NURSING ASSESSMENT FOR CA
 Weight loss
 Frequent infection
 Skin problems
 Pain
 Hair Loss
 Fatigue
 Disturbance in body image/ depression
GOAL IN MANAGEMENT OF CANCER
 Cure – eradication of malignant diseases
 Control – prolonged survival and containment of cancer
cell growth
 Palliation – relief of symptoms associated with the
disease
NURSING INTERVENTION FOR IMPAIRED SKIN
INTEGRITY
 Keep skin free of foreign substance
 Avoid use of medicated solutions
 Avoid pressure, trauma, infection
 Avoid exposure to heat, cold or sunlight
NURSING INTERVENTION FOR ANOREXIA,
VOMITING, NAUSEA
 Provide small, frequent feedings
 Make the food appealing
 Avoid extremes of temperatures
 Administer antiemetics before meals
NURSING INTERVENTION FOR DIARRHEA
 Encourage low residue, bland, high protein foods
 Provide good perineal hygiene
 Monitor electrolytes, Na, K, Cl
NURSING INTERVENTION FOR ANEMIA,
LEUKOPENIA, THROMBOCYTOPENIA
 Isolate patient, strict asepsis
 provide frequent rest period
 Encourage high protein diet
 Assess for bleeding and signs of infection
 Monitor lab results CBC, WBC, Platelet count
 Broad spectrum antibiotics or in combination
MANAGEMENT OF STOMATITIS
 Use soft-bristled toothbrush
 Oral rinses with saline gargles/ tap water
 Avoid ALCOHOL-based rinses
MANAGEMENT OF ALOPECIA
Alopecia begins within 2 weeks of therapy
 Regrowth within 8 weeks of termination
 Encourage to acquire wig before hair loss occurs
 Encourage use of attractive scarves and hats
 Provide information that hair loss is temporary BUT
anticipate change in texture and color
Nursing Intervention: PROMOTE NUTRITION
 Serve food in ways to make it appealing
 Consider patient’s preferences
 Provide small frequent meals
 Avoids giving fluids while eating
 Oral hygiene PRIOR to mealtime
 Vitamin supplements
Nursing Intervention: RELIEVE PAIN
 Mild pain- NSAIDS
 Moderate pain- Weak opiods
 Severe pain- Morphine
 Administer analgesics round the clock with additional
dose for breakthrough pain
Nursing Intervention: DECREASE FATIGUE
 Plan daily activities to allow alternating rest periods
 Light exercise is encouraged
 Small frequent meals
Nursing Intervention: IMPROVE BODY IMAGE
 Therapeutic communication is essential
 Encourage independence in self-care and decision
making
 Offer cosmetic material like make-up and wigs
Nursing Intervention: ASSIST IN THE GRIEVING
PROCESS
 Some cancers are curable
 Grieving can be due to loss of health, income, sexuality,
and body image
 Answer and clarify information about cancer and
treatment options
 Identify resource people
 Refer to support groups
Nursing Intervention: MANAGE COMPLICATION:
INFECTION
 Fever is the most important sign (38.3)
 Administer prescribed antibiotics X 2weeks
 Maintain aseptic technique
 Avoid exposure to crowds
 Avoid giving fresh fruits and veggie
 Handwashing
 Avoid frequent invasive procedures
Nursing Intervention: MANAGE COMPLICATION: Septic
shock
 Monitor VS, BP, temp
 Administer IV antibiotics
 Administer supplemental O2
Nursing Intervention: MANAGE COMPLICATION:
Bleeding
 Thrombocytopenia (<100,000) is the most common
cause
 <20, 000 spontaneous bleeding
 Use soft toothbrush
 Use electric razor
 Avoid frequent IM, IV, rectal and catheterization
 Soft foods and stool softeners
 GI SYSTEM
 Nausea and vomiting
o administer anti-emetics
o NPO 4-6 hrs before chemotherapy
o bland diet foods in small amounts after
treatment
 Antimetabolites and antibiotics
RENAL SYSTEM
 encourage to increase OFI and frequent voiding
 Monitor serum electrolytes, BUN, creatinine
 Administer allopurinol
 Cisplatin, metothrexate, mitomycin
CARDIOPULMONARY SYSTEM
 Cardiotoxic – doxurubicin, daunorubicin
o Monitor for signs of CHF and cardiac ejection
fraction
 Pulmonary fibrosis – bleomycin, carmustine, busulfan
o Monitor pulmonary function test
Nursing Care: Pre-transplant
 Provide protected environment - strict reverse isolation
2. Monitor central lines frequency
3. Provide care receiving chemotherapy
 Post transplant
 Prevent infection
- Maintain protective environment
- Administer antibiotics
- Check IV set ups q12hrs
2. Provide mouth care for stomatitis and mucositis
 Post transplant
3. Monitor carefully for bleeding
 check for occult blood
 observe for easy bruising
 Check platelet ct daily
 replaced blood component
4. Maintain fluid and electrolyte balance
5. Provide client health teaching
COLON CANCER
PRE-OP NURSING INTERVENTION
1. Provide HIGH protein, HIGH calorie and LOW residue
diet
a. 2.Provide information about post-op care and stoma
care
2. Administer antibiotics 3-5 day prior
3. Enema or colonic irrigation the evening and the morning
of surgery
4. NGT is inserted to prevent distention
5. Monitor UO, F and E, Abdomen PE
POST-OP NURSING INTERVENTION
1. 1. Monitor for complications
2. Leakage from the site, prolapse of stoma, skin irritation
and pulmo complication
3. 2. Assess the abdomen for return of peristalsis
4. 3. Assess wound dressing for bleeding
5. 4. Assist patient in ambulation after 24H
6. 5.provide nutritional teaching
–Limit foods that cause gas-formation and odor
–Cabbage, beans, eggs, fish, peanuts
–Low-fiber diet in the early stage of recovery
POST-OP NURSING INTERVENTION
7. Instruct to splint the incision and administer pain meds
before exercise
8. The stoma is PINKISH to cherry red, Slightly edematous
with minimal pinkish drainage
9. Manage post-operative complication
COLOSTOMY CARE
 Colostomy begins to function 3-6 days after surgery
 BEST time to do skin care is after shower
 Apply tape to the sides of the pouch before shower
 Assume a sitting or standing position in changing the
pouch
 Instruct to GENTLY push the skin down and the pouch
pulling UP
 Wash the peri-stomal area with soap and water
 Cover the stoma while washing the peri-stomal area
 Lightly pat dry the area and NEVER rub
 Measure the stomal opening
 The pouch opening is about 0.3 cm larger than the
stomal opening
 Apply adhesive surface over the stoma and press for 30
seconds
 Expect that stool will be liquid postoperatively but will
become more solid, depending on the area of colostomy.
 Ascending colon colostomy – liquid stool.
 Transverse colon colostomy – loose to semiformed stool.
 Descending colon colostomy – close to normal stool.
o Empty the pouch or change the pouch when
o 1/3 to ¼ full (Brunner)
o ½ to 1/3 full (Kozier)
BREAST CANCER
PRE-OP NURSING INTERVENTION
1. Explain breast cancer and treatment options
2. Reduce fear and anxiety and improve coping abilities
3. Promote decision making abilities
4. Provide routine pre-op care:
1. Consent, NPO, Meds, Teaching about breathing exercise
POST- OP NURSING INTERVENTION
1. Position patient:
 Supine
 Affected extremity elevated to reduce edema
2. Relieve pain and discomfort
 Moderate elevation of extremity
 IM/IV injection of pain meds
 Warm shower on 2nd day post-op
3. Maintain skin integrity
 Immediate post-op: snug dressing with drainage
 Maintain patency of drain (JP)
 Monitor for hematoma w/in 12H and apply bandage
and ice, refer to surgeon
 Drainage is removed when the discharge is less than
30 ml in 24 H
  Lotions, Creams are applied ONLY when the incision  Maintain strict asepsis techniques
is healed in 4-6 weeks  Administer IV antibiotics
4. Promote activity  Administer blood products
 Support operative site when moving o Anticoagulants
 Hand, shoulder exercise done on 2ndday o Cryoprecipitate
 Post-op mastectomy exercise 20 mins TID
 NO BP or IV procedure on operative site HYPERCALCEMIA
 Heavy lifting is avoided NURSING INTERVENTION
 Elevate the arm at the level of the heart  Monitor serum calcium level.
 On a pillow for 45 minutes TID to relieve transient  Correct fluid and electrolyte imbalance.
edema  Prepare the client for dialysis

POST- OP NURSING INTERVENTION

TEACH FOLLOW-UP care
 Regular check-up
 Monthly BSE on the other breast
 Annual mammography

PROSTATE CANCER
Nursing Interventions: Post-prostatectomy
 Maintain continuous bladder irrigation. Note that
drainage is pink tinged w/in 24 hours
 Monitor urine for the presence of blood clots and
hemorrhage
 Ambulate the patient as soon as urine begins to clear
in color

1. Provide for bladder retraining after foley catheter removal

a. Perineal exercises
b. restrict caffeine
c. limit fluid intake at nigth
2. Education
a. Avoid lifting, straining, and prolonged travel
b. possible impotence

SPINAL CORD COMPRESSION

NURSING INTERVENTION
 Assess for back pain and neurological deficits.
 Prepare the client for radiation and/or chemotherapy
 Surgery may need to be performed
 Instruct the client in the use of neck or back braces if
they are prescribed.

TUMOR LYSIS SYNDROME

 Instruct the client regarding the importance of fluid
intake during chemotherapy.
 Administer diuretics as prescribed.
 Administer allopurinol (Zyloprim), as prescribed.
 Prepare to administer IV infusion of glucose and
insulin to treat Hyperkalemia.
 Prepare the client for dialysis

SIADH
NURSING INTERVENTION
 Initiate fluid restriction and increased sodium intake as
prescribed.
 Administer democlocyline (Declomycin) as prescribed
 Monitor serum sodium levels.

SEPSIS AND DIC