Oncology Chapter 12 PDF

Management of Patients With Oncologic Disorders Chapter 12 Dr. Alberti Molloy University  Compare the function & behavior of normal and cancer cells Identify the agents and factors that are carcinogenic the role of nurses...

Management of Patients With Oncologic Disorders Chapter 12 Dr. Alberti Molloy University  Compare the function & behavior of normal and cancer cells Identify the agents and factors that are carcinogenic the role of nurses in health education and prevention Describe of oncologic disorders Objectives Differentiate among the goals of cancer care prevention, diagnosis cure, control and palliative care the roles of surgery, radiation therapy, chemotherapy Describe & stem cell transplantation the nursing process as a framework for the care of Utilize patients with cancer *** Epidemiology Ø 2nd leading cause of death in the U.S. Ø Older adults > 55 yrs. Old Ø Racial disparities Is the following statement Malignant tumors spread by true or false? way of blood and lymph channels to other areas of the body  Rationale: Malignant tumors spread by way of blood and lymph channels to other areas of the body. Cells bear little resemblance to the normal cells of the tissue from which they arose True Cancer Disease process that begins when a cell is transformed by genetic mutation of cellular DNA ____________: Abnormal cells invade surrounding tissue and gain access to lymph and blood vessels carrying them to other areas of the body Malignant cancer cells: cells or processes that are characteristic of cancer Benign cancer cells: cells that are not cancerous Characteristics of Benign and Malignant Neoplasms (table 12-1) Benign Malignant Cells can spread Cells tend not to spread Usually grow rapidly Most grow slowly Often invade basal membrane that surrounds Do not invade nearby tissue nearby healthy tissue Do not metastasize (spread) to other Can spread via bloodstream or lymphatic parts of the body system, or by sending "fingers" into nearby Tend to have clear boundaries tissue May recur after removal, sometimes in areas other the original site Carcinogensis Malignant transformation Three-step process Initiation: apoptosis (cell death) Promotion: preneoplastic/benign lesions Progression: angiogenesis (growth of new blood vessels that allow cancer cells to grow) Carcinogenic Agents and Factors Physical agents: Chemical agents: sunlight, Genetic, familial Viruses, bacteria tobacco, radiation, chronic factors asbestos irritation Lifestyle factors Hormonal agents Ø Primary prevention: Refer to Chart 12-2 Ø Secondary prevention: Refer to Table 12-3 Ø Tertiary prevention Prevention Health Promotion & Disease Prevention o Healthy diet o Healthy weight, Body mass index (BMI) o Limit alcohol consumption o Avoid exposure to environmental hazards o Engage in physical activity o Protect skin and eyes from UVA/UVB o Remove at risk-tissue (moles) Screening recommendations o Mammogram o Clinical breast exam o Colonoscopy o Fecal testing o Prostate screening o Screening for gene mutations o Pap test Cancer warning signs C= A= U= T= I= O= N=  Determine Identify Diagnosis of Cancer Evaluate Obtain Tumor Staging Grading Ø GX: cannot be determined Ø G1: tumor cells are well differentiated Ø G2: tumor cells are moderately differentiated Ø G3: Poorly differentiated, but tissue of origin can be established Ø G4: more aggressive, less responsive to treatment Management of Cancer Specific to type, stage, grade of cancer Cure: Control: Palliation:  Case Study Emanuel Jones, 60 years of age, is a male patient diagnosed with small cell carcinoma. He underwent surgery in the past to remove the left lower lobe of his lung. He is receiving chemotherapy. Two weeks before a round of chemotherapy, a complete blood count with differential, and a renal and metabolic profile are obtained for the patient. The patient presents to the oncology clinic for chemotherapy with a temperature of 101°F. Further assessment reveals decreased breath sounds in the right base of the right lung, and a productive cough expectorating green-colored mucus. The patient is short of breath and has a pulse oximetry reading that is SaO2 of 85% on room air. The patient has a history of benign prostate hypertrophy (BPH) and has complaints of urinary frequency and burning upon urination. The patient is admitted to the oncology unit in the hospital. The oncologist orders the following: blood, sputum, and urine cultures; and a chest x-ray. An x-ray of the kidneys, ureters, and bladder (KUB) is ordered. An arterial blood gas (ABG) on room air, CBC with differential, and renal and metabolic profile are ordered. Oxygen is ordered to begin with nasal cannula at 2 L/min and titrate to keep SaO2 greater than 90%. A broad-spectrum antibiotic, levofloxacin, 500 mg in 100 mL of NS is prescribed to be administered IV over 60 minutes once daily.  A. After examining the physician’s orders, in what sequence should the nurse provide the care to the patient admitted to the hospital? Give the rationale for the sequence chosen. Nursing B. On what areas should the nurse focus the assessment to detect potential complications for Mr. Jones? Management C. What patient education does Mr. Jones need from the nurse to help prevent the reoccurrence of an infection and to get treatment for an infection promptly?  A. Diagnostic Which type of B. Palliative surgery is being done when lesions C. Prophylactic that are removed D. Reconstructive are likely to develop into cancer?  Rationale: The type of surgery being done when lesions that are removed are likely to develop into cancer is called C. Prophylactic prophylactic surgery. Surgical Treatment Diagnostic surgery/Biopsy: excisional, needle, incisional Tumor removal: wide excision, local excision Prophylactic surgery: ex-mastectomy Palliative surgery Reconstructive surgery: improve function/cosmetic  Nurse as advocate & liaison Individualized to age, organ involvement, comorbidities Nursing Combination with radiation & chemotherapy Management Assess: infection, bleeding, thrombophlebitis, wound dehiscence, fluid & electrolyte imbalance, organ dysfunction Discharge care  Curative: thyroid, localized cancers of head & neck, cervix Radiation Control: when tumor can’t be removed (prostate, Therapy breast, lung) Palliative: relieve symptoms (spinal mets, brain)  Repeated treatments over time Depends on depth of tumor External Radiation reactions Radiation Toxicity Nursing Management External -radiation markings -education & premedicate, encourage not to miss appointment -side effects maybe systemic-fatigue, altered taste, bone marrow suppression -skin-sunburn, sloughing, dry scaly, itchy, blisters, permanent discoloration, hair loss -mild soap or water alone, Eucerin, cornstarch powder -educate to avoid sun exposure, tightly fitted clothes, harsh fabrics, detergent, no deodorant, or perfumes, use electric razor Internal Radiation Brachytherapy -high dose to a localized area -can be implanted by means of seeds, beads or catheters into body cavities or interstitial compartments; can be administered orally -sealed source-intracavity; unsealed-drink Internal Radiation (cont.) Intracavity radioisotopes-gynecologic cancers; remain in place for prescribed period and then are removed. -bedrest and log-rolled to prevent displacement; urinary catheter, low-residue diet and antidiaherrial agent Interstitial Implants -treating prostate, pancreatic or breast -temporary or permanent-depending on the radioisotopes used- may have short half-life -implants consist of seeds, needles, wires or small catheters positioned to provide a local radiation source and less frequently dislodged. -farther away the tissue from the radiation source, lower the dosage. Nursing Management Intracavity and some interstitial: radiation source may emit radiation while the implant is in place: PRECAUTIONS: -private room, sign on doors, limit visitors, maintain 6-foot distance from radiation source. -contacts with healthcare team are guided by principles of time, distance and shielding to minimize exposure. Nursing Care of the Patient Undergoing Radiation Therapy Promote healing, patient comfort, quality of life Assessment ü Skin ü Nutritional status ü Well-being Protecting caregivers  Agents used in attempt to destroy May be combined with cancer cells by surgery, radiation interfering with cellular therapy, or both function, replication Chemotherapy Curative, control, or Cell kill and cell cycle palliative Chemotherapy Administration Dosage Extravasation Hypersensitivity reactions Central catheters Chemotherapy Toxicity Gastrointestinal Hematopoietic Renal Cardiopulmonary Reproductive Neurologic Cognitive Fatigue Nursing Management in Chemotherapy Assessing Assessing Modifying Administering Preventing Managing Protecting Assessing Assessing Modifying Administering Preventing Managing Protecting fluid, cognitive risks for chemotherapy nausea and fatigue caregivers electrolyte status infection, vomiting status bleeding Hematopoietic Stem Cell Transplantation (HSCT) Used to treat several malignant and nonmalignant diseases Types of HSCT Allogeneic Autologous Syngeneic Myeloablative Nonmyeloablative  Implementing pretransplantation care Providing care during Nursing treatment Management in Providing posttransplantation care HSCT Caring for recipients Caring for donors Hyperthermia  Maintaining tissue integrity Stomatitis Nursing Care of Radiation-associated impairment of skin integrity Patients with Alopecia Malignant skin lesions Cancer (***see chart 12-6)  Promoting nutrition Nutrition Nutritional impairment Anorexia Malabsorption Nursing Care of Cancer-related anorexia-cachexia syndrome Pain Relieving pain Patients with Fatigue Decreasing fatigue Cancer (cont.) Body Improving body self image Image Complications Malnutrition Nursing actions Increased risk for weight loss & anorexia Administer antiemetics/antacids as Impair body’s ability to ingest, digest, prescribe absorb nutrients Monitor lab data (albumin, ferritin) Cancer treatment: affect desire for food Oral hygiene Limit liquids during meals Collaborate with dietician Infection Minimize exposure Assess patient for to people, evidence of handwashing, Electric razor infection (include family in education) Pain Management Monitoring and Managing Potential Complications Infection Septic shock: life threatening Bleeding, hemorrhage (p. 369) Hospice Should be referred in a timely fashion Comprehensive, multidisciplinary approach to care of patients with terminal illness, their families Focuses on Ø Quality of life Ø Palliation of symptoms Ø Psychosocial, spiritual care Concept Map Presenting Symptoms Medical history Clinical data Nursing problem Nursing problem Nursing problem Concept Map Nursing problem/diagnosis # 1 Nursing Nursing Patient goals intervention intervention Nursing Nursing intervention intervention