Nursing Care Plan for Cancer

Nursing diagnosis: acute/chronic Pain related to disease process—compression or destruction of nerve tissue, infiltration of nerves or their vascular supply, obstruction of a
nerve pathway, inflammation, metastasis to bones; side effects of various cancer therapy agents

Possibly evidenced by
Reports of pain
Self-focusing, narrowed focus
Alteration in muscle tone; facial mask of pain
Distraction/guarding behaviors
Autonomic responses, restlessness (acute pain)

Desired Outcomes/Evaluation Criteria—Client Will
Pain Level
Report maximal pain relief or control with minimal interference with activities of daily living (ADLs).
Pain Control
Follow prescribed pharmacological regimen.
Demonstrate use of relaxation skills and diversional activities as indicated for individual situation.

Nursing intervention with rationale:
1. Determine pain history, for example, location of pain, frequency, duration, and intensity using a rating scale (scale of 0–10), or verbal rating scale—“no pain” to “excruciating pain”; and relief measures used. Believe client’s report.
Rationale: Information provides baseline data to evaluate need for, and effectiveness of, interventions. Pain of more than 6 months’ duration constitutes chronic pain, which may affect therapeutic choices. Recurrent episodes of acute pain can occur within chronic pain, requiring increased level of intervention. Note: The pain experience is an individualized one composed of both physical and emotional responses.

2. Determine timing and precipitants of “breakthrough” pain when using around-the-clock agents, whether oral, intravenous (IV), topical, transmucosal, epidural, or patch medications.
Rationale: Pain may occur near the end of the dose interval, indicating need for higher dose or shorter dose interval. Pain may be precipitated by identifiable triggers, or occur spontaneously, requiring use of short half-life agents for rescue or supplemental doses.

3. Evaluate painful effects of particular therapies, such as surgery, radiation, chemotherapy, or biotherapy. Provide information to client and SO about what to expect.
Rationale: A wide range of discomforts are common such as incisional pain, burning skin, low back pain, mouth sores, or headaches, depending on the procedure or agent being used. Pain is also associated with invasive procedures to diagnose or treat cancer.

4. Provide nonpharmacological comfort measures such as massage, repositioning, and back rub; as well as diversional activities, such as music, reading, and TV.
Rationale: Promotes relaxation and helps refocus attention.

5. Encourage use of stress management skills and complementary therapies such as relaxation techniques, visualization, guided imagery, biofeedback, laughter, music, aromatherapy, and Therapeutic Touch.
Rationale: Enables client to participate actively in nondrug treatment of pain and enhances sense of control. Pain produces stress and, in conjunction with muscle tension and internal stressors, increases client’s focus on self, which in turn increases the level of pain.

6. Provide cutaneous stimulation, such as heat and cold packs, or massage.
Rationale: May decrease inflammation, muscle spasms, reducing associated pain.

7. Be aware of barriers to cancer pain management related to client, as well as the healthcare system.
Rationale: Clients may be reluctant to report pain for reasons such as fear that disease is worse; worry about unmanageable side effects of pain medications; belief that pain has meaning, such as “God wills it,” they should overcome it; or that pain is merited or deserved for some reason. Healthcare system problems include factors such as inadequate assessment of pain, concern about controlled substances or client addiction, inadequate reimbursement, and cost of treatment modalities.

8. Administer analgesics, as indicated, for example: Opioids such as codeine, morphine (MSContin, Kadian), oxycodone (oxycontin), hydrocodone (Vicodin), hydromorphone (Dilaudid), methadone (Dolophine), fentanyl (Duragesic, Actiq, Fentora), or oxymorphone (Numorphan, Opana
Rationale: Effective for localized and generalized moderate to severe pain, with long-acting or controlled-release forms available. Routes of administration include oral; transmucosal; transdermal; nasal; rectal; and subcutaneous, IV, epidural, and intrathecal infusions, which may be delivered via patientcontrolled analgesia (PCA). Fentanyl citrate (Oralet) is available as a transmucosal agent that is absorbed through the mucosa of the inner cheek. Note: Intramuscular (IM) route is not recommended for pain medications because absorption is not reliable, in addition to being painful and inconvenient.

9. Prepare for and assist with procedures such as nerve blocks, cordotomy, commissural myelotomy, or radiation therapy.
Rationale: May be used in severe, intractable pain unresponsive to other measures. Note: Radiation is especially useful for bone metastasis and may provide fast onset of pain relief even with only one treatment.

10. Refer to structured support group, psychiatric clinical nurse specialist, psychologist, or spiritual advisor for counseling, as indicated.
Rationale: May be necessary to reduce anxiety and enhance client’s coping skills, decreasing level of pain. Note: Hypnosis can heighten awareness and help to focus concentration to decrease perception of pain.