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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.

Ineffective Airway Clearance | Nursing Care Plan for Lung Cancer

Nursing diagnosis: ineffective airway clearance related to increased amount or viscosity of secretions; restricted chest movement, pain; fatigue, weakness

Possibly evidenced by

Changes in rate and depth of respiration

Abnormal breath sounds

Ineffective cough

Dyspnea

Desired Outcomes/Evaluation Criteria—Client Will

Respiratory Status: Airway Patency

Demonstrate patent airway, with fluid secretions easily expectorated, clear breath sounds, and noiseless respirations.

Nursing intervention with rationale:

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

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

2. Assist client with and provide instruction in effective deep breathing, coughing in upright position (sitting), and splinting of incision.

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

3. Observe amount and character of sputum and aspirated secretions. Investigate changes, as indicated.

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

4. Suction if cough is weak or breath sounds not cleared by cough effort. Avoid deep endotracheal and nasotracheal suctioning in client who has had pneumonectomy if possible.

Rationale: “Routine” suctioning increases 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.

5. Encourage oral fluid intake, at least 2,500 mL/day, within cardiac tolerance.

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

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

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

7. Provide and assist client with incentive spirometer and postural drainage and percussion, as indicated.

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

8. Use humidified oxygen and ultrasonic nebulizer. Provide additional fluids intravenously (IV), as indicated.

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

9. Administer bronchodilators, expectorants, and analgesics, as indicated.

Rationale: Relieves bronchospasm to improve airflow. Expectorants increase mucus production and liquefy and reduce viscosity of secretions, facilitating removal. Alleviation of chest discomfort

promotes cooperation with breathing exercises and enhances effectiveness of respiratory therapies.

Impaired Gas Exchange | Nursing Care Plan for Lung Cancer

Nursing diagnosis: impaired gas exchange 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/Evaluation Criteria—Client Will

Respiratory Status: Gas Exchange

Demonstrate improved ventilation and adequate oxygenation of tissues by arterial blood gases (ABGs) within client’s normal range.

Be free of symptoms of respiratory distress.

Nursing intervention with rationale:

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

Rationale: Respirations may be increased as a result of pain or as an initial compensatory mechanism to accommodate for loss of lung tissue. However, increased work of breathing and cyanosis may indicate increasing oxygen consumption and energy expenditures or reduced respiratory reserve, for example, in an elderly client or extensive COPD.

2. Auscultate lungs for air movement and abnormal breath sounds.

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

3. Investigate restlessness and changes in mentation and level of consciousness.

Rationale: May indicate increased hypoxia or complications such as mediastinal shift in a client who has had a pneumonectomy when accompanied by tachypnea, tachycardia, and tracheal

deviation.

4. Assess client response to activity. Encourage rest periods, limiting activities to client tolerance.

Rationale: Increased oxygen consumption and demand and stress of surgery may 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.

5. Note development of fever.

Rationale: Fever within the first 24 hours after surgery is frequently due to atelectasis. Temperature elevation within postoperative day 5 to 10 usually indicates an infection, such as wound or systemic.

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

Rationale: Airway obstruction impedes ventilation, impairing gas exchange.

7. Reposition frequently, placing client in sitting and supine to side positions.

Rationale: Maximizes lung expansion and drainage of secretions.

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

Rationale: Research shows that positioning clients 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.

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

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

10. Administer supplemental oxygen via nasal cannula, partial rebreathing mask, or high-humidity face mask, as indicated.

Rationale: Maximizes available oxygen, especially while ventilation is reduced because of anesthetic, depression, or pain, and during period of compensatory physiological shift of

circulation to remaining functional alveolar units.

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Let's Get Technical

NEARLY 30 years ago, with snow blanketing the country and all seven local junior football teams, plus the local rugby club idle, I had to somehow, fill four blank pages of sport for my local paper.

OK, nice big pictures of kids playing on snow-covered football pitches filled some space; a look forward to hoped for action at the weekend, plus weather forecasting and injury bulletins did for more column inches; a bigger than usual fixture list plus league tables helped. But, I still had a full page to fill.

Then, I remembered the local basketball club had a Sunday game; so, I went along, wrote it up and gave them more publicity than they had ever had. This got me into basketball, a game which I had previously not rated too-highly.

With regard to the present little local difficulties with referees in football, basketball has a couple of features which just might help-out the Beautiful Game. The first of these is the Personal Foul, the second is the Technical Foul.

The Personal Foul does what it says on the tin - each player is held responsible for every foul he commits, and after his fifth foul, he is out of the game. Such a rule in football would soon get rid of our "hammer throwers". Ross Tokeley for instance would only have to play about half an hour per match.

But the real beauty is the Technical Foul. "Techies" as they are known can be awarded for just about anything the referees consider to be against the spirit of the game: bad language, extreme dissent, any kind of misbehaviour. They are usually awarded against coaches, indeed, some coaches deliberately take Techies if they feel the referee is agin them.

The Techie is called and the opposition are given either one or two free throws - basketball's equivalent of the penalty kick, with, sometimes, if the Techie was a particularly bad one, possession given to the opposition from the restart. This is of course a big advantage in a game where possession is so crucial.

Now, imagine this in football. A manager is giving the referee all sorts of abuse from the bench. The referee goes over, indicates he has incurred a technical foul and awards the opposition a penalty kick.

I don't think it would take too-long for even the most-obnoxious, ginger-headed of managers to realise, he'd better stop having a go at the referee, or it is going to be extremely costly to his side.

And while we're importing sanctions from other games - what about a rugby-style citing officer, to look at footage of a game, after it has ended, and adjudicating on fouls or foul play which the referee might have missed? This too could clean up a lot of the nefarious paractices which besmirch the beautiful game.

Also, let's bring-in the sin bin, from ice hockey and rugby, so that any player receiving a yellow card has to spend ten minutes sitting out the action. Other rugby practices worth importing include the ten metres sanction for not immediately retreating to allow a free kick to be taken (if the offending side don't immediately get back - the kick position is advanced ten metres) and the practice of calling-up the captain so that he hears why his team mate is being yellow-carded and sin-binned.

I've said before and I will say again doubtless, football needs a spell of zero tolerance and these imports from other sports will surely help clean it up.

It's worth a try I feel.

B.Sc Nursing Colleges in Kerala

A K G Memorial Co-Operative College of Nursing, Talap,Kannur Distt.-670002, Kerala(50)
Al Shifa College of Nursing,P B NO.26, Perinthalmanna, MalappuramDistt-679322,Kerala(60)
Amala College of Nursing, Amala Instt Of Medical Sciences, Amalanagar P P, Thrissur-680555,Kerala(50)
Amrita College of Nursing, Amrita Vishwa Vidyapeetham (Deemed Uty)A I M S,Campus, amrita Lane, Eramakara PO< Kochi-68202(50)
Archana College of Nursing,Archana Hospital Complex, Pandalam ,Distt, Pathanamthitta-689501,Kerala(60)
Aswini College of Nursing,Ndathara Post, Thrissur-680751,(50)
Azeezia Nursing College, Diamond Hills, Meeyyannoor, Kolam-691537,Kerala(50)
B C F College of Nursing,Chemmanakary, Akkarapadam Po, Vaikom-686143, Kottayam District,Kerala(40)
Baby Memorial College of Nursing, Green View Villa Colony Road, Kuthiravattam PO,Calicut-673016, Kerala(50)
Bishop Benziger College of Nursing,post box No. 46, Sastri Junction, Kollam 691001,Kerala(50)
C H Memorial College of Nursing,Pernthalmanna road, valancherry, Malapuram district, Pin676552(40)
C S I College of Nursing,Dr Somervell Memorial C SI Medical College& Hospital, Karkonam Po, Thiruvanathapuram Dist-695504(50)
Canossa College of Nursing,St Martin De Porres Hospital, Cherukunnu, Kannur Distt(50)
Caritas College of Nursing, Caritas Hospital, Thellakom Po, Kottyam-686016, Kerala(50)
Century College of Nursing, Poinachi, Thekkil post, Kasaragod District-671541(50)
City Hospital College of Nursing,John Mill road, Thalap,Kannur-670002(50)
College of Nursing, Academy of Medical Sciences, Pariyaram Medical College, Kannur-670503(50)
College of Nursing,Nettur Po Thalassery 670105, Kannur distt, Kerala(50)
Kannur Medical college, Anjarakandi, Post Mamba, Kannur-670611,Kerala(50)
College of Nursing, Ananthapuri Hospitals, 31/1424, Chacka, National Highway, pettah Po, Thiruvananthapuram-695024(50)
College of Nursing,E M S Memorial Co-Operative Hosp&Research Centre, P B No.25, Perintalmanna 679322, Malappuram Dist, Kerala(50)
College of Nursing,Moulana Hospital, Near Railway Station, Po Angadippuram-679321, Perinthalmanna, Malappuram District, Kerala(50)
Crescent College of Nursing, M P –X I I -551, Mottambram Po Madayi, Kannur Distt-670304,Kerala(70)
Crescent College of Nursing,Cresent Medical Centre, Alathur Po, Palakkad, Kerala-678541(50)
Govt College of Nursing,T D Medical College, Alappuzha-688005(60)
Govt College of Nursing,Gandhi Nagar Post, Distt Kottyam-686008 Kerala(50)
Govt College of Nursing,Velappaya Medical College, Trissur, Mulankunnathukavu, Trissur dist.-680596(60)
Govt. College of Nursing,Kozhicode MNedical College, Po Kozhikode-673008,Kerala(50)
Govt. College of Nursing,Medical college PO, Thiruvananthapuram 695011,Kerala(50)
Holy Cross College of Nursing, Kottiyam, Kollam-691571,Kerala(50)
Holy Family College of Nursing,Muthalakodam PO, Thodupuzha-685605, Idukki District,Kerala(50)
Indira Gandhi College of Nursing, P B NO 2019, Gandhi Nagar, Kochi-682020(50)
Institute of Nursing Education, SM E Regional Centre, Chuttippara, Pathanamthitta(50)
Institute of Nursing Education School of Medical Education , M G University, Regional Centre , Victoria Buildings, Nedumkandam, Idukki Dist.-685553(60)
Institute of Nursing EducationSCM E ,MG University, Regional Centre, Puthupally, Kottyam Kerala,Pin 686009(50)
Institute of Nursing Education School of MedicalEdu, Mahathmagandhi University, Gandhi Nagar Po, Distt Kottyam-686008,Kerala(50)
Institute of Nursing Education School of MedicalEdu,M G University, St. Mary’s Building, Regional Centre, Pala, Kottayam District(50)
Institute of Nursing Education School of MedicalEdu, M G University, Regional Centre ,Pkv Buildings, Perumanoor Po, Thevara, Kochi-15,(50)
Institute of Nursing Education School of MedicalEdu, M G University, Regional CentreMun.Buildings, Rly Station Rd, Angamaly-683572,(50)
Institute of Nursing Education School of MedicalEdu, M G University, Regional Centre,Our Towers Bldg, T d Road, Ernakula,-682035,Kerala(40)
J D T Islam Orphanage Committee, College of Nursing, Vellimadukunnu, Calicut-673012,Kerala(50)
Josco College of Nursing, Josco Multi Speciallity,Hospital, Iranikudy Post ,Pandalam-689501,Alappuzha District,Kerala(40)
Jubliee College of Nursing,St. James Medical Academy, River Bank Chalakudy-680307,Kerala(50)
Jubliee Mission College of Nursing,P B No. 737, East Fort, Thrissur-680005 Kerala(50)
K M C T College of Nursing,, Mampatta, Manassery Po, Mukkom, Calicut-673602,Kerala(50)
K V M College of Nursing, K V M Hospital Complex, Cherthala-688524, Alappuzha Dist(70)
Karuna College of Nursing, Karuna Medical college Campus, Vilayodi Chittur-pallakad-678103(50)
Kerala Institute of Medical Sciences, College of Nursing, Anamukham, P B No.1,Anayara Po, Thiruvananthapuram-695029(50)
Koyili College of Nursing, Koyili Hospital Pallikkunnu Po, Kannur-4(50)
Lisie College of Nursing, Lisie Hospital, P B No 3053, Cochin-682018,Ernakulam Distt,Kerala(50)
Little Flower College of Nursing, Little Flower Hospital&Res Centre, Post Box:23, Angamaly-683572, Ernakulam Distt(50)
Lourde College of Nursing, Lourde Hospital Buildings, Chiravakku, Taliparamba-670141, Distt. Kannur, Kerala(50)
M E S College of Nursing, Malaparamba, Palachode (Post), Kolathur (via), Perintha Imanna, Malappuram Dist.-679338(50)
M I M S College of Nursing, Vadakkedath Paramba ,Puthukode (PO) Vazhayur, Malappuram Dist,Pin-673633,Kerala(50)
Malankara Orthodox Syrian Church College of Nursing, , M O S C Medical College, Kolencherry, Ernakulam Distt 682311,Kerala(50)
Malik Deenar College of Nursing, Talangara ,Kasaragod-671122, Kerala (50)
Mar Baselios College of Nursing, Kothamangalam Po 686691, Ernakulam Distt., Keral(60)
Mar Sleeva College of Nursing, Cherpumkal Po, Palai, Kottyam Distt -686584,Kerala(50)
Mary Mata College of Nursing, Karinada ,Neyyattinkara, Trivandrum 695121(40)
Medical Trust College of Nursing, Medical Trust Hospital, M G Road, Kochi 682016(50)
Mercy College of Nursing, Mercy Hospital, Valakom, Kottarakkara, Kollam Distt-691532,Kerala(60)
Mother College of Nursing Mother Hospital Pvt. Ltd., Pullazhi Po, Olari, Thrichur-680012, Kerala(50)
Muthoot College of Nursing,Mothoot Medical centre, Kozhencherry-689641, Pathanamthitta District, Kerala State(50)
Muthoot Medical Centre, College of Nursing, Ring Road, Pathanamthitta, Kerala-689645(50)
National Hospital College of Nursing,Indira Gandhi Road, Calicut-673001, Kerala(50)
Nightangale College of Nursing, R I M S Speciality Hospital, Govt College Road, Nedumangad-695541, Triruvananthapuram Kerala(50)
Nirmala College of Nursing, Nirmala Hospital,Marikunnu Po, Calicut-673012, Kerala 630(50)
P V S College of Nursing, P V S Hospital Building, Railway Station road, Kozhikode-673002(50)
Pushpagiri Medical College Hospital, Pathanamthitta, Thiruvalla-689101 Kerala(50)
Ruckmoni College of Nursing, Ponnambi ,Vellarada Pin-695505,Dist Trivandurm (50)
S S N Medical Mission College of Nursing, Sreenivasapuram Po., Varkala-695145, Thiruvanthapuram Dist, Kerala(70)
Samaritan College of Nursing, Samaritan Hospital, Pazhanganad, Kizhakkamalam-683562,Kerala (70)
Samaritan College of Nursing, Samaritan Hospital, Pazhanganad, Kizhakkamalam-683562,Kerala(50)
San Joe College of Nursing, San Joe Hospital, Perumbavoor-683542, Ernakulam Dist. Kerala(50)
Saraswathy College of Nursing, Saraswathi Hospital Campus, Parassala, Parassala Po, Thiruvananthapuram Dist, Kerala-695502(50)
Sidhi Sadan Lourdes College of Nursing, Chemmbumukku, Kakkanad, Kochi-682021,Kerala(50)
St Andrew’s College of Nursing, Panachamoodu Vellarada Post, Trivandram Distt-695505,Kerala(50)
St Gregorios College of Nursing, Parumala Po, Pathanamthitta Distt, Kerala-689626(50)
St John’s College of Nursing,St John’s Hospital, Kattappana -685515,Idukki District,Kerala(50)
St Joseph’s College of Nursing, Anchal , Kollam District-691306(50
St Joseph’s College of Nursing, Dharmagiri, Kothamangalam-686691, Ernakulam Distt(60)
St Thomas College of Nursing, St Thomas Mission Hospital Pallickal Po, Kattanam 690503,Alappuzha(50)
St Thomas College of Nursing, Kurisumoodu Po, Chethipuzha, Changanacherry-686104,Distt, Kottyam(50)
T M M College of Nursing, Tiruvalla Medical Mission ,Po Box No.50, Tiruvalla-630101,Distt. Pathananthitta (50)
Thephilus College of Nursing, Mar Geevarghese Dionysis Memorial Hospital, Devagiri Po,Kangazha, Kottyam-686555(50)
Upasana College of Nursing, Puthuchira Umayanalloor Industrial Estate,Po Kollam-691589(75)
V N S S College of Nursing, P B No. 32,Q SRoad, Kollam-691001(60)
Vijaya College of Nursing, Chengamanadu Po, Kizhakketheruvu, Kottarakara,Kollam Dist-691557(60)
Westfort College of Nursing,(W A H E ) P B No. 16, M G Kavu, Pottore, Thrissur 680581(50)