Cancer Flashcards
End-of-life care, types of cancers
Identify 3 goals of cancer treatment.
- Cure: complete cancer removal
- Control: prolonged survival & containment of cancer cell growth
- Palliation: symptom relief, improve QOL
List examples of primary, secondary, & tertiary prevention of cancer.
- Primary: reduce cancer risk in healthy people - Immunizations, health promotion, risk reduction
- Secondary: screenings
- Tertiary: monitoring & preventing recurrence, screening for second malignancies
Common side effects of chemotherapy & nursing management of those s/e
- N/V, alopecia
- Fatigue, anemia, LOA
- High risk of infection & bleeding
Nursing management:
- Antiemetics
- Monitor for infection & bleeding
- Assess cognition & fatigue
Surgeries & their purpose used in treating & diagnosing cancer
- Biopsy: identify cancer (excisional small, incisional large, needle sample)
- Local excision: remove mass & small part of normal tissue
- Wide excision: remove tumor, lymph nodes, surrounding structures & tissues
- Prophylactic surgery: remove nonvital tissues/organs risk of cancer
- Palliative surgery: improve symptoms, QOL
- Reconstructive surgery
Care for Dry Skin Desquamation
- Use lukewarm water to bathe area
- Apply vitamin A & D ointment
Avoid:
- Lotions, perfumes, soaps, etc.
- Rubbing, scratching, shaving with straight-edged razor
- Hot or cold temperatures
- Tight clothing, adhesive tape
Care for Wet Skin Desquamation
- Report any blistering, no disrupting blisters
- Avoid frequent washing of area
- Use prescribed creams or ointments
- Nonadhesive absorbent dressing (drainage)
- Moisture vapor-permeable dressing like hydrocolloids (without drainage)
- Consult with enterostomal therapist for eschar
NI & Precautions when administering IV chemotherapy
- Monitor for extravasation
- Never give vesicant chemo in peripheral veins like hands or wrist
- Placed on forearm
- Short-duration infusions only
- Frequent, prolonged requires central line
- Monitor for hypersensitivity reactions, toxicity, infection, bleeding
List medications used to increase WBCs (neutrophils).
- Granulocyte colony-stimulating factors
- Granulocyte-macrophage “ “
(Stimulate bone marrow to produce WBCs, especially neutrophils; reduce neutropenia)
Side effects of Oxaliplatin
- Neurotoxicity exacerbated by cold exposure
- Lip paresthesia
- Discomfort or tightness in back of throat
- Inability to breathe
- Jaw pain
Superior Vena Cava Syndrome & Nursing Management
- Obstruction by tumor or thrombosis in SVC
- Facial & periorbital edema, vein distention (head, neck, chest), seizures, HA
NM:
- Identify those at risk & assess
- Avoid upper extremity BP & IV
- Elevate HOB
Tumor Lysis Syndrome & Nursing Management
- Result of chemotherapy destroying large number of tumor cells
- Hypocalcemia (high phosphate)
- Renal failure d/t kidneys unable to excrete metabolites
- Hallmark signs: hyperuricemia, P, K, Ca (24-48 hrs post chemo)
NM:
- Sodium bicarb for hydration: increase UOP, pH 7-7.5
- Allopurinol inhibits nucleic acids converting to uric acid
- Diuresis, hemodialysis
Hypercalcemia S/Sx & Nursing Management
- Calcium released from bones > kidney excretion or bone reabsorption
- S/Sx: polyuria, polydipsia, nocturia, muscle weakness, hyporeflexia, fatigue, confusion
NM:
- Treat primary disease
- Hydrate with NS
- Diuretics
- Biphosphonates, calcitonin
- Inorganic phosphate salts (neutra-phos)
Infection & Nursing Management
- Common sites: lungs, GI tract, mouth, rectum, peritoneal cavity, blood
NM:
- Monitor WBC, wounds, IVs, sepsis
- Report fever, chills, sweating
- Isolate patient in room, no visitors
- Avoid invasive procedures, dental, sex, douching
- Administer Abx after cultures
Bleeding & Nursing Management/Prevention
- Thrombocytopenia (PLT < 100,000)
NM:
- Monitor PLT lab, educate s/sx (bruises, occult blood, AMS)
- Bleed prevention: soft bristle toothbrush, electric razor, fluids, stool softener
- Avoid invasive/IM/IV 1x day & meds that interfere with clots (aspirin)
- Platelet transfusion (benadryl or hydrocortisone to prevent reaction)
Spinal Cord Compression S/Sx & Nursing Management
- Tumor in epidural space causes pressure & motor/sensory issues
- S/Sx: intense local neck/back pain, motor weakness, paresthesia, change in bowel/bladder function
NM:
- Analgesics
- Assess, prevent immobility
- Chemo/radiotherapy
- ROM, bowel/bladder issues
Cancer Pain Management
Analgesics
- Nonopioids: Tylenol, NSAIDs (Ibuprofen, Celecoxib, Indomethacin, Ketorolac)
- Opioids: Morphine, Hydromorphone, Oxycodone, Fentanyl, Methadone, Tramadol
- Nonpharm methods: imagery, relaxation
Risk Factors for Colon Cancer
- Old age
- Fam Hx
- Smoker
- High fat/protein diet
- DM II, IBD
- Males, obesity, AA, Jewish
Treatment & Nursing Management for Colon Cancer
- Surgery: segmental resection, colostomy
NM:
- Optimal nutrition: high calories, protein, carbs; low residue
- Prevent infection: Abx, IV 60 min before surgery
- Fluid volume balance: Monitor I&O, restrict fluids
- Educate/emotional support: appearance, wound, anxiety
Risk Factors for Pancreatic Cancer
- Increases with age, 70-80
- AA males
- Exposure to chemicals or toxins
- High fat or meat diet
- Smoking, alcohol
- Diabetes, pancreatitis, obesity
Treatment & Nursing Management for Pancreatic Cancer
- Gemcitabine
- Surgery
- Chemo/radiation therapy
NM:
- Postoperative care, pain management
- TPN, may need to gain weight, maintain w/ insulin
- Digestive enzyme replacement
AML: Induction therapy & Nursing management
- Chemo destroys leukemic & healthy cells
- Requires hospitalization due to neutropenia possibility
NM:
- Administer PBRCs & platelets
- Promptly treat infections
- Granulocytic growth factors (life-threatening infection)
Hodgkin’s (Prognosis & Treatment)
- Single node, malignant Reed-Sternberg cells
- Excellent cure rate with treatment
- Treatment determined by stage; may include chemo/radiation therapy
Non-Hodgkin’s (Prognosis & Treatment)
- Lymphoid tissues infiltrated with cancerous cells, unpredictable spread
- Increases with age
- Prognosis & treatment depends on type; may include chemo/radiation or interferon
Palliative care vs. Hospice care
Palliative
- Life-threatening illness diagnosed
- Disease not responsive to cure
- Improve QOL, pain management
Hospice
- Death must be accepted
- Pain management
- Patient & family viewed as single unit of care; bereavement care
Patient eligibility for hospice
- Patient made the decision to stop disease-directed therapy
- Focus on symptom relief
- For terminal illness, organ failure, frailty (i.e. dementia)
Competent pain management for end-of-life care
- Education on safe use of opioids; addressing fears & concerns
- Pain management goals
- Treating side effects
- Monitoring risk of opioid misuse
Supportive measures for patient & family during end-of-life
- Respond to difficult questions
- Open-ended statements or questions
- Seek clarification
- Realistic reassurance
- Dealing with grief
- Assess patient preferences
