Cancer Flashcards
What is CANCER
Cancer or malignant cells are those that are abnormal, do not serve a purpose, and are harmful to normal tissue.
What causes the problems associated with Cancer?
Many of the problems associated with cancer are caused by either cancer itself, or the treatment for cancer (or both).
If left untreated, even cancer of a non-vital organ or tissue can metastasize and cause some of the following problems (4)
1) Reduced blood-producing function
2) Altered GI function
3) Peripheral nerve, motor, and sensory deficits
4) Decreased respiratory and cardiac function
What is the goal of cancer management? (2)
- Cure or control cancer
2. Minimize side effects of treatment(s)
What is cancer management dependent on? (4)
1) Type,
2) location,
3) size and extent of cancer
4) Health of person
What treatments can we employ to manage cancer?
Which two treatments are we prioritizing?
1) Surgery
2) Radiation **
3) Chemotherapy **
4) Immunotherapy
5) Small Molecular Inhibitor Targeted Therapy
6) Hormone Therapy
* * Where we will focus our time/what we’re expected to understand
What are the 3 main nursing priorities related to cancer? (nursing diagnoses)
- Reduced WBCs –> Impaired Immunity –> Risk for Infection
- Reduced RBCs –> Poor Perfusion –> Fatigue/Oxygenation (Breathing)
- Reduced PLTs –> Poor Clotting –>
* Risk for Bleeding*
What is myelosuppression? Cause? Results in?
The killing of healthy blood cells and temporary suppression of BM function (no replacement) caused by chemotherapy.
Results in: PANCYTOPENIA Decreased WBCs (esp. neuts), RBCs, and PLTs
What causes neutropenia?
What are the risks of neutropenia and what is the most common causes?
Chemotherapy causes temporary suppression of the immune system
Dose-related Risk for Infection and Sepsis
Most infections are from an overgrowth of normal flora (Opportunistic Infections)
Infection Prevention involves
3 broad categories
- INFECTION PREVENTION
- Hand Washing
- Neutropenic precautions - Nurse-Led Protocols (details later)
- Prevention & Early Recognition of Sepsis
Interventions for Neutropenia, AKA _____ involve (2 broad categories)
Neutropenic Precautions/Reverse Isolation
1. INFECTION PREVENTION
2. Pharmacological interventions
don’t need to know specifics
Neutropenia is defined as an ANC
ANC <500 cells/mm3 or < 1000 cells/mm3 with fever
Per Institute policy
this bothers me bc you’ll see this resulted in units of 10^3/mcL which would look like an ANC of 1.0 or 0.5.
Neutropenic Precautions:
Room + Visitor-related precautions (4)
Dietary Precautions (3)
- Private room
- Mask on pt when outside of the room - NO fresh plants or flowers
- NO Stagnant water
- LIMIT visitors and NO visitors who are sick
Dietary Precautions:
- NO raw veggies/fruits
- NO undercooked meat (sushi)
- NO PEPPER
Neutropenic Precautions:
Nursing Interventions (9)
What’s our #1 priority?
- Hand washing (#1 priority!)
- Avoid shared supplies
- Need their own dedicated supply - Monitor VS’s (esp. temp)
- Inspect mouth, skin, mucous membranes,
and line sites daily. - Hygiene w/ antibacterial soap DAILY
- Activity/Rest
- Coughing + deep Breathing
- To prevent pneumonia/atelectasis - NO indwelling catheters
- UNLESS absolutely necessary - Asepsis
-
Report any changes to the Provider
- Fever, Cough
- Skin, mucous membranes
- CVAD
- Drainage
Infection Prevention:
What are Nurse-Led Protocols?
Name them. (4)
What is the goal?
Protocols that are implemented when S/S of infection are present that result in a specific order set.
- Obtain Cultures (“Pan” cultures)
- Sputum, urine, blood cultures - Diagnostics
- CBC, lactic acid, etc. - Antibiotic Administration
- Antibiotic Stewardship
Goal:
Prevention & Early Recognition of sepsis
Neutropenic Precautions
Home-care Patient Teaching (10)
- Handwashing
- tell pt to teach visitors this too - Hygiene: daily baths w/ antimicrobial soap
- Avoid crowds & sick people
- Avoid sharing personal items
- Dietary restrictions (we know dis)
- Wash dishes well (dishwasher); don’t
reuse drinking cups - Monitor temperature & S/S of infection
- No gardening
- No pet litter
- Condom use
Cancer-associated Risk for Bleeding is r/t:
Thrombocytopenia
Cancer + Risk for Bleeding:
A PLT count of
A PLT count of <50,000/mm3 can lead to prolonged bleeding.
A PLT count of <20,000/mm3 can lead to spontaneous bleeding.
Cancer + Risk for Bleeding
Nursing Interventions/Assessments/Precautions
(4 broad categories)
- Bleeding Precautions
- Neurological assessments
- Injury Precautions
- Fall Precautions
- Line removals,
- Avoid rectal temps/meds - Treatments
- PLT transfusion
- Neumega (PLT-growth factor)
Cancer + Risk for Bleeding: Assessment
What assessment do we perform r/t our biggest concern?
Name the S/S of bleeding (6)
- Neurological assessment
- Risk for Spontaneous brain bleed (SAH)!
S/S:
1. Petechiae
2. Excessive bruising
- Internal bleeding--bruises on lower
back/flank area
3. Prolonged bleeding (after venipuncture)
- PLT count checked before line removal
4. Blood in urine and stool
5. Hypotension
6. Tachycardia
Cancer + Risk for Bleeding:
5 General Interventions r/t Bleeding Precautions:
Which one is used to assess for internal bleeding?
- Lift sheets
- Use a Soft-Bristle toothbrush
- Assess IV sites
- Abdominal Girth measurement
- Internal bleeding assessment - Fall Precautions
Cancer + Risk for Bleeding:
Bleeding Precautions r/t Venipuncture
- Assess IV sites
- Avoid IM injections/Venipunctures
- Promote Hemostasis
- Apply pressure for 10 min. after
- Use of Ice
- Apply pressure for 10 min. after
Cancer + Risk for Bleeding:
Bleeding Precautions
AVOID (3)
NO (3)
Avoid:
- Enemas
- Rectal thermometers/temps
- Rectal tubes/meds
NO:
- Electric razor
- NO dental floss
- Nose blowing
Cancer + Fatigue
What causes cancer-related fatigue? (2)
- Anemia (BM suppression & Chemo effects)
2. Nutritional status
Cancer + Fatigue
Describe cancer-related fatigue and how it may impact a patient’s life:
Far worse than ”everyday fatigue”
- May be considered worse than the side effects of cancer/ cancer Tx (N/V, pain)
May have a profound effect on ADLs and the Ability to perform ADLs
Cancer + Fatigue:
3 Main Assessments
- Anemia Assessment
- Neurological assessment
- Spontaneous bleeding
- Petechiae - Nutritional status
- I&O - ADL assessment
Cancer + Fatigue:
Nursing Interventions
- Exercise
- Yoga, walking, etc. - Assess for an underlying cause and treat
- Energy Conservation/ Activity Mx
- Set Priorities
- Plan ahead
- Ask for help
- Optimize sleep - Massage
- Healing touch
Cancer + Oxygenation:
Cause?
Interventions
Tumors in various locations of the CV/PV system that lead to HYPOXIA & POOR TISSUE OXYGENATION
Interventions:
- CV/Respiratory Assessments
- Oxygen
What are some other big areas for nursing interventions? (4)
- GI-related issues
- Motor & Sensory Deficits
- Pain
- Psychosocial interventions
Cancer + GI:
What causes GI issues r/t to cancer?
May be from:
- Cancer itself
- Chemotherapy
- Radiation
Cancer + GI:
What are the 4 main GI issues related to cancer:
- Cachexia
- Mucositis/Stomatitis
- N/V
- Changes in taste
Cancer + GI:
What is Cachexia?
What are our Interventions r/t for this and what’s an important consideration?
Cachexia: weakness and wasting of the body due to severe chronic illness.
Interventions related to NUTRITION!
- Should be patient-specific!
1. Protein and CHO-rich foods
2. Small, frequent meals
3. Nutritional supplements
Cancer + GI: Mucositis & Stomatitis
What do we want to promote for these?
Interventions (6)
Assess, assess, assess!
Promote Hygiene!
- Cold therapy (ice/ice-pops)
- Oral cryotherapy
- Mouth rinses/Medicated mouthwashes
- Sodium bicarbonate
- Lidocaine
- Magic mouthwash - Use non-irritating mouth cleansers
- NO floss
- Use a Soft bristle toothbrush
- Mucosal Protectants
Cancer + GI: Nausea & Vomiting
What usually causes N/V?
Name the 4 types:
Main cause: Chemotherapy!
- Acute:
- Occurs suddenly during chemo - Anticipatory:
- Triggered by thought, sight, smell - Delayed:
- Occurs 1-5 days after chemo - Breakthrough
- Occurs even w/ Tx of N/V
Cancer + GI: Nausea & Vomiting
What is our #1 Priority?
What drug therapy did Messer mention?
ADEQUATE CONTROL of N/V
- Serotonin (5-HT3) antagonist drugs
- Ondansetron
Cancer + Motor & Sensory Deficits
What causes these deficits?
What can this result in? Describe it.
What’s this put patients at risk for?
Occurs with bone and brain metastasis, compressed nerves –> restricts mobility
Results in Peripheral Neuropathy
- Loss of sensation in lower extremities
- May be painful
- Loss of balance
- Injury to feet (unaware of injury)
RISK FOR INJURY!
Cancer + Motor & Sensory Deficits
Assessment (3)
Interventions (3)
Assessment:
- Pain
- Mobility
- ADLs
Interventions:
- Promote optimization
- Offer assistance
- PT/OT referral
Cancer + Pain
What kind of approach do we take?
Multimodal pain management
- Opioids
- Analgesics
- PT
- Healing touch
- Massage
- Acupuncture
- Aromatherapy
Cancer + Psychosocial Care
Who can we include in Psychosocial management? (4)
What do we need to consider for family/caregivers?
- Support Services
- Case Manager
- Navigator
- Palliative Care
ASSESS Caregiver role strain!
Cancer + Psychosocial
What do we want to assess? (7)
- Anxiety and depression
- Fear of Recurrence - Sleep Disturbances
- Physical Changes
- Effects of Reduced function/ADLs
- Sexual Dysfunction/ Fertility issues
- Work/ Inability to participate in normal roles
- Spiritual issues
Cancer + Psychosocial + Physical Changes
Alopecia + Interventions
Loss of hair on all parts of the body (eyebrows, lashes, etc.)
Interventions:
- Protect scalp
- wear hat while in the sun - Coping assessment and Mx
Cancer + Psychosocial
What kind of Cognitive changes may occur?
Chemo-brain (chemotherapy)
Brain tumor/ mets
Cancer + Treatment
What is radiation?
What’s the most common type?
Use of high-energy radiation to treat cancer
Most common type: Gamma rays
then Beta rays for internal forms
Cancer + Radiation Therapy
What are the goals for radiation therapy?
Goals:
- Cure
- Control
- Palliative
- Minimize destruction of normal tissue and maximize destruction of abnormal tissue.
- Localized effects (with exception)
Cancer + Radiation Therapy
How is it given?
Differentiate Exposure & Dose
What are the 3 considerations for Dose?
Typically given in a series of divided doses
- Exposure- amount delivered
- Dose- amount actually absorbed
- Intensity
- Duration
- Closeness
Cancer + Radiation Therapy
How is it administered? (2)
- Teletherapy
2. Brachytherapy
Cancer + Radiation Therapy
What is Teletherapy?
External beam
Cancer + Radiation Therapy
What is Brachytherapy?
What are the 2 Types?
What is a major consideration when caring for a patient receiving this therapy?
Internal device; Direct contact with cancer
- PO, IV, surgical insertion
- Unsealed: body fluids are also radioactive
- Sealed: Only the patient emits radiation
Patient emits radiation as long as the device is emitting radiation
Cancer + Radiation Therapy
Brachytherapy Precautions
- Private room
- Sign on door
- Keep door closed
- Wear a lead apron while providing care
- Restrict time in the room
- Keep visitors 6 feet away/limit time
- NO LONGER THAN 30 min - Do not assign pregnant caregivers
- Special handling of bed linens and dressings
Cancer + Radiation Therapy Side Effects (8)
- Skin changes (dermatitis)
- Hair loss
- Usually at the site radiation was rec’d - Altered taste
- Fatigue
- Inflammation
- Tissue Fibrosis/ scarring
- Secondary malignancies
- CV Disease
Cancer + Radiation Therapy Patient Education (2)
- Do not remove markings
- Skincare
- Specific to location and type of radiation
- Avoid scrubbing areas
- Use mild soaps, etc.
