Med Surg Ch.8 Care of patients with cancer

A patient is scheduled for bone marrow biopsy to confirm the diagnosis of leukemia. As the nurse reinforces provider instructions regarding the procedure, an appropriate nursing statement regarding bone marrow biopsy would be:

"It introduces a needle to aspirate tissue samples."

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?

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

A patient is scheduled for a computed tomography (CT) scan. To prepare the patient appropriately, the nurse should provide the patient with which information?

"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?

"You sound very angry today."

- Surgery * biopsy - obtain specimen *prophylaxis - removal if you had family hx * exploration- determine effectiveness of therapy * pallative - pain relief * curative- attempt to cure *restorative Be Proactive Explore Pain relief or a Real Cure) <<~~~ acronym for reasons for surgery - Radiation * destroy the malignant cells 2 types- internal and external - Chemo. * antineoplatic/cytotoxic agent- decrease malignant cells/ poisonous to cells

3 most common therapies for malignancies

External radiation therapy has far fewer side effects than it did in the past, but it does include skin reaction (change in texture and/or color; moist desquamation [rare]), loss of taste, and fatigue. Mental slowness is not a side effect of external radiation therapy. Contamination to others can occur with internal radiation therapy.

A patient is scheduled to receive external radiation therapy. Which potential side effects should the nurse include in patient teaching points?

External radiation therapy has far fewer side effects than in the past but does include skin reaction, loss of appetite, and fatigue.

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.)

The suffix -oma refers to a tumor and the root carcin- refers to the type of tissue from which the cancer originates. Carcinomas originate in epithelial tissue, which comprises any area or organ that has skin and/or mucous membranes, such as the lung

A patient is told that she has a malignant growth in the lung. The nurse is accurate in describing this tumor as which type?

Due to the rapid reproduction and growth of cancerous cells, available nutrients for normal cells are depleted by the needs of the cancer cells.

A patient who has lung cancer is losing weight and asks the LPN/LVN why this occurs. To reply accurately, the nurse should understand which concept regarding weight loss in patients with lung cancer?

A side-lying position will help prevent aspiration of mucus and fluids produced during the dying process.

A patient who is near death has the following nursing diagnosis: Impaired gas exchange related to fluid in the lungs. Which of these interventions is most appropriate?

This indicates the patient's ability to clot appropriately has improved.

A patient with bone marrow cancer received a platelet infusion 24 hours ago. Which assessment finding would indicate the most therapeutic effect from the transfusion?

Your patient will begin chemotherapy next week. Based on the understanding of the effects of chemotherapy, what patient education would be appropriate?

Advise the patient to use good birth control methods, because most chemotherapeutic agents are teratogenic.

- Phys affect of the disease - pt knowledge of the disease, process, tx and prognosis - needs of pt and family are met - anticipation of therapeutic affects - Preparation for a lifestyle change or death

Assessment

40 -50

At what age does most cancer screenings start?

Inhibits cancer growth

Benefits of Vitamin C

Harmless neoplasm

Benign

* unusual bleeding or D/C * Sores that will not heal * Change in bladder or bowel habits * lumps in the breast or other areas * persistant cough * obvious change in moles * difficulty swallowing

Cancer warning signs

chemicals, Viruses and radiation that have the potential to cause caner

Carcinogenics

Malignancy that begins in the Skin mucous membrane or the tissues (epithelial tissue) * Prefixes can be added ex. ADENOcarcinoma

Carcinoma

Will cause renal damage * Fluid administration is important to flush the drug through the kidneys to prevent damage. * May also ^ intracranial pressure, therefore mental status and BP should be assessed EVERY HOUR

Cisplatin (Platinol) effects on the body during Chemo?

-Oma = swelling/ collection of fluids ex. Hematoma - blood filled= bruise -Sarcoma - Carcinoma - leukemia/lymphoma -Melanoma

Classifications of Tumors

- Imbalanced Nutrition - Risk for infection - Pain (acute or chronic) - impaired skin integrity - disturbed body image

Common NSG DX

- anorexia/ mucositis/ wt loss - n/v/d - constipation - cystitis- monitor for hematuria and cloudiness - immunosuppression/ bone marrow suppression/ infection - hyperuricemia- can cause gout- prescribe (allopurinol) -Fatigue - Alopecia- loss of hair - Pain- chronic or acute

Common problems for cancer patients

A 40-year-old woman is scheduled for external radiation therapy for breast cancer. To help the patient cope with her illness and the effects of radiation therapy, what should the nurse help her to focus on?

Complying with scheduled radiation therapies, Protecting the skin by applying lotion, and understanding the therapeutic effects and side effects of the treatment

- Biopsy- Removal of living cells to examine under a microscope ( excision - cut out or aspiration- suction) - Radiologic studies- X-ray film (mammogram), CT scan, Istope, MRI ( reviews "slices" of tissue) - Endoscopy- direct visualization of the inside of the body (colonoscope) - Lab test- CBC, PSA(prostate baseline @ 50), tumor markers - CA 125 for ovarian cancer - CA 19-9- GI, pancreatic, liver cancer test after tx to check for reassurance - CA 27-29 - breast cancer

Diagnostic test

A terminally ill female patient reminiscing about the "good old days" becomes increasingly confused. She talks of seeing relatives who have died. Which nursing intervention(s) would be appropriate?

Discuss the patient's behaviors with the family, encourage the family to talk to the patient in quiet tones and promote a calm environment

Fibrous capsule that usually surrounds bening growth * usually prevents spread of other cells * benign are almost always encapsulated

Encapsulated

A patient has recently been diagnosed with cancer. What is the best initial nursing intervention for this patient?

Encourage the patient to verbalize feelings and fears

- Determine the expected outcome and if they are met - assess signs of complications and side affects of the tx, nutritional status, and pain - Change ineffective interventions to meet failed outcomes - Colab. with pt and other members of the health care team

Evaluation

factors that put you at a higher risk for cancer. Ex. Age/sex/ race

Genetic disposition

They are usually classified by the organ or tissue that they impact

How are tumors Classified?

Pts with HIV are already immunocompromised. They are more susceptible for abnormal cell growth

How can HIV affect your ability to obtain cancer?

* traveling through blood * directly being implanted from one organ to another during surgery. By an instrument or gloves touching the contaminated area and then a healthy area. * by breaking off from a diseased organ and attaching to a new healthy area.

How can Malignant cells metastsize?

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?

Humor is a healthful part of everyone's life.

Sexual activity should be avoided for 24 to 48 prior to the test because this could affect the PSA level.

In preparing a male patient for a prostate-specific antigen (PSA) test, what should the LPN/LVN tell the patient to avoid?

Before chemotherapy, a female patient expresses concerns regarding hair loss. She says that her partner will no longer love her because she will not be as attractive. An appropriate nursing problem statement would be:

Lack of power over effects of chemotherapy

Cancers of blood forming systems

Leukemia & Lymphoma

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?

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

Major measures to help prevent cancer in patients should be taught by the nurse at every given opportunity. Those things that should be taught to patients about the prevention of cancer include moderation in drinking alcohol, increasing (not decreasing) ascorbic acid (vitamin C), maintenance of normal weight, checking the chemical makeup of the local water supply, and avoiding nitrite and nitrate food additives.

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?

Uncontrolled growth * known as cancer cells * multiply at great rates * larger nucleus than reg. cells

Malignant

There are two types of tumors: benign and malignant. A difference between the two types is:

Malignant cells do not know when to stop multiplying, whereas benign cells have controlled patterns of reproduction and follow signals to stop.

Malignancy of pigment cells

Melanoma

Tissue that connects the internal organs to abd cavity wall

Mesentery

Spread of tumor cells *spreading to other areas of the body * not all malignant cells metastasize, but MOST do

Metastasis

permanent change of the cells

Mutation

new growth of tissue/tumor of an abnormal replicated cell * can cause an issue if it begin to press up against another organ

Neoplasm

gene with the potential to cause cancer

Oncogene

viruses that have the ability to cause cancer * Hep B, C, D= Liver cancer * T- cell Lymphotrope virus= T cell Lymphoma * HPV(Cervical carcinoma)= throat/ mouth cancer

Oncoviruses

Comfort care for the dying patient and maintaining a high quality of care until death

Palliative care

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?

Place patient in Fowlers position

- remain infection free - hemorrhage free - verbalize relief of nausea - Maintain a healthy wt - adjust to new body image - verbalize fears and develop coping mechanism

Planning (pt will)

- pt needs private room - radioactive substance are secreted through URINE, VOMIT, FECES, and SPUTUM (handle with gloves & follow correct disposal plan) - Don't spend more than 30 minute in an 8 hr shift with the pt - not allowed around pregnant women or children -

Precautionary measures for pt on radiation

The nurse reinforces patient instructions regarding neutropenic precautions. Important topics should include which of the following?

Pregnancy, diet restriction and hand hygiene

Prediction of survival

Prognosis

The family members attending to the needs of a dying patient express distress regarding the noisy breathing. An important nursing action would be to:

Reassure family members

Cells from original site that speaks to other areas around the tumor. * if this is not treated it can break away from the original site and spread becoming fatal

Regional Malignancy

Malignant tumor of connective tissue i.e cartilage, bone, blood vessels ect ( arose from Mesenchymal tissue) * prefixes can be added ex. OSTEOsarcoma

Sarcoma

Make up cancer of the stomach, uterus, lungs skin and tongue

Sarcoma and Carcinoma are found in what areas?

Pain is not unique to cancer but is a common occurrence in cancer patients. An important point to keep in mind when employing pain control efforts is to:

Seek a combination of interventions to offer the best pain control.

T- Primary Tumor N- Regional Nodes M- Metastasis #1-4 reflects the amount of malignancy that has attacked the tissues (severity)

TNM Staging

- Cytology = Pap smear - Occult blood = hidden blood in stool

Test to detect cancer

Doxorubicin is cardiotoxic, often resulting in congestive heart failure (CHF). Signs of CHF include jugular vein distention and rales.

The nurse is caring for a patient with leukemia who is receiving doxorubicin (Adriamycin). What should be reported to the physician immediately as a toxic effect of this drug?

Red meat and processed meats should be limited, while foods high in fiber, as well as cruciferous vegetables and whole grains, should be encouraged. Fatty fish twice per week will increase omega-3 intake.

The nurse is talking with the patient about ways to minimize the risk of the patient getting cancer. The LPN/LVN informs the patient of which dietary recommendation? (Select all that apply.)

A patient undergoes chemotherapy and loses her hair. Which of these findings is most indicative that the patient has satisfactorily adjusted to her alopecia?

The patient uses humor about her hair loss.

healthy normal genes that control the growth of cells in the body

Tumor suppressor Genes

Nitrates and nitrite can encourage cancer

What additives stimulate cancer?

* Stress * diet *wt/ obesity * alcohol consumption *Environment * viruses * Genetic disposition

What can contribute to risk of getting cancer?

Cancer cells change the makeup & fx of cancer cells. * they don't look or behave like normal cells

What effects does cancer cells have on DNA?

A group of diseases that characteristically grow in an uncontrolled manner w/ the spread of abnormal cells

What is cancer?

Hypercalcemia is a common occurrence with bone cancer. * INCREASED calcium levels

What lab values are effected with a pt with bone cancer?

An indwelling urinary catheter will allow elimination of urine without disrupting the implant

When a pt has a radiation cervical implant what's likely for the pt to have?

decrease immune system

Why are elderly at higher risk for developing cancer?

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?

breast development

Antineoplastic drugs are used to decrease the number of malignant cells in a generalized area * steriods are usually used in combination with antineoplastic drugs * Bone Marrow and Stem cell are usually used to correct the damage done by Chemo

chemo drugs

A patient who recently had chemotherapy for lung cancer complains of uncontrollable nausea and vomiting with accompanying loss of appetite. An appropriate problem statement would be:

inadequate nutrition

Cause no harm alone but in combination with a carcinogen can cause cancer after. * Alcohol + nicotine= faster occurrence of cancer

promoters

- wash once a day with mild soap and warm water - limit sun exposure - no lotion - wear loose clothing - dont remove markers - do not shave with out permission

skin care with radiation