NURSING MANAGEMENT OF CANCER
TUTOR || September 21, 2022
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Outline
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Remember
Lecturer Book
(Exams)
  
Heading 1
1. Heading 2
• The quick brown fox jumps over the lazy dog
 The quick brown fox jumps over the lazy dog
▪ The quick brown fox jumps over the lazy dog
• The quick brown fox jumps over the lazy dog
Subheading
Nursing Management of Cancer
Maintaining Tissue Integrity
 Some of the most frequently encountered
disturbances of tissue integrity include
stomatitis, skin and tissue reactions to
radiation therapy, alopecia, and malignant
skin lesions.
Managing Stomatitis
 Assess oral cavity daily.
 Instruct patient to report oral burning, pain,
areas of redness, open lesions on the lips,
pain associated with swallowing, or
decreased tolerance to temperature extremes
of food.
 Encourage and assist in oral hygiene.
Discussions:
 (brush with soft toothbrush, use nonabrasive
toothpaste after meals and bedtime, floss
every 24 hours unless painful or platelet
count falls below 40,000/mm3); advise patient
to avoid irritants such as commercial
mouthwashes, alcoholic beverages, and
tobacco.
 For mild stomatitis, use normal saline mouth
rinses and a soft toothbrush or toothette,
remove dentures except for meals (make sure
dentures fit properly), apply water-soluble lip
lubricant, and avoid foods that are spicy or
hard to chew and those with extremes of
temperature.
 For severe stomatitis, obtain tissue samples
for culture and sensitivity tests, assess gag
reflex and ability to chew and swallow
MED-SURG
Discussions:
 Instructed to use oral rinses as prescribed or
Previous
position patient on side and irrigate mouth
Trans with suction available, remove dentures, use
 toothette or gauze soaked with solution for
cleansing, use water-soluble lip lubricant,
provide liquid or pureed diet, and monitor for
dehydration.
 Help patient minimize discomfort by using
prescribed topical anesthetic, administering
prescribed systemic analgesics, and
performing appropriate mouth care.
Managing Radiation-Associated Skin
Impairments
 Provide careful skin care by avoiding the use
of soaps, cosmetics, perfumes, powders,
lotions and ointments, and deodorants.
Discussions:
 Use only lukewarm water to bathe the area,
and avoid applying hot-water bottles, heating
pads, ice, and adhesive tape to the area. Do
not shave the area.
 Instruct the patient to avoid rubbing or
scratching the area, exposing the area to
sunlight or cold weather, or wearing tight
clothing over the area.
 If wet desquamation occurs, do not disrupt
any blisters that have formed, report
blistering, and use prescribed ointments
Discussions:
 If the area weeps, apply a non-adhesive
absorbent dressing. If the area is without
drainage, use moisture and vapor permeable
dressings such as hydrocolloids and
hydrogels on noninfected areas.
Addressing Alopecia
 Discuss potential hair loss and regrowth with
patient and family; advise that hair loss may
occur on body parts other than the head.
 Explore potential impact of hair loss on self-
image, interpersonal relationships, and
sexuality.
 Prevent or minimize hair loss
Discussions:
 use scalp hypothermia and scalp tourniquets,
if appropriate, cut long hair before treatment,
avoid excessive shampooing and any hair
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[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
processing, avoid excessive combing or
brushing
 Suggest ways to assist in coping with hair
loss (eg, purchase wig or hairpiece before
hair loss; wear head coverings).
 Explain that hair growth usually begins again
once therapy is completed.
Managing Malignant Skin Lesions
 Carefully assess and cleanse the skin,
reducing superficial bacteria, controlling
bleeding, reducing odor, protecting skin from
pain and further trauma, and relieving pain.
 Assist and guide the patient and family
regarding care for these skin lesions at home;
refer for home care as indicated.
Promoting Nutrition
Discussions:
 Most patients with cancer experience some
weight loss during their illness. Anorexia,
malabsorption, and cachexia are common
examples of nutritional problems.
 Teach the patient to avoid unpleasant sights,
odors, and sounds in the environment during
mealtime.
 Suggest foods that are preferred and well
tolerated by the patient, preferably high-
calorie and high-protein foods.
Discussions:
 Respect ethnic and cultural food preferences.
 Encourage adequate fluid intake, but limit
fluids at mealtime.
 Suggest smaller, more frequent meals.
 Promote relaxed, quiet environment during
mealtime with increased social interaction as
desired.
 Encourage nutritional supplements and high-
protein foods between meals.
 Encourage frequent oral hygiene and provide
pain relief measures to make meals more
pleasant.
 Provide control of nausea and vomiting.
 Decrease anxiety by encouraging
verbalization of fears and concerns, use of
relaxation techniques, and imagery at
mealtime.
 For collaborative management, provide
enteral tube feedings of commercial liquid
diets, elemental diets, or blenderized foods as
prescribed.
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 Administer appetite stimulants as prescribed
by physician.
 Encourage family and friends not to nag or
cajole patient about eating.
Relieving Pain
 Use a multidisciplinary team approach to
determine optimal management of pain for
optimal quality of life.
 Assure patient that you know that pain is real
and will assist him or her in reducing it.
 Help patient and family play an active role in
managing pain.
 Provide education and support to correct
fears and misconceptions about opioid use.
 Encourage strategies of pain relief that
patient has used successfully in previous pain
experience.
 Teach patient new strategies to relieve pain
and discomfort: distraction, imagery,
relaxation, cutaneous stimulation, etc.
 Patients with cancer may have other sources
of pain, such as arthritis or migraine
headaches, that are unrelated to the
underlying cancer or its treatment.
 The nurse assesses the patient for the source
and site of pain as well as those factors that
influence the patient’s perception and
experience of pain, such as fear and
apprehension, fatigue, anger, and social
isolation.
 Pain assessment scales are useful for
assessing the patient’s pain before and after
pain-relieving interventions are instituted to
assess the effectiveness of interventions.
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
Discussions:
 In today’s society, most people expect pain to
disappear or resolve quickly. Although it is
often controllable, advanced cancer pain is
commonly irreversible and not quickly
resolved. For many patients, pain is often
seen as a signal that cancer is advancing and
that death is approaching.
 As patients anticipate pain and anxiety
increases, pain perception heightens,
producing fear and further pain. Thus, chronic
cancer pain can lead to a cycle progressing
from pain to anxiety to fear and back to pain,
especially when the pain is not adequately
managed.
 The nurse assists the patient and family to
take an active role in managing pain.
 The nurse provides education and support to
correct fears and misconceptions about
opioid use. Inadequate pain management
leads to a diminished quality of life
characterized by distress, suffering, anxiety,
fear, immobility, isolation, and depression.
Decreasing Fatigue
 Help patient and family to understand that
fatigue is usually an expected and temporary
side effect of the cancer process and
treatments.
 Help patient to rearrange daily schedule and
organize activities to conserve energy
expenditure
Discussions:
 encourage patient to alternate periods of rest
and activity.
 Encourage patient and family to plan to
reallocate responsibilities, such as childcare,
cleaning, and preparing meals.
Discussions:
 A patient who is employed full time may need
to reduce the number of hours worked each
week.
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 Encourage adequate protein and calorie
intake; assess for fluid and electrolyte
disturbances.
 Encourage regular, light exercise, which may
decrease fatigue and facilitate coping.
 Encourage use of relaxation techniques and
mental imagery.
 Address factors that contribute to fatigue and
implement pharmacologic and
nonpharmacologic strategies to manage pain.
 Administer blood products as prescribed.
Improving Body Image and Self-Esteem
Discussions:
 A creative and positive approach is essential
when caring for the patient with altered body
image. It is also important to individualize
care for each patient.
 Assess patient’s feelings about body image
and level of self-esteem. Encourage patient to
verbalize concerns.
 Identify potential threats to patient’s self-
esteem
Discussions:
 eg, altered appearance, decreased sexual
function, hair loss, decreased energy, role
changes). Validate concerns with patient.
 Encourage continued participation in activities
and decision making.
 Assist patient in self-care when fatigue,
lethargy, nausea, vomiting, and other
symptoms prevent independence.
 Assist patient in selecting and using
cosmetics, scarves, hair pieces, and clothing
that increase his or her sense of
attractiveness.
 Encourage patient and partner to share
concerns about altered sexuality and sexual
function and to explore alternatives to their
usual sexual expression.
 Refer patient to collaborating specialists as
needed.
Assisting in Grieving
 Encourage verbalization of fears, concerns,
negative feelings, and questions regarding
disease, treatment, and future implications.
 Encourage active participation of patient or
family in care and treatment decisions.
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor

 Visit family frequently to establish and Managing Septic Shock

maintain relationships and physical  Assess frequently for infection and
closeness. inflammation throughout the course of the
 Involve spiritual advisor as desired by the disease.
patient and family.  Prevent septicemia and septic shock, or
 Allow for progression through the grieving detect and report for prompt treatment.
process at the individual pace of the patient  Monitor for signs and symptoms of septic
and family. shock
 Advise professional counseling as indicated Discussions:
for patient or family to alleviate pathologic  Observe for altered mental status, either
grieving. subnormal or elevated temperature, cool and
 If patient enters the terminal phase of clammy skin, decreased urine output,
disease, assist patient and family to hypotension, tachycardia, other dysrhythmias,
acknowledge and cope with their reactions electrolyte imbalances, tachypnea, and
and feelings. abnormal arterial blood gas [ABG] values
 Maintain contact with the surviving family  Instruct patient and family about signs of
members after death of the patient. septicemia, methods for preventing infection,
and actions to take if infection or septicemia
Monitoring & Managing Potential Complications occurs.
Managing Infection
 Assess patient for evidence of infection Managing Bleeding and Hemorrhage
Discussions:
 Monitor platelet count and assess for
 Check vital signs every 4 hours, monitor white
bleeding
blood cell (WBC) count and differential each
Discussions:
day, and inspect all sites that may serve as
 petechiae or ecchymosis; decrease in
entry ports for pathogens (eg, intravenous [IV]
hemoglobin or hematocrit; prolonged bleeding
sites, wounds, skin folds, bony prominences,
from invasive procedures, venipunctures,
perineum, and oral cavity)
minor cuts, or scratches; frank or occult blood
 Report fever (≥38.3°C [101°F] or ≥38°C
in any body excretion, emesis, or sputum;
[100.4°F] for greater than 1 hour), chills,
bleeding from anybody orifice; altered mental
diaphoresis, swelling, heat, pain, erythema,
status
exudate on anybody surfaces.
 Instruct patient and family about ways to
Discussions:
minimize bleeding
 Also report change in respiratory or mental
Discussions:
status, urinary frequency or burning, malaise,
 use soft toothbrush or toothette for mouth
myalgias, arthralgias, rash, or diarrhea.
care, use electric razor for shaving, avoid
 Discuss with patient and family about placing
foods that are difficult to chew
patient in private room if absolute WBC count
 Initiate measures to minimize bleeding
is less than 1,000/mm3 and the importance of
Discussions:
patient avoiding contact with people who
 draw blood for all laboratory work with one
have known or recent infection or recent
daily venipuncture; avoid taking temperature
vaccination.
rectally or administering suppositories and
 Instruct all personnel in careful hand hygiene
enemas; avoid intramuscular injections, use
before and after entering room.
smallest needle possible if necessary; avoid
 Avoid rectal or vaginal procedures (rectal
bladder catheterizations, use smallest
temperatures, examinations, suppositories,
catheter if necessary; maintain fluid intake of
vaginal tampons) and intramuscular
at least 3 L/24 h unless contraindicated; avoid
injections.
medications that will interfere with clotting
Discussions:
such as, aspirin; recommend use of water-
 Avoid insertion of urinary catheters; if
based lubricant before sexual intercourse.
catheters are necessary, use strict aseptic
technique.
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[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
 When platelet count is less than 20,000/mm3,
institute bed rest with padded side rails,
avoidance of strenuous activity, and platelet
transfusions as prescribed.
Promoting Home- and Community-Based Care
Teaching Patients Self-Care
 Provide information needed by patient and
family to address the most immediate care
needs likely to be encountered at home.
 Verbally review, and reinforce with written
information, the side effects of treatments and
changes in the patient’s status that should be
reported.
 Discuss strategies to deal with side effects of
treatment with patient and family.
 Identify learning needs on the basis of the
priorities identified by patient and family as
well as on the complexity of home care.
 Instruct patient and family and provide
ongoing support that allows them to feel
comfortable and proficient in managing
treatments at home.
 Refer for home care nursing to provide care
and support for patients receiving advanced
technical care.
 Provide follow-up visits and phone calls to
patient and family, and evaluate patient
progress and ongoing needs.
Continuing Care
 Refer patient for home care
Discussions:
 assessment of the home environment,
suggestions for modifications to assist patient
and
 family in addressing patient’s physical needs
and physical care, and ongoing assessment
of the psychological and emotional effects of
the illness on patient and the family
 Assess changes in the patient’s physical
status and report relevant changes to the
physician.
 Assess adequacy of pain management and
the effectiveness of other strategies to
prevent or manage side effects of treatment.
 Help coordinate patient care by maintaining
close communication with all health care
providers involved in the patient’s care.
 Make referrals and coordinate available
community resources.
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Nursing Management Related to Treatment
Cancer Surgery
 Complete a thorough preoperative
assessment for all factors that may affect
patients undergoing surgery.
 Assist patient and family in dealing with the
possible changes and outcomes resulting
from surgery
Discussions:
 provide education and emotional support by
assessing patient and family needs and
exploring with them their fears and coping
mechanisms. Encourage them to take an
active role in decision making when possible.
 Explain and clarify information the physician
has provided about the results of diagnostic
testing and surgical procedures, if asked.
 Communicate frequently with the physician
and other health care team members to
ensure that the information provided is
consistent.
 After surgery, assess patient’s responses to
the surgery and monitor for complications
such as infection, bleeding, thrombophlebitis,
wound dehiscence, fluid and electrolyte
imbalance, and organ dysfunction.
 Provide for patient comfort.
 Provide postoperative teaching that
addresses wound care, activity, nutrition, and
medications.
 Initiate plans for discharge, follow-up care,
and treatment as early as possible to ensure
continuity of care.
 Encourage patient and family to use
community resources such as the American
Cancer Society for support and information.
Bone Marrow Transplantation
 Before BMT, perform nutritional assessments
and extensive physical examinations and
ensure that organ function tests, as well as
psychological evaluations, are completed as
ordered.
 Ensure that patient’s social support systems
and financial and insurance resources are
evaluated.
 Reinforce information for informed consent.
 Provide patient teaching about the procedure
and pre-transplantation and post
transplantation care.
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor

 During the treatment phase, closely monitor

for signs of acute toxicities (eg, nausea,
diarrhea, mucositis, and hemorrhagic cystitis),
and give constant attention to patient.
 During the bone marrow infusions or stem cell
reinfusions, monitor vital signs and blood
oxygen saturation, assess for adverse effects
Discussions:
 fever, chills, shortness of breath, chest pain,
cutaneous reactions, nausea, vomiting,
hypotension or hypertension, tachycardia,
anxiety, and taste changes

 Because of the high risk for dying from sepsis

and bleeding, support patient with blood
products and hemopoietic growth factors and
protect from infection.
 Assess for early graft-versus-host disease
(GVHD) effects on the skin, liver, and GI tract
as well as GI complications
Discussions:
 eg, fluid retention, jaundice, abdominal pain,
ascites, tender and enlarged liver, and
encephalopathy
 Monitor for pulmonary complications, such as
pulmonary edema, and interstitial and other
pneumonias, which often complicate recovery
after BMT.

 Provide ongoing psychosocial patient

assessment, including the stressors affecting
patients at each phase of the transplantation
experience.

Hyperthermia
 Explain to patient and family about the
procedure, its goals, and its effects.
 Assess the patient for adverse effects, and
make efforts to reduce their occurrence and
severity.
 Provide local skin care at the site of the
implanted hyperthermic probes.

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