cancer Flashcards
cancer care
purpose is to prolong survival time and improve quality of life
TNM staging
Tumor size and extent
Nearby lymph nodes
Metastasized
stage 0 - abnormal cells but not spread
stage 4 - spread distal parts
grade X - cannot be assessed
G1 - well differentiated
G4 - undifferentiated
surgeries
curative - removal all cancer tissue and associated lymph nodes
palliative - improve quality of life. reduce pain, relive obstructions, prevent hemorrhages
post-op care:
- pain management
- early mobility - get pt up as soon as they can
- assess tubes and drains
- psychosocial support - grieving, fear, depression
chemotherapy
goal: destroy cancer cells without excessive destruction of normal cells
- disease is wide spread and cannot be removed or is resistant to radiation
- allows time for normal cells to recover but not enough time for cancer cells to recover
- dosage is determined by type of cancer and patient size
- higher dose more for aggressive cancer
- lasts months 4-12 times every 3-4 weeks
- absorbed through skin and mucous membrane so use safe handling precautions
- needs two nurses to ID chemo- npsg
- chemo = toxic to everyone
chemo nursing care
- specialty gloves, double gowns if handling body secretions
- pts excrete chemo in saliva, fluids, and skin
- fluids considered a biohazard
- tell pt to not skip doses
- kills rapidly dividing cells
- assess bone marrow suppression
- neutropenia - low WBC (priority care is prevent pt from infection)
- thrombocytopenia - low platelet. (don’t give nsaids, check toothbrush for blood and soft bristles, use electric razor)
- anemia - low RBC (iron supplement, possibly o2 therapy, allow rest time
- GI N/V - provide antiemetics
- alopecia/hair loss
- prevent bleeding, mouth care, cognitive changes (chemo brain), bone pain
neutropenia care
- CBC and WBC counts daily
- nadir (low point neutrophil count) - 7-14 days post chemo – tell pt to avoid being around sick ppl
- ANC less than 500-1000 (anc = wbc x neutrophils)
- private room, masked visitors
- limit people and health care personnel in room
- vitals q4
- change iv tubing daily
- avoid catheters
- good nutrition
- don’t share
- antimicrobial soap
- clean toothbrush weekly - dishwasher
- avoid crowds
- avoid raw foods
- avoid fresh cut flowers
- don’t reuse things w/o washing
- report if… persistent cough, temp over 100, foul smell drainage, boils or abscess, foul smell urine
- use condom
thromboytopenia
- handle gently
- avoid im injections
- smallest gauge needles
- ice to trauma
- report bleeding/bruising
- no enemas
- electric shavers
- soft toothbrush
- caution blowing nose
- protect from falls
- avoid aspirin or nsaids
- limit contact sports
- avoid hard foods
- notify pcp is excessive bleeding
- stool softener
- do not wear tight clothing
- avoid intracranial pressure
antiemetics
- give before during and after chemo
- teach pt to take at first sign n/v
- ondansetron iv/po
radiation
goal: destroy cancer cells and minimize damage to normal cells
- damages dna of cancer cells – rapid dividing cancer cells are more sensitive to radiation
- local therapy, adjuvant w/ chemo
- stay far away from radiation source and shield
- give in small doses more frequently
external radiation
teletherapy
- radiation beam pointed at tumor
- done over several wks, 5 days then rest on wkends to all normal tissue to repair
- pt is not radioactive or hazardous to others
internal radiation
brachytherapy
- direct and continuous contact
- radioactive isotopes placed inside pt near tumor at a higher dose
- pt emits radiation for period of time and is hazardous to others (after isotope is gone then no longer radioactive)
- unsealed: taken orally and excreted in wastes
- radioactive implant: pt needs private room, portable led shield, wear lead apron, 30 min visit, 6 ft away, never touch with bare hands
side effects radiation
- vary to site
- local hair loss (likely permanent)
- altered taste sensations bc metabolites released
- fatigue bc increased energy demands
- inflammatory responses leading to tissue fibrosis and scarring
- bone marrow suppression
SVC syndrome
obstruction of the superior vena cava by lymph nodes and tumors
s/s: HA, confusion, facial swelling, dyspnea
- appearance veins on face, neck, upper arms, chest
- life threatening symptoms: stridor, respiratory compromise, depressed central NS
- stabilize secure airway to support with breathing and circulation
- prepare for emergency endovenous recanalization
tumor lysis syndrome
emergency caused by massive tumor cell dealth with relsease of large amounts potassium, phosphate,and nucleic acis into systemic circulation leading to n/v, anorexia, diarrhea, lethargy, hematuria, muscle cramps, hf, cardiac dysrthymias
- give insulin to drive potassium into the cells along wtih dextrose to maintain bg
- happens most often with first cycle chemo
hospice
approach that addressed holistic needs of pt and families to facilitate quality of life and peaceful death
- provide care centers for terminally ill pts in a home-like, non- institutional environment
- symptoms and pain management, emotional, spiritual support for individual and family
