ATI Cancer PDF Chapter 79 General Principles of Cancer

07/24/15 February 10, 2021 7:33 PM rm_pn_2020_ams_chp79 CHAPTER 79 UNIT 13 IMMUNE SYSTEM AND CONNECTIVE A tumor is an abnormal collection of cells, but TISSUE DISORDERS SECTION: CANCER‑RELATED DISOR...

07/24/15 February 10, 2021 7:33 PM rm_pn_2020_ams_chp79 CHAPTER 79 UNIT 13 IMMUNE SYSTEM AND CONNECTIVE A tumor is an abnormal collection of cells, but TISSUE DISORDERS SECTION: CANCER‑RELATED DISORDERS not all tumors are cancers. Noncancerous General Principles tumors are benign. They do have the potential CHAPTER 79 of pressing on healthy organs and tissues as of Cancer they grow, but they do not invade other tissues and they do not metastasize. Cancer is a neoplastic disease process that involves abnormal cell growth and differentiation. BODY TISSUES Cancers can arise from almost any tissue in the body. Normal body cells grow, divide, and die in an Cancerous cells decrease the functional ability of the orderly fashion. In cancer, dying cells grow and tissue in which they are located. Epithelial tissue: carcinomas form new abnormal cells and can form new blood Glandular organs: adenocarcinomas vessels to provide nourishment for continued Mesenchymal tissue: sarcomas Blood‑forming cells: leukemias growth. Genetic mutations are responsible for Lymph tissue: lymphomas abnormal cancerous growth. These mutations are Plasma cells: myelomas either inherited, or caused by something external. Viruses, physical and chemical agents, hormones, HEALTH PROMOTION AND familial history, and lifestyle are thought to be DISEASE PREVENTION Consume a healthy diet (low‑fat with increased factors that trigger abnormal cell growth. consumption of fruits, vegetables, and lean protein). Limit intake of sugar, salt, nitrates, nitrites, and Cancer cells can invade surrounding tissues and processed and red meats. spread to other areas of the body through lymph Maintain a healthy body weight/body mass index. Avoid use of tobacco products. and blood vessels (metastasis). No matter where Limit alcohol consumption to one drink per day for cancer spreads, it always is named based on the females and two drinks per day for males. Avoid risky lifestyle choices (recreational drug use, origin in which it started. For example, colon cancer needle sharing, unprotected sexual intercourse). that spreads to the liver is called metastatic colon Avoid exposure to environmental hazards (radiation, chemicals). Use personal protective equipment cancer. Metastasis is usually diagnosed when there when available. is onset of new findings (bone pain indicative of Engage in physical activity or exercise routinely. Protect skin and eyes from UVA and UVB rays. bone metastasis; change in bowel or bladder tone Remove at‑risk tissue such as moles to prevent indicative of nervous system involvement). conversion to skin cancer. Chemoprevention is the use of medications or other Screening and early diagnosis are the most substances to disrupt cancer development. ◯ Aspirin and celecoxib to reduce the risk of important aspects of health education and care. colon cancer The nurse should prevent, recognize, and treat ◯ Vitamin D and tamoxifen to reduce the risk of breast cancer complications associated with carcinoma. Immunization to prevent human papilloma virus (HPV), Clients of African, Hispanic, or Native American which is associated with cervical, vulvar, and vaginal cancers in females and anal cancer and genital warts descent have an increased risk of death from in females. cancer than white Americans, despite a lower Immunization for Hepatitis B to prevent liver disease, which can progress to liver cancer. risk for developing many cancer types. PN ADULT MEDICAL SURGICAL NURSING CHAPTER 79 General Principles of Cancer 527 07/24/15 February 10, 2021 7:33 PM rm_pn_2020_ams_chp79 07/24 Screening recommendations African American clients have increased risk of colorectal and pancreatic cancers. Instruct clients to discuss benefits and risks for each Hispanic American and African American clients have a screening exam with their provider to determine if and higher occurrence rate of liver cancer. when screening should take place. Clients at increased risk Native American and African American clients have a for specific cancer types might need to start screenings higher occurrence rate of renal pelvis cancer. earlier or have them more frequently. Genetic predisposition Mammogram: Annually for female clients 45 to 54 years. At 55 years, clients can transition to every two years. Exposure to chemicals, tobacco, and alcohol Clients in good health should continue screening as long Exposure to some viruses and bacteria as there is at least 10 years continued life expectancy. Liver cancer can develop after many years of infection Clinical breast exam: Every 3 years for clients 20 to with hepatitis B or hepatitis C. 39 years. Annually for clients older than 40 years. Infection with human T‑cell leukemia virus increases the risk of lymphoma and leukemia. Colonoscopy: At age 50 and then every 10 years Infection with Epstein‑Barr virus has been linked to an Fecal testing: Guaiac-based fecal occult blood test or fecal increased risk of lymphoma. immunochemical test annually; or stool DNA test every HPV infection is the main cause of cervical cancer. 3 years. HIV increases the risk of lymphoma and Kaposi’s sarcoma. Prostate screening: Male clients should be given the Helicobacter pylori can increase the risk of stomach opportunity to make an informed decision with their cancer and lymphoma of the stomach lining. provider after receiving information about the benefits, risks, and uncertainty related to prostate screening. The Diet: A diet high in fat, red meat, processed meat, discussion with their provider about screening should preservatives, and additives, and low in fiber occur at 50 years of age for males who have average risks, Sun, ultraviolet light, or radiation exposure: 45 years of age for males who have high risk, and 40 years Ionizing (radon, x‑ray) and UV (sun, tanning beds) of age for males who have higher risks. Sexual lifestyles: Multiple sexual partners or STIs Screening for gene mutations: For clients who have a strong family history of breast or colon cancer Poverty, obesity, and chronic GERD Pap test: Clients age 21 to 29, every 3 years. Clients age 30 Chronic disease to 65, every 5 years with an HPV DNA test, or every 3 years Air pollution with Pap test alone. Low-dose helical CT: For healthy adults who are current or former smokers aged 55 to 74 years with a 30-year pack EXPECTED FINDINGS history, either currently smoking or abstained within the Benign tumors are often slower growing, have cells that last 15 years. closely resemble the surrounding area, and primarily have localized effects unless they compress blood vessels or nerves. DATA COLLECTION Malignant tumors have cells that are different from the cells around them, and can grow very rapidly if they are more abnormal. These cells continually RISK FACTORS proliferate toward the outer edges of the tumor, so that Age: Highest incidence of cancer occurs in older adults. they can take over other tissue and access vasculature Female older adults most commonly develop colorectal, and lymphatics. breast, lung, pancreatic, and ovarian cancers. The findings associated with the presence of a tumor Male older adults most commonly develop lung, are dependent on the tissue in which they are located; colorectal, prostate, pancreatic, and gastric cancers. clients will report pain and possible physiological changes if organ or tissue function has been disrupted. Immune function: Cancer incidence increases among clients who are immunosuppressed. Laboratory tests Chronic irritation and tissue trauma: Incidence of skin Laboratory testing can help identify cancerous tumors. cancer is higher in people who have burn scars or other Tests include tumor markers and tests used for screening, types of severe skin injury. such as CA-125. Race Non-Hispanic white American females are more likely to develop breast cancer than any other group. Non-Hispanic white American males are at an increased risk for testicular cancer than any other group. African American males are at an increased risk for prostate cancer than any other group. 528 CHAPTER 79 General Principles of Cancer CONTENT MASTERY SERIES 07/24/15 February 10, 2021 7:33 PM rm_pn_2020_ams_chp79 Diagnostic procedures COMPLICATIONS Diagnostic procedures help determine the size and Malnutrition location of tumors, and can include imaging tests used for screening in addition to biopsy and other types of imaging Clients who have cancer are at increased risk for weight (MRI, CT scan, fluoroscopy, PET scan, nuclear imaging). loss and anorexia. The presence of carcinoma in the body increases the Staging of cancer amount of energy required for metabolic function. Cancer can impair the body’s ability to ingest, digest, The tumor‑node‑metastasis (TNM) system is used to and absorb nutrients. stage cancer. Adverse effects of cancer treatment can affect the desire TUMOR (T) for food or the ability to eat. Findings include nausea, TX: Unable to evaluate the primary tumor vomiting, changes in taste, anorexia, pain, diarrhea, TØ: No evidence of primary tumor early satiety, dry mouth, thickened saliva, and irritation Tis: Tumor in situ to the gastrointestinal tract. T1, T2, T3, and T4: Size and extent of tumor NURSING ACTIONS NODE (N) Administer antiemetics and antacids as prescribed. NX: Unable to evaluate regional lymph nodes Monitor relevant laboratory data (albumin, ferritin, NØ: No evidence of regional node involvement and transferrin). N1, N2, and N3: Number of nodes that are involved Encourage frequent oral hygiene. and/or extent of spread Incorporate client preferences into meal planning when possible. METASTASIS (M) Avoid early satiety by limiting liquids during meals. MX: Unable to evaluate distant metastasis Instruct the client to collaborate with dietary MØ: No evidence of distant metastasis services. M1: Presence of distant metastasis CLIENT EDUCATION Grading Understand how to manage the expected effects of treatment. Grading is needed because some cancer cells are more Consume adequate protein, carbohydrates, and calories. malignant than others. Well‑differentiated means the cells look much like normal cells and tend to grow slowly. Constipation/gastric stasis/intestinal obstruction Undifferentiated, or poorly differentiated, means the cells do not look like normal cells and tend to grow quickly and spread. NURSING ACTIONS GX: Grade cannot be determined. Can be related to cancer or cancer treatment. G1: Tumor cells are well differentiated. Opioids can cause delayed emptying, slowed G2: Tumor cells are moderately differentiated. bowel motility. G3: Tumor cells are poorly differentiated but the tissue Administer stool softener or laxative as needed. of origin can be established. Encourage fluids, fiber, and activity as tolerated. Tumor cells are poorly differentiated, and determination of the tissue of origin is difficult. ONCOLOGIC EMERGENCIES Prognosis Syndrome of inappropriate Early diagnosis of cancer usually results in a better antidiuretic hormone (SIADH) prognosis. Many cancers spread or metastasize before SIADH occurs when excessive levels of antidiuretic any manifestations are noted. hormones are produced. Because antidiuretic hormones Minority populations tend to have a worse prognosis help the kidneys and body to conserve the correct amount for cancer related to several factors (low socioeconomic of water, SIADH causes the body to retain water. This status, lack of access to health care, or reluctance to results in a dilution of electrolytes (such as sodium) in the seek treatment). blood. It is most commonly associated with lung and brain For the client who has successful cancer treatment, cancers. Key findings include decreased urine output, the nurse should help create a survivorship plan. The concentrated urine, weight gain, confusion, and seizures. client will need to continue prevention and screening for new cancer or recurrence of the original cancer, as NURSING ACTIONS well as watch for manifestations of metastasis. The Monitor for hyponatremia and low blood osmolality. client might require ongoing therapy for the effects of Administer furosemide, 0.9% sodium chloride IV, and cancer and cancer treatment, such as pain management hypertonic sodium chloride solution as prescribed for or fertility treatments. The nurse should assist with severe hyponatremia. management and help the client coordinate care among Monitor vital signs and blood sodium level because various providers. furosemide promotes sodium excretion and hypertonic sodium chloride can cause fluid overload. PN ADULT MEDICAL SURGICAL NURSING CHAPTER 79 General Principles of Cancer 529 07/24/15 February 10, 2021 7:33 PM rm_pn_2020_ams_chp79 07/24 Hypercalcemia Spinal cord compression A common complication of breast, lung, head, and neck Occurs when vertebrae degrade secondary to cancer, or cancers; leukemias and lymphomas; multiple myelomas; tumors invade the spinal column. Without immediate and bony metastases of any cancer intervention, permanent neurologic damage can occur. MANIFESTATIONS: Anorexia, nausea, vomiting, shortened MANIFESTATIONS: Changes in sensation, muscle strength, QT interval, kidney stones, bone pain, and changes in reduced deep tendon reflexes, worsening back pain, and mental status bowel or bladder retention NURSING ACTIONS: Administer 0.9% sodium chloride IV, NURSING ACTIONS furosemide, pamidronate, and phosphates as prescribed. Plan to administer high-dose IV corticosteroids to reduce inflammation around the spinal cord. Superior vena cava syndrome Prepare the client for possible radiation therapy or surgery to relieve cord compression. Results from obstruction (metastases from breast or lung cancers) of venous return and engorgement of the vessels CLIENT EDUCATION: An MRI usually confirms diagnosis. from the head and upper body Tumor lysis syndrome (TLS) MANIFESTATIONS: Periorbital and facial edema, erythema of the upper body, dyspnea, and epistaxis TLS occurs when tumors are rapidly destroyed, releasing intracellular content into the bloodstream faster than NURSING ACTIONS the body can process them. This rapid release causes Position the client in a high‑Fowler’s position initially hyperkalemia, hyperphosphatemia, and hyperuricemia. to facilitate lung expansion. Without correction, TLS leads to kidney injury and Use high‑dose radiation therapy for emergency changes in cardiac function that can lead to death. Older temporary relief. age increases risk, as well as certain chemotherapy agents and types of cancer. Hematologic disorders MANIFESTATIONS: Gastrointestinal distress, flank pain Hematologic problems can be caused by the cancer itself muscle cramps and weakness, seizures, and mental or chemotherapy. status changes Anemia: When cancer invades the bone marrow, it NURSING ACTIONS decreases the number of red blood cells, platelets Administer IV fluids and encourage fluid intake of 3 L (thrombocytopenia) and white blood cells (neutropenia). daily, including consumption of alkaline fluids to lower Disseminated intravascular coagulation: Secondary to uric acid levels. leukemia or adenocarcinomas Administer medications (diuretics, allopurinol, sodium polystyrene) to reduce potassium, uric acid, and NURSING ACTIONS phosphorus levels. Observe for bleeding, and apply pressure as needed. Be prepared to administer blood clotting factors that CLIENT EDUCATION: Hemodialysis and intensive care have been lost through bleeding and need to be replaced might be required. with plasma transfusions. Heparin also can be used to slow the cascade of events that makes the body overuse its blood clotting factors. Sepsis Pathogens in the body can lead to septicemia and septic shock, which are life-threatening. Clients who are neutropenic are at an increased risk. NURSING ACTIONS: Institute resuscitation measures, including obtaining blood cultures, measuring blood lactate, and administering antibiotics and crystalloid fluids. Vasopressors can be required if fluid administration is insufficient. 530 CHAPTER 79 General Principles of Cancer CONTENT MASTERY SERIES 07/24/15 February 10, 2021 7:33 PM rm_pn_2020_ams_chp79 Application Exercises Active Learning Scenario 1. A nurse is caring for a client who has lung cancer A nurse is assisting with preparing an in‑service about and is exhibiting manifestations of syndrome identifying risk factors for cancer to a group of adults at a of inappropriate antidiuretic hormone (SIADH). community health fair. What information should the nurse Which of the following findings should the nurse include in the in‑service? Use the ATI Active Learning report to the provider? (Select all that apply.) Template: System Disorder to complete this item. A. Behavioral changes RISK FACTORS B. Client report of headache Identify two types of cancer with increased C. Urine output 40 mL/hr incidence in female older adults. D. Client report of weight gain Identify two types of cancer with increased E. Increased urine specific gravity incidence in male older adults. Identify one type of cancer with a risk factor related to racial background. 2. A nurse is reinforcing teaching with a middle adult Describe three diet-related risk factors. client about screening prevention for cancer. Which of the following statements by the client indicates Describe at least three lifestyle-related risk factors. an understanding of the information reviewed? PATHOPHYSIOLOGY RELATED TO CLIENT A. “I will need to have a mammogram PROBLEM: Describe at least three viruses/bacteria every 2 years beginning at age 45.” and the type of cancer they can cause. B. ”I should have a colonoscopy every 15 years beginning at age 60.” C. “I will need to have a Pap test every 5 years beginning at age 30.” D. ”I should have a fecal occult test done every 3 years.” 3. A nurse is contributing to the plan of care for a client who has malnutrition due to cancer. Which of the following interventions should the nurse include in the plan? (Select all that apply.) A. Advise the client to keep a food diary. B. Encourage the client to use a anesthetic mouthwash before meals. C. Check the laboratory report of ferritin. D. Eat nutrient-dense foods last at meal time. E. Encourage the client to limit drinking fluids during meals. 4. A nurse is reviewing the medical record of a client who had surgery to stage ovarian cancer. The nurse reviews the following diagnostic notation on the pathology report: T2‑N3‑MX. Which of the following findings should the nurse identify as a supporting diagnosis? A. The tumor is moderate in size. B. No lymph nodes contain cancer cells. C. The tumor is receptive to current medication therapy. D. The cancer has metastasized to other areas in the body. PN ADULT MEDICAL SURGICAL NURSING CHAPTER 79 General Principles of Cancer 531 07/24/15 February 10, 2021 7:33 PM rm_pn_2020_ams_chp79 Application Exercises Key Active Learning Scenario Key 1. A. CORRECT: Behavioral changes indicate cerebral Using the ATI Active Learning Template: System Disorder edema due to SIADH. This finding should RISK FACTORS be reported to the provider. Older adult females: Colorectal, breast, lung, B. CORRECT: A client report of headache indicates pancreatic, and ovarian cancers cerebral edema due to SIADH. This finding should be reported to the provider. Older adult males: Lung, colorectal, prostate, C. Urine output of 40 mL/hr is a finding consistent pancreatic and gastric cancers with suspected SIADH and does not need Risk related to racial background: Testicular, breast, to be reported to the provider. colorectal, pancreatic, liver, and renal pelvis cancers D. CORRECT: A client report of weight gain can Diet‑related: Diet high in fat and red meat, low in fiber indicate cerebral edema due to SIADH and Lifestyle‑related should be reported to the provider. Multiple sexual partners or STIs ◯ E. An increased urine specific gravity is a finding consistent with Sun, ultraviolet light, and radiation exposure ◯ SIADH and does not need to be reported to the provider. Use of tobacco and alcohol ◯ NCLEX® Connection: Physiological Adaptation, Alterations in PATHOPHYSIOLOGY RELATED TO CLIENT PROBLEM Body Systems Hepatitis B or C: Liver cancer Human T‑cell leukemia virus: Lymphoma and leukemia 2. A. The client should begin annual mammograms Epstein‑Barr virus: Lymphoma beginning at age 40. Human papilloma virus: Cervical cancer B. The client should begin to have a colonoscopy at HIV: Lymphoma and Kaposi’s sarcoma age 50 and then every 10 years thereafter. Helicobacter pylori: Stomach cancer and C. CORRECT: Current recommendations for clients 30 to 65 lymphoma of the stomach lining years old include having a Pap test every 5 years. Clients 21 to 29 years old should have a Pap test every 3 years. NCLEX® Connection: Health Promotion and Maintenance, Health D. The client should have a fecal occult test done every Promotion/Disease Prevention year. The client can have the stool DNA test every 3 years in place of fecal occult blood testing. NCLEX® Connection: Health Promotion and Maintenance, Health Promotion/Disease Prevention 3. A. CORRECT: The use of a food diary assists in monitoring changes in eating habits that occur in malnutrition due to cancer. B. CORRECT: The use of a oral anesthetic mouthwash before eating can soothe the client’s mouth prior to eating. This can ease the process of chewing and swallowing for the client. C. CORRECT: Ferritin is an indicator of the protein intake of a client who has malnutrition due to cancer. D. Instruct the client to eat nutrient-dense foods first to increase adequate nutritional intake to treat malnutrition. E. CORRECT: Encourage the client to limit drinking fluids with meals because fluids can cause early satiety and decrease adequate intake of food, causing malnutrition, when the client has cancer. Some fluids are needed to treat dry mouth and thickened saliva. NCLEX® Connection: Basic Care and Comfort, Nutrition and Oral Hydration 4. A. CORRECT: A T2 designation describes the size and extent of the ovarian tumor using the tumor‑node‑metastasis (TNM) staging system. A T1 tumor is smallest in size, and a T4 tumor is largest. B. A N3 designation indicates that three adjacent lymph nodes show evidence of spread of cancer using the TNM staging system. C. The TNM diagnostic notation of the staging system is not used to indicate the response of a tumor to a medication therapy regimen used for treatment. D. The MX designation indicates there is no evidence of distant metastasis to other areas of the body using the TNM staging system. NCLEX® Connection: Physiological Adaptation, Basic Pathophysiology 532 CHAPTER 79 General Principles of Cancer CONTENT MASTERY SERIES 07/24/15 March 23, 2021 11:56 AM rm_pn_2020_ams_chp80 CHAPTER 80 UNIT 12 IMMUNE SYSTEM AND CONNECTIVE CLIENT EDUCATION TISSUE DISORDERS Perform self‑examination (breast and testicular) SECTION: CANCER‑RELATED DISORDERS practices at home. Cancer Screening Understand the general findings that could CHAPTER 80 indicate cancer. If found, notify the provider for and Diagnostic further screening. Change in bowel or bladder habits, change in shape or Procedures ◯ texture of a body or skin region ◯ Difficulty eating, chewing, swallowing, or decreased appetite ◯ Non-healing sores or wounds, or a cough or Screening and diagnostic procedures provide hoarseness that does not go away objective and subjective client data. Screening ◯ Unexplained pain, night sweats, fatigue, weight loss, and diagnosis for cancer can involve the use of or weight gain ◯ Unusual bleeding hands‑on data collection techniques, invasive procedures, radiography and imaging studies, BIOPSY and laboratory testing. The type and location of Provides definitive diagnosis indicating the site of origin the suspected cancer dictate which methods are (specific cell type) and cell characteristics (specific receptors on cell surface). used. Identification of tumor cells is required for Can be obtained during other procedures (endoscopy, definitive diagnosis and the development of a laparoscopy, thoracotomy). targeted treatment plan. Shave biopsy (basal or squamous cell skin cancer): Sampling of outer skin layers (raised lesions) using a scalpel or razor blade. INDICATIONS Needle biopsy (fine or core): Aspiration of tumor close to the skin surface for fluid and tissue sampling. Bone CLIENT PRESENTATION marrow aspiration is a form of needle biopsy used to Cancer diagnose leukemia and lymphoma. Altered body function (fatigue, weakness, anorexia) Incisional or excisional (open) biopsy: Cutting through Change in body structure (weight loss, masses) skin to remove part (incisional) or all (excisional) of a Change in body symmetry or onset of recent findings tumor. Punch biopsy is a form of excisional biopsy used (pain, nausea, vomiting) to diagnose skin cancer. A circular instrument punches a Metastasis 2 to 6 mm sample of subcutaneous fat. Secondary sites of discomfort Sentinel lymph node biopsy: Biopsy of lymph node closest Swelling and/or tenderness of lymph nodes or areas to the cancer. A dye or colloid is used to create a map of of the body affected nodes. Presence of masses If the lymph node is negative, the lymph nodes in the Altered function of another body system surrounding area are assumed to be cancer-free. Bone pain If the lymph node is positive, surgical excision of lymph nodes in the area is performed (lymph node dissection). CONSIDERATIONS NURSING ACTIONS Verify a signed informed consent form from the client. Assist with obtaining a health history and physical Assemble supplies and facilitate aseptic technique. assessment including client report of findings and Prevent bleeding. Withhold anticoagulants as prescribed. family history of cancer or genetic disorder. Monitor findings of coagulation studies. Inspect for changes in color, symmetry, movement, or Monitor for bleeding (visible staining of dressing, body function. hypotension, tachycardia). Auscultate for adventitious sounds that indicate altered Provide a safe environment until effects of sedation are body system function. minimal. (Maintain bed rest. Withhold oral intake.) Palpate to detect masses or tissue abnormalities. Ensure adequate oxygenation during the recovery period. Percuss for changes in expected sound over organs. Position the client in a recovery position appropriate to ◯ Dullness in the lungs or bowel can indicate areas of the procedure (lay on right side following liver biopsy). consolidation or tumor. ◯ Increased liver size (noted by measurement of borders [dullness]) can indicate inflammation or tumor. Report unexpected findings to the provider. Reinforce explanations when there is need for further testing or evaluation of unexpected findings. PN ADULT MEDICAL SURGICAL NURSING CHAPTER 80 Cancer Screening and Diagnostic Procedures 533 07/24/15 March 23, 2021 11:56 AM rm_pn_2020_ams_chp80 07/24 LABORATORY TESTS X‑rays: Provide visualization of body structures (chest x‑ray, mammogram) Performed to check for possible cancer or effects on the With angiography, the client is injected with dye and body (electrolyte imbalance, altered function) then x‑rays are taken to map vascular structures, Liver function tests: Elevation can indicate primary liver such as arterial, venous, or lymphatic mapping. cancer or metastasis of another cancer (colorectal cancer). NURSING ACTIONS: Monitor for allergic reaction to contrast dye (dyspnea, tachycardia, restlessness). Tumor marker assays: Detect the presence of normal body proteins at higher than expected levels (carcinoembryonic Computerized axial tomography (CT) scanning: Combines antigen, prostate‑specific antigen [PSA], alpha fetoprotein). x‑ray images taken from different angles and uses Samples of urine, stool, tissue, blood, or other body computer processing to create cross‑sectional images. Can fluids are tested for an excess of specific proteins or be performed with or without contrast. Contrast can be DNA patterns. administered orally or intravenously. Used to detect cancer, measure the severity of cancer, or MRI: Uses magnetic field and radio waves rather than monitor for a positive response to the cancer treatment radiation to generate pictures of tissue and organs. regimen (expected finding is a decrease in the tumor Contrast can be added to enhance the images. Clients who marker or return to expected reference range). have any type of metal inside the body (clips, pacemaker, Genetic tests: Identify the presence of certain genes in a metal implants) should not have a MRI. sample of blood or saliva. Ultrasound: High‑energy sound waves bounce off internal Genetic overexpression or the existence of extra genes can tissues and organs to produce an echo pattern that can be increase the risk of cancer or cause rapid tumor growth. seen as an ultrasound image. A biopsy can be performed Genetic mutations can be inherited. Positive results during the ultrasound. indicate the client is at high risk for development of certain types of cancer (presence of BRCA1 and BRCA2 Nuclear imaging: Evaluates the function of organs and genes associated with breast cancer). structures by detecting the presence of radiation in the Informed consent might be required prior to some types body after the client is given a radioactive tracer (IV or of testing. oral). Used for detection and staging of cancer. Cancerous The client might want to talk with a genetic counselor tissues can absorb more or less tracer than expected. to clarify misconceptions regarding positive results and These tissues are distinguishable by nuclear imaging. cancer risk. Positron emission tomography (PET): Measures positrons Other testing: Can be done in addition to biopsy to identify released with tissue uptake of radioactive sugar (more tumor cell type (sputum analysis, cytology of fluid sampling). rapid in cancer). Mammography (PEM) can be performed this way. CT can be used with PET scans. NURSING ACTIONS: Reinforce explanations of the purpose of testing, as appropriate. Electrocardiogram, echocardiogram, or multigated acquisition scan: Used to evaluate heart function prior CLIENT EDUCATION: Laboratory testing can continue to cancer treatment or to identify damage following throughout treatment (to monitor progress) and following chemotherapy or radiation to the upper body. treatment (to screen for return of cancer). Other types of imaging: Bone scan, gallium scan, and thyroid scan IMAGING STUDIES Common imaging techniques are used as secondary tools Endoscopy to assist in the treatment of cancer. Imaging is completed Permits visualization inside the body using flexible around the time of diagnosis to measure the severity scopes and cameras. Tumors can be visualized in the of cancer. joints (arthroscopy), respiratory system (laryngoscopy, bronchoscopy), body cavity (mediastinoscopy, CT scan, MRI, PET scan, ultrasound, and x‑ray thoracoscopy), or gastrointestinal system (enteroscopy, Provide visualization of tumors and their borders. sigmoidoscopy). Organs can be visualized as well Detect metastasis to organs and other body structures. (hysteroscopy, cystoscopy). Clients can be given dye (IV pyelogram) or contrast NURSING ACTIONS (barium enema) to enhance visualization. Verify signed informed consent form. Monitor the client during remission. Prepare the client as indicated for the type of procedure Digital imaging: Usually more accurate. Digital storage of to be performed. images and results allows for information to be easily shared Provide a safe environment until effects of sedation are among members of the interprofessional treatment team. minimal (maintain bed rest, withhold oral intake). Ensure adequate oxygenation during the recovery period. 534 CHAPTER 80 Cancer Screening and Diagnostic Procedures CONTENT MASTERY SERIES 07/24/15 March 23, 2021 11:56 AM rm_pn_2020_ams_chp80 INTERPRETATION OF FINDINGS Application Exercises Findings that indicate or increase suspicion of cancer must be further evaluated. 1. A nurse in a clinic is talking with a client scheduled A variety of imaging and laboratory tests can be used to for a sentinel lymph node biopsy. Which of the detect the following. following information should the nurse include? ◯ Degree of tumor involvement A. Dye is used during the procedure. ◯ Type of tumor B. The lymph nodes closest to the tumor ◯ Areas of metastasis are removed during the biopsy. ◯ Complications of cancer C. A small amount of chemotherapy is used to test the lymph node response. NURSING ACTIONS D. A 2 mm plug of tissue is removed during the biopsy. Instruct the client about routine cancer screenings as part of health promotion and disease prevention. Provide care before, during, and after the procedure as 2. A nurse is reinforcing teaching with a client indicated by procedure type. who is scheduled for nuclear imaging for Reinforce teaching and provide resources for client suspected cancer. Which of the following statements should the nurse make? about self‑care in the home environment. A. “The presence of a liver enzyme will be identified.” B. “You will be given an injection of a radioactive substance.” Active Learning Scenario C. “An endoscope will be inserted through your mouth.” A nurse is discussing data collection as part of D. “The tumor will be aspirated.” screening for cancer with a newly licensed nurse. What information should the nurse include in the discussion? Use the ATI Active Learning Template: 3. A nurse is collecting information from a client Diagnostic Procedure to complete this item. in a provider’s office. Which of the following findings should the nurse identify as an indication INTERPRETATION OF FINDINGS of possible cancer? (Select all that apply.) Describe at least three findings indicating A. Temperature 102° F (38.9° C) for more than 48 hr the presence of metastasis. B. Sore that does not heal Describe four data collection techniques C. Difficulty swallowing and possible findings. D. Unusual discharge CLIENT EDUCATION: Identify two self‑assessment E. Weight gain 4 lb (1.8 kg) in 2 weeks techniques that can identify data. 4. A nurse is reinforcing teaching with a client who is scheduled for a shave biopsy for suspected cancer. Which of the following client statements indicates understanding of the procedure? A. “A test of my bone marrow will be performed.” B. “A lymph node will be removed.” C. “A needle will be inserted into the mass.” D. “A small skin sample will be obtained.” 5. A nurse is contributing to the plan of care for a client who is scheduled for genetic testing for suspected cancer. Which of the following interventions should the nurse recommend for inclusion in the plan? A. Encourage the client to seek genetic counseling. B. Send testing results to the client’s insurance agency. C. Verify the prescription for a tumor marker assay. D. Ensure the client is placed in a recovery position after testing. PN ADULT MEDICAL SURGICAL NURSING CHAPTER 80 Cancer Screening and Diagnostic Procedures 535 07/24/15 March 23, 2021 11:56 AM rm_pn_2020_ams_chp80 Application Exercises Key Active Learning Scenario Key 1. A. CORRECT: The client will receive a dye or colloid Using the ATI Active Learning Template: Diagnostic Procedure as a tracer to help identify lymph nodes during INTERPRETATION OF FINDINGS a sentinel lymph node biopsy. B. The lymph nodes close to the tumor might be Metastasis removed in a later procedure if the sentinel Discomfort at secondary sites lymph node is positive for cancer. Swelling and/or tenderness of lymph nodes or areas of the body C. Chemotherapy is not administered during Presence of masses a sentinel lymph node biopsy. Altered function of another body system D. A punch biopsy involves removing a Bone pain 2 to 6 mm plug of tissue. NCLEX® Connection: Reduction of Risk Potential, Data collection techniques Diagnostic Tests Inspection for changes in color, symmetry, movement, or body function Auscultation for adventitious sounds, which can 2. A. Liver function tests involve the identification of altered indicate altered body system function liver enzymes, which can be present in a client who has Palpation to detect masses or tissue abnormalities cancer. They are not nuclear imaging tests. Percussion to detect changes in expected sound over B. CORRECT: Nuclear imaging involves the administration of an organs, which can indicate inflammation or tumor oral or IV radioactive tracer to identify cancerous tissue. C. Endoscopy permits visualization inside the CLIENT EDUCATION: Testicular and breast self‑examinations body. It is not a form of nuclear imaging. NCLEX® Connection: Coordinated Care, Referral Process D. A needle biopsy is performed to aspirate fluid and tissue samples for cancer cells. It is not a form of nuclear imaging. NCLEX® Connection: Reduction of Risk Potential, Diagnostic Tests 3. A. Presence of a fever for an extended period is not a finding of possible cancer. Unexplained night sweats can indicate a need to have a cancer screening. B. CORRECT: A sore that does not heal is a finding of possible cancer. C. CORRECT: Difficulty swallowing is a finding of possible cancer. D. CORRECT: The presence of unusual discharge is a finding of possible cancer. E. CORRECT: Weight gain or loss can indicate possible cancer. NCLEX® Connection: Physiologic Adaptation, Basic Pathophysiology 4. A. Bone marrow aspiration is a type of needle biopsy. B. Sentinel node biopsy involves excision of a lymph node. C. Needle biopsy involves aspiration of a tumor for fluid and tissue sampling. D. CORRECT: A shave biopsy is a sampling of the outer skin layer using a scalpel or razor blade. NCLEX® Connection: Reduction of Risk Potential, Diagnostic Tests 5. A. CORRECT: It is recommended that clients having genetic testing done receive counseling. B. Genetic testing information is confidential. Do not send the information unless the client requests it. C. A tumor marker assay is a laboratory test to identify the presence of specific body proteins in blood, body secretions, and tissue. It is not a component of genetic testing. D. Genetic testing involves collection of blood or saliva. Recovery positioning is not required following testing. NCLEX® Connection: Reduction of Risk Potential, Diagnostic Tests 536 CHAPTER 80 Cancer Screening and Diagnostic Procedures CONTENT MASTERY SERIES 07/24/15 January 22, 2021 2:40 PM rm_pn_2020_ams_chp81 CHAPTER 81 UNIT 13 IMMUNE SYSTEM AND CONNECTIVE Lymph node dissectionor sentinel lymph node biopsy TISSUE DISORDERS is done to determine if the cancer has spread or there is SECTION: CANCER‑RELATED DISORDERS added risk of spread. CHAPTER 81 Cancer Treatment Prophylactic surgeryinvolves removing precancerous Options tissue, or normal tissue, for a client at high risk for developing cancer. Rehabilitative or reconstructive surgeriesimprove appearance or functional ability for clients following Cancer treatment is based on the cell of cancer treatment. origin of the cancer. When metastasis occurs, More extensive surgeries(tumors involving multiple organs or structures, lymph node involvement, deep treatment is still based on the primary tumor lesions) increase the risk of complications and typically origin even though the malignancy is located require longer recovery periods. Intensive care can be required. elsewhere in the body. Many cancers are curable NURSING ACTIONS when diagnosed early. Provide perioperative care as indicated by tumor location and procedure type. Cancer treatment options focus on removing Prevent general postoperative complications or destroying cancer cells and preventing (infection, fluid or electrolyte imbalance, hemorrhage, thromboembolism, inadequate oxygenation, shock). the continued abnormal cell growth and Prevent and treat pain as prescribed using differentiation. Treatment can be curative or pharmacological and nonpharmacological measures. Reinforce teaching with the client on care for drains, palliative. The treatment plan is guided by client wounds, and implanted devices. factors (age, childbearing desire, pregnancy, Provide psychological support to the client to facilitate coping with diagnosis and body image changes current state of health, expected lifespan) and following surgery. can involve several treatment methods. Assist the client to develop strategies to compensate for loss of function of organs, tissue, or limbs. Adjuvant treatment is what is given in addition CLIENT EDUCATION: Monitor for complications after to the primary treatment standard and can discharge. include hormone, radiation, and targeted INTERPROFESSIONAL COLLABORATION Support groups for clients who have cancer, as well as therapies; immunotherapy; and chemotherapy. their family and friends. Therapy services as indicated for the client’s Nursing care for clients who have cancer should condition, such as physical, speech, respiratory, and include collaboration with supportive therapies occupational therapies. and services, counseling, and transfer of care to another provider at discharge. Chemotherapy Chemotherapy involves administration of systemic or local PROCEDURES cytotoxic medications that damage a cell’s DNA or destroy rapidly dividing cells. Cancer treatment includes manipulation or removal of Chemotherapeutic agents are often selected in relation the tumor. to their effect on various stages of cell division. Tumor reductioncan be done through topical procedures Subsequently, combinations of anticancer medications (cryosurgery, laser therapy, ablation) or by destruction are used to enhance destruction of cancer cells. of the main arteries that provide blood flow to the tumor Most chemotherapy agents are cytotoxic. The adverse (artery embolization). effects of these agents are related to the unintentional harm done to normal rapidly proliferating cells, Tumor excisioncan be open or endoscopic (curettage and such as those found in the mucous membranes of electrodissection for skin cancer). the gastrointestinal (GI) tract, hair follicles, and The tumor and tissue immediately surrounding it bone marrow. (tumor margin) are removed. The goal is that all of the For some cancer medications, agents that protect healthy outermost tissue that was removed does not contain cells (cytoprotectants or chemoprotectants) are given cancer cells (a negative margin). before or with chemotherapy to decrease the effect on Surgery can be done for biopsy (diagnosis and staging), normal tissues. Examples include amifostine and mesna. or relief (palliation) based on findings. PN ADULT MEDICAL SURGICAL NURSING CHAPTER 81 Cancer Treatment Options 537 07/24/15 January 22, 2021 2:40 PM rm_pn_2020_ams_chp81 07/24 Chemotherapy can be administered in a health care NURSING ACTIONS setting, provider’s office, clinic, or home. Instruct the client/family in the proper use of vascular Most chemotherapy medications, including access devices. oral, are absorbed through the skin and mucous Instruct family to dispense oral medications directly into membranes. Anyone preparing, giving, or disposing a cup and not to touch pills or liquids with the hands. of these medications must wear proper personal Closely monitor IV infusions and notify the charge nurse protective equipment. to provide immediate treatment for extravasation. Care Return unused chemotherapeutic agents to the includes identifying the antidote (neutralizing solution) dispensary or dispose of them per agency policy. Do for the specific medication the client is receiving. not dispose of medications in the regular trash or sewage system. INTRACAVITARY CHEMOTHERAPY ROUTE Involves the administration of chemotherapy directly into a body cavity (abdomen, pleural space, or bladder) Depending on the agent, it can be given by the topical A small catheter can be used. (for skin lesions); oral; parenteral; IV; intra‑arterial; Local irritation can be increased, but systemic adverse intraventricular (into the ventricles of the brain); effects are usually prevented. intracavitary, which includes intraperitoneal (into the In some cases, the medication can be removed following abdominal cavity); intravesicular (into the bladder); a dwell time. intrapleural (into the pleural space); or intrathecal (into the spinal cavity) route. Specialized training/ CLIENT EDUCATION certification is necessary for the administration of Some discomfort can be present during infusion. some agents. Monitor for evidence of infection at the site Oral anticancer medications are just as toxic to the of administration. client taking the medication and the nurse handling the medication as are standard chemotherapy medications. Oral medications should not be crushed, split, broken, INDICATIONS or chewed. Chemotherapy can be used to cure a disease, help control its progression, or as palliative treatment for CATHETERS individuals who have a terminal disease. Chemotherapy is most commonly used for treatment A central catheter is usually placed for IV chemotherapy of cancer. It can also be used for other disorders administration or blood testing. (autoimmune diseases). Some medications can cause serious damage to the skin and muscle tissue if they leak outside a vein (vesicants). Getting these through a central venous catheter rather than a short‑term peripheral IV reduces the risk that CONSIDERATIONS the medication will leak and damage tissues. Many different types of central venous catheters can be PREPROCEDURE used. Two of the more commonly used included the Because administration of chemotherapeutic peripherally inserted central catheter and implanted medications is limited to certified individuals, port. (Refer to CHAPTER 24: CARDIOVASCULAR DIAGNOSTIC management of adverse effects is the primary focus of AND THERAPEUTIC PROCEDURES.) health care personnel. A port is implanted when therapy is intended to be Instruct the client on findings that indicate given on a long‑term basis. The port is comprised of a potential complications. The client should report small reservoir that is covered by a thick septum. findings immediately. CATEGORIES OF MEDICATIONS There are several categories of chemotherapy COMPLICATIONS medications based on how they work and the chemical Immunosuppression/neutropenia structure. Medications are selected based on the sensitivity of cancer cells to the medications and the Due to bone marrow suppression by stage of the cancer. Understanding the mechanism cytotoxic medications. of the medication’s action can help with predicting The most significant adverse effect of chemotherapy. possible adverse effects. Clients who have neutropenia might not develop a high Categories include alkylating agents, antimetabolites, fever or have purulent drainage, even when an infection antimitotic agents, antitumor antibiotics, topoisomerase is present. inhibitors, and other miscellaneous medications. The risk of serious infection increases as the absolute neutrophil count (ANC) falls. An ANC less than 1,000/mm3 indicates a weak immune system and the need to initiate neutropenic precautions. 538 CHAPTER 81 Cancer Treatment Options CONTENT MASTERY SERIES 07/24/15 January 22, 2021 2:40 PM rm_pn_2020_ams_chp81 NURSING ACTIONS ◯ Prokinetic agents (metoclopramide) Monitor temperature, white blood cell (WBC) ◯ Benzodiazepines (lorazepam) count, and ANC. ◯ Cannabinoids (dronabinol, nabilone) Report a fever greater than 37.8° C (100° F) to the ◯ Neurokinin-1 receptor antagonists (netupitant) provider immediately. NURSING ACTIONS Monitor skin and mucous membranes for infection Ensure antiemetics are given before chemotherapy and (breakdown, fissures, and abscess). repeated based on the response and duration of CINV. Obtain prescribed cultures prior to initiating Administer antiemetic medications for several days after antimicrobial therapy. each treatment, even when CINV appears to be controlled. NEUTROPENIC PRECAUTIONS Remove vomiting cues, such as odor and emesis basins. Ensure the client is assigned to a private room. Have the Implement nonpharmacological methods to reduce nausea client remain in the room unless they need to leave for (visual imagery, relaxation, acupuncture, distraction). a diagnostic procedure or therapy. In this case, place a Perform calorie counts to determine intake. Provide mask on the client during transport. liquid nutritional supplements as needed. Add protein Protect the client from possible sources of infection (live powders to food or tube feedings. plants, stagnant water, contaminated equipment). Administer megestrol to increase appetite if prescribed. Have client, staff, and visitors perform frequent hand Monitor for findings of dehydration or fluid and hygiene. Restrict visitors who are ill. electrolyte imbalance. Avoid invasive procedures that could cause a break Perform mouth care prior to serving meals to in tissue (rectal temperatures, injections, indwelling enhance appetite. urinary catheters) unless necessary. CLIENT EDUCATION Keep dedicated equipment (blood pressure machine, Some antiemetics can provide prophylactic treatment if thermometer, stethoscope) in the client’s room. given before meals. Administer colony‑stimulating factors (filgrastim) as Eat several small meals a day if better tolerated. prescribed to stimulate WBC production. Low‑fat dry foods (crackers, toast) and avoiding Follow agency policy regarding prohibitions of fresh drinking liquids during meals can prevent nausea. flowers and plants in the room. Select foods that are served cold and do not CLIENT EDUCATION require cooking. Cooking food can emit odors that Avoid crowds while undergoing chemotherapy. stimulate nausea. Take temperature daily. Report elevated temperature to Encourage consumption of high‑protein, high‑calorie, the provider. nutrient‑dense foods and avoidance of low‑ or Avoid food sources that could contain bacteria (fresh empty‑calorie foods. Use meal supplements as needed. fruits and vegetables; undercooked meat, fish, and eggs; Use plastic eating utensils, suck on hard candy, and pepper and paprika). avoid consuming red meats to prevent or reduce the Avoid yard work, gardening, or changing a pet’s litter sensation of metallic taste. box. Wear disposable gloves when working with house Create a food diary to identify items that can plants or doing outdoor gardening. trigger nausea. Discard liquid beverages that have been sitting at room temperature for longer than 1 hr. Alopecia Wash all dishes in hot, soapy water or a dishwasher. An adverse effect of certain chemotherapeutic medications Wash glasses and cups after each use. that is usually temporary. The amount of hair lost can Wash toothbrush daily in the dishwasher or rinse in a vary, and can occur anywhere on the body. bleach solution. Do not share toiletry or personal hygiene items with others. NURSING ACTIONS Report manifestations of bacterial or viral infections Discuss the effect of alopecia on self‑image. immediately to the provider. Discuss options (hats, turbans, wigs) deal with hair loss. The American Cancer society has information on a Nausea, vomiting, anorexia variety of products. Recommend clients select a head covering prior to treatment. Many medications used for chemotherapy are Reinforce that hair should return about 1 month after emetogenic (induce vomiting) or cause anorexia and an chemotherapy is discontinued. The new hair can differ altered taste in the mouth. from the original hair in color, texture, and thickness. A combination of medications can help treat chemotherapy-induced nausea and vomiting (CINV). CLIENT EDUCATION These include: Hair loss occurs 7 to 10 days after treatment begins (for ◯ Serotonin blockers (ondansetron, palonosetron) some agents). ◯ Neurokinin receptor antagonists (aprepitant) Avoid the use of damaging hair care measures ◯ Corticosteroids (dexamethasone, methylprednisolone) (electric rollers, curling irons, hair dye, permanent ◯ Dopamine antagonists (promethazine, prochlorperazine) waves). A soft hair brush or wide‑tooth comb for ◯ Proton pump inhibitors (omeprazole) grooming is preferred. ◯ Histamine 2 antagonists (cimetidine) Consider cutting the hair short before treatment to decrease weight on the hair follicle. PN ADULT MEDICAL SURGICAL NURSING CHAPTER 81 Cancer Treatment Options 539 07/24/15 January 22, 2021 2:40 PM rm_pn_2020_ams_chp81 07/24 Consider collaborating with a hairdresser to assist with Follow recommendations regarding the use of coating wig selection. Wearing a wig before therapy begins can agents, topical analgesics, topical anesthetics, or oral or reduce appearance changes. parenteral analgesics that can be prescribed. After hair loss, protect the scalp from sun exposure and Choose soft, bland foods and supplements that are high use a diaper rash ointment/cream for itching. in calories (mashed potatoes, scrambled eggs, cooked Use head coverings to reduce body heat loss and protect cereal, milk shakes, ice cream, frozen yogurt, bananas, skin while wearing helmets, headphones, headsets, or wigs. and breakfast mixes). Avoid spicy, salty, acidic, rough, or The oncologist might prescribe a cold cap during hard food. treatment to decrease hair loss. Avoid drinking alcohol and the use of tobacco. Drink at least 2 L of water per day, as long as there is no Hypersensitivity fluid restriction prescribed by the provider. A client taking chemotherapy medication has an increased Anemia and thrombocytopenia risk for hypersensitivity reactions. Reactions can occur as early as 1 hr following infusion but are also possible after Secondary to bone marrow suppression (myelosuppression) several doses. Anemia NURSING ACTIONS NURSING ACTIONS Stop the medication immediately if manifestations of a ◯ Monitor for fatigue, pallor, dizziness, and shortness hypersensitivity reaction occur. of breath. Assist with the administration of emergency treatment, ◯ Help the client manage anemia‑related fatigue by following facility protocol for hypersensitivity reactions. scheduling activities with rest periods in between and CLIENT EDUCATION using energy saving measures (sitting during showers Watch for and report indications of a hypersensitivity and ADLs). reaction immediately. ◯ Administer erythropoietic medications (darbepoetin If hypersensitivity occurs, desensitization to the alfa, epoetin alfa) and antianemic medications (such medication might be required so that the client can as ferrous sulfate) as prescribed. continue to receive the treatment most appropriate to ◯ Monitor Hgb values to determine response to combat the cancer. medications. Be prepared to assist with the administration of blood if prescribed. Oral effects Thrombocytopenia Mucositis r efers to inflammation in the mucous lining of NURSING ACTIONS the upper GI tract from the mouth to the stomach. Monitor for petechiae, ecchymosis, bleeding of the Stomatitis refers to inflammation of tissues in the oral gums, nosebleeds, and occult or frank blood in stools, cavity (gums, tongue, roof and floor of mouth, inside lips urine, or vomitus. and cheeks). Institute bleeding precautions. ◯ Avoid IVs and injections. When needlesticks are NURSING ACTIONS necessary, use the smallest gauge needle possible. Examine the client’s mouth several times a day, and ◯ Apply pressure for approximately 10 min after blood inquire about the presence of oral lesions. is obtained. Document the location and size of lesions. For new ◯ Handle client gently and avoid trauma. lesions, obtain a specimen for culture and report them to ◯ To avoid bruising, do not over inflate the blood the provider. pressure cuff. Avoid using glycerin‑based mouthwashes or mouth Administer thrombopoietic medications such as oprelvekin swabs for client care. Nonalcoholic, anesthetic to stimulate platelet production. Monitor platelet count, mouthwashes are recommended. and be prepared to assist with the administration of Administer a topical anesthetic prior to meals. platelets if the count falls below 10,000/mm3. Discourage consumption of salty, acidic, or spicy foods. Offer oral hygiene before and after each meal. Use CLIENT EDUCATION lubricating or moisturizing agents to counteract dry mouth. Understand how to manage active bleeding. Understand measures to prevent bleeding (use electric CLIENT EDUCATION razor and soft‑bristled toothbrush, avoid blowing nose Rinse the mouth with a solution of 0.9% sodium chloride, vigorously, ensure that dentures fit appropriately). Avoid room‑temperature tap water, or salt and soda water. participation in contact sports or any activity in which Frequency is guided by the intensity of the mucositis. injury is likely. Perform gentle flossing and brushing using a Avoid the use of NSAIDs. soft‑bristled toothbrush or foam swabs to avoid Understand how to prevent injury when ambulating traumatizing the oral mucosa. (wear closed‑toes shoes, remove tripping hazards in the Rinse the mouth before and after meals. Avoid home) and apply cold if injury occurs. mouthwash that contains alcohol or other irritants. Take medications to control infection as prescribed (nystatin suspension, acyclovir). 540 CHAPTER 81 Cancer Treatment Options CONTENT MASTERY SERIES 07/24/15 January 22, 2021 2:40 PM rm_pn_2020_ams_chp81 Chemotherapy‑induced peripheral neuropathy Internal radiation causes body fluids to be contaminated with radiation, and body wastes should be disposed of Loss of sensory or motor function of peripheral nerves appropriately, as directed by the facility. is caused by exposure to certain anticancer medications. Cytoprotectants (amifostine) are sometimes used to Higher doses of medication lead to greater neuropathy. protect against harmful effects of radiation therapy, NURSING ACTIONS such as dryness of the mouth caused by radiation Monitor for loss of sensation in hands and feet, treatment for head and neck cancer. orthostatic hypotension, loss of taste, and constipation. Radiation exposure to health care personnel and Monitor for orthostatic hypotension. visitors is reduced by limiting indirect contact time, Monitor for early manifestations including numbness, maintaining indicated distances from sources of tingling, and redness. radiation, and preventing direct contact with the source. Reinforce teaching how to prevent injury, including falls. Inform regarding risk of erectile dysfunction and Internal radiation therapy treatment options.