Lung Cancer Nursing Care Plan Notes

 

Description
  • Also called bronchogenic cancer.
  • It is a malignant tumor of the lung arising within the bronchial wall or epithelium.
  • Bronchogenic cancer is classified according to cell type: epidermoid (squamous cell – most common), adenocarcinoma, small cell (oat cell) carcinoma, and large cell (undifferentiated) carcinoma.
  • The lung is also a common site of metastasis from cancer elsewhere in the body through venous circulation or lymphatic spread.
  • The primary predisposing factor in lung cancer is cigarette smoking.
  • Lung cancer risk is also high in people occupationally exposed to asbestos, arsenic, chromium, nickel, iron, radioactive substances, isopropyl oil, coal tar products, and petroleum oil mists.
  • Complications include superior vena cava syndrome, hypercalcemia (from bone metastasis), syndrome of inappropriate antidiuretic hormone (SIADH), pleural effusion, pneumonia, brain metastasis, and spinal cord compression.

lung cancer

Risk Factors

Modifiable
  • Approximately 80% of lung cancers are related to cigarette smoking. Lung cancer is 10 times more common in smokers than in nonsmokers. In particular,squamous cell and small cell carcinoma are associated with smoking
  • Other risk factors include exposure to carcinogenic industrial and air pollutants—such as asbestos,coal dust,radon,and arsenic
Non-modifiable
  • Family history
Assessment
  • New or changing cough, dyspnea, wheezing, excessive sputum production, hemoptysis, chest pain (aching, poorly localized), malaise, fever, weight loss, fatigue, or anorexia.
  • Decreased breath sounds, wheezing, and possible pleural friction rub (with pleural effusion) on examination.
Diagnostic Evaluation
  • Chest X-ray may be suspicious for mass; CT or position emission tomography scan will be better visualize tumor.
  • Sputum and pleural fluid samples for cytologic examination may show malignant cells.
  • Fiberoptic bronchoscopy determines the location and extent of the tumor and may be used to obtain a biopsy specimen.
  • Lymph node biopsy and mediastinoscopy may be ordered to establish lymphatic spread and help plan treatment.
  • Pulmonary function test, which may be combined with a split-function perfusion scan, determines if the patient will have adequate pulmonary reserve to withstand surgical procedure.
Primary Nursing Diagnosis
  • Ineffective airway clearance related to obstruction caused by secretions or tumor
Medical Management
  • Oxygen through nasal cannula based on level of dyspnea.
  • Enteral or total parenteral nutrition for malnourished patient who is unable or unwilling to eat.
  • Removal of the pleural fluid (by thoracentesis or tube thoracostomy) and instillation of sclerosing agent to obliterate pleural space and fluid recurrence.
  • Radiation therapy in combination with other methods.
Surgical Intervention
  • Resection of tumor, lobe, or lung.
Pharmacologic Intervention
  • Expectorants and antimicrobial agents to relieve dyspnea and infection.
  • Analgesics given regularly to maintain pain at tolerable level. Titrate dosages to achieve pain control.
  • Chemotherapy using cisplatin in combination with a variety of other agents and immunotherapy treatments may be indicated.

Lung-cancer-treatment

Nursing Intervention
  • Elevate the head of the bed to ease the work of breathing and to prevent fluid collection in upper body (from superior vena cava syndrome).
  • Teach breathing retraining exercises to increase diaphragmatic excursion and reduce work of breathing.
  • Augment the patient’s ability to cough effectively by splinting the patient’s chest manually.
  • Instruct the patient to inspire fully and cough two to three times in one breath.
  • Provide humidifier or vaporizer to provide moisture to loosen secretions.
  • Teach relaxation techniques to reduce anxiety associated with dyspnea. Allow the severely dyspneic patient to sleep in reclining chair.
  • Encourage the patient to conserve energy by decreasing activities.
  • Ensure adequate protein intake such as milk, eggs, oral nutritional supplements; and chicken, fowl, and fish if other treatments are not tolerated – to promote healing and prevent edema.
  • Advise the patient to eat small amounts of high-calorie and high-protein foods frequently, rather than three daily meals.
  • Suggest eating the major meal in the morning if rapid satiety is the problem.
  • Change the diet consistency to soft or liquid if patient has esophagitis from radiation therapy.
  • Consider alternative pain control methods, such as biofeedback and relaxation methods, to increase the patient’s sense of control.
  • Teach the patient to use prescribed medications as needed for pain without being overly concerned about addiction.
Documentation Guidelines
  • Physical findings:Adequacy of airway and breathing; vital signs; heart and lung sounds; pain (nature, location,duration,and intensity); intake and output
  • Complications:Pneumonia,hypoxia,infection,dehydration, poor wound healing
  • Response to interventions:Response to pain medication
  • Response to treatment:Chest tube drainage; wound healing; condition of skin following radiation; side effects from chemotherapy
Discharge and Home Healthcare Guidelines

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. Be sure the patient understands any medication prescribed, including dosage, route,action,and side effects. 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 how to maximize her or his respiratory effort.