Lung cancer is the leading cause of cancer death in the United States and usually develops within the wall or epithelium of the bronchial tree. The two major categories are small cell lung cancers (SCLC), such as oat cell; and non–small cell lung cancers (NSCLC), which include adenocarcinoma, squamous cell and large cell carcinomas.
Treatment options can include combinations of surgery, radiation, and chemotherapy. Surgery is the primary treatment for stage I and stage II tumors. Selected stage III carcinomas may be operable if the tumor is resectable. Surgical procedures for operable tumors of the lung include:
- Pneumonectomy (removal of an entire lung), performed for lesions originating in the mainstem bronchus or lobar bronchus.
- Lobectomy (removal of one lobe), preferred for peripheral carcinoma localized in a lobe.
- Wedge or segmental resection, performed for lesions that are small and well contained within one segment.
- Endoscopic laser resection may be done on peripheral tumors to reduce the necessity of cutting through ribs.
Nursing Care Plan for Lung Cancer | Nursing Priorities
Here is a Sample of Nursing Care Plan for Lung Cancer (Post Operative care ).
Nursing Care Plan for Lung Cancer: Nursing Priorities & Discharge Goals
Nursing Priorities | Nursing Care Plan for Lung Cancer
- Maintain/improve respiratory function.
- Control/alleviate pain.
- Support efforts to cope with diagnosis/situation.
- Provide information about disease process/prognosis and therapeutic regimen.
Discharge Goals | Nursing Care Plan for Lung Cancer
- Oxygenation/ventilation adequate to meet individual activity needs.
- Pain controlled.
- Anxiety/fear decreased to manageable level.
- Free of preventable complications.
- Disease process/prognosis and planned therapies understood.
- Plan in place to meet needs after discharge.
Nursing Care Plan for Lung Cancer: Nursing Diagnosis
Nursing Care Plan for Lung Cancer | Nursing Diagnosis of Lung Cancer- Gas Exchange, impaired May be related to Removal of lung tissue; Altered oxygen supply; (hypoventilation); Decreased oxygen-carrying capacity of blood (blood loss)
Nursing Care Plan for Lung Cancer: Nursing Intervention & Rationale
Nursing Interventions of Lung Cancer with Rationale
Respiratory Management (NIC)
Nursing Interventions of Lung Cancer with Rationale: Independent
- Note respiratory rate, depth, and ease of respirations. Observe for use of accessory muscles, pursed-lip breathing, changes in skin/mucous membrane color, e.g., pallor, cyanosis. Rationale: Respirations may be increased as a result of pain or as an initial compensatory mechanism to accommodate for loss of lung tissue; however, increased work of breathing and cyanosis may indicate increasing oxygen consumption and energy expenditures and/or reduced respiratory reserve, e.g., elderly patient or extensive COPD.
- Auscultate lungs for air movement and abnormal breath sounds. Rationale: Consolidation and lack of air movement on 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/level of consciousness. Rationale: May indicate increased hypoxia or complications such as mediastinal shift in pneumonectomy patient when accompanied by tachypnea, tachycardia, and tracheal deviation.
- Assess patient response to activity. Encourage rest periods/limit activities to patient tolerance. Rationale: 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. Rationale: Fever within the first 24 hr after surgery is frequently due to atelectasis. Fever within the 5th to 10th postoperative day usually indicates an infection, e.g., wound or systemic.
Airway Management (NIC)
Nursing Care Plan for Lung Cancer
Nursing Interventions of Lung Cancer with Rationale: Independent
- Maintain patent airway by positioning, suctioning, use of airway adjuncts. Rationale: Airway obstruction impedes ventilation, impairing gas exchange.
- Reposition frequently, placing patient in sitting positions and supine to side positions. Rationale: Maximizes lung expansion and drainage of secretions.
- Avoid positioning patient with a pneumonectomy on the operative side; instead, favor the “good lung down” position. Rationale: 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/assist with deep-breathing exercises and pursed-lip breathing as appropriate. Rationale: Promotes maximal ventilation and oxygenation and reduces/prevents atelectasis.
Tube Care: Chest (NIC)
Nursing Care Plan for Lung Cancer
Nursing Interventions of Lung Cancer with Rationale: Independent
- Maintain patency of chest drainage system for lobectomy, segmental/wedge resection patient. Rationale: Drains fluid from pleural cavity to promote re-expansion of remaining lung segments.
- Note changes in amount/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/hemothorax; sudden cessation suggests blockage of tube, requiring further evaluation and intervention.
- Observe presence/degree of bubbling in water-seal chamber. Rationale: 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.
Airway Management (NIC)
Nursing Care Plan for Lung Cancer
Nursing Interventions of Lung Cancer with Rationale: Collaborative
- 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.
- Assist with/encourage use of incentive spirometer. Rationale: Prevents/reduces atelectasis and promotes re-expansion of small airways.
- Monitor/graph ABGs, pulse oximetry readings. Note hemoglobin (Hb) levels. Rationale: Decreasing PaO2 or increasing PaCO2 may indicate need for ventilatory support. Significant blood loss can result in decreased oxygen-carrying capacity, reducing PaO2.
Nursing Care Plan for Lung Cancer: Overview; Nursing Care Plan for Lung Cancer: Nursing Priorities & Discharge Goals; Nursing Care Plan for Lung Cancer: Nursing Diagnosis; Nursing Care Plan for Lung Cancer: Nursing Intervention with Rationale. Nursing Care Plan for Lung Cancer.
