Cancer, one of the leading causes of death in the world, is characterized by the unregulated or uncontrolled growth of cells that infiltrate and damage tissues and organs in the body.
Symptoms of cancer can vary depending on which part of the body is affected. Some of the general signs of cancer include:
- Fatigue
- Lump under the skin
- Sudden and unintended weight changes
- Skin changes
- Swollen lymph nodes
- Bowel and bladder habit changes
- Difficulty swallowing
- Persistent cough
- Dyspnea
- Unexplained bleeding
- Hoarseness
- Persistent and unexplained muscle pain
- Persistent and unexplained fever
- Persistent indigestion
Cancer cells develop when abnormal cells divide and mutate. Gene mutations can be inherited or acquired from carcinogens, radiation, or viruses.
Factors that increase the risk for cancer development include:
- Older age
- Unhealthy lifestyle choices or habits
- Family history
- Chronic health conditions
- Environmental/occupational hazards
Early cancer diagnosis offers the best chance of treatment and survival. There are a wide array of cancer screening tests available. To confirm a cancer diagnosis, various tests may be conducted including physical exams, urine, stool, and blood tests, and imaging tests like MRI, CT scan, and PET scan. Biopsies can confirm the type of cancer cells along with the stage and grade.
Cancer treatments may include surgery, chemotherapy, radiation, bone marrow transplant, immunotherapy, hormone therapy, and targeted drug therapy.
Nursing Process
A cancer diagnosis has a tremendous effect on a person’s physiologic, psychological, and social well-being. Despite advances in treatment, there is still fear and anxiety associated with the diagnosis of cancer.
As healthcare professionals caring for patients with cancer, nurses are in a position to change people’s perceptions and attitudes about cancer and its treatment. It is vital to help people decrease the risk of developing cancer, encourage cancer screenings, help patients adhere to cancer treatments, and provide support to the patient and family as they cope with their prognosis.
Nursing Care Plans
Once the nurse identifies nursing diagnoses related to cancer, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for cancer.
Acute Pain
There are different causes of cancer pain but it is mostly caused by tumors pressing on nerves, bones, and other organs. In some cases, the pain is caused by cancer treatments like chemotherapy drugs and radiation.
Nursing Diagnosis: Acute Pain
Related to:
- Disease process
- Tumor growth
- Inflammatory process
- Cancer treatment
As evidenced by:
- Diaphoresis
- Distraction behavior
- Expressive behaviors
- Guarding behavior
- Positioning to ease pain
- Protective behavior
- Report of activity changes
- Changes in vital signs
Expected Outcomes:
- The patient will report a decrease in pain
- The patient will implement two strategies to ease pain
Assessment:
1. Assess causative factors for pain.
Pain in cancer can be caused by the disease process or due to cancer treatments. Determining the causative factor of pain will help plan and evaluate the most appropriate interventions.
2. Assess pain effect on activities.
Assess if the pain is preventing the patient from moving, eating, or other ADLs.
Interventions:
1. Encourage the patient to use nonpharmacologic pain relief interventions.
Massage, meditation, heat, and other diversional activities promote relaxation and pain relief.
2. Administer pain relief medications as needed.
Opioids and NSAIDs may be prescribed to help manage pain in patients with cancer.
3. Educate the patient about the pain management plan.
Improved control of pain is achieved when the patient has a better understanding of the nature of the pain, its causes, and treatment.
4. Offer resources for coping with the psychological impacts of pain.
Cancer pain affects all aspects of the patient’s well-being. Cognitive behavioral strategies can help the patient with coping with discomfort and other unpleasant effects of pain.
5. Encourage complementary therapies if not contraindicated.
Complementary therapies like acupuncture, yoga, aromatherapy, and hypnotherapy can help relieve pain without the adverse effects of medication.
Death Anxiety
Patients diagnosed with advanced cancer often report death anxiety. This is emotional distress that is associated with the anticipation of death and the process of dying, negatively affecting a person’s quality of life.
Nursing Diagnosis: Anxiety
Related to:
- Anticipation of the outcome of the disease process
- Anticipation of pain
- Anticipation of suffering
- Awareness of imminent death
- Uncertainty of own prognosis
- Discussions surrounding death
- Changes in family roles
As evidenced by:
- Expresses fear of dying
- Expresses concern about the impact of one’s death on family members
- Expresses deep sadness
- Expresses fear of premature death
- Expresses fear of pain related to dying
- Expresses fear of a prolonged dying process
- Expresses fear of suffering related to dying
- Expresses fear of separation from loved ones
- Expresses fear of the unknown
- Reports negative thoughts related to death and dying
- Expresses powerlessness
Expected Outcomes:
- The patient will express feelings about death and its effects and seek help in coping
- The patient will express acceptance of their prognosis
Assessment:
1. Assess the patient’s psychosocial maturity and fear of dying.
According to reports, females are more at risk for developing death anxiety than males. There is also an increased risk of developing stress-related illnesses when faced with anticipatory death.
2. Assess the patient’s pain experience.
Patients with advanced cancer may require palliative care. Pain management and relief should be a priority in end-stage cancer as this can help improve the dying patient’s experience at the end of life.
Interventions:
1. Encourage the patient to verbalize thoughts and feelings.
Acknowledging the patient’s feelings and emotions about the cancer diagnosis and imminent death enhances trust and a therapeutic relationship. Oncology nurses are often a support system for patients as they undergo cancer treatments.
2. Educate the patient about the stages of grief.
The grieving process is important to help frame and identify one’s feelings. Understanding the grieving process will reinforce the normality of feelings experienced by the patient after a cancer diagnosis, allowing them to deal with grieving more efficiently.
3. Encourage family members to be involved in patient care.
A reliable support system will help the patient feel less isolated. Encourage the patient to lean on their friends and family for support.
4. Refer to grief counseling.
Counselors and spiritual advisors can assist the patient with their feelings of anxiety and anticipatory grieving.
Risk for Infection
Patients with cancer have a higher risk of infection due to immune system changes. Cancer itself and its treatments reduce the body’s ability to fight infection.
Nursing Diagnosis: Risk for Infection
Related to:
- Immunosuppression
- Cancer treatments
- Chronic disease processes
- Invasive treatment procedures
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred yet and nursing interventions are directed at the prevention of symptoms.
Expected Outcomes:
- The patient will identify and initiate interventions that can help reduce the risk of infection
- The patient will be free from any signs of infection
Assessment:
1. Assess and evaluate signs of infection through laboratory values.
Cultures may be requested to identify causative factors for infections and appropriate therapy. CBC with differentials can help determine the status of myelosuppression due to the effects of chemotherapy.
2. Assess and monitor for signs of infection.
Early recognition of infection in various parts of the body enables the initiation of early interventions to prevent complications.
Interventions:
1. Encourage infection control measures.
Frequent hand washing protects the patient from infection. Screening visitors and placing the patient in isolation will help reduce the risk of airborne and droplet infections.
2. Remain home when possible.
Patients with cancer should reduce their interaction with lots of people such as in stores or restaurants. When venturing out for necessary appointments or errands, a mask should be worn to reduce the transmission of diseases.
3. Provide adequate rest periods but remain active.
Patients with cancer experience fatigue and weakness due to the effects of the disease and its treatment. Ensuring that the patient has adequate rest periods reduces the incidence of fatigue while adequate exercise can prevent the loss of muscle function and support healthy immune function.
4. Alert the healthcare team to signs of infection.
A cold or flu virus can be detrimental to a patient with cancer. Ensure the patient knows to alert the healthcare team to any symptoms such as a fever, cough, chills, sore throat, or mouth sores.
5. Maintain asepsis of invasive lines.
Patients may have PICC lines, implanted ports, or urinary catheters. Maintain sterile technique when changing a PICC dressing or accessing a port to prevent introducing bacteria. Clean urinary catheters daily and discontinue once appropriate.
References
- ACCN Essentials of Critical Care Nursing. 3rd Edition. Suzanne M. Burns, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP. 2014. McGraw Hill Education.
- Cancer Center. WebMD. 2005 – 2022 WebMD LLC. From: https://www.webmd.com/cancer/default.htm
- Cancer. World Health Organization. 2022 WHO. From: https://www.who.int/health-topics/cancer#tab=tab_1
- Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 9th Edition. Donna D. Ignatavicius, MS, RN, CNE, ANEF. 2018. Elsevier, Inc.
- What Is Cancer? National Cancer Institute. Updated: May 5, 2021. From: https://www.cancer.gov/about-cancer/understanding/what-is-cancer
