# A nurse is caring for a client with stage IIB non-small cell lung cancer who is receiving concurrent chemoradiotherapy and has fatigue, decreased appetite, and mild skin irritation at the radiation site. Which nursing intervention should be the priority during this treatment phase?

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> subject: Adult Health

## 문제

A nurse is caring for a client with stage IIB non-small cell lung cancer who is receiving concurrent chemoradiotherapy and has fatigue, decreased appetite, and mild skin irritation at the radiation site. Which nursing intervention should be the priority during this treatment phase?

The client is experiencing fatigue, decreased appetite, and mild skin irritation at the radiation site.

## 보기

1. Monitor for signs of pneumonitis and assess respiratory status every 4 hours **✔ 정답**
2. Encourage high-protein supplements to maintain nutritional status
3. Apply moisturizing lotion to the radiation site twice daily
4. Administer prescribed antiemetics 30 minutes before meals

**정답: 1**

## 해설

Monitoring for pneumonitis is the priority as it is a life-threatening complication of concurrent chemoradiotherapy for lung cancer. Other options manage symptoms but do not address the most urgent risk.

## 심화 해설

Clinical Context and Priority Setting

The client has stage IIB non-small cell lung cancer (NSCLC) and is undergoing concurrent chemoradiotherapy (CCRT). The reported symptoms—fatigue, decreased appetite, and mild skin irritation—are expected side effects of this treatment modality. However, when establishing nursing priorities during active CCRT, the nurse must apply a physiological risk-based framework. The most immediate, life-threatening complication associated with thoracic radiation is radiation pneumonitis, an acute inflammatory response of the lung parenchyma to radiation exposure.

Why Respiratory Assessment is the Priority

Radiation pneumonitis typically develops 1 to 3 months after completing radiotherapy, but the inflammatory cascade begins during treatment. Early signs can be subtle and easily mistaken for fatigue or general deconditioning. Monitoring for pneumonitis directly addresses the "Airway and Breathing" components of the ABC (Airway, Breathing, Circulation) priority framework, which takes precedence over nutritional support, skin integrity, or nausea management in a client who is currently stable but at risk for rapid respiratory decline. The rationale is grounded in the pathophysiology: ionizing radiation damages type II pneumocytes and vascular endothelial cells, triggering a release of pro-inflammatory cytokines. This leads to interstitial edema, impaired gas exchange, and, if unrecognized, progressive fibrosis.

The critical nature of this complication is underscored by the clinical context of the provided evidence. While the studies focus on the consolidation phase with durvalumab, they highlight that the risk of symptomatic radiation pneumonitis (SRP) is a significant, dose-limiting toxicity that begins with the radiation delivered during the CCRT phase [2]. A client's baseline frailty and inflammatory status, which can be exacerbated by poor nutrition, can increase susceptibility to SRP [2]. Therefore, while nutritional interventions (option 2) are important for long-term treatment tolerance, they do not address an immediate, potentially fatal physiological threat. Similarly, skin care (option 3) and antiemetic timing (option 4) are valid comfort and safety interventions, but they are secondary to a focused respiratory assessment when the risk of pneumonitis is present.

Integrating Evidence into the Nursing Action

The nurse’s priority intervention—monitoring respiratory status every 4 hours—is a direct application of surveillance for SRP. The assessment should include auscultation for fine crackles, evaluation of respiratory rate and effort, and pulse oximetry. A non-productive cough or low-grade fever can be an early, insidious presentation. The research context reinforces that treatment completion and outcomes are heavily influenced by the ability to manage and detect such toxicities early. Non-completion of subsequent therapy has been associated with poor pretreatment inflammatory and nutritional markers, which are physiological states worsened by uncontrolled pneumonitis . Furthermore, the safety profiles of various CCRT regimens consistently identify pneumonitis as a key adverse event requiring vigilant monitoring, a principle that remains constant even as consolidation therapies evolve [3, 4]. By prioritizing respiratory assessment, the nurse is not merely performing a task but is actively engaging in early detection of a complication that could compromise the client’s entire treatment trajectory and survival.References (research sources)

- [2]Frailty profiles and symptomatic radiation pneumonitis in patients with lung cancer undergoing radiotherapy: A latent class analysis.Research articleZhang J, Zhao X, Li S, Liao J, Xu L, Fei Y, Wu J, Guan Q. (2026) · DOI: 10.1016/j.apjon.2025.100840

## 임상 시나리오

Thoracic Radiation: Priority Nursing AssessmentEarly Detection of Radiation Pneumonitis
For a client undergoing concurrent chemoradiotherapy for lung cancer, the highest priority is monitoring for radiation pneumonitis. This life-threatening complication can present subtly with non-productive cough, dyspnea, and low-grade fever.

Apply the ABC framework. A respiratory assessment, including auscultation and SpO2 monitoring every 4 hours, directly addresses the 'Breathing' component and takes precedence over nutrition, skin care, or nausea management.

CautionDo not dismiss new or worsening respiratory symptoms as simple fatigue. Instruct the client to report any cough or shortness of breath immediately, as early intervention with corticosteroids is critical to prevent irreversible pulmonary fibrosis.

## 핵심 개념

- **Radiation Pneumonitis** — Acute inflammation of lung tissue caused by radiation therapy, presenting with cough, dyspnea, and fever, typically occurring 1-3 months after treatment completion.
- **Concurrent Chemoradiotherapy (cCRT)** — The simultaneous administration of chemotherapy and radiation therapy, used to enhance tumor cell kill but increasing the risk of treatment-related toxicities.
- **NCLEX Prioritization Framework** — A decision-making model using ABCs (Airway, Breathing, Circulation) and Maslow's hierarchy to determine which patient need poses the most immediate threat to survival.

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