Cancer is a general term used to describe a disturbance of cellular growth and refers to a group of diseases and not a single disease entity. Because cancer is a cellular disease, it can arise from any body tissue, with manifestations that result from failure to control the proliferation and maturation of cells.
There are more than 150 different types of cancer, including breast cancer, skin cancer, lung cancer, colon cancer, prostate cancer, and lymphoma. Symptoms vary depending on the type. Cancer treatment may include chemotherapy, radiation, and/or surgery.
Nursing Care Plans
Here are 13 cancer nursing care plans (NCP).
Test selection depends on history, clinical manifestations, and index of suspicion for a particular cancer.
- Endoscopy: Used for direct visualization of body organs/cavities to detect abnormalities.
- Scans (e.g., magnetic resonance imaging [MRI], CT, gallium) and ultrasound: May be done for diagnostic purposes, identification of metastasis, and evaluation of response to treatment.
- Biopsy (fine-needle aspiration [FNA], needle core, incisional/excisional): Done to differentiate diagnosis and delineate treatment and may be taken from bone marrow, skin, organ, and so forth. Example: Bone marrow is done in myeloproliferative diseases for diagnosis; in solid tumors for staging.
- Tumor markers (substances produced and secreted by tumor cells and found in serum, e.g., carcinogenic embryonic antigen [CEA], prostate-specific antigen [PSA], alpha-fetoprotein, human chorionic gonadotropin [HCG], prostatic acid phosphatase, calcitonin, pancreatic oncofetal antigen, CA 15-3, CA 19-9, CA 125, and so on): Helpful in diagnosing cancer but more useful as prognostic indicator and/or therapeutic monitor. For example, estrogen and progesterone receptors are assays done on breast tissue to provide information about whether or not hormonal manipulation would be therapeutic in metastatic disease control. Note: Any hormone may be elevated because many cancers secrete inappropriate hormones (ectopic hormone secretion).
- Screening chemistry tests, e.g., electrolytes (sodium, potassium, calcium), renal tests (BUN/Cr), liver tests (bilirubin, AST, alkaline phosphatase, LDH), bone tests (calcium):Depend on individual condition, risk factors.
- CBC with differential and platelets: May reveal anemia, changes in RBCs and WBCs; reduced or increased platelets.
- Chest x-ray: Screens for primary or metastatic disease of lungs.
- Support adaptation and independence.
- Promote comfort.
- Maintain optimal physiological functioning.
- Prevent complications.
- Provide information about disease process/condition, prognosis, and treatment needs.
- Patient is dealing with current situation realistically.
- Pain alleviated/controlled.
- Homeostasis achieved.
- Complications prevented/minimized.
- Disease process/condition, prognosis, and therapeutic choices and regimen understood.
- Plan in place to meet needs after discharge.
1. Anticipatory Grieving
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
- 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.
|Expect initial shock and disbelief following diagnosis of cancer and traumatizing procedures (disfiguring surgery, colostomy, amputation).||Few patients are fully prepared for the reality of the changes that can occur.|
|Assess patient and SO for stage of grief currently being experienced. Explain process as appropriate.||Knowledge about the grieving process reinforces the normality of feelings and reactions being experienced and can help patient deal more effectively with them.|
|Provide open, nonjudgmental environment. Use therapeutic communication skills of Active-Listening, acknowledgment, and so on.||Promotes and encourages realistic dialogue about feelings and concerns.|
|Encourage verbalization of thoughts or concerns and accept expressions of sadness, anger, rejection. Acknowledge normality of these feelings.||Patient may feel supported in expression of feelings by the understanding that deep and often conflicting emotions are normal and experienced by others in this difficult situation.|
|Be aware of mood swings, hostility, and other acting-out behavior. Set limits on inappropriate behavior, redirect negative thinking.||Indicators of ineffective coping and need for additional interventions. Preventing destructive actions enables patient to maintain control and sense of self-esteem.|
|Be aware of debilitating depression. Ask patient direct questions about state of mind.||Studies show that many cancer patients are at high risk for suicide. They are especially vulnerable when recently diagnosed and discharged from hospital.|
|Visit frequently and provide physical contact as appropriate, or provide frequent phone support as appropriate for setting. Arrange for care provider and support person to stay with patient as needed.||Helps reduce feelings of isolation and abandonment.|
|Reinforce teaching regarding disease process and treatments and provide information as appropriate about dying. Be honest; do not give false hope while providing emotional support.||Patient and SO benefit from factual information. Individuals may ask direct questions about death, and honest answers promote trust and provide reassurance that correct information will be given.|
|Review past life experiences, role changes, and coping skills. Talk about things that interest the patient.||Opportunity to identify skills that may help individuals cope with grief of current situation more effectively.|
|Note evidence of conflict; expressions of anger; and statements of despair, guilt, hopelessness, “nothing to live for.”||Interpersonal conflicts or angry behavior may be patient’s way of expressing and dealing with feelings of despair or spiritual distress and could be indicative of suicidal ideation.|
|Determine way that patient and SO understand and respond to death such as cultural expectations, learned behaviors, experience with death (close family members, friends), beliefs about life after death, faith in Higher Power (God).||These factors affect how each individual deals with the possibility of death and influences how they may respond and interact.|
|Identify positive aspects of the situation.||Possibility of remission and slow progression of disease and new therapies can offer hope for the future.|
|Discuss ways patient and SO can plan together for the future. Encourage setting of realistic goals.||Having a part in problem solving and planning can provide a sense of control over anticipated events.|
|Refer to visiting nurse, home health agency as needed, or hospice program, if appropriate.||Provides support in meeting physical and emotional needs of patient and SO, and can supplement the care family and friends are able to give.|
2. Situational Low Self-Esteem
May be related to
- Biophysical: disfiguring surgery, chemotherapy or radiotherapy side effects, e.g., loss of hair, nausea/vomiting, weight loss, anorexia, impotence, sterility, overwhelming fatigue, uncontrolled pain
- Psychosocial: threat of death; feelings of lack of control and doubt regarding acceptance by others; fear and anxiety
Possibly evidenced by
- Verbalization of change in lifestyle; fear of rejection/reaction of others; negative feelings about body; feelings of helplessness, hopelessness, powerlessness
- Preoccupation with change or loss
- Not taking responsibility for self-care, lack of follow-through
- Change in self-perception/other’s perception of role
- Verbalize understanding of body changes, acceptance of self in situation.
- Begin to develop coping mechanisms to deal effectively with problems.
- Demonstrate adaptation to changes/events that have occurred as evidenced by setting of realistic goals and active participation in work/play/personal relationships as appropriate.
|Discuss with patient and SO how the diagnosis and treatment are affecting the patient’s personal life, home and work activities.||Aids in defining concerns to begin problem-solving process.|
|Review anticipated side effects associated with a particular treatment, including possible effects on sexual activity and sense of attractiveness and desirability (alopecia, disfiguring surgery). Tell patient that not all side effects occur, and others may be minimized or controlled.||Anticipatory guidance can help patient and SO begin the process of adaptation to new state and to prepare for some side effects (buy a wig before radiation, schedule time off from work as indicated).|
|Encourage discussion of concerns about effects of cancer and treatments on role as homemaker, wage earner, parent, and so forth.||May help reduce problems that interfere with acceptance of treatment or stimulate progression of disease.|
|Acknowledge difficulties patient may be experiencing. Give information that counseling is often necessary and important in the adaptation process.||Validates reality of patient’s feelings and gives permission to take whatever measures are necessary to cope with what is happening.|
|Evaluate support structures available to and used by patient and SO.||Helps with planning for care while hospitalized and after discharge.|
|Provide emotional support for patient and SO during diagnostic tests and treatment phase.||Although some patients adapt or adjust to cancer effects or side effects of therapy, many need additional support during this period.|
|Use touch during interactions, if acceptable to patient, and maintain eye contact.||Affirmation of individuality and acceptance is important in reducing patient’s feelings of insecurity and self-doubt.|
|Refer for professional counseling as indicated.||May be necessary to regain and maintain a positive psychosocial structure if patient and SO support systems are deteriorating.|