Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

Chemotherapy

Varies with drug

Cisplatin or carboplatin in combination with gemcitabine, paclitaxel, docetaxel, etopo-side, or vinorelbine

Etoposide and cisplatin or etoposide and carboplatin, ifosfamide, carboplatin, and etoposide, or cyclophosphamide, doxoru-bicin, and vincristine, topotecan, irinotecan

More effective in treating NSCLC

More effective in treating SCLC

Independent

Maintain a patent airway. Position the head of the bed at 30 to 45 degrees. Increase the patient's fluid intake, if possible, to assist in liquefying lung secretions. Provide humidified air. Suction the patient's airway if necessary. Assist the patient in controlling pain and managing dyspnea. Assist the patient with positioning and pursed-lip breathing. Allow extra time to accomplish the activities of daily living. Teach the patient to use guided imagery, diversional activities, and relaxation techniques. Provide periods of rest between activities.

Discuss the expected preoperative and postoperative procedures with patients who are undergoing surgical intervention. Emphasize the importance of coughing and deep breathing after surgery. Splinting the patient's incision may decrease the amount of discomfort the patient feels during these activities. Monitor closely the patency of the chest tubes and the amount of chest tube drainage. Notify the physician if the chest tube drainage is greater than 200 mL/hr for more than 2 to 3 hours, which may indicate a postoperative hemorrhage. Early in the postoperative period, begin increasing the patient's activity. Help the patient sit up in the bedside chair, and assist the patient to ambulate as soon as possible.

Explain the possible side effects of radiation or chemotherapy. Secretions may become thick and difficult to expectorate when the patient is having radiation therapy. Encourage the patient to drink fluids to stay hydrated. Percussion, postural drainage, and vibration can be used to aid in clearing secretions.

The patient may experience less anxiety if allowed as much control as possible over his or her daily schedule. Explaining procedures and keeping the patient informed about the treatment plan and condition may also decrease anxiety. If the patient enters the final phases of lung cancer, provide emotional support. Refer the patient and family to the hospice staff or the hospital chaplain. Encourage them to verbalize their feelings surrounding impending death. Allow for the time needed to adjust while you help the patient and family begin the grieving process. Assist in the identification of tasks to be completed before death, such as making a will; seeing specific relatives and friends; or attending an approaching wedding, birthday, or anniversary celebration. Urge the patient to verbalize specific funeral requests to family members.

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