Lung Cancer: A Conference for Health Care Professionals

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The Irish Cancer Society welcomes you
to
Lung Cancer A Conference for Health Care
Professionals
Thursday 29th March 2007 Stillorgan Park Hotel,
Co. Dublin
Kindly supported by
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DYSPNOEA and RESPIRATORY REHABILITATION

• Helen Murphy, Senior Physiotherapist
• Our Ladys Hospice, Harolds Cross, Dublin 6W

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• WORD BREATHLESS
• spent with labour or violent action
• out of breath
• laboured breathing
• WORD DYSPNOEA
• shortness of breath
• WORD RESPIRATORY
• Physical aspect of breathing or mechanical

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The Normal Process of Breathing

• A person breathes in through the nose
• Breathing action is driven by the contraction and
  relaxation of the diaphragm. Which contracts
  downwards making the chest cavity longer while
  its associated intercostal muscles contract,
  widening the chest, allowing inspiration to take
  place.
• Ribs cage move upwards and outwards
• Abdominal muscles rise upwards
• Shoulders down and accessory muscles relaxed

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• and out through the mouth
• The diaphragm and external intercostal muscles
  relax and expiration occurs. The diaphragm is
  now back in its resting stage due to elastic
  recoil and pull of abdominal muscles.
• Ribs cage muscles recoil and ribs move
  downwards / inwards
• Shoulders down accessory muscles relaxed
• Breathe all the air out completely before
  breathing in again.

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Different Types of Lung Cancer

• Non-small cell
• Small cell
• Combined patterns of the above
• Adenocarcinoma
• Mesothelioma
• Metastases
• Large Cell Carcinoma

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What Happens with Lung Disease Changes that
take place -

• Loss of elasticity
• Loss of healthy lung tissue airways collapse
• ? Dead space
• ? Air entry
• Sputum secretions retention ? obstruction
• Pain
• Learned misuse of respiratory musculature
• Poor posture
• Poor exercise tolerance

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What is the result?

• Anxiety / panic attacks
• Weakness / atrophy of respiratory muscle
• ? Function A.D.L.s
• ? Exchange of gases
• Social isolation
• Cyanosis cough
• Poor posture and increased tone in accessory
  muscles ? always in tense position
• Fatigue
• Dyspnoea / Breathlessness

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Dyspnoea / Breathlessness

• is an uncomfortable sensation or awareness of
  breathing

It is one of the most frightening and distressing
symptoms for patients with cancer Occurs in a
third of all patients for Palliative Care Potter
et al 2003
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Contd.

• Symptoms of Dyspnoea can completely dominate an
  individuals life accounting for
• a high proportion of physical disability
• loss of independence and dignity
• lowered self-esteem with associated psychosocial
  distress.
• Bailey 1995, Bredin 1999

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BREATHLESSNESS - Sensation or private phenomenon

• Incorporates both sensory physiology and the
  psychology of perception. (Mahler 1990)
• The mechanics and the emotional experience are
  inseparable.
• W O B Effort is central to concept of
  breathlessness.

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The Aim of Physiotherapy in the Management of the
Breathless Patients

• is
• To teach skills that will help the individual
• To maximise breathing efficiency
• and improve the objective
• For the patient to have control over breathing
  rate and pattern
• Thereby reducing the overall work of breathing

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Observation

• Chest shape
• symmetry of breathing regulary
• pattern of breathing
• Pattern of muscle use
• Cough sputum retention
• Extercise tolerance
• Presence of ankle oedema
• Cardiac involvement
• General appearance
• colour
• anxious

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Assessment

• Colour
• Finger clubbing
• Ascullate
• O2 sats
• Respiratory rate

Subjective

• Borg Scale
• Excursion of breath
• 6-Minute walk test (6 MWT)
• Quality-of-life questionnaires
• Factors that elevate or exacerbate

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Outcomes

• Borg Scale is a rating scale of perceived
  exertion (RPE)
• Barthel Index developed to measure functional
  independence in personal care and mobility
• ADL
• Functional Independence Measure (FIM)
• 6-Minute walk test
• 12-Minute self paced walk test (SPWT)

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Physical Exercise / Education

• ACBT (Active Cycle of Breathing Exercises)
  Breathing re-education.
• Relaxation of the accessory muscles is important
  in learning to cope with breathlessness.
• To be able to control the extent to which you use
  the accessory muscles while using the appropriate
  muscles in an energy efficient way.

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• Positioning
• The function of the lung has been shown to
  significantly improve with appropriate
  positioning.
• Positioning helps to eliminate unnecessary
  muscle activity.
• A position with the upper limbs supported causes
  relaxation of the upper chest and shoulders and
  allows movement of the lower chest and abdomen.

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Contd.

• Positioning is used for
• Breathlessness
• Postural drainage
• thus increasing the ventilation of collapsed
  airways

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• Re-Educate Correct Posture
• The aim is to utilise motor learning with
  training of the holding ability of the postural
  stabilizers.
• Repeat and maintain correct movement or position.
• Do this frequently.

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• Airway clearance techniques
• Percussion and vibration
• Autogenic drainage
• Advice on bronchodilators and nebulizers
• Coughing techniques
• Huffing
• Expectoration

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Breathing Control
This is normal tidal breathing using the lower
chest with relaxated upper chest and shoulders

• Mobility and Pacing / Energy Conservation
  Techniques
• Mobility aids
• Pacing on slopes stairs
• Positions to avoid

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Contd.

• Exercise programme tailored for each individual
  needs, i.e

• Purse lip breathing
• Avoid breath holding
• Relaxed diaphragmatic breathing
• Enhancing the exhaled breath

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Contd.
Empower

• Decrease of fear
• Reassure family and friends to support
• impact of anxiety
• coping mechanisms
• Activities that increase breathlessness in a way
  that the patient can control.
• Progression
• Exercise
• Demonstrate
• Set realistic goals
• Pacing
• Little and often

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Breathless people have lost control of their most
basic physiological requirement and therefore
need some control of their treatment Hough 2001

• Meeting the needs of the patient and empowering /
  giving confidence and reassurance.
• Good communication between team members is
  paramount.
• Group settings offer reassurance that people are
  not alone in their feelings

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References

• Bredin M, Corner J, Krishmasamy, M, Plant I,
  Bailey C, Hern R (1999). Multicentre randomised
  controlled trial of nursing intervention for
  breathlessness in patients with lung cancer. BMJ
  318 (71SS) 901-904
• Bailey C (1995) Nursing as therapy in the
  management of breathlessness in lung cancer. Eur
  J Cancer Care 4(4) 184-190
• Hough A (2001). Physiotherapy in Respiratory
  Care An evidence-based Approach to Respiratory
  and Cardiac Management. (3rd Ed) Nelson Thornes
  UK.
• Mahler DA (1990) Dyspnoea (Lung Biology in
  Health and Disease) Marcel Dekker NY.
• Potter J, Hami F, Bryan T, Quigley C. (2003).
  Symptoms in 400 patients referred to palliative
  care services Prevalence and patterns. Journal
  Palliative Medicine, June, Vol 17 (4) 310 314.

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Breathing control in high side lying
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Breathing control in high side lying
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Breathing control in high side lying
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Huffing with wound support
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Thoracic expansion exercises
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Chest clapping
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Self treatment thoracic expansion exercises
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Forward kneeling
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Forward lean sitting
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Forward lean standing
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Relaxed standing
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Breathing control while stair climbing
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The Irish Cancer Society welcomes you
to
Lung Cancer A Conference for Health Care
Professionals
Thursday 29th March 2007 Stillorgan Park Hotel,
Co. Dublin
Kindly supported by
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The Role of the Lung Cancer Nurse Specialist
Quality of Life

• Ms Rita Luddy
• Lung Cancer Nurse Co-Ordinator
• St. James Hospital

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Role of the Lung Cancer Nurse Specialist
Quality of Life

• Introduction
• Definition
• Core Elements
• Conclusion

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Introduction

• Lung Cancer is the leading cause of cancer
  related deaths
• world-wide (Silvestri, G.A., 2002)
• 95 of lung cancers are related to smoking.

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Definition of LCNS

• Formal recognised post registration education
• Encompasses a major clinical focus
• Works closely with medical para-medical
  colleagues
• Participate in nursing research audits
• Acting as a consult in education clinical
  practise
• National Council for the Professional Development
  of Nursing Midwifery 2001

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Definition - contd

• First level nurse
• Locally recognised as part of the specialist lung
  cancer multidisciplinary team
• Designated as a specialist in lung cancer
• Consultations and follow up consultations
• The British National Lung Cancer Forum
• Integrating lung cancer nursing a good practise
  guide

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Core Elements of the LCNS Role

• Communication
• Information
• Co-ordinated care

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Core Elements - contd

• Nursing assessment
• MDT membership
• Patient Advocacy

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Core Elements - contd

• Accessibility
• Support

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Integrating nursing across the lung cancer
journey www.nlcfn.co.uk
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Conclusion

• The Lung Cancer Nurse Specialist is a key
  member of the MDT
• This role needs to continue developing and
  adapting to the needs of the patient, carers
  the service

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Any Questions?
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The Irish Cancer Society welcomes you
to
Lung Cancer A Conference for Health Care
Professionals
Thursday 29th March 2007 Stillorgan Park Hotel,
Co. Dublin
Kindly supported by