Cancer Symptoms and their Management:

Symptom Clinical Manifestations Possible Nursing Diagnosis Interventions (including Medications and complementary
(including Diagnostics) alternative therapy)
Anemia Chest pain, cold Fatigue related to decreased ● Assess the patient’s ability to perform their ADLs. Fatigue
hands/feet, dizziness, hemoglobin as evidenced by can limit the ability to complete daily tasks, their work,
fatigue, headaches, inability to maintain usual level responsibilities within their family.
irregular heartbeat, pale of physical activity. ● Monitor hematology labs (HGB, HCT, RBCs). Decreased
skin, shortness of breath, RBCs are associated with decreased oxygen carrying capacity.
weakness Deficient knowledge related to The other lab values can assist with determine the progression
unfamiliarity with the health of the patient’s anemia, establish a baseline, or monitoring
condition as evidenced by trends.
questions directed towards ● Assess for causes of fatigue. This could be caused by tissue
health care team. hypoxia from anemia or another cause that can cause activity
intolerance.
● Assist in the developing a schedule for activities and rest.
This helps to reserve energy that may become depleted if the
patient over-exerts themselves. The plan should stress the
importance of frequent periods of rest to create a balance
while helping the patient to complete their desired activities.
● Educate the patient on techniques to conserve energy. The
techniques that could be included are delegation, setting
priorities, and clustering tasks.
● Provide supplemental oxygen as the patient needs. Oxygen
saturation should be at 90% or above.
Neutropenia Low grade fever, mouth
(<1500/microliter) sores, skin abscesses,
Severe swollen gums, symptoms
(<500/microliter) indicative of infection
Thrombocytopenia Blood in urine or stools,
easy bruising, enlarged
spleen, epistaxis, fatigue,
jaundice, menstrual flow
(unusually heavy),
petechiae, prolonged
bleeding, superficial
bleeding
Risk for infection related to
impaired immune system as
evidenced by reduced neutrophil
value present within CBC.
Anxiety related to situational
crisis as evidenced by expressed
concerns regarding immune
system.
Risk for bleeding related to
treatment related side effects as
evidenced by decreased platelet
counts present in CBC.
Risk for injury related to altered
clotting factors (or
thrombocytopenia) as evidenced
by alterations label values
associated with coagulation.
● Monitor the patient’s WBC count. A low cell count could
indicate a risk for severe infection.
● Assess and monitor nutritional status, serum albumin, and
weight gain/loss. Poor nutritional status may cause the cells to
be unable to respond to pathogen.
● Investigate medication or treatment usage that may cause
immunosuppression. Certain medications and treatments that
the patient is receiving can lead to reductions in immunity.
● Encourage the patient to express thoughts and feelings. This
provides an opportunity to examine and discuss the patient’s
concerns and possible misconceptions.
● Maintain frequent contact with the patient in order to
provide assurance that they are not alone. It also could convey
respect, acceptance and foster trust.
● Be aware that isolation can have effects on the patient.
Sensory deprivation may result when there is insufficient
stimulation. This may intensify feelings of anxiety, fear, and
alienation.
● Evaluate the patient’s medication usage. Certain
medications (i.e. chemotherapy agents, NSAIDs,
anticoagulants) can interfere with clotting mechanisms or alter
platelet activity. Certain medications inhibit platelet
aggregation, inhibit vitamin K synthesis, or inhibit action of
thrombin.
● Review lab results for coagulation status. Different lab tests
and values should be assessed. Platelet counts can be assessed
within the CBC. Coagulation can be assessed with
PT/PTT/INR. Bleeding can directly be assessed through
bleeding time. The blood clotting cascade is system that
requires both intrinsic and extrinsic factors. Derangements in
any involved factors can alter the ability to clot. These lab

Neuropathy Depends on nerves
affected. Numbness with
gradual onset, tingling in
hands or feet, pain
(burning, jabbing, sharp, or
throbbing), sensitivity to
touch, lack of coordination,
muscle weakness, cold or
heat intolerance, excessive
or inability to sweat, issues
with GI or GU systems
Impaired physical mobility
related to sensory-perceptual
impairment as evidenced by
tingling and pain in the patient’s
lower extremities (below the
knees) bilaterally
Disturbed sensory perception
related to altered sensory
reception as evidenced by
numbness to the patient’s feet
and tingling of the patient’s
hands.
tests provide information about coagulation and the potential
to bleed.
● Check stool and urine for occult blood. This testing is use to
distinguish if bleeding is occurring through the GI or GU
tracts. This bleeding might not be visible.
● Use a soft bristled toothbrush and nonabrasive toothpaste.
Avoid using toothpicks and dental floss. Using this method
reduces the trauma to the oral mucous membranes and the risk
of bleeding from the gums.
● Limit straining with bowel movements, nose blowing,
coughing, or sneezing. These activities may cause trauma to
the mucous membranes within the rectum, nasal passages, and
upper airways.
● Educate the patient to avoid NSAIDs. NSAIDs can
● Observe and investigate reports of sensory loss, pain, or
altered sensations. Peripheral neuropathies may result in
severe discomfort, distortion in tactile sensation, and increases
the risk falls or injury.
● Assist the patient with ambulation or positional changes.
This can be dependent on the severity of the patient’s
neuropathy. This promotes patient safety, especially when
balanced is affected.
● Evaluate the patient’s need for assistive devices. Correct use
of wheelchairs, canes, and other assistive devices can enhance
activity and lessen the danger of falls.
● Assess the safety of the environment. Blockages can limit
one’s ability to ambulate their environment without potential
for harm. Removing blockages (i.e. rugs, toys, pets, clutter)
can reduce this risk.
● Assess the patient’s response to the limitation. Acceptance
of limitations
 ● Note progression of thrombophlebitis. Prolonged immobility
allows for clot formation in those who have physical mobility
impairment.
Cognitive Depression, anxiety, Fear or anxiety related to cancer ● Provide an open environment in which the patient feels safe
disorders fatigue, pain, sleep (situational crisis) as evidence to discuss feelings. This helps the patient to feel accepted in
disturbances, difficulty expressed concerns regarding their present condition without feeling judged and promotes a
with new learning, taking changes in life events. feeling of control.
longer to complete tasks, ● Maintain frequent contact with the patient. Communicate as
difficulty multitasking, Situational low self-esteem much as is appropriate. This provides assurance that the
difficulty formulating related to feelings of lack of patient is not alone with what they are experiencing.
speech, altered moods, control and doubt regarding ● Explain the recommended treatment, its purpose, and
acceptance by others as possible side effects. Assist the patient is preparing for the
evidenced by preoccupation with prescribed treatments. The goal is to minimize the damage to
change or loss. normal cells while destroying the cancerous cells. The
different treatments could be surgical, chemotherapy,
radiation, biotherapy.
● Refer the patient for counseling services if indicated. This
might be necessary in order to regain and maintain a positive
psychosocial structure if patient and support systems are
deteriorating.
● Provide emotional support for the patient during diagnostic
tests and during the treatment phase. Some patients adapt to
the effects of cancer or the side effects of therapy; however,
many require additional support.
● Acknowledge difficulties the patient might be experiencing.
Give information that counseling is often necessary and
important in the adaption process. This validates the reality of
what the patient is feeling and gives permission to take the
measures necessary to cope with what is happening.
Chemo Induced Complaint of nausea, Nausea related to cancer ● Record the patient’s hydration status. This includes daily
Nausea (CIN) tachycardia, perspiration, treatment medication as weights, blood pressure, I&Os, and skin assessments. Nausea
light-headedness,
 dizziness, pallor, excessive
salivation, anorexia,
weakness
Mucositis Mouth and guns (red,
shiny, or swollen), blood in
the mouth, sores in the
mouth or on the gums or
tongue, difficulty with
swallowing or talking,
sensations while eating
(feelings of dryness, mild
evidenced by the patient
reporting nausea.
Situational low self-esteem
related to nausea and vomiting
as evidenced by verbalization of
negative feelings about their
body.
Impaired oral mucous
membranes related to
chemotherapy related to as
evidenced by stomatitis.
tends to be correlated with vomiting. Vomiting can change a
patient’s hydration status due to the fluid loss.
● Assess the patient’s nausea characteristics. A thorough
assessment of the patient’s nausea can help determine
interventions to ease the problem.
● Review anticipated side effects associated with their
particular treatment. Tell the patient that not all side effects
occur and that others can be minimized/controlled.
Anticipatory guidance can help the patient and begin the
process of adaption to new state and to prepare for potential
side effects, such as nausea.
● Acknowledge the difficulties that the patient might be
experiencing. Give information that counseling is often
necessary and important in the adaption process. This
validates the reality that the what the patient feels. This gives
permission to take whatever measures are necessary to cope
with what is occurring.
● Evaluate support structures available and what is used by
the patient. This helps with the planning of the care that the
patient might utilize during their admission and after
discharge.
● Medications: ondansetron, aprepitant, fosaprepitant,
dexamethasone, methylprednisone, metoclopramide,
compazine, cannabinoids, benzodiazepines, antihistamines
● Assess the patient’s oral cavity daily (at a minimum). Note
any findings, such as discoloration, lesions, edema, bleeding,
etc. Refer the patient to a provider as appropriate. The oral
examination can show signs of oral disease, symptoms of
systemic disease, drug side effects, and trauma to the oral
cavity.
 burning, or pain),
soft-whitish patches in
mouth or on tongue,
presence of pus in mouth
or on tongue, increased
mucous, thicker saliva
Alopecia Hair loss, anxiety, itching,
small dents in nails
Pain Fatigue, numbness, muscle
spasms, insomnia, weight
less, anxiety, depression,
limited mobility, tense
muscles, flu-like
symptoms. Some
symptoms can vary due to
the location and type of
pain.
Disturbed body image related to
alteration in structure as
evidenced by the patient
focusing behavior on their
changed body part.
Acute pain related to side of
effects of various cancer therapy
agents S evidenced by the
patient’s reports of pain.
Acute pain relation to cancer
process as evidenced by
guarding behaviors.
● Inspect for indications of infection. Culture the lesions if
indicated. Early evaluation promotes immediate treatment.
Specific manifestations can direct the patient’s treatment plan.
● Observe the patient’s ability to eat and drink. The patient
could develop difficulty or inability to chew or swallow. This
could occur secondary and related to pain, inflammation, or
ulceration of the oral mucous membranes.
● Assess the perceived impact of change in the patient’s
ADLs, social participation, relationships, and occupation.
These alterations in the patient’s body image can have an
effect on the patient’s ability to carry out daily roles and
responsibilities.
● Assess the result of the body image disturbance in relation
to the patient’s developmental stages. Those who are affected
by this type of change can find that these changes are often
rapid and can alter perceptions toward social and intimate
relationships.
● Assess what this change means to the patient. The extent of
response is more related to the value or importance the patient
places in the part or function than the actual value or
importance. This necessitates support to work through to
optimal resolution
● Evaluate and be aware of the painful effects of particular
therapies. Provide information to the patient so they are aware
of what to expect. There is a wide range of common
discomforts associated with the disease process and the
treatment. This depends on the treatment being utilized within
the patient’s treatment plan. Pain is associated with invasive
procedures that are involved with the diagnosis or treatment of
the cancer.
● Determine the timing or the precipitating factors of
breakthrough pain. Pain may occur near the end of the dose
interval. This could indicate the need for adjustments in the
dose or the dosing interval. Pain might have identifiable
triggers or can occur spontaneously. This might require the
addition of supplemental doses of medication.
● Provide nonpharmacological comfort and diversional
activities. This promotes relation and aids in refocusing the
patient’s attention.
● Be aware of barriers to management of cancer pain. Patients
might be reluctant to report pain for reasons, such as fear of
disease process worsening.
● Treatment options: acupuncture, behavioral therapy,
biofeedback, electrical stimulation, medications, physical
therapy, psychotherapy, relaxation techniques, surgery
 References

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Neutropenia. (n.d.) Retrieved from https://www.medicinenet.com/neutropenia/article.htm#what_causes_neutropenia

Thrombocytopenia. (n.d.) Retrieved from

https://www.mayoclinic.org/diseases-conditions/thrombocytopenia/symptoms-causes/syc-20378293

Messenger, A. G. (2019, May 22). Alopecia areata: clinical manifestations and diagnosis. Retrieved from

https://www.uptodate.com/contents/alopecia-areata-clinical-manifestations-and-diagnosis.

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Neuroscience​, ​12​(1), 36–44. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5819720/

Peripheral neuropathy. (n.d.) Retrieved from

https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061

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of-chemotherapy-induced-nausea-and-vomiting.

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https://www.mayoclinic.org/diseases-conditions/thrombocytopenia/symptoms-causes/syc-20378293
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https://www.oncolink.org/support/side-effects/gastrointestinal-side-effects/mucositis/all-about-mucositis.

Vannorsdall, T. D. (2016, May 31). Understanding cancer-related cognitive impairment. Retrieved from

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https://allcare4u.com/what-is-acute-pain/.