Ch16 Cancer Part One
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Ch16 Cancer Part One

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Basic knowledge re cancer and nursing care

Basic knowledge re cancer and nursing care
Textbook Med-surg, Lewis, 7th edition

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Ch16 Cancer Part One Ch16 Cancer Part One Presentation Transcript

  • Ch. 16 Cancer
    August 25, 2010
  • Objectives
    Explain the use of OR, chemo, radiation, and biologic & targeted therapy in the treating cancer
    Discuss the appropriate nsg mgmt of patients receiving the above interventions
  • Terminology Review
    Benign VS Malignant
    Carcinogens
    Carcinomas VS Sarcomas
    Protooncogenes VS Oncogenes
    Hyperplasia VS Hypertrophy
  • Classification of Cancer
    Tumors can be classified by
    Anatomic site
    Histology
    Grading severity
    Extent of disease
    Staging
  • Grades of Abnormal Cells
    Grade 1
    slightly different but well differentiated
    Grade 2
    Grade 3
    Grade 4
    Cells immature, primitive and undifferentiated
    Cell of origin is difficult to determine
  • Clinical Staging
    0: Cancer in situ
    1: Tumor limited to tissue of origin; localized tumor growth
    2: Limited local spread
    3: Extensive local and regional spread
    4: Metastasis
  • Interpreting TNM
    Breast cancer T2 N2 M0
    Prostate cancer T3 N2 M0
  • Detection
    Prevention
    C- change in bowel or bladder habit (colon cancer)
    A- a sore that doesn't heal on skin or on mouth
    U- unusual bleeding or discharge from rectum, bladder, or vagina
    T- thickening or lump in the breast tissue
    I- indigestion or difficulty swallowing
    O- obvious changes in a wart or mole (skin cancer)
    N- nagging cough or hoarseness (lung or throat cancer)
    Lifestyle habits to reduce risks
    Avoid or reduce exposure to known or suspected carcinogens
    Cigarette smoke, excessive sun exposure
    Eat a balanced diet
    Exercise regularly
    Obtain adequate rest
    Regular health examination
    Change perceptions of stressors
    Learn to cope with stress
    Enjoy consistent periods of relaxation and leisure
  • Surgery
    Chemotherapy
    Radiation
    Biologic & Targeted Therapy
    Medical Interventions
  • Goals
    Cure
    Control
    Palliation
    Collaborative Care of Cancer
  • Surgical therapy is used
    Prophylaxis – removal of at risk tissue
    Dx – Biopsy
    Cure – attempts to remover all CA tissue
    Control – debulks the tumor, does not cure
    Determine efficacy of Tx – “second look”
    Palliation – does not extend life, ↑ quality of life
    Reconstruction - ↑ function/appearance
    Surgery
  • Purpose: To destroy CA cells with minimal exposure of the normal cells to the damaging actions of radiation
    Radiation
  • Mechanism of Action
    Delivery methods
    Teletherapy (Externally)
    Brachytherapy (Internally)
    Brachytherapy safety principles: ALARA, time, distance, and shielding
    Radiation Tx for CA - cont
  • Vary acc. to the side
    Local skin ∆
    ∆ taste sensations
    Fatigue r/t ↑ energy demands
    Inflammatory response r/t radiation
    S/E of Radiation Therapy
  • Teach accurate objective facts to help the clt to cope
    Do not remove markings
    Administer skin care
    Do not use lotions or ointments
    Avoid direct sun exposure
    Care for xerostomia
    R/O bone fracture
    Nsg Care/Mgmt: Radiation Tx
  • Chemotherapy
    Used to cure and/or add survival time
    Some selectivity for killing cancer cells over normal cells
  • S/E of Chemo
    Skin Δ
    Hair
    Intestinal tissues
    Spermatocytes
    Hematopoietic Sx Δ
    Anxiety & sleep disturbances
  • Chemotherapy Administration
    Given by Oncology nurse
    Checked by 2 nurses
    Cancer cycle: course of tx subj.to Nadir
    Nadir: the time when bone marrow activity + WBC are @ their lowest
  • Nsg Care/Mgmt: Chemotherapy
    Major role of the oncology - Chemo
    Drug therapy
    Protection from infection
    CAM
  • Tx issues with Chemo
    Drug dosage
    Drug schedule
    Drug administration:
    Oral
    IV: Central line
    Spine
    Interthecal
    Extravasation
    Vesicants
  • Biologic & Targeted Therapy
    Biological response modifier: modify the clt biologic responses to tumor cells – 3 ways
    Targeted therapy: targeting specific cellular pathways that are important in tumor growth
  • Stem Cell Transplantation
    Source Hematopoietic SCT: BMT, PSCT, umbilical cord blood
    Types of HSCT: allogeneic (HLA), syngeneic, autologous
    Allows very high dose of chemo & radiation
    Goal: eradicate tumor cell and/or clear the marrow for engraftment of SCT
    BMT VS PSCT
  • Main Oncology Nursing Outcome
    Management of fatigue, nausea and vomiting, prevention of infection, and return to usual function
  • Oncology Nursing Approach/Intervention/Measure
    symptom experience (dyspnea, fatigue, mucositis, nausea and vomiting, pain, peripheral neuropathy, and sleep-wake disturbances),
    functional status (nutritional status and return to usual functioning),
    safety prevention of adverse events (prevention of infection), and
    psychological distress (depression)
  • Oncology Emergencies
    IV access issues
    Adverse response to chemo drugs
    Sepsis
    DIC
  • Collaborative Tx in Oncology Emergencies
    Prevention
    Intravenous IV abx tx
    Anticoagulants
    Cyroprecipitated clotting factors
  • Questions & Answers
  • Resources
    Article: Put Evidence in Practice
    Nursing-Sensitive Patient Outcomes: The Development of the Putting Evidence Into Practice Resources for Nursing Practice
    PodCast on Blackboard/Media Library
    Managing stress
    Advocating cancer clients and caregivers