CARE OF PATIENTS BY USING NURSING PROCESS FOR B.SC NURSING AND M.SC NURSING STUDENTS

1. TOPIC :
CARE OF PATIENTS WITH CANCER
PRESENTED BY:
BHUMIKABEN.G.THAKOR

2. INTRODUCTION
 Nurses have traditionally been involved with the
care, tertiary prevention and rehabilitation of patients
after cancer diagnosis and treatment.

3. HOLISTIC NURSING CONSIDERATIONS
1) Primary level care:
 Prevention and Screening/ client education
2) Secondary level care:
 Diagnostic Testing Treatment and side-effects of
Surgery, Radiotherapy ,Chemotherapy
3) Tertiary level care:
 End of life and psychosocial issues

4. 1) Primary level care:
 PREVENTION AND SCREENING Patient Education
 Health promotion:
Diet high in whole grains,Vit C, & fruits & vegetables.
Limit fat, alcohol, smoked.
Maintain healthy immune system.
 Avoidance of carcinogens:
Limit exposure to sun, tobacco smoke/chew, radiation,
viruses,chronic irritants, immunosuppressants.

5. Continue…
 Regular cancer screening : ACS Cancer Detection
Guidelines
 C A U T I O N Annual physical exam,

6. Continue…
BREAST SELF EXAMINATION
TESTICULAR SELF
EXAMINATION

7. 2) SECONDARY level care:
 DIAGNOSTIC TESTING
 Patient Education And Support
 Common laboratory tests: CBC, bilirubin, alkaline
and acid phosphatase, tumor markers (PSA)
 Radiological procedures: CT, PET, MRI, ultrasound,
mammography
 Endoscopic procedures:
Bronchoscopy,
Esophagoscopy etc.

8. CANCER TREATMENT
CHEMOTHERAPY
Nursing Care
 Prior to administration: hydration and anti-emetics
 During administration: vesicant precautions: gloves,
monitor IV site closely
 Post administration: utilize interventions for common
side effects:
 Myelo suppression
 infection,
 bleeding,
 fatigue ,
 GI complications – anorexia,Nausea/Vomiting,
 xerostomia, Alopecia

9. Chemotherapeutic Agents/
Anti Neo plastic Drugs
Examples :
 Alkylating Agents
e.g Cytoxan, Cisplatin
 Antimetabolites
e.g Methotrexate ,5-FU
 Plant Alkaloids (Anti-mitotics)
e.g Vincristine (Oncovin)
 Antibiotics
e.g Bleomycin

10. Immunotherapy/Targeted Therapy
Biological Response
Modifiers(BRM)
 Interferon Monoclonal Antibodies – Herceptin
Interleukin
 Colony Stimulating Factor (CSF)- Neupogen ,Epogen
 Gene Therapy

11. CANCER TREATMENT
EXTERNAL RADIATION
Nursing Care
 Teletherapy :
• Promote nutrition and rest
• Do not remove simulation markings
• Utilize interventions for common side effects:
Myelosuppression – infection, bleeding, fatigue
GI complications – anorexia, Nausea/Vomiting,
taste alterations, mucositis, xerostomia, diarrhea

12. CANCER TREATMENT
INTERNAL RADIATION
Nursing Care
 Brachytherapy – Sealed vs Unsealed
 Safety considerations:
• Private room. Radioactive caution sign
• Limit visitors to ½ hr; no under 18,
• no pregnant
• Rotate nurse assignments/ wear dosimeter

13. CANCER TREATMENT –
SURGERY NursingCare
 Pre-operative teaching
 Nutritional promotion
 pre and post operative Pain control
 Monitor for post-operative complications

14. THE PATIENT WITH CANCER
A NURSING PROCESS APPROACH

The following common problems should be
considered:
 Infection
 Bleeding
 Pain
 Malnutrition
 Fatigue
 Psychosocial Issues

15. FOCUSEDASSESSMENT of
the Patient with Cancer
 S/S of bleeding: Platelets, CBC, gums, stools, urine,
skin, LOC
 S/S of infection: Temp, WBC, respiratory, urinary,
skin, invasive sites Pain: W H A T S U P or S L I D A
 Nutritional Status: Weight, serum albumin &
transferrin, appetite, Nausea &Vomiting, diarrhea,
food aversions/preferences
 Coping skills of patient and
 Patient knowledge: disease, treatment, outcomes

16. DIAGNOSIS
 Chronic pain r/t disease process and therapy
 Nutrition, imbalanced; less than body requirements r/t
anorexia,
 Fatigue r/t myelosuppression
 Risk for injury r/t bleeding tendencies
 Risk for infection r/t diminished immunity
 Risk for ineffective coping r/t diagnosis of cancer
 Body image disturbance r/t surgical Intervention /
alopecia

17. PLANNING
 Patient will demonstrate:
 Platelet, CBC, albumin, transferrin levels in normal range
 No evidence of bleeding
 No evidence of infection
 Pain relieved and/or controlled
 Progressive weight gain toward goal
 Performance of ADLs within level of ability
 Verbalized awareness of own coping abilities

18. IMPLEMENTATION
 CHRONIC PAIN R/T DISEASE PROCESS
 Acknowledge and accept patient report
 Determine patient’s acceptable pain level
 Administer analgesics per MD orders
 Utilize cognitive-behavioral strategies:
• Guided imagery
• Distraction
• Relaxation etc.

19.  NUTRITION IMBALANCED; LESS THAN BODY
REQUIREMENTS R/T ANOREXIA
 Monitor serum albumin, transferrin, body weight,
intake & output
 Identify patient food likes and dislikes
 Offer small frequent nutrient dense meals/snacks
 Administer anti-emetics & analgesics ac per MD
orders
 ANTI-EMETIC Examples:Zofran, TIgan, Ativan,
Compazine

20.  RISK FOR INFECTION R/T DIMINISHED
IMMUNITY
 Monitor WBC
 Daily Observe closely for S/S infection
 Neutropenic precautions: limit invasive procedures,
private room, no exposure to communicable illness
strict hand washing, no fresh flower, fruits,
vegetables,

21.  RISK FOR INJURY R/T BLEEDING TENDENCIES
 Monitor platelet, CBC, H&H levels
 Observe for S/S bleeding and or hypoxia
 Bleeding precautions: gentle handling, fall
precautions, electric razor, soft toothbrush, gentle
nose blowing, avoid invasive procedures, no rectal
temps, no intercourse
 Administer stool softeners as per MD orders
 Administer transfusion therapy as per MD orders

22.  RISK FOR INEFFECTIVE COPING
 BODY IMAGE DISTURBANCE
 Utilize effective communication techniques and
attentive listening skills
 Encourage patient verbalizations of fears and
concerns
 Provide information on support groups, hospice care
• Provide information regarding plastic surgery,
prosthetic options

23. EVALUATION
 PATIENT WILL: Be free from bleeding, infecti
 Verbalize relief, reduction and control of pain
 Maintain optimal nutritional status
 free of Nausea &V
 Perform ADLs to desired level
 Express feelings about disease, prognosis, body
image, etc.
 Demonstrate healthy coping mechanisms

24. SUPPORTIVE CARE OF PATIENTWITH CANCER
 Symptom control caring for them in their own home
if they so wish
 Supporting them if they decide to refuse treatment for
their cancer
 Emotional support
 Psychosocial support

25. ADDITIONAL CONSIDERATIONS
 Palliative care
 Hospice care
 Complementary therapies
 Community-based care
 Evidence-based practice
 Clinical trials and research