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 • Exhibits healing (reepithelialisation) of oral mucosa within 5 to 7 days (mild stomatitis). • Exhibits healing of oral tissues within 10 to 14 days (severe stomatitis). • Exhibits no oral ulceration. • Consumes adequate fluid and food. • Exhibits absence of dehydration and weight loss.

Rationale

Nursing interventions

c. Use normal saline mouth rinses every 2 hours while awake; every 6 hours at night. d. Use soft toothbrush. e. Remove dentures except for meals; be certain dentures fit well. f. Apply lip lubricant. g. Avoid foods that are spicy or hard to chew and those with extremes of temperature. Severe stomatitis (confluent ulcerations with bleeding and white patches covering more than 25% of oral mucosa). h. Obtain tissue samples for culture and sensitivity tests of areas of infection. i. Assess ability to chew and swallow; assess gag reflex. j. Use oral rinses as prescribed or place patient on side and irrigate mouth; have suction available (may combine in solution saline, anti- Candida agent, such as Mycostatin, and topical anaesthetic agent as described below). k. Remove dentures. l. Use toothette or gauze soaked with solution for cleansing. m. Use lip lubricant. n. Provide liquid or pureed diet.

c. Assists in removing debris, thick secretions and bacteria. d. Minimises trauma. e. Minimises friction and discomfort.

f. Promotes comfort. g. Prevents local trauma.

h. Assists in identifying need for antimicrobial therapy.

i. Patient may be in danger of ­aspiration. j. Facilitates cleansing, provides for safety and comfort.

k. Prevents trauma from ill-fitting ­dentures. l. Limits trauma, promotes comfort. m. Promotes comfort. n. Ensures intake of easily digestible foods. o. Decreased oral intake and ­ulcerations potentiate fluid deficits. 4. a. Alleviates pain and increases sense of well-being; promotes participation in oral hygiene and nutritional intake. b. Adequate management of pain related to severe stomatitis can facilitate improved quality of life, participation in other aspects of activities of daily living, oral intake and verbal communication. c. Promotes removal of debris, ­healing and comfort.

o. Monitor for dehydration.

4. Minimise discomfort. a. Consult doctor for use of topical anaesthetic, such as a lidnococaine viscous mouthwash 1%.

b. Administer systemic analgesics as prescribed.

c. Perform mouth care as described.

Nursing problem: Impaired tissue integrity: alopecia Goal: Maintenance of tissue integrity; coping with hair loss

Nursing interventions 1. Discuss potential hair loss and regrowth with patient and family.

Rationale 1. Provides information so patient and family can begin to prepare cognitively and emotionally for loss.

Expected outcomes • Identifies alopecia as potential side effect of treatment.

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