NURSING MANAGEMENT OF CLIENTS WITH
DISTURBANCES IN CELLULAR FUNCTIONING
LEARNING OBJECTIVES:
At the end of the discussion, the students will be able
to:
1. Summarize the nursing roles and
opportunities in cancer prevention, detection,
diagnosis and treatment of cancer
2. Enumerates the case finding and early
detection methods of cancer.
3. Explains the major health problems of client
with cancer and its specific nursing diagnosis with
interventions.
4. Identify the psychosocial implications of
cancer.
5. Differentiate the modes of treatment for
cancer and its specific nursing responsibilities.
6. Discuss the nursing management for oncologic
emergencies.
CANCER
 CANCER affects every age group.
 The incidence of cancer is higher in men than in
women and higher in industrialized sectors and
nations
 Refers to class of diseases or disorders
characterized by the development of abnormal
cells that divide uncontrollably and have the
ability to infiltrate and destroy normal body
tissue
WARNING SIGNS OF CANCER
C - Change in bowel or bladder habits
A - Sore that does not heal
U - Unusual bleeding
T - Thickening or lump
I - Persistent indigestion
O - Obvious change in warts or mole
N - Nagging cough or persistenthoarseness
A - Anemia
L - Loss of appetite
DETECTION AND PREVENTION OF CANCER
 PRIMARY PREVENTION
Acquisition of knowledge and skills
necessary to educate client, community about
cancer risk.
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 SECONDARY PREVENTION
Cancer screening programs for
individuals who are found to be at high risk for
cancer
NURSING RESPONSIBILITIES IN EARLY DETECTION OF
CANCER
STEPS TO REDUCE CANCER RISK
When teaching individual patients or groups,
nurses can recommend the following cancer prevention
strategies:
1. Increase consumption of fresh vegetables
(especially those of the cabbage family.)
2. Increase fiber intake.
3. Increase intake of Vitamin A.
4. Increase intake of foods rich in Vitamin C.
5. Practice weight control.
6. Reduce intake of dietary fat.
7. Practice moderation in consumption of salt-cured,
smoked and nitrate-cured foods.
8. Stop smoking cigarettes and cigars.
9. Reduce alcohol intake.
10. Avoid overexposure to sun.
RECOMMENDATION FOR EARLY DETECTION OF CANCER
BREAST CANCER
Risk Factors
• Menarche before age 11
• Menopause after age 50
• Family history of breast cancer – especially
mother or sister
• History of uterine cancer
• Nulliparity or birth of first child after age 30
• History of uterine cancer
• Link with obesity, diabetes and hypertension
• Presence of benign breast cyst.
Screening
• Breast Self-Examination
• Regular mammograms (screen all middle aged
woman)
COLORECTAL CANCER
 COLORECTAL means colon and rectum combined
 Highest for people older than 85 years of age
 High for people with family history of colon
cancer, polyps adenomatous, of inflammatory
bowel disease, high fat, high protein (with high
intake of beef), low fiber diet, genital or breast
cancer in women
 Diagnostic Procedure - Lesions that are single, hard, & fixed on
1. Colonoscopy – an insertion of fiber optic scope palpation or associated with cervical
through the rectum for direct visualization of the lymphadenopathy, suggest malignancy.
colon.
2. Digital Rectal Examination SCREENING:
Use of fine or large bore needle biopsy,
PROSTATE CANCER Ultrasound, MRI, CT Scan & Thyroid Scan
Risk Factors
• Increasing age, after age 50 LUNG CANCER
• Having father or brother with prostate cancer  Most common from cigarette smoking.
doubles the risk of relatives  Genetic, underlying respiratory diseases, COPD,
• A diet high in red meat increase risk TB
• Difficulty and frequent urination, urinary  most common symptom is a cough or change in
retention, decreased size and force of the urinary cough
stream  Repeated unresolved URTI
• Every man older than 40 should have DRE (
Digital rectal exam ) as part of regular check up Diagnostic Examination:
• The more advanced lesion, it becomes “ stony Chest x – ray - is performed to search for pulmonary
hard “ and fixed density, a solitary peripheral nodule (coin lesion),
atelectasis and infection.
DIAGNOSTIC PROCEDURE
 Digital Rectal Examination NURSING PROCESS: THE PATIENT WITH CANCER
 Prostate Specific Antigen
I. ASSESSMENT
TESTICULAR CANCER • Regardless of type of cancer treatment or
• Primarily affect young to middle-aged men (20 to prognosis many patients with cancer are
35 years old) susceptible to the following problems and
• Most testicular tumors originate in gonadal cells. complications.
• An important role of the oncology nurse is to
Signs: assess the patient for these problems and
 Early sign – firm painless, smooth testicular mass complications
varying in size
 Late sign – ureteral obstruction, abdominal mass, 1. Infection
shortness of breath
A. Assess factors that promotes infection:
Screening: Testicular Self-Examination(TSE)  · Impaired skin & mucus membrane integrity
 · Chemotherapy
CERVICAL CANCER  · Radiation Therapy
• Refers to the cancer of the neck of the uterus.  · Biologic Response Modifiers
 · Malignancy
Assessment:  · Malnutrition
 Painless vaginal bleeding post-menstrual and  · Urinary Catheter, Intravenous Catheter
post-coital  · Other Invasive Procedures
 Foul-smelling or serosanguinous vaginal  · Contaminated Equipment
discharge  · Age
 Pelvic, lower back, leg or groin pain  · Chronic Illness
 · Prolonged Hospitalization
Diagnostic Procedure
1. Pap’s Smear B. Monitoring laboratory studies to detect early
changes in WBC count
THYROID CANCER – Leukopenia
– Granulocytopenia
– Neutropenia
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C. Chest x- ray C. Determine diet history, any episodes of anorexia,
changes in appetite, altered taste, nausea, diarrhea,
2. Bleeding situation and foods that aggravate or relieve anorexia and
medication history
A. Assess factors that contribute to bleeding
– Bone marrow suppression from radiation D. Clinical and laboratory data useful in assessing
– Chemotherapy Patient’s nutritional status
– Medications that interfere with
coagulation and platelet functioning o Anthropometrical measurements
B. Common bleeding sites: o Serum protein levels
– Skin and mucous membranes o Serum electrolytes
– Intestinal o Skin response to intradermal
– Genito-Urinary Tract injection
– Respiratory tract o Hemoglobin and hematocrit
– Brain levels
C. Signs of bleeding o Serum Iron Levels
– Gross hemorrhage 6. Pain
– Blood in the stools, urine, sputum, or
vomitus A. Related factors causing pain:
– Oozing at injection sites  Underlying disease
– Bruising (ecchymosis)  Pressure exerted by tumor
– Petechiae  Diagnostic procedures
– Changes in mental status  Cancer treatment
B. Assess site of pain, pain perception, pain scales
3. Skin Problems C. Give emphasis not only to physical pain but
Assess predisposing factors and other risk factors psychosocial as well.

4. Hair Loss 7. Fatigue

Assess also the psychological impact of this side  Fatigue has been recognized as one of the
effect on the patient and the family significant and frequent symptoms experienced
by patients receiving cancer therapy.
5. Nutritional Concerns  Assess for feelings of weariness, weakness, lack
of energy, inability to carry out ADL, lack of
COMMON NUTRITIONAL PROBLEMS motivation, and inability to concentrate
1. Anorexia  Assess for physiologic and psychological stressors
2. Mal-absorption that contribute to fatigue, (pain, nausea,
3. Cachexia constipation, fear, anxiety)

A. Impaired nutritional status may contribute to: 8. Psychosocial Status

 Disease progression
 Immune incompetence
 Increased incidence of infection
 Delayed tissue repair
 Diminished functional ability
 Decreased capacity to continue
chemotherapy
B.Physical signs of weight loss and cachexia are secondary
to decreased protein and caloric intake, metabolic,
mechanical effects of cancer and systemic disease, side
effects of the treatment or emotional status of the
patient.
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9. Body Image and Self-Esteem
II. Nursing Diagnosis
• Risk for infection related to altered immunologic
response
• Impaired skin integrity: erythematous and wet
desquamation reaction to radiation therapy.
• Impaired oral mucous membranes related to
stomatitis.
• Imbalanced nutrition: less than body
requirements related to nausea and vomiting.
 • Fluid and electrolyte imbalance related to
anorexia, nausea & vomiting, altered taste,
diarrhea
• Anticipatory grieving related to loss of body parts
and altered role functioning
• Disturbed body image and situational low self-
esteem related to changes in appearance,
function and roles
• Self – care deficit due to fatigue, malaise, and
protective isolation
• Anxiety due to knowledge deficit and uncertain
future
• Disturbed body image r/t changes in appearance,
function and roles
• Grieving r/t anticipatory loss and altered role
functioning
• Potential for spiritual distress
• Deficient knowledge about disease process,
treatment, complication management, and self-
care measures
III. Planning
o Maintenance of tissue integrity
o Maintenance of nutrition
o Relief of pain
o Relief of fatigue
o Improve body image
o Effective progression through grieving
process
o Absence of complications
Nursing Interventions
Managing Stomatitis
o Provide good oral hygiene.
o Use soft bristled toothbrushes and nonabrasive
toothpaste.
o Oral swabs with sponge like applicators maybe
use in place of toothbrush.
o Avoid alcohol based mouth rinses.
o Lubricate cracked and dry lips
o Adequate food and fluid intake is encouraged
Maintaining Tissue Integrity
o Handle affected area gently.
o Avoid rubbing or use of hot or cold water, soaps,
powder, lotion and cosmetics avoided
o Avoid tissue injury by wearing loose-fitting
clothing.
o Aseptic technique should be observed during
dressing and wound care.
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Assisting Patients to cope with Alopecia:
o Provide information about hair loss, support
patient and family in coping with disturbing
effects of therapy.
o Instruct to acquire a wig or hairpiece before hair
loss.
o Encourage use of attractive scarves and hats.
Managing Malignant Skin Lesion:
o Carefully assessing and cleansing the skin.
o Reducing superficial bacteria.
o Controlling the bleeding.
o Reducing odor.
o Protecting the skin from pain and further trauma.
Promoting Nutrition:
o Prepare foods that are appealing.
o Patient’s preferences as well as physiologic and
metabolic requirements are considered when
selecting foods.
o Encouraged small frequent feedings.
o Inform patient the advantage of receiving
alternative methods of feeding by parenteral or
enteral route.
Relieving Pain:
o Provide adequate rest and sleep
o Promote diversional activities
o Provide adequate rest and sleep
o Offer Empathy
o Give pain reliever medications as ordered
Decreasing Fatigue
o Help the patient and the family to understand
that is an expected and temporary side effect of
cancer process and of many treatments used.
o Help patient identify sources of fatigue
o Plan activities to conserve energy as well as
alternate periods of rest.
o Regular, light exercise is recommended
Body Image and Self-Esteem
o Positive approach is necessary
o Encourage independence and continued
participation in self-care decision making
o Patient should be assisted to assume tasks and
participate in those activities that are personally
of most value.
o Identify any negative feeling that that the patient
has or threats to body image.
o Referral to support groups
Assisting in the Grieving process
 o Grieving is a normal response to fears and
anticipated losses that include, loss of heath,
normal sensations, body image, social
interaction, sexuality and intimacy.
o Assess response of patient and family about the
diagnosis and planned treatment.
o Assist in answering inquiries and questions,
identifying resources and support people.
o Assist patient and family acquire knowledge to
cope with the disease process
o Assist patient and family members to
acknowledge and cope with their reactions and
feelings.
Managing and Monitoring Potential Complications
1. Infection
o Strict asepsis technique
o Health teaching on how to recognize signs and
symptoms of infection
o Maintain skin integrity.
o Monitoring laboratory data.
o Administration of antibiotics as ordered
2. Septic Shock
o Assess signs and symptoms of septic shock.
o Neurologic assessment
o Fluids and electrolyte status monitoring
o Administration of intravenous fluids, blood
products, vasopressors, oxygen and broad spectrum
antibiotic as ordered.
3. Bleeding and Hemorrhage
o Monitor laboratory values especially platelet
count
o Assess the patient for bleeding
o Taking steps to prevent trauma and minimize the
risk for bleeding
PROMOTING HOME AND COMMUNITY BASED CARE
1. Teaching Patients Self-Care
2. Continuing Care
NURSING MANAGEMENT DIFFERENT
MODALITIES OF TREATMENT
1. SURGERY
Types:
 Diagnostic
 Prophylactic
 Palliative
 Reconstructive
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The patient undergoing surgery for cancer
requires general peri-operative nursing care with
specific care related to the patient’s age, organ
impairment, nutritional deficits, disease of
coagulation and altered immunity that may
increase the risk.
 Peri-operatively, the nurses asses the patient
response to the surgery.
 Monitor possible complication: Post-Operative
teaching about wound care, activity nutrition and
medications information is given.
2. RADIATION THERAPY
Ionizing radiation that is used to:
 Interrupt cellular growth
 Cure cancer
 Used to control malignant disease when tumor
cannot be removed surgically used when local
metastasis is present
 Used prophylactically to prevent leukemia; infiltration
to the brain and spinal cord.
SOURCE OF RADITAION THERAPY
 External Radiation therapy (Teletherapy)
-administer through an x-ray
machine
 Internal Radiation Therapy
-administer near or within the
tumor
Types:
 Sealed Source (Brachytherapy )
 Unsealed
BRACHYTHERAPY
- From the greek word “bradys” means, “short
- distance”
- Also known as internal radiotherapy, sealed
source radiotherapy,
curietherapyorendocurietherapy is a form of
radiotherapy where a radiation source is a
place inside or next to the area requiring
treatment.
BRACHYTHERAPY SAFETY PRECAUTION IN RADIATION THERAPY
- Is commonly used as an effective treatment
for cervical, prostate, breast and skin cancer  Assigning to a private room
and can also be used to treat tumors in many  Posting notices
other body sites.  Dosi meter badge must be worn
- Can be used alone or in combination with  Not assigning pregnant staff
other therapy such as surgery EBRT and  Prohibit children
chemotherapy  Limit visits 30 minutes daily
 Maintain 3 feet distance
SIDE EFFECT OF RADIATION THERAPY
AND IT’S RESPONSE
3. CHEMOTHERAPY
1. Skin Reaction - Anti-neoplastic agents that are used in an attempt to
- Erythema, dry/moist desquamation destroy tumor cells by interfering with cellular
- Atrophy telangiectasia, depigmentation
function and reproduction.
- Necrotic or ulcerative lesion
Goal:Cure, Control, Palliation
o Nursing Responsibility: Route:Topical, Oval, IV, IM, Subcutaneous,
 Observe for early signs of skin reaction and report Arterial, Intra-cavity, and Intrathecal.
immediately
 Keep area dry Special Problem:Extravasation
 Was area with water, no soap and pat to dry and
do not rub Contraindication:
 Do not apply ointment, powders, lotion on the
area 1. Infection
 Do not apply heat, avoid sunshine or cold 2. Recent Surgery
 Use soft fabric for clothing 3. Impaired Renal or hepatic functions
 DO NOT ERASE MARKING ON THE SKIN 4. Recent Rad. Therapy
5. Pregnancy
2. Infection 6. Bone Marrow Depression
3. Hemorrhage
4. Fatigue (radiation cause exhaustion) 2. CHEMOTHEPEUTIC AGENT
5. Weight loss
6. Stomatitis 1. Alkylating
7. Diarrhea - Busulfan, cabopatin, chlorambucilm,
8. Nausea and Vomiting
asplatin, cyclophosphamide, decabazine,
9. Headache
10. Alopecia hexamathyl, melamine, fosfamde
11. Cystitis nitrogen mustard, theothecin.
12. Social Isolation - Alter DNA structure by misreading DNA
code initiating breaks in DNA molecule,
cross linking DNA strands.
PRINCIPLES OF RADIATION PROTECTION 2. Antimetablikes
- Cytaraine 5-flourfacil (5-FU)
1. Distance
- Maintain a distance of at least 3 feet when Pentatastine
not performing nursing procedure - Interfere with biosynthesis of
2. Time metabolic or nucleic acid necessary
- Limit contact with the patient for 5 minutes for RNA and DNA synthesis.
each time, a total of 30 minutes per shift
3. Shielding
- Use lead shield during contact with client
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 3. Plant alkaloids b. Diarrhea
- etoposide, teniposide, vinblastine, c. Constipation
vineristine 2. Integumentary System
a. Pruritus, Urticaria, and systemic signs
- Arrest metaphase by inhibiting
b. Stomatitis
mitotic tubular formation (spindle) c. Alopecia
inhibit DNA and protein synthesis. d. Skin Pigmentation
4. Anti-tumor Antibiotic e. Nail Changes
- Bleomian, doxorubicin,mitomycin 3. Hematopoetic System
- Interfere with DNA synthesis by a. Anemia
binding to DNA, prevent RNA b. Neutropenia
c. Thrombocytopenia
synthesis
4. Genito – Urinary System
Vesicant – are those agent if deposited into the a. Hemorrhagic changes
b. Urine color changes
subcutaneous tissues can cause extravasation
5. Reproductive System
 Dactoinomycin
a. Premature menopause or amenorrhea
 Paunorubicin
 Doxorubicin SAFETY PRECAUTIONS IN ADMINISTERING
 Nitrogen mustard CHEMOTHERAPY
 Mitomycin
*Use of biologic safety cabinet for the
 Vinblastine
preparation of all chemotherapeutic agents
 Vincristine
*Wear surgical gloves when handling anti-
INDICATION OF EXTRAVASATION DURING
neoplastic agent and the excretions of patients
ADMINISTRATON OF VESICANTS
who received chemotherapy
 Absence of blood return from the intravenous
*Wear disposable long sleeved gown when
catheter
prepares and administering chemotherapeutic
 Resistance to flow of the intravenous fluid
agents
 Swelling, pain, and redness at the site
*Use Leur lock fitting in all intravenous tubing
Of the extravasation is suspected:
used to deliver chemotherapy
 Medication administration must be stopped
*Disposable of all equipment used in
immediately
chemotherapy preparation and administration in
 Ice applied on the site (expect for vesicant)
appropriate, leak – proof, puncture proof
vinca alkaloid
container.
 Physician may aspirate any infiltrate
medication from the tissue and infect
*Dispose of all chemotherapeutic waste as
neutralizing solution onto the area reduce to
hazardous material.
reduce tissue damage
4. THERMAL THERAPY or HYPERTHERMIA
Example of neutralizing solution: Sodium
The generation of temperatures greater
thiosulfate, Nyaluronidase, and Sodium
than physiologic fever range ( above 41.5 ‘C ) has
Bicarbonate
been used for many years to destroy tumors in
human cancer.
SIDE EFFECT OF CHEMOTHERAPY
Using radio waves can produce heat,
ultrasound, microwaves, magnetic waves, and
1. Gastrointestinal System
hot water baths, hot wax immersions.
a. Nausea and Vomiting

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Principles:
1. Malignant cells are sensitive to harmful effects of
high temperatures.
2. Malignant cells lack repair mechanisms necessary
to repair cell damage by elevated temperature.
3. Most tumor cells lack an adequate blood supply
during periods if increased cellular demand such
as during Hyperthermia.
Nursing Management:
o Local skin care
5. BIOLOGIC RESPONSE MODIFIERS
- is also called IMMNUNOTHERAPY
- Substances that are able to trigger the immune
system to indirectly affect tumors.
- These include cytokines such as interferons and
interleukins.
- The basis of BRM is restoration, stimulation,
modification and augmentation of the body’s
natural defense against cancer
- E.g. BCG – treat bladder cancer
BRM (Biological Response Modifiers)
Nursing Management:
• Patients receiving BRM therapy have many of
the same needs as cancer patients undergoing
treatment approaches
• BRM therapies are still investigational a
considered a last-chance effort by many patients.
• Essential that the nurse assess the need for
education, support and guidance for the patient
and family in planning and evaluating patient
care.
6. PHOTODYNAMIC THERAPY
- A ternary treatment for cancer involving 3 key
components: a photosensitizer, light and tissue
oxygen.
- A photosensitizer is a chemical compound
(Porfimer) that can be excited by a light of a
specific wavelength.
- Use as a treatment for basal cell carcinoma.
MAJOR SIDE EFFECT:
PHOTOSENSITIVITY FOR 4 TO 6 WEEKS AFTER
TREATMENT
NURSING MANAGEMENT:
• Instruct client to protect themselves from direct
and indirect sunlight to prevent skin burns.
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• Liver and renal function should be monitor
• Offer emotional support and educate the client
and family regarding the therapy
8. GENE THERAPY
• A technique for correcting defective genes
responsible for disease development.
• A gene is inserted into the genome to replace an
abnormal, disease causing gene.
• Viruses are used as a gene therapy vectors such
as retrovirus, adenovirus,herpes simplex virus.
9. BONE MARROW TRANSPLANTATION
Types
1. Autologous – from patient
2. Allogenic - from a donor other than a
patient. Eg.family member, matched
unrelated donor,(bone marrow registry)
3. Syngeneic - from an identical twin
Procedure:
1. Donor suitability is determined through
tissue antigen typing of human leukocyte antigen
(HLA) and mixed leukocyte culture (MLC)
2. Donor bone marrow is aspirated from
multiple sites along iliac crest under general
anesthesia
3. Donor marrow is infused IV into the
recipient
COMPLICATIONS:
1. Failure of engraftment
2. Infection: highest risk in 3 to 4 weeks
3. Pneumonia: non-bacterial or intestinal
pneumonia are principal causes of death on the
first 3 months post-transplant
4. (GVHD) Graft vs., host disease: principal
complication caused by an immunologic reaction
of engrafted lymphoid cells against the tissue of
the recipient
- Acute GHVD – develops within first 100
days post-transplant and affects
GUT, liver, marrow, and lymphoid tissue
-Chronic GVHD – Develops 100 – 400
days post-transplant manifested by multi-
organ involvement
5. Recurrent malignancy
6. Late complications such as cataracts, and endocrine
abnormalities
NURSING CARE PRETRANSPLANT
1. Recipient immunosuppression attained with total
body irradiation (TBI) and chemotherapy to
eradicate existing disease and create space in
host marrow to allow transplanted cells to grow.
2. Provide protective environment.
A. Client should be in laminar airflow room or
strict reverse isolation.
B. Objects must be sterilized before being
brought to the room.
C. When working with children, introduce new
people were they can be seen, but outside child’s
room so they can see what they look like without
isolation garb.
3. Monitor central lines frequently. Check patency and
observe signs of infection such as fever, redness around
sight.
4. Provide care for client receiving chemotherapy and
radiation therapy that induce immunosuppression.
NURSING CARE POST TRANSPLANT
1. Prevent Infection.
2. Provide mouth care for stomatitis and mucositis.
3. Provide skin care.
4. Monitor carefully for bleeding.
5.Maintain fluid and electrolyte balance and promote
nutrition.
6. Provide client teaching and discharge planning
concerning:
• Home environment (cleaning, pets, visitors)
• Diet modifications
• Medication regimen –schedule, dosage, effects,
side effects.
• Communicable disease and immunizations
• Daily hygiene and skin care
• Fever
• Activity
9. UNPROVEN & UNCONVENTIONAL THERAPIES
• Also called Complementary and Alternative
Medicine.
• CAM treatments are the diverse group of medical
and health care systems, practices & products
that are not presently considered to be effective
by the standards of medicine.
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Nursing Management
 Trusting relationship, supportive care, and
promotion of hope with the patient and family.
 Truthful responses should be given in
nonjudgmental manner to questions and
inquiries about unproven methods.
 The nurse should encourage any patient who
uses unconventional therapies to inform the
physician about such use.
NURSING MANAGEMENT FOR ONCOLOGIC
EMERGENCIES:
1. SUPERIOR VENA CAVA SYNDROME (SVCS)
INTERVENTIONS:
 Assess for signs and symptoms of SVCS.
 Monitor cardiopulmonary and neurologic status.
 Promote energy conservation to minimize
shortness of breath.
 Prepare the patient for radiation therapy to the
mediastinal area.
2. SPINAL CORD COMPRESSION
INTERVENTIONS:
 Assess for back pain and neurological deficits.
 Prepare the client for radiation and/or
chemotherapy.
 Surgery may be needed to remove the tumor and
relieve the pressure to spinal cord.
 Instruct the client in the use of neck or back
braces if they are prescribed.
3. HYPERCALCEMIA
INTERVENTIONS:
 Monitor calcium level.
 Administer oral or parenteral Normal Saline fluids
as prescribed.
 Administer medications to lower the calcium
level as prescribed.
 Prepare the client for dialysis if the condition
becomes life threatening or is accompanied by
renal impairment.
4. PERICARDIAL EFFUSION & CARDIAC TAMPONADE
INTERVENTIONS:
 Monitor vital signs and oxygen saturation
frequently.
 Assess for pulsusparadoxus.
 Monitor ECG tracings
 Assess heart and lung sounds.
 Monitor and record intake and output
 Elevate the head of patient’s bed.
 Minimize patient’s physical activity.
 Reposition and encourage the patient to cough.
 Provide frequent oral hygiene.
 As needed, maintain patient IV access, reorient
the patient, and provide supportive measures
and appropriate patient instruction.
5. DIC/CONSUMPTION COAGULOPATHY
INTERVENTIONS:
 Measure and document Intake & output
 Inspect all body orifices & tubes for bleeding
 Prevent bleeding
 Administer anticoagulant as prescribed.
 Administer cryoprecipitated clotting factors if DIC
progress and hemorrhage is the primary problem.
PSYCHOSOCIAL ASPECTS OF CANCER CARE
When cancer becomes a part of life’s journey it is
hardwork.
 Providing support for client (your presence as a
caring person)
 Providing support for the family
 Promoting positive self-concept
 Promoting coping throughout the cancer
continuum
A. Diagnosis and treatment (clients received
diagnosis and treatment in different ways)
B. Survivorship (client who entered successful
treatment enter an indeterminate period of long
–term survivorship)
C. Recurrent disease and progression (most clients
live with the threat or reality of recurrent
disease)
D. Terminal illness, “when everything is done that
can be done, compassion is the only thing that
brings beauty and meaning to our lives. It is the
irreplaceable gift.

6. SIADH

INTERVENTIONS:
 Monitor accurate recording of intake and output.
 Initiate fluid restriction and increased sodium
intake as prescribed.
 Administer antidiuretic hormone antagonist as
prescribed.
 Monitor serum sodium levels.

7. TUMOR LYSIS SYNDROME

INTERVENTIONS:
 Monitor Intake and Output.
 Encourage oral/IV hydration.
 Administer diuretics as prescribed.
 Administer medications that increase the
excretion of purine as prescribed.
 Prepare to administer IV infusion of glucose
and insulin to treat hyperkalemia.
 Prepare the client for dialysis if hyperkalemia
and hyperuricemia persist despite treatment.

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