Post-Operative Nursing Care Plan for Lung Cancer Case Study Report

This report presents a nursing case study centered on a 66-year-old patient, Mr. Joseph Bailey, who underwent a thoracotomy and right upper lobe lobectomy for early-stage non-small cell lung cancer. The report details various risk factors associated with the surgery, including infection, lung collapse, and fluid leakage, emphasizing the need for careful wound care and monitoring. It discusses potential post-operative complications such as hemorrhage, cardiac issues, right-to-left shunt, and ischemia, highlighting the importance of vigilant patient observation and timely intervention. A comprehensive care plan is provided, focusing on mobilization, skin integrity, and the role of physiotherapy in patient recovery. Additionally, the report stresses the significance of patient education regarding the disease, its triggers, and post-operative self-care, including dietary guidelines. The report references several studies to support the nursing interventions and care strategies discussed. This analysis provides valuable insights into managing post-operative complications and optimizing patient outcomes in lung cancer cases.

Running head: NURSING CASE
Nursing case
Name:
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Running head: NURSING CASE
Risk factors
The patient in question is suffering from an early stage non-small cell lung cancer. He has
undergone a major surgery in order to try and deal with the disease. The thoracotomy and
lobectomy in the upper right lobe is a major and risky surgery that is usually followed by several
complications. There are several risk factors that are associated with the surgery such as
infection, collapsing of the lung, leaking of air fluid into the chest and the formation of pus
between the lungs and the walls of the chest (Irie, Nakanishi, Yasuda, Fujino, Hamada,&
Hyodo,2016).
The fact that he has underwent a surgery means that there are wounds that need to be
treated in a proper manner. The healing process has just begun and thus there need to be tender
care of the wounds and any other openings that may be there. The lack of proper care usually
leads to infection as there are several bacteria that may be lurking around .Infection is harmful as
it may lead to worsening of the part of the body that has been operated ( Nakada, Noda, Kato,
Shibasaki, Mori, Asano, & Ohtsuka,2019). Also, the surgery is conducted on the lungs which
are a sensitive part of the body due to the functions that it carries out. The surgeons need to be

Running head: NURSING CASE
careful when conducting the surgery in order to protect the lungs from any harmful substance. In
some cases, the surgery may be so intense leading to the body not being able to sustain it and this
leads to the collapse of the lungs. Another risk factor is that of air fluid leaking into the chest.
This is a very dangerous thing as no fluid is required to go into the chest. Any such happenings
may result in the lungs not functioning properly and this will result to lack of breath and finally
death. Therefore it is important that the surgeon is careful in the surgery process (Ueda,
Murakami, Tanaka, & Hamano, 2019)
Post-operative complications
There are several complications that may arise after the conclusion of the thoracotomy
and lobectomy surgery. The patient therefore needs to be observed carefully in order to minimize
the effects of these complications. One such complication is that of hemorrhage (Agostini,
Lugg, , Adams, Smith, Kalkat, Rajesh, & Bishay,2018).This is the immediate bleeding after the
surgery and can be as a result of surgical bleeding or coagulopathy. The patient mat bleed
profusely and if not checked will result in death in a matter of hours. It is recommended that any
chest output of 1000ml in an hour should result in the patient being taken back to the operating
room .In order to correct the bleeding, a set of coagulation tests are performed and the bleeding
stopped. In some cases, the prescription given may lead to the patient to start bleeding and thus it
is important that the nurses check on this and act immediately to save the patient (Chen, Yamada,
Sato, Aoyama, Takahagi, Menju, & Date, 2015).
Another form of complication that may occur after the surgery is cardiac complication (
Ibrahim, & Burt, 2019). This is the most common type of complications that affect a huge
number of patients that have undergone the surgery. The lung is a sensitive part and thus the

Running head: NURSING CASE
chances of the patient developing cardiac problems are high. The functioning rate of the lungs is
affected and the patient may find himself breathing at a much faster rate (Tuinman, et al,2017).
The nurses need to monitor the patient in order to check on any sign of cardiac complications. In
such cases, the patient may be given a blocking agent that is usually recommended for the
controlling of the rate (Karadag, Calıskan, & Iseri, 2016)..
Also, the patient may suffer from right to left shunt. This usually occurs due to the
pressure that is being exerted on the right hand side of the lungs during the cause of the surgery.
Intense pressure may result in a reflex that results in the right to left shunt (Bendixen, Jørgensen,
Kronborg, Andersen, & Licht,2016).
Ischemia is another complication that may come about as a result of the surgery. It
normally occurs when there is no enough blood supply to the specific organ of a body. The
lobectomy surgery takes a toll on the patient and this may lead to blockage of several arteries
that may transmit blood to the lungs. The blockage result in the shortage of blood and this will
put the patient in danger. The nurses ought to ensure that all the arteries and veins are clear so as
to avoid such complications (Vannucci, & Gonzalez-Rivas,2016).
Care plan
Mobilization
The patient may be unable to freely move
Nurse assessment and intervention
Check on the patient functional level
The nurse to assess how the patient is functioning

Running head: NURSING CASE
Rationale
It provides the design of a management plan
Nurse assessment and intervention
Evaluate use of assistive devices
Nurse should assess whether the patient uses the device
Rationale
Correct use of the devices reduces danger of harming oneself
Nurse assessment and intervention
Check on the patient nutrition needs
The nurse should assess the nutrition of the patient
Rationale
Required energy cab be sourced from good nutrition
Sleeping
Patient may lack enough sleep
Nurse assessment and intervention
Check on stress levels
The nurse must provide stress therapy to the patient

Running head: NURSING CASE
Rationale
The patient may be affected mentally by the disease thus lack sleep.
Nurse assessment and intervention
Assess the sleeping pattern
Nurse to develop a sleeping plan
Rationale
The patient sleeping pattern may have changed after surgery
Nurse assessment and intervention
Monitor for sleeping aids
The nurse should educate the patient on use of sleeping ids
Rationale
The patient may be using sleeping aids that affect his pattern (Mariani, et al,, 2017).
Skin integrity
Skin is impaired after surgery
Nurse assessment and intervention
Assess site of skin impairment
The nurse to determine etiology

Running head: NURSING CASE
Rationale
The wound should be assessed to determine intervention
Nurse assessment and intervention
Impairment has only damaged the skin
The nurse to observe the extent of damage and offer medication
Rationale
The wound may have gone further than the skin
Nurse assessment and intervention
Monitor skin care practice
The nurse to educate the patient on the best practices
Rationale
The patient may carry out bad practices that deteriorate the skin further
Role of physiotherapy
The physiotherapy has a role of ensuring that the patient is able to get back to his feet and
that the physical functioning and health of the patient is restored.in doing so, the physiotherapy
nay recommend counseling, training and exercise that will speed up the process of restoring the
physical health of the patient. It is important that the patient adheres to this in order to fasten the
process (Kendall, Abreu, Pinho, Oliveira, & Bastos,2017).

Running head: NURSING CASE
Education
The patient education on the disease that he has ben suffering from is very important
before and after the surgery. The patient needs to understand the disease in detail and know of
the causes. This is critical information to have as most of the patients do not understand what
they are suffering from. The patient will be educated on the several factors that may trigger the
disease and the prevention measures that one needs to put in place in order to avoid it. In relation
to post surgery education, the patient needs to be aware of the best way to take care of himself
even after leaving the hospital. This is also important as the patient needs to follow the
guidelines that he was given by the doctors and the nurses in order for him to stay healthy. The
education also involves the following of a strict diet in order to avoid foods that may trigger the
disease (Ferguson, Thompson, Huisingh-Scheetz, Farnan, Hemmerich, Acevedo, & Small,
2015).

Running head: NURSING CASE
References
Agostini, P. J., Lugg, S. T., Adams, K., Smith, T., Kalkat, M. S., Rajesh, P. B., ... & Bishay, E.
(2018). Risk factors and short-term outcomes of postoperative pulmonary complications
after VATS lobectomy. Journal of cardiothoracic surgery, 13(1), 28.
Bendixen, M., Jørgensen, O. D., Kronborg, C., Andersen, C., & Licht, P. B. (2016).
Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic
surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled
trial. The Lancet Oncology, 17(6), 836-844.
Chen, F., Yamada, T., Sato, M., Aoyama, A., Takahagi, A., Menju, T., ... & Date, H. (2015).
Postoperative pulmonary function and complications in living-donor lobectomy. The
Journal of Heart and Lung Transplantation, 34(8), 1089-1094.
Ferguson, M. K., Thompson, K., Huisingh-Scheetz, M., Farnan, J., Hemmerich, J., Acevedo, J.,
& Small, S. (2015). The impact of a frailty education module on surgical resident
estimates of lobectomy risk. The Annals of thoracic surgery, 100(1), 235-241.

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Ibrahim, K., & Burt, B. M. (2019). The impact of insight on post-lobectomy
complications. Journal of thoracic disease, 11(Suppl 3), S289.
Irie, M., Nakanishi, R., Yasuda, M., Fujino, Y., Hamada, K., & Hyodo, M. (2016). Risk factors
for short-term outcomes after thoracoscopic lobectomy for lung cancer. European
Respiratory Journal, 48(2), 495-503.
Karadag, M., Calıskan, N., & Iseri, O. (2016). Effects of case studies and simulated patients on
students' nursing care plan. International journal of nursing knowledge, 27(2), 87-94.
Kendall, F., Abreu, P., Pinho, P., Oliveira, J., & Bastos, P. (2017). The role of physiotherapy in
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Mariani, E., Chattat, R., Vernooij-Dassen, M., Koopmans, R., & Engels, Y. (2017). Care plan
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Nakada, T., Noda, Y., Kato, D., Shibasaki, T., Mori, S., Asano, H., ... & Ohtsuka, T. (2019).
Risk factors and cancer recurrence associated with postoperative complications after
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nursing, 38(6), 578-583.

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Ueda, K., Murakami, J., Tanaka, T., & Hamano, K. (2019). Unclassifiable Infectious
Complications after Lobectomy for Cancer: Etiology, Risks, and Outcomes. The
Thoracic and cardiovascular surgeon, 67(04), 315-320.
Vannucci, F., & Gonzalez-Rivas, D. (2016). Is VATS lobectomy standard of care for operable
non-small cell lung cancer?. Lung Cancer, 100, 114-119.