Cancer Nursing Diagnosis and Care Plans

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Cancer Nursing Care Plans Diagnosis and Interventions

Cancer NCLEX Review and Nursing Care Plans

Cancer is an umbrella term for diseases that involve the rapid and uncontrollable division of abnormal cells that are able to cause the destruction of normal body cells and tissues. Cancer is known as a leading cause of death worldwide, second to cardiovascular disease.

However, modern research has tremendously improved treatments for various cancers, resulting in positive leaps in survival rates as well as the quality of life of cancer patients.

Signs and Symptoms of Cancer

Each type of cancer has its own set of warning signs and symptoms, but the following are general signs and symptoms related to cancer:

  • Fatigue that is usually unexplained
  • Lump
  • Unintentional weight loss or weight gain
  • Unexplained bruising and/or bleeding
  • Changes in the skin – may include erythema or redness, yellowing or darkening of the skin, existing moles that changes in size, shape and/or color, and sores that do not heal
  • Bladder or bowel changes
  • Hoarseness of voice
  • Difficulty of breathing
  • Difficulty swallowing
  • Persistent cough
  • Indigestion that does not go away
  • Unexplained joint and/or muscle pain that may be unrelieved by over-the-counter pain relievers
  • Unexplained fevers and/or night sweats
  • Persistent indigestion

Causes of Cancer

There are two major causes of cancer and these are:

  • Genetics – genetic mutations can be inherited by children from their parents.
  • Carcinogens – chemicals and biologic agents can initiate the malignant transformation of cells. Carcinogenesis or the process of cell transformation due to carcinogens involve:
    • Initiation – exposure to the carcinogen
    • Promotion – repeated exposure that causes the alteration of cells
    • Progression – the abnormal cells show malignant behavior

Risk Factors of Cancer

  • Age – most people are diagnosed with cancer at age 65 or older, although cancer can be diagnosed at any age
  • Gender – in general, there are more male cancer patients than females; however, the cancer type can be a factor in relation to gender (for example, women are more prone to breast cancer than men)
  • Family history – some types of cancer can be inherited
  • Lifestyle and habits – frequent exposure to sun, drinking more than the recommended alcohol limit, smoking, unsafe sex, sedentary lifestyle, and other habits and lifestyle factors may predispose a person to cancer
  • Chronic health problems – having ulcerative colitis, for instance, may increase the risk for developing colorectal cancer; obesity can also contribute to the development of cancer
  • Environment – second hand smoking greatly increases the risk for lung cancer

Pathophysiology of Cancer

  1. Genetic mutation. The disease process of cancer starts when the genetic mutation in the cellular DNA transforms an abnormal cell.
  2. Neoplasia or proliferation. The abnormal cells grow uncontrollably without following any physiologic demand. Cancer cells also do not appear the same as normal cells and are termed “undifferentiated”. They tend to increase in number and size at the periphery while attempting to infiltrate the body tissues nearby in order to destroy them.
  3. Metastasis. Malignant cells invade other parts of the body by means of using blood and lymphatic channels. They can also “metastasize” or spread to a distant body part or region.

Complications of Cancer

Cancer has many complications, and the most common ones include:

  • Fatigue
  • Pain
  • Weight loss
  • Breathing problems
  • Bowel changes such as diarrhea or constipation
  • Nausea and vomiting
  • Chemical imbalances in the body
  • Metastasis of cancer – advancement and spread
  • Cancer recurrence – cancer may come back even after successful treatment

Diagnosis of Cancer

  • Cancer screening – screening exams are useful in diagnosing cancer early to give the patient the opportunity to be treated as soon as possible
  • Physical exam -the doctor will find lumps, skin changes, and other signs and symptoms related to cancer
  • Imaging tests – X-rays, CT scans, PET scans, ultrasounds, and other imaging exams can be used to examine the body in a non-invasive method; imaging tests are useful in knowing the extent of cancer, also known as cancer staging
  • Biopsy – the collection of cell samples and the subsequent examination of these cells under a microscope; this can be a definitive diagnostic tool to determine if cancer cells exist

Treatment for Cancer

There are different objectives of cancer treatment, and they are:

  1. Curative – the goal of curative cancer treatment could be to cure the cancer for an optimal quality of life.
  2. Neoadjuvant / primary – the goal of primary cancer treatment is to reduce the tumor burden, usually in patients with locally advanced or early stage disease; this cancer therapy is given to the patient prior to surgery.
  3. Adjuvant – the goal of adjuvant cancer treatment is to destroy the remaining cancer cells after neoadjuvant or primary cancer therapy has been administered; it aims to lower the chance of cancer recurrence; it can be radiotherapy, chemotherapy, hormone therapy, or a combination of these.
  4. Palliative – the goal of palliative cancer treatment is symptom control, which is the relief of the symptoms of cancer and the side effects of treatment in order to make the patient comfortable and allow him/her to have an optimal quality of life.

Prevention of Cancer

  1. Smoking Cessation. It is strongly recommended to stop smoking or not to start smoking at all. Smoking has been associated not only to lung cancer, but also other types of cancer such as esophageal and mouth cancers.
  2. Reduce exposure to the sun. Studies show that long exposures to the sun greatly increase the risk for skin cancer. The ultraviolet or UV rays from the sun causes severe damage to the outer layer of the skin. Make sure to spend time under the sun in the recommended hours (such as before 10 AM and after 3PM), wear protective clothing, apply sunscreen on the skin, and stay in the shade.
  3. Perform regular exercise. Exercising at least 30 minutes a day during most days of the week can reduce the risk of cancer. Walking is a good beginner’s exercise for people who are not used to regular exercise.
  4. Adhere to healthy food and diet and maintain a healthy weight. Eating processed meats regularly increases the risk of cancer. A diet rich in vegetables, fruits, lean proteins, and whole grains can help lower one’s cancer risk. Obesity is associated with cancer, so ensure to eat healthy and exercise regularly.
  5. Avoid alcohol, or at least drink in moderation. Healthy women may have up to 1 unit of alcoholic drink per day, while men can have 2 units per day.
  6. Get immunized. Some cancers such as cervical cancer and liver cancer are caused by viruses. To prevent getting infected and to lower the risk for these types of cancer, it is important to have immunizations against HPV and other cancer-associated viruses.
  7. Attend cancer screening. Patients should be encouraged to have cancer screening exams and to speak up about their risk factors such as family history.

Nursing Diagnosis for Cancer

Nursing Care Plan for Cancer 1

Nursing Diagnosis: Deficient Knowledge related to a new diagnosis of cancer as evidenced by the patient’s verbalization of “I want to know more about my new diagnosis and care”

Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of cancer and its management.

Nursing Interventions for CancerRationale
Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. denial of diagnosis or poor lifestyle habits)To address the patient’s cognition and mental status towards the new diagnosis and to help the patient overcome blocks to learning.
Explain what cancer is and its symptoms (which may vary depending on the exact type of cancer). Avoid using medical jargon and explain in layman’s terms.To provide information on  cancer and its pathophysiology in the simplest way possible. 
Educate the patient about his/her  cancer treatment plan.  If the patient is for systemic anti-cancer therapy (SACT) and/or radiotherapy, explain the treatment protocol that will be administered, its purpose, risks, and possible side effects. If the patient is for surgery, explain the procedure to the patient.   To give the patient enough information on the treatment plan, so that he/she can provide or deny informed consent.   
Demonstrate how to perform blood sugar monitoring.To empower the patient to monitor his/her blood sugar levels at home.  
Inform the patient of the details about the prescribed medications (e.g. drug class, use, benefits, side effects, and risks) for supportive care, such as pain medications, anti-emetics and bowel medications. Explain how to properly self-administer each of them. Ask the patient to repeat or demonstrate the self-administration details to you.To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details. 
Use open-ended questions to explore the patient’s lifestyle choices and behaviors that can be linked to the development of  cancer. Teach the patient how to modify these risk factors (e.g. , smoking, excessive alcohol intake, low fiber, and high-fat diet, obesity, sedentary lifestyle, etc).To assist the patient in identifying and managing modifiable risk factors related to  cancer. 

Nursing Care Plan for Cancer 2

  • Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to abdominal pain and cramping secondary to cancer, as evidenced by  abdominal cramping, stomach pain, bloating, weight loss, nausea and vomiting, and loss of appetite

Desired Outcome: The patient will be able to achieve weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.

Nursing Interventions for CancerRationale
Explore the patient’s daily nutritional intake and food habits (e.g. mealtimes, duration of each meal session, snacking, etc.)To create a baseline of the patient’s nutritional status and preferences. 
Create a daily weight chart and a food and fluid chart. Discuss with the patient the short-term and long-term nutrition and weight goals.To effectively monitory the patient’s daily nutritional intake and progress in weight goals.
Help the patient to select appropriate dietary choices to increase dietary fiber, caloric intake, and alcohol and coffee intake. To promote nutrition and healthy food habits, as well as to boost the energy levels of the patient. Dietary fiber can help reduce stool transit time, thus promoting regular bowel movement. 
Refer the patient to the dietitian.To provide more specialized care for the patient in terms of nutrition and diet in relation to newly diagnosed cancer.   Symptom control: Administer the prescribed medications for abdominal cramping and pain, such as antispasmodics. Promote bowel emptying using laxatives as prescribed.To reduce cramping, relieve the stomach pain and help the patient to have a better appetite. To treat persistent and/or severe constipation, which is a common symptom of cancer.

Nursing Care Plan for Cancer 3

Nursing Diagnosis: Fatigue related to side effects of chemotherapy for cancer and/or emotional distress due to the diagnosis, as evidenced by overwhelming lack of energy, verbalization of tiredness, generalized weakness, and shortness of breath upon exertion

Desired Outcome: The patient will establish adequate energy levels and will demonstrate active participation in necessary and desired activities. 

Nursing Interventions for CancerRationale
Ask the patient to rate fatigue level (mild, moderate, or severe fatigue). Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.  To create a baseline of activity levels, degree of fatigability, and mental status related to fatigue and activity intolerance. 
For patients with grade 3 fatigue (severe fatigue), consider discussing having a treatment break with the oncology team.Anti-cancer therapies such as chemotherapy treatments may increase the fatigue levels in a cancer patient, disabling them to perform even the most basic daily activities such as eating and bathing. Having a treatment break may be needed to allow the patient to recuperate before receiving further doses.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media for long periods. Alternate periods of physical activity with rest and sleep.To gradually increase the patient’s tolerance to physical activity.
Teach deep breathing exercises and relaxation techniques.  Provide adequate ventilation in the room.To allow the patient to relax while at rest.  To allow enough oxygenation in the room.
Refer the patient to physiotherapy / occupational therapy team as required.To provide more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity.

Nursing Care Plan for Cancer 4

Acute Pain

Nursing Diagnosis: Acute Pain related to the tumor pressing on the nerves and bones secondary to cancer as evidenced by reports of discomfort and pain score of 10 out of 10.

Desired Outcome: The patient will report a reduced level of pain between 0 to 3 out of 10.

Nursing Interventions for CancerRationale
Promote effective coping strategies and emotional support such as guided imagery, visualization, deep-breathing exercises, or progressive relaxation.    These techniques refocus concentration, develop a sense of control, and improve coping mechanisms in dealing with the stress of traumatic damage and pain, which is likely to last for a long time.
Offer pain relief at least 30 minutes prior to any procedure, such as accessing the central venous lines, or undergoing an imaging test such as a CT scan.This method enables the patient to prepare better for activities and manage discomfort.
Inform the patient that it is critical to take medicine before the discomfort gets unbearable.    This technique relaxes the muscles and increases engagement.
Monitor any indications of atypical or intense pain, as well as severe, escalating, and disorientated pain that is not alleviated by painkillers.This approach may indicate the emergence of tissue ischemia, infection, and compartmental disease problems.

Nursing Care Plan for Cancer 5

Nausea/ Vomiting

Nursing Diagnosis: Nausea/ Vomiting is related to the expected side effects of chemotherapy secondary to cancer as evidenced by verbal reports of nausea and/or vomiting.

Desired Outcome: The patient will verbalize being free from the feeling of nausea.

Nursing Interventions for CancerRationale
Ensure that an emesis basin is easily accessible to the patient.  Vomiting and nausea are directly connected. Therefore, if the nausea is psychogenic, place the emesis container out of sight but still within the patient’s access.  
Administer anti-emetics as prescribed. Refer to the physician if there is a suspected need to change the type of anti-emetics, or increase the dose if the current anti-emetics are not working.    Many cancer treatments have nausea and vomiting as their main expected side effect. Anti-emetics are usually prescribed with these cancer medications; however, there may be a need to review the type and dosage of anti-emetics if the currently prescribed ones are not effective.
Teach the patient to use non-pharmacological nausea management approaches such as deep breathing, relaxation, music therapy, and guided imagery.These approaches are used to assist people in resolving nausea and vomiting.
Instruct the patient and caregiver on hydration and food options for nausea and vomiting.    Patients and their caregivers can achieve proper hydration and nutritional status by recognizing food factors that make the patient feel nauseous.
Apply acupressure or acu-stimulation bands as directed.  In certain circumstances, stimulation of the Neiguan P6 acupuncture point on the ventral side of the wrist has been shown to diminish nausea. This approach has been proven beneficial for those suffering from motion sickness.  

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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