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Ch 21, cancer care.ppt

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    Ch 21, cancer care.ppt Ch 21, cancer care.ppt Presentation Transcript

    • CHAPTER 21 CARING FOR CLIENTS WITH CANCER
    • PATHOPHYSIOLOGY
      • Cancer is characterized by abnormal, unrestricted cell growth.
      • NEOPLASMS/TUMORS-new growth of abnormal tissue
      • CLASSIFIED BY:
      • Origin
      • Manner of growth
      • benign – not invasive or spreading
      • malignant – invasive & capable of spreading – box 21-1
    • Classification of Tumor Cells – table 21-1
      • CARCINOMAS – originate from epithelial cells
      • LYMPHOMAS – originate from organs that fight infection
      • LEUKEMIAS – originate from organs that form blood
      • SARCOMAS – originate from connective tissue, like bone or muscle
      • METASTASIS or spreading
      • Primary site – areas where the tumor first forms
      • Secondary site – areas where the cancerous cells move or metastasis
      • BENIGN TUMORS – do not move, may just slowly grow larger
    • ETIOLOGY
      • Cancer is the 2 nd leading cause of death in the US
      • Lung cancer is #1 cause of cancer deaths
      • Most common cancers in men: prostate, lung & colon
      • Most common cancers in women:breast, lung & colon
      • chemical agents such as tobacco smoke, asbestos, & coal dust account for about 75% of cancers
      • environmental factors such as prolonged exposure to sunlight, radiation, & pollutants
      • diet – box 21-2
      • viruses & bacteria
      • defective genes
      • medically prescribed interventions such as immunosuppressive drugs, hormone replacements & anticancer drugs
    • SIGNS & SYMPTOMS OF CANCER
      • Change in bowel/bladder function
      • Sores that do not heal
      • Unusual bleeding or discharge
      • Thickening or lump in breast or other body parts
      • Indigestion or difficulty in swallowing
      • Recent change in a wart or mole
      • Nagging cough or hoarseness
    • DIAGNOSTIC TESTS
      • Labs
      • tumor markers – table 21-3
      • Radiological & Imaging Tests
      • Xrays
      • CT
      • Nuclear medicine scans using radioisotopes
      • MRI
      • PET scans
      • Radioimmunoconjugates
      • Ultrasound
      • Fluoroscopy
    • OTHER STUDIES
      • BIOPSY – tissue examined under microscope
      • FROZEN SECTION – sample frozen and then thinly sliced to see under microscope – quicker decision maker
      • ENDOSCOPY – done with scope to upper or lower GI system
      • CYTOLOGY – cells examined under microscope
    • STAGING OF TUMORS
      • Table 21-4
      • Stage I – Malignant cells are confined to the tissue of origin, no signs of metastasis
      • Stage II – Spread of cancer is limited to the local area, usually to area lymph nodes
      • Stage III – Tumor is larger, probably has invaded surrounding tissue or both
      • Stage IV – Cancer has invaded or metastasized to other parts of the body
    • SURGERY
      • RANGE OF SURGICAL INTERVENTION
      • Extent of the disease
      • actual pathology
      • age and physical condition of pt
      • anticipated results
    • SURGERY
      • Primary treatment used when tumors are confined & have not invaded vital organs; considered curative
      • Salvage surgery is when there has been a local recurrence of cancer
      • Prophalactic surgery is when the client is at considerable risk for cancer
      • Palliative surgery is used to relieve uncomfortable symptoms or prolong life
      • Reconstructive or plastic surgery done after extensive surgery or to correct defects caused by the original surgery
    • RADIATION THERAPY
      • Uses high-energy ionizing radiation to destroy cancer cells
      • External radiation therapy – aimed at specific body location; usually done daily for a specified number of times; outpt
      • Internal radiation therapy – sealed brachytherapy-done as inpt-radioactive source implanted directly into the tumor-box 21-5 safety measures
      • Possible side effects: alopecia, n/v/d, cystitis, pneumontitis, fatigue,stomatitis, leukopenia, thrombocytopenia, fibrosis
      • Nursing guidelines 21-1, client & family teaching 21-1
    • Nursing care of pt receiving radiation
      • Provide information on procedure and possible side effects
      • Protect skin
      • Maintain intact oral mucous membranes
      • Provide emotional support
      • Monitor for s/s of bone marrow suppression
      • Monitor for s/s of bleeding due to low platelet count
    • CHEMOTHERAPY
      • Drug Therapy Table 21-1
      • Antineoplastic drugs are used to destroy tumor cells by interfering with cellular function and reproduction
      • Cell Cycle-Specific Drugs – work when the cell is in a specific stage of reproduction – used for rapidly growing tumors
      • Cell Cycle-Nonspecific drugs – effective during any phase of the cell cycle or even when not reproducing
    • Routes & Devices
      • Oral & IV are the most common routes
      • IV – must monitor for s/s of extravasation at site or leakage of the drug into the surrounding tissue – Table 21-5
      • Common Vascular Devices: PICC lines, Hickman or Broviac Catheters, implanated ports –
      • Advantages
      • long term use
      • less venipunctures
      • less problems when a client has poor veins
      • drug can go directly into the heart & central circulation
    • ADVERSE EFFECTS AND NURSING CARE
      • Adverse effects
      • n/v most common within first 24 hrs
      • stomatitis
      • alopecia
      • bone marrow depression
      • fatigue
      • Nursing care-nursing guidelines 21-2
      • Safety measures for nurses when administering chemo –Box 21-6
      • monitor for s/s of anaphylactic reactions
      • increase fluid intake
      • administer antiemetic drugs
      • dietary modifications
    • Bone Marrow Transplantation
      • Nursing Guidelines 21-3
      • Autologous – client receives own bone marrow that was harvested
      • Allogeneic – receives bone marrow from a histocompatible, but unrelated donor
      • Syngeneic – client receives bone marrow from an identical twin
      • Stem cell – receive their own stem cells that have been grown due to infusion of hematopoietic growth factors
    • Other Cancer Treatments
      • Immunotherapy uses biologic response modifiers (BRM) to stimulate the body’s natural immune system to restrict & destroy the cancer cells
      • Hyperthermia uses temperatures > 106.4F to destroy tumor cells
      • Gene therapy replaces altered genes with correct genes
      • Clinical trials – testing new treatments for specific cancers
    • Complementary & Alternative Therapy – Table 21-7
      • Imagery
      • Medicinal therapy
      • Special diets
      • Mystical & spiritual approaches
    • Nursing Care-Nursing Care Plan 21-1
      • Pain management
      • Fatigue
      • Infection
      • Anxiety, fear & depression
      • Client & family teaching