Nursing Care for Cancer Patients

Under supervision

- Prof. Dr. Mohamed Latif, CEO of the Egyptian Health Council

 Dr. Kawthar Mahmoud, Head of the Egyptian Nursing Syndicate - Member of the Senate

Supervised by

Prof. Dr. Hussein Khaled, former Minister of Higher Education

Prepared by 

1. Assessment
   In this step, the nurse collects the necessary information about the patient. This is considered one of the most crucial steps and involves gathering information from various sources, including interviews with the patient and their family members, as well as the patient's medical records.
2. Nursing Diagnosis
   After gathering sufficient information, along with the medical diagnosis, the nurse determines the nursing diagnosis for the condition, which marks the beginning of the nursing care plan for the patient.
3. Planning
   In this step, an appropriate plan is developed based on the nursing diagnosis, and priorities are set to achieve the desired goal of the nursing care plan or the nursing process.
4. Implementation
   In this step, the nurse applies the nursing care plan in practice according to the priorities set during the planning phase.
5. Evaluation
   This is the final stage of the nursing care plan, in which the nurse reviews the outcomes of the plan’s application and the interventions implemented for patient care. If the results are unsatisfactory, the nurse must document the evaluation to reassess and identify the patient's problems and needs and formulate a new plan. This will be part of the evaluation step (Step 1).

It is very important to note that the nursing process is continuous and never stops until the patient is discharged from the hospital, including the discharge plan and follow-up care.

Therefore, nursing care for cancer patients must address their various needs throughout the course of their illness, including appropriate screening, symptom management, patient care practices, and preventive measures, while maintaining the highest possible level of normal function and taking supportive measures before, during, and after treatment. Cancer causes significant damage to the patient's body, internal organs, psychological state, social activities, and also affects family members and those around the patient. Specifically, the application of the nursing process involves the following:

• The patient will report a decrease in pain.
• The patient will implement two pain relief strategies.

Assessment:

1. Assess the causes of pain.
   Pain in cancer can result from the disease process or cancer treatments. Identifying the cause of the pain will help plan and assess the most appropriate interventions.
2. Assess the impact of pain on activities.
   Assess whether the pain prevents the patient from moving, eating, or performing other daily activities.

Nursing Interventions:

1. Encourage the patient to use non-pharmacological pain relief interventions: such as massage, meditation, heat, and other recreational activities that help promote relaxation and pain relief.
2. Administer pain-relieving medications as needed: Opioids and non-steroidal anti-inflammatory drugs may be prescribed to help manage pain in cancer patients.
3. Educate the patient about the pain management plan: Better pain control is achieved when the patient has a better understanding of the nature, causes, and treatments of pain.
4. Provide resources to cope with the psychological effects of pain: Cancer pain affects all aspects of the patient's well-being. Behavioral strategies can help the patient cope with discomfort and other unpleasant effects of pain.
5. Encourage complementary therapies if there are no contraindications: Complementary therapies such as acupuncture, yoga, aromatherapy, and hypnosis can help relieve pain without the harmful effects of medications.

• Death Anxiety
Patients diagnosed with advanced cancer often report death anxiety. It is an emotional distress associated with the anticipation of death and the dying process, negatively affecting the individual's quality of life.
Nursing Diagnosis: Anxiety
Associated with: Expectation of disease outcome, expectation of pain, expectation of suffering, awareness of imminent death, uncertainty of diagnosis, discussions around death, changes in family roles.
As evidenced by: Expressing fear of death, expressing concern about the impact of one's death on family members, expressing deep sadness, expressing fear of premature death, expressing fear of pain associated with death, expressing fear of the prolonged dying process, expressing fear of suffering associated with death, expressing fear of separation from loved ones, expressing fear of the unknown, mentioning negative thoughts about death and dying, expressing helplessness.
Expected Outcomes:

• The patient will express their feelings about death and its effects and will seek help in coping.
• The patient will express acceptance of their diagnosis.

Assessment:

1. Assess the patient's condition.
2. Assess the patient's experience with pain.
   Patients with advanced cancer may require palliative care. Pain management and relief should be a priority during the final stages of cancer, as it can help improve the dying patient's experience at the end of life.

Nursing Interventions:

1. Encourage the patient to express their thoughts and feelings: Acknowledging the patient's feelings about their cancer diagnosis, its outcomes, and consequences may enhance trust and the therapeutic relationship. Oncology nurses often serve as a support system for patients undergoing cancer treatments.
2. Educate the patient about the stages of grief: The grieving process is important to help identify one's feelings. Understanding the grieving process normalizes the emotions the patient experiences after a cancer diagnosis, enabling them to cope with grief more effectively.
3. Encourage family members to participate in patient care: A reliable support system will help the patient feel less isolated. Encourage the patient to rely on friends and family for support.

• Risk for Infection
Cancer patients are at an increased risk of infection due to changes in the immune system, and cancer itself and its treatments reduce the body's ability to fight infections.
Nursing Diagnosis: Risk for Infection
Related to: Immunosuppression, cancer treatments, chronic disease processes, invasive treatment procedures.
As evidenced by: Infection risk diagnosis is not confirmed by signs and symptoms, as the problem has not yet occurred, and nursing interventions are directed at preventing symptoms.
Expected Outcomes:

• The patient will identify and begin interventions that can help reduce the risk of infection.
• The patient will be free from signs of infection.

Assessment:

1. Evaluate and assess signs of infection through laboratory tests. Certain laboratory tests may be ordered to identify the causative agents of infection and appropriate treatments, such as a complete blood count to identify bone marrow suppression due to chemotherapy effects.
2. Evaluate and monitor signs of infection. Early detection of infection in different parts of the body provides the opportunity for early intervention to prevent complications.

Nursing Interventions:

1. Encourage infection control measures: Frequent handwashing is recommended to protect the patient from infections. Screening visitors and placing the patient in isolation will help reduce the risk of infection.
2. Monitor for warning signs of infection when there are any wounds or openings (due to catheters or infusions).
3. Stay home when possible. Cancer patients should limit their interaction with large crowds, such as stores or restaurants. When going out for appointments or essential tasks, wearing a mask will reduce the transmission of diseases.
4. Ensure adequate rest while staying active: Cancer patients experience fatigue and weakness due to the effects of the disease and its treatments. Ensuring the patient gets enough rest reduces fatigue, while sufficient exercise can prevent muscle function loss and support healthy immune function.
5. The patient should notify the healthcare team if any signs of infection occur. A cold or flu virus can be harmful to a cancer patient. Ensure the patient informs the healthcare team of symptoms like fever, cough, chills, sore throat, or mouth sores.

• Avoid applying pressure to the scalp.
• Do not use cold water.
• It is recommended to obtain a wig before hair loss, with a prescription.
• If the patient has long hair, it should be trimmed before starting chemotherapy treatment.
• Clean the patient's bed and room from fallen hair regularly.
• Educate the patient that their hair will grow back.

▶️ Skin Changes:

• Educate the patient that skin discoloration is a temporary condition and the skin will return to its normal state.
• You can add moisturizing oils to the water used for bathing.
• Use skin moisturizers no more than three times a day.
• Drink 8–12 cups of water daily.
• Protect the skin from severe and cold air to prevent dryness.
• Avoid using hot water during showers.
• Avoid daily showers unless necessary.

▶️ Loss of Appetite:

• Encourage the patient to eat despite a loss of appetite.
• Replace three main meals with six light meals.
• Serve food to the patient in a comfortable environment, free of odors.
• The patient’s meals should be high in protein and carbohydrates.
• Monitor fluid intake, output, weight, and daily calorie intake.
• Offer the patient their preferred flavors and avoid giving fluids before meals.
• Cold foods are preferred as they do not trigger nausea.
• Avoid foods like undercooked eggs or those containing yeast and bacteria, such as dairy.
• Encourage light exercises before meals.

▶️ Nausea and Vomiting:

• Give the patient anti-nausea medications before, during, and after chemotherapy doses.
• Sleeping during chemotherapy doses can help prevent nausea and vomiting.
• Continue giving anti-nausea medications throughout chemotherapy.
• Hard candies that do not dissolve quickly can help the patient overcome nausea.
• Maintain oral hygiene.
• Avoid strong-smelling foods and stick to multiple small, high-protein, and carbohydrate meals.
• Help the patient practice deep, slow breathing techniques.
• Listening to music or watching TV can help the patient relax and forget the feeling of nausea.

▶️ Mouth Sores:

• Use saltwater and soda for gargling from time to time.
• Offer the patient soft foods and avoid hot foods and spices.
• Remove dentures from the mouth after eating.
• Clean the teeth and mouth with a soft brush and avoid commercial toothpaste.
• If white spots appear inside the mouth, use medications like Nystatin after consulting the doctor.

▶️ Gastrointestinal Disorders (Diarrhea or Constipation):

• Provide appropriate foods for each condition. If the patient suffers from diarrhea, reduce fiber-rich foods; do the opposite if constipated.
• Administer medications as prescribed by the doctor.
• Maintain cleanliness of the anal area.
• Monitor fluid and electrolyte loss due to diarrhea.

▶️ Fatigue:

• Adjust the patient’s daily tasks according to their ability to perform them.
• Allow rest when the patient feels fatigued.
• Ensure the patient gets enough sleep hours to restore energy.

▶️ Changes in Sexual Function:

• Pregnancy should not occur during chemotherapy.
• Wait for five years before planning another pregnancy.
• Educate the couple that cancer is not contagious.
• Encourage the patient to discuss with their partner how their condition and sexual desires are affected by chemotherapy.

▶️ Providing Emotional Support to Cancer Patients:

• The cancer patient should express their feelings to someone (family, friends, cancer survivors, counselors, or mental health specialists), even if they prefer not to talk to others about their illness.
• Focus on positive thoughts even if the time is difficult or inappropriate, or try to find hope instead of thinking the worst, but avoid pretending to be optimistic unless it is genuine.
• Try to focus on everything that can be done to stay as healthy as possible.
• Focusing on the patient’s hobbies may help avoid the anxiety that comes with overthinking about the illness.