Nursing care for patients with lung cancer revolves around

comprehensive supportive care and patient teaching can minimize

complications and speed recovery from surgery, radiation
and/or chemotherapy. Here are 5 lung cancer nursing care plans.

1. Impaired Gas Exchange

May be related to

Removal of lung tissue

Altered oxygen supply (hypoventilation)
Decreased oxygen-carrying capacity of blood (blood loss)

Possibly evidenced by

Dyspnea
Restlessness/changes in mentation
Hypoxemia and hypercapnia
Cyanosis

Desired Outcomes

Demonstrate improved ventilation and adequate

oxygenation of tissues by ABGs within patients normal
range.
Be free of symptoms of respiratory distress.

Nursing Interventions Rationale

Note respiratory rate, depth, and ease of
respirations. Observe for use of accessory
muscles, pursed-lip breathing, changes in
skin or mucous membrane color, pallor,
cyanosis.
Respirations may be increased as a res
of pain or as an initial compensatory
mechanism to accommodate for loss o
tissue; however, increased work of
breathing and cyanosis may indicate
increasing oxygen consumption and en
 Nursing Interventions
Auscultate lungs for air movement and
abnormal breath sounds.
Investigate restlessness and changes in
mentation or level of consciousness.
Assess patient response to activity.
Encourage rest periods and limit activities
to patient tolerance.
Note development of fever.
Maintain patent airway by positioning,
suctioning, use of airway adjuncts.
Reposition frequently, placing patient in
sitting positions and supine to side
positions.
Avoid positioning patient with a
pneumonectomy on the operative side;
instead, favor the good lung down
Rationale
expenditures and/or reduced respirato
reserve.
Consolidation and lack of air movemen
operative side are normal in the
pneumonectomy patient; however, the
lobectomy patient should demonstrate
normal airflow in remaining lobes.
May indicate increased hypoxia or
complications such as mediastinal shift
pneumonectomy patient when accomp
by tachypnea, tachycardia, and trache
deviation.
Increased oxygen consumption deman
and stress of surgery can result in incr
dyspnea and changes in vital signs wit
activity; however, early mobilization is
desired to help prevent pulmonary
complications and to obtain and maint
respiratory and circulatory efficiency.
Adequate rest balanced with activity ca
prevent respiratory compromise.
Fever within the first 24 hr after surge
frequently due to atelectasis. Tempera
elevation within the 5th to 10th
postoperative day usually indicates a w
or systemic.
Airway obstruction impedes ventilation
impairing gas exchange.
Maximizes lung expansion and drainag
secretions.
Research shows that positioning patien
following lung surgery with their good
down maximizes oxygenation by usin
 Nursing Interventions Rationale

gravity to enhance blood flow to the h

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

Encourage and assist with deep-breathing Promotes maximal ventilation and

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

Maintain patency of chest drainage system

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

Bloody drainage should decrease in am

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

Air leaks immediately postoperative ar

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

Maximizes available oxygen, especially

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

Assist with and encourage use of Prevents or reduces atelectasis and

incentive spirometer. promotes re-expansion of small airway

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

indicate need for ventilatory support.

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

2. Ineffective Airway Clearance

May be related to

Increased amount/viscosity of secretions

Restricted chest movement/pain
Fatigue/weakness

Possibly evidenced by

Changes in rate/depth of respiration

Abnormal breath sounds
Ineffective cough
Dyspnea

Desired Outcomes

Demonstrate patent airway, with fluid secretions easily expectorated,

clear breath sounds, and noiseless respirations.

Nursing Interventions Rationale

Noisy respirations, rhonchi, and wheez

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

Assist patient and instruct in effective Upright position favors maximal lung
deep breathing and coughing with upright expansion, and splinting improves forc
position (sitting) and splinting of incision. cough effort to mobilize and remove
secretions. Splinting may be done by n
 Nursing Interventions
Observe amount and character of sputum
or aspirated secretions. Investigate
changes as indicated.
Suction if cough is weak or breath sounds
not cleared by cough effort. Avoid deep
endotracheal or nasotracheal suctioning in
pneumonectomy patient if possible.
Suction the patient as needed, and
encourage to begin deep breathing and
coughing as soon as possible.
Encourage oral fluid intake (at least 2500
mL/day) within cardiac tolerance.
Assess for pain or discomfort and
medicate on a routine basis and before
breathing exercises.
Assist with incentive spirometer, postural
drainage and percussion as indicated.
Use humidified oxygen and/or ultrasonic
nebulizer. Provide additional fluids via IV
as indicated.
Rationale
(placing hands anteriorly and posterior
over chest wall) and by patient (with
pillows) as strength improves.
Increased amounts of colorless, blood-
streaked, or watery secretions are nor
initially and should decrease as recove
progresses. Presence of thick or tenaci
bloody, or purulent sputum suggests
development of secondary problems
(dehydration, pulmonary edema, local
hemorrhage, or infection) that require
correction and treatment.
Routine suctioning increases risk of
hypoxemia and mucosal damage. Deep
tracheal suctioning is generally
contraindicated following pneumonecto
reduce the risk of rupture of the bronc
stump suture line. If suctioning is
unavoidable, it should be done gently
only to induce effective coughing.
Adequate hydration aids in keeping
secretions loose or enhances expector
Encourages patient to move, cough mo
effectively, and breathe more deeply t
prevent respiratory insufficiency.
Improves lung expansion or ventilation
facilitates removal of secretions. Postu
drainage may be contraindicated in so
patients and in any event must be
performed cautiously to prevent respir
embarrassment and incisional discomf
Providing maximal hydration helps loo
liquefy secretions to promote expector
Impaired oral intake necessitates IV
supplementation to maintain hydration
 Nursing Interventions Rationale

Relieves bronchospasm to improve air

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

3. Acute Pain

May be related to

Surgical incision, tissue trauma, and disruption of

intercostal nerves
Presence of chest tube(s)
Cancer invasion of pleura, chest wall

Possibly evidenced by

Verbal reports of discomfort

Guarding of affected area
Distraction behaviors, e.g., restlessness
Narrowed focus (withdrawal)
Changes in BP, heart/respiratory rate

Desired Outcomes

Report pain relieved/controlled.

Appear relaxed and sleep/rest appropriately.
Participate in desired/needed activities.

Nursing Interventions Rationale

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

 Nursing Interventions Rationale

symptoms, which may involve viscera,

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

Discrepancy between verbal and/or

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

Fear, distress, anxiety, and grief over

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

Pain perception and pain relief are

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

Fears or concerns can

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

Provide comfort measures: frequent

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

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

Prevents undue fatigue and incisional s

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

Assist with patient-controlled analgesia

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

4. Fear/Anxiety

May be related to

Situational crises
Threat to/change in health status
Perceived threat of death

Possibly evidenced by

Withdrawal
Apprehension
Anger
Increased pain, sympathetic stimulation
Expressions of denial, shock, guilt, insomnia

Desired Outcomes

Acknowledge and discuss fears/concerns.

 Demonstrate appropriate range of feelings and appear
relaxed/resting appropriately.
Verbalize accurate knowledge of situation.
Report beginning use of individually appropriate coping strategies.

Nursing Interventions Rationale

Patient and SO are hearing and assimi

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

Support may enable patient to begin

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

Provide opportunity for questions and

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

When extreme denial or anxiety is

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

Fear and/or anxiety will diminish as pa

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

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

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

when experiencing extreme or persiste

physical discomfort.

5. Deficient Knowledge

May be related to

Lack of exposure, unfamiliarity with information/resources

Information misinterpretation
Lack of recall

Possibly evidenced by

Statements of concern; request for information

Inadequate follow-through of instruction
Inappropriate or exaggerated behaviors, e.g., hysterical,
hostile, agitated, apathetic

Desired Outcomes

Verbalize understanding of ramifications of diagnosis,

prognosis, possible complications.
Participate in learning process.
Verbalize understanding of therapeutic regimen.
Correctly perform necessary procedures and explain
reasons for the actions.
Initiate necessary lifestyle changes.

Nursing Interventions Rationale

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

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

surgical intervention, and information

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

Reinforce surgeons explanation of

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

Follow-up assessment of respiratory st

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

Identify signs and symptoms requiring

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

Weakness and fatigue should decrease

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

Provide appropriate care before surgery:

If patient is to undergo surgery,

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

Explain expected postoperative Health teaching is more effective

procedures, such as insertion of an before surgery, when the patient is
indwelling catheter, use of an
 Nursing Interventions
endotracheal tube or chest tube, dressing
changes, and IV therapy.
Teach patient how to perform deep
breathing, coughing, and ROM exercises.
Evaluate availability or adequacy of
support system(s) and necessity for
assistance in self-care or home
management.
Recommend alternating rest periods with
activity and light tasks with heavy
tasks. Stress avoidance of heavy lifting,
isometric or strenuous upper body
exercise. Reinforce physicians time
limitations about lifting.
Recommend stopping any activity that
causes undue fatigue or increased
shortness of breath.
Encourage inspection of incisions. Review
expectations for healing with patient.
Instruct patient or SO to watch for and
report places in incision that do not heal
or reopening of healed incision, any
drainage (bloody or purulent), localized
area of swelling with redness or increased
pain that is hot to touch.
Suggest wearing soft cotton shirts and
Rationale
conscious and aware.
Helpful in immediately maximizing lun
volume after surgery.
General weakness and activity limitatio
may reduce individuals ability to meet
needs.
Generalized weakness and fatigue are
in the early recovery period but should
diminish as respiratory function improv
and healing progresses. Rest and sleep
enhance coping abilities, reduce
nervousness (common in this phase),a
promote healing. Strenuous use of arm
place undue stress on incision because
muscles may be weaker than normal f
months following surgery.
Exhaustion aggravates respiratory
insufficiency.
Healing begins immediately, but comp
healing takes time. As healing progres
incision lines may appear dry, with cru
scabs. Underlying tissue may look brui
and feel tense, warm, and lumpy (reso
hematoma).
Signs and symptoms indicating failure
heal, development of complications
requiring further medical evaluation or
intervention.
Reduces suture line irritation and pres
 Nursing Interventions Rationale

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

Keeps incision clean, promotes circulat

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

Support incision with Steri-Strips as

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

Simple arm circles and lifting arms ove

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

Stress importance of avoiding exposure to

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

Meeting cellular energy requirements a

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

Agencies such as these offer a broad r

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

Other Nursing Diagnoses

Airway Clearance, ineffectiveincreased amount/viscosity

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