Cancer

Question 1

Disease Related Consequences of Cancer

Answer 1

• Always affects a person’s physical & psychological functioning & stresses the family
• Cancers left untreated often cause:
  > reduced immunity & blood-producing funcs
  > altered GI structure & func
  > motor & sensory deficits; “chemo brain”
  > reduced gas exchange

Question 2

Radiation Therapy

Answer 2

• Purpose:
  > destroy cx cells & have minimal damaging effects on surrounding normal cells
• Types:
  > most radiation is ionizing radiation; causes cells to die or become unable to divide
  > Gamma Rays: used most commonly bc of their ability to deeply penetrate tissues
  > Beta Particles: are weaker & must be placed w/in or very close to cancer cells

Question 3

Teletherapy

delivery type of radiation

Answer 3

• Radiation delivered from a source outside of pt
• Delivered in sm doses on a daily basis for set time period
• Pt is not radioactive

Question 4

Brachytherapy

delivery type of radiation

Answer 4

• Radiation source is w/in pt
• Sealed or unsealed
• In brachytherapy the pt emits radiation for a period of time & is a potential hazard to others
• Sealed: pt emits radiation when implant in place
• Unsealed: pt body fluids are radioactive & must be handled according to guidelines

Question 5

Radiation Therapy Side Effects

Answer 5

• Skin changes
• Hair loss
• Altered taste sensations
• Fatigue
• Inflammation of tissue leads to tissue fibrosis & scarring
• Other effects depend on area exposed to radiation

Question 6

Radiation Therapy - Nursing Interventions

Answer 6

• Explain purpose & side effects of radiation therapy
• Skin care
• Instruct pt not to remove any temporary ink markings until entore course of radiation therapy is completed
• Follow department’s policy regarding use & timing of skin care products

Question 7

Chemotherapy

Answer 7

• Typically given every 3-4 weeks for a specified # of times
• Typically given IV
  > extravasation (infiltration) of drug into surrounding tissue is a serious comp
  > close monitoring is critical for prevention of extravasation

Question 8

Chemotherapy Side Effects

Answer 8

• Result of systemic effects of damaging normal cells as well as cx cells
• Anemia
  > dcrd #s of RBCs & Hgb
• Neutropenia
  > dcrd #s of WBCs leading to immunosuppression
• Thrombocytopenia
  > dcrd # of platelets
• N/V
• Mucositis (sores in mouth)
• Alopecia/hair loss
• Skin changes
• Anxiety
• Sleep distrubances
• Altered bowel elimination
• Changes in cognitive func
• Psychosocial issues

Question 9

Neutropenia Interventions

Answer 9

• Prevention of infection is critical since bone marrow func is suppressed
• At extreme risk for sepsis
  > can lead to death during treatment
• Encourage pt to report symps:
  > skin & mucous membrane changes
  > cough
  > burning on urination
  > pain around venous access site
  > new drainage from any body area
• Strict hangwashing procedures
• Use aseptic technique w/ any invasive procedure
• Consider any temp elevation a sign of infection
• Instruct pts to avoid crowds & sick ppl
• Monitor WBC & ANC (absolute neutrophil count)
• Admin Filgrastim (Neupogen) as needed

Question 10

Anemia Interventions

for chemo

Answer 10

• Monitor pt for anemia
  > fatigue
  > hypoxia
• Admin of erythrocyte stimulating agents (ESA) can prevent or improve anemia
  > EX: Darbepoetin alpha (Aranesp), epoetin alfa (Epogen)
• Blood transfusion is common

Question 11

Thrombocytopenia Interventions

for chemo

Answer 11

• Monitor pt for thrombocytopenia
  > bruising
  > bleeding
• Transfusion of platelets may be required
• Admin of growth factor for platelet
  > EX: Oprelvekin (Neumega)
• Follow best practice for prevention of injury for pt

Question 12

Chemotherapy - Nursing Interventions

N/V
mucositis
alopecia
cognitive changes

Answer 12

• N/V
  > ensure antiemetics are given b4 chemo
• Mucositis
  > frequent mouth assessment & oral hygiene
  > use soft-bristle toothbrush, clean weekly, no sharing
• Alopecia
  > reassure pts tht hair loss is temporary
  > give resources fro support coping w/ changes in body image
• Cognitive Changes
  > support pt tht reports a change in cognitive therapy
  > “chemo brain”: difficult w/ concentration, mem loss, learning new info
  > warn pts against participating in activites like: excessive alcohol intake, recreational drug use, & activities tht incr risk for head injury

Question 13

Chemotherapy Induced Peripheral Neuropathy (CIPN) Interventions

Answer 13

• Teach them how to prevent injury
• Protect feet & other body areas wehn sensation is reduced
• Well-fitting shoes
• Inspect feet daily
• Avoid extremes of temperature
• Test water temperature
• Use potholders when cooking
• Use gloves when washing dishes or gardening
• Eat foods high in fiber, increase fluid intake unless restricted
• Stand up slowly
• Avoid area rugs
• Use handrails when using stairs