Unit 2 Oncology Nursing PDF

NCM 112A: Oncology Nursing PARTS OF THE CELL Prof. André N. Canaria, DPed, MSN, RN Oncology: study of tumor CANCER: Hippocrates: Greek word: Carcinos or crayfish ABC of Physiologic Alteration Anatomy and Physiology Biographical data Chief complaint (CAUTIO...

NCM 112A: Oncology Nursing PARTS OF THE CELL Prof. André N. Canaria, DPed, MSN, RN Oncology: study of tumor CANCER: Hippocrates: Greek word: Carcinos or crayfish ABC of Physiologic Alteration Anatomy and Physiology Biographical data Chief complaint (CAUTION US) Diagnostic and Laboratory Nucleus § Unit function of the cell NEOPLASM § Ovoid, oval, or circular NEO (new) PLASM (growth) § Master control of the cell Benign Neoplasm § Centrally located, one nucleus = one cell - grows slowly and usually by expansion § Regulates, controls, and modifies all the - non-life threatening metabolic activities of the cell pituitary adenoma fibroadenoma (most common Cytoplasm type of benign neoplasm of young § Contains cytoplasmic organelles and woman) inclusion bodies Acoustic neuroma § Cytoplasmic organelles – living uterine fibroma structures found within the osteochondroma cytoplasm which are directly meningioma involved in the metabolic Malignant Neoplasm activities of the cell - spread by invasion to surrounding tissue § Inclusion bodies- inert, non-living cervical -> vaginal canal structures bleeding ORGANELLES foul Cell membrane - spread by metastasis to distant organs § Serves as protection through circulation, lymph nodes or § Limits the territorial boundaries of the cell lymphatic drainage § Gives the cell a definite shape and size § Serves as a semi-permeable membrane Lungs -> Brain which selectively allow diffusion of 1. Adenocarcinoma - Glandular substances in and out of the cell 2. Renal Cell Carcinoma 3. Epithelial Cell Lining Carcinoma Mitochondria 4. Kaposi Sarcoma - Connective Tissue on skin (AIDS) § Powerhouse of the cell -> Kaposi; Kapurple § Generates ATP from substances coming 5. Leukemia - WBC bloods the vascular bed from CHO, CHON, and Fats 6. Melanoma - Melanocytes; Most Aggressive Endoplasmic Reticulum THE CELL § A network of tubes, tubules, microtubules nut structure of the body which act as circulatory and excretory cell ® tissue ® organ ® system ® human body systems of the cell Brief History § It is where substances pass through § Robert Hooke: he used a microscope to § Smooth or agranular – transport examine cork (plant) cell products other than proteins § Cytology: study of cell § Rough or granular – transport § Robert Brown: discovered the nucleus in proteins coming from ribosomes. 1883 Nucleolus § Matias Schleiden: all plants are § Contains DNA, RNA, and proteins composed of cells § Makes ribosomal subunits from proteins § Theodor Schwann: discovered that and ribosomal RNA – transcription, animals are made up of cells processing and assembly ® synthesis ® § Rudolf Virchow: observes under the cell metabolism microscope that cells are dividing  Chromatin Non-Modifiable Factors § DNA synthesis § Genetics - oncogene (Leukemia) § Cell replication § Race: White (skin) RELEVANCE OF MEDICATIONS Philippines: Plant Alkaloids § Cardiovascular § Organic compounds = CHON § CVA § OnCOvin = Vincristine = Constipation § Cancer: lung, prostate, § Nephrotoxic breast, colorectal § Neuropathy Japanese: gastric cancer § Numbness Blacks: all cancers except skin § Decreased peristalsis Asian/African: Liver Cancer § No bowel movement = increase Philippines: fluid intake (1.5 Liters per day), § Poor increase fiber diet. § Poverty Alkylating Agents § Parasite § Prevents cells from dividing and § Age replicating by damaging the DNA Decrease age: thymus gland: T- § CYtoxan = CYclophosphamide = CYstitis Lymphocytes Willm’s tumor (2-4 years old) Antitumor Antibiotic Testicular CA (15-35 years old) § Doxo-Rubi-cin Colorectal CA (50-70 years old; ­ § Diarrhea – Reddish urine (discoloration) 85) Prostate CA (after 50: increase ­ Antimetabolites 65) - Preventing cancer cells from malignant § Sex cancer cells (replication) Male: 1. Methotrexate § Brain, bone, eyes, § gold standard treatment nasopharynx, oral, § RA (Rheumatrex) esophageal, laryngeal, hepatotoxic – Liver lungs, stomach, liver, Function Test (LFT) l pancreas, kidneys, ALT/SGPT bladder, lymphoma, 2. 6-Mercaptopurine leukemia, prostate § 6-mp increases uric acid cancer § Treatment: Allopurinol Female: § Breast, thyroid, BIOGRAPHICAL DATA AND RISK FACTORS gallbladder, cervical Modifiable Factors (ABCDE) cancer, uterine cancer § Alcohol: oral, larynx, esophagus, § Brain, bone, eyes, stomach, liver, pancreas, ovaries nasopharynx, oral, § Behavior: sexual promiscuity- general esophageal, laryngeal, warts (HPV, APV, Cervical Cancer) lungs, stomach, liver, § Cigarette smoking: Lung Cancer (3 years pancreas, kidneys, cured) bladder, lymphoma, § Diet: leukemia Carcinogenic foods with preservatives, smoked, dried, CHIEF COMPLAINT processed (Asia, Africa [Tropical]) Change in bowel bladder pattern Obese: A sore throat that doesn’t heal § Increased fats Unusual bleeding or discharge § Adipose tissue Thickening or lump on breast or elsewhere § Deposit of Estrogen Indigestion or difficulty swallowing § Female- ovaries, adrenal Obvious change in wart or mole cortex Nagging/ horse of voice § Male- Decreased Unexplained weight loss estrogen Severe anemia § Employment/ Occupation CHIEF COMPLAINT 3. X-RAY Obstruction ® ischemia ® pain Pregnant (ok) Provocation: cause; tumor >20 weeks (ok) Quality: description: knife-like Jewelry (remove) Radiation: Where located and other organs? Severity: Pain scale method of 0-10 (absence- 4. CT SCAN severe) non-invasive Timing: when occurred? with/out contrast medium remove jewelries DIAGNOSTIC AND LABORATORY TESTS flat supine: small pillow under the head 1. CBC § “Lie still” RBC: 4-5 Million § > 5= polycythemia: 5. MRI hemoconcentration magnetic ® metal § < 4= anemia: SOB, fatigue, pallor non-invasive informed consent (metal implants?) WBC: 5-10 mm3 xCI: Large Tatoo: Metal Liquids -> Burns § < 5 = leukopenia = clot: CVA supine (reverse/ private/ neutropenic) Claustrophobic assesses § > 10 = leukocytosis: infection; § Give: inflammation conscious sedation minor tranquilizer Platelets: 150 000 - 400 000 Headphone: “drum-like” § < 150 000 = thrombocytopenia: bleeding tendencies (potential for 6. BIOPSY Fluid Volume Deficit related to cell differentiation bleeding) cell study § > 400 000 = thrombocytosis: increase clot; CVA (prophylaxis histopathology and anticoagulant) Coumadin / invasive Lovenox (enoxaparin) – blood § MD= explain details -> obtain thinner. consent § RN: reinforcement/reassurance 2. TUMOR MARKERS - blood test Secure and witness Detection of location and origin (­ level of consent TM) Sterile procedure a) PSA (Prostate Specific Antigen) VS b) AFP (Alpha Fetoprotein) Complication: § Neural tube defect: pregnancy § bleeding § Testicular and liver pressure c) HCG (Human Chorionic Gonadotropin) bed rest § pregnancy H. Mole VS § choriocarcinoma or ovarian Cancer 7. MAMMOGRAPHY CA125= cancer antigen breast x-ray § Normal:0-35 tumor 2.9 ng/mL= not normal menstruation But does not necessarily Contraindication: there is cancer § Deodorant (tawas/ talc powder: Can have normal CA test contains alum) even though you have § Alum mimics calcium crystals one of these cancers § Pregnancy  8. BONE MARROW ASPIRATION/ BIOPSY Drainage: Gold standard diagnosis for patient with Jackson Pratt leukemia and other blood dyscrasia Hemovac Invasive § used as collapsible device that § Explain suction the drainage from the § Informed consent surgical site thereby promoting § Sterile healing Harvest common aspiration: Chest tube § Posterior iliac crest § Drainage ® water ® suction Monitor baseline VS § Drains blood and air from lungs Complication: thereby establishing: § Bleeding - Pa (-) Pa § Inflammation - VS and site of Lung re-expansion infection/ complication Pleur-e-vac H2O-sealed drainage TREATMENT MODALITIES FOR CANCER Perioperative/ Surgery Radiation Therapy encompasses the entire surgical Directly destroys the tumor without experience affecting the healthy cells → (DNA Helix) example: Expensive § breast mass - frozen - diagnostic External Radiation/ Tele (Distance) section Therapy § thyroid cancer - total § Beam (heat) → skin: S/E: skin thyroidectomy - irritation, erythema, curative/therapeutic desquamation, fatigue: N/V § bone cancer – pain/ debulking - § Impaired skin integrity palliative § Management: Avoid sunlight Pre-op: decision to pursue surgery → OR Body lotion avoided table Cleanse the eradicate area with H2O Intra-op: OR Table → PACU Do not erase the Post-op: PACU → surgical ICU/Ward → markings Home Internal Radiation/ Brachytherapy Most common post-op complications § Interstitial (implanted in the § Bleeding or hemorrhage → BP cuff tissues) § Respiratory: Pneumonia and Retinoblastoma atelectasis → incentive Prostate spirometry § Systemic (oral: thyroid: § Abdominal surgery: dehiscence radioactive iodine: Sodium and evisceration Iodide) § Bowel: paralytic ileus CI: (-) breast feeding § Womb: infection and nonhealing mothers, pregnant, child Redness Flush toilet 2-3 times Erythema: capillary § Intracavitary cesium (uterine dilatation cervical cancer) Edema/swelling: IV → interstitial Principles of Internal Radiation: Shielding (lead-lined apron) Discharge/odor Timing (30 minutes) – social isolation Approximation of the Distance (3 to 6 feet away: 36 to 72 inches) wound edges – social isolation Give private room Loss or impaired function – NO MORE Radiation hazard: yellow and black § Pain → dolor Complete bed rest § R → Rubor (red) No ambulation § E → Tumor (swelling) Stool softener § E → Calor (heat) Urinary catheter § D -à Savor Increase residual diet  In case of displacements: Brachy Therapy Medications: 4Ls: Not recommended: decreases CNS § Lead-lined apron response (EPS) § Long-handled forceps § Plasil § Lead-lined container § Compazine § Lalake sa radiation department Recommended Chemotherapy § Tigan Antineoplastic § Phenergan § Cytotoxic § Reglan cells → DNA – RNA – § Zafran CHON synthesis No obnoxious stimuli irritates → vesicants→ IV line (central line) Hormonal because it is direct to the A. Prednisone right atrium § leukemia § highly prolific § non-Hodgkin’s lymphoma cells that can § Glucocorticoids →↑ fluid → wt. gain access to gain the large veins – Moonfaced - acne near heart § vesicants – highly reactive B. Nolvadex chemicals that combines with § Anti-estrogen (blocks the action of estrogen) protein, DNA, and other cellular components to result in cellular Breast CA changes immediately after Ovarian CA exposure. § S/E Side Effects: hot flushes § hair follicles - 14th day (temporary Irritable alopecia) ↑BP/ menopausal -like Temporary alopecia syndrome § Vitamin A and D § Wig Bone Marrow Transplantation § Cold compress Gold standard treatment for leukemia § Baseball cap Invasive – consent Donor: § mucus membrane → stomatitis § identical twin: isograft → soft smooth cold soda lidocaine anesthetic § Person: allograft mouthwash § Pig: xenograft § Self: autograft § Bone Marrow Suppression: posterior iliac crest: most common site: ↓ RBC: anemia: fatigue: HARVEST → Filtered: OR → How? → IV via activity intolerance = central catheter blood transfusion and Immunosuppressed patients: (inhibits T bed rest lymphocytes) ↓ WBC: leukopenia: risk § Allergic on medications for infection = § Respiratory infection neutropenic (reverse § Graft versus host disease isolation) Treatment: Prednisone ↓ thrombocytes: bleeding SRCHB *Surgery, Radiation Therapy, Chemotherapy, § Sperm: sterility Hormonal, Bone Marrow Transplantation → enhance Sperm bank ADJUVANT THERAPY cryopreservation No sex for 72” No masturbation for 72” § GIT lining → stimulates vomiting center CNS N/V “ALKalosis” HypUkalemia Weakness Antiemetic 30 min before chemo  LEADING CANCER DEATHS IN THE PHILIPPINES § Radical Prostatectomy → prostate seminal vesicle 1. LUNG CANCER § Complication: Bronchogenic carcinoma(malignant) brown lungs § Impotence Etiology: § Incontinence § Asbestos / Air pollutants § Over 70: no treatment § Stilphostrol: estrogen replacement § Bacteria (PTB)(COPD) therapy:↓testosterone: ↓ tumor size § Cigarette smoking, coke miners, cement dust § Testicular removal orchiectomy § Anti-CA: ABarelix Pathophysiology: § Treatment herbal: saw palmetto berry 1. ABC- cancers gene/oncogene (gynecomastia) 2. Carcinogen § External/internal radiation 3. 1st exposure INITIATION 4. Constant exposure: PROMOTION WHO Ladder of Pain 5. Somatic mutation (DNA) 6. Cell alteration 1-3 Mild 7. New growth (↑ tumor size): § non-opioid (non-narcotic) PROGRESSION § Adjuvant therapy (S.R.C.) 8. Infiltrate: invade § TCA 9. Bronchogenic Carcinoma § TOFRANIL 10. Nagging cough/dry cough § NSAID with food 11. DOB → SOB→ dullness percussion § Naproxen 12. ↓ breath sounds → hemoptysis → dx late: § Salsalate § Advil poor 3 years die § Ibuprofen Diagnostics: § Diclofenac 1. Chest X-ray: pulmonary density § NSAID Side Effects 2. CT Scan § Vomiting 3. Bronchoscopy § Anorexia a) Visualize § Nausea b) Brush up biopsy § Diarrhea c) Removal of early malignancy § Abdominal Pain d) Meds 4. Treatment: 4-7 Moderate § Chemo § non-opioid § Radiation § adjuvant § opioid (narcotic)-weak § Surgery § Right Pneumonectomy § Codeine § (no) lump 8-10 Severe § (no) collapse § Non-opioid § (no) chest tube § Adjuvant Therapy § Position on the affected side of § Opioid (narcotic) – strong surgery § Morphine sulfate § Segmentectomy/ lobectomy § Demerol § (+) hemothorax Face Scale: Wong Baben Assessment § (+) pressure § Green: 0= No Pain § (+) lumps § Light Green: 2= Mild § (+) collapse § Blue: 4= Moderate § (+) chest tube § Maroon/Violet: 6= Moderate § Unaffected site for the position § Orange: 8= Severe § Red: 10= Severe 2. PROSTATE CANCER (blue color) 3. COLORECTAL CANCER § Family history of CA/mana § Age (↑ 50: ↑ 65) / matanda Family history of CA § More common: obese Age 50-70 ↑ 85 (Incidence) § A fewer – American (blacks) TURCOT’S: § STD § GI polyps § (Pathophysiology) § Rectal polyps get down on it 1. Prostatic tumor/ obstruction History of inflammatory bowel disease (IBD) – 2. Change in bladder habits ulcerative colons/Chron’s disease 3. Perennial pain and pain on ejaculation Excessive red meat & ↓ dietary fiber § DRE – digital rectal exam Resected colorectal CA § hard stony “lump” § CARCINOGEN + ONCOGENE § PSA § CANCER → IRRITATION IN GI § Transrectal UTZ § 4 C’s – B. § Biopsy § Sign 1: change in bowel pattern alternating diarrhea/ constipation § Pain management: advanced → morphine (PCA- for the past 2 weeks patient controlled analgesia) (follow WHO ladder of pain)  § 4 C’s – B. 5. HEPATOCELLULAR CARCINOMA - malignant § Sign 1: change in bowel pattern Etiology: alternating diarrhea/ constipation § Hepatitis B & C for the past 2 weeks § Estrogen / Oral Contraceptives § People from Africa or Asia (Tropical) § Sign 2: change in stool § Alcohol and Alfatoxin B and Arsenic appearance: pencil – like* (metastatic CA) § Sign 3: chronic rectal bleeding: HEPATITIS → dysfunctional hematochezia § Signs and Symptoms: § Sign 4: chronic anemia § Loss of appetite § Indigestion and Steatorrhea Assessment and Diagnostic Findings (fatty, foamy, frothy, foul, § Fecal occult blood testing frequent, floating) § NO RED MEAT (false (+) result) § Vomiting § NO STRAINING (false (+) result) § Enlarged liver § NO VIT C (disintegrate) (false (-) § RUQ pain result) Diagnostic Test: § Barium Enema § Liver function test: § Instill – Barium Sulfate § ALT: transaminase levels § NPO § Tumor Marker § Laxative § Alkaline Phosphatase- § Cleansing enema abdominal UTZ (CT § Proctosigmoidoscopy SCAN) § Colonoscopy § ALP § Colonoscopy with biopsy Treatment: § CEA § Surgery – lobectomy – simultaneously Management: collect specimen for biopsy (frozen § Chemo: Fluorouracil (5-Fu)- antagonistic section) to Folic Acid § Radiation: ↓ pain § Radiation – intracavitary § Chemotherapy: § Surgery - Bowel surgeries § 5 FU § Total Colectomy – entire colon § ↓ doses (hepatotoxicity) ILeostomy § Liver transplantation ILeum (small intestine) § Twin Liquid § Son § Duodenum: bile § Sandimmune juice Cyclosporine A-Imuran § Jejunum: Immunosuppressant intestinal juice § Taken for life § Ileum: § Right lobe: to recipient pancreatic juice § Left lobe: coming from the donor § Partial Colectomy Ascending Colon – liquid 6. OVARIAN CANCER Transverse Colon – semi- Obesity formed Vaginal use of talcum powder (1950s) asbestos Descending Colon Age ↑ 50 /Sigmoid Colon – formed: Race (white & European women) x gas forming Infertility 4. ESOPHAGEAL CANCER Abuse of fertility drugs Esophageal stricture related to attempted suicide Nulliparity (no child) - muriatic acid Signs and Symptoms: Smoking § Amenorrhea Older men § Abdominal enlargement People from Asia and Africa § Abdominal disturbances GERD § Ascites Diagnosis Management: refer gynecological oncologist § Esophago-gastro-duodenoscopy with 1. P.E. biopsy 2. UTZ § Imaging Studies 3. CA125-HCG Treatment: CRS 4. Laparotomy § Esophagectomy with: Surgical: § Colon intersection/ interposition § Oophorectomy § Jejunal graft transfer § TAHBSO § Dacron graft/prosthetics Chemo- TAXOL § Esophagus joint to stomach Hormonal therapy: Nolvadex (tamoxifen) 7. LARYNGEAL CANCER Hypertension VOCAL: HR increase § Voice Straining Headache § Older men Hyperglycemia § Cigarette smoking Nursing Diagnosis: RFI § Alcohol 1. Antihypertensive: Phentolamine § Laryngitis (+) pus: from oral hygiene 2. Diet: well- balanced Voice: hoarse, harsh, low voice 3. Quiet moment / “dim” light Humidifies air: dryness of throat 4. Adrenalectomy Smell: ¯ acuity: cannot smell even the rotten food 9. BREAST CANCER (Pink Color) Dx: laryngoscopy Advancing maternal age Sx: Laryngectomy Breast Cancer History (family) § Nursing Considerations Cigarette smoking § Before: Diet: ­ fat due to estrogen: ­ tumor Mode of communication Early menarche and late menopause Use of humidifier First child after the age of 30 § After: § (Not protected by progesterone) Airway (emergency resuscitation; Gravida 0 equipment at bedside) ABCDEFG ® tumor* Nutrition: Signs and Symptoms: (*upper outer quadrant of § IV Hyperalimentation (TPN) the breast, 50%) Glucose (70%) § Bleeding ulceration and nipple discharge § monitor blood sugar § Retraction of the nipple (hyperglycemia) § Evidence of fungal infection Insulin § Asymmetry § Monitor blood sugar § Skin dumpling / Pea d aura/ orange (hypoglycemia) peeling Lipids § Thinking or lump in breast or elsewhere Amino acids (hallmark) Fluid intake Diagnostics Heparin § Mammogram § TPN cyst, mass Hypertonic solution § Ultrasound Hyperosmolarity ® Central Line Only § Biopsy ® Verification: CXR frozen section § Amplifier ® to augment the voice (monotone staging of tumor voice: robot-like voice) Treatment: § Esophageal ® speech Chemotherapy (-) voice Radiotherapy (+) voice Hormonal – tamoxifen (Nolvadex) Dysarthria Breast Surgery Lumpectomy: 8. PHEOCHROMOCYTOMA § Lumps and surrounding tissue are Hereditary (oncogene) damages adrenal removed: medulla § Modified Radical Mastectomy (MRM) Age 25-50 (M&F) Breast and associated lymph Formation of benign tumor from the adrenal nodes are removed medulla § Radical Mastectomy (RM) Breast, pectoral muscle, and Salt - mineralocorticoids axillary muscle Complication: Sugar - glucocorticoids § Lymphedema ® Post-op Bleeding and drainage Sex – androgen and estrogen assessment with hemovac or JP Adrenal Medulla: ­ Epinephrine/ drainage Norepinephrine (Catecholamines) ROM & hand pumps Elevate the affected arm in a ­ Catecholamines pillow above the heart ­ Epinephrine: heart stimulation: Assess BP on the unaffected arm § ­ HR: palpitation: ­ BP Support group ­ Norepinephrine: vasoconstriction: ­ BP= Pink color fatal (200/ 130: HPN crisis ® stroke) Philippines: I can serve Earliest TRIAD Pheochromocytoma (PCCA): USA: Reach to recovery § Palpitation Teach BSE: 7 days after § Occipital Headache menopause, same day each § Diaphoresis month  Arm Exercises For life: monthly injection § Wall arm climbing exercises (2 arms) of Vitamin B12, IM, § Pendulum swing Vastus Lateralis § Squeezing a ball § Best source: Dairy § Combing your hair products 10. PANCREATIC CANCER 12. CERVICAL CANCER / (cotton candy necrosis) Risk Factors: Advancing Maternal Age § Alcohol, smoking, ­ red meat and ­ fat Behavior (Sexual Promiscuity) diet, stress, pancreatitis, sex (M), Cigarette smoking hereditary Disease: STD (HPV; Herpes warts) Signs and Symptoms: Early age of sexual intercourse before age 16 § Exocrine (digestion of macromolecules) Signs and Symptoms: § Lipase § Unusual bleeding or discharge: 3Ps § Amylase § Post coital bleeding § Trypsin § Painful intercourse Indigestion § Period menstrual and discharge Mid-epigastric pain irregularity VANDA Discharge § Endocrine § ­ white discharge with douching § Alpha cell: glucagon § Menorrhagia: heavy menstruation § Beta cell: insulin § Metrorrhagia: bleeding in Hyperglycemia induced between periods § Poor progress Diagnosis § Late-stage § Papsmear: determine cervical dysplasia detection ® colonoscopy (visualization of cervix for ERCP: contrast medium: assess iodine allergy biopsy/ cold cone biopsy) Treatment: § May undergo Laparotomy for Staging of § Chemotherapy: Gemzar (antineoplastic) Tumor § Pancreaticoduodenectomy (Whipple’s § Situ: 0 procedure) § Entire cervix: 1 § Complication: § Upper 2/3: 2 Hypovolemic shock: § Lower 3rd: 3 § Hypo (tachy)2 § Rectum/bladder: 4 § ¯ BP,­ HR,­ RR Treatment: § Surgery: Hysterectomy 11. STOMACH OR GASTRIC CANCER § Partial Hysterectomy: removal of Alcohol uterus only § 1st damage pancreas ® Gastrinoma § Total Hysterectomy: removal of (Gastrin secreting tumor of the pancreas) uterus and cervix ® Zollinger Ellison syndrome § Radial Hysterectomy: uterus, Blood type A cervix, vagina Cured/smoked/ Pickled/ canned / Processed § TAHBSO: entire uterus, cervix, vagina, fallopian tube, ovaries foods § Internal Radiation/ Brachytherapy Decrease dietary fiber § Intracavity cesium Esophago Gastro Duodenoscopy with biopsy § Chemotherapy: Carboplatin § NPO § Adjuvant Therapy: § Topical anesthesia § Compressed nitrogen gas (silver) ® cryoprobe Signs and symptoms: § Indigestion 13. RENAL CELL CARCINOMA AND BLADDER CANCER § Change in the bowel pattern VANDA 5'cs § Cigarette smoking Blood in stool (melena) § Common in men and Hereditary Coffee ground emesis (Chematoemesis) § Carcinogen like current dust, gas stove, asbestos, Ragan gas Treatment: Surgery: § Contrast medium § Billroth 1: Gastroduodenostomy § Chemotherapy and Chronic use of § Billroth 2: Gastrojejunostomy analgesic § Complication for both: Dumping Signs and Symptoms: Syndrome § Palpable node § Total gastrectomy: § Fatigue § Esophagus ® duodenum § Change in bladder, habits or pattern § Complication: § Bladder Pernicious anemia: IF+ § Frequency Vit. B12 § Painless hematuria*  Management Diagnosis: § Bladder § Thyroid scan § Intravesical chemotherapy § Radio-isotope: IV (consent) Instill med into bladder § Biopsy via urinary catheter § Surgery Treatment: Cystectomy § Surgery = total thyroidectomy: Urinary diversion § Hypothyroidism Illeal conduit § Thyroid replacement for life Indiana pouch § Radiation Therapy § Meticulous skin care § RAI-SI 131 I: § Renal: Oral or systemic § Sumo Theraphy circulation Radiotherapy/ Radiation Nephrectomy 2-3x: flush toilet § Complication: 14. SKIN CANCER Pregnancy – Congenital Advancing age (immune system theory) hypothyroidism: Blue eyed Cretinism Cigarette smoking Breastfeeding Direct UVA (10 AM-4 PM: Phil) Children Employment: § Construction worker 16. ORAL CANCER § Coal miners Fair Skin Older persons Genetic mutations/ hereditary Race (white) HIV infection/ AIDS Alcohol & Cigarette Smoking § Kaposi sarcomas Lalake § CAUTION = AO Signs and Symptoms: § A sore that decent heal § a sore that does not heal (Squamous Cell) § Obvious change in wart or mole § appearance of white patches (Melanoma) (Leukoplakia) Signs and Symptoms Treatment: § Asymmetry § Chemotherapy § Boarder Irregularity § Radiation – external § Color change § Surgery – surgical resection of tongue § Diameter > 6 mm. or ¼ inch § Glossectomy, Thumb, Speech Diagnostics: § PE: inspection ABCD + palpation therapy thickening § Conservative nerve dissection § Cell differentiation thru biopsy Treatment: 17. LEUKEMIA § Topical chemotherapy White blood ® WBC flows/ floods the vascular bed § External radiation Etiology: § Immunotherapy § Surgery § Genetic/ Hereditary - oncogene § Skin resection and grafting- pain § Excessive Cytoxin at buttocks § Neoplasm from other organs Thigh/ buttocks: § Exposure to petrochemicals (gasoline, common site for benzene, jet fuel) harvesting § T-lymphoma Virus Check for: § lonizing Radiation § Circulation § Chromosomal Abnormality § Mobility § Sensation § GENETIC*® CARCINOGENS- oncogene ® somatic mutations (DNA) ® Altered 15. THYROID CANCER cell growth ® (not normal) increase in Frequent exposure to radiation abnormal and immature WBC- (Risk for Female Infection) ® increase immature WBC Fifteen and Forty leads to: Family history of endocrine problem or cancer § Bone Marrow § palpable node AML § dysphagia Adult § dyspnea Magalona  § Lymph Nodes Clear ALL Sugar Lymphocytes Protein Little child § Liver function test and kidney function test Less than 10 years old § Determine involvement of the § Both bone marrow and lymph liver and kidney nodes increase WBC Treatment Decrease RBC § Chemotherapy § Anemia (SOB, § Hormonal: Prednisone Pallor) § Infection prevention (Reverse isolation)- § Weakness Neutropenic Precaution § Loss of appetite § X: contact sports cause bruising § Activity § Bone Marrow Transplantation – gold intolerance standard treatment Decrease Platelets Surgical: § Thrombocytope § Splenectomy nia (bleeding § Splenomegaly tendencies) § Old RBC store + § Potential fluid microorganism store volume deficit § Rupture related to § * Primarily Sepsis or bleeding death § Lymphatic System § Bleeding § Lymphadenopathy Ionizing Radiation § Splenomegaly § Flu-like symptoms) 18. HODGKIN’S LYMPHOMA fever Malignant cancer of the lymphatic system Joint weakness Risk Factors: Malaise § Hereditary Anorexia § Age 20-30: above 50 years old Joint pain § Epstein – Bar Virus / kissing decrease Weight loss § HAE* ® Carcinogen; oncogene Signs and symptoms of Leukemia § “Mass on my neck” § Lymphadenopathy § Painless cervical lymph node § Excessive weight loss § Flu-like symptoms and night § Unusual bleeding sweats § Knee and joint pain Diagnosis § Enlarged spleen § Lymph node biopsy § Malaise and weakness § Reed Sternberg cells § Increase temperature, cold and sore Treatment: throat § BMT § Anemia, pallor, SOB § Radiation Diagnostics § Combination therapy: § CBC: § Chemo and radiation § ­ WBC >100,000 mm³ § ABVD § ¯ RBC Management (ABVD): Chemotherapy § ¯ Platelet § Adriamycin (Antitumor Antibiotic) § BMA Bone Marrow Aspiration § Bleomycin (Antineoplastic Antibiotic) § Gold standard diagnosis § Vinblastine (Plant Alkaloid) § AML § Dacarbazine (Alkylating DNA Synthesis) § Auer Rod § Lumbar Puncture (4 tubes): 19. BRAIN TUMOR § Complications: spinal headache Boys 3-7year old 6-8 hours Flat supine Radiation Pain management AIDS/Congenital immune defect Provide fluids Inherited Position flat prone Neoplasm from other organs § Study cell (WBC 0-5) BRAIN* ® M-K-Hypothesis (Monro- Kellie hypothesis)  § due to the muted space for the expansion § Surgery on the skull an increase in one of the Craniotomy intracranial components would cause a § Supratentorial change in the volume of the other. § Semi-fowlers § brain tissue = 1400g § Infratentonial § ICP = 10-20 mm H2O § Flat on either § blood supply = 75ml side: right and § CSF = 75ml left Brin tissue 1400 + Brain Tumor = increase Brain § Management of Craniotomy Mass § Assess airway § increase ICP and decrease blood supply § Bleeding and VS assessment § cardinal sign of increase ICP § Complete neuro checks Pain Headache § Don’ts: Valsalva and Vomiting Projectile vomiting § Evaluate CSF leaks: Dextrostixs Papilledema § Fluids: Mannitol § Swelling of the § Glucocorticoid (Decadron: optic disc Dexamethasone) § Pupil § Head of Bed elevated § Altered cerebral tissue perfusion § Institute measures to prevent Cerebral hypoxia seizure Early sign: § Altered LOC 20. ACOUSTIC NEUROMA § Restlessness 8th cranial nerve tumor § Confusion Vestibulocochlear § Review LOC: § Hereditary § Alert ® Vigilant ® § Increase radio frequency Lethargic ® Stupor ® § Neuro fibromatosis Coma ® Death Signs and Symptoms: § Late sign of ICP: Cushing Triad § Tinnitus § Vital Sign Changes: § Loss of hearing BP increase 200/130 Treatment: 70 widening § Removal of the benign tumor Pulse pressure § Radiation Therapy: Gamma knife Bradycardia 21. RETINOBLASTOMA Bradypnea Cancer of retina Breathing irregularity § Frontal: Immature § Personality changes Children 2 to 4 years old § Decrease in cognition and Hereditary-> chromosome #13 defective -> intellectual functioning increase retinal production unchecked -> § Occipital: retinoblastoma -> cat's eye reflex, "white pupil, § Visual impairment "Leukocoria"; unilateral blindness § Manipulation, language and Surgical Managements: calculation § Enucleation, artificial eye (glass or § Parietal: Sensation plastic) § Cerebellum: Unsteady gait § Radiation therapy: Interstitial seeds § Temporal: Hearing, gustatory radioactive 125I, 3 to 4 weeks § Wernicke’s § Receptive area 22. NEPHROBLASTOMA - CSR § Sensory speech area Wilm's Tumor = No palpation § Receptive aphasia Hereditary, Congenital, undescended testes Speak slowly, clearly, Neuroblastoma face the patient, hand Mother- Carcinogen gestures, pantomime Hereditary and defective “deletion” § Management: chromosome +1 leads to neuroblastoma § CT Scan ® tumor at the adrenal gland (abdominal § MRI enlargement), tumor at orbital § Treatment: (exophthalmos), and tumor at the bones § Radiation (bone pain) 23. OSTEOSARCOMA Management Bone cancer; malignant § Teach TSE (Monthly) > Lift Hereditary § After warm bath shower > Roll Male (5 to 20 years old) § "I have 2 eggs the left and right. Hold them Radiation exposure upright so clear and bright. Lift them, roll Metastasis (secondary degree lesion) them 123. Cute dark eggs are cute to see." Signs and symptoms: § Thickening (CXR) § Brittle bones § Bone fracture § Occasional fatigue § Nocturnal Bone pain § Edema and swelling Diagnosis: Bone X-ray, Scan - MRI, Biopsy Management: Surgery: Amputation § Complication: § Hemorrhage and phantom pain § Chemotherapy § Vincristine (Oncovin) - constipation § Actinomycin (Antibiotic) § Cyclophosphamide (Cytoxan) - cystitis § PCA: Morphine § B4 giving med make sure the patient is awake and alert § Narcotic: WOF: Respiratory depression § Narcan/Naloxone HCl: antidote 24. TESTICULAR CANCER Hereditary Boys 15-39 Cryptorchidism DES (Di-ethyl stilbestrol) - Emergency Contraception § Son: testicular cancer § Daughter: vaginal cancer or insufficiency § DES leads to testicular tumor Sign and symptoms: § Lump (painless pea sized lump) § Large scrotum or testicle § Loaded-heaviness (groin) § Leg pain § Lymphedema Diagnosis: § Flashlight § Transillumination § Biopsy Surgical: § Inguinal orchiectomy § Surgical removal of testicle via an incision in the groin § Radiation to the lymphatics § Chemotherapy: § Cisplatin (Platinol) alkylating agent § Complication: Cystitis