Cervical cancer NCLEX Review Care Plans
Nursing Study Guide on Cervical Cancer
Cervical cancer is a disease considered to be one of the most common gynecological cancers. It is another type of cancer that affects the cells lining the cervix. This occurs when the cells multiply at an unprecedented rate, affecting localized areas and allowing its spread or dissemination across neighboring tissues and organs such as the liver, vagina, and lungs. This process of dispersion or spread is known as metastasis.
Often, infection with Human papillomavirus (HPV) predisposes an individual to cervical cancer. And much like other terminal diseases, cervical cancer develops gradually, which sometimes makes diagnosis and treatment easier since it allows newly developed screening tests to detect the cancer cells at a more extended period.
Nursing Stat Facts 1
Types of Cervical Cancer
There are various types of cervical cancer, including:
- Squamous cell carcinoma – cancerous cells are found in the surface, lining the cervix
- Adenocarcinoma – cancer is found in cells producing mucus (i.e., glands)
- Mixed carcinoma – it would possess the characteristic of both types
Signs and Symptoms of Cervical Cancer
During the first stages of cervical cancer, the signs and symptoms are usually absent and aren’t as pronounced as in the later stages, making it challenging to distinguish fully. Meanwhile, advanced cervical cancer has the following signs and symptoms:
- There is an abnormal vaginal bleeding after intercourse, between regular periods, following pelvic examination, and after menopause.
- Pain during intercourse
- An unusual or abnormal vaginal discharge
Furthermore, cervical cancer, which has metastasized (advance stage), exhibits the following signs and symptoms:
- Pelvic pain and Bone pain
- Difficulty in peeing
- Swelling of legs
- Kidney failure
- Weight loss and anorexia (i.e., lack of appetite)
Causes of Cervical Cancer
The onset of cervical cancer starts with the over-proliferation of cells which forms a malignant tumor. The common cause linked with this disease is infection with the typical human papillomavirus (HPV). HPV has many different types, and its signs and symptoms usually present themselves as genital warts, skin warts, and other manifestations of skin disorders.
Risk factors of Cervical Cancer
The following factors may put an individual at a higher risk of acquiring or developing cervical cancer:
- Active sexual history with multiple sex partners
- Engaging in intercourse before the age of 16 or within the time your period begins
- A weak or problematic immune system
- Immunocompromised patients (e.g., patients who have HIV or any sexually transmitted disease)
- Long-term intake of birth control pills, about 5 years and above
Complications of Cervical Cancer
As with other cancers, cervical cancer can spread or metastasize to other areas of the body, causing additional complications. In some cases, the development of other types of cancers is most likely to occur after treatment, such as:
- Lung cancer
- Stomach, bladder, pancreas, or ureter cancer
- Acute myeloid leukemia and bone cancer
- Colorectal or anal cancer
- Radiation therapy may increase the risk of getting stomach, vulvar, urinary bladder, and anal cancers.
If a woman aims to get pregnant, chances are, she may have a hard time conceiving since treatments affect fertility. Similarly, there is a possibility of passing an increased risk of cervical cancer from mother to daughter. Other complications include decreased libido.
Diagnosis of Cervical Cancer
A significant screening test that detects cervical abnormalities is the use of the Papanicolaou test or Pap smear. This test is considered to be the routine screening test in detecting early-stage cancer. The process begins by collecting and scraping cells on the surface of the cervix. Then the laboratory personnel examine the sample under the microscope.
If there is a notable diagnostic finding, a physician may request and perform a biopsy where a small piece of cervical tissue is collected. Colposcopy, which is similar to a pelvic exam, may be used to check the vagina and obtain the tissue sample.
Other laboratory tests the attending doctor may order include:
- Loop electrosurgical excision procedure (LEEP) where the physician takes a tissue sample from the cervix using an electrified wire loop.
- Scalpel or cold knife conization
- Chest X-ray to examine the lungs
- IVP or CT scan to view the urinary tract, cystoscopy
- Proctosigmoidoscopy and barium enema to examine the rectum
- Blood tests for liver and kidney function
- Imaging techniques such as CT scans or PET scans
Treatment for Cervical Cancer
Treatment for cervical cancer may vary depending on the current stage of the disease, but it may also depend if a patient has other health complications. Usually, radiation therapy, chemotherapy, and surgery are effective treatments used for invasive cervical cancer.
But there are also other options, especially if cancer is present on the surface of the cervix. This procedure involves destroying cancerous cells using surgery, tissue removal using LEEP, and cold knife conization.
- Radiation therapy (or radiotherapy). This utilizes high-powered rays in destroying cancer cells and impeding further spread.
- External radiation – aims the high-energy beam at the lower quadrant, specifically the pelvis.
- Internal radiation (or brachytherapy) – uses a radioactive implant placed inside the patient’s cervix. Then the implant releases cancer-destroying rays to target tumors while also avoiding damage to healthy tissues nearby.
- Chemotherapy. This medical treatment employs the use of drugs to destroy cancer cells. It is often used for cervical cancer that has metastasized in localized areas or other parts of the body.
- Biological therapy. Also known as immunotherapy, acts by hyper-focusing on specific markers in immune cells to suppress or activate a response. The drug used in this procedure is called pembrolizumab (Keytruda), where it inhibits a particular protein found on cells to slow down their growth and further shrink the tumor.
Prevention of Cervical Cancer
There are several means to prevent cervical cancer, but one of the most significant ways is to detect early-cell changes before it can progress alarmingly to cancerous cells. Taking regular pelvic exams and Pap tests are effective routine screening tests that can pick up the early warning signs. Expert recommendations involve:
- Getting a Pap test if the person’s age is 21 and above at least every 3 years. And five years intervals, if a person’s age is between 30 to 65
- There’s no need for screening in women without the disease history and who’ve had their cervix removed
- If an individual is sexually active, it is advised to take other tests for STDs
Nursing Care Plans for Cervical Cancer
Nursing Care Plan 1
Nursing Diagnosis: Deficient Knowledge related to new diagnosis of cervical cancer as evidenced by 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 cervical cancer and its management.
|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 cervical cancer is and its symptoms. Avoid using medical jargons and explain in layman’s terms.||To provide information on cervical cancer and its pathophysiology in the simplest way possible.|
|Educate the patient about his/her cervical cancer treatment plan. If 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 an informed consent.|
|Explain to the patient the need for regular blood tests to check for the full blood count, especially the neutrophil count, as well as the indicators for liver function, kidney function, and the tumor marker CA 125.||Regular blood tests are required to check the patient’s response to treatment and any progression of the disease.|
|Inform the patient 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 cervical cancer. Teach the patient on how to modify these risk factors (e.g., smoking, excessive alcohol intake, obesity, unhealthy food choices, sedentary lifestyle, etc.).||To assist the patient in identifying and managing modifiable risk factors related to cervical cancer.|
Nursing Care Plan 2
Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to consequences of chemotherapy for cervical cancer, as evidenced by abdominal cramping, stomach pain, diarrhea or constipation, bloating, weight loss, nausea and vomiting, and loss of appetite
Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.
|Explore the patient’s daily nutritional intake and food habits (e.g., meal times, 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 a more specialized care for the patient in terms of nutrition and diet in relation to newly diagnosed cervical cancer.|
|Perform symptom control:Give pain medications as needed and refer to pain specialist if the cancer pain becomes worse. Administer the prescribed medications for abdominal cramping and pain, such as antispasmodics. Promote bowel emptying using laxatives as prescribed for constipation. On the other hand, provide advice on taking anti-diarrheal medications for diarrhea.||Cancer pain may require the aid of a pain specialist as it is difficult to manage compared to most types of pain. To reduce cramping, relieving the stomach pain and helping the patient to have a better appetite. To treat persistent and/or severe constipation/diarrhea.|
Nursing Care Plan 3
Nursing Diagnosis: Fatigue related to consequence of chemotherapy for cervical cancer (e.g., immunosuppression and malnutrition) 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.
|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 in 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 a more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity.|
Other possible nursing diagnoses:
- Acute Pain
- Anticipatory Grieving
- Fear/ Anxiety
- Risk for Altered Oral Mucous Membranes
- Risk for Impaired Skin Integrity
- Risk for Disturbed Body Image
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
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.