{ "name": "Cancer (Oncology Nursing)", "slug": "cancer", "url": "https://nursingplex.com/care-plans/cancer", "category": "Basic Nursing & General Care Plans", "summary": "Supportive care across diagnosis, chemotherapy, radiation and survivorship, with heavy focus on symptom and infection control.", "nursing_diagnoses": [ "Risk for infection", "Imbalanced nutrition", "Fatigue", "Anticipatory grieving" ], "overview": [ "Cancer is uncontrolled proliferation of abnormal cells that lose normal regulation, invade surrounding tissue and can spread through blood and lymph to distant sites. Nursing care spans the whole trajectory: screening and diagnosis, active treatment with surgery, chemotherapy, radiation, targeted or immune therapy, survivorship, and for some patients, palliative and end-of-life care.", "Most acute nursing problems in oncology come from the treatment rather than the tumor. Chemotherapy attacks rapidly dividing cells, so bone marrow, gastrointestinal lining and hair follicles suffer predictably — producing neutropenia, anemia, thrombocytopenia, mucositis, nausea and alopecia. Radiation causes localized skin and tissue reactions in the treatment field plus systemic fatigue.", "The single greatest threat during treatment is infection during the nadir, when the white count bottoms out roughly 7–14 days after a chemotherapy cycle. A neutropenic patient may have no pus, no redness and no cough — a temperature of 38 °C alone is an emergency." ], "key_facts": [ { "label": "Nadir", "text": "Lowest blood counts typically 7–14 days after chemotherapy; highest infection and bleeding risk." }, { "label": "Neutropenic fever", "text": "A single temperature ≥38.3 °C, or ≥38.0 °C for one hour, requires cultures and antibiotics within an hour." }, { "label": "Bleeding risk", "text": "Platelets below 50,000/mm³ mean bleeding precautions; below 20,000/mm³ carries spontaneous bleeding risk." }, { "label": "Extravasation", "text": "Stop the infusion, leave the needle in place, aspirate residual drug and notify the provider immediately." }, { "label": "Tumor lysis syndrome", "text": "High potassium, phosphate and uric acid with low calcium shortly after treatment of bulky, fast-growing tumors." }, { "label": "Radiation skin care", "text": "Wash gently with mild soap and water, no powders or lotions unless approved, never remove skin markings, avoid sun and heat." } ], "nursing_priorities": [ "Prevent and rapidly detect infection during myelosuppression.", "Prevent bleeding and manage anemia-related fatigue.", "Control nausea, vomiting and mucositis so nutrition can be maintained.", "Manage cancer pain to a level acceptable to the patient, around the clock.", "Protect skin and tissue in the radiation field and prevent extravasation injury.", "Maintain nutrition, weight and hydration against treatment-related losses.", "Support body image, role change, anticipatory grief and coping.", "Coordinate accurate information, advance directives and survivorship planning." ], "assessment": { "subjective": [ "Fatigue that is not relieved by rest and limits usual activity", "Pain described by site, quality, timing and what relieves or worsens it", "Nausea, taste changes, early satiety, mouth soreness or difficulty swallowing", "Numbness or tingling in hands and feet from neurotoxic agents", "Fear, uncertainty about prognosis, and worry about family and finances", "Distress about hair loss, surgical change, sexuality and fertility" ], "objective": [ "Temperature and any subtle sign of infection; absolute neutrophil count and nadir timing", "Petechiae, bruising, gum or nose bleeding, blood in stool or urine; platelet count", "Pallor, tachycardia, exertional dyspnea; hemoglobin and hematocrit", "Oral mucosa for erythema, ulceration, white plaques or bleeding", "Weight trend, intake, albumin and prealbumin", "Skin in the radiation field for erythema, dryness, moist desquamation", "IV site for swelling, burning, blanching or loss of blood return during vesicant infusion", "Electrolytes, uric acid, renal and liver function after treatment initiation" ], "related_factors": [ "Bone marrow suppression from chemotherapy or radiation", "Disruption of rapidly dividing mucosal and skin cells", "Tumor invasion, compression of nerves and organs, and metastasis to bone", "Hypermetabolic tumor demand with anorexia and altered taste", "Immobility, deconditioning and anemia", "Loss of role, altered appearance and threat of death" ] }, "goals": [ "The client will remain free of infection, with temperature and white cell recovery within expected parameters for each cycle.", "The client will show no active bleeding, with platelet count monitored and bleeding precautions followed.", "The client will report nausea controlled at a tolerable level and maintain oral intake.", "The client will maintain weight within 5 percent of baseline throughout treatment.", "The client will report pain at or below the agreed goal and be able to sleep and move.", "The client will demonstrate intact oral mucosa or healing mucositis with a followed mouth care regimen.", "The client will verbalize feelings about appearance and role changes and identify sources of support.", "The client and family will explain the treatment plan, warning signs and when to call the oncology team." ], "interventions": [ { "title": "1. Preventing and detecting infection", "points": [ "Track the absolute neutrophil count and anticipate the nadir 7–14 days after each cycle so monitoring intensifies before symptoms appear.", "Take temperature at least every 4 hours during the nadir and treat a single fever as an emergency — cultures and broad-spectrum antibiotics within one hour of onset.", "Teach that neutropenic patients cannot mount classic inflammation; there may be no redness, swelling or purulent drainage even with serious infection.", "Enforce meticulous hand hygiene by staff, patient and visitors; screen out visitors with any illness or recent live-vaccine exposure.", "Avoid rectal temperatures, suppositories, enemas and urinary catheters, which breach mucosal barriers.", "Advise a neutropenic diet as ordered — thoroughly cooked food, washed peeled fruit, no unpasteurized dairy or raw eggs — and no fresh flowers or standing water in the room.", "Inspect all catheter and port sites daily and use strict aseptic technique for every access.", "Do not give live vaccines during treatment, and confirm household contacts are appropriately vaccinated." ] }, { "title": "2. Managing bleeding risk and anemia", "points": [ "Institute bleeding precautions when platelets fall below 50,000/mm³: soft toothbrush, electric razor, no flossing, no aspirin or NSAIDs, no contact activity.", "Avoid intramuscular injections and unnecessary venipuncture; apply pressure for at least five minutes after any needle stick.", "Assess daily for petechiae, ecchymosis, gum or nasal bleeding, blood in urine or stool, and any headache or neurologic change suggesting intracranial bleed.", "Prevent constipation with stool softeners to avoid straining and rectal trauma.", "For anemia, cluster care and plan rest periods around activity, and teach paced activity rather than complete rest, which worsens deconditioning.", "Administer transfusions or growth factors as ordered, monitoring for reaction." ] }, { "title": "3. Controlling nausea, vomiting and mucositis", "points": [ "Give antiemetics on a schedule before chemotherapy and continue around the clock during the emetogenic window rather than waiting for nausea.", "Combine agents as prescribed — a 5-HT3 antagonist, dexamethasone and an NK-1 antagonist for highly emetogenic regimens — and add lorazepam for anticipatory nausea.", "Offer small, frequent, bland, room-temperature or cool foods; strong odors and hot dishes trigger nausea.", "Teach a mouth care routine of saline or sodium bicarbonate rinses four or more times daily with a soft brush; avoid alcohol-based mouthwash, which burns and dries.", "Inspect the mouth daily and treat mucositis early with prescribed topical anesthetics and antifungals; oral candidiasis is common.", "Suggest ice chips during infusion of agents where cryotherapy reduces mucositis, when ordered." ] }, { "title": "4. Managing cancer pain", "points": [ "Accept the patient's report as the standard and reassess after every intervention rather than at set intervals only.", "Give around-the-clock long-acting analgesia with short-acting breakthrough doses; PRN-only dosing leaves patients chasing pain.", "Do not withhold opioids over addiction fears in cancer pain; physical dependence is expected and is not addiction.", "Anticipate and treat opioid side effects from the start — a scheduled bowel regimen from day one, since tolerance to constipation never develops.", "Add adjuvants for specific pain types: gabapentinoids or duloxetine for neuropathic pain, bisphosphonates and radiation for bone metastases, corticosteroids for compression.", "Use non-drug measures — positioning, heat or cold where allowed, massage, relaxation — as additions, not replacements." ] }, { "title": "5. Safe administration of chemotherapy and biotherapy", "points": [ "Verify the regimen, dose calculation, cumulative dose limits and laboratory clearance with a second qualified nurse before administration.", "Wear appropriate personal protective equipment and handle body fluids with precautions for 48 hours after treatment.", "Confirm blood return before and periodically during vesicant infusion, and stay with the patient for the first minutes of a new agent.", "For suspected extravasation, stop the infusion immediately, leave the catheter in place, aspirate residual drug, notify the provider and follow the antidote protocol.", "Monitor for infusion reactions — flushing, hypotension, dyspnea, back pain — especially with monoclonal antibodies and platinum agents; have emergency drugs at the bedside.", "Watch for tumor lysis syndrome after treatment of bulky disease: rising potassium, phosphate and uric acid with falling calcium; hydrate and give allopurinol or rasburicase as ordered." ] }, { "title": "6. Radiation-related care", "points": [ "Wash the treatment field gently with lukewarm water and mild soap, pat dry, and apply only approved lotions after treatment, not before.", "Never remove skin markings and never apply heat, ice, powder, deodorant or adhesive tape to the field.", "Advise loose cotton clothing and complete sun protection of the field during and after therapy.", "Report moist desquamation early so dressings and treatment breaks can be arranged.", "For internal (sealed source) implants, apply time, distance and shielding: limit time in the room, keep visitors at a distance, exclude pregnant staff and children, and keep long forceps and a lead container available for a dislodged source — never touch it with hands.", "Explain that radiation fatigue is real, cumulative and peaks near the end of a course." ] }, { "title": "7. Nutrition, hydration and mobility", "points": [ "Weigh at consistent intervals and act on a loss above 5 percent rather than waiting for cachexia.", "Offer high-protein, high-calorie foods and supplements; add plastic utensils and marinades for metallic taste, and cold foods when odors are intolerable.", "Encourage fluids to protect kidneys from drug and tumor lysis products unless restricted.", "Consult dietetics early and consider enteral support before nutritional decline becomes severe.", "Promote daily walking as tolerated; exercise reduces cancer-related fatigue more reliably than rest." ] }, { "title": "8. Psychosocial, sexual and end-of-treatment support", "points": [ "Prepare the patient for hair loss before it happens, discuss wigs, scarves and scalp protection, and confirm regrowth after treatment.", "Address fertility and sexuality openly and early; referral to fertility preservation must happen before treatment starts.", "Screen for distress and depression at intervals, not just at diagnosis, and refer for counseling or peer support.", "Give honest information at the patient's pace, and involve family only as the patient wishes.", "Discuss advance directives and goals of care as routine planning rather than as a signal of failure.", "Provide a survivorship plan at completion: surveillance schedule, late effects to watch for, and who to call." ] } ], "patient_teaching": [ "Take your temperature whenever you feel unwell and call immediately for 38 °C or higher — do not wait and do not take fever-reducing medicine first.", "Avoid crowds and anyone with an infection during the low-count period, and wash hands frequently.", "Use a soft toothbrush and electric razor, and report any unusual bruising, bleeding gums, nosebleeds or black stools.", "Take antinausea medicine on schedule, not only when you feel sick, and eat small frequent meals.", "Rinse your mouth with saline or baking soda solution several times a day and report mouth sores early.", "Drink fluids generously unless you have been told otherwise, and keep a record of weight each week.", "Care for the radiation field as taught, keep markings intact, and protect the area from sun.", "Keep every appointment for labs and treatment, and bring an updated list of all medicines and supplements." ] }