PAMANTASAN NG CABUYAO

Bachelor of Science in Nursing

NCM112 – Care of Client with Problem in Oxygenation

Name: Aquino, Chelsea A. Date: October 19, 2021

Year and Section: 3BSN-A Score:

OVERVIEW OF ONCOLOGY NURSING AND APPLY NURSING PROCESS ON CHEMOTHERAPY AND RADIOTHERAPY

WHAT IS ONCOLOGY NURSING?

Oncology is the branch of medicine that researches, identifies, and treats cancer. A physician who works in the field of oncology is an
oncologist. The field of oncology in nursing, in particular, is one of the most challenging and rewarding fields in nursing. Cancer nursing practice
covers all age groups and nursing specialties and is carried out in a variety of health care settings, including the home, community, acute care
institutions, and rehabilitation centers. The scope, responsibilities, and goals of cancer nursing, also called oncology nursing, are as diverse and
complex as those of any nursing specialty. Because many people associate cancer with pain and death, nurses need to identify their own reactions to
cancer and set realistic goals to meet the challenges inherent in caring for patients with cancer. In addition, the cancer nurse must be prepared to
support the patient and family through a wide range of physical, emotional, social, cultural, and spiritual crises.

Oncology nurses care for cancer patients, serving as their first line of communication, and helping to coordinate the many aspects of their
care throughout cancer treatment. They play important roles in caring for persons with solid tumors and blood-related malignancies as well as
educating patients and families on the complex issues related to the cancer process and treatment procedures. Oncology nurses are healthcare
professionals who are specially trained to administer chemotherapy and radiation treatments. They are also responsible for monitoring cancer
patients’ vital signs and overall well-being, helping them manage pain and lessen side effects as they undergo treatment.

Oncology nurses must keep track of numerous details throughout the day for each patient—and they likely have to tend to several patients
each day. One mistake could adversely affect a patient’s health, so their attention to detail is critical. Oncology nurses are also there to provide
compassion for their patients, and to keep their patients calm in the midst of a difficult situation. They often form relationships with their patients and
learn about the person’s life and family.
 Oncology nurses practice in a variety of settings, including hospitals, outpatient care centers, clinics, private practices, and long-term care
facilities. The scope of oncology nursing spans from prevention and early detection to treatment (such as surgical oncology, radiation oncology, and
medical oncology), symptom management, and palliative care. Oncology nurses work with adult and pediatric patients with cancer.

The oncology nurse has many roles, from helping with cancer screening, detection, and prevention, to the intensive care focus of bone marrow
transplantation. The following are the responsibilities of the nurse in cancer care:

• Support the idea that cancer is a chronic illness that has acute exacerbations rather than one that is synonymous with death
and suffering.
• Assess own level of knowledge relative to the pathophysiology of the disease process.
• Make use of current research findings and practices in the care of the patient with cancer and his or her family.
• Identify patients at high risk for cancer.
• Participate in primary and secondary prevention efforts.
• Assess the nursing care needs of the patient with cancer.
• Assess the learning needs, desires, and capabilities of the patient with cancer.
• Identify nursing problems of the patient and the family.
• Assess the social support networks available to the patient.
• Plan appropriate interventions with the patient and the family.
• Assist the patient to identify strengths and limitations.
• Assist the patient to design short-term and long-term goals for care.
• Implement a nursing care plan that interfaces with the medical care regimen and that is consistent with the established goals.
• Collaborate with members of a multidisciplinary team to foster continuity of care.
• Evaluate the goals and resultant outcomes of care with the patient, the family, and members of the multidisciplinary team.
• Reassess and redesign the direction of the care as determined by the evaluation.
 APPLICATION OF THE NURSING PROCESS IN CHEMOTHERAPY
Once a diagnosis is made, the oncologist discusses the disease stage with the patient. Staging will dictate the treatment of cancer.
Chemotherapy — which is defined as the destruction of cancer cells — may be used, as well as radiation therapy. In chemotherapy, antineoplastic
agents are used in an attempt to destroy tumor cells by interfering with cellular functions and reproduction. Chemotherapy is used primarily to treat
systemic disease rather than lesions that are localized and amenable to surgery or radiation. Chemotherapy may be combined with surgery or
radiation therapy, or both, to reduce tumor size preoperatively, to destroy any remaining tumor cells postoperatively, or to treat some forms of
leukemia. The goals of chemotherapy (cure, control, palliation) must be realistic because they will define the medications to be used and the
aggressiveness of the treatment plan.

The nurse has an important role in assessing and managing many of the problems experienced by the patient undergoing chemotherapy.
Because of the systemic effects on normal as well as malignant cells, these problems are often widespread, affecting many body systems.

Assessing Fluid and Electrolyte Status

Anorexia, nausea, vomiting, altered taste, and diarrhea put the patient at risk for nutritional and fluid , and electrolyte disturbances. Changes in
the mucosa of the gastrointestinal tract may lead to irritation of the oral cavity and intestinal tract, further threatening the patient’s nutritional status.
Therefore, it is important for the nurse to assess the patient’s nutritional and fluid, and electrolyte status frequently and to use creative ways to
encourage an adequate fluid and dietary intake.

Modifying Risks for Infection and Bleeding

Suppression of the bone marrow and immune system is an expected consequence of chemotherapy and frequently serves as a guide in
determining appropriate chemotherapy dosage. How ever, this effect also increases the risk for anemia, infection, and bleeding disorders. Therefore,
nursing assessment and care focus on identifying and modifying factors that further increase the pa tient’s risk. Aseptic technique and gentle
handling are indicated to prevent infection and trauma. Laboratory test results, particularly blood cell counts, are monitored closely. Untoward
changes in blood test results and signs of infection and bleeding must be reported promptly. The patient and family members are instructed about
measures to prevent these problems at home

Chemotherapy drugs are distributed throughout the body by the bloodstream and have the potential to cause significant morbidity and
mortality if not used correctly and cautiously, thereby heightening the critical importance of the oncology nurse's education, training, and
chemotherapy certifications. Chemotherapy may be used as a single agent or in combination with other drugs, but it is more commonly used in
combination for greater efficacy against cancer and to reduce the potential for drug resistance.
 NURSING CARE PLAN FOR CHEMOTHERAPY

PLANNING
NURSING
ASSESSMENT GOAL/ EXPECTED EVALUATION
DIAGNOSIS NURSING INTERVENTIONS RATIONALE
OUTCOME
Subjective Data: Fatigue related After 8 hours of INDEPENDENT: THE GOAL WAS
“Hinang-hina ako to effects of nursing • Establish rapport. • To gain the patient’s trust and MET.
lagi pagkatapos chemotherapy interventions, the promote cooperation.
kong magpa- as evidenced by patient will be • Have patient rate fatigue, using • Helps in developing a plan for At the end of the
chemo,” as overwhelming able to: a numeric scale, if possible, managing fatigue. shift, the patient
verbalized by the lack of energy, • Report and the time of day when it is has been able to
patient. inability to improved most severe.
maintain usual sense of • Report
Objective Data: routines, and energy and • Asees for sources of • Coping with discomfort requires improved
• Lethargy lethargy decreasing discomfort. energy expenditure. sense of
• Weak levels of energy and
appearance fatigue. • Plan care to allow for rest • Frequent rest periods and naps decreasing
• Disinterest in • Perform ADLs periods. Schedule activities for are needed to restore and levels of
surroundings and periods when patient has most conserve energy. Planning will fatigue.
• Inability to participate in energy. Involve patient and SO allow patient to be active during • Perform
concentrate desired in schedule planning. times when energy level is ADLs and
activities at higher, which may restore a participate in
the level of feeling of well-being and a sense desired
ability. of control. activities at
the level of
• Establish realistic activity goals • Provides for a sense of control ability.
with patient. and feelings of accomplishment.

• Encourage adequate protein • Protein and calorie depletion

and calorie intake. decreases activity tolerance.

• Assist with self-care needs • Weakness may make ADLs

when indicated; keep bed in difficult to complete or place the
low position, pathways clear of patient at risk for injury during
furniture; assist with activities.
ambulation.
• Encourage use of relaxation • Promotion of relaxation and
techniques, mental imagery. psychological rest decreases
physical fatigue.

• Encourage patient to do • Enhances strength and stamina

whatever possible (self- and enables patient to become
bathing, sitting up in chair, more active without undue
walking). Increase activity level fatigue.
as individual is able.
• Monitor physiological response • Tolerance varies greatly
to activity (changes in BP, depending on the stage of the
heart and respiratory rate). disease process, nutrition state,
fluid balance, and reaction to
therapeutic regimen.

• Assess for fluid and electrolyte • May contribute to altered nerve

imbalance. transmission and muscle
function.

• Perform pain assessment and • Poorly managed cancer pain can

provide pain management. contribute to fatigue.

DEPENDENT:
• Administer blood products as • Lowered hemoglobin and
prescribed. hematocrit predispose patient to
fatigue due to decreased oxygen
availability
COLLABORATIVE:
• Refer to physical or • Programmed daily exercises and
occupational therapy. activities help patient maintain
and increase strength and
muscle tone, enhance sense of
well-being. Use of adaptive
devices may help conserve
energy.
 APPLICATION OF THE NURSING PROCESS IN RADIATION THERAPY
Radiation therapy (also called radiotherapy) is a cancer treatment that uses high doses of radiation to kill cancer cells and shrink tumors. At
low doses, radiation is used in x-rays to see inside your body, as with x-rays of your teeth or broken bones. At high doses, radiation therapy kills
cancer cells or slows their growth by damaging their DNA. Cancer cells whose DNA is damaged beyond repair stop dividing or die. When the
damaged cells die, they are broken down and removed by the body. Radiation therapy does not kill cancer cells right away. It takes days or weeks of
treatment before DNA is damaged enough for cancer cells to die. Then, cancer cells keep dying for weeks or months after radiation therapy ends.

The patient receiving radiation therapy and the family often have questions and concerns about its safety. To answer questions and allay fears
about the effects of radiation on others, on the tumor, and on the patient’s normal tissues and organs, the nurse can explain the procedure for
delivering radiation and describe the equipment, the duration of the procedure (often minutes only), the possible need for immobilizing the patient
during the procedure, and the absence of new sensations, including pain, during the procedure. If a radioactive implant is used, the nurse informs the
patient and family about the restrictions placed on visitors and health care personnel and other radiation precautions. Patients also need to understand
their own role before, during, and after the procedure.

Certain chemicals, including chemotherapy agents, act as radiosensitizers and sensitize more hypoxic (oxygen-poor) tumors to the effects of
radiation therapy. Radiation is delivered to tumor sites by external or internal means.

External beam radiation therapy comes from a machine that aims radiation at cancer. If external radiation therapy is used, one of several
delivery methods may be chosen, depending on the depth of the tumor. Depending on the amount of energy they contain, x-rays can be used to
destroy cancerous cells at the skin surface or deeper in the body. The higher the energy, the deeper the penetration into the body.

Internal radiation therapy is a treatment in which a source of radiation is put inside the body. The radiation source can be solid or liquid.
Internal radiation therapy with a solid source is called brachytherapy. In this type of treatment, seeds, ribbons, or capsules that contain a radiation
source are placed in the body, in or near the tumor. Like external beam radiation therapy, brachytherapy is a local treatment and treats only a specific
part of your body.

Protecting the Skin and Oral Mucosa

The nurse assesses the patient’s skin, nutritional status, and the general feeling of well-being. The skin and oral mucosa are assessed
frequently for changes (particularly if radiation therapy is directed to these areas). The skin is protected from irritation, and the patient is instructed to
avoid using ointments, lotions, or powders on the area.
 Gentle oral hygiene is essential to remove debris, prevent irritation, and promote healing. If systemic symptoms, such as weakness and
fatigue, occur, the patient may need assistance with activities of daily living and personal hygiene. Additionally, the nurse offers reassurance by
explaining that these symptoms are a result of the treatment and do not represent deterioration or progression of the disease.

Protecting the Caregivers

When a patient has a radioactive implant in place, nurses and other health care providers need to protect themselves as well as the patient
from the effects of radiation. Specific instructions are usually provided by the radiation safety officer from the x-ray department. The instructions
identify the maximum time that can be spent safely in the patient’s room, the shielding equipment to be used, and special precautions and actions to
be taken if the implant is dislodged. The nurse should explain the rationale for these precautions to keep the patient from feeling unduly isolated.

NURSING CARE PLAN FOR RADIATION THERAPY

PLANNING
NURSING GOAL/
ASSESSMENT EVALUATION
DIAGNOSIS EXPECTED NURSING INTERVENTIONS RATIONALE
OUTCOME
Subjective Data: Impaired skin After 8 hours of INDEPENDENT: THE GOAL WAS
“Namumula yung integrity nursing In erythematous areas: MET.
balat ko related to interventions, • Assess skin frequently for side • A reddening or tanning effect
pagkatapos ng effects of the patient will effects of cancer therapy; note (radiation reaction) may develop At the end of the
radiation therapy, radiation be able to: breakdown and delayed wound within the field of radiation. Dry shift, the patient
tapos parang moist therapy as healing. Emphasize the desquamation (dryness and has been able to:
din yung mga evidenced by • Display importance of reporting open pruritus), moist desquamation
blisters,” as erythematous timely areas to the caregiver. (blistering), ulceration, hair loss,
verbalized by the and moist healing of loss of dermis and sweat glands
patient. desquamation skin lesions, may also be noted.
reactions wounds, or
Objective Data: pressure • Avoid the use of soaps, • Maintains cleanliness without
• Erythematous sores cosmetics, perfumes, powders, further skin irritation, drying, and
skin without lotions and ointments, damage.
• Moist complication. deodorants. Use only lukewarm
desquamation • Participate in water to bathe the area.
• Skin ulceration prevention
• Rashes measures • Encourage patient to avoid • Helps prevent skin friction and
• Hyperpigmenta and vigorous rubbing and trauma to sensitive tissues.
tion treatment scratching and to pat skin dry
• Localized area program. instead of rubbing.
hot to touch
• Avoid tight clothing in the area. • Allows air circulation to affected
Use cotton clothing. area.

• Turn or reposition frequently. • Promotes circulation and

prevents undue pressure on skin
and tissues.

• Review skin care protocol for • Designed to minimize trauma to

patient receiving radiation area of radiation therapy. Can
therapy: Avoid rubbing or use potentiate or otherwise interfere
of soap, lotions, creams, with radiation delivery. May
ointments, powders or actually increase irritation and
deodorants on area; reaction.

If wet desquamation occurs:

• Do not disrupt any blisters that • Open weeping areas are
have formed. susceptible to bacterial infection.
• Avoid frequent washing of the Care must be taken to prevent
area. Report any blistering. the introduction of pathogens.

• Use prescribed creams or • Decreases irritation and

ointments. inflammation of the area.
• If the area weeps, apply a thin • Enhances drying.
layer of gauze dressing