Nursing Process Cellular Aberration

Evolve.
Adapt.
Overcome.
CEFI is now ready.
NCM 106
NURSING PROCESS: THE PATIENT WITH CANCER
KENNETH P. VELUYA
College Name
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.

I. ASSESSMENT
Regardless of type of cancer treatment or

prognosis many patients with cancer are
susceptible to the following problems and
complications
An important role of the oncology nurse
is to assess the patient for these
problems and complications
COLLEGE OF NURSING
1. INFECTION
B. Monitoring laboratory studies to detect

A. Assess factors that promotes infection
early changes in WBC count
· Impaired skin & mucus membrane integrity

· Chemotherapy
• Leukopenia
· Radiation Therapy
• Granulocytopenia
· Biologic Response Modifiers
• Neutropenia
· Malignancy C. Chest x-ray
· Malnutrition
· Urinary Catheter, Intravenous Catheter
· Other Invasive Procedures
· Contaminated Equipment
· Age
· Chronic Illness
· Prolonged Hospitalization
COLLEGE OF NURSING
2. BLEEDING
A. Assess factors that B. Common bleeding

C. Signs of bleeding
contribute to bleeding sites
• Gross hemorrhage
• Blood in stool, urine,
– Bone marrow suppression from sputum, vomitus
radiation • Skin and mucous
membranes • Oozing at injection sites
– Chemotherapy
• Intestinal • Bruising, petechiae
– Medications that interfere with
• Genito-Urinary Tract • Changes in mental status
coagulation and platelet
functioning • Respiratory tract
• Brain
COLLEGE OF NURSING
3. SKIN PROBLEMS - Assess predisposing factors and other risk factor
- Assess also the psychological impact of this side effect on the

4. HAIR LOSS patient and the family
COLLEGE OF NURSING
5. NUTRITIONAL PROBLEMS ANOREXIA, MALABSORPTION, CACHEXIA
B. Physical signs of weight loss

A. Impaired nutritional C. Determine diet history, any
and cachexia are secondary to
status may contribute to: episodes of anorexia,
decreased protein and caloric
changes in appetite, altered
intake, metabolic, mechanical
taste, nausea, diarrhea,
effects of cancer and systemic
situation and foods that
• Disease progression disease, side effects of the
aggravate or relieve anorexia
treatment or emotional status
• Immune incompetence and medication history
of the patient.
• Increased incidence of
infection
• Anthropometrical measurements
• Delayed tissue repair
• Serum protein levels
• Diminished functional ability
D. Clinical and laboratory • Serum electrolytes
• Decreased capacity to
data useful in assessing • Skin response to intradermal
continue chemotherapy
Patient’s nutritional status injection
• Hemoglobin and hematocrit levels
• Serum Iron Levels
COLLEGE OF NURSING
6. PAIN
A. Related factors causing

pain:
• Underlying disease C. Give emphasis not only to

B. Assess site of pain, pain
• Pressure exerted by physical pain but
perception, pain scales
psychosocial as well.
tumor
• Diagnostic procedures
• Cancer treatment
COLLEGE OF NURSING
7. FATIGUE 8. PSYCHOSOCIAL STATUS
• Fatigue has been recognized as

one of the significant and frequent
symptoms experienced by
patients receiving cancer therapy.
• Assess for feelings of weariness,
weakness, lack of energy, inability
to carry out ADL, lack of
motivation, and inability to 9. BODY IMAGE AND SELF-ESTEEM
concentrate
• Assess for physiologic and
psychological stressors that
contribute to fatigue, (pain,
nausea, constipation, fear, anxiety)
COLLEGE OF NURSING

II. NURSING DIAGNOSIS
Risk for infection related to altered Imbalanced nutrition: less than body
immunologic response requirements related to nausea and
Impaired skin integrity: erythematous vomiting
and wet desquamation reaction to
Fluid and electrolyte imbalance related
radiation therapy
to anorexia, nausea & vomiting, altered
Impaired oral mucous membranes
taste, diarrhea
related to stomatitis
COLLEGE OF NURSING

Anticipatory grieving related to loss of Self – care deficit due to fatigue,

body parts and altered role functioning malaise, and protective isolation
Disturbed body image and situational Anxiety due to knowledge deficit and
low self-esteem related to changes in uncertain future
appearance, function and roles
COLLEGE OF NURSING

Disturbed body image r/t changes in

appearance, function and roles Potential for spiritual distress
Deficient knowledge about disease

Grieving r/t anticipatory loss and process, treatment, complication
altered role functioning management, and self-care measures
COLLEGE OF NURSING

III. PLANNING
Maintenance of tissue integrity

Maintenance of nutrition
Relief of pain
Relief of fatigue
Improve body image
Effective progression through grieving process
Absence of complications
COLLEGE OF NURSING

IV. NURSING INTERVENTIONS
Managing Stomatitis
Provide good oral hygiene
Use soft-bristled toothbrush and non-abrasive toothpaste
Oral swabs with sponge like applicators
Avoid alcohol based mouth rinses
Lubricate cracked and dry lips
Adequate food and fluid intake is encouraged
COLLEGE OF NURSING

Maintaining Tissue
Integrity Handle affected area gently
Avoid rubbing or use of hot or cold water, soaps, powder,

lotion and cosmetics avoided
Avoid tissue injury by wearing loose-fitting clothing
Aseptic technique should be observed during dressing and

wound care
COLLEGE OF NURSING

Assisting patient to
cope with Alopecia
Provide information about hair loss, support patient and
family in coping with disturbing effects of therapy
Instruct to acquire a wig or hairpiece before hair loss
Encourage use of attractive scarves and hats

COLLEGE OF NURSING

Promoting nutrition
Prepare foods that are appealing
Patient’s preferences as well as physiologic and metabolic

requirements are considered when selecting foods
Encouraged small frequent feedings
Inform patient the advantage of receiving alternative

methods of feeding by parenteral or enteral route
COLLEGE OF NURSING

Relieving pain
Provide adequate rest and sleep
Promote diversional activities
Offer Empathy
Give pain reliever medications as ordered

COLLEGE OF NURSING

Decreasing Fatigue Help the patient and the family to understand that is an
expected and temporary side effect of cancer process and of
many treatments used
Help patient identify sources of fatigue
Plan activities to conserve energy as well as alternate

periods of rest
Regular, light exercise is recommended

COLLEGE OF NURSING

Body image and self-
esteem Positive approach is necessary
Encourage independence and continued participation in self-
care decision making
Patient should be assisted to assume tasks and participate in
those activities that are personally of most value
Identify any negative feeling that that the patient has or
threats to body image
Referral to support groups

COLLEGE OF NURSING

Assisting in grieving
process Assess response of patient and family about the diagnosis
and planned treatment
Assist in answering inquiries and questions, identifying

resources and support people
Assist patient and family acquire knowledge to cope with the

disease process
Assist patient and family members to acknowledge and cope

with their reactions and feelings
COLLEGE OF NURSING
QUESTIONS???
THANK YOU FOR LISTENING…

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Evolve.

NURSING PROCESS: THE PATIENT WITH CANCER

NURSING PROCESS: THE PATIENT WITH CANCER

Regardless of type of cancer treatment or

B. Monitoring laboratory studies to detect

· Impaired skin & mucus membrane integrity

A. Assess factors that B. Common bleeding

3. SKIN PROBLEMS - Assess predisposing factors and other risk factor

- Assess also the psychological impact of this side effect on the

5. NUTRITIONAL PROBLEMS ANOREXIA, MALABSORPTION, CACHEXIA

B. Physical signs of weight loss

A. Related factors causing

• Underlying disease C. Give emphasis not only to

7. FATIGUE 8. PSYCHOSOCIAL STATUS

• Fatigue has been recognized as

NURSING PROCESS: THE PATIENT WITH CANCER

NURSING PROCESS: THE PATIENT WITH CANCER

Anticipatory grieving related to loss of Self – care deficit due to fatigue,

NURSING PROCESS: THE PATIENT WITH CANCER

Disturbed body image r/t changes in

Deficient knowledge about disease

NURSING PROCESS: THE PATIENT WITH CANCER

Maintenance of tissue integrity

NURSING PROCESS: THE PATIENT WITH CANCER

NURSING PROCESS: THE PATIENT WITH CANCER

Avoid rubbing or use of hot or cold water, soaps, powder,

Avoid tissue injury by wearing loose-fitting clothing

Aseptic technique should be observed during dressing and

NURSING PROCESS: THE PATIENT WITH CANCER

Instruct to acquire a wig or hairpiece before hair loss

Encourage use of attractive scarves and hats

NURSING PROCESS: THE PATIENT WITH CANCER

Patient’s preferences as well as physiologic and metabolic

Encouraged small frequent feedings

Inform patient the advantage of receiving alternative

NURSING PROCESS: THE PATIENT WITH CANCER

Promote diversional activities

Give pain reliever medications as ordered

NURSING PROCESS: THE PATIENT WITH CANCER

Plan activities to conserve energy as well as alternate

Regular, light exercise is recommended

NURSING PROCESS: THE PATIENT WITH CANCER

Referral to support groups

NURSING PROCESS: THE PATIENT WITH CANCER

Assist in answering inquiries and questions, identifying

Assist patient and family acquire knowledge to cope with the

Assist patient and family members to acknowledge and cope

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