Nursing Assignment on Lung Cancer and Chemotherapy Medication

This nursing assignment discusses the pathophysiology of lung cancer, the pharmacokinetics of chemotherapy medication, the effectiveness and adverse effects of chemotherapeutic drugs, and the comparison of different medications used in the treatment of lung cancer. It also addresses the side effects of chemotherapy agents and the adverse effects of morphine.

Running head: NURSING ASSIGNMENT
Nursing Assignment
Name of the student:
Name of the university:
Author note:

1Nursing Assignment
Introduction:
Lung cancer is one of the leading cause of death related to cancer. According to Abs.gov, (2019),
Australia the death rate caused by lung cancer is around 5.3% of all death. The rate of lung cancer is
high in case of men as compared to women. The prognosis of lung is very poor which means the
incidence rate of lung cancer is almost same as that of the mortality rate (Corre et al. 2016). This essay
focuses on the a patient who is suffering from lung cancer and also has been diagnosed with metastases.
People suffering from lung cancer usually feel shortness of breathing, chest pain, diarrhea, nausea and
vomiting (Walte et al.2015). In the assignment the pathophysiology of the lung cancer which is
responsible for the shortness of breathing is explained in detail. Metastases of the lung cancer and their
effect on liver is also mentioned. The patient is relying on chemotherapeutic agents, hence the
pharmacokinetics of the chemotherapeutic drugs has been stated. Effectiveness and adverse effect of the
chemotherapeutic agents has also been addressed. Cisplatin is used in the combination with docixatol for
the effective treatment of the lung cancer. Nuvilumab is also used in the treatment of the cancer. In the
assignment both the medication are compared. The patient is administered with morphine IV which also
has side effect such as, nausea, constipation, vomiting and to reduce that Naloxone is prescribed.
Pathophysiology of the lung cancer:
Lung cancer is of two types among which the rate of non-small lung cancer is high as compared
to small cell lung cancer. One of the most important risk factor that results in lung cancer is smoking. It
is also caused due to genetic factors or the environmental factors such as asbestos, tar, soot and metals
such as chromium, arsenic and nickel. Certain dietary which contain beta carotene is also responsible for
the lung cancer. These risk factor damages the cell lining of the lung causing lung cancer. In the case
study, Nigel is suffering from non-small lung cancer (DiPiro et al 2014). He is at stage 4 of the lung
cancer and metastasis has also been observed. Due to the lung cancer the patient is suffering from

2Nursing Assignment
shortness of breathing. When the epithelial cells of the lungs damages and starts to grow exponentially,
it can cause lung cancer. The epithelial cancer can cause difficulties in the breathing and also shortness
of breathing. In case of lung cancer, the airway gets blocked due to which the mucus that is trapped in
the lung can cause infection which creates lack of oxygen. Lack of oxygen can cause shortness of
breathing. Hence in case of lung cancer, the patient usually suffer from breathing difficulty (Sadik et al.
2014).
Lung cancer effects the epithelial cells of the body. It starts from lung and spread to lymph node,
kidney, brain and other parts of the body. In metastasis, the cells break from their origin of site to other
distant sites. The cancerous cells reaches to the other distant sites through blood stream or the lymphatic
system. As the lungs and liver are situated adjacent to each other, the cancerous cells of lungs can easily
effect the liver. It also effects the metabolism of liver by affecting the lymph nodes which leads to liver
damage. In case of Nigel, due to the metastasis, his health is getting deteriorated (Reck et al. 2014).
Chemotherapy medication’s pharmacokinetics:
According to the case study, the patient is suffering from stage 4 non-small lung cancer, which
has been spread to different sites other than the site of origin. The metastasis of the lung cancer is
distributed all over the body. As the lung plays an important role in the drug metabolism, the
pharmacokinetics of the drugs is also effected. The first pass metabolism is defined as the process
where the drug absorption is reduced before reaching to systematic movement through the blood. Nigel
was administered with chemotherapeutic drugs by oral administration. Both the drug which has been
administered to the patient is absorbed by the liver and helps in further metabolism of drugs which is
excreted in the form of urine. These drugs after administration pass to the digestive system through the
hepatic system by portal vein. This metabolized drugs are then converts into small active drug that
emerges in the rest of the circulatory system. Hence by such process the hepatic first-metabolism is

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reduced to minimal (Rapoport et al. 2015). As the patient is suffering from second cancer the drug is
infused intravenously in to the patient, where the chemotherapeutic drug is administered directly in to
the veins and is absorbed more efficiently. It directly acts on the site of infection and is more effective in
the treatment of cancer. Whereas, in the case of oral administration, the half of the amount of the drug is
lost due to digestion and then metabolism into the liver. Therefore it is more convenient to administer
these drugs intravenously not orally. The bioavailability of such chemotherapeutic drugs which is IV
infusion is about 100%, hence the drug can very easily dodge first pass metabolism. Hence, by
considering the second cancer liver, it can be stated that it has no effect on the pharmokinetics of the
drugs which include, cisplatin and docexatol, as it can directly act on the drug through the blood stream
(Kenmotsu and Tanigawara 2015)
Effect of chemotherapeutic drug on lung cancer:
According to the case study, Nigel who is 78 years old has been diagnosed with stage four cancer
named as non-small lung cancer which was further formed to metastasis. In order to treat the lung
cancer, the patient is administered with Cisplatin and docetaxel. Cisplatin and docetaxel is given
intravenously in about every three weeks. The combination of cisplatin and docexatol is very commonly
used in the treatment of lung cancer. Cisplatin is chemotherapeutic drug which contain platinum which
is very effective in the treatment of cancer. It works to stop the metastasis of the patient by cross linking
with the guanine bases of the double stranded DNA helix. As a result of the drug the DNA strand is
unable to uncoil. These uncoiling of DNA stops the cell division. Due to which the cancer cells are
unable to divide further and hence their growth stops (Qin et al. 2017). It also effects the downstream
process of the DNA by adding methyl group to it. Addition of methyl group induces miscoding of the
bases of the DNA strand. Addition of methyl group creates hindrance in the RNA transcription and as
well as protein synthesis (Li et al. 2015). However, if is the advanced stage of lung cancer, the drug

4Nursing Assignment
fails to prevent the cancerous cell growth, then docexatol is used with cisplatin. Docetaxol is used in the
combination of cisplatina as Docetaxel is used as a combination with Cisplatin as it is unable to cure the
lung cancer alone by docexatol. Docetaxel is defined as a semisynthetic taxoid that acts in the manner of
synergistic agent which is used to improve the action of Cisplatin. It is anti-mitotic chemotherapeutic
medication which is used for the treatment of breast. Ovarian, and non-small cell lung cancer which the
patient is suffering from. Docetaxel works by binding with the tubulin with the high affinity in a reverse
manner in a ratio of 1:1. It damages the normal function of the microtubule by the binding. It also
prevents the depolarization of the tubule, which works to stabilizes the abnormal effect of microtubules,
which is important for the interphase. Hence the cell cycle stops and the cancer is prevented
(Nieuweboer et al. 2015).
Combination Comparison of nivolumab with Cisplatin and docetaxel :
Cisplatin, docetaxel is prescribed to the patient in order to treat the non-small lung cancer. It is
prescribed in the combination, however has a different mode of action. Cisplatin is chemotherapeutic
drug which contain platinum. It works to stop the metastasis of the patient by cross linking the guanine
bases of the double stranded DNA helix. As a result of the drug the DNA strand is unable to uncoil
which stops the cell division. It also effects the downstream process of the DNA by adding methyl group
to it. Addition of methyl group induces miscoding of the bases of the DNA strand. Docetaxol is
prescribed in combination with cisplatin. It is an anti- mitotic drug which helps to stop the cell division
and also works to enhance the medication effect of the cisplatin. Both the medication works to prevent
the cell division of the cancerous cells. However the major differnces that has been observed is their site
of action. Cisplatin works at the DNA level whereas, docexatol works at the chromosome level (Abe et
al. 2015).

5Nursing Assignment
Cisplatin works in combination with the docexatol as a chemotherapeutic drugs, but nivolumab
works more as an immunotherapeutic drugs and work in immune cells. These medication is prescribed
after cisplatin has been administrated to the patient. It is an antibody Ig4 which targets the checkpoint
for the PDI (programmed cell death). In patient suffering from cancer high expression of PDI has been
observed. The PDI belongs to CD28 family and is mainly observed b cells, myeloid and Tcells. These
immunotherapeutic drugs block these particular checkpoint which works to reduce the inhibitory
signalling, which restores the natural immune response of T cell (Sato et al. 2018). All of the
chemotherapeutic drugs follws ac different molecular pathway to treat cancer. They response rate of
cisapltin nad docexatol is less than that of the nivolumab (Borghae et al. 2015). The response rate of
nivomulab is forty to seventy percent whereas, the response rate of cisplatin and docexatol is thirty to
fifty percent. Survival rate of patient consuming cisplatin is less than that of the nivolumab. The survival
rate of nivomumab is around 10 months whereas, that of cisplatin and docexatol is 9 months. Hence the
combination of these drugs helps in curing lung cancer in to the patient.
Side effect of chemotherapeutic agent:
The patient, nigel is administered with different medication such as, Cisplatin, docetaxel, and
nivolumab. These medication are prescribed to the patient suffering from cancer but it has some adverse
effect on the body such as, nausea, vomiting, diarrhoea and dry mouth. These are chemotherapy drugs.
Cisplatin is used in the treatment of cancer. It contain platinum and is administered alone or in the
combination of another medication to stop metastasis. It has some side effects such as, loss of appetite,
nausea, vomiting, and diarrhoea (Ciarimboli 2014). Another medication is docetaxel, which is also used
as chemotherapeutic agent. The side effects of docetaxel which is frequently observed in case of patient
is hair loss, diarrhoea, and allergic reaction. The patient is also prescribed nivolumab, which is also a
chemotherapy agent and has some side effects such as, weight loss, diarrhoea dizziness and chest pain.

6Nursing Assignment
All the chemotherapy agent has some similar side effects such as, dizziness, vomiting and diarrhoea.
This medication are prescribed to the patient in order to avoid the first-pass hepatic metabolism. It is
administered intravenously in higher concentration. When these chemotherapeutic agent are
administered, they are circulated in to the blood to work in to the lungs (Ho and Mackey 2014). Apart
from the lungs, the drugs are also circulated in to the gastrointestinal tract of the patient and causing side
effects such as, vomiting, nausea and diarrhoea. When these drugs circulate in to the gastrointestinal
tract, they trigger a zone that induces vomiting and nausea. Due to the high concentration in the gastro
intestinal tract, it provides signal to the brain, due to chemotherapeutic stimuli which activates the
receptors such as, chemoreceptors present in the intestinal wall of the gastrointestinal tract. These
chemoreceptors sends messages to the vomiting centre situated in the medulla of brain inducing
vomiting. It releases dopamine and serotonin and also associated with the release of acetylcholine.
Acetylcholine activates the vomiting reflex and hence the patients experience nausea and vomiting (de
Weger, Beijnen and Schellens 2014). These chemotherapy drugs damages the intestinal cell wall
inducing diarrhoea. Hence to reduce the adverse effect of these chemotherapy drugs such as, Cisplatin,
docetaxel, and nivolumab, Ondansetron is prescriebed. Ondansetron is an antagonist serotonin of type 3
receptor which reduces the side effects of chemotherapeutic drugs (x Wang 2015).
Adverse effect of morphine:
Morphine is defined as the psychoactive drug which is used to reduce the pain sensation by
acting on the central nervous system. It is also considered as the opiate analgesic and is used commonly
in order to reduce the chronic pain and acute pain. As the patient is suffering from acute chest pain as
well as shortness of breathing. Hence in order to reduce the pain the Patient is administered with
morphine (Weldon, Ariano and Grierson 2016). Morphine is administered in case of patient suffering

7Nursing Assignment
from chest pain, but it has certain side effects such as , the patient taking morphine IV have higher
chances of getting infected by pulmonary edema. It can also cause respiratory depression among the
patient. The respiratory is commonly observed in patient consuming morphine IV for the pain relief.
Due to the administration of morphine IV, the systemic vasodilation occurs, which causes respiratory
depression among the patient. Respiratory depression is commonly observed in patient suffering from a
respiratory known as hypoxia. There are other symptoms such as, high blood pressure that is visible in
patient suffering from respiratory depression. There are other adverse effect also observed in case of
morphine administration such as, nausea, constipation, vomiting, dizziness and dry mouth. To reduce the
adverse effect of morphine IV, other medication are prescribed by the doctor (Kotlinska-Lemieszek,
Klepstad and Haugen 2015). To reduce the adverse effect of morphine in the digestive system, such as
constipation, consumption of dietary fibres as well as drinking enough water is suggested. Laxative is
prescribed by the general practitioner. As mentioned above, respiratory depression can be caused by the
administration of intravenous morphine IV (Jaroch et al. 2016). Hence in order to treat the respiratory
depression, an antidote named as naloxone is prescribed by the doctor. Naloxone works to reduce the
hypertension that is works to reduce the blood pressure by acting on the central nervous system
(D’Onofrio et al. 2015). It acts as an antagonist on the receptor of the central nervous system. Other side
effects such as, dizziness, nausea and vomiting, a particular diet such as, the diet devoid of the NaCl is
suggested along with vegetables that can reduce the blood pressure.
Conclusion:
From the above essay, it can be concluded that the patient is suffering from non-small lung
cancer which is the most prevalent type of lung cancer. In the above essay, the case study of the patient
who is 78 years old is explained. In the essay, the pathophysiology of the lung cancer which is
responsible for causing shortness of breathing is explained. Metastases of the lung cancer and its effect

8Nursing Assignment
on the liver is also explained. Impact of the chemotherapeutic agent which has been prescribed by the
doctor is explained. The pharmacokinetics of the chemotherapeutic agent is also explained. Apart from
that, the mode of action of the chemotherapeutic agent along with their adverse effect such as, vomiting,
nausea and diarrhoea is also explained. The effects of these chemotherapeutic agent on the
gastrointestinal tract is mentioned. The effectiveness of these chemotherapeutic drugs in the treatment of
the cancer is stated in detail. In addition, the adverse effect of morphine is also discussed.

9Nursing Assignment
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