Use this nursing care plan and management guide to provide care for patients with cancer. Enhance your understanding of nursing assessment, interventions, goals, and nursing diagnosis, all specifically tailored to address the unique needs of individuals with cancer.
Table of Contents
- What is Cancer?
- Nursing Care Plans and Management
- Nursing Problem Priorities
- Nursing Assessment
- Nursing Diagnosis
- Nursing Goals
- Nursing Interventions and Actions
- 1. Providing Emotional Support and Assisting in Grieving
- 2. Enhancing Body Image and Self-Esteem
- 3. Managing Acute Pain
- 4. Improving Nutritional and Fluid Volume Status
- 5. Decreasing Fatigue
- 6. Minimizing Infection Risk
- 7. Maintaining Oral Mucous Membrane Integrity and Preventing Stomatitis
- 8. Maintaining Skin Integrity
- 9. Normalizing Bowel Function
- 10. Managing Sexuality Concern
- 11. Reducing Fear and Anxiety and Providing Emotional Support
- 12. Administer Medications and Provide Pharmacologic Support
- Recommended Resources
- See also
What is Cancer?
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 and Management
Nurses have a huge set of responsibilities for handling a patient with cancer. Nursing care plans for cancer involve assessment, support for therapies (e.g., chemotherapy, radiation, etc.), pain control, promoting nutrition, and providing emotional support.
Nursing Problem Priorities
The following are the nursing priorities for patients with cancer:
- Perform assessments and administer cancer treatments
- Manage treatment-related side effects
- Provide supportive care and education
- Coordinate interdisciplinary care
- Offer emotional support and counseling
- Advocate for patient needs
- Monitor patient responses and report changes
- Facilitate access to resources and support services
Assess for the following subjective and objective data:
- Unexplained weight loss
- Fatigue and weakness
- Persistent pain
- Changes in the skin, such as yellowing or darkening
- Changes in bowel or bladder habits
- Difficulty swallowing or persistent indigestion
- Changes in a mole or wart
- Persistent cough or hoarseness
- Unexplained bleeding or bruising
- Lumps or thickening in the body, such as the breast or testicles
Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with cancer is based on the nurse’s clinical judgement and understanding of the patient’s unique health condition. While nursing diagnoses serve as a framework for organizing care, their usefulness may vary in different clinical situations. In real-life clinical settings, it is important to note that the use of specific nursing diagnostic labels may not be as prominent or commonly utilized as other components of the care plan. It is ultimately the nurse’s clinical expertise and judgment that shape the care plan to meet the unique needs of each patient, prioritizing their health concerns and priorities.
Goals and expected outcomes may include:
- The patient will identify and express feelings appropriately.
- The patient will continue normal life activities, looking toward/planning for the future, one day at a time.
- The patient will verbalize understanding of the dying process and feelings of being supported in grief work.
- The patient will verbalize understanding of body changes and acceptance of self in the situation.
- The patient will begin to develop coping mechanisms to deal effectively with problems.
- The patient will demonstrate adaptation to changes/events that have occurred as evidenced by the setting of realistic goals and active participation in work/play/personal relationships as appropriate.
- The patient will report maximal pain relief/control with minimal interference with ADLs.
- The patient will demonstrate the use of relaxation skills and diversional activities as indicated for the individual situation.
- The patient will demonstrate stable weight/progressive weight gain toward the goal with normalization of laboratory values and be free of signs of malnutrition.
- The patient will participate in specific interventions to stimulate appetite/increase dietary intake.
- The patient will display adequate fluid balance as evidenced by stable vital signs, moist mucous membranes, good skin turgor, prompt capillary refill, and individually adequate urinary output.
- The patient will report an improved sense of energy.
- The patient will perform ADLs and participate in desired activities at a level of ability.
- The patient will remain afebrile and achieve timely healing as appropriate.
- The patient will identify and participate in interventions to prevent/reduce the risk of infection.
- The patient will display intact mucous membranes, which are pink, moist, and free of inflammation/ulcerations.
- The patient will demonstrate techniques to maintain/restore the integrity of oral mucosa.
- The patient will participate in techniques to prevent complications/promote healing as appropriate.
- The patient will maintain the usual bowel consistency/pattern.
- The patient will verbalize understanding of the effects of cancer and therapeutic regimen on sexuality and measures to correct/deal with problems.
- The patient will maintain sexual activity at the desired level possible.
- The patient will demonstrate individual involvement in the problem-solving process directed at appropriate solutions for the situation.
- The patient will encourage and allow a member who is ill to handle the situation in their own way.
- The patient will display an appropriate range of feelings and lessened fear.
- The patient will appear relaxed and report anxiety is reduced to a manageable level.
Nursing Interventions and Actions
Therapeutic interventions and nursing actions for patients with cancer may include:
1. Providing Emotional Support and Assisting in Grieving
Patients with cancer often experience a range of complex emotions including fear, anxiety, sadness, anger, and uncertainty. They may grieve the loss of their health, normalcy, and future plans. Grieving in the context of cancer can involve coming to terms with the diagnosis, facing potential treatment side effects and limitations, and adjusting to the impact on relationships and daily life.
Assess the patient and significant other (SO) for the stage of grief currently being experienced. Explain the process as appropriate.
Knowledge about the grieving process reinforces the normality of feelings and reactions being experienced and can help patients deal more effectively with them.
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 the grief of current situation more effectively.
Note evidence of conflict; expressions of anger; and statements of despair, guilt, hopelessness, and “nothing to live for.”
Interpersonal conflicts or angry behavior may be the patient’s way of expressing and dealing with feelings of despair or spiritual distress and could be indicative of suicidal ideation.
Determine ways that the 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, and 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.
Expect initial shock and disbelief following the diagnosis of cancer and traumatizing procedures (disfiguring surgery, colostomy, amputation).
Few patients are fully prepared for the reality of the changes that can occur.
Provide an 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, and rejection. Acknowledge the normality of these feelings.
Patients may feel supported in the 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, and redirect negative thinking.
Indicators of ineffective coping and need for additional interventions. Preventing destructive actions enables patients to maintain control and a sense of self-esteem.
Be aware of debilitating depression. Ask the patient direct questions about the 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 the hospital.
Visit frequently and provide physical contact as appropriate, or provide frequent phone support as appropriate for the setting. Arrange for a care provider and support person to stay with the patient as needed.
Helps reduce feelings of isolation and abandonment.
Reinforce teaching regarding disease process and treatment and provide information as appropriate about dying. Be honest; do not give false hope while providing emotional support.
Patients 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.
Identify positive aspects of the situation.
The possibility of remission and slow progression of the disease and new therapies can offer hope for the future.
Discuss ways patients and SO can plan together for the future. Encourage the 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 the physical and emotional needs of the patient and SO, and can supplement the care family and friends are able to give.
2. Enhancing Body Image and Self-Esteem
The diagnosis and treatment process of cancer can lead to feelings of self-doubt, insecurity, and reduced confidence, which can be compounded by changes in physical appearance, functional abilities, and social relationships. These feelings can significantly impact a patient’s well-being and ability to cope with the challenges of their illness, making it crucial for nurses to address and support the patient’s self-esteem.
Discuss with the 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 the 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 the patient that not all side effects occur, and others may be minimized or controlled.
Anticipatory guidance can help the patient and SO begin the process of adaptation to a new state and prepare for some side effects (buy a wig before radiation, and schedule time off from work as indicated).
Encourage discussion of concerns about the effects of cancer and treatments on the role of homemaker, wage earner, parent, and so forth.
May help reduce problems that interfere with the acceptance of treatment or stimulate the progression of the disease.
Acknowledge the difficulties the patient may be experiencing. Give information that counseling is often necessary and important in the adaptation process.
Validates the reality of the 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 patients and SO.
Helps with planning for care while hospitalized and after discharge.
Provide emotional support for the patient and SO during diagnostic tests and treatment phases.
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 the patient, and maintain eye contact.
Affirmation of individuality and acceptance is important in reducing the 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 the patient and SO support systems are deteriorating.
3. Managing Acute Pain
Pain is a common experience for patients with cancer due to the invasive nature of the disease. Cancer cells can invade surrounding tissues and nerves, causing inflammation, pressure, or injury, which triggers the body’s natural response to perceive it as painful. This pain can be related to the cancer itself, surgery, radiation therapy, chemotherapy, or other treatments, and can significantly impact a patient’s quality of life.
Determine pain history (location of pain, frequency, duration, and intensity using a numeric rating scale (0–10 scale), or verbal rating scale (“no pain” to “excruciating pain”) and relief measures used.
The information provides baseline data to evaluate the effectiveness of interventions. The pain of more than 6 mo duration constitutes chronic pain, which may affect therapeutic choices. Recurrent episodes of acute pain can occur within chronic pain, requiring an increased level of intervention. Note: The pain experience is an individualized one composed of both physical and emotional responses.
Determine the timing or precipitants of “breakthrough” pain when using around-the-clock agents, whether oral, IV, or patch medications.
Pain may occur near the end of the dosing interval, indicating the need for a higher dose or shorter dose interval. Pain may be precipitated by identifiable triggers, or occur spontaneously, requiring the use of short half-life agents for rescue or supplemental doses.
Evaluate and be aware of the painful effects of particular therapies (surgery, radiation, chemotherapy, biotherapy). Provide information to the patient and SO about what to expect.
A wide range of discomforts is common (incisional pain, burning skin, low back pain, headaches), depending on the procedure and agent being used. Pain is also associated with invasive procedures to diagnose or treat cancer.
Provide non-pharmacological comfort measures (massage, repositioning, backrub) and diversional activities (music, television)
Promotes relaxation and helps refocus attention.
Encourage the use of stress management skills or complementary therapies (relaxation techniques, visualization, guided imagery, biofeedback, laughter, music, aromatherapy, and therapeutic touch).
Enables patient to participate actively in the non-pharmacological treatment of pain and enhances a sense of control. Pain produces stress and, in conjunction with muscle tension and internal stressors, increases the patient’s focus on self, which in turn increases the level of pain.
Provide cutaneous stimulation (heat or cold, massage).
May decrease inflammation, and muscle spasms, reducing associated pain. Note: Heat may increase bleeding and edema following acute injury, whereas cold may further reduce perfusion to ischemic tissues.
Be aware of barriers to cancer pain management related to patients, as well as the healthcare system.
Patients may be reluctant to report pain for reasons such as fear that disease is worse; worry about unmanageable side effects of pain medications; beliefs that pain has meaning, such as “God wills it,” they should overcome it, or that pain is merited or deserved for some reason. Healthcare system problems include factors such as inadequate assessment of pain, concern about controlled substances or patient addiction, inadequate reimbursement, or cost of treatment modalities.
Evaluate pain relief and control at regular intervals. Adjust medication regimen as necessary.
The goal is maximum pain control with minimum interference with ADLs.
Inform the patient and SO of the expected therapeutic effects and discuss the management of side effects
This information helps establish realistic expectations and confidence in own ability to handle what happens.
Discuss the use of additional alternative or complementary therapies (acupuncture and acupressure).
May provide reduction or relief of pain without drug-related side effects.
Administer analgesics as indicated.
See Pharmacologic Management
4. Improving Nutritional and Fluid Volume Status
Nutritional and fluid volume status can be significantly affected in patients with cancer. Many individuals experience changes in appetite, taste alterations, and difficulty swallowing, leading to poor intake and malnutrition. Cancer treatments such as chemotherapy and radiation can cause nausea, vomiting, and diarrhea, further impacting nutritional status.
Monitor daily food intake; have the patient keep a food diary as indicated.
Identifies nutritional strengths and deficiencies.
Measure height, weight, and tricep skinfold thickness (or other anthropometric measurements as appropriate). Ascertain the amount of recent weight loss. Weigh daily or as indicated.
If these measurements fall below minimum standards, the patient’s chief source of stored energy (fat tissue) is depleted.
Assess skin and mucous membranes for pallor, delayed wound healing, and enlarged parotid glands.
Helps in the identification of protein-calorie malnutrition, especially when weight and anthropometric measurements are less than normal.
Monitor I&O and specific gravity; include all output sources, (emesis, diarrhea, draining wounds. Calculate 24-hr balance).
Continued negative fluid balance, decreasing renal output, and concentration of urine suggest developing dehydration and the need for increased fluid replacement.
Weigh as indicated.
Sensitive measurement of fluctuations in fluid balance.
Monitor vital signs. Evaluate peripheral pulses and capillary refill.
Reflects adequacy of circulating volume.
Observe for bleeding tendencies (oozing from mucous membranes, puncture sites); the presence of ecchymosis or petechiae.
Early identification of problems (which may occur as a result of cancer or therapies) allows for prompt intervention.
Monitor laboratory studies (CBC, electrolytes, serum albumin).
Provides information about the level of hydration and corresponding deficits.
Hematest stools, and gastric secretions.
Certain therapies (antimetabolites) inhibit the renewal of epithelial cells lining the GI tract, which may cause changes ranging from mild erythema to severe ulceration with bleeding.
Review laboratory studies as indicated (total lymphocyte count, serum transferrin, and albumin or prealbumin).
Helps identify the degree of biochemical imbalance, and malnutrition and influences the choice of dietary interventions. Note: Anticancer treatments can also alter nutrition studies, so all results must be correlated with the patient’s clinical status.
Encourage the patient to eat a high-calorie, nutrient-rich diet, with adequate fluid intake. Encourage the use of supplements and frequent or smaller meals spaced throughout the day.
Metabolic tissue needs are increased as well as fluids (to eliminate waste products). Supplements can play an important role in maintaining adequate caloric and protein intake.
Create a pleasant dining atmosphere; encourage the patient to share meals with family and friends.
Makes mealtime more enjoyable, which may enhance intake.
Encourage open communication regarding anorexia.
Often a source of emotional distress, especially for SO who wants to feed patients frequently. When the patient refuses, SO may feel rejected or frustrated.
Adjust diet before and immediately after treatment (clear, cool liquids, light or bland foods, candied ginger, dry crackers, toast, and carbonated drinks). Give liquids 1 hr before or 1 hr after meals.
The effectiveness of diet adjustment is very individualized in the relief of posttherapy nausea. Patients must experiment to find the best solution or combination. Avoiding fluids during meals minimizes becoming “full” too quickly.
Control environmental factors (strong or noxious odors or noise). Avoid overly sweet, fatty, or spicy foods.
Can trigger nausea and vomiting response.
Encourage the use of relaxation techniques, visualization, guided imagery, and moderate exercise before meals.
May prevent the onset or reduce the severity of nausea, decrease anorexia, and enable the patient to increase oral intake.
Identify the patient who experiences anticipatory nausea and vomiting and take appropriate measures.
Psychogenic nausea and vomiting occurring before chemotherapy generally do not respond to antiemetic drugs. A change of treatment environment or patient routine on treatment day may be effective.
Administer antiemetic on a regular schedule before or during and after administration of antineoplastic agent as appropriate.
Nausea and vomiting are frequently the most disabling and psychologically stressful side effects of chemotherapy.
Evaluate the effectiveness of antiemetics.
Individuals respond differently to all medications. First-line antiemetics may not work, requiring alteration in or use of combination drug therapy.
Encourage increased fluid intake to 3000 mL per day as individually appropriate or tolerated.
Assists in the maintenance of fluid requirements and reduces the risk of harmful side effects such as hemorrhagic cystitis in patients receiving cyclophosphamide (Cytoxan).
Minimize venipunctures (combine IV starts with blood draws). Encourage the patient to consider central venous catheter placement.
Reduces potential for hemorrhage and infection associated with repeated venous puncture.
Avoid trauma and apply pressure to puncture sites.
Reduces potential for bleeding and hematoma formation.
Provide IV fluids as indicated.
Given for general hydration and to dilute antineoplastic drugs and reduce adverse side effects (nausea and vomiting, or nephrotoxicity).
Refer to a dietitian or nutritional support team.
Provides a specific dietary plan to meet individual needs and reduce problems associated with protein, calorie malnutrition, and micronutrient deficiencies.
Insert and maintain NG or feeding tube for enteric feedings, or central line for total parenteral nutrition (TPN) if indicated.
In the presence of severe malnutrition (loss of 25%–30% body weight in 2 mo) or if the patient has been NPO for 5 days and is unlikely to be able to eat for another week, tube feeding or TPN may be necessary to meet nutritional needs.
5. Decreasing Fatigue
Fatigue is a common and distressing symptom experienced by many patients with cancer. It can significantly impact their quality of life and daily functioning. Cancer-related fatigue may be caused by various factors, including the disease itself, side effects of treatment, emotional distress, and anemia. Effective management strategies, such as adequate rest, balanced activity, optimizing nutrition, and addressing underlying causes, are essential to help patients cope with fatigue.
Have the patient rate fatigue, using a numeric scale, if possible, and the time of day when it is most severe.
Helps in developing a plan for managing fatigue.
Monitor physiological response to activity (changes in BP, heart, and respiratory rate).
Tolerance varies greatly depending on the stage of the disease process, nutrition state, fluid balance, and reaction to the therapeutic regimen.
Plan care to allow for rest periods. Schedule activities for periods when the patient has the most energy. Involve patient and SO in schedule planning.
Frequent rest periods and naps are needed to restore and conserve energy. Planning will allow the patient to be active during times when the energy level is higher, which may restore a feeling of well-being and a sense of control.
Establish realistic activity goals with the patient.
Provides a sense of control and feelings of accomplishment.
Assist with self-care needs when indicated; keep the bed in a low position, and pathways clear of furniture; assist with ambulation.
Weakness may make ADLs difficult to complete or place the patient at risk for injury during activities.
Encourage the patient to do whatever is possible (self-bathing, sitting up in a chair, walking). Increase activity level as the individual is able.
Enhances strength and stamina and enables the patient to become more active without undue fatigue.
Perform pain assessment and provide pain management.
Poorly managed cancer pain can contribute to fatigue.
Refer to physical or occupational therapy.
Programmed daily exercises and activities help patients maintain and increase strength and muscle tone, and enhance a sense of well-being. The use of adaptive devices may help conserve energy.
6. Minimizing Infection Risk
Patients with cancer are at an increased risk of developing infections due to the compromised immune system caused by the disease and its treatments. The risk of infection can be further heightened during periods of low white blood cell counts, such as during chemotherapy or after a bone marrow transplant. It is crucial to implement strict infection control measures, including proper hand hygiene, isolation precautions when necessary, and timely administration of prophylactic antibiotics, to minimize the risk of infections and ensure the safety of these vulnerable patients.
Temperature elevation may occur (if not masked by corticosteroids or anti-inflammatory drugs) because of various factors (chemotherapy side effects, disease process, or infection). Early identification of infectious processes enables appropriate therapy to be started promptly.
Assess all systems (skin, respiratory, genitourinary) for signs and symptoms of infection on a continual basis.
Early recognition and intervention may prevent progression to a more serious situation or sepsis.
Monitor CBC with differential WBC and granulocyte count, and platelets
Bone marrow activity may be inhibited by the effects of chemotherapy, the disease state, or radiation therapy. Monitoring the status of myelosuppression is important for preventing further complications (infection, anemia, or hemorrhage) and scheduling drug delivery.
Obtain cultures as indicated.
The culture results help identify the specific microorganisms causing the infection and guide appropriate antibiotic therapy for effective treatment.
Promote good handwashing procedures by staff and visitors. Screen and limit visitors who may have infections. Place in reverse isolation as indicated.
Protects patient from sources of infection, such as visitors and staff who may have an upper respiratory infection (URI).
Emphasize personal hygiene.
Limits potential sources of infection and secondary overgrowth.
Reposition frequently; keep linens dry and wrinkle-free.
Reduces pressure and irritation to tissues and may prevent skin breakdown (potential site for bacterial growth).
Stress the importance of good oral hygiene.
The development of stomatitis increases the risk of infection and secondary overgrowth.
Avoid or limit invasive procedures. Adhere to aseptic techniques.
Reduces risk of contamination, and limits portal of entry for infectious agents.
Administer antibiotics as indicated.
May be used to treat the identified infections or given prophylactically in immuno- compromised patients. See Pharmacologic Management
7. Maintaining Oral Mucous Membrane Integrity and Preventing Stomatitis
Patients with cancer are susceptible to developing stomatitis, a condition characterized by inflammation and ulcers in the oral mucous membranes, due to the effects of chemotherapy and radiation therapy. Nursing interventions for preventing stomatitis include providing meticulous oral hygiene, such as gentle brushing with a soft toothbrush and regular rinsing with a non-alcoholic mouthwash, and encouraging patients to maintain adequate oral hydration.
Assess dental health and oral hygiene periodically.
Identifies prophylactic treatment needs before initiation of chemotherapy or radiation and provides baseline data of current oral hygiene for future comparison.
Monitor for and explain to the patient signs of oral superinfection (thrush).
Early recognition provides an opportunity for prompt treatment.
Culture suspicious oral lesions.
Identifies organism(s) responsible for oral infections and suggests appropriate drug therapy.
Encourage the patient to assess the oral cavity daily, noting changes in mucous membrane integrity (dry, reddened). Note reports of burning in the mouth, changes in voice quality, ability to swallow, sense of taste, development of thick or viscous saliva, and blood-tinged emesis.
Good care is critical during treatment to control stomatitis complications.
Discuss with patient areas needing improvement and demonstrate methods for good oral care.
Products containing alcohol or phenol may exacerbate mucous membrane dryness and irritation.
Initiate and recommend an oral hygiene program to include:
May be soothing to the membranes.
- Avoidance of commercial mouthwashes, lemon or glycerine swabs
Rinsing before meals may improve the patient’s sense of taste.
- Use of mouthwash made from warm saline, dilute solution of hydrogen peroxide or baking soda and water
Rinsing after meals and at bedtime dilutes oral acids and relieves xerostomia.
- Brush with a soft toothbrush or foam swab
Prevents trauma to delicate and fragile tissues. Note: The toothbrush should be changed at least every 3 mo.
- Floss gently or use WaterPik cautiously
Removes food particles that can promote bacterial growth. Note: Water under pressure has the potential to injure gums or force bacteria under the gum line.
- Keep lips moist with lip gloss or balm, K-Y Jelly, Chapstick
Promotes comfort and prevents drying and cracking of tissues.
Encourage the use of mints or hard candy or artificial saliva (Ora-Lube, Salivart) as indicated.
Stimulates secretions and provides moisture to maintain the integrity of mucous membranes, especially in presence of dehydration and reduced saliva production.
Instruct regarding dietary changes: avoid hot or spicy foods and acidic juices; suggest the use of a straw; ingest soft or blenderized foods, Popsicles, and ice cream as tolerated.
Severe stomatitis may interfere with nutritional and fluid intake leading to negative nitrogen balance or dehydration. Dietary modifications may make foods easier to swallow and may feel soothing.
Encourage fluid intake as individually tolerated.
Adequate hydration helps keep mucous membranes moist, preventing drying and cracking.
Discuss the limitations of smoking and alcohol intake.
May cause further irritation and dryness of mucous membranes. Note: May need to compromise if these activities are important to the patient’s emotional status.
Refer to a dentist before initiating chemotherapy or head or neck radiation.
Prophylactic examination and repair work before therapy reduces the risk of infection.
Administer medications as indicated.
See Pharmacologic Management
8. Maintaining Skin Integrity
Patients with cancer may experience compromised skin integrity due to various factors such as impaired immune function, treatment side effects, or prolonged bed rest. Nursing interventions focus on promoting skin hygiene, maintaining moisture balance, and protecting vulnerable areas from pressure or friction.
Assess skin frequently for side effects of cancer therapy; note breakdown and delayed wound healing. Emphasize the importance of reporting open areas to the health care providers.
A reddening or tanning effect (radiation reaction) may develop within the field of radiation. Dry desquamation (dryness and pruritus), moist desquamation (blistering), ulceration, hair loss, and loss of dermis and sweat glands may also be noted. In addition, skin reactions (allergic rashes, hyperpigmentation, pruritus, and alopecia) may occur with some chemotherapy agents.
Assess skin and IV site and vein for erythema, edema, tenderness; welt-like patches, itching and burning; or swelling, burning, soreness; blisters progressing to ulceration or tissue necrosis.
The presence of phlebitis, vein flare (localized reaction), or extravasation requires immediate discontinuation of antineoplastic agents and medical intervention.
Bathe with lukewarm water and mild soap.
Maintains cleanliness without irritating the skin.
Encourage the patient to avoid vigorous rubbing and scratching and to pat the skin dry instead of rubbing.
Helps prevent skin friction and trauma to sensitive tissues.
Turn or reposition frequently.
Promotes circulation and prevents undue pressure on skin and tissues.
Review skin care protocol for patients receiving radiation therapy: Avoid rubbing or the use of soap, lotions, creams, ointments, powders, or deodorants on the area.
Designed to minimize trauma to the area of radiation therapy. Can potentiate or otherwise interfere with radiation delivery. May actually increase irritation and reaction. Skin is very sensitive during and after treatment, and all irritation should be avoided to prevent dermal injury.
Avoid applying heat or attempting to wash off marks or tattoos placed on the skin to identify the area of irradiation.
Helps control dampness or pruritus. Maintenance care is required until skin and tissues have regenerated and are back to normal.
Recommend wearing soft, loose cotton clothing; have female patients avoid wearing bras if it creates pressure.
Protects skin from ultraviolet rays and reduces the risk of recall reactions.
Apply cornstarch, Aquaphor, Lubriderm, and Eucerin (or other recommended water-soluble moisturizing gel) to the area twice daily as needed.
See Pharmacologic Management
Encourage liberal use of sunscreen or block and breathable, protective clothing.
Development of irritation indicates the need for alteration of rate or dilution of chemotherapy and change of IV site to prevent a more serious reaction.
Wash skin immediately with soap and water if antineoplastic agents are spilled on unprotected skin (patient or caregiver).
Dilutes drug to reduce the risk of skin irritation and chemical burn.
Advise patients receiving 5-fluorouracil (5-FU) and methotrexate to avoid sun exposure. Withhold methotrexate if the sunburn is present.
Sun can cause exacerbation of burn spotting (a side effect of 5-fluorouracil) or can cause a red “flash” area with methotrexate, which can exacerbate the drug’s effect.
Review expected dermatologic side effects seen with chemotherapy (rash, hyperpigmentation, and peeling of skin on palms).
Anticipatory guidance helps decrease concern if side effects do occur.
Inform the patient that if alopecia occurs, hair could grow back after completion of chemotherapy, but may or may not grow back after radiation therapy.
Anticipatory guidance may help in preparation for baldness. Men are often as sensitive to hair loss as women. Radiation’s effect on hair follicles may be permanent, depending on radiation dosage.
Apply an ice pack or warm compresses per protocol.
Controversial intervention depends on the type of agent used. Ice restricts blood flow, keeping the drug localized, while heat enhances the dispersion of neoplastic drug or antidote, minimizing tissue damage.
9. Normalizing Bowel Function
Bowel movements in patients with cancer can vary depending on the type and location of the cancer, as well as the specific treatment being received. Constipation in patients with cancer can occur due to various factors such as reduced physical activity, side effects of medications (such as opioids), dehydration, or tumor obstruction. It can lead to discomfort, abdominal pain, and decreased appetite. On the other hand, diarrhea in patients with cancer can be caused by chemotherapy, radiation therapy, or infection, and it can result in fluid and electrolyte imbalances, dehydration, and malabsorption.
Ascertain usual elimination habits.
Data is required as a baseline for future evaluation of therapeutic needs and effectiveness.
Assess bowel sounds and record bowel movements (BMs) including frequency, and consistency (particularly during the first 3–5 days of Vinca alkaloid therapy).
Defines problems (diarrhea, constipation). Note: Constipation is one of the earliest manifestations of neurotoxicity.
Monitor I&O and weight.
Dehydration, weight loss, and electrolyte imbalance are complications of diarrhea. Inadequate fluid intake may potentiate constipation.
Check for impaction if the patient has not had BM in 3 days or if abdominal distension, cramping, or headache are present.
Further interventions and alternative bowel care may be needed.
Monitor serum Electrolytes as indicated.
Electrolyte imbalances may contribute to altered GI function.
Encourage adequate fluid intake (2000 mL per 24 hr), increased fiber in the diet; regular exercise.
May reduce the potential for constipation by improving stool consistency and stimulating peristalsis; can prevent dehydration associated with diarrhea.
Provide small, frequent meals of foods low in the residue (if not contraindicated), maintaining needed protein and carbohydrates (eggs., cooked cereal, bland cooked vegetables).
Reduces gastric irritation. The use of low-fiber foods can decrease irritability and provide bowel rest when diarrhea is present.
Adjust diet as appropriate: avoid foods high in fat (butter, fried foods, nuts); foods with high-fiber content; those known to cause diarrhea or gas (cabbage, baked beans, chili); food and fluids high in caffeine; or extremely hot or cold food and fluids.
GI stimulants may increase the gastric motility frequency of stools.
Administer IV fluids as indicated.
Prevents dehydration, and dilutes chemotherapy agents to diminish side effects.
Administer Antidiarrheal agents (loperamide, diphenoxylate/atropine, and bismuth subsalicylate) as indicated.
See Pharmacologic Management
Administer Stool softeners, laxatives, and enemas as indicated.
Prophylactic use may prevent further complications in some patients (those who will receive Vinca alkaloid, have poor bowel patterns before treatment, or have decreased motility).
See Pharmacologic Management
10. Managing Sexuality Concern
Sexuality patterns for patients with cancer may be affected due to physical changes, fatigue, emotional distress, and treatment side effects. Patients may experience decreased libido, changes in body image, and challenges related to intimacy and sexual function.
Discuss with the patient and SO the nature of sexuality and reactions when it is altered or threatened. Provide information about the normality of these problems and that many people find it helpful to seek assistance with the adaptation process.
Acknowledges the legitimacy of the problem. Sexuality encompasses the way men and women view themselves as individuals and how they relate between and among themselves in every area of life.
Advise patient of side effects of prescribed cancer treatment that are known to affect sexuality.
Anticipatory guidance can help patients and SO begin the process of adaptation to a new state.
Provide education and resources on sexual health
This includes providing information on the potential impact of cancer and its treatment on sexual functioning, addressing common concerns and misconceptions, discussing available support services and counseling options, and offering guidance on techniques and strategies to enhance intimacy and sexual well-being.
Provide private time for hospitalized patients. Knock on the door and receive permission from the patient and SO before entering.
Sexual needs do not end because the patient is hospitalized. Intimacy needs continue and an open and accepting attitude toward the expression of those needs is essential.
Refer to a sex counselor as indicated.
May require additional assistance in dealing with the situation.
11. Reducing Fear and Anxiety and Providing Emotional Support
Fear and anxiety are common emotional responses experienced by patients with cancer and their families, stemming from uncertainty, treatment-related concerns, and the impact of the disease on daily life. Family patterns may be influenced by these fears and anxieties, leading to changes in communication, roles, and relationships within the family unit.
Review the patient’s and SO’s previous experience with cancer. Determine what the doctor has told the patient and what conclusion the patient has reached.
Clarifies patient’s perceptions; assists in the identification of fear(s) and misconceptions based on diagnosis and experience with cancer.
Note ineffective coping (poor social interactions, helplessness, giving up everyday functions, and usual sources of gratification).
Identifies individual problems and provides support for the patient and SO in using effective coping skills.
Be alert to signs of denial and depression (withdrawal, anger, inappropriate remarks). Determine the presence of suicidal ideation and assess potential on a scale of 1–10.
Patients may use the defense mechanism of denial and express hope that the diagnosis is inaccurate. Feelings of guilt, spiritual distress, physical symptoms, or lack of cure may cause the patient to become withdrawn and believe that suicide is a viable alternative.
Encourage the patient to share thoughts and feelings.
Provides an opportunity to examine realistic fears and misconceptions about the diagnosis.
Provide an open environment in which the patient feels safe to discuss feelings or refrain from talking.
Helps patients feel accepted in their present conditions without feeling judged, and promotes a sense of dignity and control.
Maintain frequent contact with the patient. Talk with and touch the patient as appropriate.
Provides assurance that patient is not alone or rejected; conveys respect for and acceptance of the person, fostering trust.
Be aware of the effects of isolation on the patient when required by immunosuppression or radiation implant. Limit the use of isolation clothing and masks as possible.
Sensory deprivation may result when sufficient stimulation is not available and may intensify feelings of anxiety, fear, and alienation.
Assist the patient and SO in recognizing and clarifying fears to begin developing coping strategies for dealing with these fears.
Coping skills are often stressed after diagnosis and during different phases of treatment. Support and counseling are often necessary to enable individuals to recognize and deal with fear and to realize that control and coping strategies are available.
Provide accurate, consistent information regarding diagnosis and prognosis. Avoid arguing about the patient’s perceptions of the situation.
Can reduce anxiety and enable patients to make decisions and choices based on realities.
Permit expressions of anger, fear, and despair without confrontation. Give information that feelings are normal and are to be appropriately expressed.
Acceptance of feelings allows the patient to begin to deal with the situation.
Explain the recommended treatment, its purpose, and potential side effects. Help patients prepare for treatments.
The goal of cancer treatment is to destroy malignant cells while minimizing damage to normal ones. Treatment may include surgery (curative, preventive, palliative), as well as chemotherapy, radiation (internal, external), or organ-specific treatments such as whole-body hyperthermia or biotherapy. Bone marrow or peripheral progenitor cell (stem cell) transplant may be recommended for some types of cancer.
Explain procedures, providing opportunities for questions and honest answers. Stay with patients during anxiety-producing procedures and consultations.
Accurate information allows patients to deal more effectively with the reality of the situation, thereby reducing anxiety and fear of the unknown.
Provide primary and consistent caregivers whenever possible.
May help reduce anxiety by fostering therapeutic relationships and facilitating continuity of care.
Promote a calm, quiet environment.
Facilitates rest, conserves energy and may enhance coping abilities.
Encourage and foster patient interaction with support systems
Reduces feelings of isolation. If family support systems are not available, outside sources may be needed immediately, (local cancer support groups).
Provide reliable and consistent information and support for SO.
Allows for better interpersonal interaction and reduction of anxiety and fear.
Include SO as indicated or patient desires when major decisions are to be made.
Provides a support system for the patient and allows SO to be involved appropriately.
Note components of family, presence of extended family, and others (friends and neighbors).
Helps the patient and caregiver know who is available to assist with care or provide respite and support.
Identify patterns of communication in the family and patterns of interaction between family members.
Provides information about the effectiveness of communication and identifies problems that may interfere with the family’s ability to assist the patient and adjust positively to the diagnosis and treatment of cancer.
Assess role expectations of family members and encourage discussion about them.
Each person may see the situation in own individual manner, and clear identification and sharing of these expectations promote understanding.
Assess energy direction (are efforts at resolution and problem-solving purposeful or scattered?).
Provides clues about interventions that may be appropriate to assist patient and family in directing energies in a more effective manner.
Note cultural and religious beliefs.
Affects patient and SO reaction and adjustment to diagnosis, treatment, and outcome of cancer.
Listen for expressions of helplessness.
Helpless feelings may contribute to difficulty adjusting to the diagnosis of cancer and cooperating with the treatment regimen.
Deal with family members in a warm, caring, respectful way. Provide information (verbal and written), and reinforce as necessary.
Provides feelings of empathy and promotes an individual’s sense of worth and competence in the ability to handle the current situations.
Encourage appropriate expressions of anger without reacting negatively to them.
Feelings of anger are to be expected when individuals are dealing with the difficult and potentially fatal illness of cancer. Appropriate expression enables progress toward the resolution of the stages of the grieving process.
Acknowledge the difficulties of the situation (diagnosis and treatment of cancer, possibility of death).
Communicates acceptance of the reality the patient and family are facing.
Identify and encourage the use of previous successful coping behaviors.
Most people have developed effective coping skills that can be useful in dealing with the current situation.
Stress the importance of continuous open dialogue between family members.
Promotes understanding and assists family members to maintain clear communication and resolving problems effectively.
Refer to support groups, clergy, and family therapy as indicated.
May need additional assistance to resolve problems of disorganization that may accompany a diagnosis of potentially terminal illness (cancer).
12. Administer Medications and Provide Pharmacologic Support
Medications play a critical role in the management of cancer patients, aiming to treat the cancer itself, alleviate symptoms, and manage side effects. The specific medications used depend on the type and stage of cancer, and may include chemotherapy drugs, targeted therapies, immunotherapy, hormonal therapy, and supportive medications such as pain relievers, anti-nausea drugs, and blood cell boosters.
Opioids: codeine, morphine (MS Contin), oxycodone (oxycontin) hydrocodone (Vicodin), hydromorphone (Dilaudid), methadone (Dolophine), fentanyl (Duragesic); oxymorphone (Numorphan)
A wide range of analgesics and associated agents may be employed around the clock to manage pain. Note: Addiction to or dependency on drugs is not a concern.
Acetaminophen (Tylenol); and nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, ibuprofen (Motrin, Advil)
Effective for localized and generalized moderate to severe pain, with long-acting and controlled-release forms available.
Routes of administration include oral, transmucosal, transdermal, nasal, rectal, and infusions (subcutaneous, IV, intraventricular), which may be delivered via PCA. IM use is not recommended because absorption is not reliable, in addition to being painful and inconvenient. Note: Research is in process for an oral transmucosal agent (fentanyl citrate [oralet]) to control breakthrough pain in patients using fentanyl patches.
Adjuvant drugs are useful for mild to moderate pain and can be combined with opioids and other modalities.
Analgesic rinses (mixture of Koatin, pectin, diphenhydramine [Benadryl], and topical lidocaine [Xylocaine])
An aggressive analgesia program may be required to relieve intense pain. Note: Rinse should be used as a swish-and-spit rather than a gargle, which could anesthetize the patient’s gag reflex.
Antifungal mouthwash preparation such as nystatin (Mycostatin), and antibacterial Biotane
May be needed to treat or prevent secondary oral infections, such as Candida, Pseudomonas, and herpes simplex.
When given before beginning a mouth care regimen, may prevent nausea associated with oral stimulation.
Opioid analgesics: hydromorphone (Dilaudid), morphine.
May be required for acute episodes of moderate to severe oral pain.
Cornstarch, Aquaphor, Lubriderm, and Eucerin (or other recommended water-soluble moisturizing gel)
Cornstarch is commonly used to absorb moisture and alleviate discomfort in areas prone to excessive sweating or skin folds. Aquaphor, Lubriderm, Eucerin, or other water-soluble moisturizing gels are beneficial for patients with cancer as they provide hydration to the skin, help relieve dryness or itching, and promote skin integrity by creating a protective barrier.
- Loperamide (Imodium)
Loperamide is commonly used as an antidiarrheal medication in patients with cancer. It works by slowing down the movement of the intestines, allowing for more water absorption and firming up the stool.
- Diphenoxylate/atropine (Lomotil)
Diphenoxylate is an opioid receptor agonist that helps reduce intestinal motility and fluid secretion, while atropine is added to discourage abuse of the medication. This combination is effective in managing diarrhea in cancer patients.
- Bismuth subsalicylate (Pepto-Bismol)
Bismuth subsalicylate has antidiarrheal properties and also provides some protective effects on the intestinal lining. It can help relieve symptoms of diarrhea and reduce stool frequency in patients with cancer.
Stool softeners such as docusate sodium (Colace)
These medications work by promoting water absorption in the intestines, making the stool softer and easier to pass. They can help alleviate discomfort and straining during bowel movements, which is especially beneficial for patients who may be experiencing side effects of cancer treatment, such as opioids, that can contribute to constipation.
Laxatives such as polyethylene glycol (PEG)
PEG is an osmotic laxative that works by drawing water into the intestines, softening the stool and promoting bowel movements. It is often prescribed for short-term use to relieve constipation caused by factors such as medications, immobility, or dietary changes.
Recommended nursing diagnosis and nursing care plan books and resources.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
More care plans related to basic nursing concepts:
- Cancer (Oncology Nursing) | 13 Care Plans
- End-of-Life Care (Hospice Care or Palliative) | 4 Care Plans
- Geriatric Nursing (Older Adult) | 11 Care Plans
- Prolonged Bed Rest | 8 Care Plans
- Surgery (Perioperative Client) | 13 Care Plans
- Systemic Lupus Erythematosus | 4 Care Plans
- Total Parenteral Nutrition | 4 Care Plans