Ch 21, cancer care.ppt

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Ch 21, cancer care.ppt

  1. 1. CHAPTER 21 CARING FOR CLIENTS WITH CANCER
  2. 2. PATHOPHYSIOLOGY  Cancer is characterized by abnormal, unrestricted cell growth.  NEOPLASMS/TUMORS-new growth of abnormal tissue  CLASSIFIED BY:  Origin  Manner of growth benign – not invasive or spreading malignant – invasive & capable of spreading – box 21-1
  3. 3. Classification of Tumor Cells – table 21-1  CARCINOMAS – originate from epithelial cells  LYMPHOMAS – originate from organs that fight infection  LEUKEMIAS – originate from organs that form blood  SARCOMAS – originate from connective tissue, like bone or muscle
  4. 4.  METASTASIS or spreading  Primary site – areas where the tumor first forms  Secondary site – areas where the cancerous cells move or metastasis  BENIGN TUMORS – do not move, may just slowly grow larger
  5. 5. ETIOLOGY  Cancer is the 2nd leading cause of death in the US  Lung cancer is #1 cause of cancer deaths  Most common cancers in men: prostate, lung & colon  Most common cancers in women:breast, lung & colon  chemical agents such as tobacco smoke, asbestos, & coal dust account for about 75% of cancers  environmental factors such as prolonged exposure to sunlight, radiation, & pollutants  diet – box 21-2  viruses & bacteria  defective genes  medically prescribed interventions such as immunosuppressive drugs, hormone replacements & anticancer drugs
  6. 6. SIGNS & SYMPTOMS OF CANCER  Change in bowel/bladder function  Sores that do not heal  Unusual bleeding or discharge  Thickening or lump in breast or other body parts  Indigestion or difficulty in swallowing  Recent change in a wart or mole  Nagging cough or hoarseness
  7. 7. DIAGNOSTIC TESTS  Labs  tumor markers – table 21-3  Radiological & Imaging Tests  Xrays  CT  Nuclear medicine scans using radioisotopes  MRI  PET scans  Radioimmunoconjugates  Ultrasound  Fluoroscopy
  8. 8. OTHER STUDIES  BIOPSY – tissue examined under microscope  FROZEN SECTION – sample frozen and then thinly sliced to see under microscope – quicker decision maker  ENDOSCOPY – done with scope to upper or lower GI system  CYTOLOGY – cells examined under microscope
  9. 9. STAGING OF TUMORS  Table 21-4  Stage I – Malignant cells are confined to the tissue of origin, no signs of metastasis  Stage II – Spread of cancer is limited to the local area, usually to area lymph nodes  Stage III – Tumor is larger, probably has invaded surrounding tissue or both  Stage IV – Cancer has invaded or metastasized to other parts of the body
  10. 10. SURGERY  RANGE OF SURGICAL INTERVENTION  Extent of the disease  actual pathology  age and physical condition of pt  anticipated results
  11. 11. SURGERY  Primary treatment used when tumors are confined & have not invaded vital organs; considered curative  Salvage surgery is when there has been a local recurrence of cancer  Prophalactic surgery is when the client is at considerable risk for cancer  Palliative surgery is used to relieve uncomfortable symptoms or prolong life  Reconstructive or plastic surgery done after extensive surgery or to correct defects caused by the original surgery
  12. 12. RADIATION THERAPY  Uses high-energy ionizing radiation to destroy cancer cells  External radiation therapy – aimed at specific body location; usually done daily for a specified number of times; outpt  Internal radiation therapy – sealed brachytherapy- done as inpt-radioactive source implanted directly into the tumor-box 21-5 safety measures  Possible side effects: alopecia, n/v/d, cystitis, pneumontitis, fatigue,stomatitis, leukopenia, thrombocytopenia, fibrosis  Nursing guidelines 21-1, client & family teaching 21-1
  13. 13. Nursing care of pt receiving radiation  Provide information on procedure and possible side effects  Protect skin  Maintain intact oral mucous membranes  Provide emotional support  Monitor for s/s of bone marrow suppression  Monitor for s/s of bleeding due to low platelet count
  14. 14. CHEMOTHERAPY  Drug Therapy Table 21-1  Antineoplastic drugs are used to destroy tumor cells by interfering with cellular function and reproduction  Cell Cycle-Specific Drugs – work when the cell is in a specific stage of reproduction – used for rapidly growing tumors  Cell Cycle-Nonspecific drugs – effective during any phase of the cell cycle or even when not reproducing
  15. 15. Routes & Devices  Oral & IV are the most common routes  IV – must monitor for s/s of extravasation at site or leakage of the drug into the surrounding tissue – Table 21-5  Common Vascular Devices: PICC lines, Hickman or Broviac Catheters, implanated ports –  Advantages • long term use • less venipunctures • less problems when a client has poor veins • drug can go directly into the heart & central circulation
  16. 16. ADVERSE EFFECTS AND NURSING CARE  Adverse effects  n/v most common within first 24 hrs  stomatitis  alopecia  bone marrow depression  fatigue  Nursing care-nursing guidelines 21-2  Safety measures for nurses when administering chemo – Box 21-6  monitor for s/s of anaphylactic reactions  increase fluid intake  administer antiemetic drugs  dietary modifications
  17. 17. Bone Marrow Transplantation  Nursing Guidelines 21-3  Autologous – client receives own bone marrow that was harvested  Allogeneic – receives bone marrow from a histocompatible, but unrelated donor  Syngeneic – client receives bone marrow from an identical twin  Stem cell – receive their own stem cells that have been grown due to infusion of hematopoietic growth factors
  18. 18. Other Cancer Treatments  Immunotherapy uses biologic response modifiers (BRM) to stimulate the body’s natural immune system to restrict & destroy the cancer cells  Hyperthermia uses temperatures > 106.4F to destroy tumor cells  Gene therapy replaces altered genes with correct genes  Clinical trials – testing new treatments for specific cancers
  19. 19. Complementary & Alternative Therapy – Table 21-7  Imagery  Medicinal therapy  Special diets  Mystical & spiritual approaches
  20. 20. Nursing Care-Nursing Care Plan 21-1  Pain management  Fatigue  Infection  Anxiety, fear & depression  Client & family teaching

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