Lung cancer is the leading cancer killer among men and women in the United States, last 2008 (American Cancer Society, 2008). In the Philippines, Lung Cancer deaths reached 8,518 or 2.02% of total deaths according to a survey by WHO last 2011.
Lung cancer is divided into two categories: small cell lung cancers (SCLC) and non-small cell lung cancers (NSCLC).
Non-small cell lung cancers are further divided into cell types:
- Squamous cell carcinoma
- Large cell carcinoma
Also lung cancer is divided into different stages for the purpose of appropriate medical treatment and care.
Stage I: The earliest and most curable stage. Cancer is localized to the lungs and has not spread to other organs or distant sites.
Stage II: The cancer is in the lung and nearby lymph nodes.
Stage III: Cancer has spread to lymph nodes within the lung and/or around the area of the lungs.
Stage IV: Metastatic spread to both lungs and to other organs.
References: Lung Cancer Organization (2014) & American Cancer Society, Inc. (2014)
- Cigarette Smoking
- Secondhand smoke
- Arsenic, Asbestos, and other occupational and environmental pollution
- Underlying respiratory diseases
- Lobectomy is a removal of one lobe and preferred for peripheral carcinoma localized in a lobe. The chest cavity is entered through a long back-to-front incision, and the diseased lobe is removed.
- Bilobectomy is procedure where two lobes of the lung is removed.
- Wedge or segmental resection is performed when the lesions is contained within one segment.
- Endoscopic laser resection is performed when there is presence of peripheral tumors.
- Pneumonectomy is the removal of the entire lung.
Nursing Priorities and Management for Lung Cancer
1. Maintain a patent airway
- Auscultate chest for character of breath sounds, noting adventitious breath sounds.
- Provide a turning schedule, placing the patient in supine, sitting, and on his sides.
- Suction the patient as needed. However, avoid routine suctioning because it increases the risk of hypoxemia and mucosal damage.
- Instruct in effective deep breathing and coughing with upright position (sitting) and splinting of incision.
- Perform postural drainage, vibration, and percussion as indicated.
- Administer bronchodilators, expectorants, and oral analgesics as indicated.
2. Improving Gas Exchange
- Measure vital signs (BP, RR, HR, and Temp.) noting abnormalities.
- Monitor pulse oximetry and ABG readings.
- Encourage patient to breathing techniques such as diaphragmatic and pursed-lip breathing every two hours. These techniques are usually taught prior to surgery.
3. Controlling the pain
- Assess client’s verbal (pain scale) and nonverbal pain cues (facial grimacing, guarding behavior).
- Provide comfort measures such as back rubs and support with pillows.
- Instruct patient to use diversional activities: guided imagery, visualization, and deep breathing.
- Assist with self-care activities.
- Administer intermittent analgesics as indicated especially before deep-breathing and coughing exercises.
4. Maintaining Fluid Volume and Nutrition
- Assess intake, output, vital signs, and jugular distention.
- Administer intravenous fluids as indicated. Fluids should be administered at a low hourly rate and titrated as prescribed by the physician.
5. Provide information about disease process, prognosis, and planned therapies. (Discussed in the sample nursing care plan)
Nursing Care Plan Lung Cancer
- American Cancer Society, Inc. (2014). Lung Cancer (Non-Small Cell). Retrieved at http://www.cancer.org/cancer/lungcancer-non-smallcell/detailedguide/non-small-cell-lung-cancer-staging
- Doenges, M., Moorhouse, M., Murr, A. (2006) Nursing Care Plans: Guidelines for individualizing client care across the lifespan. F. A Davis Company, Philadelphia. 7th edition.
- Gulamick, Klopp, Galanes, et al., (1994) Nursing Care Plans: Pulmonary Care Plans. Mosby. Third Edition
- Lung Cancer Org. (2014). Types and Staging of Lung Cancer. Retrieved at http://www.lungcancer.org/find_information/publications/163-lung_cancer_101/268-types_and_staging
- Mosby. 2006. Mosby’s Pocket Dictionary of Medicine, Nursing, and Health Professions. Elsevier Singapore. 5th edition.
- Schilling McCann, J. (2007). Lippincott manual of nursing practice series: Pathophysiology. Lippincot Williams & Wilkins, Philadelphia.
- Silvestri, L. (2008). Comprehensive Review for the NCLEX-RN Examination. Saunders Elsevier. 4th edition.
- Smeltzer, S., Bare, B., Hinkle, J., Cheever, K. (2010). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. Lippincott Williams & Wilkins. 12th edition