Nursing Care of Clients with Problems in Oxygenation, Fluid and Electrolyte, Infectious,
Inflammatory and Immunologic Response, Cellular Aberration, Acute and Chronic
Module 1: Nursing Care Management of Clients with Cellular Aberration (Cancer)
Clinical Instructor: Racquel C. Cruz RN, MSN
1st Semester | S.Y. 2022-2023
E. Nursing Care Management of Clients with
Cellular Aberrations
• Physical
• Physiological
• Psychological
• Spiritual
• Socio-economic
• Environmental
Learning Objectives:
1. Describe the concept of hospice in providing care for
patients with advanced cancer.
2. Identify the nursing responsibilities and management in
handling dying clients
3. Enumerate the roles of the nurse in handling patients
undergoing the grieving process.
4. Identify assessment parameters and nursing management
of patients with oncologic emergencies.
Holistic Nursing
Holistic – nurses believe that the human being,
composed of a Mind, Body, and Soul integrated into an
inseparable whole that is greater than the sum of the
parts, is in constant interaction with the universe and all
that it contains.
Health and well-being depend on attaining harmony in
these relationships.
Healing – the journey toward Holism. Using Presence,
Intent, Unconditional Acceptance, Love, and
Compassion (Consideration), holistic nurses can
facilitate growth and healing and help their clients to
find meaning in their life experiences, life purpose, and
reason for being.
The National Consensus Project for Quality Palliative
Care identified the following eight key domains
underlying a more comprehensive and humane
approach to care of the dying. These include:
1. Structure and Processes of Care: The timely plan of
care is based on a comprehensive interdisciplinary
assessment of the patient and family.
2. Physical Aspects of Care: Pain, other symptoms,
and side effects are managed based on the best
available evidence, with attention to disease-specific
pain and symptoms, which is skillfully and
systematically applied.
3. Psychological and Psychiatric Aspects of Care :
Psychological status is assessed and managed based
on the best available evidence, which is skillfully and
systematically applied. When necessary, psychiatric
issues are addressed and treated.
4. Social Aspects of Care: Comprehensive
interdisciplinary assessment identifies the social
needs of patients and their families, and a plan
of care is developed to respond to these needs
as effectively as possible.
5. Spiritual, Religious, and Existential Aspects of
Care: Spiritual and existential dimensions are assessed
and responded to based on the best available
evidence, which is skillfully and systematically applied.
6. Cultural Aspects of Care: The palliative care
program assesses and attempts to meet the needs of
the patient, family, and community in a culturally
sensitive manner.
7. Care of the Imminently Dying Patient: Signs and
symptoms of impending death are recognized and
communicated in developmentally appropriate
language for children and patients with cognitive
disabilities with respect to family preferences. Care
appropriate to this phase of illness is provided to the
patient and family.
8. Ethical and Legal Aspects of Care: The patient’s
goals, preferences, and choices are respected within
the limits of applicable state and federal law, within
current accepted standards of medical care, and form
the basis for the plan of care.
LOSS, GRIEVING, DYING, AND DEATH
Definition of Terms:
Dying
 Process of coming to an end (ends in death)
Death
 Permanent cessation of all vital functions
 End of human life
 Both an event (moment of death) and a state
(being dead)
Clinicians’ Attitudes Toward Death
They identified four “Awareness Contexts”:
Death Awareness
 Closed awareness
o The patient is unaware of his or her
terminal state while others are aware.
 Suspected awareness
o The patient suspects what others know
and attempts to find out.
 Mutual Pretense awareness
o The patient, the family, and the health
care professionals are aware that the
patient is dying but all pretend
otherwise.
 Open awareness
o All are aware that the patient is dying
and are able to openly acknowledge
Definition of Terms
Peri-Death
 the last hours of life; the actual death and the
care of the body after death
Loss
 someone or something of real or symbolic
meaning
Nearing Death Awareness:
 the dying person’s knowledge of death and his
or her attempts to describe this experience to
health care providers, family, and friends
Do Not Resuscitate (DNR)
 aka: No Code
 Orders that no effort be made to revive a
patient if he suffered from Cardio-Pulmonary
arrest.
 Nursing Care of Clients with Problems in Oxygenation, Fluid and Electrolyte, Infectious, Inflammatory and Immunologic Response,
Cellular Aberration, Acute and Chronic
Module 1: Nursing Care Management of Clients with Cellular Aberration (Cancer)

Clinical Instructor: Racquel C. Cruz RN, MSN

1st Semester | S.Y. 2022-2023

Terms Related to Death and Dying ❖ Fears prolonged illness

1. Loss ❖ Encounters death of family
• Is an actual or potential situation in which members and peers
a valued object, person or alike is
inaccessible or changed so that it is no
❖ See death as having
7. 65 years
longer perceived as valuable. and above multiple meanings.
2. Bereavement ❖ e.g. freedom from pain,
• Is the SUBJECTIVE response to a loss reunion with already
through the death of a person with deceased family members.
whom there has been a significant
relationship.
3. Grief  When it is not possible to prevent a patient
• Is the TOTAL RESPONSE to the dying, and medical care is no longer possible or
emotional experience of the loss as useful, the nurse provides supportive care to
manifested in THOUGHTS, FEELINGS, the patient and family.
and BEHAVIORS.  The main goals are to:
4. Mourning 1. keep the patient comfortable and free
• Is the behavioral process through of pain
which grief is eventually resolved or 2. make the patient's final days as good
altered; it is often influenced by culture as possible for both patient and family,
and customs. with as little suffering as possible
• Culturally patterned expression 3. help the patient to die peacefully
(rituals) of the bereaved person’s 4. provide comfort to the family.
thought and feelings.
MODELS OF GRIEF
DEVELOPMENT OF CONCEPT OF DEATH (From Ultimate Learning guide to Nursing Review)

PERIOD CHARACTERISTICS Stages of Grieving by Kubler Ross

❖ Does not understand Stages of Grieving
concept of death By: Elizabeth Kubler – Ross
1. Infancy – ❖ Believes death is reversible, “DABDA”
5 years a temporary departure or Duration of any stage can vary from as little as few
hours to as long as period of months.
sleep
Stages Typical
❖ Understands that death is Comment
1. Denial
final “This cannot
 refuses to believe that loss
❖ Believes OWN death can be be true.”
2. 5 – 9 is happening
years avoided 2. Anger
❖ Associates’ death with  client and family may direct
aggression or violence anger at a nurse or hospital
“Why me?”
about matters that
❖ Understand death as the normally would not bother
inevitable end of life them.
3. 9 – 12
❖ Begins to understand own 3. Bargaining
years “I just want to
 seeks to bargain to avoid
mortality see my
loss
grandchild’s
❖ Fears of lingering death  may express feeling of
birth, then I’ll
guilt or fear of punishment
❖ May fantasize that death be
for past sins, real or
can be defied, acting out ready. . . .”
imagined
4. 12 – 18 defiance through reckless 4. Depression
years behavior  grieves over what has
❖ Views death in religious happened and what
and philosophic terms cannot be
 may talk freely or may
❖ Has attitude towards death withdraw “I just don’t
5. 18 – 45 that is influenced by  S/Sx of grief: know how
years ✓ Repeated somatic my kids are
religious cultural beliefs. distress going to get
✓ Tightness in the along after I’m
❖ Accepts own mortality
chest gone.”
❖ Encounters death of ✓ Choking or
6. 45 – 65 parents and some peers shortness of breath
years ❖ Experiences peak of death ✓ Sighing
anxiety ✓ Empty feeling in
the abdomen
 Nursing Care of Clients with Problems in Oxygenation, Fluid and Electrolyte, Infectious, Inflammatory and Immunologic Response,
Cellular Aberration, Acute and Chronic
Module 1: Nursing Care Management of Clients with Cellular Aberration (Cancer)

Clinical Instructor: Racquel C. Cruz RN, MSN

1st Semester | S.Y. 2022-2023

✓ Loss of muscular • Should understand the wider concepts of

power spirituality
✓ Intense subjective • Should respect all the religion and belief of
distress clients
5. Acceptance
 comes to terms with loss Nursing Diagnoses Related to Dying
“I’ve lived a
 may have decreased
good life, 1. Fear
interest in surroundings
and I have no 2. Hopelessness
and support persons.
regrets.” 3. Powerlessness
 May wish to begin making
plans
❖ Pioneering work that prompted for increased HOSPICE CARE
attention to the needs of the dying and ❑ Focus: Support and Care of the Dying person,
bereaved. family, with the goal of FACILITATING A
PEACEFUL AND DIGNIFIED DEATH.
PARKE’S MODEL (5 Stages of grief) ▪ Improve QUALITY OF LIFE, rather than CURE.
1. NUMBNESS – Brief denial as a psychological ▪ Starts when the person has only 6 months or
defense less to live.
2. YEARNING – Lasts several months with Goals:
intense psychological distress with thoughts - Control and relieve pain and symptoms of illness.
focused on the deceased. - Provide physical comfort for the terminally ill.
3. DISORGANIZATION – Characterized by - Provide social, emotional, spiritual comfort for the
severe depression, social withdrawal, lack of client, family, and friend.
interest in people and activities.
4. REORGANIZATION – Begins 6-9 months with
Goals of Hospice Care:
gradual renewal of interest in people and - Meet Physiologic Needs
activities - Provide spiritual support.
5. (Progression through the stages of grief
❖ Final Stage of Disease Phase
normally takes 2 years or longer)
❖ Time of Dying Phase
❖ Bereavement Period Phase
NURSING CARE MANAGEMENT OF THE DYING
PATIENTS
1. Assist the client achieve a dignified and Preparing Clients through Grief
peaceful death P - prepare and provide for physiologic needs.
 Provide relief from loneliness, fear, and R - Role modeling by those who have successfully
depression. coped.
 Maintain the client sense of security, E - Establish support coping behavior that was
self confidence, dignity, and self-worth successful in the past
 Maintain hope P - Pull support systems by mobilizing existing and
 Help the client accept his or her losses identifying new ones.
 Provide physical comfort A - Allow expression of diverse feelings and emotions.
R - Refer to self-help groups
2. Maintain physiologic and psychological
E - Expand coping behaviors by introducing new
comfort
mechanisms.
 Personal hygiene measures
 Pain control (this is the highest priority
when caring for dying clients)
 Relief of respiratory difficulties
 Assistance with movement. Nutrition,
hydration, and elimination
 Measures related to sensory changes

3. Provide spiritual support

 Sense of forgiveness
 Need for love and hope.

Spiritual Care in Nursing

• It is an essential component of comprehensive
nursing care
• It can decrease suffering and aid in physical
and mental healing
• Nurse should have skill in developing trusting
relationship with clients
• Nurse should communicate with sensitivity and
empathy to have a good understanding of the
patient’s values