management of cancer pt

1. ADVANCE NURSING
MANAGEMENT OF
ONCOLOGY

2. Objectives
At the end of the unit, students will be able
to:
• Utilize Functional health pattern to identify
patients problems related to oncology
disorders including:
Pain
• Integrate pathophysiology and
pharmacology concepts of oncology
disease.

3. Objectives
• Apply nursing process with support on
Evidence-Based Nursing (EBN) to provide
to the clients with oncology disorders.
• Discuss the holistic approach for nursing
management of the patient with oncology
diseases.
• Develop a teaching plan for a client
experiencing disorders of the oncology
disorders.

4. Pain Management
Presented by
Sana Jahangir
MSCN,POST RN BSc. N,
RM,RN

5. Pain
“an unpleasant sensory and emotional
experience associated with actual or
potential tissue damage - or described in the
terms of such damage”.
(American Pain Society[APS], 2008)

6. Types of Pain
Location :
• Classification of pain based on location (e.g., head
, back, chest ) may be problematic.
Referred
• (Appear to arise in a different site) to other part of
the of body. For example: cardiac pain may be felt
in the shoulder or left arm.
Visceral pain
• (Pain arising from organs or hollow viscera) is often
perceived in an area remote from the organ
causing the pain.

7. Types of Pain
Duration:
Acute pain
• pain lasts only through the expected recovery
period, whether it has sudden or slow onset,
regardless of its intensity.
Chronic pain
• Also known as persistent pain, is prolonged,
usually recurring or lasting three months or longer
and interferes with functioning.

8. Types of Pain
Intensity:
•Most practitioners classify intensity of pain by using a
standard scale: 0 (no pain) to 10 (worst possible pain).
Mild:
•pain in the one to three range
Moderate:
•pain with a rating of four to six
Severe:
•pain reaching seven to ten

9. Etiology
Nociceptive pain
• Is experience when an intact, properly functioning
nervous system sends signals that tissues are
damaged requiring attention and proper care.
• For example, the pain experienced following a cut
or broken bone alerts the person to avoid further
damage until it is properly healed.

10. Etiology
Somatic pain
• originates in the skin, muscles, bone, or connective
tissue. The sharp sensation of a paper cut or
aching of a sprained ankle are common examples
of somatic pain.
Neuropathic pain
• Is associated with damaged or malfunctioning
nerves due to injury or illness (e.g., post-herpetic
neuralgia, diabetic peripheral neuropathy), injury
(e.g., phantom limb pain, spinal cord injury pain), or
undetermined reasons.

11. Etiology
The two subtypes of neuropathic pain are based on
the part of the nervous system believed to be
damaged.
Peripheral Neuropathic Pain
• (e.g., phantom limb pain, post-herpetic neuralgia,
carpal tunnel syndrome) follows damage or
sensitization of peripheral nerves.
Central Neuropathic Pain
• (e.g., spinal cord injury pain, post stroke pain,
multiple sclerosis pain) results from malfunctioning
nerves in the central nervous system (CNS).

12. Etiology
Sympathetically maintained pain
• occurs occasionally when abnormal connections
between pain fibers and the sympathetic nervous
system perpetuate problems with both the pain and
sympathetically controlled functions (e.g., edema,
temperature and blood flow regulation).

13. Common Myths About Pain
Myths
• The nurse is the best judge of
a client’s pain.
• If pain is ignored it will go
away.
• Client should not take any
measures to relieve their pain
until it is unbearable.
• Most complain of pain are
purely psychological (e.g “it’s
all in your head”) only real pain
manifest in obvious physical
signs such as moaning or
grimacing.
Fact
• Pain is subjective experience;
only the client can judge the
level and severity of pain.
• Pain is a real experience that
can be appropriately treated.
• Pain control and relief
measures are effective in
lowering pain levels and help
client function more normally
and comfortably .
• Most client honestly report
their perception of pain.
• Physical responses to pain
vary greatly depending on
experience and cultural norms.

14. Common Myths About Pain
Myths
• Client with severe tissue
damage experience significant
pain; those with lesser damage
feel less pain.
• Client’s taking pain
medications will become
addictions to the drugs.
Fact
• Visible expression of pain are
not always relievable
indicators of its severity.
• Individual perception of pain
are subjective; the extent of
tissue damage is not
necessary proportional to the
extent of pain experienced.
• Addiction is unlikely when
analgesics are carefully
administered and closely
monitored.

15. Concepts Associated with
Pain
Pain threshold
•The least amount of stimuli that is needed for a
person to label a sensation as pain.
Pain tolerance
•the maximum amount of painful stimuli that a person
is willing to withstand without seeking avoidance of the
pain or relief.
•Hyperpathia & Hyperalesia
•denotes heightened responses to painful stimuli (e.g.,
severe pain response to a paper cut).
Allodynia
•nonpainful stimuli (e.g., light touch, contact with linen,
water or wind) that produces pain.

16. Physiology of Pain
• Nociceptive Pain
• Neuropathic Pain
• Gate Control Theory of Pain

17. Nociceptive Pain
• In nociceptive pain, injury or inflammation
stimulates special injury-sensing receptors in the
peripheral nervous system. The receptors then
communicate this information to the brain, resulting
in the sensation of pain. The two types of
nociceptive pain are somatic pain, which comes
from skin, musculoskeletal structures, or
connective tissue, and visceral pain, which initiates
in organs and the lining of body cavities.

18. Neuropathic Pain
• Damage to peripheral nerves or to the central
nervous system can result in neuropathic pain.
Patients describe this poorly localized type of pain
as tingling, burning or fiery, or shooting. Typesof
neuropathic pain include phantom limb pain that
occurs after a limb amputation as well as the
peripheral extremity pain that diabetics often
experience.

19. Gate Control Theory of Pain

20. Factors Affecting the Pain
Experience
• Developmental Stage
• Environment and Support People
• Ethnic and Cultural Values
• Previous Pain Experiences
• Meaning Of Pain

21. Assessment
• Data Collection
• Pain threshold is the level of intensity at
which pain becomes appreciable or
perceptible.
• Pain tolerance is the level of intensity or
duration of pain the client is willing or able to
endure.
• Assessment Tools
• Initial Pain Assessment Tool
• Pain Intensity Scales
• Psychosocial Pain Assessment
• Developmental Considerations
• Children and Adolescents

22. Nursing Diagnosis
NANDA-approved diagnoses
• Acute Pain
• Chronic Pain

23. Outcome Identification and
Planning
• Planning focuses on mutual goal setting.
• A goal of nursing care is to use both
nonpharmacologic and pharmacologic
interventions in planning strategies to control or
maintain clients at desired levels of functioning
and pain.

24. Implementation
• Cognitive-Behavioral Interventions
• Nurse-Client Relationship
• Biofeedback
• Pharmacologic Pain Management
• Treatment of Neuropathic Pain

25. Evaluation
• Client’s facial expression and posture
• Presence (or absence) of restlessness
• Vital sign monitoring
• Ongoing use of pain assessment tools