Chapter 11
Oncology: Nursing management in cancer care
247
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Nursing interventions
3. Prevent unpleasant sights, odours and
sounds in the environment.
4. Use distraction, music therapy,
biofeedback, self-hypnosis,
relaxation techniques and guided
imagery before, during and after
chemotherapy.
5. Administer prescribed antiemetics,
sedatives and corticosteroids before
chemotherapy and afterward as
needed.
6. Ensure adequate fluid hydration
before, during and after drug
administration; assess intake and
output.
7. Encourage frequent oral hygiene.
8. Provide pain relief measures, if
necessary.
9. Assess other causes of nausea
and vomiting, such as constipation,
gastrointestinal irritation, electrolyte
imbalance, radiation therapy,
medications and central nervous
system metastasis.
10. Consult with dietician as needed.
Rationale
3. Unpleasant sensations can stimulate
the nausea and vomiting centre.
4. Decreases anxiety, which can
contribute to nausea and vomiting.
Psychological conditioning may also
be decreased.
5. Administration of antiemetic regime
before onset of nausea and vomiting
limits the adverse experience and
facilitates control. Combination
drug therapy reduces nausea and
vomiting through various triggering
mechanisms.
6. Adequate fluid volume dilutes drug
levels, decreasing stimulation of
vomiting receptors.
7. Reduces unpleasant taste sensations.
8. Increased comfort increases physical
tolerance of symptoms.
9. Multiple factors may cause nausea
and vomiting.
10. Interdisciplinary collaboration essential
in addressing complex patient needs.
Expected outcomes
• Reports decrease in nausea.
• Reports decrease in incidence of
vomiting.
• Consumes adequate fluid and food
when nausea subsides.
• Demonstrates use of distraction,
relaxation and imagery when
indicated.
• Exhibits normal skin turgor and
moist mucous membranes.
• Reports no additional weight loss.
Plan of Nurs ing Care
Care of patient with cancer
(
continued
)
CHART
11-4
Nursing interventions
1. Teach patient to avoid unpleasant
sights, odours, sounds in the
environment during mealtime.
2. Suggest foods that are preferred
and well tolerated by the patient,
preferably high-kilojoule and high-
protein foods. Respect ethnic and
cultural food preferences.
3. Encourage adequate fluid intake, but
limit fluids at mealtime.
4. Suggest smaller, more frequent
meals.
5. Promote relaxed, quiet environment
during mealtime with increased social
interaction as desired.
6. If possible, serve wine at mealtime
with foods.
7. Consider cold foods, if desired.
8. Encourage nutritional supplements
and high-protein foods between
meals.
Rationale
1. Anorexia can be stimulated or
increased with noxious stimuli.
2. Foods preferred, well tolerated, and
high in kilojoules and protein maintain
nutritional status during periods of
increased metabolic demand.
3. Fluids are necessary to eliminate
wastes and prevent dehydration.
Increased fluids with meals can lead
to early satiety.
4. Smaller, more frequent meals are
better tolerated because early satiety
does not occur.
5. A quiet environment promotes
relaxation. Social interaction at
mealtime increases appetite.
6. Wine often stimulates appetite and
adds kilojoules.
7. Cold, high-protein foods are often
more tolerable and less odorous than
hot foods.
8. Supplements and snacks add protein
and kilojoules to meet nutritional
requirements.
Expected outcomes
• Patient and family identify minimal
nutritional requirements.
• Exhibits weight loss no greater than
10% of pre-treatment weight.
• Reports decreasing anorexia and
increased interest in eating.
• Demonstrates normal skin turgor.
• Identifies rationale for dietary
modifications. Patient and family
verbalise strategies to address/
minimise nutritional deficits.
• Participates in kilojoule counts and
diet histories.
• Uses appropriate relaxation and
imagery before meals.
• Exhibits laboratory and clinical
findings indicative of adequate
nutritional intake: normal serum
protein and transferrin levels;
normal serum iron levels; normal
haemoglobin, haematocrit and
lymphocyte levels; normal urinary
creatinine levels.
• Consumes diet high in required
nutrients.
Nursing problem:
Imbalanced nutrition: less than body requirements, related to anorexia, cachexia or malabsorption
Goal:
Maintenance of nutritional status and of weight within 10% of pre-treatment weight
