Oncology Nursing 2024 F.pptx

Oncology Nursing Sue Cagir DNP, MS, RN, CNE  Student Learning Outcomes  Identify one’s own feelings regarding the discontinuity of cancer.  Relate the structure and function of the normal cells to the transitions that occur with a cancer cell.  Compare benign and malignant tumors.  Li...

Oncology Nursing Sue Cagir DNP, MS, RN, CNE  Student Learning Outcomes  Identify one’s own feelings regarding the discontinuity of cancer.  Relate the structure and function of the normal cells to the transitions that occur with a cancer cell.  Compare benign and malignant tumors.  List several factors that contribute to carcinogenesis.  Discuss nursing interventions for patients receiving different methods of cancer therapy.  Describe the nurse’s role in primary, secondary, and tertiary cancer prevention and health education.  Investigate complimentary therapies.  Examine various chemotherapeutic drugs and common side-effects.  Identify special monitoring for various cancer treatments. 2 Overview of Cancer Healthy cells transform into malignant cells upon exposure to certain etiological agents –viruses, chemicals, and physical agents. Malignant cells metastasize and extend directly into adjacent tissue, moving through the lymph system, entering the blood circulation, and diffusing into body cavities. Risk Factors Age: Older Women most commonly develop colorectal, breast, lung, pancreatic, and ovarian cancer Older Men most commonly develop lung, colorectal, prostate, pancreatic and gastric cancers Risk Factors Race Genetic disposition Exposure to chemicals, tobacco, alcohol, viruses and bacteria Sun Exposure A diet high in red meat and fat and low in fiber  General Disease- Related Consequences of Cancer Decreasing Immunity and Blood Producing Function Occur most often with leukemia and lymphoma or any cancer that invades the bone marrow and reduces the production of WBCs, RBCs, and platelets, causing thrombocytopenia Increase risk of infection Can be caused by the cancer or chemotherapy Can experience weakness, fatigue and bleeding General Disease- Related Consequences of Cancer Altered GI Structure and Function Impaired absorption and elimination related to tumor obstruction or compression Tumors increase the metabolic rate, increasing the need for protein, fats, and carbohydrates. Liver tumors reduce function and lead to malnutrition.  Motor and Sensory Deficits Occurs when cancers invade the bone or brain or compress nerves Bone metastases cause pain, fractures, spinal cord obstruction, and hypercalcemia, which decrease mobility Sensory changes occur if the spinal cord is damaged by tumor pressure or compression Sensory, motor, and cognitive functions are impaired when cancer is in the brain Pain is often significant, especially in the terminal stages of the disease process Decreased Respiratory Function Disrupts respiratory function and gas exchange (i.e., tumors in an airway cause an obstruction) Lung capacity is decreased, and gas exchange is impaired Tumors can compress blood and lymph vessels in the chest, blocking blood flow through the chest and lungs, causing pulmonary edema and dyspnea  Cancers/Tumors Classified according to the type of tissue from which they evolve Carcinomas begin in epithelial tissue (e.g., skin, gastrointestinal tract lining, lung, breast, uterus) Sarcomas begin in nonepithelial tissue (e.g., bone, muscle, fat, lymph system) Adenocarcinomas arise from glandular organs Leukemias are malignancies of the blood-forming cells Lymphomas arise from the lymph tissue Multiple myeloma arise from plasma cells and affects the bone  Nursing Role for Prevention of Cancer Primary – reducing risk of disease through health promotion – Educate on avoiding known carcinogens – Teach healthy dietary & lifestyle choices Secondary – screening & early detection – Cancer screening (mammograms, rectal exams, colonoscopies) Tertiary – monitoring for & preventing recurrence, screening for 2⁰ cancers – Regular follow-ups – Multidisciplinary collaborative team approach to maintain health and rehabilitation. 11  Health Promotion and Disease Prevention Healthy Diet – low fat, increased fruit vegetables, and lean protein Limit intake of sugar, salt, processed foods, and red meats Maintain a healthy body weight/body mass index Limit alcohol consumption to one drink per day (females) and 2 drinks per day for males Avoid risky lifestyle choices (recreational drugs use, needle sharing, unprotected sexual intercourse) Avoid exposures to environmental hazards (radiation, chemicals)- use personal protective equipment when available Health Promotion and Disease Prevention Breastfed infants exclusively for the first 6 months of life Engage in physical activity or exercise routinely Protect skin and eyes from UVA and UVB rays Remove at-risk tissue such as moles to prevent conversion to skin cancer Chemoprevention Chemoprevention is the use of medication or other substances to disrupt cancer development Aspirin and celecoxib to reduce the risk of colon cancer Vitamin D and tamoxifen to reduce the risk of breast cancer Immunizations to prevent human papillomavirus (HPV), which is associated with cervical, anal, head, and neck cancers Immunizations for Hepatitis B to prevent liver disease, which can progress to liver cancer  Screening Recommendations Mammograms Clinical Breast Exams Colonoscopy Fecal Testing Prostate screening – Prostate-specific antigen testing (PSA) Screening for gene mutation – for clients who have a strong family history of breast, or colon cancer Pap Test – starts at age of 21 years-old Low-dose helical Cat Scan – for healthy adults who are current or former smokers aged 55- 74 years with a 30 –year pack history either currently smoking or abstained within the last 15 years Assessments- Risk Factors Age – cancer risks usually increase with age Immune factors- an increased risk with immunosuppressed Chronic irritation and tissue trauma- Race Genetic predisposition Exposure to chemicals, tobacco, and alcohol Diet – high in fat, red meat, processed meat, preservatives and additives and low in fiber Other Manifestations Weight loss (unintentional) Fatigue/weakness Pain (may not occur until late in the disease process) Nausea/anorexia Cancer Management Systemic or local medications used to cure and/or increase the survival rate by damaging cell DNA and interfering with cell mitosis Rapid-growth tumors are more sensitive to chemotherapy Chemotherapy Systemic or local cytotoxic medication that damages a cell’s DNA or destroy rapidly dividing cells A combination of medications usually given  Classification (all-cause bone marrow depression) Alkylating Agents Mechlorethamine, cyclophosphamide. cisplatin Antimetabolite Fluorouracil, methotrexate Antibiotic Doxorubicin hydrochloride, bleomycin, dactinomycin Antimitotics Vincristine, vinblastine Hormones Estrogen, progesterone, tamoxifen citrate, paclitaxel Biological Epoetin alfa, filgrastim modifiers  Common Side Effects and Interventions to Counteract Bone Marrow Suppression: neutropenia and leukopenia (WBC less than 1,000 mm3) Interventions to enhance the immune system include a balanced diet, ret and handwashing Interventions to avoid infections include: – Limit visitors who might be ill – Avoid fresh fruits, vegetables, and live plants Monitor temperature. Consider any temperature elevation in a client with neutropenia a possible sign of infection and report to provide Common Side Effects and Interventions to Counteract Anemia (Hgb less than 10 g/dL) Administer oxygen therapy; provide iron-rich foods Monitor CBCs and administer blood transfusions as needed Administer erythropoietin and epoetin alfa to increase RBCs Thrombocytopenia Administer prescribed platelet transfusion; oprelvekin to increase platelets. Implement bleeding precautions; avoid use of aspirin  Common Side Effects and Interventions to Counteract Alopecia (hair loss 2 weeks after the start of treatment. Regrowth occurs 1 month after the last chemotherapy treatment Apply ice to the client’s scalp during chemotherapy to slow hair loss. Use a gentle shampoo, hats, scarves, and sunscreen Refer client to the American Cancer Society which provides wigs and supportive services  Common Side Effects and Interventions to Counteract Anorexia, Nausea, Vomiting, and GI Issues Administer antiemetic before therapy: ondansetron, dolasetron Administer loperamide to manage diarrhea The client would drink cool beverages and eat small favorite meals high in potassium with high-calorie supplements. Avoid unpleasant odors Provide soft, bland high-protein foods at room temperature for stomatitis and use a straw for fluids. Rinse mouth with a topical anesthetic May need topical steroids and zinc supplements  Common Side Effects and Interventions to Counteract Elevated Uric Acid, Crystal, and Urate Stone Formulation Administer allopurinol; increase IV fluids Mucositis: Often develops in the GI tract, especially in the mouth (stomatitis) Mucous membranes because they undergo rapid cell division- are killed more rapidly than the cells are replaced Provide frequent mouth assessment and oral mucosa, including teeth cleaning and mouth rinsing. Avoid traumatizing oral mucosa due to the risk of bleeding, use soft tissue toothbrushes or swabs Specific Medications have specific Toxic Effects Doxorubicin hydrochloride irreversible cardiomyopathy Anzemet, methotrexate: renal toxicity Vincristine sulfate: peripheral neuropathy Cognitive Function - Chemo Brain Reduce ability to concentrate, recall information, and learn new information during treatment and for months to 3 years following treatment Most common in women treated for breast cancer Radiation Therapy destroys cancer cells with minimal exposure of normal cells to the damaging actions of radiation. Cells damaged by radiation either die or become unable to divide Gamma rays are used most commonly because of their ability to penetrate tissues and damage cells. Radiation Delivery – Teletherapy – Brachytherapy  Radiation Teletherapy: distance treatment; the radiation source is external to the client Brachytherapy: Short or close therapy; radiation comes into direct, continuous contact with the tumor tissues Provides a high dose of radiation with a limited amount to surrounding tissue  In Brachytherapy, the radiation source is within the client, who emits radiation and is a hazard to those around for a period of time Brain Cancer Breast Cancer Cervical, Uterus Cancer Prostate Cancer Eye Cancer Among others  Radiation Nursing Interventions Ensure precise client positioning with each radiation treatment to align with fixing devices and markings. Assess the condition of skin and cleanse the area gently each day with water or mild soap Wet reaction: skin’s response to radiation; skin becomes dry or develops blisters that may break, causing pain and potential for infection IF dry reaction, keep it clean and lubricated If wet reaction, clean and cover to prevent infection  Radiation Nursing Interventions Instruct client to not remove skin markings; avoid powders, lotions, and creams unless prescribed by a provider Instruct client to wear soft, loose clothing and avoid exposure to the sun Advise client to avoid prolonged sun exposure during treatment and for one year after completing radiation therapy  Radiation Nursing Interventions-Sealed Implants Assist the client in a private room. Place a “Caution Radioactive Material” sign on the client’s door in the hospital setting Wear a lead apron while providing care; pregnant nurses should not care for these clients. Limit visitors to ½ hour each day and instruct them to remain at least 6 feet from the source Do not touch the radioactive sources with bare hands Save all radioactive dressing and liens until the radioactive source is removed Follow institution guidelines for radiation containment Managing Cancer Pain Provide effective pain management and monitor the client’s response Assess body image disturbances, coping mechanisms, and support systems and make appropriate referrals Complimentary Therapy Mind-Body Connection Hypnosis Deep Tissue Massage Prayer and Spirituality THC – Marijuana Acupuncture Many More…. References ATI nursing - assessment technologies institute. (2019). Content mastery series review module: Registered nurse adult medical surgical nursing (11.0 ed.).