MedSurg-LEC-Transes-MIDTERMS PDF

1ST SEMESTER A.Y. 2024-2025 |MEDSURG 3 - LEC Oncology Nursing III. NURSING CARE OF AT-RISK AND SICK ADULT PROLIFERATIVE PATTERNS CLIENTS WITH CELLULAR ABER...

1ST SEMESTER A.Y. 2024-2025 |MEDSURG 3 - LEC Oncology Nursing III. NURSING CARE OF AT-RISK AND SICK ADULT PROLIFERATIVE PATTERNS CLIENTS WITH CELLULAR ABERRATION A. Review of Anatomy and Physiology of all HYPERPLASIA Systems Involved Tissue growth based on an excessive rate of B. Application of Nursing Process to Patient with cell division, leading to a larger than usual Cellular Aberration number of cells. C. Pathophysiology of Specific Cellular Aberration Condition The process of hyperplasia is potentially D. Diagnostic and Laboratory Procedures for reversible. Patients with Cellular Aberrations Can be a normal tissue response to an E. Medical and Surgical Managements for irritating stimulus. Patients with Cellular Aberrations E.g., Callus. F. Nursing Intervention and Responsibilities for Patients with Cellular Aberration DYSPLASIA Bizarre cell growth differing in size, shape, and cell arrangement. ONCOLOGY METAPLASIA Branch of medicine that deals with the study, detection, treatment, and management of Conversion of one type of cell in a tissue to cancer and neoplasia. another type not normal for that tissue. Oncology Nurse – RN who cares for and ANAPLASIA educates patients with cancer. Change in the DNA cell structure and orientation to one another, characterized by loss of differentiation and a return to a more CANCER primitive form. A large group of diseases characterized by: NEOPLASIA Uncontrolled growth and spread of Uncontrolled cell growth, either benign or abnormal cells. malignant. Proliferation (rapid reproduction by cell division). Metastasis (spread or transfer of cancer METASTASIS: 3 STAGES cells from one organ or part to another not Invasion – Neoplastic cells from primary directly connected). tumor invade into surrounding tissue with Complex disease which occurs when normal penetration of blood or lymph. cells mutate into abnormal cells that take over Spread – Tumor cells spread through lymph normal tissue, eventually harming and or circulation or by direct expansion. destroying the host. Establishment and Growth – Tumor cells are ROOT WORDS established and grow in secondary site: lymph “Neo“ – new “A“ – none nodes or in organs from venous circulation. “Plasia“ – growth “Ana“ – lack “Plasm“ – substance “Hyper“ – excessive TUMORS (NEOPLASMS) “Trophy“ – size “Meta“ – change This gradual increase in the number of “Oma“ – tumor “Dys“ – bad, dividing cells creates a growing mass of tissue “Statis“ – location deranged called a “tumor“ or “neoplasms“. If the rate of cell division is relatively rapid, and no “suicide“ signals are in place to trigger cell death, the tumor will grow quickly in size. If the cells divide more slowly, tumor growth will be slower. @chadrayg 35 MEDSURG 3 - LEC 1ST SEMESTER | Oncology Nursing PATHOPHYSIOLOGY PATTERN AND STRUCTURE, Abnormal cell formed by mutation of DNA. EITHER GROSS OR MICROSCOPIC Cell grows and proliferates. Fluid-filled – CYST Metastasis occurs when abnormal cells invade Glandular – ADENO other tissue, through lymph and blood. Finger-like – PAPILLO Cancer development linked to immune system Stalk – POLYP failure. EMBRYONIC ORIGIN Ectoderm (usually gives rise to epithelium). CLASSIFICATION OF CANCER Entoderm (usually gives rise to glands). Mesoderm (usually gives rise to connective BENIGN tissues). Tumors that cannot spread by invasion or metastasis; hence, the only grow locally. MALIGNANT BENIGN TUMORS Tumors that are capable of spreading by Suffix- “OMA“ is used. invasion and metastasis. Adipose Tissue – LipOMA By definition, the term “cancer“ applies only to Bone – osteOMA malignant tumors. Muscle – myOMA Blood Vessels – angiOMA CHARACTERISTICS OF NEOPLASIA Fibrous Tissue – fibrOMA BENIGN Well-differentiated MALIGNANT TUMOR Slow growth Named according to embryonic cell origin. Encapsulated Ectodermal, Endodermal, Glandular, Epithelial Non-invasive Use the suffix- “CARCINOMA“ Does NOT metastasize Pancreatic Adeno Carcinoma MALIGNANT Squamous Cell Carcinoma Undifferentiated Mesodermal, Connective Tissue Origin Use the suffix- “SARCOMA“ Erratic and uncontrolled growth. FibroSarcoma Expansive and invasive Myosarcoma Secretes abnormal proteins AngioSarcoma METASTIZES Characteristics Criteria Benign Malignant CARCINOGENESIS Cell Character Normal Abnormal The process by which cancer develops. Growth Expands Infiltrates INITIATION Rate Slow Fast Carcinogens alter the DNA of the cell. Metastasize Never Metastasize Cell will either die or mutate, non-reversible. PROMOTION Repeated, prolonged exposure to carcinogens. NOMENCLATURE OF NEOPLASIA Potentiates effects of initiator. Tumor is named according to: Latent period. PARENCHYMA PROGRESSION Hepatoma – liver Irreversible period. Osteoma – bone Cells undergo NEOPLASTIC transformation then Myoma – muscle malignancy METASTASIS. @chadrayg 36 MEDSURG 3 - LEC 1ST SEMESTER | Oncology Nursing Regional Lymph Nodes (N) RISK FACTORS Nx Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1 Metastasis in single lymph node in the true pelvis MODIFIABLE FACTORS N2 Metastasis in multiple regional lymph nodes in true Chemical Carcinogen pelvis N3 Metastasis in common iliac lymph node(s) Tobacco Nitrosamines Distant Metastasis (M) Alcohol Aflatoxin Mx Distant metastasis cannot be assessed Hydrocarbons Talc M0 No distant metastasis Benzopyrenes M1 Distant metastasis Physical Carcinogen M1a Non-regional lymph nodes Radiation T Tumor T0-T4 Trauma N Node N0-N3 Infectious Carcinogen M Metastasis M0-M1 Epstein-Barr Virus (EBV) → Burkitt Lymphoma Hepatitis B and C Normal T0, N0, M0 Stage I T1, N0, M0 5 cm diameter of the tumor Stage IV with metastasis any size of the tumor Immunosuppression Tis – carcinoma in situ (non-infiltrating) NON-MODIFIABLE FACTORS x – can’t be assessed Genetics/ family Age CANCER GRADING History The degree of DIFFERENTIATION. Race Grade 1 – Low grade Grade 2 – Intermediate grade Grade 3 TUMOR STAGING AND GRADING Grade 4 – High grade Staging determines size of tumor and existences of metastasis. DIFFERENT KINDS OF CANCER Grading classifies tumor cells by type of tissue. The TNM system is based on the extent of the Some common CARCINOMAS: Lung, breast tumor (T), the extent of spread to the lymph (women), colon, bladder, prostate (men). nodes (N), and the presence of metastasis (M). Leukemias: Bloodstream TNM Classification System Lymphomas: Lymph Nodes Primary Tumor (T) Some common SARCOMAS: Fat, bone muscle. Tx Primary tumor cannot be assessed T0 No evidence of primary tumor Tis Carcinoma in situ WARNING SIGNS OF CANCER T1 Tumor invades subepithelial connective tissue layer CAUTION US! T2 Tumor invades muscle T2a Tumor invades superficial muscle Change in bowel or bladder habits. T2b Tumor invades deep muscle A sore that does not heal. T3 Tumors invade perivesical tissue Unusual bleeding or discharge. T3a – Microscopically T3b – Macroscopically (extravesical mass) Thickening or lumps in breast or elsewhere. T4 Tumor invades any of the following: prostatic stroma, Indigestion or difficulty in swallowing. seminal vesicles, uterus, vagina, pelvic wall, abdominal Obvious change in wart or mole. wall T4a Tumor invades prostatic stroma, seminal vesicles, Nagging or persistent cough or hoarseness. uterus, or vagina Unexplained anemia. T4b Tumor invades pelvic wall or abdominal wall Sudden unexplained weight loss. @chadrayg 37 MEDSURG 3 - LEC 1ST SEMESTER | Oncology Nursing LABORATORY AND CANCER DETECTION AND DIAGNOSIS DIAGNOSTIC TESTS Early cancer may not have any symptoms. Cervical Cancer Screening Breast Cancer Screening LABORATORY TESTS Prostate and Ovarian Cancer Screening. Complete blood cell count (CBC) Colon Cancer Screening Tumor Markers – Identify substances (specific Biopsy – Performed to obtain a tissue sample proteins) in the blood that are made by the for histologic analysis of cells suspected to be tumor. malignant. Prostatic-Specific Antigen (PSA): Prostate cancer. Carcinoembryonic Antigen (CEA): Colon CANCER PREVENTION cancer. Avoid tobacco. Alkaline Phosphatase: Bone metastasis. Protect yourself from excessive sunlight. Biopsy – Acquisition of tissue for exact Limit alcohol and tobacco. histologic diagnosis. Diet: Fine Needle Aspiration Biopsy (FNAB) – Limit fats and calories. Gauge 23-needle. Consume fruits and vegetables. Core needle biopsy – Gauge 14/16 needle. Avoid cancer viruses. Incision Biopsy – Removal of a chunk of Avoid carcinogens at work. tissue. Some Carcinogens in the Workplace Excision Biopsy – Removal of the whole Carcinogen Occupation Type of mass. Cancer Arsenic Mining, pesticide workers Lung, skin, liver Lung, DIAGNOSTIC TESTS Asbestos Construction workers mesothelioma DETERMINE LOCATION OF CANCER Benzene Petroleum, rubber, Leukemia chemical workers X-rays Metal workers, Chromium Lung Computed tomography electroplaters Ultrasounds Leather dust Shoe manufacturing Nasal, bladder Chemical, dye, rubber Magnetic resonance imaging Naphthylamine workers Bladder Nuclear imaging Radon Underground mining Lung Coal, gas, petroleum Angiography Soots, tars, oils workers Lung, skin, liver DIAGNOSIS OF CELL TYPE Rubber workers, polyvinyl Vinyl chloride Liver Tissue Samples – From biopsies, shredded chloride manufacturing Wood dust Furniture manufacturing Nasal cells (e.g., Papanicolaou (PAP) smear), and washings. Industrial pollution. Cytologic Examination – Tissue examined under microscope. TREATMENT MODALITIES DIRECT VISUALIZATION Aimed towards: Sigmoidoscopy Control – Goal for chronic cancers. Cystoscopy Palliative Care – Quality of life maintained Endoscopy at highest level for the longest possible time. Bronchoscopy Exploratory Surgery – Lymph node biopsies to SURGERY determine metastasis. Surgical removal of tumors; most commonly used treatment. @chadrayg 38 MEDSURG 3 - LEC 1ST SEMESTER | Oncology Nursing Preventive or Prophylactic – Removing Mitotic Inhibitor – Stops mitosis. nonvital tissues or organs that are at increased Vincristine (Oncovin) → Constipation risk of developing cancer. Vinblastine Diagnostic Surgery – Such as a biopsy, is CELL CYCLE NON-SPECIFIC DRUGS usually performed to obtain a tissue sample The therapeutic effect of the drugs affects all for analysis of cells suspected to be phases of the cell cycle. malignant. Alkylating Agent – Breaks DNA helix thereby Curative/Palliative Surgery – To relieve interfering with DNA replication. symptoms such as ulceration, obstruction, Busulfan (Myleran) → hyperuricemia hemorrhage, pain, and malignant effusions. Cyclophosphamide (Cytoxan) → cystitis Reconstructive Surgery – May follow curative Cisplatin (Platinol) → nephrotoxic, tinnitus or extensive surgery in an attempt to improve Carmustine (BICNu) → staining function or obtain a more desirable cosmetic Antibiotics (-cin) effect. Daunorubicin → cardiotoxic & bone marrow SURGICAL ONCOLOGY depression The branch of medicine that uses manual and Doxorubicin (Adriamycin) → alopecia instrumental means to deal with the diagnosis Actinomycin (Dactinomycin) →cardiotoxicity and treatment of Cancer. Bleomycin → pulmonary fibrosis ROUTES OF CHEMOTHERAPY CHEMOTHERAPY Oral – Most convenient for patients. Use of antineoplastic drugs to promote tumor IV – Most common. cell death, by interfering with cellular functions Intramuscular and reproduction. Intrathecal – Ommaya reservoir (directly into May be combined with surgery, radiation CSF) therapy, or both to: Intraperitoneal reduce tumor size preoperatively Intracavitary (neoadjuvant), Intravesical – For reproductive system. destroy any remaining tumor cells Topical postoperatively (adjuvant), or Check for phlebitis and extravasation. treat some forms of leukemia or lymphoma High calorie and high protein diet. (primary). Encourage hydration. CELL KILL AND THE CELL CYCLE Monitor CBC. G1 – Protein / RNA synthesis. Oral examination for stomatitis. S – DNA synthesis. Teratogenic. G2 – Protein / RNA synthesis. Hair loss is a concern. M – Mitosis. Encourage counseling. G0 – Resting. Report complications. CELL CYCLE SPECIFIC DRUGS Administer antiemetics. The therapeutic effect of the drugs only works Practice aseptic technique at all times. on a specific phase of the cell cycle. You should wear gloves, gown and mask when Italicized words after each drug are SIDE EFFECTS. handling chemo drugs. Antimetabolites – Blocks synthesis and metabolism of DNA protein. Methotrexate →liver toxicity, photosensitivity Mercaptopurine Topoisomerase Inhibitor – Blocks enzymes needed for DNA synthesis. Etoposide Irinotecan (Camptosar) @chadrayg 39 MEDSURG 3 - LEC 1ST SEMESTER | Oncology Nursing RADIOTHERAPY NURSING MANAGEMENT The use of radiation in treating cancer. Promote measures that relieve pain and TELETHERAPY (EXTERNAL) discomfort. Radiation delivered in uniform dose to tumor. Pharmacologic and non-pharmacologic NURSING CARE OF PATIENT UNDERGOING interventions. TELETHERAPY Promote measures to maintain intact skin integrity. Inform them that they are not a hazard. Promote measures to prevent injury from Wash the area with warm water or very mild abnormal bleeding. soap. Monitor platelet count; avoid aspiring Pat dry and don’t remove markings. products, etc. Don’t use anything unless prescribed. Promote measures that identify and prevent Avoid irritation. infection. COMPLICATIONS Monitor WBC count; encourage frequent Radiation Dermatitis handwashing and overall cleanliness. Dry desquamation Wet desquamation Help decrease the client’s fatigue and increase Head and Neck his activity level. Stomatitis Tooth decay Promote measures that ensure adequate Xerostomia Osteoradionecrosis nutritional intake. Chest High protein, high calorie diet. Non-productive Esophagitis Ensure adequate fluid and electrolyte balance. cough Radiation fibrosis Pelvis Diarrhea Vaginal stenosis★ Cystitis Sterility Erectile dysfunction Abdomen Nausea and vomiting Brain Cerebral edema Scalp irritation Alopecia BRACHYTHERAPY Delivers high dose to the tumor and less to other tissues; radiation source is placed in tumor or next to it. Sealed Unsealed Sealed vs Unsealed Sealed Criteria Unsealed Yes Private room Yes No Pregnant minors No Yes Strict bed rest No No Flush 3x Yes No Radioactive after Yes No Disposable utensils Yes Yes Film badge must be worn Yes @chadrayg 40  1ST SEMESTER A.Y. 2024-2025 |MEDSURG 3 - LEC Specific Cellular Aberration IV. SPECIFIC CELLULAR ABERRATION bone marrow production resulting in anemia, A. Leukemia thrombocytopenia (i.e., low platelet count), and B. Colorectal Cancer either low or elevated WBC counts (rarely, the C. Lung Cancer WBC may be within normal range). D. Prostate Cancer E. Breast Cancer There is also impaired development of all myeloid cells: monocytes, granulocytes (i.e., neutrophils, basophils, eosinophils), LEUKEMIA erythrocytes, and platelets. Cells characterized by UNCONTROLLED CHRONIC MYELOID LEUKEMIA (CML) proliferation of WHITE BLOOD CELLS in the Arises from a mutation in the myeloid stem bone marrow replacing marrow elements. cell. The WBC can also proliferate in the liver, ACUTE LYMPHOCYTIC LEUKEMIA (ALL) spleen, and lymph nodes. Results from an uncontrolled proliferation of Types of Leukemia – The leukemias are immature cells (lymphoblasts) derived from named after the specific lines of blood cells the lymphoid stem cell. affected primarily. CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) Myeloid – Stem cells that produce Common malignancy of older adults, and the nonlymphoid blood cells. most prevalent type of adult leukemia in the Lymphoid – Stem cells that produce Western world. lymphocytes. Typically derived from a malignant clone of B Monocytic lymphocytes. The leukemias are named also according to the maturation of cells. Acute – The cells are primarily immature. LABORATORY FINDINGS Chronic – The cells are primarily mature or Peripheral WBC count varies widely differentiated. Bone marrow aspiration biopsy reveals a large percentage of immature cells: BLASTS ASSESSMENT FINDINGS Erythrocytes and platelets are decreased. ACUTE LEUKEMIA Onset of symptoms is abrupt. MEDICAL MANAGEMENT Pallor Organomegaly Chemotherapy. Fatigue Headache Bone marrow transplantation. Dyspnea Vomiting Hemorrhages NURSING MANAGEMENT CHRONIC LEUKEMIA Manage and prevent infection. Less severe symptoms. Monitor temperature. Organomegaly. Assess for signs of infection. BE ALERT if the neutrophil count drops TYPES OF LEUKEMIA below 1,000 cells/mm. Maintain skin integrity. ACUTE MYELOID LEUKEMIA (AML) Provide pain relief. Originates due to a series of genetic mutations in the myeloid HSC leading to clonal Provide information as to chemotherapy and development of abnormal blast cells. bone marrow transplantation. As these blast cells (i.e., immature leukocytes) continue to proliferate, they crowd out normal @chadrayg 41 MEDSURG 3 - LEC 1ST SEMESTER | Specific Cellular Aberration COLORECTAL CANCER Colostomy Irrigation 1st time: Stimulate peristalsis. Duke’s Disease 2nd time: Evacuation of feces. Second deadliest cancer. Semi-fowler’s position. Equally occurring in men and women. Warm normal saline. Complication includes perforation, peritonitis, Start with 200 ml. and obstruction. Clean gloves to dilate the stoma. Lubricate catheter. DIAGNOSIS 2-4 inches insertion. 18 inches above the stoma. Digital Rectal Exam (DRE): Annually after 40. Retain the catheter for 5-10 minutes. Occult stool exam: Annually after 50. Drain after 15-20. Colonoscopy – Confirmatory Stop irrigation momentarily when cramps Carcinoembryonic Antigen (CEA) – Monitoring are felt. CT scan Diet Colostomy irrigation is done to mimic RISK FACTORS normal bowel movement. High fat, high protein, low fiber Diet should be as close to normal as Age: >50 years old. possible. Avoid gas-forming foods (Nuts, Eggs, Polyps Cauliflower, Gum, Carbonated drinks). Irritable Bowel Disease SURGERY LUNG CANCER Malignant tumor of the lung arising from the Hemicolectomy epithelial lining of the bronchus. Transverse colectomy Deadliest cancer. Sigmoidectomy Late diagnosis. Abdominoperineal procedure Non-specific manifestations. Mile’s procedure No screening test. PREOP Women are more predominant (due to higher Bowel cleansing. incidence of smoking): not directly correlated, Low residue 3-5 days before. 10-15% only. Clear liquid then NPO post-midnight. May arise in the peripheral lung (more often Laxative and cleansing enema. adenocarcinomas) or in the central/hilar Pre-op antibiotic: Neomycin tablets or enema. region (more often squamous cell POSTOP carcinomas). Positioning: Semi-fowler RISK FACTOR APR: Side-lying Air Pollution/ Asbestos Sitz bath when ambulatory. Bacterial Infection Stoma Care Cigarette Smoking Red and protruding 1/2 inch: Normal 55-84 years old; peak: 65-74 years old. Dark, Dusky Brown Black: Necrosis Flatus and Fecal drainage: 4-7 days. Empty pouch 1/3 to 1/2 full. SMALL CELL LUNG CARCINOMA (15%) Use Karaya paste as a skin barrier. Always smoking related. No touch and no pain sensation. Highly malignant tumor. Pouch must fit. Nystatin powder for Candida Albicans. @chadrayg 42 MEDSURG 3 - LEC 1ST SEMESTER | Specific Cellular Aberration NON-SMALL CELL CARCINOMA PROSTATE CANCER Adenocarcinoma (50%) – Invasive malignant Most common male cancer. epithelial tumor with glandular differentiation Early stages rarely produce symptoms. or mucin production by the tumor cells. Can be screened. Squamous Cell Carcinoma (20%) – More Digital Rectal Examination (DRE) common in men and is strongly associated Prostate Specific Antigen (PSA) with smoking. Interior to (1) Central PRECURSOR (PREINVASIVE LESIONS) (2) Peripheral Atypical Adenomatous Hyperplasia (3) Transitional