NURSING ASSESSMENT FOR CA Weight loss Frequent infection Skin problems Pain Hair Loss Fatigue Disturbance in body

in body image/ depression GOAL IN MANAGEMENT OF CANCER Cure eradication of malignant diseases Control prolonged survival and containment of cancer cell growth Palliation relief of symptoms associated with the disease

Serve food in ways to make it appealing Consider patients preferences Provide small frequent meals Avoids giving fluids while eating Oral hygiene PRIOR to mealtime Vitamin supplements

Nursing Intervention: RELIEVE PAIN Mild pain- NSAIDS Moderate pain- Weak opiods Severe pain- Morphine Administer analgesics round the clock with additional dose for breakthrough pain Nursing Intervention: DECREASE FATIGUE Plan daily activities to allow alternating rest periods Light exercise is encouraged Small frequent meals Nursing Intervention: IMPROVE BODY IMAGE Therapeutic communication is essential Encourage independence in self-care and decision making Offer cosmetic material like make-up and wigs Nursing Intervention: ASSIST IN THE GRIEVING PROCESS Some cancers are curable Grieving can be due to loss of health, income, sexuality, and body image Answer and clarify information about cancer and treatment options Identify resource people Refer to support groups Nursing Intervention: MANAGE COMPLICATION: INFECTION Fever is the most important sign (38.3) Administer prescribed antibiotics X 2weeks Maintain aseptic technique Avoid exposure to crowds Avoid giving fresh fruits and veggie Handwashing Avoid frequent invasive procedures Nursing Intervention: MANAGE COMPLICATION: Septic shock Monitor VS, BP, temp Administer IV antibiotics Administer supplemental O2 Nursing Intervention: MANAGE COMPLICATION: Bleeding Thrombocytopenia (<100,000) is the most common cause <20, 000 spontaneous bleeding Use soft toothbrush Use electric razor Avoid frequent IM, IV, rectal and catheterization Soft foods and stool softeners

NURSING INTERVENTION FOR IMPAIRED SKIN INTEGRITY Keep skin free of foreign substance Avoid use of medicated solutions Avoid pressure, trauma, infection Avoid exposure to heat, cold or sunlight NURSING INTERVENTION FOR ANOREXIA, VOMITING, NAUSEA Provide small, frequent feedings Make the food appealing Avoid extremes of temperatures Administer antiemetics before meals NURSING INTERVENTION FOR DIARRHEA Encourage low residue, bland, high protein foods Provide good perineal hygiene Monitor electrolytes, Na, K, Cl NURSING INTERVENTION FOR ANEMIA, LEUKOPENIA, THROMBOCYTOPENIA Isolate patient, strict asepsis provide frequent rest period Encourage high protein diet Assess for bleeding and signs of infection Monitor lab results CBC, WBC, Platelet count Broad spectrum antibiotics or in combination MANAGEMENT OF STOMATITIS Use soft-bristled toothbrush Oral rinses with saline gargles/ tap water Avoid ALCOHOL-based rinses

MANAGEMENT OF ALOPECIA Alopecia begins within 2 weeks of therapy Regrowth within 8 weeks of termination Encourage to acquire wig before hair loss occurs Encourage use of attractive scarves and hats Provide information that hair loss is temporary BUT anticipate change in texture and color Nursing Intervention: PROMOTE NUTRITION

GI SYSTEM Nausea and vomiting o administer anti-emetics o NPO 4-6 hrs before chemotherapy o bland diet foods in small amounts after treatment Antimetabolites and antibiotics RENAL SYSTEM encourage to increase OFI and frequent voiding Monitor serum electrolytes, BUN, creatinine Administer allopurinol Cisplatin, metothrexate, mitomycin CARDIOPULMONARY SYSTEM Cardiotoxic doxurubicin, daunorubicin o Monitor for signs of CHF and cardiac ejection fraction Pulmonary fibrosis bleomycin, carmustine, busulfan o Monitor pulmonary function test Nursing Care: Pre-transplant Provide protected environment - strict reverse isolation 2. Monitor central lines frequency 3. Provide care receiving chemotherapy Post transplant Prevent infection - Maintain protective environment - Administer antibiotics - Check IV set ups q12hrs 2. Provide mouth care for stomatitis and mucositis Post transplant 3. Monitor carefully for bleeding check for occult blood observe for easy bruising Check platelet ct daily replaced blood component 4. Maintain fluid and electrolyte balance 5. Provide client health teaching COLON CANCER PRE-OP NURSING INTERVENTION 1. Provide HIGH protein, HIGH calorie and LOW residue diet a. 2.Provide information about post-op care and stoma care 2. Administer antibiotics 3-5 day prior 3. Enema or colonic irrigation the evening and the morning of surgery 4. NGT is inserted to prevent distention 5. Monitor UO, F and E, Abdomen PE POST-OP NURSING INTERVENTION 1. 1. Monitor for complications 2. Leakage from the site, prolapse of stoma, skin irritation and pulmo complication 3. 2. Assess the abdomen for return of peristalsis 4. 3. Assess wound dressing for bleeding 5. 4. Assist patient in ambulation after 24H 6. 5.provide nutritional teaching

Cabbage, beans, eggs, fish, peanuts Low-fiber diet in the early stage of recovery
POST-OP NURSING INTERVENTION 7. Instruct to splint the incision and administer pain meds before exercise 8. The stoma is PINKISH to cherry red, Slightly edematous with minimal pinkish drainage 9. Manage post-operative complication COLOSTOMY CARE Colostomy begins to function 3-6 days after surgery BEST time to do skin care is after shower Apply tape to the sides of the pouch before shower Assume a sitting or standing position in changing the pouch Instruct to GENTLY push the skin down and the pouch pulling UP Wash the peri-stomal area with soap and water Cover the stoma while washing the peri-stomal area Lightly pat dry the area and NEVER rub Measure the stomal opening The pouch opening is about 0.3 cm larger than the stomal opening Apply adhesive surface over the stoma and press for 30 seconds Expect that stool will be liquid postoperatively but will become more solid, depending on the area of colostomy. Ascending colon colostomy liquid stool. Transverse colon colostomy loose to semiformed stool. Descending colon colostomy close to normal stool. o Empty the pouch or change the pouch when o 1/3 to full (Brunner) o to 1/3 full (Kozier) BREAST CANCER PRE-OP NURSING INTERVENTION 1. Explain breast cancer and treatment options 2. Reduce fear and anxiety and improve coping abilities 3. Promote decision making abilities 4. Provide routine pre-op care: 1. Consent, NPO, Meds, Teaching about breathing exercise POST- OP NURSING INTERVENTION 1. Position patient: Supine Affected extremity elevated to reduce edema 2. Relieve pain and discomfort Moderate elevation of extremity IM/IV injection of pain meds Warm shower on 2nd day post-op 3. Maintain skin integrity Immediate post-op: snug dressing with drainage Maintain patency of drain (JP) Monitor for hematoma w/in 12H and apply bandage and ice, refer to surgeon Drainage is removed when the discharge is less than 30 ml in 24 H

Limit foods that cause gas-formation and odor

Lotions, Creams are applied ONLY when the incision is healed in 4-6 weeks 4. Promote activity Support operative site when moving Hand, shoulder exercise done on 2ndday Post-op mastectomy exercise 20 mins TID NO BP or IV procedure on operative site Heavy lifting is avoided Elevate the arm at the level of the heart On a pillow for 45 minutes TID to relieve transient edema POST- OP NURSING INTERVENTION TEACH FOLLOW-UP care Regular check-up Monthly BSE on the other breast Annual mammography PROSTATE CANCER Nursing Interventions: Post-prostatectomy Maintain continuous bladder irrigation. Note that drainage is pink tinged w/in 24 hours Monitor urine for the presence of blood clots and hemorrhage Ambulate the patient as soon as urine begins to clear in color

Maintain strict asepsis techniques Administer IV antibiotics Administer blood products o Anticoagulants o Cryoprecipitate

HYPERCALCEMIA NURSING INTERVENTION Monitor serum calcium level. Correct fluid and electrolyte imbalance. Prepare the client for dialysis

1. Provide for bladder retraining after foley catheter removal a. Perineal exercises b. restrict caffeine c. limit fluid intake at nigth 2. Education a. Avoid lifting, straining, and prolonged travel b. possible impotence SPINAL CORD COMPRESSION NURSING INTERVENTION Assess for back pain and neurological deficits. Prepare the client for radiation and/or chemotherapy Surgery may need to be performed Instruct the client in the use of neck or back braces if they are prescribed. TUMOR LYSIS SYNDROME Instruct the client regarding the importance of fluid intake during chemotherapy. Administer diuretics as prescribed. Administer allopurinol (Zyloprim), as prescribed. Prepare to administer IV infusion of glucose and insulin to treat Hyperkalemia. Prepare the client for dialysis SIADH NURSING INTERVENTION Initiate fluid restriction and increased sodium intake as prescribed. Administer democlocyline (Declomycin) as prescribed Monitor serum sodium levels. SEPSIS AND DIC