Lung cancer

Lung cancer is the most common cause of cancer death in men and women.
Lung cancer is the carcinoma of the lungs characterized by uncontrolled growth of
tissues of the lung. It usually develops within the wall or epithelium of the bronchial
tree. Its most common types are epidermoid (squamous cell) carcinoma, small cell
(oat cell) carcinoma, adenocarcinoma, and large cell (anaplastic) carcinoma. Although
the prognosis is usually poor, it varies with the extent of metastasis at the time of
diagnosis and the cell type growth rate. Only about 13% of patients with lung cancer
survive 5 years after diagnosis.

Lung cancer is mostly attributable to inhalation of carcinogenic pollutants by a

susceptible host. Any smoker older than 40, especially if the person began to smoke
before age 15, has smoked a whole pack or more per day for 20 years, or works with
or near asbestos. Pollutants in tobacco smoke cause progressive lung cell
degeneration. Lung cancer is 10 times more common in smokers than in nonsmokers.
Cancer risk is determined by the number of cigarettes smoked daily, the depth of
inhalation, how early in life smoking began, and the nicotine content of cigarettes.

Nursing Care Plans

Nursing care for patients with lung cancer revolves around comprehensive supportive
care and patient teaching can minimize complications and speed recovery
from surgery, radiation and/or chemotherapy.

Here are five (5) lung cancer nursing care plans:

1. Impaired Gas Exchange

2. Ineffective Airway Clearance
3. Acute Pain
4. Fear/Anxiety
5. Deficient Knowledge
6. Other Nursing Diagnoses
 7. Impaired Gas Exchange: Excess or deficit in oxygenation and/or carbon dioxide
elimination at the alveolar-capillary membrane.

8. May be related to

 Removal of lung tissue

 Altered oxygen supply (hypoventilation)
 Decreased oxygen-carrying capacity of blood (blood loss)

Possibly evidenced by

 Dyspnea
 Restlessness/changes in mentation
 Hypoxemia and hypercapnia
 Cyanosis

Desired Outcomes

 Demonstrate improved ventilation and adequate oxygenation of tissues by

ABGs within patient’s normal range.
 Be free of symptoms of respiratory distress.

Nursing Interventions Rationale

Respirations may be increased as a result of

pain or as an initial compensatory mechanism
Note respiratory rate, depth, and ease of
to accommodate for loss of lung tissue;
respirations. Observe for use of accessory
however, increased work of breathing and
muscles, pursed-lip breathing, changes in skin
cyanosis may indicate increasing oxygen
or mucous membrane color, pallor, cyanosis.
consumption and energy expenditures and/or
reduced respiratory reserve.

Consolidation and lack of air movement on

operative side are normal in the
Auscultate lungs for air movement and
pneumonectomy patient; however, the
abnormal breath sounds.
lobectomy patient should demonstrate normal
airflow in remaining lobes.
Nursing Interventions Rationale

May indicate increased hypoxia or

Investigate restlessness and changes in complications such as mediastinal shift in
mentation or level of consciousness. pneumonectomy patient when accompanied by
tachypnea, tachycardia, and tracheal deviation.

Increased oxygen consumption demand

and stress of surgery can result in increased
dyspnea and changes in vital signs with
Assess patient response to activity. Encourage activity; however, early mobilization is desired
rest periods and limit activities to patient to help prevent pulmonary complications and
tolerance. to obtain and maintain respiratory and
circulatory efficiency. Adequate rest balanced
with activity can prevent respiratory
compromise.

Fever within the first 24 hr after surgery is

frequently due to atelectasis. Temperature
Note development of fever.
elevation within the 5th to 10th postoperative
day usually indicates a wound or systemic.

Maintain patent airway by positioning, Airway obstruction impedes ventilation,

suctioning, use of airway adjuncts. impairing gas exchange.

Reposition frequently, placing patient in sitting Maximizes lung expansion and drainage of
positions and supine to side positions. secretions.

Research shows that positioning patients

following lung surgery with their “good lung
Avoid positioning patient with a
down” maximizes oxygenation by using
pneumonectomy on the operative side; instead,
gravity to enhance blood flow to the healthy
favor the “good lung down” position.
lung, thus creating the best possible match
between ventilation and perfusion.

Encourage and assist with deep-breathing

Promotes maximal ventilation and oxygenation
exercises and pursed-lip breathing as
and reduces or prevents atelectasis.
appropriate.

Maintain patency of chest drainage system for

Drains fluid from pleural cavity to promote re-
lobectomy, segmental or wedge resection
expansion of remaining lung segments.
patient.
Nursing Interventions Rationale

Bloody drainage should decrease in amount

and change to a more serous composition as
recovery progresses. A sudden increase in
Note changes in amount or type of chest tube amount of bloody drainage or return to
drainage. frank bleedingsuggests
thoracic bleeding or hemothorax; sudden
cessation suggests blockage of tube, requiring
further evaluation and intervention.

Air leaks immediately postoperative are not

uncommon, especially following lobectomy or
Observe presence or degree of bubbling in segmental resection; however, this should
water-seal chamber. diminish as healing progresses. Prolonged or
new leaks require evaluation to identify
problems in patient versus the drainage system.

Maximizes available oxygen, especially while

ventilation is reduced because of
Administer supplemental oxygen via nasal
anesthetic, depression, or pain, and during
cannula, partial rebreathing mask, or high-
period of compensatory physiological shift of
humidity face mask, as indicated.
circulation to remaining functional alveolar
units.

Assist with and encourage use of incentive Prevents or reduces atelectasis and promotes
spirometer. re-expansion of small airways.

Decreasing Pao2 or increasing Paco2 may

Monitor and graph ABGs, pulse oximetry indicate need for ventilatory support.
readings. Note hemoglobin (Hb) levels. Significant blood loss can result in decreased
oxygen-carrying capacity, reducing Pao2.

Acute Pain: Unpleasant sensory and emotional experience arising from actual or potential tissue
damage or described in terms of such damage; sudden or slow onset of any intensity from mild to
severe with anticipated or predictable end and a duration of <6 months.

May be related to

 Surgical incision, tissue trauma, and disruption of intercostal nerves

 Presence of chest tube(s)
  Cancer invasion of pleura, chest wall

Possibly evidenced by

 Verbal reports of discomfort

 Guarding of affected area
 Distraction behaviors, e.g., restlessness
 Narrowed focus (withdrawal)
 Changes in BP, heart/respiratory rate

Desired Outcomes

 Report pain relieved/controlled.

 Appear relaxed and sleep/rest appropriately.
 Participate in desired/needed activities.

Nursing Interventions Rationale

Helpful in evaluating cancer-related pain

Ask patient about pain. Determine pain symptoms, which may involve viscera, nerve,
characteristics: continuous, aching, stabbing, or bone tissue. Use of rating scale aids patient
burning. Have patient rate intensity on a 0–10 in assessing level of pain and provides tool for
scale. evaluating effectiveness of analgesics,
enhancing patient control of pain.

Discrepancy between verbal and/or nonverbal

Assess patient’s verbal and nonverbal pain
cues may provide clues to degree of pain, need
cues.
for or effectiveness of interventions.

Fear, distress, anxiety, and grief over

confirmed diagnosis of cancer can impair
Note possible pathophysiological and ability to cope. In addition, a posterolateral
psychological causes of pain. incision is more uncomfortable for patient than
an anterolateral incision. The presence of chest
tubes can greatly increase discomfort.

Pain perception and pain relief are subjective,

Evaluate effectiveness of pain control.
thus pain management is best left to patient’s
Encourage sufficient medication to manage
discretion. If patient is unable to provide input,
pain; change medication or time span as
the nurse should observe physiological and
Nursing Interventions Rationale

appropriate. nonverbal signs of pain and administer

medications on a regular basis.

Encourage verbalization of feelings about the Fears or concerns can increase muscletension
pain. and lower threshold of pain perception.

Provide comfort measures: frequent changes of

position, back rubs, support with pillows. Promotes relaxation and redirects attention.
Encourage use of relaxationtechniques, Relieves discomfort and augments therapeutic
visualization, guided imagery, and appropriate effects of analgesia.
diversional activities.

Schedule rest periods, provide quiet Decreases fatigue and conserves energy,
environment. enhancing coping abilities.

Prevents undue fatigue and incisional strain.

Encouragement and physical assistance and
Assist with self-care activities, breathing and/or
support may be needed for some time before
arm exercises, and ambulation.
patient is able or confident enough to perform
these activities because of pain or fear of pain.

Assist with patient-controlled analgesia (PCA)

or analgesia through epidural catheter.
Administer intermittent analgesics routinely as
indicated, especially 45–60 min before
respiratory treatments, deep-breathing or
coughing exercises.
Maintaining a constant drug level avoids cyclic
periods of pain, aids in muscle healing, and
improves respiratory function and emotional
comfort and coping.

Anxiety: Vague uneasy feeling of discomfort or dread accompanied by an autonomic response.

Fear: Response to perceived threat that is consciously recognized as a danger.

May be related to

 Situational crises
 Threat to/change in health status
 Perceived threat of death
Possibly evidenced by

 Withdrawal
 Apprehension
 Anger
 Increased pain, sympathetic stimulation
 Expressions of denial, shock, guilt, insomnia

Desired Outcomes

 Acknowledge and discuss fears/concerns.

 Demonstrate appropriate range of feelings and appear relaxed/resting
appropriately.
 Verbalize accurate knowledge of situation.
 Report beginning use of individually appropriate coping strategies.

Nursing Interventions Rationale

Patient and SO are hearing and assimilating

new information that includes changes in self-
image and lifestyle. Understanding perceptions
Evaluate patient/SO level of understanding of
of those involved sets the tone for
diagnosis.
individualizing care and provides information
necessary for choosing appropriate
interventions.

Support may enable patient to begin exploring

and dealing with the reality of cancer and its
Acknowledge reality of patient’s fears or
treatment. Patient may need time to identify
concerns and encourage expression of feelings.
feelings and even more time to begin to express
them.

Provide opportunity for questions and answer

them honestly. Be sure that patient and care Establishes trust and reduces misperceptions
providers have the.same understanding of and/or misinterpretation of information
terms used.

When extreme denial or anxiety is interfering

Accept, but do not reinforce, patient’s denial of
with progress of recovery, the issues facing
Nursing Interventions Rationale

the situation. patient need to be explained and resolutions

explored.

Fear and/or anxiety will diminish as patient

Note comments or behaviors indicative of begins to accept or deal positively with reality.
beginning acceptance and/or use of effective Indicator of patient’s readiness to accept
strategies to deal with situation. responsibility for participation in recovery and
to “resume life.”

May help restore some feeling of control or

Involve patient/SO in care planning. Provide
independence to patient who feels powerless in
time to prepare for events or treatments.
dealing with diagnosis and treatment.

It is difficult to deal with emotional issues

Provide for patient’s physical comfort. when experiencing extreme or persistent
physical discomfort.

Deficient Knowledge: Absence or deficiency of cognitive information related to specific topic.

May be related to

 Lack of exposure, unfamiliarity with information/resources

 Information misinterpretation
 Lack of recall

Possibly evidenced by

 Statements of concern; request for information

 Inadequate follow-through of instruction
 Inappropriate or exaggerated behaviors, e.g., hysterical, hostile,
agitated, apathetic

Desired Outcomes

 Verbalize understanding of ramifications of diagnosis, prognosis, possible

complications.
  Participate in learning process.
 Verbalize understanding of therapeutic regimen.
 Correctly perform necessary procedures and explain reasons for the actions.
 Initiate necessary lifestyle changes.

Nursing Interventions Rationale

Provides individually specific information,

Discuss diagnosis, current and/or
therapies, and expected outcomes.
creating knowledge base for subsequent
learning regarding home management.
planned
Radiation or chemotherapy may follow surgical
intervention, and information is essential to
enable the patient or SO to make informed
decisions.

Reinforce surgeon’s explanation of particular

Length of rehabilitation and prognosis depend
surgical procedure, providing diagram as
on type of surgical procedure, preoperative
appropriate. Incorporate this information into
physical condition, and duration or degree of
discussion about short or long-term recovery
complications.
expectations.

Follow-up assessment of respiratory status and

general health is imperative to assure optimal
Discuss necessity of planning for follow-up
recovery. Also provides opportunity to
care before discharge.
readdress concerns/ questions at a less stressful
time.

Identify signs and symptoms requiring medical

evaluations, e.g., changes in appearance of
Early detection and timely intervention may
incision, development of respiratory difficulty,
prevent/ minimize complications.
fever, increased chest pain, changes in
appearance of sputum.

Weakness and fatigue should decrease as

lung(s) heals and respiratory function improves
during recovery period, especially if cancer
Help patient determine activity tolerance and
was completely removed. If cancer is
set goals.
advanced, it is emotionally helpful for patient
to be able to set realistic activity goals to
achieve optimal independence.
Nursing Interventions Rationale

Provide appropriate care before surgery:

 If patient is to undergo surgery,

supplement or reinforce the
information given by the healthcare Can help allay anxiety and provides an
opportunity to discuss fears or concerns.
team about the disease and the
surgical procedure.

 Explain expected postoperative

procedures, such as insertion of an
Health teaching is more effective before
indwelling catheter, use of
an surgery, when the patient is conscious and
endotracheal tube or chest tube, aware.
dressing changes, and IV therapy.

Teach patient how to perform deep breathing,
coughing, and ROM exercises.
Evaluate availability or adequacy of support
system(s) and necessity for assistance in self-
care or home management.
Recommend alternating rest periods with
activity and light tasks with heavy
tasks. Stress avoidance of heavy lifting,
isometric or strenuous upper body exercise.
Reinforce physician’s time limitations about
lifting.
Recommend stopping any activity that causes
undue fatigue or increased shortness of breath.
Encourage inspection of incisions. Review
expectations for healing with patient.
Instruct patient or SO to watch for and report
Helpful in immediately maximizing lung
volume after surgery.
General weakness and activity limitations may
reduce individual’s ability to meet own needs.
Generalized weakness and fatigue are usual in
the early recovery period but should diminish
as respiratory function improves and healing
progresses. Rest and sleep enhance coping
abilities, reduce nervousness (common in this
phase),and promote healing. Strenuous use of
arms can place undue stress on incision
because chest muscles may be weaker than
normal for 3–6 months following surgery.
Exhaustion aggravates respiratory
insufficiency.
Healing begins immediately, but complete
healing takes time. As healing progresses,
incision lines may appear dry, with crusty
scabs. Underlying tissue may look bruised and
feel tense, warm, and lumpy (resolving
hematoma).
Signs and symptoms indicating failure to heal,
Nursing Interventions Rationale

places in incision that do not heal or reopening development of complications requiring further
of healed incision, any drainage (bloody or medical evaluation or intervention.
purulent), localized area of swelling with
redness or increased pain that is hot to touch.
Suggest wearing soft cotton shirts and loose- Reduces suture line irritation and pressure from
fitting clothing, cover or pad portion of incision clothing. Leaving incisions open to air
as indicated, leave incision open to air as much promotes healing process and may reduce risk
as possible. of infection.
Keeps incision clean, promotes circulation or
Shower in warm water, washing incision
healing. Climbing out of tub requires use of
gently. Avoid tub baths until approved by
arms and pectoral muscles, which can put
physician.
undue stress on incision.
Support incision with Steri-Strips as needed Aids in maintaining approximation of wound
when sutures or staples are removed. edges to promote healing.
Provide rationale for arm and shoulder Simple arm circles and lifting arms over the
exercises. Have patient/SO demonstrate head or out to the affected side are initiated on
exercises. Encourage following graded increase the first or second postoperative day to restore
in number and/or intensity of routine normal range of motion (ROM) of shoulder and
repetitions. to prevent ankylosis of the affected shoulder.
Stress importance of avoiding exposure to
Protects lung(s) from irritation and reduces risk
smoke, air pollution, and contact with
of infection.
individuals with URIs.
Meeting cellular energy requirements and
Review nutritional and/or fluid needs. Suggest
maintaining good circulating volume for tissue
increasing protein and use of high-calorie
perfusion facilitate tissue regeneration or
snacks as appropriate.
healing process.
Agencies such as these offer a broad range of
Identify individually appropriate community
services that can be tailored to provide support
resources.
and meet individual needs.