NURSING CARE PLAN FOR CLIENT WITH LUNG CANCER

1. Definition
Lung cancer is one of killer disease among both men and women. It claims more lives each year
than colon, prostate, lymph and breast cancers combined. Estimated new cases and deaths from lung
cancer in the United States in 2008 New cases: 215,020 and Deaths: 161,840.
source: http://www.cancer.gov

There are two major types of lung cancer: small cell lung cancer (SCLC) and non–small cell
lung cancer (NSCLC). Sometimes a lung cancer shows characteristics of both types and is labeled
small cell/large cell carcinoma. Both types have the capacity to synthesize bioactive products and
produce paraneoplastic syndromes such as the syndrome of inappropriate antidiuretic hormones
(SIADH), Cushing’s syndrome, and Eaton-Lambert syndrome of neuromuscular disorder.
SCLC accounts for 13% of all lung cancers and is almost always caused by smoking. SCLC is
characterized by small, round to oval cells generally beginning in the euroendocrine cells of the
bronchoepithelium of the lungs. They start multiplying quickly into large tumors and can spread to the
lymph nodes and other organs. At the time of diagnosis, approximately 70% have already metastasized,
often to the brain. SCLC is sometimes called small cell undifferentiated carcinoma and oat
cellcarcinoma.

2. Etiology

Although the actual etiology of lung cancer isn't known, but there are several factors that seem
responsible for the increased incidence of lung cancer:

1. Smoking.
No doubt a major factor. A definitive statistical relationship has been established
between heavy smokers (more than twenty cigarettes a day) from lung cancer (carcinoma
bronkogenik). Smokers like this have a tendency to ten times greater than in light smokers.
Furthermore, heavy smokers who had and had abandoned his habit to return to the risk of
nonsmokers within about 10 years. Carcinogenic hydrocarbons have been found in tobacco tar
from cigarettes which, when worn on the skin of animals, causing tumors.

2. Irradiation.
The incidence of lung carcinoma is high in cobalt miners in Schneeberg and radium
miners in Joachimsthal (more than 50%died of of lung cancer ) associated with the presence of
radioactive materials in the form of radon . This material is believed to be the etiologic agent of
operatives.

3. Lung cancer caused by work.

There is a high incidence of workers exposed to nickel carbonyl (buster nickel) and
arsenic (repellent grass). Workers breaker hematite (lung - lung hematite) and people - people
who worked with asbestos and with chromate is also experiencing an increased incidence.

4. Air pollution.
Those who live in cities have a lung cancer rate is higher than in those who live in the
village and although it has been known of the carcinogens from industrial and diesel vapor in
the atmosphere in the city.
 (Thomson, Pathology Lecture Notes, 1997).

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 mall cell carcinoma are
associated with smoking. Other risk factors include exposure to arcinogenic industrial and air pollutants
—such as asbestos, coal dust, radon, and rsenic—and family history genetic considerations Mutations
in several genes, including SLC22A1L, TP53, KRAS2, BRAF, and EGFR, have been implicated in
pathogenesis of lung cancer. Recently, a locus for a lung cancer susceptibility gene has been linked to a
site on chromosome

3. Patogenesis
Pathogenesis of lung cancer has advanced impressively. Environmental carcinogens and a gene
locus determining susceptibility have been identified. The pathology of lung cancer has been classified
into categories with major clinical implications. The cellular and molecular genetic changes underlying
lung cancer have become better understood over the past 25 years, but the stepwise progression of
respiratory epithelium from normal to neoplastic is not yet well demarcated, limiting abilities to
advance early detection and chemoprevention. The translation of improved understanding of dominant
signal transduction pathways in lung cancer to rationally designed therapeutic strategies has had recent
successes, demonstrating a proof of principle for targeted therapy in lung cancer. Improvement in
overall patient outcomes has been stubbornly slow and will require concerted efforts.

4. Patofisiology
The pathophysiology of lung cancer development is complex and incompletely understood. The
genes influenced in the pathogenesis of lung cancer produce proteins involved in cell growth and
differentiation, cell cycle processes, apoptosis, angiogenesis, tumor progression, and immune
regulation. Unveiling these mechanisms should translate into novel means of risk stratification,
prevention, early detection, and therapy.

5. Nursing Diagose
A. Pre Sugery
• Damage to gas exchange related to hypoventilation
• Ineffective airway clearance related to:
• Loss of function of airway cilia
• Increase the number / viscosity of lung secretions.
• Increased airway resistance
• Fear / anxiety related to:
Crisis situations
Threats to / change in health status, fear of death.
Psychological factors.
• Lack of knowledge about the condition, action, prognosis. Related to:
Lack of information.
Error information interpretation.
Lack of recall.

B. Post Sugery
• Damage to gas exchange. Related to:
 • Appointment of lung tissue
• Impaired oxygen supply
• Decrease in the oxygen-carrying capacity of blood (blood loss).
• Ineffective airway clearance , Related to :
• Increase the number / viscosity of secretions
• Limitations of chest movement / pain.
• Weakness / fatigue.
• Pain (acute).Related to:
• A surgical incision, tissue trauma, and internal nerve disorders.
• The hose chest.
• Invasion of cancer to the pleura, chest wall
• Anxiety. Related to :
• Crisis situations
• Threats / health status change
• The threat of death.

6. Intervention and Rasional

A. Pre Sugery

1). Damage to gas exchange related to hypoventilation.

Criteria results:
• Demonstrate improved ventilation and adequate oksigenisi with GDA in the normal range and
free of symptoms of respiratory distress.
• Participate in treatment programs, the ability / situation.

Intervention:
a) Assess respiratory status frequently, note the increase in the frequency or respiratory effort or
changes in breathing pattern.
Rational : dyspnea is the compensatory mechanisms of airway resistance.

b) Note presence or absence of additional noise and the presence of additional sounds, such
krekels, wheezing.
Rational : The sound of the breath can be decreased, not the same as or no on sakit.Krekels
area is evidence of increased fluid in the network area as a result of increased permeability of
alveolar-capillary membrane. Wheezing is evidence of resistance or narrowing of the airway in
relation to the mucus / edema and tumor.

c) Assess adanmya cyanosis

Rational: oxygenation significant decrease occurred before cyanosis. Central cyanosis of the
"organ" warm example, tongue, lips and ears are the most indicative.

d) Collaboration moist oxygen delivery as indicated

Rational: Maximizing oxygen supply to the exchange.
 e) Keep an eye or draw a series of GDA.
Rational: Indicates ventilation or oxygenation. Used as a basis for evaluation or therapy
effective indicator needs a change of therapy.

2). Ineffective airway clearance related to:

• Loss of function of airway cilia
• Increase the number / viscosity of lung secretions.
• Increased airway resistance
Criteria results:
• States / show loss of dyspnea.
• Maintaining a patent airway with clean breath sounds
• Removing secretions without difficulty.
• Demonstrate behaviors to improve / maintain airway bersiahn.

Intervention:
a) Note the change effort and breathing patterns.
Rational: Use of intercostal muscle / abdominal and nasal dilation showed increased effort to
breathe.

b) Observation ekspensi decreased chest wall and there.

Rational: Expansion dad limited or no connection with fluid accumulation, edema, and
secretions in the lobe section.

c) Record the characteristics of cough (eg, permanent, effective, not effective), as well as
sputum production and characteristics.
Rational: Characteristics of cough may change depending on the cause / etiology breatihing
failed . Sputum when there may be many, thick, bloody, adan / or puulen.

d) Maintain the position of the body / head right and use airway equipment as needed.
Rational: Easily maintain patent airway if the airway is affected patients.

e) Collaboration of bronchodilators, eg aminophylline, albuterol, etc.. Watch for adverse side

effects of medication, eg tachycardia, hypertension, tremors, insomnia.
Rationale: Drugs given to relieve bronchial spasm, reduce the viscosity of secretions, improve
ventilation, and facilitate disposal of secretions. Require changes in dose / drug options.

3). Fear / anxiety related to:

• Crisis situations
• Threats to / change in health status, fear of death.
• Psychological factors.

Criteria results:
• States of awareness of anxiety and healthy ways to cope.
• Recognize and discuss fear.
• It appears relaxed and dropped to the level of anxiety reported to diatangani.
• Demonstrate problem solving and effective use of resources.
 Intervention:
a) Observation of increased anxiety, emotional instability.
Rational: The worsening of the disease can cause or increase anxiety.

b) Maintain a quiet environment with little stimulation.

Rational: Lowering anxiety with relaxation and increase energy savings.

c) Show / Helps with relaxation techniques, meditation, imagination guidance.

Rational: To provide an opportunity for patients to handle their own ansietasnya and feel in
control.

d) Identify the client's perception of threats by circumstances.

Rational: Helping the introduction of anxiety / fear and identify measures that can help to
individuals.

e) Encourage the patient to recognize and express feelings.

Rational: The first step in overcoming the feelings are toward the identification and expression.
Encourage self-acceptance situations and ability to cope.

4). Lack of knowledge about the condition, action, prognosis. Related to:
• Lack of information.
• Error information interpretation.
• Lack of recall.

Criteria results:
• Explain the relationship between the disease and therapy.
• Describe / declare diet, medication, and program activities.
• Identify the correct signs and symptoms that require medical attention.
• Create a plan for further treatment.

Intervention:
a) Encourage learning to meet patient needs. Rippling information in a clear / concise.
Rational: Recovering from failed lung disorders can greatly impede the scope of patient
attention, concentration and energy for the receipt of information / new task.

b) Provide written and verbal information about drug

Rationale: Providing a safe drug usage instructions memmampukan patients to follow the
proper course of treatment.

c) Assess the nutritional counseling about eating plan; the needs of high-calorie foods.
Rational: Patients with severe respiratory problems usually experience weight loss and anorexia
that require increased nutrients to menyembuhan.

d) Provide guidelines for the activity.

Rational: Patients must avoid to be too tired and offset istirahatdan period of activity to improve
the strain / stamina and prevent consumption / oxygen demand excessive.

B. Post ٍSugery
 1). Damage to gas exchange. Related to:
• Appointment of lung tissue
• Impaired oxygen supply
• Decrease in the oxygen-carrying capacity of blood (blood loss).

Criteria results:
• Demonstrate improved ventilation and adequate tissue oxygenation with the GDA within the
normal range.
• Free symptoms of respiratory distress.

Intervention:
a) Record the frequency, depth and ease of breathing. Observation on the use of muscle aids, lip
breathing, changes in skin / mucous membranes.
Rationale: Respiratory increase as a result of pain or as a mechanism for initial compensation of
loss of lung tissue.

b) Auscultation gerakamn lung for air and breath sounds not normal.
Rational: Consolidation and lack of air movement on the operated side of normal in patients
pneumonoktomi. However, patients must demonstrate lubektomi normal air flow in the lobes
that remain.

c) Maintain airway kepatenan patients by giving the position, exploitation, and use of
equipment
Rationale: Airway obstruction affects ventilation, interfere with gas exchange.

d) Change positions frequently, place the patient in a sitting position also backs up to his side.
Rational: Maximizing lung expansion and drainage of secretions.

e) Encourage / assist with breathing in and breathing exercises with the right lip.
Rationale: Increase maximum ventilation and oxygenation and reduce / prevent atelectasis.

2). Ineffective airway clearance , Related to :

• Increase the number / viscosity of secretions
• Limitations of chest movement / pain.
• Weakness / fatigue.

Criteria results:
Indicate airway patency, with fluid secretions easily removed, clear breath sounds, and
breathing was noisy.

Intervention:
a) Auscultation chest for breath sounds and characteristics of the secretions.
Rationale: Respiratory noisy, rhonchi, and wheezing showed retained secretions and / or
obstruiksi airway.

b) Help the patient with / instructed to breath deeply and cough effectively with high sitting
position and pressed the incision area.
 Rational: The sitting position allows maximum lung expansion and emphasis menmguatkan
cough effort to mobilize and remove secretions. Emphasis is done by nurses.

c) Observation on the amount and character of sputum / aspiration of secretions.

Rationale: Increasing the number of colorless secretions / aqueous initially normal and should
be decreased according to the progress of healing.

d) Encourage oral fluid intake (at least 2500 ml / day) in cardiac tolerance.
Rational: Hydration is adequate to maintain the discharge is lost / increase in expenditure.

e) Collaboration of bronchodilators, expectorants, and / or analgesics as indicated.

Rationale: Eliminates spasm of bronchial to improve air flow, dilute and reduce the viscosity of
secretions.

3). Pain (acute).Related to:

• A surgical incision, tissue trauma, and internal nerve disorders.
• The hose chest.
• Invasion of cancer to the pleura, chest wall

Criteria results:
• Reporting neyri missing / controlled.
• Looks to relax and sleep / rest well.
• Participate in activities that desired / required.

Intervention:
a) Ask the patient about pain. Determine the characteristics of pain. Create a range of intensity
on a scale of 0-10.
Rational: To assist in the evaluation of painful symptoms of cancer. The use of the range scale
to help the patient in assessing the level of pain and provide tools for evaluation keefktifan
analgesics, improved pain control.

b) Assess the verbal statements and non-verbal pain patients.

Rational: Ketidaklsesuaian between verbal cues / nonverbal clues can provide the degree of
pain, the need / keefketifan intervention.

c) Write down the possible causes of pain patofisologi and psychology.

Rational: posterolateral incision more uncomfortable for the patient from the anterolateral
incision. In addition, fear, distress, anxiety and loss of appropriate cancer diagnosis can impair
ability to cope.

d) Encourage states tentangnyeri feelings.

Rational: Fear / problems can increase muscle tension and lower the threshold of pain
perception.

e) Provide comfort measures. Encourage and teach the use of relaxation techniques
Increase relaxation and diversion of attention.

4). Anxiety. Related to :

• Crisis situations
• Threats / health status change
• The threat of death.

Criteria results:
• Recognize and discuss the fear / problem
• Demonstrate the proper range of feelings and facial appearance seemed to relax / rest
• Stating that accurate knowledge about the situation.

Intervention:
a) Evaluate the level of understanding of patients / people closest to the diagnosis.
Rational: Patients and those close to hear and assimilate new information that includes changes
to existing self-image and lifestyle. Understanding this perception involves the composition of
individual care pressures and provide the information necessary to select appropriate
interventions.

b) Acknowledge fear / problem and encourage patients to express feelings

Rational: Support enabled patients began open or accept the reality of cancer and its treatment.

c) Accept a denial of patients but do not be corroborated.

Rational: If the extreme denial or ansiatas affect the progress of healing, dealing with patient
issues need to be explained and emebuka part of the solution.

d) Give the opportunity to ask and answer honestly. Ensure that patients and caregivers have the
same understanding.
Rational: Creating trust and reduce misperceptions / incorrect interpretation of information ..

e) Involve patients / people closest in planning treatment. Give time to prepare for events /
treatment.
Rational: It can help fix some sense of control / independence in patients who feel helpless tek
in receiving treatment and diagnosis.

f) Give fiik patient comfort.

Rational: It is difficult to accept the issue if the experience of extreme emotions / physical
discomfort settled.

5). Lack of knowledge about the condition, action, prognosis.Related to :

• Lack of or do not know the information / resources
• One interperatasi information.
• Lack of recall

Criteria results:
• Expressing understanding of the ins and outs of the diagnosis, treatment program.
• Perform the necessary procedures correctly and explain the reasons such action.
• Participate in the learning process.
• Making changes in lifestyle.

Intervention:
a) Discuss the diagnosis, plan / this sasat therapy and expected outcomes.
Rational: To provide individual-specific information, create knowledge to learn more about
management at home. Radiation and chemotherapy can accompany surgical intervention and
critical information to enable patients / people closest to making an informed decision.

b) Strengthen explanation surgeons about the surgical procedure by providing the appropriate
diagram. Enter this information in a discussion about the expectations of short-term / long of
healing.
Rational: The length of rehabilitation and prognosis depend on the type of surgery, the condition
preoperatively, and the duration / degree of complication.

c) Discuss the need for planning to evaluate the current care home.
Rationale: Assessment of respiratory status and evaluation of public health imperative to assure
optimal healing. Also provides an opportunity to refer issues / questions at the time that a little
stress.