Cellular Aberrations - Cell Cycle (Nursing)

NRG 301 – CARE FOR CLIENTS WITH HEALTH PROBLEMS CELLULAR ABERRATION 1st Semester | S.Y. 2023-2024 Transcribe by: Stanley Galaura (BS NURSING – 13F) LECTURER: Ma’am Miranda, R. Reference: Ma’am Miranda’s Video Lecture, Brunner & Sud...

NRG 301 – CARE FOR CLIENTS WITH HEALTH PROBLEMS CELLULAR ABERRATION 1st Semester | S.Y. 2023-2024 Transcribe by: Stanley Galaura (BS NURSING – 13F) LECTURER: Ma’am Miranda, R. Reference: Ma’am Miranda’s Video Lecture, Brunner & Suddarth Medical Surgical Nursing Disclaimer: No copyright Infringement Intended; this is for ✓ Each cells have identical educational purposes only. Made by Stanley G. (Personal property genetic material & Usage). G0 cells ✓ If there is no need for cell RESTING PHASE cycle, they go to resting INTRODUCTION TO THE CELL CYCLE, CYCLINS cells Cellular Aberrations – involves many changes, shape ✓ If there is need for cell change, size change, structure change, function cycle, will go back to G1 change of the cells. Anatomy of the Generalized Cell Cyclins – timer/switch which controls the progression of o Nucleus – control center of the cell, contains the cell cycles. DNA o Has different cyclins in each phase o Cytoplasm – area where most of the cell process o Causes a braking action, preventing cycle from occurs. proceeding. o Plasma membrane – the skin, barrier, encloses all o Cyclin-dependent kinases (CDK) – controls the the organelles of the cell, controls who goes in cell cycle and out of the cell. ▪ Enzyme that works with cyclins Overview of the cell o Cyclins are proteins o Normal human cells have 23 pairs of o Cyclins as checkpoints in cell cycle ensure that chromosomes, 46 chromosomes all in all. it proceeds in the correct order. ▪ Each chromosomes have DNA, in the o No cyclins → too many cells → abnormal cells → chromosomes there is small genes cancer. o All normal cells have entire human genome in Malfunction of regulators of cell growth and division every cell o Causes rapid proliferation of immature cells ▪ Except sex and mature RBCs o Immature cells are cancerous/malignant o Human genome project – identifies the genes of o Knowledge about these is useful for making of the human, determines what should be the chemotherapeutic drugs added and removed DNA. ▪ Chemotherapeutic drugs – disrupts o Normal cells have 35,000 genes, about 50 of cancer cells during different stages of genes are very active during embryonic life. their cell cycle. o Normal cells undergo mitosis Proto-oncogenes – genes of early development in the ▪ To develop tissue during embryonic, embryonic life. childhood, adolescence o Activity not needed after embryonic life. ▪ To replace lost/damaged normal tissue o Not abnormal genes ▪ Very essential for cell growth and repair. o Part of every human’s cellular DNA. The normal cell cycles – consists of 4 phases Tumor suppressor genes – slow down cell division, repair DNA mistakes, and tell cells when to die (Apoptosis, Gap 1 (G1) ✓ Cell enlarges programmed cell death). GETTING READY ✓ Synthesize proteins o Quality control ✓ Prepares DNA replication o Removes old and dying cells Synthesis (S) phase ✓ DNA replicated DNA REPLICATION ✓ Chromosomes in cell are TERMS duplicated Cancer – disease process, begins when abnormal Gap 2 (G) ✓ Cell prepares for the cell is transformed by the genetic mutation of the FINAL CHECK actual mitosis/cell division cellular DNA. ✓ Why? To verify that the o Abnormal cell forms a clone, begins to cell is fully ready (Making proliferate abnormally, ignoring growth- sure DNA is replicated) regulating signals in the environment surrounding the cell. Mitosis (M) phase ✓ Parent cell divides into 2 Hyperplasia – increased number of cells in a tissue FINAL MOMENT copies (Daughter cells) or cell, abnormal number of cells, increases in size. Page 1 of 8 Cell cycle, Benign vs. Malignant, Risk factors, Prevention, Spread, Diagnostic Tests, Staging & Grading, Pt. management Metaplasia – one type of cell that changes into a 2. Treatment w/ intent to cure – involves chemotherapy, different type of cell radiation, combination of therapy. Completely remove o Reversible change in which one and destroy cancer cells. differentiated cell type (epithelial or a. Palliative treatment – for those that cancer isn’t mesenchymal) replaced by another cell type treatable, goal? Improve the quality of life Dysplasia – cell starts to look and behaves i. Managing symptoms abnormally, pre-cancerous, early signs, not yet ii. Reducing drugs malignant 3. Managed chronic or intermittent disease – goal is to o Abnormal development/growth of tissues, manage the disease and not make it worse. organs, cells 4. Recurrence/second cancer – re-assessing the cancer. Anaplasia – when cells become highly abnormal. o Seen in aggressive cancers o Loss of mature/specialized features of a PROGRESSION OF DISEASE AND TIME cell/tissue as in malignant tumors Prevention and detection Neoplasia – new growth, tumor, can be benign or o Community outreach malignant, uncontrolled cell growth, follows no o Education physiologic demand o Screening Benign – not malignant, abnormal growth that is o Genetic counseling stable, treatable, not life threatening o Preventive strategies Malignant – cancerous, cells are invasive and tend Abnormal finding and diagnostic evaluation to metastasize, uncontrollable/resistant to therapy, o Pt. and family educ. ↑nursing and other health care services rapidly spreading. o Psychosocial support Invasion – growth of primary tumor into the o Navigation through healthcare surrounding host tissues system Metastasis – dissemination/spread of malignant First line (Initial) Tx., adjuvant Tx, Sx. cells to distant sites management o Direct spread of tumor cells to body o Continued educ and support cavities or through lymphatic and blood o Home care circulation o PT o Stage 4 cancer o Toxicity assessment and Hypertrophy – ↑ in size of cells, ↑ in size of organ management Hyperplasia – ↑in number of cells in organ/tissue, Second- and third-line Tx., ↑ acuity, ↑ Sx. results in ↑ mass of tissue organ experience, changes in functional status and Atrophy – reduced size of organ, ↓cell size and quality of life number o Palliative care Survivorship Necrosis – cell death o Continued educ. And support Apoptosis – programmed cell death o Home car Differentiation – cells/tissues undergo a change o PT toward a more specialized form/function, esp. o Nutrition during embryonic development. o Toxicity assessment and mgt. End-of-life care CANCER CARE TRAJECTORY o Social work o Palliative care o Pt. and family educ. o Psychosocial support o Smooth transition to hospice Pre-Trajectory before any signs and symptoms are present Past life Hx Onset of Sx Trajectory onset 1st onset of signs and symptoms Onset of Sx. Communicating the Dx Adaptation and assimilation of Dx. Seeking support Living with progressive disease Enduring sequential Tx. 1. Diagnosis and staging – to plan for the most appropriate Sx. burden Relentless vigilance care and treatment, to depict prognosis of the pt. Downward phase (prognosis as outlook if pt. improves or not). Oscillations of progressive disease Acute episodes and moments of crisis BS NURSING - Stanley G. Page 2 of 8 Cell cycle, Benign vs. Malignant, Risk factors, Prevention, Spread, Diagnostic Tests, Staging & Grading, Pt. management Dying phase o Exercise Dissonance between active Tx and end of life o Occupational exposure Preparing for death o Cigarette smoking o Sexual activity PATHOPHYSIOLOGY OF MALIGNANT PROCESS Abnormal cell transformed by genetic EPIDEMIOLOGY OF CANCER 1 mutations of the cellular DNA Risk factors and S&S of common cancers 2 Abnormal cell forms clone Clone proliferate abnormally BREAST CANCER RX FACTORS SIGNS & SX. Ignores growth-regulating signals in ▪ Female ▪ Lumps, mass environment surrounding the cell. ▪ Age >50 ▪ Breast thick or axilla 3 Cell acquires invasive characteristic Changes occur in surrounding tissues ▪ ▪ Family Hx. Personal Hx. of breast ▪ Change in size, contour, texture Ca ▪ Skin 4 Cell infiltrates tissues and gains access to the lymph and blood vessels ▪ 2 or more 1st degree dimpling/retraction relatives ▪ Peau d’ orange skin Carry cells to other parts of the body ▪ Known BRCA1 or ▪ Nipple discharge, (Metastasis) BRCA2 mutation retraction, scaliness ▪ Biopsy Hx. ▪ Erythema MULTISTAGE PROCESS OF CARCINOGENESIS ▪ Atypical hyperplasia ▪ Pain, tenderness ▪ DCIS or LCIS NORMAL CELL ▪ Postmenopausal Normal Cell obesity metastasis: Carcinogenic exposure (Chemical, ▪ Early menarche/late Lung radiation, virus, etc.) menopause Bone-back leg ▪ Late1st Liver INITIATE DCELL pregnancy/nulliparous Initiated cell OCP Selective clonal exposure ▪ Radiation to chest wall ▪ Alcohol ------------------ Initiation -------------------- ▪ Obesity and ↑fat diet ▪ Hormone replacement therapy PRENEOPLASTIC LESION Preneoplastic lesion PROSTATE CANCER Genetic change RX FACTORS SIGNS & SX. ▪ Male ▪ Weak uri system & freq. ------------------ Promotion ------------------- ▪ Age >50 years ▪ Difficulty starting ▪ African-American stream or stopping ▪ Family Hx., 1st degree stream MALIGNANT TUMOR relative, ↑Rx if ▪ Pain or burning Metastasis diagnosed before 40 urination ▪ ↑fat diet ▪ Urinary retention ------------------ Progression ----------------- ▪ Hematuria Prostate cancer cells rely on testosterone Testosterone=androgen COLORECTAL CANCER RISK FACTORS RX FACTORS SIGNS & SX. Endogenous risk factors – factors that are not modifiable ▪ >60 y/o. ▪ Change in bowel or changeable ▪ Inflammatory bowel habits o Genetic predisposition – cancer runs in the conditions ▪ Rectal bleed family. ▪ Sedentary lifestyle ▪ Abdominal pain o Sex – there are cancers that are prevalent to a ▪ ↑fat, ↓fruits & vegies ▪ ↓stool diameter specific age. ▪ Heavy alcohol or low fiber ▪ Anemia o Age ▪ Family Hx. (esp. if dx. ▪ Rectal pressure, pain o Race – Before 40 y/o.) ▪ Weight loss o Family history – also includes the environment ▪ Anorexia Exogenous risk factors – precipitating factors, something that can be changed o Alcohol – when in excess can increase risk, in huge amounts can impact liver o Diet BS NURSING - Stanley G. Page 3 of 8 Cell cycle, Benign vs. Malignant, Risk factors, Prevention, Spread, Diagnostic Tests, Staging & Grading, Pt. management LUNG CANCER Causes enlarged lymph Hodgkin RX FACTORS SIGNS & SX. nodes → affects immune lymphoma ▪ Cigarette smoking ▪ chronic cough, system ▪ Occupational wheezing Blood and bone marrow Acute exposure ▪ persistent respi- infx. Affects WBCs lymphocytic o Asbestos ▪ dull chest pain WBCs leukemia o Arsenic ▪ hemoptysis (Myelogenous) o Chromium ▪ dyspnea Lymphocytes Polycythemia o Coal products ▪ weight loss Leukemia (Lymphocytic) vera o Nickel refining RBCs (Erythemia) o Smelter Overproduction of workers RBC, ↑WBC+PLTs o Ionizing Rx. For additional radiation bone marrow o radon disease COMPARISON BETWENN BENIGN AND MALIGNANT CLASSIFICATIONS OF CANCER Benign tumor – not cancerous, don’t spread CLASS TISSUE OF ORIGIN EXAMPLES Malignant tumor – cancerous cells, and spreads to IFICATION other tissues & organs. Tissues that protect and Adenocarci- covers the body of breast, Features BENIGN MALIGNANT Carcinomas Adenocarcinoma lung, prostate Growing Slow Fast, variable (Glandular Doesn’t Grows periphery epithelium) Squamous infiltrate Infiltrate and Squamous cell cell carci- of surrounding destroy carcinoma skin, lung, tissues surrounding (Squamous esophagus encapsulated tissues epithelium) Capsulated Yes No Connective & Supportive **sarc-oma Invasive No Invasive tissues (bones, cartilages) Osteosarc- Metastasis No Yes Bone (most (Bone) Gain access to common in bone) the blood and Cartilage (rare, Chondrosarc- lymphatics → within the bones) (Cartilage) metastasizes. Adipose (deep soft Shape Smooth, oval, Nodular, stellate, tissue) Liposarc- lobulated, regular irregular Smooth muscle (Adipose) Pains Painful Painless (very rare) Sarcomas Skeletal muscle Leiomyosarc- Skin No Skin dimpling (common in young (Smooth) Nipple No retraction Nipple retraction children) Prognosis Good Bad Fibrous tissue (long Rhabdosarc- Damage to Relatively smaller Relatively bigger or flat bones) (Skeletal) Membrane lining human body cavities Fibrosarc- body (asbestos exposure) (Fibrous General Localized, General effects – Blood vessels (Liver tissue) effects doesn’t cause anemia, weakness, involvement r/t vinyl generalized weight loss chloride monument Mesothelial effects unless exposure) sarc- (Lining) location interferes with vital Angiosarc- functions (Vessels) Ability to Doesn’t usually Usually cause death Myeloma Originates in plasma cells, Disrupts the cause cause death unless controlled plasma cells unless location death interferes with Lymphocytes, Non-Hodgkin vital functions Lymphoma Lymphatic system, the Lymphoma lymph nodes BS NURSING - Stanley G. Page 4 of 8 Cell cycle, Benign vs. Malignant, Risk factors, Prevention, Spread, Diagnostic Tests, Staging & Grading, Pt. management CHARACTERISTICS OF CANCER CELLS o Carcinomas generally spreads via this Genetically altered via gene or chromosome spread mutations o Small localized tumor signals blood vessels to o Lack normal controls in cell grow and access more blood to the tumor division/apoptosis ▪ Tumor may then grow and spread o Express inappropriate genes ▪ Tumor releases signaling molecules ▪ Telomerase – encourages intense Carcinogenesis – when a normal cell becomes a and unrestricted cell division cancer cell. o Genetically unstable due to loss of DNA o DNA of normal cells mutated repair mechanisms o Initiation → promotion → transformation → ▪ More prone to radiation damage progression than normal cells o Carcinogen – any substance/agent that o Excessive divide (proliferate) → indefinitely affects cell DNA, can cause cancer produces neoplasms. ▪ Chemical substances ▪ Neoplasm – new tumors ▪ Physical agents (Asbestos dust) o Live indefinitely – don’t show apoptosis. ▪ Biological agents (certain viruses ▪ Normal cells have specific lifespan and bacteria) ▪ Cancer cells don’t have lifespan ▪ May be inhaled, absorbed through o Lost of normal cell attachment → becomes skin or ingested metastatic Biological carcinogens – viruses, parasites, bacteria ▪ Travelling via blood/lymph to that may affect the DNA of our cells invade distant sites o Happens when this virus injects their DNA to o Secretes signals for angiogenesis the cell of the host. ▪ Angiogenesis – growth of blood o Papovirus/HPV (Human papilloma Virus, vessels into tumor. SV40B, Polyoma virus Tumor antigens – a marker/molecule/antigen, that is o Herpes virus-Epstein bar virus seen in the surface of the cancer cells. Targets for o Adenovirus – 12,18,31 immunotherapy. o Hepatitis B virus (HBV) – affects liver. o Tumor-specific antigens (TSA) – unique to Physical carcinogens tumor cells, not present in normal cells. o UV lights – may affect depends on intensity ▪ Induce immune response → tumor of exposure and qty. of melanin rejection ▪ Skin cancer ▪ Specific to cancer cells ▪ Squamous cell carcinoma o Tumor-associated antigens (TAA) – ▪ Basal cell carcinoma expressed or present on normal cells ▪ Melanoma ▪ Naturally don’t induce host immune o Ionizing radiation – nuclear explosions or responses. high energy radiation Tx.: ▪ Can be used as an immune therapy ▪ ↑Leukemia, breast, colon, thyroid, Invasion and metastasis – when cancer cell invades lung cancer surrounding tissues and blood vessels, transported by o Asbestos fiber – mesothelioma (very rare, the circulatory system to distant sites. affects lungs and abdomen) and lung cancer, found in cements METHODS OF SPREAD OF CANCER CELLS Chemical carcinogens o Polycyclic aromatic hydrocarbon (HPA) – Haematogenous spread – travels to the cigarette smoke, tobacco, grilled meat, bloodstream. smoked/meat fish o Common in sarcomas – breast, thyroid, liver, ▪ Skin, lung, gaster, liver kidney, ovary, prostate. o Aromatic amine and azo dyes – textile dyes o Veins are invaded by tumor cells → ▪ Liver, vesica thrombus formation → detachment of parts o Nicotine – cigarette → tumor emboli (can be solid, gas, and ▪ Lung, oral, respiratory tract anything) → may obstruct vessels o Halogenated compound – dioxin, heated o Common sites – liver, lungs, bones, brain plastic, PVC, bleaching agents for paper Lymphatic spread - travels via lymphatic system ▪ Kidney, lung, liver o Usually seen in carcinomas BS NURSING - Stanley G. Page 5 of 8 Cell cycle, Benign vs. Malignant, Risk factors, Prevention, Spread, Diagnostic Tests, Staging & Grading, Pt. management o Arsenic – soil, water, plant, cosmetic Endoscopy – direct visualization of body cavity, inserts product, seafood, cigarette endoscope into cavity/opening, allows tissue biopsy, ▪ Skin, lung, liver fluid aspiration, excision of small tumors o Nitrosamine – preservatives, coloring agent o For diagnostic and therapeutic purposes for meat, they produce nitrates o Diagnostic uses – bronchial, GI CA ▪ Nasopharynx, esophagus, gaster, Nuclear medicine imaging – IV injection/ingestion of oral radioisotope substance, followed by imaging that o Alcohol – beverages concentrated radioisotopes ▪ Oropharynx, larynx, esophagus, o Diagnostic uses – bone, liver, kidney, spleen, liver, colon, breast brain, thyroid cancers Positron emission tomography (PET) – use of cancer, LEVEL OF PREVENTION provides B&W or colored images of biologic activity of Primary prevention – preventing before it begins. particular area. o Removal/reduction of risk factors o Detection of cancer or response to Tx. o Avoiding onset of disease PET infusion – use PET scanner and CT scanner in one o Immunization – HPV machine, provide combined anatomic detail, spatial Secondary prevention – early detections, resolution, and functional abnormalities screenings, biopsy, exfoliative cytology o Same diagnostic use to PET. o Early detection → improves prognosis Protein tumor markers Tertiary prevention – Tx. of existing lesions ✓ 1st type of tumour marker identified o Treating and managing current health issues Carcinoembryonic Prognostic value for pt. w/ o Curing and preventing death antigen (CEA) colon cancer o Chemotherapy, radiation therapy a-Fetoprotein Elevated with pancreatic, gastric, colonic, and bronchogenic cancer DIAGNOSTIC TESTS USED TO DETECT CANCER Carbohydrate Gastrointestinal Tumor marker identification – analysis of substance Antigen 19-9 adenocarcinoma found in – tumor tissue, blood, other body fluids. May be Prostate-specific Screening for prostate cancer found in normal body tissues antigen older than 50 o Diagnostic uses – breast, colon, lung, ovarian, Carbohydrate Antigen present Most of testicular, prostate CA antigen 125 ovarian carcinomas Genetic tumor markers – analysis of presence of Human chorionic Gestational trophoblastic mutations/alterations in genes found in tumors/body gonadotropin in disease tissues. Testicular Germ o Assist in Dx, Tx. selection, prediction to response cell tumors to therapy, and Rx. Of progression/recurrence o Diagnostic uses – breast, lung, kidney, ovarian, brain, leukemia, lymphoma CA, investigational TUMOR STAGING AND GRADING Mammography – x-ray images of breast Tumor staging and grading – to categorize and staging o Diagnostic uses – Breast CA the cancer. o Pain for small breasts o Helps doctor to determine if cancer is MRI – magnetic field + radiofrequency signals, create advanced or not sectioned images o T – extent of primary tumor o Diagnostic uses – neurologic, pelvic, skeletal, o N – absence or presence and extent of abdominal, thoracic CA regional lymph node metastasis CT scan – narrow beam x-ray, scans successive layers of o M – absence or presence of distant tissues for cross-sectional view metastasis o Diagnostic uses – neurologic, pelvic, skeletal, Primary Tumor (T) abdominal, thoracic CA o Tx – primary tumor can’t be assessed Fluoroscopy – x-ray that identify contrasts in body tissue o T0 – no evidence of primary tumor densities, uses contrast agents. o Tis – carcinoma in situ o Diagnostic uses – skeletal, lung, GI CA o T1, T2, T3, T4 - ↑ size and/or local extent or Ultrasonography/ultrasound – high freq. sound waves primary tumor T1- 0-2 cm echoing off body tissues, converted e-images, assess o T1 – smaller tumor T2- 2-5cm T3- >5cm deep tissue within body o T4 – larger and more invasive T4- broken through skin or attached to chest wall. o Diagnostic uses – bronchial, GI CA BS NURSING - Stanley G. Page 6 of 8  Cell cycle, Benign vs. Malignant, Risk factors, Prevention, Spread, Diagnostic Tests, Staging & Grading, Pt. management Regional lymph nodes (N) – describes absence and o IV admin. Of light-sensitive agent presence of cancer in lymph nodes (Hematoporphyrin derivative/ HPD) N1- swollen nodes o Nx – regional nodes can’t be assessed o Exposure of light within 24-48 hrs. > CA cell can be felt N2- Nodes feel o N0 – no regional lymph node metastasis death swollen and lumpy N3- Swollen nodes o N1, N2, N3 – ↑ involvement of regional lymph o Drug is being absorbed by the cancer cell, located near collarbone nodes laser will activate the cell Distant metastasis (M) o Palliative Tx. of dysphagia associate with o Mx – distant metastasis can’t be assessed esophageal and dyspnea associated with o M0 – no distant metastasis endobronchial obstruction o M1 – distant metastasis Radiofrequency ablation – radiofrequency energy usage, generates heat and destroys cancer cells PATIENT MANAGEMENT (ONCOLOGY) o Probe is inserted to the tumor → heat applied → heat kills Clinical findings (biopsy or CT scans) → cancer diagnosis o Used for small liver and kidney tumors → staging/grading → therapeutic intention (palliative or o Minimally invasive curative??) → therapeutic decision o Localized application of thermal energy > destroys CA cells thru heat > temp exceeds TYPES OF BIOPSIES 50C. Excisional biopsy – excisional biopsy, complete o Nonresectable liver tumors, pain control w/ removal of lesions, whole thing is removed for exam bone metastasis. o Commonly used when doctor strongly suspects a cancerous lump TYPES OF SURGERIES o Employed with small lesions ( cell the tumor growth. destruction o Removal of cancer → usage of OTHER THERAPIES chemotherapy Radiation therapy – uses high radiation energy, can Cryoablation – freezing, liquid nitrogen, very cold be implanted within the body or probe to freeze tissue > cause cell destruction o Destroys the DNA of the cancer cells o Cervical, prostate, rectal CA Chemotherapy – uses to kill cancer cells or also Electrosurgery – electrical energy to destroy tissue slows cancer cell progression o Basal, squamous cell skin CA o Oral chemo Laser surgery – highly focused light energy to cut or o IV chemo vaporize a tissue Hematopoietic stem cell transplantation (Bone o Used when shrinking tumors and removal of marrow transplant) – replacing the cancer blood tumors forming o Targets specific areas of areas o Leukemia o Minimal damage to surrounding tissues Targeted therapies – blocking specific pathways o Given to skin cancer, throat, cervix, cancer that cancer depends for their multiplication and o Dyspnea associated with endobronchial division obstructions Gene therapy – modifying the genes or introducing Photodynamic therapy – combination of light new genes sensitive drug and laser light to destroy cancer cells o Not widely used BS NURSING - Stanley G. Page 7 of 8 Cell cycle, Benign vs. Malignant, Risk factors, Prevention, Spread, Diagnostic Tests, Staging & Grading, Pt. management o Part of the human genome project Complementary and alternative medicines – acupunctures, yoga, herbal medicines o Used alongside cancer treatment o Enhances overall feeling NURSING MANAGEMENT Maintain tissue integrity – for post-cancer treatments, prevents further complications o Radiation therapy may cause burns in the skin. Promoting nutrition – especially when cancer affects appetite. o Therapies may weaken the body o Maintain strength of pt. needed to support their body and immune system to recover from the Tx. they have Relieving pain – various means, medications, non- pharma (diversional activities, cold hot compresses) Decreasing fatigue – cancer related fatigue may be common. o When pt is fatigue > they won’t participate in treatment anymore Improving body image and self-esteem – assist in whatever way we can. o Listen to them, let them express themselves o Due to hair loss, gaunt appearances may affect the pt. Assisting in grieving process – uncertainty of life and death. Monitoring and managing potential complications – closely monitor in relation to cancer and the Tx related to cancer. o Sx. of infections? o Adverse reactions to the Tx.? Promoting home and community-based care – step-down care, nursing homes, Nurse roles: o Education – Tx. option, healthcare practices, info. About the Tx. and disease o Monitoring o Documentation o Proper referral o Being up to date o Caregiver o Advocate o Case manager o Educator o Change agent o Counselor o Educator o epidemiologist BS NURSING - Stanley G. Page 8 of 8