Module 2A Cellular Regulation PowerPoint (1).pdf

Cellular Regulation NUR 211 Unit 2 Module 2A Jill Huffman, MSNed, RN Learning Outcomes 1. Collaborate with the interprofessional team to coordinate high-quality care for patients with leukemia, skin cancer, breast cancer, lung cancer, and sickle cell anemia. 2. Implem...

Cellular Regulation NUR 211 Unit 2 Module 2A Jill Huffman, MSNed, RN Learning Outcomes 1. Collaborate with the interprofessional team to coordinate high-quality care for patients with leukemia, skin cancer, breast cancer, lung cancer, and sickle cell anemia. 2. Implement nursing interventions to help the patient and family cope with the psychosocial impact caused by leukemia, skin cancer, breast cancer, lung cancer, and sickle cell anemia. 3. Apply knowledge of anatomy, physiology, and pathophysiology to assess patients with leukemia, skin cancer, breast cancer, lung cancer, and sickle cell anemia. 4. Use clinical judgement to plan care for patients with leukemia, skin cancer, breast cancer, lung cancer, and sickle cell anemia across the lifespan. 5. Teach the patient and caregiver(s) about common drugs for leukemia, skin cancer, breast cancer, lung cancer, and sickle cell anemia. Learning Resources • Ignatavicius, D. (2021). Review Chapters 19 & 20, pp. 467-470, 556-563, 793-798, 803-812, 1433-1450 • Ignatavicius, D. (2021). Study Guide, Chapter 23 (questions 41-44), Chapter 27 (questions 36-43), Chapter 37 (questions 1-9, 16-25), and Chapter 65 (questions 10-20). • Perry & Hockenberry (2023). Chapter 44, pp. 1314-1318; Chapter 43 pp. 1273-1283 • Silvestri, L. (2023). Chapter 35. • ATI RN Adult Medical Surgical Nursing 11.0 - Chapter 92 • ATI RN Nursing Care of Children - Chapter 21 pp. 126-128, & Chapter 40 Types of Leukocytes-Review Leukocytes • Produced in the red bone marrow • Primary function is the Bodies defense, such as destruction on bacteria and viruses • Respond predictably – help us gage severity of infection and recovery • Differential WBC count is used to aid in the diagnosis of diseases, assist in determining bacterial or viral infections, helps in revealing activity that points to occult (hidden) infections, or may signal the intensity of chemotherapy. • Lifespan ranges from a few days to several years • Normal WBC level – 11 yr and older (4.5-11.1), 2-10 yr (4.5-13.5), 1-23 mo (6.1-17.5), Birth (9.1-30.1) Leukemia • Blood cancer that results from a loss of cellular regulation leading to uncontrolled production of immature WBC’s (“blast” cells) in the bone marrow • Exact cause is unknown • Excess of abnormal immature leukocytes (WBC’s) • Bone marrow failure leading to a reduction in the production on red blood cells, most white blood cells, and platelets • Results in: • anemia – due to decreased erythrocytes • infection – due to neutropenia • bleeding (thrombocytopenia)- due to decreased platelets Leukemia: Risk Factors • Genetics/family history- males more frequently than females • Viral Infections • Immunological Disorders • Exposure to radiation or chemotherapeutic agents • Environmental factors that have been associated with damage to the immune system including smoking and chemicals such as benzene Leukemia Classifications Classified by acuity and predominant cell type Acute Myeloid Leukemia (AML) • Rapid onset • Myeloid cells – bone marrow cells that can develop into red blood cells, white blood cells, or platelets • Majority of cases are in adults, but can occur in both children and adults • Uncontrolled production of immature WBC’s (myeloblasts) • Neutropenia & Thrombocytopenia • Hyperplasia of bone marrow and spleen • Bone infarctions (necrosis or death of bone tissue) may cause pain • Prognosis is dependent on the age of onset or the disease Auer Rod Chronic Myeloid Leukemia (CML) • Slow onset, lasts longer • Also affects the myeloid cells • Most cases involve older adults • Men>women • Often asymptomatic in the early stages • Chromosome abnormality that occurs spontaneously • Symptoms: decreased appetite, weight loss, fever • May cause splenomegaly, bone damage, extremely high or low platelet count • Prognosis – overall 5-year survival rate is approximately 59% Acute Lymphocytic Leukemia (ALL) • Rapid onset, progresses quickly • Excess of Lymphoblasts in bone marrow • Most common in children under the age of 5 years, may also affect adults >50 yrs • Males>Females • Elevated WBC with increased lymphocytes • Combination therapies used to produce remission • Prognosis- 92% chance of remission in children whereas adults have about a 69% 5-year survival rate Chronic Lymphocytic Leukemia (CLL) • Slow Onset • Lymphoid cells • Proliferation, accumulation of small abnormal, mature lymphocytes • Older adults – diagnosis most commonly at 70 yrs of age and older • Symptoms may be vague • May be years before treatment required • Prognosis- 83% 5-year survival rate Clinical Manifestations of Leukemia • General manifestations result from • Anemia • Infection • Bleeding • Hepatomegaly • Lymphadenopathy • Splenomegaly • Bone pain • Meningeal irritation • Oral lesions Leukemia: Assessment Findings • Fever, pallor, fatigue, anorexia, activity intolerance, malaise, irritability, hemorrhage, and bone/joint pain • Hepatomegaly, splenomegaly, lymphadenopathy • Pathological fractures • Increased intracranial pressure • Abnormalities of the skin including petechiae and ecchymosis • Bleeding from mucous membranes Leukemia: Diagnostic Tests • CBC • Platelets • Chest X-ray • Lymph node biopsy • Bone marrow biopsy Leukemia: Considerations • Risk for bleeding • Nutrition • Anxiety, coping, sexuality • Fatigue • Pain • Fluid & Electrolytes • Elimination • Immunity/Infection Leukemia: Treatment • Remission or cure • Symptom relief • Eradicating the leukemia with chemotherapy • Bone marrow transplant • Prognosis – depends on various factors including age at diagnosis, initial WBC count, type of cell involved, and sex of the child Leukemia: Surgical Options • Stem cell transplant (SCT) • Transplant may be autologous, donor, or syngeneic • Donors require a match • Hematopoietic growth factor administered to donor before harvesting Leukemia: Surgical Options • Bone marrow transplant (BMT) • Treatment of choice for some types and suitable donor • Autologous • Allogenic • In conjunction with chemotherapy • Graft-versus-host disease (GVHD) • Immune cells identify body tissue as foreign • Allogenic BMT or SCT may precipitate • Acute • Chronic Medications • Chlorambucil (Leukeran) • Hydroxyurea • Corticosteroids • Cyclophosphamide • Chemotherapy Complementary therapies for symptoms & side effects • Acupuncture • Aromatherapy • Exercise • Hypnosis • Massage • Meditation • Music therapy • Relaxation techniques • Tai chi • Yoga Activity • Youtube video on Leukemia • https://www.youtube.com/watch?v=Z3B-AaqjyjE Sickle Cell Anemia Flattened Shape Larger surface area to carry more oxygen. Flexible Able to squeeze through narrow blood vessels (capillaries) Filled with Hemoglobin Hemoglobin is a protein that gives blood its red color. It carries oxygen to your body's organs and tissues and transports carbon dioxide from your organs and tissues back to your lungs No Nucleus Red blood cells are biconcave discs that do not contain a nucleus. This allows for more space for hemoglobin to carry oxygen Structure and Function of the Red Blood Cell Normal Red Blood Cells Versus Sickle Cells • Normal Red Blood Cells • Smooth • Disk-shaped • Flexible • Sickle Cells • Stiff and sticky • When they lose their oxygen, they form into the shape of a sickle or crescent, like the letter C Sickle Cell Anemia Pathophysiology • Erythrocytes • Hemoglobin • Hemoglobin A (Hb A) • Hemoglobin S (Hgb S) • Sickle Cell Anemia • Normal Hgb A replaces abnormal Hgb S • Insufficient oxygen levels of Hgb S causes RBCs to become rigid, deformed • RBCs abnormally crescent shaped • Capillary Occlusion Capillary Occlusion by Sickle Cells Sickle Cell Anemia: Etiology • Genetic mutation • Transmitted as autosomal recessive defect • Risk of having child with SCD is 25% if both parents have trait Sickle Cell Disease versus Sickle Cell Trait • Sickle Cell Disease (SCD) • Inherited two abnormal Hgb S genes • Sickle cell trait (SCT) • Inherited one sickle cell Hgb gene “S” from one parent plus one normal Hgb “A” gene from the other parent • “Carrier” • HgbSA Sickle Cell Anemia-Risk Factors and Prevalence • African American or Eastern Mediterranean heritage • Most common genetic disorder and inherited RBC disease • Prevalence • About 1 in 13 African American babies is born with sickle cell trait. Diagnostics • Screening • Sickle Cell test: electrophoresis • Routine ultrasounds • CBC • Skeletal X-rays • MRI Precipitating Factors • Situations that precipitate sickling • fever • dehydration • infection • overexertion • weather changes (cold) • alcohol ingestion • smoking • emotional or physical stress • high altitudes • pregnancy Sickle Cell Crisis • Acute exacerbation of the disease • Can vary considerably in severity and frequency • Care focuses on the prevention and treatment of the crisis Types of Sickle Cell Crisis • Vaso-occlusive crisis • Manifestations: fever, painful swelling of hands, feet, and joints; and abdominal pain • Splenic Sequestration • Manifestations: profound anemia, hypovolemia, and shock • Hyper hemolytic Crisis • Manifestations: anemia, jaundice, and reticulocytosis • Aplastic Crisis • Manifestations: profound anemia and pallor Sickle Cell Anemia Complications • S troke, S welling (hands & feet), S pleen problems • I nfections, I nfarctions • C rises, C ardiac problems • K idney disease • L iver disease • E ye problems (retinopathy), E rection (priapism) Sickle Cell Anemia: Complications • Infections • Retinal damage • Hemorrhage • Infarctions • Heart failure • Pain • Priapism • Chronic ulcers • Avascular necrosis • Dactylitis • Multi-system failure • Death Sickle Cell Anemia: Clinical Manifestations ● Acute ● Pallor, dizziness, fatigue, irritability ● Abdominal pain ● Joint pain ● Jaundice ● Urinary insufficiency ● Inflamed fingers or toes ● Shortness of breath ● Chronic ● Significant risk of stroke ● Enlarged spleen, liver ● Renal insufficiency ● Gallstones ● Delayed development in children Sickle Cell Anemia: Nursing Interventions • Hydration and blood flow • Positioning • Assist with ROM exercises • Balance of rest and activity • Diet • Monitor for complications • Reinforce education • Adherence to immunization schedules • Inherited disorder Sickle Cell Anemia: Medical Management • Administer oxygen • Prophylactic antibiotics • Pain management • Folic Acid supplementation • Hydroxyurea • Blood transfusions • Risk of iron overload • Risk of alloimmunization Sickle Cell Anemia: Surgical Options • Bone marrow transplantation (BMT) • Matched sibling donors • Lack of availability of matched sibling donors • Concerns regarding regimen-related toxicity • Splenectomy • Prognosis Complementary and Alternative therapies • Massage for pain reduction • Nutritional supplements • Alpha-lipoic acid • Acetyl-L-carnitine Lifespan Considerations • Pediatric clients • Asymptomatic until 4–6 months • Acute chest syndrome • High risk of stroke • Pregnant clients • More frequent pain crises • More intense symptoms • Higher risk of complications Activity • Youtube video on Sickle Cell anemia • https://www.youtube.com/watch?v=2CsgXHdWqVs Skin Cancer Skin Cancer- Basal Cell Carcinoma • Arise from the basal cell layer of the epidermis • Usually scaly in appearance, may be a pearly papule with a central crater, waxy, have a pearly border • Often found on the face and upper trunk • Metastasis is rare, may have underlying tissue destruction • Risk factors include - frequent contact with certain chemicals - overexposure to the sun - radiation treatment • More common in fair-skinned people • Prognosis – With early detection and complete removal the outcome is favorable • This type of cancer recurs in 40% to 50% of patients treated Skin cancer- Squamous Cell Carcinoma • Arises from the epidermis • Firm, nodular lesion topped with a crust or central area of ulceration and indurated margins • 10% of patients have rapid invasion with metastasis via the lymphatic system. • Risk factors - Sun-exposed areas - Sites of chronic irritation - Areas of previous injuries such as burns, scars and ulcers Skin Cancer – Malignant Melanoma • Cancerous neoplasm in which pigment cells (melanocytes) invade the epidermis, dermis, and sometimes the subcutaneous tissue. • Most deadly skin cancer • Can metastasize to any organ, including the brain and heart • Risk factors - Exposure to the sun - Heredity - History of skin cancer Skin Cancer – Malignant Melanoma • Malignant Melanoma can be divided into FOUR primary types: 1. Superficial spreading melanoma 2. Lentigo malignant melanoma 3. Nodular melanoma 4. Acral lentiginous melanoma Superficial Spreading Melanoma • Most common type of melanoma • May occur anywhere on the body • Slightly elevated, irregularly shaped lesions • Varying colors: tan, brown, black, blue, gray or pink Lentigo Malignant Melanoma • Usually found on the head and neck of older adults • Appear as tan, flat lesions • Change shape and size Nodular Melanoma • Grow and metastasis faster than the other types • Appear as a blueberry type growth • Varying colors: blue-black to pink • Patient may report a blood blister that does not go away Acral Lentiginous Melanoma • Occurs in areas NOT exposed to sunlight where no hair follicles are present • Common locations: hands, soles of feet, and mucous membranes Prognosis – Skin Cancer • If the cancer spreads to the Lymph nodes, there is a 50% 5-year survival rate • If the cancer metastasis to other areas, treatment is focused on Palliative care • Key factor is the thickness of the lesion: - 1 mm thick have a survival rate of almost 100% - 3 mm thick or more have a survival rate of less than 50% Treatment - Skin Cancer • Surgical interventions • Cryosurgery - local application of liquid nitrogen • Curettage and Electrodesiccation - use of a dermal curette to scrape away cancerous tissue, followed by the application of an electric probe to destroy remaining tumor tissue • Excision - surgical removal of small lesions • Mohs surgery - tissue is removed in sections (horizontal layers) and examined until no more cancer remains. Occasionally the patient requires a lymph node resection during this surgery. • Wide excision - deep skin resection often involving full-thickness skin in the area of the lesion. • Topical therapies • Radiation • Chemotherapy Breast Cancer Breast Cancer • Has many forms with different clinical signs and symptoms • Some have a palpable lump in the breast and others are only visible on a mammogram • Two categories: • Noninvasive - remains within the mammary duct • Invasive - most common type ● Most common sites of metastasis are brain, bones, liver, and lung Risk factors for Breast Cancer ● Female - although males can have breast cancer ● Age - >65 years ● Genetics ● Breast density ● Ionizing radiation ● Reproductive history ● Menstrual history ● Oral contraceptives ● Hormone replacement therapy ● Obesity ● Alcohol consumption Breast Cancer Screening • Mammography - annual screening every year for women starting at the age of 45-54 years • Breast Self-Awareness/Self-Examination - Monthly • Clinical Breast Examination - every 3 years for women 20-30 years and yearly for women age 40 years and older Assessment findings ● Non-tender, fixed mass ● Peau d’orange ● Increased vascularity ● Nipple inversion/retraction ● Ulcerations ● Enlargement of axillary and supraclavicular lymph nodes Treatment for Breast Cancer ● Pain management ● Depression and Anxiety treatment ● Diet ● Chemotherapy ● Radiation ● Surgical Intervention ○ Lumpectomy ○ Mastectomy -partial mastectomy, total simple mastectomy, or modified radical mastectomy Surgical Interventions for Mastectomy ● Patient may have drain tubes, usually JP drains, that collect fluid from the surgical site. These are removed in the physician's office. ● Educate patient to keep drain tubing from kinking or getting pulled ● Elevate head of bed at least 30 degrees with affected arm elevated on a pillow ● Pain management ● No blood pressures or needle sticks in the affected arm ● Educate patient on importance of continuing ordered exercise regimen. Breast Reconstruction ● Can be done at the same time as the mastectomy or after ● Use of breast expanders (saline or silicone) is the most common method ● Autologous reconstruction - using the patient’s own skin, fat, and muscle from an donor site ● Nurse must closely monitor the incision for s/s of infection and poor tissue perfusion ● No heavy lifting ● Avoid pressure on incision site ● Optimal appearance may not occur for 3-6 months after surgery Lung Cancer Lung Cancer ● Leading cause of cancer-related deaths world-wide ● Poor prognosis with a 5-year survival rate of 19% ● Occurs as a result of repeated exposure to inhaled substances that cause chronic tissue irritation or inflammation interfering with cellular regulation of cell growth ● Can be classified as Small-cell (SCLC) or Non-small cell (NSCLC) ● Tumors can grow and obstruct the bronchus interfering with gas exchange Lung Cancer Risk Factors ● Cigarette smoking is the major risk factor and is responsible for 81% of all lung cancer deaths ● Exposure to secondhand smoke ● Chronic exposure to asbestos, beryllium, chromium, coal distillates, radiation, cobalt, iron oxide, mustard gas, petroleum distillates, tar, nickel, and uranium ● Air pollution ● Environmental carcinogens ● Genetics ● Advancing age Warning Signs of Lung Cancer ● Hoarseness ● Change in respiratory pattern ● Persistent cough or change in cough ● Blood-streaked sputum ● Rust-colored or purulent sputum ● Frank hemoptysis ● Wheezing ● Chest pain or chest tightness ● Shoulder, arm, or chest wall pain ● Recurring episodes of pleural effusion, pneumonia, or bronchitis ● Dyspnea ● Weight loss ● Clubbing of fingers Non-Surgical Management of Lung Cancer ● Chemotherapy ● Targeted therapy - common treatment for NSCLC. Increased survival time but is not a cure ● Immunotherapy - a type of targeted therapy designed to allow the patient’s immune system to better recognize and attack cancer cells. ● Radiation Therapy ● Photodynamic Therapy (PDT) - used to remove small bronchial tumors when they are accessible by bronchoscopy Photodynamic Therapy (PDT) Surgical Management of Lung Cancer ● Surgical procedures are typically performed by open thoracotomy and includes: ○ Removal of tumor only ○ Removal of lung segment ○ Lobectomy - removal of lobe of lung ○ Pneumonectomy - removal of the entire lung Chest Tube Management ● Place below the chest level ● Assess for difficulty breathing ● Check alignment of trachea ● Observe for s/s of infection ● Assess bubbling in the water-seal chamber; should be gentle bubbling on exhalation, cough, or sneeze ● Monitor tubing to prevent kinks in the tubing ● Perform hourly checks ● Monitor and document drainage ● Encourage the patient to deep breath and cough ● Administer pain medication as needed ● If chest tube is dislodged, immediately cover insertion site with a sterile gauze and notify the physician