Textbook of Medical-Surgical Nursing 3e

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Chapter 11

Oncology: Nursing management in cancer care

Plan of Nurs ing Care Care of patient with cancer ( continued )

CHART 11-4

Expected outcomes

Rationale

Nursing interventions

i. Each day: change drinking water, denture cleaning fluids and respiratory equipment containing water. 5. Assess intravenous sites every day for evidence of infection: a. Change peripheral short-term intravenous sites every 72 hours. b. Cleanse skin with an alcohol wipe (70% w/w ethyl alcohol or 60% v/v isopropyl alcohol) or povidone- iodine before arterial puncture or venipuncture. c. Change central venous catheter dressings every 48 hours. d. Change all solutions and infusion sets every 48 hours. e. Use evidence-based guidelines for care of peripheral and central venous access devices. 6. Avoid intramuscular injections. 7. Avoid insertion of urinary catheters; if catheters are necessary, use strict aseptic technique. 8. Teach patient or family member to administer granulocyte (or ­granulocyte- macrophage) colony-stimulating factor when prescribed. 9. Advise patient to avoid exposure to animal excreta; discuss dental procedures with physician; and avoid vaginal or rectal manipulation during sexual contact during period of neutropenia (Marrs, 2006; Zitella et al., 2006). a. Avoid the use of soaps, cosmetics, perfumes, powders, lotions and ointments, deodorants. b. Use only lukewarm water to bathe the area. c. Avoid rubbing or scratching the area. d. Avoid shaving the area with a straight-edged razor. e. Avoid applying hot-water bottles, heating pads, ice and adhesive tape to the area. f. Avoid exposing the area to sunlight or cold weather. Nursing interventions 1. In erythematous areas:

i. Stagnant water is a source of infection.

5. Nosocomial staphylococcal septicaemia is closely associated with intravenous catheters. a. Incidence of infection is increased when catheter is in place . 72 hours. b. An alcohol wipe and povidone- iodine is effective against many Gram-positive and Gram-negative pathogens. c. Allows observation of site and removes source of contamination. d. Once introduced into the system, microorganisms are capable of growing in infusion sets despite replacement of container and high flow rates. e. Nursing research determines best practice. 6. Reduces risk for skin abscesses. 7. Rates of infection greatly increase after urinary catheterisation. 8. Granulocyte colony-stimulating factor decreases the duration of neutropenia and the potential for infection. 9. Minimises exposure to potential sources of infection and disruption of skin integrity.

Nursing problem: Impaired skin integrity: erythematous and wet desquamation reactions to radiation therapy Goal: Maintenance of skin integrity

Rationale 1. Care to the affected areas must focus on preventing further skin irritation, drying and damage.

Expected outcomes • Avoids use of soaps, powders and other cosmetics on site of radiation therapy. • States rationale for special care of skin. • Exhibits minimal change in skin. • Avoids trauma to affected skin region (avoids shaving, constricting and irritating clothing, extremes of temperature, and use of adhesive tape). • Reports change in skin promptly. • Demonstrates proper care of blistered or open areas.

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