This document discusses various general interventions for clients with cancer including surgery, radiation therapy, chemotherapy, hormone therapy, immunotherapy, and management of oncologic emergencies. It describes the purpose and side effects of different cancer treatments and collaborative nursing care for clients undergoing these therapies. Key interventions discussed include skin care during radiation, managing side effects of chemotherapy like nausea and hair loss, and treating emergencies like sepsis, spinal cord compression, and hypercalcemia.

1. Chapter 28 General Interventions for Clients with Cancer

2. General Disease-Related Consequences of Cancer Impaired immune and hematopoietic function Altered gastrointestinal structure and function Motor and sensory deficits Decreased respiratory function

3. Surgery as Cancer Treatment Oldest form of cancer treatment used for: Prophylaxis Diagnosis Cure Control Palliation Determining efficacy of therapy Reconstruction

4. Radiation Therapy for Cancer Purpose: to destroy cancer cells with minimal exposure of the normal cells to the damaging actions of radiation Mechanism of action Killing effects of radiation Teletherapy Brachytherapy

5. Side Effects of Radiation Therapy Vary according to the site Local skin changes and hair loss that will likely be permanent depending on the total absorbed dose Altered taste sensations Fatigue related to increased energy demands Inflammatory responses that cause tissue fibrosis and scarring

6. Nursing Care of Clients Undergoing Radiation Therapy Teach accurate objective facts to help client cope. Do not remove markings. Administer skin care. Do not use lotions or ointments. (Continued)

7. Nursing Care of Clients Undergoing Radiation Therapy (Continued) Avoid direct exposure of the skin to the sun. Care for xerostomia (dry mouth). Bone exposed to radiation is more vulnerable to fracture.

8. Chemotherapy Treating cancer with chemical agents Major role in cancer therapy Used to cure and increase survival time Some selectivity for killing cancer cells over normal cells Normal cells most affected: the skin, hair, intestinal tissues, spermatocytes, and blood-forming cells

9. Chemotherapy Drugs Antimetabolites Antitumor antibodies Alkylating agents Antimitotic agents Topoisomerase inhibitors Miscellaneous chemotherapeutic agents Combination chemotherapy

10. Treatment Issues Drug dosage Drug schedule Drug administration: Extravasation Vesicants

11. Side Effects of Chemotherapy Alopecia or hair loss Nausea and vomiting Mucositis in the entire gastrointestinal tract Skin changes Anxiety, sleep disturbance (Continued)

12. Side Effects of Chemotherapy (Continued) Altered bowel elimination Decreased mobility Hematopoietic system changes Bone marrow suppression

13. Nursing Care of Clients Undergoing Chemotherapy Drug therapy Protection from infection Complementary and alternative therapies

14. Hormonal Manipulation Some hormones make hormone-sensitive tumors grow more rapidly. 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.

15. Side Effects of Hormone Therapy Androgens and antiestrogen receptor drugs cause masculinizing effects in women. For men and women receiving androgens, acne may develop, hypercalcemia is common, and liver dysfunction may occur with prolonged therapy. ( Continued)

16. Side Effects of Hormone Therapy (Continued) Feminine manifestations often appear in men who take estrogens, and gynecomastia can occur.

17. Immunotherapy: Biological Response Modifiers Drugs that modify the client’s biologic responses to tumor cells Cytokines: enhance the immune system Interleukins, interferons Side effects: generalized and sometimes severe inflammatory reactions, peripheral neuropathy, skin rashes, increased depression

18. Gene Therapy Experimental as a cancer treatment Renders tumor cells more susceptible to damage or death by other treatments Injection into tumor cells, enabling the immune system to better recognize cancer cells as foreign and kill them Monoclonal antibodies Antisense drugs

19. Oncologic Emergencies Sepsis and disseminated intravascular coagulation Collaborative management includes: Prevention (the best measure) Intravenous antibiotic therapy Anticoagulants, cryoprecipitated clotting factors

20. Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Water is reabsorbed to excess by the kidney and put into system circulation. SIADH is most commonly found in carcinoma of the lung Collaborative management includes: Fluid restriction Increased sodium intake Drug therapy with demeclocycline that works in opposition to antidiuretic hormone

21. Spinal Cord Compression Tumor directly enters the spinal cord or the vertebrae collapse from tumor degradation of the bone. (Continued)

22. Spinal Cord Compression (Continued) Collaborative management includes: Early recognition and treatment Palliative High-dose corticosteroids High-dose radiation Surgery External back or neck braces to reduce pressure in the spinal cord

23. Hypercalcemia Occurs most often in clients with bone metastasis Fatigue, loss of appetite, nausea and vomiting, constipation, polyuria, severe muscle weakness, loss of deep tendon reflexes, paralytic ileus, dehydration, electrocardiographic changes (Continued)

24. Hypercalcemia (Continued) Collaborative management includes: Oral hydration Drug therapy Dialysis

25. Superior Vena Cava Syndrome Superior vena cava is compressed or obstructed by tumor growth. Condition can lead to a painful, life-threatening emergency. Signs include edema of face, Stokes’ sign, edema of arms and hands, dyspnea, erythema, and epistaxis. (Continued)

26. Superior Vena Cava Syndrome (Continued) Late-stage signs include hemorrhage, cyanosis, change in mental status, decreased cardiac output, and hypotension. Collaborative management includes high-dose radiation therapy, but surgery only rarely.

27. Tumor Lysis Syndrome Large numbers of tumor cells are destroyed rapidly, resulting in intracellular contents being released into the bloodstream faster than the body can eliminate them. Collaborative management includes: Prevention Hydration Drug therapy