Textbook of Medical-Surgical Nursing 3e

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Unit 3   Applying concepts from the nursing process

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

CHART 11-4

Expected outcomes • Identifies positive and negative feelings and threats to self-image. • Verbalises meaning that hair and possible hair loss has. • States rationale for modifications in hair care and treatment. • Uses mild shampoo and conditioner and shampoos hair only when ­necessary. • Avoids hair dryer, curlers, sprays, and other stressors on hair and scalp. • Wears hat or scarf over hair when exposed to sun. • Takes steps to deal with possible hair loss before it occurs; hires, borrows, purchases wig or hairpiece. • Maintains hygiene and grooming. • Interacts and socialises with others. • States that hair loss and necessity of wig are temporary.

Nursing interventions 2. Explore potential impact of hair loss on self-image, interpersonal relationships and sexuality. 3. Prevent or minimise hair loss through the following: a. Use scalp hypothermia and scalp tourniquets, if appropriate. b. Cut long hair before treatment. c. Use mild shampoo and conditioner, gently pat dry, and avoid excessive shampooing. d. Avoid electric curlers, curling irons, dryers, clips, barrettes, hair sprays, hair dyes and permanent waves. e. Avoid excessive combing or brushing; use wide-toothed comb. 4. Prevent trauma to scalp. a. Lubricate scalp with vitamins A&D ointment to decrease itching. b. Have patient use sunscreen or wear hat when in the sun. 5. Suggest ways to assist in coping with hair loss: a. Purchase wig or hairpiece before hair loss. b. If hair loss has occurred, take photograph to wig shop to assist in selection. c. Begin to wear wig before hair loss. d. Contact a cancer body for donated wigs or a store that specialises in this product. e. Wear hat, scarf or turban. 6. Encourage patient to wear own clothes and retain social contacts. 7. Explain that hair growth usually begins again once therapy is completed.

Rationale 2. Facilitates coping.

3. Retains hair as long as possible.

a. Decreases hair follicle uptake of chemotherapy (not used

for patients with leukaemia or lymphoma because tumour cells may be present in blood vessels or scalp tissue).

 b–e. Minimises hair loss due to the weight and manipulation of hair.

4. Preserves tissue integrity. a. Assists in maintaining skin integrity.

b. Prevents ultraviolet light ­exposure.

5. Minimises change in appearance.

a. Wig that closely resembles hair colour and style is more easily selected if hair loss has not begun. b. Facilitates adjustment.

e. Conceals loss. 6. Assists in maintaining personal ­identity. 7. Reassures patient that hair loss is usually temporary.

Nursing problem: Imbalanced nutrition, less than body requirements, related to nausea and vomiting Goal: Fewer episodes of nausea and vomiting before, during and after chemotherapy

Nursing interventions 1. Assess the patient’s previous experiences and expectations of

Rationale 1. Identifies patient concerns,

Expected outcomes • Identifies previous triggers of nausea and vomiting. • Exhibits decreased apprehension and anxiety. • Identifies previously used successful interventions for nausea and vomiting.

misinformation, potential strategies for intervention. Also gives patient sense of empowerment and control. 2. Each patient responds differently to food after chemotherapy. A diet containing foods that relieve the patient’s nausea or vomiting is most helpful.

nausea and vomiting, including causes and interventions used. 2. Adjust diet before and after drug administration according to patient preference and tolerance.