Chapter 8 Care of Patients with Cancer

screening guidelines for early detection of cancer

-breast: women age >20 -mammography: women age 40, 45-54 annual, >55 biannual or annual -cervix: women age 21-65, cervical cancer age 21, ages 21-29 screened every 3 yrs, ages 30-64 screened every 5yrs -colorectal: men and women age >50, fecal occult blood test annual starting at 50 yrs old, fecal immunochemical annual starting at age 50, flex sig every 5yrs starting at age 50, double contrast barium enema every 5yrs starting at age 50, colonoscopy every 10yrs starting at age 50, CT colonography every 5yrs starting at age 50 -endometrial: women at menopause -lung: current or former smokers ages 55-74 in good health with atleast 30 pack year hx, are still smoking or have quit within the past 15yrs -prostate: men age >50, african american age >45 -cancer related check up: men and women age >20

measures to prevent cancer: identify high risk people

-lung: heavy smokers >50 years of age, started smoking at 15 years old or earlier, smoked a pack a day for 20yrs, exposure to smoke, exposure to asbestos, arsenic and other chemicals in workplace, radiation or radon exposure, hx of TB -breast: hx of breast cancer, close relatives with hx of breast cancer, early menarche, late menopause, never had children, first child after age 30, exposure to cyclic estrogen, higher educational and socioeconomic status, consumption of alcohol -colon and rectum: hx of rectal polyps, rectal polyps runs in family, hx of IBS -uterine and cervical: frequent sex in early teens or with many partners, hx of HPV, low socioeconomic status, poor care during or after pregnancy, smoking/hx of, exposure to DES in utero -uterine and endometrial: estrogen therapy, tamoxifen therapy, late menopause, hx of infertility, diabetes, htn, gallbladder disease, obesity, pelvic irradiation -skin: exposure to sun or tanning booth, fair complexion, work with coal tar, pitch or creosote -oral: heavy smoker and drinker, use of smokeless tobacco, poor oral hygiene, HPV -ovary: hx of ovarian cancer among close relatives, hx of breast cancer, hx of never having children -prostate: age >65 yrs, black ancestry, hx of family prostate cancer -stomach: hx of stomach cancer in close relatives, diet heavy in smoked, pickled or salted foods, linked with blood group A -pancreas: smoking or recreational drugs -bladder: smoking -leukemia: down syndrome, exposure to radiation and benzene, HTLV-1 infection, Philadelphia chromosome

contributing factors

-predisposing/intrinsic factor: age, sex, race (esophagus cancer more common in men, prostate cancer more common in black males, breast cancer more common in white women) -dietary: high in fat, red meat and processed meats, low in fruit and veggies, alcohol (15%-20% of cancer deaths in the U.S. are associated with obesity, obesity is associated with 30% increase in breast cancer risk) -disease: type 2 diabetes

classification of tumors

-sarcoma: arises from mesenchymal tissues (bone, muscles, connective tissues) -carcinoma: originates in epithelial tissues (lining of organs, skin) -leukemia and lymphoma: cancers of blood forming system

You are teaching a patient with neutropenia from cancer treatment about precautions to take during this time. Which of the following should be included in your teaching plan? (Select all that apply.) 1. "Wash your hands frequently." 2. "Eat only raw fruits and vegetables during this time." 3. "Neutropenia is associated with abnormal bleeding." 4. "You may experience a sore throat and fever; this is a normal response."

1. "Wash your hands frequently." 2. "Eat only raw fruits and vegetables during this time."

A terminally ill female patient becomes increasingly confused and is having some hallucinations. Which nursing intervention(s) would be appropriate? (Select all that apply.) 1. Discuss the patient's behaviors with the family. 2. Encourage the family to talk to the patient in quiet tones. 3. Apply physical restraints. 4. Promote a calm environment. 5. Force oral fluids.

1. Discuss the patient's behaviors with the family. 2. Encourage the family to talk to the patient in quiet tones. 4. Promote a calm environment.

A patient receiving a chemotherapy agent that is a vesicant should be monitored for which adverse effect? 1. Infiltration of the intravenous fluid containing the chemotherapy agent into the surrounding skin 2. Orthostatic hypotension due to fluid expansion in the vascular system 3. Dehydration due to the emetogenic effect of the drug 4. The presence of blood in the urine or stool

1. Infiltration of the intravenous fluid containing the chemotherapy agent into the surrounding skin

Which side effect of chemotherapy puts the patient at high risk for bleeding? 1. Thrombocytopenia 2. Elevated potassium 3. Neutropenia 4. Anemia

1. Thrombocytopenia

A 40-year-old woman is scheduled for external radiation therapy for breast cancer. What patient teaching instructions would be appropriate for this patient? (Select all that apply.) 1. "Keep away from other family members until your radiation is completed." 2. "Be sure you go to all scheduled radiation therapy appointments." 3. "Protect your skin by applying lotion to the radiated area daily." 4. "Keep out of the sun during radiation therapy." 5. "Always wear snug-fitting clothing."

2. "Be sure you go to all scheduled radiation therapy appointments." 4. "Keep out of the sun during radiation therapy."

The family members attending to the needs of a dying patient express distress regarding the patient's noisy breathing. What would be your best action? 1. Hold all pain medications. 2. Administer atropine as ordered. 3. Place the patient in supine position. 4. Arrange for hospitalization of the patient.

2. Administer atropine as ordered.

What term would indicate to you that a substance in the environment can cause cancer to develop? 1. Biologic 2. Carcinogenic 3. Emetogenic 4. Immunotherapeutic

2. Carcinogenic

A patient with cancer who is receiving chemotherapy asks you why her hair would fall out because of this treatment. What is your best response? 1. "The cells of your hair fall out to show that the chemotherapy is working." 2. "Chemotherapy can cause hair loss if you are lacking protein in your diet." 3. "Chemotherapy affects all fast-growing cells, including normal cells." 4. "You must have a low white blood cell count."

3. "Chemotherapy affects all fast-growing cells, including normal cells."

Which statement should be included in the teaching plan for a patient with thrombocytopenia? 1. "Take your temperature every 4 hours." 2. "Eat a diet that contains cooked foods only." 3. "Use a soft-bristled toothbrush and do not floss." 4. "Rinse your mouth with antiseptic mouthwash twice daily."

3. "Use a soft-bristled toothbrush and do not floss."

Which side effects can you expect to see in a patient receiving a biologic response modifier for cancer treatment? 1. Severe alopecia 2. Constipation and decreased appetite 3. Cough and shortness of breath 4. Fever, chills, and flu-like symptoms

4. Fever, chills, and flu-like symptoms

primary brain cancer sites of metastasis

CNS

melanoma cancer sites of metastasis

GI tract, lymph nodes, lung, brain

cancer

a group of diseases that characteristically grow in an uncontrolled manner with the spread of abnormal cells and spread into surrounding tissue, 68% of pts live 5 years or longer, incidence of all cancers is 20% higher in men, lung cancer is the leading cause of cancer death in men

A patient is scheduled for a computed tomography (CT) scan. To prepare the patient appropriately, the nurse should provide the patient with which information? a) "The test is noninvasive." b) "The test provides for direct visualization." c) "The test requires a small surgical incision." d) "The test involves the use of a powerful magnet."

a) "The test is noninvasive."

A patient who is in the terminal stages of his illness says to the LPN/LVN, "Get out of here! You do everything so slowly. Leave me alone!" Which of these responses by the nurse is most appropriate? a) "You sound very angry today." b) "You cannot talk to me that way." c) "I'm leaving until you stop being so angry." d) "I'm sorry the way I work annoys you so much."

a) "You sound very angry today."

A patient is scheduled to receive external radiation therapy. Which potential side effects should the nurse include in patient teaching points? Select all that apply. a) Fatigue b) Loss of taste c) Mental slowness d) Skin reaction at site of exposure e) Potential contamination to others

a) Fatigue b) Loss of taste d) Skin reaction at site of exposure

A nursing assistant says to the LPN/LVN, "I can't believe that Mrs. Feld, who is so sick and so near death, still enjoys a good laugh." Which of these ideas should the nurse use as the basis for discussing Mrs. Feld's behavior? a) Humor is a healthful part of everyone's life. b) The patient's behavior indicates that she may be suicidal. c) Use of humor at this time shows an inability to face reality. d) It is inappropriate for the assistant to encourage humor at this time.

a) Humor is a healthful part of everyone's life.

The greatest number of cancer deaths in women will be from cancer of which site? a) Lung and bronchus b) Breast c) Pancreas d0 liver

a) Lung and bronchus

A patient voices concerns about potential risk factors for the development of ovarian cancer. What is considered the greatest risk factor for the development of the disease? a) Never having had children b) Social alcohol use c) Black ancestry d) History of rectal polyps

a) Never having had children

A patient undergoes chemotherapy and loses her hair. Which of these findings is most indicative that the patient has satisfactorily adjusted to her alopecia? a) The patient uses humor about her hair loss. b) The patient washes her remaining hair daily. c) The patient visits a patient who has had hair loss. d) The patient is making arrangements to buy a wig.

a) The patient uses humor about her hair loss.

The patient who has had significant exposure to asbestos has an increased risk of developing a) lung cancer. b) oral cancer. c) liver cancer. d) renal cancer.

a) lung cancer.

human T cell lymphotropic virus causes

adult T cell leukemia and lymphoma

cancer promotion

ae substances that arent carcinogenic when found alone but when theyre in the body with a known carinogen cancer occurs faster (ex: alcohol with nicotine use, chronic irritation/presence of a mole or exposure to UV rays)

cultural considerations

african americans are more susceptible to acral lentiginous type of melanoma and whites and least susceptible to it, lentigo maligna melanoma is found most often in hawaii

biologic response modifiers/BRMs

agents that manipulate the immune system in the hope of controlling or curing a malignancy with little or no toxic effect on normal cells, either stimulate or suppress immune activity, include interferons, interleukins, CSF, monoclonal antibodies, vaccines, gene therapy and nonspecific immunomodulating agents, make immune system function better, stimulate the immune system to recognize cancer cells and institute action to destroy them, pts may need to be in ICU

common problems related to cancer or cancer tx

anorexia, malnutrition, mucositis, oral care, significant weight los of 2 or more lbs per week, n/v/d, constipation, cystitis, immunosuppression, decreased WBCs, anemia, bleeding problems, hyperuricemia, fatigue, alopecia, pain, difficulty eating and drinking

common carcinogen substances

asbestos, benzene, tobacco, alcohol, radon, ionizing radiation, sunlight, diethylstilbestrol, estrogens, androgens, vinyl chloride, aromatic amines, arsenic, chromium, nickel dust, chronic hep B or C infection, human T cell lymphotropic virus type 1, HPV, phenacetin, alkylating agents used for chemo, cyclosporines

measures to prevent cancer: environment

avoid and limit exposure to carcinogens, use filter or bottled water, know what substances are used in household, yard, recreation and workplaces, use protective clothing, gloves and masks when spraying pesticides or using chemicals, keep areas well ventilated, wash hands and any exposed skin after using chemicals, use sunscreen of SPF 30 or higher, wear protective clothing and sunglasses when outdoors, avoid sunburn, tanning salons and sunlamps, wear a heat when outdoors, (australians have the highest rate of skin cancer), avoid swimming and playing water sports in contaminated water, avoid eating fish from contaminated waters, wash fruits and veggies before eating or cooking

_____________ have the highest rate of skin cancer. a) Chinese b) Australians c) Mexicans d) Canadians

b) Australians

A patient is receiving hormone therapy for treatment of prostate cancer. The nurse should inform the patient that he is likely to experience which effect? a) Loss of body fat b) Breast development c) Menstrual-like bleeding d) An increase in facial hair

b) Breast development

Major measures to help prevent cancer in patients should be taught by the nurse at every given opportunity. What are those things that should be taught to patients about the prevention of cancer? Select all that apply. a) Increase alcohol intake. b) Maintain a normal weight. c) Decrease ascorbic acid in the diet. d) Abstain from nitrite and nitrate food additives. e) Have your drinking water supply checked for contaminants.

b) Maintain a normal weight. d) Abstain from nitrite and nitrate food additives. e) Have your drinking water supply checked for contaminants.

A patient who is near death has the following nursing diagnosis—Impaired gas exchange related to fluid in the lungs. Which intervention is most appropriate? a) Suction the patient as needed. b) Place the patient in the Fowler position. c) Teach the patient how to do pursed-lip breathing. d) Encourage the patient to cough and breathe deeply at least every 3 hours.

b) Place the patient in the Fowler position.

reasons for surgery

biopsy to obtain specimen, prophylaxis for preventative tx, explorative to determine effectiveness of therapy, palliative to offer pain relief, curative to attempt cure, reconstructive

dx tests

biopsy, radiologic studies, endoscopy, lab tests

prostate cancer sites of metastasis

bone (spine and legs), pelvic nodes

toxic effects of chemo

bone marrow suppression, cardiotoxicity, neurotoxicity, pulmonary toxicity, hepatoxicity, nephrotoxicity, ototoxicity

breast cancer sites of metastasis

bone, liver, lung, brain

lung cancer sites of metastasis

brain, bone, liver, lymph nodes, pancreas

genetic predisposition

breast cancer more likely to occur in women who have a close female relative who developed breast cancer before age of 50, HNPCC and lynch syndrome is an inherited genetic condition that increases risk for colon and endometrial cancer, gene markers have been found for colon, breast, prostate, pancreatic cancer and leukemia

epstein barr causes

burkitts lymphoma

A patient is planning a weight-reduction program. When assisting the patient to make healthy food choices, the patient should be reminded to keep the total fat intake to no more than ____% of the daily total caloric intake. a) 15 b) 25 c) 30 d) 35

c) 30

According to the American Cancer Society (ACS), diagnosis of cancer in the localized stages would result in a 5-year survival rate of _____%. a) 70 b) 80 c) 95 d) 98

c) 95

Research has shown that the negative cancer-causing impact of foods containing nitrates may be blocked by combining them with vitamin a) A. b) B. c) C. d) D.

c) C.

A patient has recently been diagnosed with cancer. What is the best initial nursing intervention for this patient? a) Provide literature about the specifics of the cancer b) Introduce the patient to a recovering cancer patient c) Encourage the patient to verbalize feelings and fears d) Reassure the patient that "everything will work out fine"

c) Encourage the patient to verbalize feelings and fears

carcinogens

cancer causing substances -external environment: chemicals, sources of radiation, viruses and infectious agents -internal environment: exogenous hormones, inherited genes, advanced age (biggest risk factor for developing cancer), immune system response, medical conditions -occupational: PCBs, pesticides, pitch, asphalt, crude paraffin, petroleum products, tobacco, asbestos, chemical wastes from industry and cars

hyperuricemia

caused by antimetabolite destruction of cancer cells

constipation

caused by certain antineoplastic drugs such as vincristine, vinblastine and taxol -increase fluids, add fiber to diet, give stool softeners or fiber laxatives, increase exercise, give suppositories or enemas

cystitis

caused by cytoxan and ifosfamide

nausea and vomiting

caused by radiation of the abdomen or lower back often starting 7-10 days after beginning of tx

diarrhea

caused by radiation to the abdomen, lower back, pelvis, chemo effect on intestinal mucosa, teach pt to avoid high fiber foods, add low fiber foods to diet such as bananas and cheese, clean rectal area and apply petroleum jelly, A&D ointment or creams to decrease discomfort and protect skin from breakdown, monitor pt for dehydration

HPV causes

cervical carcinoma and throat and mouth cancer in nonsmokers

side effects of radiation therapy

changes to the skin (redness, rash, peeling), alopecia, fatigue, reduced immunity, irritation of oral mucous membranes, oral pain, risk of infection, loss of taste, irritation of pharynx and esophagus, indigestion, increased ICP, inflamed lung tissue, n/v/d, anorexia, cystitis, sexual dysfunction, urethral and rectal stenosis, bone marrow depression, leukopenia, anemia, thrombocytopenia, depressed immune function, elevated temp, urinary frequency, mucositis

physical carcinogen: radon gas

colorless odorless gas found with the decay of radioactive materials in rocks and soil, can enter homes or businesses through cracks in the floors, walls or foundations, people who live in areas that have more radon emission from the earth have a higher incidence of malignancy

A patient who has been prescribed an antineoplastic drug for his newly diagnosed cancer asks the nurse what the most common side effect is for these drugs. What is the nurse's most accurate response? a) "An elevated temperature is a common side effect." b) "Gastrointestinal upset is the most common side effect." c) "These drugs almost always cause a vitamin B12 deficiency." d) "Most of these drugs cause some degree of bone-marrow depression."

d) "Most of these drugs cause some degree of bone-marrow depression."

When planning an educational program for women concerning the diagnosis of new cancer cases, which body site had the greatest number of new diagnoses for 2015? a) Ovary b) Uterine c) Colon d) Breast

d) Breast

Intake of cruciferous vegetables is recommended to prevent cancer. Which vegetable belongs to this classification? a) Green beans b) Asparagus c) Parsley d) Cabbage

d) Cabbage

When assisting with the development of a care plan for the patient with cancer, which nursing diagnosis will be of the highest priority? a) Disturbed body image b) Activity intolerance c) Self-care deficit d) Risk for injury

d) Risk for injury

HIV and cancer

damages immune system and decreases immunocompetence causing the body to become mor susceptible to the growth of abnormal cells

chemo antineoplastic agents goals

decrease the number of malignant cells in a generalized malignancy, to reduce the size of a localized tumor, relieve sx or prepare pt for surgery, treat escaped cancer cells to prevent recurrence or metastasis

BRM sx

depression, confusion, fatigue, somnolence, irritation, agitation, hallucinations, anxiety, sleep problems, fever, chills, rigors, flu like sx

radiation therapy

destroys malignant cells without permanent damage to adjacent body tissues, course of tx is spread over a period of days to weeks, the RAD is the unit used for measuring dosages of radiation,

cigarette smoking

direct cause of cancer in the lungs and linked to esophageal, pancreatic, bladder, kidney, liver and colon cancers

measures to prevent cancer: nutrition and exercise

encourage maintenance of normal weight, encourage healthy diet, limit intake of red and processed meats (hot dogs, bacon, sausage, lunch meats like bologna, processed chicken nuggets), limit intake of foods high in sugars (soda, candy, dessert), limit foods high in saturated fats (cheese, butter, whole milk, dairy), encourage intake of whole grains, veggies and fruits, avoid drinking excessive amounts of alcohol (only 2 drinks a day), limit salted, grilled and smoked foods, encourage exercise, eat a diet of brightly colored varied fruits and veggies, balance daily caloric intake, eat fatty fish twice a week, substitute olive oil for cooking and salad dressing, limit saturated and trans fats, eat veggies such as broccoli, cauliflower, cabbage, spinach, swiss chard, turnip greens, beet greens, tomatoes, carrots, yellow squash and sweet potatoes, eat whole grains such as beans, cereals, flaxseed, breads and pastas, avoid white potatoes, rice and bread substituting with sweet potato and brown rice,

CSF

enhance a quick recovery of the bone marrow after radiation or chemo, stimulates bone marrow to function more wuickly

physical carcinogen: viruses

experiments involving animals have demonstrated that a number of cancers can be produced in animals by injecting them with a filtrate from virus infected malignant growths, these viruses are known as oncoviruses because of their ability to cause cancer, capable of introducing new genetic material into a normal cell and transforming it into a malignant one, cell reproduction can be altered when viruses interact with carcinogens (ex: HIV, hep B, epstein barr, HPV, HTLV-1, Hpylori, schistosoma haematobium parasite found in africa and middle east)

human genome project

focused on finding genetic markers or oncogenes, such markers or the proteins they produce could identify high risk individuals who might undergo more vigorous regular dx testing to detect any malignancy in early stages

interleukins

help immune system cells recognize and destroy abnormal cells -interleukin 2 is used to decrease bleeding tendencies, used for pts with melanoma, renal cell carcinoma and lymphoma -pts often experience fluid shifts and capillary leak syndrome, edema affecting heart and lungs

nursing care goals for cancer radiation therapy

help the pt and family cope with the dx of cancer and understand the radiation therapy tx, teach the pt and family how to recognize and manage the expected side effects of radiation

TNM staging system

identifies how much the cancer or malignancy has spread -T: primary tumor -N: regional nodes -M: metastasis -the number written beside each letter indicates how much the malignancy has spread and attacked other tissues

weight loss nursing implications

increase protein intake to equal 1.5g/kg of weight per day, eat small frequent meals and add calorie dense snacks, refer pt to dietician for counseling, use oral supplements if they have dysphagia, monitor weight, attend to preference for foods, provide pleasant restful environment during meals, supplement feedings

internal radiation therapy/brachytherapy

introduces radioactive element into the body, can be administered by placing it in a sealed container and inserted into a body cavity at the site of the tumor or placed directly into the tumor or in an unsealed form and taken orally or injected by syringe

mucositis and stomatitis

irritation and inflammation of the mucosa in the mouth, sores in mouth, results in pain interfering with eating and swallowing, use cryotherapy (ice water or ice chips), teach strict oral hygiene, frequently brush teeth with soft brush or tooth sponges using gentle strokes, rinse mouth with plain water or saline after brushing or after meals and at bedtime, teach pts to avoid mouthwash containing alcohol, clean toothbrushes weekly in dishwasher or rinse them with bleach or hydrogen peroxide and then rinse with hot water, for pain relief use swish and spit topical compounds (tell them not to swallow), avoid spicy foods, alcohol and tobacco, include frequent oral intake of liquids that are not chemically irritating, use artificial saliva and frequent consistent mouth care, drink water

tips for nurses caring for pt who are receiving sources of radiation

know the element used, its half life and the ways in which it might be eliminated from the body

hep B causes

liver cancer

colorectal cancer sites of metastasis

liver, lymph nodes, adjacent structures

anorexia

loss of appetite, associated with changes in taste and inflammation of mouth and tongue, pt often say they have a metallic taste in mouth, red meat doesnt taste good, taste of sweets is altered, Megace (female hormone) has proven to work well to stimulate appetite, deficiency in protein and calories, severe malnutrition

chemo induced peripheral neuropathy/CIPN

loss of sensation or motor function of peripheral nerves from certain chemo agents, related to dosage of nerve damaging drugs -sx: loss of sensation in hands and feet, impaired gait and balance, orthostatic hypotension, erectile dysfunction, neuropathic pain, loss of taste discrimination, severe constipation -priority nursing care: prevent injury

bone marrow suppression

major reason that doses of chemo must be limited, slows production of erythrocytes, leukocytes and platelets, can cause severe suppression, usually temporary, improvement in bone marrow function occurs within weeks to months of completed therapy -monitor WBC count, frequent handwashing to prevent infection, maintain strict asepsis in pt care, teach pt to report s/s of infection, take measures to help lower risk of bleeding, handle pt gently using lift sheets, tell pt to weight themselves daily and keep a record, report sudden weight gain or dyspnea, keep needle sticks to a minimum, use small gauge needles, apply pressure to puncture sites, test urine and stool for blood, ask if pt has abdominal pain, measure abdominal girth daily, assess skin for petechiae or ecchymosis

monoclonal antibodies/MoAbs

manufactured using genetic engineering to make antibodies against certain cancer cells, bind to antigens on cell surface of the tumor preventing the cancer cell from growing and dividing

physical carcinogen: radiation

may originate from xray machines, radioactive elements or UV rays from the sun, capable of penetrating certain body tissues and causing the development of malignant cells in the affected area, people with fair complexions have less protective pigment and therefore are more likely to develop skin cancer from UV rays then people with darker skin, severe sunburn before age 18 can lead to malignant melanoma (survivors from atomic blasts at hiroshima and nagasaki at the end of WW2 experienced high incidence of leukemia)

cancer pathophysiology

normal cells replicate only to replace damaged or dead cells, neoplasms have an abnormal replication of cells and may be benign or malignant, cancer cells reproduce in an uncontrolled way, metastasis is the movement of cancer cells from the original cancer site to other areas of the body

precautions when caring for a pt receiving internal radiation from unsealed source

observe time, distance and shielding for protection, wear gloves when handling bedpans, linens and pts clothing, dispose of urine, feces and vomit according to policy, handle dressings with forceps and dispose of them according to policy, follow hospital procedure for disposal of pts linens and clothing

chemo administration

oral, intra arterial, intraperitoneal, intraventricular, intrathecal (within a space of the spine), IV infusion -vesicants: chemicals causing tissue damage upon direct contact, can cause severe local injury if they escape from the vein into which theyre given

chemo antineopalastic/cytotoxic agents

poisonous to cells, normal cells dont reproduce in exactly the same way as malignant cells so normal cells are able to repair themselves more rapidly and effectively, steroids are often used in combo with antineoplastic drugs

precautionary measures when a pt is receiving internal radiation therapy from sealed source

put pt in private room, place a sign on pts door, observe time and distance, limit time spent in room, work quick and efficiently, avoid standing near the part of pts body being element is located, stand at shoulders or feet, check linens, bedpans and emesis basins routinely for loss of seal, if a sealed source is dislodged but hasnt fallen out of pts body notify xray dept, if course falls out dont pick it up with your bare hands use forceps and place it in a lead container, most pts placed on bedrest or told to remain in certain positions, visitors should spend limited time in room, no children or pregnant women should visit

cancer genetic factors

results from defect in the DNA of genes, can be inherited or caused by mutation, oncogene (normal gene involved in cell growth and reproduction that becomes mutates and predisposes the cell to becoming cancerous) and tumor suppressor genes (healthy normal genes that slow cell division, make cell repairs and tell cells when to die), immunocompetence (capability of ones immune system to deal with foreign cells), carcinogens in external and internal environment

side effects of chemo

severe anemia, reduced immunity, thrombocytopenia, alopecia, mucositis, n/v/d, constipation

skin care during radiation tx

shower or wash area once a day using warm water and mild soap, use hand rather then washcloth, dry with soft clean towel, pat dont rub, dont remove ink markings, limit cold and sun exposure, wear sunscreen SPF 30 in areas not being radiated, dont apply sunscreen to affected skin, dont use lotion, salve or alcohol on affected area, wear loose 100% cotton clothes, dont shave or use electric razor without permission

interferons

slow cell division in cancer cells, stimulate natural killer cells, delay appearance of oncogenes and assist cancerous cells to revert to more normal cells, used for leukemia, melanoma, multiple myeloma, carcinoid tumors and renal carcinoma

common therapies, problems and nursing care

surgery, radiation, chemo, hormone manipulation, immunotherapy with biologic response modifiers, bone marrow or stem cell transplant,

principles of radiation protection

the amount of radiation a nurse might receive while caring for a pt being treated with internal radioactive elements depends on the distance between the nurse and the pt, the amount of time spent in actual proximity to the pt and the degree or shielding provided, total time spent should be <30mins per shift

nursing care of pts receiving chemo

toxicity on cells that have a short life span (blood cells, hair follicles, epithelial cells of mucous membranes), most chemo agents are excreted in body fluids, most are teratogenic

detection of cancer warning signs

unusual bleeding or discharge, sore throat that doesnt heal, change in bowel or bladder habits, lump in breast or other part of body, nagging cough, obvious change in mole, difficulty swallowing (cancer screenings are suggested to begin at age 40 or 50)

prevention of bleeding in pts with thrombocytopenia

use soft toothbrush, brush lightly, dont floss, use electric razor, prevent constipation by increasing fluids and fiber, take stool softener, avoid nonprescription drugs that inhibit platelet function such as aspirin, ibuprofen, alka seltzer and cold medicines, avoid injury, avoid contact sports, apply ice to injured area for 1hr, avoid tight constricting clothes or shoes, dont wear jewelry with sharp edges, use lube for intercourse, avoid anal intercourse, blow nose gently without occluding either nostril

hormone therapy

used as an adjunct to other types of cancer therapy, can slow tumor growth or prevent cancer recurrence, when a hormone is added to the body the balance of naturally produced hormones changes, giving large amounts of one hormone prevents the uptake of other hormones, if the tumor growth is aided by one type of hormone giving another type prevents the uptake of the growth promoting hormone and slows the progress of the tumor,

cancer tx infection prevention

wash hands before eating, after toileting, after blowing nose, after handling items other people have used (money, railings, shopping carts, library books, newspapers, mail), after touching a pet, after spending time in public, dont share personal care items, clean toothbrushes, stay away from people with infections, bathe daily, examine mouth daily for sores or white patches, perform mouth care frequently, examine skin for broken areas, wash dishes, utensils and items in hot sudsy water, dont reuse cups or glasses without washing, dont eat raw uncooked foods, if WBC is low maintain low bacteria diet by avoiding salads, raw fruits and veggies or undercooked meat, dont handle garden flowers, plant or earth, dont clean out litter boxes or bird cages, monitor temp daily, dont give rectal enemas or suppositories or rectal temps, dont nick or scratch skin, report signs of infection (temp >100, persistent cough, color or foul smelling nose or wound drainage, presence of boil or abscess, cloudy foul smelling urine or burning on urination)