Nursing Care Plan Lung Cancer (Postoperative Care)

CARE SETTING

Inpatient surgical and possibly subacute units.

RELATED CONCERNS

1. Cancer
2. Hemothorax/pneumothorax
3. Psychosocial aspects of care
4. Radical neck surgery: laryngectomy (postoperative care)
5. Surgical intervention
6. Patient Assessment Database (Preoperative)
7. Findings depend on type, duration of cancer, and extent of metastasis.

ACTIVITY/REST

May report: 
Fatigue, inability to maintain usual routine, dyspnea with activity

May exhibit: 
Lassitude (usually in advanced stage)

CIRCULATION

May exhibit: 

1. Jugular venous distention (JVD) (with vena caval obstruction)
2. Heart sounds: Pericardial rub (indicating effusion)
3. Tachycardia/dysrhythmias
4. Clubbing of fingers

EGO INTEGRITY

May report: 

1. Frightened feelings, fear of outcome of surgery
2. Denial of severity of condition/potential for malignancy
3. May exhibit: Restlessness, insomnia, repetitive questioning

ELIMINATION

May report: 

1. Intermittent diarrhea (hormonal imbalance, SCLC)
2. Increased frequency/amount of urine (hormonal imbalance, epidermoid tumor)

FOOD/FLUID

May report: 

1. Weight loss, poor appetite, decreased food intake
2. Difficulty swallowing
3. Thirst/increased fluid intake

May exhibit: 

1. Thin, emaciated, or wasted appearance (late stages)
2. Edema of face/neck, chest, back (vena caval obstruction); facial/periorbital edema (hormonal imbalance, SCLC)
3. Glucose in urine (hormonal imbalance, epidermoid tumor)

PAIN/DISCOMFORT

May report: 

1. Chest pain (not usually present in early stages and not always in advanced stages), which may/may not be affected by position change
2. Shoulder/arm pain (particularly with large cell or adenocarcinoma)
3. Bone/joint pain: Cartilage erosion secondary to increased growth hormones (large cell carcinoma or adenocarcinoma)
4. Intermittent abdominal pain

May exhibit: 

1. Distraction behaviors (restlessness, withdrawal)
2. Guarding/protective actions

RESPIRATION

May report: 

1. Mild cough or change in usual cough pattern and/or sputum production
2. Shortness of breath
3. Occupational exposure to pollutants, industrial dusts (e.g., asbestos, iron oxides, coal dust), radioactive material
4. Hoarseness/change in voice (vocal cord paralysis)
5. History of smoking

May exhibit: 

1. Dyspnea, aggravated by exertion
2. Increased tactile fremitus (indicating consolidation)
3. Brief crackles/wheezes on inspiration or expiration (impaired airflow)
4. Persistent crackles/wheezes; tracheal shift (space-occupying lesion)
5. Hemoptysis

SAFETY

May exhibit: 

1. Fever may be present (large cell carcinoma or adenocarcinoma)
2. Bruising, discoloration of skin (hormonal imbalance, SCLC)

SEXUALITY

May exhibit: 

1. Gynecomastia (neoplastic hormonal changes, large cell carcinoma)
2. Amenorrhea/impotence (hormonal imbalance, SCLC)

TEACHING/LEARNING

May report: 

1. Familial risk factors: Cancer (especially lung), tuberculosis
2. Failure to improve
3. Discharge plan
4. DRG projected mean length of inpatient stay: 9.9 days
5. Assistance with transportation, medications, treatments, self-care, homemaker/maintenance tasks.
6. Refer to section at end of plan for postdischarge considerations.

DIAGNOSTIC STUDIES

1. Fiberoptic bronchoscopy: Allows for direct visualization, regional washings, and cytologic brushing of lesions (large percentage of bronchogenic carcinomas may be visualized).
2. Chest x-ray (PA[posteroanterior] and lateral), chest computed tomography (CT): Outlines shape, size, and location of lesion. May reveal mass of air in hilar region, pleural effusion, atelectasis, or erosion of ribs or vertebrae.
3. Positron emission tomography (PET): Useful diagnostic tool in early detection of cancer, allowing measurement of differential metabolic activity in normal and diseased tissues.
4. Magnetic resonance imaging (MRI) scan: May be used in combination or instead of CT scans to determine tumor size/location and for staging.
5. Cytologic examinations (sputum, pleural, or lymph node): Performed to assess presence/stage of carcinoma, and may identify tumors of the bronchial wall.
6. Needle or tissue biopsy: May be performed on scalene nodes, hilar lymph nodes, or pleura to establish diagnosis.
7. Mediastinoscopy: Used for staging of carcinoma and to examine for metastasis.
8. Pulmonary function studies and ABGs: Assess lung capacity to meet postoperative ventilatory needs.
9. Skin tests, absolute lymphocyte counts: May be done to evaluate for immunocompetence (common in lung cancers).
10. Bone scan; CT scan of brain, liver; gallium scan of liver, spleen, bone: Used to detect metastasis.

NURSING PRIORITIES

1. Maintain/improve respiratory function.
2. Control/alleviate pain.
3. Support efforts to cope with diagnosis/situation.
4. Provide information about disease process/prognosis and therapeutic regimen.

DISCHARGE GOALS

1. Oxygenation/ventilation adequate to meet individual activity needs.
2. Pain controlled.
3. Anxiety/fear decreased to manageable level.
4. Free of preventable complications.
5. Disease process/prognosis and planned therapies understood.
6. Plan in place to meet needs after discharge.