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L&E Chapter 008 Lo


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  • What is the significance of knowing the leading types of cancer? Discuss nursing activities to prevent cancer. Discuss available local resources for cancer.
  • Define the terms. Discuss the characteristics of benign and encapsulated tumors. A patient is tentatively diagnosed with a suspicious malignancy. What are appropriate responses by a nurse when asked by a patient, “Am I going to die?”
  • Compare and contrast benign and malignant tumors. Correlate features of benign and malignant tumors with possible signs and symptoms. Give specific examples of benign and malignant tumors.
  • Discuss the word origins of these tumors. Give specific examples of each of the main groups of cancer. Reinforce the differences between benign and malignant neoplasms.
  • Discuss how cancers cells spread from one site to another. What are the clinical implications of knowing how cancer is spread? The patient is informed by her physician that her cancer has metastasized to the lung. When asked about the meaning of the word metastasis, what is an appropriate nursing response? The nurse anticipates a number of patient questions and concerns regarding prognosis, management, and outcomes. How would the nurse approach the situation to best meet the patient’s needs?
  • Explain the importance of TNM staging in cancer management and prognosis. The physician indicated that the patient had a right breast cancer T2N2M0. Interpret the stages and discuss the clinical significance of the stage of cancer. During a breast self-examination, the patient finds a suspicious mass under her left armpit. The patient asks the nurse, “What should I do?” Discuss appropriate nursing responses.
  • Review TNM staging and how it is used to determine treatment options and prognosis.
  • Give specific examples of these causative factors. Discuss how the patient can be exposed to these cancer-causing agents. How is age related to the development of cancer? Identify common carcinogens and discuss how the nurse can reduce exposure to these cancer agents.
  • Discuss the current research findings on cigarette smoking and cancer. What important patient teaching instructions are required regarding the use of synthetic estrogens? Discuss the mechanism of cancer development associated with petrofluorocarbons and immunosuppressive therapies. Discuss the advantages and disadvantages of the human papillomavirus vaccine. Discuss the advantages and disadvantages of sunlight and ultraviolet rays. Include the value of meeting daily requirements of vitamin D.
  • Discuss the mechanisms of action of promoters. Give specific examples. Provide examples of chronic irritation. How does it lead to the development of cancer? Explain how radiation and radon gas exposure leads to the development of cancer. Include the amount and duration of exposure to the agent.
  • Discuss how the nurse can reduce exposure to cancer-causing agents. Reinforce the mechanism of cancer development associated with these agents. How does the nurse encourage smoking cessation? Discuss important teaching of patients using the Nicoderm patch. Alcohol consumption is associated with a number of cancers. Discuss current treatment regimens for acute intoxication and eventual rehabilitation of patients with alcoholism.
  • Discuss how these viruses are transmitted. What are the signs and symptoms of these viral infections? What are the current treatment modalities? Discuss currently available vaccines.
  • What are the current recommendations for managing patients who are at high risk for breast cancer? What are the gene markers for colon cancer, breast cancer, and leukemia? What is the Genome Project? What is the significance of the project?
  • Discuss ethnic predisposition to certain cancers. What are the clinical applications of knowing ethnic risk factors? How does the nurse reduce the risk for specific cancers among ethnically at-risk groups?
  • What are intrinsic factors? How do these contribute to the development of cancer? Discuss how stress contributes to the development of cancer. Give specific types of cancer that are related to stress. Discuss the importance of diet in preventing cancer. Include discussion on the importance of antioxidants.
  • How can the nurse encourage the maintenance of normal weight? Discuss effective nursing actions that encourage healthy food choices. What are stimulators and inhibitors? Give specific examples. Describe environmental measures to prevent cancer. Discuss how to reduce the risk of cancer. Emphasize the importance of early detection and treatment. Identify lifestyles associated with a high risk for cancer.
  • Provide an example of a diet teaching plan for patients who are at risk for cancer. Give specific examples of healthy food choices. Suggest ways to incorporate healthy food choices with cultural food preferences. Review the assessment of nutritional status.
  • Discuss various cancer screening programs. Discuss clinical experiences related to these screening procedures. What are some of the critical preprocedure patient teaching? Teach breast self-examination. What are the warning signals of cancers? Demonstrate the process of checking for occult blood, including conditions that would result in false-positive and false-negative readings.
  • Discuss the clinical significance of the early warning signs of cancer. How does the nurse reassure the patient who has complaints that are among the early warning signs of cancer? Correlate these early warning signs with possible cancers.
  • Discuss the preparation of the patient for a biopsy. Discuss radiologic findings associated with various cancers. How does the nurse prepare the patient for endoscopy?
  • What is prostate-specific antigen? What are the clinical implications of the results? Give examples how tumor markers help diagnose and determine appropriate therapies. How does the nurse facilitate effective coping strategies?
  • What are the psychosocial needs of a patient with a diagnosis of cancer? Discuss healthy and unhealthy coping strategies. Discuss local resources for patients diagnosed with cancer. Emphasize the importance of these support groups. A 36-year-old female is diagnosed with metastatic breast cancer. She is married with two children, aged 5 years and 9 years. She lives with her husband of 10 years. Discuss psychosocial issues related to her clinical condition and lifestyle. The above patient is scheduled for chemotherapy after a radical mastectomy. What are the roles and responsibilities of the LVN/LPN? How does the nurse deal with her or his own perception of the illness?
  • Discuss specific examples of these treatment modalities. Explain the mechanism of action of these treatment modalities. What are the most common side effects?
  • What are the most critical skin assessments on a patient who had external radiation? List critical nursing interventions that help maintain skin integrity. What are some of the precautions associated with external radiation therapy?
  • Discuss how the nurse can reduce exposure to the radiation. Identify specific nursing diagnoses associated with radiation therapy. How does the nurse deal with a patient who has a large family?
  • Reinforce the importance of these factors in reducing exposure to radiation. Discuss misconceptions associated with radiation therapy. How does the nurse prevent social isolation of a patient who has had radiation treatments?
  • What is hormone therapy? Give examples. What is the mechanism of action? Give examples of immunotherapy. What are the critical nursing assessments before, during, and after administration? Discuss different types of donors for bone marrow transplant.
  • Discuss appropriate nursing interventions to help alleviate these common problems associated with cancer therapies. Revisit the use of local support groups and the value of other patient’s and cancer survivor experiences. How does the nurse assist with the alterations in body image associated with hair loss? Prepare a comprehensive teaching plan for a patient who has had various antineoplastic treatments. Emphasize immunosuppression and the need for meticulous attention to potential sources of infection. Discuss challenges in teaching patients with special needs. Evaluate certain Internet sites for usefulness and current information. Discuss the importance of consulting the physician regarding experimental treatment options. Encourage use of reputable websites. Indicate the dangers of misleading information.
  • Discuss issues regarding patient decisions for supplemental feedings. What is the rationale for ensuring adequate nutrition? Discuss anecdotes on the use of supplemental feeding among cancer patients.
  • Define “metastasis.” Review the pathophysiology of metastasis. A patient was diagnosed with an advanced prostate cancer with metastasis to the bone. What are the clinical laboratory findings to confirm the diagnosis? A patient with lung cancer was admitted to the acute care facility for uncontrollable violent behaviors. What nursing assessments and diagnostic tests would confirm the presence of brain metastasis?
  • Discuss personal experiences related to caring for the dying patient. Define “palliative care.” What is the role of the LVN/LPN in assisting the patient and the family in end-of-life decision making? List nursing approaches to grieving and fear. Discuss other related issues regarding the care of a terminally ill patient.
  • Give specific patient statements that would demonstrate the different stages of death and dying. Discuss appropriate nursing responses to facilitate patient and family transition to the various stages. Emphasize the importance of caring for the patient and the family. How does the nurse deal with his or her perception of end of life? Is it appropriate for the nurse to shed tears for the dying patient? Discuss.
  • What are the common fears faced by the new graduate nurse in dealing with the dying patient? What are the common themes associated with death? What are the roles of pain medications and other pharmacologic agents in promoting comfort?
  • List nursing strategies to address the death-rattle and delirium. Discuss available resources in the clinical facilities. What is terminal hydration? What is the role of nursing with regard to withholding fluids and nutrition? Discuss personal experiences regarding end-of-life care. Discuss personal beliefs on the end of life. How does the nurse accommodate the patient’s beliefs?
  • Transcript

    • 1. Lesson 8.1 Chapter 8
      • Care of Patients with Cancer
    • 2. Learning Objectives
      • Theory
      • 1. Identify characteristics of neoplastic (abnormal tissue) growth.
      • 2. Identify at least five factors that may contribute to the development of a malignancy.
      • 3. State at least four practices that can contribute to prevention and early detection of cancers.
      • 4. Describe ways to include the recommendations of the American Cancer Society for routine checkups and detection of cancers into patient education.
      • 5. Discuss the pros and cons of the various treatments available for cancer.
      • 6. State the major problems and appropriate nursing interventions for a patient coping with expected side effects of radiation or chemotherapy.
      • 7. State the stages of the grieving process experienced by the dying cancer patient.
      • Clinical Practice
      • 1. Devise a general plan of nursing care for the patient receiving chemotherapy.
      • 2. Discuss the teaching necessary for the patient who has bone marrow suppression from cancer treatment.
      • 3. Institute nursing interventions to help the patient cope with the common problems of cancer and its treatment.
      • 4. Utilize appropriate nursing interventions to help patients and families deal with the psychosocial effects of cancer and its treatment.
      • 5. Identify nursing interventions to help the patient cope with death and dying.
    • 3. Figure 8-1
    • 4. Physiology of Cancer
      • Neoplasm
      • Benign and encapsulated
      • Malignant
      • Metastasis
    • 5. Figure 8-2
    • 6. Classification of Tumors
      • Organs or tissues from which they first began
      • Main groups of cancers:
        • Sarcomas
        • Carcinomas
        • Leukemias and lymphomas
        • Melanomas
    • 7. Metastasis
      • Moving of malignant cells to another site:
        • Blood and body fluids
        • Entering a body cavity
      • Prognosis (prediction of survival) depends on how much the malignant cells have attacked body tissues
    • 8. TNM Staging System
      • T for primary tumor
      • N for regional nodes
      • M for metastasis
      • Examples:
        • T1, N0, M0 means that the tumor is small and localized (no involvement of regional lymph nodes and no metastasis)
        • T1, N2, M0 indicates a small (T1) tumor with moderate regional involvement (N2) but no metastasis to distant sites (M0)
    • 9. TNM Staging System for Cancer
      • T0 No evidence of primary tumor
      • TIS Carcinoma in situ
      • T1 T2 T3 T4 Progressive increase in tumor size and involvement
      • TX Tumor cannot be assessed
      • N0 Regional lymph nodes not demonstrably abnormal
      • N1 N2 N3 Increasing degrees of demonstrable abnormality of regional lymph nodes
      • NX Regional lymph nodes cannot be assessed clinically
      • M0 No evidence of distant metastasis
      • M1 M2 M3 Ascending degrees of distant metastasis, including metastasis to distant lymph nodes
      • M4 Multiple organ involvement
    • 10. Causative Factors
      • Mutation:
        • Oncogenes and tumor suppressor genes
      • Carcinogens:
        • Certain chemicals, sources of radiation, and viruses
      • Age
    • 11. Chemical Carcinogens
      • Petrofluorocarbons (e.g., polychlorinated biphenyls or PCBs) and some pesticides (e.g., DDT)
      • Cigarette smoking
      • Immunosuppressive drugs
      • Synthetic estrogens
      • (Refer to Table 8-2 for more information.)
    • 12. Other Causes of Cancer
      • Promoters
      • Chronic irritation
      • Physical carcinogens:
        • Radiation
        • Radon gas
    • 13. Figure 8-3
    • 14. Cancer and Viruses
      • Hepatitis B virus (HBV) and liver cancer
      • Epstein‑Barr virus (EBV) and Burkitt's lymphoma
      • Human T‑cell lymphotropic virus (HTLV) and T‑cell leukemia and lymphoma
      • Human papillomavirus (HPV), cervical carcinoma, and throat cancer in nonsmokers
    • 15. Genetic Predisposition
      • Breast cancer is more likely to occur in women who have a close female relative who developed breast cancer before the age of 50
      • Gene markers in colon cancer, breast cancer, and leukemia
      • Human Genome Project
      • Genetic markers or oncogenes
    • 16. Cultural Cues 8-1: Race Factors
      • Some populations are at a higher risk for certain types of cancer
      • For example, of the four types of melanoma, African Americans are most susceptible to the acral lentiginous type whereas whites are least susceptible to it
      • Cases of lentigo maligna melanoma are found most often in Hawaii
    • 17. Contributing Factors
      • Intrinsic factors
      • Stress
      • Diet
    • 18. Measures to Prevent Cancer
      • Encouraging maintenance of normal weight
      • Stimulators and inhibitors
      • Alcohol
      • Environment
      • (Refer to Table 8-3 for major risk factors for cancer.)
    • 19. Nutritional Therapies 8-1: Dietary Recommendations to Minimize Risk for Cancer
      • Eat a varied diet and avoid obesity.
      • Reduce total saturated and unsaturated fat intake to 30% of total caloric intake.
      • Eat more high-fiber foods: Whole-grain cereals, breads, pastas, fresh fruits, and vegetables.
      • Include foods rich in vitamins A and C in the daily diet.
      • Eat cruciferous vegetables and those containing beta carotene daily: Cabbage, broccoli, Brussels sprouts, kohlrabi, cauliflower, carrots, yellow squash.
      • Avoid smoked, salt-cured, nitrite-cured, and charred (blackened) foods.
      • Keep alcohol consumption moderate: No more than two drinks or two glasses of wine or beer per day (one drink for women).
    • 20. Detection of Cancer
      • Screening
      • Warning signals
      • Cytology
      • Occult blood
      • (Refer to Box 8-2 for information on measures for early detection of cancer.)
    • 21. Box 8-1: The Seven Warning Signs of Cancer
      • CAUTION
      • C hange in bowel or bladder habits
      • A sore that does not heal
      • U nusual bleeding or discharge
      • T hickening or lump in breast or elsewhere
      • I ndigestion or difficulty in swallowing
      • O bvious change in wart or mole
      • N agging cough or hoarseness
    • 22. Diagnostic Tests
      • Biopsy
      • Imaging studies:
        • “ Hot spot" and “cold spot” on x-rays
        • Computed tomography
        • Magnetic resonance imaging
      • Endoscopy
    • 23. Laboratory Tests
      • Prostate‑specific antigen
      • Tumor markers:
        • Used to confirm a diagnosis, the response to therapy
        • Used to detect a relapse
        • CEA and CA 19‑9
    • 24. Nursing Management After a Cancer Diagnosis: Assessment
      • Thorough physical assessment
      • Psychosocial assessment of the patient and family or significant others:
        • Psychosocial needs
        • Coping abilities and techniques
        • Resources for support and care
        • (Refer to Box 8-4 for common nursing
        • diagnoses for used for patients with cancer.)
    • 25. Common Therapies
      • Surgery
      • Radiation
      • Chemotherapy
      • Hormone manipulation
      • Immunotherapy with biologic response modifiers
      • Bone marrow transplantation
    • 26. Nursing Care of Patients Undergoing External Radiation Therapy
      • Help the patient cope with the diagnosis of cancer and its treatment with radiation therapy
      • Teach how to recognize and manage the expected side effects of radiation:
        • Skin care
    • 27. Principles of Radiation Protection
      • The distance between the nurse and the patient
      • The amount of time spent in actual proximity to the patient
      • The degree of shielding provided
    • 28. Figure 8-5
    • 29. Chemotherapy
      • Antineoplastic drugs decrease the number of malignant cells in a generalized malignancy (Refer to Table 8-5 more information.)
      • Cytotoxic and not limited to malignant cells
      • Steroids
      • Vesicants
      • (Refer to Table 8-6 for information on assessing toxic effects of chemotherapy.)
    • 30. Other Treatment Modalities
      • Hormone therapy
      • Immunotherapy using biologic response modifiers:
        • Interleukins and interferons
        • Monoclonal antibodies
        • Miscellaneous agents, including cancer vaccines
      • Bone marrow transplantation
      • Gene therapy
    • 31. Common Problems Related to Cancer or Cancer Therapy
      • Anorexia, mucositis, and weight loss
      • Nausea, vomiting, and diarrhea
      • Constipation
      • Cystitis
      • Immunosuppression, bone marrow suppression, and infection
      • Hyperuricemia
      • Fatigue
      • Alopecia
      • Pain
      (Refer to Patient Teaching 8-2, Table 8-7, and Box 8-7 for more information.)
    • 32. Nutritional Therapies 8-2: Nutritional Formulas and Preparations for Supplemental Feedings
      • Carnation Instant Breakfast Clintec/Carnation
      • Delmark Instant Breakfast Sandoz
      • Forta Shake Ross
      • Meritene Powder Novartis
      • Sustacal Powder, Sustacal Liquid Mead, Johnson
      • Ensure Abbott
      • Promote Ross
      • Isocal Novartis
      • Prosobee Mead, Johnson
      • Resource Sandoz
    • 33. Table 8‑8: Common Sites of Metastasis
      • Breast cancer Bone, lung, liver, brain
      • Lung cancer Brain, bone, liver, lymph nodes, pancreas
      • Colorectal cancer Liver, lymph nodes, adjacent structures
      • Prostate cancer Bone (especially spine and legs), pelvic nodes
      • Melanoma GI tract, lymph nodes, lung, brain
      • Primary brain Central nervous system Cancer
    • 34. Care for the Dying Cancer Patient
      • Psychological process of death
      • Grieving
      • Fear
      • Palliative care
    • 35. Box 8-8: Kübler-Ross’ Stages of Dying
      • Denial (This can’t happen to me!)
      • Anger (Why me?)
      • Bargaining (Yes me, but . . .)
      • Depression (It is me, I give up . . .)
      • Acceptance ( I’m ready . . .)
    • 36. Box 8-9: Common Fears of the Dying Patient
      • Almost all dying patients face varying levels of fear. Specifically, these fears may include:
      • Fear of the unknown
      • Fear of abandonment and loneliness
      • Fear of loss of relationships
      • Fear of loss of experiences in the future
      • Fear of dependency and loss of independence
      • Fear of pain
    • 37. Nursing Management of the Dying Patient
      • Anticipatory guidance
      • Terminal hydration
      • End-stage symptom management
      • Pain
      • Dyspnea
      • Death rattle
      • Delirium
      • (Table 8-9 provides information on spiritual beliefs and practices regarding death in various religions.)