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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 5 lung cancer nursing care plans.

1. 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 patients normal
range.
Be free of symptoms of respiratory distress.

Nursing Interventions Rationale

Note respiratory rate, depth, and ease of Respirations may be increased as a res
respirations. Observe for use of accessory of pain or as an initial compensatory
muscles, pursed-lip breathing, changes in mechanism to accommodate for loss o
skin or mucous membrane color, pallor, tissue; however, increased work of
cyanosis. breathing and cyanosis may indicate
increasing oxygen consumption and en
Nursing Interventions Rationale

expenditures and/or reduced respirato


reserve.

Consolidation and lack of air movemen


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.

May indicate increased hypoxia or


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

Increased oxygen consumption deman


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

Fever within the first 24 hr after surge


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

Maintain patent airway by positioning, Airway obstruction impedes ventilation


suctioning, use of airway adjuncts. impairing gas exchange.

Reposition frequently, placing patient in


Maximizes lung expansion and drainag
sitting positions and supine to side
secretions.
positions.

Avoid positioning patient with a Research shows that positioning patien


pneumonectomy on the operative side; following lung surgery with their good
instead, favor the good lung down down maximizes oxygenation by usin
Nursing Interventions Rationale

gravity to enhance blood flow to the h


position. lung, thus creating the best possible m
between ventilation and perfusion.

Encourage and assist with deep-breathing Promotes maximal ventilation and


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

Maintain patency of chest drainage system


Drains fluid from pleural cavity to prom
for lobectomy, segmental or wedge
re-expansion of remaining lung segme
resection patient.

Bloody drainage should decrease in am


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

Air leaks immediately postoperative ar


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

Maximizes available oxygen, especially


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

Assist with and encourage use of Prevents or reduces atelectasis and


incentive spirometer. promotes re-expansion of small airway

Monitor and graph ABGs, pulse oximetry Decreasing Pao2 or increasing Paco2 ma
Nursing Interventions Rationale

indicate need for ventilatory support.


Significant blood loss can result in
readings. Note hemoglobin (Hb) levels.
decreased oxygen-carrying capacity,
reducing Pao2.

2. Ineffective Airway Clearance

May be related to

Increased amount/viscosity of secretions


Restricted chest movement/pain
Fatigue/weakness

Possibly evidenced by

Changes in rate/depth of respiration


Abnormal breath sounds
Ineffective cough
Dyspnea

Desired Outcomes

Demonstrate patent airway, with fluid secretions easily expectorated,


clear breath sounds, and noiseless respirations.

Nursing Interventions Rationale

Noisy respirations, rhonchi, and wheez


Auscultate chest for character of breath
indicative of retained secretions and/o
sounds and presence of secretions.
airway obstruction.

Assist patient and instruct in effective Upright position favors maximal lung
deep breathing and coughing with upright expansion, and splinting improves forc
position (sitting) and splinting of incision. cough effort to mobilize and remove
secretions. Splinting may be done by n
Nursing Interventions Rationale

(placing hands anteriorly and posterior


over chest wall) and by patient (with
pillows) as strength improves.

Increased amounts of colorless, blood-


streaked, or watery secretions are nor
initially and should decrease as recove
Observe amount and character of sputum progresses. Presence of thick or tenaci
or aspirated secretions. Investigate bloody, or purulent sputum suggests
changes as indicated. development of secondary problems
(dehydration, pulmonary edema, local
hemorrhage, or infection) that require
correction and treatment.

Routine suctioning increases risk of


Suction if cough is weak or breath sounds
hypoxemia and mucosal damage. Deep
not cleared by cough effort. Avoid deep
tracheal suctioning is generally
endotracheal or nasotracheal suctioning in
contraindicated following pneumonecto
pneumonectomy patient if possible.
reduce the risk of rupture of the bronc
Suction the patient as needed, and
stump suture line. If suctioning is
encourage to begin deep breathing and
unavoidable, it should be done gently
coughing as soon as possible.
only to induce effective coughing.

Encourage oral fluid intake (at least 2500 Adequate hydration aids in keeping
mL/day) within cardiac tolerance. secretions loose or enhances expector

Assess for pain or discomfort and Encourages patient to move, cough mo


medicate on a routine basis and before effectively, and breathe more deeply t
breathing exercises. prevent respiratory insufficiency.

Improves lung expansion or ventilation


facilitates removal of secretions. Postu
Assist with incentive spirometer, postural drainage may be contraindicated in so
drainage and percussion as indicated. patients and in any event must be
performed cautiously to prevent respir
embarrassment and incisional discomf

Providing maximal hydration helps loo


Use humidified oxygen and/or ultrasonic
liquefy secretions to promote expector
nebulizer. Provide additional fluids via IV
Impaired oral intake necessitates IV
as indicated.
supplementation to maintain hydration
Nursing Interventions Rationale

Relieves bronchospasm to improve air


Expectorants increase mucus productio
liquefy and reduce viscosity of secretio
Administer bronchodilators, expectorants,
facilitating removal. Alleviation of ches
and/or analgesics as indicated.
discomfort promotes cooperation with
breathing exercises and enhances
effectiveness of respiratory therapies.

3. Acute Pain

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

Ask patient about pain. Determine pain Helpful in evaluating cancer-related pa


Nursing Interventions Rationale

symptoms, which may involve viscera,


nerve, or bone tissue. Use of rating sc
characteristics: continuous, aching,
aids patient in assessing level of pain a
stabbing, burning. Have patient rate
provides tool for evaluating effectivene
intensity on a 010 scale.
analgesics, enhancing patient control o
pain.

Discrepancy between verbal and/or


Assess patients verbal and nonverbal pain nonverbal cues may provide clues to d
cues. of pain, need for or effectiveness of
interventions.

Fear, distress, anxiety, and grief over


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

Pain perception and pain relief are


subjective, thus pain management is b
Evaluate effectiveness of pain control.
left to patients discretion. If patient is
Encourage sufficient medication to
unable to provide input, the nurse sho
manage pain; change medication or time
observe physiological and nonverbal si
span as appropriate.
pain and administer medications on a
regular basis.

Fears or concerns can


Encourage verbalization of feelings about
increase muscletension and lower thre
the pain.
of pain perception.

Provide comfort measures: frequent


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

Schedule rest periods, provide quiet Decreases fatigue and conserves energ
environment. enhancing coping abilities.
Nursing Interventions Rationale

Prevents undue fatigue and incisional s


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

Assist with patient-controlled analgesia


(PCA) or analgesia through epidural
Maintaining a constant drug level avoid
catheter. Administer intermittent
cyclic periods of pain, aids in musclehe
analgesics routinely as indicated,
and improves respiratory function and
especially 4560 min before respiratory
emotional comfort and coping.
treatments, deep-breathing or coughing
exercises.

4. Fear/Anxiety

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 assimi


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

Support may enable patient to begin


Acknowledge reality of patients fears or exploring and dealing with the reality o
concerns and encourage expression of cancer and its treatment. Patient may
feelings. time to identify feelings and even mor
to begin to express them.

Provide opportunity for questions and


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

When extreme denial or anxiety is


Accept, but do not reinforce, patients interfering with progress of recovery, t
denial of the situation. issues facing patient need to be explai
and resolutions explored.

Fear and/or anxiety will diminish as pa


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

Involve patient/SO in care planning. May help restore some feeling of contr
Provide time to prepare for events or independence to patient who feels pow
treatments. in dealing with diagnosis and treatmen

Provide for patients physical comfort. It is difficult to deal with emotional iss
Nursing Interventions Rationale

when experiencing extreme or persiste


physical discomfort.

5. Deficient Knowledge

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

Discuss diagnosis, current and/or planned Provides individually specific informatio


therapies, and expected outcomes. creating knowledge base for subseque
learning regarding home management
Radiation or chemotherapy may follow
Nursing Interventions Rationale

surgical intervention, and information


essential to enable the patient or SO t
make informed decisions.

Reinforce surgeons explanation of


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

Follow-up assessment of respiratory st


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

Identify signs and symptoms requiring


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

Weakness and fatigue should decrease


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

Provide appropriate care before surgery:

If patient is to undergo surgery,


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

Explain expected postoperative Health teaching is more effective


procedures, such as insertion of an before surgery, when the patient is
indwelling catheter, use of an
Nursing Interventions Rationale

endotracheal tube or chest tube, dressing


conscious and aware.
changes, and IV therapy.

Teach patient how to perform deep Helpful in immediately maximizing lun


breathing, coughing, and ROM exercises. volume after surgery.

Evaluate availability or adequacy of


General weakness and activity limitatio
support system(s) and necessity for
may reduce individuals ability to meet
assistance in self-care or home
needs.
management.

Generalized weakness and fatigue are


in the early recovery period but should
Recommend alternating rest periods with diminish as respiratory function improv
activity and light tasks with heavy and healing progresses. Rest and sleep
tasks. Stress avoidance of heavy lifting, enhance coping abilities, reduce
isometric or strenuous upper body nervousness (common in this phase),a
exercise. Reinforce physicians time promote healing. Strenuous use of arm
limitations about lifting. place undue stress on incision because
muscles may be weaker than normal f
months following surgery.

Recommend stopping any activity that


Exhaustion aggravates respiratory
causes undue fatigue or increased
insufficiency.
shortness of breath.

Healing begins immediately, but comp


healing takes time. As healing progres
Encourage inspection of incisions. Review incision lines may appear dry, with cru
expectations for healing with patient. scabs. Underlying tissue may look brui
and feel tense, warm, and lumpy (reso
hematoma).

Instruct patient or SO to watch for and


report places in incision that do not heal Signs and symptoms indicating failure
or reopening of healed incision, any heal, development of complications
drainage (bloody or purulent), localized requiring further medical evaluation or
area of swelling with redness or increased intervention.
pain that is hot to touch.

Suggest wearing soft cotton shirts and Reduces suture line irritation and pres
Nursing Interventions Rationale

loose-fitting clothing, cover or pad portion from clothing. Leaving incisions open t
of incision as indicated, leave incision promotes healing process and may red
open to air as much as possible. risk of infection.

Keeps incision clean, promotes circulat


Shower in warm water, washing incision
healing. Climbing out of tub requires u
gently. Avoid tub baths until approved by
arms and pectoral muscles, which can
physician.
undue stress on incision.

Support incision with Steri-Strips as


Aids in maintaining approximation of w
needed when sutures or staples are
edges to promote healing.
removed.

Simple arm circles and lifting arms ove


Provide rationale for arm and shoulder
head or out to the affected side are ini
exercises. Have patient/SO demonstrate
on the first or second postoperative da
exercises. Encourage following graded
restore normal range of motion (ROM)
increase in number and/or intensity of
shoulder and to prevent ankylosis of th
routine repetitions.
affected shoulder.

Stress importance of avoiding exposure to


Protects lung(s) from irritation and red
smoke, air pollution, and contact with
risk of infection.
individuals with URIs.

Meeting cellular energy requirements a


Review nutritional and/or fluid needs.
maintaining good circulating volume
Suggest increasing protein and use of
for tissue perfusion facilitate tissue
high-calorie snacks as appropriate.
regeneration or healing process.

Agencies such as these offer a broad r


Identify individually appropriate
of services that can be tailored to prov
community resources.
support and meet individual needs.

Other Nursing Diagnoses

Airway Clearance, ineffectiveincreased amount/viscosity


of secretions, restricted chest
movement/pain, fatigue/weakness.
Pain, acutesurgical incision, tissue trauma, disruption of
intercostal nerves, presence of distress/anxiety.
Self-Care deficitdecreased strength/endurance, presence
of pain, intolerance to activity, depression, presence of
therapeutic devices, e.g., IV lines.

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