Care of a Client with Cancer Flashcards
Goals of Cancer Tx
cure: pt will be free of Ca and have normal lifespan
control: Ca is treated like a chronic disease requiring frequent monitoring of Pt for s/sx of recurrence
palliation: relief of control of sx, focus on quality of life
Surgery
- remove Ca and surrounding tissue
- resect normal tissue w/ tumor as necessary
- regional spread sites may be removed
- debulking: remove as much of tumor as possible
- prophylactic: prevention of Ca
- supportive surgical procedures (PEG tub, colostomy, suprapubic cystosomy)
- palliative surgical procedures: more comfort, not cure (debulking, colostomy/urostomy)
- reconstructive or rehabilitative (restore function of appearance)
Radiation
- local tx used to prevent continued growth of highly mitotic Ca cells
- causes bonds in DNA to break preventing cell proliferation (normal cells are able to recover)
- can be used to cure, control, and for palliation (used to tx benign tumors to stop growth)
- internal radiation (brachytherapy): implantation of insertion of radioactive material directly into or near the tumor (used when needing a higher dose of radiation than normal tissue can tolerate), can be sealed or unsealed
- unsealed (temporary): PO or IV, not confined to a body area and can enter other body fluids, is eliminated in excreta, which can be harmful to others for up to 48hrs
- sealed: temporary or permanent implant in or near tumor, client emits radiation while implant is in place, but excreta is not radioactive
Care of client w/ temporary sealed radiation:
private room with bath
lead shield
dosimeter (nurses wear to see how much radiation they were exposed to over shift)
visitors: <16YO or pregnant (also nurse) not permitted, <30 min/day, 6 ft from pt
Care of client w/ unsealed radiation (up to 48 hours):
care of urine and stool
private room and bath
linens contained in special bags
Chemotherapy
goal is to decrease # Ca cells at primary and metastatic sites and effect cells at different phases in the cell cycle using cell cycle-nonspecific and cell cycle-specific chemo drugs
action = kill Ca cells or inhibit the reproduction of Ca cells
combo of 2 or more is common to maximize response, decrease nadir (point at which RBC, WBC, and platelets is at it’s lowest)
Administering Chemotherapy
response to chemo is determined by:
- Mitotic rate- ↑ response with ↑ mitosis
- Tumor size- > response with decr. Ca cells
- As tumor grows, cells become less active and convert to resting state and not die (chemo less effective)
- Tumor age- ↑ response with young tumor
- Tumor location- more difficult if need to cross BBB
- Resistant tumor cells- variant cells resist chemo
IV Extravasation
Pt should have central line for chemo, b/c extravasation could occur
SE of Radiation and Chemo: Bone marrow suppression
- onset is r/t lifespan of the types of blood cells
- neutrophils: 1-2wks
- platelets: 2-3wks
- erythrocytes: 120 days
occurs more w/ just chemo or with chemo/radiation combo
depends on area being radiated and the type, dosage and nadir of chemo agent being used
thrombocytopenia: watch for s/sx of bleeding, small trauma may cause bleeding (<20,000 = risk for spontaneous bleed)
leukopenia (WBC <4,000)
neutropenia (ANC <1,000) place pt on neutropenic precautions
SE of Radiation and Chemo: Fatigue
- interferes w/ daily living skills
- universal sx affecting most pt w/ Ca
- anemia is one cause
- other causes: accumulation of toxic substances that are left in the body after cells are killed by Ca tx, energy needed to repair and heal body tissue, lack of sleep caused by some chemo drugs
SE of Radiation and Chemo: GI, Anorexia
appetite suppression and the satiety center in brain is affected
- cachexia w/ large tumors
- eating difficulties d/t GI, head and neck Ca’s
- measure weight (2x/week)
- small frequent high caloric, high protein meals
- may need enteral or parenteral nutrition
SE of Radiation and Chemo: GI, N/V
Chemo: n/v occur w/in 1 hour of starting chemo, pre-medicate w/ anti-emetic and continue 48-72 hours post-chemo, encourage hydrations (2 L/day)
Radiation: n/v may occur immediately after first tx, prophylactic antiemetic 1 hour before tx, watch for dehydration, diarrhea d/t bowel radiation (pelvic ration, full bladder may move small bowel away from tx field)
SE of Radiation and Chemo: Oral-esophageal Reactions
Xerostomia- d/t dec saliva l/t dec taste (dysgeusia), teeth hygiene
Dysphagia- Diff swallowing- c/o lump in throat with swallowing
Odynophagia- painful swallowing
Mucositis- irritation, inflammation, ulcer formation of oral mucosa
Candidiasis – fungal infection
Dysgeuisia- loss of taste
Tx of Oral-esophageal Reactions
- Saliva substitutes (OTC or prescription)
- Hygiene before and after meals and hs
- Frequent small amts of water
- Saline gargle ( 1tsp salt in 1L water) bid
- May add 1 tsp baking soda for odor (Bicarb gargle)
- Brushing teeth- soft tooth brush or toothettes
- Flossing may be contraindicated if dec platelets
- Tx with analgesics, antibiotics, topical anesthetics
- BMX solution- Benadryl, Maalox, Xylocaine-at equal -proportions relieve pain
- Avoid- alcohol-or glycerin-based mouthwashes or swabs, hard or spicy foods
SE of Radiation: Skin Reaction
erythema: w/in 1-24 hours of tx followed by dry desquamation (itchy)
wet desquamation: oozing of serum d/t inability of epidermal cells to replace dead cells (discomfort and drainage)
- worse in pressure areas
- painful, drainage, risk of infection
- wash with warm water and pat dry
- expose site to air
alopecia (localized from radiation, if from chemo - usually across whole body)
photosensitivity
PPE (palmar-plantar erthrodyesthesia): hand-foot syndrome, may range from redness and tingling of extremities to severe desquamation, ulcer and blister formation, pain
(if severe, hold chemo for up to 2 wks to allow regeneration)
tx: no lotions/creams unless Rx, soft clothing, avoid sun and heat exposure, observe for wet desquamation
