Therefore, early diagnosis is the most important factor. The nurse coordinates collaborative efforts of the entire health-care team and encourages participation of the patient and family in care. The patient's knowledge of the disease process is determined, misinformation corrected, and verbal and written information supplied about the disease, its progression, its treatment, and expected outcomes. The patient's and family's positive coping mechanisms are identified and supported, and verbalization of feelings and fears, particularly with regard to changes in body image, pain and suffering, and dying and death, is encouraged. Assistance is provided with personal hygiene and physical care.
Physical care is directed at the maintenance of fluid and electrolyte balance and proper nutrition.
Nutrition is a special concern because tumors compete with normal tissues for nutrients and grow at their expense and because the disease or treatments can cause anorexia, altered taste sensations, mouth ulcerations, vomiting, diarrhea, and draining fistulas. Elimination is maintained by administering stool softeners as necessary if analgesic drugs result in constipation. Comfort is achieved through correct body alignment, noninvasive measures such as guided imagery and cutaneous stimulation, and prescribed pharmacological measures, preferably administered on a regular schedule to prevent pain, with additional dosing to relieve breakthrough pain. Hospice care if needed is discussed with the patient and family. The nurse encourages family members to assume an active role in the patient's care, fosters communication between patient and family and other health-care providers, and assists the patient to maintain control and to carry out realistic decision making about issues affecting life and death.