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

Rationale 9. Oral hygiene stimulates appetite and increases saliva production. 10. Pain impairs appetite. 11. Nausea and vomiting increase anorexia. 12. Increased activity promotes appetite. 13. Relief of anxiety may increase appetite. 14. Proper body position and alignment are necessary to aid chewing and swallowing. 15. Tube feedings may be necessary in the severely debilitated patient who has a functioning gastrointestinal system. 16. Parenteral nutrition with supplemental fats supplies needed kilojoules and proteins to meet nutritional demands, especially in the non-functional gastrointestinal system. 17. Although the mechanism is unclear, medications such as megestrol acetate (Megace) have been noted to improve appetite in patients with cancer and HIV infection. 18. Pressuring patient to eat may cause conflict and unnecessary stress. 19. Multiple factors contribute to anorexia and nausea.

Expected outcomes • Carries out oral hygiene before meals. • Reports that pain does not interfere with meals. • Reports decreasing episodes of nausea and vomiting. • Participates in increasing levels of activity. • States rationale for use of tube feedings or hyperalimentation. • Participates in management of tube feedings or parenteral nutrition, if prescribed.

Nursing interventions 9. Encourage frequent oral hygiene. 10. Provide pain relief measures. 11. Provide control of nausea and ­vomiting. 12. Increase activity level as tolerated. 13. Decrease anxiety by encouraging verbalisation of fears, concerns; use of relaxation techniques; imagery at mealtime. 14. Position patient properly at mealtime. 15. For collaborative management, provide enteral tube feedings of commercial liquid diets, elemental diets or blended foods as prescribed. 16. Provide parenteral nutrition with lipid supplements as prescribed. 18. Encourage family and friends not to nag or cajole patient about eating. 19. Assess and address other contributing factors to nausea, vomiting and anorexia such as other symptoms, constipation, GI irritation, electrolyte imbalance, radiation therapy, medications and central nervous system metastasis. Nursing interventions 1. Encourage several rest periods during the day, especially before and after physical exertion. 2. At minimum, promote patient’s ­normal sleep habits. 3. Rearrange daily schedule and organise activities to conserve energy expenditure. 4. Encourage patient to ask for others’ assistance with necessary chores, such as housework, childcare, shopping, cooking. 5. Encourage reduced job workload, if possible, by reducing number of hours worked per week. 17. Administer appetite stimulants as prescribed by doctor.

Nursing problem: Fatigue Goal: Increased activity tolerance and decreased fatigue level

Rationale 1. During rest, energy is conserved and levels are replenished. Several shorter rest periods may be more beneficial than one longer rest period. 2. Sleep helps to restore energy levels. 3. Reorganisation of activities can reduce energy losses and stressors.

Expected outcomes • Reports decreasing levels of fatigue. • Increases participation in activities gradually. • Rests when fatigued. • Reports restful sleep. • Requests assistance with activities appropriately. • Reports adequate energy to participate in activities important to them (e.g. visiting with family, hobbies). • Consumes diet with recommended protein and kilojoule intake.

4. Conserves energy.

5. Reducing workload decreases ­physical and psychological stress and increases periods of rest and relaxation.