_________________________________________________________ Chapter 25 The Patient with Cancer 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 25.1
5
DISCUSS
• Discuss the various tests and procedures
used to diagnose cancer, and provide
examples of uses for each.
• Have students form pairs and role-play a
nurse and a patient. Assign one or more
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe three
commonly used tests to diagnose cancer.
18 Chapter 25 The Patient with Cancer _________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 25.1
6
DISCUSS
• Discuss the processes of internal and
external radiation and issues related to
caregiver safety. Also discuss nursing
management of radiotherapy’s side effects.
• Discuss chemotherapy, including the types
of antineoplastic drugs used and their side
effects.
• Divide the class into four groups and assign
each group a type of cancer therapy
(surgery, radiation, chemotherapy, or
biotherapy). Have each group identify what
nursing considerations should be taken into
account before a patient receives the therapy.
What are possible side effects? What care
might the nurse provide to this patient? Have
each group present its findings to the class.
• Divide the class into small groups and
present them with the following scenario:
• A 56-year-old man with colon cancer
arrives at the oncology clinic to receive
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Compare and
contrast the reasons for using surgery,
chemotherapy, or radiation to treat cancer.
_________________________________________________________ Chapter 25 The Patient with Cancer 19
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 25.1
Critical Thinking Question
A 46-year-old woman visits the clinic for a routine checkup. She is concerned about cancer
because it runs in her family. She wants to know what her chances are of developing cancer
and what she can do to prevent it. What information should the nurse provide to the patient,
and what routine screenings should be done to detect cancer early?
Discussion Guidelines: The nurse should stress to the patient that it is difficult to determine who
will get cancer, although early detection and early treatment are the best weapons against cancer.
Instructor Notes/Student Feedback
20 Chapter 25 The Patient with Cancer _________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 25.2
Instructor Preparation
Textbook Objectives Covered
6. Explain the nursing care of patients undergoing each type of cancer therapy: surgery, radiation,
chemotherapy, and biotherapy. (cont.)
7. Assist in developing a nursing care plan for the terminally ill patient with cancer and the
patient’s family
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Guest speaker: oncology nurse
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying the care of the patient with cancer, including:
• Diagnostic tests and procedures for cancer
• Assemble materials and supplies needed for each lesson as indicated below.
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• adjuvant (p. 393)
• alopecia (p. 395)
• alternative therapy (p. 400)
• antineoplastic (p. 395)
• chemotherapy (p. 395)
• complementary therapy (p.
400)
• extravasation (p. 399)
• neoadjuvant (p. 393)
• neoplasm (p. 385)
• neutropenia (p. 399)
• radiotherapy (p. 393)
_________________________________________________________ Chapter 25 The Patient with Cancer 21
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 25.2
Student Preparation
Assignments 2 hours
5
READ – Textbook (pp. 389-393)
ANSWER – Text
• Review Questions for the NCLEX Examination: 4 (p. 413)
ANSWER – Study Guide
• Part IIF: 14 (p. 145)
6
READ – Textbook (pp. 393-412)
ANSWER – Text
• Review Questions for the NCLEX Examination: 8 (p. 413)
ANSWER – Study Guide
• Part IB: 1-3 (p. 144)
7
READ – Textbook (pp. 393-412)
REVIEW
• Figure 25-5: Listening and touching convey acceptance and caring (p. 404)
• Table 25-12: Oncologic Emergencies (p. 411)
ANSWER – Text
• Review Questions for the NCLEX Examination: 10 (p. 413)
ANSWER – Study Guide
• Part IIF: 12, 18-23 (pp. 145–147)
• Part IIIG: 1-4 (p. 147)
50-Minute Lesson Plan
Lecture Outline 20 minutes
5
&
6
Slide 28
Assessment: Health History
• Chief complaint
• Pain, lesions, lumps, or changes in body function
• Complete description of problem and signs and symptoms
• Medical history
TALKING POINTS:
• People who develop one of the common signs of cancer are often aware of how serious
the condition might be.
• Why do some people ignore the signs of cancer?
22 Chapter 25 The Patient with Cancer _________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 25.2
Slide 29
Assessment: Health History (cont.)
• Review of systems
• Record any of the following signs and symptoms: pain, lumps, fatigue, activity
intolerance, lesions of the skin or mucous membranes, easy bruising or bleeding,
Slide 30
Assessment: Health History (cont.)
• Functional assessment
• Describe the patient’s diet, use of alcohol and tobacco, safe sex practices, activity,
sleep routines
• Document the occupation and describe a usual day
Slide 31
Assessment: Physical Examination
• Vital signs, height, and weight
• Inspect face, scalp, and oral mucosa for lesions
• Palpate the neck for enlarged lymph nodes
• Inspect skin for color, lesions, edema, and bruising
6
Slide 32
Ineffective Denial
• Deny the seriousness of the situation and do not seek medical care
• Encourage people to learn the warning signs of cancer and to report them promptly
TALKING POINTS:
Anxiety
• Patient needs encouragement, support, and honest information
Slide 34
Deficient Knowledge
• Tell patient about diagnostic procedures, including preparation, what the procedure is like,
and any specific postprocedure care
_________________________________________________________ Chapter 25 The Patient with Cancer 23
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 25.2
Slide 35
Assessment: Health History
• Note patient’s diagnosis and treatment plan
• Complete drug profile; record allergies prominently
TALKING POINTS:
• What psychological assessment should be done?
Assessment: Health History (cont.)
Assessment: Physical Examination
• Note general appearance, level of consciousness, posture, and gait
• Assess mental and emotional state
Assessment: Physical Examination (cont.)
• Observe patient’s respiratory effort and auscultate the lungs
Slide 39
Anxiety
• Encourage patient to express feelings and identify the source of the anxiety
• Listening and touch can be very effective in reducing anxiety
• Recognize need for patient teaching or referrals
TALKING POINTS:
Slide 40
Ineffective Coping
• Strategies to promote coping include teaching, encouraging self–care within the patient’s
limitations, treating physical signs and symptoms, emphasizing abilities, coaching in
relaxation strategies, and encouraging the use of coping strategies that have been
effective in the past
TALKING POINTS:
• The patient may need help in setting priorities and in coping with the side effects of
therapy.
24 Chapter 25 The Patient with Cancer _________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 25.2
Slide 41
• Neurotoxicity
Risk for Injury
• Pneumonitis and pulmonary fibrosis
• Encourage coughing and deep-breathing exercises
• Protect patient from exposure to people who have upper respiratory infections
• Cardiac toxicity
TALKING POINTS:
• Patients receiving doxorubicin (Adriamycin) may show signs of heart failure.
• What should you do if you assess signs of heart failure?
Slide 42
Risk for Injury (cont.)
• Thrombocytopenia
• Avoid trauma and bruising
• Minimal invasive procedures: rectal temperatures
• After venipunctures or injections, apply pressure for 5 minutes to control oozing
TALKING POINTS:
• Both radiation and chemotherapy can suppress the production of platelets.
• How does a low platelet count affect the blood?
Slide 43
Risk for Injury (cont.)
• Anemia
• Monitor hemoglobin and hematocrit
• Encourage a diet high in iron
TALKING POINTS:
• When should anemia be anticipated?
• Anemia is treated with packed red blood cells and erythropoietin (epoetin alfa).
• Female patients of childbearing age should discuss specific reproductive guidelines with
their physicians.
_________________________________________________________ Chapter 25 The Patient with Cancer 25
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 25.2
Slide 44
Risk for Infection
• Avoid crowds and close contact with others who have infectious diseases
• Promptly report any signs of infection
• Compromised host precautions
• Private room
TALKING POINTS:
• What signs of infection should be reported?
• The venous access device presents a potential portal for infection.
Slide 45
Imbalanced Nutrition: Less Than Body Requirements
• High-protein, high-calorie diet
• Small, frequent feedings
• Light exercise before meals may stimulate the appetite
• Nutritional supplements (such as Carnation Instant Breakfast, Ensure, or Sustacal),
TALKING POINTS:
• Anorexia is common with cancer therapy, but maintaining good nutrition is essential.
Slide 46
Impaired Oral Mucous Membranes
• Frequent, gentle mouth care
• Artificial saliva
• Encourage increased fluid intake, chew sugarless gum or candies, suck on ice chips, and
moisten dry food before eating
TALKING POINTS:
Slide 47
Constipation
• Monitor patient’s bowel movements
• The physician may prescribe a high-fiber diet, stool softeners, laxatives, and phosphate or
bisphosphate enemas to prevent or treat constipation
26 Chapter 25 The Patient with Cancer _________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 25.2
Slide 48
Fatigue
• Assess the patient’s need for assistance and schedule activities to conserve energy
• Encourage patient to prioritize activities and ask others to assume less important ones
• Daily naps and mild exercise helpful
TALKING POINTS:
Disturbed Body Image
• Be sensitive to patient’s concern about hair loss
• Use wigs, scarves, or hats
TALKING POINTS:
• The effects of cancer and cancer treatments can alter physical appearance and function.
Dysfunctional Grieving
• Listen in an accepting way that lets the patient know the feelings are understood
• Support patient and provide practical information about adapting to the loss
TALKING POINTS:
• Changes in body appearance often trigger a grief response.
• What are some behaviors that suggest that the patient is beginning to accept the loss or
change?
Impaired Family Processes
• Encourage family to remain involved
TALKING POINTS:
• While undergoing treatment for cancer, the patient may be concerned with meeting
Slide 52
Ineffective Therapeutic Regimen Management
• Pretreatment teaching plan informs patient of what the prescribed therapy involves
• Chemotherapy
• Teaching plan includes drugs administered, potential side effects, related precautions
TALKING POINTS:
• What are some sources of information on cancer you can give to the patient?
_________________________________________________________ Chapter 25 The Patient with Cancer 27
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 25.2
Slide 53
Recovery and Rehabilitation
• If the outcome of treatment appears to be a cure, the patient and family are usually
overjoyed
• Some patients become excessively concerned with their bodies, constantly looking for
new evidence of cancer
• Periodic checkups essential but may be dreaded because the patient realizes that
7
Slide 54
Terminal Illness
• Although increasing numbers of people are surviving cancer, it is still the second leading
cause of death
• If treatment is unsuccessful, patient begins to decline
• For patients who wish to die at home, hospice provides support and teaching
TALKING POINTS:
• Provide information about home health care, hospice, and voluntary and charitable
Slide 55
Terminal Illness (cont.)
• Be attentive and accepting
• Listening carefully is more important than talking
• Guide patients to claim their accomplishments and find peace
• Terminally ill patients should remember that although they are going to die eventually,
they are living now and can still have some pleasure
Oncologic Emergencies
• Conditions sometimes develop that require emergency intervention as a result of the
TALKING POINTS:
• See Table 25-11.
28 Chapter 25 The Patient with Cancer _________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 25.2
Activities
Classroom Choose from below to make 30 minutes
Online
5
DISCUSS
• Discuss assessment during the diagnostic
phase. Outline components of the health
history and the physical examination.
• Divide the students into groups. Have each
group discuss how they would proceed with
a head-to-toe physical examination for a
POST AND COMMENT
• Post the following discussion topic online
and have students comment. What are the
three most important nursing interventions
you might expect to use when caring for a
patient undergoing chemotherapy? Explain
your answer.
6
DISCUSS
• Discuss Risk of injury and Risk of infection in
cancer patients receiving treatment, as well
as appropriate nursing interventions to help
avoid these risks.
• Invite an oncology nurse to speak to the
class about nursing care for patients
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe
nursing interventions for cancer patients
receiving treatment who have Imbalanced
nutrition, Impaired oral mucous membranes,
Constipation, Fatigue, Disturbed body
7
DISCUSS
• Discuss how nurses can work effectively
with terminally ill cancer patients, and how
awareness of their own feelings about death
can help nurses care for these patients.
• Discuss the risk factors, signs and
POST AND COMMENT
• Post the following discussion topic online
and have students comment. List the top two
diagnoses for the patient who has been told
they have terminal cancer. Include your top
two interventions for each.
_________________________________________________________ Chapter 25 The Patient with Cancer 29
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 25.2
Critical Thinking Question
A 42-year-old patient is undergoing diagnostic tests to determine if he has lung cancer. He
has had a nagging cough for approximately 6 months, and some abnormalities were noted
on a recent chest x-ray. What are some diagnostic tests that might be used to determine if
this patient has cancer? What are some nursing interventions that might be appropriate for
this patient during the diagnostic phase?
Discussion Guidelines: Some diagnostic tests that might be used for this patient include
computed tomography (CT) scans and magnetic resonance imaging (MRI). The patient may also
Instructor Notes/Student Feedback
30 Chapter 25 The Patient with Cancer _________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
25
Assessments for
The Patient with Cancer
CHAPTER OBJECTIVES
Lesson 25.1:
2. Explain the differences between benign and malignant tumors.
4. Describe measures to reduce the risk of cancer.
6. Explain the nursing care of patients undergoing each type of cancer therapy: surgery, radiation,
chemotherapy, and biotherapy.
Lesson 25.2:
5. List nursing responsibilities in the care of patients having diagnostic tests to detect possible cancer.
(cont.)
7. Assist in developing a nursing care plan for the terminally ill patient with cancer and the patient’s
family.
Assessments by Lesson & Objective
1
Evolve Instructor Resources
• Test Bank: 16, 18
2
Study Guide
• Part IIF: 2 (p. 145)
Evolve Instructor Resources
• Test Bank: 4, 5, 26, 31, 32
Evolve Student Resources
• NCLEX Review: 1
3
Study Guide
• Part IA: 1-9 (p. 143)
Evolve Instructor Resources
• Test Bank: 1, 15, 33
_________________________________________________________ Chapter 25 The Patient with Cancer 31
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
4
Study Guide
• Part IC: 1 (p. 144)
• Part IIF: 1 (p. 145)
Evolve Instructor Resources
Evolve Student Resources
• NCLEX Review: 2, 7-9
5
Study Guide
• Part IIF: 14 (p. 145)
Evolve Instructor Resources
6
Study Guide
• Part IB: 1-3 (p. 144)
• Part IE: 1-5 (p. 144)
• Part IIF: 4-11, 15-17 (pp. 145-146)
Evolve Instructor Resources
7
Study Guide
• Part IIF: 12, 18-23 (pp. 145–147)
• Part IIIG: 1-4 (p. 147)
Evolve Instructor Resources
• Test Bank: 7, 13, 19, 24, 25
Evolve Student Resources
Instructor’s Notes/Student Feedback