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Oncology

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Oncology Oncology Presentation Transcript

  • Oncology: Nursing the Patient with Cancer Presented By Christine Hicks
  • 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
  • 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
  • Increase in Survival Rates
    • Due to:
      • Earlier Diagnosis
      • Earlier Treatment
      • Improved Practices
      • Heightened Awareness of Prevention & Detection
  • Normal Cell Growth
    • G 0 Phase –
    • G 1 Phase –
    • S Phase –
    • G 2 Phase –
    • M Phase –
  • Characteristics of Malignant Cells
    • Larger Cells with a Large Nuclei & Usually Irregular
    • Undifferentiated/Poorly Differentiated
    • Increased Mitosis
    • Disruption of Physiological Functioning
  • Patterns of Cell Growth
    • Hyperplasia
    • Metaplasia
    • Dysplasia
    • Anaplasia
    • Neoplasia
    • Metastasis
  • Carcinogenesis
    • Initiation
    • Promotion
    • Progression
  • Etiology
    • Viruses
    • Role of Oncogenes
    • Immune Response Failure
  • 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
    • Carcinogens
      • Genotoxic
      • Promotor Substances
    • Chemical Agents
    • Physical Agents
    • Drugs & Hormones
  • Risk Factors
    • Genetic & Familial Factors
    • Dietary Factors
    • Hormonal Agents
    • Age
    • Occupation
    • Gender
    • Geographic Location
    • Stress
    • Precancerous Lesions
  • Prognosis
    • Depends On:
      • Time of Detection
      • Rate of Tumor Growth & Spread
      • Hosts Physiological Reaction
      • Type of Treatment Received
  • GOALS
    • Promotion of Healthy Lifestyles
    • Preventative Screening
    • Early Detection
    • Early Intervention
    • Management of Treatment Plan
    • Supportive Care
  • 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
    • Stop Smoking
    • Reduce alcohol intake
    • Avoid overexposure to sun
  • Preventative Screening
    • American Cancer Society Recommendations
    • Health Fair
    • Discounts/Insurance Coverage
  • Early Detection
    • Cancer’s Seven Warning Signals
      • CAUTION
    • Cancer-specific Diagnostic Exams
    • Blood Studies
    • Cytologic Exams
    • Tumor Markers
    • Oncologic Imaging
    • Biopsy
      • Direct/Indirect
      • Total/Subtotal
      • Frozen/Paraffin
    • Ultrasound
    • Direct Visualization
    • Magnetic Resonance Imaging (MRI)
  • Staging
    • Staging I – III
      • Invasion
      • Expansion
      • Establishment
    • TNM Staging System
      • T (tumor)
      • N (node)
      • M (metastasis)
  • 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
  • Impact of Cancer
    • Community
    • Client
    • Family
  • Early Intervention
    • Management Aims
      • Cure
      • Control
      • Palliation
    • Methods
      • Surgery
      • Radiation
      • Chemotherapy
      • Immunotherapy
  • Surgery
    • Diagnostic--Biopsy
    • Prophylactic
    • Palliative
    • Reconstructive
    • Radical
  • Radiation
    • Purpose is to interrupt cellular growth
    • Types
      • External
      • Internal
    • External
      • Nursing Management
        • Skin Care
        • Major Side Effect--Nausea
      • Patient Teaching
    • Internal
      • Nursing Management
        • Protection—Distance, Time & Shielding
        • Nursing Care
      • Patient Teaching
  • Chemotherapy
    • Purpose is to attempt to kill tumor cells by interfering with cell function & reproduction
    • Classification
      • Cell cycle-Specific
      • Cell cycle-Nonspecific
    • Categories
      • Alkylating Agents – Cytoxan, Mustargen
      • Antimetabolites – Methotrexate, 5 FU
      • Antitumor Antibiotics – Adriamycin, Bleomycin
    • Plant Alkaloids – Vincristine(Oncovin), Prednisone, DES, Nolvadex
    • Misc -- Platinol
  • Immunotherapy
    • Biologic Response Modifiers
      • Interleukins
      • Interferons
      • Monoclonal Antibiotics
      • Colony-stimulating Factors
      • Erythropoietin
  • Bone Marrow Transplantation
    • Types
      • Allogenic
      • Autologous
      • Syngenic
    • Nursing Care
      • Donor
      • Pre-transplant Conditioning Regimen
      • Side Effects of Regimen
    • Post-transplant Complications
      • Major Organ Failure
      • Graft-versus-Host Disease
      • Infections
  • Imagery Techniques
  • Unproven Unconventional Methods
  • 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
    • 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
    • Give hope – Make each day important
  • 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
      • Prevention (continued)
        • Nutritional & Fluid Status
        • Avoid Respiratory Problems
        • Avoid Invasive Procedures
      • Assessment
        • Temperature
        • Skin Integrity
        • Blood Counts
      • Treatment
        • Antibiotics
    • Potential for Disruption of Skin Integrity
      • Stomatitis
      • Alopecia
      • Skin Lesions
    • Alteration in Nutrition
      • Anorexia
      • Malabsorption
      • Cachexia
    • Pain & Discomfort
      • Source of Pain
      • World Health Organization 3-Step Ladder
        • Non-opiods
        • Weak-opiods
        • Strong-opiods
      • Adjuvant Medications
    • Fatigue
      • Sources of Fatigue
      • Conservation of Energy
      • Rest Periods/Light Exercise
      • Prioritizing Activities
      • Proposed Change in Work & Home Responsibilities
  • Other Nursing Diagnoses
    • Anxiety
    • Anticipatory Grieving
    • Risk for Injury
    • Caregiver Role Strain
    • Ineffective/Family Coping
    • Body Image Disturbance
      • Encourage independence & self-care
      • Positive Approach
      • Referral to Support Groups
  • 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
  • Supportive Care
    • Hospice
      • Relieve symptoms
      • Provide psychosocial & spiritual support for client & family
  • Oncologic Emergencies
    • Cardiac Tamponade
    • Superior Vena Cava Syndrome
    • Sepsis & Septic Shock