Chapter 18 Caring for Clients With Cancer PDF

Timby’s Introductory Medical– Surgical Nursing, 13e Chapter 18: Caring for Clients With Cancer Copyright © 2018 Wolters Kluwer Health | Lippincott Williams & Wilkins Cancer #1  Pathophysiology: abnormal,...

Timby’s Introductory Medical– Surgical Nursing, 13e Chapter 18: Caring for Clients With Cancer Copyright © 2018 Wolters Kluwer Health | Lippincott Williams & Wilkins Cancer #1  Pathophysiology: abnormal, unrelated cell proliferation; neoplasms—new growths of abnormal tissue o Classifications See Table 18-1  Tissue type: based on origin  Carcinomas: epithelial cells  Lymphomas: organs that fight infection  Leukemias: organs that form blood  Sarcomas: connective tissue; bones or muscles  Growth: benign or malignant  See Table 18-2 Copyright © 2022 Wolters Kluwer · All Rights Reserved Cancer #2 Benign tumors Malignant tumors o Noninvasive o Invasive o Grow large o Uncontrolled growth o Slow growth rate o Cause alterations in cell membrane; fluid o Do not usually cause movement in and out of death unless impair cell function of vital organ o Tumor-specific antigens o Types: Lipomas, Meningiomas, o Types: Bone, Skin, Hemangiomas Brain, Lung, Pancreas Copyright © 2022 Wolters Kluwer · All Rights Reserved Cancer #3 Metastasis: development of secondary tumor from the primary tumor; lymph nodes and blood vessels o Carcinogenesis: malignant transformation  Steps Initial process: alters the genetic structure of the cell DNA; carcinogens Promotion: cells begin to mutate cell populations Progression: invades adjacent tissues and metastasizes Copyright © 2022 Wolters Kluwer · All Rights Reserved Cancer #4  Etiology o Incidence of cancer  Second leading cause of death in the United States  One in two men and one in three women develop cancer at some point o Most common cancer: lung cancer  Men: prostate, lung, and colon cancer  Women: breast, lung, and colon cancer o Damage to DNA: mutated or damaged; oncogenes and tumor suppressor genes Copyright © 2022 Wolters Kluwer · All Rights Reserved Cancer #5 Contributing factors o Chemical agents: effects of tobacco and nicotine, exposure to asbestos, pesticides, formaldehydes  Lungs, liver, and kidneys: due to biotransformation o Environmental: exposure to sunlight, radiation, pollutants, electromagnetic fields, nuclear power plants o Diet: foods high in fat (smoked/preserved with salt, nitrates, and alcohol) and obesity o See Box 18-1 o Viruses and bacteria; Kaposi sarcoma, Helicobacter pylori Copyright © 2022 Wolters Kluwer · All Rights Reserved Cancer #6 Contributing factors—(cont.) o Medications: immunosuppressive drugs, hormone replacements, anticancer drugs o Immune system: defective  Fails to recognize malignant cells or not stimulated to fight cancer cells  Malignant cells survive and proliferate Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #1 A client has all of the following in his health history. Which would contribute most to the development of oral cancer? A) Alcohol abuse B) Poor dental hygiene C) Frequent bouts of tonsillitis D) Chewing smokeless tobacco Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #1 D) Chewing smokeless tobacco Rationale: Smokeless tobacco or snuff is a precipitating factor for oral cancer. Copyright © 2022 Wolters Kluwer · All Rights Reserved Cancer #7 Signs and Symptoms C- Change in bowel/bladder habits o American Cancer Society (2012) A- An unhealing sore  CAUTION U- Unusual bleeding Other: headaches, T- Thickening lump weight loss, chronic I- Indigestion pain, persistent fatigue, O- Obvious change in size low-grade fever, of wart or mole infections N- Nagging cough See Box 18-2 Copyright © 2022 Wolters Kluwer · All Rights Reserved Cancer #8 Cancer Prevention o Education: awareness of warning signs and factors of cancer development o Cancer screening programs o Periodic physical examinations o Emphasize and teach self-examinations; breasts, skin, testicles o Avoid risk factors o Reduce Cancer Risks: See Box 18-3 Copyright © 2022 Wolters Kluwer · All Rights Reserved Cancer #9  Diagnostic Methods o Client’s history, physical examination o Laboratory tests  Tumor markers: proteins, antigens, hormones, genes, or enzymes released by cancer cells  See Table 18-3  Complete blood count: CBC; anemia o X-ray imaging: contrast medium; iodine or barium o Computed tomography (CT) scan: tumor density, size, volume, or location Copyright © 2022 Wolters Kluwer · All Rights Reserved Cancer #10  Diagnostic Methods—(cont.) o Magnetic resonance imaging (MRI) o Nuclear imaging: radioimmunoconjugates, PET, SPECT; “hot spots” and “cold spots” o Ultrasound: solid and cystic tumors of abdomen, chest, breast, pelvis, and heart o Fluoroscopy: movement of body structures; Example: barium study/swallow o Biopsy, frozen sections, cytology o Endoscopy: gastroscopy, bronchoscopy, colonoscopy Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #2 A nurse is conducting a skin assessment on a client. Which of the following characteristics of a mole on the skin warrants further evaluation by a primary provider? A) Brown color B) Irregular shape C) Located on the neck D) Skin around area sunburned Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #2 B) Irregular shape Rationale: Nevi (moles) are typically brown. An irregularly shaped mole warrants further evaluation, particularly if the mole was once circular and has changed. Copyright © 2022 Wolters Kluwer · All Rights Reserved Cancer #11  American Joint Committee on Cancer; TNM classification; tumor size, node involvement, metastasis o Stages: See Table 18-4 based on growth sight  0—cancer is in situ; malignant cells confined  I, II, and III—spread to lymph nodes and/or organs  IV—metastasized to other organs o Grading: differentiated (closely resemble tissue of origin) and undifferentiated (little resemblance of tissue to origin); graded from I to IV o Tumor Staging and Grading: based on growth and cell type Copyright © 2022 Wolters Kluwer · All Rights Reserved Cancer #12 Treatment o Surgery: primary method of diagnosing, staging, and treating  Tumor excision: local and wide (radical), debulking or cytoreductive surgery  Salvage surgery: local recurrence of cancer Example: lumpectomy, mastectomy  Prophylactic/preventative surgery: family history or genetic predisposition Copyright © 2022 Wolters Kluwer · All Rights Reserved Cancer #13  Surgery—(cont.) o Palliative: helps relieve uncomfortable symptoms,tumor removal  Examples: paracentesis, thoracentesis, nerve blocks o Reconstructive/plastic surgery: correct defects o Mohs surgery: shaving off layers of skin; chemosurgery— topical chemical application to skin o Other: cryosurgery, electrosurgery, laser, Radiofrequency ablation, robotic Copyright © 2022 Wolters Kluwer · All Rights Reserved Cancer #14  Treatment—(cont.) o Radiation: destroys cell by breaking a strand of DNA molecule, preventing growth and division o Types  External radiation therapy (ERT): target tumors and lymph nodes See Box 18-5  Internal radiation therapy (brachytherapy): interstitial implants, intracavitary implants See Box 18-6  Systemic internal radiation therapy: iodine-131; administered orally, IV, or body cavity  Avoid exposure: wash hands, drink plenty of fluids, flush toilet sever times, avoid kissing/sexual contact Copyright © 2022 Wolters Kluwer · All Rights Reserved Cancer #15 Radiation side effects: alopecia, erythema, desquamation, stomatitis, xerostomia, anorexia, nausea, cystitis, pneumonitis, fatigue Other o Myelosuppression: depression of bone marrow o Leukopenia: decreased white blood cell count o Thrombocytopenia: decreased platelet count o Fibrosis: small intestine, lungs, bladder; cataracts, sterility, new cancers Copyright © 2022 Wolters Kluwer · All Rights Reserved Cancer #16 Radiation Safety o Length of exposure  Private rooms o Distance o Shielding: lead-lined o Contaminated articles; gloves Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #3 A client has frequent nausea and vomiting following radiation to the abdomen. An appropriate intervention for the nurse to use is: A) Administer antibiotics before meals. B) Monitor fluid intake and output. C) Serve the diet while food is hot. D) Provide music and conversation during meals. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #3 B) Monitor fluid intake and output. Rationale: Fluid imbalance could easily result from nausea and vomiting; therefore, it is important to monitor fluid intake and output. Copyright © 2022 Wolters Kluwer · All Rights Reserved Cancer #17  Treatment—(cont.) o Chemotherapy: antineoplastic agents—interfering with cellular function and reproduction  Cell cycle patterns: synthesis, mitosis, gaps 1 and 2, gap 0, checkpoints and cyclins, cell cycle-specific/nonspecific  Drugs: interfering with RNA and DNA synthesis  Examples: alkylating agents, nitrosoureas, topoisomerase I, antimetabolites  Routes: IV routes (PICC, Hickman, IVAD), oral, IM, SQ, topical, intrathecal, intraperitoneal  See Boxes 18-7 and 18-8 Copyright © 2022 Wolters Kluwer · All Rights Reserved Cancer #18 Chemotherapy side effects: nausea, vomiting, stomatitis, alopecia, myelosuppression, fatigue Nursing Management: o Monitor for gout, increased uric acid levels, joint pain, edema o Hair loss: obtain wig, cap, scarf. Usually temporary and growth in 4-6 months o Dietary modifications: small, frequent meals o Increase fluid intake: 2500 to 3000 mL/day o Report excessive weight loss, change in level of consciousness, paresthesia Copyright © 2022 Wolters Kluwer · All Rights Reserved Cancer #19 Peripheral Stem Cell Transplant o Replaces bone marrow destroyed by cancer or cancer treatments; engraftment o Types  Autologous: frozen and reinfused from self  Allogeneic: donor stem cells; GVHD, immunosuppressant drugs; minitransplant  Syngeneic: identical twin with identical tissue type; does not cause GVHD Copyright © 2022 Wolters Kluwer · All Rights Reserved Cancer #20  Targeted Therapies o Biologic response modifiers (BRMs) o Nonspecific biologic response modifiers (BCGs)  Examples: cytokines—interferons, interleukin-2 o Monoclonal antibody immunotherapy (MOABs) o Cancer vaccines—clinical trials o Hyperthermia—thermal therapy o Photodynamic therapy (PDT) o Gene therapy Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Care Plan: Cancer Nursing Diagnosis: Fatigue o Encourage protein and calorie intake. o Plan care around energy level. Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements o Encourage intake of sufficient calories. o Administer antiemetics as ordered before meals. Nursing Diagnosis: Disturbed Body Image o Explore strengths and resources. Copyright © 2022 Wolters Kluwer · All Rights Reserved Cancer #21 Care of the Terminally Ill Client Gently carry out tasks to reduce pain/discomfort. Control pain. Provide adequate fluid/nutrition. Keep client warm and dry. Control odors. Maintain dignity. Copyright © 2022 Wolters Kluwer · All Rights Reserved