NCM 112 Lecture Notes (Finals) PDF

ILOILO DOCTORS COLLEGE NCM 112 COLLEGE OF NURSING S.Y. 2024-2025 LECTURE MEDICAL SURGICAL NURSING ADAPTED FROM: DISCUSSION / PPT NAME: ELIJHA XHANTAL A. PEÑASCOZA COU...

ILOILO DOCTORS COLLEGE NCM 112 COLLEGE OF NURSING S.Y. 2024-2025 LECTURE MEDICAL SURGICAL NURSING ADAPTED FROM: DISCUSSION / PPT NAME: ELIJHA XHANTAL A. PEÑASCOZA COURSE OUTLINE: FINALS An anomaly due to distinctive morphologic CANCER alterations of the cell and aberration of ★ INTRODUCTION tissue patterns CANCER CELLS developed. ★ LUNG CA ★ ★ THYROID CA PANCREATIC CA PREDISPOSING FACTORS ★ BREAST CA 1. Heredity ★ PROSTATE CA ○ Genes ★ CERVICAL CA ★ ENDOMETRIAL CA 2. Chemicals ★ OVARIAN CA ○ Household ★ LEUKEMIA ○ Occupation ★ LYMPHOMA 3. Nulliparous ○ wala kapahuway imo CELLULAR ABERRATION endometrium lining since wala ka kaagi busong ○ increase estrogen INTRODUCTION 4. Hormonal changes ONCOLOGY DEFINED 5. Trauma Branch of medicine that deals with ○ consistent injury the study, detection, treatment and 6. Both sexes management of cancer and neoplasia. FEMALE Etiologic Factors: Childless, nulliparous Oncogenes – specialized cells triggering CA 1 or 2 children cells growth 1st baby born after age 30 Early menarche, late menopause WHAT IS CANCER? ○ Menarche-12 years old A large group of disease characterized by: ○ Still Menstruating- 55 years old Uncontrolled growth and spread of PATHOPHYSIOLOGY abnormal cells Proliferation ○ (rapid reproduction by cell division) Metastasis ○ (spread or transfer of cancer cells from one organ or part to another not directly connected) A departure from what is normal, usual or expected Typically one that unwelcome or unexpected A characteristic that deviates from the NORMAL type  ILOILO DOCTORS COLLEGE NCM 112 COLLEGE OF NURSING S.Y. 2024-2025 LECTURE MEDICAL SURGICAL NURSING NAME: ELIJHA XHANTAL A. PEÑASCOZA PATTERN OF CELL PROLIFERATION METAPLASIA conversion of one type of cell in a tissue to another type not normal for that tissue ANAPLASIA change in the DNA cell structure and orientation to one another characterized by loss of differentiation and a return to a more primitive form. NEOPLASIA uncontrolled cell growth, either benign or malignant METASTASIS (3 STAGES) INVASION CLASSIFICATION OF CANCER ACCORDING TO BEHAVIOR IF TUMOR neoplastic cells from primary tumor invade into surrounding tissue with BENIGN penetration of blood or lymph Tumors that cannot spread by invasion or ↓ metastasis; hence, they grow locally SPREAD Characteristics: tumor cells spread through lymph or circulation or by direct expansion Well-differentiated Slow growth ↓ Encapsulated ESTABLISHMENT AND GROWTH Non-invasive Does NOT metastasize cells are established and grow in secondary site MALIGNANT lymph nodes or in organs from Tumors that are capable of spreading by circulation invasion and metastasis. By definition, the LITTLE HISTORY term “cancer” applies only to malignant tumors. Cancer was recognized in ancient times by Characteristic: skilled observers who give the name “CANCER” ( Latin, ‘CANCRI’ --- CRAB) Undifferentiated because it reaches out in many directions Erratic and Uncontrolled Growth like the legs of a crab. Expansive and Invasive Secretes abnormal proteins Is a disease of the cell in which the normal METASTASIZES mechanisms of control of growth and proliferation are disturbed. 2 I PEÑASCOZA  ILOILO DOCTORS COLLEGE NCM 112 COLLEGE OF NURSING S.Y. 2024-2025 LECTURE MEDICAL SURGICAL NURSING NAME: ELIJHA XHANTAL A. PEÑASCOZA A disease caused when cell divide METASTASIS – spread of cancer cells from uncontrollably and spread into surrounding primary tumor to distant sites tissues MUCOSITIS – inflammation of the lining of Resulting to distinctive morphologic the mouth, throat, gastrointestinal tract alterations of the cell and aberrations of often associated with cancer therapy tissue patterns MYELOSUPPRESSION – suppression of the Is caused by changes to the DNA or genetic blood cell producing function of the bone mutations of the cellular DEOXYRIBONUCLEIC marrow. ACID. CYTOKINES - substance produced primarily Genetic mutations may be inherited and / by the cells of the immune system to or acquired, leading to abnormal cell enhance production and functioning behavior components of the immune system. DEFINITION OF TERMS EXTRAVASATION - leakage of intravenous medication from the veins into the BRACHYTHERAPY – delivery of radiation subcutaneous tissues therapy through internal implants placed inside or adjacent to the tumors. GRADING - Identification of the type of tissue from which the tumor originated and CARCINOGENESIS – process of transforming the degree to which the tumor cells retain normal cells to malignant cells the functional and structural characteristics of the original tissue. CARCINOGENS – chemicals ; physical factors; and other agents that cause NADIR - lowest point of white blood cell cancers depression after therapy that has toxic effects on the bone marrow. CHEMOTHERAPY – the use of medications to kill tumor cells by interfering with cellular NEOPLASIA – uncontrolled cell growth that functions and production. follows no physiologic demands. ALOPECIA – hair loss PALLIATION – relief of symptoms and promotion of comfort and quality of life ANAPLASIA – a pattern of growth in which regardless of the disease stage. cells lack normal characteristics and differ in shape and organization with respect to RADIATION THERAPY –the use of ionizing their cells origin. Usually this anaplastic cells radiation to kill malignant cells are malignant cells STAGING – process of determining the ANGIOGENESIS – growth of new blood extent of disease, including tumor size and vessels that new cancer cells to grow spread or metastasis to distant sites. APOPTOSIS – a normal cell mechanism of STOMATITIS – inflammation of oral tissues, program cell death often associated with some chemotherapeutic agents and radiation BENIGN – not cancerous; benign tumors therapy to head and neck region may but are unable to spread to other organs or body THROMBOCYTOPENIA – decrease in the number of circulating platelets; associated MALIGNANT – having cells that are with the potential bleeding. characteristic of cancer. HYPERPLASIA – an increase in cell number 3 I PEÑASCOZA  ILOILO DOCTORS COLLEGE NCM 112 COLLEGE OF NURSING S.Y. 2024-2025 LECTURE MEDICAL SURGICAL NURSING NAME: ELIJHA XHANTAL A. PEÑASCOZA HYPERTROPHY – an increase in cell size GENETICS AND FAMILY HISTORY METAPLASIA – replacement of one adult cell 1. Colon Cancer type by a different adult cell type 2. Premenopausal breast cancer DYSPLASIA - changes in cell size, shape and DIETARY HABITS organization 1. Low-Fiber ADENOCARCINOMA – cancer arises from 2. High-fat glandular tissues. 3. Processed foods 4. Alcohol EX. Cancer of the breast, lung, thyroid, colon, and pancreas VIRUSES AND BACTERIA CARCINOMA – a form of cancer that is 1. DNA viruses- Hepa B, Herpes, EBV, composed of epithelial cells; develops in CMV, Papilloma Virus tissues covering or lining organs of the body 2. RNA Viruses- HIV such as skin, uterus or breast 3. Bacterium- H. pylori SARCOMA – a cancer of supporting or IMMUNE DISEASE connective tissues such as cartilage, bones, 1. AIDS muscles of fats GRAFT – VERSUS – HOST DISEASE (GVHD) an immune response initiated by T lymphocytes or T cells of donor tissue against the recipient tissues ( skin, GIT, liver); UNDESIRABLE RESPONSE T – Cells are WBC that helps the immune system fight against infected host cells, producing cytokines and regulating the immune response. CANCER DIAGNOSIS GRAFT-VERSUS- TUMOR EFFECT BIOPSY - The most definitive the donor immune cell response CT, MRI against the malignancy. Desirable Tumor Markers response. CANCER STAGING ETIOLOGY OF CANCER Uses the T-N-M staging system PHYSICAL AGENTS T- tumor 1. Radiation N- Node 2. Exposure to irritants M- Metastasis 3. Exposure to sunlight ➔ Used to describe the extent of cancer CHEMICAL AGENTS spread in the body. ➔ Help determine prognosis & guide 1. Smoking treatment. 2. Dietary ingredients 3. Drugs 4 I PEÑASCOZA  ILOILO DOCTORS COLLEGE NCM 112 COLLEGE OF NURSING S.Y. 2024-2025 LECTURE MEDICAL SURGICAL NURSING NAME: ELIJHA XHANTAL A. PEÑASCOZA PROMOTION Tx – tumor not adequately assess Repeated exposure to carcinogens causes T0 – no evidence of primary tumor proliferation and expansion of initiated cells T1 – T4 = size of the tumor with increase abnormal genetic formation. Generally leads to the formation of preneoplastic or benign lesion. Nx - cannot evaluated N0 - no lymph node involvement PROGRESSION N1-N3 = number and/or extent of spread to The altered cells exhibit increasingly nearby lymph node, within higher number malignant behavior. more extensive involvement These cells has the ability to stimulate Mx - cannot be evaluated angiogenesis ( growth of new blood vessels to allow cancer cells to grow), to invade M0 - No distant / Did not spread adjacent tissues and to metastasize M1 - Distant metastasis is present ROLE OF IMMUNE SYSTEN x - cannot be evaluated When the Immune system fails to identify 0 - no evidence and stop the growth of transformed (abnormal) cells, a tumor can develop and 1 -4 =present progress. CANCER GRADING Patients who are immune compromised have an increased incidence of developing CLASSIFICATION OF CELLS cancer. ★ Grade 1 – well-differentiated (benign) Post transplanted client who are receiving ★ Grade 2 – moderate immunosuppressive therapy to organ well-differentiated (borderline) rejection ★ Grade 3 – poorly differentiated Acquired immune deficiency syndrome ★ Grade 4 – very poorly differentiated > Kaposi sarcoma ( a cancer that forms in the lining of blood and lymph vessels Grade 3 & 4 - malignant Patients who were previously treated for CARCINOGENESIS ONE cancer are at risk for secondary cancer. - malignant transformation GENERAL MEDICAL MANAGEMENT INITIATION carcinogens ( substance that can cause Surgery- cure, control, palliate cancer ) Chemotherapy Radiation therapy Causes mutations in the cellular DNA Normally these alteration are reverse GENERATIVE PROMOTIVE by DNA repair mechanism or and changes initiate programmed PREVENTIVE NURSING MANAGEMENT cellular death (APOPTOSIS). On this stage the mutation are not 1. Lifestyle Modification significant until the second step 2. Nutritional Management 5 I PEÑASCOZA  ILOILO DOCTORS COLLEGE NCM 112 COLLEGE OF NURSING S.Y. 2024-2025 LECTURE MEDICAL SURGICAL NURSING NAME: ELIJHA XHANTAL A. PEÑASCOZA 3. Screening Hair Loss 4. Early Detection Fatigue Disturbance in body image/ SCREENING depression MALE and FEMALE NURSING INTERVENTION 1. Occult Blood MAINTAIN TISSUE INTEGRITY 2. CXR Handle skin gently 3. DRE (Digital Rectal Exam) Do NOT rub affected area Lotion may be applied FEMALE Wash skin only with SOAP and Water 1. SBE ( Self Breast Examination) MANAGEMENT OF STOMATITIS 2. Mammography Use soft-bristled toothbrush 3. Pap’s Smear (Swab in Cervix) Oral rinses with saline gargles/ tap water MALE Avoid ALCOHOL-based rinses 1. DRE for prostate MANAGEMENT OF ALOPECIA 2. Testicular self-exam Alopecia begins within 2 weeks of WARNING SIGNS OF CANCER therapy Regrowth within 8 weeks of termination ○ but not like the original state of the hair Encourage to acquire wig before hair loss occurs Provide information that hair loss is temporary BUT anticipate change in texture and color RELIEVE PAIN Mild pain- NSAIDS Moderate pain- Weak opioids Severe pain- Morphine Administer analgesics round the clock with additional dose for breakthrough pain MANAGEMENT COMPLICATION: INFECTION Fever is the most important sign (38.3) Administer prescribed antibiotics X NURSING ASSESSMENT 2 weeks Weight loss Maintain aseptic technique Frequent infection Avoid exposure to crowds Skin problems Avoid giving fresh fruits and veggie Pain Handwashing Avoid frequent invasive procedures 6 I PEÑASCOZA  ILOILO DOCTORS COLLEGE NCM 112 COLLEGE OF NURSING S.Y. 2024-2025 LECTURE MEDICAL SURGICAL NURSING NAME: ELIJHA XHANTAL A. PEÑASCOZA ALKYLATING AGENTS MANAGEMENT COMPLICATION: BLEEDING Cyclophosphamide (CYTOXAN) Thrombocytopenia (