Nursing Care Plan for Cancer Diagnosis: Comprehensive Guide for Patient Care

Table of Contents

What is Cancer?

Cancer is a broad term encompassing over 100 diseases characterized by the uncontrolled growth and spread of abnormal cells. It’s not a single disease but rather a collection of related diseases, all stemming from disruptions in the normal cellular life cycle. Cancer can originate in virtually any tissue of the body, and its manifestations arise from the body’s failure to regulate cell proliferation and maturation.

The diversity of cancer is vast, with types ranging from common forms like breast, skin, and lung cancer, to colon, prostate cancer, and lymphoma, among many others. Each type of cancer presents with varying symptoms, reflecting the specific organs and systems affected. Treatment approaches are equally diverse, often involving a combination of chemotherapy, radiation therapy, and surgery, tailored to the individual cancer type and stage.

Close-up of a nurse in blue scrubs holding a patient's hand in a hospital room, emphasizing compassionate cancer nursing care.

Nursing Care Plans and Management

Nurses play an indispensable role in the holistic care of patients diagnosed with cancer. A comprehensive Nursing Care Plan For Cancer Diagnosis is crucial, encompassing a wide array of responsibilities. These include thorough assessment, providing essential support for cancer therapies like chemotherapy and radiation, effective pain management, promoting optimal nutrition, and delivering vital emotional and psychological support. The nursing care plan is not just about managing the disease but also about enhancing the patient’s quality of life throughout their cancer journey.

Nursing Problem Priorities

In managing patients with cancer, nurses prioritize several key areas to ensure comprehensive and effective care:

• Conducting thorough assessments and skillfully administering cancer treatments as prescribed.
• Proactively managing treatment-related side effects to improve patient comfort and adherence to therapy.
• Delivering comprehensive supportive care and education to empower patients and families with knowledge and coping strategies.
• Coordinating interdisciplinary care to ensure a holistic and integrated approach to treatment and support.
• Providing empathetic emotional support and counseling to address the psychological impact of cancer diagnosis and treatment.
• Actively advocating for patient needs to ensure their preferences and rights are respected throughout care.
• Diligently monitoring patient responses to treatment and promptly reporting any significant changes to the healthcare team.
• Facilitating access to essential resources and support services to address the broader needs of patients and their families.

Nursing Assessment

A detailed nursing assessment is the first step in creating an effective nursing care plan for cancer diagnosis. Nurses must be vigilant in identifying both subjective reports from the patient and objective clinical signs.

Assess for the following subjective and objective data:

• Unexplained Weight Loss: Significant unintentional weight loss can be an early indicator of cancer.
• Persistent Fatigue and Weakness: Cancer-related fatigue is often profound and unrelieved by rest. Generalized weakness can also be a significant symptom.
• Chronic Pain: Pain that is persistent, new onset, or changes in character needs careful evaluation.
• Skin Changes: Note any new onset of jaundice (yellowing), darkening of the skin, or changes in moles or warts.
• Altered Bowel or Bladder Habits: Changes in bowel habits, such as persistent constipation or diarrhea, or changes in bladder function warrant investigation.
• Dysphagia or Indigestion: New or persistent difficulty swallowing or ongoing indigestion can be symptoms of certain cancers.
• Changes in Moles or Warts: Monitor for any changes in size, shape, color, or texture of moles or warts.
• Persistent Cough or Hoarseness: A cough that doesn’t resolve or new onset hoarseness can be indicative of respiratory or throat cancers.
• Unexplained Bleeding or Bruising: Bleeding without injury or easy bruising requires assessment to rule out underlying causes, including cancer.
• Palpable Lumps or Thickening: Self-examination and clinical examination should assess for any new lumps or thickening, particularly in the breast, testicles, or other areas.

Nursing Diagnosis

Following a comprehensive assessment, nurses formulate nursing diagnoses to precisely address the health challenges posed by cancer. These diagnoses are the foundation of the nursing care plan for cancer diagnosis, guided by the nurse’s expert clinical judgment and deep understanding of each patient’s specific condition. While standardized nursing diagnoses provide a framework for care, their application is always tailored to the individual needs of the patient within various clinical settings. The nurse’s expertise is paramount in prioritizing and customizing the care plan.

Examples of nursing diagnoses frequently relevant to cancer patients include:

• Complicated Grieving related to cancer diagnosis and perceived loss of normalcy and future plans.
• Disturbed Body Image related to changes in physical appearance from cancer treatment.
• Acute Pain related to tissue inflammation and treatment side effects.
• Imbalanced Nutrition: Less than Body Requirements related to nausea and altered taste.
• Fatigue related to cancer treatments and emotional distress.
• Risk for Infection related to weakened immune system secondary to cancer treatment.
• Risk for Impaired Oral Mucous Membrane related to effects of chemotherapy and radiation therapy.
• Impaired Skin Integrity related to radiation exposure.
• Constipation related to decreased physical activity, opioid use, and dehydration.
• Disturbed Body Image related to changes in physical appearance and emotional distress impacting sexuality.
• Anxiety related to fear of cancer prognosis and uncertainty about treatment outcomes.
• Ineffective Coping related to new cancer diagnosis and changes in family dynamics.

Nursing Goals

The goals within a nursing care plan for cancer diagnosis are patient-centered and aim to promote physical, emotional, and psychological well-being. Expected outcomes are designed to be achievable and measurable. Examples of nursing goals for cancer patients include:

• The patient will identify and express feelings appropriately throughout their cancer journey.
• The patient will maintain engagement in normal life activities to the best of their ability, while planning realistically for the future, taking each day as it comes.
• The patient will verbalize understanding of the disease process, treatment plan, and prognosis, and express feelings of being supported in their journey, including grief work if necessary.
• The patient will verbalize acceptance of body changes resulting from cancer and its treatment, and demonstrate acceptance of self in their current situation.
• The patient will develop and utilize effective coping mechanisms to manage the challenges and stressors associated with cancer.
• The patient will demonstrate adaptation to changes and significant life events, as evidenced by setting realistic goals and actively participating in work, leisure, and personal relationships as appropriate.
• The patient will report optimal pain relief or control with minimal interference in their daily activities (ADLs).
• The patient will effectively use relaxation skills and engage in diversional activities as appropriate for their individual needs and preferences.
• The patient will maintain a stable weight or demonstrate progressive weight gain towards their ideal weight, with normalization of relevant laboratory values, and be free from signs of malnutrition.
• The patient will actively participate in specific interventions designed to stimulate appetite and increase dietary intake.
• The patient will exhibit adequate fluid balance, indicated by stable vital signs, moist mucous membranes, good skin turgor, prompt capillary refill, and individually appropriate urinary output.
• The patient will report an improved sense of energy and reduced fatigue.
• The patient will perform activities of daily living (ADLs) and participate in desired activities at their maximum level of ability.
• The patient will remain afebrile and achieve timely wound healing as appropriate, minimizing infection risks.
• The patient will identify and actively participate in interventions aimed at preventing or reducing the risk of infection.
• The patient will display intact mucous membranes that are pink, moist, and free of inflammation or ulcerations.
• The patient will demonstrate effective techniques to maintain or restore the integrity of their oral mucosa.
• The patient will participate in techniques to prevent complications and promote healing as appropriate for their specific situation.
• The patient will maintain their usual bowel consistency and pattern, or manage changes effectively.
• The patient will verbalize understanding of the effects of cancer and treatment on their sexuality, and measures to address any problems.
• The patient will maintain sexual activity at their desired level, to the extent possible within their condition and treatment.
• The patient will demonstrate personal involvement in problem-solving processes aimed at finding appropriate solutions for their situation.
• The patient will encourage and allow family members who are ill to manage their situation in their own way, respecting individual coping styles.
• The patient will display an appropriate range of emotions and experience a reduction in fear and anxiety.
• The patient will appear relaxed and report that anxiety is reduced to a manageable level.

Nursing Interventions and Actions

Therapeutic nursing interventions and actions are crucial components of the nursing care plan for cancer diagnosis. These interventions are designed to address the identified nursing diagnoses and achieve the established goals.

1. Providing Emotional Support and Assisting in Grieving

Cancer diagnosis and treatment can trigger a complex array of emotions. Nurses play a critical role in providing emotional support and guiding patients through the grieving process, which is a key element of a nursing care plan for cancer diagnosis.

Nursing Diagnosis: Complicated Grieving related to cancer diagnosis and perceived loss of normalcy and future plans, as evidenced by expressions of sadness, anger, and statements of hopelessness.

Interventions:

• Assess the patient and significant others (SO) for their current stage of grief. Understanding the stage of grief allows for tailored support and intervention. Explain the grieving process to the patient and SO to normalize their feelings and reactions.
• Review past life experiences, role changes, and coping skills with the patient. Identifying past coping mechanisms can empower patients to utilize these skills in their current situation. Discuss topics of interest to the patient to foster connection and normalcy.
• Monitor for signs of conflict, anger, despair, guilt, hopelessness, or suicidal ideation. These are critical indicators of emotional distress and potential risk. Intervene promptly and appropriately, considering referral for mental health support.
• Explore the patient’s and SO’s understanding of and responses to death. Cultural expectations, past experiences with death, religious beliefs, and faith all influence how individuals cope with mortality. Understanding these factors allows for culturally sensitive and spiritually informed care.
• Acknowledge the initial shock and disbelief that often follow a cancer diagnosis and invasive procedures. Patients and families are often unprepared for the reality of cancer and its treatments.
• Create an open, nonjudgmental environment. Use therapeutic communication techniques such as active listening and validation to encourage open dialogue about feelings and concerns.
• Encourage verbalization of thoughts and concerns. Accept expressions of sadness, anger, and rejection as normal responses to a difficult situation. Normalize these feelings to provide reassurance and support.
• Be aware of mood swings, hostility, and acting-out behaviors. These can indicate ineffective coping. Set clear limits on inappropriate behavior and redirect negative thinking patterns.
• Be vigilant for signs of debilitating depression. Cancer patients are at increased risk for depression and suicide, particularly after diagnosis and hospital discharge. Ask direct questions about their mental state and assess for suicidal ideation.
• Visit patients frequently and offer physical contact if appropriate. For settings where physical presence is limited, provide frequent phone support. Arrange for a caregiver or support person to stay with the patient if needed to reduce feelings of isolation and abandonment.
• Provide honest and realistic information about the disease process, treatment, and prognosis. Avoid false hope but offer emotional support and accurate information. Address questions about death directly and honestly to build trust.
• Identify and highlight positive aspects of the situation. Focus on possibilities like remission, slowed disease progression, and new treatment options to instill hope.
• Discuss future planning with patients and SO. Encourage realistic goal setting to foster a sense of control and purpose amidst uncertainty.
• Refer to home health agencies, visiting nurses, or hospice programs as appropriate. These services provide essential physical and emotional support to patients and families, supplementing care provided by loved ones.

2. Enhancing Body Image and Self-Esteem

Cancer and its treatments often lead to significant changes in body image and self-esteem. Addressing these concerns is an important part of a holistic nursing care plan for cancer diagnosis.

Nursing Diagnosis: Disturbed Body Image related to changes in physical appearance from hair loss and surgical scars, as evidenced by patient’s reluctance to engage in social activities and verbalized feelings of self-consciousness.

Interventions:

• Discuss with the patient and SO how the cancer diagnosis and treatment are impacting the patient’s life. Address personal life, home, and work activities to understand the scope of their concerns and begin problem-solving.
• Review anticipated side effects of treatment, including effects on sexual activity, attractiveness, and desirability. Provide anticipatory guidance about potential side effects like alopecia and surgical changes. Emphasize that not all side effects occur, and many can be minimized or managed.
• Encourage discussion of concerns about the impact of cancer and treatment on roles. Address roles such as homemaker, wage earner, and parent to explore potential disruptions and support needed.
• Validate the patient’s difficulties and feelings. Provide information that counseling is often beneficial and important in the adaptation process. Normalize seeking help and validate the challenges they are facing.
• Assess available support structures and their utilization by patients and SO. Identify existing support systems to plan for care during hospitalization and after discharge.
• Provide emotional support during diagnostic tests and treatment phases. Many patients need extra support during these periods, even if they are generally coping well.
• Use touch during interactions, if acceptable, and maintain eye contact. These nonverbal cues affirm individuality and acceptance, reducing feelings of insecurity and self-doubt.
• Refer for professional counseling as needed. If patient and SO support systems are insufficient, professional counseling may be necessary to maintain positive psychosocial well-being.

3. Managing Acute Pain

Pain is a prevalent symptom for cancer patients. Effective pain management is a cornerstone of a nursing care plan for cancer diagnosis and focuses on both pharmacological and non-pharmacological approaches.

Nursing Diagnosis: Acute Pain related to tissue inflammation and treatment side effects as evidenced by patient reports of persistent pain, guarding behaviors, and limited mobility.

Interventions:

• Obtain a comprehensive pain history. Assess pain location, frequency, duration, intensity (using pain scales), and effective relief measures. This baseline data is crucial for evaluating intervention effectiveness. Differentiate between acute and chronic pain, as management approaches may differ. Recognize that pain is a subjective experience with both physical and emotional components.
• Determine triggers for “breakthrough” pain. For patients on around-the-clock pain medication, identify the timing and triggers of breakthrough pain to optimize medication dosing and timing. Pain occurring at the end of dosing intervals may indicate the need for dose adjustment.
• Educate patients and SO about potential pain associated with therapies. Provide information about expected discomforts from surgery, radiation, chemotherapy, and diagnostic procedures to prepare them and reduce anxiety.
• Implement non-pharmacological comfort measures. Offer massage, repositioning, back rubs, and diversional activities (music, TV) to promote relaxation and distract from pain.
• Encourage stress management and complementary therapies. Promote relaxation techniques, visualization, guided imagery, biofeedback, laughter, music, aromatherapy, and therapeutic touch to enhance pain management and patient control.
• Provide cutaneous stimulation. Apply heat or cold, and massage as appropriate to decrease inflammation, muscle spasms, and pain. However, be mindful of contraindications for heat and cold based on the patient’s condition.
• Address barriers to effective cancer pain management. Recognize patient-related barriers (fear of addiction, beliefs about pain) and healthcare system barriers (inadequate pain assessment, concerns about opioid prescriptions) that can hinder pain control.
• Regularly evaluate pain relief and control. Adjust medication regimens as needed to achieve maximum pain control with minimal impact on ADLs.
• Educate patients and SO about medication effects and side effect management. Realistic expectations and understanding of side effects can improve adherence and confidence in pain management.
• Discuss alternative and complementary therapies like acupuncture and acupressure. These may offer pain relief without drug-related side effects.
• Administer analgesics as prescribed. Follow the prescribed medication regimen, utilizing opioids, NSAIDs, and adjuvant analgesics as indicated (see Pharmacologic Management section).

4. Improving Nutritional and Fluid Volume Status

Maintaining adequate nutrition and fluid balance is vital for cancer patients. A nursing care plan for cancer diagnosis includes strategies to address nutritional deficits and fluid imbalances.

Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to nausea and altered taste as evidenced by weight loss, poor appetite, and patient’s report of food aversion.

Interventions:

• Monitor daily food intake and consider having the patient keep a food diary. This helps identify nutritional strengths and deficiencies and track intake patterns.
• Measure height, weight, and anthropometric measurements. Assess for recent weight loss and compare measurements to standards to identify nutritional depletion.
• Assess skin and mucous membranes for signs of malnutrition. Observe for pallor, delayed wound healing, and parotid gland enlargement, which can indicate protein-calorie malnutrition.
• Monitor intake and output (I&O) and urine specific gravity. Track all output sources (emesis, diarrhea, wound drainage). Calculate 24-hour fluid balance. Negative fluid balance, decreased urine output, and concentrated urine suggest dehydration.
• Weigh the patient daily or as indicated. Weight fluctuations are a sensitive indicator of fluid balance changes.
• Monitor vital signs, peripheral pulses, and capillary refill. These parameters reflect circulating volume status and hydration.
• Observe for bleeding tendencies. Note oozing from mucous membranes or puncture sites, ecchymosis, or petechiae, which can indicate fluid and electrolyte imbalances or treatment side effects.
• Monitor laboratory studies. Review CBC, electrolytes, and serum albumin levels to assess hydration and nutritional status.
• Test stools and gastric secretions for blood. Chemotherapy can affect the GI lining, leading to ulceration and bleeding.
• Review nutritional laboratory studies. Assess total lymphocyte count, serum transferrin, albumin, and prealbumin to identify biochemical imbalances and guide dietary interventions. Correlate lab results with the patient’s clinical status, as cancer treatments can alter nutritional markers.
• Encourage 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.
• Create a pleasant dining atmosphere. Encourage eating with family and friends to enhance meal enjoyment and intake.
• Promote open communication about anorexia. Address emotional distress related to anorexia, especially for SOs who may be frustrated by the patient’s reduced appetite.
• Adjust diet before and after treatment. Recommend clear, cool liquids, bland foods, candied ginger, crackers, toast, and carbonated drinks. Separate liquids from meals to avoid early satiety.
• Control environmental factors that can trigger nausea. Minimize strong odors, noise, and avoid overly sweet, fatty, or spicy foods.
• Encourage relaxation techniques, visualization, guided imagery, and moderate exercise before meals. These can help prevent nausea, reduce anorexia, and improve oral intake.
• Identify patients with anticipatory nausea and vomiting. Implement measures such as changing the treatment environment or routine on treatment days, as anticipatory nausea may not respond to antiemetics.
• Administer antiemetics regularly. Give antiemetics before, during, and after chemotherapy as appropriate to prevent and manage nausea and vomiting.
• Evaluate antiemetic effectiveness. Recognize individual variability in response to antiemetics and adjust therapy as needed, possibly using combination drug therapy.
• Encourage increased fluid intake to 3000 mL/day, as tolerated. Adequate hydration supports fluid balance and reduces the risk of side effects like hemorrhagic cystitis with cyclophosphamide.
• Minimize venipunctures. Combine IV starts with blood draws and consider central venous catheter placement to reduce potential for hemorrhage and infection from repeated punctures.
• Avoid trauma and apply pressure to puncture sites. Minimize bleeding and hematoma formation.
• Administer IV fluids as indicated. Provide IV fluids for hydration and to dilute chemotherapy drugs, reducing side effects like nausea and nephrotoxicity.
• Refer to a dietitian or nutritional support team. A dietitian can develop individualized dietary plans to address specific needs and prevent malnutrition.
• Consider enteral or parenteral nutrition. Insert and maintain NG or feeding tubes for enteral feedings or central lines for total parenteral nutrition (TPN) if oral intake is severely compromised and malnutrition is significant.

5. Decreasing Fatigue

Cancer-related fatigue is a common and debilitating symptom. A nursing care plan for cancer diagnosis must include strategies to manage fatigue and improve patients’ energy levels.

Nursing Diagnosis: Fatigue related to cancer treatments and emotional distress as evidenced by reports of exhaustion, reduced physical activity, and difficulty completing daily tasks.

Interventions:

• Have the patient rate their fatigue using a numeric scale. Assess the time of day when fatigue is most severe to tailor interventions.
• Monitor physiological responses to activity. Assess changes in BP, heart rate, and respiratory rate during activity to determine activity tolerance.
• Plan care to include rest periods. Schedule activities for times when the patient has the most energy and involve the patient and SO in scheduling to promote control and well-being.
• Establish realistic activity goals. Setting achievable goals provides a sense of accomplishment.
• Assist with self-care needs as indicated. Keep the bed low, pathways clear, and assist with ambulation to prevent injury and conserve energy.
• Encourage patients to perform self-care activities they are capable of. Gradually increase activity levels as tolerated to enhance strength and stamina.
• Perform pain assessment and provide pain management. Uncontrolled pain exacerbates fatigue.
• Provide supplemental oxygen as indicated. Address anemia and hypoxemia, which contribute to fatigue.
• Refer to physical or occupational therapy. Therapy can help patients maintain and improve strength, muscle tone, and overall well-being. Adaptive devices can conserve energy.

6. Minimizing Infection Risk

Cancer patients are highly susceptible to infections. Minimizing infection risk is a crucial aspect of a nursing care plan for cancer diagnosis.

Nursing Diagnosis: Risk for Infection as evidenced by weakened immune system secondary to chemotherapy.

Interventions:

• Monitor temperature regularly. Elevated temperature can indicate infection, although it may be masked by medications. Early detection is key.
• Assess all systems for signs and symptoms of infection. Conduct ongoing assessments of skin, respiratory, and genitourinary systems to identify infections early.
• Monitor CBC with differential WBC, granulocyte count, and platelets. Chemotherapy and cancer can suppress bone marrow function, increasing infection risk.
• Obtain cultures as indicated. Culture results guide appropriate antibiotic therapy.
• Promote good handwashing for staff and visitors. Screen and limit visitors with infections. Implement reverse isolation as needed to protect the patient.
• Emphasize personal hygiene. Good hygiene limits potential sources of infection.
• Reposition frequently and keep linens dry and wrinkle-free. Prevent skin breakdown and pressure ulcers, which are potential infection sites.
• Promote adequate rest and exercise. Balance rest with activity to prevent complications like pneumonia and thrombus formation.
• Stress good oral hygiene. Stomatitis increases infection risk.
• Avoid or limit invasive procedures and adhere to aseptic technique. Minimize contamination and portals of entry for pathogens.
• Administer antibiotics as prescribed. Administer antibiotics to treat identified infections or prophylactically in immunocompromised patients (see Pharmacologic Management section).

7. Maintaining Oral Mucous Membrane Integrity and Preventing Stomatitis

Stomatitis is a common complication of cancer treatment. A nursing care plan for cancer diagnosis addresses oral health to prevent and manage stomatitis.

Nursing Diagnosis: Risk for Impaired Oral Mucous Membrane related to effects of chemotherapy and radiation therapy, as evidenced by increased susceptibility to stomatitis, patient report of oral discomfort, and changes in mucous membrane appearance.

Interventions:

• Assess dental health and oral hygiene periodically. Identify pre-existing dental issues and baseline oral hygiene for comparison and proactive management.
• Monitor for and educate the patient about signs of oral superinfection (thrush). Early recognition allows for prompt treatment.
• Culture suspicious oral lesions. Identify causative organisms and guide appropriate drug therapy.
• Encourage daily oral cavity assessment by the patient. Instruct patients to report changes in mucous membrane integrity, burning sensations, voice changes, swallowing difficulty, taste alterations, thick saliva, or blood-tinged emesis.
• Discuss areas for improvement in oral care and demonstrate proper techniques. Educate patients to avoid alcohol-based mouthwashes and lemon-glycerin swabs that can worsen dryness and irritation.
• Implement and recommend an oral hygiene program:
  • Avoid commercial mouthwashes and lemon-glycerin swabs.
  • Use a mouthwash of warm saline or dilute solutions of hydrogen peroxide or baking soda and water. Rinse before meals to improve taste and after meals and bedtime to dilute acids and relieve xerostomia.
  • Brush with a soft toothbrush or foam swab. Prevent trauma to fragile tissues. Replace toothbrushes regularly.
  • Floss gently or use a WaterPik cautiously. Remove food particles. Be gentle to avoid gum injury.
  • Keep lips moist with lip gloss or balm, K-Y Jelly, or Chapstick. Prevent dryness and cracking.
• Encourage mints, hard candy, or artificial saliva. Stimulate saliva production and maintain moisture.
• Instruct on dietary modifications. Avoid hot, spicy, and acidic foods. Suggest straws, soft foods, blenderized foods, Popsicles, and ice cream for comfort.
• Encourage adequate fluid intake. Maintain mucous membrane moisture.
• Discuss limitations of smoking and alcohol. These can further irritate and dry mucous membranes.
• Refer to a dentist before chemotherapy or head/neck radiation. Prophylactic dental care can reduce infection risk.
• Administer medications as prescribed. Use antifungal and antibacterial mouthwashes, analgesics, and anti-nausea medications as needed (see Pharmacologic Management section).

8. Maintaining Skin Integrity

Skin integrity can be compromised by cancer treatment. Maintaining skin integrity is an important focus in a nursing care plan for cancer diagnosis.

Nursing Diagnosis: Impaired Skin Integrity related to radiation exposure as evidenced by skin redness, dryness, and patient report of burning sensation.

Interventions:

• Assess skin frequently for side effects of cancer therapy. Note breakdown and delayed wound healing. Emphasize reporting open areas to healthcare providers. Monitor for radiation reactions (redness, tanning, dry/moist desquamation, ulceration, hair loss) and chemotherapy-related skin reactions (rashes, hyperpigmentation, alopecia).
• Assess skin, IV sites, and veins for signs of complications. Monitor for erythema, edema, tenderness, welts, itching, burning, swelling, blisters, ulceration, or tissue necrosis, which can indicate phlebitis, vein flare, or extravasation.
• Bathe with lukewarm water and mild soap. Maintain cleanliness without irritation.
• Encourage gentle skin care. Advise patients to avoid vigorous rubbing or scratching and to pat skin dry.
• Turn and reposition patients frequently. Promote circulation and prevent pressure ulcers.
• Review skin care protocols for radiation therapy. Emphasize avoiding rubbing, soap, lotions, creams, ointments, powders, or deodorants in the radiation field. Avoid washing off radiation markings.
• Recommend soft, loose cotton clothing. Advise female patients to avoid bras if they cause pressure.
• Apply cornstarch, Aquaphor, Lubriderm, Eucerin, or other water-soluble moisturizing gels as needed. (See Pharmacologic Management section)
• Encourage sunscreen use and protective clothing. Protect skin from sun exposure to prevent reactions.
• Wash skin immediately with soap and water if antineoplastic agents spill on unprotected skin. Dilute the drug to reduce irritation.
• Advise patients receiving 5-FU and methotrexate to avoid sun exposure. These drugs increase sun sensitivity.
• Review expected dermatologic side effects with chemotherapy. Provide anticipatory guidance about rashes, hyperpigmentation, and skin peeling.
• Inform patients about potential alopecia. Hair may grow back after chemotherapy but may not after radiation.
• Apply ice packs or warm compresses per protocol. Use as indicated for specific chemotherapy agents to minimize tissue damage from extravasation.

9. Normalizing Bowel Function

Bowel function can be significantly affected by cancer and its treatment. A nursing care plan for cancer diagnosis addresses both constipation and diarrhea.

Nursing Diagnosis: Constipation related to decreased physical activity, opioid use, and dehydration as evidenced by patient report of infrequent bowel movements, abdominal discomfort, and reduced appetite.

Interventions:

• Ascertain usual elimination habits. Establish a baseline for evaluating changes and treatment effectiveness.
• Assess bowel sounds and record bowel movements (BMs). Monitor frequency and consistency, especially during Vinca alkaloid therapy. Constipation can be an early sign of neurotoxicity.
• Monitor I&O and weight. Dehydration and electrolyte imbalances are complications of diarrhea. Inadequate fluid intake can worsen constipation.
• Check for impaction. Suspect impaction if no BM in 3 days or if abdominal distension, cramping, or headache occur.
• Monitor serum electrolytes as indicated. Electrolyte imbalances can affect GI function.
• Encourage adequate fluid intake, increased dietary fiber, and regular exercise. These measures can prevent constipation and manage diarrhea.
• Provide small, frequent meals of low-residue foods. If diarrhea is present, offer eggs, cooked cereal, and bland cooked vegetables to reduce gastric irritation.
• Adjust diet as needed. Avoid high-fat foods, high-fiber foods, gas-producing foods, caffeine, and extremely hot or cold foods and fluids, which can stimulate GI motility.
• Administer IV fluids as indicated. Prevent dehydration and dilute chemotherapy agents to reduce side effects.
• Administer antidiarrheal agents as prescribed. Use medications like loperamide, diphenoxylate/atropine, and bismuth subsalicylate to manage diarrhea (see Pharmacologic Management section).
• Administer stool softeners, laxatives, and enemas as indicated. Prophylactic use may be appropriate for patients at high risk for constipation, such as those receiving Vinca alkaloids (see Pharmacologic Management section).

10. Managing Sexuality Concerns

Cancer and its treatment can significantly impact sexuality. Addressing these concerns is an important part of holistic nursing care plan for cancer diagnosis.

Nursing Diagnosis: Disturbed Body Image related to changes in physical appearance and emotional distress as evidenced by patient’s report of decreased libido, altered self-perception, and concerns about intimacy.

Interventions:

• Discuss the nature of sexuality and reactions to changes or threats to sexuality with patients and SOs. Provide information that these problems are common and seeking help is beneficial. Normalize sexuality concerns as a valid aspect of cancer care.
• Advise patients about treatment side effects that can affect sexuality. Provide anticipatory guidance to help patients and SOs adapt.
• Provide education and resources on sexual health. Offer information on the impact of cancer and treatment on sexual function, address misconceptions, discuss support services, and suggest strategies to enhance intimacy.
• Provide private time for hospitalized patients. Recognize that sexual needs continue during hospitalization and respect intimacy needs.
• Refer to a sex counselor as indicated. Professional counseling may be needed for complex sexual health concerns.

11. Reducing Fear and Anxiety and Providing Emotional Support

Fear and anxiety are common emotional responses to cancer. Reducing these emotions and providing emotional support is central to a nursing care plan for cancer diagnosis.

Nursing Diagnosis: Anxiety related to fear of cancer prognosis, uncertainty about treatment outcomes, and impact on life as evidenced by patient’s expression of fear, worry, and impaired ability to make decisions.

Nursing Diagnosis: Ineffective Coping related to new cancer diagnosis and changes in family dynamics as evidenced by expressions of hopelessness, withdrawal, and increased family tension.

Interventions:

• Review the patient’s and SO’s previous experience with cancer. Determine what the doctor has communicated and the patient’s understanding. Clarify perceptions and identify fears and misconceptions.
• Identify the stage and degree of grief experienced by the patient and SO. Interventions should be tailored to the stage of grief and coping behaviors.
• Note ineffective coping behaviors. Observe for poor social interactions, helplessness, giving up daily functions, and loss of usual sources of pleasure. Provide support to develop effective coping skills.
• Be alert to signs of denial and depression. Recognize withdrawal, anger, inappropriate remarks. Assess for suicidal ideation and potential risk.
• Encourage patients to share thoughts and feelings. Provide opportunities to discuss fears and misconceptions.
• Create an open environment. Help patients feel safe to discuss feelings or to refrain from talking without judgment.
• Maintain frequent contact. Talk to and touch patients appropriately to convey acceptance and foster trust.
• Be aware of the effects of isolation. Sensory deprivation from isolation can intensify anxiety and fear. Limit isolation precautions when possible.
• Assist patients and SOs in recognizing and clarifying fears. Help them develop coping strategies to manage fears.
• Provide accurate and consistent information about diagnosis and prognosis. Avoid arguing about patient perceptions but provide realistic information.
• Permit expressions of anger, fear, and despair without confrontation. Normalize these feelings and allow for appropriate expression.
• Explain recommended treatment, purpose, and side effects. Prepare patients for treatments to reduce anxiety.
• Explain procedures and answer questions honestly. Stay with patients during anxiety-provoking procedures.
• Provide primary and consistent caregivers whenever possible. Foster therapeutic relationships and continuity of care.
• Promote a calm, quiet environment. Facilitate rest and enhance coping.
• Encourage interaction with support systems. Reduce isolation and connect patients with support groups or community resources.
• Provide reliable information and support for SOs. Reduce anxiety and fear for family members.
• Include SOs in decision-making as indicated. Involve family in care planning and support.
• Assess family components, extended family, and support network. Identify available resources for care and support.
• Identify family communication and interaction patterns. Assess effectiveness of communication and identify potential problems.
• Assess role expectations of family members. Encourage discussion and understanding of individual expectations.
• Assess energy direction. Determine if coping efforts are purposeful or scattered to guide interventions.
• Note cultural and religious beliefs. Recognize the influence of beliefs on responses to cancer.
• Listen for expressions of helplessness. Address feelings of helplessness that can hinder coping.
• Interact with family members in a caring and respectful manner. Provide information and reinforce as needed to promote worth and competence.
• Encourage appropriate expressions of anger. Accept anger as a normal response to cancer.
• Acknowledge the difficulties of the situation. Validate the reality of the challenges faced.
• Identify and encourage the use of previous successful coping behaviors. Help patients utilize existing strengths.
• Stress open dialogue between family members. Promote clear communication and problem-solving.
• Refer to support groups, clergy, and family therapy as indicated. Provide additional support for complex issues.

12. Administer Medications and Provide Pharmacologic Support

Pharmacological interventions are essential in managing cancer and its symptoms. A nursing care plan for cancer diagnosis includes appropriate medication administration and monitoring.

Medications commonly used in cancer care:

• Opioids: codeine, morphine (MS Contin), oxycodone (oxycontin), hydrocodone (Vicodin), hydromorphone (Dilaudid), methadone (Dolophine), fentanyl (Duragesic), oxymorphone (Numorphan). Used for pain management. Addiction is not a primary concern in cancer pain management.
• Acetaminophen (Tylenol) and Nonsteroidal Anti-inflammatory Drugs (NSAIDs): aspirin, ibuprofen (Motrin, Advil), piroxicam (Feldene), indomethacin (Indocin). Used for mild to moderate pain, often in combination with opioids.
• Corticosteroids: dexamethasone (Decadron). Used for pain associated with inflammation, bone metastasis, spinal cord compression, and neuropathic pain.
• Analgesic Rinses: Mixture of Kaopectate, pectin, diphenhydramine (Benadryl), and topical lidocaine (Xylocaine). Used for oral pain relief. Swish and spit to avoid numbing gag reflex.
• Antifungal Mouthwash: nystatin (Mycostatin), antibacterial mouthwash (Biotane). Used to treat or prevent oral infections.
• Antiemetics: Used to prevent and manage nausea and vomiting.
• Opioid Analgesics (for oral pain): hydromorphone (Dilaudid), morphine. Used for severe oral pain.
• Skin Moisturizers: Cornstarch, Aquaphor, Lubriderm, Eucerin, or other water-soluble moisturizing gels. Used to manage skin irritation and dryness.
• Antidiarrheals: loperamide, diphenoxylate/atropine, bismuth subsalicylate. Used to manage diarrhea.
• Stool Softeners: docusate sodium (Colace). Used to prevent and manage constipation.
• Laxatives: polyethylene glycol (PEG). Used to treat constipation.

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources:

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Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care This handbook is praised for its evidence-based approach to nursing interventions, providing a three-step system for client assessment, nursing diagnosis, and care planning. It includes detailed instructions for implementing care and evaluating outcomes, enhancing diagnostic reasoning and critical thinking skills.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition) This resource offers over two hundred care plans updated with the latest evidence-based guidelines. The tenth edition includes new ICNP diagnoses, care plans addressing LGBTQ health issues, and electrolyte and acid-base balance.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales A quick-reference tool designed to help nurses efficiently identify correct diagnoses for patient care planning. The sixteenth edition features the most current nursing diagnoses and interventions, with an alphabetized listing covering over 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care This manual assists nurses in planning, individualizing, and documenting care for over 800 diseases and disorders. It provides subjective and objective data for each diagnosis, sample clinical applications, prioritized actions/interventions with rationales, and documentation guidelines.

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health This comprehensive e-book includes over 100 care plans covering medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health nursing. It emphasizes interprofessional “patient problems” to improve patient communication.

See also

Other recommended site resources for this nursing care plan:

More care plans related to basic nursing concepts:

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