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Chapter 16 Oncology: Nursing Management in Cancer Care

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Presentation on theme: "Chapter 16 Oncology: Nursing Management in Cancer Care"— Presentation transcript:

1 Chapter 16 Oncology: Nursing Management in Cancer Care

2 Cancer Disease process that begins when abnormal cell is transformed by genetic mutation of cellular DNA Metastasis: abnormal cells have invasive characteristics, infiltrate other tissues Malignant cancer cells: demonstrate uncontrolled growth that does not follow physiologic demand

3 Malignant Process Cell proliferation: uncontrolled growth with ability to metastasize and destroy tissue, and cause death Cell characteristics: presence of tumor-specific antigens, altered of shape, structure, metabolism Metastasis: Lymphatic spread Hematogenous spread Angiogenesis Carcinogenesis

4 Characteristics of Benign and Malignant Neoplasms
Cell characteristics Mode of growth Rate of growth Metastasis General effects Tissue destruction Ability to cause disease

5 Question Tell whether the following statement is true or false:
Malignant tumors spread by way of blood and lymph channels to other areas of the body.

6 Answer True. Rationale: Malignant tumors spread by way of blood and lymph channels to other areas of the body. Cells bear little resemblance to the normal cells of the tissue from which they arose.

7 Carcinogenic Agents and Factors
Viruses, bacteria Physical factors: sunlight, radiation, chronic irritation Chemical agents: tobacco, asbestos Genetic, familial factors Diet Hormones

8 Question Which specific agents or factors are associated with the etiology of cancer? Dietary and genetic factors Hormonal and chemical agents Viruses All of the above

9 Answer D. All of the Above
Rationale: Specific agents or factors associated with the etiology of cancer include viruses and bacteria, physical factors; sunlight, radiation, chronic irritation, chemical agents; tobacco, asbestos, genetic and familial factors, diet, hormones.

10 Primary and Secondary Prevention
Primary prevention: concerned with reducing cancer risk in healthy people Secondary prevention: involves detection, screening to achieve early diagnosis, intervention Now great emphasis on primary, secondary prevention of cancer

11 Primary Prevention Avoid known carcinogens
Lifestyle, dietary changes to reduce cancer risk Public, patient education

12 Secondary Prevention Identification of patients at high cancer risk
Cancer screening Self-breast exam Self-testicular exam Screening colonoscopy PAP test Public, patient education

13 Diagnosis of Cancer Determine presence, extent of tumor
Identify possible spread (metastasis) of disease or invasion of other body tissues Evaluate function of involved, uninvolved body systems, organs Obtain tissue, cells for analysis, including evaluation of tumor stage, grade

14 Tumor Staging and Grading
Staging: determines size of tumor, existence of metastasis Grading: classification of tumor cells Tissue of origin Degree to which cell retain structure and function of tissue of origin TNM T: extent of primary tumor N: lymph node involvement M: extent of metastasis

15 Cancer Management Cure Control Palliation

16 Surgical Treatment Diagnostic surgery
Biopsy: excisional, needle, incisional Tumor removal: wide excision, local excision Prophylactic surgery Reconstructive surgery

17 Question Which type of surgery is being done when lesions that are removed are likely to develop into cancer? Diagnostic Palliative Prophylactic Reconstructive

18 Answer C. Prophylactic Rationale: The type of surgery being done when lesions that are removed are likely to develop into cancer is called prophylactic surgery. Diagnostic surgery such as a biopsy is usually performed to obtain a tissue sample for analysis of cells suspected to be malignant. Palliative surgery is performed in an attempt to relieve complications of surgery. Reconstructive surgery is carried out in an attempt to improve function or obtain a more desirable cosmetic effect.

19 Radiation Therapy Curative, control, or palliative External radiation
Internal radiation Radiation reactions Effect on GI system Effect on bone marrow Systemic effects Long-term effects, tissue changes

20 Nursing Care of the Patient Undergoing Radiation Therapy
Patient, family education Restrictions, precautions Skin care Oral care Protection of care providers

21 Chemotherapy Agents used to destroy tumor cells by interfering with cellar function, replication Curative, control, or palliative Cell kill, cell cycle

22 Chemotherapeutic Agents
Classification Administration Dosage Extravasation Hypersensitivity reactions

23 Chemotherapy Toxicity
Gastrointestinal Hematopoietic Renal Cardiopulmonary Reproductive Neurologic Fatigue

24 Nursing Management in Chemotherapy
Assessing fluid, electrolyte status Modifying risks for infection, bleeding Administering chemotherapy Protecting caregivers

25 Bone Marrow Transplantation (BMT)
Used for hematological cancers that effect marrow or solid tumors treated with chemotherapy dosage that ablates bone marrow Types of BMT Allogenic Autologous (Syngeneic) Graft vs. host disease Venous occlusive disease

26 Nursing Management in Bone Marrow Transplantation
Implementing pretransplantation care Providing care during treatment Providing posttransplantation care Caring for recipients Caring for donors

27 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 & D ointment to area

28 Impaired Skin Integrity: Wet Desquamation
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 (Swearingen, 2008) Consult with enterostomal therapist (ET), physician if eschar forms

29 Alopecia Discuss potential hair loss, regrowth with patient, family
Explore potential impact of hair loss on self-image, interpersonal relationships, sexuality Prevent or minimize hair loss Prevent trauma to scalp Suggest ways to assist in coping with hair loss: Encourage patient to wear own clothes, retain social contacts Explain that hair growth usually begins again once therapy is completed

30 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

31 Altered Nutrition: Nausea and Vomiting (cont’d)
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

32 Nutritional Problems Anorexia Malabsoprtion Cachexia

33 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

34 Nutritional Problems: Expected Outcomes (cont’d)
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

35 Nutritional Problems: Expected Outcomes (cont’d)
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

36 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

37 Altered Body Image (cont’d)
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

38 Question Which measure should the RN not teach a client about protecting the skin between radiation treatments? Handle the area gently. Avoid irritation with soap and water. Use a heating pad every day on the area. Wear loose fitting clothes.

39 Answer C. Use a heating pad every day on the area.
Rationale: Measures to protect a client’s skin between radiation treatments include handling the area gently, avoiding irritation with soap and water, and wearing loose-fitting clothing. The client should not use a heating pad every day on the area because it will not promote tissue repair.

40 Monitoring and Managing Potential Complications
Infection Septic shock Bleeding, hemorrhage

41 Factors Contributing to Infection
Impaired skin, mucous membrane integrity Chemotherapy Radiation therapy Biologic response modifiers  Malignancy Malnutrition Medications  Urinary catheter Intravenous catheter

42 Factors Contributing to Infection (cont.)
Other invasive procedures Contaminated equipment Age Chronic illness Prior infections Recent travel Pet excreta Prolonged hospitalization

43 Septic Shock 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

44 Bleeding and Hemorrhage
Thrombocytopenia (decrease in circulating platelet count): most common cause of bleeding in patients with cancer, usually defined as platelet count of less than 100,000/mm3 (0.1 × 1012/L) Plan of nursing care addresses nursing assessment parameters, interventions for patients at risk for bleeding

45 Question Tell whether the following statement is true or false:
Rationale: The most common cause of bleeding in cancer patients is thrombocytopenia.

46 Answer True. Rationale: The most common cause of bleeding in cancer patients is thrombocytopenia.

47 Hospice Comprehensive, multidisciplinary approach to care of patients with terminal illness, their families Focuses on Quality of life Palliation of symptoms Psychosocial, spiritual care

48 Oncologic Emergencies
Superior vena cave syndrome Spinal cord compression Pericardial effusion, cardiac tamponade Disseminated intravascular coagulation (DIC) Syndrome of inappropriate secretion of antidiuretic hormone Tumor lysis syndrome


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