LESSON PLAN ON LUNG CANCER

Subject Medical surgical nursing

Unit
Topic
Group
Place
Date & time
Teaching method
AV aids / instructional aids
Name of the student teacher
Name of the evaluator
Student Pre requisite
General Objective
patient with lung cancer.
Specific objective
Unit-V
Lung Cancer
Post Basic BSc( N) 1st year
L.T-2 College of nursing vimsar burla
lecture cum discussion,
Chalk board, posture, bulletin board, handout and power point slide
Mr.pankaj kumar Jena
Mr. Sunil Bahadur
Students have some knowledge regarding anatomy and physiology of lung
At the end of the class students able to understand about breast cancer and able to give care to the
At the end of the class students will be able to
 Define lung cancer
 Enlist types of breast cancer
 Enumerate Causes and risk factors of lung cancer
 Describe pathophysiology of lung cancer
 Explain clinical manifestation of lung cancer
 Explain D/E of lung cancer

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 Describe stages of lung cancer

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 Explain management of lung cancer
Review of previous class About cancer
Introduction •Lung cancer is cancer that starts in the cells that make up the lungs. Many other types of cancer, such as
breast or kidney, can spread (metastasize) to the lungs. When this happens, the cancer is not called lung
cancer.
•This is because cancer is named for--and treatment is based on--the site of the original tumor. For
example, if breast cancer spreads to the lungs, it will be treated as metastatic breast cancer, not lung
cancer.
S.N Tim Specific Content Teaching learning A.V. Aids Evaluation
o e objective activity Used
 2 Define lung DEFINITION: T: Explain definition Powerpoint Define lung
1 mint cancer and Lung carcinoma is a malignant lung tumor characterized of lung cancer. slide cancer?
by uncontrolled cell growth in tissues of the lung. If left S: Listen about Chalk board
explain the untreated, this growth can spread beyond the lung by the
incidence rate definition
process of metastasis into nearby tissue or other parts of the
of lung cancer. body.
INCIDENCE OF LUNG CANCER:-
Lung cancer mainly occurs in older people. About 2 out of 3
people diagnosed with lung cancer are 65 or older.
• About 14% of all new cancers are lung cancers.
• About 224,390 new cases of lung cancer (117,920 in men
and 106,470 in women)
2 4 Enlist types of TYPES OF LUNG CANCER:- T: Enlist types of Posture Enlist types of
mint lung cancer 1. Small cell carcinoma: It generally starts in one of the lung cancer. lung cancer?
larger breathing tubes, grows fairly rapidly, and is likely S: Listen carefully
to be large by the time of diagnosis. about types of lung
o Spreads more quickly and aggressively cancer
o Accounts for 15% of case
o Found mostly in heavy smokers
2. Non-small cell lung cancer (NSCLC) :Most common type
● About 80-85% are NSCLC
● Grows more slowly
It is further classified into the following:-
I. Epidermoid carcinoma or Squamous cell carcinoma:
◊ 30-35% of lung cancer Arise from bronchial
epithelium.
◊ Cavitations may also occur.

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◊ Slow growth, metastasis not common.
II. Adenocarcinoma: Page
◊ 25-30% of lung cancer
◊ Arise from bronchiole mucus gland
◊ Slow growth,
◊ Rarely cavity,
◊ Strongly linked to cigarette smoking.
III. Large cell carcinoma:
◊ 10-20% of lung cancer,
◊ Cavitations common,
◊ Slow, metastasis may occur to kidney, liver and
3

5
5
mint

5
mint

4
mint
Enumerate
etiology of lung
cancer

Describe
pathophysiolog
y of lung cancer

Explain clinical
manifestation/
sign
symptoms
and
of
B
U
D
V
Y
G
S
F
L
H
IT
P
E
R
A
C
M
O
N


Adrenals,
◊ May be located centrally, mid lung or
peripherally.
Tobacco smoke:-Smoking is by far the leading risk factor
for lung cancer. About 80% of lung cancer deaths are
thought to result from smoking.
Exposure to other cancer-causing agents in the work
place: Radioactive such as uranium Inhaled chemicals
such as beryllium, silica, coal Products, mustard gas.
Certain dietary supplements:-large studies found that
smokers who took beta Carotene supplements actually
had an increased risk of lung cancer.
Exposure to asbestos:-People who work with asbestos
(such as in mines, Mills, textile plants, places.
Talc and talcum powder: Talc is a mineral that in its
natural form may contain asbestos.
PATHOPHYSIOLOGY:

 Sputum (Spit or phlegm).

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CLINICAL MANIFESTATION/SIGN SYMPTOMS:

 A cough that gets worse.
Page
T: Enumerate
etiology of lung
cancer
S: Listen carefully
about causes and
risk factors of lung
cancer

T: Describe
pathophysiology of
lung cancer
S: Listen carefully
about
pathophysiology of
lung cancer

T: Explain
clinicalmanifestation
of lung cancer
 Chest pain that is often worse with deep breathing, S: Listen carefully
Powerpoint
slide
Chalk board

Bulletin board

Powerpoint
slide
Chalk board
What are the
causes of lung
cancer?.

Describe
pathophysiology
of lung cancer?

Explain c/m of
lung cancer?
 lung cancer coughing, or laughing. about clinical
 Coughing up blood. manifestation of
 Hoarseness. lung cancer
 Weight loss and loss of appetite.
 Shortness of breath.
 Feeling tired or weak.
 Infections such as bronchitis and pneumonia.
 Bone pain (like pain in the back or hips):-Nervous system
changes (such as headache,weakness, dizziness, balance
problems, or seizures), from cancer spread to the brain
or spinal cord.
 Yellowing of the skin and eyes (jaundice), from cancer
spread to the liver.
 HORNER SYNDROME Cancers of the top part of the lungs
(sometimes called Pancoast tumors) sometimes can
affect certain nerves to the eye and part of the face,
causing a group of symptoms called Horner syndrome:
 Drooping or weakness of one eyelid
 Reduced or absent sweating on the same
 side of the face sometimes cause severe
 Shoulder pain.
 SUPERIOR VENA CAVA SYNDROME
 Tumors in this area can press on the SVC, which can
cause the blood to back up in the veins. This can lead to
swelling in the face, neck, arms, and upper chest.
 PARANEOPLASTIC SYNDROMES:- Some lung cancers can
make hormone-like substances that enter the

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bloodstream and cause problems with distant tissues
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and organs, even though the cancer has not spread to
those tissues or organs. These problems are called
paraneoplastic syndromes.
 Excess growth/thickening of certain bones, especially
those in the finger tips
 Excess breast growth in men (gynecomastia)

7. 3 Describe stages STAGES OF LUNG CANCER T: Describe stages of Powerpoint Explain stages of
mint of lung cancer American Joint Committee on Cancer (AJCC) TNM lung cancer . slide lung cancer?
system, which is based on: S: Listen carefully Chalk board
 Sr. no Stages Features about stages of lung
The size of the T0 There is no evidence of a cancer
main(primary) primary tumor.
tumor(T) T1 The tumor is no larger than 3
centimeters, not reached
PLEURA.
T2 The tumor has 1 or more,
larger than 3 cm across but
not larger than 7 cm.
BROCHUS
T3 The tumor has 1 or more of
the following features, It is
larger than 7 cm across CHEST
WALL.
T4 The cancer has 1 or more, A
tumor of any size has grown
into the space between the
lungs

Sr. no Stages Features

Whether the N0 There is no spread to nearby
Cancer has lymph nodes.
Spread to N1 The cancer has spread to lymph
nearby nodes within
(regional) the lung , bronchus enters the
lymph nodes lung

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(N). N2 The cancer has spread to lymph

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nodes
around the carina ,
mediastinum
N3 The cancer has spread to lymph
nodes near
the collarbone on either side

Sr. no Stages Features

M M0 No spread to distant
 Categories for lung organs or areas. This
cancer includes the other lung,
lymph nodes
away than those
mentioned in the N stages
above, and other organs
M1a The cancer has spread to
the other lung.
• Cancer cells are found
in the fluid around the
lung
M1b The cancer has spread to
distant lymph
nodes or to other organs
6. 5 min Explain D/E of DIGNOSTIC EVALUATION:- T: Explain D/E of Powerpoint What are the
lung cancer Medical history and physical exam:- lung cancer slide diagnostic
Blood tests:- S: Listen carefully Chalk board evaluation for
 A complete blood count (CBC) looks at whether patient lung cancer?
about D/E of lung
blood has normal numbers of different types of blood cancer
cells.
 Blood chemistry tests can help spot abnormalities in
some of patient organs, such as the liver or kidneys. For
example, e.g. high level of lactate dehydrogenase (LDH).
Imaging Tests:-
1. Chest x-ray
 This is often the first test will do to look for any

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abnormal areas in the lungs.

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2. Computed tomography (CT) scan:-
 A CT scan uses to make detailed cross-sectional
images of patient body.
 can show the size, shape, and position of any lung
tumors and can help find enlarged lymph nodes

3. CT-guided needle biopsy:

 If a suspected area of cancer is deep within patient
body, a CT scan can be used to guide a biopsy
 needle into the suspected area.
4. Positron emission tomography (PET) scan:-
 For this test, a form of radioactive sugar (known as
FDG) is injected into the blood.
 This radioactivity can be seen with a special
camera. PET/CT scans.
5. Needle biopsy:- can often use a hollow needle to get a
small sample from a suspicious area (mass). fine needle
aspiration (FNA) biopsy, core biopsy.
6. Bronchoscopy:- Bronchoscopy can help the find some
tumors or blockages in the lungs.
7. Thoracoscopy:-spread to the spaces between the lungs
and the chest wall, or to the linings.
7. 15 MANAGEMENT T: Explain Powerpoint Explain
mint Explain MEDICAL MANAGEMENT:- management of lung slide management of
management of PHOTODYNAMIC THERAPY (PDT):- This type of treatment can cancer Chalk board lung cancer?
lung cancer be used to treat very early-stage lung cancers that are only in and handout
S: Listen carefully
the outer layers of the lung airways, about mng of lung (nursing
THORACENTESIS: - This is done to drain the fluid. management
cancer
LASER THERAPY:- )
 Used to treat very small tumors in the linings of airways.
 Open up airways blocked by larger tumors to help
people breathe better.
PHARMACOLOGICAL MANAGEMENT:-
 CHEMOTHERAPY:-for lung cancer Chemotherapy

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(chemo) is treatment with anti-cancer drugs injected

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into a vein or taken by mouth. These drugs enter the
bloodstream and gob throughout the body, making this
treatment useful for cancer anywhere in the body.
SURGICAL MANAGEMENT:-
1. Lobectomy:In this surgery, the entire lobe containing
the tumor is removed. Segmentectomy or wedge
resection: In these surgeries, only part of a lobe is
removed. This approach might be used, for example, if a
person doesn’t have enough lung function to withstand
removing the whole lobe.
2. Pneumonectomy: This surgery removes an entire lung.
 This might be needed if the tumor is close to the center
of the chest.
3. VIDEO-ASSISTED THORACIC SURGERY (VATS)
 Increasingly, treat early-stage lung cancers in the
outer parts of the lung with a procedure called
video-assisted thoracic surgery (VATS), which
requires smaller incisions than a thoracotomy.
 During this operation, a thin, rigid tube with a tiny
video camera on the end is placed through a small
cut in the side of the chest to help the surgeon see
inside the chest on a TV monitor.
 One of the incisions is enlarged if a lobectomy or
pneumonectomy is done to allow the specimen to
be removed. Because only small incisions are
needed, there is usually less pain after the surgery
and a shorter hospital stay – typically 4 to 5 days.
4. RADIOFREQUENCY ABLATION (RFA)
 RFA uses high-energy radio waves to heat the tumor.
A thin, needle-like probe is put through the skin and
moved in until the tip is in the tumor. Placement of
the probe is guided by CT scans. Once the tip is in
place, an electric current is passed through the
probe, which heats the tumor and destroys the
cancer cells.
 Might have some pain where the needle was inserted
for a few days after the procedure. Major
complications are uncommon, but they can include

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the partial collapse of a lung or bleeding into the
lung. Page
PALLIATIVE PROCEDURES FOR LUNG CANCER
• Palliative, or supportive care, is aimed at relieving symptoms
and improving a person’s quality of life.
• ISSUES ARE ADDRESSED IN PALLIATIVE CARE:-Physical,
Emotional and coping, Spiritual.
NURSING MANAGEMENT:
Assessment:
 Monitor S/S of respiratory failure
 Administer chemotherapy and other desired
 medications
 Educate patient with their disease and its progression
 Respiratory assessment
 Lab investigations and other diagnostic tests
 Patient’s knowledge and understanding of diagnosis and
treatment,
 Patient’s anxiety level and support system, Exposure to
carcinogen
NURSING DIAGNOSIS:
 Ineffective airway clearance related to increased
tracheobroncheal secretion
 Ineffective breathing pattern related to decreased lung
capacity
 Altered nutrition less then body requirement related
increased metabolic demand and decreased food intake
 Anxiety related to lack of knowledge
 Pain related to the pressure of the tumor
8. 2 Explain T: Explain Powerpoint What are the
mint prevention of prevention of lung slide prevention of
lung cancer cancer Chalk board lung cancer?
S: Listen carefully
about prevention of
lung cancer

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Summary: The above topic is summarized by introduction, definition, etiology, pathophysiology, stages, clinical manifestation, diagnostic
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evaluation, management and prevention of lung cancer.
Conclusion: While lung cancer remains a very challenging cancer to treat, new treatments that capitalizes on advances in our understanding
of cancer. It is likely that a more personalized approach to treatment using biological markers and combinations of therapies will provide
better results in the future.
Evaluation: by asking question.
Assignment / Application: 1. Explain pathophysioplogy of lung cancer
2. Explain management of lung cancer.
 Bibliography: Brunner and Suddarth’s.(2016), Text book of medical surgical nursing; 12 th edition: publish by. Lippincott Williums and wilkins, page no.588-
591.
 Javed Ansari and Davinden kaur.(2011), Text book of medical surgical nursing volume-ii; 1 st edition: publish by pee vee, page no. 392-400.
 Joyce M Black Jane Hokanson Hawks “ Medical surgical Nursing ” 7th edition volume no 7 Elsevier publications page number :1814-1828.
 Kushi LH, Doyle C, McCullough M, et al. American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: Reducing the risk of
cancer with healthy food choices and physical activity. CA Cancer J Clin. 2012;62:30-67.
 Lewis.Bucher, Heitkempeer, Harding, Kwong.(2017), Roberts medical surgical nursing, assessment and management of clinical problems; 3 rd south asia
edition: publish by RELX India pvt.ltd , new delhi; page no. 471-476.
 https://www.mayoclinic.org/diseases-conditions/lung-cancer/symptoms-causes/syc-20374620
 https://www.medicinenet.com/lung_cancer/article.htm
 https://www.cancer.gov/types/lung
 https://en.wikipedia.org/wiki/Lung_cancer
 https://medlineplus.gov/lungcancer.html

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