Oncology Nursing Nurse Licensure Examination Review

Oncology defined Branch of medicine that deals with the study, detection, treatment and management of cancer and neoplasia

Branch of medicine that deals with the study, detection, treatment and management of cancer and neoplasia

“Root words” Neo- new Plasia- growth Plasm- substance Trophy- size +Oma- tumor Statis- location

Neo- new

Plasia- growth

Plasm- substance

Trophy- size

+Oma- tumor

Statis- location

“Root words” A- none Ana- lack Hyper- excessive Meta- change Dys- bad, deranged

A- none

Ana- lack

Hyper- excessive

Meta- change

Dys- bad, deranged

Characteristics of Neoplasia Uncontrolled growth of Abnormal cells 1. Benign 2. Malignant 3. Borderline

Uncontrolled growth of Abnormal cells

1. Benign

2. Malignant

3. Borderline

Characteristics of Neoplasia BENIGN Well-differentiated Slow growth Encapsulated Non-invasive Does NOT metastasize

BENIGN

Well-differentiated

Slow growth

Encapsulated

Non-invasive

Does NOT metastasize

Characteristics of Neoplasia MALIGNANT Undifferentiated Erratic and Uncontrolled Growth Expansive and Invasive Secretes abnormal proteins METASTASIZES

MALIGNANT

Undifferentiated

Erratic and Uncontrolled Growth

Expansive and Invasive

Secretes abnormal proteins

METASTASIZES

Nomenclature of Neoplasia Tumor is named according to: 1. Parenchyma, Organ or Cell Hepatoma- liver Osteoma- bone Myoma- muscle

Tumor is named according to:

1. Parenchyma, Organ or Cell

Hepatoma- liver

Osteoma- bone

Myoma- muscle

Nomenclature of Neoplasia Tumor is named according to: 2. Pattern and Structure, either GROSS or MICROSCOPIC Fluid-filled  CYST Glandular  ADENO Finger-like  PAPILLO Stalk  POLYP

Tumor is named according to:

2. Pattern and Structure, either GROSS or MICROSCOPIC

Fluid-filled  CYST

Glandular  ADENO

Finger-like  PAPILLO

Stalk  POLYP

Nomenclature of Neoplasia Tumor is named according to: 3. Embryonic origin Ectoderm ( usually gives rise to epithelium) Endoderm (usually gives rise to glands) Mesoderm (usually gives rise to Connective tissues)

Tumor is named according to:

3. Embryonic origin

Ectoderm ( usually gives rise to epithelium)

Endoderm (usually gives rise to glands)

Mesoderm (usually gives rise to Connective tissues)

BENIGN TUMORS Suffix- “OMA” is used Adipose tissue- LipOMA Bone- osteOMA Muscle- myOMA Blood vessels- angiOMA Fibrous tissue- fibrOMA

Suffix- “OMA” is used

Adipose tissue- LipOMA

Bone- osteOMA

Muscle- myOMA

Blood vessels- angiOMA

Fibrous tissue- fibrOMA

MALIGNANT TUMOR Named according to embryonic cell origin 1. Ectodermal, Endodermal, Glandular, Epithelial Use the suffix- “CARCINOMA” Pancreatic AdenoCarcinoma Squamos cell Carcinoma

Named according to embryonic cell origin

1. Ectodermal, Endodermal, Glandular, Epithelial

Use the suffix- “CARCINOMA”

Pancreatic AdenoCarcinoma

Squamos cell Carcinoma

MALIGNANT TUMOR Named according to embryonic cell origin 2. Mesodermal, connective tissue origin Use the suffix “SARCOMA FibroSarcoma Myosarcoma AngioSarcoma

Named according to embryonic cell origin

2. Mesodermal, connective tissue origin

Use the suffix “SARCOMA

FibroSarcoma

Myosarcoma

AngioSarcoma

“PASAWAY” 1. “OMA” but Malignant HepatOMA, lymphOMA, gliOMA, melanOMA 2. THREE germ layers “ TERATOMA” 3. Non-neoplastic but “OMA” Choristoma Hamatoma

1. “OMA” but Malignant

HepatOMA, lymphOMA, gliOMA, melanOMA

2. THREE germ layers

“ TERATOMA”

3. Non-neoplastic but “OMA”

Choristoma

Hamatoma

CANCER NURSING Review of Normal Cell Cycle 3 types of cells 1. PERMANENT cells- out of the cell cycle Neurons, cardiac muscle cell 2. STABLE cells- Dormant/Resting (G0) Liver, kidney 3. LABILE cells- continuously dividing GIT cells, Skin, endometrium , Blood cells

Review of Normal Cell Cycle

3 types of cells

1. PERMANENT cells- out of the cell cycle

Neurons, cardiac muscle cell

2. STABLE cells- Dormant/Resting (G0)

Liver, kidney

3. LABILE cells- continuously dividing

GIT cells, Skin, endometrium , Blood cells

CANCER NURSING Cell Cycle G0------------------G1  S  G2  M G0- Dormant or resting G1- normal cell activities S- DNA Synthesis G2- pre-mitotic, synthesis of proteins for cellular division M- Mitotic phase (I-P-M-A-T)

Cell Cycle

G0------------------G1  S  G2  M

G0- Dormant or resting

G1- normal cell activities

S- DNA Synthesis

G2- pre-mitotic, synthesis of proteins for cellular division

M- Mitotic phase (I-P-M-A-T)

CANCER NURSING Proposed Molecular cause of CANCER: Change in the DNA structure  altered DNA function  Cellular aberration  cellular death  neoplastic change Genes in the DNA- “proto-oncogene” And “anti-oncogene”

Proposed Molecular cause of CANCER:

Change in the DNA structure  altered DNA function  Cellular aberration

 cellular death

 neoplastic change

Genes in the DNA- “proto-oncogene” And “anti-oncogene”

CANCER NURSING Etiology of cancer 1. PHYSICAL AGENTS Radiation Exposure to irritants Exposure to sunlight Altitude, humidity

Etiology of cancer

1. PHYSICAL AGENTS

Radiation

Exposure to irritants

Exposure to sunlight

Altitude, humidity

CANCER NURSING Etiology of cancer 2. CHEMICAL AGENTS Smoking Dietary ingredients Drugs

Etiology of cancer

2. CHEMICAL AGENTS

Smoking

Dietary ingredients

Drugs

CANCER NURSING Etiology of cancer 3. Genetics and Family History Colon Cancer Premenopausal breast cancer

Etiology of cancer

3. Genetics and Family History

Colon Cancer

Premenopausal breast cancer

CANCER NURSING Etiology of cancer 4. Dietary Habits Low-Fiber High-fat Processed foods alcohol

Etiology of cancer

4. Dietary Habits

Low-Fiber

High-fat

Processed foods

alcohol

CANCER NURSING Etiology of cancer 5. Viruses and Bacteria DNA viruses- HepaB, Herpes, EBV, CMV, Papilloma Virus RNA Viruses- HIV, HTCLV Bacterium- H. pylori

Etiology of cancer

5. Viruses and Bacteria

DNA viruses- HepaB, Herpes, EBV, CMV, Papilloma Virus

RNA Viruses- HIV, HTCLV

Bacterium- H. pylori

CANCER NURSING Etiology of cancer 6. Hormonal agents DES OCP especially estrogen

Etiology of cancer

6. Hormonal agents

DES

OCP especially estrogen

CANCER NURSING Etiology of cancer 7. Immune Disease AIDS

Etiology of cancer

7. Immune Disease

AIDS

CANCER NURSING CARCINOGENSIS Malignant transformation I  P  P Initiation Promotion Progression

CARCINOGENSIS

Malignant transformation

I  P  P

Initiation

Promotion

Progression

CANCER NURSING CARCINOGENSIS INITIATION Carcinogens alter the DNA of the cell Cell will either die or repair

CARCINOGENSIS

INITIATION

Carcinogens alter the DNA of the cell

Cell will either die or repair

CANCER NURSING CARCINOGENSIS PROMOTION Repeated exposure to carcinogens Abnormal gene will express Latent period

CARCINOGENSIS

PROMOTION

Repeated exposure to carcinogens

Abnormal gene will express

Latent period

CANCER NURSING CARCINOGENSIS PROGRESSION Irreversible period Cells undergo NEOPLASTIC transformation then malignancy

CARCINOGENSIS

PROGRESSION

Irreversible period

Cells undergo NEOPLASTIC transformation then malignancy

CANCER NURSING Spread of Cancer 1. LYMPHATIC Most common 2. HEMATOGENOUS Blood-borne, commonly to Liver and Lungs 3. DIRECT SPREAD Seeding of tumors

Spread of Cancer

1. LYMPHATIC

Most common

2. HEMATOGENOUS

Blood-borne, commonly to Liver and Lungs

3. DIRECT SPREAD

Seeding of tumors

CANCER NURSING Body Defenses Against TUMOR 1. T cell System/ Cellular Immunity Cytotoxic T cells kill tumor cells 2. B cell System/ Humoral immunity B cells can produce antibody 3. Phagocytic cells Macrophages can engulf cancer cell debris

Body Defenses Against TUMOR

1. T cell System/ Cellular Immunity

Cytotoxic T cells kill tumor cells

2. B cell System/ Humoral immunity

B cells can produce antibody

3. Phagocytic cells

Macrophages can engulf cancer cell debris

CANCER NURSING Cancer Diagnosis 1. BIOPSY The most definitive 2. CT, MRI 3. Tumor Markers

Cancer Diagnosis

1. BIOPSY

The most definitive

2. CT, MRI

3. Tumor Markers

CANCER NURSING Cancer Grading The degree of DIFFERENTIATION Grade 1- Low grade Grade 4- high grade

Cancer Grading

The degree of DIFFERENTIATION

Grade 1- Low grade

Grade 4- high grade

CANCER NURSING Cancer Staging 1. Uses the T-N-M staging system T- tumor N- Node M- Metastasis 2. Stage 1 to Stage 4

Cancer Staging

1. Uses the T-N-M staging system

T- tumor

N- Node

M- Metastasis

2. Stage 1 to Stage 4

CANCER NURSING GENERAL MEDICAL MANAGEMENT 1. Surgery- cure, control, palliate 2. Chemotherapy 3. Radiation therapy 4. Immunotherapy 5. Bone Marrow Transplant

GENERAL MEDICAL MANAGEMENT

1. Surgery- cure, control, palliate

2. Chemotherapy

3. Radiation therapy

4. Immunotherapy

5. Bone Marrow Transplant

CANCER NURSING GENERAL Promotive and Preventive Nursing Management 1. Lifestyle Modification 2. Nutritional management 3. Screening 4. Early detection

GENERAL Promotive and Preventive Nursing Management

1. Lifestyle Modification

2. Nutritional management

3. Screening

4. Early detection

SCREENING 1. Male and female- Occult Blood, CXR, and DRE 2. Female- SBE, CBE, Mammography and Pap’s Smear 3. Male- DRE for prostate, Testicular self-exam

1. Male and female- Occult Blood, CXR, and DRE

2. Female- SBE, CBE, Mammography and Pap’s Smear

3. Male- DRE for prostate, Testicular self-exam

Nursing Assessment Utilize the ACS 7 Warning Signals CAUTION C- Change in bowel/bladder habits A- A sore that does not heal U- Unusual bleeding T- Thickening or lump in the breast I- Indigestion O- Obvious change in warts N- Nagging cough and hoarseness

Utilize the ACS 7 Warning Signals

CAUTION

C- Change in bowel/bladder habits

A- A sore that does not heal

U- Unusual bleeding

T- Thickening or lump in the breast

I- Indigestion

O- Obvious change in warts

N- Nagging cough and hoarseness

Nursing Assessment Weight loss Frequent infection Skin problems Pain Hair Loss Fatigue Disturbance in body image/ depression

Weight loss

Frequent infection

Skin problems

Pain

Hair Loss

Fatigue

Disturbance in body image/ depression

Nursing Intervention MAINTAIN TISSUE INTEGRITY Handle skin gently Do NOT rub affected area Lotion may be applied Wash skin only with SOAP and Water

MAINTAIN TISSUE INTEGRITY

Handle skin gently

Do NOT rub affected area

Lotion may be applied

Wash skin only with SOAP and Water

Nursing Intervention MANAGEMENT OF STOMATITIS Use soft-bristled toothbrush Oral rinses with saline gargles/ tap water Avoid ALCOHOL-based rinses

MANAGEMENT OF STOMATITIS

Use soft-bristled toothbrush

Oral rinses with saline gargles/ tap water

Avoid ALCOHOL-based rinses

Nursing Intervention MANAGEMENT OF ALOPECIA Alopecia begins within 2 weeks of therapy Regrowth within 8 weeks of termination Encourage to acquire wig before hair loss occurs Encourage use of attractive scarves and hats Provide information that hair loss is temporary BUT anticipate change in texture and color

MANAGEMENT OF ALOPECIA Alopecia begins within 2 weeks of therapy

Regrowth within 8 weeks of termination

Encourage to acquire wig before hair loss occurs

Encourage use of attractive scarves and hats

Provide information that hair loss is temporary BUT anticipate change in texture and color

Nursing Intervention PROMOTE NUTRITION Serve food in ways to make it appealing Consider patient’s preferences Provide small frequent meals Avoids giving fluids while eating Oral hygiene PRIOR to mealtime Vitamin supplements

PROMOTE NUTRITION

Serve food in ways to make it appealing

Consider patient’s preferences

Provide small frequent meals

Avoids giving fluids while eating

Oral hygiene PRIOR to mealtime

Vitamin supplements

Nursing Intervention RELIEVE PAIN Mild pain- NSAIDS Moderate pain- Weak opiods Severe pain- Morphine Administer analgesics round the clock with additional dose for breakthrough pain

RELIEVE PAIN

Mild pain- NSAIDS Moderate pain- Weak opiods

Severe pain- Morphine

Administer analgesics round the clock with additional dose for breakthrough pain

Nursing Intervention DECREASE FATIGUE Plan daily activities to allow alternating rest periods Light exercise is encouraged Small frequent meals

DECREASE FATIGUE

Plan daily activities to allow alternating rest periods

Light exercise is encouraged

Small frequent meals

Nursing Intervention IMPROVE BODY IMAGE Therapeutic communication is essential Encourage independence in self-care and decision making Offer cosmetic material like make-up and wigs

IMPROVE BODY IMAGE

Therapeutic communication is essential

Encourage independence in self-care and decision making

Offer cosmetic material like make-up and wigs

Nursing Intervention ASSIST IN THE GRIEVING PROCESS Some cancers are curable Grieving can be due to loss of health, income, sexuality, and body image Answer and clarify information about cancer and treatment options Identify resource people Refer to support groups

ASSIST IN THE GRIEVING PROCESS

Some cancers are curable

Grieving can be due to loss of health, income, sexuality, and body image

Answer and clarify information about cancer and treatment options

Identify resource people

Refer to support groups

Nursing Intervention MANAGE COMPLICATION: INFECTION Fever is the most important sign (38.3) Administer prescribed antibiotics X 2weeks Maintain aseptic technique Avoid exposure to crowds Avoid giving fresh fruits and veggie Handwashing Avoid frequent invasive procedures

MANAGE COMPLICATION: INFECTION

Fever is the most important sign (38.3)

Administer prescribed antibiotics X 2weeks

Maintain aseptic technique

Avoid exposure to crowds

Avoid giving fresh fruits and veggie

Handwashing

Avoid frequent invasive procedures

Nursing Intervention MANAGE COMPLICATION: Septic shock Monitor VS, BP, temp Administer IV antibiotics Administer supplemental O2

MANAGE COMPLICATION: Septic shock

Monitor VS, BP, temp

Administer IV antibiotics

Administer supplemental O2

Nursing Intervention MANAGE COMPLICATION: Bleeding Thrombocytopenia (<100,000) is the most common cause <20, 000  spontaneous bleeding Use soft toothbrush Use electric razor Avoid frequent IM, IV, rectal and catheterization Soft foods and stool softeners

MANAGE COMPLICATION: Bleeding

Thrombocytopenia (<100,000) is the most common cause

<20, 000  spontaneous bleeding

Use soft toothbrush

Use electric razor

Avoid frequent IM, IV, rectal and catheterization

Soft foods and stool softeners

Colon cancer

COLON CANCER Risk factors 1. Increasing age 2. Family history 3. Previous colon CA or polyps 4. History of IBD 5. High fat, High protein, LOW fiber 6. Breast Ca and Genital Ca

Risk factors

1. Increasing age

2. Family history

3. Previous colon CA or polyps

4. History of IBD

5. High fat, High protein, LOW fiber

6. Breast Ca and Genital Ca

COLON CANCER Sigmoid colon is the most common site Predominantly adenocarcinoma If early  90% survival 34 % diagnosed early 66% late diagnosis

Sigmoid colon is the most common site

Predominantly adenocarcinoma

If early  90% survival

34 % diagnosed early

66% late diagnosis

COLON CANCER PATHOPHYSIOLOGY Benign neoplasm  DNA alteration  malignant transformation  malignant neoplasm  cancer growth and invasion  metastasis (liver)

PATHOPHYSIOLOGY

Benign neoplasm  DNA alteration  malignant transformation  malignant neoplasm  cancer growth and invasion  metastasis (liver)

COLON CANCER ASSESSMENT FINDINGS 1. Change in bowel habits- Most common 2. Blood in the stool 3. Anemia 4. Anorexia and weight loss 5. Fatigue 6. Rectal lesions- tenesmus, alternating D and C

ASSESSMENT FINDINGS 1. Change in bowel habits- Most common

2. Blood in the stool

3. Anemia

4. Anorexia and weight loss

5. Fatigue

6. Rectal lesions- tenesmus, alternating D and C

Colon cancer Diagnostic findings 1. Fecal occult blood 2. Sigmoidoscopy and colonoscopy 3. BIOPSY 4. CEA- carcino-embryonic antigen

Diagnostic findings

1. Fecal occult blood

2. Sigmoidoscopy and colonoscopy

3. BIOPSY

4. CEA- carcino-embryonic antigen

Colon cancer Complications of colorectal CA 1. Obstruction 2. Hemorrhage 3. Peritonitis 4. Sepsis

Complications of colorectal CA

1. Obstruction

2. Hemorrhage

3. Peritonitis

4. Sepsis

Colon cancer MEDICAL MANAGEMENT 1. Chemotherapy- 5-FU 2. Radiation therapy

MEDICAL MANAGEMENT

1. Chemotherapy- 5-FU

2. Radiation therapy

Colon cancer SURGICAL MANAGEMENT Surgery is the primary treatment Based on location and tumor size Resection, anastomosis, and colostomy (temporary or permanent)

SURGICAL MANAGEMENT

Surgery is the primary treatment

Based on location and tumor size

Resection, anastomosis, and colostomy (temporary or permanent)

Colon cancer NURSING INTERVENTION Pre-Operative care 1. Provide HIGH protein, HIGH calorie and LOW residue diet 2.Provide information about post-op care and stoma care 3. Administer antibiotics 1 day prior

NURSING INTERVENTION

Pre-Operative care

1. Provide HIGH protein, HIGH calorie and LOW residue diet

2.Provide information about post-op care and stoma care

3. Administer antibiotics 1 day prior

Colon cancer NURSING INTERVENTION Pre-Operative care 4. Enema or colonic irrigation the evening and the morning of surgery 5. NGT is inserted to prevent distention 6. Monitor UO, F and E, Abdomen PE

NURSING INTERVENTION

Pre-Operative care

4. Enema or colonic irrigation the evening and the morning of surgery

5. NGT is inserted to prevent distention

6. Monitor UO, F and E, Abdomen PE

Colon cancer NURSING INTERVENTION Post-Operative care 1. Monitor for complications Leakage from the site, prolapse of stoma, skin irritation and pulmo complication 2. Assess the abdomen for return of peristalsis

NURSING INTERVENTION

Post-Operative care

1. Monitor for complications

Leakage from the site, prolapse of stoma, skin irritation and pulmo complication

2. Assess the abdomen for return of peristalsis

Colon cancer NURSING INTERVENTION Post-Operative care 3. Assess wound dressing for bleeding 4. Assist patient in ambulation after 24H 5.provide nutritional teaching Limit foods that cause gas-formation and odor Cabbage, beans, eggs, fish, peanuts Low-fiber diet in the early stage of recovery

NURSING INTERVENTION

Post-Operative care

3. Assess wound dressing for bleeding

4. Assist patient in ambulation after 24H

5.provide nutritional teaching

Limit foods that cause gas-formation and odor

Cabbage, beans, eggs, fish, peanuts

Low-fiber diet in the early stage of recovery

Colon cancer NURSING INTERVENTION Post-Operative care 6. Instruct to splint the incision and administer pain meds before exercise 7. The stoma is PINKISH to cherry red, Slightly edematous with minimal pinkish drainage 8. Manage post-operative complication

NURSING INTERVENTION

Post-Operative care

6. Instruct to splint the incision and administer pain meds before exercise

7. The stoma is PINKISH to cherry red, Slightly edematous with minimal pinkish drainage

8. Manage post-operative complication

Colon cancer NURSING INTERVENTION: COLOSTOMY CARE Colostomy begins to function 3-6 days after surgery The drainage maybe soft/mushy or semi-solid depending on the site

NURSING INTERVENTION: COLOSTOMY CARE

Colostomy begins to function 3-6 days after surgery

The drainage maybe soft/mushy or semi-solid depending on the site

Colon cancer NURSING INTERVENTION: COLOSTOMY CARE BEST time to do skin care is after shower Apply tape to the sides of the pouch before shower Assume a sitting or standing position in changing the pouch

NURSING INTERVENTION: COLOSTOMY CARE

BEST time to do skin care is after shower

Apply tape to the sides of the pouch before shower

Assume a sitting or standing position in changing the pouch

Colon cancer NURSING INTERVENTION: COLOSTOMY CARE Instruct to GENTLY push the skin down and the pouch pulling UP Wash the peri-stomal area with soap and water Cover the stoma while washing the peri-stomal area

NURSING INTERVENTION: COLOSTOMY CARE

Instruct to GENTLY push the skin down and the pouch pulling UP

Wash the peri-stomal area with soap and water

Cover the stoma while washing the peri-stomal area

Colon cancer NURSING INTERVENTION: COLOSTOMY CARE Lightly pat dry the area and NEVER rub Lightly dust the peri-stomal area with nystatin powder

NURSING INTERVENTION: COLOSTOMY CARE

Lightly pat dry the area and NEVER rub

Lightly dust the peri-stomal area with nystatin powder

Colon cancer NURSING INTERVENTION: COLOSTOMY CARE Measure the stomal opening The pouch opening is about 0.3 cm larger than the stomal opening Apply adhesive surface over the stoma and press for 30 seconds

NURSING INTERVENTION: COLOSTOMY CARE

Measure the stomal opening

The pouch opening is about 0.3 cm larger than the stomal opening

Apply adhesive surface over the stoma and press for 30 seconds

Colon cancer NURSING INTERVENTION: COLOSTOMY CARE Empty the pouch or change the pouch when 1/3 to ¼ full (Brunner) ½ to 1/3 full (Kozier)

NURSING INTERVENTION: COLOSTOMY CARE

Empty the pouch or change the pouch when

1/3 to ¼ full (Brunner)

½ to 1/3 full (Kozier)

Breast Cancer The most common cancer in FEMALES Numerous etiologies implicated

The most common cancer in FEMALES

Numerous etiologies implicated

Breast Cancer RISK FACTORS 1. Genetics- BRCA1 And BRCA 2 2. Increasing age ( > 50yo) 3. Family History of breast cancer 4. Early menarche and late menopause 5. Nulliparity 6. Late age at pregnancy

RISK FACTORS

1. Genetics- BRCA1 And BRCA 2

2. Increasing age ( > 50yo)

3. Family History of breast cancer

4. Early menarche and late menopause

5. Nulliparity

6. Late age at pregnancy

Breast Cancer RISK FACTORS 7. Obesity 8. Hormonal replacement 9. Alcohol 10. Exposure to radiation

RISK FACTORS

7. Obesity

8. Hormonal replacement

9. Alcohol

10. Exposure to radiation

Breast Cancer PROTECTIVE FACTORS 1. Exercise 2. Breast feeding 3. Pregnancy before 30 yo

PROTECTIVE FACTORS

1. Exercise

2. Breast feeding

3. Pregnancy before 30 yo

pathophysiology

Breast Cancer ASSESSMENT FINDINGS 1. MASS- the most common location is the upper outer quadrant 2. Mass is NON-tender. Fixed, hard with irregular borders 3. Skin dimpling 4. Nipple retraction 5. Peau d’ orange

ASSESSMENT FINDINGS

1. MASS- the most common location is the upper outer quadrant

2. Mass is NON-tender. Fixed, hard with irregular borders

3. Skin dimpling

4. Nipple retraction

5. Peau d’ orange

Breast Cancer LABORATORY FINDINGS 1. Biopsy procedures 2. Mammography

LABORATORY FINDINGS

1. Biopsy procedures

2. Mammography

Breast Cancer Breast cancer Staging TNM staging I - < 2cm II - 2 to 5 cm, (+) LN III - > 5 cm, (+) LN IV- metastasis

Breast cancer Staging

TNM staging

I - < 2cm

II - 2 to 5 cm, (+) LN

III - > 5 cm, (+) LN

IV- metastasis

Breast Cancer MEDICAL MANAGEMENT 1. Chemotherapy 2. Tamoxifen therapy 3. Radiation therapy

MEDICAL MANAGEMENT

1. Chemotherapy

2. Tamoxifen therapy

3. Radiation therapy

Breast Cancer SURGICAL MANAGEMENT 1. Radical mastectomy 2. Modified radical mastectomy 3. Lumpectomy 4. Quadrantectomy

SURGICAL MANAGEMENT 1. Radical mastectomy

2. Modified radical mastectomy

3. Lumpectomy

4. Quadrantectomy

Breast Cancer NURSING INTERVENTION : PRE-OP 1. Explain breast cancer and treatment options 2. Reduce fear and anxiety and improve coping abilities 3. Promote decision making abilities 4. Provide routine pre-op care: Consent, NPO, Meds, Teaching about breathing exercise

NURSING INTERVENTION : PRE-OP

1. Explain breast cancer and treatment options

2. Reduce fear and anxiety and improve coping abilities

3. Promote decision making abilities

4. Provide routine pre-op care:

Consent, NPO, Meds, Teaching about breathing exercise

Breast Cancer NURSING INTERVENTION : Post-OP 1. Position patient: Supine Affected extremity elevated to reduce edema

NURSING INTERVENTION : Post-OP

1. Position patient:

Supine

Affected extremity elevated to reduce edema

Breast Cancer NURSING INTERVENTION : Post-OP 2. Relieve pain and discomfort Moderate elevation of extremity IM/IV injection of pain meds Warm shower on 2 nd day post-op

NURSING INTERVENTION : Post-OP

2. Relieve pain and discomfort

Moderate elevation of extremity

IM/IV injection of pain meds

Warm shower on 2 nd day post-op

Breast Cancer NURSING INTERVENTION : Post-OP 3. Maintain skin integrity Immediate post-op: snug dressing with drainage Maintain patency of drain (JP) Monitor for hematoma w/in 12H and apply bandage and ice, refer to surgeon

NURSING INTERVENTION : Post-OP

3. Maintain skin integrity

Immediate post-op: snug dressing with drainage

Maintain patency of drain (JP)

Monitor for hematoma w/in 12H and apply bandage and ice, refer to surgeon

Breast Cancer NURSING INTERVENTION : Post-OP 3. Maintain skin integrity Drainage is removed when the discharge is less than 30 ml in 24 H Lotions, Creams are applied ONLY when the incision is healed in 4-6 weeks

NURSING INTERVENTION : Post-OP

3. Maintain skin integrity

Drainage is removed when the discharge is less than 30 ml in 24 H

Lotions, Creams are applied ONLY when the incision is healed in 4-6 weeks

Breast Cancer NURSING INTERVENTION : Post-OP Promote activity Support operative site when moving Hand, shoulder exercise done on 2 nd day Post-op mastectomy exercise 20 mins TID NO BP or IV procedure on operative site

NURSING INTERVENTION : Post-OP

Promote activity

Support operative site when moving

Hand, shoulder exercise done on 2 nd day

Post-op mastectomy exercise 20 mins TID

NO BP or IV procedure on operative site

Breast Cancer NURSING INTERVENTION : Post-OP Promote activity Heavy lifting is avoided Elevate the arm at the level of the heart On a pillow for 45 minutes TID to relieve transient edema

NURSING INTERVENTION : Post-OP

Promote activity

Heavy lifting is avoided

Elevate the arm at the level of the heart

On a pillow for 45 minutes TID to relieve transient edema

Breast Cancer NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS Lymphedema 10-20% of patients Elevate arms, elbow above shoulder and hand above elbow Hand exercise while elevated Refer to surgeon and physical therapist

NURSING INTERVENTION : Post-OP

MANAGE COMPLICATIONS

Lymphedema

10-20% of patients

Elevate arms, elbow above shoulder and hand above elbow

Hand exercise while elevated

Refer to surgeon and physical therapist

Breast Cancer NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS Hematoma Notify the surgeon Apply bandage wrap (Ace wrap) and ICE pack

NURSING INTERVENTION : Post-OP

MANAGE COMPLICATIONS

Hematoma

Notify the surgeon

Apply bandage wrap (Ace wrap) and ICE pack

Breast Cancer NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS Infection Monitor temperature, redness, swelling and foul-odor IV antibiotics No procedure on affected extremity

NURSING INTERVENTION : Post-OP

MANAGE COMPLICATIONS

Infection

Monitor temperature, redness, swelling and foul-odor

IV antibiotics

No procedure on affected extremity

Breast Cancer NURSING INTERVENTION : Post-OP TEACH FOLLOW-UP care Regular check-up Monthly BSE on the other breast Annual mammography

NURSING INTERVENTION : Post-OP

TEACH FOLLOW-UP care

Regular check-up

Monthly BSE on the other breast

Annual mammography