ACTIVITY 3 – NURSING CARE PLAN

ONCOLOGY VIRTUAL DUTY

JASMINE L. PAGADILAN
Section C
 LUNG CANCER
CUES NURSING OBJECTIVES INTERVENTIONS RATIONALE EVALUATION
DIAGNOSIS

Subjective: Impaired gas exchange After 8 hours of my  Note respiratory rate, depth,  Respirations may be increased as a
After 8 hours of my
and ease of respiration. result of pain or as an initial
related to altered oxygen nursing interventions, the compensatory mechanism nursing interventions,
to
“hindi ako makatulog kase Observe for use of accessory
accommodate for the loss of lung
supply as evidenced by patient will demonstrate muscles, pursed-lip breathing, the patient has
hindi ako makahinga ng tissue; however, increased work of
dyspnea, restlessness and improved ventilation and changes in skin or mucous breathing and cyanosis may
demonstrate improved
maayos” as verbalized by respiratory rate of 23 adequate oxygenation of membrane color, pallor, ventilation and
indicate increasing oxygen
the patient. cyanosis. consumption and energy
cpm. tissues by ABGs within adequate oxygenation
expenditures and/or reduced
Trans: i can’t sleep patient’s normal range. respiratory reserve. of tissues by ABGs
becasue i can’t breath well. within patient’s normal
 Auscultate lungs for air  Consolidation and lack of air range.
movement and abnormal movement on the operative side are
Objective: normal in the pneumonectomy
breath sounds.
patient; however, the lobectomy
Vital signs: patient should demonstrate normal
airflow in remaining lobes.
Temp.: 37.1 C
 May indicate increased hypoxia or
 Investigate restlessness and
PR: 66 bpm complications such as a mediastinal
changes in mentation or level shift in pneumonectomy patient
of consciousness. when accompanied by tachypnea,
RR: 23 cpm tachycardia, and tracheal deviation.

BP: 100/70  Increased oxygen consumption

 Assess patient response to demand and stress of surgery can
 Dyspnea activity. Encourage rest result in increased dyspnea and
 restlessness periods and limit activities to changes in vital signs with activity;
patient tolerance however, early mobilization is
desired to help prevent pulmonary
complications and to obtain and
maintain respiratory and circulatory
efficiency. Adequate rest balanced
with activity can prevent
respiratory compromise.
 Note development of fever.
 Fever within the first 24 hr after
surgery is frequently due to
atelectasis. Temperature elevation
 within the 5th to 10th postoperative
day usually indicates a wound or
systemic.

 Maintain patent airway by

positioning, suctioning, use of  Airway obstruction impedes
airway adjuncts. ventilation, impairing gas
exchange.

 Reposition frequently, placing

 Maximizes lung expansion and
patient in sitting positions
drainage of secretions.
and supine to side positions.

 Encourage and assist with

deep-breathing exercises and  Promotes maximal ventilation and
pursed-lip breathing as oxygenation and reduces or
appropriate. prevents atelectasis.

 Maintain patency of chest

 Drains fluid from pleural cavity to
drainage system for lobectomy, promote re-expansion of remaining
segmental or wedge resection lung segments.
patient.

 Note changes in amount or  Bloody drainage should decrease in

type of chest tube drainage. amount and change to a more
serous composition as recovery
progresses. A sudden increase in
amount of bloody drainage or return
to frank bleeding suggests thoracic
bleeding or hemothorax; sudden
cessation suggests blockage of tube,
requiring further evaluation and
intervention.

 Administer supplemental
oxygen via nasal cannula,  Maximizes available oxygen,
partial rebreathing mask, or especially while ventilation is
high-humidity face mask, as reduced because of
indicated. anesthetic, depression, or pain, and
during period of compensatory
 physiological shift of circulation to
remaining functional alveolar units.
 Assist with and encourage the
use of incentive spirometer.
 Prevents or reduces atelectasis and
promotes re-expansion of small
airways.
 Monitor and graph ABGs,
pulse oximetry readings. Note  Decreasing Pao2 or increasing
hemoglobin (Hb) levels. Paco2 may indicate the need for
ventilatory support. Significant
blood loss can result in decreased
oxygen-carrying capacity, reducing
Pao2.
 THYROID CANCER

CUES NURSING DIAGNOSIS OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

SUBJECTIVE: Imbalanced nutrition: less After 8 hours of my  Monitor daily food intake;  Identifies nutritional strengths and
After 8 hours of my
have patient keep food diary deficiencies.
than body requirements nursing interventions, nursing interventions,
“hindi ako makakain ng as indicated.
related to poorly controlled the patient will verbalize the patient has verbalize
maasyos, masakit kase pain as evidenced by understanding  Measure height, weight, and  If these measurements fall below understanding
lalamunan ko” as inadequate food intake, sore interferences to adequate tricep skinfold thickness (or minimum standards, patient’s chief interferences to
verbalized by the patient other anthropometric source of stored energy (fat tissue) adequate intake.
buccal cavity, and a pain intake.
measurements as is depleted.
Trans: i can’t eat well, my scale of 7/10. appropriate). Ascertain
throat hurts. amount of recent weight loss.
Weigh daily or as indicated.
OBJECTIVE:
 Assess skin and mucous  Helps in identification of protein-
Vital signs: membranes for pallor, calorie malnutrition, especially
delayed wound healing, when weight and anthropometric
Temp.: 36.9 C enlarged parotid glands. measurements are less than normal.

PR: 89 bpm  Encourage patient to eat high-  Metabolic tissue needs are
calorie, nutrient-rich diet, increased as well as fluids (to
RR: 21 cpm with adequate fluid intake. eliminate waste products).
Encourage use of Supplements can play an important
BP: 120/70 supplements and frequent or role in maintaining adequate caloric
smaller meals spaced and protein intake.
 Reported throughout the day.
inadequate food
intake  Create pleasant dining  Makes mealtime more enjoyable,
 Sore buccal cavity atmosphere; encourage which may enhance intake.
patient to share meals with
 Pain scale of 7/10 family and friends.

 The effectiveness of diet

 Adjust diet before and
adjustment is very individualized in
immediately after treatment relief of posttherapy nausea.
(clear, cool liquids, light or Patients must experiment to find
bland foods, candied ginger, best solution or combination.
dry crackers, toast, Avoiding fluids during meals
 carbonated drinks). Give minimizes becoming “full” too
liquids 1 hr before or 1 hr after quickly.
meals.
 Psychogenic nausea and vomiting
 Identify the patient who occurring before chemotherapy
experiences anticipatory generally does not respond to
nausea and vomiting and take antiemetic drugs. Change of
appropriate measures. treatment environment or patient
routine on treatment day may be
effective.

 Administer antiemetic on a
regular schedule before or  Nausea and vomiting are frequently
during and after the most disabling and
psychologically stressful side
administration of
effects of chemotherapy
antineoplastic agent as
appropriate.

 Evaluate effectiveness of
antiemetic.  Individuals respond differently to
all medications. First-line
antiemetics may not work,
requiring alteration in or use of
combination drug therapy.

 Hematest stools, gastric  Certain therapies (antimetabolites)

inhibit renewal of epithelial cells
secretions.
lining the GI tract, which may cause
changes ranging from mild
erythema to severe ulceration with
bleeding.

 Helps identify the degree of

 Review laboratory studies as
biochemical imbalance,
indicated (total lymphocyte malnutrition and influences choice
count, serum transferrin, and of dietary interventions. Note:
albumin or prealbumin). Anticancer treatments can also alter
nutrition studies, so all results must
be correlated with the patient’s
clinical status.
 Refer to dietitian or
nutritional support team.  Provides for specific dietary plan to
meet individual needs and reduce
problems associated with
 protein, calorie malnutrition and
 Insert and maintain NG or micronutrient deficiencies.
feeding tube for enteric  In the presence of severe
malnutrition (loss of 25%–30%
feedings, or central line for
body weight in 2 mo) or if patient
total parenteral nutrition has been NPO for 5 days and is
(TPN) if indicated. unlikely to be able to eat for another
week, tube feeding or TPN may be
necessary to meet nutritional needs.
 CERVICAL CANCER

CUES NURSING DIAGNOSIS OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

SUBJECTIVE: Anticipatory grieving After 8 hours of my  Expect initial shock and  Few patients are fully prepared for After 8 hours of my
disbelief following diagnosis the reality of the changes that can
related to loss of significant nursing interventions, occur. nursing interventions,
“bakit ako pa ang of cancer and traumatizing
on processes of body the patient will be able to procedures (disfiguring the patient had been
nagkasakit ng ganito?” as (cervix area) as evidenced identify and express able to identify and
surgery, colostomy,
verbalized by the patient by feeling of hopelessness, feelings appropriately amputation). express feelings
denial of potential loss, and appropriately
 Assess patient and SO for  Knowledge about the grieving
showing of slight anger process reinforces the normality of
stage of grief currently being
OBJECTIVE: experienced. Explain process feelings and reactions being
experienced and can help patient
as appropriate.
Vital signs: deal more effectively with them.

 Provide open, nonjudgmental  Promotes and encourages realistic

Temp.: 36.7 C
environment. Use therapeutic dialogue about feelings and
communication skills of concerns.
PR: 72 bpm
Active-Listening,
acknowledgment, and so on.
RR: 17 cpm
 Encourage verbalization of  Patient may feel supported in
BP: 120/80
thoughts or concerns and expression of feelings by the
accept expressions of understanding that deep and often
 Feeling of
sadness, anger, rejection. conflicting emotions are normal
hopelessness Acknowledge normality of and experienced by others in this
 Denial of potential difficult situation.
these feelings.
loss
 Showing anger  Be aware of mood swings,  Indicators of ineffective coping
noted hostility, and other acting-out and need for additional
behavior. Set limits on interventions. Preventing
inappropriate behavior, destructive actions enables patient
redirect negative thinking. to maintain control and sense of
self-esteem.

 Studies show that many cancer

 Be aware of debilitating patients are at high risk for suicide.
depression. Ask patient direct They are especially vulnerable
when recently diagnosed
 questions about state of and discharged from hospital.
mind.

 Helps reduce feelings of isolation

 Visit frequently and provide
and abandonment.
physical contact as
appropriate, or provide
frequent phone support as
appropriate for setting.
Arrange for care provider and
support person to stay with
patient as needed.

 Reinforce teaching regarding  Patient and SO benefit from factual

disease process and information. Individuals may ask
treatments and provide direct questions about death, and
information as appropriate honest answers promote trust and
about dying. Be honest; do provide reassurance that correct
information will be given.
not give false hope while
providing emotional support.

 Review past life experiences,  Opportunity to identify skills that

role changes, and coping may help individuals cope with
skills. Talk about things that grief of current situation more
effectively.
interest the patient.
 Interpersonal conflicts or angry
 Note evidence of conflict; behavior may be patient’s way of
expressions of anger; and expressing and dealing with
statements of despair, guilt, feelings of despair or spiritual
hopelessness, “nothing to live distress and could be indicative of
for.” suicidal ideation.

 Possibility of remission and slow

 Identify positive aspects of progression of disease and new
the situation. therapies can offer hope for the
future.