4.4 Applying the Nursing Process to Cancer Treatment
Nurses play a crucial role in caring for clients with cancer. Clients with cancer often require extensive, prolonged support to manage symptoms and prevent complications.
Assessment
Focused assessments and diagnostic tests are based on the type of cancer diagnosed.
Nursing Diagnoses
Clients who have been diagnosed with cancer may experience a wide variety of signs and symptoms related to the type of cancer diagnosed and the medical treatments implemented. Nurses assess for signs and symptoms of common nursing diagnoses resulting from cancer treatment, including the following[1]:
- Pain
- Risk for Infection
- Impaired Integrity of Skin and Mucous Membranes
- Fatigue
- Decreased Activity Intolerance
- Imbalanced Nutrition: Less than Body Requirements
- Constipation
- Diarrhea
- Fluid and Electrolyte Imbalance
- Disturbed Body Image
- Fear
- Hopelessness
- Powerlessness
- Spiritual Distress
- Readiness for Enhanced Knowledge
Outcome Identification
Outcome identification includes setting short- and long-term goals and creating specific expected outcome statements for identified nursing diagnoses customized to each client.
Sample expected outcomes for common nursing diagnoses related to cancer are as follows:
- The client will identify and verbalize feelings related to cancer diagnosis and treatment.
- The client will remain free from infection.
- The client will identify three measures to conserve energy and manage fatigue.
- The client will express meaning and purpose in life.
Interventions
Nursing priorities for clients with cancer include the following[2],[3],[4]:
- Managing pain
- Preventing infection
- Promoting skin integrity
- Managing treatment-related side effects such as fatigue and gastrointestinal side effects
- Facilitating nutritional intake
- Providing health teaching, health promotion, and psychosocial support
- Addressing grief and loss
- Managing end-of-life care
Managing Pain
Pain is a common experience for clients with cancer due to the invasive nature of the disease. Cancer cells can invade surrounding tissues and nerves, causing inflammation, pressure, or injury, which triggers the body’s natural response to perceive it as painful. This pain can be related to the cancer itself, surgery, radiation therapy, chemotherapy, or other treatment and can significantly impact a client’s quality of life.[5]
Nurses play a crucial role in assessing pain, implementing appropriate pain relief interventions, and monitoring the effectiveness of pain management strategies. Interventions may include administering pain medications, encouraging nonpharmacological pain relief techniques, and advocating for clients’ comfort.
Read more information about pain assessment and management in the “Comfort” chapter of Open RN Nursing Fundamentals, 2e. Using the WHO ladder when managing pain in clients with cancer is discussed in the “Pain Management” section of this chapter.
Preventing Infection
Many clients diagnosed with cancer are immunocompromised as a result of the disease or treatment(s) and are at significantly increased risk for infection. If a client has an abnormally low neutrophil count, they are at high risk for rapidly developing severe infections and becoming septic. Nurses play a crucial role in implementing infection prevention measures, assessing for new signs of infection, and monitoring the effectiveness of treatment for infection. Review infection protection measures in Table 4.4.
Table 4.4. Infection Prevention Measures
| Intervention | Description |
|---|---|
| Hand Hygiene | Encourage clients, visitors, and health care providers to perform thorough handwashing with soap and water or alcohol-based hand sanitizer before and after interactions. |
| Central Line Care | Follow strict protocols for the insertion, maintenance, and care of central lines to minimize infection risk. |
| Oral Care | Promote good oral hygiene to prevent oral infections, which can be particularly problematic for clients undergoing chemotherapy. |
| Neutropenic Precautions | Implement precautions to minimize the risk of infections due to low neutrophil (white blood cell) count. These include isolation, mask-wearing, and strict hygiene. |
| Environmental Cleanliness | Maintain a clean and sanitized environment in client rooms, treatment areas, and waiting rooms. |
| Vaccination | Ensure that clients and their close contacts are up-to-date on vaccinations, including flu and pneumonia vaccines, to prevent vaccine-preventable infections. |
| Education | Educate clients and their families about infection prevention measures, recognizing early signs of infection, and when to seek medical attention. |
| Avoiding Fresh Fruits and Vegetables | For clients with compromised immune systems, advise against consuming raw or unwashed fruits and vegetables to reduce the risk of foodborne infections. |
| Catheter Care | If the client has a urinary catheter, ensure proper insertion, maintenance, and hygiene to prevent urinary tract infections. |
| Wound Care | Properly assess and care for any wounds or surgical sites to prevent infections. |
| Personal Protective Equipment (PPE) | Train health care providers and clients on the correct use of PPE, such as gloves, masks, gowns, and eye protection. |
| Hydration and Nutrition | Support clients in maintaining good nutrition and hydration, as this can help support their immune system during treatment. |
| Limiting Visitors | Limit the number of visitors and enforce infection control measures for those who do visit. |
| Respiratory Hygiene | Teach visitors and staff to cover their mouths and noses when coughing or sneezing to prevent the spread of respiratory infections. |
| Skin Integrity | Monitor and maintain the integrity of the client’s skin to prevent breakdown and potential entry points for infections. Clients undergoing cancer treatments often require central venous access devices (such as central lines or ports) for administration of chemotherapy and repetitive blood work. Nurses ensure aseptic insertion, maintenance, and care of these devices to prevent infections and other skin complications. |
| Proper Disposal of Medical Waste | Ensure that all medical waste, including used needles and other sharps, is disposed of safely to prevent accidental exposures. |
Promoting Skin Integrity
Clients with cancer often undergo biopsies, surgical interventions, and radiation treatments that cause surgical wounds or impaired skin integrity. These sites require careful nursing assessment and management to promote healing and prevent infection and other complications. Nursing interventions include repositioning, changing dressings, and providing health teaching regarding skin care and good nutrition to promote healing.
Managing Treatment-Related Side Effects
Although specially trained nurses administer chemotherapy according to prescribed protocols and guidelines, all nurses caring for clients diagnosed with cancer assess their overall health, monitor for potential side effects of treatments, and provide health teaching related to treatments.
Cancer and its treatments can lead to various distressing symptoms such as fatigue, nausea, vomiting, loss of appetite, diarrhea, constipation, mouth sores, and weight loss. Nurses assess the client’s symptoms, provide supportive care, and administer medications to alleviate discomfort.
Fatigue
Fatigue is a common and distressing symptom experienced by many clients with cancer. It can significantly impact their quality of life and daily functioning. Cancer-related fatigue may be caused by various factors, including the disease itself, side effects of treatment, emotional distress, and anemia.[6]
Nurses implement a variety of interventions to address fatigue, including energy management techniques, administering blood transfusions, and promoting rest and optimal nutrition.
Review nursing interventions for promoting energy management in the “Iron-Deficiency Anemia” section of the “Hematological Alterations” chapter.
Gastrointestinal Symptoms and Nutritional Intake
Clients with cancer are susceptible to developing stomatitis, a condition characterized by inflammation and ulcers in the oral mucous membranes due to the effects of chemotherapy and radiation therapy. See Figure 4.14[7] for an image of stomatitis. Clients are also at risk for developing additional gastrointestinal side effects such as nausea, vomiting, diarrhea, constipation, mouth sores, and decreased appetite that can cause weight loss and other complications. Nursing interventions for nausea and vomiting include administering antiemetics, IV fluids, and electrolyte replacement, as well as implementing nonpharmacological interventions for nausea. Nurses collaborate with dieticians to assess nutritional status, address dietary challenges, and provide guidance on maintaining adequate nutrition to support recovery and treatment tolerance.
Nursing interventions for preventing stomatitis include providing good oral hygiene, such as gentle brushing with a soft toothbrush and regular rinsing with a nonalcoholic mouthwash and encouraging clients to maintain adequate oral hydration. Additionally, early recognition of oral candidiasis (thrush) and notification of the health care provider lead to prompt treatment of this potential side effect of many medications.[8]
Review nursing assessments and interventions related to facilitating good nutrition in the “Applying the Nursing Process” section of the “Nutrition” chapter of Open RN Nursing Fundamentals, 2e.
Review the pathophysiology of nausea and vomiting and related medications in the “Antiemetics” section of the “Gastrointestinal” chapter of Open RN Nursing Pharmacology, 2e.
Bowel function in clients with cancer is often affected based on the type and location of the cancer, as well as the specific treatment being received. Constipation may occur due to various factors such as side effects of medications (such as opioids), reduced physical activity, and dehydration. Conversely, diarrhea is a common side effect of chemotherapy and radiation therapy and can result in fluid and electrolyte imbalances. Gastrointestinal symptoms, bowel patterns, intake and output, and weight trends should be monitored for clients receiving cancer treatment.
Review concepts related to diarrhea and constipation and common medications used to treat these conditions in the “Antidiarrheal Medications and Laxatives” section of the “Gastrointestinal” chapter of Open RN Nursing Pharmacology, 2e.
Review nursing care related to fluid and electrolyte imbalances in the “Fluids and Electrolytes” chapter of Open RN Nursing Fundamentals, 2e.
Providing Health Teaching and Promoting Health
The diagnosis and treatment of cancer can lead to feelings of fear, hopelessness, powerlessness, and spiritual distress compounded by changes in one’s physical appearance, functional abilities, and social relationships. These feelings can significantly impact a client’s well-being and ability to cope with the challenges of chronic illness, making it crucial for nurses to provide psychosocial support.[9]
Nurses educate clients about their diagnosis, treatments, potential side effects, and self-care techniques. They empower clients to make informed decisions, manage their treatment regimens, and report side effects that may require medical attention.
Nurses encourage verbalization of feelings, offer emotional support, and connect clients with appropriate resources like counseling or support groups. Nurses encourage clients to discuss feelings and concerns about the effects of cancer and associated treatments on their daily functioning and performance of their various roles such as a spouse, parent, caregiver, or employee. Nurses acknowledge the difficulties the client may be experiencing and provide anticipatory guidance related to side effects they may experience (such as buying a wig for anticipated hair loss) or changes that may affect their personal, home, or worklife as they undergo treatment.[10]
Nurses act as advocates for clients, ensuring they receive appropriate care and support. They collaborate with the health care team, address clients’ concerns, and facilitate communication between clients and providers.
Addressing Grief and Loss and Providing End-of-Life Care
Clients diagnosed with cancer typically experience feelings of loss and an associated grieving process as they adapt to changes in their body that impact their daily life and role performance. Spiritual distress is common in clients experiencing serious illness and nurses promote healthy coping and resilience.
For clients in advanced stages of cancer, nurses provide compassionate end-of-life care to clients and their families. This includes symptom control, emotional support, and ensuring client comfort and dignity in their final moments. Additionally, providing spiritual care has been shown to improve clients’ health and quality of life, including how they experience pain, cope with stress and suffering, and approach the end of life.[11]
Review information about grief and loss, common end-of-life symptoms, and related nursing care in the “Grief and Loss” chapter of Open RN Nursing Fundamentals, 2e.
Review information about how nurses provide spiritual care in the “Spirituality” chapter in Open RN Nursing Fundamentals, 2e.
Evaluation
During the evaluation stage, nurses determine the effectiveness of nursing interventions for a specific client. The previously identified expected outcomes are reviewed to determine if they were met, partially met, or not met by the time frames indicated. If outcomes are not met or only partially met by the time frame indicated, the nursing care plan is revised. Evaluation should occur every time the nurse implements interventions with a client, reviews updated laboratory or diagnostic test results, or discusses the care plan with other members of the interprofessional team.
- Makic, M. B., & Martinez-Kratz, M. R. (2023). Ackley and Ladewig’s Nursing diagnosis handbook: An evidence-based guide to planning care (13th ed.). Elsevier. ↵
- Chan, R. J., Teleni, L., McDonald, S., Kelly, J., Mahony, J., Ernst, K., Patford, K., Townsend, J., SIngh, M., & Yates, P. (2020). Breast cancer nursing interventions and clinical effectiveness: A systematic review. BMJ Supportive & Palliative Care 10(3), 276-286. http://dx.doi.org/10.1136/bmjspcare-2019-002120 ↵
- Alfaro-Díaz, C., Svavarsdottir, E. K., Esandi, N., Klinke, M. E., & Canga-Armayor, A. Effectiveness of nursing interventions for patients with cancer and their family members: A systematic review. Journal of Family Nursing, 28(2), 95-114. https://doi.org/10.1177/10748407211068816 ↵
- Vera, M. (2024). 12 cancer nursing care plans. Nurselabs. https://nurseslabs.com/cancer-nursing-care-plans/ ↵
- Vera, M. (2024). 12 cancer nursing care plans. Nurselabs. https://nurseslabs.com/cancer-nursing-care-plans/ ↵
- Vera, M. (2024). 12 cancer nursing care plans. Nurselabs. https://nurseslabs.com/cancer-nursing-care-plans/ ↵
- “Stomatitis.jpg” by https://www.scientificanimations.com/ is licensed under CC BY-SA 4.0 ↵
- Vera, M. (2024). 12 cancer nursing care plans. Nurselabs. https://nurseslabs.com/cancer-nursing-care-plans/ ↵
- Vera, M. (2024). 12 cancer nursing care plans. Nurselabs. https://nurseslabs.com/cancer-nursing-care-plans/ ↵
- Vera, M. (2024). 12 cancer nursing care plans. Nurselabs. https://nurseslabs.com/cancer-nursing-care-plans/ ↵
- Puchalski, C., Jafari, N., Buller, H., Haythorn, T., Jacobs, C., & Ferrell, B. (2020). Interprofessional spiritual care education curriculum: A milestone toward the provision of spiritual care. Journal of Palliative Medicine, 23(6), 777–784. https://doi.org/10.1089/jpm.2019.0375 ↵
a condition characterized by Inflammation and ulcers in the oral mucous membranes due to the effects of chemotherapy and radiation therapy