Oncology

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Oncology

  1. 1. Oncology: Nursing the Patient with Cancer Presented By Christine Hicks
  2. 2. Some Initial Terms • Cancer – a Disease that results when normal cells mutate into abnormal, deviant cells that then perpetuate within the body (L&B, p. 311) • Cancer – is the Latin word meaning “crab” • Neoplasia – New growth • Oncology
  3. 3. Introduction • Incidence – Increase in persons 65 years & older – Increase in Men – Increase in Industrialized Countries • Mortality Rates – Second leading cause of death in US • By Gender
  4. 4. Increase in Survival Rates • Due to: – Earlier Diagnosis – Earlier Treatment – Improved Practices – Heightened Awareness of Prevention & Detection
  5. 5. Normal Cell Growth • G 0 Phase – • G 1 Phase – • S Phase – • G 2 Phase – • M Phase –
  6. 6. Characteristics of Malignant Cells • Larger Cells with a Large Nuclei & Usually Irregular • Undifferentiated/Poorly Differentiated • Increased Mitosis • Disruption of Physiological Functioning
  7. 7. Patterns of Cell Growth • Hyperplasia • Metaplasia • Dysplasia • Anaplasia • Neoplasia • Metastasis
  8. 8. Carcinogenesis • Initiation • Promotion • Progression
  9. 9. Etiology • Viruses • Role of Oncogenes • Immune Response Failure
  10. 10. Immune System Failure (Theories) • Fails to recognize malignant cell from “self” • Tumor cells suppress Immune System • Suppressor T lymphocytes play a role in the development of malignancies
  11. 11. • Carcinogens – Genotoxic – Promotor Substances
  12. 12. • Chemical Agents • Physical Agents • Drugs & Hormones
  13. 13. Risk Factors • Genetic & Familial Factors • Dietary Factors • Hormonal Agents • Age • Occupation • Gender • Geographic Location • Stress • Precancerous Lesions
  14. 14. Prognosis • Depends On: – Time of Detection – Rate of Tumor Growth & Spread – Hosts Physiological Reaction – Type of Treatment Received
  15. 15. GOALS • Promotion of Healthy Lifestyles • Preventative Screening • Early Detection • Early Intervention
  16. 16. • Management of Treatment Plan • Supportive Care
  17. 17. Promotion of Healthy Lifestyle • Health Education • Dietary Suggestions – Increase Fresh vegetables, fiber intake, Vitamin A, Vitamin C – Reduce dietary fat, salt-cured & nitrate-cured foods – Weight Control
  18. 18. • Stop Smoking • Reduce alcohol intake • Avoid overexposure to sun
  19. 19. Preventative Screening • American Cancer Society Recommendations • Health Fair • Discounts/Insurance Coverage
  20. 20. Early Detection • Cancer’s Seven Warning Signals – CAUTION • Cancer-specific Diagnostic Exams • Blood Studies • Cytologic Exams • Tumor Markers • Oncologic Imaging
  21. 21. • Biopsy – Direct/Indirect – Total/Subtotal – Frozen/Paraffin • Ultrasound • Direct Visualization • Magnetic Resonance Imaging (MRI)
  22. 22. Staging • Staging I – III – Invasion – Expansion – Establishment • TNM Staging System – T (tumor) – N (node) – M (metastasis)
  23. 23. Grading • Type of tissue from which the tumor originated • Degree to which tumor retains function • Grade I – IV – Grade I—well-differentiated – Grade IV--undifferentiated
  24. 24. Impact of Cancer • Community • Client • Family
  25. 25. Early Intervention • Management Aims – Cure – Control – Palliation • Methods – Surgery – Radiation – Chemotherapy – Immunotherapy
  26. 26. Surgery • Diagnostic--Biopsy • Prophylactic • Palliative • Reconstructive • Radical
  27. 27. Radiation • Purpose is to interrupt cellular growth • Types – External – Internal • External – Nursing Management • Skin Care • Major Side Effect--Nausea – Patient Teaching
  28. 28. • Internal – Nursing Management • Protection—Distance, Time & Shielding • Nursing Care – Patient Teaching
  29. 29. Chemotherapy • Purpose is to attempt to kill tumor cells by interfering with cell function & reproduction • Classification – Cell cycle-Specific – Cell cycle-Nonspecific
  30. 30. • Categories – Alkylating Agents – Cytoxan, Mustargen – Antimetabolites – Methotrexate, 5 FU – Antitumor Antibiotics – Adriamycin, Bleomycin
  31. 31. • Plant Alkaloids – Vincristine(Oncovin), Prednisone, DES, Nolvadex • Misc -- Platinol
  32. 32. Immunotherapy • Biologic Response Modifiers – Interleukins – Interferons – Monoclonal Antibiotics – Colony-stimulating Factors – Erythropoietin
  33. 33. Bone Marrow Transplantation • Types – Allogenic – Autologous – Syngenic • Nursing Care – Donor – Pre-transplant Conditioning Regimen – Side Effects of Regimen
  34. 34. • Post-transplant Complications – Major Organ Failure – Graft-versus-Host Disease – Infections
  35. 35. Imagery Techniques
  36. 36. Unproven Unconventional Methods
  37. 37. General Nursing Considerations • Does the client know the diagnosis? • Assess the client’s coping skills • Who/what is client’s support system • Answer questions honestly • Know your resources & direct client to them
  38. 38. • Include family & friends in your plan of care & in the implementation of the plan as appropriate • Include the client • Allow the client to make decisions & support the decision
  39. 39. • Give hope – Make each day important
  40. 40. Management of Treatment Plan • Potential for Infection – Leading cause of death of Cancer patients – Factors predisposing Cancer patients to Infection – Prevention • Handwashing • Visitor Restrictions • Protective Environment
  41. 41. – Prevention (continued) • Nutritional & Fluid Status • Avoid Respiratory Problems • Avoid Invasive Procedures – Assessment • Temperature • Skin Integrity • Blood Counts
  42. 42. – Treatment • Antibiotics
  43. 43. • Potential for Disruption of Skin Integrity – Stomatitis – Alopecia – Skin Lesions
  44. 44. • Alteration in Nutrition – Anorexia – Malabsorption – Cachexia
  45. 45. • Pain & Discomfort – Source of Pain – World Health Organization 3-Step Ladder • Non-opiods • Weak-opiods • Strong-opiods – Adjuvant Medications
  46. 46. • Fatigue – Sources of Fatigue – Conservation of Energy – Rest Periods/Light Exercise – Prioritizing Activities – Proposed Change in Work & Home Responsibilities
  47. 47. Other Nursing Diagnoses • Anxiety • Anticipatory Grieving • Risk for Injury • Caregiver Role Strain • Ineffective/Family Coping
  48. 48. • Body Image Disturbance – Encourage independence & self-care – Positive Approach – Referral to Support Groups
  49. 49. Rehabilitation • Coping with changes in functional abilities • Attitudes of others • Needing to adjust work schedule • Coping with Transient problems of Treatment • On-going Assessment • 5 Year Survival
  50. 50. Supportive Care • Hospice – Relieve symptoms – Provide psychosocial & spiritual support for client & family
  51. 51. Oncologic Emergencies • Cardiac Tamponade • Superior Vena Cava Syndrome • Sepsis & Septic Shock

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