5B Nursing Care of Patient with Cancer

What are the four major sources of symptoms in patients with cancer?

• Cancer itself

• Cancer treatment

• Non-cancer conditions (comorbidities, infection, dehydration)

• The symptoms themselves (acute vs chronic)

Why is identifying the etiology of a cancer patient’s symptom important for nursing care?

• Guides appropriate nursing interventions

• Prevents treating symptoms incorrectly

• Helps prioritize safety and quality of life

• Essential for NCLEX-style clinical judgment

How can cancer itself directly cause patient symptoms?

• Tumor compression of organs, nerves, or vessels

• Increased metabolic demand → fatigue, weight loss

• Metastasis causing organ-specific symptoms (bone pain, SOB, neuro changes)

How do cancer treatments commonly contribute to patient symptoms?

• Damage to rapidly dividing cells

• Affects GI tract, skin, bone marrow

• Leads to nausea, stomatitis, fatigue, anemia, infection risk

What is the difference between acute and chronic symptoms in cancer patients?

• Acute: Sudden onset, short duration

• Chronic: Long-lasting, persistent, may be progressive

What is the nurse’s primary goal in symptom management for cancer patients?

• Improve comfort and quality of life

• Prevent complications

• Maintain safety across all stages of care (treatment, survivorship, palliative)

Why are cancer symptoms often described as multifactorial?

• Symptoms may result from cancer, treatment, and comorbidities at the same time

• Multiple causes can worsen severity

• Nursing care must address more than one contributing factor

What is the nurse’s role in symptom assessment for patients with cancer?

• Identify the cause of the symptom

• Assess severity, onset, and impact on daily life

• Communicate findings promptly to guide treatment decisions

Why is symptom management considered a core nursing responsibility in cancer care?

• Nurses monitor symptoms continuously

• Early intervention prevents complications

• Focuses on comfort, safety, and quality of life

What is stomatitis and why is it a concern in patients receiving cancer treatment?

• Inflammation and ulceration of the oral mucosa

• Caused by chemotherapy or radiation

• Leads to pain, difficulty eating, and increased infection risk

Why does chemotherapy commonly cause stomatitis?

• Chemotherapy damages rapidly dividing cells

• Oral mucosal cells divide quickly and are easily injured

What nursing interventions help prevent or reduce stomatitis?

• Oral care protocols

• Gentle, frequent oral hygiene

• Cryotherapy (ice chips during chemotherapy)

What is radiation-associated skin impairment?

• Skin damage caused by radiation therapy

• Occurs only in the radiation treatment field

• Includes redness, dryness, peeling, and breakdown

Why is alopecia an important nursing concern even though it is not life-threatening?

• Has significant psychosocial and body-image impact

• Can affect self-esteem and emotional well-being

What nursing priorities are most important for patients with altered skin integrity?

• Protect the skin barrier

• Prevent infection

• Provide emotional and body-image support

What is anorexia in patients with cancer?

• Loss of appetite

• Can be caused by cancer, treatment side effects, nausea, or fatigue

What distinguishes cancer-related cachexia from simple weight loss?

• Severe muscle wasting and weight loss

• Caused by metabolic and inflammatory changes

• Not reversible with nutrition alone

What is the nursing focus when caring for a patient with cancer cachexia?

• Symptom management and comfort

• Realistic nutritional goals

• Avoid force-feeding

What are the three main types of chemotherapy-related nausea?

• Acute (within 24 hours)

• Delayed (after 24 hours)

• Anticipatory (occurs before treatment)

What is anticipatory nausea and vomiting?

• A learned or conditioned response

• Occurs before chemotherapy begins

• Triggered by sights, smells, or memories of treatment

Why is it important to identify the timing of nausea in cancer patients?

• Timing helps determine the type of nausea

• Guides appropriate treatment and prevention strategies

What is the primary nursing goal in managing nausea and vomiting in cancer patients?

• Prevent dehydration and electrolyte imbalance

• Maintain nutrition and comfort

• Improve treatment tolerance

Why are antiemetics often given before chemotherapy?

• Prevention is more effective than treating established nausea

• Reduces severity and complications

How are alternative therapies used in the management of nausea and vomiting?

• As adjuncts to medications

• Support relaxation and comfort

• Not replacements for pharmacologic treatment

Why is the patient’s self-report the most reliable indicator of pain?

• Pain is subjective

• No objective test can accurately measure pain

• NCLEX prioritizes patient report over observations

What factors influence the choice of pain medication administration route?

• Severity of pain

• Ability to swallow

• GI function

• Need for rapid vs continuous pain control

What is a key nursing consideration when using transdermal opioid patches?

• Provides continuous, long-term pain control

• Not for opioid-naïve patients

• Requires monitoring for respiratory depression

When are epidural analgesics most commonly used in cancer care?

• Severe or refractory pain

• When other routes are ineffective

• Requires close monitoring

What is cancer-related fatigue?

• Persistent exhaustion not relieved by rest

• Affects physical and mental functioning

• Common during cancer treatment

Which intervention is most effective for managing cancer-related fatigue?

• Exercise

• Shown to be more effective than rest alone

Why is rest alone not effective for cancer-related fatigue?

• Fatigue is not caused by lack of sleep alone

• Has metabolic and treatment-related causes

• Requires active management

What are common psychosocial concerns for patients with cancer?

• Fear of the unknown or dying

• Role changes in family

• Social and financial stress

• Loss of control

Why is addressing psychosocial distress a nursing priority?

• Emotional distress worsens physical symptoms

• Affects coping and treatment adherence

• Impacts overall quality of life

What are common bowel elimination problems in patients with cancer?

• Diarrhea (chemo/radiation related)

• Constipation (opioids, immobility)

What genitourinary complications may occur with cancer treatment?

• Renal toxicity

• Renal failure

• Cystitis

• Electrolyte imbalances

What nursing assessments are most important when monitoring elimination issues?

• Intake and output

• Urine output

• Electrolytes and kidney function

What is the primary nursing goal when managing elimination alterations in cancer patients?

• Prevent complications

• Maintain fluid and electrolyte balance

• Detect problems early

What is cardiac toxicity in patients receiving cancer treatment?

• Damage to heart muscle caused by chemotherapy

• Can be irreversible

• May lead to decreased ejection fraction and heart failure

Why is decreased ejection fraction concerning in cancer patients?

• Indicates weakened cardiac pumping

• Can progress to heart failure

• Causes fatigue, dyspnea, and edema

What assessment findings may indicate chemotherapy-induced heart failure?

• Shortness of breath

• Peripheral edema

• Fatigue

• Decreased exercise tolerance

Why are cardiac effects of chemotherapy considered high-risk?

• May be irreversible

• Can occur during or years after treatment

• Early symptoms may be subtle

What is pulmonary fibrosis and how is it related to cancer treatment?

• Scarring and stiffening of lung tissue

• Caused by some chemotherapy or radiation

• Leads to decreased lung function

What symptoms suggest decreased lung function in a cancer patient?

• Shortness of breath

• Low oxygen saturation

• Exercise intolerance

• Persistent cough

Why is pulmonary fibrosis a serious complication in cancer patients?

• It is often progressive

• Not reversible

• Impairs oxygen exchange

What is “chemo brain”?

• Cognitive impairment related to chemotherapy

• Affects memory, attention, and processing speed

• Usually not permanent

How does delirium differ from dementia in cancer patients?

• Delirium: Acute, fluctuating, often reversible

• Dementia: Chronic, progressive, irreversible

What is peripheral neuropathy and why is it a nursing concern?

• Nerve damage causing numbness, tingling, or pain

• Affects hands and feet

• Increases fall and injury risk

What nursing interventions help reduce injury risk in patients with peripheral neuropathy?

• Fall precautions

• Gait and balance assessment

• Patient education on safety

What is osteoporosis and how does it affect cancer patients?

• Decreased bone density

• Increases fracture risk

• Can be worsened by cancer treatment

What are bone metastases?

• Spread of cancer to bone tissue

• Causes severe pain

• Increases risk of pathologic fractures

What is the primary nursing priority for patients with bone metastases?

• Prevent fractures

• Manage pain

• Promote safe mobility

What is a hypersensitivity reaction (HSR) in cancer treatment?

• An exaggerated immune response to a drug (often chemotherapy or biologics)

• Can be mild or life-threatening

When can hypersensitivity reactions occur after chemotherapy administration?

• Anytime between 5 minutes and 6 hours after infusion

What is a Type I anaphylactic reaction?

• Severe, life-threatening allergic reaction

• Can cause airway compromise, hypotension, and shock

What is a flare reaction and how does it differ from anaphylaxis?

• Localized inflammatory reaction at infusion site

• Less severe than anaphylaxis

• Does not usually involve airway or circulation

What is myelosuppression?

• Depression of bone marrow function

• Leads to decreased production of blood cells

What blood cell deficiencies result from myelosuppression?

• Anemia (↓ RBCs)

• Thrombocytopenia (↓ platelets)

• Neutropenia (↓ neutrophils)

What is the nadir in cancer treatment?

• The lowest absolute neutrophil count (ANC) following chemotherapy, targeted therapy, or radiation

• Period of highest infection risk

Why is neutropenia especially dangerous for cancer patients?

• Greatly increases risk for severe infection

• Signs of infection may be minimal or absent

What is the purpose of neutropenic (reverse isolation) precautions?

• Protect the immunocompromised patient from infection

• Reduce exposure to bacteria and fungi

What are key components of neutropenic precautions?

• Private room

• Masks and gloves when in contact

• No sick visitors or children

• Only cooked foods

• No fresh flowers or plants

Why are fresh flowers prohibited for neutropenic patients?

• Soil and water harbor fungi and bacteria

• Increases risk of serious infection

What is sepsis?

Life-threatening organ dysfunction caused by an abnormal response to infection

What factors increase sepsis risk in cancer patients?

• Immunosuppression

• Loss of skin or mucosal barriers

• Central vascular access devices

• Age extremes

• Co-morbidities

Why is fever in a neutropenic patient considered an emergency?

• May be the only sign of infection

• Can rapidly progress to sepsis and shock

Who is considered a cancer survivor?

• Anyone living with a history of cancer

• From diagnosis through the remainder of life

What long-term issues are common during cancer survivorship?

• Psychosocial concerns

• Cognitive effects

• Long-term effects of surgery, radiation, and anticancer therapy

What is the nurse’s role in survivorship care?

• Monitor for late effects of treatment

• Provide education and emotional support

• Address long-term physical and psychosocial needs

What is an oncologic emergency?

• An acute, life-threatening complication caused by cancer or cancer treatment

• Requires immediate recognition and intervention to prevent death or permanent disability

What causes Superior Vena Cava (SVC) syndrome?

• Compression or invasion of the superior vena cava by a tumor or enlarged lymph nodes

• Commonly from lung cancer or lymphoma

Why is SVC syndrome dangerous?

• mpaired venous return from the upper body

• Can cause airway edema, increased ICP, cerebral anoxia, and death

What are classic signs and symptoms of SVC syndrome?

• Facial, neck, and upper extremity edema

• Shortness of breath, cough, stridor

• Headache, dizziness, visual changes

• Distended neck and chest veins

What nursing position is priority for a patient with suspected SVC syndrome?

• Elevate head of bed (Semi-Fowler’s)

• Avoid supine or prone positioning

What nursing actions should be avoided in SVC syndrome?

• Blood pressure measurements in upper extremities

• Venipuncture in arms

• Tight clothing or jewelry around neck and arms

What treatments are used for SVC syndrome?

• Chemotherapy or radiation

• Oxygen therapy

• Corticosteroids

• Diuretics (if fluid overload)

• Intravascular stent (severe cases)

What diagnostic tests help confirm SVC syndrome?

• Chest X-ray

• Thoracic CT scan (preferred)

• Thoracic MRI

What is spinal cord compression?

Compression of the spinal cord or nerve roots due to metastatic tumor growth, vertebral collapse, or paravertebral masses

Which cancers are most commonly associated with spinal cord compression?

• Breast cancer

• Lung cancer

• Prostate cancer

What is often the earliest symptom of spinal cord compression?

• Back or neck pain, often radiating

• Pain worsens with movement, coughing, or sneezing

What neurologic findings suggest spinal cord compression?

• Weakness

• Numbness or tingling

• Loss of vibration sensation

• Bowel or bladder dysfunction

• Paralysis in severe cases

What is the preferred diagnostic test for spinal cord compression?

MRI of the spine

What treatments are used for spinal cord compression?

• Radiation therapy

• Corticosteroids to reduce inflammation

• Surgery (vertebroplasty or kyphoplasty)

What are key nursing priorities for spinal cord compression?

• Frequent neurologic assessments

• Pain management

• Assist with mobility and ROM

• Manage bowel and bladder dysfunction

What is hypercalcemia in cancer patients?

• A life-threatening metabolic disorder caused by excessive calcium release from bones

• Common in multiple myeloma, lung, and breast cancer

What are hallmark signs and symptoms of hypercalcemia?

• Fatigue and weakness

• Confusion, ↓ LOC

• Nausea, vomiting, constipation

• Polyuria, polydipsia, dehydration

• Dysrhythmias

What lab value confirms hypercalcemia?

Total serum calcium > 10.4 mg/dL

What is the primary treatment for hypercalcemia?

• Aggressive hydration (oral or IV)

• Promotes renal excretion of calcium

What nursing interventions are important for hypercalcemia?

• Monitor mental status

• Ensure adequate hydration

• Encourage mobility and weight-bearing

• Implement fall precautions

What is tumor lysis syndrome (TLS)?

• A potentially fatal condition caused by rapid destruction of tumor cells

• Releases intracellular contents into the bloodstream

When does tumor lysis syndrome occur?

• Spontaneously

• After chemotherapy, radiation, or immunotherapy

What electrolyte abnormalities are seen in tumor lysis syndrome?

• Hyperkalemia

• Hyperuricemia

• Hyperphosphatemia

• Hypocalcemia

What neurologic symptoms are associated with TLS?

• Fatigue, weakness

• Altered mental status

• Muscle cramps, tetany

• Paresthesias

• Seizures

What cardiac manifestations may occur in TLS?

• Dysrhythmias

• Peaked T waves

• Widened QRS

• Cardiac arrest

What renal findings suggest tumor lysis syndrome?

• Flank pain

• Oliguria or anuria

• Acute kidney injury

• Acidic urine

What treatments are used for tumor lysis syndrome?

• Aggressive IV hydration

• Diuresis if urine output is low

• Allopurinol

• Kayexalate

• Dialysis (severe cases)

What are the nursing priorities for tumor lysis syndrome?

• Monitor labs and electrolytes closely

• Strict intake and output

• Continuous cardiac monitoring

• Early recognition of symptoms

What is the biggest NCLEX takeaway for tumor lysis syndrome?

• Electrolyte emergency

• Decreased urine output after chemo = suspect TLS immediately

What is the primary goal of end-of-life care?

Comfort, dignity, and quality of life rather than cure.

What is an advance directive?

A legal document that communicates a patient’s healthcare wishes if they cannot speak for themselves.

What is the difference between a living will and a health care proxy?

A living will outlines treatment preferences; a health care proxy designates someone to make decisions.