MedSurge Unit 1 Review

• Stomatitis - inflammation and ulcers of the oral mucosa
• Oral mucositis - damage to submucosa caused by chemotherapy or radiation therapy

• Nursing Care:
• +regular mouth care - brushing and flossing
• +pt on antibiotics should have yogurn or buttermilk unless contraindicated
• + pt on chemo or radiaiton should aviod use of alcohol and tobacco

• Nursing Dx:
• Impaired Oral Mucous Membrane
• -assess oral mucous membranes & lesions q 4-8 hrs
• -mouth care after meals, at bedtime, q 2-4 hrs while awake - saline or sodium bicarb rinse - no mouthwash (alcohol)
• -Teach about condition, mouth care and treatments - instruct to avoid tobacco, alcohol, and spicy foods

• Impalanced Nutrition: Less than body Requirements
• -Assess food intake and pt ability to chew and swallow. Daily weight. Provide straws or feeding syringes as needed
• -Encourage high-calorie, high-protein diet considerate of food preferences. Soft foods as needed, eggnog, milk shakes, ensure, popsicles, pudding, etc
• -provide analgesics for pain as needed

-Discuss the pattern and timing of hair loss

-Encourage wearing cheerful, brightly colored head coverings; assist in color coordinating them with usual clothing

-Refer to a good wig shop before hair loss is experienced

- Refer to support groups "Look good....Feel Better"

- Reassure that hair will grow back after chemotherapy is discontinues - but color and texture of new hair may be different

• Poverty?
• Stress?
• Diet
• Occupation?
• Toacco use
• Alcohol use
• Recreational Drug Use
• Obesity
• Sun Exposure

• Diet:
• Avoid obesity
• cut down on fat intake
• include variety of fruits & vegs daily
• Eat more high-fiber foods - whole grain cerals and breads, vegs, fruits
• Limit alcohol
• limit salt-cured, smoked, and nitrate-cured foods

• Alkylating agents
• Mitotic Inhibitors
• Antimetabolic agents
• Antineoplastic antibiotics
• Hormones and hormone

• Non- phase specific
• Alkylating Agents - kills cancer cells by alterig the shape of the DNA double helix in a way that prevents DNA from duplicating

• Nitrogen Mustards -Cyclophosphamide
• nitrosoureas
• platinum compounts

Side Effects - headache, alopecia, nausea, vomiting, stomatitis, anorexia, fluid retention, bone marrow suppression, neurotoxicity, ototoxicity, pumonary toxicity, anaphylaxis

Antimetabolite Agents- interferes with metabolic processes (usually) in the S phase causing cell death. Mimick nutrients that the cell uses to synthesize DNA, RNA, and proteins. When antimetabolites are used they dont function properly causing disruption of cell function.

• Folic Acid analogs -Methotrexate,
• Purine analogs
• Pyrimidine analogs - 5-fluorouracil

Side Effects: Nausea, vomiting, stomatitis, anorexia, rash, alopecia, headache, bone marrow supression, diarrhea, mucositis, hepatotoxicity, pulmonary toxicity, neurotoxicity, anaphylaxis

• non phase specific
• Antibiotic Antineoplastic Agents - contain substances obtained from bacteria that have the ability to kill cancer cells - bind to DNA & changes its shape like alkylating agents but must be administered IV into the body orgna or cavity - very cytotoxic so only used for specific cancers

• Anthrocyclines - Adriamycin
• Nonanthracyclines - Bleomycin

Side Effects - nausea, vomiting, stomatitis, anorexia, headache, rash, alopecia, bone marrow suppression, mucositis, pulmonary toxicity, cardiac toxicity, anaphylaxis

Hormones - only effecive on hormone dependent cancers such as breast and prostate cancer - block hormones that are essential for tumor growth - not cytotoxic

Prednisone

Side Effects Hormones: Weight gain, abdominal distension, sweating, flushing, diarrhea, nervousness, hirsutism, thrombophlebitis, muscle wasting, osteoporosis, hepatotoxicity

Side Effects Hormone antagonists - hot blashes, insomnia, breast enlargement or pain, headache, diarrhea, nausea, CHF, sexual dysfunction, ocular toxicity

• • Mitotic Inhibitors - Interferes in the M phase and inhibits cell division by blocking mitosis. Binds to tubulin and interferes with mitotic spindle Slows or stops the disease process.
• vinca alkaloids - Vincristine

Side Effects: Nausea, vomiting, stomatitis, anorexia, rash, alopecia, loss of energy and strength, bone marrow suppression, pulmonary or cardiac toxicity, nephrotoxicity, neurotoxicity, anaphylaxis

• administer antiemetic drugs
• encourage small, frequent, low-fat meals with dry foods such as crachers and toast
• avoid liquids with meals
• sit upright for an hour after eating

• Cure- primary treatment (60%)
• Diagnostic (90%)
• Prophylaxis
• Debulking procedure
• Palliation
• Body image disturbance - reconstruction

• • C Change in bowel or bladder
• • A A lesion that does not heal
• • U Unusual discharge from any orifice
• • T Thickening lump in breast or elsewhere
• • I Indigestion or difficultyswallowing/dysphagia
• • O Obvious change in a wart or mole
• • N Nagging cough or persistent hoarseness

• Pain in later stages
• • Fatigue
• • Cachexia
• • Anemia
• • Infection/leukopeniaWBC’s < 4,000 (Normal 5,000-10,000)
• • Bleeding/thrombocytopeniaPlatelets < 150,000 (Normal 150,000-400,000 uL)

Fine needle biopsy - use of a very thin needle to aspirate a small amount of tissue from the tumors

Needle core biopsy - use of a slightly larger needle than that used for a fine-needle biopsey to extract a small amount of tissue from tumors that cannot be aspirated by fine-needle aspiration

• risk for infection
• catheter obstruction
• extravasation

teach to observe for redness, swelling, pain, or exudate at site

• 1. ongoing assessment of pain
• 2. Evaluate patients functional goals
• 3. Est a plan with combinations of nonnarcotic drugs with adjuvants (corticosteroids, antidepressants)
• 4. Eval degreee of pain relief
• 5. Progress to stronger drugs as needed
• 6. Try combinations and escalate dosages until maximal pain relief balanced with patients need to funciton is anchieved

Radiation therapy - delivering ionizing radiations of gamma and x-rays

External radiation - teletherapy - from outside the patient - delivers relatively uniform dosage

• Internal radiation - brachytherapy - seed planted in the tissue
• - keep pt in private room
• -dispost of body fluids in special containers
• -limit visitation

-embolism in the blood/ lymph