Lung cancer is the uncontrolled growth of abnormal cells, which may occur in the lining of

the trachea, bronchi, bronchioles, or alveoli. Ninety five percent of lung cancers are
bronchogenic (arise from the epithelial lining of the bronchial tree).

definition
Cancer is the growth of abnormal cells that tend to attacking surrounding tissue and spread to
other organs a far away. Cancer occurs because of uncontrolled cell proliferation that occurs
without limit and without purpose for the host. Lung cancer is the abnormality of cells that
undergo proliferation in the lung (underwood, pathology, 2000). Lung cancer is the growth of
cancer cells that can not controlled in the lung tissue that can be caused by several
environmental carcinogens, especially cigarette smoke (Medicine, 2001) .Tumor lung is a
malignancy in the lung tissue (price, pathophysiology, 1995).
Lung cancer growth most often in end middle age or in the elderly; This disease is more
frequent in men than in women, but the incidence in women increased (Finkelmeier 2000).
Pri ratio compared to first lady 8: 1; now less than 2: 1 (Shield 1994).

Cause for Lung Cancers

Carcinogenesis, Initiation by a carcinogen (cancer-causing agent), for example, cigarette
smoke, asbestos, or coal dust. Promotion by a secondary factor, for example, number of years
smoking or number of cigarettes smoked. Progression, that is, the growth of pre-malignant
cells and their ability to metastasize.

Lifestyle risk factors: Smoking, most common risk factor: 85% of people are or were former
smokers. Others risk factor is Environmental tobacco smoke (secondhand smoke).About
3,400 lung cancer deaths in nonsmoking adults. Nonsmokers chronically exposed to
secondhand smoke may have as much as a 24% increased risk for developing lung cancer.

Occupational risks: Radon, Asbestos fibers e.g. insulation and shipbuilding (7 times increased
risk of death in asbestos workers & Asbestos exposure combined with cigarette smoking act
synergistically to produce an increased risk of lung cancer), Arsenic (copper refining and
pesticides), Beryllium (airline industry and electronics), Metals (nickel or copper),
Chromium, Cadmium, Coal tar (mining), Mustard gas, Air pollution: diesel exhaust,
Radiation, Tuberculosis.

Biological risks Sex/age: Males have a greater risk of lung cancer than do females, although
incidence rate is declining significantly in men, from high of 102 per 100,000 in 1984 to 77.8
per 100,000 in 2002. Lung cancer incidence doubled in females from 1975 to 2000 and now
has stabilized. Increased risk is associated with increasing age. 70% of all lung cancers
diagnosed in individuals over the age of 65 and the number of cases diagnosed at 50 or earlier
is increasing.
Family history: Lung cancer in one parent increases their children’s risk of the diagnosis of
lung cancer before age 50.

Genetic predisposition: Genetic susceptibility is a contributing factor in those that develop

lung cancer at a younger age. A single gene for lung cancer has not been identified.
Abnormalities of p53 gene, a tumor-suppressor gene, have been suggested to be mutated in
many people with lung cancer. EGFL6 gene identified as potential tumor marker.

Race: African Americans, native Hawaiians, and non-Hispanic whites have greater risk of
lung cancer. Black men between the age of 35 and 64 years of age have twice the risk
compared to non-Hispanic Whites.

Chronic inflammation, chronic obstructive pulmonary disease (COPD), and pulmonary

fibrosis: Tuberculosis: Scarring of healthy lung tissue may lead to lung cancer development.
Pulmonary fibrosis: Silica is the probable lung carcinogen. COPD: Airflow limitation results
in a 6.44 times greater risk for lung cancer compared with the risk associated with absence of
ventilator impairment.

Type of Lung Cancer

To categorize lung cancers visible Pathologic features on light microscopy, are used. Lung
cancers are divided into two major groups, Small Cell Lung Cancer and Non–Small Cell
Lung Cancer

Non-Small Cell Lung Cancer

1. Squamous cell (epidermoid forms in the lining of the bronchial tubes). Most common
type of lung cancer in men. Decreasing incidence in last two decades. Typically
develops in segmental bronchi, causing bronchial obstruction and regional lymph
node involvement. Symptoms are related to obstruction : nonproductive cough,
pneumonia, atelectasis, that is, a collapsed lung, chest pain is a late symptom
associated with bulky tumor, Pancoast Tumor, or pulmonary sulcus tumor, begins in
the upper portion of the lung and commonly spreads to the ribs and spine causing
classic shoulder pain that radiates down the ulnar nerve distribution. Treatment:
surgical resection is preferred before the development of metastatic disease,
chemotherapy and radiation therapy to decrease the incidence of recurrence.
2. Adenocarcinoma. Most common form in Unites States, Increasing incidence in
females. Occurs in non smokers. adenocarcinoma develops in the periphery of the
lungs and frequently metastasizes to brain, bone, and liver. Symptoms: no symptoms
with small peripheral lesions, Identifi ed by routine chest radiograph/CT scan.
Treatment: surgical resection and chemotherapy and radiation therapy to decrease the
incidence of recurrence.
3. Bronchioalveolar (BAC). Form near the lung’s air sacs. BAC may have abnormal
gene in their tumor cells. Targeted chemotherapy treatment appears to be effective.
4. Large cell. Large cell: 10% of all lung cancer cases. Bulky peripheral tumor.
Metastasizing to brain, bone, adrenal glands, or liver. Symptoms related to obstruction
or metastatic spread pneumonitis and pleural effusions. Treatment: surgical resection
(limited because of the often aggressive course of this tumor type) and chemotherapy
and radiation therapy (palliative role to minimize symptoms of advanced disease).
Small-Cell Lung Cancer
Patients with SCLC often have widespread disease at the time of diagnosis. Rapid clinical
deterioration in patients with chest masses often indicates SCLC

1. Oat cell carcinoma Oat cell carcinoma: 13% of all lung cancers. Most aggressive type,
greater tendency to metastasize than Non-Small Cell Lung Cancer Strongly related to
cigarette smoking often occurs within the mainstem bronchi and segmental bronchi;
80% of cases have hilar and mediastinal node involvement. Symptoms:
Paraneoplastic syndrome: syndrome of inappropriate antidiuretic hormone (SIADH),
Hyponatremia, fluid retention, weakness, and fatigue, Ectopic adrenocorticotropic
hormone (ACTH) production, Hypokalemia, hyponatremia, hyperglycemia, lethargy,
and confusion. Treatment for Oat cell carcinoma, Surgery rarely indicated even in
those with limited stage disease because of the need for immediate systemic therapy
and chemotherapy and radiation therapy offers the best hope for prolonged survival
and quality of life. Majority of the patients respond to chemotherapy and radiation
therapy but recurrence rate is very high. Two-thirds of patients demonstrate evidence
of extensive disease at the time of diagnosis.
2. Non-Bronchogenic Carcinomas. Undifferentiated non-small cell lung cancer
(NSCLC). Non-bronchogenic carcinomas undifferientated non-small cell lung cancer
(NSCLC) : <5% of all lung cancers combined: Mesothelioma a rare tumor of the
parietal pleura, Mesothelioma is another rare type of cancer which affects the
covering of the lung (the pleura). It is often caused by exposure to asbestos, bronchial
adenoma (carcinoid), fibrosarcoma.

Staging of Lung Cancer

Knowing the stage of Lung Cancer is important because treatment is often decided according
to the stage of a Lung cancer. TNM staging system. TNM staging takes the following factors
into account. The size of the Lung Cancer (T). Whether Lung Cancer cells have spread into
the lymph nodes (N) whether the Lung Cancer has spread anywhere else in the body -
secondary cancer or metastases (M)

Stage of Lung cancer

TNM (Tumor, Nodes, Metastases) system of staging

TNM Stage of Lung cancer Description:

Primary tumor (T)
 TX; Primary tumor cannot be assessed, or tumor proven by the presence of malignant
cells in sputum or bronchial washings but not visualized by imaging or bronchoscopy.
 T0 : No evidence of primary tumor

 Tis : Carcinoma in situ

 T1 : Tumor 3 cm in greatest dimension, surrounded by lung or visceral pleura, without
bronchoscopic evidence of invasion more proximal than the lobar bronchus (i.e., not
in the main bronchus)
  T2: Tumor with any of the following features of size or extent: 3 cm in greatest
dimension. Involves main bronchus, 2 cm distal to the carina Invades the visceral
pleura Associated with atelectasis or obstructive pneumonitis that extends to the hilar
region but does not involve the entire lung.
 T3 : Tumor of any size that directly invades any of the following: chest wall
(including superior sulcus tumors), diaphragm, mediastinum pleura, parietal
pericardium; or tumor in the main bronchus, 2 cm distal to the carina, but without
involvement of the carina; or associated atelectasis or obstructive pneumonitis of the
entire lung
 T4: Tumor of any size that invades any of the following: mediastinum, heart, great
vessels, trachea, esophagus, vertebral body, carina; or tumor with a malignant pleural
or pericardial effusion, b or with satellite tumor nodule(s) within the ipsilateral
primary-tumor lobe of the lung

Regional lymph nodes (N)

 NX Regional lymph nodes cannot be assessed
 N0 No regional lymph node metastasis

 N1 Metastasis to ipsilateral peribronchial and/or ipsilateral hilar lymph nodes, and

intrapulmonary nodes involved by direct extension of the primary tumor
 N2 Metastasis to ipsilateral mediastinal and/or subcarinal lymph node(s)
 N3 Metastasis to contralateral mediastinal, contralateral hilar, ipsilateral, or
contralateral scalene, or supraclavicular lymph node(s)

Distant Metastasis (M)

 MX Presence of distant metastasis cannot be assessed
 M0 No distant metastasis

 M1 Distant metastasis present

Stage grouping (TNM subsets):

 Stage IA (T1 N0 M0), IB (T2 N0 M0). Most common form of early lung cancer
located only in the lungs. Detected on routine chest X-ray in patients who present for
unrelated medical condition or routine examination. Treatment-surgical resection.
 Stage IIA (T1 N1 M0), IIB (T2 N1 M0, T3 N0 M0). Tumors in the lung and lymph
nodes (hilar and bronchopulmonary nodes). Treatment-surgical resection and adjuvant
radiation or chemotherapy, or both. Induction chemotherapy before surgery is being
investigated. Patients with significant co-morbid disease surgery may not be an
option.
 Stage IIIA (T3 N1 M0, T1 N2 M0, T2 N2 M0, T3 N2 M0) Cancer in the lung and
lymph nodes on the same side of the chest. T3 tumors involving the main stem
 bronchi produce hemoptysis, Dyspnea, wheezing, atelectasis, and post obstructive
pneumonia. T3 tumors involving the pericardium or diaphragm may be symptomatic
but those involving the chest wall usually cause pain. Nodal disease is often
asymptomatic, if extensive nodal disease may cause compression of the proximal
airways and superior vena cava syndrome. Treatment—selected cases surgical
resection (T3NO-1), commonly multi-modality therapy with chemotherapy being
primary form of treatment; multiple trials of combined chemotherapy, radiation with
or without surgery are under investigation.
 Stage IIIB (T4 N0 M0, T4 N1 M0, T4 N2 M0, T1 N3 M0, T2 N3 M0, T3 N3 M0, T4
N3 M0) Cancer has spread to the lymph nodes on the opposite side of the chest. T4
tumors invade the mediastinum structures, and/or malignant pleural effusions. N3—
metastases. Treatment—chemotherapy and radiation therapy; in rare exceptions,
surgery may be considered.
 Stage IV (Any T Any N M1) Evidence of metastatic disease. Treatment often
palliative (to relieve symptoms). Clinical trials may offer some survival benefit.

Complications of Lung Cancer

Like many other neoplasm disease Complications of Lung Cancer occurs when lung cancer
metastasized to other organ, outside the Lung. Disease progression and metastasis cause
various complications. Early stage and localized disease may be asymptomatic. Symptoms
are often medically treated and attributed to conditions such as bronchitis, pneumonia, and
chronic obstructive pulmonary disease. Symptoms: cough & wheezing, increased sputum
production, hemoptysis, Dyspnea, pneumonia, pleural effusions.

Advanced disease predominant at time of diagnosis related to tumor growth and compression
of adjacent structures. When the primary tumor spreads to intrathoracic structures,
complications may include tracheal obstruction; esophageal compression with dysphagia;
phrenic nerve paralysis with hemidiaphragm elevation and dyspnea; sympathetic nerve
paralysis with Horner’s syndrome with ptosis, miosis, hemifacial anhydrosis, clubbing,
hypertrophic osteoarthropathy, bone pain, fatigue, dysphagia from esophageal compression,
wheezing or stridor, phrenic nerve paralysis with elevated hemidiaphragm, arrhythmias and
heart failure (from pericardial involvement), hypoxia related to lymphangitic spread, superior
vena cava syndrome (swelling of the face, neck and upper extremities and related to
compression of blood vessels in the neck and upper thorax.

Symptoms: chronic cough, Dyspnea, weight loss, increased sputum production, hemoptysis,
hoarseness (involvement of the laryngeal nerve), pleural effusions and atelectasis, chronic
pain, pain over the shoulder and medial scapula, arm pain with or without muscle wasting
along ulnar distribution,
Lung cancer usually cause breathing or heart problems such as:
• Pleural effusion
• Pericardial effusion
• Coughing up large amounts of bloody sputum.
• Collapse of a lung (pneumothorax).
• Blockage of the airway (bronchial obstruction).
• Recurrent infections, such as pneumonia.
Other complications are anorexia and weight loss, sometimes leading to cachexia, digital
clubbing, and hypertrophic osteoarthropathy. Endocrine syndromes may involve production
of hormones and hormone precursors.

Extra thoracic spread of disease: adrenal glands (50%), liver (30%), brain (20%), bone
(20%), kidneys (15%), scalene lymph nodes. Prognosis remains poor and has improved very
slightly despite medical advances: <14% combined 5-year survival rate.

Nursing Diagnosis for Lung Cancer

To determine nursing diagnosis for Lung cancer, Nurses use Nursing assessment as tools for
collecting data from the patients. Its included patient history, physical psychosocial
assessment, and result from Diagnostic tests.

Nursing Assessment Nursing care Plans for Lung Cancer

Patient History
Establish a history of persistent cough, chest pain, Dyspnea, weight loss, or hemoptysis.
Smoking history, other risk factors (family history, occupational risks), associated diseases
(COPD, tuberculosis, and emphysema), symptom description and onset. Ask if the patient has
experienced a change in normal respiratory patterns or hoarseness. Some patients initially
report pneumonia, bronchitis, and epigastria pain, symptoms of brain metastasis, arm or
shoulder pain, or swelling of the upper body. Ask if the sputum has changed color, especially
to a bloody, rusty, or purulent hue. Elicit a history of exposure to risk factors by determining
if the patient has been exposed to industrial or air pollutants. Check the patient’s family
history for incidence of lung cancer

Physical examination
The clinical findings of lung cancer may be localized to the lung or may result from the
regional or distant spread of the disease. Lung auscultation, respiratory rate and depth,
palpitation of supraclavicular area for tumor or lymphatic involvement or both, clubbing,
nicotine stains to skin, hair, teeth. Lung cancer clinical manifestations depend on the type and
location of the tumor. Because the early stages of this disease usually produce no symptoms,
it is most often diagnosed when the disease is at an advanced stage. In 10% to 20% of
patients, lung cancer is diagnosed without any symptoms, usually from an abnormal finding
on a routine chest x-ray.

Auscultation may reveal a wheeze if partial bronchial obstruction has occurred. Auscultate
for decreased breath sounds, rales, or rhonchi. Note signs of an airway obstruction, such as
extreme shortness of breath, the use of accessory muscles, abnormal retractions, and stridor.
Monitor the patient for oxygenation problems, such as increased heart rate, decreased blood
pressure, or an increased duskiness of the oral mucous membranes. Metastases to the
mediastinum lymph nodes may involve the laryngeal nerve and may lead to hoarseness and
vocal cord paralysis. The superior vena cava may become occluded with enlarged lymph
nodes and cause superior vena cava syndrome; note edema of the face, neck, upper
extremities, and thorax.

Psychosocial
The patient is faced with a psychological adjustment to the diagnosis of a chronic illness that
frequently results in death. Patient undergoes major lifestyle changes as a result of the
physical side effects of cancer and its treatment. Interpersonal, social, and work role
relationships change. Evaluate the patient for evidence of altered moods such as depression or
anxiety, and assess the patient’s coping mechanisms and support system.

Diagnostic tests For Lung Cancer

1. Chest radiographs plain anterior-posterior and lateral views not reliable to find lung
tumors in their earliest stage.
2. Chest Computed Tomography (CT) three-dimensional image of the lungs and lymph
nodes (can detect tumors as small as 5 millimeters). CT is only about 80% accurate in
predicting mediastinum node involvement.
3. Spiral computed tomography of the chest.
4. Magnetic Resonance Imaging (MRI) 92% accuracy in the diagnosis of mediastinum
invasion.
5. Positron Emission Tomography (PET) scan is based upon increased glucose
metabolism in cancer cells. The PET scan uses a glucose analogue
radiopharmaceutical to identify increased glycolysis in tumor tissues. The PET scan is
a highly sensitive test in the diagnosis and staging of lung cancer.
6. Bronchoscopic detection of tumor auto fluorescence could improve cure rates in
selected groups at high-risk.
7. Sputum cytology
8. Percutaneous transthoracic needle biopsy
9. Fine needle aspiration or biopsy
10. Bronchoscopy.
11. Mediastinoscopy to evaluate lymph node involvement.
12. Scalene node biopsy (evaluate lymph node involvement)
13. experimental Photodynamic therapy; An injection of a light-sensitive agent with
uptake by cancer cells, followed by exposure to a laser light within 24 to 48 hours,
will result in fluorescence of cancer cells or cell death. Especially helpful in
identifying developing cancer cells or “carcinoma in-situ.” Also used to determine the
extent of disease and the response to treatment.
14. Assessment of distant metastasis: Abdominal CT (identify adrenal or liver metastasis),
Head CT, MRI (brain), Bone scan; Thoracentesis (detect malignant cells in the pleural
fluid).

Nursing Diagnosis for Lung Cancer

Common Nursing diagnosis found in nursing care plans for patient with Lung Cancer:
1. Impaired gas exchange related to Removal of lung tissue, altered oxygen supply.
2. Ineffective Airway Clearance May be related to : Increased amount or viscosity of
secretions, Restricted chest movement, pain, Fatigue, weakness
 3. Acute Pain May be related to: Surgical incision, tissue trauma, and disruption of
intercostals nerves, Presence of chest tube, Cancer invasion of pleura, chest wall
4. Fear/Anxiety [specify level] May be related to: Situational crises, Threat to or change
in health status, Perceived threat of death.
5. Deficient Knowledge [Learning Need] regarding condition, treatment, prognosis, self-
care, and discharge needs. May be related to : Lack of exposure, unfamiliarity with
information or resources, Information misinterpretation, Lack of recall

Common Treatment Methods of Lung Cancer

A common treatment method of Lung Cancer is Surgery, chemotherapy and radiotherapy is
all classified as a treatment for lung cancer. Knowing the stage of Lung Cancer is important
because treatment is often decided according to the stage of a Lung cancer. Lung cancer
accounts for more deaths than prostate, breast, and colon cancer combined. The 1-year
survival rate remains approximately 41%, and the 5-year survival rate is 15%. Only 16% of
lung cancers are found at an early, localized stage, when the 5-year survival rate is 49%. The
survival rate for lung cancer has not improved over the last 10 years.

Common treatment methods of Lung Cancer

Surgery Treatment for Lung Cancer

The treatment of choice for non-small cell lung cancer, Stage IA, IB, IIA, IIB, and selected
cases of stage IIIA : lobectomy (removal of a lobe of the lung), pneumonectomy (removal of
one lung), wedge resection or segmentectomy for patients with inadequate pulmonary reserve
who cannot tolerate lobectomy, VATS (Video Assisted Thoroscopic Surgery), palliative
surgery. Before surgery patient must know the risk factor from Lung Cancer Surgery; Risks
from lung cancer surgery include damage to structures in or near the lungs, general risks
related to surgery, and risks from general anesthesia

Patient education before surgery: patient understands surgical procedure, incision, placement
of chest tubes; smoking cessation before surgery to reduce pulmonary complications pain
control; bronchodilators, coughing and deep-breathing exercises, early ambulation after
surgery.
After surgery : assess respiratory function (respiratory rate, level of dyspnea, use of accessory
muscles, and arterial blood gases); monitor chest tube drainage and air leaks ; monitor
oxygen saturation at rest and ambulation ; assess pain control ; chest physical therapy
(bronchial drainage positions, deep breathing, coughing) ; early ambulation ; monitor for
atrial arrhythmias ; discharge planning and home care arrangements.

Chemotherapy Treatment for Lung Cancer

Researchers are continually looking at different ways of combining new and old drugs for
advanced non-small cell lung cancer.

Chemotherapy Treatment for Non-Small Cell Lung Cancer

 1. Customize treatment; Erlotinib (Tarceva) for people whose tumors have epidermal
growth factor receptors, a genetic mutation. Gefitinib (Iressa) effective in people
whose lung tumors have similar genetic mutations.
2. Targeted treatments for advanced non-small cell lung cancer; Sunitinib (Sutent) works
by cutting off blood supply and blockingnthe cancer cells their ability to grow.
Sorafenib (Nexavar) suppresses receptors for vascular endothelial growth factor
platelet derived growth factor—plays a critical role in the growth of blood vessels that
feed the cancer (angiogensis).
3. Combined methods are the treatment of choice for selected cases of stage IIIA and
IIIB; Cispatin, Paclitaxel and Gemcitabine, Gemcitabine and Vinorelbine, Carboplatin
and Paclitaxel and radiation, Cisplatin and Vinblastine and radiation
4. Stage IV; Carboplatin and Paclitaxel, Carboplatin and Gemcitabine, Cisplatin and
Vinorelbine, Docetaxel and Gemcitabine, Pemetrexed, Chemotherapy combined with
Cetuximab (Erbitux): Cetuximab binds to epidermal growth factor receptors (EGFR),
preventing a series of reactions in the cell that lead to lung cancer.
5. Progression of disease: Single-agent Docetaxel, Gemcitabine, Paclitaxel
6. Investigational New treatment approaches are being investigated all the time. Mage-
A3 vaccine and non-small cell lung cancer, Bortezomib (Velcade) proteasome
inhibitors destroys cancer cells

Chemotherapy Treatment for Small-Cell Lung Cancer

1. Limited-stage disease; Pulmonary resection stage I or stage II, Etoposide and
Cisplatin and Radiation, Etoposide and Carboplatin
2. Extensive stage disease: Etoposide and Carboplatin +/− Paclitaxel, Adriamycin,
Cyclophosphamide
3. Investigational: Vaccine-autologous dendritic cell-adenovirus p53

Chemotherapy treatment Complications, Myelosuppression (infection, anemia, bleeding),

nephrotoxicity, nausea and vomiting, mucositis (inflammation of the mucous membranes),
fatigue, SIADH and hyponatremia, hypotension, anaphylaxis, alopecia (hair loss),
neurotoxicity (peripheral neuropathies, central nervous system toxicity), cardiomyopathy,
arrhythmias, congestive heart failure, myocardial infarction, pneumonitis or pulmonary
fibrosis, taste changes.
Patient education (chemotherapy): chemotherapeutic agents, treatment schedule, adverse
effects of drugs.

Radiation therapy Treatment for Lung Cancer

1. External beam radiotherapy used as an adjunct to surgery to decrease tumor size, to
cure patients considered inoperable for medical or pathologic reasons, or to decrease
symptoms. Radiation after surgery: to improve resectability of tumor & to sterilize
microscopic disease. Radiation after surgery: to treat disease confined to one hemi
 thorax with hilar or mediastinum nodal metastasis & to reduce local recurrence (if
positive surgical margins exist). Prophylactic cranial irradiation: limited disease
small-cell lung cancer to reduce reoccurrence in CNS.
2. Brachytherapy placement of radioactive sources (seeds or catheter) directly into or
adjacent to a tumor. Intraoperative: reduce local recurrence. Symptom palliation
(relief of pain from bone metastases, hemoptysis, superior vena cave syndrome,
airway obstruction).

Complications of radiation therapy: Dyspnea, cough, initial increase in mucus production,

and then dry cough, fatigue, skin erythema, esophagitis and dysphagia, pneumonitis, lung
fibrosis.
Patient education: radiation therapy: indelible markings, treatment schedule, site-specific
adverse effects (within treatment field).

Treatment alternatives
Neoadjuvant is therapy given before the primary therapy to improve effectiveness (e.g.,
chemotherapy or radiation before surgery). Adjuvant treatments are equally beneficial and
often given concurrently or immediately following one another to maximize effectiveness
(e.g., surgery and adjuvant chemotherapy after surgery), multimodality is therapy that
combines more than one method of treatment (e.g. concurrent chemotherapy and radiation,
such as, adjuvant and Neoadjuvant)

Home care considerations

After lung surgery: smoking cessation, control of incision pain, wound care, breathing
exercises and coughing, pursed lip breathing exercises, maintain fluid intake, maintaining
your nutrition, resume activity, regaining arm and shoulder function.

During and after radiation therapy: monitor side effects of radiation therapy and report any
change in.
Symptoms: Dyspnea, fatigue is common lasting 4–6 weeks after therapy, good nutrition,
liquid diet supplement during periods of esophagitis, avoid wearing tight clothes, skin care.

During and after chemotherapy, advise patients:

1. To identify all treatment related side effects and report changes
2. Fatigue may last weeks to months
3. To plan their day, and allow for periods of rest
4. Try activities such as yoga, exercise, meditation, and guided imagery
5. Keep a diary and document symptoms, activity level, nutrition, treatments, and
emotions
6. To monitor effectiveness of pain medications
7. To monitor for any signs of infection, such as an increased temperature, redness or
swelling, and that the latter symptoms may not be present during weeks of impaired
immunity following chemotherapy administration
8. Monitor weight change and appetite
 9. Nutritional supplements

Pulmonary rehabilitation programs: exercise strengthening, breathing exercises, walking

program, nebulizers/aerosol medication delivery, disease specific instruction and support.
Support groups: Lung Cancer specific, Better Breathers Club a support group sponsored by
the American Lung Association for patients with chronic lung disease. Hospice: dignified
dying, pain management, end of life issues, patient/family support.

NCP Nursing Care Plan For Lung Cancer

NCP Nursing care Plan for Lung Cancer. Common Nursing Diagnosis found in nursing care
plan for Lung Cancer: Impaired gas exchange related to Removal of lung tissue, altered
oxygen supply, Ineffective Airway Clearance May be related to Increased amount or viscosity
of secretions, Restricted chest movement, pain, Fatigue, weakness, Acute Pain May be related
to Surgical incision, tissue trauma, and disruption of intercostals nerves, Presence of chest
tube, Cancer invasion of pleura, chest wall, Fear/Anxiety specify level May be related to:
Situational crises, Threat to or change in health status, Perceived threat of death, Deficient
Knowledge [Learning Need] regarding condition, treatment, prognosis, self-care, and
discharge needs. May be related to: Lack of exposure, unfamiliarity with information or
resources, Information misinterpretation, Lack of recall

Sample Nursing care Plan for Lung Cancer with interventions and rationale

Nursing diagnosis Impaired gas exchange

May be related to:
• Removal of lung tissue (Surgery Treatment for Lung Cancer)
• Altered oxygen supply hypoventilation
• Decreased oxygen-carrying capacity of blood (blood loss).
Nursing outcomes and evaluation criteria client will: Respiratory status: gas exchange,
Demonstrate improved ventilation and adequate oxygenation of tissues by arterial blood
gases (ABGs) within client normal range, be free of symptoms of respiratory distress, the
patient will maintain adequate ventilation. The patient will maintain a patent airway.
Nursing Interventions Nursing care Plan for Lung Cancer Nursing diagnosis Impaired gas
exchange:
Respiratory Management:
1. Note respiratory rate, depth, and ease of respirations. Observe for use of accessory
muscles, pursed-lip breathing, or changes in skin or mucous membrane Rationale
Respirations may be increased as a result of compensatory mechanism to
accommodate for loss of lung tissue or pain.
2. Auscultate lungs for air movement and abnormal breath sounds. Rationale
Consolidation and lack of air movement on operative side are normal in the client
who has had a pneumonectomy; but in a client who has had a lobectomy should
demonstrate normal airflow in remaining lobes.
3. Investigate restlessness and changes in mentation and level of consciousness.
Rationale May indicate increased hypoxia or complications such as mediastinum shift
in a client who has had a pneumonectomy when accompanied by tachypnea,
tachycardia, and tracheal deviation.
 4. Assess client response to activity. Encourage rest periods, limiting activities to client
tolerance. Rationale Increased oxygen consumption and demand and stress of surgery
may 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.
5. Note development of fever. Rationale Fever within the first 24 hours after surgery is
frequently due to atelectasis. Temperature elevation within postoperative day 5 to 10
usually indicates an infection, such as wound or systemic.

Airway Management:
1. Maintain patent airway by positioning, suctioning, and use of airway adjuncts.
Rationale Airway obstruction impedes ventilation, impairing gas exchange. (Refer to
ND: ineffective Airway Clearance).
2. Reposition frequently, placing client in sitting and supine to side positions. Rationale
Maximizes lung expansion and drainage of secretions.
3. Avoid positioning client with a pneumonectomy on the operative side. Rationale
Research shows that positioning clients 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.
4. Encourage and assist with deep-breathing exercises and pursed lip breathing, as
appropriate. Rationale Promotes maximal ventilation and oxygenation and reduces or
prevents atelectasis.
5. Administer supplemental oxygen via nasal cannula, partial rebreathing mask, or high-
humidity face mask, as indicated. Rationale 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.
6. Assist with and encourage use of incentive spirometer. Rationale Prevents or reduces
atelectasis and promotes reexpansion of small airways.
7. Monitor and graph ABGs and pulse oximetry readings. Note hemoglobin (Hgb)
levels. Rationale Decreasing PaO2 or increasing PaCO2 may indicate need for
ventilatory support. Significant blood loss results in decreased oxygen-carrying
capacity, reducing PaO2.

Tube Care Chest:

1. Maintain patency of chest drainage system following lobectomy and segmental wedge
resection procedures. Rationale Drains fluid from pleural cavity to promote re
expansion of remaining lung segments.
2. Note changes in amount or type of chest tube drainage. Rationale 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 a hemothorax, sudden cessation suggests
blockage of tube, requiring further evaluation and intervention.
3. Observe for presence of bubbling in water-seal chamber. Rationale Air leaks
appearing immediately postoperatively 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 client
versus a problem in the drainage system.

Nursing diagnosis Ineffective Airway Clearance

May be related to:
• Increased amount or viscosity of secretions
• Restricted chest movement, pain
• Fatigue, weakness
Nursing Outcomes and Evaluation Criteria Client Will:
• Respiratory Status: Airway Patency
• Demonstrate patent airway, with fluid secretions easily expectorated, clear breath sounds,
and noiseless respirations.

Nursing Interventions nursing care Plan for Lung Cancer Nursing diagnosis Ineffective
Airway Clearance
1. Auscultate chest for character of breath sounds and presence of secretions. Rationale:
Noisy respirations, rhonchi, and wheezes are indicative of retained secretions or
airway obstruction.
2. Assist client with and provide instruction in effective deep breathing, coughing in
upright position (sitting), and splinting of incision. Rationale Upright position favors
maximal lung expansion, and splinting improves force of cough effort to mobilize and
remove secretions. Splinting may be done by nurse placing hands anteriorly and
posterior over chest wall and by client, with pillows, as strength improves.
3. Observe amount and character of sputum and aspirated secretions. Investigate
changes, as indicated. Rationale Increased amounts of colorless (or blood-streaked) or
watery secretions are normal initially and should decrease as recovery progresses.
Presence of thick, tenacious, bloody, or purulent sputum suggests development of
secondary problems for example, dehydration, pulmonary edema, local hemorrhage,
or infection that require correction or treatment.
4. Suction if cough is weak or breathe sounds not cleared by cough effort. Avoid deep
endotracheal and nasotracheal suctioning in client who has had pneumonectomy if
possible. Rationale Suctioning increases risk of hypoxemia and mucosal damage.
Deep tracheal suctioning is generally contraindicated. If suctioning is unavoidable, it
should be done gently and only to induce effective coughing.
5. Encourage oral fluid intake, within cardiac tolerance. Rationale Adequate hydration
aids in keeping secretions loose and enhances expectoration.
 6. Assess for pain and discomfort and medicate on a routine basis and before breathing
exercises. Rationale Encourages client to move, cough more effectively, and breathe
more deeply to prevent respiratory insufficiency.
7. Provide and assist client with incentive spirometer and postural drainage and
percussion, as indicated. Rationale Improves lung expansion and ventilation and
facilitates removal of secretions. Note: Postural drainage may be contraindicated in
some clients, and, in any event, must be performed cautiously to prevent respiratory
embarrassment and incision discomfort.
8. Use humidified oxygen and ultrasonic nebulizer. Provide additional fluids
intravenously (IV), as indicated. Rationale Maximal hydration helps promote
expectoration. Impaired oral intake necessitates IV supplementation to maintain
hydration.
9. Administer bronchodilators, expectorants, and analgesics, as indicated. Rationale
Relieves bronchospasm to improve airflow. Expectorants increase mucus production
and liquefy and reduce viscosity facilitating removal of secretions.

Nursing Diagnosis Acute Pain

May be related to:
• Surgical incision, tissue trauma, and disruption of intercostals nerves
• Presence of chest tubes
• Cancer invasion to pleura or chest wall
Nursing Outcomes and Evaluation Criteria Client Will:
• Pain Level
• Report pain relieved or controlled.
• The patient will express feelings of comfort and decreased pain
• Appear relaxed and sleep or rest appropriately.
• Participate in desired as well as needed activities.
Nursing Interventions and rationale nursing care Plan for Lung Cancer with nursing diagnosis
Acute Pain
1. Ask client about pain. Determine pain location and characteristics. Have client rate
intensity on a scale of 0 to 10. Rationale Helpful in evaluating cancer related pain
symptoms, which may involve viscera, nerve, or bone tissue. Use of rating scale aids
client in assessing level of pain and provides tool for evaluating effectiveness of
analgesics, enhancing client control of pain.
2. Assess client verbal and nonverbal pain cues. Rationale Discrepancy between verbal
and nonverbal cues may provide clues to degree of pain and need for and
effectiveness of interventions.
3. Note possible pathophysiological and psychological causes of pain. Rationale Fear,
distress, anxiety, and grief can impair ability to cope. Posterolateral incision is more
uncomfortable for client than an anterolateral incision. Discomfort can greatly
increase with the presence of chest tubes.
4. Evaluate effectiveness of pain control. Encourage sufficient medication to manage
pain; change medication or time span as appropriate. Rationale Pain perception and
pain relief are subjective, thus pain management is best left to client’s discretion. If
 client is unable to provide input, the nurse should observe physiological and
nonverbal signs of pain and administer medications on a regular basis.
5. Encourage verbalization of feelings about the pain. Rationale Fears and concerns can
increase muscle tension and lower threshold of pain perception.
6. Provide comfort measures such as frequent changes of position, back rubs, and
support with pillows. Encourage use of relaxation techniques including visualization,
guided imagery, and appropriate Diversional activities. Rationale Promotes relaxation
and redirects attention. Relieves discomfort and therapeutic effects of analgesia.
7. Schedule rest periods, provide quiet environment. Rationale Decreases fatigue and
conserves energy, enhancing coping abilities.
8. Assist with self care activities, breathing, arm exercises, and ambulation. Rationale
Prevents undue fatigue and incision strain. Encouragement and physical assistance
and support may be needed for some time before client is able or confident enough to
perform these activities because of pain or fear of pain.
9. Assist with patient-controlled analgesia (PCA) or analgesia through epidural catheter.
Administer intermittent analgesics routinely, as indicated, especially 45 to 60 minutes
before respiratory treatments, and deep-breathing and coughing exercises. Rationale
Maintaining a constant drug level avoids cyclic periods of pain, aids in muscle
healing, and improves respiratory function and emotional comfort and coping.

Nursing Diagnosis Fear/Anxiety [specify level]

May be related to:
• Situational crises
• Threat to or change in health status
• Perceived threat of death
Nursing Outcomes and Evaluation Criteria Client Will:
• Fear Self-Control or Anxiety Self-Control
• Acknowledge and discuss fears and concerns.
• Demonstrate appropriate range of feelings and appear relaxed and resting appropriately.
• Verbalize accurate knowledge of situation.
• Report beginning use of individually appropriate coping strategies.
Nursing Interventions and rationale nursing care Plan for Lung Cancer with nursing diagnosis
Fear/Anxiety:
1. Evaluate client and significant other (SO) level of understanding of diagnosis.
Rationale Client and SO are hearing and assimilating new information that includes
changes in self-image and lifestyle. Understanding perceptions of those involved sets
the tone for individualizing care and provides information necessary for choosing
appropriate interventions.
2. Acknowledge reality of client’s fears and concerns and encourage expression of
feelings. Rationale Support may enable client to begin exploring and dealing with the
reality of cancer and its treatment. Client may need time to identify feelings and even
more time to begin to express them.
3. Provide opportunity for questions and answer them honestly. Be sure that client and
care providers have the same understanding of terms used. Rationale Establishes trust
and reduces misperceptions or misinterpretation of information.
 4. Accept, but do not reinforce, client’s denial of the situation. Rationale When extreme
denial or anxiety is interfering with progress of recovery, the issues facing client need
to be explained and resolutions explored.
5. Note comments and behaviors indicative of beginning acceptance or use of effective
strategies to deal with situation. Rationale Fear and anxiety will diminish as client
begins to accept and deal positively with reality. Indicator of client’s readiness to
accept responsibility for participation in recovery and to “resume life.”
6. Involve client and SO in care planning. Provide time to prepare for events and
treatments. Rationale May help restore some feeling of control and independence to
client who feels powerless in dealing with diagnosis and treatment.
7. Provide for client’s physical comfort. Rationale It is difficult to deal with emotional
issues when experiencing extreme or persistent physical discomfort.

Nursing Diagnosis Deficient Knowledge Learning Need regarding condition, treatment,

prognosis, self-care, and discharge needs
Related to:
• Lack of exposure, unfamiliarity with information or resources
• Information misinterpretation
• Lack of recall
Nursing Outcomes and Evaluation Criteria Disease Process and Treatment Regimen Client
Will:
• Verbalize understanding of ramifications of diagnosis, prognosis, and possible
complications.
• Participate in learning process Knowledge of the Disease Process.
• Verbalize understanding of therapeutic regimen.
• Correctly perform necessary procedures and explain reasons for the actions.
• Initiate necessary lifestyle changes.

Nursing Interventions and rationale nursing care Plan for Lung Cancer with nursing diagnosis
Deficient Knowledge Learning Need regarding condition, treatment, prognosis, self-care, and
discharge needs:
1. Discuss diagnosis, current and planned therapies, and expected outcomes. Rationale
Provides individually specific information, creating knowledge base for subsequent
learning regarding home management. Radiation or chemotherapy may follow
surgical intervention, and information is essential to enable the client and SO to make
informed decisions.
2. Reinforce surgeon’s explanation of particular surgical procedure, providing diagram
as appropriate. Incorporate this information into discussion about short- and long-term
recovery expectations. Rationale Length of rehabilitation and prognosis depend on
type of surgical procedure, preoperative physical condition, and duration and degree
of complications.
3. Discuss necessity of planning for follow-up care before discharge. Rationale Follow-
up assessment of respiratory status and general health is imperative to assure optimal
 recovery. Also provides opportunity to readdress concerns or questions at a less
stressful time.
4. Identify signs and symptoms requiring medical evaluations, such as changes in
appearance of incision, development of respiratory difficulty, fever, increased chest
pain, and changes in appearance of sputum. Rationale Early detection and timely
intervention may prevent or minimize complications. Stress importance of avoiding
exposure to smoke, air pollution, and contact with individuals with upper respiratory
infections (URIs).
5. Review nutritional and fluid needs. Suggest increasing protein and use of high-calorie
snacks as appropriate. Rationale Meeting cellular energy requirements and
maintaining good circulating volume for tissue perfusion facilitate tissue regeneration
and healing process.
6. Identify individually appropriate community resources, such as American Cancer
Society, visiting nurse, social services, and home care. Rationale Agencies such as
these offer a broad range of services that can be tailored to provide support and meet
individual needs.
7. Help client determine activity tolerance and set goals. Rationale Weakness and fatigue
should decrease as lung heals and respiratory function improves during recovery
period, especially if cancer was completely removed. If cancer is advanced, it is
emotionally helpful for client to be able to set realistic activity goals to achieve
optimal independence.
8. Evaluate availability and adequacy of support system(s) and necessity for assistance
in self-care and home management. Rationale General Weakness and activity
limitations may reduce individual’s ability to meet own needs.
9. Encourage alternating rest periods with activity and light tasks with heavy tasks.
Stress avoidance of heavy lifting and isometric or strenuous upper body exercise.
Reinforce physician’s time limitations about lifting. Rationale 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. Note: Strenuous
use of arms can place undue stress on incision because chest muscles may be weaker
than normal for 3 to 6 months following surgery.
10. Recommend stopping any activity that causes undue fatigue or increased shortness of
breath. Rationale Exhaustion aggravates respiratory insufficiency.
11. Instruct and provide rationale for arm and shoulder exercises. Have client or SO
demonstrate exercises. Encourage following graded increase in number and intensity
of routine repetitions. Rationale Simple arm circles and lifting arms over the head or
out to the affected side are initiated on the first or second postoperative day to restore
normal range of motion (ROM) of shoulder and to prevent ankylosis of the affected
shoulder.
12. Encourage inspection of incisions. Review expectations for healing with client.
Rationale 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).
 13. Instruct client and SO to watch for and report places in incision that do not heal or
reopening of healed incision, any drainage (bloody or purulent), and localized area of
swelling with redness or increased pain that is hot to touch. Rationale Signs and
symptoms indicating failure to heal, development of complications requiring further
medical evaluation and intervention.
14. Suggest wearing soft cotton shirts and loose-fitting clothing; cover portion of incision
with pad, as indicated, and leave incision open to air as much as possible. Rationale
Reduces suture line irritation and pressure from clothing. Leaving incisions open to
air promotes healing process and may reduce risk of infection.
15. Shower in warm water, washing incision gently. Avoid tub baths until approved by
physician. Rationale Keeps incision clean and promotes circulation and healing. Note:
“Climbing” out of tub requires use of arms and pectoral muscles, which can put undue
stress on incision.
16. Support incision with butterfly bandages as needed when sutures and staples are
removed. Rationale Aids in maintaining approximation of wound edges to promote
healing.

Patient Teaching, Discharge And Home Healthcare Guidelines for patient with Lung
Cancer

Patient Teaching, Discharge and Home Healthcare Guidelines for patient with Lung Cancer
usually divide in to before surgery and post surgery. Be sure the patient understands any
medication prescribed, including dosage, route, action, and side effects. Teach the patient
about medical procedure before surgery and post surgery. Teach the patient how to maximize
her or his respiratory effort.

Patient Teaching, Discharge and Home Healthcare Guidelines for Lung Cancer
 Before surgery, supplement and reinforce what the physician has told the patient about
the disease and the operation.
 Teach the patient about postoperative procedures and equipment. Discuss urinary
catheterization, chest tubes, endotracheal tubes, dressing changes, and I.V. therapy.
 If the patient is receiving chemotherapy or radiation therapy, explain possible adverse
effects of these treatments. Teach him ways to avoid complications, such as infection.
Also review reportable adverse effects.
 Educate high-risk patients about ways to reduce their chances of developing lung
cancer or recurrent cancer.
 Refer smokers to local branches of the American Cancer Society or Smokenders.
Provide information about group therapy, individual counseling, and hypnosis.
 Urge all heavy smokers older than age 40 to have a chest X-ray annually and
cytologic sputum analysis every 6 months. Also encourage patients who have
recurring or chronic respiratory tract infections, chronic lung disease, or a nagging or
changing cough to seek prompt medical evaluation.
Patient Teaching, Discharge and Home Healthcare Guidelines for Lung Cancer post Surgery
 Provide the patient with the names, addresses, and phone numbers of support groups,
such as the American Cancer Society, the National Cancer Institute, the local hospice,
the Alliance for Lung Cancer Advocacy, Support & Education (ALCASE), and the
Visiting Nurses Association
 Teach the patient to recognize the signs and symptoms of infection at the incision site,
including redness, warmth, swelling, and drainage. Explain the need to contact the
physician immediately
 Warn an outpatient to avoid tight clothing, sunburn, and harsh ointments on his chest.
Teach him exercises to prevent shoulder stiffness.
 Teach him how to cough and breathe deeply from the diaphragm and how to perform
range-of-motion exercises. Reassure him that analgesics and proper positioning will
help to control postoperative pain.