Ch. 20 Concepts of Care for Patients w/ Cancer

Question 1

Cancer Management

Answer 1

Purpose is to cure or control disease while minimizing the side effects of therapy

Question 2

Impaired Immunity & Clotting

Answer 2

Bone marrow dysfunction

Cause: disease or chemo

Question 3

Altered GI Function

Answer 3

Increase metabolic rate w/ wt. loss/cachexia (body wasting & malnutrition)

Malnutrition, constipation

Obstruct or compressed tumors

Question 4

Altered Peripheral Nerve Function

Answer 4

Chemotherapy-induced peripheral neuropathy (numb, pain, ataxia)

Cause: disease or chemo

Question 5

Motor & Sensory Deficits

Answer 5

Bone invasion/ brain tumor/ compress nerve

Bone mets: fracture risk, pain, mobility

Question 6

Altered Respiratory & Cardiac Function

Answer 6

Airway obstruction, hypoxia

Pleural effusion, radiation and chemo affect cardiac function (CAD, pericarditis, HTN)

Loss of cardiac muscle mass (HF)

Question 7

Radiation Therapy

Answer 7

The use of high-energy radiation to kill cancer cells minimizing damage to healthy tissue

Factors: intensity, duration, & distance

Series of treatments divided doses over a period of time

Question 8

Radiation Therapy Goal

Answer 8

Greater destruction of cancer cells while reducing normal tissue damage

Question 9

External Beam Radiation

Answer 9

Outside pt/specific markings

Tattoo ink, mesh mask, precise delivery

Common cancers use - head and neck area, breast, lung, colon, prostate, brain, skin, esophageal

Question 10

Internal Devices (Brachytherapy) Radiation

Answer 10

Radioactive isotopes in solid form or w/in body fluids

Implanted radiation source (seeds, ribbons, capsules)

High dose vs low dose rate continuously

Common cancer use - head and neck cancers, breast, cervix, prostate, eye

Question 11

Radiation Therapy Safety & Priorities

Answer 11

Private room w/ door closed w/ precaution sign

Dosimeter badge

Lead apron/no pregnant RN

Visitors: 1/2 hr per day

Hazardous waste

Question 12

Radiation Therapy Acute Effects

Answer 12

Brain - swelling, nausea, confusion, hair loss

Head/Neck - difficulty or pain w/ swallowing; malnutrition; wt. loss; reduced oral intake; damage salivary glands and cause dry mouth

Breast/Chest wall

Abdomen/pelvis

Eye

Question 13

Radiation Therapy Long-Term Effects

Answer 13

Neuro

Head/neck

Lung - pulmonary fibrosis

Heart - cardiomyopathy

Breast/Chest wall

Abdomen/Pelvis

Soft tissue

Question 14

Radiation Therapy Local Side Effects

Answer 14

Radiation dermatitis (common)

Site of external beam - red, rash, desquamation (skin peeling/shedding)

Question 15

Radiation Therapy Systemic Side Effects

Answer 15

Fatigue

Bone marrow suppression

Immunity reduction

Question 16

Nursing Priorities & Interventions w/ Radiation Therapy

Answer 16

Airway and swallowing issues if radiation in head, neck, throat, upper chest

Normal tissues sensitive to radiation

Skin breakdown w/ high risk of infection

Care of tattoo

Avoid tight clothing and friction

Good hygiene and risk of tooth decay

Only lotion on area by MD

Increase sunset - limit exposure

Fatigue and insomnia

Question 17

Chemotherapy/Cytotoxic Systemic Therapy

Answer 17

Used to kill cancer cells and disrupt cellular regulation

Determined by tumor type, tumor markers, growth rate of cells, and pt status

Typically IV (CVAD)

Other routes - CSF, Intra-peritoneal, Intra-arterial, infused beads

Question 18

Precautions & Complications w/ Chemotherapy

Answer 18

Topical risks to nurses/pharmacists in preparation

PPE, eye protection, double or chemo gloves, gown

Extravasation - pain, infection, tissue loss

PO drugs - toxic in handling; education to home care pt; disposal of drugs; do not crush, split, break, or chew

Question 19

Neutropenia Precautions

Answer 19

Infection risks from reduced immunity, neutropenia, bone marrow suppression

Importance of neutropenia signs

Question 20

What should be reported immediately to PCP if pt has neutropenia?

Answer 20

Fever over 100.4/38.0

Question 21

Neutropenic Precautions

Answer 21

Cleans hands before entering and when leaving room

Avoid raw or under cooked fruits and vegetables; raw or undercooked eggs or shellfish

No live flowers or plants

Do not enter if feeling unwell

Question 22

Acute Side Effects of Chemotherapy Drugs

Answer 22

Nausea/Vomiting (chemotherapy induced nausea and vomiting (CINV))

Peripheral Neuropathy (chemotherapy induced peripheral neuropathy (CIPN))

Mucositis - mouth sores or thrush; monitor fluid status and nutrition

Alopecia - hair loss

Changes in cognitive function - memory loss, “chemo brain”

Psychosocial concerns - sleep issues, anxiety

Age related concerns

Question 23

Nausea/Vomiting (chemotherapy induced nausea and vomiting (CINV))

Answer 23

Prevention of N/V prior, during, and after treatment

Common meds - zofran, dexamethasone

Question 24

Peripheral Neuropathy (chemotherapy induced peripheral neuropathy (CIPN))

Answer 24

Sensory perception or motor function

Gait, ataxia, taste loss, numbness feet/hands, prevention of injury, erectile dysfunction

Question 25

Complications of Chemotherapy Drugs

Answer 25

Anemia > hypoxia

Thrombocytopenia > clotting & bleeding

Bladder toxicity > hemorrhagic cystitis

Cardiotoxicity & pulmonary toxicity > HF

Question 26

Acute Complications of Cancer or Cancer Treatment

Answer 26

High risk for sepsis (low WBC) & DIC (excessive bleeding)

SIADH > paraneoplastic phenomenon - fluid balance or restriction, low Na

Spinal cord compression - neuro deficits/monitor neuro

Multiple myeloma/Bone metastasis - hypercalcemia

Tumor lysis syndrome - massive cancer cell destruction; AKI, high K, high uric acid, high phos

Question 27

Patient Education for Chemotherapy Patients

Answer 27

Hand-washing, PPE
Avoid crowds, bath daily
Wash foods
Cough, urine issues, CVAD issue monitor
Sepsis
Report of fever, infection symptoms, rash, skin changes