Oncology -(Ms. P) 3-21-23

Note

The type used depends of the client's general health and on the shape, size, and location of the tumor The ideal radiation dose is one that kills the cancer cells with an acceptable level of damage to normal tissues --- damage to normal tissues cannot be avoided

Outpatient Based

This has emerged as an approach to providing services & support to patients & families who opt not to, or are not eligible for, home hospice but could benefit from comprehensive palliative care in the community. Most of these occur in ambulatory clinics or practices. They may opt to assist the health-care-provider to co-manage opioid prescribing. Many non-oncology patients lack proper palliative care follow-up nag toro y specialists evel us candiniore-t? huim chale sietvices.

Community based

This involves home-based palliative care. It has become more common due to the aging of society & a desire for people to remain at home rather than live in an institution. The goal is to manage symptoms and provide support in the home. This has helped to reduce hospital readmissions and mortality.

External radiation EBRT

" EXTERNAL BEAM RADIATION THERAPY - CALED EBRT) • IS THE MOST COMMONIY USED FORM OF RADIATION THERAPY. RADIATION IS DELIVERED FROM AN OUTSIDE SOURCE • BECAUSE THE SOURCE IS EXTERNAL - THE CLIENT IS NOT RADIOACTIVE, AND THERE IS NO HAZARD TO OTHERS THERE ARE DIFFERENT DELIVERY TECHNIQUES USED, BUT THE TOTAL DOSAGE IS USUALLY 1 TO 5 SEPARATE TREATMENT SESSIONS REGARDLESS OF THE DELIVERY METHOD - THE AREA IS IDENTIFIED AND MARKED • THE PATIENT MUST BE EXACTLY THE SAME POSITION FOR ALL TREATMENTS • (CAN GET BATH BUT DON'T WASH OFF MARKS)

ALOPECIA

Add later

Note: Role of the immune system

Age-related changes - declining organ function, increased incidence of chronic diseases and diminished immunocompetence Immunodificiency diseases - AIDS

C.H. 12 Cancer

Cancer

Internal Radiation

INCLUDES LOCALIZED IMPLANTATION OR SYSTEMIC RADIONUCLIDE ADMINISTRATION

Chemo continues

(CHEMOTHERAPY (CONT.) A SEROUS COMPLICATION OF IV INFUSION IS EXTRAVASATION - OCCURS WHEN DRUG LEAKS INTO THE SURROUNDING TISSUES • SOME CHEMOTHERAPY AGENTS ARE REFERRED TO VESICANTS (CHEMICALS THAT DAMAGE TISSUE ON DIRECT CONTACT) RESULTS INCLUDE PAIN, INFECTION, AND TISSUE LOSS • SOMETIMES SURGICAL INTERVENTION IS NEEDED FOR SEVERE TISSUE DAMAGE • MOST IMPORTANT NURSING INTERVENTION FOR EXTRAVASATIONIS PREVENTION • CLOSE MONITORING IS CRITICAL TO PREVENT LARGE LEAKS CAUSING EXTENSIVE DAMAGE MANAGEMENT OF EXTRAVASATION IS SPECIFIC TO THE DRUG (FIRST STEP IS STOP THE INFUSION!) • WITH SOME DRUGS, COLD COMPRESSES ARE PRESCRIBED • OTHER AGENTS REQUIRE WARM COMPRESSES 33 ANTIDOTES OR CHEMOPROTECTIVE AGENTS MAY BE INJECTED INTO THE SITE OF EXTRAVASATION

Nursing Care of Clients With Cancer

(REFER TO CHART 12-6, P. 337-349 MAINTAINING SKIN & TISSUE INTEGRITY • IMPAIRED ORAL MUCOSA/STOMATITIS • PROMOTING NUTRITION RELATED TO NAUSEA AND VOMITING • PROMOTING NUTRITION RELATED TO ANOREXIA, CACHEXIA, OR MALABSORPTION • RELIEVING PAIN • DECREASING FATIGUE IMPROVING BODY IMAGE AND SELF-ESTEEM ASSISTING WITH GRIEVING PROCESS • PREVENTION OF INFECTION • PREVENTION OF BLEEDING KNOW THIS!!!

3 types of chronic life limiting illnesses

1)Terminal illness (i.e. cancer) usu. diagnosed when one is highly functioning, with a short, steady decline before death. 2) Organ failure - (i.e. heart failure, end-stage- kidney disease, or chronic lung disease) usually follows a slow decline after diagnosis, with episodic illnesses, exacerbation or hospitalization, where one has difficulty returning back to functional baseline. 3) Frailty (i.e. dementia) typically diagnosed when one is already frail, with a slow decline over years.

Epidemiology of cancer 1. What percent of cancer occurs in those older than 55? 2. Does cancer occur more/ have a higher incidence in men or women? 3. cancer is the _____leading cause of death in the US 4. ___ in 4 deaths are caused by cancer 5. What are men's leading causes of death from cancer in the USA? 6. What are women's leading causes of death from cancer in the USA? 7. What is the leading type of cancer death in men and women?

1. 78% OCCUR IN THOSE OLDER THAN 55 2. MEN > WOMEN 3. 2nd leading cause 4. 1 in 4 deaths are caused by cancer 5. Leading causes of death from cancer - men: lung, prostate, colorectal - women: lung, breast, colorectal 6. lung cancer

Cancer 1. What is cancer and what does it involve? 2. What organ system does cancer involve? 3. Do treatment approaches have the potential for multisystem effects? 4. What age group does cancer involve? 5. What settings are the nursing care of cancer clients performed in?

1. Cancer is a group of disorders with different causes, manifestations, treatments and prognoses. 2. involves any organ system 3. yes 4. any group 5. Various settings: acute care institutions, outpatient centers, rehabilitation facilities, homes, long term facilities, and physician's offices

Note: Tumor staging and grading

T - extent of primary tumor N - lymph node involvement M - extent of metastasis Example: TI, NI, MO Grade I is well differentiated - appears fairly similar to normal cell (low grade) Grade IV - usually palliative care given with stage IV

Toxicities of radiation

ACUTE/EARLY TOXICITIES: ALOPECIA SKIN REACTIONS (RADIATION DERMATITIS) HYPERPIGMENTATION • STOMATITIS XEROSTOMIA • MUCOSITIS • IF ESOPHAGITIS, MAY INCLUDE CHEST PAIN AND DYSPHAGIA ANOREXIA, NAUSEA, VOMITING AND DIARRHEA • ANEMIA LEUKOPENIA THROMBOCYTOPENIA FATIGUE SYSTEMIC SIDE EFFECTS: FATIGUE MALAISE ANOREXIA LATE EFFECTS: DYSPHAGIA INCONTINENCE COGNITIVE IMPAIRMENT SEXUAL DYSFUNCTION

ALTERED BODY IMAGE

ASSESS PATIENT'S FEELINGS ABOUT BODY IMAGE, LEVEL OF SELF- ESTEEM IDENTIFY POTENTIAL THREATS TO PATIENT'S SELF-ESTEEM VALIDATE CONCERNS WITH PATIENT ENCOURAGE CONTINUED PARTICIPATION IN ACTIVITIES, DECISION MAKING ENCOURAGE PATIENT TO VERBALIZE CONCERNS INDIVIDUALIZE CARE FOR PATIENT • ASSIST PATIENT IN SELF-CARE WHEN FATIGUE, LETHARGY, NAUSEA, VOMITING, OTHER SYMPTOMS PREVENT INDEPENDENCE • ASSIST PATIENT IN SELECTING AND USING COSMETICS, SCARVES, HAIR PIECES, CLOTHING THAT INCREASE HIS OR HER SENSE OF ATTRACTIVENESS • ENCOURAGE PATIENT, PARTNER TO SHARE CONCERNS ABOUT ALTERED SEXUALITY AND SEXUAL FUNCTION, TO EXPLORE ALTERNATIVES TO USUAL SEXUAL EXPRESSION • REFER TO COLLABORATING SPECIALISTS AS NEEDED

ALTERED NUTRITION: NAUSEA AND VOMITING

ASSESS PATIENT'S PREVIOUS EXPERIENCES, EXPECTATIONS OF NAUSEA AND VOMITING, INCLUDING CAUSES, INTERVENTIONS USED ADJUST DIET BEFORE, AFTER DRUG ADMINISTRATION ACCORDING TO PATIENT PREFERENCE, TOLERANCE PREVENT UNPLEASANT SIGHTS, ODORS, SOUNDS IN ENVIRONMENT USE DISTRACTION, MUSIC THERAPY, BIOFEEDBACK, SELF-HYPNOSIS, RELAXATION TECHNIQUES, GUIDED IMAGERY BEFORE, DURING, AFTER CHEMOTHERAPY ADMINISTER PRESCRIBED ANTIEMETIC, SEDATIVES, CORTICOSTEROIDS BEFORE CHEMOTHERAPY, AFTERWARD AS NEEDED • ENSURE ADEQUATE FLUID HYDRATION BEFORE, DURING, AFTER DRUG ADMINISTRATION; ASSESS INTAKE, OUTPUT ENCOURAGE FREQUENT ORAL HYGIENE • PROVIDE PAIN RELIEF MEASURES IF NECESSARY • CONSULT WITH DIETICIAN AS NEEDED ASSESS, ADDRESS OTHER CONTRIBUTING FACTORS TO NAUSEA, VOMITING°

Note

Acute or early toxicities most often begin within 2 weeks of the initiation of treatment - occurs when normal cells within the treatment area are damaged and cellular death exceeds regeneration Body tissue most often affected are those that normally proliferate rapidly, such as the skin, epithelial lining of the gastrointestinal tract, and the bone marrow Early effects tend to be temporary and most often subside within 6 months of the cessation of treatment Late effects (approximately 6 months to years after treatment) of radiation therapy may occur in body tissues that were in the field of radiation 1) Chronic, usually a result of permanent damage to tissues, loss of elasticity, and changes secondary to a decreased vascular supply 2) Severe late effects include fibrosis, atrophy, ulceration, and necrosis bladder - may affect the lungs, heart, central nervous system, and With improved planning and accuracy of treatment delivery occurrence of late toxicities has diminished However, late or chronic symptoms, such as dysphagia, incontinence, cognitive impairment, and sexual dysfunction may persist for several years

Hospice Care

All hospice care is palliative care; however, not all palliative care is hospice care. The difference is that hospice care is an application of palliative care delivered at the end-of-life. Hospice care focuses on quality of life, & by necessity, it usu. includes realistic emotional, social, spiritual, & financial preparation for death. Hospice in the U.S.A. is not a place, but a philosophy of care in which the end-of- life is viewed as a developmental stage,

End- Of- Life Symptom Assessment

Anticipating & planning interventions for symptoms is cornerstone of both palliative & end-of-life care. Patients & family members cope more effectively with new symptoms and exacerbations when they know what to expect. As death approaches & organ systems begin to fail, observable, expected changes in the body take place. Read Table 13-4, p. 377 on the Stages of the Dying Process. Symptoms that are often experienced in the end- of-life stage include the following. (READ textbook for further discussion of these symptoms) Pain Dyspnea Impaired Secretions Anorexia & Cachexia Anxiety & Depression Delirium Additional symptoms such as fatigue, constipation, nausea & vomiting)

Notes

BIOLOGICAL RESPONSE MODIFIERS - INVOLVES THE USE OF NATURALLY OCCURRING OR RECOMBINANT (PRODUCED BYGENETIC ENGINEERING) AGENTS OR TREATMENT METHODS THAT CAN ALTER THE IMMUNOLOGIC RELATIONSHIP B/W THE TUMOR AND THE PATIENT WITH CANCER (HOST) TO PROVIDE A THERAPEUTIC BENEFIT. THE GOAL IS TO DESTROY OR STOP THE MALIGNANT GROWTH. THE BASIS OF BMR TREATMENT LIES IN THE RESTORATION, MODIFICATION, STIMULATION, OR AUGMENTATION OF THE BODY'S NATURAL IMMUNE DEFENSES AGAINST CANCER. MOBS - THEORETICALLY THIS TYPE OF SPECIFICITY ALLOWS MOABS TO DESTROY THE CANCER CELLS AND SPARE NORMAL CELLS.

Brachytherapy

BRACHYTHERAPY • THE PLACEMENT OF RADIOACTIVE SOURCES WITHIN OR IMMEDIATELY NEXT TO THE CANCER SITE FOR A SPECIFIC TIME PERIOD. • IT CAN HELP SPARE EXPOSURE TO NORMAL SURROUNDING TISSUE. • THE RADIATION SOURCE CAN BE IMPLANTED VIA NEEDLES OR RODS, SEEDS, BEADS, RIBBONS, OR CATHETERS PLACED INTO BODY CAVITIES OR INTERSTITIAL TISSUE COMPARTMENTS. • THE RADIATION SOURCE IS WITHIN THE CLIENT - THEREFORE, THE CLIENT EMITS RADIATION FOR A PERIOD OF TIME AND IS A POTENTIAL HAZARD TO OTHERS.

Other Therapies

C. HEMATOPOIETIC STEM CELL TRANSPLANTATION (HSCT) HSCT IS CONSIDERED TO BE THE STANDARD OF CARE IN CERTAIN ADULT HEMATOlOGIc MalIgnanCIes MALIGNANT MYELOMA LAGTELEUKEMIA nON-hODGKIN LYMPHOMA HYPERTHERMIA THE USE OF TEMPERATURES GREATER THAN PHYSIOLOGIC FEVER RANGE (GREATER THAN 106.7°F) TO DESTROY CANCEROUS TUMORS MOST EFFECTIVE WHEN COMBINED WITH RADIATION THERAPY, CHEMOTHERAPY, OR BIOLOGIC THERAPY

Note

COMMON MEDS USED FOR TX OF NAUSEA: ONDANSETRON (ZOFRAN) AND PHENERGAN (SERATONIN BLOCKERS) FOR DELAYED NAUSEA: GIVE MEDS FIRST AND THEN TRY OTHER METHODS SUCH AS DISTRACTION, BIOFEEDBACK, ETC.

Notes: Different kinds of cancer

Cancer can originate almost anywhere in the body. Carcinomas, the most common types of cancer, arise from the cells that cover external and internal body surfaces. Lung, breast, and colon are the most frequent cancers of this type in the United States. Sarcomas are cancers arising from cells found in the supporting tissues of the body such as bone, cartilage, fat, connective tissue, and muscle. Myeloma - cancer of the plasma cells. Lymphomas are cancers that arise in the lymph nodes and tissues of the body's immune system Leukemias are cancers of the immature blood cells that grow in the bone marrow and tend to accumulate in large numbers in the bloodstream.

Note: What causes cancer?

Cancer is often perceived as a disease that strikes for no apparent reason. While scientists don't yet know all the reasons, many of the causes of cancer have already been identified. Besides intrinsic factors such as heredity, diet, and hormones, scientific studies point to key extrinsic factors that contribute to the cancer's development: chemicals (e.g., smoking), radiation, and viruses or bacteria. Among the various factors that can cause cancer, tobacco smoking is the greatest public health hazard. Cigarette smoke contains more than two dozen different chemicals capable of causing cancer. Cigarette smoking is the main cause of lung cancer and contributes to many other kinds of cancer as well, including cancer of the mouth, larynx, esophagus, stomach, pancreas, kidney, and bladder. Current estimates suggest that smoking cigarettes is responsible for at least one out of every three cancer deaths, making it the largest single cause of death from cancer. Other forms of tobacco use also can cause cancer. For example, cigars, pipe smoke, and smokeless tobacco can cause cancers of the mouth. Chemicals and radiation that are capable of triggering the development of cancer are called "carcinogens." Carcinogens act through a multiste process that initiates a series of genetic alterations ("mutations") and stimulates cells to proliferate. A prolonged period of time is usually required for these multiple steps. There can be a delay of several decades between exposure to a carcinogen and the onset of cancer. For example, young people exposed to carcinogens from smoking cigarettes generally do not develop cancer for 20 to 30 years. Another example - tanning beds. This period between exposure and onset of disease is the lag time. Life style factors known to increase risk: Diet, Obesity, Insufficient physical activity Viruses - - HPV

Note:

Cardiovascular disease is the leading cause of death in the US Although death rates have declined, cancer death rates in African American men remain substantially higher than those among Caucasian men and two times those of Hispanic men African American women have a lower risk of cancer overall than white women, but they have 14% higher death rates for all cancers compared with white women and women in general *Racial disparities may be attributed to the burdens of comorbid conditions, such as cardiovascular disease, and poverty experienced more often in the African American population than in others Cancer deaths also vary by geography - - - states where tobacco use is high, the incidence of lung cancer tends to be greater Areas where there is greater socioeconomic disparity - the incidence of advanced cancer and overall cancer death rates are higher than in regions where there is not such disparity

TABLE 12-1 Characteristics of Benign and Malignant Cells

Cell Benign- Well-differentiated cells resemble normal cells of the tissue from which the tumor originated. Malignant- Cells are undifferentiated and may bear little resemblance to the normal cells of the tissue from which they arose. Mode of growth Benign- Tumor grows by expansion and does not infiltrate the surrounding tissues; usually encapsulated. Malignant- Grows at the periphery and overcomes contact inhibition to invade and infiltrate surrounding tissues Rate of growth Benign- Rate of growth is usually slow. Malignant- Rate of growth is variable and depends on level of differentiation; the more anaplastic the tumor, the faster its growth. Metastasis Benign- Does not spread by metastasis. Malignant- Gains access to the blood and lymphatic channels and metastasizes to other areas of the body or grows across body cavities such as the peritoneum. General effects Benign- Usually a localized phenomenon that does not cause generalized effects unless its location interferes with vital functions. Malignant- Often causes generalized effects, such as anemia, weakness, systemic inflammation, weight loss, and CACS. Tissue destruction Benign- does not usually cause tissue damage unless its location interferes with blood flow. Malignant- Often causes extensive tissue damage as the tumor outgrows its blood supply or encroaches on blood flow to the area; may also produce substances that cause cell damage. Ability to cause death Benign- Does not usually cause death unless its location interferes with vital functions. Malignant- Eventually causes death unless growth can be controlled.

Note

Chemotherapy may be given in the hospital, outpatient center, or home setting by multiple routes In certain regimens, adjunct chemotherapeutic agents are given with the chemotherapy agent to protect normal cells from injury For oral chemotherapeutic drug administration ---because these oral agents can be absorbed through skin and mucous membranes and exert toxic effects --- the person who handles and administers these medications need to use PPE in the same way as during IV chemotherapy administration Oral agents must not be crushed, split, broken or chewed --- these drugs are biohazardous and must be discarded according to agency policy Disposal of expired or discontinued oral chemotherapy agents can be problematic - best to take back to oncology clinic in the container in which they were dispensed or contact dispensing pharmacist about specific disposal methods ------ can't be flushed, shouldn't be taken to collection sites, because these drugs can be harmful to those collecting

Note:

Critical phases of wound healing last for about 25 days following incision. Most chemotherapy agents act by interfering with protein synthesis Protein needed for wound healing

According to Gicely Saunders, who founded the world- renowned St. Christopher's Hospice in London, the principles underlying hospice are as follows:

Death must be accepted. The patient's total care is best managed by an interdisciplinary team whose members communicate regularly with one another. Pain & other symptoms of terminal illness must be managed. The patient & family should be viewed as a single-unit of care. Home care of the dying is necessary, Bereavement care must be provided to family members. Research & education should be ongoing.

Sealed radiation

IMPLANTED WITHIN OR NEAR THE TUMOR • CAN BE TEMPORARY OR PERMANENT "LOW-DOSE RADIATION" (LDR) • LOW-ENERGY RADIATION IS USED MOST OF THE TIME SOME ARE SMALL (SEEDS, NEEDLES) AND LEFT IN PLACE - OVER TIME, LOSES RADIOACTIVITY OTHERS ARE REMOVED AND REUSED IN OTHER PATIENTS WHILE IN PLACE - THE CLIENT EMITS RADIATION, BUT EXCRETA IS: NOT RADIOACTIVE HIGH-DOSE RATE (HDR) - CLIENT COMES INTO THE RADIATION THERAPY DEPARTMENT SEVERAL TIMES A WEEK STRONGER RADIATION IMPLANTS ARE PUT IN PLACE FOR ONLY AN HOUR OR SO CLIENT IS ONLY RADIOACTIVE WHEN THE IMPLANT IS IN PLACE

Communication in Palliative & End-of-Life Care

Expert communication is a tenet of palliative & end-of-life care. Throughout the course of a serious illness, patients & their families encounter complicated treatment options & bad news about disease progression. They may have to make difficult decisions at the time of diagnosis, when disease-focused treatments fail, when the effectiveness of a particular intervention is being discussed, & were critical decisions about hospice care are presented. points on the treatment continuum demand patience, empathy, & honesty from nurses. Therapeutic communication can be learned and, like other skills, must be practiced to gain expertise. One skill nurses have the opportunity to master is responding to emotiono Nurses often meet patients in vulnerable states experiencing strong emotions such as anxiety, anger, fear, & sadness.

Note

GI - For both radiation and chemotherapy - nausea and vomiting are common side effects ---- If administering an antiemetic When should the nurse administer it? 30 minutes prior to therapy Hematopoietic system - depression of bone marrow results in decreased WBC (leukopenia), granulocytes (neutropenia), BC ( anemia), and platelets ( thrombocytopenia) . This also results in increased risk of bleeding and infection. Renal - can impair water secretion - causing SIADH, decreased renal perfusion, interstitial nephritis. Cardiopulmonary - those with pre-existing heart/lung disorders are at greater risk and dose may be lowered. Reproductive - possible sterility; women may develop problems with ovulation or early menopause; may chemo agents are teratogenic patients are advised to use reliable methods of birth control while on chemo Neuro - can affect the central nervous system, peripheral nervous system, and/or the cranial nerves - may have sensory alterations in hands/feet. (numbness, tingling, pricking, burning pain, etc. - some sx worse with exposure to cold. Some drugs may cause hearing loss as well. Cognitive - may have difficulty remembering dates, multitasking, managing numbers and finances, organization, become easily distracted, etc. - referred to as "chemo- brain" Fatigue - unusual, persistent, and subjective sense of tiredness that is not proportional to recent activity and interferes with usual functioning.

Management of Cancer

Goals of treatment: • cure - complete eradication of malignant disease. • control - prolonged survival & containment of cancer cell growth. • palliation - relief of symptoms associated with the disease & improvement of quality of life.

What causes cancer

Heredity Lifestyle Hormones Viruses bacteria Chemical agents: tobacco, asbestos Physical factors: sunlight, radiation, chronic irritation

Note

Historically, hematopoietic stem cells were obtained by harvesting large amounts of bone marrow tissue from a donor under general anesthesia -..._- However, today we're able to utilize apheresis ( removal of whole blood from patient) to collect hematopoietic stem cells from blood, process them and infuse or re-infuse them into the client Stem cells can also be collected from umbilical cord blood harvested from the placenta of newborns at birth Main types of HSCT: ALLOGENIC - from a donor other than the patient (family or another person) AUTOLOGOUS - From the patient SYNGENEIC - from an identical twin SKILLED NURSING CARE is required during the treatment phase of HSCT. The acute toxicity of nausea, diarrhea, mucositis, and hemorrhagic cystitis require close monitoring and symptom management by the nurse. Nursing management during stem cell infusion consists of monitoring the patient's v.s. and blood oxygen saturation; assessing for adverse effects such as fever, chills, SOB, chest pain, cutaneous reactions, N/V, hypotension or hypertension, tachycardia, anxiety, and taste changes; and providing strategies for symptom control, ongoing support, and patient education. Until engraftment of the new marrow occurs, the patient is a HIGH RISK for death from sepsis and bleeding. A cluster of symptoms referred to as engraftment syndrome may occur during the neutrophil recovery phase in both allogenic and autologous transplants. Clinical features of this syndrome vary widely but may include noninfectious fever associated with skin rash, weight gain, diarrhea, and pulmonary infiltrates with improvement noted after the initiation of corticosteroid therapy rather than antibiotic therapy. UNTIL engraftment is well established, the patient requires support with blood products and hematopoietic growth factors.

Institution based

In the hospital, the delivery of palliative care is typically through am interdisciplinary consultation service where primary teams consult specialists for one or more of the following reasons: Pain management Symptom management Goals of care discussions - (most common reason) End-of-life issues Psychosocial distress • Spiritual or existential distress. The core interdisciplinary team usu. Consists of physicians, nurses, advanced practice nurses, social workers, and chaplains. Other members may also include pharmacists, nutritionists, e music/art therapists, ethicists, & psychologists.

Settings for palliative care & end of life care

Institution-based Outpatient-based Community-based Hospice care

Radiation Therapy

MAY BE ADMINISTERED: • TO CURE • LOCALIZED CANCERS (HEAD, NECK, CERVIX) • TO CONTROL • WHEN TUMOR CAN'T BE SURGICALLY REMOVED • REDUCE TUMOR SIZE PRIOR TO SURGERY • PREVENT SPREAD • AS PALLIATIVE TREATMENT • RELIEVE SYMPTOMS OF METASTATIC DISEASE TREAT ONCOLOGIC EMERGENCIES (SUPERIOR CAVA SYNDROME, BRONCHIAL AIRWAY OBSTRUCTION, OR SPINAL CORD COMPRESSION)

The Nurse Framework- table 13-3

N - Name the emotion U - Understand the emotion R - Respect (or praise) the patient S - Support the patient E - Explore the emotion

Nutritional Problems

NUTRITIONAL PROBLEMS • ANOREXIA • MALABSOPRTION • CACHEXIA (WEAKNESS & WASTING OF BODY D/T CHRONIC ILLNESS) NUTRITIONAL PROBLEMS: EXPECTED OUTCOMES • EXHIBITS WEIGHT LOSS NO GREATER THAN 10% OF PRETREATMENT WEIGHT • REPORTS DECREASING ANOREXIA, INCREASED INTEREST IN EATING • DEMONSTRATES NORMAL SKIN TURGOR • IDENTIFIES RATIONALE FOR DIETARY MODIFICATIONS • PATIENT, FAMILY VERBALIZE STRATEGIES TO ADDRESS, MINIMIZE NUTRITIONAL DEFICITS • PARTICIPATES IN CALORIE COUNTS, DIET HISTORIES • USES APPROPRIATE RELAXATION, IMAGERY BEFORE MEALS • EXHIBITS LABORATORY, CLINICAL FINDINGS INDICATIVE OF ADEQUATE NUTRITIONAL INTAKE CONSUMES DIET HIGH IN REQUIRED NUTRIENTS • CARRIES OUT ORAL HYGIENE BEFORE MEALS • REPORTS THAT PAIN DOES NOT INTERFERE WITH MEALS REPORTS DECREASING EPISODES OF NAUSEA, VOMITING • PARTICIPATES IN INCREASING LEVELS OF ACTIVITY STATES RATIONALE FOR USE OF TUBE FEEDINGS OR PARENTERAL NUTRITION • PARTICIPATES IN MANAGEMENT OF TUBE FEEDINGS OR PARENTERAL NUTRITION IF PRESCRIBED

Note

Nurses work collaboratively with other providers to manage symptoms associated with radiation therapy in order to promote: healing patient comfort quality of life The area of the body being irradiated partially guides the focus of nursing assessments If systemic symptoms --- such as weakness and fatigue occur, the nurse explains that these symptoms are a result of the treatment and do not represent deterioration or progression of the disease

Note: Surgery

Obtain tissue sample for analysis Excisional Used for easily accessible tumors Skin, breast, upper and lower GI, upper respiratory Incisional Wedge removed if mass is too large to be removed Needle Sample suspicious masses Breast, thyroid, lung, liver, kidney Fast, inexpensive May require 'guided imaging' with use of CT

Palliative & End-of-Life Care

Palliative care uses an interdisciplinary model of care, focusing on symptom management & psychosocial/spiritual support for those with serious, life-limiting illnesses. Hospice is a type of palliative care focusing on comfort at the end-of-life. The client has made the decision to forego disease-directed therapies & focus solely on the relief of symptoms associated with their illness & the dying process.

Naming Cancers

Prefix / Meaning adeno- gland chondro- cartilage erythro- red blood cell hemangio- blood vessels hepato- liver lipo- fate lympho- lymphocyte melano- pigment cell myelo- bone marrow myo- muscle osteo- bone

Unsealed nursing care of hospital clients with unsealed implants

Presents potential contamination hazard/ all articles in room are considered contaminated After d/c articles are discarded but taken to protecied area til detectable radioactivity decays Rubber gloves worn with direct care > No pregnant staff Articles in room phone, call light, floors covered plastic disposable plastic /paper used for dietary trays & utensils pts, Flush toilet several times Keep linen & gowns kept in separate isolation bags

Note

Primarily used to treat systemic disease rather than localized ™ lesions that are amenable to surgery or radiation

Note: Prevention

Primary Prevention - - - Teaching & immunizations Secondary Prevention - - - Testing - understanding the role of genetics in cancer cell development has contributed to prevention and screening efforts PSA - Prostate specific antigen a tumor-specific antigen (TSA) ---- these are proteins that develop over time as the cells become mature These proteins distinguish malignant cells from benign cells of the same tissue type Many TSA's have been identified and have aided in assessing the extent of disease in a person and in tracking the course of illness during treatment or relapse

Carcinogens

Read pages 304-307 VIRUSES & BACTERIA • Human papillomavirus (HPV) • Hepatitis b virus (HBV) •Epstein-barr virus (EBV) • Helicobacter pylori • PHYSICAL AGENTS • Exposure to sunlight, radiation, chronic irritation or inflammation • Tobacco carcinogens • Industrial chemicals • Asbestos • CHEMICALS • Tobacco smoke (single most lethal chemical) accounts for 1/3rd of cancer deaths • Smokeless tobacco & ENDS • Workplace exposure - pesticides, formaldehydes, arsenic, soot, tar, wood dust, nickel •GENETIC/FAMILIAL FACTORS Associated with extra, too few, or translocated chromosomes • Certain cancer syndromes identified by a specific genetic alterations • LIFESTYLE FACTORS • Diet • Obesity • Insufficient physical activity These factors are 2nd only to tobacco as major risk factors • HORMONES • Tumor growth promoted by disturbances in hormonal balance • Endogenous - body's own hormone production • Exogenous - external hormonal factors

Oncologic Emergencies

SEE TABLE 12-13 P. 360-362 • SUPERIOR VENA CAVE SYNDROME - COMPRESSION OR INVASION OF S.V.C Y TUMOR, ENLARGED LYMPH NODES, INTRALUMINAL THROMBUS THAT OBSTRUCTS VENOUS CIRCULATION; OR DRAINAGE OF HEAD, NECK, ARMS, & THORAX. S/S= PROGRESSIVE SOB, EDEMA OF ARMS, NECK, HANDS, THORAX. DIFFICULTY SWALLOWING - SKIN TIGHTNESS. INCREASED ICP: DILATED THORACIC VESSELS CAUSING VENOUS PATTERNS ON CHEST WALL. NURSING CARE: AVOID ELEVATION OF EXTREMITY; AVOID UPPER VENI-PUNCTURES & B/P, • SPINAL CORD COMPRESSION - USU. CAUSED BY COMPRESSION OF THE CORD & ITS NERVE ROOTS BY A METASTATIC PARAVERTEBRAL TUMOR - MAY LEAD TO SIGNIFICANT & PERMANENT NEUROLOGICAL IMPAIRMENT WITH MULTIPLE PHYSICAL AND PSYCHOSOCIAL CONSEQUENCES. S/S = LOCAL INFLAMMATiON, EDEMA & IMPAIRED BLOOD SUPPLY TO NERVE TISSUE. LOCAL BACK OR NECK PAIN - PAIN IS EXACERBATED BY MOVEMENT, SUPINE RECUMBENT POSITION, COUGHING, SNEEZING, OR VALSALYA (MANEUVER. (CONT) (continyed) Neuro dysfunction = numbness, tingling, coldness in affected area, etc. Bladder & bowel dysfunction depending on level of compression. Nursing - neuro assessment, control pain, prevent complications of immobility, maintain muscle tone, bowel & bladder program - I.e. cath, support. O Hypercalcemia - calcium released from bones is more than kidneys can excrete. Seen more in breast, lung, & renal cancers & in myelomas & some leukemias. S/S _weak, fatigue, decreased LOC, N, V, & constipation, polydipsia, dehydration & dysrhythmias. Nursing care-_monitor for s/s hypercalcemia such as muscle weakness, decreased LOC. Provide for safety & hinereasefulds unless contraindicated TUD mag= Sedation Tumor lysis syndrome- occurs spontaneously or after radiation, bio- therapy, or chemo. Causes electrolyte Imbalances - potentially fatal - I.e. hyperkalemia, increased phosphatemia, hyperuricemia. S/S = depends on the extent of the metabolic abnormality. Clinical tumor lysis syndrome occurs either 3 days prior to or 7 days after cytotoxic cancer therapy. This is present when 21 of these 3 conditions occur: ACUTE KIDNEY INJURY, DYSRHYTHMIAS, or SEIZURES. Other symptoms include: neurologic- fatigue, weakness, alt. mental status, seizures, parasthesias; cardiac - increased b/p, dysrhythmia GI = anorexia, N/V/D, abd. Cramps.; Renal- flank pain, oliguria, anuria, kidney, injury, acidic urine - PH; Other - gout, pruritis. These all require medical management -aggressive fluid replacement. Nurse monitors fluids & assists with meds.

Note: Naming cancers

Scientists use a variety of technical names to distinguish the many different types of carcinomas, sarcomas, lymphomas, and leukemias. In general, these names are created by using different Latin prefixes that stand for the location where the cancer began its unchecked growth. For example, the prefix "osteo" means bone, so a cancer arising in bone is called an osteosarcoma. Similarly, the prefix "adeno" means gland, so a cancer of gland cells is called adenocarcinoma--for example, a breast adenocarcinoma.

Brachytherapy may be delivered via sealed or unsealed routes.

Sealed: Interstitial Intercavity Unsealed (Systemic) IV, oral

Different Kinds of Cancer

Some common Carcinomas: Lung Breast (women) Colon Bladder Prostate (men) Leukemias: hematopoietic cells in the bone marrow Myelomas: Plasma cells Lymphomas: Lymphocytes (lymph nodes/body organs) Some common sarcomas Fat Bone Muscle

Chart 12-3 TNM Classification System

T The extent of the primary tumor N The absence or presence and extent of regional lymph node metastasis M The absence or presence of distant metastasis The use of numerical subsets of the TNM components indicates the progressive extent of the malignant disease. Primary Tumor (T) Tx Primary tumor cannot be assessed T0 No evidence of primary tumor Tis Carcinoma in situ T1, T2, T3, T4 Increasing size or local extent of the primary tumor Regional Lymph Nodes (N) Nx Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1, N2, N3 Increasing involvement of regional lymph nodes Distant Metastasis (M) Mx Distant metastasis cannot be assessed M0 No distant metastasis M1 Distant metastasis

Other therapies

TARGETED THERAPIES BIOLOGIC RESPONSE MODIFIERS BASIS FOR TREATMENT LIES IN THE RESTORATION, MODIFICATION, STIMULATION OR AUGMENTATION OF THE BODY'S NATURAL IMMUNE DEFENSES AGAINST CANCER MONOCLONAL ANTIBODIES - (MOBS) -ENABLE THE GROWTH AND PRODUCTION OF TARGETED ANTIBODIES FOR SPECIFIC MALIGNANT CELL. GENE THERAPY INCLUDES APPROACHES THAT CORRECT GENETIC DEFECTS, MANIPULATE GENES TO INDUCE TUMOR CELL DESTRUCTION, OR ASSIST THE BODY'S IMMUNE DEFENSE IN THE HOPE OF PREVENTING OR COMBATING CANCER COMPLEMENTARY, ALTERNATIVE, AND INTEGRATIVE HEALTH THERAPIES INTEGRATIVE HEALTHCARE UTILIZES A COMPREHENSIVE INTERDISCIPLINARY APPROACH TO PREVENTING AND TREATING ILLNESS, AND PROMOTING HEALTH THAT BRINGS TOGETHER COMPLEMENTARY, ALTERNATIVE, AND CONVENTIONAL THERAPIES SOME COMPLEMENTARY APPROACHES ARE SUPPORTED BY CLINICAL RESEARCH WHILE OTHERS ARE NOT THE USE OF COMPLEMENTARY STRATEGIES IS INFLUENCED BY AGE, RACE, ETHNICITY, AND GEOGRAPHY ALTHOUGH MANY COMPLEMENTARY MODALITIES CAN BE A SOURCE OF COMFORT AND EMOTIONAL SUPPORT FOR CLIENTS, ASSESS OF COMPLEMENTARY THERAPY USE IS IMPORTANT FOR CLIENT SAFETY

Chemotherapy

TREATMENT THAT INVOLVES THE USE OF ANTINEOPLASTIC DRUGS IN AN ATTEMPT TO DESTROY CANCER CELLS BY INTERFERING WITH CELLULAR FUNCTIONS, INCLUDING REPLICATION AND DNA REPAIR • PRIMARILY USED TO TREAT SYSTEMIC DISEASE AND GOAL MAY BE: • CURE • CONTROL • PALLIATION • MAY BE COMBINED WITH SURGERY, RADIATION THERAPY, OR BOTH TO REDUCE TUMOR SIZE PREOPERATIVELY, TO DESTROY ANY REMAINING TUMOR CELLS POSTOPERATIVELY , OR TO TREAT SOME FORMS OF TEN LEUKEMIA OR LYMPHOMA • CLIENTS RECEIVING CHEMOTHERAPY IN CONJUNCTION WITH OTHER CANCER THERAPIES ARE AT INCREASED RISK FOR EXPERIENCING SIDE EFFECTS • THE GOAL OF NURSING INTERVENTIONS IS TO PREVENT OR MINIMIZE SIDE EFFECTS

Review diagnostic tests in table 12-4, p. 311

Test Description Examples of Diagnostic Uses Tumor marker identification Analysis of biochemical mediators found in tumor tissue, blood, or other body fluids that are indicative of cancer cells or specific characteristics of cancer cells. These biochemical mediators may also be found in some normal body tissues. Breast, colon, lung, ovarian, testicular, prostate cancers Genetic tumor markers (also called prognostic indicators) Analysis for the presence of mutations (alterations) in genes found in tumors or body tissues. Assists in diagnosis, selection of treatment, prediction of response to therapy, and risk of progression or recurrence. Breast, lung, kidney, ovarian, brain cancers; leukemia; and lymphoma. Many uses of genetic profiling are considered investigational. Mammography Use of x-ray images of the breast. Breast cancer Magnetic resonance imaging (MRI) Use of magnetic fields and radiofrequency signals to create sectioned images of various body structures. Neurologic, pelvic, abdominal, thoracic, breast cancers Computed tomography (CT) scan Use of narrow-beam x-ray to scan successive layers of tissue for a cross-sectional view. Neurologic, pelvic, skeletal, abdominal, thoracic cancers Fluoroscopy Use of x-rays that identify contrasts in body tissue densities; may involve the use of contrast agents. Skeletal, lung, gastrointestinal cancers Ultrasonography (ultrasound) High-frequency sound waves echoing off body tissues are converted electronically into images; used to assess tissues deep within the body. Abdominal and pelvic cancers Endoscopy Direct visualization of a body cavity or passageway by insertion of an endoscope into a body cavity or opening; allows tissue biopsy, fluid aspiration, and excision of small tumors. Used for diagnostic and therapeutic purposes. Bronchial, gastrointestinal cancers Nuclear medicine imaging Uses IV injection or ingestion of radioisotopes followed by imaging of tissues that have concentrated the radioisotopes. Bone, liver, kidney, spleen, brain, and thyroid cancers Positron emission tomography (PET) Through the use of a tracer, provides black-and-white or color-coded images of the biologic activity of a particular area, rather than its structure. Used in detection of cancer or its response to treatment. Lung, colon, liver, pancreatic, head and neck cancers; Hodgkin and non-Hodgkin lymphoma and melanoma PET fusion Use of a PET scanner and a CT scanner in one machine to provide an image combining anatomic detail, spatial resolution, and functional metabolic abnormalities. See PET Radioimmunoconjugates Monoclonal antibodies are labeled with a radioisotope and injected IV into the patient; the antibodies that aggregate at the tumor site are visualized with scanners. Colorectal, breast, ovarian, head and neck cancers; lymphoma and melanoma Vascular imaging Use of contrast agents that are injected into veins or arteries and monitored by fluoroscopy, CT, or MRI imaging in order to assess tumor vasculature. Used to assess tumor vascularity prior to surgical procedures. Liver and brain cancers

Goal of Hospice care

The goal of hospice care is to enable the patient to remain at home, surrounded by the people & objects that have been important to them throughout life. The patient & the family comprise the unit of care. Hospice care does not seek to hasten death or encourage the prolongation of life through artificial means.

Note

The result of underlying disease or various treatment modalities, patients with cancer may experience a variety of secondary problems such as reduced WBC counts, infection, bleeding, skin and nutritional problems, pain, fatigue, and psychological stress. - chart 12-6 provides nursing care plans for clients with cancer Some of the most frequently encountered disturbances of tissue integrity include stomatitis, skin and tissue reactions to radiation therapy, alopecia, and metastatic skin lesions. Septicemia, septic shock - life-threatening complications that must be prevented or detected, treated promptly Patients who are neutropenic and/or who have hematologic malignancies are at greatest risk Signs, symptoms include altered mental status, either subnormal or elevated temperature, cool and clammy skin, decreased urine output, hypotension, tachycardia, other dysrhythmias, electrolyte imbalances, tachypnea, abnormal arterial blood gas values

Note

Waste products - follow hospital guidelines

Characteristics of malignant cells

benign and malignant cells differ in many cellular growth characteristics including: method and rate of growth i • ability to metastasize (spread) • destruction of tissue • ability to cause death ** (review table 12-1, p. 303) • the degree of anaplasia (a pattern of growth in which cells lack normal characteristics and differ in shape and organization with respect to their cells of origin) is associated with increased malignant potential

Nursing Management of Surgical Clients

nursing management of surgical clients read pg. 315 • general perioperative care • other treatments in combination • radiation and chemotherapy - contribute to postoperative complications such as: infection, impaired wound healing, altered pulmonary or renal function, and development of venous thromboembolism • anxiety • procedure, findings, limitations, changes in body, prognosis monitor for complications • infection bleeding thrombophlebitis wound dehiscence • fluid and electrolyte imbalance • organ dysfunction metic effect.

Note: Diagnosis

patients w/ suspected cancer undergo extensive testing to: 1) determine presence & extent of cancer 2) identify possible dx of metastasis 3) evaluate the function of involved & uninvolved body systems and organs 4) obtain tissue and cells for anaylsis including evaluation of tumor stage and grade. Remember: Waiting period for patient/family Anxiety Expensive Support client and family throughout diagnostic testing and diagnosis

IMPAIRED SKIN INTEGRITY: ERYTHEMATOUS AREAS

• AVOID USE OF SOAPS, COSMETICS, PERFUMES, POWDERS, LOTIONS AND OINTMENTS, DEODORANTS USE ONLY LUKEWARM WATER TO BATHE AREA • AVOID RUBBING OR SCRATCHING AREA AVOID SHAVING AREA WITH STRAIGHT-EDGED RAZOR AVOID APPLYING HOT-WATER BOTTLES, HEATING PADS, ICE, ADHESIVE TAPE TO AREA • AVOID EXPOSING AREA TO SUNLIGHT OR COLD WEATHER • AVOID TIGHT CLOTHING IN AREA: USE COTTON CLOTHING • APPLY VITAMIN A AND D OINTMENT TO AREA

Chemo

• CREMOTHERAPY DRUGS ARE GIVEN ON A REGULAR BASIS AND ARE TIMED I TO MAXIMIZE CANCER CELL KILL AND MINIMIZE DAMAGE TO NORMAL CELLS THE SCHEDULE MAY VARY TO ACCOMMODATE THE CLIENT'S RESPONSE TO THERAPY, BUT CHEMOTHERAPY IS USUALLY SCHEDULED EVERY 3 TO 4 WEEKS FOR A SPECIFIED NUMBER OF TIMES (ON AVERAGE, 4 TO 12 TIMES) • NEWER PROTOCOLS OF GIVING HIGHER DOSES MORE OFTEN ARE CALLED DOSE-DENSE CHEMOTHERAPY - THIS AGGRESSIVE APPROACH OFTEN RESULTS IN MORE INTENSE SIDE EFFECTS THAN TRADITIONAL DOSING SCHEDULES • CHEMOTHERAPY AGENTS POSE A MUCH HIGHER RISK OF HYPERSENSITIVITY REACTION THAN OTHER MEDICATIONS AND HAVE BEEN ASSOCIATED WITH LIFE-THREATENING OUTCOMES WHEN SIGNS AND SYMPTOMS OCCUR, THE MEDICATION SHOULD BE IMMEDIATELY DISCONTINUED AND EMERGENCY PROCEDURES INITIATED (PER HOSPITAL PROTOCOL)

IMPAIRED SKIN INTEGRITY: WET DESQUAMATION ( Pruned Skin)

• DO NOT DISRUPT ANY BLISTERS THAT HAVE FORMED • AVOID FREQUENT WASHING OF AREA • REPORT ANY BLISTERING • USE PRESCRIBED CREAMS OR OINTMENTS • IF AREA WEEPS, APPLY NONADHESIVE ABSORBENT DRESSING • IF AREA IS WITHOUT DRAINAGE, USE MOISTURE-, VAPOR- PERMEABLE DRESSINGS SUCH AS HYDROCOLLOIDS, HYDRO GELS ON NONINFECTED AREAS • CONSULT WITH ENTEROSTOMAL THERAPIST (ET), PHYSICIAN IF ESCHAR FORMS

NURSING CARE FOR CLIENTS RECEIVING EXTERNAL BEAM RADIATION THERAPY (EBRT):

• NURSE ASSESSES SKIN AREA REGULARLY THROUGHOUT COURSE OF TREATMENT AND FOR SEVERAL WEEKS POST COMPLETION OF • THERAPY • NUTRITIONAL STATUS AND GENERAL FEELINGS OF WELL-BEING ARE ASSESSED THROUGHOUT THE COURSE OF TREATMENT • IF SYSTEMIC SYMPTOMS SUCH AS FATIGUE OCCUR, THE NURSE EXPLAINS THAT THESE SYMPTOMS ARE A RESULT OF THE TREATMENT AND DO NOT REPRESENT DETERIORATION OR PROGRESSION OF THE DISEASE. • RECOMMEND AEROBIC EXERCISE AS THE EVIDENCED-BASED TREATMENT FOR THIS FATIGUE.

Sealed nursing care of hospital clients with sealed implants

• NURSING CARE OF HOSPITALIZED CLIENTS WITH SEALED IMPLANTS • ASSIGN THE CLIENT TO A PRIVATE ROOM • PLACE A "CAUTION: RADIOACTIVE MATERIAL" SIGN ON THE DOOR • KEEP THE DOOR TO THE ROOM CLOSED AS MUCH AS POSSIBLE • IF PORTABLE LEAD SHIELDS ARE USED, PLACE THEM BETWEEN THE CLIENT AND THE DOOR WEAR A DOSIMETER AT ALL TIMES WHILE CARE FOR CLIENT • WEAR A LEAD APRON WHILE PROVIDING CARE * • PREGNANT NURSES OR THOSE ATTEMPTING TO CONCEIVE SHOULD NOT CARE FOR THESE CLIENTS • DO NOT ALLOW PREGNANT WOMEN OR CHILDREN YOUNGER THAN 16 YEARS TO VISIT • LIMIT EACH VISITOR TO ONE-HALF HOUR/DAY AND WHILE VISITING, STAY AT LEAST 6 FEET FROM THE CLIENT Note PATIENTS RECEIVING INTERNAL RADIATION EMIT RADIATION WHILE THE IMPLANT IS IN PLACE; THEREFORE, CONTACT WITH THE HEALTHCARE TEAM IS GUIDED BY THE PRINCIPLES OF: TIME, DISTANCE, AND SHIELDING TO MINIMIZE EXPOSURE OF PERSONNEL TO RADIATION. WEAR DOSIMETER - RADIOLOGY SAFETY OFFICER AT FACILITY WILL DETERMINE EXACT PRECAUTION - DEPENDS ON WHETER LOW-DOSE OR HIGH-DOSE RADIATION WAS USED AND FOR THE LENGTH OF TIME - NEVER TOUCH THE RADIOACTIVE SOURCE WITH BARE HANDS - IF BECOMES • SAVE ALL DRESSINGS AND BED LINENS IN THE CLIENT'S ROOM UNTIL AFTER THE RADIOACTIVE SOURCE IS REMOVED - AFTER THE SOURCE IS REMOVED, DISPOSE OF DRESSINGS AND LINENS IN THE USUAL MANNER • IF INDWELLING CATHETERS ARE USED, THEY ARE INSERTED IN SURGERY AT TIME OF IMPLANTATION WITH RADIOACTIVE SOURCE FOLLOW HOSPITAL PROTOCOL REGARDING BEDREST, BATHROOM PRIVILEGES, LOW- RESIDUE DIETS, AND ANTIDIARRHEAL AGENTS Note Other equipment can be removed from the room at any time without special precautions and does not pose a hazard to other people If clients expire shortly after insertion of radioactive source, body must remain in room until implants can be safely removed

Nursing management in chemotherapy

• NURSING MANAGEMENT INCLUDES: ASSESSING FLUID AND ELECTROLYTE STATUS ASSESSING COGNITIVE STATUS MODIFYING RISKS FOR INFECTION AND BLEEDING • ADMINISTERING CHEMOTHERAPY • PREVENTING NAUSEA AND VOMITING MANAGING COGNITIVE CHANGES MANAGING FATIGUE • PROTECTING CAREGIVERS • MEASURES SHOULD BE TAKEN TO PREVENT EXPOSURE TO CHEMOTHERAPEUTIC AGENTS RECEIVED BY DIRECT CONTACT, INHALATION, OR INGESTION

Nursing care cont.

• RELIEVING PAIN • DECREASING FATIGUE • ASSISTING IN THE GRIEVING PROCESS • MONITORING AND MANAGING POTENTIAL COMPLICATIONS • INFECTION SEPTIC SHOCK • BLEEDING AND HEMORRHAGE Give meds around the clock for pain as prescribed

Chemotherapy Toxicity

• TOXICITY ASSOCIATED WITH CHEMOTHERAPY CAN BE ACUTE OR CHRONIC • EFFECTS MY INVOLVE VIRTUALLY ANY BODY SYSTEM • GASTROINTESTINAL SYSTEM - N & V MOST COMMON SIDE EFFECT OF CHEMOTHERAPY (MAY PERSIST FOR 24-48 HRS. WITH DELAYED N & V UP TO 1 WEEK AFTER ADMINISTRATION • HEMATOPOIETIC SYSTEM - MYELOSUPPRESSION (BONE MARROW DEPRESSION) • RENAL SYSTEM • CARDIOPULMONARY SYSTEM REPRODUCTIVE SYSTEM • NEUROLOGIC SYSTEM COGNITIVE IMPAIRMENT • FATIGUE

Tumor Staging and Grading

• complete diagnostic evaluation includes identifying the stage and grade of the tumor • staging • common language used to accurately communicate about cancer in and across clinical settings and in research • determines the size of the tumor, the existence of local invasion, lymph node involvement, and distant metastasis • the tumor, nodes, and metastasis (nm) system is one system used to describe many solid tumors (review chart 12-3, p. 312) • grading • classification of tumor cells according to differentiation • values range from i - iv

Surgery

• diagnostic surgery • biopsy - excisional - incisional - needle • surgery as primary treatment - removal of entire tumor or as much as is feasible (debulking), as well as any involved surrounding tissue, including regional lymph nodes • prophylactic surgery - removing non-vital tissues or organs that are at increased risk of developing cancer. • palliative surgery - when surgical cure is not possible - used to relieve symptoms, make the client as comfortable as possible, & promote quality of life. see table 12-6, p. 315 • reconstructive surgery - to improve function or obtain a more desirable cosmetic effects

Role of the Immune System

• normally the immune system can detect the development of abnormal cells and destroy them before cell growth becomes uncontrolled • if the immune system fails to identify and stop the growth of transformed cells ... tumor can develop and progress conditions/diseases that compromise the immune system: • age-related changes • immunodeficiency diseases • autoimmune diseases • immunosuppressive drug therapy

Diagnosis

• physical examination • imaging studies • laboratory tests • procedures • pathologic analysis

Prevention

• primary prevention - concerned with reducing risks of disease othrough health promotion and risk reduction strategies • immunizations ( hpv vaccine) refer to chart 12-2, p. 309 for guidelines on nutrition and physical activity for cancer prevention !!! • public, patient education • secondary prevention • screening and early detection • breast and testicular self-examination • pap test • mammograms • psa • screening colonoscopy • tertiary prevention • focuses on monitoring for and preventing recurrence of the primary cancer • screens for development of second malignancies in cancer survivors review table 12-3 pages 310-311 - the american cancer society screening guidelines for the early detection of cancer

Treatment Modalities

• surgery • radiation therapy • chemotherapy • hematopoietic stem cell transplantation • hyperthermia • targeted therapies • complementary, alternative, and integrative health therapies