- a build up of cellular waste products associated with rapid lysis of cancerous and normal cells exposed to cytotoxic drugs;
- difficulty resting and sleeping associated with fear, anxiety, and discomfort;
- tissue hypoxia associated with anemia (a result of malnutrition and chemotherapy-induced bone marrow suppression);
- overwhelming emotional demands associated with the diagnosis of cancer and treatment with chemotherapy;
- increased energy expenditure associated with an increase in the metabolic rate resulting from continuous, active tumor growth and increased levels of certain cytokines (e.g. tumor necrosis factor, interleukin-1);
- effects of medications used for control of pain, nausea, and anxiety.
¶Some of the etiological factors presented here are under investigation.
|The client will experience a reduction in fatigue as evidenced by:|
- verbalization of feelings of increased energy
- ability to perform usual activities of daily living
- increased interest in surroundings and ability to concentrate.
|Nursing Actions and Selected Purposes/Rationales|
- Assess for:
- signs and symptoms of fatigue (e.g. verbalization of lack of energy and inability to maintain usual routines, lack of interest in surroundings, decreased ability to concentrate, lethargy)
- client's perception of the severity of fatigue using a fatigue rating scale; have client try to determine the severity of fatigue currently and an average for each week since last treatment.
- Inform client that a feeling of persistent fatigue is not unusual and is a result of the disease itself as well as a side effect of chemotherapy.
- Assist client to identify personal patterns of fatigue (e.g. time of day, after certain activities) and to plan activities so that times of greatest fatigue are avoided.
- Implement measures to reduce fatigue:
- perform actions to promote rest and/or conserve energy:
- schedule several short rest periods during the day
- minimize environmental activity and noise
- limit the number of visitors and their length of stay
- assist client with self-care activities as needed
- keep supplies and personal articles within easy reach
- implement measures to reduce fear and anxiety (see Diagnosis 1, action b)
- implement measures to promote sleep (e.g. encourage relaxing diversional activities in the evening, allow client to continue usual sleep practices unless contraindicated, reduce environmental stimuli, administer prescribed sedative-hypnotics)
- implement measures to reduce discomfort (see Diagnoses 3, action d and 4, action c)
- instruct client in energy-saving techniques (e.g. using shower chair when showering, sitting to brush teeth or comb hair, prioritizing activities and eliminating those that are optional)
- perform actions to promote an adequate nutritional status (see Diagnosis 2, action c)
- encourage client to maintain a fluid intake of at least 2500 ml/day to promote elimination of the by-products of cellular breakdown
- administer the following if ordered for treatment of anemia:
- folate, iron
- epoetin alfa (EPO)
- blood transfusions (e.g. packed red blood cells)
- peripheral blood stem cell transplantation
- increase activity gradually as tolerated
- perform actions to facilitate client's psychological adjustment to the diagnosis of cancer and the treatment regimen and its effects (see Diagnoses 10, actions c-j and 11, action b).
- Consult appropriate health care provider (e.g. oncology nurse specialist, physician) if signs and symptoms of fatigue worsen.