Cancer remains one of the leading causes of mortality worldwide, characterized by the uncontrolled growth and spread of abnormal cells. As healthcare professionals, nurses play a crucial role in the care and management of patients with cancer. Understanding cancer nursing diagnoses is essential for providing effective, patient-centered care throughout the cancer journey.
Understanding Cancer
Cancer develops when cells in the body begin to grow and multiply uncontrollably. This abnormal growth can occur in any part of the body and may spread to other areas, disrupting normal bodily functions. The symptoms of cancer can vary widely depending on the type and location of the cancer, but some common signs include:
- Unexplained weight loss
- Fatigue
- Fever
- Pain
- Skin changes
- Changes in bowel or bladder habits
- Persistent cough or difficulty breathing
- Unexplained bleeding or bruising
- Lumps or thickening under the skin
Cancer can be caused by various factors, including genetic mutations, exposure to carcinogens, certain viruses, and lifestyle choices. Risk factors for cancer development include:
- Age (risk increases with age)
- Family history of cancer
- Tobacco use
- Excessive alcohol consumption
- Obesity
- Lack of physical activity
- Exposure to radiation or certain chemicals
- Chronic inflammation
Early detection and diagnosis of cancer are crucial for successful treatment outcomes. Screening tests, imaging studies, and biopsies are commonly used to diagnose cancer and determine its stage and grade.
The Role of Nursing in Cancer Care
Nurses are integral to the oncology care team, providing comprehensive care to patients throughout their cancer journey. The nursing process in cancer care involves:
- Assessment: Gathering data about the patient’s physical, emotional, and psychosocial status.
- Diagnosis: Identifying actual or potential health problems based on the assessment data.
- Planning: Developing a care plan with specific goals and interventions.
- Implementation: Carrying out the planned interventions.
- Evaluation: Assessing the effectiveness of the interventions and modifying the care plan as needed.
Nursing care plans are essential tools that help prioritize care, guide interventions, and ensure continuity of care for cancer patients.
Cancer Nursing Diagnoses and Care Plans
The following section presents five common nursing diagnoses relevant to cancer patients and their related factors, nursing interventions, rationales, and desired outcomes.
1. Impaired Oral Mucous Membrane
Nursing Diagnosis Statement: Impaired Oral Mucous Membrane related to the side effects of chemotherapy and radiation therapy.
Related factors/causes:
- Chemotherapy-induced mucositis
- Radiation therapy to the head and neck region
- Immunosuppression
- Poor oral hygiene
Nursing Interventions and Rationales:
- Assess the oral cavity daily for signs of mucositis, including redness, ulceration, or white patches.
Rationale: Early detection allows for prompt intervention and prevention of complications. - Teach and encourage proper oral hygiene practices, including gentle brushing with a soft toothbrush and alcohol-free mouthwash.
Rationale: Good oral hygiene helps prevent infection and promotes the healing of oral tissues. - Administer prescribed oral rinses or topical medications as ordered.
Rationale: These treatments can help reduce pain, prevent infection, and promote healing of oral mucosa. - Encourage frequent sips of water or ice chips to keep the mouth moist.
Rationale: Maintaining oral moisture helps prevent the drying and cracking of oral tissues. - Provide soft, non-irritating foods, and avoid hot, spicy, or acidic foods.
Rationale: Appropriate food choices minimize discomfort and further injury to oral tissues.
Desired Outcomes:
- The patient will demonstrate improvement in oral mucous membrane integrity within seven days.
- The patient will report decreased oral pain and discomfort within three days.
- The patient will maintain adequate oral intake despite oral mucositis.
2. Fatigue
Nursing Diagnosis Statement: Fatigue related to the effects of cancer and its treatment.
Related factors/causes:
- Anemia secondary to chemotherapy
- Altered metabolism due to cancer
- Sleep disturbances
- Emotional stress and anxiety
Nursing Interventions and Rationales:
- Assess the patient’s fatigue level using a standardized scale (e.g., Fatigue Severity Scale).
Rationale: Quantifying fatigue helps track changes over time and evaluate the effectiveness of interventions. - Encourage the patient to maintain a balanced schedule of rest and activity.
Rationale: Proper energy management helps conserve strength and reduce fatigue. - Collaborate with a dietitian to ensure adequate nutrition and hydration.
Rationale: Proper nutrition and hydration support energy levels and overall well-being. - Teach energy conservation techniques, such as prioritizing activities and using assistive devices.
Rationale: These strategies help patients manage their limited energy more effectively. - Administer prescribed medications for anemia or other contributing factors as ordered.
Rationale: Addressing underlying causes can help alleviate fatigue.
Desired Outcomes:
- The patient will report a decrease in fatigue levels within two weeks.
- The patient will demonstrate increased participation in daily activities within one week.
- The patient will verbalize understanding of energy conservation techniques within three days.
3. Anxiety
Nursing Diagnosis Statement: Anxiety related to cancer diagnosis and uncertain prognosis.
Related factors/causes:
- Fear of death or disability
- Uncertainty about treatment outcomes
- Changes in body image
- Financial concerns
Nursing Interventions and Rationales:
- Assess the patient’s level of anxiety using a standardized tool (e.g., Hamilton Anxiety Rating Scale).
Rationale: Quantifying anxiety helps track changes and evaluate the effectiveness of interventions. - Provide a calm and supportive environment, allowing the patient to express fears and concerns.
Rationale: Open communication helps build trust and allows for addressing specific anxiety triggers. - Teach relaxation techniques such as deep breathing, progressive muscle relaxation, or guided imagery.
Rationale: These techniques can help reduce anxiety and promote a sense of control. - Provide accurate information about the disease, treatment, and prognosis in collaboration with the healthcare team.
Rationale: Knowledge can help reduce fear of the unknown and empower the patient. - Refer the patient to support groups or counseling services as appropriate.
Rationale: Professional support and peer interactions can provide additional coping strategies and emotional support.
Desired Outcomes:
- The patient will report a decrease in anxiety levels within one week.
- The patient will demonstrate using at least two relaxation techniques within three days.
- The patient will verbalize an improved understanding of their condition and treatment plan within five days.
4. Risk for Infection
Nursing Diagnosis Statement: Risk for Infection related to immunosuppression secondary to cancer treatment.
Related factors/causes:
- Neutropenia due to chemotherapy
- Compromised skin integrity
- Presence of invasive devices (e.g., central lines, urinary catheters)
- Malnutrition
Nursing Interventions and Rationales:
- Monitor laboratory values, mainly white blood cell count and absolute neutrophil count.
Rationale: These values indicate the patient’s risk for infection and guide protective measures. - Implement strict hand hygiene and teach its importance to the patient and visitors.
Rationale: Proper hand hygiene is the most effective way to prevent the spread of infection. - Assess for signs and symptoms of infection (e.g., fever, redness, swelling) regularly.
Rationale: Early detection of infection allows for prompt treatment and prevention of complications. - Maintain an aseptic technique when performing invasive procedures or caring for wounds.
Rationale: The aseptic technique minimizes the risk of introducing pathogens. - Educate the patient about neutropenic precautions, including avoiding crowds and consuming only well-cooked foods.
Rationale: These precautions help reduce exposure to potential pathogens.
Desired Outcomes:
- The patient will remain free from signs and symptoms of infection throughout the treatment period.
- The patient will demonstrate proper hand hygiene techniques within 2 days.
- The patient will verbalize understanding of neutropenic precautions within three days.
5. Imbalanced Nutrition: Less Than Body Requirements
Nursing Diagnosis Statement: Imbalanced Nutrition: Less Than Body Requirements related to side effects of cancer treatment and altered metabolism.
Related factors/causes:
- Nausea and vomiting secondary to chemotherapy
- Altered taste sensation
- Decreased appetite
- Fatigue affects the ability to prepare or consume meals
Nursing Interventions and Rationales:
- Assess the patient’s nutritional status, including weight, dietary intake, and laboratory values.
Rationale: This information provides a baseline for monitoring nutritional status and guiding interventions. - Administer antiemetics as prescribed and teach non-pharmacological methods to manage nausea.
Rationale: Controlling nausea can improve food intake and nutritional status. - Offer small, frequent meals and nutrient-dense foods based on the patient’s preferences.
Rationale: This approach can help increase caloric intake without overwhelming the patient. - Collaborate with a dietitian to develop an individualized nutrition plan.
Rationale: A tailored plan can address specific nutritional needs and preferences. - Consider enteral or parenteral nutrition support if oral intake remains inadequate.
Rationale: Alternative feeding methods may be necessary to meet nutritional requirements and support healing.
Desired Outcomes:
- The patient will demonstrate weight stabilization or gain within two weeks.
- The patient will report improved appetite and food intake within one week.
- The patient will maintain adequate hydration status throughout the treatment period.
Conclusion
Nursing care for cancer patients requires a comprehensive understanding of cancer nursing diagnoses and the ability to develop and implement appropriate care plans. By addressing common issues such as oral mucositis, fatigue, anxiety, infection risk, and nutritional imbalances, nurses can significantly improve patient outcomes and quality of life throughout the cancer journey.
Continuous assessment, individualized interventions, and ongoing evaluation are critical to successful cancer nursing care. As research in oncology continues to advance, nurses must stay updated on the latest evidence-based practices to provide the highest quality care to patients with cancer.
References
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- Carpenito-Moyet, L. J. (2013). Nursing diagnosis: Application to clinical practice. Lippincott Williams & Wilkins.
- Eilers, J., Harris, D., Henry, K., & Johnson, L. A. (2014). Evidence-based interventions for cancer treatment-related mucositis: Putting evidence into practice. Clinical Journal of Oncology Nursing, 18(6), 80-96.
- Fitch, M. I., Howell, D., McLeod, D., & Green, E. (2012). Screening for fatigue in cancer patients: Performance of three fatigue instruments. Journal of Pain and Symptom Management, 44(3), 451-460.
- Lalla, R. V., Bowen, J., Barasch, A., Elting, L., Epstein, J., Keefe, D. M., … & Mucositis Guidelines Leadership Group of the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO). (2014). MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer, 120(10), 1453-1461.
- Neefjes, E. C., van der Vorst, M. J., Blauwhoff-Buskermolen, S., & Verheul, H. M. (2013). Aiming for a better understanding and management of cancer-related fatigue. The Oncologist, 18(10), 1135-1143.
