Cancer and Chemotherapy
1. Chronic Pain related to growth / metastatic tumor
- Clients are able to:
- Lowering the level of pain
- Controll of pain
- Increase a sense of comfort
With the outcomes:
- Measure the pain by using a pain scale, set goals for the reduction of pain, which is expected and make action plans to manage the pain.
- Describing about pain management plan both pharmacological and non-pharmacological, including recognition of gains and losses in the management of pain medications and non-drug use.
- Demonstrated ability to calm, relax.
- Accept the situation being experienced and able to act with the minimum of pain.
1. Analgesic administration:
- Assess the client’s experience when dealing with the pain for the first time, if possible, try to intervene to reduce pain.
- Encourage clients to describe past experience about the pain and the methods used to deal with the pain, including the experience of side effects, the type of coping response, and how to express pain.
- Describes the adverse effects of the pain was unbearable.
- Encourage clients to report on the location, intensity and quality of pain when you’re in pain
- Ask the client to manage the level of pain, time, originator, treatment and care, and other actions that can reduce the pain.
- Determine the client’s use of the drug is needed.
- Intensity, character, time of occurrence, duration and factors that aggravate the reduction of pain, should be assessed and documented at the time after the initial evaluation.
- Attention may give effect to the feelings of the client to report pain and use of analgesics.
- The intensity of the pain and discomfort should be assessed and documented after the procedure that causes pain with a few new things about pain and pain interval.
- To help plan the treatment of pain.
2. Acute Pain related to actual or potential tissue damage caused by metastatic tumor.
With the outcomes:
- Decreased pain scale 1-3.
- Client report reduced pain / lost.
- Client looks relaxed.
- Client are able to rest.
1. Pain management
- Perform a comprehensive assessment of pain: location, characteristics, duration, frequency, quality and predisposing factors.
- Observation of non-verbal reactions of discomfort.
- Use therapeutic communication techniques to determine the client’s experience of pain.
- Evaluation of past painful experiences.
- Help clients and families to seek and find support.
- Control of environmental factors that affect pain such as room temperature, lighting and noise.
- Reduce pain precipitation factor.
- Choose and pain management (pharmacological / non-pharmacological).
- Teach relaxation techniques.
- Give analgesics corresponding program.
- Evaluate the effectiveness of pain control.
- Increase rest-sleep.
- Collaboration with the doctor if any pain complaints and the action does not work.
- Monitor client acceptance of pain management.
2. Analgesic administration:
- Determine the location, characteristics, quality and degree of pain before treatment.
- Check the doctor’s instructions about the type of medication, dosage and frequency.
- Check history of allergy.
- Select the required analgesics.
- Determine analgesic options depending on the type and severity of pain.
- Determine the analgesic of choice, the optimal route of administration and dose.
- Choose a route administration of drugs intravenously or intra-muscular, for the treatment of pain regularly.
- Monitor vital signs before and after the administration of analgesics.
- Give analgesics on time especially when severe pain.
- Evaluation of analgesic efficacy and side effects.
- The intensity of the pain and discomfort should be assessed and documented after the procedure that causes pain with a few new things about the pain and the interval of pain.
- Approaches to therapeutic communication techniques will increase client confidence.
- Clients experience the pain of the past can be used as an initial evaluation for pain management.
- Minimization of external influences capable of helping clients to overcome pain and prevent pain.
- Can provide a sense of calm to the client and make the client more relaxed so that pain can be reduced.
- Analgesic is needed on the conditions and severe pain was unbearable.
- Client’s response to the evaluation procedure can be used as material for further pain management.
- The intensity of pain, location and quality are the basis for determining which interventions will be carried out.
- The accuracy and precision of providing analgesic administration program, is necessary in the treatment of pain.
- Appropriate analgesic selection, and service that is able to minimize the pain at the time of delivery as well as the faster analgesic effect is felt by the client is needed in pain management.
- Evaluation of the response to the administration of analgesics can be used to assess the effectiveness of analgesics given.
3. Anxiety related to change in health status
- Clients and families showed anxious
With the outcomes:
- Adaptive coping
- Able to control the anxiety
- Assess the level of anxiety, the factors that influence the onset of anxiety.
- Reassure the client that the nurse is ready to assist clients facing health problems and encourage clients to express their feelings, fears and perceptions.
- Assess the client’s expectations to treatment and care.
- Understand the client’s perception of stressful situations.
- Accompany clients to provide security and reduce fear.
- Provide factual information about diagnosis, action, and prognosis.
- Encourage the family to accompany the client.
- Help clients to identify situations that cause anxiety.
- Teach relaxation techniques to reduce anxiety.
- Preliminary data of anxiety is necessary to determine the client’s level of anxiety and the factors affecting it can be seen that the nurse can minimize / prevent clients from influential factor.
- Presence and readiness of nurses in handling / accompany client during the period of anxiety can help clients to fulfill a sense of security so as to reduce anxiety.
- The presence of the family, can provide mental suport to clients.
- Relaxation techniques can reduce stress arising.
4. Nausea related to chemotherapy
- Nausea will be reduced
With the outcomes:
- Clients feel more comfortable
- Balanced fluid status
- Adequate nutrient intake
- Assess the client’s cause of nausea and vomiting.
- Keep the client, after vomiting and put wipes in a convenient location accessible by the client.
Provide oral care after vomiting.
- Give / teaching methods of distraction from the sensation of nausea eg using music, etc..
- Keep the environment clean, quiet and well ventilated.
- Avoid sudden movements, let the client remain supine.
- Collaboration of antiemetics.
- Give antiemetics one hour before administration of chemotherapy.
- Motivate clients to eat / drink a little but often.
- Give diet favored in warm conditions and serve to draw.
- With a known cause of the nurse can determine the appropriate action to deal with nausea / vomiting.
- Hygiene and oral care can eliminate the smell and taste of vomit, and can reduce the stimulus for nausea / vomiting.
- The smell from the kitchen, the bathroom can stimulate nausea / vomiting.
- Movement of clients can further stimulate the onset of nausea / vomiting.
- Giving antiemetic, is more effective in reducing / preventing nausea in clients with chemotherapy.
- Eat / drink a little but often can reduce the sensation of vomiting due to a full stomach.
- Diet interesting and liked by the client can be an appetite client so that the client’s nutritional needs are met.