Nursing Adults with Chronic Health and Rehabilitation Concerns PDF

NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns Active Learning Guide: Cancer and the Nursing Process Purpose/Overview...

NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns Active Learning Guide: Cancer and the Nursing Process Purpose/Overview Active learning guides help students to focus their study time by using knowledge-level information, then focusing on application and analysis of information to provide context in relation to the course and career skills. Students should review the active learning guide before beginning to engage with the module content, then work to complete the guide during and after to engage with the content. An active learning guide is not the same as a study guide or a test blueprint. It serves as a guide to help the student navigate the course and content. Instructions Review the active learning guide before you begin reading and engaging with other content in the module. Looking at the questions beforehand will give you a preview of the information you will be learning, including the key concepts and takeaways. As you work through the module content, complete the active learning guide. Some questions may be reflective and require that you finish all content before responding. The completed learning guide will be turned in one week before the exam. There are a possible 20 points for this learning guide. Brittney- Red, Minton-Purple Harper- Pink, Sean-Blue, Ethan-Green Reading Focus A Sacred Covenant: The Spiritual Ministry of Nursing: (6 points) Please answer the following questions about spiritual ministry. Chapter 4 has information to help support your answer. Minton 1. In working with your patient today, tell us how you felt about the need for compassion for patients, no matter what their physical problems or cultural differences might be. Today I worked with an alcoholic patient. Regardless of his life decisions, he deserves compassionate care to get better. Some people will blow them off and act like what they’re fighting isn’t a disease, but others will show them compassionate care regardless, and in this scenario, it benefitted the patient's outcome. 2. You can consider those that are difficult to deal with as a different culture. Also, how did it show you that nursing is an art, not just a science? Nursing is an art and not only a science because if you don’t have compassion and mercy for others, you will not be able to fulfill all of the patient needs ahead of you. Harper  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns 3. In working with your patient today, tell us how you felt about the need for compassion for patients, no matter what their physical problems or cultural differences might be. In working at the hospital, I’ve come across multiple patients that are Marseilles and there are various cultural differences, especially regarding health. Although there may be cultural differences and language barriers, love is a universal language and, through showing kindness and making an effort to make the patient as comfortable as possible, compassion can be displayed through actions rather than direct verbal communication. 4. You can consider those that are difficult to deal with as a different culture. Also, how did it show you that nursing is an art, not just a science? I was able to show how nursing is an art and not just a science through attempting to understand in ways that aren’t just using words, building a trusting relationship through doing everything possible to explain everything I was doing for the patient and paying attention to physical cues rather than relying on verbal communication to ensure the patient is comfortable and pleased throughout their experience. Brittney 5. In working with your patient today, tell us how you felt about the need for compassion for patients, no matter what their physical problems or cultural differences might be: I think compassion is so important as it can give an avenue for you to build a trusting relationship with the patient and allow the patient to be more vulnerable. Compassion is way for them to also see that you are a human and have feelings too. 6. You can consider those that are difficult to deal with as a different culture. Also, how did it show you that nursing is an art, not just a science? It is an art by being able to find a level to correlate with your patient and being able to see yourself in their shoes to be able to provide way better care and truly understand the needs of the patients. Ethan 7. In working with your patient today, tell us how you felt about the need for compassion for patients, no matter what their physical problems or cultural differences might be. Many patients have family that can come visit them, but will have to leave to take care of other responsibilities. This means that the nurses are usually the ones that the patient sees the most, and being a compassionate nurse can show that you truly care about their health. 8. You can consider those that are difficult to deal with as a different culture. Also, how did it show you that nursing is an art, not just a science? Every patient is an individual, and no two patients are going to fit the same plan of care even if they are being treated for the same condition. Sean 9. In working with your patient today, tell us how you felt about the need for compassion for patients, no matter what their physical problems or cultural differences might be.  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns Some diagnostic procedures are embarrassing. To gain this information a particular type of material needs to be accessed, gained or collected. To reassure the patient, trust will need to be established, active listening used to validate patient concerns, Respect patient privacy, Continue to communicate with the patient and remain professional. 10. You can consider those that are difficult to deal with as a different culture. Also, how did it show you that nursing is an art, not just a science? Nursing as an artform showcases the humanistic features of patient care, empathy focus, communication, personalized attention and holistic healing that nurses use. Nurses use creativity, intuition and emotional intelligence to start and establish a therapeutic relationship with the patient. This can help the nurse alleviate andy paint and suffering and encourage well being. In the text, you will see essential boxes, such as Assessment Abnormalities Tables, which discuss abnormal findings in the assessment of adults. Biologic Sex Consideration Boxes which contain a summary of how the disease affects male and female. Clinical Judgment Model Case Studies at the end of every chapter are available to promote your understanding of the decision-making process. Many other tables and boxes are noted in the text that will bring out the most valuable information organized in an effective summary. Biology of Cancer 1. Explain the process of cell proliferation in your own words. Cell Cycle includes the following stages: G1 Phase (G1) -> Cells grow and prepare for DNA reproduction. Needed proteins and organelles are produced. S Phase (Synthesis) -> Cell replication of its DNA, securing each new cell has an identical set of chromosomes. G2 Phase (G2) -> Cell growth continues and readies for mitosis. G2 checks for any replication errors then will correct or repair any if found. M Phase (Mitosis) -> Cell division replicates its DNA and cytoplasm to create two daughter cells. Mitosis is segmented into stages: Prophase, metaphase, anaphase, and telophase, then cytokinesis. Cytokinesis is where the cell will divide into two. Regulation -> Is tightly regulated through signals and checkpoints to secure accuracy and inhibit uncontrolled cell division. This can lead to manifestations like cancer. Cyclins and cyclin-dependent kinases (CDKs) are proteins that regulate and have a vital role in continuing to advance the cells through the phases of the cell cycle.  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns External Signals -> Hormones, Growth Factors, and nutrients from the outside environment can influence cell growth and proliferation. These signals bind to receptors on the surface of the cell, triggering intracellular pathways that will promote cell cycle progression. Apoptosis -> If a damaged cell is beyond the state of repair, it will undergo a programmed cell death to prevent the propagation of faulty cells. 2. What is one theory of how cancer develops? Bone marrow cells/stem cells become defective. These defective cells will reproduce more of the same defective cells (cancer). 3. Does genetics have any role in the development of cancer? Cancer involves the malfunction of genes that control differentiation and proliferation. Two types of normal genes that can be affected by mutation are protooncogenes and tumor suppressor genes. Protooncogenes are normal cell genes that are important regulators of normal cell processes. Protooncogenes promote growth. Mutations that change the expression of protooncogenes can cause them to function as oncogenes (tumor-inducing genes). Think of the protooncogene as the genetic lock that keeps the cell in its mature functioning state. When this lock is “unlocked,” which can occur through exposure to carcinogens (agents that cause cancer) or oncogenic viruses, genetic alterations and mutations occur. Thus oncogenes can change a normal cell to a malignant one. This cell regains a fetal appearance and function. For example, some cancer cells make new proteins characteristic of the embryonic and fetal periods of life. These proteins, found on the cell membrane, include carcinoembryonic antigen (CEA) and α-fetoprotein (AFP). They can be found in the blood by laboratory studies. Other cancer cells, such as small cell lung cancer, make hormones that are usually made by cells arising from the same embryonic cells as the tumor cells. Gene mutations can occur in 2 ways: inherited from a parent (passed from one generation to the next) or acquired during a person’s lifetime. See more about mutations in Chapter 13. We think the genetic predisposition to cancer plays a role in about 5% to 10% of cancers. These genetic alterations lead to a high risk for developing a specific type of cancer. However, most cancers do not result from inherited genes. They are acquired from damage to genes occurring during one’s lifetime. An acquired mutation is passed on to all cells that develop from that single cell. The damaged cell may die or repair itself. However, if cell death or repair does not occur before cell division, the cell will replicate into daughter cells, each with the same genetic alteration.  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns 4. What are carcinogens, and how do they affect the patient? Carcinogens are cancer-causing agents capable of producing cell alterations. Many are detoxified by protective enzymes and harmlessly excreted. If this protective mechanism fails, carcinogens can enter the cell’s nucleus and alter deoxyribonucleic acid (DNA). Carcinogens may be chemical, radiation, or viral. Chemical carcinogens Many chemicals are carcinogens (e.g., benzene, arsenic, formaldehyde). People exposed to these chemicals over time have a greater incidence of certain cancers. The long latency period from the time of exposure to cancer development makes it hard to identify cancer-causing chemicals. Radiation Radiation can cause cancer in almost any body tissue. When cells are exposed to a source of radiation, damage occurs to DNA. A higher incidence of cancer may occur in people exposed to radiation in certain occupations, such as radiologists, radiation chemists, aircrews, and uranium miners. Ultraviolet (UV) radiation has long been associated with melanoma and squamous and basal cell skin cancers. Skin cancer is the most common type of cancer among whites in the United States. Sunlight exposure is the main source of UV exposure, giving off UVA and UVB rays. UV radiation from tanning beds also causes skin cancer. Viral carcinogens Certain DNA and ribonucleic acid (RNA) viruses, termed oncogenic, can alter the cells they infect and induce malignant transformation. These viruses have been identified as causative agents of cancer in animals and humans. Burkitt lymphoma is associated with Epstein-Barr virus (EBV).5 People with acquired immunodeficiency syndrome (AIDS), caused by human immunodeficiency virus (HIV), have a high incidence of Kaposi sarcoma (see Chapter 15). Other viruses linked to cancer include hepatitis B virus, which is associated with primary liver cancer (hepatocellular cancer), and human papillomavirus (HPV). HPV can cause lesions that progress to squamous cell cancers, such as cervical, anal, and head and neck cancers. 5. What is meant by “metastasis”? Progression is the last stage. Here, we see increased growth rate of the tumor, increased invasiveness, and metastasis (spread of the cancer to a distant site). Some cancers have an affinity for a particular tissue or organ as a site of metastasis. For example, colon cancer often spreads to the liver. Other cancers are unpredictable in their pattern of metastasis. The most common sites of metastasis are lungs, liver, bone, and brain (Fig. 16.3).  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns Classification of Cancer 6. How are tumors classified according to anatomic site classification? In the anatomic classification of tumors, the tumor is identified by the tissue of origin, anatomic site, and behavior of the tumor (benign or malignant) (Table 16.4). Carcinomas originate from embryonal ectoderm (skin and glands) and endoderm (mucous membrane linings of the respiratory tract, GI tract, and genitourinary [GU] tract). Sarcomas originate from embryonal mesoderm (connective tissue, muscle, bone, fat). Lymphomas and leukemias originate from the hematopoietic system 7. How are tumors classified using histologic classification? In histologic grading of tumors, the appearance of cells and degree of differentiation are evaluated pathologically. Grading is based on the degree to which the cells resemble the tissue of origin. Poorly differentiated (undifferentiated) tumors have a poorer prognosis than those that are closer in appearance to the normal tissue of origin (well-differentiated) 8. Explain disease classification according to staging: Classifying the extent and spread of disease is termed staging. Staging is based on the anatomic extent of disease. Although there are similarities in the staging of various cancers, there are many differences for specific types of cancer. Staging can be done initially and at several points. Clinical staging is done at the completion of the diagnostic workup to guide treatment selection. Prevention 9. To reduce the risk of cancer, the focus is early detection and prompt treatment. What are the teaching points that are essential for the nurse to use in educating the public? In educating the public, the goals of a nurse are to motivate people to recognize behaviors that may negatively affect health and encourage awareness of and participation in health-promoting behaviors. Specifically when teaching about cancer, it’s important to try to lessen the fear that surrounds the diagnosis. Teach people to be familiar with their bodies and how to perform self-examinations. Encourage them to seek immediate medical care if they notice a change in what is normal for them or if cancer is suspected. Encourage patients to follow the recommended cancer screening guidelines for breast, colon, cervical, and prostate cancer from the American Cancer Society Inform patients of the warning signs for cancer to watch for and identify early such as: ○ Change in bowel or bladder habits ○ A sore that does not heal ○ Unusual bleeding or discharge from any body orifice ○ Thickening or a lump in the breast or elsewhere ○ Indigestion or difficulty in swallowing ○ Obvious change in a wart or mole ○ Nagging cough or hoarseness 10. What screenings are essential in early detection of cancer?  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns Mammogram screenings→ breast cancer Pap smear→ cervical cancer Colonoscopy screening→ colon cancer Colorectal screenings→ prostate cancer Cholesterol, diabetes, and osteoporosis screening may also be recommended Detection - Cues 11. What are the warning signs of cancer? change in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge from any body orifice, thickening or a lump in the breast or elsewhere, indigestion or difficulty in swallowing, obvious change in a wart or mole, nagging cough or hoarseness 12. What health history would be relevant to the diagnosis of cancer? family history, exposure to carcinogens, when signs and symptoms first started 13. What diagnostic tests are used to diagnose cancer? endoscopic examination, radiographic studies, PET scan, genetic markers, bone marrow examination 14. What laboratory studies are used to diagnose cancer? cytology, chest x-ray, CBC and chemistry, liver function studies 15. What is the only definitive method to diagnose cancer? pathologic evaluation Analysis of Cue: Hypothesis 16. There will be times of high anxiety as patients await the results of screenings, diagnostic or laboratory tests. Write a nursing diagnosis addressing this issue. Fear r/t unknown test results. Prioritize Hypothesis 17. Explain the process of choosing the priority clinical problem. Maslow’s hierarchy– physiological first, then safety! Generate Solutions 18. What are the goals of nursing care for patients diagnosed with cancer? The goals of cancer treatment are cure, control, and palliation. When caring for the patient with cancer, knowing the treatment goals will help you appropriately communicate with, teach, and support the patient. Take Action 19. Care of the Patient receiving Chemo  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns a. Who can administer chemotherapy? Only persons specifically trained in chemotherapy handling techniques should be involved with the preparation and administration of cancer drugs. b. What actions does the nurse take to protect self during the preparation of the chemo agent? While providing many benefits, chemotherapy is strong medicine, so it is safest for people without cancer to avoid direct contact with the drugs. That's why oncology nurses and doctors wear gloves, goggles, gowns and masks. c. IV route for chemo is most common. What venous problems could result from IV chemo? Major concerns associated with IV chemotherapy administration include venous access problems, device- or catheter-related infection, and extravasation.10 It is the infiltration of drugs into tissues surrounding the infusion site, causing local tissue damage. Many chemotherapy drugs are either irritants or vesicants. Irritants damage the intima of the vein, causing phlebitis and sclerosis and limiting future peripheral venous access. They will not cause tissue damage if infiltrated. Vesicants, if inadvertently infiltrated into the skin, may cause severe local tissue breakdown and necrosis d. What are vesicants? What actions should be taken if extravasation occurs with a vesicant? Vesicants are a type of chemotherapy drug that, if inadvertently infiltrated into the skin, may cause severe local tissue breakdown and necrosis. If extravasation occurs with a vesicant, it’s important to immediately stop the infusion, notify the physician and monitor the patient for any complications that may occur. ○ To lessen discomfort and risks of infection and infiltration, IV chemotherapy can be given through a central venous access device (CVAD) ○ CVADs are placed in large blood vessels and they allow frequent, continuous, or intermittent administration of chemotherapy e. What is the effect of chemo on normal tissue? What is bone marrow suppression? How does the nurse protect the patient? Because chemotherapy drugs cannot selectively distinguish between normal cells and cancer cells, chemotherapy-induced side effects result from the destruction of normal cells, especially those that are rapidly proliferating such as: Bone marrow stem cells→ Myelosuppression (infection, bleeding, anemia) Epithelial cells lining GI tract→ Anorexia, mucositis (including stomatitis, esophagitis), nausea, vomiting, and diarrhea Hair follicle cells→ Alopecia Neutrophils→ Leukopenia and infection Ova and testes→ Reproductive problems ~Bone marrow suppression, also called myelosuppression, is one of the most common effects of chemotherapy and can also occur with radiation.  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns ~Treatment-induced myelosuppression can result in distressing effects like infection, hemorrhage, and overwhelming fatigue. ~The major difference in manifestations between radiation therapy and chemotherapy is that radiation (a local therapy) only affects bone marrow within the treatment field while chemotherapy (a systemic therapy) affects bone marrow function throughout the body and, when the therapies are combined, the risk for myelosuppression greatly increases. → The nurse can protect the patient by Monitoring CBC, especially the neutrophil, platelet, and RBC counts as patients often have the lowest blood cell counts between 7 and 10 days after starting therapy. Take every measure to prevent (neutropenia) infections in patients ○ Hand hygiene is the mainstay of patient safety. Monitor temperature routinely. ○ Any sign of infection should be treated promptly. ○ Fever in the presence of neutropenia is a medical emergency. ○ WBC growth factors are used to reduce the duration of chemotherapy-induced neutropenia as a prophylactic measure to prevent neutropenia when highly myelosuppressive chemotherapy drugs are used As thrombocytopenia can result in spontaneous bleeding or major hemorrhage, avoid invasive procedures Teach patients to avoid activities that place them at risk for injury or bleeding. Risk for serious bleeding is generally not present until the platelet count falls below 20,000/μL so, when the count drops that low, we often give platelet transfusions. Anemia is also common in patients undergoing either radiation therapy or chemotherapy, generally having a later onset (about 3 to 4 months after starting treatment) so patients with low hemoglobin levels may receive RBC growth factors How does the nurse assist the patient to deal with the fatigue and GI effects of chemo? FATIGUE: Help patients recognize that fatigue is common. Teach them energy conservation strategies. Help patients identify days or times during the day when they typically feel better and encourage them to be more active during those periods. Patients may need to rest before activity and have others help with work or home tasks as ignoring fatigue or overstressing the body when fatigue is tolerable may lead to an increase in symptoms. Maintaining exercise and activity within tolerable limits is often helpful in managing fatigue. ○ Walking programs are a way for most patients to keep active without overtaxing themselves. ○ Staying active helps improve mood and avoid the debilitating cycle of fatigue- depression-fatigue that can occur in patients with cancer. GI: Preventing nausea and vomiting with the first cycle lowers the risk so, if it does occur, initiate aggressive emesis control.  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns ○ give prophylactic antiemetic and anti anxiety medication 1 hour before treatment ○ patient may find that eating a light meal of nonirritating food before treatment is helpful. Delayed nausea and vomiting can develop 24 hours to a week after treatment ○ Assess patients who have nausea and vomiting for signs and symptoms of dehydration and metabolic alkalosis. ○ Treatment includes antiemetic drugs, diet adjustments, and nondrug interventions (e.g., relaxation breathing). Radiation- and chemotherapy-induced diarrhea are best managed with diet adjustments, antidiarrheals, antimotility drugs, and antispasmodics ○ recommend a diet low in fiber and residue before chemotherapy known to cause diarrhea by limiting foods high in roughage (e.g., fresh fruits, vegetables, seeds, nuts) ○ avoid fried, fatty, or highly seasoned foods, and foods that are gas-producing. ○ because bowel mucosal injury from radiation may cause temporary lactose intolerance, avoid milk products Depending on the severity of the diarrhea, the patient may need hydration and electrolyte supplements Lukewarm sitz baths may ease discomfort and cleanse the rectal area if rectal irritation develops ○ rectal area must be clean and dry to maintain skin integrity. ○ Inspect the perianal area for evidence of skin breakdown. ○ Systemic analgesia may be used for painful skin irritations. ○ Note the number, volume, consistency, and character of stools per day. ○ Have patients keep a diary or log to record episodes and aggravating and alleviating factors. Patients diagnosed with head and neck cancer who receive radiation are at high risk for mucositis ○ Teach patients to continue regular dental follow-up every 6 months. They should use fluoride supplements as recommended by their dentist. ○ Saliva substitutes may help patients with xerostomia. ○ Many patients find that drinking small amounts of water frequently has a similar effect. Oral assessment and careful intervention to keep the oral cavity moist, clean, and free of debris are essential to prevent infection and promote nutrition intake. ○ Implement standard oral care protocols that address prevention and management of mucositis. ○ Routinely assess the oral cavity, mucous membranes, characteristics of saliva, and ability to swallow. ○ Referral to a dentist for all necessary dental work is common before starting treatment. ○ Teach the patient to self-examine the oral cavity and how to perform oral care.  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns ○ They should perform oral care before and after each meal, at bedtime, and as needed throughout the day. ○ A saline solution of 1 tsp of salt in 1 L of water is an effective cleansing agent. ○ Adding 1 tsp of sodium bicarbonate to the oral care solution can decrease odor, ease pain, and dissolve mucin. Have the patient use a soft-bristled toothbrush. ○ Treat mucositis or pain in the throat with systemic and topical analgesics and antibiotics if infection is present Anorexia is a common side effect of cancer and cancer treatment ○ have a dietitian involved in patient care before cancer treatment starts ○ Monitor patients during and after treatment to ensure that weight loss does not become excessive. ○ Observe for dehydration. ○ Most tolerate small, frequent meals of high-protein, high-calorie foods best so nutrition supplements can be helpful. ○ The patient may need enteral (EN) or parenteral nutrition (PN) if they are severely malnourished, if symptoms will interfere with nutrition for a time, or if the bowel needs rest. ○ Monitor for and manage other symptoms that interfere with appetite (e.g., nausea, vomiting, pain, depression). f. How does anorexia affect the patient? release of TNF and IL-1 from macrophages causes a decrease in appetite 20. Care of the patient receiving Radiation a. What is radiation? high energy waves that cause ions to be produced in the cells, and break bonds in DNA leading to cell death b. Define “simulation” related to radiation. Treatment fields are defined, filmed, and marked out on the skin c. What is the difference between internal and external radiation? Internal Radiation Radiation can be delivered as brachytherapy, which means “close” or internal radiation treatment. It consists of the implantation or insertion of radioactive materials directly into the tumor (interstitial) or near the tumor (intracavitary or intraluminal). This allows for direct delivery of radiation to the target with minimal exposure to surrounding healthy tissues. It is often used in combination with external radiation as a supplemental “boost” treatment. It may be a primary or adjuvant therapy. External Radiation Radiation can be delivered externally (external beam radiation therapy) or internally (brachytherapy). External beam radiation is the most common form of radiation treatment delivery. With this technique, the patient is exposed to radiation from a megavoltage treatment machine. The beam passes through the external tissues to reach the internal target. A linear accelerator is the most commonly used machine for delivering external beam radiation (Fig. 16.13).  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns Gamma knife technology (used to deliver highly accurate stereotactic treatment to a localized treatment volume) uses a cobalt source. What are the responsibilities of the nurse? Preparation and Education -> Explain the procedure to the patient and family. This will include possible side effects and needed safety precautions. Secure informed consent is obtained. Safety -> Nurse is responsible for following safety protocols to protect the patient along with themselves and possible visitors. This can include the using of body shields, keeping a safe distance and limiting the time spent near and exposed to the patient. Post Treatment Care -> Distribute care and patient education after the implant is removed if applicable. Patient education to recognize signs and symptoms of complications and when to contact and report adverse side effects to hcp. Monitoring and Support -> Monitor patient skin for adverse reactions like redness, irritation or burns. Provide support for managing common side effects including fatigue, nausea and appetite changes. d. How does the nurse care for the effects of radiation on the skin? Although skin care protocols vary, basic skin care principles apply. The goal is to prevent infection and promote wound healing. Protect radiated skin from temperature extremes. Do not use heating pads, ice packs, and hot water bottles in the treatment field. Avoid constricting garments, rubbing, harsh chemicals, and deodorants since they may traumatize the skin. e. What is the difference between dry and wet desquamation? Dry reactions are uncomfortable and cause pruritus. Lubricate dry skin with a nonirritating lotion emollient that contains no metal, alcohol, perfume, or additives. These can be irritating. Calendula ointment and topical hyaluronic acid cream are effective for managing radiation dermatitis. Aloe vera gel is useful for preventing skin problems. Wet desquamation generally causes pain, drainage, and increased risk for infection. Skin care for moist desquamation includes keeping tissues clean with normal saline compresses or modified Burow’s solution soaks. Protect the skin from further damage with moisture vapor–permeable dressings or Vaseline petrolatum gauze. Because protocols vary widely, you should verify the guidelines in Table 16.12 with your agency’s radiation oncology department. 21. Care of the patient receiving Surgery for cancer  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns a. Why does a patient have surgery to “debulk” tumors? With debulking, as much tumor as possible is removed. The patient then receives chemotherapy and/or radiation therapy. This type of surgery can make chemotherapy or radiation therapy more effective, since the tumor mass is reduced before treatment is started b. What type of surgeries would be considered Curative? Examples of surgeries used for cure or control of cancer include radical neck dissection, mastectomy, thyroidectomy, nephrectomy, hysterectomy, and oophorectomy. 22. What is “supportive and palliative” care? When cure or control of cancer is no longer possible, the focus shifts to supportive care and palliation of symptoms. Surgical procedures can be part of supportive care that maximizes bodily function or facilitates cancer treatment. Evaluate 23. What are the end results of cancer? As the overall death rate from cancer decreases, the number of cancer survivors continues to increase. There are currently more than 16.9 million cancer survivors in the United States. Some of these persons are cancer free. Others still have evidence of cancer and may be receiving treatment. The increase in survivorship is attributed to the aging and growth of the population and improvements in early detection and treatment. Survival statistics vary by the type and stage of cancer. Audio Visual Focus These questions may be answered after watching the video “Extravasation Management.” (2:48) 1. What are the steps to safely manage the patient with an extravasation? If extravasation suspected stop infusion -> Do not flush line -> Disconnect IV tubing, leave IV access device in place -> Attempt to aspirate residual medication using small syringe as appropriate -> Then remove cannula/access device -> Assess the site -> Assess patient symptoms that are being reported -> Notify physician. Cold compress is recommended ->  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns These questions may be answered after watching the video “Radiation Therapy for Cancer - A Brief Overview.” (2:22) 2. Provide a summary of the actions of radiation therapy: Having to do x rays, a lot of fear of the unknown. The goal is to be able to get rid of the cancer all together. Radiation kills the cancer cell by damaging the cancer cells and the gene of it. This prevents the cell from growing and being able to multiply. Radiation is something that can cure patients. Radiation can reduce pain and make symptoms reduce. Website Focus Area Answer the questions related to the websites in this module. Healthy People 2030 3. Search for cancer screenings and list three objectives for prevention in 2030 Increase the proportion of adults who get screened for colorectal cancer Increase the proportion of adults who get screened for lung cancer Reduce the colorectal death rate