Respiratory Part 2
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Transcript of Respiratory Part 2
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Respiratory Part 2
Medical Surgical Nursing
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Influenza• AKA– Flu
• Highly contagious• Pathogen– Viral
• Epidemic– Rapid and extensive spreading infection and
affecting many individuals in an area or a population at the same time
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FYI
• Influenza & its complications (primarily bacterial pneumonia) are the 8th leading cause of death in the US.
• @60,000 year
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H1N1
• Newly identified stain• Pandemic–(World-wide
epidemic)
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Mode of transmission
• Airborne droplet• Direct contact
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Influenza Statistics
• Incubation period–Short
• Onset–Rapid
• Duration–Up to a week
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Influenza: S&S (local)
• Runny nose• Sore throat• Cough–Dry–Non-productive
productive– Substernal burning
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Influenza: S&S (systemic)
• Chills & fever• H/A• Malaise• Muscle aches• Fatigue &
weakness
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Older adults
• Higher risk of–Complications•Pneumonia•Death
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Why are older adult more susceptible to complications of influenza?
• Cilia– i
• Chest muscle strength– i
• Chest wall– Stiffer
• Cough– Less effective
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Assessment
• S&S• Vital Signs
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IDT
• “Most URI’s are self-limiting”
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IDT
• Self-care• Symptomatic relief• Prevent
complications• Prevent spread
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Dx test
• Throat swab– R/O streptococci
• CBC– WBC normal • Vial
– WBC increased• Bacterial
• Chest x-ray– R/O pneumonia
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Flu Vaccine: Is it effective?
• Polyvalent influenza virus vaccine
• 85% effective
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Flu Vaccine: Who should get it?
• Age >50 years• Nursing home residents• Pg women• Chronically ill• Immunosuppressed• Resp. conditions• Healthcare workers• Fam. members of those
at risk
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Flu Vaccine: Who should not get it?
• Allergic to eggs
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Small Group Questions
1. What pathogen is assoc. with flu?2. Identify 5 S&S of the flu3. What type of isolation would you use for a
client with the flu4. Mary asks you if she should get the flu
vaccine, how do you respond?5. What priority nursing diagnosis would you
give for a person with the flu?
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Which of the following nursing interventions is appropriate after a
client has had a bronchoscopy?A. Report abnormal lab valuesB. Lay flat for 8 hours with a sand bag
to the puncture siteC. NPO until gag reflex returnsD. Push fluids
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Tuberculosis
• AKA–TB
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Tuberculosis - FYI
• Causes more death than any other disease. 2 billion world wide, 15 million in the US
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Tuberculosis - FYI
• When treated, about 90% of those with active TB survive!
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Tuberculosis
• Pathophysiology– Mycrobacterium
tuberculosis– Tubercle bacillus
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Tuberculosis
Pathophysiology• Mode of transmission– Air-borne
• alveoli• Multiplies in alveoli
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Tuberculosis
• Immune response phase–Macrophages attack TB– TB has waxy cell wall that protects it from
macrophages– Immune system surrounds the infected
macrophages– Forms a Lesion–Called a Tubercle
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Tuberculosis• Dormant phase–Contagious?• No
– Symptomatic?• No
–PPD?• positive
– chest x-ray?• Negative
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Tuberculosis
• Active phase–If an infected person has a weakened
immune system, –the TB escapes and infects the body
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Tuberculosis• 5-10% become active• Only contagious when
active• Primarily affect lungs
but…– Kidneys– Liver– Brain– Bone
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TuberculosisEtiology• Assoc. w/– Poverty– Malnutrition– Overcrowding– Substandard housing– Inadequate health care
• Elderly• HIV• Prison
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Tuberculosis: S&S (active phase)• NOC sweats• Low grade fever• Wt loss• Chronic productive cough–Rust colored & thick
• Hemoptysis • SOB
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Tuberculosis: Dx test• PPD –Mantoux skin test–> 10mm in diameter– induration – Indicates: • Latent TB
–Read• 48-72 after
– Intradermal: • 15-degrees
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Tuberculosis
• Diagnostic tests– X-ray– Symptoms– Acid Fast Bacillus
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Tuberculosis: Tx / Rx
• INH– isonicotinyl hydrazine – Isoniazid – Toxic to the liver
• Rifampin– Turns urine red
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Tuberculosis: Prevention
• Clean well ventilated living areas• Resp. isolation –Negative pressure room
• If exposed take–INH
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Tuberculosis: complication• Malnutrition• S/E of Rx treatment• Multi-drug resistance• Spread of TB infection
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Small Group Questions
1. What type of pathogen is TB?2. What is the mode of transmission?3. What are the classic S&S of TB ?4. How to administer and read a PPD?5. If a pt is PPD +, what does that mean?
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Small Group Questions
6. What is the standard screening method of TB?
7. That medications are used to treat TB, what are their side effects?
8. Where in the US is TB most prevalent? Why?
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COPD - overview
COPD?– Chronic Obstructive Pulmonary
Disease– Broad classifications of diseases
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COPDCharacteristics
• Airflow limitation • Irreversible• Dyspnea on exertion• Progressive• Abn. inflammatory response of the lungs
to noxious particles or gases
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Pathophysiology
• Noxious particles of gas • Inflammatory response • Narrowing of airway
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Pathophysiology
• Inflammation • Thickening of the wall of the
pulmonary capillaries
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COPD
• Includes–Emphysema–Chronic bronchitis
• Does not include–Asthma
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COPD - FYI
• COPD 4th leading cause of death in the US• 12th leading cause of disability• Death from COPD is on the rise while death
from heart disease is going down
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COPD: Risk Factors
• Smoking• Passive smoking• Occupational
exposure• Air pollution
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COPD risk factors
• #1– Smoking
• Why is smoking so bad??–↓ phagocytes–↓ cilia function–↑ mucus production
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Chronic Bronchitis
• Disease of the airway• Definition:– cough + sputum production – > 3 months
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Chronic Bronchitis
Pathophysiology• Pollutant irritates airway • Inflammation• h secretion of mucus • Bronchial walls thicken – Lumen narrows–plugs
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Chronic Bronchitis
• Alveoli/bronchioles become damaged• ↑ susceptibility to LRI
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Emphysema: Pathophysiology
• Affects alveolar membrane–Destruction of alveolar wall–Loss of elastic recoil–Over distended alveoli
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Emphysema
Pathophysiology• Over distended alveoli–Damage to adjacent pulmonary
capillaries–Impaired passive expiration
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Emphysema
• Damaged pulmonary capillary bed– h pulmonary pressure – h work load for right ventricle – Right side heart failure
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Emphysema
• Nursing Diagnosis–Impaired gas exchange
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COPD Compare and contrast
• Chronic Bronchitis is a disease of the ___________?–Airway
• Emphysema is a disease affecting the ___________?–Alveoli
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C.O.P.D.
• Risk factors, S&S, treatment, Dx, Rx - same for Chronic Bronchitis & Emphysema
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C.O.P.D.
Clinical Manifestation (primary)
1. Cough2. Sputum production3. Dyspnea on exertion(Secondary)• Wt. loss• Resp. infections• Barrel chest
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C.O.P.D.Nrs. Assessment
• Risk factors• Past Hx / Family Hx• Pattern of development• Presence of comobidities• Current Tx• Impact
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Dx tests
• ABG’s–Baseline PaO2
• Rule out other diseases–CT scan–X-ray
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C.O.P.D. Medical Management
• Risk reduction– Smoking cessation!• (The only thing that slows down the
progression of the disease!)
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C.O.P.D. Rx. therapy
Primary• Bronchodilators• CorticosteriodsSecondary• Antibiotics• Mucolytic agents• Anti-tussive agents
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Bronchodilators• Action:–h the size of the lumen–Relieve bronchospasms–Reduce airway obstruction–↑ ventilation
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Bronchodilators
• Examples–Albuterol (Proventil, Ventolin, Volmax)–Metaproterenol (Alupent)–Ipratropium bromide (Atrovent)–Theophylline (Theo-Dur)*
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Glucocorticoids
• Action–Potent anti-inflammatory agent
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Corticsteriods
• S/E–Na+ & H20 retention–Never D/C abruptly
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Glucocorticoids
• Examples–Prednisone–Methyprednisone–Beclovent
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C.O.P.D. Medical Management
• Treatment–O2• 2 L/min
–Pulmonary rehab• Breathing exercises• Pulmonary hygiene
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Small Group Questions
1. What 2 diseases are assoc. with COPD?2. Describe the pathophysiology of COPD.3. What effect does smoking have on the resp.
system?4. Differentiate between chronic bronchitis and
emphysema.5. What are the 3 main S&S of COPD?6. What 2 classifications of meds are used to treat
clients with COPD (what are their actions)?
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Pneumonia
Pathophysiology• An inflammatory process in which there
is consolidation –In the alveolar spaces.
• Gas exchange cannot take place in consolidated area
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PneumoniaCausative agents• Viral pneumonia• Bacterial Pneumonia
– Streptococcus pneumoniae– Pneumocystis Pneumonia
• Fungal pneumonia• Radiation pneumonia• Chemical pneumonitis• Aspiration pneumonia• Hypostatis pneumonia
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Pneumonia FYI
• Most common cause of death from infectious agents• 66,000 deaths / year• $$$
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Pneumonia: Progression of events• Inflammation • h Exudate • i movement of O2 and CO2 • WBC migrate into the alveoli
• Fill air-containing spaces• i ventilation – i Oxygen saturation
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Pneumonia: Risk factors
• Immunosuppressant• Smoking• Prolonged immobility• Depressed cough reflex• NPO• ETOH intoxication• Gen. anesthetic or opiod• Advanced age
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Pneumonia: S&S TYPICAL
• Onset– Acute
• Shaking• Chills• Fever• Cough
– Productive• Sputum
– Rust-colored – Purulent
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Pneumonia: S&S TYPICAL
• Chest pain– Sharp– Localized
• Breath sounds– Diminished– Crackles – Respiratory distress
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Pneumonia: S&S ATYPICAL
• “Walking pneumonia”• Milder symptoms• Fever• H/A• Muscle aches• Malaise
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Pneumonia: S&S ATYPICAL
• Cough–Hacking–Non-productive
• Self limited
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S&S Elderly
• General deterioration• Weak• Abd. Symptoms–Anorexia
• Confusion• Tachycardia• Tachypnea
• Do Not C/O–Cough–Pain–Fever –Sputum
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Pneumonia: Dx
• Sputum C&S• CBC / WBC–h• Bacteria
–i• Viral
• ABG’s• Pulse oximetry• Chest x-ray
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Pneumonia: Medications
• Primary– Antibiotics– Bronchodilators– Expectorant
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Antibiotics
• Action–Attacks pathogens
• Nursing consideration– Educate to take all –Not contagious after 24 hours on meds
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Bronchodilators
• Dilate bronchi• Reduce bronchospasms• Improve ventilation
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Expectorants
• Break up mucus–i viscosity
• Liquefies mucus • Easier to expectorate• Take with lots of water!
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Pneumonia: Medications
• Secondary–Antibiotics–Antipyretic–Analgesic
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Pneumonia: Nursing
• Fluids– 2,500 – 3,000 mL/day– Humidifier
• Chest physiotherapy– TCDB– I.S.
• Assess respiratory status• Position
– HOB • Rest
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Pneumonia – Nursing Interventions
• O2 per order• Maintaining nutrition–Gatorade– Ensure
• Promoting the patients knowledge
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Pneumonia
Prevention• Vaccine– Pneumonia– Flu
• Treat URI• Avoid irritants
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Pneumonia: Small Group Questions
1. Describe the pathophysiology of pneumonia.2. What is the difference btw typical and atypical
pneumonia?3. What causes pneumocystis carinii?4. What lab values are associated with bacterial
pneumonia? / viral pneumonia?
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Pneumonia: Small Group Questions
5. What is Nosocomial pneumonia6. Identify 5 risk factors for developing pneumonia7. What medications might be administered to treat a
pt. with pneumonia?8. What nursing education would you give to a patient
with pneumonia?9. What are the gerontological considerations of caring
for the elderly in regards to pneumonia?
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Lung Cancer
Pathophysiology• Carcinogen binds to
the DNA and changes it
• Abnormal growth• Usually develops on
the wall of the bronchial tree
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FYI
• Lung Cancer is the number one cancer killer in the US
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Lung CancerEtiology/Contributing factors• #1
– Tobacco Smoke (85%)– Second hand smoke
• Carcinogens– Asbestos– Uranium– Arsenic– Nickel– Iron oxide– Radon– Coal dust
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Lung Cancer
Clinical manifestations: early• Insidious and
asymptomatic • until late stages
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FYI
– 70% of lung CA have metastasized by the time of diagnosis
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Lung Cancer
S&S: Early• Objective symptoms
– #1: • Cough
– #2 • Repeated respiratory
tract infection– Wheezing– Dyspnea
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Lung Cancer
S&S: Late• Hemoptysis • Chest pain• Wt loss• Anemia• Anorexia
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Lung Cancer
Dx exams/procedures• X-ray• CT scan• Biopsy via
Bronchoscopy– cytology
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Lung Cancer
Treatment• Surgery– Removal
• Chemotherapy – Metastasis
• Radiation – To shrink or reduce
symptoms
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Lung CA
• Priority Nrs Dx– Ineffective
breathing– Ineffective Airway
clearance– Ineffective Gas
exchange
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Assessment
• Resp assessment• Smoking hx• Lab values• S&S of
complications
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Assessment
• S&S of complications– Edema– H/A– Dizziness– Vision changes– Difficulty breathing– C/O pain
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Interventions
• Assess q4hrs• HOB • Pulmonary hygiene– TCDB– IS
• O2 per order• Suction PRN• Emotional support
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Secondary Nrs Dx
• Activity intolerance• Pain• Grieving
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Activity intolerance
• Document response to activity– Pulse– Resp. status– Fatigue
• Planned rest periods• Increase activities
gradually• Enc to remain as active as
possible
• Allow fam. To provide assist PRN
• Keep frequently used objects nearby
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Pain
• Assess pain• Administer
analgesics PRN
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PAIN & CANCER
• “For cancer pain, maintain a continuous medication schedule using opiates, NSAIDs and other drugs as ordered”– Addiction is not a concern for the terminal cancer
client; adequate pain relief that does not allow “breakthrough” pain is vital.
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Pain
• Assess pain• Administer analgesics
PRN• Alternative pain relief– Massage– Positioning– Distraction– Relaxation techniques
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Pain
• Provide diversion activities– TV– Reading– Social events
• Allow family to remain
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Grieving
• Spend time with client & family
• Answer questions honestly
• Enc. Pt to express feelings (fear, anxiety, concerns)
• Assist to understand the grief process
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Grieving
• Enc other support systems– Spiritual– Social groups– Social services– Hospice
• Discuss advanced directives– Living will
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Lung Cancer
Preventative measures• Stop smoking
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Small Group Questions
• What is the number one carcinogen of lung cancer?
• What are the early S&S of lung cancer?• Who is Lung Cancer diagnosed?• How is lung cancer usually treated?• What is one priority nursing diagnosis for a
client with lung cancer? Identify 3 nursing interventions for this diagnosis