CARE

OF
PATIEN
TS
WITH
CANCE
 R OF
THE
LUNGS

WHAT IS LUNG CANCER?

Lung cancer is the abnormal, uncontrolled cell growth in lung tissues,
resulting in a tumor. A tumor in the lung may be primary when it develops
in lung tissue. It may be secondary when it spreads (metastasizes) from
cancer in other areas of the body, such as the liver, brain, or kidneys.
There are two major categories of lung cancer— small cell and non-small
cell.

Repetitive exposure to inhaled irritants increases a person’s risk for lung

cancer. Cigarette smoke, occupational exposures, air pollution containing
benzopyrenes, and hydrocarbons have all been shown to increase risk.

TYPES OF LUNG CANCER

SMALL
CELL-OAT
CELL
CARCINOMA
– FAST

GROWING,
EARLY
METASTASIS
NON-SMALL CELL:
• Adenocarcinoma—moderate growth rate, early
metastasis • Squamous cell—slow-growing, late
metastasis • Large cell—fast-growing, early metastasis

ASSESSMENT
 Subjective Cues Objective cues
• Coughing due to irritation from mass. Presence of mucous or exudate
• Fatigue may not be until later in disease.
• Coughing up blood (hemoptysis).
• Weight loss due to the caloric needs of the tumor, taking away from the
needs of the body.
• Anorexia.
• Difficulty breathing (dyspnea) caused by damaged lung tissue. The
patient begins to have respiratory problems later in the disease.
• Chest pains as mass presses on surrounding tissue; may not be
until late in disease.
• Sputum production.
• Pleural effusion.
• hoarseness

MEDICAL
MANAGEMENT-PHYSICIAN’S
ORDER
 Special Notation
• Surgical removal of affected a
the lung (wedge resection, seg
resection, lobectomy) or total l
(pneumonectomy).
• Radiation therapy to decrease
size. • Oxygen therapy to supplem
needs of the body.
• High-protein, high-calorie diet
the needs of the body.

LABORATORY /DIAGNOSTIC
EXAMINATION
➢Mass in lung shown on chest x-ray.
➢CT scan shows mass, lymph node involvement.
➢Bronchoscopy may show cancer cells on bronchoscopic washings; may
reveal tumor site.
➢Cancer cells seen in sputum.
➢Biopsy will show cell type:
➢Needle biopsy through chest wall for peripheral
tumors.
➢Tissue biopsy from lung for deeper tumors.
➢Bone scan or CT scans shows metastasis of the disease.
MEDICATIONS
• Chemotherapy often with a combination of drugs: •
cyclophosphamide, doxorubicin, vincristine, etoposide,
cisplatin • may see relapse after treatment
• Administer antiemetics to combat side effects of
chemotherapy: • ondansetron,
prochlorperazine
• Administer analgesics for pain control:
• morphine, fentanyl
IV as ordered
NURSING CARE PLANS
Nursing Diagnosis Intervention Evaluation

Risk for infection

Maintain or teach asepsis for dressing changes and wound care, peripheral IV and central venous
management, and catheter care and handling. Wash hands and teach patient and SO to wash hands
before contact with patients and between procedures with the patient. Instances when to wash
hands:
• Before putting on gloves and after taking them off.
• Before and after touching a patient, before handling an invasive device (foley catheter, IV catheter,
and so on) regardless of whether or not gloves are used.
• After contact with body fluids or excretions, mucous membranes, nonintact skin, or wound
dressings.
• If moving from contaminated body site to another site during the care of the same individual.
• After contact with inanimate surfaces and objects in the immediate vicinity of the patient.
• After removing sterile or nonsterile gloves.
• Before handling medications or preparing food.
Encourage intake of protein-rich and calorie-rich foods.
Encourage fluid intake of 2,000 to 3,000 mL of water per day, unless contraindicated.
Patient remains free of infection, as evidenced by normal vital signs and absence of signs
and symptoms of infection.
Early recognition of infection to allow for prompt treatment.
Patient will demonstrate meticulous hand washing technique.

Impaired Gas Exchange related to ventilation perfusion

imbalance
• Position patient with head of bed elevated, in a semi-Fowler’s position (head of bed at 45 degrees
when supine) as tolerated.
• If patient has unilateral lung disease, position the patient properly to promote
ventilation-perfusion.
• Turn the patient every 2 hours. Monitor mixed venous oxygen saturation closely after turning. If it
drops below 10% or fails to return to baseline promptly, turn the patient back into a supine position
and evaluate oxygen status.
• Maintain an oxygen administration device as ordered, attempting to maintain oxygen saturation at
90% or greater.
• If the patient is permitted to eat, provide oxygen to the patient but in a different manner (changing
from mask to a nasal cannula).
• Administer humidified oxygen through appropriate device (e.g., nasal cannula or face mask per
physician’s order); watch for onset of hypoventilation as evidenced by increased somnolence after
initiating or increasing oxygen therapy.
• Help patient deep breathe and perform controlled coughing. Have patient inhale deeply, hold
breath for several seconds, and cough two to three times with mouth open while tightening the
upper abdominal muscles as tolerated.
• Encourage slow deep breathing using an incentive spirometer as indicated. • Pace activities and
schedule rest periods to prevent fatigue. Assist with ADLs. • Administer medications as prescribed.
Patient maintains optimal gas exchange as evidenced by usual mental status, unlabored respirations at
12-20 per minute, oximetry results within normal range, blood gases within normal range, and baseline
HR for patient.
Patient maintains clear lung fields and remains free of signs of respiratory distress.
Acute pain • Suggest use of non-pharmacological techniques as appropriate. •
Encourage increased oral fluid intake (2-3 liters if no
contraindications)..
• Encouraged the use of analgesic (e.g., acetaminophen) or
antispasmodics (e.g., phenazopyridine) as prescribed
• Determine timing or precipitants of “breakthrough” pain when using
around-the-clock agents, whether oral, IV, or patch
medications.
• Provide nonpharmacological comfort measures (massage,
repositioning, backrub) and diversional activities (music,
television)
• Encourage use of stress management skills or complementary therapies
(relaxation techniques, visualization, guided imagery, biofeedback, laughter, music,
aromatherapy, and therapeutic
touch).
• Provide cutaneous stimulation (heat or cold, massage).
Client will use
pharmacological and nonpharmacological pain relief strategies.
Client will report
satisfactory pain control at a level less than 3 to 4 on a scale of 0 to 10.
Altered
Nutrition: Less Than Body Requirements
• Ascertain patient’s dietary program and usual pattern then compare with recent
intake.
• Discuss eating habits and encourage a diabetic diet (balanced diet) as prescribed
by the doctor.
• Consult dietician and/or physician for further assessment and recommendation
regarding food preferences and nutritional support.
• Provide liquids containing nutrients and electrolytes as soon as the patient can
tolerate oral fluids then progress to a portion of more solid food as tolerated.
• Observe for signs of hypoglycemia: changes in LOC, cold and clammy skin, rapid
pulse, hunger, irritability, anxiety, headache, lightheadedness, shakiness.
• Regular exercise
• Refer the patient to an exercise physiologist, physical therapist, or cardiac
rehabilitation nurse for specific exercise instructions.
• Ingest appropriate amounts of
calories/nutrients.
• Display usual energy level.
• Demonstrate stabilized weight or gain toward usual/desired range with normal
laboratory values.
Risk for
Ineffective Therapeutic Regimen
Managemen t
• Investigate the patient’s prior efforts to manage the HIV
care regimen.
• Evaluate the patient’s self-management skills, including the
ability to maintain medication administration
• Assess for factors that may negatively affect success with
following the regimen.
• Assess the patient’s financial resources for health care.
• Determine and ensure that patient’s knowledge about the
symptoms, causes, treatment, and prevention of
hyperglycemia.
Patient
demonstrates knowledge of diabetes self-care measures.
Risk for Impaired Skin
Integrity.
• Use foot cradle on the bed. Use space boots on ulcerated
heels, elbow protectors, and pressure-relief mattresses.
• Wash feet daily with mild soap and warm water. Check
water temperature before immersing feet in the water.
• Inspect feet daily for erythema or trauma. • Change socks or
stockings daily. Encourage the patient to wear white cotton
socks. • Use gentle moisturizers on the feet. • Cut toenails
straight across after softening toenails with a bath.
• The patient should not walk barefoot.
Patient’s skin on legs and feet remains intact while the
patient is hospitalized. Patient will
demonstrate
proper foot care.
Anticipatory Grieving
• Expect initial shock and disbelief following diagnosis of cancer and traumatizing
procedures (disfiguring surgery, colostomy, amputation).
• Provide open, nonjudgmental environment. Use therapeutic communication skills
of Active-Listening, acknowledgment, and so on.
• Encourage verbalization of thoughts or concerns and accept expressions of
sadness, anger, rejection. Acknowledge normality of these feelings.
• Visit frequently and provide physical contact as appropriate, or provide frequent
phone support as appropriate for setting. Arrange for care provider and support
person to stay with patient as needed.
• Determine way that patient and SO understand and respond to death such as
cultural expectations, learned behaviors, experience with death (close family
members, friends), beliefs about life after death, faith in Higher Power (God).
Identify and express feelings appropriately.
Continue normal life activities, looking
toward/planning for the future, one day at a time.
Verbalize understanding of the dying process and feelings of being
supported in grief work.