Republic of the Philippines

Mindanao State University

COLLEGE OF HEALTH SCIENCES
Marawi City

NURSING CARE PLAN FOR CANCER DISEASES

A Compilation Presented To
Prof. Ulysses T. Abellana, MAN, RN
Faculty
Nursing Department
College of Health Sciences
Mindanao State University – Marawi City

In Partial Fulfillment for the Requirements

In the course NSG 125.6
Oncology Duty
1st Semester, A.Y. 2020-2021

Presented By

AL-MUJIB P. TANOG
Section C

February 4, 2021

CUES
S: “Madalas po akong walang
ganang kumain dahil parang
wala akong nalalasahan sa
mga kinakain ko” as
verbalized by the patient.
O:
 Body weight 20% or
more under ideal for
height and frame,
decreased subcutaneous
fat / muscle mass.
 Diarrhea and/or
constipation, abdominal
cramping.
VS:
T = 37.0 C
P = 100 bpm
R = 22 cpm
BP = 110/75 mmHg
O2 Sat = 98%
Patient Profile:
Name: Mr. Joseph Bacala
Sex: Male
Age: 43 years old
Race: Asian
Lifestyle: Obese with high iodine intake diet
Job: Professor
NURSING DIAGNOSIS
Altered Nutrition: Less than
body requirements r/t
consequences of
chemotherapy, radiation,
surgery (e.g. anorexia, gastric
irritation, taste distortions,
nausea) aeb reported
inadequate food intake,
altered taste sensation, loss
of interest in food and
perceived/actual inability to
ingest food.
Dx:
NURSING CARE PLAN
OBJECTIVES
Within the duration of my 8
hours shift, patient will be
able to participate in specific
interventions to stimulate
appetite / increase dietary
intake.
THYROID CANCER
INTERVENTIONS
1. Monitor daily food
intake; have patient keep
food diary as indicated.
2. Measure height, weight,
and tricep skinfold
thickness (or other
anthropometric
measurements as
appropriate). Ascertain
amount of recent weight
loss. Weigh daily or as
indicated.
3. Assess skin and mucous
membranes for pallor,
delayed wound healing,
enlarged parotid glands.
4. Encourage patient to eat
high-calorie, nutrient-rich
diet, with adequate fluid
intake. Encourage use of
supplements and
frequent or smaller
meals spaced throughout
the day.
5. Create pleasant dining
atmosphere; encourage
patient to share meals
with family and friends.
RATIONALE EVALUATION
Identifies nutritional After my 8 hours of duty,
strengths and deficiencies. client was able to participate
in specific interventions to
stimulate appetite / increase
If these measurements fall
below minimum standards, dietary intake.
patient’s chief source of
stored energy (fat tissue) is
depleted.
Helps in identification of
protein-calorie malnutrition,
especially when weight and
anthropometric
measurements are less than
normal.
Metabolic tissue needs are
increased as well as fluids (to
eliminate waste products).
Supplements can play an
important role in maintaining
adequate caloric and protein
intake.
Makes mealtime more
enjoyable, which may
enhance intake.
6. Encourage open Often a source of emotional
communication regarding distress, especially for SO
anorexia. who wants to feed patient
frequently. When patient
refuses, SO may feel rejected
or frustrated.

7. Adjust diet before and The effectiveness of diet

immediately after adjustment is very
treatment (clear, cool individualized in relief of
liquids. Light or bland post-therapy nausea.
foods, candied ginger, Patients must experiment to
dry crackers, toast, find best solution or
carbonated drinks). Give combination. Avoiding fluids
liquids 1 hour before or 1 during meals minimizes
hour after meals. becoming “full” too quickly.

8. Control environmental Can trigger nausea and

factors (strong or noxious vomiting response.
odors or noise). Avoid
overly sweet, fatty, or
spicy foods.

9. Encourage use of May prevent onset or reduce

relaxation techniques, severity of nausea, decrease
visualization, guided anorexia, and enable patient
imagery, moderate to increase oral intake.
exercise before meals.

10. Identify the patient who Psychogenic nausea and

experiences anticipatory vomiting occurring before
nausea and vomiting and chemotherapy generally does
take appropriate not respond to antiemetic
measures. drugs. Change of treatment
environment or patient
routine on treatment day
may be effective.
11. Administer antiemetic on
a regular schedule before
or during and after
administration of
antineoplastic agent as
appropriate.
12. Evaluate effectiveness of
antiemetic.
13. Hematest stools, gastric
secretions.
14. Review laboratory
studies as indicated (total
lymphocyte count, serum
transferrin, and albumin
or prealbumin).
15. Refer to dietitian or
nutritional support team.
Nausea and vomiting are
frequently the most disabling
and psychologically stressful
side effects of chemotherapy.
Individuals respond
differently to all medications.
First-line antiemetics may not
work, requiring alteration in
or use of combination drug
therapy.
Certain therapies
(antimetabolites) inhibit
renewal of epithelial cells
lining the GI tract, which may
cause changes ranging from
mild erythema to severe
ulceration with bleeding.
Helps identify the degree of
biochemical imbalance,
malnutrition and influences
choice of dietary
interventions. Note:
Anticancer treatments can
also alter nutrition studies, so
all results must be correlated
with the patient’s clinical
status.
Provides for specific dietary
plan to meet individual needs
and reduce problems
associated with protein,
 calorie malnutrition and
micronutrient deficiencies.

16. Insert and maintain NG In the presence of severe

or feeding tube for malnutrition (loss of 25%-
enteric feedings, or 30% body weight in 2 mos.)
central line for total or if patient has been NPO
parenteral nutrition for 5 days and is unlikely to
(TPN) if indicated. be able to eat for another
week, tube feeding or TPN
may be necessary to meet
nutritional needs.
 NURSING CARE PLAN

CUES NURSING DIAGNOSIS OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

S: “Natatakot po ako na baka Risk for infection Within the duration of my 8 1. Promote good Protects patient from sources After my 8 hours of duty,
po lumala ang kalagayan ko hours shift, patient will be handwashing procedures of infection, such as visitors patient was able to remain
dahil sa impeksyon” as able to remain afebrile and by staff and visitors. and staff who may have an afebrile and achieve timely
achieve timely healing as Screen and limit visitors upper respiratory infection healing as appropriate and be
verbalized by the patient.
appropriate and be able to who may have infections. (URI). able to identify and
O: identify and participate in Place in reverse isolation participate in interventions
interventions to prevent / as indicated. to prevent / reduce risk of
 Inadequate secondary
reduce risk of infection. infection.
defenses and 2. Emphasize personal Limits potential sources of
immunosuppression (e.g. hygiene. infection and secondary
bone marrow overgrowth.
suppression or dose-
limiting side effect of 3. Monitor temperature. Temperature elevation may
occur (if not masked by
both chemotherapy and
corticosteroids or anti-
radiation).
inflammatory drugs) because
 Fever of various factors
(chemotherapy side effects,
disease process, or infection).
Early identification of
VS:
infectious process enables
T = 38.5 C appropriate therapy to be
P = 100 bpm started promptly.
R = 22 bpm
BP = 110/75 mmHg 4. Assess all systems (skin, Early recognition and
O2 Sat = 98% respiratory, intervention may prevent
genitourinary) for signs progression to more serious
and symptoms of situation or sepsis.
Patient Profile: Dx: LUNG CANCER infection on a continual
Name: Mr. Arnold Villanosa basis.
Sex: Male 5. Reposition frequently; Reduces pressure and
Age: 52 keep linens dry and irritation to tissues and may
Race: Asian wrinkle-free. prevent skin breakdown
Lifestyle: Smoker, Alcohol drinker (potential site for bacterial
Job: Barangay Captain growth).
6. Promote adequate rest
and exercise periods.
Limits fatigue, yet encourages
sufficient movement to
prevent stasis complications
(pneumonia, decubitus, and
thrombus formation).

7. Stress importance of Development of stomatitis

good oral hygiene. increases risk of infection and
secondary overgrowth.

8. Avoid or limit invasive Reduces risk of

procedures. Adhere to contamination, limits portal
aseptic techniques. of entry for infectious agents.

9. Monitor CBC with Bone marrow activity may be

differential WBC and inhibited by effects of
granulocyte count, and chemotherapy, the disease
platelets as indicated. state, or radiation therapy.
Monitoring status of
myelosuppression is
important for preventing
further complications
(infection, anemia, or
hemorrhage) and scheduling
drug delivery.

10. Obtain cultures as Identifies causative

indicated. organism(s) and appropriate
therapy.

11. Administer antibiotics as May be used to treat

indicated. identified infection or given
prophylactically in immune-
compromised patient.

CUES
S: “Di po mawala sa akin ang
takot po sa kung ano po ang
mangyayari sa akin” as
verbalized by the patient.
O:
 Increased tension,
shakiness, apprehension,
restlessness, insomnia.
 Feelings of helplessness,
hopelessness,
inadequacy.
VS:
T = 37.0 C
P = 100 bpm
R = 22 bpm
BP = 110/75 mmHg
O2 Sat = 98%
Patient Profile:
Name: Mrs. Maria De Jesus
Sex: Female
Age: 54 years old
Race: Asian
Lifestyle: Smoker, alcohol drinker, not physically active, not breastfeeding
Job: Government Employee
NURSING DIAGNOSIS
Fear and anxiety r/t
situational crisis aeb
expressed concerns
regarding changes in life
events.
Dx:
NURSING CARE PLAN
OBJECTIVES
Within the duration of my 8
hours shift, patient will be
able to demonstrate
appropriate range of feelings,
lessened fear, appear relaxed
and report anxiety is reduced
to a manageable level.
BREAST CANCER
INTERVENTIONS RATIONALE EVALUATION
1. Review patient’s and SO’s Clarifies patient’s After my 8 hours of duty,
previous experience with perceptions; assists in patient was able to
cancer. Determine what identification of fear(s) and demonstrate appropriate
the doctor has told misconceptions based on range of feelings, lessened
patient and what diagnosis and experience fear, appear relaxed and
conclusion patient has with cancer. report anxiety is reduced to a
reached. manageable level.
2. Encourage patient to Provides opportunity to
share thoughts and examine realistic fears and
feelings. misconceptions about
diagnosis.
3. Provide open Helps patient feel accepted in
environment in which present condition without
patient feels safe to feeling judged, and promotes
discuss feelings or to sense of dignity and control.
refrain from talking.
4. Maintain frequent Provides assurance that
contact with patient. Talk patient is not alone or
with and touch patient as rejected; conveys respect for
appropriate. and acceptance of the
person, fostering trust.
5. Be aware of effects of Sensory deprivation may
isolation on patient when result when sufficient
required by stimulation is not available
immunosuppression or and may intensify feelings of
radiation implant. Limit anxiety, fear, and alienation.
use of isolation clothing
and masks as possible.
6. Assist patient and SO in Coping skills are often
recognizing and clarifying stressed after diagnosis and
 fears to begin developing during different phase of
coping strategies for treatment. Support and
dealing with these fears. counseling are often
necessary to enable
individual to recognize and
deal with fear and to realize
that control and coping
strategies are available.

7. Provide accurate, Can reduce anxiety and

consistent information enable patient to make
regarding diagnosis and decisions and choices based
prognosis. Avoid arguing on realities.
about patient’s
perceptions of situation.

8. Permit expressions of Acceptance of feelings allows

anger, fear, despair patient to begin to deal with
without confrontation. situation.
Give information that
feelings are normal and
are to be appropriately
expressed.

9. Explain the The goal of cancer treatment

recommended is to destroy malignant cells
treatment, its purpose, while minimizing damage to
and potential side normal ones. Treatment may
effects. Help patient include surgery (curative,
prepare for treatments. preventive, palliative), as well
as chemotherapy, radiation
(internal, external), or organ-
specific treatments such as
whole-body hyperthermia or
biotherapy. Bone marrow or
peripheral progenitor cell
(stem cell) transplant may be
recommended for some
types of cancer.
10. Explain procedures,
providing opportunity for
questions and honest
answers. Stay with
patient during anxiety-
producing procedures
and consultations.
11. Provide primary and
consistent caregivers
whenever possible.
12. Promote calm, quiet
environment.
13. Identify stage and degree
of grief patient and SO
are currently
experiencing.
14. Note ineffective coping
(poor social interactions,
helplessness, giving up
everyday functions and
usual sources of
gratification).
15. Be alert to signs of denial
and depression
(withdrawal, anger,
inappropriate remarks).
Determine presence of
suicidal ideation and
assess potential on a
scale of 1-10.
Accurate information allows
patient to deal more
effectively with reality of
situation, thereby reducing
anxiety and fear of the
unknown.
May help reduce anxiety by
fostering therapeutic
relationship and facilitating
continuity of care.
Facilitates rest, conserves
energy, and may enhance
coping abilities.
Choice of interventions is
dictated by stage of grief,
coping behaviors (anger,
withdrawal, denial).
Identifies individual problems
and provides support for
patient and SO in using
effective coping skills.
Patient may use defense
mechanism of denial and
express hope that diagnosis is
inaccurate. Feelings of guilt,
spiritual distress, physical
symptoms, or lack of cure
may cause patient to become
withdrawn and believe that
suicide is a viable alternative.
16. Encourage and foster Reduces feelings of isolation.
patient interaction with If family support systems are
support systems. not available, outside sources
may be needed immediately,
(local cancer support groups).

17. Provide reliable and Allows for better

consistent information interpersonal interaction and
and support for SO. reduction of anxiety and fear.

18. Include SO as indicated Provides a support system for

or patient desires when patient and allows SO to be
major decisions are to be involved appropriately.
made.