Objective To explore the application value of predictive nursing based on risk management theory in nursing of lung cancer patients undergoing chemotherapy.Methods Ninety-eight lung cancer patients receiving chemotherapy at the First Affiliated Hospital of the Air Force Medical University of the Chinese People's Liberation Army from January 2023 to December 2023 were selected.They were randomly divided into a control group and an observation group,with 49 patients in each group.The control group received routine nursing interventions,while the observation group received proactive nursing based on risk management theory in addition to routine care.Self-care abilities,psychological status,and nutritional status before and after intervention(after the first cycle of chemotherapy)were compared between the two groups.Nursing quality,nursing satisfaction after intervention,and occurrence of adverse reactions during the intervention period were also compared between two groups.Results After intervention,both groups showed improvement in self-care abilities.Scores for health knowledge,self-concept,self-care skills,and self-care responsibility in the observation group were significantly higher than those in the control group(P<0.05).Scores on the Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS),and Mishel Uncertainty in Illness Scale(MUIS)were significantly reduced after intervention in both groups(P<0.05),with more significant reductions in the observation group compared to the control group(P<0.05).After intervention,the nutritional status of the observation group was better than that of the control group(Z=2.686,P=0.008).Compared with control group,the observation group had higher rates of compliance in treatment and nursing(97.96%vs 83.67%),nursing planning(100.00%vs 81.63%),basic care(95.52%vs 81.63%),and safety nursing(97.96%vs 83.67%),and the differences were significant(P<0.05).Nursing satisfaction was higher in the observation group than in the control group(93.88%vs 71.43%,x2=8.611,P<0.05).The observation group had a significantly lower incidence of adverse reactions compared to the control group(20.41%vs 40.81%,x2=4.804,P<0.05).Conclusion Proactive nursing based on risk management theory effectively enhances self-care abilities,improves psychological and nutritional status,reduces the risk of adverse reactions,and contributes to higher nursing quality and satisfaction in lung cancer patients undergoing chemotherapy.