Lung cancer is the leading cause of death in both men and women, and is responsible for approximately 1.6 million deaths annually worldwide (World Health Organisation, 2014). According to Australian Institute of Health and Welfare (AIHW, 2011), in 2011, 8114 deaths were caused by lung cancer, where 18.8% were accountable for all cancer related deaths. According to the Australian Government Cancer Australia (2014), the survival rate of five years from diagnosis is less than 14%, however the age-regulated mortality rate in Australia is significantly lower than in Northern America, Northern Europe and Eastern Asia. AIHW (2011) predict in 2020 an estimated 13,640 people will be diagnosed with lung cancer in Australia, due to the yearly exponential diagnosis rate. Statistics show that Indigenous Australians are nearly twice at risk of developing lung cancer than non indigenous people due to co morbidities and rural remoteness (AIHW, 2013). One of the main types of lung cancers is non-small cell lung cancer (NSCLC), which is responsible for 80% of all lung cancers (Peters et al, 2012). Lung adenocarcinoma is a derivative form of NSCLC, which accounts for 40% of all cases of lung cancer (Mazzone, 2012).
This assignment will examine a case report of a patient newly diagnosed with stage IIIA adenocarcinoma, after surgical resection difficulties resulting in pneumonectomy. The purpose of this assignment is to evaluate the nursing management of a patient to facilitate understanding and express clinical decision-making progress throughout care. Examination of anatomical and physiological processes and diagnostic procedures will be used to diagnose the presenting disease. Interventions such as lung resection and alternative treatments that are used globally to maintain homeostasis will also be analysed. Nursing management of the patient from admission to discharge date will be critiqued based on best practice. An evaluation of the patients’ ethical and cultural issues will be addressed followed by a plan of future management promoting well being.
ER, is a 74 year old non-indigenous male, who presented to his local physician for symptoms of dyspnoea for a month, recent haemoptysis and 5 kilogram weight loss in 2 weeks. ER medical history and current medications includes:
Hypertension: coveram 10 mg mane
Hypercholesterolemia: rosuvastatin 10mg nocte
Transient ischemic attack (TIA) in 1997 with no residual weakness or deficits: asasantin 200/25mg twice per day.
ER is an ex smoker of which his daily amount was 5 cigarettes a day, which started when he was in the Australian army aged 18 years old and ceased in 1997 after having a TIA. ER is relatively fit; he goes for walks everyday and swims frequently. ER lives at home with his wife of 53 years; they don’t have any children but have a network of very supportive friends. There is no family history of cardiac disease or cancer.
Due to ER’s symptoms a chest x-ray was taken and a suspicious mass in the right upper lung lobe was discovered. This triggered further investigations such as a Computed Tomography (CT) of the chest, which confirmed a large mass with possible involvement of the pulmonary artery. A referral was made to a cardiothoracic surgeon for discussion of interventions and prognosis. ER attended a bronchoscopy, to visualize the extent of the mass and to take a biopsy. The results tested positive for stage IIIA adenocarcinoma. It was decided surgical intervention was the next immediate step. ER was admitted to hospital under a cardiothoracic surgeon for a video assisted thoracotomy surgery (VATs) to remove the cancer.
The surgeon investigated the lung thoracoscopically, realizing the tumor was central with dense attachment to the pulmonary artery and proceeded with a right pneumonectomy. Complications arose when the tumor began to bleed into the left lung causing the surgeon to halt the operation to clear out the pleural