Textbook of Medical-Surgical Nursing 3e

249

Chapter 11

Oncology: Nursing management in cancer care

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

CHART 11-4

Nursing interventions 6. Encourage adequate protein and kilojoule intake. 7. Encourage use of relaxation techniques, mental imagery. 8. Encourage participation in planned exercise programs. 9. For collaborative management, administer blood products as prescribed. 10. Assess for fluid and electrolyte disturbances. 11. Assess for sources of discomfort. Nursing interventions 1. Use pain scale to assess pain and discomfort characteristics: location, quality, frequency, duration, etc. 2. Assure patient that you know that pain is real and will assist him or her in reducing it. 3. Assess other factors contributing to patient’s pain: fear, fatigue, anger, etc. 4. Administer analgesics to promote optimum pain relief within limits of doctor’s prescription. 5. Assess patient’s behavioural responses to pain and pain ­experience. 6. Collaborate with patient, doctor and other healthcare team members when changes in pain management are necessary. Nursing problem: Chronic pain Goal: Relief of pain and discomfort 7. Encourage strategies of pain relief that patient has used successfully in previous pain experience. 8. Teach patient new strategies to relieve pain and discomfort: distraction, imagery, relaxation, cutaneous stimulation, etc. 12. Provide strategies to facilitate mobility.

Rationale 6. Protein and kilojoule depletion decreases activity tolerance. 7. Promotion of relaxation and

Expected outcomes • Uses relaxation exercises and imagery to decrease anxiety and promote rest. • Participates in planned exercise program gradually. • Reports no breathlessness during activities. • Exhibits acceptable haemoglobin and haematocrit levels. • Exhibits normal fluid and electrolyte balance. • Reports decreased discomfort. • Exhibits improved mobility.

psychological rest decreases physical fatigue. 8. Proper exercise programs increase endurance and stamina. 9. Lowered haemoglobin and haematocrit predispose patient to fatigue due to decreased oxygen availability. 10. May contribute to altered nerve transmission and muscle function. 11. Coping with discomfort requires energy expenditure. 12. Impaired mobility requires increased energy expenditure. changes in pain level and evaluation of interventions. 2. Fear that pain will not be considered real increases anxiety and reduces pain tolerance. 3. Provides data about factors that decrease patient’s ability to tolerate pain and increase pain level. 4. Analgesics tend to be more effective when administered early in pain cycle. 5. Provides additional information about patient’s pain. patient, doctor and healthcare team to be effective; patient’s participation decreases the sense of powerlessness. 7. Encourages success of pain relief strategies accepted by patient and family. 8. Increases number of options and strategies available to patient. Rationale 1. Provides baseline for assessing 6. New methods of administering analgesia must be acceptable to

Expected outcomes • Reports decreased level of pain and discomfort on pain scale. • Reports less disruption from pain and discomfort. • Explains how fatigue, fear, anger, etc., contribute to severity of pain and discomfort. • Accepts pain medication as prescribed. • Exhibits decreased physical and behavioural signs of pain and discomfort in acute pain (no grimacing, crying, moaning; displays interest in surroundings and activities). • Takes an active role in administration of analgesia. • Identifies additional effective pain relief strategies. • Uses alternative pain relief strategies appropriately. • Reports effective use of new pain relief strategies and decrease in pain intensity. • Reports that decreased level of pain permits participation in other activities and events.

Nursing problem: Anticipatory grieving related to loss; altered role functioning Goal: Appropriate progression through grieving process

Nursing interventions 1. Encourage verbalisation of fears, concerns and questions regarding disease, treatment and future implications. 2. Explores previous successful coping strategies.

Rationale 1. An increased and accurate knowledge base decreases anxiety and dispels misconceptions.

Expected outcomes • The patient and family progress through the phases of grief as

evidenced by increased verbalisation and expression of grief.

2. Provides frame of reference and examples of coping.

Continues on following page