Chapter 11
Oncology: Nursing management in cancer care
249
Continues on following page
Nursing interventions
6. Encourage adequate protein and
kilojoule intake.
7. Encourage use of relaxation
techniques, mental imagery.
8. Encourage participation in planned
exercise programs.
9. For collaborative management,
administer blood products as
prescribed.
10. Assess for fluid and electrolyte
disturbances.
11. Assess for sources of discomfort.
12. Provide strategies to facilitate mobility.
Rationale
6. Protein and kilojoule depletion
decreases activity tolerance.
7. Promotion of relaxation and
psychological rest decreases physical
fatigue.
8. Proper exercise programs increase
endurance and stamina.
9. Lowered haemoglobin and
haematocrit predispose patient to
fatigue due to decreased oxygen
availability.
10. May contribute to altered nerve
transmission and muscle function.
11. Coping with discomfort requires
energy expenditure.
12. Impaired mobility requires increased
energy expenditure.
Expected outcomes
• Uses relaxation exercises and
imagery to decrease anxiety and
promote rest.
• Participates in planned exercise
program gradually.
• Reports no breathlessness during
activities.
• Exhibits acceptable haemoglobin and
haematocrit levels.
• Exhibits normal fluid and electrolyte
balance.
• Reports decreased discomfort.
• Exhibits improved mobility.
Plan of Nurs ing Care
Care of patient with cancer
(
continued
)
CHART
11-4
Nursing interventions
1. Use pain scale to assess pain and
discomfort characteristics: location,
quality, frequency, duration, etc.
2. Assure patient that you know that pain
is real and will assist him or her in
reducing it.
3. Assess other factors contributing to
patient’s pain: fear, fatigue, anger, etc.
4. Administer analgesics to promote
optimum pain relief within limits of
doctor’s prescription.
5. Assess patient’s behavioural
responses to pain and pain
experience.
6. Collaborate with patient, doctor and
other healthcare team members when
changes in pain management are
necessary.
7. Encourage strategies of pain relief
that patient has used successfully in
previous pain experience.
8. Teach patient new strategies
to relieve pain and discomfort:
distraction, imagery, relaxation,
cutaneous stimulation, etc.
Rationale
1. Provides baseline for assessing
changes in pain level and evaluation of
interventions.
2. Fear that pain will not be considered
real increases anxiety and reduces
pain tolerance.
3. Provides data about factors that
decrease patient’s ability to tolerate
pain and increase pain level.
4. Analgesics tend to be more effective
when administered early in pain cycle.
5. Provides additional information about
patient’s pain.
6. New methods of administering
analgesia must be acceptable to
patient, doctor and healthcare
team to be effective; patient’s
participation decreases the sense of
powerlessness.
7. Encourages success of pain relief
strategies accepted by patient and
family.
8. Increases number of options and
strategies available to patient.
Expected outcomes
• Reports decreased level of pain and
discomfort on pain scale.
• Reports less disruption from pain
and discomfort.
• Explains how fatigue, fear, anger,
etc., contribute to severity of pain
and discomfort.
• Accepts pain medication as
prescribed.
• Exhibits decreased physical and
behavioural signs of pain and
discomfort in acute pain (no
grimacing, crying, moaning; displays
interest in surroundings and
activities).
• Takes an active role in administration
of analgesia.
• Identifies additional effective pain
relief strategies.
• Uses alternative pain relief strategies
appropriately.
• Reports effective use of new pain
relief strategies and decrease in pain
intensity.
• Reports that decreased level of
pain permits participation in other
activities and events.
Nursing problem:
Chronic pain
Goal:
Relief of pain and discomfort
Nursing interventions
1. Encourage verbalisation of fears,
concerns and questions regarding
disease, treatment and future
implications.
2. Explores previous successful coping
strategies.
Rationale
1. An increased and accurate knowledge
base decreases anxiety and dispels
misconceptions.
2. Provides frame of reference and
examples of coping.
Expected outcomes
• The patient and family progress
through the phases of grief as
evidenced by increased verbalisation
and expression of grief.
Nursing problem:
Anticipatory grieving related to loss; altered role functioning
Goal:
Appropriate progression through grieving process
