Presentation on theme: "Cancer Lake Sumter Community College Irene Owens MSN, FNP Fall 2010."— Presentation transcript:
1 CancerLake Sumter Community CollegeIrene Owens MSN, FNPFall 2010
2 Cancer Statistics (NCI, 2003 a; WHO, 2003) Cancer rates will increase by 50% to 15 million new cases in 2020.The three leading cancer killers worldwide are lung, stomach, and liver cancers.Industrial nations with the highest overall cancer ratesDeveloping countries with the lowest cancer ratesOverall cancer incidence and mortalityStatistics for mortality and incidence of all cancers vary by race, socioeconomic disparities and unequal access to medical car.Cancer rates vary relative to select demographic variables.22
3 2005 Estimated US Cancer Cases* Men 710,040Women 662,87032% Breast12% Lung & bronchus11% Colon & rectum6% Uterine corpus4% Ovary4% Non-Hodgkin lymphoma4% Melanoma of skin3% Thyroid2% Pancreas2% Urinary bladder20% All Other SitesProstate 33%Lung & bronchus 13%Colon & rectum 11%Urinary bladder 6%Melanoma of skin 4%Non-Hodgkin lymphoma 4%Kidney 3%Oral Cavity 3%Leukemia 3%Pancreas 2%All Other Sites 18%Now we will turn our attention to the number of new cancers anticipated in the US this year. It is estimated that 1.37 million new cases of cancer will be diagnosed in Cancers of the prostate and breast will be the most frequently diagnosed cancers in men and women, respectively, followed by lung and colorectal cancers both in men and in women.*Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder.Source: American Cancer Society, 2005.
4 2005 Estimated US Cancer Deaths* Men 295,280Women 275,000Lung & bronchus 32%Prostate 10%Colon & rectum 10%Pancreas 5%Leukemia 5%Non-Hodgkin 4% lymphomaEsophagus 4%Liver & intrahepatic 3% bile ductUrinary bladder 3%Kidney 3%All other sites 21%25% Lung & bronchus15% Breast10% Colon & rectum6% Ovary6% Pancreas4% Leukemia3% Non-Hodgkin lymphoma3% Uterine corpus2% Multiple myeloma2% Brain/ONS24% All other sitesLung cancer is, by far, the most common fatal cancer in men (32%), followed by prostate (10%), and colon & rectum (10%). In women, lung (25%), breast (15%), and colon & rectum (10%) are the leading sites of cancer death.ONS=Other nervous system.Source: American Cancer Society, 2005.
5 Cancer Death Rates*, by Race and Ethnicity, 1996-2000 Overall, cancer death rates are higher in men than women in every racial and ethnic group. African-American men and women have the highest rates of cancer mortality. Asian and Pacific Islander women have the lowest cancer death rates, about half the rate for African-American women.*Per 100,000, age-adjusted to the 2000 US standard population.† Hispanic is not mutually exclusive from whites, African Americans, Asian/Pacific Islanders, and American Indians.Source: Surveillance, Epidemiology, and End Results Program, , Division of Cancer Control andPopulation Sciences, National Cancer Institute, 2003.
6 9,000 new cases of childhood cancer 1,500 deathsOne third die from leukemia5 year survival for childhood cancer is 75%10 year survival approaches 70%
7 Changing Cancer Statistics AgingElderly will double from 1.3 to 2.6 million fromDiversifying25% Hispanic25% African American, Asian American and Native Americans50% population ethnically and culturally diverse
8 Cancer Survival Increasing 9.3 million Americanshave a cancer historyRepresents 3.4 % US population14% diagnosed over 20 yearsago
10 Cancer Development Environmental Factors ----Chemical: Tobacco, alcohol, asbestos, pesticides, hair dyes, preservatives, etc.----Physical: radiation, chronic irritation, sunlight----Viral: HPV
11 Cancer DevelopmentPersonal factors: age, immune factor, genetic risks, host susceptibility, lifestyle, risky health practices, gender, socioeconomic factors, racePsychosocial Factors: Socioeconomic Factors: Barriers to access, poverty, no insurance, lack of education, lack of early detection
12 Normal Cells vs. Cancer Cells Normal vs Cancer CellsPage 402 in Iggy
13 Characteristics of Cancer Cells Lack of contact inhibitionInability to differentiateCancer cells derive from a single cellAbnormal cellular proliferationLocal tumor formationInvasion of surrounding tissueAbility to metastasize
14 Pathophysiology of Cancer Development Initiation: Normal cell exposed to any carcinogen( initiator), the normal cell’s DNA can be damaged or mutated. A carcinogen is any chemical, physical, or genetic agent that can irreversibly alter cellular DNA, causing abnormal cells to be produced.Promotion: substance that promote or enhance growth of initiated cancer cell such as hormones, drugs or chemicalsProgression- develops own blood supply
16 Promotion - OncogenesOncogenes are genes that encode proteins to promote cellular proliferationOncogenes are derived from normal proto-oncogeneA proto-oncogene is essential for growth, proliferation, differentiation, apoptosisResults in uncontrolled growth and replication of cellsMutations in proto-oncogene yields uncontrolled growth-stimulatory proteins (deregulation)
17 Progression Cancer cells divide uncontrollably Tumors form and invade surrounding structuresTumors form new blood vessels (angiogenesis)Cancer cells can form new colonies (metastasis)
18 Tumor-Suppressor Genes Normal braking signal to stop cellular divisionDefect in tumor suppressor geneMutation causes inactivation or deletion of tumor-suppressor geneChanges incell adhesion, signal transduction, nuclear transcription and cell cycle
19 Apoptosis – Programmed Cell Death Unscheduled apoptosis occurs in Parkinson’s, Alzheimer’s and autoimmune diseaseDefect in apoptosis occurs with cancer
20 Angiogenesis Important in normal growth and development wound healing and pregnancyCancer - critical for growth and spread of most cancers by forming new blood vesselsTarget of anti-angiogenic therapy is normal endothelial cell rather than unstable tumor cell
23 Comparison of Normal and Tumor Neovasculature Normal colorectal mucosaNearby colorectal cancerFrom Konerding et al. In Molls and Vaupel, eds. Blood Perfusion and Microenvironment of Human Tumors, 2002, with permission.
24 Metastasis Cells detach from original tumor Cells spread through blood, lymphatics, or seedingCells establish new colony in distant site
25 Routes of Tumor SpreadDirectMetastaticLymphatic
29 Prevention of Cancer Lifestyle Changes DO NOT SMOKE! STOP SMOKING!! Minimize sun exposureAvoid risky behaviors: ETOH abuse, multiple sex partners
30 Health Behaviors Dietary changes - 5 fruits/vegetables a day Exercise Know the 7 warning signsControl weightDecrease stressPractice self examStop or prevent smoking
31 Breast Cancer Screening and Early Detection Baseline mammogram by age 40Mammogram annually after 50Clinical Breast Exam every 3 yearsBreast self-exam every monthHigh risk women need increased surveillance
32 Breast Cancer 211,000 new cases Most frequently diagnosed cancer in womenSecond leading cause of cancer death40,480 expected deathsRisk factors – advancing age, family history of breast cancer, atypical hyperplasia, long menstrual history, obesity after menopause
33 Screening Guidelines for the Early Detection of Breast Cancer, American Cancer Society Yearly mammograms are recommended starting at age 40.A clinical breast exam should be part of a periodic health exam, about every three years for women in their 20s and 30s, and every year for women 40 and older.Women should know how their breasts normally feel and report any breast changes promptly to their health care providers. Breast self-exam is an option for women starting in their 20s.Women at increased risk (e.g., family history, genetic tendency, past breast cancer) should talk with their doctors about the benefits and limitations of starting mammography screening earlier, having additional tests (i.e., breast ultrasound and MRI), or having more frequent exams.The American Cancer Society states that women aged 40 and older should have an annual mammogram and clinical breast exam (CBE) as part of a periodic health exam. Women should know how their breasts normally feel and report any changes to their health care provider. A breast self-examination (BSE) is an option for women starting in their 20s.
34 Screening Guidelines for the Early Detection of Cervical Cancer, American Cancer Society Screening should begin approximately three years after a women begins having vaginal intercourse, but no later than 21 years of age.Screening should be done every year with regular Pap tests or every two years using liquid-based tests.At or after age 30, women who have had three normal test results in a row may get screened every 2-3 years. However, doctors may suggest a woman get screened more frequently if she has certain risk factors, such as HIV infection or a weakened immune system.Women 70 and older who have had three or more consecutive Pap tests in the last ten years may choose to stop cervical cancer screening.Screening after a total hysterectomy (with removal of the cervix) is not necessary unless the surgery was done as a treatment for cervical cancer.The American Cancer Society cervical cancer screening guidelines state that women should begin screening approximately three years after she begins having vaginal intercourse, but no later than 21 years of age. Screening should be done every year with regular Pap tests or every two years using liquid-based tests. At or after age 30, women who have had three normal tests in a row may get screened every 2-3 years. Women 70 and older who have had three or more consecutive normal Pap tests in the last 10 years may choose to stop cervical cancer screening.
35 Prostate Cancer Screening & Early Detection Digital rectal exam every year after age 50PSA every year after age 50Increased surveillance of high risk men particularly African Americans
36 Prostate Cancer 220,900 new cases and 28,900 deaths in 2003 Early prostate cancer has no symptomsRisk factors: age, AA, family historyTreatment: surgery, radiation, hormone therapy, watchful waiting
37 Screening Guidelines for the Early Detection of Prostate Cancer, American Cancer Society The prostate-specific antigen (PSA) test and the digital rectal examination (DRE) should be offered annually, beginning at age 50, to men who have a life expectancy of at least 10 years.Men at high risk (African-American men and men with a strong family history of one or more first-degree relatives diagnosed with prostate cancer at an early age) should begin testing at age 45.For men at average risk and high risk, information should be provided about what is known and what is uncertain about the benefits and limitations of early detection and treatment of prostate cancer so that they can make an informed decision about testing.The prostate-specific antigen (PSA) test and the digital rectal exam (DRE) should be offered annually, beginning at age 50, to men who have a life expectancy of at least 10 years.
38 The American Cancer Society’s Estimates In the United States during 2008:215,020 new cases of lung cancer will be diagnosed.161,840 deaths will occur as the result of this disease.Lung Cancer
39 Lung Cancer Persistent cough, blood-streaked sputum, chest pain Cigarette smoking most common cause
40 Colorectal Cancer 105,500 colon; 42,000 rectal; 57,100 deaths 3rd most common cancerNo symptoms in early stagesHereditary Non-polyposis colorectal cancer and NPC (non-polyposis) are hereditary)
41 Screening Guidelines for the Early Detection of Colorectal Cancer, American Cancer Society Beginning at age 50, men and women should follow one of the following examination schedules:A fecal occult blood test (FOBT) every yearA flexible sigmoidoscopy (FSIG) every five yearsAnnual fecal occult blood test and flexible sigmoidoscopy every five years*A double-contrast barium enema every five yearsA colonoscopy every ten years*Combined testing is preferred over either annual FOBT or FSIG every 5 years alone.The American Cancer Society recommends that beginning at age 50, men and women should receive a fecal occult blood test (FOBT) every year, or a flexible sigmoidoscopy (FSIG) every five years, or an annual FOBT and FSIG every five years (preferred to either method alone), or a double-contrast barium enema every five years, or a colonoscopy every ten years.People who are at moderate or high risk for colorectal cancer should talk with a doctor about a different testing schedule
42 Testicular CancerThe American Cancer Society estimates that about 8,090 new cases of testicular cancer will be diagnosed during 2008 in the United States. It is estimated that 380 men will die of testicular cancer in The rate of testicular cancer has been increasing in many countries, including the United States.
43 Testicular Exams The best time to examine is after a shower. Hold the penis out of the way and examine each testicle separately. Hold the testicle between your thumbs and fingers with both hands and roll it gently between the fingers. Look and feel for any hard lumps or nodules (smooth rounded masses) or any change in the size, shape, or consistency of the testes.
44 Diagnosis The ideal is to find early ( a few cells) ---Detectable at 1 cm ( 10 billion cells)
46 Diagnosis of Cancer Cytology Studies CXR CBC Sigmoidoscopy or colonoscoyLFT Radiologic studiesRadioisotpoe scansCTMRICEA, AFP, CA-27-29, BRCA-1 BRCA-2Bone MarrowBiopsy
47 Biopsy Definitive means of diagnosing Benign or malignant, the anatomic tissue, the degree of cellular differentiation of the cancer cells present.Differentiate needle vs incisional vs. excisional biopsy
50 TNM Classification System Table 23-7 Staging of CancerGrading of Cancer Table 23-6Staging vs. Grading
51 Staging of Cancer TNM System for major solid tumors size of Tumorpresence of Nodespresence of MetastasisDuke’s staging for colorectal cancerCancer is best treated in the early stages
52 Nursing Interventions during Assessment Phase Variability of Distress--- Depends onPsychological make-upFamily and Social support systemSpecific diseaseSelf Concept EffectsPhysical ChangesChanges in RolesChanges in Body FunctionLengthy diagnostic period
53 You’ve been diagnosed with Cancer… What do want to know? Is it curable?How long do I have to live?Will disabilities be temporary or permanent?What types of physical impairment will occur?What are side effects of treatment?When can I return to work?What will it cost? Other????
54 Assessment How is your client coping? Well…………….. Is he or she able to confront reality? Remain flexible? Accept support? Remain hopeful and optimistic?Poorly……………..Use avoidance, feel hopeless, pessimistic, inflexible??
55 Medical Interventions Goals of intervention----Treat patient effectivelyWith appropriate therapyFor sufficient durationCUREWith minimal functional & structural impairmentIf can’t curePrevent further metastasis, relieve symptoms, maintain highest quality of life as long as possibleChoice of treatment depends on… tumor type, extent of disease and clients’ physical status
56 Cancer Treatment & Goals SurgeryRadiation therapyChemotherapyTargeted TherapyCureControlPalliation
57 Clinical Implications PreventionScreening and early detectionDiagnosis and stagingTreatment selectionTargeted therapy
58 Surgical Interventions For diagnosisFor stagingFor treatmentFor curePalliative…. Debulking, reduce pain, relieve airway, urinary, GI, Respiratory obstructions and relieve pressure on brain and spinal cord
59 HER/2neu Oncogene Encodes transmembrane receptor, tyrosine kinase Over-expressed in 25-30% breast and ovarian cancersOver-expression is associated with rapid proliferation and metastasisAssociated with poorer survival
60 Cancer Surgery Oldest cancer treatment Used for Local control of diseaseSingle therapy: small tumorsAdjuvant therapy with XRT & chemotherapySupportive/palliative therapy
61 Principles of Surgery (Rosenberg, 2001) Surgery treatment of choice for malignant tumorsRemoves malignant tumor and a margin of adjacent normal tissueRemoves malignant tumor with attention to postprocedure quality of life issuesType and extent of surgical procedureSurgical procedures include strategies to decrease local and systemic spread (Cady, 2001).6161
62 Principles of Surgery (cont’d) Role of surgery (Frogge & Cunning, 2000; Rosenberg, 2001)Establish tissue diagnosis.Determine stage of disease.Treat disease (Jennings, 2001; Mintzer, 1999).Place therapeutic and supportive hardware.Assess response to treatment by “second-look” procedures.Reconstruct affected body parts.6262
63 Principles of Surgery (cont’d) Types and classifications of surgery (cont’d)CryosurgeryChemosurgeryLaserStereotactic surgery (Chang & Adler, 2001)Laparoscopic resection (Bickert & Frickel, 2002)Endoscopy (Carrion & Seigne, 2002)Radiofrequency ablation (Iannitti et al., 2002; Zagoria et al., 2002)Safety measures in delivery of surgeryAseptic technique reduce risk of infectionAnesthesiaElectrical hazardsInformed consent obtainedClient prepared for surgery6363
64 Assessment: Surgery (Frogge & Cunning, 2000; Marek & Boehnlein, 2003; Pfifer, 2001) Pertinent personal historyFactors that may increase complications of surgeryFactors that may influence discharge planningPhysical examinationCardiovascularPulmonaryRenalGIMobilityNutritionComfort level6464
65 Assessment: Surgery (cont’d) Psychosocial examinationExplore client’s and family’s concerns.Assess client’s and family’s current level of coping.Critical laboratory and diagnostic dataCardiovascular—ECGHematologic—complete blood count, prothrombin time, partial thromboplastin timeHepatic—liver function studiesRenal—urinalysis, blood urea nitrogen, creatinine, electrolytesPulmonary—chest x-ray examinationNutritional—serum albumin6565
66 Surgical ProceduresIncisional biopsy: obtain tissue for pathologic examination.Excisional biopsy: establish tissue diagnosis and tumor removal.Needle biopsy: obtain tissues for pathologic examination; determine stage.Fine-needle aspirationCore biopsySentinel node biopsy6666
67 Surgical Procedures (cont’d) Diagnostic laparotomy: determine stage and extent of diseaseLocal excisionPrimary treatmentCytoreductive surgeryRemoval of solitary metastasisPalliative treatment6767
68 Surgical Procedures (cont’d) Wide excision; laserPrimary treatmentCytoreductive surgeryPalliative treatmentStereotaxisObtain biopsy.Implantation of radioactive sources, hyperthermia, or chemotherapeutic agents6868
70 Interventions: Surgery (Boehnlein & Marek, 2003; Frogge & Cunning, 2000; Lefor, 1999) Maximize safety for client and family.Implement preoperative medical preparation regimen as ordered.Decrease incidence and severity of complications unique to surgery.Teach turning, coughing, and deep breathing (TCDB); schedule activities after surgery; use incentive spirometer; assist client to remove mucus or sputum.Turn and shift positions in bed every 2 hours; massage uninjured areas; mattress overlays for high-risk clients; change surgical dressing; protective film, hydrocolloid barriers, and/or collection devices around drains or tubes with drainage; early ambulation.7070
71 Interventions: Surgery (cont’d) (Boehnlein & Marek, 2003; Frogge & Cunning, 2000; Lefor, 1999) Decrease incidence and severity of complications unique to surgery (cont’d).Splint incision during TCDB or movement; non-pharmacologic methods for pain control; analgesic and antiemetic medicationsClient and family discuss feelings, fears, and concerns; client and family teaching; encourage coping strategies; referrals for physical and psychosocial support; adequate rest periods7171
72 Interventions: Surgery (cont’d) Monitor for unique complications of surgery.Assess respiratory effort, rate, and rhythm and subjective responses to breathing; inspect chest wall for symmetric movement, use of accessory muscles, diaphragmatic breathing, and sternal retraction; auscultate lungs.Assess incision site for redness, swelling, increased drainage, discomfort, and approximation of surgical margins; assess bony prominences for reddened areas.Assess for bowel sounds; assess for signs of dehydration; assess fluid loss and intake and output ratio, daily weights and progressive diet; monitor nutritional status.7272
73 Interventions: Surgery (cont’d) Enhance adaptation and rehabilitation.Implement postoperative teaching plan and include multidisciplinary team in discharge planning.Involve client and family in assessment, planning, and evaluation of care; instruct client and family about rehabilitation programs; refer client and family in support programs; refer to professional counselor as indicated.7373
74 Nursing Diagnoses: Surgery Acute PainImpaired Skin IntegrityDeficient Knowledge related to type of and rationale for surgical procedure, potential immediate and long-term complications of surgeryAnxietyIneffective Airway ClearanceImbalanced Nutrition: Less Than Body Requirements7474
75 Radiation Therapy Used for local control of disease Most often used in adjuvant settingUsed in palliation of pain, obstruction, & bleedingGoal is to destroy cancer cells with minimal exposure of the normal cells to the damaging radiation actions of radiation
76 Radiation TherapyHigh energy ionizing rays that destroy cell’s ability to reproduceDamages cell’s DNACells damaged by radiation either die outright or become unable to divide.Three different types of energy or rays Table 28-5 page 488
77 Radiation Therapy Teletherapy External beam or radiation Client is not radioactive & poses no exposure threat to caregiversFractionation divided total dose into small frequent doses to decrease damage to surrounding cellsPatient PreparationMarking's/tattoo’s for locationForms/molds to keep precise positioningTeaching
78 Brachytherapy Means short or close therapy The radiation source is in the client thus the patient emits radiation for a period of time and is hazard to others.
79 Brachytherapy Sealed Patient emits radiation while implant in place ( waste products not radioactive)temporary or permanentIntracavity: in cavity hours, ribbons catheters or needlesInterstitial: Beads, seeds implanted in tumor
80 Brachytherapy Unsealed Systemic IV or PO or instilled into cavity Enter body fluids/waste products are radioactiveIsolate 3-4 days, flush toilet several times for a few daysExample: iodine to treat thyroid cancers
81 Sealed Implants Caregiver Precautions 3 Principles of Distance, Time and ShieldingPrivate Room/private bathCaution sign on doorDosimeter film badgeNo pregnant women or child under 16Limit visitors to ½ hour per day ( 6 feet away)Lead container and long forcepsChart 24-1, 24-2
82 Teletherapy Adverse Effects Determined by:Size of fieldArea treatedTotal dose of radiationIn GeneralLocalized skin changes and alopeciaFatigueAnorexia, taste disturbancesSkin reaction 2 weeks into treatmentHighest risk for damage for damage are tissues that divide quickly such as bone marrow, mucosal lining of the GI and GU tract, hair follicles, ovaries and testes
83 General Nursing Interventions Assess for: patterns of fatigue, EXERCISE may reduce fatigue, asses for infections and bleedingMonitor CBC for anemia, neutropenia and thrombocytopeniaAssure adequate pain management if neededSkin care with mild soap and water, pat dry, no lotions See Chart 24-2Assure adequate nutrition..hi calorie, hi protein
84 Adverse Effects of Radiation System Specific ChestAbdominalPelvisBrain
85 Chemotherapy Classification of Chemotherapy Drugs Table3 24-2 Methods of Administration Table 24-3Nursing Management
86 Principles of Antineoplastic Therapy Cancer chemotherapy (Chu & DeVita, 2001)Cellular kineticsCell cycle (Vermeulen et al., 200Cell-cycle timeGrowth fraction of tumorTumor burden8686
87 Principles of Antineoplastic Therapy (cont’d) Approaches to chemotherapySingle-agent chemotherapyCombination chemotherapyRegional chemotherapyHigh-dose chemotherapyFactors influencing the response to antineoplastic agentsCharacteristics of the tumorCharacteristics of the clientAdministration schedule8787
88 Principles of Antineoplastic Therapy (cont’d) Roles of chemotherapyCureSingle-treatment modalityCombined-treatment modalityControlExtend length and quality of life when cure is not realisticPalliationImprove comfort when neither cure nor control is possibleRelief of tumor-related symptoms (Chu & DeVita, 2001)8888
89 Antineoplastic Therapy: Types and Classifications Phase of action during cell cycle: cell cycle–specific and cell cycle–nonspecific agentsMechanism of action, biochemical structure, and physiologic actionAlkylating agentsAntimetabolitesAntitumor antibioticsPlant alkaloidsHormonal agentsMiscellaneous agents8989
90 Routes of Administration OralSubcutaneousIntravenousIntrarterialIntrathecal/intraventricularIntraperitonealIntravesicularIntrapleural9090
91 Assessment: Neoplastic Therapy Pertinent personal and family historyType of cancer and phase of cancer trajectoryPrevious cancer therapy and time interval since last therapyDietary intakeAlternative and complementary therapy useKnowledge of rationale for and goals of treatment; agents to be given; potential side effects; and relative risks and benefits of treatment9191
92 Assessment: Neoplastic Therapy (cont’d) Physical examinationRenal—intake and output, color of urinary output, patterns of urinary eliminationGI systemHematologic systemNeurologic systemPulmonary systemPerformance status9292
93 Assessment: Neoplastic Therapy (cont’d) Psychosocial assessmentPrevious responses to stressors and effective coping mechanisms usedLevel of independence and responsibility, desire, and ability for self-careSupport systems and personnel available to client and family9393
94 Assessment: Neoplastic Therapy (cont’d) Laboratory and diagnostic dataComplete blood count with differentialCreatinine, BUN, and liver function testsElectrolyte levels (Brown et al., 2001; Goodman, 2000; Gullatte, 2001)Other pertinent data specific to chemotherapy agents9494
95 Potential Side Effects of Chemotherapy HematopoieticNeutropeniaThrombocytopenia: avoid ASA and ASA containing products, check for bruisingAnemiaGastrointestinalAnorexiaNausea and vomitingMucositisStomatitisDiarrhea and constipationPancreatitisHepatic toxicity9595
96 Potential Side Effects of Chemotherapy (cont’d) IntegumentaryDermatitisHyperpigmentationAlopeciaNail changesRadiation recallRash and urticariaGenitourinaryCystitis and hemorrhagic cystitisAcute renal failureChronic renal insufficiency9696
97 Potential Side Effects of Chemotherapy (cont’d) CardiovascularCardiac toxicityVenous fibrosisPhlebitisExtravasationNeurologicCentral neurotoxicityOtotoxicityMetabolic encephalopathyPeripheral neuropathy9797
98 Potential Side Effects of Chemotherapy (cont’d) PulmonaryFibrosisPneumonitisEdemaReproductiveInfertilityChanges in libidoErectile dysfunctionAmenorrhea9898
99 Potential Side Effects of Chemotherapy (cont’d) Mood alterationsAnxietyDepressionEuphoriaMetabolic AlterationsHypocalcemia/hypercalcemiaHypocalcemia/hyperglycemiaHyperphosphatemiaHyperuricemiaHypokalemia/hyperkalemiaHypomagnesemia9999
100 Potential Side Effects of Chemotherapy (cont’d) Latent effectsCognitive dysfunctionLearning disabilitiesChanges in memorySecondary malignanciesOtherHypersensitivityFatigueOcular toxicity100100
101 Hormonal Manipulation Slow Tumor growthControl not cure--hormone agonists--hormone antagonists--hormone inhibitorsAdverse reactions Male feminizationFemale MasculinizationAcneHypercalcemiaLiver dysfunction
102 Immunotherapy Biological Response Modifiers Interleukins--Help immune system cells recognize & destroy abnormal body cellsInterferons---Slow down tumor cell divisionColony Stimulating Facotrs---induce rapid recovery of bone marrow
103 Rationale Theory of immune surveillance An intact immune system is able to recognize cancer cells as different from normal cells and can destroy cancer cells.Cancer cells are constantly produced by the body and destroyed by the functioning immune system.Cancer develops when the immune system does not function properly or is unable to recognize cancer cells as foreign (Brown et al., 2001).103103
105 Nursing Diagnoses: Antineoplastic Therapy Deficient Knowledge related to chemotherapy protocol, names of agents, potential side effectsImbalanced Nutrition: Less Than Body RequirementsRisk for InfectionImpaired Oral Mucous MembraneSexual dysfunctionFatigueDisturbed Body ImageConstipationDiarrheaNausea105105
106 Bone Marrow Suppression Nursing Interventions Chart 28-7 and Chart 28-8 page 497Chart page 497Remember Fever in client with neutropenia is a medical emergencyChart Page 498
107 Bone Marrow Suppression Medications Epoetin Alfa (Epogen, Procrit): stimulates RBC’sFilgrastim ( Neupogen): Prevent infectionOprelvekin (Neumega): Stimulates production of platelets
108 Gastrointestinal Adverse Effects Nursing Interventions Stomatitis (oral Mucositis)Gentle cleansingsoft toothbrush, brushing all tooth surfaces for at least 90 seconds and at least twice a day. Floss at least every day Bland rinses ( normal saline, sodium bicarbonate, or a combo.) 4 times per dayArtificial saliva if dryTopical AnestheticsAvoid hot/cold or spicy foods, citrusEat soft foodsAvoid alcohol, tobacco, and irritating foods use water based moisturizers to protect lipsMaintain adequate hydrationJanuary ONS Connect Evidence base practice
109 Gastrointestinal Adverse Effects Nursing Interventions Antiemetics 6-12 hours before chemo and every 4-6 hours after chemo for 24 hours at leastIf uncontrolled can lead to anorexia, malnutrition and dehydrationDiarrhea… low residue or liguid diet monitor electrolytes and I&O’s, antidiarrheals, nutmeg, apples and bananas slow , A&D ointment to rectum after washing
110 Alopecia Is Temporary Not always confined to just the head Color and Texture may change with re-growthLoss depends on drug usedSelect wigs, hats, turbans, before lossInstruct patient to not wash their hair every day/ avoid use of hairdryers