Cancer Diagnosis Nursing Care Plan: Comprehensive Guide for Patient Care

Table of Contents

Understanding Cancer

Cancer is not a single disease but rather a collective term for over 100 diseases characterized by abnormal cell growth. This uncontrolled proliferation and lack of cell maturation can originate in any tissue within the body, leading to a wide range of manifestations. Essentially, cancer disrupts the normal cellular lifecycle, causing cells to divide and spread without the typical regulatory signals.

From breast cancer and skin cancer to lung, colon, prostate cancer, and lymphoma, the diversity of cancer is vast. Each type presents with unique symptoms and requires tailored treatment approaches, which may include chemotherapy, radiation therapy, and surgery, or a combination of these modalities.

Nursing Care Plans and Comprehensive Management

Nurses are integral to the care of patients diagnosed with cancer, playing a multifaceted role in their journey. A well-structured Cancer Diagnosis Nursing Care Plan is essential for effective patient management. This plan encompasses a wide spectrum of responsibilities, including thorough assessment, administering and supporting cancer therapies (such as chemotherapy and radiation), effective pain management, promoting optimal nutrition, and providing crucial emotional and psychological support. The nursing care plan acts as a roadmap, guiding interventions and ensuring holistic patient-centered care.

Prioritized Nursing Problems

When caring for patients with cancer, nurses must prioritize several key areas to ensure the best possible outcomes:

• Conducting comprehensive assessments and administering prescribed cancer treatments with precision.
• Proactively managing the often challenging side effects associated with cancer treatments.
• Delivering robust supportive care and patient education to empower patients and families.
• Collaborating and coordinating care with an interdisciplinary team of healthcare professionals.
• Providing empathetic emotional support and counseling to address the psychological impact of cancer.
• Acting as a patient advocate, ensuring their needs and preferences are met within the healthcare system.
• Vigilantly monitoring patient responses to treatment and promptly reporting any significant changes in condition.
• Facilitating access to necessary resources and support services to enhance the patient’s overall well-being.

In-depth Nursing Assessment

A thorough nursing assessment is the foundation of an effective cancer diagnosis nursing care plan. Nurses must meticulously gather both subjective and objective data to understand the patient’s unique presentation and needs.

Subjective and Objective Assessment Data:

• Unexplained Weight Loss: Document any unintentional and significant weight loss, as this can be an early indicator of cancer or a consequence of the disease process.
• Persistent Fatigue and Weakness: Evaluate the patient’s level of fatigue and weakness, noting its impact on daily activities. Differentiate between typical tiredness and cancer-related fatigue, which is often unrelenting and not relieved by rest.
• Chronic Pain: Assess the presence, location, intensity, characteristics, and aggravating/relieving factors of persistent pain. Cancer pain can be caused by the tumor itself, treatment, or related complications.
• Skin Changes: Observe for any alterations in skin color, such as jaundice (yellowing) or hyperpigmentation (darkening). Note any new moles, changes in existing moles, or lesions that are slow to heal.
• Changes in Bowel or Bladder Habits: Inquire about any new onset constipation, diarrhea, changes in stool caliber, urinary frequency, urgency, or blood in urine or stool. These changes can signal cancers of the gastrointestinal or genitourinary tracts.
• Dysphagia or Persistent Indigestion: Assess for difficulty swallowing (dysphagia) or persistent indigestion, which could be indicative of esophageal or stomach cancer.
• Mole or Wart Changes: Carefully examine any moles or warts for changes in size, shape, color, or border irregularity, which are potential warning signs of skin cancer (melanoma).
• Persistent Cough or Hoarseness: Evaluate a persistent cough that is not related to a respiratory infection or hoarseness that lasts for more than a few weeks, as these can be symptoms of lung or laryngeal cancer.
• Unexplained Bleeding or Bruising: Investigate any unexplained bleeding (e.g., nosebleeds, bleeding gums, rectal bleeding) or easy bruising, which could be related to blood cancers or the effects of cancer treatment.
• Palpable Lumps or Thickening: Systematically palpate the body, including breasts, testicles, lymph nodes, and other areas, for any new lumps or thickening that could be indicative of underlying malignancy.

Close-up of a nurse assessing a patient, gently palpating the patient's neck to check for swollen lymph nodes.

Formulating Nursing Diagnoses

Following a comprehensive assessment, nurses utilize their clinical judgment and understanding of cancer to formulate relevant nursing diagnoses. These diagnoses are crucial for structuring the cancer diagnosis nursing care plan, guiding interventions, and prioritizing patient needs. While the specific nursing diagnoses may vary based on the clinical setting and individual patient presentation, they serve as a standardized framework for addressing common challenges associated with cancer.

Here are examples of nursing diagnoses frequently relevant to cancer patients:

• Complicated Grieving related to cancer diagnosis and perceived loss of normalcy and future plans.
• Disturbed Body Image related to changes in physical appearance from hair loss, surgical scars, or weight changes.
• Acute Pain related to tissue inflammation, tumor compression, nerve involvement, and treatment side effects.
• Imbalanced Nutrition: Less than Body Requirements related to nausea, vomiting, anorexia, altered taste, and metabolic demands of cancer.
• Fatigue related to cancer treatments, anemia, pain, emotional distress, and altered metabolic processes.
• Risk for Infection related to immunosuppression secondary to cancer and its treatments.
• Risk for Impaired Oral Mucous Membrane Integrity related to effects of chemotherapy and radiation therapy.
• Impaired Skin Integrity related to radiation exposure, chemotherapy, surgical incisions, and immobility.
• Constipation related to decreased physical activity, opioid use, dehydration, and tumor obstruction.
• Disturbed Body Image related to changes in physical appearance and emotional distress impacting sexuality.
• Anxiety related to fear of cancer prognosis, uncertainty about treatment outcomes, and impact on life.
• Ineffective Coping related to new cancer diagnosis and changes in family dynamics.

Setting Nursing Goals and Expected Outcomes

Establishing clear and measurable goals is a vital component of the cancer diagnosis nursing care plan. These goals provide direction for nursing interventions and serve as benchmarks for evaluating patient progress. Goals should be patient-centered, realistic, and achievable, considering the individual’s overall condition and prognosis.

Examples of nursing goals and expected outcomes for cancer patients include:

• Emotional Well-being: The patient will identify and express their feelings openly and appropriately throughout their cancer journey.
• Maintaining Quality of Life: The patient will continue to engage in normal life activities to the best of their ability, focusing on present moments while also planning realistically for the future.
• Acceptance and Understanding: The patient will verbalize an understanding of the cancer process, treatment plan, and, if applicable, the dying process, expressing a sense of support and peace.
• Positive Self-Perception: The patient will verbalize an understanding and acceptance of body changes resulting from cancer and treatment, fostering a positive self-image.
• Effective Coping Mechanisms: The patient will develop and utilize healthy coping mechanisms to manage the emotional, physical, and social challenges associated with cancer.
• Adaptation and Adjustment: The patient will demonstrate adaptation to changes and events related to cancer by setting realistic goals and actively participating in work, leisure, and personal relationships as appropriate.
• Pain Management: The patient will report optimal pain relief or control with minimal disruption to activities of daily living (ADLs).
• Stress Reduction: The patient will demonstrate the use of relaxation techniques and diversional activities to manage stress and enhance comfort.
• Nutritional Status: The patient will maintain a stable weight or achieve progressive weight gain toward their ideal body weight, with normalization of relevant laboratory values and absence of malnutrition signs.
• Adequate Hydration: The patient will maintain adequate fluid balance, as evidenced by stable vital signs, moist mucous membranes, good skin turgor, prompt capillary refill, and appropriate urinary output.
• Energy Levels: The patient will report an improved sense of energy and reduced fatigue.
• Functional Ability: The patient will perform ADLs and participate in desired activities at their maximum level of ability.
• Infection Prevention: The patient will remain afebrile and achieve timely wound healing, free from signs and symptoms of infection.
• Oral Mucous Membrane Integrity: The patient will display intact, pink, moist, and inflammation-free oral mucous membranes and demonstrate techniques to maintain oral hygiene.
• Skin Integrity: The patient will maintain intact skin integrity, free from breakdown and complications.
• Bowel Function: The patient will maintain their usual bowel consistency and pattern.
• Sexual Health: The patient will verbalize understanding of the effects of cancer and treatment on sexuality and implement measures to address any concerns, maintaining sexual activity at their desired level.
• Problem-Solving and Decision-Making: The patient will actively participate in the problem-solving process, contributing to decisions related to their care.
• Reduced Fear and Anxiety: The patient will display a reduced range of fear and anxiety, appearing relaxed and reporting manageable anxiety levels.

Nursing Interventions and Actions: Implementing the Care Plan

Therapeutic nursing interventions and actions are the core of the cancer diagnosis nursing care plan. These actions are designed to address the identified nursing diagnoses and achieve the established goals. Interventions are evidence-based, patient-centered, and tailored to the individual’s specific needs and circumstances.

1. Providing Comprehensive Emotional Support and Facilitating Healthy Grieving

Cancer diagnosis and treatment can evoke intense emotions in patients, including fear, anxiety, sadness, anger, and uncertainty. Nurses play a vital role in providing emotional support and assisting patients and their families in navigating the grieving process associated with cancer.

Nursing Interventions:

• Grief Assessment: Regularly assess the patient and their significant others (SOs) to identify their current stage of grief and tailor support accordingly. Explain the grieving process to normalize their feelings and reactions.
• Life Experience Review: Review past life experiences, role changes, and coping skills with the patient. Help them identify past coping strategies that may be useful in managing their current situation.
• Monitor for Distress Signals: Be vigilant for signs of conflict, anger, despair, guilt, hopelessness, or suicidal ideation. These indicators require prompt intervention and may signal spiritual distress or ineffective coping.
• Cultural and Spiritual Considerations: Explore the patient’s and SO’s understanding of and response to death, considering cultural expectations, past experiences with death, beliefs about life after death, and spiritual faith. These factors significantly influence how individuals cope with the possibility of death.
• Acknowledge Initial Shock: Recognize that initial shock and disbelief are common reactions to a cancer diagnosis and traumatizing procedures.
• Therapeutic Communication: Create an open, nonjudgmental environment and utilize therapeutic communication techniques such as active listening and acknowledgment to encourage dialogue about feelings and concerns.
• Encourage Verbalization: Encourage patients to verbalize their thoughts and concerns, accepting expressions of sadness, anger, and rejection as normal responses to their situation.
• Manage Mood Swings: Be aware of potential mood swings, hostility, or acting-out behaviors. Set limits on inappropriate behavior and redirect negative thinking patterns.
• Depression Screening: Be alert to signs of debilitating depression. Directly inquire about the patient’s mental state, as cancer patients are at increased risk for suicide, especially after diagnosis and hospital discharge.
• Reduce Isolation: Visit patients frequently, provide appropriate physical contact, and ensure phone support as needed. Arrange for a caregiver or support person to stay with the patient if necessary to alleviate feelings of isolation and abandonment.
• Honest Information and Hope: Provide honest and factual information about the disease process and treatment, including information about dying when appropriate. Avoid false hope while offering genuine emotional support.
• Identify Positives: Help patients identify positive aspects of their situation, such as potential for remission, slow disease progression, and advancements in cancer therapies.
• Future Planning: Discuss ways patients and SOs can plan for the future together, encouraging the setting of realistic and achievable goals to foster a sense of control.
• Referral to Support Services: Refer patients to visiting nurses, home health agencies, or hospice programs as needed to provide comprehensive physical and emotional support.

2. Enhancing Body Image and Fostering Positive Self-Esteem

Cancer and its treatment can profoundly impact a patient’s body image and self-esteem. Physical changes, altered functional abilities, and shifts in social relationships can lead to self-doubt and insecurity. Nurses play a crucial role in supporting patients in maintaining a positive self-image and coping with these changes.

Nursing Interventions:

• Open Communication: Discuss with the patient and SO how the cancer diagnosis and treatment are affecting the patient’s personal life, home, and work activities to identify specific concerns.
• Anticipatory Guidance: Review anticipated treatment side effects, including potential impacts on sexual activity, attractiveness, and desirability (e.g., alopecia, surgical scars). Emphasize that not all side effects occur and that some can be minimized or managed.
• Role Exploration: Encourage discussion about concerns related to changes in roles as homemaker, wage earner, or parent, as these concerns can hinder treatment acceptance.
• Validate Difficulties: Acknowledge the difficulties patients may be experiencing and provide information that counseling is often beneficial during the adaptation process.
• Support System Assessment: Evaluate the support structures available to and utilized by patients and SOs to plan for both inpatient and post-discharge care.
• Emotional Support During Procedures: Provide consistent emotional support throughout diagnostic tests and treatment phases, recognizing that patients may need additional support during this time.
• Therapeutic Touch: Utilize touch during interactions, if acceptable to the patient, and maintain eye contact to affirm individuality and reduce feelings of insecurity.
• Professional Counseling Referral: Refer patients for professional counseling as needed to help them regain and maintain a positive psychosocial structure, especially if support systems are strained.

3. Effective Management of Acute Pain

Pain is a common and often debilitating symptom for cancer patients, resulting from the disease itself, surgery, radiation therapy, chemotherapy, or other treatments. Effective pain management is a priority in the cancer diagnosis nursing care plan to enhance patient comfort and quality of life.

Nursing Interventions:

• Comprehensive Pain Assessment: Conduct a thorough pain history, including location, frequency, duration, and intensity (using pain scales). Document relief measures used to establish baseline data and evaluate intervention effectiveness. Differentiate between acute and chronic pain.
• Breakthrough Pain Management: Determine the timing and triggers of breakthrough pain when patients are on around-the-clock pain medication. This helps identify the need for dose adjustments or supplemental short-acting pain relievers.
• Therapy-Related Pain Awareness: Be aware of potential pain associated with specific cancer therapies (surgery, radiation, chemotherapy). Provide anticipatory guidance to patients and SOs about what to expect.
• Non-Pharmacological Comfort Measures: Implement non-pharmacological comfort measures such as massage, repositioning, back rubs, and diversional activities (music, television) to promote relaxation and refocus attention.
• Stress Management and Complementary Therapies: Encourage stress management techniques and complementary therapies (relaxation, visualization, guided imagery, biofeedback, laughter, music, aromatherapy, therapeutic touch) to enhance pain control and sense of self-efficacy.
• Cutaneous Stimulation: Provide cutaneous stimulation (heat or cold, massage) to decrease inflammation, muscle spasms, and associated pain. Consider contraindications for heat and cold therapy based on the patient’s condition.
• Address Pain Management Barriers: Be aware of patient-related and healthcare system-related barriers to effective cancer pain management. Address patient fears about addiction, side effects, or beliefs about pain. Advocate for adequate pain assessment and treatment within the healthcare system.
• Regular Pain Reassessment: Evaluate pain relief and control at regular intervals and adjust medication regimens as needed to achieve maximum pain control with minimal interference in ADLs.
• Medication Education: Educate patients and SOs about expected therapeutic effects and side effect management of pain medications to build realistic expectations and confidence.
• Alternative Therapies Discussion: Discuss the use of additional alternative or complementary therapies like acupuncture and acupressure for pain relief.
• Pharmacological Pain Management: Administer analgesics as prescribed, following a stepwise approach to pain management based on pain intensity and type.

4. Optimizing Nutritional and Fluid Volume Status

Cancer and its treatments can significantly impact a patient’s nutritional and fluid status, leading to malnutrition, dehydration, and electrolyte imbalances. Maintaining optimal nutrition and hydration is crucial for supporting the patient’s strength, immune function, and overall well-being. A cancer diagnosis nursing care plan must address these needs proactively.

Nursing Interventions:

• Nutritional Intake Monitoring: Monitor daily food intake and encourage patients to keep a food diary to identify nutritional strengths and deficiencies.
• Anthropometric Measurements: Measure height, weight, and triceps skinfold thickness (or other anthropometric measurements) to assess nutritional status and recent weight loss.
• Skin and Mucous Membrane Assessment: Assess skin and mucous membranes for pallor, delayed wound healing, and parotid gland enlargement, which can indicate protein-calorie malnutrition.
• Fluid Balance Monitoring: Monitor intake and output (I&O), including all output sources (emesis, diarrhea, wound drainage), and urine specific gravity. Calculate 24-hour fluid balance to detect fluid deficits or excesses.
• Daily Weight Monitoring: Weigh patients daily or as indicated to detect subtle fluid balance changes.
• Vital Signs and Circulation Assessment: Monitor vital signs, peripheral pulses, and capillary refill to assess circulatory volume and hydration status.
• Bleeding Tendency Observation: Observe for bleeding tendencies (oozing, ecchymosis, petechiae), which can be exacerbated by nutritional deficiencies and treatment effects.
• Laboratory Studies Monitoring: Monitor relevant laboratory studies (CBC, electrolytes, serum albumin) to assess hydration status and nutritional deficits.
• Stool and Gastric Secretion Testing: Perform Hemoccult tests on stool and gastric secretions to detect gastrointestinal bleeding, which can be related to treatment effects.
• Biochemical Imbalance Assessment: Review laboratory studies (total lymphocyte count, serum transferrin, albumin, prealbumin) to identify the degree of biochemical imbalance and malnutrition, guiding dietary interventions.
• High-Calorie, Nutrient-Rich Diet: Encourage patients to consume a high-calorie, nutrient-rich diet with adequate fluid intake. Recommend supplements and frequent, smaller meals throughout the day to meet increased metabolic needs and fluid requirements.
• Pleasant Dining Environment: Create a pleasant dining atmosphere and encourage patients to share meals with family and friends to enhance appetite and intake.
• Open Communication About Anorexia: Encourage open communication regarding anorexia, addressing emotional distress associated with reduced appetite, especially for SOs.
• Dietary Adjustments Before/After Treatment: Adjust diet before and after treatment (clear liquids, bland foods, candied ginger, dry crackers, toast, carbonated drinks). Give liquids 1 hour before or 1 hour after meals to manage nausea and avoid feeling full quickly.
• Environmental Control: Control environmental factors that can trigger nausea (strong odors, noise). Avoid overly sweet, fatty, or spicy foods.
• Relaxation and Exercise Before Meals: Encourage relaxation techniques, visualization, guided imagery, and moderate exercise before meals to reduce nausea and improve appetite.
• Anticipatory Nausea Management: Identify patients with anticipatory nausea and vomiting and implement appropriate measures, such as changing treatment environment or routine.
• Antiemetic Administration: Administer antiemetics on a regular schedule before, during, and after chemotherapy administration as prescribed to prevent and manage nausea and vomiting.
• Antiemetic Effectiveness Evaluation: Evaluate the effectiveness of antiemetics and adjust medication regimens as needed.
• Increased Fluid Intake Encouragement: Encourage increased fluid intake (3000 mL/day or as tolerated) to maintain hydration and reduce side effects of treatment.
• Venipuncture Minimization: Minimize venipunctures and consider central venous catheter placement to reduce potential for hemorrhage and infection.
• Trauma Prevention and Pressure Application: Avoid trauma and apply pressure to puncture sites to prevent bleeding and hematoma formation.
• IV Fluid Administration: Administer IV fluids as indicated for hydration and to dilute antineoplastic drugs.
• Dietitian/Nutrition Support Referral: Refer patients to a dietitian or nutritional support team for individualized dietary plans and management of malnutrition.
• Enteral or Parenteral Nutrition: Consider NG or feeding tube for enteral feedings or central line for total parenteral nutrition (TPN) in cases of severe malnutrition or prolonged inability to eat orally.

5. Managing Cancer-Related Fatigue

Fatigue is a pervasive and distressing symptom for many cancer patients, significantly impacting their quality of life. Addressing fatigue is a key aspect of the cancer diagnosis nursing care plan.

Nursing Interventions:

• Fatigue Assessment: Have patients rate their fatigue using a numeric scale and identify the time of day when fatigue is most severe to develop personalized management plans.
• Physiological Response Monitoring: Monitor physiological responses to activity (changes in BP, heart rate, respiratory rate) to assess activity tolerance.
• Rest and Activity Planning: Plan care to incorporate rest periods and schedule activities for times when the patient has the most energy. Involve patients and SOs in schedule planning to promote a sense of control.
• Realistic Activity Goals: Establish realistic activity goals with patients to provide a sense of accomplishment and prevent overexertion.
• Self-Care Assistance: Assist with self-care needs when indicated and ensure a safe environment to prevent injury during activities.
• Encourage Activity Within Limits: Encourage patients to engage in activities they are capable of (self-bathing, sitting in a chair, walking) and gradually increase activity levels as tolerated to improve strength and stamina.
• Pain Management: Perform pain assessment and provide effective pain management, as unmanaged pain can exacerbate fatigue.
• Supplemental Oxygen Administration: Provide supplemental oxygen as indicated, especially if anemia or hypoxemia contribute to fatigue.
• Physical/Occupational Therapy Referral: Refer patients to physical or occupational therapy for tailored exercise programs and adaptive devices to conserve energy and improve functional abilities.

6. Minimizing the Risk of Infection

Cancer and its treatments, particularly chemotherapy, can compromise the immune system, significantly increasing the risk of infection. Preventing infection is paramount in the cancer diagnosis nursing care plan.

Nursing Interventions:

• Temperature Monitoring: Monitor temperature regularly, as fever may be an early sign of infection (unless masked by medications).
• Systematic Infection Assessment: Continuously assess all systems (skin, respiratory, genitourinary) for signs and symptoms of infection.
• CBC and Differential Monitoring: Monitor CBC with differential WBC and granulocyte count, and platelet count to assess myelosuppression and infection risk.
• Culture and Sensitivity Testing: Obtain cultures as indicated to identify causative organisms and guide antibiotic therapy.
• Hand Hygiene Promotion: Emphasize and promote rigorous handwashing procedures for staff and visitors.
• Visitor Screening and Restriction: Screen and limit visitors who may have infections and implement reverse isolation if indicated to protect immunocompromised patients.
• Personal Hygiene Promotion: Emphasize and assist with personal hygiene practices to limit potential infection sources.
• Repositioning and Skin Care: Reposition patients frequently and keep linens dry and wrinkle-free to prevent skin breakdown and pressure ulcers, which can be infection portals.
• Rest and Exercise Balance: Promote adequate rest and exercise periods to prevent fatigue and stasis complications (pneumonia, pressure ulcers, thrombus formation).
• Oral Hygiene Emphasis: Stress the importance of good oral hygiene to prevent stomatitis and oral infections.
• Invasive Procedure Limitation: Avoid or limit invasive procedures and adhere to strict aseptic techniques during procedures to minimize infection risk.
• Antibiotic Administration: Administer antibiotics as indicated for treatment of identified infections or prophylactically in high-risk patients.

7. Maintaining Oral Mucous Membrane Integrity and Preventing Stomatitis

Stomatitis, inflammation and ulceration of the oral mucous membranes, is a common side effect of cancer treatments, particularly chemotherapy and radiation therapy. Maintaining oral mucous membrane integrity is essential for patient comfort and preventing secondary infections. The cancer diagnosis nursing care plan includes proactive oral care measures.

Nursing Interventions:

• Dental and Oral Hygiene Assessment: Assess dental health and oral hygiene periodically, especially before initiating chemotherapy or radiation therapy, to identify pre-existing issues and establish baseline data.
• Oral Superinfection Monitoring: Monitor for and educate patients about signs of oral superinfection (thrush) for early detection and treatment.
• Suspicious Lesion Culture: Culture suspicious oral lesions to identify causative organisms and guide appropriate antifungal or antiviral therapy.
• Patient Self-Assessment Education: Encourage patients to assess their oral cavity daily for changes in mucous membrane integrity, discomfort, taste changes, or bleeding.
• Oral Care Education and Demonstration: Discuss areas needing improvement in oral hygiene and demonstrate proper oral care techniques.
• Oral Hygiene Program Implementation: Initiate and recommend a comprehensive oral hygiene program:
  • Avoidance of Irritants: Avoid commercial mouthwashes, lemon or glycerin swabs, and alcohol-based products that can exacerbate dryness and irritation.
  • Therapeutic Mouth Rinses: Use mouthwash made from warm saline, dilute hydrogen peroxide solution, or baking soda and water to rinse before meals and at bedtime.
  • Gentle Brushing: Brush with a soft toothbrush or foam swab to prevent trauma to delicate tissues. Replace toothbrushes regularly.
  • Gentle Flossing/WaterPik: Floss gently or use a WaterPik cautiously to remove food particles, avoiding gum trauma.
  • Lip Moisturization: Keep lips moist with lip gloss, balm, or K-Y Jelly to prevent dryness and cracking.
• Saliva Stimulation: Encourage the use of sugar-free mints, hard candy, or artificial saliva to stimulate secretions and maintain mucous membrane moisture, especially in cases of dehydration or reduced saliva production.
• Dietary Modifications: Instruct patients on dietary modifications, such as avoiding hot, spicy, or acidic foods and juices. Suggest using a straw and consuming soft or blenderized foods, Popsicles, and ice cream as tolerated to minimize oral irritation and facilitate swallowing.
• Fluid Intake Encouragement: Encourage adequate fluid intake to keep mucous membranes moist.
• Smoking and Alcohol Limitation: Discuss the limitations of smoking and alcohol intake, as they can further irritate oral mucous membranes.
• Pre-Treatment Dental Referral: Refer patients to a dentist before initiating chemotherapy or head and neck radiation for prophylactic examination and dental work.
• Pharmacological Management: Administer medications as prescribed, such as antifungal or antiviral mouthwashes, to treat or prevent oral infections.

8. Maintaining Skin Integrity

Cancer patients are at risk for impaired skin integrity due to compromised immune function, treatment side effects (especially radiation), and prolonged bed rest. Maintaining skin integrity is vital for preventing infection and promoting comfort. The cancer diagnosis nursing care plan includes strategies to protect and maintain skin health.

Nursing Interventions:

• Frequent Skin Assessment: Assess skin frequently for side effects of cancer therapy, noting breakdown, delayed wound healing, redness, dryness, and burning sensations, especially in radiation treatment fields.
• IV Site Monitoring: Assess skin around IV sites and veins for erythema, edema, tenderness, welt-like patches, itching, burning, swelling, blisters, ulceration, or tissue necrosis, which may indicate phlebitis, extravasation, or allergic reactions.
• Lukewarm Water Baths: Bathe patients with lukewarm water and mild soap to maintain cleanliness without irritating the skin.
• Gentle Drying: Encourage patients to avoid vigorous rubbing and scratching and to pat skin dry to prevent friction and trauma.
• Frequent Repositioning: Turn or reposition patients frequently to promote circulation and prevent pressure ulcers.
• Radiation Skin Care Protocol: Review skin care protocols for patients receiving radiation therapy:
  • Avoid Irritants: Avoid rubbing, soap, lotions, creams, ointments, powders, or deodorants on the radiation area, as these can potentiate irritation or interfere with radiation delivery.
  • Do Not Remove Markings: Avoid applying heat or washing off markings or tattoos used to identify the irradiation area.
• Loose Cotton Clothing: Recommend wearing soft, loose cotton clothing and advise female patients to avoid bras if they create pressure.
• Moisturizing Agents: Apply cornstarch, Aquaphor, Lubriderm, Eucerin, or other recommended water-soluble moisturizing gels to the affected area as needed to soothe and protect the skin.
• Sun Protection: Encourage liberal use of sunscreen or sunblock and breathable, protective clothing to protect skin from ultraviolet rays and reduce the risk of recall reactions.
• Immediate Skin Washing for Spills: Advise patients and caregivers to immediately wash skin with soap and water if antineoplastic agents spill on unprotected skin.
• Sun Exposure Avoidance with Specific Chemotherapy: Advise patients receiving 5-fluorouracil (5-FU) and methotrexate to avoid sun exposure, as it can exacerbate skin reactions.
• Dermatologic Side Effect Education: Review expected dermatologic side effects of chemotherapy (rash, hyperpigmentation, peeling) to provide anticipatory guidance.
• Alopecia Education: Inform patients about the possibility of alopecia (hair loss) and hair regrowth after chemotherapy, noting that hair regrowth after radiation may be less predictable.
• Temperature Compresses: Apply ice packs or warm compresses per protocol to manage localized reactions at IV sites, considering the type of agent used.

9. Normalizing Bowel Function

Bowel function can be significantly disrupted in cancer patients due to the disease, medications (especially opioids), and reduced physical activity. Managing constipation and diarrhea is an important aspect of the cancer diagnosis nursing care plan.

Nursing Interventions:

• Usual Elimination Habit Assessment: Ascertain usual elimination habits to establish a baseline for evaluating therapeutic needs and effectiveness.
• Bowel Sound and Movement Monitoring: Assess bowel sounds and record bowel movements (BMs), including frequency and consistency, especially during Vinca alkaloid therapy, as constipation can be an early sign of neurotoxicity.
• I&O and Weight Monitoring: Monitor I&O and weight to detect dehydration, weight loss, and electrolyte imbalances associated with diarrhea or inadequate fluid intake contributing to constipation.
• Impaction Assessment: Check for impaction if the patient has not had a BM in 3 days or if abdominal distension, cramping, or headache are present.
• Serum Electrolyte Monitoring: Monitor serum electrolytes as indicated, as imbalances can contribute to altered GI function.
• Fluid, Fiber, and Exercise Encouragement: Encourage adequate fluid intake (2000 mL/24 hours), increased dietary fiber, and regular exercise to improve stool consistency and stimulate peristalsis, reducing constipation risk.
• Low-Residue Diet (if indicated): Provide small, frequent meals of low-residue foods (if not contraindicated) while maintaining adequate protein and carbohydrates to reduce gastric irritation and bowel stimulation in cases of diarrhea.
• Dietary Adjustments: Adjust diet as appropriate, avoiding high-fat foods, high-fiber foods, gas-producing foods, caffeine, and extremely hot or cold foods and fluids, which can exacerbate diarrhea or GI discomfort.
• IV Fluid Administration: Administer IV fluids as indicated to prevent dehydration and dilute chemotherapy agents to reduce side effects.
• Antidiarrheal Agent Administration: Administer antidiarrheal agents (loperamide, diphenoxylate/atropine, bismuth subsalicylate) as indicated to manage diarrhea.
• Stool Softener and Laxative Administration: Administer stool softeners, laxatives, and enemas as indicated, especially prophylactically for patients at risk for constipation (e.g., those receiving Vinca alkaloids or opioids).

10. Addressing Sexuality Concerns

Cancer and its treatment can significantly impact a patient’s sexuality, leading to decreased libido, altered body image, and intimacy challenges. Addressing sexuality concerns is an important, often overlooked, aspect of holistic cancer care and should be included in the cancer diagnosis nursing care plan.

Nursing Interventions:

• Open Discussion About Sexuality: Discuss the nature of sexuality and potential reactions to alterations or threats to sexual function with patients and SOs. Normalize these problems and inform them that seeking assistance is common and helpful.
• Treatment Side Effect Education: Advise patients about specific side effects of prescribed cancer treatments that are known to affect sexuality, providing anticipatory guidance.
• Sexual Health Education and Resources: Provide education and resources on sexual health, addressing concerns, misconceptions, support services, counseling options, and strategies to enhance intimacy and sexual well-being.
• Privacy Provision: Provide private time for hospitalized patients to address intimacy needs, respecting their privacy by knocking before entering and seeking permission to enter.
• Sex Counselor Referral: Refer patients to a sex counselor as indicated for additional support and specialized guidance.

11. Reducing Fear and Anxiety and Providing Consistent Emotional Support

Fear and anxiety are common and understandable emotional responses to a cancer diagnosis. Nurses play a crucial role in reducing fear and anxiety and providing consistent emotional support to patients and their families throughout their cancer journey. This is a cornerstone of a patient-centered cancer diagnosis nursing care plan.

Nursing Interventions:

• Previous Cancer Experience Assessment: Review the patient’s and SO’s previous experiences with cancer to identify potential fears and misconceptions.
• Grief Stage Identification: Identify the stage and degree of grief the patient and SO are currently experiencing to tailor interventions appropriately.
• Ineffective Coping Sign Monitoring: Note signs of ineffective coping (poor social interactions, helplessness, withdrawal) to identify patients needing additional support.
• Denial and Depression Alertness: Be alert to signs of denial and depression (withdrawal, anger, inappropriate remarks). Assess for suicidal ideation and potential risk.
• Encourage Thought and Feeling Sharing: Encourage patients to share their thoughts and feelings to address realistic fears and misconceptions.
• Open and Safe Environment Provision: Provide an open environment where patients feel safe to discuss feelings or remain silent without judgment.
• Frequent Contact and Reassurance: Maintain frequent contact with patients, talking and touching them appropriately to provide assurance and convey respect and acceptance.
• Isolation Effect Awareness: Be aware of the effects of isolation when required by immunosuppression or radiation implants and minimize sensory deprivation by limiting isolation measures when possible.
• Fear Clarification and Coping Strategy Development: Assist patients and SOs in recognizing and clarifying fears to develop effective coping strategies.
• Accurate and Consistent Information: Provide accurate, consistent information about diagnosis and prognosis, avoiding arguments about the patient’s perceptions.
• Emotional Expression Permittance: Permit expressions of anger, fear, and despair without confrontation, assuring patients that these feelings are normal.
• Treatment Explanation: Explain the recommended treatment, its purpose, and potential side effects, and help patients prepare for treatments to reduce anxiety and fear of the unknown.
• Procedure and Consultation Explanation: Explain procedures, provide opportunities for questions and honest answers, and stay with patients during anxiety-provoking procedures and consultations.
• Consistent Caregiver Assignment: Provide primary and consistent caregivers whenever possible to foster therapeutic relationships and continuity of care.
• Calm and Quiet Environment: Promote a calm, quiet environment to facilitate rest, conserve energy, and enhance coping abilities.
• Support System Interaction Encouragement: Encourage and foster patient interaction with support systems, including family, friends, and cancer support groups, to reduce feelings of isolation.
• SO Support: Provide reliable and consistent information and support for SOs to reduce their anxiety and enable them to better support the patient.
• SO Involvement in Decision-Making: Include SOs as indicated or as the patient desires when major decisions are to be made.
• Family and Support Network Assessment: Note family components, extended family, friends, and neighbors who can provide support and respite care.
• Family Communication Pattern Assessment: Identify communication patterns within the family and patterns of interaction to assess effectiveness and identify potential problems.
• Role Expectation Discussion: Assess role expectations of family members and encourage open discussion to promote understanding and shared expectations.
• Energy Direction Assessment: Assess energy direction (purposeful or scattered problem-solving efforts) to guide interventions for more effective energy utilization.
• Cultural and Religious Belief Consideration: Note cultural and religious beliefs, as they affect patient and SO reactions to diagnosis, treatment, and outcomes.
• Helplessness Expression Listening: Listen for expressions of helplessness, which can hinder adjustment and treatment cooperation.
• Warm and Respectful Family Interaction: Interact with family members in a warm, caring, and respectful way, providing verbal and written information and reinforcement as needed.
• Anger Expression Encouragement: Encourage appropriate expressions of anger without negative reactions to facilitate grieving process progression.
• Situation Difficulty Acknowledgment: Acknowledge the difficulties of the cancer diagnosis and treatment process.
• Previous Coping Strategy Identification: Identify and encourage the use of previously successful coping behaviors.
• Open Family Dialogue Stress: Stress the importance of continuous open dialogue between family members for understanding and problem-solving.
• Support Group and Therapy Referral: Refer to support groups, clergy, and family therapy as indicated for additional support in managing complex emotional and family dynamics.

12. Administering Medications and Providing Pharmacologic Support

Pharmacologic interventions are a crucial component of cancer care, encompassing pain management, symptom control, and treatment side effects management. The cancer diagnosis nursing care plan includes meticulous medication administration and monitoring.

Pharmacologic Agents Commonly Used in Cancer Care:

• Opioid Analgesics: Codeine, morphine (MS Contin), oxycodone (OxyContin), hydrocodone (Vicodin), hydromorphone (Dilaudid), methadone (Dolophine), fentanyl (Duragesic), oxymorphone (Numorphan) for moderate to severe pain management, with various routes of administration available (oral, IV, transdermal, rectal, subcutaneous). Addiction is not a primary concern in cancer pain management.
• Non-Opioid Analgesics: Acetaminophen (Tylenol) and NSAIDs (aspirin, ibuprofen [Motrin, Advil], piroxicam [Feldene], indomethacin [Indocin]) for mild to moderate pain, often used in conjunction with opioids.
• Corticosteroids: Dexamethasone (Decadron) for pain associated with inflammatory processes, metastatic bone pain, spinal cord compression, and neuropathic pain.
• Analgesic Rinses: Mixtures of Kaopectate, pectin, diphenhydramine (Benadryl), and topical lidocaine (Xylocaine) for oral pain relief from stomatitis. Use as a swish-and-spit, not gargle, to avoid numbing the gag reflex.
• Antifungal and Antibacterial Mouthwashes: Nystatin (Mycostatin) and antibacterial mouthwashes like Biotane to prevent or treat secondary oral infections (Candida, Pseudomonas, herpes simplex).
• Antiemetics: To prevent and manage nausea and vomiting associated with chemotherapy and radiation therapy.
• Skin Moisturizers and Protectants: Cornstarch, Aquaphor, Lubriderm, Eucerin, and other water-soluble moisturizing gels to protect skin integrity, relieve dryness, and absorb moisture.
• Antidiarrheal Agents: Loperamide, diphenoxylate/atropine, and bismuth subsalicylate to manage diarrhea.
• Stool Softeners: Docusate sodium (Colace) to prevent constipation by softening stool.
• Laxatives: Polyethylene glycol (PEG) to relieve constipation by drawing water into the intestines and promoting bowel movements.

Recommended Resources for Cancer Nursing Care Planning

For further information and resources on cancer diagnosis nursing care plans, consider these recommended books and resources:

• Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
• Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
• Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
• Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
• All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health

See Also

Explore these additional resources for related nursing care plans:

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