Nueva Ecija University of Science and Technology: O V A A

Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY

Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
OFFICE OF THE VICE-PRESIDENT FOR ACADEMIC AFFAIRS

ABLAZA, FRANCES ANNE B.
BSN 3B
UNIT III. PRE TEST
TRUE OR FALSE
Direction: Write TRUE is the statement is correct and FALSE if the statement is incorrect.
___TRUE_______1. Nursing care plans for cancer involves assessment, support for therapies (e.g., chemotherapy, radiation, etc.), pain control, promoting nutrition, and emotional
support.
____TRUE______2. Acute pain is an unpleasant sensory and emotional experience arising from actual or potential tissue damage.
___TRUE_______3. Imbalanced Nutrition: Less than body requirements: Intake of nutrients sufficient to meet metabolic needs.
___TRUE_______4. Cancer is a general term used to describe a disturbance of cellular growth and refers to a group of diseases and not a single disease entity.
___FALSE______5. Fatigue is an overwhelming, sustained sense of exhaustion and decreased capacity for physical and mental work at critical level.
CRITICAL THINKING ACTIVITIES

Direction: answer the following learning activities regarding what you have learned and submit to your instructor.
Your answers will be graded with the use of provided rubric by your instructor.
1. Choose five (5) among the thirteen (13) cancer nursing care plans and conceptualize your own nursing care plan to a cancer patient who needs your support and nursing care.
Make an in-depth nursing care plan along with its corresponding problems.
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1. ANTICIPATORY GRIEVING
ASSESSMENT NURSING OUTCOME PLANNING NURSING RATIONALE EVALUATION
DIAGNOSIS IDENTIFICATION INTERVENTION
Subjective: Anticipatory grieving After the nursing Short term: Independent: 1. Knowledge about GOAL WAS MET
“Mamamatay na po ba related to perceived interventions the After 8 hours of 1. Assess patient and the grieving process
ako” as verbalized by potential death of patient will be able to nursing interventions significant for stage of reinforces the
the client. patient. express his grief and the patient will be able grief currently being normality of feelings
Objective: participate in decision to: experienced. Explain and reactions being
 Mood is dysphoric making for the future.  Discuss and process as appropriate. experienced and can
and tearful at times express feelings. 2. Provide open, non help patient deal more
 Pre orbital  Demonstrate judgemental effectively with them.
puffiness adaptive grieving environment, Use 2. Patient may feel
 Apathetic behavior behaviors. therapeutic supported in expression
 Fatigue Long term: communication skills of feelings by the
 Restlessness After 3 days of nursing of active listening, understanding that
 Anorexia interventions, the acknowledgement, and deep and often
 Pale conjunctiva patient will be able to: so on. conflicting emotions
Vital signs:  Participate in self- 3. Visit frequently and are normal and
Temp: 37.5C care activities. provide physical experienced by others
PR: 80 bpm  Sleep adequately contact as appropriate, in this difficult
RR: 18 cpm  Look towards and or provide frequent situation.
BP:130/80 mmHg plan for the future. phone support as 3. Helps reduce the
appropriate for setting. feelings of isolation
Arrange for care and abandonment.
provider and support 4. Patient and
person to stay with significant other
patient as needed. benefit from factual
4. Reinforce teaching information.
regarding disease Individuals may ask

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process and treatments direct questions about
and provide death, and honest
information as answers promote trust
appropriate about and provide
dying. Be honest; do reassurance that correct
not give false hope information will be
while providing given.
emotional support. 5. Having a part in
5. Discuss ways patient problem solving and
and significant other planning can provide a
can plan together for sense of control over
the future. Encourage anticipated events.
setting of realistic
goals,
2. ACUTE PAIN
Subjective: Acute pain related to After the nursing Short term: Independent: 1. A wide range of GOAL WAS MET
“Sumasakit lagi yung side effects of various interventions the After 3 hours of 1. Evaluate and be discomforts are
kaliwang dibdib ko” as cancer therapy agents patient will be able to nursing interventions aware of painful effects common (incisional

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verbalized by the report maximal pain the patient will be able of particular pain, burning skin, low
client. relief. to: therapies (surgery, back pain, headaches),
Pain scale: 8/10  Demonstrate use radiation, depending on the
Objective: of relaxation chemotherapy, procedure and agent
 Facial grimace techniques and biotherapy). Provide being used. Pain is also
 Appeared weak diversional information to patient associated with
 Restlessness activities and SO about what to invasive procedures to
Vital signs: Long term: expect. diagnose or treat
Temp: 37.5C After 24 hours of 2. Provide cancer.
PR: 80 bpm nursing interventions, nonpharmacological 2. Promotes relaxation
RR: 18 cpm the patient will be able comfort measures and helps refocus
BP:130/90 mmHg to: (massage, attention.
 Report pain is repositioning, backrub) 3. Enables patient to
relieved with a and diversional participate actively in
pain scale of 8/10 activities (music, nondrug treatment of
to 3/10 television) pain and enhances
3. Encourage use of sense of control. Pain
stress management produces stress and, in
skills or conjunction with
complementary muscle tension and
therapies (relaxation internal stressors,
techniques, increases patient’s
visualization, guided focus on self, which in
imagery, biofeedback, turn increases the level
laughter, music, of pain.
aromatherapy, and 4. May decrease
therapeutic touch). inflammation, muscle
4. Provide cutaneous spasms, reducing
stimulation (heat or associated pain. Note:
cold, massage). Heat may increase

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5. Discuss use of bleeding and edema
additional alternative following acute injury,
or complementary whereas cold may
therapies (acupuncture further reduce
and acupressure). perfusion to ischemic
tissues.
Dependent: 5. May provide
1. Administer reduction or relief of
analgesics as indicated pain without drug-
related side effects.
1. To relieve the pain.
3. FATIGUE

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Subjective: Fatigue related to After the nursing Short term: Independent: 1. Frequent rest periods GOAL WAS MET
“Nanghihina ako at decreased metabolic interventions the After 2 hours of 1. Plan care to allow and naps are needed to
nanginginig ang mga energy production as patient will be able to nursing interventions for rest periods. restore and conserve
kamay ko” as evidenced by lack of perform ADLs and the patient will be able Schedule activities for energy. Planning will
verbalized by the energy participate in desired to identify measures to periods when patient allow patient to be
client. activities at level of improve sense of has most energy. active during times
ability energy. Involve patient and SO when energy level is
Objective: Long term: in schedule planning. higher, which may
 Lack of energy After 24 hours of 2. Assist with self-care restore a feeling of
 Drowsiness nursing interventions, needs when indicated; well-being and a sense
 Restlessness the patient will be able keep bed in low of control.
 Weakness to regain strength and position, pathways 2. Assist with self-care
 Decreased activity will be able to clear of furniture; assist needs when indicated;
performance participate in simple with ambulation. keep bed in low
Vital signs: ADLs. 3. Encourage patient to position, pathways
Temp: 37.5C do whatever clear of furniture; assist
PR: 80 bpm possible (self-bathing, with ambulation.
RR: 18 cpm sitting up in chair, 3. Enhances strength
BP:130/90 mmHg walking). Increase and stamina and
activity level as enables patient to
individual is able. become more active
4. Monitor without undue fatigue.
physiological response 4. Tolerance varies
to activity (changes in greatly depending on
BP, heart and the stage of the disease
respiratory rate). process, nutrition state,
fluid balance, and
Dependent: reaction to therapeutic
1. Provide regimen.
supplemental oxygen

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as indicated. 1. Presence of anemia
and hypoxemia reduces
O2available for cellular
uptake and contributes
to fatigue.
4. RISK FOR FLUID VOLUME DEFICIT


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Subjective: Fluid volume deficit After the nursing After 8 hours of Independent: 1. Continued negative GOAL WAS MET
“Madalas akong related to active fluid interventions the nursing interventions, 1. Monitor I&O and fluid balance,
nadudumi at volume loss patient was able the patient will be able specific gravity; decreasing renal output
nanghihina ako” maintain normal bowel to: include all output and concentration of
Passed loose watery function and fluid  Verbalize sources, (emesis, urine suggest
stool 3-4 times a day balance. reduction in diarrhea, draining developing dehydration
frequency of wounds. Calculate 24- and need for increased
Objective: stools. hr balance). fluid replacement.
 Dry lips 2. Monitor vital signs. 2. Reflects adequacy of
 Poor skin turgor After 3 days of nursing Evaluate peripheral circulating volume.
 Restlessness interventions, the pulses, capillary refill. 3. Assists in
Vital Signs: patient will be able to: 3. Encourage increased maintenance of fluid
Temp: 36C  Maintain normal fluid intake to 3000 mL requirements and
PR: 87 bpm bowel functioning. per day as individually reduces risk of harmful
RR: 20cpm  Maintain fluid appropriate or side effects such as
BP: 110/70 mmHg balance. tolerated. hemorrhagic cystitis in
Dependent: patient receiving
1. Provide IV fluids as cyclophosphamide
indicated. (Cytoxan).
1. Given for general
hydration and to dilute
antineoplastic drugs
and reduce adverse
side effects (nausea
and vomiting, or
nephrotoxicity).

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5. RISK FOR INFECTION

Subjective: Risk for infection After the nursing After 8 hours of Independent: 1. Temperature elevation GOAL WAS MET
“Masakit yung tahi ko related to invasive interventions the nursing interventions, 1. Monitor may occur (if not masked
tapos parang nilalagnat procedure. patient will be able to the patient will be able temperature. by corticosteroids or anti-
ako” as verbalized by remain afebrile and to: 2. Reposition inflammatory drugs)
the client achieve timely healing  Maintain frequently; keep linens because of various factors
Objective: as appropriate. temperature within dry and wrinkle-free. (chemotherapy side
 Weak in normal range 3. Promote adequate effects, disease process, or
appearance rest and exercise infection). Early
 Fatigue After 3 days of nursing periods. identification of infectious
Vital Signs: interventions, the 4. Avoid or limit process enables
Temp: 38C patient will be able to: invasive procedures. appropriate therapy to be
PR: 87 bpm  Identify and Adhere to aseptic started promptly.
RR: 20cpm verbalize techniques. 2. Reduces pressure and
BP: 110/70 mmHg interventions that Depedent: irritation to tissues and
will reduce the risk 1. Monitor CBC with may prevent skin
for infection differential WBC and breakdown (potential site
granulocyte count, and for bacterial growth).
platelets as indicated. 3. Limits fatigue, yet
2. Administer encourages sufficient
antibiotics as indicated. movement to prevent stasis
complications (pneumonia,
decubitus, and thrombus
formation).
4. Reduces risk of

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contamination, limits
portal of entry for
infectious agents.
1. Bone marrow activity
may be inhibited by effects
of chemotherapy, the
disease state, or radiation
therapy. Monitoring status
of myelosuppression is
important for preventing
further complications
(infection, anemia, or
hemorrhage) and
scheduling drug delivery.
2. May be used to treat
identified infection or
given prophylactically in
immuno- compromised
patient.
UNIT IV. PRE TEST

TRUE OR FALSE
Direction: Write TRUE if the statement is correct and FALSE if the statement is incorrect. Write your answer below before the number of each item.
__TRUE________1. Diagnostic surgery is the definitive method of identifying the cellular characteristics that influence all treatment decisions. Surgery may be the primary

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method of of treatment, or it may be prophylactic, palliative or reconstructive.
__TRUE________2. Prophylactic surgery involves removing non-vital tissues or organs that are likely to develop cancer.
__TRUE________3. Treatment options offered to cancer patients should be based on realistic and achievable goals for each specific type of cancer.
__TRUE________4. Diagnostic surgery, such as biopsy, is usually performed to obtain a tissue sample for analysis of cells suspected to be malignant. In most instances, the
biopsy is taken from the actual tumor.
__TRUE________5. When cure is not possible, the goals of treatment are to make the patient as comfortable as possible and to promote a satisfying and productive life for as long
as possible.

Directions: Answer the following learning activities by providing your reflections regarding what you have learned and submit to your instructor.
Your answers will be graded with the use of the provided rubric by your instructor.

www.neust.edu.ph

1. As part of the health care team, what you must have to be able to completely eradicate malignant disease (cure), prolonged survival and containment of cancer cell
growth (control), or relief of symptoms associated with the disease (palliation) along with the patient, and the patients family?
- As a part of the healthcare team we must educate the patient and the patient’s family to have a clear understanding about the treatment options and goals. Open
communication and support are vital as the patient and family periodically reassess treatment plans and goals when complications of therapy develop or disease progresses.
Multiple modalities are commonly used in cancer treatment. A variety of therapies, including surgery, radiation therapy, chemotherapy, and biologic response modifier (BRM)
therapy, may be used at various times throughout the treatment.
2. Why do you think surgery is the primary approach in treating cancer?
- Surgery has become the primary approach in treating cancer because its goal is to remove the entire tumor or as much as is feasible (a procedure sometimes called debulking)
and any involved surrounding tissue, including the regional lymph nodes. Surgery is used to prevent, diagnose, stage and treat the cancer.
3. Why do you think prophylactic surgery is considered in treating cancer?
-Prophylactic surgery is considered when treating cancer because it is one of the preventive measures used to minimize or to prevent the risk of developing cancer in an organ
or gland that has yet to develop cancer and is known to be at high risk of developing cancer.
4. When cure is not possible for a certain cancer patient whether the period is extremely brief or lengthy, as a nurse and as a healthcare provider how you will provide
high quality of life among cancer patients?
-When cure is not possible, the goal of the treatment is to make the patient as comfortable as possible and to promote a satisfying and productive life for the patient as long as
possible. Whether the period extremely brief or lengthy, the major goal is a high quality of life- with quality defined by the patients and family. Honest and informative
communication with the patient and family about the goal of surgery is essential to avoid false hope and disappointment. Palliative surgery is performed in an attempt to relieve
complications of cancer.
5. As a nurse how you could recognize the impact and importance of reconstructive surgery in considering its importance to the patient’s altered body image that may
have effect on patient’s quality of life?
- As a nurse we have to recognize the patients needs and the impact that altered functioning and altered body image. By providing the patient and the family with opportunities
to discuss the issues, as a nurse we must have an open communication to the patient and family for them to be accurately assessed and diagnosed and also to provide proper
interventions for the patient.

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UNIT V. PRE TEST

TRUE OR FALSE
Direction: Write TRUE if the statement is correct and FALSE if the statement is incorrect.
__TRUE________1.Radiation may be used to cure the cancer, as in Hodgdkin’s disease, testicular seminomas, thyroid carcinomas, localized cancer of the head and neck, and

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cancers of the uterine cervix. Radiation therapy may also be used to control malignant disease when a tumor cannot be removed surgically or when local nodal metastasis is
present, or it can be used prophylactically to prevent leukemic infiltration to the brain or spinal cord.
__FALSE_______2. Toxicity or radiation therapy is localized to the region being irradiated. Toxicity may be decreased when concomitant chemotherapy is administered.
__TRUE________3. The patient undergoing surgery for cancer requires general perioperative nursing care, along with specific care related to the patient’s age, organ impairment,
nutritional deficits, and disorders of coagulation, and altered immunity that may increase the risk for postoperative complications.
__TRUE________4. Certain systemic side effects are also commonly experienced by patients receiving radiation therapy. These manifestations, which are generalized, include
fatigue, malaise, and anorexia.
__TRUE________5. Chemotherapy may be combined with surgery or radiation therapy, or both, to reduce tumor size preoperatively, to destroy any remaining tumor cells
postoperatively, or to treat some forms of leukemia.

Direction: Answer the following learning activities by providing your reflections regarding what you have learned and submit to your instructor.
Your answers will be graded with the use of the provided rubric by your instructor.
1. Discuss your understanding regarding radiation therapy and its importance.

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- Radiation therapy is used in cancer patients to interrupt the cellular growth, and it can also be used to cure cancer and control malignant disease when a tumor cannot be
removed surgically. Radiation therapy is a type of cancer treatment that uses high doses of radiation to kill cancer cells and shrink the tumors.
2. The patient receiving radiation therapy and the family often have questions and concerns about its safety. As a nurse how will you discuss radiation therapy to the
patient and and family along with your nursing management?
-As a nurse we have to explain the procedure for delivering radiation and describe the equipment, duration of the procedure, the possible need for immobilizing the patient
during the procedure, and the absence of new sensations including pain during the procedure. Explaining the procedures to patient and the family reduces fear and anxiety.
3. When a patient has a radioactive implant in place, nurses and other health care providers need to protect themselves as well as the patient from the effects of
radiation. How will you protect yourself from the effects of radiation?
- Specific instructions are usually provided by the radiation safety officer from the x-ray department. The instructions identify the maximum time that can be spent safely in
the patients room, the shielding equipment to be used, and special precautions and actions if the implant is dislodged.The nurse should explain the rationale for these precautions to
keep the patient from feeling unduly isolated.
4. Discuss your understanding regarding the use of chemotherapy as an attempt to destroy tumor cells.
- When I hear the word cancer chemotherapy is the first word that comes in my mind, it is the most common and known type of procedure to prevent cancer. Chemotherapy is
done to destroy tumor cells by interfering with cellular functions and reproduction.
5. Discuss how to administer chemotherapeutic agents.
- Chemotherapeutic agents may be administered in the hospital, clinic, or home setting by topical, oral, intravenous, intramuscular, subcutaneous, arterial, intracavitary, and
intrathecal routes. The administration route usually depends on the type of agent, the required dose and the type of location, and extend tumor being treated.
6. Discuss the different toxicity associated with chemotherapy.
- Toxicity associated with chemotherapy can be acute or chronic. Cells with rapid growth rates are very susceptible to damage and various body systems may be affected as
well.
 Gastrointestinal system- the most common side effects of chemotherapy are nausea and vomiting, delayed nausea and vomiting 48-72 hours before chemotherapy are
troublesome, if this happens the entire gastrointestinal tract is susceptible to mucositis and diarrhea. The common cause of it are the antimetabolites and antitumor antibiotics.

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 Renal system- Chemotherapeutic agents such as Cisplatin, methotrexate and mitomycin are particularly oxic to the kidneys and can cause renal damage.
 Cardiopulmonary system- antitumor antibiotics specifically the daunorubicin and doxirubicin can cause cardiac toxicities such as congestive heart failure.
 Neurologic system- the taxanes and plant alakloids, especially vincristine can cause neurologic damage with repeated doses. Peripheral neuropathies, loss of deep tendon
reflexes, and paralytic ileus may occur.
7. Discuss the sources of cancer pain and how you could assist as a nurse in alleviating the pain felt by your patients?
- The sources of cancer pain can be through bone metastasis, Nerve compression, inflitration; lymphatic venous obstruction, ischemia, organ obstruction, organ infiltration,
skin inflammation, ulceration, infection and necrosis. As a nurse we have to provide support and education for the client, providing adequate rest and sleep, diversional activities,
mood elevation, empathy, and giving medications such as antidepressants, antianxiety agents, and analgesics enhances tolerance to pain.
8. Despite advances in cancer care, infection remains the leading cause of death. As a nurse how you will fight this challenge to keep your patient safe and free from
infection?
- We have to provide strict asepsis especially when it comes to handling intravenous lines, catheters, and other invasive equipment. Limit the exposure of the patient and
provide a protective environment. Patient who suffer from infection may be administered antibiotics to treat the infection, also the patient is encouraged to cough and perform deep
breathing exercises frequently to avoid atelectasis. And lastly is to educate the patient and the family to recognize the signs and symptoms of infection and to report immediately,
perform effective hand hygiene, and to maintain skin integrity.
9. As a nurse and a healthcare provider, discuss how you will provide cancer rehabilitation?
- As a nurse, we play an important role in the rehabilitation of the cancer patient, so we must participate in efforts to educate in the efforts to educate and inform everyone to
ensure that the right of the patients with cancer are maintained. The nurses assist the patients and families to resume pre existing roles. Psychologists and clergy or spiritual
advisors are consulted to assist with psychosocial and spiritual concerns. The nurses encourage patients to regain the highest level of functioning and independence possible.

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Republic of the Philippines

NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY

OFFICE OF THE VICE-PRESIDENT FOR ACADEMIC AFFAIRS

CRITICAL THINKING ACTIVITIES

Transforming Communities through Science and Technology

OFFICE OF THE VICE-PRESIDENT FOR ACADEMIC AFFAIRS

Transforming Communities through Science and Technology

OFFICE OF THE VICE-PRESIDENT FOR ACADEMIC AFFAIRS

Transforming Communities through Science and Technology

OFFICE OF THE VICE-PRESIDENT FOR ACADEMIC AFFAIRS

Transforming Communities through Science and Technology

OFFICE OF THE VICE-PRESIDENT FOR ACADEMIC AFFAIRS

1. To relieve the pain.

Transforming Communities through Science and Technology

OFFICE OF THE VICE-PRESIDENT FOR ACADEMIC AFFAIRS

Transforming Communities through Science and Technology

OFFICE OF THE VICE-PRESIDENT FOR ACADEMIC AFFAIRS

4. RISK FOR FLUID VOLUME DEFICIT

Transforming Communities through Science and Technology

OFFICE OF THE VICE-PRESIDENT FOR ACADEMIC AFFAIRS

Transforming Communities through Science and Technology

OFFICE OF THE VICE-PRESIDENT FOR ACADEMIC AFFAIRS

5. RISK FOR INFECTION

Transforming Communities through Science and Technology

OFFICE OF THE VICE-PRESIDENT FOR ACADEMIC AFFAIRS

UNIT IV. PRE TEST

Transforming Communities through Science and Technology

OFFICE OF THE VICE-PRESIDENT FOR ACADEMIC AFFAIRS

CRITICAL THINKING ACTIVITIES

Transforming Communities through Science and Technology

OFFICE OF THE VICE-PRESIDENT FOR ACADEMIC AFFAIRS

Transforming Communities through Science and Technology

OFFICE OF THE VICE-PRESIDENT FOR ACADEMIC AFFAIRS

UNIT V. PRE TEST

Transforming Communities through Science and Technology

OFFICE OF THE VICE-PRESIDENT FOR ACADEMIC AFFAIRS

CRITICAL THINKING ACTIVITIES

Transforming Communities through Science and Technology

OFFICE OF THE VICE-PRESIDENT FOR ACADEMIC AFFAIRS

Transforming Communities through Science and Technology

OFFICE OF THE VICE-PRESIDENT FOR ACADEMIC AFFAIRS

Transforming Communities through Science and Technology

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