Nursing Management or Care of Bone Cancer Patient

Nursing Management of Bone Tumor or Cancer Patients

What is Bone Tumors or Neoplasms?

A bone tumor is a neoplastic growth of tissue in bone. Abnormal growths found in the bone can be either benign (noncancerous) or malignant (cancerous). Bone tumors may be benign or malignant, benign tumors of the bone are more common than malignant bone tumors. Malignant tumors are primary, originating in the bone, or secondary, originating from elsewhere in the body (e.g., breast, lung, prostate, or kidney) and traveling to the bone (metastasis). Secondary or metastatic bone tumors are more common than primary bone tumors.

Nursing Interventions or Care of Bone Tumor Patients:

Nursing Assessment:

1. Obtain history of progression of disease; presence of pain, fever, weight loss, malaise.
2. Palpate mass gently. Note size and associated soft tissue swelling, pain, and tenderness.
3. Review records for evidence of pathologic fracture.
4. Assess neurovascular status and range of motion of extremity.
5. Evaluate mobility and ability to perform activities of daily living.
6. Assess knowledge of cancer, experiences with family or others, and present coping.

Nursing Diagnosis of Bone Cancer Patient:

• Deficient knowledge related to disease process and therapeutic regimen.
• Pain related to pathological process and surgery
• Risk for injury: pathologic fracture related to tumor.
• Ineffective coping related to fear of the unknown, perception of disease process, and inadequate support system.
• Risk for low situational self-esteem related to loss of body part or changing role.

Planning and Goals:

The major goals include knowledge of disease process and treatment regimen, control of pain, absence of pathological fractures, effective patterns of coping, improved self-esteem, and absence of complications.

Nursing Interventions of Bone Tumor or Cancer Patient:

Promoting Understanding:

1. Explain diagnostic tests, treatments, and expected results.
2. Reinforce and clarify information provided by the physician.
3. Encourage independence and function as long as possible.
4. Postoperatively, monitor vital signs; assess blood loss and development of complications (eg, deep vein thrombosis, pulmonary emboli, infection, contracture, and disuse atrophy).
5. Elevate affected part to control swelling; assess neurovascular status of extremity; immobilize the area with splints, casts, or elastic bandages until the affected area heals.

Controlling Pain:

• Use non-pharmacologic and pharmacologic pain management techniques, including external radiation with systemic radioisotopes.
• Works with patient do design the most effective pain management regimen.
• Prepare patient and give support during painful procedure.

Preventing Pathologic Fracture:

1. Support affected bones and handle gently during nursing care.
2. Use external supports (eg, splints) for additional protection.
3. Follow prescribed weight-bearing restrictions.
4. Show patient how to use ambulatory assistance devices safely and how to strengthen unaffected extremities.

Enhancing Effective Coping:

• Encourage patient and family to verbalize fears, concerns and feelings honestly.
• Support and accept patient and family as they deal with the impact of the malignant bone tumor.
• Expect feelings of shock, despair, and grief.
• Refer to health professionals and clergy for specific psychological help.

Promoting Self-esteem:

1. Support family in working through adjustments that must be made, specifically changes in body image due to surgery and possible amputation.
2. Provide realistic reassurance about the future and resumption of role-related activities; encourage self-care and socialization.
3. Involve patient and family throughout treatment to encourage confidence and restoration of self-concept, and promote a sense of control.

Monitoring and Managing Potential Problems:

• Minimize pressure on wound site to promote circulation.
• Promote healing with an aseptic, non-traumatic wound dressing.
• Monitor and report laboratory findings.
• Reposition patient frequently to prevent skin breakdown; use therapeutic bed when indicated.

Achieving Adequate Nutritional Status:

1. Administer antiemetic’s medication and provide relaxation techniques to reduce gastrointestinal reaction.
2. Control stomatitis (resulting from cancer therapies) with anesthetic or antifungal mouthwash.
3. Provide adequate hydration, nutritional supplements, or total parenteral nutrition.

Managing Osteomyelitis and Wound Infections:

• Use prophylactic antibiotics and strict aseptic dressing techniques.
• Prevent other infections (eg, upper respiratory), so that hematogenous spread does not result in osteomyelitis.
• Monitor white blood cell count, and instruct patient to avoid contact with people who have colds or infections.

Promoting Home and Community-Based Care:

1. Prepare and coordinate continuing health care and direct patient education toward medications, dressings, treatment regimens, weight-bearing limitations, and physical and occupational therapy programs.
2. Teach signs and symptoms of complications to patient and family.
3. Arrange for home care, and advise patient to keep telephone, numbers of contact people readily available.
4. Emphasize the need for long-term health supervision to ensure cure or to detect tumor recurrence or metastasis.
5. Explore end-of-life issues if patient has metastatic disease.

Maria Mona

Maria Khatun Mona is a Founder and Editor of Nursing Exercise Blog. She is a Nursing and Midwifery Expert. Currently she is working as a Registered Nurse at Evercare Hospital, Dhaka, Bangladesh. She has great passion in writing different articles on Nursing and Midwifery. Mail her at “maria.mona023@gmail.com”