CA Midterms 1-4 (1) PDF

**LESSON 1: CONCEPTS IN THE CARE OF AT RISK AND SICK ADULT CLIENTS** **WITH CELLULAR ABERRATIONS** **Oncology** - The area in Medical-Surgical nursing that focuses on the client with cancer, this subject focuses on cancer as a disease, its treatment and the basic concepts of Oncology Nu...

**LESSON 1: CONCEPTS IN THE CARE OF AT RISK AND SICK ADULT CLIENTS** **WITH CELLULAR ABERRATIONS** **Oncology** - The area in Medical-Surgical nursing that focuses on the client with cancer, this subject focuses on cancer as a disease, its treatment and the basic concepts of Oncology Nursing. - Branch of medicine that deals with the study, detection, treatment and management of cancer and neoplasia. **Terminologies Relate to Cancer Nursing** **Alopecia** - Hair Loss Anaplasia ========= - Cells that lack normal cellular characteristics and differ in shape and organization with respect to their cells or origin; usually, anaplastic cells are malignant. **Adenocarcinoma** - Cancer that arise from glandular tissue Biopsy ====== - A diagnostic procedure to remove a small sample of tissue to be examined microscopically to detect malignant cells. Brachytherapy ============= - The delivery of radiation therapy through internal implants. Cancer ====== - A disease process whereby cells proliferate abnormally, ignoring growth-regulating signals in the environment surrounding the cell.; disease of the cell Carcinogenesis ============== - The process of transforming normal cells into malignant cells. Carcinoma ========= - Form of cancer that is composed of epithelial cells. **Chemotherapy** The use of drugs to kill tumor cells by interfering with cellular functions and reproduction. **Control** - Containment of the growth of cancer cells. Cure ==== - Prolonged survival and disappearance of all evidence of disease so that the patient has the same life expectancy as anyone else in his or her age group. Cytokines ========= - Substances produced by cells of the immune system to enhance production and functioning of components of the immune system. Dysplasia ========= - Bizarre cell growth resulting in cells that differ in size, shape, or arrangement from other cells of the same type of tissue. Extravasation ============= - The leaking of drugs from the veins into the subcutaneous tissues. Grading ======= - Identification of the type of tissue from which the tumor originated and the degree to which the tumor cells retain the functional and structural characteristics of the tissue of origin. Hyperplasia =========== - An increase in the number of cells of a tissue; most often associated with periods of rapid body growth. **Hypertrophy** - Increase in cell size Malignant ========= - Having cells or process that are characteristic of cancer. Metaplasia ========== - The conversion of one type of mature cell into another type of cell. Metastasis ========== - The spread of cancer cells from the primary tumor to distant sites. Myelosuppression ================ - Suppression of the blood cell-producing function of the bone marrow. **Nadir** - The lowest point of white blood cell depression after therapy that has toxic effects on the bone marrow. Neoplasia ========= - Uncontrolled cell growth that follows no physiologic demand. **Neutropenia** - An abnormally low absolute neutrophil count **Oncology** - The field or study of cancer **Palliation** - The relief of symptoms associated with cancer Radiation therapy ================= - The use of ionizing radiation to interrupt the growth of malignant cells. **Sarcoma** - A cancer of supporting or connective tissue Stomatitis ========== - Inflammation of the oral tissues, often associated with some chemotherapeutic agents Staging ======= - The process of determining the size and spread, or metastasis, of a tumor. Thrombocytopenia ================ - A decrease in the number of circulating platelets; associated with the potential for bleeding Tumor ===== - Any neoplasm in which cells are permanently altered Tumor-specific antigen (TSA) ============================ - Protein on the membrane of cancer cells that distinguishes the malignant cell from a benign cell of the same tissue type Vesicant ======== - A substance that can cause tissue necrosis and damage, particularly when extravasated. **Root Words** ---------------- -- Characteristics of Neoplasia ============================ Uncontrolled growth of abnormal cells 1. Benign 2. Malignant 3. Borderline +-----------------------------------+-----------------------------------+ | **Benign** | **Malignant** | +===================================+===================================+ | Well-differentiated | Undifferentiated | +-----------------------------------+-----------------------------------+ | Slow growth | Erratic and | | | | | | Uncontrolled Growth | +-----------------------------------+-----------------------------------+ | Encapsulated | Expansive and | | | | | | Invasive | +-----------------------------------+-----------------------------------+ | Non-invasive | Secreted abnormal proteins | +-----------------------------------+-----------------------------------+ | Does NOT | Metastasizes | | | | | metastasize | | +-----------------------------------+-----------------------------------+ Nomenclature of Neoplasia ========================= Tumor is named according to: 1. Parenchyma organ or cell. - Hepatoma -- liver - Osteoma -- bone - Myoma -- muscle 2. Pattern and Structure, either gross or microscopic - Fluid-filed -- cyst - Glandular -- adeno - Finger-like -- papillo - Stalk -- polyp 3. Embryonic origin - Ectoderm (usually gives rise to epithelium) - Endoderm (usually gives rise to glands) - Mesoderm (usually gives rise to connective tissue) Benign Tumors ============= Suffix- "OMA" is used - - - - - Malignant Tumors ================ Named according to embryonic cell origin. 1. Ectodermal, endodermal, glandular, epithelial - uses the suffix- "CARCINOMA" - - 2. Mesodermal, connective tissue origin -- use the suffix- "SARCOMA" - - - "PASAWAY" ========= 1. "OMA" but Malignant  Hepatoma - - - 2. Three germ layers - 3. Non-neoplastic but "OMA" - - **Cancer Nursing** Review of Normal Cell Cycle Three types of cells ==================== 1. Permanent Cells -- out of the cell cycle - Neurons, cardiac muscle cell 2. Stable Cells -- dormant/resting (G0) - Liver, kidney 3. Labile Cells -- continuously dividing - GIT cells, skin, endometrium, blood cells Cell Cycle ========== G0 \-\-\-\-\-\-\-\-\-\-\--G1\-\-\--S\-\-\--G2\-\-\-\--M - G0 -- Dormant or resting - G1 -- Normal cell activities - S -- DNA Synthesis - G -- Pre-mitotic, synthesis of protein/cellular division - M -- Mitotic phase (IPMAT: Interphase, Prophase, Metaphase, Proposed Molecular cause of Cancer ================================== 1. Change in the DNA structure 2. Altered DNA function 3. Cellular aberration 4. Cellular death 5\. Neoplastic Change **Genes in the DNA:** - Proto-oncogene - Anti-oncogene Etiology of Cancer ================== 1. Physical Agents - Radiation - Exposure to irritant - Exposure to sunlight - Altitude, humidity 2. Chemical Agents - Smoking - Dietary ingredient - Drugs - Industrial Compounds 3. Genetics and Family History - Colon cancer - Premenopausal breast cancer 4. Dietary Habits - Low-fiber - High-fat - Processed foods - Alcohol 5. Viruses and Bacteria - DNA Viruses -- Hepatitis B, Herpes, EBV, CMV, Papilloma Virus - RNA Viruses -- HIV, HTCLV - Bacterium -- H, pylori 6. Hormonal Agents - DES (Diethylstillbestrol) 7. Immune Disease - AIDS Predisposing Factors ==================== - - - - - - - - - Carcinogenesis / Oncogenesis ============================ Malignant transformation - - - - Initiation ========== Carcinogens alter the DNA of the cell; Cell with either die or repair. Promotion ========= Repeated exposure to carcinogens; abnormal gene will express; latent period Progression =========== Irreversible period; cells undergo neoplastic transformation them malignancy Pathogenesis of Cancer ====================== - Cellular Transformation and Derangement Theory - Failure of the Immune ResponseTheory Spread of Cancer ================ 1. Lymphatic -- most common 2. Hematogenous -- Blood-borne, commonly to liver and lungs 3. Direct Spread -- seeding of tumors Body Defenses Against Tumor =========================== 1. Cytotoxic T cells kills tumor cells 2. B cells can produce antibody 3. Phagocytic cells Macrophages can engulf cancer cell debris **Characteristics of Benign and Malignant Neoplasm** ------------------------------------------------------ ------------ --------------- **Benign** **Malignant** **LESSON 2: RISK** **ASSESSMENT AND PROCEDURES** **Primary Prevention** Activities are aimed at intervention before pathologic change has begun **How?** 1. By acquiring the knowledge and skills necessary to educate the community about cancer risk 2. Assisting clients to avoid known carcinogens 3. Adapting a healthier diet and various lifestyle change Secondary Prevention (early detection) ====================================== Provides the opportunity to detect precancerous lesions or early -- stage cancers, to treat them promptly. **How?** 1. Provide individualized education & recommendations 2. Nurses need to be familiar with ongoing developments in the field of genetics and cancer 3. Public awareness about health promoting behaviors Tertiary Prevention =================== The care and rehabilitation of the patient after cancer diagnosis and treatment. Summary of Recommendations for the Early Detection of Cancer ============================================================ 1. 2. 3. (PSA) blood test and DRE from age 50 4. - Fecal occult blood test and flexible sigmoidoscopy every 5 years - Colonoscopy every 10 years Double-contrast barium enema (DCBE) every 5 to 10 years - Digital rectal exam (DRE) -- done at the same time as sigmoidoscopy, colonoscopy, and DCBE Anoscopy ======== - Performed if abnormalities are found during a digital rectal exam (DRE). As an endoscopic test, an anoscopy reveals abnormalities through the use of a thin, lighted, flexible tube called anoscope. The anoscope is lubricated and then placed a few inches into the rectum. The patient may experience some discomfort during the procedure. A tissue sample for a biopsy may be taken during an anoscopy. **5. Testes** --Testicular Self-examination (TSE) should be performed monthly. Warning Signs that Men should look for: - Painless swelling - Feeling of heaviness - Hard lump (size of a pea) - Sudden collection of fluid in the scrotum - Dull ache in the lower abdomen or in the groin - Pain in the testicle or in the scrotum 6. Uterus ========= **Endometrium** -- examination of a sample of endometrial tissue for high risk women for cancer when menopause begins. Common Causes of Cancer ======================= 1. Breast Cancer - Early menarche - Late menopause - Nulliparous or older than 30 years at the birth of the first child 2. Lung Cancer - Tobacco abuse - Asbestos - Radiation exposure - Air pollution 3. Prostate Cancer - Positive family history - Difficulty in urination 4. Colorectal cancer - Familial polyposis - Ulcerative colitis - High--fat, low-fiber diet 5. Cervical Cancer - Sexual behavior - HPV and AIDS - Low socioeconomic status - Cigarette smoking 6. Mouth cancer - Heavy smoker and alcohol drinker - Poor oral hygiene 7. Head and Neck Cancer - Alcohol and tobacco use - Poor oral hygiene - Long term sun exposure - Occupational exposure 8. Skin Cancer - Individuals with fair complexion - Positive family history - Moles, sun exposure between 11 am to 9. Uterus, Ovary, and Endometrial Cancer - Unusual bleeding or discharge, over age 50 - Late menopause after age 55 - Diabetes, high blood pressure **Dietary Recommendations Against Cancer** - Avoid obesity - Cut down on total fat intake - Eat more fiber foods - Include foods rich in Vit. A & C in daily diet - Include cruciferous vegetables in diet - Be moderate in drinking alcoholic beverages Nursing Assessment 7 Warning Signs of Cancer: C.A.U.T.I.O.N =========================================================== +-----------------------------------+-----------------------------------+ | | Change in bowel/bladder habits | +===================================+===================================+ | | A sore that does not heal | +-----------------------------------+-----------------------------------+ | | Unusual bleeding or discharge, | | | | | | Unexplained sudden weight loss | | | Unexplained anemia | +-----------------------------------+-----------------------------------+ | | Thickening or lump in the breast | +-----------------------------------+-----------------------------------+ | **I** | Indigestion | +-----------------------------------+-----------------------------------+ | **O** | Obvious change in warts or mole | +-----------------------------------+-----------------------------------+ | | Nagging cough or hoarseness | +-----------------------------------+-----------------------------------+ - Frequent infection - Skin problems - Pain - Hair Loss - Fatigue - Disturbance in body image/depression Staging of Neoplasia ==================== Determining the size of the tumor and existence of metastases. Uses the T-N-M staging system ============================= Tumor size ------- ------------------------------------------------------------ Presence or absence of regional lymph **node involvement** **M** Presence or absence of distant **metastases** T -- primary tumor - T~X~ -- primary tumor is unable to be assessed - T~O~ -- no evidenced of primary tumor - T~is~ -- carcinoma in situ - T1, T2, T3, T4 -- increasing in size of primary tumor N -- presence or absence of regional lymph node involvement - N~X~ -- regional LN are unable to be assessed - N~O~ -- no regional LN involvement - N1, N2, N3 -- increasing involvement of regional LN M -- presence or absence of distant metastasis. - MX -- unable to be assessed - M~O~ -- absence of distant metastasis - M1, M2, M3 -- presence of distant metastasis **Cancer Grading** Classification of tumor cells; Evaluation of histologic make -- up and extent of differentiation - Grade 1 -- cells are well-differentiated - Grade 2 -- moderately well-differentiated - Grade 3 -- poorly differentiated - Grade 4 -- very poorly differentiate **LESSON 3: RESULTS AND IMPLICATIONS OF DIAGNOSTIC / LABORATORY EXAMINATIONS** Variety of Laboratory Tests if Cancer is suspected: - Used to screen high-risk patients, pinpoint the stage of cancer - Identify treatment options and evaluate whether the cancer is responding to treatment - Used to determine whether a patient has a cancer recurrence Imaging Tests Used to Detect Cance **Imaging Tests Used To Detect Cancer** **Ultrasonography** A high procedure that uses high-energy sound waves to look at the tissues and organs inside the body. The sound waves make echoes that form pictures of the tissues and organs on a computer screen (sonogram) Magnetic Resonance Imaging (MRI) ================================ A medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. Computerized Tomography Scan (CT or CAT Scan) ============================================= Used computers and rotating X-ray machines to create cross-sectional images of the body. A CT Scan or Computerized Tomography Scan is a medical imaging technique used in radiology to get detailed images of the body noninvasively for diagnostic purposes. Esophagogastroduodenoscopy (EGD) ================================ Often referred to as an upper endoscopy An invasive procedure that can help in evaluating and managing several conditions that involve the upper gastrointestinal (GI) tract -- which is composed of the esophagus, stomach, and upper portion of the small intestine. Using the mouth and throat for access, a fiber optic endoscope equipped with a camera is used to visualize your upper GI tract, obtain a biopsy, or treat gastrointestinal conditions. Positron Emission Tomography (PET) ================================== A functional imaging technique that uses radioactive substances known as radiotracers to visualize and measure changes in metabolic processes, and in other physiological activities including blood flow, regional chemical composition, and absorption. Types of Laboratory Test for Cancer Circulating Tumor Cell (CTC) Test May be used to monitor metastatic breast colorectal, and prostate cancers. This diagnostic test helps capture, identify and count circulating tumor cells in a blood sample. Complete Blood Count (CBC) Test =============================== A complete blood count test measures the number of blood cells circulating in the bloodstream. The test also measures hemoglobin, a protein in red blood cells that carries oxygen, and hematocrit, the ratio of red blood cells to plasm. Flow Cytometry ============== This test is used to diagnoses and classify certain cancers, such as leukemia and lymphoma, and to evaluate the risk of recurrence. May be used as part of the stem cell transplantation process. It measures the properties of cells in a sample of bone marrow, lymph nodes or blood. May also be used to measure the amount of DNA in cancer cells. The presence of certain substances, or antigens, on the surface of cells may help identify the cell type. Widely used, laser-method for analyzing the expression of cell surface and intracellular molecules. MammaPrint Test =============== The MammaPrint 70-Gene Breast Cancer Recurrence Assay may be used to determine the risk that a patient's cancer will return. A high-risk score means the cancer has a threein-ten chance of returning. A low-risk result puts the chances at one in 10. BluePrint Test ============== The BluePrint 80-Gene Molecular Subtyping Assay examines which of the tumor's mutations are dictating the cancer's behavior. When used with the MammaPrint Assay, BluePrint may narrowly define each tumor into a subtype classification, which also may help guide treatment decision. Oncotype DX Test ================ The Oncotype DX Lab Test is used to determine whether chemotherapy is likely to benefit patients with early-stage breast cancer. It also helps evaluate the likelihood of disease recurrence. This diagnostic test is often performed on a small amount of tissue removed during breast cancer surgery and then examined at a molecular level. Tumor Marker Tests ================== Tumor markers are substances in the body that are produced in much higher quantities when cancer or certain benign conditions are present. The substances may be found in the blood, urine, stool, or tumor tissue. Most of these substances are proteins, but sometimes gene expression patterns and DNA changes are used as tumor markers as well. Used to diagnose cancer include: CA-125 Test =========== Measures the amount of the cancer antigen 123 (CA-125) in a person's blood. CA-125 is a protein that is biomarker or tumor maker. The protein is found in higher concentration in cancer cells, particularly ovarian cancer cells. Prostate-Specific Antigen Test ============================== Measures the level of PSA in the blood. The prostate gland produces PSA, a protein that at an elevated level may be a sign of prostate cancer. A high PSA reacting also may indicate noncancerous conditions, such as inflammation of the prostate (prostatitis) and enlargement of the prostate (benign prostatic hyperplasia).  Genetic and Genomic Testing =========================== **Genetics** refers to the genes a person is born with that are inherited from past generations. Genetic tests may help determine whether a person has inherited gene mutations that may increase the risk of cancer. **Genomics** refers to the molecular composition of a tumor. +-----------------------------------+-----------------------------------+ | **Genetics** | **Genomics** | +===================================+===================================+ | Study of heredity | Study of an organism's complete | | | set of genetic | | | | | | information | +-----------------------------------+-----------------------------------+ | Study of function and composition | Includes both genes (Coding) and | | of single genes | noncoding DNA | +-----------------------------------+-----------------------------------+ | "Gene": specific sequence of DNA | "Genome": the complete genetic | | that codes for a functional | information of an organism. | | molecule | | +-----------------------------------+-----------------------------------+ Advance Genomic Testing ======================= May help find gene mutations that may driving cancer's behavior. In advanced genomic testing, a biopsy is taken of the patient's tumor, cancer cells are isolated and extracted from the biopsy sample, and the cancer cells' DNA is sequenced in the lab. Then, the sophisticated equipment is used to scan the sequenced genetic profile for abnormalities that dictate how the tumor functions. Gene Mutations ============== Permanent abnormal changes in the DNA of a gene. These mutations may increase the risk of developing cancer and other diseases. **There are two types of gene mutations:** **Acquired Mutations** occur when cells are damaged during replication, by viruses or by exposure to carcinogens, such as tobacco smoke or radiation. **Hereditary or Germline Mutations** are passed down from generation to generation. Gene Mutations that may play a role in the development of cancer include: BRCA1 and BRCA2 =============== Mutations in the BRCA1 and BRCA2 (Breast Cancer 1 and Breast Cancer 2) genes may increase the risk of breast and/ or ovarian cancer. BRCA mutations may be inherited and are associated with an increased risk of developing cancer. Microsatellite Instability and Mismatch Repair Deficiency ========================================================= Cancer is sometimes caused when the DNA in normal cells becomes damaged. But the body fixes this damage before cancer forms, using mechanisms found in normal cells that look for repair flaws in DNA. One of those mechanisms is called **mismatch repair** which corrects errors that occur when cells divide. When that function breaks down, the cells have what's referred to as a Mismatch Repair Deficiency (MMR). This volatility is called Microsatellite Instability (MSI-H), and it sometimes causes cells to mutate and grow out of control, forming tumors. PD-L1 ===== Programed cell death receptor 1, or PD-1, is a protein receptor found on T-cells, which are immune cells that protect the body from disease and infections. PD-1 is called a **checkpoint protein** because it seeks out cells and checks to see if they are harmful. When the PD-1 on an immune cells interacts with PD-L1 on another cell, it shuts down an immune response. Some cancer cells may have many PD-L1 receptors, allowing them to disguise themselves as healthy cells when "checked" by the immune system. +-----------------------+-----------------------+-----------------------+ | **Pathophysiologic | | | | Basis of Malignant** | | | | | | | | **Neoplasia** | | | +=======================+=======================+=======================+ | **Predisposing | | | | Factors / Etiologic | | | | Factors** | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ Cancer Cell Proliferation ========================= It disrupts normal cell growth and interfere with tissue function. **Pressure** -- due to increase in size **Obstruction** -- become compressed and obstructed **Pain** -- due to: pressure on nerve ending, distention of organs/vessels, lack of oxygen to tissues and organs **Effusion** -- when lymphatic flow is obstructed **Ulceration** -- due to pressure on tissue causes ischemia Vascular Thrombosis, Embolism, ============================== **Thrombophlebitis** -- increased clotting caused by abnormal coagulation factors produced by tumors Paraneoplastic Syndrome ======================= Malignant cells produce enzymes, hormones, and other substances **Anemia** -- interfered RBC production **Hypercalcemia** -- results from metastasis to the bones DIC (Disseminated Intravascular =============================== **Coagulation)** -- precipitated by the release of tissue thromboplastin Anorexia & Cachexia Syndrome ============================ The final outcome of unrestrained cancer cell growth - Tumors produce alteration in enzyme system for normal metabolism - Tumors revert to anaerobic metabolism - Protein depletion, serum albumin levels decrease - Tumors takes up sodium - Cancer cells produce anorexigenic substances - Taste sensation diminishes or becomes altered **LESSON 4: PRINCIPLES OF MANAGEMENT FOR CELULLAR ABERRATION** **GENERAL MEDICAL MANAGEMENT or TREATMENT MODALITIES for CANCER** **Methods of Treating Patient with Cancer** The range of possible treatment goals may include: 1. Cure 2. Control 3. Palliation Multiple modalities, commonly used in cancer treatment: 1. Surgery 2. Radiation therapy 3. Chemotherapy 4. Immunotherapy 5. Bone Marrow Transplant 1. Surgery ========== A surgical removal of the entire cancer remains the ideal and most frequently used treatment method. A. Diagnostic Surgery ===================== The definitive method of identifying the cellular characteristics that influence all treatment decisions. B. Primary Method of Treatment ============================== The goal is to remove the entire tumor or as much as is feasible and any involved surrounding tissue, including regional lymph nodes. **[2 Common Surgical Approaches: ]** a. **Local excision (Preventive Surgery)** -- It includes removal of the mass and a small margin of normal tissue that is easily accessible b. **Radical (wide) excision (en bloc dissections / curative surgery)** -- Surgery to remove a tumor and a large amount of normal tissue surrounding it. Nearby lymph nodes may also be removed. c. **Salvage Surgery** -- An additional treatment option that uses an extensive surgical approach, to treat the local recurrence of the cancer after a less extensive primary approach is used. d. **Electrosurgery --** Use of high frequency electrical energy in the radio transmission frequency band applied directly to tissue to induce histological effects; application of electrical current through tissue to cut tissue or coagulate bleeding. e. **Cryosurgery --** A procedure in which an extremely cold liquid or an instrument called cryoprobe is used to freeze and destroy abnormal tissue; a cryoprobe is cooled with substances such as liquid nitrogen, liquid nitrous oxide, or compressed argon gas. f. **Chemosurgery --** A method of treating cancer involving the use of chemicals to destroy malignant tissues (layer by layer removal of abnormal tissue) g. **Laser surgery --** A surgical procedure that uses the cutting power of a laser beam to make bloodless cuts in tissue or to remove a surface lesion such as a tumor h. **Sterotactic Radio Surgery (SRS) --** A type of external radiation therapy hat uses especial equipment to position the patient and precisely give a single large dose of radiation to a tumor; it is used to treat brain tumors and other brain disorders that cannot be treated by regular surgery - Strereotactic frame is inserted - Target site is located (X-Y-Z) - Point of intersection of all 3 coordinates identify the target tissue - The stereotaxic probe is passed to target area - Used in precise localization and treatment of deep brain lesions [Definition of Limb Salvage Surgery ] ================================================= A set of surgical techniques that have been developed to restore the skeletal continuity following the enbloc resection of bone and soft tissue neoplasm. [Goal of Limb Salvage Surgery ] =========================================== - Painless limb - Functional, tumor free limb C. Prophylactic Surgery ======================= Involves removing of nonvital tissues or organs that are likely to develop cancer. **[Factors considered when electing PS: ]** a. Family history & genetic predisposition b. Presence or absence of symptoms c. Potential risks & benefits d. Ability to detect cancer at an early stage e. Patients acceptance of the postoperative outcome D. Palliative Surgery ===================== - Performed in an attempt to relieve complications of cancer - Done for relief of distressing s/s or for Retardation of metastasis - Done when cure is not possible - The major goal is a high quality of life E. Reconstructive Surgery ========================= May follow curative or radical surgery & is carried out to improve function or obtain a more desirable cosmetic effect. Nursing Management in Cancer Surgery ==================================== - Provides education and emotional support by assessing patient and family needs - Explore with the patient and family their fears and coping mechanisms - Encourage them to take an active role in decision making when possible - Should be consistent in answering the queries of the patient and family about the result of diagnostic test and surgical Nursing Management After Surgery ================================ - Assess the patients' responses to the surgery - Monitors for possible complications such as: infection, bleeding, wound dehiscence, fluid and electrolyte imbalance and organ Dysfunction - Provides for patients' comfort - Post-op teaching on wound care, activity, nutrition and medication information **2. Radiation Therapy** [Uses of Radiation Therapy ] ======================================== a. **Primary modality** -- the only treatment used and aims to achieve local cure of the cancer b. **Adjuvant therapy** -- used in conjuction with chemotherapy to enhance destruction of cancer cells c. **Palliative** -- to relieve pain Types of Radiation Therapy ========================== 1. External RT (Teletherapy, DXT) 2. Internal RT - Sealed Source (Brachytherapy) - Unsealed Principles of Radiation Therapy =============================== 1. Distance 2. Time 3. Shielding Nursing Considerations for Sealed Source IRI ============================================ 1. Client's back is turned towards the door. 2. Encourage the client to turn to sides at regular intervals. 3. The client should be on complete bed rest. 4. The client should be given enema before the procedure 5. The client should be given low fiber diet. 6. The client should have a Foley catheter in place during the procedure. 7. Have long forceps and lead container readily available Teaching Guidelines Regarding External Radiation Therapy ======================================================== 1. It is painless. 2. Lie very still on the special table while the intervention is being given. 3. Each treatment usually lasts for few minutes 4. Will remain alone in the room while the machine is in operation. 5. You may communicate. 6. There is no residual radioactivity after radiation therapy. Nursing Interventions for Side Effects of Radiation Therapy =========================================================== 1. Skin Radiations ================== - Observe for early signs of skin reaction and report to physician - Keep area dry - Wash area with water, no soap and pat dry - Do not apply ointments, powders or lotion - Do not apply heat, avoid direct sunshine or cold on the area - Use soft cotton fabrics for clothing to prevent irritation - Do not erase markings on the skin, serves as guide for areas of irradiation. 2. Infection ============ - - - 3. Hemorrhage ============= - - - - - 4. **Fatigue** - Plenty of rest and good nutrition 5. **Weight loss** 6. Stomatitis and Xerostomia ============================ - - - - 7. **Diarrhea, nausea and vomiting, headache,** alopecia and cystitis may also occur 8. **Social isolation** is also experienced 3. Chemotherapy =============== Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy is a systemic therapy, meaning that the drugs travel in the bloodstream throughout the entire body. The goals of chemotherapy may be cure, control, and palliation of manifestations. Recommended when: - Disease is widespread - The risk of undetectable disease is high - The tumor cannot be resected and is resistant to radiation therapy **Routes of Administration of Chemotherapy** ---------------------------------------------- **1. Intravenous Chemotherapy** Vascular Access Devices (VAD's) can be implanted (e.g. Port-A-Cath) and peripherally inserted central catheters (PICC lines). **2. Regional Chemotherapy** **The methods are as follows:** 1. Topical - skin ================= 2\. **Intra-arterial infusions** -- direct to major organs or tumor sites 3. **Intra-cavitary** - cavity 4\. **Intraperitoneal** -- intra-abdominal area 5. **Intrathecal** -- via Omnaya reservoir or via lumbar puncture **Contraindications to Chemotherapy:** 1. Infection 2. Recent Surgery 3. Impaired Renal or Hepatic Function 4. Pregnancy 5. Bone Marrow Depression **Chemotherapy has the following Characteristics:** - It affects both normal and cancer cells - Has fraction cell-kill - May be cell-cycle specific (CCS) or cell-cycle non-specific (CCNS) **[Classification of Chemotherapeutic Agents: ]** **1.CCS** -- destroy cancer cells at specific stage of cell division a. b. c. d. **2. CCNS** -- destroy cancer cells at any stage of cell division a. Alkylating Agents - (Busulfan, Cisplatin, Procarbazine, Cyclophosphamide, Chlorambucil, Ifosfamide) b. Antitumor Antibodies (Bleomycin sulfate, Doxorubicin, Plicamycin) c. Hormonal Agents (Anastrozole, Flutamide, Goserelin, Megestrol **Note:** Ratio: Answer B The lymphatic system brings immune response factors to the area to fight the cancer, which causes lymphedema **Safe Handling of Chemotherapeutic Agents:** - Wear mask, eye shield, gloves and backclosing gown - Wash skin with soap and water in case of contact with chemotherapeutic agent - Expel air bubbles on wet cotton - Vent vials to reduce internal pressure after mixing - Label IV bottle with "ANTINEOPLASTIC CHEMOTHERAPY" **Nursing Intervention** ------------------------------- **Maintain Tissue Integrity** 1. 2. 3. 4. Management of Stomatitis ======================== 1. 2. 3. Management of Alopecia ====================== Alopecia begins within 2 weeks of therapy 1. Regrowth within 8 weeks of termination 2. Encourage to acquire wig before hair loss occurs 3. Encourage use of attractive scarves and hats 4. Provide information that hair loss is temporary BUT anticipate change in Promote Nutrition ================= 1. Serve food in ways to make it appealing 2. Consider patient's preferences 3. Provide small frequent meals 4. Avoids giving fluids while eating 5. Oral hygiene PRIOR to mealtime 6. Vitamin supplements Relieve Pain ============ 1. Mild pain- NSAIDS 2. Moderate pain- Weak opiods 3. Severe pain- Morphine 4. Administer analgesics round the clock with additional dose for breakthrough pain Decrease Fatigue ================ 1. Plan daily activities to allow alternating rest periods 2. Light exercise is encouraged 3. Small frequent meals Improve Body Image ================== 1. Therapeutic communication is essential 2. Encourage independence in self-care and decision making 3. Offer cosmetic material like make-up and wigs Assist in The Grieving Process ============================== 1. Some cancers are curable 2. Grieving can be due to loss of health, income, sexuality, and body image 3. Answer and clarify information about cancer and treatment options 4. Identify resource people 5. Refer to support groups Manage Complication: Infection ============================== 1. Fever is the most important sign (38.3) 2. Administer prescribed antibiotics X 2weeks 3. Maintain aseptic technique 4. Avoid exposure to crowds 5. Avoid giving fresh fruits and veggie 6. Handwashing 7. Avoid frequent invasive procedures Manage Complication: Septic Shock ================================= 1. 2. 3. Manage Complication: Bleeding ============================= 1. 2. 3. 4. 5. catheterization 6. **Other Treatment for Cancer** **Biotherapy**-- the use of (BRM's) Biologic Response Modifiers (ex. Interferons, Interleukins) - Hematopoietic Growth Factors (ex.Erythropoietin, Neupogen, Neumega) - Monoclonal antibodies (MoAbs) - Bone marrow transplantation - Psychosocial Aspects of Cancer Care: - Provide support for the client and family - Promote positive self -- concept - Promote coping with cancer experience A 45-year-old client, mother of two children, just been told that her cancer is terminal. The client delivered her first child at age 40, and she noticed a painless mass in upper outer quadrant of her left breast, which she just ignored. She is now on stage 3 breast cancer and advised to undergo Mastectomy. She is still undecided for the surgery