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1 Nursing Care & Interventions in Managing Those with Cancer Keith Rischer RN, MA, CEN.

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Presentation on theme: "1 Nursing Care & Interventions in Managing Those with Cancer Keith Rischer RN, MA, CEN."— Presentation transcript:

1 1 Nursing Care & Interventions in Managing Those with Cancer Keith Rischer RN, MA, CEN

2 2 Todays Objectives… 1. Identify the goals of cancer therapy. 2. Distinguish between cancer surgery for cure and cancer surgery for palliative care. 3. Discuss the nursing care needs for clients undergoing therapy for cancer. 4. Discuss radiation therapy. 5. Identify nursing interventions for patients undergoing chemotherapy. 6. Discuss care of patients with neutropenia 7. Discuss care of patients with thrombocytopenia 8. Explain the rationale for hormonal manipulation therapy. 9. Explain the basis of targeted therapy for cancer.

3 Consequences of Cancer 3 Impaired immune and hematopoietic function Bone marrow Anemia and thrombocytopenia Altered gastrointestinal structure and function Tumors obstruct structures Tumors increase metabolic rate Tumors in liver reduce liver function Diet high in protein and carbohydrates supplement when 5% weight loss Monitor albumin

4 4 Consequences of Cancer Motor and sensory deficits Bone metastases Spinal cord compression Pain Decreased respiratory function Airway obstruction Tumor compression Pleural effusions

5 5 Surgery as Cancer Treatment Oldest form of cancer treatment used for: Prophylaxis Remove at risk tissue Diagnosis (biopsy) Cure Control (debulks) Palliation Determining efficacy of therapy (second look) Reconstruction Side effects of surgical therapy

6 6 Radiation Therapy Purpose Mechanism of action Ionizing radiation Cells die or unable to divide Exposure amount delivered Dose amount absorbed Killing effects of radiation Given in a series of divided doses Fractionation…180-280 rads qd typical Some organs can tolerate more radiation YouTube - Radiation Therapy to Treat Cancer YouTube - Radiation Therapy to Treat Cancer

7 7 Radiation Therapy Teletherapy (Beam) Distant-external treatment Brachytherapy Unsealed Body fluids potential hazard Isotopes given IV or instilled in body cavities Iodine ingestion for thyroid cancer Sealed Body fluids NOT hazard, but pt. may be Implanted in proximity to tumor

8 8 Nursing Care w/Sealed Implants Private room with private bath Caution: Radioactive Material note Nurse wears dosimeter film badge No pregnant women or children under 16 not to visit Limit visitors 30 min/day Stay 6 ft away Never touch radioactive source with hands Save all dressings and bed linens until radioactive source is removed.

9 9 Side Effects of Radiation Therapy Local skin changes Hair loss Altered taste sensations Fatigue Debilitating Can last for months Tissue fibrosis and scarring of healthy tissue

10 10 Nursing Care w/Radiation Therapy Education Skin care Dry skin in path of radiation Do not use lotions or ointments. Avoid direct exposure of the skin to the sun. Care for xerostomia (dry mouth). Bone exposed to radiation is more vulnerable to fracture. Reproductive effects Depends on site Harvest sperm or ova

11 11 Chemotherapy Mechanism Cytotoxic Some selectivity Damages cell DNA cell division Rapidly dividing cells more sensitive to chemo Skin, hair Intestinal tissues Spermatocytes Blood-forming cells

12 12 Chemotherapy Drug Categories Table 28-6 p.492 Antimetabolites Act as counterfeit metabolites so cells cant divide Cell cycle specific Antitumor antibodies Interrupt DNA and RNA Cell cycle nonspecific Alkylating agents Cross link DNA-prevents DNA/RNA synthesis Cell cycle nonspecific Antimitotic agents Interfere with mitosis-prevent division Cell cycle specific

13 13 5-Fluorouracil (5-FU) Anti-metabolite IV SE Decr. WBC & platelets Stomatitis Anorexia Darkening of skin…sun sensitivity Nursing responsibilities Use sunscreen when outside Menstrual changes…decreased sperm counts

14 14 Cytoxan (Cyclophosphamide) Alkylating agent po or IV SE N&V 2-4 hours after tx Pancytopenia 14 days after tx Alopecia 2-3 weeks after tx Loss of appetite Nursing Considerations Can cause hemorrhagic cystitis…incr. po and stop if hematuria Mesna (Mesnex) often given to protect po or IV

15 15 Vincristine (Oncovin) Anti-mitotic IV SE Constipation/abd. Cramping Stomatitis Alopecia 2-3 weeks after tx Nursing considerations Increase fiber

16 Chemotherapy Treatment Issues 16 Combination chemotherapy More effective-possible more toxic Drug dosage Dependant on type of cancer & client size Drug schedule – Usually every 3 to 4 weeks for 6-12x Drug administration IV route most common Use central lines or ports to avoid vessel irritation Extravasation YouTube - P9290001 Getting her port accessed YouTube - P9290001 Getting her port accessed

17 17 Side Effects of Chemotherapy Fatigue Alopecia or hair loss Nausea and vomiting Antiemetics Zofran Ativan Compazine Mucositis-open sores mouth (stomatitis) see Mouth care chart 28-6 p.496 Skin changes Bone marrow suppression Anemia Immunosuppression Thrombocytopenia

18 18 Neutropenia Highest risk Chemo/radiation Liver/kidney disease Tumors bone marrow, sm. Cell lung CA, lymphoma, breast cancer, elderly >70 yrs Treatment Filgrastim: granulocyte colony stimulating factor Red Flag T>100.4 and ANC <500 Medical management Cultures IV abx Nursing assessments/priorities

19 19 Neutropenic Precautions chart 28-7 p.497 Good handwashing!!! Private room – cleaned daily Do not use supplies from common areas – straws, etc. No water pitchers Limit # of health care providers, visitors VS q 4 hrs Watch for sepsis Inspect mouth, skin, mucous membranes q 8 hrs Inspect any open areas for sx infection No flowers and potted plants Fungi

20 20 Absolute Neutrophil Count (ANC) Normal Range > 2,500/mm3 1000-2500…safe to continue chemotherapy 1000-1500 minimal risk 500-1000 moderate risk <500 SEVERE risk WBC x(%neutrophils + % bands) Example: breast CA after chemo WBC 2000, neutrophils 14.8%, bands 5% 2000 x (0.148 +.05)= 2000 x 0.198= 396

21 21 Thrombocytopenia Reduction of platelets below normal range Normal = 150,000-400,000 mm3 Etiology: Bone marrow suppression Critical values 50,000 or less- risk of bleeding <20,000 spontaneous life threatening hemorrhages (brain bleed) Consider platelet transfusion if febrile or bleeding <10,000 transfusions recommended

22 22 Nursing Priorities w/Thrombocytopenia chart 28-9 p.497 Handle gently Avoid punctures Apply ice to trauma No rectal temps, lubricate suppositories Electric razor Mouth care – no flossing, avoid dental work, avoid hard foods, check denture fit Avoid contact sports Shoes with firm soles

23 23 Hormone Therapy Patho Types of CA Breast, prostate, endometrium Treatment Surgical (remove the hormone producing organ) Pharmocologic suppression Steroids or estrogen

24 24 Stem Cell/Bone Marrow Transplant Goal Give higher than usual dose of chemo to prepare way for engraftment of stem cell transfusion Bone marrow wiped out WBC>0.1 Bone marrow/stem cells harvested from pelvis/iliac crest of matched donor or self (autologous) Strained-administered as IV infusion NHL, multiple myeloma, some breast/testicular CA Takes 2-4 weeks before stem cells will take very high risk of infection

25 25 Oncology Case Study 70yr male PMH: metastatic GB CA-dx 2006 w/hepatic resection, radiation therapy completed, currently on weekly chemo Malignant pleural effusions CAD, HTN HPI: Progressive worsening of SOB since last thoracentesis 2 weeks ago. Sudden onset of severe SOB early am. Incr. weakness w/nausea. No c/o CP VS: T-98.2 P-123 (ST) R-22 BP 101/68 sats 90% RA Assessment: Resp: severely diminished right side Other systems WNL

26 26 Oncology Case Study Medical/Nursing Priorities… Nursing Assessments… Nursing Interventions…

27 27 Oncology Case Study: Oncology Floor 83 yr. female new admission PMH: rectal CA 1987 w/surgical resection/colostomy and radiation Chief c/o: Persistent low abd. crampy pain w/nausea CT: large poorly differentiated carcinoma in pelvis w/migration to lymph nodes Small bowel obstruction: ? tumor

28 28 Oncology Case Study: Priorities Medical… NG to LIS NPO IVF: NS @ 100cc/hr Nursing… Pain control Nausea control Volume status

29 29 Breast Cancer Article YouTube - Breast cancer real story

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