Oncology-Nursing.pdf

ONCOLOGY NURSING Classification of Cancer: Common Terminologies Squamous cell carcinoma – surface epithelial Oncogene – cancer genes that alter normal genes Adenosarcoma – glandular epithelial Proto oncogenes...

ONCOLOGY NURSING Classification of Cancer: Common Terminologies Squamous cell carcinoma – surface epithelial Oncogene – cancer genes that alter normal genes Adenosarcoma – glandular epithelial Proto oncogenes – repressed oncogene that can Fibrosarcoma – fibrous connective tissue activated by etiologic and risk factors Liposarcoma – adipose tissue Anaplasia – no resemblance to tissues of origin Chondrosarcoma – cartilage Metaplasia – replacement of the original cell with Osteosarcoma – bone another type of cell Hemangiosarcoma – blood vessels Carcinoma – cancer cell composed of epithelial cells Lymphangiosarcoma – lymph vessels that can spread Leiomyosarcoma – smooth muscles Neoplasm – growth of new tissue Rhabdomyosarcoma – striated muscles Tumor – same with neoplasm Glioma – glial cells Dysplasia – alteration in the size, shape and Neurolemic sarcoma – nerve sheath organization of differentiated cells Leukemia – blood Hyperplasia – an increase in the number of normal cells Classification of Benign: Glandular tissue – adenoma Bone – osteotoma Cancer Cells Nerve cells – neuroma Fibrous tissue - fibroma Tumor can be: BENIGN MALIGNANT Localized Systemic Etiology Encapsulated Non encapsulated Exact cause is still unknown Hyperplasia, Anaplasia, metaplasia Viruses – cancer of the liver, burkitt’s lymphoma ↑ functional activity (↑ or ↓ function of the Chemical Agents – tar, asphalt, arsenicals, fuels, oil organ involved) Drugs – chemodrugs No metastasis With metastasis Physical Agents – radiation (direct invasion, lymphatic, Predisposing Factors: embolism, diffusion) Age – (60% of cancer clients are over 65 y/o) Fatal if it occurs in Harmful Sex – Breast cancer for females and Prostate CA for restricted area (skull) males Fully differentiated Hardly differentiated Geographic location – cancer of the stomach (Japan) Slow growth Rapid growth Occupation – factory workers (lung cancer) Hereditary – breast, ovaries and colon Diet – cured and salted foods (stomach) Cancer Stress – decreased immune system Synonymous to death and pain Precancerous lesions – moles, polyps (colon and Chronic disease that has acute exacerbation stomach) Not a single disease with single cause Common in men Early Detection: (SECONDARY) Leading cancer is lung cancer Chest xray and sputum cytology (lung cancer) Male: prostate Physical exam (every year for over 40 y/o) skin, Female: breast lymph nodes, mouth, thyroid, breast, testes, rectum, prostate Oral Exam - annually  TSE – monthly following shower Digital Rectal Exam – annually for 40y/o and U terus annual pap smear above B reast regular BSE Sigmoidoscopy – for 50 y/o and above annually B asic PE yearly for all adults for 2 years then every 3 years if negative L ung control or preferably stop smoking, Fecal Occult Blood – doctor’s recommendation annual chest xray for high risk BSE – every month after menstruation O ral annual oral exam by the doctor Breast Clinical Exam – done by physician (every C olon or Rectum DE, 3 years for 20-40 y/o then yearly for over 40 Proctosigmoidoscopy (40y/o) y/o) S kin avoid undue exposure to sunlight (10-2 PM) Mammography – once for 35-40 y/o, then yearly for over 50 y/o Diagnostic Exam Pap smear – age 18 and all sexually active women then yearly after 3 negative results Biopsy Pelvic Exam – same with pap smear FNA Endometrial tissue sampling – menopause Incision Excision Factors that lead to Cancer CT scan Smoking – lung cancer MRI Sunlight (10am to 2pm) – basal/squamous PET cell (skin cancer) Direct Visualization Ionizing Radiation – medical and dental – Bronchoscopy xrays – Gastroscopy Nutrition and diet (high fats and low fiber – Proctosigmoidoscopy diet) Mammogram Alcohol – liver, oral and esophagus cancer Pap smear Chewing of tobacco (mouth, larynx and UTZ throat) Angiogram Estrogen – endometrial cancer Lymphangiogram Occupational hazards (nickel and asbestos) Blood Studies Antigen-skin-testing 7 Warning Signals (CAUTION US) Staging and Grading C hange in bowel and bladder habits T Tumor T0-T4 A sore that does not heal N Node N0-N3 U nusual bleeding or discharge M Metastasis M0-M1 T hickening or lump in breast or elsewhere I ndigestion or difficulty in swallowing Normal T0, N0, M0 O bvious change in wart or mole Stage I T1, N0, M0 N agging cough or hoarseness of the voice Stage II T2, N1, M0 U nexplained anemia Stage III T3, N2, M0 S udden weight loss Stage IV with metastasis Tis – carcinoma in situ (non-infiltrating) X – can’t be assessed 7 SAFEGUARDS Staging System T – Tumor T0-T4 Most often cancer is detected during N – Node N0-N3 routine exam M – Metastasis M0-M3 Questions that need to be answered: Example (Is the disease curable or not?) Tis – carcinoma in situ (non-infiltrating) X – can’t be assessed Client Reaction during Diagnoses Client will use coping strategies to ↓ his anxiety level Normal T0, N0, M0 such as: Stage I T1, N0, M0, < 2cm diameter Denial- of the tumor Rational inquiry-seek more information Stage II T2, N1, M0, > 2 < 5cm diameter Affect Reversal-make light of the situation of the tumor (laughing etc.) Stage III T3, N2, M0, > 5cm diameter Mutuality-share concerns and talk with of the tumor other persons Stage IVany size of the tumor with metastasis Suppression-conscious forgetting Displacement or redirection-do other things Grading System – Microscopic study of the cell – The poorer the differentiation of the cells the Client Reaction during Diagnoses Confrontational poorer is the prognosis Redefine or revise Passive acceptance Carcinogenesis: Process of cancer formation Disengagement Initiation – exposure to carcinogens Externalization or Projection Promotion – exposure to carcinogenic Moral masochism chemicals will promote the function of Compliance and cooperational proto oncogenes Transformation – conversion to malignant cell Intervention Phase Progression – malignant behavior of the Therapeutic communications (silence, non cells judgemental, acceptance, active friendliness, setting limits) Stages of Metastatic Process Strategizing how to use effective coping mechanism (client and SO) Invasion of adjacent tissue Cancer management will involve surgery, Spread of cancer cells radiation, chemo and immunotherapy in Establishment and growth at secondary site combination. Effective Test must be Specific for the type of Cancer Surgery Used in diagnosing, staging and treating the client Reliable FNA, I&E biopsy Economical on terms and benefits Cytology specimens Acceptable to the client (most important) Palliative – relieves pain, airway obstruction. Reconstructive – restore maximal function and Points to Remember appearance Most client fear of death upon confirmation Preventive – removal of target organ of Cancer Clients usually ignored cardinal signs of Cancer Radiation Therapy  Range will be 2,000-5,000 centigrays (cGy) Flush the toilet several times after use Protect staff and visitors ↑ 5,000 cGy will ↑ SE Marked room and kardex with Normal cells and cancer cells are both affected RADIATION HAZARD The goal is to destroy malignant cells without SEALED SOURCE harming normal cells by: radioisotope is placed into needles, beads, Fractionation-small frequent dose seeds, ribbons or catheter then implanted Alternating the site directly into the tumor. Alpha particle-fast moving helium nucleus (slight Requires a private room and bathroom penetration) Room must be lead-shield proof Beta particle-fast moving electron (moderate Lead container and long forcep on bedside penetration) Check linen and other materials for the Gamma ray-similar to light ray (high penetration) presence of isotope Sodium Iodide (131 I)-for thyroid gland Gold (198 Au)-effective for ascites and pleural effusion Chemotherapy Sodium Phosphate (32 P)-for RBC Use of chemicals to destroy cancer cells Destroys the ability of the cell to reproduce by Interferes DNA & RNA activities associated damaging the DNA with cell division Often used in combination with radiation therapy Radiation Safety Cytotoxic - is an agent capable of destroying cells Distance - the greater the distance the Cytotoxic drug - alkylating and antimetabolites lesser the exposure Time - the less time spent close to radiation the less exposure (max of 30 min per shift) Antineoplastic Drugs Shielding - use lead aprons and gloves Standards - kept as low as reasonably Alkylating Agents achievable Attack the DNA of rapidly dividing cell Monitoring device - film badge (measure Nitrosurea: Carmustine (BCNU) the whole exposure of the nurse) Nitrogen Mustard: Chlorambucil (Leukeran) Cyclophosphamide (Cytoxan) Vinca Alkaloids Types of RADIATION Interfere with mitosis (M phase) External Radiation Vincristine (Oncovin) Vinblastine (Velban) – Administered by high energy xray machine Antimetabolites (radioisotope Cobalt for Prostate and Lung Inhibits protein synthesis (S phase) CA) Azathioprine (Imuran) Internal Radiation Fluorouracil (5-FU) – Via injection or orally Methotrexate (Mexate) given with leucovorin to protect normal cells Internal Radiation Antibiotics UNSEALED SOURCE Inhibit RNA Radioisotope is administered IV or orally Doxorubicin HCl (Adriamycin) Mithramycin NaP04 (32 P) IV for polycythemia vera (Mithracin) (131 I) PO for Grave’s disease Potential hazard exist because it’s not Antimetabolites encased Inhibits protein synthesis (S phase) Isotope maybe excreted via body fluids Azathioprine (Imuran)  Fluorouracil (5-FU) Cerebellar toxicity Methotrexate (Mexate) given with leucovorin to Ototoxicity protect normal cells Cardiac Antibiotics Pericardial Effusion Inhibit RNA Arrhythmias Doxorubicin HCl (Adriamycin) Mithramycin CHF (Mithracin) Pulmonary Hormone Pleural Effusion Inhibit RNA and protein synthesis in tissues that Pneumonitis are dependent on the opposite sex GIT Androgens, Estrogens, Progestins, Steroids Stomatitis (Analogue, Exogenous) Esophagitis Hormone Antagonist: Mitotane (Lysodren) Pharyngitis cortisol antagonist, Tamoxifen Citrate Taste alteration (Nolvadex) estrogen antagonist Anorexia Immune Agents Nausea and vomiting Introduction of an agent to stimulate Constipation and diarrhea production of antibodies Weight loss Bacillus Calmette-Guerin (BCG) C&R SIDE EFFECTS GUT C&R Goal: Nephrotoxicity Hemorrhagic cystitis Destroy all malignant cells without excessive Hyperuricemia destruction of normal cell Urine color changes Control growth of tumor when cure is not Reproductive possible Loss of libido Note: all rapid dividing cells (GI mucosa, hair follicles Impotence and bone marrow) are susceptible to the action of Amenorrhea chemo and radiation therapy. Irregular menses Menopausal symptoms Azoospermia Reasons of Combining Drugs Sterility Synergy - two or more agents works together to Gynecomastia enhance the effect Hepatic Adjuvant - an additional treatment Hepatotoxicity ↑’s malignant cell destructions, ↓’s the SE Integumentary Principle of MDT is instituted to avoid and prevent Alopecia the SE Dermatitis and ulcers Hematopoietic C&R SIDE EFFECTS ↓ bone marrow activity Common: nausea and vomiting anemia, prone to infection and bleeding tendency Stomatitis Metabolic Alopecia (2-3 weeks to occur) TLS and Hyperkalemia Bone marrow depression Neurologic/Sensory/Perceptual Perceived Change in Body Image Meningeal irritation Obvious reminder of disability CN and peripheral neuropathy need for prosthesis (breast, leg and eye)  need for hardware (wheel chair, crutches) Wilm’s Tumor need for medication (CR therapy) Hodgkin’s and Non Hodgkin’s extent of disability or limitation Leukemia Type of loss Prostate Cancer symbols of sexuality Brain Tumor social acceptability (colostomy) Common: cerebellar astrocytoma, brain ability to communicate (laryngectomy, aphasia) stem glioma, medulloblastoma (brain stem) anatomic changes (amputation) s/sx: increased ICP, headache, n&v, Terminally Ill projectile vomiting, decreased LOC, 50% die from the disease seizures, papilledema time from diagnosis to death ranges from Intervention: symptomatic, surgery, weeks- years radiation and chemotherapy (vincristine and not all clients become terminally ill cyclophosphamide) others die during initial treatment; others Follow peri-op craniotomy die from complications of treatment Cancer of the Larynx Endpoint: no response to treatment and Cause: smoking progressions cannot be controlled s/sx: hoarseness of the voice, dysphagia, HOSPICE CARE coughing, bloody sputum standard of care for terminally ill cancer Intervention: laryngectomy and radical neck clients dissection symptom control Most preventable type of cancer pain management Lung Cancer providing comfort and dignity Cause: smoking 24 hour – 7 day coverage Types: adenocarcinoma (common), small services are given based on client’s need cell (fatal) not on its ability to pay s/sx: chronic cough, wheezing, dyspnea, Ethical Issues repeated unresolved URTI, chest/shoulder caring can be just successful as curing; pain, hemoptysis, hoarseness, dysphagia, when curing is not an option head and neck edema care is exercised during the final stage of life Intervention: chemo and radiation, surgery (wedge, segment, lobe, entire lung) Goals of Intervention to care without functional and structural Breast Cancer impairment s/sx: non tender fixed lump (tail of spence), if cure is not possible goals must dimpling, bleeding = prevent further metastasis Stage I (25cm + nodes) Stage IV = maintain high quality of life (metastasis) Intervention: chemo and radiation, surgery CANCER Lumpectomy, segmental mastectomy (lobe), Brain Tumor simple mastectomy (entire breast), MRM, Cancer of the Larynx RM, URBAN Lung Cancer Follow post-op nursing Breast Cancer management Cancer of the Stomach Cancer of the Colon Cancer of the Stomach Cancer of the Liver Most common GI cancer, cured foods, low in Cancer of the Pancreas fiber  s/sx: vague fullness, bleeding LATE: ascites, Filgrastim (Neupogen) = stimulates palpable mass neutophils production Intervention: C&R, surgery (billroth I&II) Hodgkin’s and Non-Hodgkin’s Follow post-op procedures Lymphoma Cancer of the Colon Obstruction of the lymph nodes Cause: low fiber high cholesterol diet, POLYPS s/sx: edema s/sx: change in BM, bleeding, obstruction Hodgkin’s – painless, localized (left Adenocarcinoma thoracic duct and right lymphatic Intervention: C&R, surgery duct), lymph node biopsy reveals Follow post-op procedures REED-STERNBERG cell or GIANT cell Colostomy care Non-Hodgkin’s – painful, systemic Cancer of the Liver CHLORAMBUCIL (LEUKERAN) PO 10 Usually a complication of CIRRHOSIS or from mg OD metastasis Wilm’s Tumor Hepatic failure Nephroblastoma s/sx: similar to cirrhosis Renal parenchyma, left kidney (unilateral) Intervention: C&R, (Fluorouracil 5 FU, Cytoxan, Stage I kidney, stage II beyond Oncovin), liver transplant kidney encapsulated, stage III GALL BLADDER CA – 1 YEAR SURVIVAL abdomen, stage IV metastasis, stage Cancer of the Pancreas V bilateral Mostly adenocarcinomas s/sx: during bathing and dressing Head of the pancreas mass will be noticed, non-tender, s/sx: obstruction of the CBD, anorexia, weight IVP reveals mass, loss, pain (upper abdomen, left hypochondriac), ”NO PALPATION” jaundice Intervention: Nephrectomy (good Dx: increased serum lipase and bilirubin prognosis) Intervention: C&R, surgery (WHIPPLE’S, Cancer of the Skin pancreatoduodenectomy, anastomosis of Types: basal cell (common), squamous cell stomach, duodenum, CBD and pancreatic duct) (rapid), malignant (less frequent) Precancerous: leukoplakia (mouth and lips), nevi Prostate Cancer (moles, color change to black, bleeding, BPH – cancer of the prostate irritation), senile keratosis (brown scalelike s/sx: asymptomatic spots among elderly) Dx: elevation of CEA, PSA, AP Cause: UV light, chemicals and irritation Intervention: Prostatectomy Intervention: protection against sunlight, Follow post-op procedure of prostatectomy irritants and chemicals, lotion (para-amino TESTICULAR CA – (curable) CRYPTORCHIDISM benzoic acid), report change in lesion, Leukemia CHEMOTHERAPY & IMMUNOTHERAPY ALL – immature proliferation CLL – same, adult AML – reduction of granulocytes CML – myeloid stem cell, blood cells s/sx: related to blood level derangement DX: bone marrow biopsy Set A as: CANCER POST TEST a. reconstructive 1. Which of the following would be considered an b. curative iatrogenic cause of cancer? c. palliative A. ionizing radiation from radon d. rehabilitative b. ionizing radiation from uranium ore 8. Which of the following nursing interventions c. xrays to treat tumor would be most helpful in making the respiratory d. ultraviolet radiation from the sun effort of a client with metastatic lung cancer more 2. A nurse is providing health education in a efficient? community setting about measures to avoid a. teaching the diaphragmatic breathing excessive sun exposure. Which of the following techniques statement is true: b. administering cough suppressants as ordered a. reapply sun screen only when you go to the c. teaching and encouraging pursed lip breathing water d. placing the client in a low semi fowlers position b. avoid peak exposure hours from 10 AM to 2 PM 9. To manage possible nausea and vomiting, the c. wear loosely woven clothing for added nurse should discuss, ventilation a. eating frequent, small meals through out the d. apply sunscreen after exposure day 3. A nurse is palpating a female clients breast. The b. eating three normal meals a day area of the breast in which tumors are commonly c. eating only cool foods with no odor found in the? d. limiting the amount of food intake A. upper inner quadrant 10. What are the common side effects of chemo b. lower inner quadrant and radiation therapy? c. lower outer quadrant A. stomatitis, nausea and vomiting, depression d. upper outer quadrant B. stomatitis, loss of hair and anemia 4. Which of the following statements would be C. fatigue, alopecia and bone marrow depression correct about pap smear? D. dysphagia, anemia and fatigue A. it is recommended every other year 11. Common site of metastatic activity? b. repeat every 3 years after 4 consecutive A. bone B. brain negative results C. lungs D. liver c. it should be done at age 18 or earlier if sexually 12. What is the early sign of Cancer of the Larynx? active A. hoarseness of the voice d. colposcopy is needed after 4 negative results B. dysphagia 5. What is the single most important risk factor for C. coughing cancer? D. bloody sputum A. family history 13. Common type of lung cancer? b. lifestyle A. Small oat cell c. age B. Squamous d. menopause or hormonal events C. Large cell 6. Which of the following is an environmental D. adenocarcinoma factor of cancer? 14. All of the following are considered early sign of A. gender breast cancer EXCEPT? b. air pollution A. bloody discharge c. immunologic status B. dimpling or “peau d’ orange” d. age C. tender lump 7. Kris is on the terminal stage of breast cancer. Her D. fixed lump doctor decided to perform an operation to lessen her intractable pain. This operation is considered  15. What is the early sign of Stomach Cancer? 3. To elicit more information regarding hoarseness of A. Melena the voice the nurse should ask which question? B. Hematochezia A. do you eat high fats low fibers C. Vague fullness of the stomach B. do you strain your voice D. Ascites C. do you smoke cigarettes 16. T1N2M1 means? D. do you eat spicy foods A. normal B. stage I 4. What is the most common adverse effect of C. stage III D. stage IV chemotherapy? CANCER POST TEST A. alopecia Matching Type B. stomatitis I. CA liver a. mole C. nausea and vomiting II. CA pancreas b. painful adenopathy D. anemia III. Wilm’s c. bone marrow 5. A client is receiving an internal radioactive implant biopsy and discovers the implant in the bed linen, what IV. Hodgkin’s d. kernicterus should a nurse do? V. Non Hodgkin’s e. painless adenopathy A. report to the physician at once VI. CA skin f. increased ICP B. pick up with a long-handled forceps and put it in a VII. Leukemia g. whipple’s procedure lead container h. no palpation C. put the implant back in place using long handled Set A Key Answers forceps CANCER POST TEST D. leave the room immediately and notify the radiation Matching Type department I. CA liver a. mole 6. Which of the following is likely to decrease pain of II. CA pancreas b. painful adenopathy stomatitis secondary to CHEMO? III. Wilm’s c. bone marrow biopsy A. recommend to discontinue therapy IV. Hodgkin’s d. kernicterus B. provide a solution of hydrogen peroxide and water V. Non Hodgkin’s e. painless adenopathy for use as mouth rinse VI. CA skin f. increased ICP C. monitor platelet count VII. Leukemia g. whipple’s procedure D. check regularly for s/sx of stomatitis h. no palpation 7. The nurse instructs the client the diagnosis of breast Set A Key Answers cancer is confirmed by? Set B A. BSE breast self examination CANCER POST TEST B. mammography 1. A client with nagging cough makes an appointment C. FNAB fine needle aspiration biopsy to see the physician, after reading that this is one of 7 D. chest xray warning signals of cancer. What is another warning 8. For client newly diagnosed with radiation induced sign of cancer? thrombocytopenia, the nurse should include which A. rashes specific intervention? B. nausea and vomiting A. bedrest must be encouraged C. alopecia B. reverse isolation upon admission D. dysphagia C. check petechia every shift CANCER POST TEST D. all of the above 2. Which type of cancer causes the most death in 9. Risk for impaired skin integrity from external women? radiation had been made, what will be your nursing A. breast intervention? B. ovarian A. apply talcum powder on the site C. lung B. remove tumor skin marking after radiation D. all of the above C. wear protective gears when giving direct care D. avoid use of soap on the irradiated areas 10. Which of the following organs is an occasional site of metastasis activity? A. liver B. colon C. lungs D. brain E. bones Set B Key Answers 1. D 2. C 3. C 4. C 5. B 6. B 7. C 8. C 9. D 10. B