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General Interventions for Clients with Cancer

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Author: Ignatavicius and Workman

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General Interventions for Clients with Cancer

  1. 1. Chapter 28 General Interventions for Clients with Cancer
  2. 2. General Disease-Related Consequences of Cancer <ul><li>Impaired immune and hematopoietic function </li></ul><ul><li>Altered gastrointestinal structure and function </li></ul><ul><li>Motor and sensory deficits </li></ul><ul><li>Decreased respiratory function </li></ul>
  3. 3. Surgery as Cancer Treatment <ul><li>Oldest form of cancer treatment used for: </li></ul><ul><ul><li>Prophylaxis </li></ul></ul><ul><ul><li>Diagnosis </li></ul></ul><ul><ul><li>Cure </li></ul></ul><ul><ul><li>Control </li></ul></ul><ul><ul><li>Palliation </li></ul></ul><ul><ul><li>Determining efficacy of therapy </li></ul></ul><ul><ul><li>Reconstruction </li></ul></ul>
  4. 4. Radiation Therapy for Cancer <ul><li>Purpose: to destroy cancer cells with minimal exposure of the normal cells to the damaging actions of radiation </li></ul><ul><li>Mechanism of action </li></ul><ul><li>Killing effects of radiation </li></ul><ul><li>Teletherapy </li></ul><ul><li>Brachytherapy </li></ul>
  5. 5. Side Effects of Radiation Therapy <ul><li>Vary according to the site </li></ul><ul><li>Local skin changes and hair loss that will likely be permanent depending on the total absorbed dose </li></ul><ul><li>Altered taste sensations </li></ul><ul><li>Fatigue related to increased energy demands </li></ul><ul><li>Inflammatory responses that cause tissue fibrosis and scarring </li></ul>
  6. 6. Nursing Care of Clients Undergoing Radiation Therapy <ul><li>Teach accurate objective facts to help client cope. </li></ul><ul><li>Do not remove markings. </li></ul><ul><li>Administer skin care. </li></ul><ul><li>Do not use lotions or ointments. </li></ul><ul><li>(Continued) </li></ul>
  7. 7. Nursing Care of Clients Undergoing Radiation Therapy (Continued) <ul><li>Avoid direct exposure of the skin to the sun. </li></ul><ul><li>Care for xerostomia (dry mouth). </li></ul><ul><li>Bone exposed to radiation is more vulnerable to fracture. </li></ul>
  8. 8. Chemotherapy <ul><li>Treating cancer with chemical agents </li></ul><ul><li>Major role in cancer therapy </li></ul><ul><li>Used to cure and increase survival time </li></ul><ul><li>Some selectivity for killing cancer cells over normal cells </li></ul><ul><li>Normal cells most affected: the skin, hair, intestinal tissues, spermatocytes, and blood-forming cells </li></ul>
  9. 9. Chemotherapy Drugs <ul><li>Antimetabolites </li></ul><ul><li>Antitumor antibodies </li></ul><ul><li>Alkylating agents </li></ul><ul><li>Antimitotic agents </li></ul><ul><li>Topoisomerase inhibitors </li></ul><ul><li>Miscellaneous chemotherapeutic agents </li></ul><ul><li>Combination chemotherapy </li></ul>
  10. 10. Treatment Issues <ul><li>Drug dosage </li></ul><ul><li>Drug schedule </li></ul><ul><li>Drug administration: </li></ul><ul><ul><li>Extravasation </li></ul></ul><ul><ul><li>Vesicants </li></ul></ul>
  11. 11. Side Effects of Chemotherapy <ul><li>Alopecia or hair loss </li></ul><ul><li>Nausea and vomiting </li></ul><ul><li>Mucositis in the entire gastrointestinal tract </li></ul><ul><li>Skin changes </li></ul><ul><li>Anxiety, sleep disturbance </li></ul><ul><li>(Continued) </li></ul>
  12. 12. Side Effects of Chemotherapy (Continued) <ul><li>Altered bowel elimination </li></ul><ul><li>Decreased mobility </li></ul><ul><li>Hematopoietic system changes </li></ul><ul><li>Bone marrow suppression </li></ul>
  13. 13. Nursing Care of Clients Undergoing Chemotherapy <ul><li>Drug therapy </li></ul><ul><li>Protection from infection </li></ul><ul><li>Complementary and alternative therapies </li></ul>
  14. 14. Hormonal Manipulation <ul><li>Some hormones make hormone-sensitive tumors grow more rapidly. </li></ul><ul><li>Some tumors actually require specific hormones to divide, therefore decreasing the amount of these hormones to hormone-sensitive tumors can slow the cancer growth rate and increase survival time. </li></ul>
  15. 15. Side Effects of Hormone Therapy <ul><li>Androgens and antiestrogen receptor drugs cause masculinizing effects in women. </li></ul><ul><li>For men and women receiving androgens, acne may develop, hypercalcemia is common, and liver dysfunction may occur with prolonged therapy. </li></ul><ul><li>( Continued) </li></ul>
  16. 16. Side Effects of Hormone Therapy (Continued) <ul><li>Feminine manifestations often appear in men who take estrogens, and gynecomastia can occur. </li></ul>
  17. 17. Immunotherapy: Biological Response Modifiers <ul><li>Drugs that modify the client’s biologic responses to tumor cells </li></ul><ul><li>Cytokines: enhance the immune system </li></ul><ul><li>Interleukins, interferons </li></ul><ul><li>Side effects: generalized and sometimes severe inflammatory reactions, peripheral neuropathy, skin rashes, increased depression </li></ul>
  18. 18. Gene Therapy <ul><li>Experimental as a cancer treatment </li></ul><ul><li>Renders tumor cells more susceptible to damage or death by other treatments </li></ul><ul><li>Injection into tumor cells, enabling the immune system to better recognize cancer cells as foreign and kill them </li></ul><ul><li>Monoclonal antibodies </li></ul><ul><li>Antisense drugs </li></ul>
  19. 19. Oncologic Emergencies <ul><li>Sepsis and disseminated intravascular coagulation </li></ul><ul><li>Collaborative management includes: </li></ul><ul><ul><li>Prevention (the best measure) </li></ul></ul><ul><ul><li>Intravenous antibiotic therapy </li></ul></ul><ul><ul><li>Anticoagulants, cryoprecipitated clotting factors </li></ul></ul>
  20. 20. Syndrome of Inappropriate Antidiuretic Hormone (SIADH) <ul><li>Water is reabsorbed to excess by the kidney and put into system circulation. </li></ul><ul><li>SIADH is most commonly found in carcinoma of the lung </li></ul><ul><li>Collaborative management includes: </li></ul><ul><ul><li>Fluid restriction </li></ul></ul><ul><ul><li>Increased sodium intake </li></ul></ul><ul><ul><li>Drug therapy with demeclocycline that works in opposition to antidiuretic hormone </li></ul></ul>
  21. 21. Spinal Cord Compression <ul><li>Tumor directly enters the spinal cord or the vertebrae collapse from tumor degradation of the bone. </li></ul><ul><ul><li>(Continued) </li></ul></ul>
  22. 22. Spinal Cord Compression (Continued) <ul><li>Collaborative management includes: </li></ul><ul><ul><li>Early recognition and treatment </li></ul></ul><ul><ul><li>Palliative </li></ul></ul><ul><ul><li>High-dose corticosteroids </li></ul></ul><ul><ul><li>High-dose radiation </li></ul></ul><ul><ul><li>Surgery </li></ul></ul><ul><ul><li>External back or neck braces to reduce pressure in the spinal cord </li></ul></ul>
  23. 23. Hypercalcemia <ul><li>Occurs most often in clients with bone metastasis </li></ul><ul><li>Fatigue, loss of appetite, nausea and vomiting, constipation, polyuria, severe muscle weakness, loss of deep tendon reflexes, paralytic ileus, dehydration, electrocardiographic changes </li></ul><ul><li>(Continued) </li></ul>
  24. 24. Hypercalcemia (Continued) <ul><li>Collaborative management includes: </li></ul><ul><ul><li>Oral hydration </li></ul></ul><ul><ul><li>Drug therapy </li></ul></ul><ul><ul><li>Dialysis </li></ul></ul>
  25. 25. Superior Vena Cava Syndrome <ul><li>Superior vena cava is compressed or obstructed by tumor growth. </li></ul><ul><li>Condition can lead to a painful, life-threatening emergency. </li></ul><ul><li>Signs include edema of face, Stokes’ sign, edema of arms and hands, dyspnea, erythema, and epistaxis. </li></ul><ul><li>(Continued) </li></ul>
  26. 26. Superior Vena Cava Syndrome (Continued) <ul><li>Late-stage signs include hemorrhage, cyanosis, change in mental status, decreased cardiac output, and hypotension. </li></ul><ul><li>Collaborative management includes high-dose radiation therapy, but surgery only rarely. </li></ul>
  27. 27. Tumor Lysis Syndrome <ul><li>Large numbers of tumor cells are destroyed rapidly, resulting in intracellular contents being released into the bloodstream faster than the body can eliminate them. </li></ul><ul><li>Collaborative management includes: </li></ul><ul><ul><li>Prevention </li></ul></ul><ul><ul><li>Hydration </li></ul></ul><ul><ul><li>Drug therapy </li></ul></ul>

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