Nursing Oncology PDF

Oncology defined Branch of medicine that deals with the study, detection, treatment and management of cancer  “Root words”  Neo- new  Plasia- growth  Plasm- substance  Trophy- size  +Oma- tumor  Statis- location “Root words”  A- none  Ana- lack  Hyper- excessive  Meta- change  Dys- ba...

Oncology defined Branch of medicine that deals with the study, detection, treatment and management of cancer  “Root words”  Neo- new  Plasia- growth  Plasm- substance  Trophy- size  +Oma- tumor  Statis- location “Root words”  A- none  Ana- lack  Hyper- excessive  Meta- change  Dys- bad, deranged CANCER NURSING Etiology of cancer 1. PHYSICAL AGENTS  Radiation  Exposure to irritants  Exposure to sunlight  Altitude, humidity CANCER NURSING Etiology of cancer 2. CHEMICAL AGENTS  Smoking  Dietary ingredients  Drugs CANCER NURSING Etiology of cancer ❖ Genetics and Family History  Colon Cancer  Breast cancer CANCER NURSING Etiology of cancer ❖ Dietary Habits ❑ Low-Fiber ❑ High-fat ❑ Processed foods ❑ alcohol CANCER NURSING Etiology of cancer ❖Viruses and Bacteria  DNA viruses- HepaB, Herpes, EBV, CMV, Papilloma Virus  RNA Viruses- HIV, HTCLV  Bacterium- H. pylori CANCER NURSING Etiology of cancer ❖Hormonal agents  DES  OCP especially estrogen CANCER NURSING Etiology of cancer ❖Immune Disease  AIDS  CANCER NURSING Body Defenses Against TUMOR  1. T cell System/ Cellular Immunity  Cytotoxic T cells kill tumor cells  2. B cell System/ Humoral immunity  B cells can produce antibody  3. Phagocytic cells  Macrophages can engulf cancer cell debris  CANCER NURSING Cancer Diagnosis  1. BIOPSY  The most definitive  2. CT, MRI  3. Tumor Markers CANCER NURSING Cancer Staging The degree of DIFFERENTIATION  Stage 1- Low grade  Stage 4- high grade CANCER NURSING GENERAL MEDICAL MANAGEMENT  1. Surgery- cure, control, palliate  2. Chemotherapy  3. Radiation therapy  4. Immunotherapy  5. Bone Marrow Transplant CANCER NURSING GENERAL Pharmacology  1. antimetabolites  2. antibiotics  3. plant alkaloids  4. antiemetics CANCER NURSING GENERAL Promotive and Preventive Nursing Management  1. Lifestyle Modification  2. Nutritional management  3. Screening  4. Early detection SCREENING  1. Male and female- Occult Blood, CXR, and DRE  2. Female- SBE, CBE, Mammography and Pap’s Smear  3. Male- DRE for prostate, Testicular self-exam Nursing Assessment Utilize the ACS 7 Warning Signals  CAUTION  C- Change in bowel/bladder habits  A- A sore that does not heal  U- Unusual bleeding  T- Thickening or lump in the breast  I- Indigestion  O- Obvious change in warts  N- Nagging cough and hoarseness Nursing Assessment  Weight loss  Frequent infection  Skin problems  Pain  Hair Loss  Fatigue  Disturbance in body image/ depression Nursing Intervention  MAINTAIN TISSUE INTEGRITY  Handle skin gently  Do NOT rub affected area  Lotion may be applied  Wash skin only with SOAP and Water Nursing Intervention  MANAGEMENT OF STOMATITIS  Use soft-bristled toothbrush  Oral rinses with saline gargles/ tap water  Avoid ALCOHOL-based rinses Nursing Intervention MANAGEMENT OF ALOPECIA Alopecia begins within 2 weeks of therapy Regrowth within 8 weeks of termination Encourage to acquire wig before hair loss occurs Encourage use of attractive scarves and hats Provide information that hair loss is temporary BUT anticipate change in texture and color Nursing Intervention PROMOTE NUTRITION Serve food in ways to make it appealing Consider patient’s preferences Provide small frequent meals Avoids giving fluids while eating Oral hygiene PRIOR to mealtime Vitamin supplements Nursing Intervention RELIEVE PAIN Mild pain- NSAIDS Moderate pain- Weak opiods Severe pain- Morphine Administer analgesics round the clock with additional dose for breakthrough pain Nursing Intervention DECREASE FATIGUE Plan daily activities to allow alternating rest periods Light exercise is encouraged Small frequent meals Nursing Intervention IMPROVE BODY IMAGE Therapeutic communication is essential Encourage independence in self-care and decision making Offer cosmetic material like make-up and wigs Nursing Intervention ASSIST IN THE GRIEVING PROCESS Some cancers are curable Grieving can be due to loss of health, income, sexuality, and body image Answer and clarify information about cancer and treatment options Identify resource people Refer to support groups Nursing Intervention MANAGE COMPLICATION: INFECTION Fever is the most important sign (38.3) Administer prescribed antibiotics X 2weeks Maintain aseptic technique Avoid exposure to crowds Avoid giving fresh fruits and veggie Handwashing Avoid frequent invasive procedures Nursing Intervention MANAGE COMPLICATION: Septic shock Monitor VS, BP, temp Administer IV antibiotics Administer supplemental O2 Nursing Intervention MANAGE COMPLICATION: Bleeding Thrombocytopenia ( 5 cm, (+) LN  IV- metastasis Breast Cancer  MEDICAL MANAGEMENT  1. Chemotherapy  2. Tamoxifen therapy  3. Radiation therapy Breast Cancer  SURGICAL MANAGEMENT 1. Radical mastectomy 2. Modified radical mastectomy 3. Lumpectomy 4. Quadrantectomy Breast Cancer NURSING INTERVENTION : PRE-OP  1. Explain breast cancer and treatment options  2. Reduce fear and anxiety and improve coping abilities  3. Promote decision making abilities  4. Provide routine pre-op care:  Consent, NPO, Meds, Teaching about breathing exercise Breast Cancer NURSING INTERVENTION : Post-OP 1. Position patient:  Supine  Affected extremity elevated to reduce edema Breast Cancer NURSING INTERVENTION : Post-OP 2. Relieve pain and discomfort  Moderate elevation of extremity  IM/IV injection of pain meds  Warm shower on 2nd day post-op Breast Cancer NURSING INTERVENTION : Post-OP 3. Maintain skin integrity  Immediate post-op: snug dressing with drainage  Maintain patency of drain (JP)  Monitor for hematoma w/in 12H and apply bandage and ice, refer to surgeon Breast Cancer NURSING INTERVENTION : Post-OP 3. Maintain skin integrity  Drainage is removed when the discharge is less than 30 ml in 24 H  Lotions, Creams are applied ONLY when the incision is healed in 4-6 weeks Breast Cancer NURSING INTERVENTION : Post-OP Promote activity  Support operative site when moving  Hand, shoulder exercise done on 2ndday  Post-op mastectomy exercise 20 mins TID  NO BP or IV procedure on operative site Breast Cancer NURSING INTERVENTION : Post-OP Promote activity  Heavy lifting is avoided  Elevate the arm at the level of the heart  On a pillow for 45 minutes TID to relieve transient edema Breast Cancer NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS  Lymphedema  10-20% of patients  Elevate arms, elbow above shoulder and hand above elbow  Hand exercise while elevated  Refer to surgeon and physical therapist Breast Cancer NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS  Hematoma  Notify the surgeon  Apply bandage wrap (Ace wrap) and ICE pack Breast Cancer NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS Infection  Monitor temperature, redness, swelling and foul- odor  IV antibiotics  No procedure on affected extremity Breast Cancer NURSING INTERVENTION : Post-OP TEACH FOLLOW-UP care  Regular check-up  Monthly BSE on the other breast  Annual mammography Discussion of  Palliative Care  Oncologic Emergencies  Lung Cancer  Male & Female reproductive Cancers  Brain Tumors Critical Thinking  Scenario: A 49 y/o male has a 32 year history of cigarette smoking. He often eats out with associates and typically eats red meat and potatoes. One of his associates is a 51 y/o female whose mother dies of breast cancer. She is 40lbs over her ideal weight because she likes to snack during the day. She is also a heavy coffee drinker because she is from Seattle. Case Study 1 R.T. is a 64-year-old man who comes to his primary care provider’s (PCP’s) offi ce for a yearly examination. He initially reports having no new health problems; however, on further questioning, he admits to having developed some fatigue, abdominal bloating, and intermittent constipation. His nurse practitioner completes the examination, which includes a normal rectal exam with a stool positive for guaiac. Diagnostic studies include a CBC with differential, chem 14, and carcinoembryonic antigen (CEA). R.T. has not had a recent colonoscopy and is referred to a gastroenterologist for this procedure. A 5-cm mass found in the sigmoid colon confirms a diagnosis of a polypof the colon. A referral is made for surgery. The pathology report describes the tumor as stae 11, which means that the cancer has extended into the mucous layer of the colon. A metastatic work-up is negative. 1. Identify 6 risk factors for colon cancer: 2. Discuss the recommended screening procedures related to colon cancer. 3. What warning sign did R.T. have? 4. What would early signs be for colorectal cancer? 5. What would late signs be? Case Study 1 R.T. is a 64-year-old man who comes to his primary care provider’s (PCP’s) offi ce for a yearly examination. He initially reports having no new health problems; however, on further questioning, he admits to having developed some fatigue, abdominal bloating, and intermittent constipation. His nurse practitioner completes the examination, which includes a normal rectal exam with a stool positive for guaiac. Diagnostic studies include a CBC with differential, chem 14, and carcinoembryonic antigen (CEA). R.T. has not had a recent colonoscopy and is referred to a gastroenterologist for this procedure. A 5-cm mass found in the sigmoid colon confirms a diagnosis of a polypof the colon. A referral is made for surgery. The pathology report describes the tumor as stae 11, which means that the cancer has extended into the mucous layer of the colon. A metastatic work-up is negative. 6. After bowel prep, R.T. is admitted to the hospital for an exploratory laparotomy, small bowel resection and sigmoid colectomy. - What are five major complications for him? 7. After surgery, R.T. is admitted to the surgical intensive care unit (SICU) with a large abdominal dressing. The nurse rolls R.T. side to side to remove the soiled surgical linen, and the dressing becomes saturated with a large amount of serosanguineous drainage. Would the drainage be expected after abdominal surgery? Explain. Case Study 2 You are a home health nurse who has been seeing P.C., who was diagnosed with lung cancer approximately 1 year ago. Her provider recently informed her that her cancer is no longer treatable; the focus of her treatment will change from curative measures to symptom relief. She is confused and somewhat angry with her provider. She vaguely remembers the term palliative treatment when discussing her situation with her provider but doesn’t know what it means. 1. How would you describe palliative treatment? Case Study 2 You are a home health nurse who has been seeing P.C., who was diagnosed with lung cancer approximately 1 year ago. Her provider recently informed her that her cancer is no longer treatable; the focus of her treatment will change from curative measures to symptom relief. She is confused and somewhat angry with her provider. She vaguely remembers the term palliative treatment when discussing her situation with her provider but doesn’t know what it means. Case progress Note: P.C. confides that she always felt that she might not survive her illness, but has never formally written down her wishes concerning what types of treatment she would or would not want. You advise her to complete an advance directive and/or living will or to complete a medical durable power of attorney and/or a surrogate decision maker form. In current practice, it is very likely that a part of the home health intake process will be completion of a Physicians Order on Life Sustaining Treatments (POLST) Paradigm form. 2. What is the purpose of these documents? Case Study 2 3. What health care decisions are considered in these documents? 4. How are advance directives and living wills formalized? 5. P.C. states she is confused and has mixed feelings about her health care wishes right now. She asks, “If I fill out this form, can I change my mind down the road?” How should you answer this question? 6. You inform P.C. that you will help with symptomatic control of her illness. What areas will you focus on, and what question would you ask P.C.? 7. As P.C. becomes more frail and incoherent, what treatment will be given? Discussion  Culturally appropriate treatment  Share your experiences