Acute Pain | Nursing Care Plan for Lung Cancer

Nursing diagnosis: acute pain 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 affected area

Distraction behaviors such as restlessness

Narrowed focus, withdrawal

Changes in blood pressure (BP), heart, or respiratory rate

Desired Outcomes/Evaluation Criteria—Client Will

Pain Level

Report pain relieved or controlled.

Appear relaxed and sleep or rest appropriately.

Participate in desired as well as needed activities.

Nursing intervention with rationale:

1. Ask client about pain. Determine pain location and characteristics; for example, continuous, aching, stabbing, or burning. Have client rate intensity on a scale of 0 to 10.

Rationale: Helpful in evaluating cancer-related pain symptoms, which may involve viscera, nerve, or bone tissue. Use of rating scale aids client in assessing level of pain and provides tool

for evaluating effectiveness of analgesics, enhancing client control of pain.

2. Assess client’s verbal and nonverbal pain cues.

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

3. Note possible pathophysiological and psychological causes of pain.

Rationale: Fear, distress, anxiety, and grief over confirmed diagnosis of cancer can impair ability to cope. In addition, a posterolateral incision is more uncomfortable for client than an

anterolateral incision. The presence of chest tubes can greatly increase discomfort.

4. Evaluate 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 client’s discretion. If client is unable to provide input, the nurse should observe physiological and nonverbal signs of pain and administer medications on a regular basis.

5. Encourage verbalization of feelings about the pain.

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

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

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

7. Schedule rest periods; provide quiet environment.

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

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

Rationale: Prevents undue fatigue and incisional strain. Encouragement and physical assistance and support may be needed for some time before client is able or confident enough to perform

these activities because of pain or fear of pain.

9. Assist with patient-controlled analgesia (PCA) or analgesia through epidural catheter. Administer intermittent analgesics routinely, as indicated, especially 45 to 60 minutes

before respiratory treatments, and deep-breathing and 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.