The second diagnostic tool is an imaging agent called Nofetumomab (verluma). Approved by FDA in 1996, it can determine the extent of disease in patients already diagnosed with small cell lung cancer through a biopsy but who have not yet been treated. Nofetumomab is a fragment of a monoclonal (synthetic) antibody that, when tagged with a radioisotope, can detect a protein found on the surface of most small cell lung cancers. The antibody collects in tumor sites and other areas of the body where protein is detected and, using special cameras, doctors can see the areas as "hotspots." (Brown, 1999, p. 7)
These two diagnostic tools are likely to improve chances that lung cancers can be detected at earlier stages, as well as produce more overarching treatment plans that focus on the actual cancerous growths rather than systemically.
Treatment
As has been stated previously treatment plans are dependant on the type (small cell or non-small cell types) and/or stage of the cancer detected. Patient's overall physical health is also a factor. Treatment can and often does include a multiple attack approach including but not limited to surgery, chemotherapy and radiation treatments used in conjunction with one another.
FDA recently approved three therapies to treat non-small cell lung cancer: Photofrin (porfimer sodium), Taxol (paclitaxel) in combination with the commonly used cancer drug cisplatin, and Gemzar (gemcitabine hydrochloride) in combination with cisplatin. Photofrin, a light-activated drug, was approved in January 1998 for patients with early stage, non-small cell lung cancer who cannot undergo surgery or radiotherapy due to other medical conditions. Administered intravenously, Photofrin accumulates in the tumor cells. A laser, directed toward the cancerous tissue, then activates the drug. A significant side effect is extreme photosensitivity, making it necessary for patients to stay out of the sun "almost completely for about a month," says Grant Williams, M.D., a medical team leader in the division of oncology drug products in FDA's Center for Drug Evaluation and Research... Photofrin may also be able to relieve symptoms in some patients with advanced non-small cell lung cancer. He explains that Photofrin has been demonstrated to be helpful in relieving breathing difficulties caused by tumors that are obstructing the flow of air through patients' bronchial tubes...Taxol (paclitaxel), already approved to treat other cancers, was approved last year for use in combination with cisplatin for the first-line treatment of non-small cell lung cancer in patients who are not candidates for surgery or radiation therapy. Gemzar (gemcitabine hydrochloride), another already approved cancer drug, received an additional approval in August for use in combination with cisplatin for the first-line treatment of patients with inoperable, locally advanced or metastatic non-small cell lung cancer...Because small cell lung cancer has typically spread by the time it's detected, it generally cannot be cured by surgery. Treatment usually begins with a combination of two or more drugs to kill cancer cells throughout the body. Later, treatment with more drugs combined with radiation therapy or radiation alone, is often prescribed. Chemotherapy (drugs) and radiation therapy shrink tumors in most patients, and sometimes the disease goes into remission. But in many cases the cancer begins to grow again when it becomes resistant to treatment. (Brown, 1999, p. 7)
The future of lung cancer treatment is uncertain, though it is clear that new drug therapies and more focused radiation, as well as broader diagnostic tool usage will continue to improve the odds that cancer can be treated and/or detected earlier and will then be less likely to be fatal. The ageing population...
will also likely contribute greater numbers of cases of lung cancer in the very near future but may also help build awareness so minimally invasive lung cancer screenings become more common and therefore help detection and decrease mortality from lung cancer.
Cultural Sensitive Care
Mexican Latino Immigrant
Nursing Diagnosis #1 Class 2 Coping Response
Significant Person displays protective behaviors disproportionate to clients' abilities
Short-term goal / significant person expresses understanding of patients actual abilty
Long-term goal / significant person and impaired person communicate effectively regarding needs and abilities.
Nursing Diagnosis #2 Compromised Family Coping Domain 9 Coping / Stress Tolerance Class 2 Coping Response Inadequate understanding of information by a primary person (NANDA, 2008, p. 249)
Short-term goal / staff expresses full scope of disease and patient needs via translator
Long-Term Goal / significant person expresses full understanding of needs and disease
Nursing Diagnosis #3 Risk of Impaired Religiosity Domain 10 Life Principles Class 3: Value/Belief/Action Congruence
At risk for impaired ability to exercise reliance on religious beliefs and/or participate in rituals of a particular faith tradition. (NANDA, 2008, p. 300-301)
Short-term goal / staff facilitates contact with family identified religious contacts
Long-term goal / patient maintain contact through home visits and/or attending services when possible
Chinese Immigrant
Nursing Diagnosis #1 Risk of Impaired Religiosity Domain 10 Life Principles Class 3: Value/Belief/Action Congruence
At risk for impaired ability to exercise reliance on religious beliefs and/or participate in rituals of a particular faith tradition. (NANDA, 2008, p. 300-301)
Short-term goal / staff facilitates contact with family identified religious contacts
Long-term goal / patient maintain contact through home visits and/or attending services when possible
Nursing Diagnosis #2 Compromised Family Coping Domain 9 Coping / Stress Tolerance Class 2 Coping Response Inadequate understanding of information by a primary person (NANDA, 2008, p. 249)
Short-term goal / staff expresses full scope of disease and patient needs via translator
Long-Term Goal / significant person expresses full understanding of needs and disease
Nursing Diagnosis #3 Spiritual Distress Domain 10: Life Principles Class 3: Value Belief/Action Congruence. (NANDA, 2008, p. 301)
Short-term goal / patient expresses concern regarding spiritual distress
Long-term goal / patient expresses coping skills to manage spiritual distress through traditional or alternative means (Beder, 2004, p. 178)
References
American Cancer Society "How many people get non-small cell lung cancer?" http://www.cancer.org/docroot/CRI/content/CRI_2_2_1x_How_Many_People_Get_Non-small_Cell_Lung_Cancer.asp?rnav=cri
Non-Small Cell Lung Cancer" http://www.cancer.org/docroot/CRI/content/CRI_2_2_1x_What_Is_Non-small_Cell_Lung_Cancer.asp?sitearea=
Beder, J.D. (2004). Voices of Bereavement: A Casebook for Grief Counselors. New York: Brunner-Routledge.
Brown, E. (1999, May). Waging War on Lung Cancer. FDA Consumer, 33, 7.
North American Nursing Diagnosis Association (NANDA) (2008) Nursing Diagnosis:
Definitions and Classification. 2nd edition New York: Wiley-Blackwell.
ACS http://www.cancer.org/docroot/CRI/content/CRI_2_2_1x_How_Many_People_Get_Non-small_Cell_Lung_Cancer.asp?rnav=cri
