PSYCHOPHYSIOLOGIC EFFECTS OF CANCER:

A. DISRUPTION OF FUNCTIONS:
= Cancer destroy normal tissues, decreasing function in that tissue or organs, they can
cause death by metastasizing into vital organs and disrupting critical physiologic
processes.
= Cancers that are left untreated can cause the following such as:

1. Impaired Immune and Hematopoietic Function

= occurs most often in clients with leukemia and lymphoma.
= can occur also with any cancer that invades the bone marrow  reduce the production of
healthy WBC  increased risk for infection  decrease number of RBC  Anemia 
decrease number of platelets  Thrombocytopenia  risk for excessive bleeding.

2. Altered Gastrointestinal Structure and Function

= Cancer can also alter GI function  impairs nutrition.
= Many tumors spread to the liver profoundly damaging this organ which has many important
functions in metabolism.
 Reduced liver function  leads to malnutrition and death.
= Changes in taste can result from cancer or the treatment  reduce appetite  anorexia and
cachexia.

3. Motor and Sensory Deficits

= Occurs when cancers invade bone or brain, or compress nerves.
= Bone sites  vertebrae, ribs, pelvis, and femur.
= Other common sites  humerus, scapula, sternum, skull and clavicle.
= Sensory changes occur if the spinal cord is damaged by tumor pressure or if the nerves are
compressed.
= Client with cancer may also have pain. It does not always accompany cancer but it can be
a significant problem for clients with terminal cancer.

4. Decreased Respiratory Function

= Cancer can disrupt gas exchange  death.
= Tumors also press on blood and lymph vessels in the chest  pulmonary edema and
dyspnea.
= Tumors also can thicken the alveolar membrane  damage pulmonary blood vessels 
reducing gas exchange.

B. HEMATOLOGIC ALTERATIONS
= When cancer invades the bone marrow  it will decrease the number of RBC  Anemia
and decreased number of platelets  Thrombocytopenia increase bleeding
tendencies.

C. INFECTION
= WBC serves as the body’s primary defense against invading organisms by engulfing and
destroying infective organisms by phagocytosis.
= WBC function is often impaired in patients with cancer.
= Infection remains a major cause of morbidity and mortality in patients with cancer.
= The typical signs of infection (swelling, redness, drainage and pain) may not occur in
immunosuppressed patients because of decreased circulating WBC (leukopenia) and a
diminished local inflammatory response.
 Fever may be the only sign of infection.
= Treatment: Broad-spectrum antibiotics

D. HEMORRHAGE
= Platelets are essential for normal blood clotting and coagulation (hemostasis).
= Thrombocytopenia – a decrease in circulating platelet count is the most common cause of
bleeding in patients with cancer.
= Platelet count decrease between 20,000/mm-50,000/mm  increases the risk of bleeding.
= Platelet transfusion – platelet counts lower than 20,000mm  risk for spontaneous
bleeding.
E. ANOREXIA-CACHEXIA SYNDROME
= Alterations in taste is one of the many causes of anorexia in patients with cancer 
manifested by increased salty, sour and metallic taste sensations and altered responses to
sweet and bitter flavors.
= Taste alterations  results from mineral (ex. Zinc) deficiencies, increase in circulating
amino acids and cellular metabolites or the administration of chemotherapeutic agents.
= Anorexia may occur because people feel full after eating only a small amount of food 
secondary to a decrease in digestive enzymes, abnormalities in the metabolism of glucose
and triglycerides and prolonged stimulation of gastric volume receptors  conveys the
feeling of being full.

Cachexia – is common in patients with cancer, especially in advanced disease.

= Cancer cachexia is related to inadequate nutritional intake, along with increasing metabolic
demand, increased energy expenditure due to anaerobic metabolism of the tumor,
impaired glucose metabolism, competition of tumor cells for nutrients, altered lipid
metabolism and a suppressed appetite.
= Cachexia is characterized by loss of body weight, adipose tissue, visceral protein and
skeletal muscles.
= Patients with cachexia complains of loss of appetite, early satiety and fatigue.
= As a result of protein loss  anemia and peripheral edema.
= Creative dietary therapies: Enteral (tube) feeding or parenteral nutrition.

PARANEOPLASTIC SYNDROME:
= Cancer is a chronic disease. However, a number of acute conditions is associated with
cancer and its treatment can occur.

1. SEPSIS AND DISSEMINATED INTRAVASCULAR COAGULATION (DIC)

 Sepsis or Septicemia – is a condition in which organisms enters the bloodstream.

= Septic shock – is a life-threatening result of sepsis and a common cause of deaths in
clients with cancer.
= Clients with cancer are at risk for infection and sepsis.
= Disseminated Intravascular Coagulation (DIC) – is a problem with the blood-clotting
process. It is triggered by many severe illnesses including cancer.
= DIC is a caused by sepsis. Often seen in leukemia and in adenocarcinomas of the lung,
pancreas, stomach and prostate.
= Bleeding from many sites is the most common problem and ranges from minimal to fatal
hemorrhage.
= Clots block the blood vessel and decrease blood flow to major organs  pain, stroke like
manifestations, dyspnea, tachycardia, oliguria and bowel necrosis.

Management:

= Focus of treatment: Reduce the infection and halting the DIC process.
= IV antibiotic therapy; Anticoagulants (Heparin); Cryoprecipitated clotting factors are given.

2. SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE (SIADH)

= Antidiuretic Hormone (ADH) is secreted by the posterior pituitary gland only when more fluid
is needed in the body.
= Cancer is the most common cause of the syndrome of inappropriate antidiuretic hormone
(SIADH).
= Carcinoma of the lung – the cancer commonly causing SIADH; but SIADH may occur in
other types of cancer especially when tumor is present in the brain.
= Drugs often used in clients with cancer also can cause SIADH (ex. Morphine Sulfate,
Cyclophosphamide).
= In SIADH, water is reabsorbed to excess by the kidney and put into systemic circulation 
water increases  hyponatremia and fluid retention.
= Mild manifestations  weakness, muscle cramps, loss of appetite and fatigue.
= Serum sodium levels range from 115-120 mEq/L (normal range = 135-145 mEq/L)
 = More serious problems when more water is retained  weight gain, nervous system
changes, personality changes, confusion and extreme muscle weakness.
= As the sodium levels drops toward 110 mEq/L  seizures  coma  Death may follow.

Management:

 Fluid restriction (1L/day); increased sodium intake

 Drug therapy – Demeclocycline given orally
 Second method  reduce or eliminate the underlying cause.
 Immediate cancer therapy: either radiation or chemotherapy

3. SPINAL CORD COMPRESSION

= Spinal cord compression and damage occur either when the tumor directly enters the spinal
cord or when the vertebrae collapse from tumor degradation of the bone.
= Often causes back pain before neurologic deficits occur.
= Neurologic problems  numbness or tingling, loss of urethral, vaginal and rectal sensation
and muscle weakness.
= If paralysis occur  usually permanent.

Management:

 Treatment is often palliative.

= High-dose corticosteroids
= High-dose radiation
= Radiation along with chemotherapy
= Surgery
= External back or neck braces may be used.

4. HYPERCALCEMIA

= Occurs most often in clients with bone metastasis.

= Cancer in bones causes bone to release calcium into the bloodstream.
= Decreased mobility and dehydration  worsen hypercalcemia.
= Early manifestations  fatigue, loss of appetite, nausea, vomiting, constipation and
polyurea.
= More serious problems  severe muscle weakness, loss of deep tendon reflexes,
paralytic ileus, dehydration and ECG changes.
= The severity of manifestations depends on how high the serum calcium level is and how
quickly it develops.

Management:

 Cancer-induced hypercalcemia develops slowly which allows the body time to adapt to
this electrolyte change.
= Oral hydration
> Normal Saline is used when parenteral hydration is needed.
= Drug therapy that lowers serum calcium levels  oral glucocorticoids, diphosphonate,
gallium nitrate and mithramycin  lower level dramatically but they do not cure
hypercalcemia but instead reduce calcium level temporarily.
= Dialysis – when cancer-induced hypercalcemia is life-threatening or occurs with renal
impairment  temporarily reduce serum calcium levels.

5. SUPERIOR VENA CAVA SYNDROME

= Superior Vena Cava (SVC) Syndrome – occurs when the SVC is compressed or
obstructed by tumor growth.
= SVC compression can lead to painful and life-threatening emergency, most often in clients
with lymphomas and lung cancer.
= The manifestations of SVC syndrome result from the blockage of blood flow in the venous
system of the head, neck and upper trunk.
 = Early manifestations occur when the client arises after a night’s sleep  includes edema of
the face, especially around the eyes and tightness of the shirt or blouse collar (stoke’s
sign).
= As the compression worsens  edema in the arms and hands, dyspnea, erythema of the
upper body and epistaxis (nosebleed).
= Late manifestations  hemorrhage, cyanosis, mental status changes from lack of blood to
the brain, decrease cardiac output and hypotension.
 Death results if compression is not relieved.

Management:

 SVC syndrome is a late-stage manifestation  tumor is usually, widespread.

> High-dose radiation therapy to the mediastinal area.
> A metal stent can be placed in the vena cava.

 A follow-up angioplasty can keep this stent open for a longer period of time.
 The best treatment results occur when SVC syndrome is in the early stages.

6. PAIN
= It is estimated that 90-95% of patients with progressive cancer experience pain.
= Although the pain may be acute, it is more frequently characterized as chronic.
= The experience of cancer pain is influenced by physical, psychosocial, cultural and spiritual
factors.
= Pain related to the underlying cancer process accounts for the pain experienced by 75% of
all patients with cancer.
= Pain is also associated with various cancer treatments.
= Acute pain is linked with trauma from surgery.
= Chronic pain syndrome such as postsurgical, neuropathies (pain related to nerve tissue
injury) can occur.
= Some chemotherapeutic agents can cause tissue necrosis, peripheral neuropathies and
stomatitis  all are potential sources of pain.
= Radiation therapy can cause pain secondary to skin or organ inflammation.
= The WHO advocates a 3-step approach to treat cancer pain.
 Analgesics are administered based on the patient’s level of pain.
Step 1  Nonopioid (NSAID) – as adjuvant treatment.
Step 11  Opioid for mild-moderate pain (pain
persisting or increasing)
Step 111  Opioid for moderate-severe pain (pain
persisting or increasing).
 Freedom from cancer pain

7. PHYSICAL STRESS

= Fatigue is one of the most significant and frequent symptoms experienced by patients
receiving cancer treatment.
= Fatigue also results from the stress of coping with cancer.
= Cancer-related fatigue is a distressing persistent subjective sense of tiredness or exhaustion
related to cancer treatment that is not proportional to recent activity and interferes with
usual functioning.
= Patient may describe variety of ways.
> Assess for feelings of weariness, weakness, lack of energy, inability to carry out necessary
and valued daily functions, lack of motivation and inability to concentrate.
> Assess physiologic and psychological stressors that can contribute to fatigue  including
anemia, electrolyte imbalance, organ dysfunction, pain, nausea, dyspnea, constipation,
fear and anxiety.
= The role of exercise  is a helpful intervention.
= Assist patients with additional non-pharmacologic strategies to minimize fatigue or help the
patient cope with existing fatigue.
= Pharmacologic interventions are occasionally utilized such as antidepressants for patients
with depression;
> Anxiolytics for those with anxiety
> Hypnotics for patients with sleep disturbances
 > Psychostimulants for some patients with advanced cancer or fatigue that does not
respond to other interventions.
= Nurses assists patients with non-pharmacologic strategies to minimize fatigue or help the
client cope with existing fatigue.

Sources of Fatigue in Cancer patients:

 Pain and pruritus
 Imbalanced nutrition R/T anorexia, nausea, vomiting, cachexia
 Electrolyte imbalance R/T vomiting, diarrhea
 Ineffective protection R/T neutropenia, thrombocytopenia, anemia
 Impaired tissue integrity R/T stomatitis, mucositis
 Impaired physical mobility R/T neurologic impairments, surgery, Bone metastasis, pain
and analgesic use
 Disturbed sleep pattern R/T cancer therapies, anxiety and pain

8. Psychological stress
= Nurses assess the patient’s psychological and mental status as the patient and their family
face this life-threatening experience, unpleasant diagnostic tests and treatment modalities
and progression of disease.
= Assess the patient’s mood and emotional reaction to the results of diagnostic testing and
prognosis and looks for evidence that the patient is progressing through the stages of grief
and can talk about the diagnosis and prognosis with family members.
= A cancer diagnosis need not include a fatal outcome but despite these facts, many patients
and their families view cancer as a fatal disease.
= Patients and families who have just been informed of a cancer diagnosis frequently respond
with shock, numbness and disbelief.
= The plan of nursing care addresses anticipatory grieving and nursing strategies for
promoting appropriate progression through the grieving process.
 During terminal phase of cancer  the nurse helps the patient and their family to
acknowledge and cope with their reaction feelings.
 The nurse also helps the patient and family to explore preferences for issues related to
end-to-life care such as withdrawal of active disease treatment, desire for the use of life-
support measures and symptoms management.
 Support  which can be as simple as holding a patient’s hand or just being with a
patient at home or the bedside, often contributes to peace of mind.

IMMUN0THERAPY (Biotherapy) – a relatively new anticancer therapy that introduces antigens

and naturally occurring substances into the patient’s body to stimulate his immune system to
attack cancer cells.

5 Major Types of Biotherapy:

1. Active Specific – inactivated tumor vaccines (autologous or allogenic) - modified and
injected into the patient to stimulate antibody production specifically to attack the tumor.
2. Active nonspecific – a biological immunostimulants such as BCG vaccine to stimulate the
nonspecific immune response.
3. Passive – transfer immune serum from an immunologically competent patient to one who is
not (short-lived immunity).
4. Adoptive – The tumor-bearing patient receives active lymphocytes that already possess
tumor reactivity and the patient’s body will eventually accept these new cells and use them
in its immunologic defenses.
5. Mediator and Hormonal – extracts of chemical mediators and hormones are used to
stimulate the immune responses.

 Biological Response Modifiers – the new approach to immunotherapy  these are

agents that are capable of modifying the relationship between the tumors and the host
by strengthening the host’s immune function.
Examples:
= Interferon
= Interleukin-2
= Colony-stimulating factors
= Monoclonal Antibodies
  Biotherapy may also produce local, systemic and anaphylactic reactions. The adverse
effects depend on the agent used, dose, route and administration schedule.

New Approaches in Cancer Therapy:

1. Hyperthermia (Thermal Therapy) – clinical study suggests that there is a synergistic effect
between temperature 41ᵒC to 42ᵒC. It is more effective when combined with radiation
therapy, chemotherapy or biologic therapy.

2. Photodynamic Therapy – use of dye and light. The dye is injected into a vein and spreads
throughout the body. After a few days, it remains only in cancer cells. A red light produced
by a laser is then used  the dye in the cell absorbs the light, causing a photochemical
reaction that destroys the cells.

Complementary and Alternative Therapies

1. Complimentary Therapies – refer to therapies that clients choose as a complement to

medical treatment. It is estimated that approximately 30% to 50% of patients with cancer
may have had the experience of using some kind of complimentary therapy.

Common Complimentary Therapies for Cancer can be categorized into:

1. Botanical Agents
= Herbs are believed to be the most “natural” and “safe” plants ingested with the hope for a
cure of cancer.
 Commonly used botanical agents: Echinacea, Essiac, ginseng, green tea, pau
d’Arco, and Hoxsey therapy. The safety for many of these botanical agents has not
been proven, especially as a compliment to medical treatment.

2. Nutritional Supplements
 Chemical compounds include vitamins, minerals, enzymes, amino acids, and
essential fatty acids, or proteins (such as shark cartilage). They are believed to have the
ability to promote health and to help cure cancer. The safety of certain compounds such
as vitamins are established; however, in mega doses, many of the compounds can be
toxic and have potential interactions with some therapeutic agents used for cancer such
as chemotherapy.
3. Dietary Supplements
 The ingestion of only natural substances is believed to have the effect of purifying the
body and slowing down the growth of cancer. Popular regimens include grape diet,
carrot juice diet and garlic, onions, and liver intake. However, the effectiveness of these
dietary regimens remains to be established.
4. Mind-Body Modalities
 The harmony of mind and body are believed to facilitate physiologic and psychologic
healing. Such modalities include relaxation, meditation, or imagery. Recent research
has shown that these modalities helped individuals with cancer adjust to the experience
of cancer.
5. Miscellaneous Therapies
 Aromatherapy has been used for clients with cancer to relieve nausea, vomiting or
retching and to decrease anxiety. However, aromatherapy might be appropriate for
clients who are highly sensitive to strong fragrance.
 Music, art and humor therapies have also been used to help clients with cancer to
reduce anxiety, to express feeling of loss and to promote optimism.

COLLABORATIVE CARE

Pain Control
1. Drugs – Analgesics
= Non-narcotic analgesics – NSAIDS, Acetaminophen
= Narcotic analgesics – Opiates and Opioids
(morphine, codeine, fentanyl)
 = Patient-Controlled Analgesics (PCA) – a method of allowing a person in pain to
administer their own pain relief. Delivered by an infusion which is programmable by the
prescriber.

2. Neurosurgical Treatments
= Peripheral Neurectomy
= Nerve Blocks – injection of local anesthetic onto or near nerves for temporary control of
pain.

Patient-controlled Analgesics (PCA)

 Temporary nerve blocks are achieved by combining a local anesthetic (such as

lidocaine) with epinephrine, a steroid (corticosteroid), and/or opioids. Epinephrine
produces constriction of the blood vessels which delays the diffusion of the anesthetic.
Steroids can help to reduce inflammation. Opioids are painkillers. Injection nerve blocks
can be either single treatments, multiple injections over a period of time, or continuous
infusions. A continuous peripheral nerve block can be introduced into a limb undergoing
surgery, for example, a femoral nerve block to prevent pain in knee replacement.

 Permanent nerve block can be effective using other drugs or methods including alcohol
or phenol to selectively destroy nerve tissue, cryoanalgesia to freeze nerves, and
Radiofrequency ablation to destroy nerve tissue using heat.

= Cordotomy – is a surgical procedure that disables selected pain-conducting tracts in the

spinal cord in order to achieve loss of pain and temperature perception. This procedure is
commonly performed patients experienced severe pain due to cancer or other diseases for
which there is currently no cure.

= Sensory Rhizotomy - a term chiefly referring to a neurosurgical procedure that selectively

destroys problematic nerve roots in the spinal cord, most often to relieve the symptoms of
neuromuscular conditions.

3. TENS (Transcutaneous Electrical Nerve Stimulation) – is the use of electric current

produced by a device to stimulate the nerves for therapeutic purposes.

4. Cognitive Pain Control Techniques

= Biofeedback – is the process of becoming aware of various physiological functions using
instruments that provide information on the activity of those systems, with a goal of being
to manipulate them at will. Processes that can be controlled include: brainwaves, muscle
tone, skin conductance, heart rate and pain perceptions.

= Distractions

= Guided Imagery – is a technique used by many natural or alternative medicine

practitioners as well as medical doctors and psychologists for aiding clients and patients to use
mental imagery to help with anything from healing their bodies with cancer guided imagery to
solving problems or reducing stress.
= Hypnosis
= Meditations

Meeting Psychological Needs – includes:

= Maintaining hope
= Maintaining spiritual needs
= Encouraging social and vocational activities
= Decreasing fear of helplessness and dependency
Meeting Physiological Needs:
= Increasing comfort
= Maintaining nutrition
= Maintaining elimination
= Maintaining personal hygiene
= Preventing the effects of immobility
Teaching the patient and family
 CARE OF CLIENTS RECEIVING RADIATION THERAPY

NURSING DIAGNOSES FOR CLIENTS RECEIVING RADIATION:

= Knowledge deficit
= High risk for infection
= Altered nutrition: Less than the body requirement
= Impaired skin integrity
= Altered oral mucous membranes
= Body image disturbances
= Fluid volume deficit
= Altered bowel elimination patterns - Diarrhea
= Ineffective breathing patterns
= Impaired gas exchange
= Social isolation

MANAGING ADVERSE EFFECTS OF RADIATION THERAPY:

1) LOCAL EFFECTS
1.1 Headaches (caused by cerebral edema)
= Assess for pain
= Administer analgesics or corticosteroids as ordered.
1.2 Pulmonary/Cardiac Effects (such as pneumonitis, pericarditis, or myocarditis due to
irradiation of lung or heart areas)
= Auscultate the chest daily, monitor V/S as ordered.
= Watch for and report coughing, dyspnea, weakness, or pain on inspiration.
= Decrease pulmonary effects through supplemental oxygenation, high fowler’s position.

1.3 Mucositis, Pharyngitis, Decreased Salivation and Taste Sensation (caused by

irradiation)
= Inspect the oral cavity and evaluate the patient’s nutritional status.
= Encourage the client to maintain optimal nutrition, emphasizing protein and
carbohydrates.
= Administer analgesics such as lidocaine solution or ointment before meals.
= Advise patient to avoid dry or thick foods, to use artificial saliva, and to drink plenty of
fluids with meals.
= Instruct patient to rinse his mouth before meals with quarter-strength hydrogen peroxide
and water to prevent accumulation of debris and to improve his appetite.
= Suggest use of sugarless lemon drops or mints to increase salivation.

1.4 Erythema
= Observe reddened areas daily and record any changes. Keep the skin dry and exposed
to air.
= Prepare skin before radiation therapy by removing ointments and dressing thoroughly
cleanse skin.

1.5 Desquamation
= If dead surface cells peel off, apply cornstarch to prevent pruritus and irritation from
clothing and bed linens.
= If desquamation is dry, apply lanolin to relieve dryness and pruritus, if ordered. Use
dressings (nonadherent pads, gauze, and nonallergic tape) to absorb drainage and
prevent irritation from clothing. Keep the skin exposed whenever possible.
= Use saline soaks, antibiotic ointments, or steroid creams for moist desquamation.
= Do not use solutions or ointments containing heavy metals (zinc)
.
1.6 Epilation (usually temporary but may be permanent with high doses of Radiation)
= If hair loss occurs in the treatment area, be supportive and encourage the use of cosmetic
replacements, such as false eyelashes.

1.7 Sweat Gland Destruction

 = To maintain skin integrity, instruct the patient to avoid exposure to intense sunlight, wind or
cold.
= Apply emollient-based lotions.
= Observe for ulceration, telangiectasis, and poor healing after trauma.

2. SYSTEMIC EFFECTS
= include GI upset, stomatitis, Alopecia and Bone marrow Depletion.

Common Nursing Diagnoses for Clients on Chemotherapy:

 Activity intolerance
 Disturbance in body image
 Pain
 Constipation
 Diarrhea
 Fluid volume deficit
 High risk for infection
 Knowledge deficit
 Impaired physical mobility
 Altered nutrition: Less than body requirements
 Self-care deficits
 Sensory perceptual alteration
 Sexual dysfunction
 Impaired skin integrity
 Altered tissue perfusion
 Altered urinary elimination patterns

Managing Common Adverse Effects of Chemotherapy

1. Bone Marrow Depression

= Establish baseline WBC and platelet count, HGB levels, and HCT before therapy begins.
Monitor these studies during therapy.
= If WBC drops suddenly or falls below 2,000/mm3, stop the drug and notify the doctor  the
drug maybe discontinued or the dosage reduced.
 Reverse isolation maybe initiated if WBC count falls below 1,500/mm3. Report a platelet
count below 100,000/mm3. if necessary, assist with transfusion.
 Monitor temperature orally Q 4 hours, and regularly inspect the skin and body orifices
for signs of infection. Observe for petechiae, easy bruising and bleeding. Check for
hematuria and monitor the patient’s BP. Be alert for signs of anemia.
 Limit SC and IM injections. If these are necessary, apply pressure for 3 to 5 minutes
after injection to prevent leakage or hematoma. Report unusual bleeding after injection.
 Take precautions to prevent bleeding. Use extra care with razors, nail trimmers, dental
floss, toothbrushes, and other sharp or abrasive objects. Avoid digital examinations,
rectal suppositories, and enemas. Increase fluid intake to prevent constipation.
 Administer vitamin and iron supplements, as ordered. Provide a diet high in iron.

2. Anorexia
 Assess the patient’s nutritional status before and during chemotherapy. Weigh him
weekly or as ordered.
 Explain the need for adequate nutrition despite loss of appetite.
 Stimulate client’s appetite by making mealtime more enjoyable, overcoming obstacles to
eating, teaching clients to be creative with their cooking.

3. Nausea and Vomiting

 Before chemotherapy begins (30 to 45 minutes), administer antiemetics, as ordered to
reduce severity of these reactions. Continue antiemetics as needed.
 Monitor and record the frequency, character, and amount of vomitus.
 Monitor serum electrolyte levels and provide TPN, if necessary.
 Use auditory or diversional stimulation, self-relaxation techniques, self-hypnosis and
therapeutic touch to relieve nausea and vomiting.
 Eat foods that minimize nausea.

4. Diarrhea and Abdominal Cramps

  Assess the frequency, color, consistency, and amount of diarrhea. Give antidiarrheals,
as ordered.
 Assess the severity of cramps and observe for signs of dehydration (poor skin turgor,
oliguria, irritability) and acidosis (confusion, nausea, vomiting, decreased LOC), which
may indicate electrolyte imbalance.
 Encourage fluids, and if ordered, give IV fluids and potassium supplements.
 Provide good skin care, especially to the perianal area.

5. Stomatitis
 Before drug administration, observe for dry mouth, erythema, and white patchy areas on
the oral mucosa. Be alert for bleeding gums or complaints of a burning sensation when
drinking acidic liquids.
 Emphasize the principles of good mouth care with the patient and his family.
 Provide mouth care Q 4 to 6 hours with NSS or quarter strength hydrogen peroxide.
Coat the oral mucosa with milk of magnesia. Avoid lemon glycerin swabs because they
tend to reduce saliva and change the mouth ph.
 To make eating more comfortable, apply a topical viscous anesthetic, such as
Lidocaine, before meals. Administer special washes as ordered.
 Consult the dietitian to provide bland foods at medium temperature.
 Treat cracked or burning lips with petrolatum.

6. Alopecia
 Reassure the patient that alopecia is usually temporary.
 Apply ice pack to cover the entire head for 10 minutes before drug administration and
30 minutes after.
 Inform him that he may experience discomfort before hair loss starts.
 Advise washing his hair with mild shampoo and avoiding frequent brushing or combing.
 Advise against permanent and hair coloring (increase the rate of hair loss).
 Suggest wearing a scarf or hat, a toupee or wig.

Nursing Management of Clients with Cancer:

FIRST-LEVEL NURSING INTERVENTIONS:

= Being aware of those persons at risk for developing cancer.
= Primary prevention counseling – emphasize on controlling and avoiding predisposing factors
= Teach clients to practice secondary prevention such as SBE, annual P.E. with chest x-ray,
PAP’s test
= Teach client especially on treatable forms of cancer, emphasizing on early diagnosis and
treatment
= Teach clients regarding the 7 warning signs of cancer

SECOND-LEVEL NURSING INTERVENTIONS:

= Perform an accurate nursing assessment

= Identify nursing problems and provide appropriate interventions such as:
> Presence of mass or lymphadenopathy – immediate referral to a doctor
> Any of warning signs – referral
THIRD-LEVEL NURSING INTERVENTIONS:

= Perform a more detailed nursing assessment

= Identify nursing problems and provide appropriate interventions such as:
> Anemia – iron-rich diet; RBC transfusion and rest.
> Hemorrhage – prophylactic platelet transfusion; controlling bleeding to prevent
complications.
> Infection – culturing blood, skin orifices and excreta; reverse isolation; thorough hand
washing.
> Malnutrition – nutritional supplements; parenteral hyperalimentation.

> Pain – position changes; distractions and diversional activities; administration of

analgesics.

> Anxiety – perceptive and supportive listener; presence of another caring person.