Ch16 Cancer Part One

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

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Ch16 Cancer Part One

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

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