Care of Patients with Cancers Flashcards
Cancer cells are abnormal mutations of normal cells and are harmful to body tissues
Cancers are either solid or hematologic
Cancers are classified by the type of tissue they arise from or primary site
Cancers are graded based cellular aspects of cancer
Cancers are staged based on the location of the tumor and degree of metastasis at diagnosis
Cancer
Cell growth is rapid
Cells can have “infinite” life span
Cells can migrate easily(metastasize)
Cancer cells are abnormal mutations of normal cells and are harmful to body tissues - Cancer
Solid: develop from specific tissues
Hematologic: develop from blood cell forming tissues
Cancers are either solid or hematologic - Cancer
Some cells are more likely to metastasize - some more malignant so cellular type drive treatment
Cancers are graded based cellular aspects of cancer - Cancer
TNM system (Tumor (size); Node (spread to regional); Metastasis) - depending on staging depends on treatment available
Cancers are staged based on the location of the tumor and degree of metastasis at diagnosis - Cancer
Always affects a person’s physical and psychological functioning & stresses the family - social; address holistically
Cancers left untreated often cause:
Disease related consequences of cancer
Reduced immunity and blood-producing functions
Altered GI structure and function
Motor and sensory deficits-“chemo brain”
Reduced Gas Exchange
Cancers left untreated often cause: - Disease related consequences of cancer
Purpose: to prolong survival time or improve quality of life
Cancer therapy includes: - use in combo
Therapies may be used separately or in combination
Types of therapy used depends on the specific type of cancer, whether the cancer has spread, and the health of the patient
Cancer management
Surgery
Radiation
Chemotherapy
Hormonal therapy - manipulate certain hormones because affect certain tissues
Photodynamic therapy - laser; reduce tumors
Immunotherapy - immunosuppressants to trigger immune sys to target cancer
Molecularly targeted therapy - less AE on other body tissues; block blood supply to tumors
Gene therapy - alter genes and put back in so not cont produce
Cancer therapy includes: - use in combo - Cancer management
Removal of diseased tissue - lymph nodes and prophylactic tissues
Prophylactic surgery
Diagnostic surgery (biopsy)
Curative surgery
Surgery alone can result in a cure rate of 30%
Surgery
Removes “at-risk” tissue to prevent cancer development
Prophylactic surgery - Surgery
Removal of all or part of a suspected lesion for examination and testing
Diagnostic surgery (biopsy) - Surgery
Removes all cancer tissue
Often do something else with it
Curative surgery - Surgery
Physical needs are similar to those related to surgery for other reasons
Provide emotional and spiritual support
Encourage expression of concerns
Monitor for bleeding, infection, dehiscence
Consider chemo and psychosocial impact
Help the patient accept changes in appearance or function
Provide information about support groups
Coordinate with PT/OT to plan strategies for regaining or maintaining optimal function
Surgery: post-op care
Purpose:
Types:
Radiation delivery types
Side effects:
Radiation therapy
Destroy cancer cells and have minimal damaging effects on the surrounding normal cells
Target rapidly producing cells
Purpose: - Radiation therapy
Most radiation is ionizing radiation
Causes cells to die or become unable to divide
Types: - Radiation therapy
Teletherapy:
Brachytherapy:
Radiation delivery types - Radiation therapy
Radiation delivered from a source outside of the patient
Delivered in small doses on a daily basis for a set time period - minimal amount of tissue damage
Patient is not radioactive - nothing inside of them
Teletherapy:
Radiation source is within the patient
Sealed or Unsealed
In brachytherapy the patient emits radiation for a period of time and is a potential hazard to others
Sealed: patient emits radiation when implant in place
Unsealed: patient body fluids are radioactive and must be handled according to guidelines
Brachytherapy:
Skin changes - severe; teletherapy more sig
Hair loss
Altered taste sensations - mucous membranes affect
Fatigue
Inflammation of tissue leads to tissue fibrosis and scarring - forever have inflammation and fibrosis
Other effects depend on the area exposed to radiation
Side effects: - Radiation therapy
Private room/bath
Place a caution sign on the door: “Caution: Radioactive Material”
If portable shields are used, place them between the patient and the door
Keep the door closed as much as possible
Personnel should wear a dosimeter film badge (measures exposure) at all times
Wear a lead apron while providing care
Pregnant nurses should not care for these patients
If attempting to conceive, do not perform direct patient care regardless of whether you are male or female
Pregnant women or children younger than 16 should not visit the patient
Limit each visitor to one-half hour per day
Never touch the radioactive source with bare hands
Save all dressings and bed linens in the patient’s room until after the radioactive source is removed
Other equipment can be removed at any time
Diff - cannot get in and out - sig concern when having these
Radiation therapy: practices for pats with sealed radioactive implants
Must stay at least 6 feet away
Limit each visitor to one-half hour per day
Explain the purpose and side effects of radiation therapy
Skin care - essential: burns and irritated skin
Instruct the patient not to remove any temporary ink markings until the entire course of radiation therapy is completed; get radiation in same area; talk about nutrition and maintaining weight
Follow the department’s policy regarding the use and timing of skin care products
Radiation therapy: nursing interventions - teletherapy
Treatment of cancer with chemical agents
Adjuvant therapy
Drugs used are given systemically and exert cytotoxic (cell-damaging) effects against healthy cells as well as cancer cells
Target rapidly producing cells
Combination chemotherapy
Chemotherapy
Used to cure and increase survival time
Acts by damaging DNA and interferes with cell division
Treatment of cancer with chemical agents - Chemotherapy
Chemotherapy used along with surgery or radiation
Adjuvant therapy - Chemotherapy
More than one specific anticancer drug given in a timed manner
Combination chemotherapy - Chemotherapy
Schedules will vary
Typically given IV
Administration of these drugs requires special education, handling and specific monitoring
Most chemotherapy drugs (even oral) are absorbed through the skin and mucous membranes - wear gloves and appropriate PPE
Anyone handling excreta from patients within 48 hours of IV chemotherapy must use extreme caution and wear personal protective equipment - same with wastes
Oral drugs are just as toxic to the patient and the person handling the drugs - handle appropriately
Chemotherapy: admin
Typically given every 3-4 weeks for a specified number of times
Schedules will vary - Chemotherapy: admin
Extravasation (infiltration) of drug into surrounding tissue is a serious complication
Most important nursing intervention for extravasation (infiltration of drug - adequate IV site is essential) is prevention; close monitoring is critical; make sure working well because damages all tissue
Toxic med and requires special handling and lot edu into it
Other routes may also be used - more PO: make sure handling appropriately - ones cannot be touching with bare hands
Typically given IV - Chemotherapy: admin
Nurses and pharmacists are at risk for absorbing them and must wear PPE
Most chemotherapy drugs (even oral) are absorbed through the skin and mucous membranes - wear gloves and appropriate PPE - Chemotherapy: admin
Result of the systemic effects of damaging normal cells as well as cancer cells
Rapid cell production: chemo side effects
Anemia
Neutropenia
Thrombocytopenia
Nausea and vomiting
Mucositis (sores in mouth)
Alopecia/hair loss
Skin changes
Anxiety
Sleep disturbance
Altered bowel elimination
Changes in cognitive function
Psychosocial issues
Chemotherapy: side effects
Decreased numbers of RBCs and hemoglobin
Suppression blood cells
Anemia - Chemotherapy: side effects
Decreased numbers of WBCs leading to immunosuppression
Suppression blood cells
Neutropenia - Chemotherapy: side effects
Decreased number of platelets
Suppression blood cells
Thrombocytopenia - Chemotherapy: side effects
Neutropenia:
Anemia:
Thrombocytopenia:
Nausea and Vomiting:
Mucositis:
Alopecia:
Cognitive changes:
Chemotherapy Induced Peripheral Neuropathy (CIPN):
Chemotherapy: nursing interventions
Prevention of infection is critical since bone marrow function is suppressed
Encourage look for s/s of infection
Patients with neutropenia are at extreme risk for sepsis
Encourage patient to report any symptoms
Strict handwashing procedures and those around them
Use aseptic technique with any invasive procedure
Consider any temperature elevation a sign of infection
Instruct patients to avoid crowds and sick people and young kids
Monitor WBC and ANC (Absolute Neutrophil Count - indication of neutrophil count: most effective against infection - below certain number then on neutropenic precautions)
Adminster filgrastim (Neupogen) as needed - med SQ stim bone marrow to stim WBC
Neutropenia: - Chemotherapy: nursing interventions
Sepsis can lead to death during treatment
Patients with neutropenia are at extreme risk for sepsis
Skin and mucous membrane changes
Cough
Burning on urination
Pain around the venous access site
New drainage from any body area
Encourage patient to report any symptoms
Monitor patient for anemia - low RBC and HH
Adminstration of erythrocyte stimulating agents (ESA) can prevent or improve anemia
Blood transfusion is common
Anemia: - Chemotherapy: nursing interventions
Fatigue
Hypoxia
Monitor patient for anemia - low RBC and HH
Ex. Darbepoetin alpha (Aranesp), epoetin alfa (Epogen) - stim bone marrow to produce more blood cell
Adminstration of erythrocyte stimulating agents (ESA) can prevent or improve anemia
Monitor patient for thrombocytopenia
Transfusion of platelets may be required
Administer of growth factor for platelet
Follow best practice for prevention of injury for the patient - bleeding precautions
Thrombocytopenia: - Chemotherapy: nursing interventions
Bruising
Bleeding
Around gum line
Monitor patient for thrombocytopenia
Es. Oprelvekin (Neumega)
Administer of growth factor for platelet
Ensure antiemetics are given before chemotherapy - premed imp
Nausea and Vomiting: - Chemotherapy: nursing interventions
Mouth sores; irritation in mouth
Mouthwashes to coat and soothe it
Frequent mouth assessment and oral hygiene
Use soft-bristled toothbrush, clean weekly, no sharing
Mucositis: - Chemotherapy: nursing interventions
Reassure patients that hair loss is temporary
Give resources for support coping with changes in body image
Alopecia: - Chemotherapy: nursing interventions
Support the patient that reports a change in cognitive therapy
“Chemo Brain”: difficulty with concentration, memory loss, difficulty learning new information; safety
Warn patients against participating in activities such as excessive alcohol intake, recreational drug use, and activities that increase the risk for head injury
Cognitive changes: - Chemotherapy: nursing interventions
COMMON and sometimes chronic
Damage cancer drugs
Teach them how to prevent injury
Protect feet and other body areas where 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
Not walk around barefoot
Loss sensation - higher risk for falls
Chemotherapy Induced Peripheral Neuropathy (CIPN): - Chemotherapy: nursing interventions
