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  Siddharth Waghmare answered this

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  Answer 1: The following features are need evaluation:

  1. Severe breathlessness
     1. The respiratory rate is high
     2. The patient sleeps in the propped-up position.
     3. The patient sits in the slightly forward (tripod position)
     4. Wheeze on expiration.
  2. There is a mass noted over the chest and ribs.
  3. The patient is extremely thin

  The patient has a history of smoking. This suggests the patient has an airway disease like a chronic obstructive pulmonary disease. This patient also has a thoracic mass and extreme loss of weight. This is suggestive of lung malignancy.

  Answer 2: The nurse should ask the following questions:

  1. Has the patient taken any inhaler therapy?
  2. Has the patient has hemoptysis?
  3. Does the patient have any neck or axillary swellings (suggestive of lymphadenopathy)?
  4. Has the patient experienced any loss of weight?
  5. Has the patient ever suffered from bilateral pedal edema (Patient with COPD can develop right heart failure due to pulmonary hypertension)

  Answer 3: The risk factors for lung cancer in this patient are:

  • Chronic smoking
  • Mass on the chest

  Answer 4: The nurse needs to collaborate with:

  • Respiratory physician:
    • The respiratory physician's help will be needed for the treatment of chronic obstructive pulmonary disease.
  • Intensivist:
    • To assess the need for ICU admission and ventilatory support.
  • Radiologist:
    • The chest of the patient needs to be imaged for lung malignancy.
    • To decide the need for image-guided biopsy.
    • To determine distant metastasis by PET-CT scan.
  • Pathologist:
    • The pathologist's help will be needed to process the biopsy sample for histopathology, immunohistochemistry.
  • Oncologist:
    • If the biopsy sample is suggestive of malignancy, the treatment of the malignancy needs to be decided upon.
    • The stage of the malignancy will help decide the choice of treatment.
  • Dietician:
    • The dietician need is needed to improve the nutrition of the patient.

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