Question

Philip, age 60, has been having difficulty catching his breath for about 2 months. He finds he gets short of breath even when resting. He has also been spitting up blood, has a wet cough, and is hoarse. He states that he has had chest pain off and on but now it has become worse. He describes it as central chest pain. Philip was treated for a basal cell carcinoma of his upper lip 12 months ago, and he has been a heavy smoker for 40 years.

A. As the nurse caring for Philip, what things would you consider in this case?

Answer 1

Philip, age : 60 .

Nursing considerations:

* Nurse has to assess the signs and symptoms experienced by Mr. Philip:

- shortness of breathing, 2 weeks even in rest

- wet, hoarse cough

- spitting up blood ( hemoptysis)

- Chest pain ( previously on and off, now become severe).

* Nurse has to collect the complete treatment history of the cancer,that he had ,and any previous history of cardiac or respiratory disorders.

* Assess for any allergic conditions

* Along with hemoptysis, presentation of chest pain and shortness of breath is indicating a severe medical problem . It may be due to cancer of the lungs, non cancer tumour in the lung tissue, tuberculosis etc.

* Monitor the vital signs and major alterations should report to the physician.

* Check for any recent weight loss.

* Check the recent history of fever and soaking sweat at night times.

* Perform coagulation test if it is indicated

* Monitor pulse oximetry and Arterial Blood Gas analysis to check the oxygenation to the tissues.

* Assess the respiration, rate , depth and presence of any abnormal breath sounds.

* Assess the cardiovascular system, heart beat rate, cardiac sounds should be assessed .

*Assess the colour, odor and consistency of sputum.

Nursing interventions:

* Provide a comfortable position, semi sitting position for the patient to ease breathing.

* Administer analgesics for pain as per physician's order.

* Assist for x-ray, CT scan of the chest.

* Assist for any bronchodcopy to find the lung abnormality.