, excessive fatigue, diaphoresis, dizziness or syncope. - The said parameters are helpful in assessing physiologic responses to the stress of activity, and if present, are indicators of overexertion associated with activity level 2. Put the patients needs and belongings closer to the patient and bedside. - this is to decrease too much activity in the patient to help control shooting levels of blood pressure to lessen the exacerbation of the disease process 3. Placed comfortably on a low-Fowlers or semi-Fowlers position - to promote lung expansion for better ventilation and perfusion of the patient 4. Encouraged to assume the orthopneic position.

 - to promote drainage of secretions for better lung expansion and therefore better ventilation and perfusion to the client 5. Provide help to the patient as needed in simple ADLs. (e.g. eating, holding a glass, etc.) - pt may have a hard time in such activities due to the feeling of numbness and weakness on the affected site. Providing assistance as needed encourages independence in performing such activities 6. Encouraged progressive activity to the patient and taught slight range-of-motion exercises when tolerated (e.g. dangling of feet, assuming a standing position, etc.). - to help restore normal activity and avoid total weakness or paralysis of the affected site due to immobility. 7. Encouraged early ambulation with assistance - to promote activity and avoid immobility to the patient and avoid pressure sores by staying too long in bed 8. Encouraged to rest when fatigued. - to not overwork the heart as it may increase the workload therefore increasing the blood pressure and may bring about complications brought about by the disease condition 9. Provided massage on the lower extremities - to provide comfort to the affected hand and stimulation through touch therapy 10. Provide a walker for walking. - a walker will help in assisting the patient to walk and ambulate that will, at the same time, avoid injury. Evaluation: Goal Met! At the end of 8 hours duty, the patient was able report a measurable increase in activity tolerance as evidenced by assume a standing position for 5 minutes and ambulate to and fro inside the patients room with less discomfort and preventing complications in the disease condition as evidenced by a blood pressure of 140/90mmHg.

BIBLIOGRAPHY
Jeanette Watson, R.N., M. Sc. N., Medical-Surgical Nursing and Related Physiology, 2nd Edition, 1979, W.B. Saunders Company Suzanne Smeltzer R.N., Brenda G. Bare R.N., Medical Surgical Nursing, 10th Edition, Lippincott Williams and Wilkins

Joyce Mielack R.N., Jane Hokanson- Hawks R.N., Medical-Surgical Nursing, 7th Edition, 2004, Elsevier Saunders Company June H. Celia R.N., M.S.N., Ed.D., Juanita Watson, R.N., M.S.N., Nurses Manual of Laboratory Tests, F.A. Davis Company, pp.20-40, pp.305 Sheila Sparks Ralph, R.N., D.N.Sc.,F.A.A.N., Cynthia M. Taylor, R.N., M.S., Nursing Diagnosis Reference Manual, 6th Edition, Lippincott Williams and Wilkins Jocelyn Yambao-Franco, M.D., Philippine Pharmaceutical Directory Review, 5th Edition, Medicomm Pacific Judith Hopfer Deglin, PharmD, April Hazard Vallerand, PhD, R.N., Daviss Drug Guide for Nurses, 9th Edition, F.A. Davis Company

TABLE OF CONTENTS
Title I. II. III. Introduction Demographic Data Gordons Functional Health Pattern Page

IV. V. VI. VII. VIII. IX. X. XI. XII. XIII. XIV.

Physical Examination Risk Factors Pathophysiology Laboratory Procedure Drug study Course in the Ward Nursing Theory Nursing Care Plan Health Teaching Bibliography