Nursing Care Plan for Bone Cancer

Tumor is the growth of new cells, abnormal, progressive, where the cells never become mature. The incidence of bone tumors when compared with other types of tumors are small, ie less than 1% of all tumors of human body. Malignant tumor, when tumor capable of spreading to other places (able to metastasize) and benign tumors say, if it is not able to metastasize. Lungs, is the organ most frequently seized by child spread of malignant tumors.

There are many different types of cancer. Cancers are usually named based on the type of cell that is affected. For example, lung cancer is caused by cells that are beyond the control of the shape of the lung, and breast cancer by cells that form the breast. A tumor is a collection of abnormal cells which accumulate together. However, not all tumors are cancerous. A tumor can be benign (not cancerous) or malignant (cancerous).

Benign tumors are usually less dangerous and not able to spread to other parts of the body. Malignant tumors are generally more serious and can spread to other areas in the body. The ability of cancer cells to leave their original location and moved to another location in the body is called metastasis. Metastasis can occur with cancer cells enter the blood stream or lymphatic system body to walk to other places in the body.

When cancer cells metastasize to other parts of the body, they are still called by the type of origin of the abnormal cells. For example, if a group of cells into diseased breast cancer and metastasizes to the bones, it is called metastatic breast cancer. Many different types of cancer are able to metastasize to the bones.

The types of the most common cancers that spread to the bones are lung, breast, prostate, thyroid, and kidney. Most of the time, when people have cancer in their bones, it is caused by cancer that has spread from elsewhere in the body to the bones. It is less common to have an original bone cancer, a cancer that arises from cells that make bone. It is important to determine whether the cancer is in the bone from elsewhere or from a cancer of the bone cells. The treatments for cancers that have metastasized to the bone based on the initial type of cancer.


Bone cancer is caused by a problem with the cells that form bone. More than 2,000 people are diagnosed in the U.S. each year with a bone tumor. Bone tumors occur most commonly in children and adolescents and are less common in the older adults. Cancer involving the bone in adults older are most commonly the result of metastatic spread from another tumor.

Signs and Symptoms

The most common symptom of bone tumors is pain. In most cases, the symptoms become gradually more severe with time. At first, the pain may only be present at night or with activity. Depending on the growth of tumor, those affected may have symptoms for weeks, months, or years before seeking medical advice. In some cases, a mass or lump may be felt in the bone or in the tissues surrounding the bone. Tumors in the leg, causing the patient to walk lame, whereas tumors in the arm cause pain when the arm is used to lift some object. Swelling of the tumor may feel warm and slightly flushed.


Based on the level of malignancy, there are 3 levels of malignant tumor stages, namely:
  1. Stage I, when a low degree of malignancy.
  2. Stage II, meaning the tumor has a high degree of malignancy.
  3. Stage III, which means the tumor has spread.
Diagnostic tests
  1. Physical examination
  2. DPL
  3. X-Rays
  4. Ct-Scan
  5. MRI
  6. biopsy
  7. bone scan

Nursing Diagnosis for Bone Cancer

1. Anxiety related to change in health status.
2. Chronic Pain related to pathologic processes.
3. Imbalanced Nutrition Less Than Body Requirements related to hypermetabolic status with regard to cancer, the consequences of chemotherapy, and radiation effects.
4. Risk for Fluid Volume Excess related to damage to fluid intake.
5. Risk for Infection related to the inadequate immunosuppression, malnutrition and invasive procedures.
6. Risk for Impaired skin integrity related to radiation effects and changes in nutritional status.

Nursing Interventions for Bone Cancer
  1. Encourage clients to express feelings and thoughts.
  2. Increase a sense of calm and comfortable environment.
  3. Determine history of pain.
  4. Give a distraction relaxation techniques.
  5. Monitor the nutrient intake every day.
  6. Control of environmental factors and diet that will be provided.
  7. Create a pleasant dining atmosphere.
  8. Assess the factors that reduce appetite.
  9. Monitor nausea and vomiting.
  10. Monitor fluid input and output.
  11. Assess vital signs.
  12. Encourage increased fluid intake.
  13. Increase rest.
  14. Emphasize the importance of oral hygiene.
  15. Assess the skin as often as possible.
  16. Wash with warm water and mild soap.
  17. Instruct the client to avoid any skin cream unless there is an indication of physicians.
  18. Encourage the use of soft and loose clothing.

Dengue Hemorrhagic Fever - 5 Nursing Interventions

DHF is an acute arbovirus infection that enters the body through the bite of a mosquito species aides. The disease often strikes children, adolescents, and adults that is characterized by fever, muscle and joint pain.

Symptoms such as headache, fever, exhaustion, severe joint and muscle pain, swollen glands (lymphadenopathy), and rash. The presence (the "dengue triad") of fever, rash, and headache (and other pains) is particularly characteristic of dengue fever.

Nursing Diagnosis and Interventions for Dengue Hemorrhagic Fever

Nursing Diagnosis 1. : Hyperthermia related to the process of dengue virus infection.

Goal: Normal body temperature
Body temperature between 36-37 0 C
Muscle pain disappeared


1. Provide / encourage patients to drink plenty of 1500-2000 cc / day (as tolerated)
Rational: To replace fluids lost due to evaporation.

2. Instruct the patient to wear clothing that is thin and easy to absorb sweat.
Rationale: Providing a sense of comfort and easy thin clothing absorbs sweat and does not stimulate an increase in body temperature.

3. Observation of intake and output, vital signs (temperature, pulse, blood pressure) every 3 hours once or more often.
Rational: Detecting early dehydration and to know the balance of fluids and electrolytes in the body. Vital Signs is a reference to determine the patient's general condition.

4. Collaboration: intravenous fluids and appropriate drug delivery program.
Rationale: Fluid replacement is essential for patients with a high body temperature. Particular drug to lower the patient's body temperature.

Nursing Diagnosis 2. : Risk for Fluid Volume Deficit related to intravascular fluid into the extravascular migration.

Objective: Not happening fluid volume deficit
Input and output balanced
Vital signs within normal limits
There is no sign of pre-shock
Capilarry refill less than 3 seconds

1. Monitor vital signs every 3 hours / more often.
Rationale: Vital sign help identify fluctuations in intravascular fluid.

2. Observation of capillary refill.
Rational: Indications adequacy of peripheral circulation.

3. Observation of intake and output. Note the color of urine / concentration.
Rationale: Decrease in urine output concentrated suspected dehydration.

4. Suggest to drink 1500-2000 ml / day (as tolerated).
Rational: To consume body fluids orally.

5. Collaboration: intravenous fluid administration.
Rational: It can increase the amount of body fluid, to prevent shock hipovolemic.

Nursing Diagnosis 3. : Risk for Shock Hypovolemic related to excessive bleeding, intravascular fluid into the extravascular migration.

Objective: Not happening hypovolemic shock
Hasl criteria:
Vital signs within normal limits

1. Monitor patient's general condition.
Raional: To monitor the condition of the patient during treatment, especially when there is bleeding. Nurses immediately know the signs of pre-shock / shock.

2. Observation of vital signs every 3 hours or more
Rationale: Nurses need to continue to observe the vital signs to ensure there is no pre-shock / shock.

3. Explain to patients and families sign of bleeding, and immediately report if there is bleeding.
Rationale: By involving the patient and family, then the signs of bleeding can be immediately identified and prompt action, and the right can be given immediately.

4. Collaboration: intravenous fluid administration.
Rationale: Intravenous fluids needed to cope with the severe loss of body fluids.

5. Collaboration: examination: HB, PCV, platelets.
Rationale: To determine the level of leakage of blood vessels experienced by patients and to take further action reference.

Nursing Diagnosis 4. : Risk for imbalanced Nutrition Less Than Body Requirements related to inadequate nutritional intake due to nausea and decreased appetite.

Goal: Not an interruption nutritional needs.
There are no signs of malnutrition.
Shows a balanced weight.

1. Assess nutritional history, including a preferred food.
Rationale: Identify deficiencies, suspect the possibility of intervention.

2. Observation and record the patient's food intake.
Rationale: Observing caloric intake / lack of quality food consumption.

3. Measure body weight per day (if possible).
Rationale: Observing weight loss / observe the effectiveness of the intervention.

4. Give food a little but often and or eat between meals.
Rational: little food can reduce vulnerabilities and increase input also prevent gastric distention.

5. Give and Help oral hygiene.
Rationale: Increased appetite and oral input.

6. Avoid foods that stimulate and gassy.
Rational: Lowering distention and gastric irritation.

Nursing Diagnosis 5. : Risk for Bleeding related to decreased blood clotting factors (thrombocytopenia)

Goal: Not bleeding.
Normal blood pressure.
Normal pulse.
There is no sign of further bleeding, platelets increased.

1. Monitor signs of decreased platelets accompanied by clinical signs.
Rationale: Platelet decline is a sign of blood vessel leakage, which at some stage may cause clinical signs such as epistaxis, petechia.

2. Monitor platelets every day.
Rationale: With the platelets are monitored on a daily basis, it can be seen the level of vascular leak and possible bleeding experienced by the patient.

3. Instruct the patient to a lot of rest (bed rest).
Rational: patient activity can lead to uncontrolled bleeding.

4. Provide information to clients and families to report any signs of bleeding such as: hematemesis, melena, epistaxis.
Rational: The involvement of patients and families may help to early treatment if there is bleeding.

5. Anticipation of bleeding: use a soft toothbrush, maintain oral hygiene, apply pressure take 5-10 minutes after each blood.
Rationale: Prevent further bleeding.

NCP Thromboangiitis Obliterans - Nursing Diagnosis and Interventions

1. Acute Pain / Chronic Pain related to vasospasm / reperfusion disorders, ischemic / tissue damage.

Goal: Pain is reduced and tissue damage is not widespread.

  • Record the characteristics of pain and paresthesias.
  • Check the patient's vital signs.
  • Discuss with the patient, how and why the pain inflicted.
  • Help the patient identify trigger factor or situation example: smoking, exposure to cold and how to handle.
  • Encourage the use of stress management techniques, entertainment activities.
  • Soak the affected area in warm water.
  • Give the room a warm, draft-free air, for example ventilation, air-conditioning, keep doors closed as indicated.
  • Monitor drug effects and action.
  • Collaboration: the medications as indicated, prepare surgical intervention when necessary.

  • Knowing the pain level.
  • To monitor the general state of the client.
  • That patients understand how to process pain.
  • That patients understand the factors that influence pain.
  • Used to divert the attention of the client.
  • Warm water will make the blood vessels will dilate and blood flow.
  • Avoid infection and keep the air hot.
  • Determine the level of effectiveness of the drug.
  • Administration of drugs to relieve pain.

2. Ineffective Tissue Perfusion is related to cessation of arterial blood flow

  • Observation of skin color on the sick.
  • Note the decrease in pulse.
  • Evaluation of pain sensation parts, for example: sharp / shallow, hot / cold.
  • View and examine the skin for ulceration, lesions, gangrene area.
  • Recommended for proper nutrition and vitamins.
  • Collaboration: the medications as indicated (vasodilator), example: drainage lesions for culture or sensitivity.

  • To see cyanosis or redness of the skin.
  • Identify the severity of the cessation of arterial blood flow.
  • Knowing levels, flavors, and forms of pain.
  • Seeing how big a part that had gangrene.
  • Proper nutrition and vitamin requirements are complete will increase the body's immune system.
  • Giving obta vasodilator make the arteries dilate and blood flow.

3. Knowledge Deficit: the need to learn about the condition, treatment needs related to lack of knowledge / resources are not familiar with, wrong perception / misunderstood.

  • Provide information to patients about the disease.
  • Encourage clients to ask questions about the disease.
  • Instruct to avoid exposure to cold.
  • Preserve the environment at a temperature above 20.9 C eliminate cold flow.
  • Discuss the possibility of moving to a warmer climate.
  • Emphasize the importance of stopping smoking, provide information on local clinics / support group.
  • Help the patient to create a method to avoid or alter discuss stress relaxation techniques.
  • Emphasize the importance of viewing each day and do the right skin care.

  • Increase patients' knowledge about the disease.
  • Knowing the client's level of curiosity about the disease.
  • Cold temperatures make the constriction of the blood vessels and will aggravate the blockage of blood flow.
  • Hot temperature makes blood vessels to maintain a state of dilatation.
  • Avoid the severity of which will happen.
  • That patients know and understand that smoking is a major contributing factor to the occurrence trombongitis.
  • Distraction and relaxation techniques to make the patient more calm in responding.
  • Avoid skin injury.

4. Anxiety related to the action procedure to be performed

  • Describe the action procedure to be performed.
  • Explain the importance of actions to be taken.
  • Observation of vital signs.
  • Give comfort to the patient.
  • Reassure the patient that the action to be performed is the best course of action.
  • Reassure the patient that the procedure acts to be performed safely.
  • Collaboration with physicians for the provision of drugs.
  • Increase patients' knowledge about action procedure.
  • In order for patients to understand why the need for that action.
  • Knowing the general state of the client.
  • Patients will feel calm and do not worry with action procedures to be performed.
  • Reduce the level of anxiety on the client.
  • Reduce negarif thinking about an act procedures.
  • To create a calm and reduce anxiety levels.