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
palliative care
- focus on controlling symptoms as compared to curative measures
- relieve pain and support best possible quality of life
- death is normal process that should be left to run its course
- does not mean abandonment
- pain control, bowel and bladder function, anxiety, nutrition, comfort care
types advanced directives
living will - describing medical interventions preferred when unable to make decisions in future
physician order of life sustaining treatment - order completed by provider for seriously ill pt describing tx the pt does and does not want
durable medical power of attorney - person designated by pt to make their medical decisions on pt behalf
DNR - legal document stating preference to not receive life sustaining tx or measures
DPOA for health care
someone else is appointed as health care proxy to make pt health care decisions when individual no longer can
nursing care for dying pt
- assess symptoms distress in collab w family
- pain, discomfort
- cultural sensitivity
- spiritual
- psychosocial
- physical signs
interventions:
- pain management
- atropine and morphine
- oxygen therapy
- important to active listen - want to tell their life story , participate in their final act of living
- finding meaning and purpose in life
signs approaching death
- skin cold, cyanotic
- bp decreases
- hr increases, irregular, decreases, and stops
- cheyne-strokes breathing
- cool extremities
- increased sleeping
- incontinence
- decreased food/fluid intake
- restlessness
- disorientation
euthanasia
- must have 6 months or less to live
- death by act - giving medication by themself not by nurse
