Professional Documents
Culture Documents
Cancer Nursing Care Plans
Cancer Nursing Care Plans
Anticipatory Grieving
Grieving: A normal complex process that includes emotional, physical, spiritual, social, and intellectual responses and behaviors by which
individuals, families, and communities incorporate an actual, anticipated, or perceived loss into their daily lives.
May be related to
Anticipated loss of physiological well-being (e.g., loss of body part; change in body function); change in lifestyle
Perceived potential death of patient
Possibly evidenced by
Changes in eating habits, alterations in sleep patterns, activity levels, libido, and communication patterns
Denial of potential loss, choked feelings, anger
Desired Outcomes
Identify and express feelings appropriately.
Continue normal life activities, looking toward/planning for the future, one day at a time.
Verbalize understanding of the dying process and feelings of being supported in grief work.
Acute Pain
Acute Pain: Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such
damage; sudden or slow onset of any intensity from mild to severe with anticipated or predictable end and a duration of <6 months.
May be related to
Disease process (compression/destruction of nerve tissue, infiltration of nerves or their vascular supply, obstruction of a nerve
pathway, inflammation)
Side effects of various cancer therapy agents
Possibly evidenced by
Reports of pain
Self-focusing/narrowed focus
Alteration in muscle tone; facial mask of pain
Distraction/guarding behaviors
Autonomic responses, restlessness (acute pain)
Desired Outcomes
Report maximal pain relief/control with minimal interference with ADLs.
Follow prescribed pharmacological regimen.
Demonstrate use of relaxation skills and diversional activities as indicated for individual situation.
Imbalanced Nutrition: Less Than Body Requirements: Intake of nutrients insufficient to meet metabolic needs.
May be related to
Hypermetabolic state associated with cancer
Consequences of chemotherapy, radiation, surgery, e.g., anorexia, gastric irritation, taste distortions, nausea
Emotional distress, fatigue, poorly controlled pain
Possibly evidenced by
Reported inadequate food intake, altered taste sensation, loss of interest in food, perceived/actual inability to ingest food
Body weight 20% or more under ideal for height and frame, decreased subcutaneous fat/muscle mass
Sore, inflamed buccal cavity
Diarrhea and/or constipation, abdominal cramping
Desired Outcomes
Demonstrate stable weight/progressive weight gain toward goal with normalization of laboratory values and be free of signs of
malnutrition.
Verbalize understanding of individual interferences to adequate intake.
Participate in specific interventions to stimulate appetite/increase dietary intake.
Risk for Fluid Volume Deficit: At risk for experiencing vascular, cellular, or intracellular dehydration.
Risk factors may include
Excessive losses through normal routes (e.g., vomiting, diarrhea) and/or abnormal routes (e.g., indwelling tubes, wounds)
Hypermetabolic state
Impaired intake of fluids
Desired Outcomes
Display adequate fluid balance as evidenced by stable vital signs, moist mucous membranes, good skin turgor, prompt
capillary refill, and individually adequate urinary output.
Nursing Interventions Rationale
Monitor I&O and specific gravity; include all output sources, Continued negative fluid balance, decreasing renal output and
(emesis, diarrhea, draining wounds. Calculate 24-hr concentration of urine suggest developing dehydration and
balance). need for increased fluid replacement.
Weigh as indicated. Sensitive measurement of fluctuations in fluid balance.
Monitor vital signs. Evaluate peripheral pulses, capillary Reflects adequacy of circulating volume.
Nursing Interventions Rationale
refill.
Assess skin turgor and moisture of mucous membranes.
Indirect indicators of hydration status and degree of deficit.
Note reports of thirst.
Assists in maintenance of fluid requirements and reduces risk
Encourage increased fluid intake to 3000 mL per day as
of harmful side effects such as hemorrhagic cystitis in patient
individually appropriate or tolerated.
receiving cyclophosphamide (Cytoxan).
Observe for bleeding tendencies (oozing from mucous
Early identification of problems (which may occur as a result
membranes, puncture sites); presence of ecchymosis or
of cancer or therapies) allows for prompt intervention.
petechiae.
Minimize venipunctures (combine IV starts
Reduces potential for hemorrhage and infection associated
with blood draws). Encourage patient to consider central
with repeated venous puncture.
venous catheter placement.
Avoid trauma and apply pressure to puncture sites. Reduces potential for bleeding and hematoma formation.
Given for general hydration and to dilute antineoplastic drugs
Provide IV fluids as indicated. and reduce adverse side effects (nausea and vomiting, or
nephrotoxicity).
Monitor laboratory studies (CBC, electrolytes, serum Provides information about level of hydration and
albumin). corresponding deficits.
Fatigue: An overwhelming, sustained sense of exhaustion and decreased capacity for physical and mental work at usual level.
May be related to
Decreased metabolic energy production, increased energy requirements (hypermetabolic state and effects of treatment)
Overwhelming psychological/emotional demands
Altered body chemistry: side effects of pain and other medications, chemotherapy
Possibly evidenced by
Unremitting/overwhelming lack of energy, inability to maintain usual routines, decreased performance, impaired ability to
concentrate, lethargy/listlessness
Disinterest in surroundings
Desired Outcomes
Report improved sense of energy.
Perform ADLs and participate in desired activities at level of ability.
Risk for Infection: At increased risk for being invaded by pathogenic organisms.
Risk factors may include
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Inadequate secondary defenses and immunosuppression, e.g., bone marrow suppression (dose-limiting side effect of both
chemotherapy and radiation).
Malnutrition, chronic disease process
Invasive procedures
Desired Outcomes
Remain afebrile and achieve timely healing as appropriate.
Identify and participate in interventions to prevent/reduce risk of infection.
Risk for Impaired Oral Mucous Membrane: Disruptions of the lips and soft tissues of the oral cavity
Risk factors may include
Side effect of some chemotherapeutic agents (e.g., antimetabolites) and radiation
Dehydration, malnutrition, NPO restrictions for more than 24 hr
Desired Outcomes
Display intact mucous membranes, which are pink, moist, and free of inflammation/ulcerations.
Verbalize understanding of causative factors.
Demonstrate techniques to maintain/restore integrity of oral mucosa.
Nursing Interventions Rationale
Risk for Altered Family Processes/Role Performance: At risk for a change in family relationships and/or functioning.
Risk factors may include
Situational/transitional crises: long-term illness, change in roles/economic status
Developmental: anticipated loss of a family member
Desired Outcomes
Express feelings freely.
Demonstrate individual involvement in problem-solving process directed at appropriate solutions for the situation.
Encourage and allow member who is ill to handle situation in own way.
Note components of family, presence of extended family Helps patient and caregiver know who is available to assist
and others (friends and neighbors). with care or provide respite and support.
Provides information about effectiveness of communication
Identify patterns of communication in family and patterns and identifies problems that may interfere with family’s ability
of interaction between family members. to assist patient and adjust positively to diagnosis and
treatment of cancer.
Each person may see the situation in own individual manner,
Assess role expectations of family members and encourage
and clear identification and sharing of these expectations
discussion about them.
promote understanding.
Provides clues about interventions that may be appropriate to
Assess energy direction (are efforts at resolution and
assist patient and family in directing energies in a more
problem solving purposeful or scattered?).
effective manner.
Affects patient and SO reaction and adjustment to diagnosis,
Note cultural and religious beliefs.
treatment, and outcome of cancer.
Helpless feelings may contribute to difficulty adjusting to
Listen for expressions of helplessness.
diagnosis of cancer and cooperating with treatment regimen.
Deal with family members in a warm, caring, respectful Provides feelings of empathy and promotes individual’s sense
way. Provide information (verbal and written), and of worth and competence in ability to handle current
reinforce as necessary. situation.
Encourage appropriate expressions of anger without Feelings of anger are to be expected when individuals are
reacting negatively to them. dealing with the difficult and potentially fatal illness of cancer.
Nursing Interventions Rationale
Desired Outcomes:
Display appropriate range of feelings and lessened fear.
Appear relaxed and report anxiety is reduced to a manageable level.
Demonstrate use of effective coping mechanisms and active participation in treatment regimen.
Nursing Interventions Rationale
Review patient’s and SO’s previous experience with cancer. Clarifies patient’s perceptions; assists in identification of
Determine what the doctor has told patient and what fear(s) and misconceptions based on diagnosis and
conclusion patient has reached. experience with cancer.
Provides opportunity to examine realistic fears and
Encourage patient to share thoughts and feelings.
misconceptions about diagnosis.
Provide open environment in which patient feels safe to Helps patient feel accepted in present condition without
discuss feelings or to refrain from talking. feeling judged, and promotes sense of dignity and control.
Provides assurance that patient is not alone or rejected;
Maintain frequent contact with patient. Talk with and touch
conveys respect for and acceptance of the person, fostering
patient as appropriate.
trust.
Be aware of effects of isolation on patient when required Sensory deprivation may result when sufficient stimulation is
by immunosuppression or radiation implant. Limit use of not available and may intensify feelings of anxiety, fear and
isolation clothing and masks as possible. alienation.
Coping skills are often stressed after diagnosis and during
Assist patient and SO in recognizing and clarifying fears to different phases of treatment. Support and counseling are
begin developing coping strategies for dealing with these often necessary to enable individual to recognize and deal
fears. with fear and to realize that control and coping strategies are
available.
Provide accurate, consistent information regarding
Can reduce anxiety and enable patient to make decisions and
diagnosis and prognosis. Avoid arguing about patient’s
choices based on realities.
perceptions of situation.
Permit expressions of anger, fear, despair without
Acceptance of feelings allows patient to begin to deal with
confrontation. Give information that feelings are normal
situation.
and are to be appropriately expressed.
Nursing Interventions Rationale
Provide reliable and consistent information and support for Allows for better interpersonal interaction and reduction of
SO. anxiety and fear.
Include SO as indicated or patient desires when Provides a support system for patient and allows SO to
major decisions are to be made. be involved appropriately.