Symptom management

• Role of the nurse:

  • education about treatment and management of adverse effects and disease symptoms
  • assist in coping with psychosocial issues
  • differentiate toxic effects from tolerable ones
  • differentiate and recognize progression of malignant process
• GI system:

  • mucositis: inflammation and ulceration of the mucus membranes and entire GI tract
  • nausea and vomiting: caused by cellular breakdown and meds
  • bowel dysfunction: diarrhea and constipation
  • anorexia: loss of appetite
  • malnutrition and cachexia: protein and colorie malnutrition = depletion of fat and muscle
  • xerostomia and altered taste sensation
  • dysphagia
• Mucositis interventions:

  • use artificial saliva
  • assess oral mucosa daily
  • good oral hygiene
  • avoid irritant food (tobacco, alcohol, spice)
  • use topical analgesic medications
• Nausea and vomiting interventions

  • eat when absence of nausea
  • administer entiemic medication
  • monitor for dehydration
• Diarrhea interventions

  • low fibre, low residue diet
  • increase fluid
  • antidiarrheal agent
• Constipation interventions

  • monitor bowel elimination
  • use stool softeners or laxatives
  • high fibre food
• Anorexia interventions

  • monitor patient weight twice a week
  • small frequent meals
  • high protein and high calorie diet
  • nutritional supplements
• Malnutrition interventions

  • increase protein and calorie intake
  • consult nutritions (5% weight loss)
  • monitor albumin and prealbumin levels
  • add nutritional supplements to food
  • explore pt‘s belief about food
• Xerostomia is a dry mouth due to decrease salivary flow, leading to taste loss. The theory is that cancer cells release substances that stimulate the bitter taste buds which alterates sweet, sour and salty sensation
• Xerostomia interventions

  • explain changes that they may experience
  • find appealing food
  • oral hygiene
• Dysphagia interventions: swallowing assessment

  • often pts with esophageal cancer or pts receiving radiotherapy
• Hematological system: due to suppression of bone marrow = CBC must be closely monitored

  • decreased WBC (leukopenia)
  • decreased platelets (thrombocytopenia)
  • decreased RBC (anemia)
• Anemia may lead to hypoxia, dyspnea and fatigue. A blood transfusion may be needed.
• Leukopenia causes increased risk for infection. Interventions include:

  • private room with positive pressure ventilation
  • good handwashing
  • monitor temperature or signs of infection
  • limit visitors
  • no flowers or plants
• Thrombocytopenia can lead to spontaneous bleeding. Interventions include:

  • observe for signs of bleeding
  • avoid punctures (IV)
  • electric razors
  • avoid foley catheters, rectal thermometers
  • avoid oral trauma (flossing)
  • stool softeners to avoid straining
• Integumentary system

  • alopecia: destruction of hair follicles temporarily, grows back in 4-8 weeks
  • skin reaction: erythema followed by dry desquamation
• Skin reaction interventions

  • use nonirritating skin moisturizer
  • advice to wear loose cloting
  • inform of photosensitivity (avoid sunlight)
  • protect from extreme temperature
• Male reproductive system

  • erectile dysfunction
  • interrupted sperm production
  • ejaculation problem
  • sperm count recovers in 2-5 years or never
• Female reproductive system

  • permanent damage with radiation therapy
  • irritation and tenderness
  • loss of lubrification
  • potential infertility
• Nervous system

  • peripheral neuropathy: presence of parathesia, weakness = increased risk for fall
  • fatigue: direct result of cancer treatment or its consequences like anemia
  • pain: compression of tumor involving nerves or inflammation/ulceration of tissues
• Psychosocial fears

  • disfigurement
  • dependency
  • unrelieved pain
  • financial depletion
  • abandonment
  • death
• Family psychosocial

  • may be angry that their needs are unmet
  • feel inadequate with regard to caring for client
  • impact on family member state of mind and disposition
• Psychosocial interventions

  • assess patient needs and refer to services
  • listen to fear and concerns
  • offer coping strategies and provide information
  • establish therapeutic relationship
  • encourage healthy lifestyle maintenance
  • maintain hope
  • encourage participation in care