Oncology and Nursing Management PDF

ONCOLOGY: NURSING MANAGEMENT IN CANCER CARE ONCOLOGY Neoplasia: New growth of tissue Tumor: “swelling” is characterized by an abnormal cell growth more than they should, which; Does not have any borders or restrictions. Metastasis: Ability to spreading.  GROUPS AND COMPONENT Tumors can be sep...

ONCOLOGY: NURSING MANAGEMENT IN CANCER CARE ONCOLOGY Neoplasia: New growth of tissue Tumor: “swelling” is characterized by an abnormal cell growth more than they should, which; Does not have any borders or restrictions. Metastasis: Ability to spreading.  GROUPS AND COMPONENT Tumors can be separated into two groups according to their behavior / parenchymal component 1) Benign Tumor (not cancerous) 2) Malignant Tumor (cancerous) Any of the malignant tumors is called cancer. All the tumors whether benign or malignant have 2 basic components. 1) Parenchyma; consists of proliferated neoplastic cells 2) Stroma; Supportive tissue consisting of connective tissue and blood vessels, lymphocytes. Enlargement and development of tumors is depending on stroma (adequate perfusion)  NOMENCLATURE -OMA AT THE END OF BENIGN TUMOR; Fibroma, chondroma, etc. mesenchymal cell tumors usually abide by this rule Epithelial tumors; adenoma (gland originated) Malignant tumor ; Epithelial; Carcinoma: Adenocarcinoma, squamous cell carcinoma, Mesenchymal; Sarcoma: Fibrosarcoma. EPITHELIAL DIFFERENCES BETWEEN BENIGN AND MALIGNANT TUMOR BENIGN TUMOR MALIGNANT TUMOR Resembles normal cells (well Doesn’t resemble normal differentiated) cells (undifferentiated) Mitosis is rare Mitosis is frequent Slower growth rate Grows fast Growth can come to halt Rarely stops growing Capsulated Uncapsulated Noninvasion Makes invasion Does not make metastasis Metastasis frequently Mild compression findings might be seen Compression findings and other symptoms METASTASIS  CANCER  A disease process that begins when an abnormal cell is transformed by the genetic mutation of cellular DNA  The abnormal cells have invasive characteristics and infiltrate other tissues.  This phenomenon is metastasis.  Cancer cells are described as malignant. These cells demonstrate uncontrolled growth that does not follow physiologic demand. MALIGNANT PROCESS  Cell proliferation: uncontrolled growth, with the ability to metastasize and destroy tissue and cause death  Cell characteristics: presence of tumor-specific antigens, altered shape, structure, and metabolism  Metastasis:  Lymphatic spread  Hematogenous spread  Angiogenesis  Carcinogenesis CARCINOGENIC AGENTS AND RISK FACTORS  Viruses and bacteria  Physical factors: sunlight, radiation, chronic irritation  Chemical agents: tobacco, asbestos  Genetic and familial factors  Diet  Hormones  Role of the immune system AGE: Cancer incidence increases with age (accumulation of somatic mutations, weakened immunity) Cancer is the second most common cause of mortality after accidents in children; leukemia. ENVIRONMENTAL FACTORS: When relation of environmental exposure and cancer is inspected, significant relations between; - Workplace: asbestos, vinyl chloride, - Nutrition; obesity, - Behaviors; alcohol, smoking, STD - Viral diseases, - Alcohol; oropharynx, larynx, esophagus, Liver - SMOKING; Lung, lips, pharynx, larynx, esophagus, pancreas, bladder cancer are found. EARLY WARNING SIGNS FOR CANCER  Cancer 7 early warning signs ( CAUTION ) Change in bowel or bladder habits. A sore that does not heal. Unusual bleeding or discharge. Thickening or lump in breast or scrotum. Indigestion or difficulty in swallowing Obvious change in a mole or wart. Nagging cough or hoarseness. PRIMARY AND SECONDARY PREVENTION Primary prevention is concerned with reducing cancer risk in healthy people.  Secondary prevention involves detection and screening to achieve early diagnosis and intervention.  There is now great emphasis on the primary and secondary prevention of cancer. PRIMARY PREVENTION  Avoid known carcinogens.  Lifestyle and dietary changes to reduce cancer risk  Public and patient education SECONDARY PREVENTION  Identification of patients at high cancer risk  Cancer screening  Self-breast exam  Self-testicular exam  Screening colonoscopy  Pap test  Public and patient education DIAGNOSIS OF CANCER  Diagnostic Tests Tumor staging and grading TNM classification  Staging: determine size of tumor and the existence of metastasis - TNM classification used: T→ extent of primary tumor N → lymph node involvement M → extent of metastasis  Grading: classification of tumor cells - Used to define the type of tissue from which the tumor cell originate, and the degree to which the tumor cells retain the functional characteristic of the tissue of origin - Obtained through biopsy or surgical excision - Grading from I- IV - I : well differentiated tumors, closely resemble the tissue of origin in structure and function - IV: poorly differentiated tumors, not clearly resemble the tissue of origin in structure or function T = tumor size e.g. 0 – No evidence of primary tumor  T I, II, III & IV – number allocated to size of primary tumor.  I represents smallest size, ranging up to stage IV. N = Regional lymph node involvement  N0: tumor cells absent from regional lymph nodes  N1: tumour cells spread to closest or small number of regional lymph nodes  N2: tumor cells spread to an extent between N1 and N3.  N3: tumor cells spread to most distant or numerous regional lymph nodes M = metastasis  M 0 – no evidence of distant metastatic spread.  M I – evidence of distant metastatic spread. STAGES CANCER MANAGEMENT  Cure ( complete eradication of malignant disease)  Control ( prolonged survival)  Palliation ( relief of symptoms associated with the disease especially pain) SURGICAL TREATMENT  Diagnostic surgery  Biopsy: excisional, needle, incisional  Tumor removal: wide excision, local excision  Prophylactic surgery  Reconstructive surgery  AS goal  The A PRIMARY TREATMENT is to remove the entire tumor and any involved surrounding tissue  2 approach: 1- local excision : used when mass is small, it includes removal of the mass and a small margin of normal tissue. 2- wide (radical) excision : considered when tumor can be removed completely and the chance of cure or control is good, include removal of tumor, L.N, adjacent and surrounding tissue of high risk for tumor spread  DIAGNOSTIC SURGERY  Used to obtain biopsy for analysis  From the tumor or from L.N near the suspicious tumor  3 types: 1- Excisional:  Used for easily accessible tumor of the skin, breast, URT, upper and lower GIT  Entire tumor with surrounding marginal tissue is removed  It helps in ↓the chance of disseminating cancer cell through surrounding tissue  Performed through endoscopy 2- Incisional biopsy:  Performed when tumor mass is too large to be removed  Wedge of tissue from the tumor is removed for analysis  Performed through endoscopy 3- needle biopsy:  Performed to obtain sample from suspicious mass that are easily accessible as growth in breast, thyroid, lung, liver and kidney  Fast, inexpensive, easy to perform, required local anesthesia 2- Incisional biopsy:  Performed when tumor mass is too large to be removed  Wedge of tissue from the tumor is removed for analysis  Performed through endoscopy 3- needle biopsy:  Performed to obtain sample from suspicious mass that are easily accessible as growth in breast, thyroid, lung, liver and kidney  Fast, inexpensive, easy to perform, required local anesthesia  Palliative surgery: - Used when cure is not possible - Goal: to make pt comfortable as possible and to promote a satisfying and productive life - Performed to relive complications as pain, ulceration, bleeding, effusion - E.g colostomy →when there is bowel obstruction pleural tube placement → for pleural effusion  Reconstructive surgery: - Followed curative or radical surgery - Performed to improve function, and done in one operation or in stages - May indicated for breast, head, neck and skin cancer. NURSING MANAGEMENT IN CANCER SURGERY  Pre op assessment for factors that affect pt  Education and emotional support  Communicate frequently with Dr and other health care member to be certain that provided information is consistent  After surgery the nurse assess pt response to surgery, and monitor him for complication (infection, bleeding, thrombophlebitis, fluid and electrolyte imbalance  Teach pt about wound care, activity, nutrition and medications RADIATION THERAPY  Curative, control, or palliative  External radiation  Internal radiation  Radiation reactions  Effect on the GI system  Effect on bone marrow  Systemic effects  Long-term effects and tissue changes  RADIATION THERAPY  It is the use of ionizing radiation to interrupt cellular growth  > 1\2 of pt with cancer receive it at some point during treatment  Used to cure thyroid carcinoma, cancer of uterine cervix, Hodgkin disease  Used to control disease when tumor cannot removed or when metastasis is present  It can used prophylacticaly to prevent leukemia infiltration to brain or spinal cord  It breaks the strand of DNA helix leading to cell death  2 types used: 1- electromagnetic rays ( X-rays & gamma rays) 2- particles ( electrons, protons, and alpha particles)  Radiation delivered to tumor by external or internal means  External radiation: - Uses depend on depth of the tumor - They use x-rays to destroy cancerous cells at the skin surface or deeper in the body - The higher the energy the deeper the penetration into the body  Internal radiation: - Or brachy therapy - It deliverers high dose of radiation to localized area - Can be implanted by needles, seeds, catheters into body cavities, it can administered orally - Pt contact with personnel is minimize to decrease exposure to radiation - Pt placed in private room, the staff member wear protective clothing, hr’s of visit limits to 30min\day , and 6 feet distance  Radiation dosage: - Depend on the target tissue sensitivity to radiation, and on the tumor size - Lethal tumor dose: is the dose that will eradicate 95% of tumor yet preserve normal tissue - It delivered over several weeks to allow healthy tissue to repair, and to achieve greater cell kill NURSING CARE OF THE PATIENT UNDERGOING RADIATION THERAPY  Patient and family education  Include restrictions and precautions  Skin care  Oral care  Protection of care providers  TOXICITY FROM RADIATION THERAPY The effect:  Altered skin integrity (alopecia, erythema)  Altered oral mucosa (stomatitis, xerostomia (mouth dryness, change & taste loss, decrease salivation)  Esophageal irritation with chest pain and dysphasia  Anorexia, nausea and vomiting & diarrhea  Anemia, leukopenia and thrombocytopenia  Fatigue and malaise  NURSING MANAGEMENT IN RADIATION THERAPY  The nurse explain the procedure for delivering radiation, describe the equipment, duration of procedure, possible need for immobilization  If implant is used the nurse informs pt and family about restrictions placed on visitors  Explain to the pt his role before, during and after procedure  Assess pt skin, nutritional status, oral mucosa for change  Pt skin protected from irritation and instructed to avoid using ointment, lotions or powder on the area  Provide oral hygiene to remove debris and promote healing  If pt feel fatigue assist him in activity of daily living  Explain that fatigue and malaise are S\E from Rx and not indicate deterioration  Explain purpose from isolating pt CHEMOTHERAPY  Agents used to destroy tumor cells by interfering with cellular function and replication  Curative, control, or palliative  Used to treat systemic disease rather than localized lesion.  It administer in coordination of cell cycle  Cell cycle time: time required for one cell to divide and reproduce 2 identical daughter cells  Types of chemotherapeutic agents PHASES OF CELL CYCLE CLASSIFICATION OF CHEMOTHERAPY  Cell cycle specific agent ( specific to certain phase of cell cycle).  Cell cycle non specific agents (act independently of cell cycle phase).  It classified by chemical group as alkalizing agents, antimetabolites, antitumor antibiotics, hormonal agent.  CHEMOTHERAPY ROLES AND CHEMOTHERAPEUTIC AGENTS ADMINISTRATION OF CHEMOTHERAPY  Routes of administration  Problem of extravasation  Increased risk for fluid and electrolyte imbalances  Risk for infection  Risk for bleeding  Protection of caregivers ADVERSE EFFECTS OF CHEMOTHERAPY  Toxicity  GI effects: nausea and vomiting, diarrhea, mucositis, and stomatitis  Hematopoietic effects: myelosuppression  Renal damage  Cardiopulmonary system: potential cardiac toxicities  Reproductive system: potential sterility, potential reproductive cell abnormalities  Neurologic effects BONE MARROW TRANSPLANTATION (BMT)  Used for hematologic cancers that affect the marrow or solid tumors, which are treated with a chemotherapy dosage that ablates the bone marrow  Graft-vs.-host disease  Venous occlusive disease  NURSING PROCESS FOR PT WITH CANCER  Assessment: - Assess factors promote infection (chemotherapy, malnutrition, intravenous catheter, age, contaminated equipment,…) - Monitor lab test as WBC’s - Assess S&S of infection - If invasive catheter is placed assess pt for sepsis - Assess pt for factors that may contribute to bleeding as ( chemotherapy, radiation, medications as aspirin, persentein, heparin) - Monitor pt for hemorrhage, melena, hematuria, hemoptysis, hematomesis, ecchymosis, and change in mental status. sputum or vomitus - Assess the pt for any skin problems, note the presence of skin lesions or ulcerations, or lesions in the MM - Note presence of alopecia, and assess it’s psychological impact on the pt - Assess pt nutritional status (if there is wt loss, cachexia (muscle wasting)) - Assess pt diet history, episode of anorexia, change in appetite, difficulty in swallowing, presence of N,V&D - Assess source and site of pain - Assess factors increase pt pain as fear, anger, fatigue, social isolation - Assess for chronic fatigue, and assess stressors contribute to fatigue as ( pain, dyspnea, fear, anxiety, and constipation) COMMON NURSING DIAGNOSES  Impaired oral mucosa  Impaired tissue integrity  Imbalanced nutrition  Chronic pain  Fatigue  Disturbed body image  Coping diagnoses and anticipatory grief COLLABORATIVE PROBLEMS  Infection  Bleeding  Superior vena cava syndrome  Hypercalcemia  Spinal cord compression  Pericardial effusion  Disseminated intravascular coagulation (DIC) HOSPICE  Comprehensive, multidisciplinary approach to the care of patients with terminal illness and their families  Focuses upon:  Quality of life  Palliation of symptoms  Psychosocial and spiritual care ONCOLOGIC EMERGENCIES  Superior vena cava syndrome  Spinal cord compression  Pericardial effusion and cardiac tamponade  Disseminated intravascular coagulation (DIC)  Syndrome of inappropriate secretion of antidiuretic hormone  Tumor lysis syndrome  SUPERIOR VENA CAVA SYNDROME