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24.11.2014
Lung cancer is a disease caused due to uncontrollable growth of tissues and tumors in the lungs. Fact: Lung cancer is more common in older people, but can occur in young people and even children.
Fact: Chronological age alone shouldn?t determine whether or not the lung cancer is treated. The patient who consents to have surgery, particularly surgery that requires a general anesthetic, renders himself dependent on the knowledge, skill, and integrity of the health care team.
Although the physician is responsible for explaining the surgical procedure to the patient, the patient may ask the nurse questions about the surgery.
Assessing and correcting physiological and psychological problems that may increase surgical risk. Giving the patient and significant others complete learning and teaching guidelines regarding the surgery.
Incisions through the skin and mucous membranes penetrate the protective barriers of the internal organs. The effects of anesthesia and other medications tend to last well into the postoperative recovery period. Providing an opportunity for the patient to describe his reactions and feelings in the stressful situation.
Patient on side in middle of bed with a pillow in front of the bottom leg with the top leg on the pillow in flexed position, a pillow against the back, a small pillow supports the arm and hand, pillow under head and shoulder. Inhale slowly through the nose, distending the abdomen and exhaling slowly through pursed lips (see Figure 1-3).
Deep breathe as often as possible, preferably 5 to 10 times every hour during the postoperative, immobilized period. The patient may lace his fingers and hold them tightly across the incision before coughing.
Flex and extend each joint, particularity the hip, knee, and ankle joints, keeping the lower back flat as the leg is lowered and straightened.
If instruction is given just before surgery, the patient may be too apprehensive to listen or too heavily sedated to comprehend. If the patient is undergoing minor surgery (one-day or same-day surgery), the patient may receive preoperative instructions several hours before surgery. DD Form 1924, Surgical Checklist, as a checklist to assemble the patient's chart and to document compliance as each step is completed. Acquire required x-ray reports and films as necessary, insert reports into patient's chart, and document compliance. If the results are not on the record, call x-ray for results and write report in comments section.
Notify the Charge Nurse or physician immediately of previously unreported abnormal x-ray findings. Acquire laboratory reports as required, insert reports into the patient's chart, and document compliance. Check with appropriate department (Internal Medicine or Cardiology) for EKG readings if not in record. Notify the Charge Nurse or physician immediately of previously unreported abnormal EKG results. 1 The skin prep is done to make the skin as free of microorganisms as possible, thus decreasing the possibility of microorganisms entering the wound from the skin surface during surgery.
Provide for the patient's security by placing side rails in the up position and by placing a call bell within the patient's reach once preoperative medication is given. Assist the operating room technician to position the patient on the OR litter and make the patient comfortable. Identify facts that are related to SF 522, Request For Administration of Anesthesia and For Performance of Operations and Other Procedures. Identify nursing implications that are related to the preparation of a patient the night before surgery.
Identify nursing implications that are related to the personal hygiene care given to a patient the night before surgery.
Identify nursing implications that are related to the preparation of a patient the morning of surgery. Problem-solving is the basic skill of identifying a problem and taking steps to resolve it. Trial and error problem-solving is an experimental approach that tests ideas to decide which methods work and which do not. A form of trial and error experimentation is used in laboratory studies when testing several solutions to a problem.
Many advances in modern healthcare have resulted from this type of experimentation; however, trial and error must be used carefully when working with people because of the possible harmful results. Today’s society prefers that only safe and proven effective treatments be given to those who are ill. Unless you have already been educated as a scientist, you probably confront problems and find solutions without using trial and error or scientific problem-solving.
Critical thinking has some characteristics that are important for solving problems in healthcare. FIGURE 33-1 · Critical thinking utilizes previous knowledge, research, and analysis, as well as common sense, to solve problems. Although you will use critical thinking during your nursing career, it alone does not give you a framework for solving problems purposefully and methodically, a necessary safeguard in healthcare. You will use the nursing process framework throughout your nursing practice, but particularly as you learn to become a nurse. NCLEX Alert It is vital that the graduate understands the components of the nursing process. The effective use of the nursing process allows you to identify not only actual problems but also potential problems. You can develop critical thinking and problem-solving skills by working through the nursing process framework repeatedly as you learn to identify and treat client needs.
For more than 50 years, the nursing process framework has been used throughout the United States and Canada as a guide for identifying needs and treating clients, although how it is used varies from one area to another. The five steps of the nursing process closely parallel the steps of scientific problem-solving. Medical History: MT a 78-year-old woman with a history of mild heart failure treated with diuretic therapy and sodium restriction, was brought to the emergency department by her daughter.
Ineffective airway clearance related to physiologic effects of pneumonia as evidenced by increased sputum, coughing, abnormal breath sounds,tachypnea, and dyspnea.
Monitor oxygen saturation levels via pulse oximetry; assist with obtaining arterial blood gases (ABGs) as ordered.
SaO2 at 95% via pulse oximetry; ABGs results confirm oxygen saturation at 95% and PaO2 at 92 mm Hg with supplemental oxygen therapy Goal #1 met. Decreased use of accessory muscles; client reporting a decrease in shortness of breath and decrease in difficulty breathing.
Begin intravenous (IV) fluid therapy as ordered using an infusion pump; prepare antibiotic for IV infusion. Gradually increase client’s activity level, assisting client out of bed to the chair—using oxygen saturation levels as a guide.
Continue monitoring vital signs and respiratory status every 4 hours, or as indicated, noting need for oxygen based on oxygen saturation levels. Administer oral antibiotic, as ordered, and indicated by improvement in the client’s condition. Instruct client and daughter in measures for continued therapy and follow-up after discharge. Daughter reporting return visit to primary care provider scheduled; client and daughter able to state signs and symptoms of recurrence. Monitor and report results of assessment, goals, and i nterventions to other healthcare team members.
Analyze (use critical thinking skills) the client’s responses to the problem, goals, and actions. Identify factors that contributed to success or failure of the nursing care plan’s outcomes or goals.


Lung cancer is responsible for more cancer deaths than other cancers like colorectal cancer, breast cancer, and prostate cancer. After one day: Your body eliminates carbon monoxide and your lungs start to clear out mucus and other smoking trash. By 40, some people will have developed signs of COPD (Chronic Obstructive Pulmonary Disease) in which the airways become narrowed, chronic bronchitis and long term disease of lungs.
If you quit at this point, the decline in lung function will not be as fast as if you continued to smoke.
In accepting this trust, the health care team members have an obligation to make the patient's welfare their first consideration during the surgical experience.
The period extending from the time of hospitalization for surgery to the time of discharge (see Figure 1-1).
That phase of the perioperative period during which the nurse admits the patient to the surgical unit and helps the individual prepare physically and emotionally for the operation.
There may be specific learning needs about the surgery that the patient and support persons should know. This could lead to bruising of tissues, injury to tissues, or inflammation of tissues that could result in pain after the anesthesia wears off. These drugs could have a depressant effect on the body; they decrease pain and reduce awareness of one's surroundings. If there are questions that you should not or are unable to answer, refer them to the Charge Nurse or physician. Turning in bed and early ambulation helps patients maintain blood circulation, stimulate respiratory functions, and decrease the stasis of gas in the intestines and resulting discomfort.
Deep breathing helps prevent postoperative pneumonia and atelectasis (incomplete expansion of the lung or a portion of the lung). This is used as a splint to minimize pressure and helps to control pain when the patient is coughing. These exercises help to prevent circulatory problems, such as thrombophlebitis, by facilitating venous return to the heart.
The best time to teach patients is relatively close to the time of surgery, which is usually the afternoon or evening before the surgery. DD Form 1924 is attached to the front of the patient's chart for easy access by all involved hospital staff.
Any special comment that indicates something very special about this particular patient will go in this block (hard of hearing, removal of a prosthesis, etc.).
Ensure that all required forms are included, complete as necessary, and in order dictated by local policy.
An enema is used to cleanse the colon of fecal material, thus reducing the possibility of wound contamination during surgery.
2 A wide area of skin around the site of the incision is shaved and cleansed to further reduce the possibility of infection. During surgery, numerous areas must be observed carefully for evidence of cyanosis to include the face, lips, and nail beds.
Good communication between all members of the health care team will ensure that the patient is well prepared and ready to undergo surgery.
Meeting with clients leads to specific interactions, including communication, observation, support, education, and provision of care. The nursing process not only includes the actions involved in tasks but also integrates critical thinking. Usually the results are completely unknown until tried because the experimenter simply does not have sufficient information to anticipate results. Eventually, you find a brand that works without causing a rash, and your trial is successful. Researchers develop strict guidelines to protect the safety and well-being of individuals and proceed with trial and error experimentation only with the permission and understanding of the individual involved. Therefore, healthcare providers rely on previously proven facts to determine which treatments are safe. When you use scientific problem-solving, you combine what you have learned from your own experience with facts previously proven through scientific study. You may use a complicated mix of inquiry, knowledge, intuition, logic, experience, and common sense called critical thinking.
When you think critically,you examine facts and compare these facts with information you already know, thereby being actively curious and critiquing ideas for reasonableness. When you think critically, you can grasp the nature and extent of problems more quickly and easily. As a nurse, you combine critical thinking skills with a scientific problem-solving method to identify client problems and to provide care in a structured, purposeful, and effective way. Potential problems are those problems that might be prevented or problems that the client is at risk for developing. Often, you will practice the steps of the nursing process as you prepare nursing care plans. Sometimes, its format varies among types of healthcare facilities and may be related to available staffing. The characteristics of the nursing process, as discussed in the following sections, are critical to its effectiveness. Table 33-1 shows the relationship between the steps of the nursing process and the concepts of the scientific problem-solving method.
The nurse follows specific, orderly, and logical steps based on the client’s most important and often most vital needs, also known as prioritization or prioritizing. To facilitate understanding of the nursing process, in this example Nursing Care Plan (NCP), the five steps of the nursing process are numbered. At time of discharge, client and daughter will verbalize measures for continued therapy and follow-up to prevent a recurrence. Rationale: Supplemental, humidified oxygen aids in improving ventilation, thereby minimizing the risk for hypoxemia without drying the mucous membranes. Rationale: IV fluid therapy aids in replacing increased fluid lost through insensible sources and provides a route for administering IV antibiotic therapy, which is effective against the causative organism. Rationale: Oral fluid intake is necessary for replacement of fluid, minimizing the risk for possible fluid volume deficit due to increased insensible fluid losses. Assist with prescribed nebulizer therapy as necessary Rationale: Coughing, deep breathing, and use of incentive spirometer aid in maximizing ventilatory capacity and mobilizing and expectorating secretions. Rationale: Continued antibiotic therapy is necessary to ensure complete eradication of the causative organism. Rationale: Knowledge about necessary therapy and follow-up aid in decreasing the risk for recurrence. There are two types (Primary Lung Cancer and Secondary Lung Cancer) of lung cancers identified in the medical world. Five pack years over a lifetime is the lower threshold ? below which the extra risk of lung cancer from smoking is fairly small.
Every one should know this message, leave smoking and give suggestion to one who is chain smoker. This lesson consists of your duties as a practical nurse to provide preoperative care for the surgical patient. A partial or complete loss of sensation, with or without loss of consciousness, as a result of a disease, an injury, or administration of a drug.
It also produces physical and psychological stress on the body relative to the extent of the surgery and injury to the tissue involved.
Surgery requires strict attention to aseptic technique, use of sterile materials, and thorough disinfecting of the skin around the operative site.
Along with other members of the health care team, the practical nurse must show warmth, sensitivity, and caring to the patient. NOTE: The above steps should be repeated every two hours during the postoperative phase or as prescribed. A clean mouth makes the patient more comfortable and prevents accidental aspiration of food particles.
The wearing of his own gown or pajamas to surgery is not permitted because of potential loss or damage. All shifts and nursing personnel must be an active participant in the preoperative phase of the surgical patient.


Nurses support and encourage individuals in their healthy habits and help clients solve health problems. However, when a problem is complex or challenging to define, you may need to use other— more formal—methods of problem-solving.
In other situations, trial and error is used when unexpected results occur that could possibly have beneficial outcomes for another problem.
Scientists and healthcare researchers use a precise method to investigate problems and arrive at solutions. This kind of thinking enables you to grasp the meaning of multiple clues and to find quick answers when facing difficult problems. You can make decisions that are logical, suitable for a particular client, and effective for solving a specific problem.
To ensure consistency among all nursing staff, use the nursing process to develop guidelines when caring for each client. Keep in mind that every time you prepare a care plan, you are developing your critical thinking skills and expanding your nursing knowledge.
In some areas of practice, registered nurses are more likely to diagnose clients, set overall goals, and plan care.
You will need to know the Nurse Practice Act and the local regulations for your location and situation.
By following the logical progression of steps to identify the client’s needs, the nurse can plan activities to meet them. Lungs with scattered coarse crackles (moist bubbling sounds as inhaled air comes in contact with secretions) and decreased breath sounds, especially in the right middle and lower lobes. Nursing Action Assess vital signs and respiratory status, including auscultation of lung sounds, initially every 1-2 hours and then as indicated.
Antipyretics reduce fever, thus decreasing the amount of insensible fluid lost in this manner. Nebulizer therapy helps to open airways and keep membranes moist, facilitating expectoration. Primary Lung Cancer affects lungs only but secondary Lung Cancer affects some other parts of the body.
Five pack years would be 20-a-day for 5 years, 10-a-day for 10 years, 5-a-day for 20 years etc.
United States is a country where 25% of the population smokes and prevalence of Lung Cancer is more. A person who smokes 10 a day will be 10 times more likely to develop lung cancer, someone who smokes 20 a day will be 20 times more likely, and 30 cigarettes a day, 30 times more likely to develop lung cancer by the time they are 75. The patient must understand what is proposed, understand all the risks, and give his consent.a. Patients should be taught postoperative exercises they will be required to do and their role in preventing complications.
In some instances, the patient may need special aids, such as a pillow between the legs, to help maintain body alignment.
If you enter the information by hand, enter the patient's ward, room, and bed in the appropriate block.
They provide care to clients by combining scientific problem-solving methods with critical thinking skills to provide care through the nursing process. In addition to how, the licensed nurse must also know why the vital signs are important and what is the relationship of the numbers obtained with the condition of the client.
Consider your dilemma if you have an allergy to an unknown substance in hand lotion, but also have a problem with dry skin and wish to soften your hands.
This method, called scientific problemsolving, allows researchers to discover the best possible safe and effective treatments for disease or dysfunction. Critical thinking is neither trial and error nor a structured scientific problem-solving system. You are reasonable and rational, continuously searching to understand the entire situation.
This entire topic presents exercises to help you develop your critical thinking skills as you continue to learn about nursing practice. Traditionally, these guidelines are developed into a format referred to as a nursing care plan (NCP). Prioritization of needs begin with Airway Breathing, and Circulation also referred to as the ABCs of nursing. Also, remember that every time you carry through with your plan, you are carrying out the work of nursing. In other areas, licensed practical nurses also diagnose and plan, as well as initiate the plan. Client describes a productive cough with thick, purulent sputum several times in the last hour. Low level of smoking over a long period of time also causes notable effect on a person?s health.
The postoperative exercises include turning, deep breathing, coughing, and extremity movement. Provide family members with information concerning their role the morning of surgery, waiting room location, postoperative visit by surgeon, rational for stay in recovery room, and presence of any special tubes or machines attached to their loved one.
However, the unexpected result of hair growth led to experimentation and development of drug forms for the treatment of hair loss. You may think randomly, without a particular method or pattern; however, you do not jump to conclusions.
You probably search frantically again, but then stop to think about where else you may have left your keys. The nursing process is also described as a systematic method that directs the nurse and client as they together (1) determine the need for nursing care, (2) plan and implement the care, and (3) evaluate the results.
Contemporary, clinical nursing units may use other terms in lieu of the nursing care plan, such as critical pathways, concept mapping, or clinical pathways, but the process of thinking through the nursing process remains basically unchanged whatever phrase is used. Determine what your role is expected to be (as a student and as a graduate) in your particular healthcare facility. As a critical thinker, you form your own beliefs or ideas rather than automatically accepting the thoughts or ideas of others. The nursing process framework enables you to develop plans of care individualized for each client, identifying what is suitable and desirable for that particular person. Tobacco smoke also causes chronic lung disease and contributes to cancer of the bladder, pancreas and kidney. Some patients may prefer pacing, be extremely cheerful, or, on the other hand, exhibit unusual behavior. In Practice: Nursing Care Plan 33-1 presents a clinical scenario about an elderly woman with pneumonia. Cigarette smoke contains hazardous gases like carbon monoxide and nitrogen oxides, as well as tiny solid particles containing tar, which damages cells in the airways of your lungs. You also use your imagination and creativity systematically to gather information and draw conclusions (Fig. You will need to review NCP 33-1 because it is a reference point for further discussion of the nursing process in the remaining topics of Unit 6. What was I wearing?” By asking yourself logical questions, remembering the facts, creating a mental image of your activities, and perhaps following a hunch about where the keys are, you may solve your problem quickly and find your keys.
If you do not find them within a reasonable time, you begin to think about other ways of handling the problem of getting to the required examination. Because the nursing care plan is available for other nurses to use as well, it provides consistency in care. This process is called critical thinking: remembering facts, using logic, asking key questions, forming a mental image, and analyzing all information.




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