Lung cancer is a malignant tumor that starts in the airways or lung tissue. Most cases are linked to smoking, and many are found only after the cancer has spread. The nursing diagnoses used most often are Impaired Gas Exchange, Chronic Pain, Inadequate Protein-Energy Nutritional Intake, and Risk for Infection. Nursing care centers on breathing and oxygenation, pain control, nutrition, infection prevention during treatment, spotting oncologic emergencies early, and supporting the patient and family, with palliative care alongside treatment.
At a glance
- What it is
- Cancer that begins in the lung. Two main groups: non-small cell lung cancer (NSCLC, about 85% of cases, including adenocarcinoma and squamous cell carcinoma) and small cell lung cancer (SCLC, about 15%, fast-growing and usually spread at diagnosis).
- Common causes and links
- Cigarette smoking is the leading cause. Others include secondhand smoke, radon, asbestos and other workplace exposures, air pollution, prior chest radiation, and family history. People who have never smoked can also get lung cancer.
- Key signs
- A cough that does not go away or changes, coughing up blood, shortness of breath, chest pain, hoarseness, repeated pneumonia, fatigue, loss of appetite, and unplanned weight loss. Bone pain, headache, or confusion can mean spread.
- Nursing focus
- Oxygenation and breathing, pleural effusion care, pain control with opioid safety, nutrition and weight, infection prevention during chemotherapy, watching for oncologic emergencies, symptom relief, and emotional and palliative support.
- Act now
- Sudden worse breathlessness or chest pain, coughing up more than streaks of blood, fever during chemotherapy, new back pain with leg weakness or loss of bladder or bowel control, swelling of the face and arms with neck vein distention, or new confusion needs the provider or rapid response team right away.
How lung cancer develops
Repeated exposure to carcinogens, mainly tobacco smoke, damages the DNA of cells lining the airways. Over years, damaged cells grow out of control and form a tumor. The tumor can block an airway, which collapses the lung beyond it and traps secretions, leading to pneumonia. It can bleed, causing hemoptysis, or spread to the pleura, where it causes a malignant pleural effusion that squeezes the lung and causes breathlessness.
Lung cancer spreads through the lymph nodes and blood, most often to the bones, brain, liver, and adrenal glands. Bone metastases cause pain and fractures and can press on the spinal cord. Some tumors make hormone-like substances (paraneoplastic syndromes), such as high calcium with squamous cell cancer and SIADH with small cell cancer.
Cancer also changes metabolism. Many patients develop cancer cachexia: loss of muscle and fat that eating more does not fully reverse, together with poor appetite, fatigue, and weakness.
How is it treated?
| Treatment | What it does |
|---|---|
| Surgery | Lobectomy or a smaller resection for early-stage NSCLC. After surgery the patient has a chest tube, pain, and a high risk of atelectasis and pneumonia. |
| Radiation | Used to cure small tumors in people who cannot have surgery, with chemotherapy for some stages, and to relieve symptoms such as bone pain, airway blockage, or superior vena cava syndrome. |
| Chemotherapy | Kills fast-dividing cells. Side effects include low blood counts, nausea, fatigue, and mouth sores. The lowest blood counts usually come about 1 to 2 weeks after a dose, depending on the drug. |
| Targeted therapy | Oral or IV drugs that act on a specific change in the tumor, such as an EGFR or ALK mutation. Tumor biomarker testing decides who can receive them. |
| Immunotherapy | Immune checkpoint inhibitors help the immune system attack the cancer. They can cause inflammation in almost any organ, such as pneumonitis, colitis, or thyroid problems, even months after starting. |
| Palliative care | Symptom relief and support for the patient and family. It can start at diagnosis, alongside cancer treatment, and does not mean stopping treatment. |
Nursing assessment
Subjective data
- Cough: how long, any change, and sputum amount and color
- Coughing up blood: how much and how often
- Shortness of breath at rest, with talking, or with activity; how many pillows needed to sleep
- Pain: location, intensity, character, what makes it better or worse, and how well current medicines work
- Appetite, early fullness, taste changes, nausea, trouble swallowing, and usual weight
- Fatigue and how it limits daily activities
- Smoking history in pack-years, current tobacco or vaping use, and exposure to radon, asbestos, or other workplace hazards
- Treatment history: date of last chemotherapy or immunotherapy, radiation, and side effects
- Fears, mood, sleep, spiritual concerns, goals of care, and support at home
Objective data
- Respiratory rate, depth, and effort; use of accessory muscles; ability to speak in full sentences
- Oxygen saturation at rest and with activity, compared with the target the provider sets
- Breath sounds: diminished sounds and dullness to percussion over an effusion, wheeze over a blocked airway, crackles with pneumonia
- Temperature, heart rate, and blood pressure; signs of infection
- Weight on the same scale, percent of meals eaten, muscle wasting
- Clubbing, hoarseness, and lymph node enlargement
- Swelling of the face, neck, or arms with distended neck and chest veins (superior vena cava syndrome)
- Leg strength, sensation, and bladder and bowel function in a patient with back pain
- Mental status: confusion or sleepiness can come from high calcium, low sodium, brain metastases, low oxygen, or medicines
- Lab results as ordered: complete blood count with absolute neutrophil count, electrolytes including sodium and calcium, albumin, and liver and kidney function
- Diagnostics as ordered: chest X-ray, CT, PET scan, biopsy with tumor biomarker testing, and pleural fluid analysis
Nursing diagnoses used with lung cancer
- Impaired Gas Exchange — tumor, pleural effusion, or blocked airways reducing the lung area available for oxygen exchange
- Chronic Pain — tumor spread to bone, chest wall, or nerves lasting longer than three months
- Inadequate Protein-Energy Nutritional Intake — poor appetite, nausea, taste changes, breathlessness during meals, and cachexia
- Risk for Infection — low neutrophil counts from chemotherapy, poor nutrition, invasive lines, and blocked airways
- Ineffective Airway Clearance — tumor blocking an airway, thick secretions, and a weak cough
- Fatigue — cancer, treatment, anemia, poor sleep, and poor nutrition
- Anxiety and Death Anxiety — a serious diagnosis, breathlessness, and uncertainty about the future
- Decreased Activity Tolerance — breathlessness and weakness with daily activities
Worked care plans
Four plans in the same ADPIE shape. The scenario is a 66-year-old woman with stage IV non-small cell lung cancer (adenocarcinoma) with a right-sided malignant pleural effusion and metastases to the ribs and thoracic spine. She smoked for 40 pack-years and quit 8 years ago. She is receiving chemotherapy with immunotherapy; her second cycle was 10 days ago. She is admitted with a week of worsening shortness of breath. Respiratory rate is 26, heart rate 104, blood pressure 126/78, and temperature 37.4°C (99.3°F). Oxygen saturation is 88% on room air and 93% on 2 L/min by nasal cannula. Breath sounds are diminished with dullness to percussion over the lower right chest, and the chest X-ray shows a large right pleural effusion. She has had constant pain in her right ribs and mid-back for 4 months, now 6/10 and worse with coughing; oncology has her on a long-acting opioid with a breakthrough dose. Leg strength, sensation, and bladder and bowel control are normal. She weighs 58 kg, down from 64 kg three months ago. Her absolute neutrophil count is 1,100/mm³, hemoglobin 10.6 g/dL, and calcium 9.4 mg/dL. The team orders a thoracentesis and consults palliative care and a dietitian.
1. Impaired Gas Exchange
Problem-focusedSubjective: “I can’t catch my breath, even just talking to you. I have to sit up to sleep.”
Objective: Respiratory rate 26, heart rate 104. Oxygen saturation 88% on room air, 93% on 2 L/min. Speaks in short phrases. Diminished breath sounds and dullness over the lower right chest. Large right pleural effusion on chest X-ray.
Impaired Gas Exchange related to compression of lung tissue by a malignant pleural effusion and tumor involvement of the lung, as evidenced by oxygen saturation of 88% on room air, respiratory rate of 26, dyspnea while talking, and diminished breath sounds on the right.
- Patient keeps oxygen saturation within the target range the provider sets
- Patient reports less breathlessness and can speak in full sentences within 24 hours after the effusion is drained
- Patient shows positioning and breathing techniques that ease dyspnea before discharge
- Monitor respiratory rate, effort, breath sounds, and oxygen saturation at the ordered frequency and with any change
- Give oxygen as ordered and adjust it to the target range the provider sets
- Raise the head of the bed and help her sit upright, leaning forward on an over-bed table, to ease breathing
- Prepare her for thoracentesis: confirm consent, position her sitting and leaning forward, and stay with her during the procedure
- After thoracentesis, monitor vital signs, oxygen saturation, and breath sounds, and report sudden chest pain, worse breathlessness, a cough that will not stop, or falling saturation, which can signal a pneumothorax or re-expansion pulmonary edema
- Teach pursed-lip breathing and pacing, and use a fan directed at the face, which can lessen the feeling of breathlessness
- Give medicines for dyspnea as ordered, such as a low-dose opioid prescribed by the palliative care team, and monitor sedation and breathing
- If fluid returns, help the team and patient discuss longer-term options such as an indwelling pleural catheter or pleurodesis
After thoracentesis her respiratory rate was 20 and her oxygen saturation stayed within her target on 1 L/min. The follow-up chest X-ray showed no pneumothorax. She spoke in full sentences and used pursed-lip breathing when walking. Goal met; the team is discussing an indwelling pleural catheter if the fluid returns.
2. Chronic Pain
Problem-focusedSubjective: “My ribs and back have hurt for months. It’s a 6 right now, and when I cough it’s like a knife. I wake up every couple of hours.”
Objective: Pain 6/10 in right ribs and mid-back for 4 months. Splints her right side when coughing, grimaces with position changes, walks only to the bathroom. Known rib and thoracic spine metastases. Leg strength, sensation, and bladder and bowel control normal.
Chronic Pain related to tumor infiltration of the ribs and thoracic spine, as evidenced by reported pain of 6/10 lasting 4 months, guarding when coughing, disturbed sleep, and reduced activity.
- Patient reports pain at or below her own acceptable level within 48 hours
- Patient sleeps longer stretches and walks in the hallway
- Patient stays alert with a normal breathing rate while on opioids, and has a regular bowel pattern
- Assess pain with the same scale each time, including location, character, and her acceptable pain level, and reassess after each dose
- Give the scheduled long-acting opioid on time and the breakthrough dose as ordered, and report pain that stays above her goal so the regimen can be adjusted
- Check sedation level and respiratory rate before and after opioid doses using your facility’s sedation scale; sedation usually comes before slowed breathing
- Give the ordered bowel regimen and track bowel movements, because opioids cause constipation that does not improve over time
- Check leg strength, sensation, and bladder and bowel function each shift, and report new or worse back pain or any change at once
- Teach her to hug a pillow against her ribs when coughing, and use heat, repositioning, relaxation, and distraction alongside medicine
- Coordinate with palliative care, and ask the team about radiation for painful bone metastases
After the palliative care team adjusted her regimen, her pain was 3/10, which she called acceptable. She slept 5 to 6 hours at a time and walked the hallway twice a day. She stayed alert with a respiratory rate of 18 to 20 and had a bowel movement every 1 to 2 days. Neurologic checks stayed normal. Goal met; radiation to the spine is being planned.
Free download
NCLEX Readiness Diagnostic
Fifty questions with a written rationale on every option, scored by section so you can see which content area is weakest. Sent as a PDF.
3. Inadequate Protein-Energy Nutritional Intake
Problem-focusedSubjective: “Food tastes like metal, and I’m full after a few bites. By the time I’ve eaten a little, I’m out of breath.”
Objective: Weight 58 kg, down from 64 kg three months ago (about 9% loss). Eats about half of each meal. Muscle wasting at the temples and upper arms. Nausea for 2 to 3 days after each chemotherapy dose.
Inadequate Protein-Energy Nutritional Intake related to poor appetite, early fullness, taste changes and nausea from chemotherapy, and breathlessness during meals, as evidenced by a 6 kg weight loss over three months, eating half of each meal, and muscle wasting.
- Patient takes the calorie and protein amounts the dietitian sets
- Patient’s weight stays stable on weekly checks
- Patient names three ways to manage taste changes and nausea
- Weigh her on the same scale at the same time, and record the percent of meals and supplements she takes
- Request a dietitian consult and give oral nutrition supplements as ordered
- Offer small, frequent meals and snacks high in protein and calories, and serve her largest meal when her appetite is best
- Give antiemetics as ordered before meals and before chemotherapy
- Let her rest before meals, keep oxygen on during meals, and sit her upright to eat
- Provide mouth care before meals and check for mouth sores or thrush
- Suggest cold or room-temperature foods, plastic utensils, and tart flavors if food tastes metallic
- Treat constipation and pain, which also reduce appetite, and focus on comfort and enjoyment of food as goals of care change
By discharge she was eating about 75% of five small meals and drinking two supplements a day. Her weight was unchanged at the 1-week check. She described using cold foods and plastic utensils and taking her antiemetic before meals. Goal partly met; continue dietitian follow-up and weekly weights.
4. Risk for Infection
Risk diagnosis- Low neutrophil count from chemotherapy, near the expected low point 10 days after treatment
- Weight loss and poor protein intake
- Invasive procedures: thoracentesis and an implanted port
- Reduced lung expansion and a weak cough, which allow secretions to collect
No “as evidenced by” — she has no fever and no signs of infection. The plan prevents infection and catches one early.
Risk for Infection related to chemotherapy-induced neutropenia, inadequate nutrition, invasive procedures, and reduced lung expansion.
- Patient stays free of fever and of signs of infection during her stay
- Patient states her fever threshold and calls the oncology team at once if she reaches it
- Patient shows hand hygiene and describes food safety and port care
- Perform hand hygiene before every contact and follow your facility’s precautions for patients with neutropenia
- Check temperature at the ordered frequency and report a temperature at or above your facility’s neutropenic fever threshold at once
- Avoid rectal temperatures, suppositories, and enemas while her counts are low
- Use aseptic technique for port access and the thoracentesis site, and check sites each shift for redness, swelling, or drainage
- Encourage deep breathing, coughing, incentive spirometry, and walking to keep the lungs expanded
- Provide oral care with a soft toothbrush and check the mouth for sores
- Keep visitors with colds away and review vaccines with the oncology team; inactivated vaccines such as influenza are generally advised, and live vaccines are avoided during treatment
- Monitor the complete blood count with absolute neutrophil count as ordered
She stayed afebrile with clean port and thoracentesis sites, and her neutrophil count was rising at discharge. She stated her fever threshold, had a working thermometer at home, and kept the oncology 24-hour number on her phone. Goal met; reassess with each chemotherapy cycle.
Interventions and rationales
Client and family teaching
- Take your temperature if you feel unwell, and call your oncology team right away for a fever at the level they gave you; do not take acetaminophen first to “wait and see”
- Wash your hands often, avoid people who are sick, and follow food safety: cook meats fully and wash fruits and vegetables
- Take long-acting pain medicine on schedule, use the breakthrough dose when needed, and take your laxatives every day while on opioids
- Call 911 for sudden severe breathlessness, chest pain, or coughing up more than a small amount of blood
- Call your team right away for new or worse back pain, leg weakness or numbness, or trouble controlling your bladder or bowels
- Report swelling of your face or arms, new confusion, extreme thirst, or new cough or diarrhea during immunotherapy
- Use pursed-lip breathing, pace your activities, sit up to breathe easier, and use a fan
- Eat small meals often, use supplements as advised, and weigh yourself weekly
- If you smoke, ask for help to quit; quitting helps even after a cancer diagnosis
- Talk with your team about your goals, an advance directive, and who will make decisions if you cannot
NurseStudyPrep.com
You’ve read the care plan. Now answer one.
A priority item in the NCLEX format. On Prep, every option gets a written rationale — including the three that are wrong.
A client with lung cancer received chemotherapy 9 days ago. The client says, “I feel a little tired, but I’m fine.” The oral temperature is 38.4°C (101.1°F), and the client looks comfortable. Which action should the nurse take first?
Why B. Nine days after chemotherapy the neutrophil count is likely near its lowest point, and fever may be the only sign of a serious infection. This is treated as an emergency: cultures and antibiotics are started promptly. Treating the fever and rechecking delays care and can hide the trend, fluids do not treat the cause, and diet teaching can wait. Prep also explains why each wrong option looks reasonable.
7 days for $1, then $19 a month, $49 for three months or $129 for the school year. Cancel any time.
Frequently asked questions
What is the priority nursing diagnosis for lung cancer?
Impaired Gas Exchange or Ineffective Airway Clearance usually comes first, because breathing and oxygenation are the most immediate threats. In a patient receiving chemotherapy, a fever moves infection to the top. Pain, nutrition, and emotional support follow once the airway and oxygenation are managed.
What is the difference between small cell and non-small cell lung cancer?
Non-small cell lung cancer is the most common type and grows more slowly; early stages may be cured with surgery or radiation. Small cell lung cancer grows fast, is strongly linked to smoking, has usually spread by the time it is found, and is treated mainly with chemotherapy, immunotherapy, and radiation.
Who should be screened for lung cancer?
The U.S. Preventive Services Task Force recommends a yearly low-dose CT scan for adults aged 50 to 80 with a 20 pack-year smoking history who still smoke or quit within the past 15 years. Screening finds cancer earlier, when it is more treatable.
Why is Chronic Pain used instead of Acute Pain?
NANDA-I uses Chronic Pain when pain has lasted longer than three months, as with bone metastases. Acute Pain fits pain of recent onset, such as after a lobectomy or a new fracture. Choose the label that matches how long this patient’s pain has lasted.
What oncologic emergencies happen with lung cancer?
Superior vena cava syndrome, spinal cord compression, high calcium, SIADH with low sodium, febrile neutropenia, and large-volume hemoptysis. Each needs prompt reporting and treatment.
Can people who never smoked get lung cancer?
Yes. Radon, secondhand smoke, air pollution, asbestos and other workplace exposures, and inherited factors can all cause lung cancer. Adenocarcinoma is the most common type in people who have never smoked.
References
- Herdman, T. H., Kamitsuru, S., & Lopes, C. T. (Eds.). NANDA International Nursing Diagnoses: Definitions and Classification, 2024–2026. Thieme.
- Siddiqui, F., Vaqar, S., & Siddiqui, A. H. Lung Cancer. In StatPearls. StatPearls Publishing; updated regularly.
- National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Non-Small Cell Lung Cancer. Current version. nccn.org.
- U.S. Preventive Services Task Force. Screening for lung cancer: US Preventive Services Task Force recommendation statement. JAMA, 2021;325(10):962–970.
- Freifeld, A. G., Bow, E. J., Sepkowitz, K. A., et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 2011;52(4):e56–e93.
- Temel, J. S., Greer, J. A., Muzikansky, A., et al. Early palliative care for patients with metastatic non-small-cell lung cancer. New England Journal of Medicine, 2010;363(8):733–742.
- Fearon, K., Strasser, F., Anker, S. D., et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncology, 2011;12(5):489–495.
- Kiss, N. Nutrition support and dietary interventions for patients with lung cancer: current insights. Lung Cancer: Targets and Therapy, 2016;7:1–9.
- Centers for Disease Control and Prevention. Lung cancer risk factors. cdc.gov.
- Ackley, B. J., Ladwig, G. B., Makic, M. B. F., Martinez-Kratz, M. R., & Zanotti, M. Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care (13th ed.). Elsevier, 2023.
Oxygen saturation targets, vital sign and lab reference ranges, neutropenic fever thresholds and protocols, opioid and antiemetic choices and dosing, sedation scales, bowel regimens, thoracentesis procedures and limits, nutrition goals, vaccine timing, screening criteria, and cancer treatment plans vary by patient, by provider, and by facility. Follow the provider’s written orders and your own institution’s policies. This page supports study and does not replace course instruction or clinical judgment.
