Cellular Regulation - Narration PDF

CELLULAR REGULATION CONCEPT INTRODUCTION OBJECTIVES  Describe variations of cellular growth (regulation)  Identify evidenced based risk factors  List appropriate diagnostic testing  Explain available treatment modalities  Describe the effects treatment modalities have for the client and appr...

CELLULAR REGULATION CONCEPT INTRODUCTION OBJECTIVES  Describe variations of cellular growth (regulation)  Identify evidenced based risk factors  List appropriate diagnostic testing  Explain available treatment modalities  Describe the effects treatment modalities have for the client and appropriate nursing care  Identify the interrelated concepts of cellular regulation and dysregulation CELLULAR REGULATION Refers to all functions carried out within a cell to maintain homeostasis, including its responses to extracellular signals (e.g. hormones, cytokines, and neurotransmitters) and the way it produces intracellular responses. Included within these functions is cellular replication and growth. (Giddens, 2021)  CELL / TISSUE HOMEOSTASIS / REPLICATION Hyperplasia increased number of normal cells Degeneration Dysplasia-abnormal cell Destruction structure (precancerous) Neoplasia abnormal number of cells Growth Which leads to growth of a Death tumor Benign neoplasm is Necrosis an abnormal mass of Malignant neoplasm is an cells which maintains abnormal mass of cells appropriate function, with abnormal function, normal differentiation, abnormal differentiation, encapsulated, no irregular borders, metastasis with metastasis CELLULAR APOPTOSIS CELLULAR REGULATION Environmental – smoking, sun exposure, HPV, Immunological – age, immunosuppressant's, HIV Genetic – first degree relative CARCINOGENESIS  Initiation – carcinogen changes cell DNA, increased cell division  Promotion – enhanced growth from hormones and body proteins  Progression – VEGF triggers growth of own blood supply  Metastasis – spreads via blood and or lymph PRIMARY HEALTH PROMOTION (PREVENTION)  Avoid carcinogens (smoking, UV exposure, chemicals)  Remove at risk tissues (polyps)  Vaccination (Gardasil for HPV)  Healthy HP practices (diet of fruit, vegetables, fiber, limit animal fat)  Keep immunity strong SECONDARY HEALTH PROMOTION (SCREENING) Colonoscopy every 10 years beginning age 45 Mammograms every year beginning age 45 Pap smears every year beginning age 25 Prostate screening (DRE/PSA) every year beginning age 50 (ACS, 2023) SEVEN WARNING SIGNS OF CANCER C Change in bowel or bladder A A sore that does not heal U Unusual Bleeding or discharge T Thickening or lump in the breast or elsewhere I Indigestion or difficulty swallowing O Obvious changes in a wart or mole N Nagging cough or hoarseness SYMPTOMS / DIAGNOSIS Symptoms Diagnosis  Palpable Mass  X-ray / CT Scan / MRI  Pain / Pressure / SOB  Visualization with biopsy  Abnormal tissue function  Labs – WBC, RBC, Hgb, Hct  Pathological fractures  Tumor markers e.g. CA19, CA125, CEA  Weight loss  Biopsy Staging / Grading  CELL PROPERTIES Normal Cell Benign Tumor Cell Malignant Tumor Cell Appearance Expected cell Same as expected Different than appearance cell appearance expected cell appearance Nucleus size Small nucleus Small nucleus Large nucleus Function Normal – cell Normal – cell Lost specific specific Adherence Tight Tight Loose Migration None None Migrates Order of growth Orderly Beyond Rapid appropriate time and place Chromosomes Euploidy (normal Euploidy (normal Aneuploidy GRADING / STAGING CANCER MANAGEMENT  Surgery  Radiation – (External beam / Brachytherapy / Systemic)  Immunotherapy – (Monoclonal Antibodies / Targeted therapy)  Chemotherapy – (Neoadjuvant / Adjuvant)  Endocrine – (Anti- Hormonal)  Bone Marrow / Stem Cell  Symptom management w/ medications SURGERY  Prophylactic – remove potentially cancerous tissue high risk, existing pre malignant condition  Diagnostic – biopsy  Curative – remove all cancer tissue, non invasive  Palliative - to alleviate symptoms, assist other treatment plans, improve quality of life RADIATION - EXTERNAL BEAM RADIATION  Given in divided doses (# times per week for # of weeks)  Skin markings ‘tattoos’  Patient in NOT radioactive  Urine and stool NOT radioactive  S/E ‘radiation dermatitis’, fatigue, bone marrow suppression  Nursing care RADIATION - BRACHYTHERAPY Intracavity Interstitial  High dose / short sessions  Low dose / permanent  Patient is radioactive till implant is  Patient is radioactive – precautions removed needed  Urine and stool NOT radioactive  Urine and stool NOT radioactive  Radiation precautions SYSTEMIC RADIATION  Given in capsule or liquid form  Tumor cell specific  Patient is radioactive – precautions needed CHEMOTHERAPY  Neoadjuvant / Adjuvant  Used in various combinations / regularly scheduled  Routes of administration: Intravenous / Oral / Intraperitoneal / Intraarterial / Intravesicular / Intrathecal  Safe Handling / Port or Central line  Precautions needed for patient bodily fluids  Causes systemic side effects / injury  Chemoprotectants / cytoprotectants IMMUNOTHERAPY / MONOCLONAL ANTIBODIES / TARGETED THERAPY  Immunotherapy – heightened inflammatory response  Monoclonal Antibodies – infusion related reactions (rash, fever, n/v, hypotension)  Targeted Therapy – skin reactions, bone marrow suppression, n/v, hyper/hypotension ENDOCRINE THERAPY Hormone positive breast cancer - Aromatase Inhibitors (post menopausal women only), antiestrogens Prostate cancer – androgen deprivation Side effects: hot flashes, sexual dysfunction, vaginal dryness, erectile dysfunction, gynecomastia STEM CELL / BONE MARROW TRANSPLANTS Bone Marrow Peripheral Blood Umbilical Cord SIDE EFFECTS OF CANCER TREATMENTS  Radiation Dermatitis  Alopecia  Nausea / Vomiting / Loss of appetite  Mucositis / Mouth sores  Cognitive changes  Infertility / Sterility  Peripheral neuropathy  Bone marrow suppression  Tumor Lysis Syndrome  Syndrome of Inappropriate Antidiuretic Hormone NURSING CARE  Radiation Dermatitis: mild soap, avoid friction, avoid sun  Alopecia: Scalp Hypothermia  Nausea / Vomiting / Loss of Appetite: Antiemetic's, small frequent meals, ginger  Mucositis / Mouth Sores: oral care  Cognitive changes: Cognitive rehabilitation programs  Infertility / Sterility: Sperm and Egg banking  Peripheral neuropathy: PT / OT  Bone marrow suppression time, colony and erythropoietin stimulating growth factors  Tumor Lysis Syndrome fluids, monitor electrolytes, cardiac monitor, allopurinol, dialysis  Syndrome of Inappropriate Antidiuretic Hormone: fluid restriction, increased sodium intake  BONE MARROW SUPPRESSION (NADIR)  Thrombocytopenia – easy bruising, bleeding – observe urine / stool, fall precautions, bleeding precautions  Anemia- fatigue, SOB – good nutrition, pace activities  Neutropenia – infection, sepsis – good hand washing, personal hygiene, safe food handling EXAMPLE NADIR Normal Levels Nadir Levels Red Blood Cell 4.0-5.2 m/uL 1.2 m/uL Count White Blood Cell 4.0-10.5 K/uL 1.0 K/uL Count Neutrophil Count 42-76 % 8% Platelet Count 140-450 K/uL 40 K/uL COLONY / ERYTHROPOIETIN STIMULATING GROWTH FACTORS  Colony Stimulating Factors – to increase neutrophils Filgrastim (Neupogen) Pegfilgrastim (Neulasta)  Erythropoietin Stimulating Agents – to increase red blood cell production Epoetin Alfa (Epogen, Procrit) Darbepoetin alfa (Aranesp) SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE (SIADH) Normal (135-145 mEq/L) Weakness Fatigue Muscle cramps