Oncology

Prostate Cancer Surgery: Postoperative Interventions

Maintain closed bladder irrigation (CBI) to keep the catheter free of obstruction and keep the urine pink (Refer to lesson 32 for information on CBI). Monitor urinary output and for hemorrhage and clots. Increase fluids to 2400 to 3000 mL a day unless contraindicated. Monitor for arterial bleeding, evidenced by bright-red urine with numerous clots; if it occurs, increase CBI and notify the surgeon immediately. Watch for venous bleeding, evidenced by burgundy-colored urine; if it occurs, inform the surgeon, who may apply traction to catheter. Expect red to light-pink urine for 24 hours; should turn amber-colored in 3 days. Monitor for transurethral resection syndrome or severe hyponatremia (water intoxication) caused by excessive absorption of bladder irrigation used during surgery (altered mental status, bradycardia, increased blood pressure, confusion). Help the client walk as early as possible and as soon as urine color begins to clear. Inform the client that feeling a continuous urge to void is normal. Instruct the client to avoid attempts to void around catheter because this will cause bladder spasms. Administer antibiotics, analgesics, stool softeners, and antispasmodics as prescribed.

Prostate Cancer: Post -op: Postirrigation Care

Monitor the client for continence and urine retention. Inform the client that some burning, urinary frequency, and dribbling may occur. The client should be voiding 150 to 200 mL of clear yellow urine every 3 to 4 hours 3 days after surgery. Inform the client that he may pass small clots and tissue debris for several days. Instruct the client to avoid heavy lifting, stressful exercise, driving, the Valsalva maneuver, and sexual intercourse for 2 to 6 weeks to prevent strain and to call the surgeon if bleeding occurs or the urine stream diminishes. Instruct the client to drink 2400 to 3000 mL of fluid daily, preferably before 8 p.m. As a means of preventing overstimulation of bladder, instruct the client to avoid alcohol, caffeinated beverages, and spicy foods. Tell the client that if urine becomes bloody he should rest and increase fluid intake and that if bleeding does not subside he should notify the surgeon.

Pancreatic Cancer: description

Most pancreatic tumors are highly malignant, rapidly growing adenocarcinomas. Pancreatic cancer is associated with advancing age, diabetes mellitus, alcohol use, history of pancreatitis, smoking, a high-fat diet, and exposure to environmental chemicals. Symptoms usually do not occur until tumor is large; prognosis is therefore poor. Assessment findings include nausea and vomiting, jaundice, unexplained weight loss, clay-colored stools, glucose intolerance, and abdominal pain.

Hodgkin's Lymphoma: Nursing Considerations

-In early stages without mediastinal node involvement, extensive external irradiation of involved lymph node regions may be performed. -With more extensive disease, radiation therapy is accompanied by multiagent chemotherapy.

Multiple Myeloma

-In this type of cancer, malignantly proliferating plasma cells invade the bone marrow, develop into tumors, and ultimately destroy bone; invasion of the lymph nodes, spleen, and liver also occurs.-The abnormal plasma cells produce an abnormal antibody (myeloma protein, a.k.a. Bence-Jones protein), which is found in the blood and urine. -Production of immunoglobulin and antibodies is decreased; the levels of uric acid and calcium increase, in some cases leading to renal failure.

Brain tumor: Kernig sign

-Loss of the ability of a supine client to completely straighten the leg when it is fully flexed at the knee and hip; indicates meningeal irritation.

General Considerations in the Care of the Client with Cancer Chemotherapy/Radiation

-Most clients experience nausea and vomiting; antiemetics will be prescribed. -Adverse effects of radiation are generally related to the area of the body being irradiated (e.g., irradiation of the throat will cause a sore throat; irradiation of the head may cause a headache). -Monitor the client for severe bone marrow suppression; during the period of greatest suppression (nadir), blood counts will be extremely low and the risk for infection and bleeding high. -Assess the oral mucous membranes for mucositis; administer frequent mouth rinses as prescribed to promote healing if it occurs. -Discuss the possibility of sterility with the client undergoing radiation therapy; inform the client of options with regard to reproduction. -Consult social services and chaplains as necessary.

Cervical cancer: Nursing Considerations

-Nonsurgical treatment includes chemotherapy, cryosurgery, external radiation therapy, internal (intracavitary) radiation implants, and laser excision. -Surgical treatments comprise conization, hysterectomy, and pelvic exenteration ( all organs in the pelvic taken out, bladder, ovaries, vag, anus, intestine).

cervical cancer: description

-Premalignant changes are described on a continuum ranging from dysplasia, the earliest premalignancy change, to carcinoma in situ, the most advanced premalignant change. -Preinvasive cancer is limited to the cervix. Invasive cancer involves the cervix and other pelvic structures (refer image). -Metastasis is usually confined to the pelvis, but distant metastasis occurs as a result of lymphatic spread in some cases. -Some risk factors include human papillomavirus (HPV) infection; cigarette smoking; and certain sexual behaviors, including early first intercourse (before age 17), multiple sex partners, and engaging in intercourse with male partners who have multiple sex partners. -Assessment findings include painless vaginal bleeding after menstruation or coitus; a foul-smelling or serosanguineous vaginal discharge; pelvic, lower back, leg, or groin pain; and certain cytological changes on the Papanicolaou test.

Nclex tips for oncology

-Priority concerns for the client with an oncological disorder include relieving pain, monitoring for life-threatening conditions such as infection and bleeding, and addressing end-of-life issues as appropriate. -Remember that pain is what the client says that it is; do not undermedicate the cancer client who is in pain. -Many treatments for cancer cause bone marrow destruction; neutropenic or bleeding precautions may need to be instituted to protect the client. -The client's personal, religious, and cultural beliefs and practices need to be considered in the plan of care when addressing end-of-life issues.

Multiple Myeloma: Nursing Considerations

-Provide supportive care to control symptoms and prevent complications, especially bone fractures, renal complications, and infections. -Encourage fluids, up to 2 to 3 L/day. -Encourage walking; provide skeletal support while the client is moving, turning, and ambulating to prevent pathological fractures and help ensure a hazard-free environment. -Administer IV fluids and diuretics to increase the renal excretion of calcium, blood transfusions for anemia, analgesics to control pain, and antibiotics for infection. -Prepare the client for local radiation therapy, chemotherapy, or other treatment procedures, such as stem cell transplantation, if prescribed.

Hodgkin's Lymphoma

-This malignancy of the lymph nodes originates in a single node or chain of nodes. -Possible causes include viral infection and previous exposure to chemical agents. -The disease, which usually involves lymph nodes, tonsils, spleen, and bone marrow, is characterized by the presence of Reed-Sternberg cells in nodes. -Biopsy of affected lymph nodes reveals the presence of Reed-Sternberg cells; the cervical nodes are most often affected first.-Assessment findings include fever, night sweats, and enlarged lymph nodes, spleen, and liver.

Prostate Cancer: surgery TURP

A, Transurethral Resection of Prostate (TURP) Bleeding is common; monitor the client for hemorrhage. Closed bladder irrigation (CBI) may be prescribed to flush the bladder and prevent clot formation; the urine produced by this procedure should be pink. Bladder spasms are common, and antispasmodics may be prescribed. Bleeding is common; monitor the client for hemorrhage. Dribbling or incontinence may occur after the surgery. Erectile dysfunction is also possible after this surgery.

Intestinal tumors: abnormal stools in colon cancer

Ascending colon: diarrhea Descending colon: constipation or some diarrhea or a flat, ribbonlike stool resulting from partial obstruction Rectal tumor: alternating constipation and diarrhea

Prostate Cancer: Surgery Suprapubic Prostatectomy

B, Suprapubic Prostatectomy(cut in front and open the bladders) The client will have an abdominal dressing that may drain copious amounts of urine; the dressing will need to be changed frequently. Hemorrhage is possible; monitor the client for blood loss. Bladder spasms are common, and antispasmodics may be prescribed. CBI will be prescribed. If prescribed, clamp the suprapubic catheter after the Foley catheter is removed and instruct the client to attempt to void; after the client has voided, assess residual urine in the bladder by unclamping the suprapubic catheter and measuring output. The healing process for this procedure is longer than that with TURP. Erectile dysfunction is a result of this procedure.

Interventions for Colostomy/Ileostomy

Before Surgery Consult with an enterostomal therapist to identify optimal placement of the ostomy. Instruct the client in the prescribed diet (usually a low-fiber diet for a day or two before surgery). Intestinal antiseptics and antibiotics may be prescribed to reduce the bacterial content of the colon and consequently the risk of infection during surgery. Bowel preparation (laxatives and enemas) may be prescribed. After Surgery Monitor the stoma for size, color, unusual bleeding, and necrotic tissue. Note that a normal stoma is red or pink, indicating high vascularity. Note that a pale-pink stoma indicates a low hemoglobin and hematocrit and a purple-black stoma indicates ischemia, requiring surgeon notification; a dry, firm, or flaccid stoma also indicates ischemia. Stool will be liquid after surgery but will become more solid, depending on the area of the colostomy. With an ascending colon colostomy, expect liquid stool. With a transverse colon colostomy, expect loose to semiformed stool. Instruct the client to avoid foods that cause excessive gas formation and odor. Teach the client to perform stoma care and irrigations as prescribed.

Laryngeal Cancer: Pre and post op

Before Surgery Establish methods of communication for the client. Encourage the client to express his or her feelings about the coming changes in body image and loss of the voice. Describe a rehabilitation program and provide information about tracheostomy care. Postoperative Airway maintenance is the priority. Place the client in the high Fowler position. The client may be receiving mechanical ventilatory support or have a tracheostomy collar with humidification. Monitor surgical drains in the neck, if these are present. Be alert for signs of hemorrhage and edema in the neck. Provide client instructions regarding stoma and laryngectomy care. Provide consultation with a speech and language pathologist as prescribed.

Lung cancer pre and post op interventions

Before Surgery Explain the potential need for a chest tube after surgery. Note that the closed chest drainage is not usually used for a pneumonectomy and that the serum that accumulates in the empty thoracic cavity eventually consolidates, preventing shifts of the mediastinum, heart, and remaining lung. After Surgery Airway is the priority; assess the client's cardiac and respiratory status and listen for the absence/presence of lung sounds. Maintain the chest tube drainage system, which will drain air and blood that accumulate in the pleural space. Administer oxygen. Check the surgeon prescriptions regarding client positioning; complete lateral turning is avoided. Provide activity as tolerated; encourage active range-of-motion exercises of the shoulder affected by surgery as prescribed.

Interventions: Surgical Resection

Before Surgery Help the surgeon and enterostomal nurse select the appropriate site for creation of a stoma as needed. Encourage the client to talk about his or her feelings in regard to the creation of stoma, if one is needed. After Surgery Assess the stoma, which should be red and moist, every hour for the first 24 hours. Watch for edema, which may be present during immediate postoperative period, in the stoma. If the stoma appears dark or dusky, notify the surgeon immediately; this indicates necrosis. Watch for prolapse or retraction of the stoma. Monitor urine flow; notify the surgeon if urine output is less than 30 mL/hr or if there is no urine output for more than 15 minutes. Ureteral stents or catheters may be left in place for 2 to 3 weeks or until healing occurs; maintain stability of the catheter to prevent dislodgment. After creation of a continent diversion or neobladder, monitor urine output closely and irrigate the catheter gently as prescribed to prevent obstruction. Monitor the urine for hematuria. Monitor the urinary drainage pouch for leaks and check skin integrity. Instruct the client to self-irrigate and catheterize the stoma at 4- to 6-hour intervals as prescribed. Encourage the client to express his or her feelings about changes in body image, embarrassment, and sexual dysfunction.

Bladder Cancer: Description

Bladder Cancer Description Papillomatous growths in the bladder urothelium undergo malignant changes and may infiltrate the bladder wall. Predisposing factors include cigarette smoking, exposure to industrial chemicals, and exposure to radiation. As the tumor progresses, it may extend into the rectum, vagina, other pelvic soft tissues, and retroperitoneal structures. Liver, bone, and lung are common sites of metastasis. Assessment findings include gross painless hematuria, urinary frequency or urgency, and dysuria. Bladder biopsy is used to confirm the diagnosis.

Bladder Cancer: Nursing Considerations

Bladder Cancer Nursing Considerations Radiation therapy is more acceptable for advanced disease that cannot be eradicated with surgery; it may also be used to relieve pain and bowel obstruction and control potential hemorrhage and leg edema caused by venous or lymphatic obstruction. Intracavitary radiation, which protects tissue adjacent to the targeted area, may be prescribed. Because external radiation alone may be ineffective, a combination of external radiation and chemotherapy or surgical resection (possibly including urinary diversion) may be prescribed. Intravesical instillation of chemotherapy may be prescribed; disinfect the toilet with household bleach after the client has voided for 6 hours after instillation. Systemic chemotherapy is used to treat inoperable and late-stage tumors. Perform the appropriate preoperative and postoperative interventions.

Prostate Cancer: surgery Retropubic Prostatectomy

C, Retropubic Prostatectomy(cut in front but doesn't open the bladders) Less bleeding occurs with this procedure than with suprapubic prostatectomy, and the client experiences fewer bladder spasms. Abdominal drainage is minimal. CBI may be prescribed. Erectile dysfunction is a consequence of this procedure.

Bleeding Precaution

Clients with platelet counts of less than 20,000/mm3 may require platelet transfusions. Initiate bleeding precautions. Examine the client for signs and symptoms of bleeding; examine all body fluids and excrement for blood.

A nurse is monitoring a client who has returned from colostomy surgery with an ostomy pouch system in place. On checking the stoma, the nurse notes that it is purple and firm. Which initial action by the nurse is appropriate? 1.Documenting the findings 2.Contacting the health care provider 3.Placing warm packs over the stoma 4.Changing the ostomy pouch system

Correct: 2 RATIONALE: A healthy stoma should be reddish pink and moist and will protrude about ¾ inch from the abdominal wall. A small amount of bleeding at the site of the stoma is normal. If the nurse checks the stoma and notes that it shows signs of ischemia (a dark-red, purplish, or black stoma or a stoma that is dry, firm, or flaccid), the health care provider must be notified immediately. Although the nurse would document the findings, this is not the initial appropriate action. Placing warm packs over the stoma or changing the ostomy pouch system are incorrect actions that are not helpful and delay necessary intervention. TEST-TAKING STRATEGY: Focus on the data in the question. Noting the words "purple and firm" in the question and recalling that this finding indicates ischemia will direct you to the correct option. Review: postoperative assessment findings that require health care provider notification after the creation of a colostomy.

A community health nurse is preparing a poster for an educational session for a group of women with whom she will be discussing the risk factors for breast cancer. Which factors increase the risk for breast cancer and should be listed on the poster? Select all that apply. 1.Multiparity 2.Early menarche 3.Early menopause 4.Family history of breast cancer 5.Exposure of the chest to high-dose radiation 6.Previous cancer of the breast, uterus, or ovaries

Correct: 2,4,5,6 Risk factors for breast cancer include family history; age; early or late menarche; late menopause; previous cancer of the breast, uterus, or ovaries; nulliparity or late first birth; exposure of the chest to high-dose radiation.

A nurse is gathering subjective data from a client with suspected bladder cancer. Which early manifestation of bladder cancer the nurse would expect the client to report? 1.Flank pain 2.Groin discomfort 3.Lower back pain 4.Painless hematuria

Correct: 4. RATIONALE: Painless hematuria is the first sign of a bladder tumor in most clients. It may be gross or microscopic and is usually intermittent. Dysuria and urinary frequency or urgency are the usual symptoms when infection or obstruction is present. Flank pain indicates renal involvement. Lower back pain and groin discomfort may occur later in the course of the disease. TEST-TAKING STRATEGY: Note the strategic word "early." Eliminate the comparable or alike options that involve discomfort or pain. Review: signs/symptoms of bladder cancer.

Prostate Cancer: surgery Perineal Prostatectomy

D, Perineal Prostatectomy ( cut between Scrotum and rectum) Bleeding is minimal. The client must be monitored closely for infection; this type of prostatectomy increases the risk. Urinary incontinence is common. The procedure causes sterility. Teach the client how to perform perineal exercises. Avoid inserting rectal tubes, taking the temperature rectally, or administering enemas.

Ovarian Cancer

Description -Malignancies of the ovaries grow and metastasize rapidly; often both ovaries are affected. -The prognosis is usually poor because the tumor is generally detected late. -Exploratory laparotomy is performed to diagnose and stage the tumor. -Some risk factors include age greater than 40 years; family history of ovarian, breast, and some types of colon cancer; diabetes mellitus; nulliparity; age greater than 30 years at first pregnancy; history of breast or colorectal cancer; infertility; early menarche; late menopause; endometriosis; obesity; a high-fat diet; and certain genetic mutations. -Assessment findings include abdominal discomfort or swelling, gastrointestinal disturbances, dysfunctional vaginal bleeding, an abdominal mass, and an increase in the tumors biochemical marker.

Testical cancer:

Description -This malignancy arises from germinal epithelium from the sperm-producing germ cells or from nongerminal epithelium from other structures in the testicles. -Testicular cancer may metastasize to lung, liver, bone, and the adrenal glands. -Early detection is made through routine testicular self-examination. -The client may experience painless testicular swelling or a dragging sensation in the scrotum. -Late signs, indicating metastasis, include testicular pain, back or bone pain, fluid in the scrotum, and respiratory symptoms; palpable lymphadenopathy, abdominal masses, and gynecomastia may also denote metastasis.

Endometrial Cancer

Description -This slow-growing uterine tumor is associated with the menopausal years. -Metastases travel through the lymphatic system to the ovaries and pelvis; by way of blood to lungs, liver, and bone; or intraabdominally to the peritoneal cavity. -Risk factors include the use of estrogen-replacement therapy, nulliparity, polycystic ovary disease, increased age, late menopause, family history, obesity, hypertension, and diabetes mellitus. -Assessment findings include postmenopausal bleeding; a watery serosanguineous vaginal discharge; low-back, pelvic, or abdominal pain; and, in advanced stages, an enlarged uterus.

Breast cancer

Description Breast cancer is classified as invasive when it penetrates tissue surrounding the mammary duct and grows in an irregular pattern. Metastasis, which occurs by way of the lymph nodes, most commonly involves the bone, lung, brain, and liver. Diagnosis is made by means of breast biopsy through needle aspiration or surgical removal of the tumor with microscopic examination for malignant cells. Risk factors include family history; advancing age; early menarche; late menopause; previous cancer of breast, uterus, or ovaries; nulliparity, late first birth; and exposure of the chest to high-dose radiation. A variety of findings may indicate the presence of breast cancer. All clients should be encouraged to perform regular breast self-examination (BSE).

Esophageal Cancer: description

Description Esophageal tumors grow rapidly; early spread to lymph nodes occurs because the esophageal mucosa is amply supplied with lymph tissue. Primary risk factors include cigarette smoking and heavy alcohol use; obesity, malnutrition, and long-term and untreated gastroesophageal reflux disease are also risk factors. Assessment findings include dysphagia (difficulty swallowing), dynophagia (painful swallowing), hoarseness, regurgitation and vomiting, weight loss, changes in bowel habits, halitosis (foul breath odor), and chest or abdominal discomfort.

Intestinal Tumors: Description

Description Malignant lesions develop in the cells lining the bowel wall or develop as polyps in the colon or rectum. Metastasis occurs by way of the circulatory or lymphatic system or by way of direct extension to other areas in the colon or other organs. Assessment findings include anorexia and weight loss, vomiting, blood in the stool and other abnormalities of the stools, guarding or abdominal distention, abdominal mass (a late sign), and cachexia (another late sign).

Lung Cancer: description

Description Malignant tumors of the lungs may be primary or metastatic. Diagnosis is made with the use of chest radiography, which will show a lesion or mass, and bronchoscopy and sputum studies, which will demonstrate cytologic findings indicative of cancer cells. Causes include cigarette smoking (including exposure to passive smoke) and exposure to environmental or occupational pollutants. There are two main types of lung cancer, small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC); epidermal (squamous cell), adenocarcinoma, and large cell anaplastic carcinoma are classified as NSCLC because of their similar responses to treatment. Assessment findings include cough, dyspnea, hoarseness, hemoptysis, chest pain, and anorexia and weight loss.

Gastric Cancer: Description

Description Risk factors for stomach cancer include Helicobacter pylori infection; a diet of smoked, highly salted, processed, or spiced foods; smoking; alcohol and nitrate ingestion; and a history of gastric ulcers. Assessment findings include anorexia and weight loss, nausea and vomiting, indigestion and epigastric discomfort, a sensation of pressure in the stomach, dysphagia, and a palpable mass. Complications include hemorrhage, obstruction, metastasis, and dumping syndrome. The goal of treatment is to remove the tumor and provide a nutritional program that will keep the client healthy.

Breast cancer s/s

Detection of mass during breast self-examination or clinical breast exam, usually in the upper outer quadrant or beneath the nipple; usually painless, except in very late stages, and fixed, irregular, and nonencapsulated Nipple retraction or elevation Asymmetry (affected breast sits higher) Bloody or clear nipple discharge Skin dimpling, retraction, or ulceration Skin edema or peau d'orange ("orange skin") appearance (refer image) Axillary lymphadenopathy Presence of lesion on mammography

Brain tumor positioning after surgery: Large tumor

If a large tumor has been removed, the client is not placed on the affected side, because the brain may suddenly shift into the newly created cavity.

Pediatric Considerations

Instruct the parents of a child with cancer to tell the child's teacher that they should be notified immediately if another child at school contracts an infectious disease. Ensure a safe environment for the child who is at risk for bleeding (e.g., padding corners of furniture, using a soft toothbrush). Help the child select a well-balanced diet. Listen to the child and family and encourage them to verbalize feelings and express concerns. As appropriate, introduce the family to other families of children with cancer.

Brain tumor: Brudzinski sign

Involuntary flexion of the hip and knee when the neck is passively flexed; indicates meningeal irritation.

Laryngeal Cancer Description

Laryngeal Cancer Description Tumors of the larynx often metastasize to the lung. Causes include cigarette smoking, alcohol use, exposure to environmental pollutants, and radiation exposure. Diagnosis is made with the use of laryngoscopy and biopsy (i.e., cytologic findings indicative of cancer). The client with laryngeal cancer may experience persistent hoarseness, change in voice quality, sore throat, a painless mass in the neck, the feeling of a lump or burning sensation in the throat, dysphagia, dyspnea, hemoptysis, or halitosis (foul breath odor).

Lung cancer: nursing consderations

Lung Cancer Enlarge Image Nursing Considerations Airway is the priority. Place the client in the Fowler position for ease of breathing. Administer oxygen and humidification to moisten and loosen secretions. Provide respiratory treatments. Monitor the client's breathing pattern, breath sounds, and pulse oximetry readings; watch for signs of respiratory impairment. Assess the client for tracheal deviation. Administer bronchodilators and corticosteroids to ease bronchospasm, inflammation, and edema. Treatment of lung cancer may include radiation, chemotherapy, immunotherapy, laser therapy (to relieve endobronchial obstruction), thoracentesis and pleurodesis (to remove pleural fluid and relieve hypoxia), pulmonary resection (refer image), or a combination thereof. Perform the appropriate preoperative and postoperative interventions.

Brain tumor NEVER positioning after surgery

Never place a client who has undergone brain surgery in the Trendelenburg position, which increases ICP and hence the risk of hemorrhage.

Testical cancer: Nursing Considerations

Nursing Considerations -Prepare the client for radiation therapy or chemotherapy; unilateral orchiectomy may be performed for diagnosis and primary surgical management, or radical retroperitoneal lymph-node dissection may be performed to stage the disease and reduce tumor volume so that chemotherapy and radiation therapy are more effective. -Discuss reproduction, sexuality, and fertility information and options with the client. Identify reproductive options (e.g., sperm storage, donor insemination, adoption). -After surgery, instruct the client to perform monthly self-examination of the remaining testicle.

Esophageal Cancer: Nursing Considerations

Nursing Considerations Assess the client's ability to swallow and determine whether he or she is receiving adequate nutrition. Radiation therapy, chemotherapy, photodynamic therapy, esophageal dilation, or surgical resection of the tumor or a combination thereof may be used to treat the cancer. In the postoperative period, the plan of care is based on the type of surgery performed; airway management is a priority concern in the immediate postoperative period, although nutritional management is also an early concern.

Breast cancer: Nursing Considerations.

Nursing Considerations Breast cancer may be treated with chemotherapy, radiation therapy (refer image), hormonal manipulation (in postmenopausal women with estrogen receptor-positive tumors), surgery (with breast reconstruction, in some cases), or a combination of these modalities. After surgery, assist the client into the semi-Fowler position; turn the client from the back to the unaffected side, with the affected arm elevated above the level of the heart to promote drainage and prevent lymphedema. If a drain (usually Jackson-Pratt) is in place, maintain suction and record the amount of drainage and drainage characteristics. Assess the surgical site for infection, swelling, and fluid collection under skin flaps. Monitor the incision site for restriction of dressing, impaired sensation, and skin color changes. If reconstruction has been performed, the client may return from surgery with a surgical brassiere and temporary prosthesis in place. No IVs, injections, blood pressure measurements, venipuncture, or any other intervention that could traumatize the affected arm should be performed on the side of the mastectomy. Consult with the health care provider and physical therapist regarding an appropriate exercise program and when such a program may be initiated safely. Provide postoperative instructions to the client.

Endometrial Cancer: Nursing considerations

Nursing Considerations External or internal radiation is used alone or in combination with surgery, depending on the stage of disease. Chemotherapy is used to treat advanced or recurrent disease. Progestational therapy may be prescribed for estrogen-dependent tumors; tamoxifen, an antiestrogen, may also be prescribed. Total abdominal hysterectomy and bilateral salpingo-oophorectomy may be performed.

Ovarian Cancer: nursing considerations

Nursing Considerations External radiation is used if the tumor has invaded other organs. Chemotherapy is used after surgery for all stages of ovarian cancer; in some cases intraperitoneal chemotherapy, which involves instillation of chemotherapy into the abdominal cavity, is delivered. Immunotherapy alters the immunological response of the ovary and promotes resistance to the tumor. Total abdominal hysterectomy and bilateral salpingo-oophorectomy may be performed.

Intestinal tumors: Nursing Considerations

Nursing Considerations Monitor the client for signs of tumor complications. Prepare the client for preoperative radiation to facilitate surgical resection and postoperative radiation to reduce the risk of recurrence or pain, hemorrhage, bowel obstruction, or metastasis. Chemotherapy is used after surgery to help control symptoms and the spread of disease. Bowel resection and creation of a colostomy or ileostomy may be performed.

Gastric Cancer Nursing Considerations

Nursing Considerations Monitor the client's weight. Assess the client's nutritional status; encourage small, bland, easily digested meals with vitamin and mineral supplements. Prepare the client for chemotherapy or radiation therapy. Prepare the client for surgical resection of the tumor. After surgery, place the client in the Fowler position (45-60 degree) for comfort. Monitor intake and output; administer IV fluids and electrolyte replacement. After surgery, keep the client from eating for 1 to 3 days as prescribed, until peristalsis returns; listen for bowel sounds. Monitor nasogastric (NG) suction; do not irrigate or remove the NG tube (assist surgeon with irrigation or removal). Advance the diet as prescribed from nothing by mouth to sips of clear water to six small, bland meals a day. Monitor the client for complications of hemorrhage, dumping syndrome, diarrhea, hypoglycemia, and vitamin B12 deficiency.

Laryngeal Cancer: Considerations

Nursing Considerations Place the client in the Fowler position to promote optimal air exchange. Monitor the client's respiratory status. Watch for signs of aspiration. Administer oxygen and provide respiratory treatments. Prepare to provide nutritional support. The choice of radiation therapy, chemotherapy, or surgical intervention depends on tumor size and the amount of tissue to be resected. Tracheostomy, performed with total laryngectomy, is permanent and is referred to as a laryngectomy stoma. Perform the appropriate pre- and postsurgical interventions. Teach the client how to care for the new stoma.

Pancreatic Cancer: Nursing Consideration

Nursing Considerations Radiation, chemotherapy, surgery (i.e., the Whipple procedure — pancreaticoduodenectomy with removal of the distal third of the stomach; pancreaticojejunostomy; gastrojejunostomy; or choledochojejunostomy) or some combination thereof is used to treat pancreatic cancer. Postoperative measures are similar to those for a client with pancreatitis as a client who has undergone gastric surgery.

prostate cancer: Nursing Consideration

Nursing Considerations Treatment may include hormone manipulation therapy to slow the tumor's growth; radiation (internal or external) to reduce the size of the lesion and limit metastasis; chemotherapy in cases involving hormone-resistant tumors; surgery; and combinations of these modalities. Perform the appropriate interventions, including irrigation, after surgery.

Complications of Intestinal Tumors: Perforation and Obstruction

Perforation Decreased blood pressure Rapid, weak pulse Distended and rigid abdomen Increased temperature Obstruction Vomiting (vomitus may contain fecal matter) Pain, constipation Abdominal distention Increased peristaltic activity, which produces an increase in bowel sounds (early sign) Hypoactive bowel sounds as the obstruction worsens

Prostate cancer: description

Prostate Cancer Description This slow-growing cancer of the prostate gland is usually an androgen-dependent type of adenocarcinoma. Risk increases with each decade after age 50. Prostate cancer may spread by way of direct invasion of surrounding tissues or through metastasis in the bloodstream and lymphatics to the bony pelvis and spine. Assessment findings include palpation of a hard pea-sized or larger nodule on rectal examination and hematuria; late symptoms include weight loss, urinary obstruction, and pain radiating from the lumbosacral area down the leg. Prostate specific antigen (PSA) is increased in various noncancer conditions and should not be used as a screening test without a digital rectal exam; PSA is routinely used to monitor the response to therapy. Diagnosis is made through biopsy of the prostate gland.

Fatigue and Nutrition

Provide small, frequent meals (high-calorie, high-protein, high-carbohydrate) that require little chewing. Assist the client in self-care and mobility activities and allow adequate rest periods during care. Do not perform activities on the client unless they are essential.

A nurse is preparing a list of instructions regarding stoma and laryngectomy care to a client who has undergone laryngectomy. Which instructions should be included in the list? Select all that apply. 1.Restrict fluid intake. 2. Obtain a medical alert bracelet. 3. Keep humidity in the home low. 4. Avoid wearing high-collared clothing. 5. Prevent debris from entering the stoma. 6. Avoid swimming and use care when showering.

RATIONALE: The nurse should teach the client how to care for the stoma, tailoring the instructions to the type of laryngectomy that has been performed. Most interventions focus on protection of the stoma and the prevention of infection. The client is instructed to avoid swimming and to use care when showering, to avoid exposure to people with infections, to prevent debris from entering the stoma, and to obtain a medical alert bracelet. Additional interventions include wearing a stoma guard or high-collared clothing to cover the stoma, increasing humidity in the home, and increasing fluid intake to 3000 mL/day to keep secretions thin. TEST-TAKING STRATEGY: Focus on the subject, laryngectomy care. Recalling that most interventions are focused on protection of the stoma and the prevention of infection will assist you in identifying the correct client instructions for home care. Review: home care instructions for a laryngectomy.

Laryngeal Cancer: the client how to care for the new stoma.

Take measures to protect the neck from injury. Clean the incision and perform stoma care. Wear a stoma guard to shield the stoma. Prevent debris from entering the stoma. Avoid swimming, use care when showering, and avoid using aerosol sprays. Wear loose-fitting, high-collared shirts and blouses to cover the stoma. Use a clean suctioning technique. Increase humidity in the home. Increase fluid intake to 3000 mL/day as prescribed. Avoid exposure to people with infections. Alternate rest periods with activity. Perform range-of-motion exercises for the arm, shoulders, and neck as prescribed. Obtain a medical alert bracelet.

Breast cancer: Postoperative care Instruction for pt

Tell the client to avoid overuse of the affected arm during the first few months after surgery. To prevent lymphedema, the client should keep the affected arm elevated. After the surgical wound has healed, and with health care provider prescription, provide incision care with an emollient to soften and prevent wound contracture. Encourage the use of Reach to Recovery (a program formed by the American Cancer Society that helps individuals cope with the breast cancer experience) volunteers. Instruct the client to perform self-examination of the remaining breast. Remind the client to protect the affected hand and arm. The affected arm should not be exposed to strong sunlight. Instruct the client not to let the affected arm hang dependent. The client should not carry a purse or any other heavy item over the affected arm. Any activity that could result in trauma, cuts, bruises, or burns of the affected arm should be avoided. The client should avoid wearing constrictive clothing or jewelry on the affected arm. The client should wear gloves when gardening and thick oven mitts while cooking. Advise the client to use a thimble when sewing. Hand cream should be applied several times a day. The client should use a cream cuticle remover instead of removing cuticles mechanically. Instruct the client to call the health care provider if signs of inflammation occur in the affected arm. A medical alert bracelet warning of lymphedema in the arm should be worn.

Bladder Cancer: Types of Surgical Resection

Transurethral Resection Local resection and fulguration (destruction of tissue by means of an electrical current sent through electrodes placed in direct contact with the tissue) Performed for very early tumors as a cure or for inoperable tumors as palliation Partial Cystectomy In this procedure, performed for early tumors and for clients who cannot tolerate radical cystectomy, as much as half of the bladder is removed. During the initial postoperative period, bladder capacity is markedly reduced, to about 60 mL; however, as bladder tissue expands, capacity increases to 200 to 400 mL. Maintenance of a continuous output of urine after surgery is critical in preventing bladder distention and stress on the suture line. A urethral catheter and suprapubic catheter is usually placed; the suprapubic catheter may be left in place for 2 weeks, until healing occurs. Cystectomy and Urinary Diversion In women, the procedure involves removal of the bladder and urethra; in men, the bladder, urethra, and (usually) the prostate and seminal vesicles are removed. When the bladder and urethra are removed, permanent urinary diversion is required.

Brain tumor positioning after surgery: infratentorial procedure

the client is usually positioned flat on one side or the other.

Brain tumor positioning after surgery: supratentorial procedure

the head is usually elevated above the level of the heart to facilitate drainage of cerebrospinal fluid and to decrease excessive blood flow to the brain to prevent hemorrhage.