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  • Fantastic presentation. Is it possible to purchase or can you send a copy to smilesrn@sbcgloal.net. THANKS
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    http://NurseReview.org Cancer Nursing http://NurseReview.org Cancer Nursing Presentation Transcript

    • Oncology Nursing Nurse Licensure Examination Review
    • Oncology defined
      • 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
    • “Root words”
      • 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
    • Characteristics of Neoplasia
      • 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
    •  
    •  
    • Nomenclature of Neoplasia
      • 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
    • 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)
    • BENIGN TUMORS
      • 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
    • MALIGNANT TUMOR
      • 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
    • 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
    • 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)
    • 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”
    • CANCER NURSING
      • 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
    • CANCER NURSING
      • 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
    • CANCER NURSING
      • 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
    • CANCER NURSING
      • Etiology of cancer
      • 7. Immune Disease
      • AIDS
    • CANCER NURSING
      • 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
    • CANCER NURSING
      • CARCINOGENSIS
      • PROMOTION
      • Repeated exposure to carcinogens
      • Abnormal gene will express
      • Latent period
    • CANCER NURSING
      • 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
    • 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
    • CANCER NURSING
      • 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 NURSING
      • 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
    • CANCER NURSING
      • 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
    • 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
    • Nursing Assessment
      • 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
    • Nursing Intervention
      • 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
    • 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
    • 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
    • Nursing Intervention
      • 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
    • 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
    • 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
    • Nursing Intervention
      • 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
    • 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
    • COLON CANCER
      • 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)
    • 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
    • Colon cancer
      • 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
    • Colon cancer
      • 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)
    • 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
    • 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
    • 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
    • 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
    • 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
    •  
    • 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
    • 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
    • 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
    • Colon cancer
      • 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
    • 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)
    • Breast Cancer
      • 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
    • Breast Cancer
      • 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
    • 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
    • Breast Cancer
      • 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
      • 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
    • 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
    • Breast Cancer
      • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • Breast Cancer
      • 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
    • Breast Cancer
      • NURSING INTERVENTION : Post-OP
      • TEACH FOLLOW-UP care
      • Regular check-up
      • Monthly BSE on the other breast
      • Annual mammography