Nursing Care Plans for Lung Cancer – Best Nursing Care Plans(2022)

This article discusses Nursing Care Plans for Lung Cancer plus its causes, symptoms, preventions, treatments, and interventions.

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.


Lung cancer is a type of cancer that starts in the lungs. Lung cancer occurs when cells divide in the lungs uncontrollably. This causes tumors to grow. These can reduce a person’s ability to breathe and spread to other parts of the body.

Normal structure and function of the lungs

Lungs are 2 sponge-like organs in the chest. The right lung has 3 sections, called lobes. The left lung has 2 lobes. The left lung is smaller because the heart takes up more room on that side of the body.

Air enters through the mouth or nose and goes into the lungs through the trachea (windpipe) when a person breathes in. The trachea divides into tubes called bronchi, which enter the lungs and divide into smaller bronchi. These divide to form smaller branches called bronchioles. At the end of the bronchioles are tiny air sacs known as alveoli.

The alveoli absorb oxygen into your blood from the inhaled air and remove carbon dioxide from the blood when you exhale. Taking in oxygen and getting rid of carbon dioxide are your lungs’ main functions.

Lung cancers typically start in the cells lining the bronchi and parts of the lung, such as the bronchioles or alveoli.

A thin lining layer called the pleura surrounds the lungs. The pleura protects the lungs and helps them slide back and forth against the chest wall as they expand and contract during breathing.

Below the lungs, a thin, dome-shaped muscle called the diaphragm separates the chest from the abdomen. When you breathe, the diaphragm moves up and down, forcing air in and out of the lungs.

Types of lung cancer

There are 2 main types of lung cancer, and they are treated very differently.

Non-small cell lung cancer (NSCLC)

About 80% to 85% of lung cancers are NSCLC. The main subtypes of NSCLC are adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. These subtypes, which start from different types of lung cells, are grouped together as NSCLC because their treatment and prognoses (outlook) are often similar.

Adenocarcinoma: Adenocarcinomas start in the cells that would normally secrete substances such as mucus.

This type of lung cancer occurs mainly in people who currently smoke or formerly smoked, but it is also the most common type of lung cancer seen in people who don’t smoke. It is more common in women than in men, and it is more likely to occur in younger people than other types of lung cancer.

Adenocarcinoma is usually found in the outer parts of the lung and is more likely to be found before it has spread.

People with a type of adenocarcinoma called adenocarcinoma in situ (previously called bronchioloalveolar carcinoma) tend to have a better outlook than those with other types of lung cancer.

Squamous cell carcinoma: Squamous cell carcinomas start in squamous cells, which are flat cells that line the inside of the airways in the lungs. They are often linked to a history of smoking and tend to be found in the central part of the lungs, near the main airway (bronchus).

Large cell (undifferentiated) carcinoma:  Large cell carcinoma can appear in any part of the lung. It tends to grow and spread quickly, which can make it harder to treat. A subtype of large cell carcinoma, known as large cell neuroendocrine carcinoma, is fast-growing cancer that is very similar to small cell lung cancer.

Other subtypes: A few other subtypes of NSCLC, such as adenosquamous carcinoma and sarcomatoid carcinoma, are much less common.

Small cell lung cancer (SCLC)

About 10% to 15% of all lung cancers are SCLC, and it is sometimes called oat cell cancer.

This type of lung cancer tends to grow and spread faster than NSCLC. About 70% of people with SCLC will have cancer that has already spread at the time they are diagnosed. Since this cancer grows quickly, it tends to respond well to chemotherapy and radiation therapy. Unfortunately, for most people, cancer will return at some point.

Other types of lung tumors

Along with the main types of lung cancer, other tumors can occur in the lungs.

Lung carcinoid tumors: Carcinoid tumors of the lung account for fewer than 5% of lung tumors. Most of these grow slowly.

Other lung tumors: Other types of lung cancer such as adenoid cystic carcinomas, lymphomas, and sarcomas, as well as benign lung tumors such as hamartomas, are rare. These are treated differently from the more common lung cancers and are not discussed here.

Cancers that spread to the lungs: Cancers that start in other organs (such as the breast, pancreas, kidney, or skin) can sometimes spread (metastasize) to the lungs, but these are not lung cancers. For example, cancer that starts in the breast and spreads to the lungs is still breast cancer, not lung cancer. Treatment for metastatic cancer to the lungs is based on where it started (the primary cancer site).

Symptoms and Signs of Lung Cancer

People with lung cancer may not have any symptoms until a later stage. If symptoms do appear, they can resemble those of a respiratory infection.

Some possible symptoms include:

  • Changes to a person’s voice, such as hoarseness
  • Frequent chest infections, such as bronchitis or pneumonia
  • Swelling in the lymph nodes in the middle of the chest
  • A lingering cough that may start to get worse
  • Chest pain
  • Shortness of breath and wheezing

In time, a person may also experience more severe symptoms, such as:

  • Severe chest pain
  • Bone pain and bone fractures
  • Headaches
  • Coughing up blood
  • Blood clots
  • Appetite loss and weight loss
  • Fatigue

Causes of Lung Cancer

Smoking causes the majority of lung cancers — both in smokers and in people exposed to secondhand smoke. But lung cancer also occurs in people who never smoked and in those who never had prolonged exposure to secondhand smoke. In these cases, there may be no clear cause of lung cancer.

How smoking causes lung cancer

Doctors believe smoking causes lung cancer by damaging the lungs’ cells. When a person inhales cigarette smoke, which is full of cancer-causing substances (carcinogens), changes in the lung tissue begin almost immediately.

At first, the body may be able to repair this damage. But with each repeated exposure, normal cells that line the lungs are increasingly damaged. Over time, the damage causes cells to act abnormally, and eventually, cancer may develop.

Stages of Lung Cancer

The staging of cancer describes how far it has spread through the body and how severe it is. Staging helps healthcare professionals and individuals decide on a suitable course of treatment.

The most basic form of staging is as follows:

  • Localized, wherein the cancer is within a limited area
  • Regional, wherein cancer has spread to nearby tissues or lymph nodes
  • Distant, wherein cancer has spread to other parts of the body

Similar to this is the TNM staging system. Healthcare professionals assess the tumor for size and spread, whether or not it affects the lymph nodes, and whether or not it has spread elsewhere.

There are also specific ways of staging non-small cell and small cell lung cancer.

Stages of Non-Small Cell Lung Cancer

Healthcare professionals typically use tumor size and spread to describe the stages of non-small cell lung cancer, as follows:

Occult or hidden: Cancer does not show up on imaging scans, but cancerous cells might appear in the phlegm or mucus.

Stage 0: There are abnormal cells only in the top layers of cells lining the airways.

Stage 1: A tumor is present in the lung, but it is 4 centimeters (cm) or under and has not spread to other parts of the body.

Stage 2: The tumor is 7 cm or under and might have spread to nearby tissues and lymph nodes.

Stage 3: Cancer has spread to lymph nodes and reached other parts of the lung and surrounding area.

Stage 4: Cancer has spread to distant body parts, such as the bones or brain.

Stages of Small Cell Lung Cancer

Small cell lung cancer has its own categories. The stages are known as limited and extensive, and they refer to whether cancer has spread within or outside the lungs.

Cancer affects only one side of the chest in the limited stage, though it might already be present in some surrounding lymph nodes.

Around one-third of people with this type find out that they have cancer when it is in the limited stage. Healthcare professionals can treat it with radiation therapy as a single area.

In the extensive stage, cancer has spread beyond the one side of the chest. It may affect the other lung or other parts of the body.

Around two-thirds of people with small cell lung cancer find out that they have it when it is already in the extensive stage.

Risk factors for Lung Cancer

A number of factors may increase the risk of lung cancer. Some risk factors can be controlled, for instance, by quitting smoking. And other factors can’t be controlled, such as family history.

Risk factors for lung cancer include:

Smoking. Your risk of lung cancer increases with the number of cigarettes you smoke each day and the number of years you have smoked. Quitting at any age can significantly lower your risk of developing lung cancer.

Exposure to secondhand smoke. Even if you don’t smoke, your risk of lung cancer increases if you’re exposed to secondhand smoke.

Previous radiation therapy. If you’ve undergone radiation therapy to the chest for another type of cancer, you may have an increased risk of developing lung cancer.

Exposure to radon gas. Radon is produced by the natural breakdown of uranium in soil, rock, and water that eventually becomes part of the air you breathe. Unsafe levels of radon can accumulate in any building, including homes.

Exposure to asbestos and other carcinogens. Workplace exposure to asbestos and other substances are known to cause cancer — such as arsenic, chromium, and nickel — can increase your risk of developing lung cancer, especially if you’re a smoker.

Family history of lung cancer. People with a parent, sibling, or child with lung cancer have an increased risk of the disease.

Complications of Lung Cancer

Lung cancer can cause complications, such as:

Shortness of breath. People with lung cancer can experience shortness of breath if cancer grows to block the major airways. Lung cancer can also cause fluid to accumulate around the lungs, making it harder for the affected lung to expand fully when you inhale.

Coughing up blood. Lung cancer can cause bleeding in the airway, which can cause you to cough up blood (hemoptysis). Sometimes bleeding can become severe. Treatments are available to control bleeding.

Pain. Advanced lung cancer that spreads to the lining of a lung or to another area of the body, such as a bone, can cause pain. Tell your doctor if you experience pain, as many treatments are available to control pain.

Fluid in the chest (pleural effusion). Lung cancer can cause fluid to accumulate in the space that surrounds the affected lung in the chest cavity (pleural space).

Fluid accumulating in the chest can cause shortness of breath. Treatments are available to drain the fluid from your chest and reduce the risk that pleural effusion will occur again.

Cancer that spreads to other parts of the body (metastasis). Lung cancer often spreads (metastasizes) to other parts of the body, such as the brain and the bones.

Cancer that spreads can cause pain, nausea, headaches, or other signs and symptoms depending on what organ is affected. It’s generally not curable once lung cancer has spread beyond the lungs. Treatments are available to decrease signs and symptoms and to help you live longer.

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Nursing care plans for lung cancer
Nursing Care Plans for Lung Cancer

Prevention of Lung Cancer

There’s no sure way to prevent lung cancer, but you can reduce your risk if you:

Don’t smoke. If you’ve never smoked, don’t start. Talk to your children about not smoking so that they can understand how to avoid this major risk factor for lung cancer. Begin conversations about the dangers of smoking with your children early so that they know how to react to peer pressure.

Stop smoking. Stop smoking now. Quitting reduces your risk of lung cancer, even if you’ve smoked for years. Talk to your doctor about strategies and stop-smoking aids that can help you quit. Options include nicotine replacement products, medications, and support groups.

Avoid secondhand smoke. If you live or work with a smoker, urge him or her to quit. At the very least, ask him or her to smoke outside. Avoid areas where people smoke, such as bars and restaurants, and seek out smoke-free options.

Test your home for radon. High radon levels can be remedied to make your home safer. For information on radon testing, contact your local department of public health or a local chapter of the American Lung Association.

Avoid carcinogens at work. Take precautions to protect yourself from exposure to toxic chemicals at work. Follow your employer’s precautions. For instance, if you’re given a face mask for protection, always wear it. Ask your doctor what more you can do to protect yourself at work. Your risk of lung damage from workplace carcinogens increases if you smoke.

Eat a diet full of fruits and vegetables. Choose a healthy diet with a variety of fruits and vegetables. Food sources of vitamins and nutrients are best. Avoid taking large doses of vitamins in pill form, as they may be harmful. For instance, researchers hoping to reduce the risk of lung cancer in heavy smokers gave them beta carotene supplements. Results showed the supplements actually increased the risk of cancer in smokers.

Exercise most days of the week. If you don’t exercise regularly, start out slowly. Try to exercise most days of the week.

Diagnosis of Lung Cancer

  1. Chest X-ray may be suspicious for mass; CT or position emission tomography scan will be better visualize the tumor.
  2. Sputum and pleural fluid samples for cytologic examination may show malignant cells.
  3. Fiberoptic bronchoscopy determines the location and extent of the tumor and may be used to obtain a biopsy specimen.
  4. Lymph node biopsy and mediastinoscopy may be ordered to establish lymphatic spread and help plan treatment.
  5. A pulmonary function test, which may be combined with a split-function perfusion scan, determines if the patient will have an adequate pulmonary reserve to withstand surgical procedures.

Nursing Care Plans for Lung Cancer Based on Nursing Diagnosis

Nursing Care Plan 1: Diagnosis – Impaired Gas Exchange

May be related to:

  • Removal of lung tissue
  • Altered oxygen supply (hypoventilation)
  • Decreased oxygen-carrying capacity of blood (blood loss)

Possibly evidenced by:

  • Dyspnea
  • Restlessness/changes in mentation
  • Hypoxemia and hypercapnia
  • Cyanosis

Desired Outcomes

Patient will:

  • Demonstrate improved ventilation and adequate oxygenation of tissues by ABGs within the patient’s normal range.
  • Be free of symptoms of respiratory distress.

Nursing Interventions

Note respiratory rate, depth, and ease of respirations. Observe for the use of accessory muscles, pursed-lip breathing, changes in skin or mucous membrane color, pallor, cyanosis.

Rationale: Respirations may be increased as a result of pain or as an initial compensatory mechanism to accommodate for the loss of lung tissue; however, increased work of breathing and cyanosis may indicate increasing oxygen consumption and energy expenditures and/or reduced respiratory reserve.

Auscultate lungs for air movement and abnormal breath sounds.

Rationale: Consolidation and lack of air movement on the operative side are normal in the pneumonectomy patient; however, the lobectomy patient should demonstrate normal airflow in the remaining lobes.

Investigate restlessness and changes in mentation or level of consciousness.

Rationale: May indicate increased hypoxia or complications such as a mediastinal shift in pneumonectomy a patient when accompanied by tachypnea, tachycardia, and tracheal deviation.

Assess patient response to activity. Encourage rest periods and limit activities to patient tolerance.

Rationale: Increased oxygen consumption demand and stress of surgery can result in increased dyspnea and changes in vital signs with activity; however, early mobilization is desired to help prevent pulmonary complications and to obtain and maintain respiratory and circulatory efficiency. Adequate rest balanced with activity can prevent respiratory compromise.

Note development of fever.

Rationale: Fever within the first 24 hr after surgery is frequently due to atelectasis. Temperature elevation within the 5th to 10th postoperative day usually indicates a wound or systemic.

Maintain patent airway by positioning, suctioning, use of airway adjuncts.

Rationale: Airway obstruction impedes ventilation, impairing gas exchange.

Reposition frequently, placing a patient in sitting positions and supine to side positions.

Rationale: Maximizes lung expansion and drainage of secretions.

Avoid positioning a patient with a pneumonectomy on the operative side; instead, favor the “good lung down” position.

Rationale: Research shows that positioning patients following lung surgery with their “good lung down” maximizes oxygenation by using gravity to enhance blood flow to the healthy lung, thus creating the best possible match between ventilation and perfusion.

Encourage and assist with deep-breathing exercises and pursed-lip breathing as appropriate.

Rationale: Promotes maximal ventilation and oxygenation and reduces or prevents atelectasis.

Maintain patency of chest drainage system for lobectomy, segmental, or wedge resection patient.

Rationale: Drains fluid from the pleural cavity to promote re-expansion of remaining lung segments.

Note changes in amount or type of chest tube drainage.

Rationale: Bloody drainage should decrease in amount and change to a more serious composition as recovery progresses. A sudden increase in the amount of bloody drainage or return to frank bleeding suggests thoracic bleeding or hemothorax; sudden cessation suggests tube blockage, requiring further evaluation and intervention.

Observe the presence or degree of bubbling in the water-seal chamber.

Rationale: Air leaks immediately postoperative are not uncommon, especially following lobectomy or segmental resection; however, this should diminish as healing progresses. Prolonged or new leaks require evaluation to identify problems inpatient versus the drainage system.

As indicated, administer supplemental oxygen via nasal cannula, partial rebreathing mask, or high-humidity face mask.

Rationale: Maximizes available oxygen, especially while ventilation is reduced because of anesthetic, depression, or pain, and during a period of a compensatory physiological shift of circulation to remaining functional alveolar units.

Assist with and encourage the use of an incentive spirometer.

Rationale: Prevents or reduces atelectasis and promotes re-expansion of small airways.

Monitor and graph ABGs, pulse oximetry readings. Note hemoglobin (Hb) levels.

Rationale: Decreasing Pao2 or increasing Paco2 may indicate a need for ventilatory support. Significant blood loss can result in decreased oxygen-carrying capacity, reducing Pao2.

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Nursing care plans for lung cancer
Nursing Care Plans for Lung Cancer

Nursing Care Plan 2: Diagnosis – Ineffective Airway Clearance

May be related to:

  • Increased amount/viscosity of secretions
  • Restricted chest movement/pain
  • Fatigue/weakness

Possibly evidenced by:

  • Changes in rate/depth of respiration
  • Abnormal breath sounds
  • Ineffective cough
  • Dyspnea

Desired Outcomes

The patient will demonstrate patent airway, with fluid secretions easily expectorated, clear breath sounds, and noiseless respirations.

Nursing Interventions

Auscultate chest for the character of breath sounds and presence of secretions.

Rationale: Noisy respirations, rhonchi, and wheezes are indicative of retained secretions and/or airway obstruction.

Assist patient and instruct in effective deep breathing and coughing with upright position (sitting) and splinting of an incision.

Rationale: Upright position favors maximal lung expansion, and splinting improves the force of cough effort to mobilize and remove secretions. Splinting may be done by a nurse (placing hands anteriorly and posteriorly over the chest wall) and by the patient (with pillows) as strength improves.

Observe the amount and character of sputum or aspirated secretions. Investigate changes as indicated.

Rationale: Increased amounts of colorless, blood-streaked, or watery secretions are normal initially and should decrease as recovery progresses. The presence of thick or tenacious, bloody, or purulent sputum suggests the development of secondary problems (dehydration, pulmonary edema, local hemorrhage, or infection) that require correction and treatment.

Suction if cough is weak or breath sounds not cleared by cough effort. Avoid deep endotracheal or nasotracheal suctioning in pneumonectomy patients if possible. Suction the patient as needed, and encourage to begin deep breathing and coughing as soon as possible.

Rationale: “Routine” suctioning increases the risk of hypoxemia and mucosal damage. Deep tracheal suctioning is generally contraindicated following pneumonectomy to reduce the risk of rupture of the bronchial stump suture line. If suctioning is unavoidable, it should be done gently and only to induce effective coughing.

Encourage oral fluid intake (at least 2500 mL/day) within cardiac tolerance.

Rationale: Adequate hydration aids in keeping secretions loose or enhances expectoration.

Assess for pain or discomfort and medicate on a routine basis and before breathing exercises.

Rationale: Encourages patient to move, cough more effectively, and breathe more deeply to prevent respiratory insufficiency.

Assist with an incentive spirometer, postural drainage, and percussion as indicated.

Rationale: Improves lung expansion or ventilation and facilitates removal of secretions. Postural drainage may be contraindicated in some patients and, in any event, must be performed cautiously to prevent respiratory embarrassment and incisional discomfort.

Use humidified oxygen and/or ultrasonic nebulizer. Provide additional fluids via IV as indicated.

Rationale: Providing maximal hydration helps loosen or liquefy secretions to promote expectoration. Impaired oral intake necessitates IV supplementation to maintain hydration.

Administer bronchodilators, expectorants, and/or analgesics as indicated.

Rationale: Relieves bronchospasm to improve airflow. Expectorants increase mucus production and liquefy and reduce the viscosity of secretions, facilitating removal. Alleviation of chest discomfort promotes cooperation with breathing exercises and enhances the effectiveness of respiratory therapies.

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Nursing care plans for lung cancer
Nursing Care Plans for Lung Cancer

Nursing Care Plan 3: Diagnosis – Acute Pain

May be related to:

  • Surgical incision, tissue trauma, and disruption of intercostal nerves
  • Presence of chest tube(s)
  • Cancer invasion of pleura, chest wall

Possibly evidenced by:

  • Verbal reports of discomfort
  • Guarding of the affected area
  • Distraction behaviors, e.g., restlessness
  • Narrowed focus (withdrawal)
  • Changes in BP, heart/respiratory rate

Desired Outcomes

Patient will:

  • Report pain relieved/controlled.
  • Appear relaxed and sleep/rest appropriately.
  • Participate in desired/needed activities.

Nursing Interventions

Ask the patient about pain. Determine pain characteristics: continuous, aching, stabbing, burning. Have the patient rate intensity on a 0–10 scale.

Rationale: Helpful in evaluating cancer-related pain symptoms, which may involve viscera, nerve, or bone tissue. Use of a rating scale aids the patient in assessing the level of pain and provides a tool for evaluating the effectiveness of analgesics, enhancing patient control of pain.

Assess patient’s verbal and nonverbal pain cues.

Rationale: Discrepancy between verbal and/or nonverbal cues may provide clues to the degree of pain, need for, or effectiveness of interventions.

Note possible pathophysiological and psychological causes of pain.

Rationale: Fear, distress, anxiety, and grief over confirmed diagnosis of cancer can impair the ability to cope. In addition, a posterolateral incision is more uncomfortable for a patient than an anterolateral incision. The presence of chest tubes can greatly increase discomfort.

Evaluate the effectiveness of pain control. Encourage sufficient medication to manage pain; change medication or time span as appropriate.

Rationale: Pain perception and pain relief are subjective; thus, pain management is best left to the patient’s discretion. If the patient is unable to provide input, the nurse should observe physiological and nonverbal signs of pain and administer medications on a regular basis.

Encourage verbalization of feelings about the pain.

Rationale: Fears or concerns can increase muscle tension and lower the pain perception threshold.

Provide comfort measures: frequent position changes, back rubs, support with pillows. Encourage the use of relaxation techniques, visualization, guided imagery, and appropriate diversional activities.

Rationale: Promotes relaxation and redirects attention. Relieves discomfort and augments therapeutic effects of analgesia.

Schedule rest periods provide a quiet environment.

Rationale: Decreases fatigue and conserves energy, enhancing coping abilities.

Assist with self-care activities, breathing and/or arm exercises, and ambulation.

Rationale: Prevents undue fatigue and incisional strain. Encouragement and physical assistance and support may be needed for some time before the patient is able or confident enough to perform these activities because of pain or fear of pain.

Assist with patient-controlled analgesia (PCA) or analgesia through the epidural catheter. Administer intermittent analgesics routinely as indicated, especially 45–60 min before respiratory treatments, deep-breathing, or coughing exercises.

Rationale: Maintaining a constant drug level avoids cyclic periods of pain, aids in muscle healing, and improves respiratory function and emotional comfort and coping.

Related FAQs

  1. What are the 1st signs of lung cancer?

Signs and Symptoms of Lung Cancer

  • A cough that does not go away or gets worse.
  • Coughing up blood or rust-colored sputum (spit or phlegm)
  • Chest pain that is often worse with deep breathing, coughing, or laughing.
  • Hoarseness.
  • Loss of appetite.
  • Unexplained weight loss.
  • Shortness of breath.
  • Feeling tired or weak.

2. What is the survival rate of lung cancer?

The lung cancer five-year survival rate (18.6 percent) is lower than many other leading cancer sites, such as colorectal (64.5 percent), breast (89.6 percent) and prostate (98.2 percent). The five-year survival rate for lung cancer is 56 percent for cases detected when the disease is still localized (within the lungs).

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Nursing care plans for lung cancer
Nursing Care Plans for Lung Cancer

3. How does lung cancer start?

Doctors believe smoking causes lung cancer by damaging the cells that line the lungs. When you inhale cigarette smoke, which is full of cancer-causing substances (carcinogens), changes in the lung tissue begin almost immediately.

4. Is cancer in the lungs curable?

As with many other cancers, a key to surviving lung cancer is catching it in its earliest stages, when it is most treatable. For patients who have small, early-stage lung cancer, the cure rate can be as high as 80% to 90%.

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