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 the 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 (NCP) and nursing diagnosis:
- Impaired Gas Exchange
- Ineffective Airway Clearance
- Acute Pain
- Fear/Anxiety
- Deficient Knowledge
- Other Nursing Diagnoses
Impaired Gas Exchange
Nursing Diagnosis
- Impaired Gas Exchange
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 |
|---|---|
| Note respiratory rate, depth, and ease of respiration. Observe for use of accessory muscles, pursed-lip breathing, changes in skin or mucous membrane color, pallor, cyanosis. | Respirations may be increased as a result of pain or as an initial compensatory mechanism to accommodate for the loss of lung tissue; however, increased work of breathing and cyanosis may indicate increasing oxygen consumption and energy expenditures and/or reduced respiratory reserve. |
| Auscultate lungs for air movement and abnormal breath sounds. | Consolidation and lack of air movement on the operative side are normal in the pneumonectomy patient; however, the lobectomy patient should demonstrate normal airflow in remaining lobes. |
| Investigate restlessness and changes in mentation or level of consciousness. | May indicate increased hypoxia or complications such as a mediastinal shift in pneumonectomy patient when accompanied by tachypnea, tachycardia, and tracheal deviation. |
| Assess patient response to activity. Encourage rest periods and limit activities to patient tolerance. | Increased oxygen consumption demand and stress of surgery can result in increased dyspnea and changes in vital signs with activity; however, early mobilization is desired to help prevent pulmonary complications and to obtain and maintain respiratory and circulatory efficiency. Adequate rest balanced with activity can prevent respiratory compromise. |
| Note development of fever. | Fever within the first 24 hr after surgery is frequently due to atelectasis. Temperature elevation within the 5th to 10th postoperative day usually indicates a wound or systemic. |
| Maintain patent airway by positioning, suctioning, use of airway adjuncts. | Airway obstruction impedes ventilation, impairing gas exchange. |
| Reposition frequently, placing patient in sitting positions and supine to side positions. | Maximizes lung expansion and drainage of secretions. |
| Avoid positioning patient with a pneumonectomy on the operative side; instead, favor the “good lung down” position. | Research shows that positioning patients following lung surgery with their “good lung down” maximizes oxygenation by using gravity to enhance blood flow to the healthy lung, thus creating the best possible match between ventilation and perfusion. |
| Encourage and assist with deep-breathing exercises and pursed-lip breathing as appropriate. | Promotes maximal ventilation and oxygenation and reduces or prevents atelectasis. |
| Maintain patency of chest drainage system for lobectomy, segmental or wedge resection patient. | Drains fluid from pleural cavity to promote re-expansion of remaining lung segments. |
| Note changes in amount or type of chest tube drainage. | Bloody drainage should decrease in amount and change to a more serous composition as recovery progresses. A sudden increase in amount of bloody drainage or return to frank bleeding suggests thoracic bleeding or hemothorax; sudden cessation suggests blockage of tube, requiring further evaluation and intervention. |
| Observe presence or degree of bubbling in water-seal chamber. | Air leaks immediately postoperative are not uncommon, especially following lobectomy or segmental resection; however, this should diminish as healing progresses. Prolonged or new leaks require evaluation to identify problems in patient versus the drainage system. |
| Administer supplemental oxygen via nasal cannula, partial rebreathing mask, or high-humidity face mask, as indicated. | Maximizes available oxygen, especially while ventilation is reduced because of anesthetic, depression, or pain, and during period of compensatory physiological shift of circulation to remaining functional alveolar units. |
| Assist with and encourage the use of incentive spirometer. | Prevents or reduces atelectasis and promotes re-expansion of small airways. |
| Monitor and graph ABGs, pulse oximetry readings. Note hemoglobin (Hb) levels. | Decreasing Pao2 or increasing Paco2 may indicate the need for ventilatory support. Significant blood loss can result in decreased oxygen-carrying capacity, reducing Pao2. |
Recommended Resources
Recommended nursing diagnosis and nursing care plan books and resources.
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- Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use. - Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively. - NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales. - Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates. - Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing. - Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans. - Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you. - Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023. - All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.
See Also
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch. - Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other nursing care plans related to respiratory system disorders:
- Asthma | 8 Care Plans
- Bronchiolitis | 5 Care Plans
- Bronchopulmonary Dysplasia (BPD) | 5 Care Plans
- Chronic Obstructive Pulmonary Disease (COPD) | 7 Care Plans
- Cystic Fibrosis | 5 Care Plans
- Hemothorax and Pneumothorax | 3 Care Plans
- Influenza (Flu) | 5 Care Plans
- Lung Cancer | 5 Care Plans
- Mechanical Ventilation | 6 Care Plans
- Near-Drowning | 5 Care Plans
- Pleural Effusion | 6 Care Plans
- Pneumonia | 11 Care Plans
- Pulmonary Embolism | 4 Care Plans
- Pulmonary Tuberculosis | 5 Care Plans
- Tracheostomy | 5 Care Plans
Hi, i need help completing head to toe assessments for my care plans : Peptic ulcer, oral cancer
Check out these guides: 5 Peptic Ulcer Disease Nursing Care Plans and Peptic Ulcer Disease
I required the nursing diagnosis of every disease condition according to NANDA approval nursing