Lung Cancer Nursing Diagnosis and Nursing Care Plans

Lung Cancer Nursing Care Plans Diagnosis and Interventions

Lung Cancer NCLEX Review and Nursing Care Plans

Lung cancer is a type of malignancy or carcinoma that develops in the lungs. It is usually characterized by the uncontrolled proliferation of lung tissues.

When it comes to developing lung cancer, those who smoke have the highest risk, but the disease can also affect nonsmokers. For people who have been smoking long-term, quitting smoking will greatly reduce their risk of lung cancer.

Types of Lung Cancer

Lung cancer can be classified into two types:

  1. Small Cell Lung Cancer (SCLC). This type is more common in heavy smokers. This type of cancer cell is both small and highly aggressive. After treatment, SCLC is more likely than other lung cancers to relapse. 
  2. Non-small Cell Lung Cancer (NSCLC). Non-small cell lung cancer is a broad term that encompasses a variety of lung cancers. This tends to spread more slowly than small cell lung cancer. Adenocarcinoma, giant cell carcinoma, and squamous cell carcinoma fall under this type. 

Stages of Lung Cancer

Non-small cell lung cancer is divided into four stages:

  • Stage 1: Cancer has not metastasized.
  • Stage 2: Cancer is detected in the lung and surrounding lymph nodes.
  • Stage 3: Cancer has metastasized in the lymph nodes and lungs
  • Stage 3A: Cancer has metastasized in the lymph nodes (only on the side where cancer cells first proliferate)
  • Stage 3B: Cancer has progressed to other lymph nodes
  • Stage 4: Cancer has metastasized to other distant organs

Causes of Lung Cancer

The majority of lung cancers are caused by smoking. Predisposed individuals include smokers and those who inhale second-hand smoke.

When smoke (which contains carcinogens) is inhaled, it quickly damages the lungs. And although the lungs are capable of repairing themselves, prolonged exposure to smoking delays the healing process.

Common causes include:

  • Active and passive smoking
  • Contact or exposure to radon
  • Inhalation of carcinogenic or hazardous substances such as:
    • Asbestos
    • Cadmium
    • Chromium
    • Uranium
    • Nickel
    • Certain petroleum products
    • Arsenic
  • Genetic predisposition
  • Occupational Exposure
  • Pollution
  • Underlying diseases such as tuberculosis

Risk Factors to Lung Cancer

  • Family history
  • Smoking or exposure to second-hand smoke
  • Previous radiation treatment
  • Exposure to carcinogens (occupational or environmental)

Signs and Symptoms of Lung Cancer

Early signs may include the following:

Additional symptoms may occur as cancer progresses, and these will depend on the site of the tumor:

  • Presence of small mass or lumps in the collarbone or neck
  • Bone pain
  • Horner syndrome
  • Jaundice
  • Paraneoplastic syndrome

Localized symptoms include: 

Diagnosis of Lung Cancer

  • Physical Examination/Assessment
  • Sputum Cytology. This determines the presence of abnormal or cancerous cells in the client’s phlegm. 
  • Mediastinoscopy. A procedure wherein the physician creates an incision at the base of the neck. The instrument (mediastinoscope) will examine the mediastinum to remove or obtain lymph node samples. It is usually done in a hospital under general anesthesia.
  • Imaging tests (e.g., MRI, CT scan, PET scans, and X-ray). These scans usually determine whether cancer has metastasized and reveal the presence of abnormal mass. 
  • Biopsy such as:
  • Needle Biopsy. This procedure involves the insertion of a needle with imaging guidance, allowing identification of nodule and removal of a tissue sample for histopathologic examination.  
  • Bronchoscopy. This test helps observe the client’s airways. A flexible and narrow tube is inserted down the throat and into the trachea to allow for a more thorough examination.

Further tests and investigations may be required depending on the stage, findings, and analysis. 

Treatment for Lung Cancer

Treatment may vary depending on the diagnosis and findings of the handling physician. In addition, therapeutic approaches may depend on the type and stage of cancer. 

Lung cancer management includes discussing treatment and care options with the following professionals:

  • Pulmonologist
  • Thoracic surgeon
  • Radiation oncologist
  • Medical oncologist

The coordination of treatment plans will be dependent on the analysis of healthcare providers. Generally, here are some approaches to cancer treatment

  1. Surgery. Some of the most common surgical interventions for lung cancer include:
    • Pneumonectomy. This procedure involves the removal of a lung, which is a common approach for patients with NSCLC. 
    • Segmentectomy. This procedure involves the removal of lung tissue (segment) to improve and preserve respiratory function. 
    • Wedge resection. This procedure involves the removal of the cancerous wedge-shaped section in the tissues of the lung. This procedure is effective given that the cancer is diagnosed earlier and found within a small area. 
  2. Radiation therapy. This is performed to control and manage neoplasm that cannot be removed surgically. Moreover, this can reduce tumor size.
  3. Chemotherapy. Chemotherapeutic agents are used to inhibit tumor growth and treat lung cancer, especially in cases when the cancer has metastasized.

Prevention of Lung Cancer

  • Smoking cessation
  • Vitamin (A, E & C) intake
  • Routine screening
  • Precaution with environmental exposure to carcinogens

Nursing Diagnosis for Lung Cancer

Lung Cancer Nursing Care Plan 1

Deficient Knowledge

Nursing Diagnosis: Deficient Knowledge related to lack of information about the condition, secondary to lung cancer, as evidenced by agitation, verbalization of concern or worry, poor follow-through on instructions, and frequent information requests.

Desired Outcome: The patient will verbalize understanding of the condition, treatment, diagnosis, prognosis, and probable complications.

Lung Cancer Nursing InterventionsRationale
Provide information to the patient about the diagnosis, planned treatments, length of therapy, possible complications, and expected outcomes.Provides base knowledge and awareness, as patients have a right to know about their care plan and treatment alternatives. Additionally, radiologic intervention or chemotherapy may be required, and providing critical information enables the patient to make an informed decision.
Include an explanation of the surgical procedure from the surgeon. Supplement a diagram if necessary. This information should be incorporated into the discussion of short- and long-term therapeutic goals.Preoperative state, type of surgery, and severity of condition all have an impact on the patient’s recovery, prognosis, and duration of rehabilitation.
Prior to setting goals, evaluate the patient’s response to the activity and his/her tolerance levels.  Monitoring the patient’s activity can help identify trends in his/her level of tolerance in performing self-care activities (or ADLs). During the recovery period, generalized weakness and fatigue should diminish as the patient’s respiratory status improves and the lung(s) recovers. Setting realistic goals and exercises will assist lung cancer patients in regaining control of their life and encourage independence.
Emphasize the need for discharge planning based on the patient’s needs and arrange for follow-up tests or appointments.It’s critical to conduct follow-up evaluations on the patient’s respiratory status, ventilation, and general well-being to ensure optimal recovery. Additionally, it allows time to revisit concerns/questions.  
Post-surgery:
Equip the patient with the necessary knowledge regarding proper deep breathing, range-of-motion exercises, and coughing techniques.This provides baseline knowledge from which the patient can use to maximize recovery. Additionally, breathing exercises to aid in maximizing lung volume following surgery.
Adjust the patient’s care plan to include alternate intervals of rest and activity. Allow for breaks in both light and heavy tasks. Recommend tension-free workouts and avoid hard exercises, heavy lifting, and isometric exercises. Maintain the physician’s restrictions on lifting duration.Lethargy and fatigue are common during the recovery period, but they often subside as the patient’s respiratory functions improve and the patient recovers. Meanwhile, rest promotes the patient’s recuperation, strengthens his or her coping mechanisms, and alleviates anxiety. Strenuous exercise should be avoided for 3-6 months following surgery since severe tension can put a strain on the incision.
Review the patient’s nutritional and fluid intake. Instruct him/her to consume a high protein diet and to consume high-calorie snacks as needed.An adequate diet stimulates tissue regeneration since the body’s energy requirements are met, and there is sufficient circulation volume to aid in tissue perfusion.

Lung Cancer Nursing Care Plan 2

Anxiety/Fear

Nursing Diagnosis: Anxiety/Fear related to change in health status, secondary to lung cancer, as evidenced by apprehension, increased pain, insomnia withdrawal, and denial.

Desired Outcome: The patient will effectively acknowledge his/her fear and will demonstrate effective coping strategies.

Lung Cancer Nursing InterventionsRationale
Assess the patient’s, his/her family members, or significant others’ (SO) understanding of the condition and diagnosis.Assessing the patient’s and significant other’s level of understanding enables the development of individualized care plans. Both the patient and SO’s knowledge base may change over time, influencing their decisions and expectations. By assessing their level of awareness of the disease state, adjustments to the care plan can be made.
Allow the patient to express any issues or anxieties they may have. Be sure to talk with a calm voice and maintain a non-judgmental attitude. Ascertain that the patient comprehends the terminology used or employs basic terms.To build trust and provide an avenue for communication and resolution of issues/concerns. The use of simple phrases will help avoid misunderstandings or misinterpretations.
Monitor the patient’s behavior, expression, and remarks to see whether he/she is beginning to accept his/her condition or is employing appropriate techniques to deal with it.The patient’s anxiety and fear will gradually subside as he or she accepts and comprehends the situation; this will enable him or her to deal better and apply measures to improve their way of life. To ascertain whether the patient is prepared, he or she will take ownership of their own care, recuperation, and coping mechanism. Additionally, the patient will readily resume normal daily activities.
Reassure the patient with positive reinforcement and acknowledge his/her worries, concerns, and anxieties. Encourage him/her to communicate negative emotions.In order to help the patient deal with the reality of cancer and its tests, treatment, or complications, it is important to provide him/her with a support system. Expression of feelings also improves the patient’s sense of comfort and control over their situation.
Work with the patient and significant other(s) in the planning process and review potential treatment options and available techniques. Provide the patient time to prepare for upcoming activities or treatments planned.When a patient lacks a support system, anxiety or fear levels may escalate. He or she may also feel uneasy, powerless, or vulnerable as a result of the treatment and diagnosis. By allowing them to participate in the care plan, they will regain a sense of control and independence.

Lung Cancer Nursing Care Plan 3

Impaired Gas Exchange

Nursing Diagnosis: Impaired Gas Exchange related to lung tissue removal, secondary to lung cancer, as evidenced by dyspnea, cyanosis, restlessness, and hypoxemia.

Desired Outcome: The patient will demonstrate the absence of respiratory distress with improved ventilation and oxygenation.

Lung Cancer Nursing InterventionsRationale
Evaluate the patient’s rate, rhythm, and depth of respiration. Observe chest movement, pursed-lip breathing, use of accessory muscles, and changes in the skin (Note for pallor, cyanosis, and color)To establish a baseline set of observations and address difficulties in breathing. Initial observation of increased respirations may indicate the body’s compensatory response for the loss of lung tissue. Meanwhile, increased respiratory effort and peripheral cyanosis may suggest an increase in energy consumption, oxygen intake, and reduced respiratory reserve.
Promote rest breaks and keep activities to a level that is tolerable of the patientEarly rehabilitation and mobilization improve circulatory efficiency and reduce the risk of pulmonary complications. By allowing proper rest, it will minimize respiratory compromise or impairment.
Observe and evaluate the patient’s response to the activity.To determine the patient’s tolerance to the program. Increased stress response to surgery, oxygen intake, and energy expenditure as a result of the activity can cause changes in the patient’s vital signs. He/she may also experience dyspnea and fatigue.
Ascertain the patency of the chest tube drainage system in patients who have undergone lung segmentectomy, lobectomy, segmental resection, or wedge resection.Chest tube helps drain fluids from the pleural space, which alleviates the patient’s dyspnea, pulmonary discomfort, and pressure. In addition, it allows re-expansion of the lung segment.
Maintain accurate arterial blood gas, hemoglobin levels, and pulse oximetry readings on the patientPatients with lung cancer frequently experience breathing difficulties, and the requirement for ventilation support may be indicated by a decrease or increase in oxygen partial pressure (PaO2). Alternatively, severe blood loss might result in diminished oxygen-carrying capacity, resulting in a decrease in PaO2.
Auscultate the patient’s lungs and monitor for air movement or abnormal breath sounds.Patients with lung cancer who have had a pneumonectomy (surgical removal of the lung) may exhibit respiratory consolidation and decreased airflow. Post-pneumonectomy, it’s also possible to observe abnormal breath sounds. On the other hand, patients who have had lobectomy surgery should have normal airflow in the remaining lobes.
Encourage the patient to adopt supine to side positions and upright sitting positions.To optimize oxygen supply, fluid drainage, and lung expansion.
Observe the patient’s level of consciousness (LOC) and assess for signs of restlessness or changes in mentation.Pneumonectomy patients experience impaired oxygen consumption which may lead to complications such as hypoxia. Tachycardia, tachycardia, and tracheal deviation may also occur as a result of a mediastinal shift.
Promote relaxation and breathing exercises (e.g., deep and pursed-lip breathing) by assisting the patient as necessary. To cultivate a supportive environment for the patient and to establish rapport. Additionally, breathing techniques will increase oxygenation and ventilation to the lungs, hence minimizing lung collapse or atelectasis.

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Lung Cancer Nursing Care Plan 4

Acute Pain

Nursing Diagnosis: Acute Pain related to tissue trauma, secondary to lung cancer, as evidenced by reports of pain, discomfort, restlessness, withdrawal, changes in blood pressure, and respiratory rate.

Desired Outcome: The patient will report pain relief and demonstrate effective strategies to alleviate his/her pain.

Lung Cancer Nursing InterventionsRationale
Take note of the patient’s verbal and nonverbal indications of pain.The disparity between verbal and nonverbal cues can reveal information about the severity of pain, the need for intervention, and the efficacy of the program.
Assess the patient’s pain by asking him/her to rate the intensity of the pain on a scale of 0 to 10. Analyze the features of pain (e.g., stabbing, persistent, sore, or burning)To assess cancer-related pain (e.g., visceral pain, tumor, nerve changes, bone pain) possibly due to surgery, pressure, tests, tumor, or treatment. On the other hand, employing a rating scale to quantify pain intensity and the efficacy of analgesics may help patients control their pain more effectively, resulting in significant control of their condition.
Assess the efficacy of pain management. Encourage the use of sufficient medication to manage pain; if necessary, modify the dosage or the time period.Pain reaction, perception, and relief are subjective. If the patient is unable to convey his or her pain, the nurse should monitor any signs of discomfort and deliver medication as needed.
Establish rest breaks and provide a calm and peaceful environment. To relax muscles, alleviate fatigue, and relieve stiffness. This might also be useful in conserving their energy stores to promote normal function.
Encourage early ambulation and support the patient with self-care activities (ADLs), energy conservation techniques, breathing exercises, and arm exercises.  It assists in preventing post-operative incisional tension and fatigue. Additionally, supporting and motivating the patient might help them develop the confidence and self-esteem necessary to execute their tasks independently.
Encourage patient-nurse communication and support him/her in verbalizing feelings of pain.To help build a trusting relationship. Similarly, patients who suffer from high levels of anxiety are more sensitive to pain, reduced pain threshold, or have an altered perception of it.
Assist the patient in controlling his/her pain through patient-controlled analgesia (PCA) or epidural analgesia. Analgesics should be routinely provided for intermittent pain (given 45–60 minutes) prior to deep breathing, respiratory treatments, or coughing exercises.It relieves the patient’s discomfort.

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Lung Cancer Nursing Care Plan 5

Ineffective Airway Clearance

Nursing Stat Facts
Nursing Stat Facts

Nursing Diagnosis: Ineffective Airway Clearance related to limited chest movement, secondary to lung cancer, as evidenced by dyspnea, ineffective coughing, presence of abnormal breath sounds, and changes in respiration

Desired Outcome: The patient will demonstrate patent airway and effective expectoration with absent abnormal breath sounds 

Lung Cancer Nursing InterventionsRationale
Perform auscultation of the lungs and listen for the presence of secretions and the nature of breath sounds.Impaired airway clearance and atelectasis are evidenced by wheezing, noisy breathing, and rhonchi. 
Suction secretions or foreign particles if the patient is unable to clear them. As needed, implement suctioning to clear excess secretions and instruct the patient on proper coughing and breathing techniques.Thick secretions can impair gas exchange in the small airways, and suctioning may be necessary for patients with lung cancer. Take note that suctioning on a “routine” basis raises the risk of hypoxemia and mucosal injury. Post-pneumonectomy patients are strongly discouraged from undergoing tracheostomy suctioning to avoid rupturing the suture line of the bronchial stump. If necessary, suctioning should be performed gently and only to the level necessary to promote efficient coughing.
Examine the patient’s sputum or aspirated secretions for volume, color, and consistency. Note the changes that have occurred.  Although it is typical to see watery, colorless, blood-streaked discharges during the early stages of recovery, they will subside as the patient recovers. When there is the presence of thick, tenacious, purulent, or bloody sputum, it signals the presence of secondary problems such as pulmonary edema, local bleeding, infection, and dehydration, all of which require rapid checking and treatment.
Provide ultrasonic nebulizer or oxygen therapy to the patient. Administer intravenous fluids (IV) as necessary.It is easier to mobilize or eliminate secretions when the body is supplied with as much hydration as possible. Furthermore, providing the patient with humidified oxygen will help to alleviate the sensation of dryness. To ensure hydration, patients who are unable to consume enough fluids through oral consumption must be given IV hydration.  
Recommend that the patient consume at least 2.5 L of fluids daily within the limits of his/her cardiac tolerance.Complications must be avoided at all costs, as they contribute to cancer progression. Proper hydration improves ventilation and secretion mobilization by keeping secretions moist and easy to expectorate.  
Instruct the patient on the proper use of splint (lung expansion is facilitated by immobilization and cushioning) techniques when coughing or performing deep breathing exercises. Advise the patient to cough in an upright position and decrease stress on the involved area.Splinting the incision relieves discomfort and pain associated with coughing and deep breathing in order to eliminate secretions. Bracing and discomfort management can be eased by splinting done by the nurse. The patient will be supported as the nurse places his/her hands over the chest wall and by the patient (when strength improves) using cushions to support themselves while trying to expectorate. Moreover, an upright position promotes lung expansion.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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