NURSING CAREPLAN
FOR
LUNG CANCER
COLLEGE OF NURSING, REGIONAL INSTITUTE OF MEDICAL SCIENCES
SUBMITTED TO SUBMITTED BY
Mrs. H. Mamata Devi Miss Anamika Sharma
Tutor 2nd Year M.Sc. Nursing
RIMS, CON RIMS, CON
Identification of patient
NAME : Mr. Subash Chandra Singh
AGE : 67 years
SEX : Male
IP NO : 302267
BED NO. : 08
WARD : MMW
EDUCATIONAL STATUS : No formal education
obtained
MARITAL STATUS : Married
OCCUPATION : Carpenter
RELIGION : Hindu
ADDRESS : Bishnupur, Manipur
D.O.A : 9/12/2020
DIAGNOSIS : Lung cancer
Chief complaint: patient came with the chief complaint of:-
Shortness of breath for one week
Easy fatigability for same duration
Anorexia and vomiting for one week
Oral ulcers for one week
History of present illness: According to the statement of the patient, he was
reasonably well before one week. Then he developed shortness of breath and anorexia
and vomiting. He also started having oral ulcers. He further informed that he had
completed his chemotherapy for lung cancer two weeks before his Illness. Patient was
admitted for further management.
Past medical history: patient is diagnosed with lung carcinoma 1 year ago
Past surgical history: no past surgical history
Family history:-
Pedigree
Pedigree
= patient
= female
= male
Family profile
SL. Name of Relationship Age Sex Educational Occupation Health
NO the family with patient status status
member
1. Mr. Subash Patient 67y M No formal Carpenter Unhealthy
Chandra education
Singh
2. Mrs. Anita Wife 52 y F Class VI House wife Healthy
3. Mrs. Pinky Daughter 39 y F Class XII Teacher Healthy
4. Mr. Abinav Son 37y M Class XII Shopkeeper Healthy
5. Mr. Junal Son 34 M Graduation Office Healthy
6. Mrs. Prima Daughter 32y F Graduation Teacher Healthy
Family history of illness: no family history of illness (communicable or non-communicable
disease) in the patient’s family.
Personal history:
Dietary habits: A non- vegetarian ; takes meal 3 times a day
Elimination habits: both bowel and bladder pattern normal.
Sleeping habits: sleeps 6-7 hours per day
Addiction: no addiction of any kind
Socio- economic status:
Income status: appropriate
No. of earning members: 5
Housing : pucca house
Ventilation: adequate ventilation
Electricity : government power supply
Water supply: PHE & pond
Physical examination date of examination:
General Appearance
1. General state of health : Unhealthy
2. Appearance : Appears weak
3. Level of consciousness : Conscious
4. Patient’s general build : Thin
5. Nutritional status
Height : 168cm
Weight : 53 kgs
BMI : 18.8
6. Facial expression : Anxious
7. Speech and language : normal and relevant
8. Position/posture and gait: : normal
9. Personal Hygiene: : not maintained
10. Breath/Odor : halitosis present
11. Hand & Nails : appears clean
Vital Signs
Temperature : 98.2 ᴼF
Pulse : 72 beat/min
Respiration: : 28 breath/min
Blood pressure : 120/ 80 mm Hg
SpO2 : 97% with O2
Head
1. Examination of the head includes
a) Ear
b) Facial color : No abnormalities found
c) De Musset’s sign (head : Pallor
bobbing with each heartbeat : Absent
d) Facial edema Absent
e) Eye : Normal
Size : Round
Shape Pupil equally round and reactive to light and
Reactivity : accommodation
NECK:
Absent
:
a) Jugular vein distention
1. Respiratory System
Chest movement : Bilaterally Symmetrical
Respiratory : 28 b/m
Air entry : Less in the right lung
Breath sounds : Normal
Cough : Absent
Oxygen on flow(L/min) : On flow by 2ml using nasal cannula
2. Cardiovascular system:
Pulse Normal
Peripheral pulse
-Radial Right: 72 b/m Left: 70 b/m
-Popliteal Right: 68 b/m Left: 68 b/m
-Post tibial Right: 62 b/m Left: 62b/m
-Dorsalise pedis Right: 60 b/m Left: 62b/m
Heart sound Normal S1 and S2 heard
-S1 sound Audible
S2 sound Audible
Neck vein distension Absent
Chest pain Absent
Gastrointestinal system
a) Mouth : oral ulcers present
b) Teeth : No dental carries
c) Oral ulcers : Present
d) Peristalsis : Present
e) Abdominal distension : Absent
f) Nausea : Absent
g) Vomiting : Absent
h) Nothing by mouth : Allowed orally
i) Nutrition route : Mouth
j) Bowel opened : Absent
k) Constipation : Absent
l) Diarrhoea : Absent
m) Malena : Absent
Genitourinary system
a) Voiding : Void freely
b) Urine : Straw colored
c) Hematuria : No
d) Retention/incontinence/any : None
other
Integumentary System
a) Skin : Warm to touch
b) Cyanosis : Absent
c) Peripheries : Warm
d) Nails : Normal, no clubbing
e) Oedema : Absent
f) Icterus : Mild present
g) Temperature : 98.2ᴼF
h) Scalp : No signs of infection
i) Eyes : Clean, no abnormalities seen
j) Nose : Clean
k) Ear : Clean
l) Sleep : Disturbed
Musculoskeletal system
a) Joint : Mobile
b) Ambulant/ bed to chair or toilet/ : Can move around with mild assistance
bed ridden.
INVASIVE
Peripheral : IV Cannula is present in the right forearm
INCISIONAL WOUND/ ANY OTHER WOUND: none
Investigation done for the patient
Sl.no Name of the Patient value Normal value Remarks
investigation
1. Blood random glucose 124 mg/dl <140 mg% Normal
2. CBC:
Hb 10.8 12.0-17.0% low
RBC 4.00 3.8-4.8 ml/ul Normal
WBC 17.1 4.0-10.0 thou/ul High
NEUTRO 74% 40-70% High
3. LFT:
Sr. Bilirubin total 0.4 0.1-1 mg% High
Sr. Bilirubin direct 0.7 0.1-0.4 mg% High
Sr. total protein 5.7 6-8 gm% Low
Sr. albumin 3.3 3.7-5.4 gm% Low
Sr. globulin 3.0 1.8 – 3.6 gm % Normal
Sr. SGOT 48 5-40 IU High
Sr. SGPT 39 5-30 IU High
4. KFT
Urea 30 10-50 mg% Normal
Creatinine 1.4 0.6-1.6 mg% Normal
Na+ 137 130-145 mEq/L Normal
K+ 4 3.6-5 mEq/L Normal
6. Hepatitis report
Hbs Ag Negative
Anti HCV Negative
7. Lipid profile
Total cholesterol 207mg% <200 mg% High
Serum triglyceride 180mg% 35-160mg% High
LDL 134 mg % 60-129mg% High
HDL 46mg% >60mg% Low
VLDL 42 mg% 25-50mg% Normal
8. CHEST X RAY OPACITY IN THE RIGHT LUNG
Treatment of the patient
Sl. Trade name Pharmacological Dose frequency route Classification
no. name
2. Inj. Augpen Amoxycilline 1.2 gm BD IV Antibiotic
and potassium
calvunate
3. Inj. PNZ Pantaprazole 40 mg BD IV Proton pump
inhibitor
4. Inj. Dexona Dexamethasone 16mg BD IV Corticosteroids
5. Hexigel Chlorhexidine - TDS L/A Antibiotic
ointment ointment
SL NO. Name of the Dose/ Frequency Action Side effects Nurses responsibility
drug route
1. Inj PNZ 40mg BD Pantoprazole is a proton CNS: Dizziness, headache To report severe
Generic name IV pump inhibitor (PPI). It CV: chest pain diarrhea; black, tarry
Pantoprazole works by reducing the EENT: rhinitis stools; abdominal
Functional Group amount of acid in the GI: vomiting, diarrhea, cramps/pain; or
Proton pump stomach which in turn abdominal pain, dyspepsia continuing headache;
inhibitor relieves acid-related METABOLIC: hypergycemia product may have to be
indigestion and heartburn MUSCULOSKELETAL: hip, discontinued
wrist, spine fractures (with • That, if diabetic,
long-term daily use) hypoglycemia may
SKIN: rash, pruritis occur
OTHER: injection site • To avoid hazardous
reaction. activities because
dizziness may occur
• To avoid alcohol,
salicylates, NSAIDs;
may cause GI irritation
2. Inj. Dexona 16 mg BD Decreases inflammation by Depression, flushing, Assess for edema,
IV suppression of migration of sweating, hypertension, cardiac
Generic name: polymorphonuclear headache, mood changes symptoms.
Dexamethasone leukocytes, fibroblasts; Hypertension,tachycardia, I&O ratio; be alert for
Functional reversal Fungal infections, decreasing urinary
Group: of increased capillary blurred vision, increased output, increasing
Corticosteroid permeability and appetite, edema; weight
lysosomal stabilization pancreatitis daily; notify prescriber
Acne, poor wound healing, of weekly gain >5 lb.
Fractures, osteoporosis Teach patient to
increase intake of
potassium,
calcium, protein
SL NO. Name of the Dose/ Frequenc Action Side effects Nurses responsibility
drug route y
3. Inj. Augmentin 1.2 gm BD Bacteriocidal, interferes Headache, fever, seizures, -Assess any
IV with cell wall replication of agitation, anaphylactic reaction
Generic name: susceptible insomnia before and after
Amoxycilline& organisms; lysis mediated by Nausea, diarrhea, vomiting, administration.
Potassium bacterial Increased, -Assess I&O
Clavulanate cell wall autolytic enzymes, Oliguria, proteinuria, ratio; report hematuria,
Functional combination hematuria, Rash, oliguria
group: increases spectrum of activity Hypo/hyperkalemia, • Assess Blood
Antibiotic against alkalosis, studies:WBC, RBC,
β-lactamase–resistant Hypernatremia Hgb, Hct,
organisms bleeding time
• Assess urinalysis,
protein,
blood, BUN, creatinine
Nursing process using Henderson’s theory
Need Assessment of patient based on 14 components of Henderson’s theory
Henderson’s 14 components Assessment of Mr. Subash
1] Breathing normally He was experiencing breathlessness with the
respiratory rate of 28breaths/min and sPo 2
was 97% with oxygen.
2] Eat and drink adequately Patient is having anorexia, not been able to
eat adequately
3] Elimination of body wastes Normal voiding
4] Movement and Posturing Normal movement and body postures
5] Sleep and Rest Experiencing insomnia, development of dark
circles
6] Select suitable clothes-dress and undress Patient is wearing comfortable cloths
7] Maintain body temperature No signs of hyperthermia or hypothermia
T=370 C
8] Keep the body clean and well groomed Patient is not well groomed
9] Avoid dangers in the environment Fatigability is present
10] Communication Speech is clear, understandable
11] Worship according to one’s faith Hindu by religion and is very religious by
nature
12] Work accomplishment Patient needs assistance in performing her
daily activities
13] Play or participate in various forms of Has lost active participation due to
recreation breathlessness and fatigability
14] Learn, discover, or satisfy the curiosity Patient is curious about the disease and her
symptoms
Nursing diagnosis based on assessment:-
Components Possible Nursing diagnosis of Mr. Subash
1] Breathing Ineffective breathing pattern related to lung
carcinoma as evidenced by breathlessness,
tachypnea and patient’s verbalization
2] nutrition Imbalanced nutrition less than the body
requirement related to anorexia secondary to
disease process as evidenced by weak
appearance of the patient and patient’s
verbalization
3] sleep and rest Disturbed sleep pattern related to
hospitalization as evidenced by frequent
yawning and appearance of dark circles
around eyes
4] hygiene Selfcare deficit related to fatigue and
weakness as evidenced by general
appearance of the patient
5] work accomplishment Activity intolerance related to breathlessness
and fatigue as evidenced by need for
assistance in performing activities of daily
living
6] curiosity and learning Anxiety related to disease condition as
evidenced by frequent questioning and facial
expression
Assessment Nursing diagnosis Goal Planning Implementation Evaluation
Ineffective breathing Breathing pattern will Assess the breathing Patient is having Breathing pattern was
I feel breathless while pattern related to lung be normal rate and pattern tachypnea with partially improved as
speaking carcinoma as respiratory rate of evidence by decrease
evidenced by 28b/min in respiratory rate
breathlessness, from 28 to 26 breaths/
tachypnea and min
patient’s verbalization Provide comfortable Provided semi
position fowlers position
Provide supplemental Oxygen @2L/min on
oxygen therapy flow
Teach pursed lip Advised pursed lip
breathing exercise breathing exercise
‘ patient appears
breathless while Provide calm Instructed others to
communicating’ environment maintain calm and
hygienic environment
Provide Inj dexamethasone
pharmacological 16mg IV X BD given
therapy as advised
Assessment Nursing diagnosis Goal Planning Implementation Evaluation
‘I feel very weak to Imbalanced nutrition Optimum nutritional To assess the dietary Assessed the dietary Nutritional level was
come out of my bed’ less than the body level will be pattern of the patient pattern of the patient partially improved as
requirement related to maintained weakness disappeared
anorexia secondary to To assess likes and Communicated with after 5 days of
disease process as dislikes of the food the patient to know implementation of the
evidenced by weak items of the patient his likes and dislikes interventions
appearance of the
patient and patient’s To encourage small Encouraged small
verbalization frequent diet to the frequent diet
patient
‘ patient is unable to
perform activities To counsel the family Counseled family
independently’ members regarding members regarding
better representation Good representation
of the food to increase of food
the appetite
To assess and Encouraged to
encourage oral maintain oral hygiene
hygiene atleast thrice and application of
a day to improve the ointment at the ulcer
taste site
To provide dietary Consulted dietician
consultation based on for patient
patient’s disease
condition for better
choice of food
Assessment Nursing diagnosis Goal Planning Implementation Evaluation
‘I am unable to sleep Disturbed sleep Normal circadian To assess the sleep Assessed the sleep Sleep pattern
since I am admitted pattern related to rhythm will be pattern of the patient pattern of the patient improved as
here’ hospitalization as maintained evidenced by fresh
evidenced by frequent To communicate with Patient find noisy and appearance of the
yawning and the patient to rule out change of patient.
appearance of dark the cause for environment that
circles around eyes insomnia causes insomnia
To provide calm and Limited visit to the
comfortable patients by the family
environment to the members and allowed
patient time to rest
Patient is yawning To discourage day Instructed to avoid
frequently and dark time naps day time sleep
circle appears around
eye. To educate not to Instructed regarding
drink fluids at night the same
as it may lead to
frequent urination
To encourage cup of Encouraged soup or
warm milk before warm milk at night
sleep as it improves before sleep
the sleep of the
patient
Health education
DIET:-
Patient is advised to take nutritious diet in order to prevent imbalanced nutrition and
general weakness
A frequent small diet should be encouraged until the appetite of the patient comes to
normal
A proper timings for the meal should be kept in order to maintain the eating habit
Diet chart should be strictly followed to maintain optimum level of health
SLEEP:-
Normal circadian rhythm to be maintained
Avoid day time sleep as it hinders the proper sleep cycle
Encourage atleast 7 hours of sleep a day
EXERCISE:-
Exercises should be avoided if breathlessness persists
MEDICATION AND FOLLOW UP:-
All the prescribed medication should be taken in proper time
One should not omit medication on self –assumption
Proper follow up should be done after discharge in order to prevent recurrence and
future complications
