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Cancer Nursing
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Cancer Nursing

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pinoynursing.webkotoh.com

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  • 1. Oncology Nursing Nurse Licensure Examination Review pinoynursing.webkotoh.com
  • 2. Oncology defined <ul><li>Branch of medicine that deals with the study, detection, treatment and management of cancer and neoplasia </li></ul>
  • 3. “Root words” <ul><li>Neo- new </li></ul><ul><li>Plasia- growth </li></ul><ul><li>Plasm- substance </li></ul><ul><li>Trophy- size </li></ul><ul><li>+Oma- tumor </li></ul><ul><li>Statis- location </li></ul>
  • 4. “Root words” <ul><li>A- none </li></ul><ul><li>Ana- lack </li></ul><ul><li>Hyper- excessive </li></ul><ul><li>Meta- change </li></ul><ul><li>Dys- bad, deranged </li></ul>
  • 5. Characteristics of Neoplasia <ul><li>Uncontrolled growth of Abnormal cells </li></ul><ul><li>1. Benign </li></ul><ul><li>2. Malignant </li></ul><ul><li>3. Borderline </li></ul>
  • 6. Characteristics of Neoplasia <ul><li>BENIGN </li></ul><ul><li>Well-differentiated </li></ul><ul><li>Slow growth </li></ul><ul><li>Encapsulated </li></ul><ul><li>Non-invasive </li></ul><ul><li>Does NOT metastasize </li></ul>
  • 7. Characteristics of Neoplasia <ul><li>MALIGNANT </li></ul><ul><li>Undifferentiated </li></ul><ul><li>Erratic and Uncontrolled Growth </li></ul><ul><li>Expansive and Invasive </li></ul><ul><li>Secretes abnormal proteins </li></ul><ul><li>METASTASIZES </li></ul>
  • 8.  
  • 9.  
  • 10. Nomenclature of Neoplasia <ul><li>Tumor is named according to: </li></ul><ul><li>1. Parenchyma, Organ or Cell </li></ul><ul><li>Hepatoma- liver </li></ul><ul><li>Osteoma- bone </li></ul><ul><li>Myoma- muscle </li></ul>
  • 11. Nomenclature of Neoplasia <ul><li>Tumor is named according to: </li></ul><ul><li>2. Pattern and Structure, either GROSS or MICROSCOPIC </li></ul><ul><li>Fluid-filled  CYST </li></ul><ul><li>Glandular  ADENO </li></ul><ul><li>Finger-like  PAPILLO </li></ul><ul><li>Stalk  POLYP </li></ul>
  • 12. Nomenclature of Neoplasia <ul><li>Tumor is named according to: </li></ul><ul><li>3. Embryonic origin </li></ul><ul><li>Ectoderm ( usually gives rise to epithelium) </li></ul><ul><li>Endoderm (usually gives rise to glands) </li></ul><ul><li>Mesoderm (usually gives rise to Connective tissues) </li></ul>
  • 13. BENIGN TUMORS <ul><li>Suffix- “OMA” is used </li></ul><ul><li>Adipose tissue- LipOMA </li></ul><ul><li>Bone- osteOMA </li></ul><ul><li>Muscle- myOMA </li></ul><ul><li>Blood vessels- angiOMA </li></ul><ul><li>Fibrous tissue- fibrOMA </li></ul>
  • 14. MALIGNANT TUMOR <ul><li>Named according to embryonic cell origin </li></ul><ul><li>1. Ectodermal, Endodermal, Glandular, Epithelial </li></ul><ul><li>Use the suffix- “CARCINOMA” </li></ul><ul><li>Pancreatic AdenoCarcinoma </li></ul><ul><li>Squamos cell Carcinoma </li></ul>
  • 15. MALIGNANT TUMOR <ul><li>Named according to embryonic cell origin </li></ul><ul><li>2. Mesodermal, connective tissue origin </li></ul><ul><li>Use the suffix “SARCOMA </li></ul><ul><li>FibroSarcoma </li></ul><ul><li>Myosarcoma </li></ul><ul><li>AngioSarcoma </li></ul>
  • 16. “PASAWAY” <ul><li>1. “OMA” but Malignant </li></ul><ul><ul><li>HepatOMA, lymphOMA, gliOMA, melanOMA </li></ul></ul><ul><li>2. THREE germ layers </li></ul><ul><ul><li>“ TERATOMA” </li></ul></ul><ul><li>3. Non-neoplastic but “OMA” </li></ul><ul><ul><li>Choristoma </li></ul></ul><ul><ul><li>Hamatoma </li></ul></ul>
  • 17. CANCER NURSING <ul><li>Review of Normal Cell Cycle </li></ul><ul><li>3 types of cells </li></ul><ul><li>1. PERMANENT cells- out of the cell cycle </li></ul><ul><ul><li>Neurons, cardiac muscle cell </li></ul></ul><ul><li>2. STABLE cells- Dormant/Resting (G0) </li></ul><ul><ul><li>Liver, kidney </li></ul></ul><ul><li>3. LABILE cells- continuously dividing </li></ul><ul><ul><li>GIT cells, Skin, endometrium , Blood cells </li></ul></ul>
  • 18. CANCER NURSING <ul><li>Cell Cycle </li></ul><ul><li>G0------------------G1  S  G2  M </li></ul><ul><li>G0- Dormant or resting </li></ul><ul><li>G1- normal cell activities </li></ul><ul><li>S- DNA Synthesis </li></ul><ul><li>G2- pre-mitotic, synthesis of proteins for cellular division </li></ul><ul><li>M- Mitotic phase (I-P-M-A-T) </li></ul>
  • 19. CANCER NURSING <ul><li>Proposed Molecular cause of CANCER: </li></ul><ul><li>Change in the DNA structure  altered DNA function  Cellular aberration </li></ul><ul><li> cellular death </li></ul><ul><li> neoplastic change </li></ul><ul><li>Genes in the DNA- “proto-oncogene” And “anti-oncogene” </li></ul>
  • 20. CANCER NURSING <ul><li>Etiology of cancer </li></ul><ul><li>1. PHYSICAL AGENTS </li></ul><ul><li>Radiation </li></ul><ul><li>Exposure to irritants </li></ul><ul><li>Exposure to sunlight </li></ul><ul><li>Altitude, humidity </li></ul>
  • 21. CANCER NURSING <ul><li>Etiology of cancer </li></ul><ul><li>2. CHEMICAL AGENTS </li></ul><ul><li>Smoking </li></ul><ul><li>Dietary ingredients </li></ul><ul><li>Drugs </li></ul>
  • 22. CANCER NURSING <ul><li>Etiology of cancer </li></ul><ul><li>3. Genetics and Family History </li></ul><ul><li>Colon Cancer </li></ul><ul><li>Premenopausal breast cancer </li></ul>
  • 23. CANCER NURSING <ul><ul><li>Etiology of cancer </li></ul></ul><ul><li>4. Dietary Habits </li></ul><ul><li>Low-Fiber </li></ul><ul><li>High-fat </li></ul><ul><li>Processed foods </li></ul><ul><li>alcohol </li></ul>
  • 24. CANCER NURSING <ul><li>Etiology of cancer </li></ul><ul><li>5. Viruses and Bacteria </li></ul><ul><li>DNA viruses- HepaB, Herpes, EBV, CMV, Papilloma Virus </li></ul><ul><li>RNA Viruses- HIV, HTCLV </li></ul><ul><li>Bacterium- H. pylori </li></ul>
  • 25. CANCER NURSING <ul><li>Etiology of cancer </li></ul><ul><li>6. Hormonal agents </li></ul><ul><li>DES </li></ul><ul><li>OCP especially estrogen </li></ul>
  • 26. CANCER NURSING <ul><li>Etiology of cancer </li></ul><ul><li>7. Immune Disease </li></ul><ul><li>AIDS </li></ul>
  • 27. CANCER NURSING <ul><li>CARCINOGENSIS </li></ul><ul><li>Malignant transformation </li></ul><ul><li>I  P  P </li></ul><ul><li>Initiation </li></ul><ul><li>Promotion </li></ul><ul><li>Progression </li></ul>
  • 28. CANCER NURSING <ul><li>CARCINOGENSIS </li></ul><ul><li>INITIATION </li></ul><ul><li>Carcinogens alter the DNA of the cell </li></ul><ul><li>Cell will either die or repair </li></ul>
  • 29. CANCER NURSING <ul><li>CARCINOGENSIS </li></ul><ul><li>PROMOTION </li></ul><ul><li>Repeated exposure to carcinogens </li></ul><ul><li>Abnormal gene will express </li></ul><ul><li>Latent period </li></ul>
  • 30. CANCER NURSING <ul><li>CARCINOGENSIS </li></ul><ul><li>PROGRESSION </li></ul><ul><li>Irreversible period </li></ul><ul><li>Cells undergo NEOPLASTIC transformation then malignancy </li></ul>
  • 31. CANCER NURSING <ul><li>Spread of Cancer </li></ul><ul><li>1. LYMPHATIC </li></ul><ul><ul><ul><li>Most common </li></ul></ul></ul><ul><li>2. HEMATOGENOUS </li></ul><ul><ul><li>Blood-borne, commonly to Liver and Lungs </li></ul></ul><ul><li>3. DIRECT SPREAD </li></ul><ul><ul><li>Seeding of tumors </li></ul></ul>
  • 32. CANCER NURSING <ul><li>Body Defenses Against TUMOR </li></ul><ul><li>1. T cell System/ Cellular Immunity </li></ul><ul><ul><li>Cytotoxic T cells kill tumor cells </li></ul></ul><ul><li>2. B cell System/ Humoral immunity </li></ul><ul><ul><li>B cells can produce antibody </li></ul></ul><ul><li>3. Phagocytic cells </li></ul><ul><ul><li>Macrophages can engulf cancer cell debris </li></ul></ul>
  • 33. CANCER NURSING <ul><li>Cancer Diagnosis </li></ul><ul><li>1. BIOPSY </li></ul><ul><ul><li>The most definitive </li></ul></ul><ul><li>2. CT, MRI </li></ul><ul><li>3. Tumor Markers </li></ul>
  • 34. CANCER NURSING <ul><li>Cancer Grading </li></ul><ul><li>The degree of DIFFERENTIATION </li></ul><ul><li>Grade 1- Low grade </li></ul><ul><li>Grade 4- high grade </li></ul>
  • 35. CANCER NURSING <ul><li>Cancer Staging </li></ul><ul><li>1. Uses the T-N-M staging system </li></ul><ul><li>T- tumor </li></ul><ul><li>N- Node </li></ul><ul><li>M- Metastasis </li></ul><ul><li>2. Stage 1 to Stage 4 </li></ul>
  • 36. CANCER NURSING <ul><li>GENERAL MEDICAL MANAGEMENT </li></ul><ul><li>1. Surgery- cure, control, palliate </li></ul><ul><li>2. Chemotherapy </li></ul><ul><li>3. Radiation therapy </li></ul><ul><li>4. Immunotherapy </li></ul><ul><li>5. Bone Marrow Transplant </li></ul>
  • 37. CANCER NURSING <ul><li>GENERAL Promotive and Preventive Nursing Management </li></ul><ul><li>1. Lifestyle Modification </li></ul><ul><li>2. Nutritional management </li></ul><ul><li>3. Screening </li></ul><ul><li>4. Early detection </li></ul>
  • 38. SCREENING <ul><li>1. Male and female- Occult Blood, CXR, and DRE </li></ul><ul><li>2. Female- SBE, CBE, Mammography and Pap’s Smear </li></ul><ul><li>3. Male- DRE for prostate, Testicular self-exam </li></ul>
  • 39. Nursing Assessment <ul><li>Utilize the ACS 7 Warning Signals </li></ul><ul><li>CAUTION </li></ul><ul><li>C- Change in bowel/bladder habits </li></ul><ul><li>A- A sore that does not heal </li></ul><ul><li>U- Unusual bleeding </li></ul><ul><li>T- Thickening or lump in the breast </li></ul><ul><li>I- Indigestion </li></ul><ul><li>O- Obvious change in warts </li></ul><ul><li>N- Nagging cough and hoarseness </li></ul>
  • 40. Nursing Assessment <ul><li>Weight loss </li></ul><ul><li>Frequent infection </li></ul><ul><li>Skin problems </li></ul><ul><li>Pain </li></ul><ul><li>Hair Loss </li></ul><ul><li>Fatigue </li></ul><ul><li>Disturbance in body image/ depression </li></ul>
  • 41. Nursing Intervention <ul><li>MAINTAIN TISSUE INTEGRITY </li></ul><ul><li>Handle skin gently </li></ul><ul><li>Do NOT rub affected area </li></ul><ul><li>Lotion may be applied </li></ul><ul><li>Wash skin only with SOAP and Water </li></ul>
  • 42. Nursing Intervention <ul><li>MANAGEMENT OF STOMATITIS </li></ul><ul><li>Use soft-bristled toothbrush </li></ul><ul><li>Oral rinses with saline gargles/ tap water </li></ul><ul><li>Avoid ALCOHOL-based rinses </li></ul>
  • 43. Nursing Intervention <ul><li>MANAGEMENT OF ALOPECIA Alopecia begins within 2 weeks of therapy </li></ul><ul><li>Regrowth within 8 weeks of termination </li></ul><ul><li>Encourage to acquire wig before hair loss occurs </li></ul><ul><li>Encourage use of attractive scarves and hats </li></ul><ul><li>Provide information that hair loss is temporary BUT anticipate change in texture and color </li></ul>
  • 44. Nursing Intervention <ul><li>PROMOTE NUTRITION </li></ul><ul><li>Serve food in ways to make it appealing </li></ul><ul><li>Consider patient’s preferences </li></ul><ul><li>Provide small frequent meals </li></ul><ul><li>Avoids giving fluids while eating </li></ul><ul><li>Oral hygiene PRIOR to mealtime </li></ul><ul><li>Vitamin supplements </li></ul>
  • 45. Nursing Intervention <ul><li>RELIEVE PAIN </li></ul><ul><li>Mild pain- NSAIDS Moderate pain- Weak opiods </li></ul><ul><li>Severe pain- Morphine </li></ul><ul><li>Administer analgesics round the clock with additional dose for breakthrough pain </li></ul>
  • 46. Nursing Intervention <ul><li>DECREASE FATIGUE </li></ul><ul><li>Plan daily activities to allow alternating rest periods </li></ul><ul><li>Light exercise is encouraged </li></ul><ul><li>Small frequent meals </li></ul>
  • 47. Nursing Intervention <ul><li>IMPROVE BODY IMAGE </li></ul><ul><li>Therapeutic communication is essential </li></ul><ul><li>Encourage independence in self-care and decision making </li></ul><ul><li>Offer cosmetic material like make-up and wigs </li></ul>
  • 48. Nursing Intervention <ul><li>ASSIST IN THE GRIEVING PROCESS </li></ul><ul><li>Some cancers are curable </li></ul><ul><li>Grieving can be due to loss of health, income, sexuality, and body image </li></ul><ul><li>Answer and clarify information about cancer and treatment options </li></ul><ul><li>Identify resource people </li></ul><ul><li>Refer to support groups </li></ul>
  • 49. Nursing Intervention <ul><li>MANAGE COMPLICATION: INFECTION </li></ul><ul><li>Fever is the most important sign (38.3) </li></ul><ul><li>Administer prescribed antibiotics X 2weeks </li></ul><ul><li>Maintain aseptic technique </li></ul><ul><li>Avoid exposure to crowds </li></ul><ul><li>Avoid giving fresh fruits and veggie </li></ul><ul><li>Handwashing </li></ul><ul><li>Avoid frequent invasive procedures </li></ul>
  • 50. Nursing Intervention <ul><li>MANAGE COMPLICATION: Septic shock </li></ul><ul><li>Monitor VS, BP, temp </li></ul><ul><li>Administer IV antibiotics </li></ul><ul><li>Administer supplemental O2 </li></ul>
  • 51. Nursing Intervention <ul><li>MANAGE COMPLICATION: Bleeding </li></ul><ul><li>Thrombocytopenia (<100,000) is the most common cause </li></ul><ul><li><20, 000  spontaneous bleeding </li></ul><ul><li>Use soft toothbrush </li></ul><ul><li>Use electric razor </li></ul><ul><li>Avoid frequent IM, IV, rectal and catheterization </li></ul><ul><li>Soft foods and stool softeners </li></ul>
  • 52. Colon cancer
  • 53. COLON CANCER <ul><li>Risk factors </li></ul><ul><li>1. Increasing age </li></ul><ul><li>2. Family history </li></ul><ul><li>3. Previous colon CA or polyps </li></ul><ul><li>4. History of IBD </li></ul><ul><li>5. High fat, High protein, LOW fiber </li></ul><ul><li>6. Breast Ca and Genital Ca </li></ul>
  • 54. COLON CANCER <ul><li>Sigmoid colon is the most common site </li></ul><ul><li>Predominantly adenocarcinoma </li></ul><ul><li>If early  90% survival </li></ul><ul><li>34 % diagnosed early </li></ul><ul><li>66% late diagnosis </li></ul>
  • 55. COLON CANCER <ul><li>PATHOPHYSIOLOGY </li></ul><ul><li>Benign neoplasm  DNA alteration  malignant transformation  malignant neoplasm  cancer growth and invasion  metastasis (liver) </li></ul>
  • 56. COLON CANCER <ul><li>ASSESSMENT FINDINGS 1. Change in bowel habits- Most common </li></ul><ul><li>2. Blood in the stool </li></ul><ul><li>3. Anemia </li></ul><ul><li>4. Anorexia and weight loss </li></ul><ul><li>5. Fatigue </li></ul><ul><li>6. Rectal lesions- tenesmus, alternating D and C </li></ul>
  • 57. Colon cancer <ul><li>Diagnostic findings </li></ul><ul><li>1. Fecal occult blood </li></ul><ul><li>2. Sigmoidoscopy and colonoscopy </li></ul><ul><li>3. BIOPSY </li></ul><ul><li>4. CEA- carcino-embryonic antigen </li></ul>
  • 58. Colon cancer <ul><li>Complications of colorectal CA </li></ul><ul><li>1. Obstruction </li></ul><ul><li>2. Hemorrhage </li></ul><ul><li>3. Peritonitis </li></ul><ul><li>4. Sepsis </li></ul>
  • 59. Colon cancer <ul><li>MEDICAL MANAGEMENT </li></ul><ul><li>1. Chemotherapy- 5-FU </li></ul><ul><li>2. Radiation therapy </li></ul>
  • 60. Colon cancer <ul><li>SURGICAL MANAGEMENT </li></ul><ul><li>Surgery is the primary treatment </li></ul><ul><li>Based on location and tumor size </li></ul><ul><li>Resection, anastomosis, and colostomy (temporary or permanent) </li></ul>
  • 61. Colon cancer <ul><li>NURSING INTERVENTION </li></ul><ul><li>Pre-Operative care </li></ul><ul><li>1. Provide HIGH protein, HIGH calorie and LOW residue diet </li></ul><ul><li>2.Provide information about post-op care and stoma care </li></ul><ul><li>3. Administer antibiotics 1 day prior </li></ul>
  • 62. Colon cancer <ul><li>NURSING INTERVENTION </li></ul><ul><li>Pre-Operative care </li></ul><ul><li>4. Enema or colonic irrigation the evening and the morning of surgery </li></ul><ul><li>5. NGT is inserted to prevent distention </li></ul><ul><li>6. Monitor UO, F and E, Abdomen PE </li></ul>
  • 63. Colon cancer <ul><li>NURSING INTERVENTION </li></ul><ul><li>Post-Operative care </li></ul><ul><li>1. Monitor for complications </li></ul><ul><li>Leakage from the site, prolapse of stoma, skin irritation and pulmo complication </li></ul><ul><li>2. Assess the abdomen for return of peristalsis </li></ul>
  • 64. Colon cancer <ul><li>NURSING INTERVENTION </li></ul><ul><li>Post-Operative care </li></ul><ul><li>3. Assess wound dressing for bleeding </li></ul><ul><li>4. Assist patient in ambulation after 24H </li></ul><ul><li>5.provide nutritional teaching </li></ul><ul><li>Limit foods that cause gas-formation and odor </li></ul><ul><li>Cabbage, beans, eggs, fish, peanuts </li></ul><ul><li>Low-fiber diet in the early stage of recovery </li></ul>
  • 65. Colon cancer <ul><li>NURSING INTERVENTION </li></ul><ul><li>Post-Operative care </li></ul><ul><li>6. Instruct to splint the incision and administer pain meds before exercise </li></ul><ul><li>7. The stoma is PINKISH to cherry red, Slightly edematous with minimal pinkish drainage </li></ul><ul><li>8. Manage post-operative complication </li></ul>
  • 66.  
  • 67. Colon cancer <ul><li>NURSING INTERVENTION: COLOSTOMY CARE </li></ul><ul><li>Colostomy begins to function 3-6 days after surgery </li></ul><ul><li>The drainage maybe soft/mushy or semi-solid depending on the site </li></ul>
  • 68. Colon cancer <ul><li>NURSING INTERVENTION: COLOSTOMY CARE </li></ul><ul><li>BEST time to do skin care is after shower </li></ul><ul><li>Apply tape to the sides of the pouch before shower </li></ul><ul><li>Assume a sitting or standing position in changing the pouch </li></ul>
  • 69. Colon cancer <ul><li>NURSING INTERVENTION: COLOSTOMY CARE </li></ul><ul><li>Instruct to GENTLY push the skin down and the pouch pulling UP </li></ul><ul><li>Wash the peri-stomal area with soap and water </li></ul><ul><li>Cover the stoma while washing the peri-stomal area </li></ul>
  • 70. Colon cancer <ul><li>NURSING INTERVENTION: COLOSTOMY CARE </li></ul><ul><li>Lightly pat dry the area and NEVER rub </li></ul><ul><li>Lightly dust the peri-stomal area with nystatin powder </li></ul>
  • 71. Colon cancer <ul><li>NURSING INTERVENTION: COLOSTOMY CARE </li></ul><ul><li>Measure the stomal opening </li></ul><ul><li>The pouch opening is about 0.3 cm larger than the stomal opening </li></ul><ul><li>Apply adhesive surface over the stoma and press for 30 seconds </li></ul>
  • 72. Colon cancer <ul><li>NURSING INTERVENTION: COLOSTOMY CARE </li></ul><ul><li>Empty the pouch or change the pouch when </li></ul><ul><ul><li>1/3 to ¼ full (Brunner) </li></ul></ul><ul><ul><li>½ to 1/3 full (Kozier) </li></ul></ul>
  • 73. Breast Cancer <ul><li>The most common cancer in FEMALES </li></ul><ul><li>Numerous etiologies implicated </li></ul>
  • 74. Breast Cancer <ul><li>RISK FACTORS </li></ul><ul><li>1. Genetics- BRCA1 And BRCA 2 </li></ul><ul><li>2. Increasing age ( > 50yo) </li></ul><ul><li>3. Family History of breast cancer </li></ul><ul><li>4. Early menarche and late menopause </li></ul><ul><li>5. Nulliparity </li></ul><ul><li>6. Late age at pregnancy </li></ul>
  • 75. Breast Cancer <ul><li>RISK FACTORS </li></ul><ul><li>7. Obesity </li></ul><ul><li>8. Hormonal replacement </li></ul><ul><li>9. Alcohol </li></ul><ul><li>10. Exposure to radiation </li></ul>
  • 76. Breast Cancer <ul><li>PROTECTIVE FACTORS </li></ul><ul><li>1. Exercise </li></ul><ul><li>2. Breast feeding </li></ul><ul><li>3. Pregnancy before 30 yo </li></ul>
  • 77. pathophysiology
  • 78. Breast Cancer <ul><li>ASSESSMENT FINDINGS </li></ul><ul><li>1. MASS- the most common location is the upper outer quadrant </li></ul><ul><li>2. Mass is NON-tender. Fixed, hard with irregular borders </li></ul><ul><li>3. Skin dimpling </li></ul><ul><li>4. Nipple retraction </li></ul><ul><li>5. Peau d’ orange </li></ul>
  • 79. Breast Cancer <ul><li>LABORATORY FINDINGS </li></ul><ul><li>1. Biopsy procedures </li></ul><ul><li>2. Mammography </li></ul>
  • 80. Breast Cancer <ul><li>Breast cancer Staging </li></ul><ul><li>TNM staging </li></ul><ul><li>I - < 2cm </li></ul><ul><li>II - 2 to 5 cm, (+) LN </li></ul><ul><li>III - > 5 cm, (+) LN </li></ul><ul><li>IV- metastasis </li></ul>
  • 81. Breast Cancer <ul><li>MEDICAL MANAGEMENT </li></ul><ul><li>1. Chemotherapy </li></ul><ul><li>2. Tamoxifen therapy </li></ul><ul><li>3. Radiation therapy </li></ul>
  • 82. Breast Cancer <ul><li>SURGICAL MANAGEMENT 1. Radical mastectomy </li></ul><ul><li>2. Modified radical mastectomy </li></ul><ul><li>3. Lumpectomy </li></ul><ul><li>4. Quadrantectomy </li></ul>
  • 83. Breast Cancer <ul><li>NURSING INTERVENTION : PRE-OP </li></ul><ul><li>1. Explain breast cancer and treatment options </li></ul><ul><li>2. Reduce fear and anxiety and improve coping abilities </li></ul><ul><li>3. Promote decision making abilities </li></ul><ul><li>4. Provide routine pre-op care: </li></ul><ul><li>Consent, NPO, Meds, Teaching about breathing exercise </li></ul>
  • 84. Breast Cancer <ul><li>NURSING INTERVENTION : Post-OP </li></ul><ul><li>1. Position patient: </li></ul><ul><li>Supine </li></ul><ul><li>Affected extremity elevated to reduce edema </li></ul>
  • 85. Breast Cancer <ul><li>NURSING INTERVENTION : Post-OP </li></ul><ul><li>2. Relieve pain and discomfort </li></ul><ul><li>Moderate elevation of extremity </li></ul><ul><li>IM/IV injection of pain meds </li></ul><ul><li>Warm shower on 2 nd day post-op </li></ul>
  • 86. Breast Cancer <ul><li>NURSING INTERVENTION : Post-OP </li></ul><ul><li>3. Maintain skin integrity </li></ul><ul><li>Immediate post-op: snug dressing with drainage </li></ul><ul><li>Maintain patency of drain (JP) </li></ul><ul><li>Monitor for hematoma w/in 12H and apply bandage and ice, refer to surgeon </li></ul>
  • 87. Breast Cancer <ul><li>NURSING INTERVENTION : Post-OP </li></ul><ul><li>3. Maintain skin integrity </li></ul><ul><li>Drainage is removed when the discharge is less than 30 ml in 24 H </li></ul><ul><li>Lotions, Creams are applied ONLY when the incision is healed in 4-6 weeks </li></ul>
  • 88. Breast Cancer <ul><li>NURSING INTERVENTION : Post-OP </li></ul><ul><li>Promote activity </li></ul><ul><li>Support operative site when moving </li></ul><ul><li>Hand, shoulder exercise done on 2 nd day </li></ul><ul><li>Post-op mastectomy exercise 20 mins TID </li></ul><ul><li>NO BP or IV procedure on operative site </li></ul>
  • 89. Breast Cancer <ul><li>NURSING INTERVENTION : Post-OP </li></ul><ul><li>Promote activity </li></ul><ul><li>Heavy lifting is avoided </li></ul><ul><li>Elevate the arm at the level of the heart </li></ul><ul><li>On a pillow for 45 minutes TID to relieve transient edema </li></ul>
  • 90. Breast Cancer <ul><li>NURSING INTERVENTION : Post-OP </li></ul><ul><li>MANAGE COMPLICATIONS </li></ul><ul><li>Lymphedema </li></ul><ul><li>10-20% of patients </li></ul><ul><li>Elevate arms, elbow above shoulder and hand above elbow </li></ul><ul><li>Hand exercise while elevated </li></ul><ul><li>Refer to surgeon and physical therapist </li></ul>
  • 91. Breast Cancer <ul><li>NURSING INTERVENTION : Post-OP </li></ul><ul><li>MANAGE COMPLICATIONS </li></ul><ul><li>Hematoma </li></ul><ul><li>Notify the surgeon </li></ul><ul><li>Apply bandage wrap (Ace wrap) and ICE pack </li></ul>
  • 92. Breast Cancer <ul><li>NURSING INTERVENTION : Post-OP </li></ul><ul><li>MANAGE COMPLICATIONS </li></ul><ul><li>Infection </li></ul><ul><li>Monitor temperature, redness, swelling and foul-odor </li></ul><ul><li>IV antibiotics </li></ul><ul><li>No procedure on affected extremity </li></ul>
  • 93. Breast Cancer <ul><li>NURSING INTERVENTION : Post-OP </li></ul><ul><li>TEACH FOLLOW-UP care </li></ul><ul><li>Regular check-up </li></ul><ul><li>Monthly BSE on the other breast </li></ul><ul><li>Annual mammography </li></ul>

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