Cancer Flashcards
Prevention & early detection of cancer
- avoid carcinogens
- diet/exercise/rest
- regular health exam
- regular cancer screenings
- learn/practice self-exams
- know the seven warning signs of cancer
7 warning signs of cancer
C hange in bowel or bladder habits
A sore that does not heal
U nusual beeding of discharge for any body orifice
T hickening or a lump in the breast or elsewhere
I ndigestion or difficulty swallowing
O bvious change in a wart or mole
N agging cough or hoarseness
Diagnostic tests for cancer
- cytology studies
- tissue biopsy
- serum lab values
- CXR
- radiologic studies
- scans
- presence of tumor markers
- bone marrow exam
Diagnosis of cancer
- health history
- diagnostic tests
waiting for results produces enormous anxiety!
Surgery purposes and outcomes
50% of cancer patients
- prophylaxis
- diagnosis (biopsy)
- cure
- control
- palliation
- “second look”
- reconstruction/rehabilitative
debulking procedure purpose
reduce size of tumor, making radiation/chemo more effective
this surgical procedure is not curative, just control
chemotherapy
mainstay of cancer treatment to treat solid tumors and hepatologic malignancies
general nursing implications for chemo administration
- certification required to administer
- toxic agents: protect patient, self, & environment
- double check dose/order with another RN
- avoid extravasation; CVCs preferred
- pre-medication common (anti-emetics, anti-infammatory, anti-allergy)
- monitor lab values (WBCs & platelets)
- provide patient/family support
avoid extravasation
- monitor often
- ensure constant free-flowing IV with good blood return
- cardinal symptom is pain, but not always
extravasation treatment
- stop infusion immediately
- attach disposable syringe at IV exit site
- aspirate slowly & gently (goal: obtain as much solution as possible)
- remove original cannula
- elevate arm
- infuse antidote intradermal per protocol
radiation therapy purpose and % of patients that receive
- to achieve local control
- carefully defined area of the body
- used independently or in conjunction with surgery/chemo
60%
types of radiation
external (teletherapy) - most common
internal (brachytherapy)
types of brachytherapy
temporary implants (sealed)
radiopharmaceutical therapy (unsealed)
When is patient radioactive?
Internal radiation
- sealed sources (solid implants)-radioactive while implant is active; secretions are not
- unsealed sources (suspended in fluid)- eliminated in waste, which is radioactive
How close can i get to a radioactive patient?
remember the principle of time, distance, & shielding
inverse square law of radiation exposure
dosimeter
care of patient with sealed implants
- private room/bath
- place “caution: radioactive material” sign on door
- wear dosimeter AAT
- no pregnant women or <16 years old in room
- limit each visitor to 30 minutes/day, keep 6 feet from source
- never touch radioactive source with hands, use forceps
- keep lead container in room and place source in there
- save all dressings/linens until after source is removed, then discard in usual manner
patient education with radiation
- wash irradiated area each day with water only, or mild soap
- use hand, not wash cloth
- rinse soap thoroughly
- do NOT wash off markings r/t radiation focus
- dry area with patting, no rubbing
- use no powders, lotions, or creams at site unless prescribed by radiologist
- wear soft clothing over site
- avoid anything that binds/rubs site
- avoid sun exposure to irradiated area
- avoid temperature extremes
side effects of chemotherapy
bone marrow suppression
gi effects
skin reactions
Bone marrow suppression
neutropenia-risk for infection
thrombocytopenia–risk for bleeding
anemia–risk for fatigue
GI effects
anorexia
N/V
stomatitis
altered bowel patterns
nursing implications with neutropenia
- monitor WBCs (WBC w/diff and absolute neutophil count (ABC))
- alterations in labs may delay treatment or decrease dose
- teach pt/family about risk for infection
- admin. WBC growth factors - filgastrim (Neupogen)
Absolute Neutrophil Count (ANC)
-actual number of netrophils (segs and bands)
>2,500 = normal >1,000 = safe <1,000 = neutropenia <500 = Precautions & Protective Isolation
Nadir
time after chemo when the WBC or platelet count is at its lowest point
patient implications- when they will feel the worst
neutropenic diet
- raw fruits and veggies which can’t be peeled are avoided
- food and flatware is wrapped for delivery
- no raw peanuts & seeds
thrombocytopenia
risk of serious bleeding not apparent until platelet count < 50,000
platelet transfusion if < 20,000
nursing implications for anemia
- monitor H&H
- teach energy conservation, but encourage activity
- encourage adequate nutrition
- if Hgb < 11, often give RBC growth factor - epoetin
- if extremely anemic, give PRBCs
nursing implications for anorexia & N/V
- anorexia - taste changes are common, focus on foods they like
- N/V (also anticipatory N/V) - anti-emetics
- monitory weight twice weekly
- monitor relevant lab values
- encourage small, frequent, high protein, high calorie meals
- nutritional supplements
nursing implications for stomatitis
- thorough oral assessment
- meticulous mouth care
- toothbrushing, flossing, unless contraindicated
- saline gargles and other rinses, NO alcohol mouthwash
- artificial saliva
- soft, non-irritating foods
Other side effects of radiation & chemo
- fatigue - r/t anemia & cancer
- alopecia
- pulmonary effects - lung damage r/t radiation, adverse drug effects
- CV effects - secondary to radiation/drug adverse effects
- reproductive effects - potential for infertility
Psychosocial concerns
- disfigurement
- secondary cancers
- recurrence after ‘cure’
- disability & death
body vigilant
once a person has had cancer, anytime something happens to them, they think the cancer is back
how nurses can enable hope in patients with cancer
- helping the pt develop an awareness of life
- id a reason for living
- help pt establish support system
- incorporate religion, as appropriate
- incorporate humor, as appropriate
spirituality and cancer
may have a positive or negative impact
may question or be angry with god, may fear relationship with their god
may develop a renewal of faith (r/t facing mortality)
social support and cancer
one of the most important parts of cancer treatment
nursing implications r/t social support and cancer
- assist when needed
- an ear to listen
- shoulder to cry on
- educate about support groups
