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 • Reports decrease in nausea. • Reports decrease in incidence of vomiting. • Consumes adequate fluid and food when nausea subsides. • Demonstrates use of distraction, relaxation and imagery when ­indicated. • Exhibits normal skin turgor and moist mucous membranes. • Reports no additional weight loss.

Rationale 3. Unpleasant sensations can stimulate the nausea and vomiting centre. 4. Decreases anxiety, which can contribute to nausea and vomiting. Psychological conditioning may also be decreased. 5. Administration of antiemetic regime before onset of nausea and vomiting limits the adverse experience and facilitates control. Combination drug therapy reduces nausea and vomiting through various triggering mechanisms. 6. Adequate fluid volume dilutes drug levels, decreasing stimulation of vomiting receptors. 7. Reduces unpleasant taste sensations. 8. Increased comfort increases physical tolerance of symptoms. 9. Multiple factors may cause nausea and vomiting.

Nursing interventions 3. Prevent unpleasant sights, odours and sounds in the environment. 4. Use distraction, music therapy, biofeedback, self-hypnosis, relaxation techniques and guided imagery before, during and after chemotherapy. 5. Administer prescribed antiemetics, sedatives and corticosteroids before chemotherapy and afterward as needed. 6. Ensure adequate fluid hydration before, during and after drug administration; assess intake and output. 7. Encourage frequent oral hygiene. 8. Provide pain relief measures, if necessary. 9. Assess other causes of nausea and vomiting, such as constipation, gastrointestinal irritation, electrolyte imbalance, radiation therapy, medications and central nervous system metastasis. 10. Consult with dietician as needed.

10. Interdisciplinary collaboration essential in addressing complex patient needs.

Nursing problem: Imbalanced nutrition: less than body requirements, related to anorexia, cachexia or malabsorption Goal: Maintenance of nutritional status and of weight within 10% of pre-treatment weight

Nursing interventions 1. Teach patient to avoid unpleasant

Rationale 1. Anorexia can be stimulated or increased with noxious stimuli.

Expected outcomes • Patient and family identify minimal nutritional requirements. • Exhibits weight loss no greater than 10% of pre-treatment weight. • Reports decreasing anorexia and increased interest in eating. • Demonstrates normal skin turgor. • Identifies rationale for dietary modifications. Patient and family verbalise strategies to address/ minimise nutritional deficits. • Participates in kilojoule counts and diet histories. • Uses appropriate relaxation and imagery before meals. • Exhibits laboratory and clinical findings indicative of adequate nutritional intake: normal serum protein and transferrin levels; normal serum iron levels; normal haemoglobin, haematocrit and lymphocyte levels; normal urinary creatinine levels. • Consumes diet high in required nutrients.

sights, odours, sounds in the environment during mealtime.

2. Suggest foods that are preferred and well tolerated by the patient, preferably high-kilojoule and high- protein foods. Respect ethnic and cultural food preferences. 3. Encourage adequate fluid intake, but limit fluids at mealtime.

2. Foods preferred, well tolerated, and high in kilojoules and protein maintain nutritional status during periods of increased metabolic demand. 3. Fluids are necessary to eliminate wastes and prevent dehydration. Increased fluids with meals can lead to early satiety. 4. Smaller, more frequent meals are better tolerated because early satiety does not occur. 5. A quiet environment promotes relaxation. Social interaction at mealtime increases appetite. 6. Wine often stimulates appetite and adds kilojoules. 7. Cold, high-protein foods are often more tolerable and less odorous than hot foods. 8. Supplements and snacks add protein and kilojoules to meet nutritional requirements.

4. Suggest smaller, more frequent meals.

5. Promote relaxed, quiet environment during mealtime with increased social interaction as desired. 6. If possible, serve wine at mealtime with foods. 7. Consider cold foods, if desired.

8. Encourage nutritional supplements and high-protein foods between meals.

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