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Unit 3
Applying concepts from the nursing process
Nursing interventions
9. Encourage frequent oral hygiene.
10. Provide pain relief measures.
11. Provide control of nausea and
vomiting.
12. Increase activity level as tolerated.
13. Decrease anxiety by encouraging
verbalisation of fears, concerns; use
of relaxation techniques; imagery at
mealtime.
14. Position patient properly at mealtime.
15. For collaborative management, provide
enteral tube feedings of commercial
liquid diets, elemental diets or blended
foods as prescribed.
16. Provide parenteral nutrition with lipid
supplements as prescribed.
17. Administer appetite stimulants as
prescribed by doctor.
18. Encourage family and friends not to
nag or cajole patient about eating.
19. Assess and address other contributing
factors to nausea, vomiting and
anorexia such as other symptoms,
constipation, GI irritation, electrolyte
imbalance, radiation therapy,
medications and central nervous
system metastasis.
Rationale
9. Oral hygiene stimulates appetite and
increases saliva production.
10. Pain impairs appetite.
11. Nausea and vomiting increase
anorexia.
12. Increased activity promotes appetite.
13. Relief of anxiety may increase
appetite.
14. Proper body position and alignment
are necessary to aid chewing and
swallowing.
15. Tube feedings may be necessary in
the severely debilitated patient who
has a functioning gastrointestinal
system.
16. Parenteral nutrition with supplemental
fats supplies needed kilojoules and
proteins to meet nutritional demands,
especially in the non-functional
gastrointestinal system.
17. Although the mechanism is unclear,
medications such as megestrol
acetate (Megace) have been noted
to improve appetite in patients with
cancer and HIV infection.
18. Pressuring patient to eat may cause
conflict and unnecessary stress.
19. Multiple factors contribute to anorexia
and nausea.
Expected outcomes
• Carries out oral hygiene before
meals.
• Reports that pain does not interfere
with meals.
• Reports decreasing episodes of
nausea and vomiting.
• Participates in increasing levels of
activity.
• States rationale for use of tube
feedings or hyperalimentation.
• Participates in management of tube
feedings or parenteral nutrition, if
prescribed.
Plan of Nurs ing Care
Care of patient with cancer
(
continued
)
CHART
11-4
Nursing interventions
1. Encourage several rest periods during
the day, especially before and after
physical exertion.
2. At minimum, promote patient’s
normal sleep habits.
3. Rearrange daily schedule and
organise activities to conserve energy
expenditure.
4. Encourage patient to ask for others’
assistance with necessary chores,
such as housework, childcare,
shopping, cooking.
5. Encourage reduced job workload, if
possible, by reducing number of hours
worked per week.
Rationale
1. During rest, energy is conserved and
levels are replenished. Several shorter
rest periods may be more beneficial
than one longer rest period.
2. Sleep helps to restore energy levels.
3. Reorganisation of activities can reduce
energy losses and stressors.
4. Conserves energy.
5. Reducing workload decreases physical
and psychological stress and increases
periods of rest and relaxation.
Expected outcomes
• Reports decreasing levels of fatigue.
• Increases participation in activities
gradually.
• Rests when fatigued.
• Reports restful sleep.
• Requests assistance with activities
appropriately.
• Reports adequate energy to
participate in activities important
to them (e.g. visiting with family,
hobbies).
• Consumes diet with recommended
protein and kilojoule intake.
Nursing problem:
Fatigue
Goal:
Increased activity tolerance and decreased fatigue level
