Care of the patient with Cancer

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mjefferds
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254725
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Care of the patient with Cancer
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2014-01-02 17:53:42
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Cancer Care
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Ch 57 Mosby's
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  1. Oncology
    the sum of knowledge about tumors: it is the branch of medicine concerning the study of tumors
  2. Carcinogenesis
    the process by which normal cells are transformed into cancer cells
  3. Carcinogens
    • substances known to increase the risk for developing cancer
    • Risk factors: smoking, dietary habits, UV radiation, environmental and chemical, smokeless tobacco, frequent heavy alcohol consumption
  4. Anaplasia
    without form and is the irreversible change in which the structures of adult cells regress to more primitive levels
  5. Neoplasm
    • uncontrolled or abnormal growth of cells
    • may be benign or malignant
  6. Benign
    not recurrent or progressive; non malignant
  7. Malignant
    • growing worse and resisting treatment, as in cancerous growths
    • growths also called tumors
  8. Metastasis
    • process by which tumor cells spread from the primary site to a secondary site
    • can occur by direct spread of tumor cells by diffusion to other body cavities or circulation by way of blood and lymphatic channels
  9. immunosurveillance
    the immune systems recognition and destruction of newly developed abnormal cells
  10. Carcinoma
    term used for malignant tumors composed of epithelial cells, which tend to metastasize
  11. Sarcoma
    • refers to malignant tumors of connective tissues, they originate from embryonal mesoderm, such as muscle, bone, or fat, usually manifesting as a painless swelling
    • may affect bone, bladder, kidneys, liver, lungs, parotids, and spleen
    • lymphomas and leukemia's originate from the hematopoietic system
  12. differentiated
    most like the parent tissue in grading of tumors
  13. Papanicolau's test (smear)
    a means of studying cells that the body has shed during the normal sequence of growth and replacement of body tissues
  14. Biopsy
    • the removal of a small piece of living tissue from an organ or other part of the body for microscopic examination; used to confirm or establish a diagnosis, establish prognosis, or follow the course of a disease
    • incisional-removal of a portion of tissue for examination, such as the bite biopsy performed during endoscopy
    • excisional-the removal of the complete lesion, with little or no margin of surrounding normal tissue removed, as in polypectomy
    • needle aspiration-the aspiration of fluid or tissue by means of a needle (breast biopsy is performed with an aspiration needle)
  15. Endoscope
    • a rigid flexible tube containing a magnifying lens and a light
    • used to visualize internal structures
  16. Computed Tomography CT
    radiographs and computed scanning system used to record images of specific structures at different angles
  17. Palliative
    therapy designed to relieve uncomfortable symptoms, but that does not produce a cure
  18. Leukopenia
    • reduction in the number of circulating white blood cells due to depression of the bone marrow
    • common problem for patients receiving chemotherapy
  19. Neutropenia
    • lack of neutrophils
    • count is less than 1000/mm and less than 500/mm in severe
  20. Thrombocytopenia
    • reduction in the number of circulationg platelets due to the depression of the bone marrow
    • count less than 20,000/mm
  21. Alopecia
    loss of hair due to the destruction of hair folicles
  22. Stomatitis
    mouth inflammation due to destruction of normal cells of the oral cavity
  23. Tumor lysis syndrome (TLS)
    an oncologic emergency with rapid lysis of malignant cells
  24. Autologous
    indicating something that has its origin within an individual, especially a factor present in tissues or fluids
  25. cachexia
    • profound state of ill health, and malnutrition, marked by weakness and emaciation
    • positioning, giving meticulous skin care, offering nutritious fluids and foods, and using other comfort measures to promote relaxation and rest will help to reduce pain and severe fatigue
  26. Nursing interventions for patient receiving external radiation
    • don't  wash markings
    • no ointments, lotions or powder on the treatment area
    • no sunlight on radiated area
    • no application of heat or cold
    • diet high in protein and calories and fluid intake of 2-3L a day
    • lethargy and fatigue are common and need frequent rest periods
  27. Biopsy review
    • can be incisional, excisional or needle aspiration
    • organs accessible to thin-needle biopsy under guidance of palpation include breasts, skin, thyroid gland, prostate, palpable lymph nodes and salivary glands
  28. PSA
    • a biological marker, specific for cellular activity in the prostate gland.
    • gold standard marker for prostate cancer, is increasingly important in the diagnostic assessment and follow up of patients with the disease
    • plays an important role in staging prostate cancer and in monitoring for recurrence
    • elevated PSA alone does not diagnose prostate cancer, could be benign enlarged prostate
    • no specific level of PSA signals the presence or absence of prostate cancer
    • PSA is done by collecting sample of blood before prostate palpation
    • normal range for man over the age of 40 is 4 ng/L
  29. How do chemotherapeutic agents work
    • used to reduce the size or slow the growth of metastic cancer
    • most work by interfering with the cells' replication process by damaging the cell and cause cellular death
    • both malignant and normal cells are affected by chemotherapy
    • rapid multiplying cells such as cells of the hematopoietic system the hair follicles and the GI system are affected the most
    • most of side effects are result from the destruction of normal cells
  30. Significance of low white blood cell count
    • leukopenia-reduction in the number of WBC's due to depression of the bone marrow
    • common to patients receiving chemotherapy
    • can lead to life threatening infections
    • normal WBC is 5,000-10,000/mm less than 4000/mm is leukopenia
    • neutropenia-lack of neutrophils the type of WBC most often suppressed.normal is 3,000-7,000/mm 1000/mm is neutropenia and less than 500/mm is severe
    • patient with severe is placed on neutropenic precautions which include: monitor fro fever and neutrophil count to identify signs and potential for infection, monitor for chills and take temp q 4 hours, report temp of more than 100.4 F, good hand hygiene with antiseptic solution for all people in contact with patient, private room, limit visitors, teach personal hygiene techniques, avoid invasive procedures as much as possible, administer hematopoetic growth factors, avoid fresh fruits and vegetables, discourage fresh flowers or live plants, watch for mites, gnats and other microscopic organisms
    • assess: mouth for stomatitis, skin for rash or eruptions, pulmonary function for adventitious breath sounds and sputum, bowel and urinary function for changes, hematuria or glycosuria
  31. Cancer seven warning signs
    • C- changes in bowel or bladder habits
    • A- a sore that does not heal
    • U- unusual bleeding or discharge
    • T-thickening or lump in breast or elsewhere
    • I- indigestion or difficulty swallowing
    • O-obvious change in warts or moles
    • N-nagging cough or hoarseness
  32. Bone marrow transplant
    • replacement of diseased or damaged bone marrow with normally functioning bone marrow
    • stem cell transplant used in solid tumor cancers
    • marrow is aspirated from posterior iliac crest while the patient is under general anesthesia. Amount extracted is 600-2500mL. After extracted can be given via IV.
    • Can be removed from an individual for personal use; autologous (indicating something that has its origin within an individual, especially a factor present in tissues or fluids.
    • Allogenic bone marrow is a transplant from someone else. Three types-syngeneic (donation from the patients identical twin), related (donation from a relative, usually a sibling), or unrelated (donation form a nonrelative)
    • Need to watch for infection
  33. TNM Cancer Staging
    • the standardization of the clinical staging of cancer. Used to determine the extent of the disease process of cancer according to 3 parameters-tumor size (T), degree of regional spread to the lymph nodes (N), and metastasis (M)
    • T subclasses primary tumor: Tx: tumor cannot be adequetly assessed, T0- no evidence of primary tumor, Tis- carcinoma in situ, T1-T4- progressive increase in tumor size and involvement
    • N subclasses, regional lymph nodes: Nx- regional lymph nodes cannot be assessed, N0- no regional lymph node metastasis, N1-N4- increasing involvement of regional lymph nodes
    • M subclasses-distant metastasis: Mx- not assessed, M0- no distant metastasis, M1-M4- distant metastasis
    • Histopathology:G1- well differentiated grade; cells differ slightly from normal cells, G2- moderately well-differentiated grade; cells are more abnormal, G3- poorly differentiated grade; cells are very abnormal, G4- undifferentiated; cells are immature and primitive; cells difficult to determine
  34. Kytril
    • Granisetron
    • antiemetic
    • S/E: H/A, constipation, somnolence, diarrhea, mild changes in BP
    • NI: administer dose over 5 minute period, beginning 30 minutes before chemotherapy. Give once a day in a 5 minute infusion, or give 2 mg po 1 hour before chemotherapy and 1 mg bid for 2 days
  35. Palliative Therapy
    therapy designed to relieve uncomfortable symptoms, but that does not produce a cure
  36. Internal radiation therapy
    • sealed or unsealed
    • sealed radioactive- placed temporarily or permanently into hollow cavities, within body tissues, or on the body's surface. Device delivers specific radiation dose continuously over hours or days
    • uterus and vagina are natural receptacles for placement of an applicator
    • unsealed internal radiation: administered via IV or orally to be absorbed throughout the body.
    • no children under 18 or pregnant woman allowed to visit
    • visitors limited to 10 minutes and stand as far away as possible
  37. Advanced cancer pain management
    • 70% complain about pain as primary symptom
    • pain is almost always late symptom and indicates  tumor obstruction, pressure on the nerves, invasion of bone, phantom sensation, peripheral neuropathy and neuralgia
    • accept patients explanation of pain and withhold judgment
    • culture and religion may play role in pain expression
    • opiods used are morphine, hydromorphone (dilaudid), fentanyl, and methadone.
    • Sustained release morphin in oral form such as MS Contin, Oramorph SR, Avinza, Kadian or Roxanol SR
    • Administration is transdermal, inhalation, IV drips, intrathecally and epidurally
    • avoid peaks and valleys of pain relief
    • treat breakthrough pain with additional doses
    • monitor and treat any opioid side effects such as constipation, vomiting, and respiratory and CNS depression
    • patient self control methods include distraction, massage, relaxation, biofeedback, hypnosis and imagery
    • promote adequate rest, sleep, diversion and other meaningful activities
    • General guidelines for the use of pain relief measures: 1-use a variety of pain relief measures, 2- use pain relief measures before the pain becomes severe; 3- include pain relief measures that the patient believes will be helpful; 4- determine the patients ability or willingness to participate actively in the use of pain relief measure; 5- rely on patient behavior to indicate pain severity rather than relying on known physical stimuli; 6- encourage the patient to try a pain relief measure at least two times before abandoning it as ineffective; 7- have an open mind as to what may relieve the patient's pain, including nonpharmacologic measures; and 8- keep trying to relieve the pain; do not become discouraged and do not stop working with the patient
    • most effective pain relief involves combination of measures: appropriate pain relief measures, opportunity to make personal and spiritual peace if there are unresolved conflicts in relationships with others, someone to listen and offer comfort
  38. External radiation
    • specific body part is marked to indicate the port at which external radiation will be directed
    • cannot wash the marked areas
    • no ointments, lotions, or powder on this area
    • no direct sunlight on area
    • no heat or cold as these would increase erythema, frying and pruritus of the skin
    • encourage diet high in protein and calories and fluid intake of 2-3L/day
    • lethargy and fatigue normal S/E
    • 60% of cancer patients treated with this form
  39. Tumor lysis syndrome (TLS)
    • an oncologic emergency with rapid lysis of malignant cells
    • may be spontaneous in patients with inordinately high tumor burdens
    • usually result of chemotherapy or less commonly , radiation
    • may occur 24 hours to 7 days after antineoplastic therapy is initiated
    • those most at risk are those who have large tumor cell burdens or markedly elevated WBC level (acute leukemia's)
    • also seen in lymphocytic leukemia and metastatic breast cancer
    • when malignant cells lyse the intracellular contents are rapidly released into the bloodstream, which results in hyperkalemia, hyperphospatemia and hyperuricemia (high uric acid) as well as secondary hypocalcemia
    • risks of renal failure and alterations in cardiac function
    • S/S include nausea, vomiting, anorexia, and diarrhea accompanied with muscle weakness and cramping with later signs tetany, paresthesias, seizures, anuria and cardiac arrest
    • medical management: prophylactic measures important before initiating antineoplastic therapy which includes pretreatment with hydration to maintain urine output of 150 mL/hr and should begin 24-48 hours before treatment and continue at least 72 hours post treatment. Diuretics to promote excretion of phosphate and uric acid to prevent volume overload and to promote the excretion of potassium in the urine. Allopurinol prevents uric acid formation and started a few days before treatment and continued for 3-5 days post treatment. Sodium bicarbonate used to maintain an alkaline urine over 7 pH. Calcium gluconate is give intravenously to correct hypocalcemia. Monitor cardiac
  40. Thrombocytopenia
    • reduction in the number of circulating platelets due to the depression of the bone marrow
    • normal 150,000-400,000/mm. Less than 20,000/mm spontaneous bleeding can occur and platelet transfusions may be necessary
    • Patient teaching: prevent injury and hemorrhage due to decreased platelets including: use soft toothbrush or swab, keep mouth clean and free of debris, avoid intrusion into rectum, use electric shaver, apply direct pressure for 5 to 10 minutes if any bleeding occurs, avoid contact sports, elective surgery and tooth extraction, avoid picking or blowing nose forcefully, avoid trauma, falls, bumps and cuts, avoid use of aspirin or aspirin preparations and use adequate lubrication and gentleness during sex

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