Esophageal cancer is a serious malignancy affecting the tube connecting the throat to the stomach. This nursing diagnosis focuses on identifying symptoms, managing complications, and providing comprehensive care for patients with esophageal cancer.
Causes (Related to)
Esophageal cancer development can be influenced by several factors:
- Chronic gastroesophageal reflux disease (GERD)
- Barrett’s esophagus
- Smoking and alcohol consumption
- Advanced age (typically over 60)
- Risk factors include:
- Obesity
- Poor nutrition
- Family history
- Chronic irritation of the esophagus
- Environmental factors such as:
- Exposure to carcinogens
- Consumption of very hot beverages
- A diet low in fruits and vegetables
Signs and Symptoms (As evidenced by)
Common manifestations that nurses must recognize for proper diagnosis and treatment.
Subjective: (Patient reports)
- Progressive difficulty swallowing (dysphagia)
- Unexplained weight loss
- Chest pain or pressure
- Chronic cough
- Hoarseness
- Loss of appetite
- Heartburn
- Food sticking in the throat or chest
Objective: (Nurse assesses)
- Documented weight loss
- Malnutrition signs
- Dehydration indicators
- Reduced muscle mass
- Abnormal lung sounds
- Enlarged lymph nodes
- Changes in vital signs
- Presence of metastases
Expected Outcomes
Successful management of esophageal cancer includes:
- Improved nutritional status
- Effective pain management
- Maintained hydration status
- Prevention of complications
- Enhanced quality of life
- Improved swallowing ability
- Better understanding of the disease process
- Adherence to treatment plan
Nursing Assessment
Monitor Nutritional Status
- Track daily weight
- Assess swallowing ability
- Monitor caloric intake
- Document nutritional supplements
- Note dietary restrictions
Evaluate Pain Levels
- Assess pain characteristics
- Monitor pain frequency
- Document pain interventions
- Track medication effectiveness
- Note pain patterns
Check for Complications
- Monitor for bleeding
- Assess for infection
- Watch for respiratory issues
- Check for metastases
- Monitor for obstruction
Assess Psychological Status
- Evaluate anxiety levels
- Monitor depression signs
- Check support systems
- Document coping mechanisms
- Assess understanding of the condition
Review Treatment Response
- Monitor therapy side effects
- Track symptom changes
- Assess functional status
- Document treatment compliance
- Note the quality of life impacts
Nursing Care Plans
Nursing Care Plan 1: Impaired Swallowing
Nursing Diagnosis Statement:
Impaired Swallowing related to esophageal tumor presence as evidenced by difficulty swallowing, choking episodes, and weight loss.
Related Factors:
- Tumor obstruction
- Esophageal narrowing
- Inflammation
- Muscle weakness
Nursing Interventions and Rationales:
- Assess swallowing ability before meals
Rationale: Prevents aspiration and ensures safe feeding - Position patient upright during meals
Rationale: Facilitates safer swallowing and reduces aspiration risk - Modify food consistency as needed
Rationale: Ensures safe and adequate nutrition intake
Desired Outcomes:
- Patient will demonstrate improved swallowing ability
- Patient will maintain adequate nutrition
- Patient will avoid aspiration
Nursing Care Plan 2: Imbalanced Nutrition
Nursing Diagnosis Statement:
Imbalanced Nutrition: Less than Body Requirements related to impaired swallowing and decreased appetite as evidenced by weight loss and reduced muscle mass.
Related Factors:
- Dysphagia
- Early satiety
- Treatment side effects
- Decreased appetite
Nursing Interventions and Rationales:
- Monitor daily nutritional intake
Rationale: Ensures adequate nutrition - Provide high-calorie, nutrient-dense foods
Rationale: Maximizes nutritional intake - Collaborate with dietary services
Rationale: Ensures appropriate dietary modifications
Desired Outcomes:
- Patient will demonstrate weight stabilization
- Patient will maintain adequate nutritional intake
- Patient will show improved energy levels
Nursing Care Plan 3: Chronic Pain
Nursing Diagnosis Statement:
Chronic Pain related to tumor progression as evidenced by verbal reports of chest and back pain and altered activity levels.
Related Factors:
- Tumor growth
- Nerve compression
- Tissue inflammation
- Metastatic disease
Nursing Interventions and Rationales:
- Administer prescribed pain medications
Rationale: Provides pain relief - Implement non-pharmacological pain measures
Rationale: Enhances pain management - Monitor pain patterns and effectiveness of interventions
Rationale: Ensures optimal pain control
Desired Outcomes:
- Patient will report decreased pain levels
- Patient will demonstrate improved activity tolerance
- Patient will maintain comfort level
Nursing Care Plan 4: Anxiety
Nursing Diagnosis Statement:
Anxiety related to disease progression and treatment uncertainty as evidenced by expressed concerns and increased tension.
Related Factors:
- Disease uncertainty
- Treatment fears
- Changed life circumstances
- Financial concerns
Nursing Interventions and Rationales:
- Provide emotional support
Rationale: Reduces anxiety levels - Educate about disease process and treatment
Rationale: Increases sense of control - Facilitate coping strategies
Rationale: Helps manage stress
Desired Outcomes:
- Patient will demonstrate reduced anxiety
- Patient will utilize effective coping mechanisms
- Patient will express understanding of condition
Nursing Care Plan 5: Risk for Infection
Nursing Diagnosis Statement:
Risk for Infection related to compromised immune system and invasive procedures as evidenced by vulnerability to infection.
Related Factors:
- Immunosuppression
- Malnutrition
- Invasive procedures
- Treatment side effects
Nursing Interventions and Rationales:
- Monitor for infection signs
Rationale: Enables early intervention - Implement infection control measures
Rationale: Prevents infection - Educate about infection prevention
Rationale: Promotes self-care
Desired Outcomes:
- Patient will remain free from infection
- Patient will demonstrate infection prevention measures
- Patient will maintain optimal immune function
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Mawhinney MR, Glasgow RE. Current treatment options for the management of esophageal cancer. Cancer Manag Res. 2012;4:367-77. doi: 10.2147/CMAR.S27593. Epub 2012 Nov 2. PMID: 23152702; PMCID: PMC3496368.
- Pichel RC, Araújo A, Domingues VDS, Santos JN, Freire E, Mendes AS, Romão R, Araújo A. Best Supportive Care of the Patient with Oesophageal Cancer. Cancers (Basel). 2022 Dec 19;14(24):6268. doi: 10.3390/cancers14246268. PMID: 36551753; PMCID: PMC9776873.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
- Sihag, S., & Merritt, R. E. (2024). Contemporary Management of Esophageal and Gastric Cancer. Surgical Oncology Clinics of North America, 33(3), i. https://doi.org/10.1016/S1055-3207(24)00019-X
