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Ch. 16 Cancer,[object Object],August 25, 2010,[object Object]
Objectives,[object Object],Explain the use of OR, chemo, radiation, and biologic & targeted therapy in the treating cancer,[object Object],Discuss the appropriate nsg mgmt of patients receiving the above interventions,[object Object]
Terminology Review,[object Object],Benign VS Malignant,[object Object],Carcinogens,[object Object],Carcinomas VS Sarcomas,[object Object],Protooncogenes VS Oncogenes,[object Object],Hyperplasia VS Hypertrophy,[object Object]
Classification of Cancer,[object Object],Tumors can be classified by,[object Object],Anatomic site,[object Object],Histology ,[object Object],Grading severity,[object Object],Extent of disease,[object Object],Staging,[object Object]
Grades of Abnormal Cells,[object Object],Grade 1,[object Object],slightly  different but well differentiated,[object Object],Grade 2,[object Object],Grade 3,[object Object],Grade 4,[object Object],Cells immature, primitive and undifferentiated,[object Object],Cell of origin is difficult to determine,[object Object]
Clinical Staging,[object Object],0: Cancer in situ,[object Object],1: Tumor limited to tissue of origin; localized tumor growth,[object Object],2: Limited local spread,[object Object],3: Extensive local and regional spread,[object Object],4: Metastasis,[object Object]
Interpreting TNM,[object Object],Breast cancer T2 N2 M0,[object Object],Prostate cancer T3 N2 M0  ,[object Object]
Detection,[object Object],Prevention,[object Object],C- change in bowel or bladder habit (colon cancer) ,[object Object],A- a sore that doesn't heal on skin or on mouth ,[object Object],U- unusual bleeding or discharge from rectum, bladder, or vagina ,[object Object],T- thickening or lump in the breast tissue ,[object Object],I- indigestion or difficulty swallowing ,[object Object],O- obvious changes in a wart or mole (skin cancer) ,[object Object],N- nagging cough or hoarseness (lung or throat cancer) ,[object Object],Lifestyle habits to reduce risks,[object Object],Avoid or reduce exposure to known or suspected carcinogens ,[object Object],Cigarette smoke, excessive sun exposure,[object Object],Eat a balanced diet ,[object Object],Exercise regularly,[object Object],Obtain adequate rest,[object Object],Regular health examination ,[object Object],Change perceptions of stressors ,[object Object],Learn to cope with stress,[object Object],Enjoy consistent periods of relaxation and leisure,[object Object]
Surgery,[object Object],Chemotherapy,[object Object],Radiation,[object Object],Biologic & Targeted Therapy,[object Object],Medical Interventions,[object Object]
Goals,[object Object],Cure,[object Object],Control,[object Object],Palliation,[object Object],Collaborative Care of Cancer,[object Object]
Surgical therapy is used,[object Object],Prophylaxis – removal of at risk tissue,[object Object],Dx – Biopsy,[object Object],Cure – attempts to remover all CA tissue,[object Object],Control – debulks the tumor, does not cure,[object Object],Determine efficacy of Tx – “second look”,[object Object],Palliation – does not extend life, ↑ quality of life,[object Object],Reconstruction - ↑ function/appearance ,[object Object],Surgery,[object Object]
Purpose: To destroy CA cells with minimal exposure of the normal cells to the damaging actions of radiation,[object Object],Radiation,[object Object]
Mechanism of Action,[object Object],Delivery methods,[object Object],Teletherapy (Externally),[object Object],Brachytherapy (Internally),[object Object],Brachytherapy safety principles: ALARA, time, distance, and shielding,[object Object],Radiation Tx for CA - cont,[object Object]
Vary acc. to the side,[object Object],Local skin ∆,[object Object],∆ taste sensations,[object Object],Fatigue r/t ↑ energy demands,[object Object],Inflammatory response r/t radiation,[object Object],S/E of Radiation Therapy,[object Object]
Teach accurate objective facts to help the clt to cope,[object Object],Do not remove markings,[object Object],Administer skin care,[object Object],Do not use lotions or ointments,[object Object],Avoid direct sun exposure,[object Object],Care for xerostomia,[object Object],R/O bone fracture ,[object Object],Nsg Care/Mgmt: Radiation Tx,[object Object]
Chemotherapy,[object Object],Used to cure and/or add survival time,[object Object],Some selectivity for killing cancer cells over normal cells,[object Object]
S/E of Chemo,[object Object],Skin Δ,[object Object],Hair,[object Object],Intestinal tissues,[object Object],Spermatocytes,[object Object],Hematopoietic Sx Δ,[object Object],Anxiety & sleep disturbances,[object Object]
Chemotherapy Administration,[object Object],Given by Oncology nurse,[object Object],Checked by 2 nurses,[object Object],Cancer cycle: course of tx subj.to Nadir,[object Object],Nadir: the time when bone marrow activity + WBC are @ their lowest ,[object Object]
Nsg Care/Mgmt: Chemotherapy,[object Object],Major role of the oncology - Chemo,[object Object],Drug therapy,[object Object],Protection from infection,[object Object],CAM,[object Object]
Tx issues with Chemo,[object Object],Drug dosage,[object Object],Drug schedule,[object Object],Drug administration:,[object Object],Oral,[object Object],IV: Central line,[object Object],Spine,[object Object],Interthecal,[object Object],Extravasation,[object Object],Vesicants,[object Object]
Biologic & Targeted Therapy,[object Object],Biological response modifier: modify the clt biologic responses to tumor cells – 3 ways,[object Object],Targeted therapy: targeting specific cellular pathways that are important in tumor growth,[object Object]
Stem Cell Transplantation,[object Object],Source Hematopoietic SCT: BMT, PSCT, umbilical cord blood,[object Object],Types of HSCT: allogeneic (HLA), syngeneic, autologous,[object Object],Allows very high dose of chemo & radiation,[object Object],Goal: eradicate tumor cell and/or clear the marrow for engraftment of SCT,[object Object],BMT VS PSCT,[object Object]
Main Oncology Nursing Outcome,[object Object],Management of fatigue, nausea and vomiting, prevention of infection, and return to usual function,[object Object]
Oncology Nursing Approach/Intervention/Measure,[object Object],symptom experience (dyspnea, fatigue, mucositis, nausea and vomiting, pain, peripheral neuropathy, and sleep-wake disturbances), ,[object Object],functional status (nutritional status and return to usual functioning), ,[object Object],safety prevention of adverse events (prevention of infection), and ,[object Object],psychological distress (depression),[object Object]
Oncology Emergencies,[object Object],IV access issues,[object Object],Adverse response to chemo drugs,[object Object],Sepsis,[object Object],DIC,[object Object]
Collaborative Tx in Oncology Emergencies,[object Object],Prevention,[object Object],Intravenous IV abx tx,[object Object],Anticoagulants,[object Object],Cyroprecipitated clotting factors,[object Object]
Questions & Answers,[object Object]
Resources,[object Object],Article: Put Evidence in Practice,[object Object],    Nursing-Sensitive Patient Outcomes: The Development of the Putting Evidence Into Practice Resources for Nursing Practice,[object Object],PodCast on Blackboard/Media Library,[object Object],Managing stress ,[object Object],Advocating cancer clients and caregivers,[object Object]

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Ch16 Cancer Part One

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