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Study Guide for Lung Cancer and
Pneumothorax
1) Compare and contrast the types of surgical procedures utilized for
lung cancer. How would you simply explain to your patient what a
lobectomy is, pneumonectomy, wedge resection, etc.?
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Pre-procedure surgical interventions are being implemented.
Consider cardiovascular status, pulmonary function, kidney
function (acid-base balance),
and other comorbidities
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Bilobectomy- two lobes of a lung removed
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Sleeve resection- cancerous lobe and segment of the main bronchus
removed
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Segmentectomy- a segment of the lung is removed
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Chest wall resection- removal of cancerous tissue in the lung and chest
wall
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Lobectomy- removal of a lobe of the lung
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Pneumonectomy- removal of the entire lung
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Wedge resection- pie shape removal of a small lesion
2) What Special interventions are done for a patient post-thoracotomy?
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Semi fowlers position
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Monitor pulmonary status, cardiovascular status with ECG monitoring,
vital signs
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Cough, deep breathing, incentive spirometer
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Monitor chest tube drainage
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Endotracheal suctioning until the patient can cough effectively
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Assess and medicate for pain, and splint incision during coughing
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Assess sputum characteristics
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Postural drainage percussion
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Humidification with oxygen and nebulize
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Assist with ROM exercises for shoulder and trunk
3) Compare and contrast the types of lung cancer
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SCLC-
o more aggressive highly malignant
obrain metastasis is common
ostrongest association with cigarette smoke
osurgery is rarely an option
onumber 1 treatment is chemo
oremission is limited to 6-8 months
oonce it reoccurs survival is only 3-4 months
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NSCLC
oAdenocarcinoma- malignant epithelial cell tumor, most
common lung cancer in nonsmokers and women, often
undetectable until metastasis, peripherally located, number
one treatment is surgery
oSquamous cell- most common in males, closely correlated
with smoking history, tends to originate in central bronchi,
early symptoms cough, and hemoptysis, number 1 treatment
surgery
oLarge cell carcinoma- invades a lot of lung tissue, rapidly
growing, high rate of metastasis, poor prognosis
4) Know and understand the recommended treatments of lung cancer
for SCLC and NSCLC
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SCLC- number 1 treatment is chemotherapy (cisplatin and
etoposide) with radiation as adjuvant/palliative
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NSCLC- number 1 treatment is surgery (verifying the extent of lung
resection)
5) Understand diagnostic studies for lung cancer
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History and physical
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Chest x ray
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Bronchoscopy
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Cytology studies (Papanicolaou pap test of sputum), bronchial
washings, percutaneous needle biopsy of lung tissue, scalene
lymph node biopsy
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Biopsy MOST DEFINITIVE
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CT scan (includes adrenal glands to assess size and lymph node
involvement)
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MRI, PET scan
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Video thoracoscopy- obtain specimens for biopsy of tissue, used for
mediastinal disorders
6) What are the causes of a pneumothorax?
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Ruptured Bleb, blister
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Air coming in trauma, diaphragmatic tears, invasive surgery.
Barotrauma
7) How would you assess for a pneumothorax?
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Frequent lung auscultation (decreased or absent breath sounds)
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Normal or hyper resonance on percussion
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Sudden pain/slight chest discomfort
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Patient will have increased respirations
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8) How does a nurse assess and care for a patient with a chest tube?
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High concentration of supplemental oxygen, monitor pulse ox
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Monitor vitals/respiratory status
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Assess for bubbling if it occurs
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Assess characteristics of drainage
9) How does a nurse manage a chest tube?
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Monitor vitals and respiratory status
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Encourage mobilization of secretions
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Comfort measures for pain
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Drainage
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Position below the chest area
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No milking or stripping of tube
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No clamping
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3 side sterile dressing, in case of dislodgement of chest tube have
sterile water in the room
odon’t want to trap air in and create a tension pneumothorax
10) Explain the different chambers of a chest tube? Where is bubbling
normal and abnormal and why?
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Collection chamber- where drainage from the patient collects
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Water seal chamber-tidal indicating the patient is breathing
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Suction (wet)- filled with water depending on order, the tube is
connected to wall suction and bubbles indicating its working
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Suction (dry)- no water, controlled with dial and connected to wall
suction and set to a prescribed order
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Bubbling is normal in the suction chamber of the wet drainage
system, it indicates that the system is working properly.
Bubbling is not normal in the water seal chamber
11) What should the nurse know about chest tube insertion?
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Verify correct procedure, patient, site, and consent
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Patient education on what is going to happen
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Comfort measures
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Lab values (CBC, coagulation studies)
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Sterile procedure
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If the chest tube becomes disconnected, air can enter the
pleural space and produce a pneumothorax
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