Lecture 17: Cancer Care Flashcards
how many canadians develop cancer
2/5!!!
What is the biological process of cancer
1.Defects in cellular proliferation
(cell divison of cancer cells)
2.Defects in cellular differentiation
(genes affected by mutation)
Origins of cancer…
1.Genetic
2.Chemical carcinogens
3.Radiation
4.Viral and bacterial carcinogens
5.Unknown causes
what are 4 stages of development of cancer….
1.Latent
2.initiation
3.Promotion
4.Progression
What is latent stage of cancer
1-40 years
-for disease to be clinically relevant, tumour must reach critical mass
What is initiation stage of cancer development…
-Mutation in cell genetic structure
Results from inherited mutation, error in DNA replication or exposure to carcinogens
What is promotion stage of cancer development…
-Reversible proliferation of altered cells
-Activities of promotions are reversible, obesity, smoking, alcohol, dietary fat
What is progression stage of cancer development…
-Increased tumour growth rate
-Increased invasiveness and spread
-Metastatic vibes
Normal cells vs cancer cells
Normal: “HEALTHY”
-Large cytoplasm
-single nucleus
-single nucleous
Cancer: “UNHEALTHY”
-Small cytoplasm
-multiple nuclei
-large nucleos
Benign vs Malignant
Benign: Tumour cells grow only locally not spreading/metastatic
Malignant: Cancer cells invade neighbouring tissues, enter blood vessels and metastasize to different sites!
Classifications of cancer…
-Carcinoma
-Sarcoma
-Blastoma
-Lymphomas
Oncologist… does what
Carcinoma is tissue in skin glands that lines organs
Sarcoma=muscle tissue
Blastoma=cancerous tumour in brain
Lymphomas and leukemias=blood cancer
Oncologist will stage cancer by symptoms and wheres its occuring
Histological analysis…
Grade 1= mild dysplasia
Grade 2= moderate dysplasia
Grade 3=Severe dysplasia
Grade 4= Anaplasia-cells immature an undifferentiated
Staging of cancer (0-4)
0- Non invasive cancer in situ
1-Limited to tissue of orgin, localized tumour growth
2-Limited local spread
3-Extensive local and regional spread
4-Metastasis
TNM classifiaction
T=tumour size
N=lymph nodes
M=Distant Metastasis
Risk factors %
60% of canadians with bad diet
54 % physical inactivity
15% obesity
-Tobacco use
-sun
-unhealthy eating/drinking
What gender is more at an unhealthy weight….. LOL
56% men
39% women
Prevention of cancer… What can we do?
-Reduce sun
-TOBBACO
-Diet
-Exercise
-Healthy weight
-limited alcohol
-cancer screening
-Warning signs
What is really bad thing that causes cancer warn your patients?
Tobbaco doesn’t just cause lungs cancer but also head,neck and bladder and kidney cancer
What are the 7 warning signs of cancer***
C-Change in bowel or bladder habits
A- A sore that dose not heal
U-Unusual bleeding or discharge from body
T-Thickening or lump in breast/anywhere
I-Indigestion or difficulty swallowing
O-Obvious change in mole or wart
N-nagging cough or hoarsness
What are 3 main collaborative care goals of cancer
1.Cure-surgery
2.Control-chemo
3.Palliation-Relief control, maintain quality of life
Factors that determine treatment modality?
-Cell type
-Location and size of tumour
-Extent of disease
-Physiological and psychological status
-Expressed needs and desires
what is the sequence of events to discover cancer and treat….
-Biopsy
-Staging/Grading
-Treatment:
-Prophlaxis
-Cure
-Control
-Palliation
What is the ideal cancer for surgical therapy
-Slow rate of cellular proliferation or replication is ideal for surgical interventions
-Margins of normal cell tissue surrounding tumour must be excised
What is chemotherapy?
-Use
-Goal
-Route of administration
-Use of chemical as systemic therapy for cancer like meds
-Goal is to reduce number of malignant cancer cells in tumour site
-Used for solid tumors and hematological cancers
-All route but MOSTLY IV
What is most common route for chemotherapy
IV (central line preferred)
3 types of chemo
1.Primary: expected to cure or control
2.Adjunct: complements another therapy like radiation
3.Palliative: slow tumor growth for pain control
What should we think about when handling chemotherapeutic agents
- CYTOTOXIC
-Drugs can be absorbed through skin
or inhaled during preparation, transport and administration
-Need training
Cytotoxic 1 and 2 (things….)
1- Cytotoxic agents are primarily eliminated from the patient by renal or hepatic
2-Tablets must be handled in matter in which avoids skin contact and liberation of powdered agents into air
What are some adverse effects of chemo administration…
1.Vesicants
2.Extravasation
3.Flare
4.Infiltration
5.effects on normal tissues
6.Nephrotoxicity
What’s vesicants
Result in tissue necrosis or formation of blisters when accidentally infused
What’s Extravasation
Delivery of a vesicant an agent which can erode or cause permanent damage to tissues
what’s a flare
Localized allergic reaction to chemo
What’s infiltration…
Delivery of a non-Vesicant or irritant into surrounding tissues
What’s nephrotoxicity + symptoms
Chemotherapy drugs can damage glomerulus renal tubules, interstitium or microvasculature
-Need kidney function
-Symptoms: Asymptomatic, electrolytes imbalances, FVD
chemo acute effects on normal tissue
N&V, allergic reactions, dysrhythmias, extravasation
chemo delayed effects on normal tissue
mucositis, alopecia, bone marrow suppression, delayed N&V, skin rashes, altered bowel function
chemo chronic effects on normal tissue
damage to heart, liver, lungs, kidneys
nausea and vomiting with chemo
- acute or delayed
- activation of chemical receptors in the chemoreceptor trigger zone of medulla
- can also experience anticipatory N&V
what is the #1 thing to pre-medicate pt w for nausea and vomiting
Ondansetron
helps w sleeping gets rid of N&V
how does chemo affect WBC
- xtra attention for prevention/exposure to infection during periods of neutropenia
- signs and sympt of infections +/- temperature
how does chemo affect RBC
- may require transfusions
- SOB/weakness
how does chemo affect platelets
experience prolonged bleeding
chemo cognitive dysfunction and psychosocial changes
- short term memory loss
- diff concentrating
- problems w task completion
- alterations in self image
- stress, fear, uncertainty
what are the goals of radiation therapy
cure, control palliation
local treatment modality
effects of radiation
- cellular damage may be lethal or sublethal
- normal tissues are usually able to recover
- cancer cells are more likely to be permanently damaged
radiation dose depends on
tumour size, and type
what does radiation therapy do
- permits max treatment of tumor w minimal damage to normal tissue
- uses immobilization devices to help client maintain a stable position
what is the simulation part of radiation treatment planning
used to determine optimal treatment method, focuses on size and orientation of radiation beams
what is external radiation (teletherapy)
most common!
- client exposed to radiation from megavolt machine
internal radiation (brachytherapy)
- implantation or insertion of radioactive materials into or close to tumor
- minimal exposure to healthy tissue
- can be used in combo w external radiation
- client is emitting radioactivity
what are some nursing care considerations for brachytherapy
- limit amount of time near pt being treated
- organize care
- shielding should be used
- wear film badge to monitor exposure
- clients should understand needs for time and distance restriction on health care providers
3 components of brachytherapy-safety
timing, distance, shield
general nursing management considerations for radiation therapy and chemo
- fatigue (plan for activities, incorporate rest periods)
- anorexia (peaks @4 weeks, small frequent meals, weigh 2x weekly)
- bone marrow suppression (prone to infection, bleeding, and overwhelming exhaustion)
- integumentary and mucosal reactions
- dry reactions to radiation (lubricate w non-irritating lotion or solution)
- wet reactions to radiation (must be kept clean, protect further damage, saline-soaked gauze)
what are the pulmonary affects of chemo and radiation + nursing management
- acute pneumonitis (radiation): bronchodilators, rest, o2 therapy
- interstitial fibrosis (radiation)
- pneumonia (chemo)
specific integumentary and mucosal reaction considerations
- erythema 1-24hrs post initial treatment - loos clothing,prevent exposure to sunlight, prevent exposure to extreme cold/hot
- dry desquamation
- wet desquamation
- taste loss
GI disturbances from chemo and radiation + nursing management
- intestinal mucosa one of the most radiosensitive
- antiemetic (metoclopramide, ondansetron, dexamethasone)
- anti-diarrheal (imodium, lomotil)
reproductive effects during chemo and radiation + nursing management
if radiation is delivered near pelvis, or high dose chemo
- low sperm count, aspermia, or deceased motility (sperm banking)
- no avenue to repair ovarian functioning (if children bearing collect eggs)
- proper shieling, counselling, pre-treatment harvesting
late effects of radiation and chemo
- increased risk for leukemia and other secondary malignancies (low)
- fibrosarcomas have been reported several yrs after radiation therapy
what do you put on dry desquamation
put on saline, moisturizer
what do you put on wet desquamation
put on gauze
- what is biological therapy?
- what are the 3 ways tumor cells are altered from these agents
- use of biological agents (interferon, interleukins, monoclonal antibodies, and growth factors)
- direct antitumor effects (tumour cell death)
- restore, augment or modulate host immune system mechanisms
- interfere w cancer cells ability to metastasize or differentiate
- what is targeted therapy
- example
- effective alone +/- surgery, radiation, and chemo
- targets and binds cell receptors important to tumour growth
- able to kill tumor cells without damaging normal cells
- ex: monoclonal antibodies (Rituximab)
bone marrow and peripheral stem cell transplantation
1. what is the goal
2. how can it be donated
3. what is bone marrow transplant allow
4. what is peripheral stem cell transplantation
- goal is cure and remission
-
can be donor or own stem cells
- allogeneic (donor)
- autologous (own) - allows safe use of high doses of chemotherapy or radiation therapy
- differs from BMT in stem cell collection method, peripheral stem cells collected by cell separator machine, fewer and less severe complications, less invasive method
what does bone marrow suppression reduce and what is pancytopenia
reduced blood cell production
pancytopenia: decreased RBCs, white blood cells and platelets
- what does thrombocytopenia do to the number of circulating platelets
- causes
- normal platelet count
- decrease in the # of circulating platelets
- causes: diseases related
- 150-400 X 109/L, critical value is <50
what is thrombocytopenia
manifestations of internal bleeding: weakness, fainting, dizziness, tachycardia, abdominal pain, hypotension
major complication is hemorrhage: insidious, acute, internal, or external
what drug should you avoid w thrombocytopenia
avoid aspirin
preventative measures of thrombocytopenia
- avoid sharp objects
- avoid invasive procedures
- apply direct pressure to all needle sites
- use soft toothbrush and gentle friction
- no flossing
- institute safety measures
- report HA or changes in LOC (beware of brain bleeds)
how do we monitor thrombocytopenia complications
- check lab values
- assess skin and mucous membranes
- assess for frank blood
- check for occult blood
- check sites (IVs)
- what is leukopenia
- causes
- decrease in total # of circulating leukocytes especially neutrophils (neutropenia)
- disease or treatment related
causes risk of low WBC count
- what is the normal value of CBC for neutrophils
- what are the values for neutropenia
- what are the critical values
- 2.5-7.5 x 10^9/L
- <1.5 x 10^9/L
- <0.5 x 10^9/L
how is febrile neutropenia defined
- fever higher than 38.3 celsius OR high than 38 degree fever for more than 1 hr in a pt who has:
1. received chemo in the past month AND
2. neutrophils less than 0.5 x10 cells/L - a minor infection can quickly become serious
signs and sympt of febrile neutropenia
- chills and diaphoresis
- cough, sore throat or new mouth sore, SOB
- nasal congestion
- burning or pain w urination, urinary fequency
- unusual vaginal discharge or irritation
- redness, soreness, or swelling in any area
- diarrhea, vomiting, pain, etc
nursing care for febrile neutropenia
- try and decrease risk of exposure to endogenous organisms
handwashing, limit exposure/avoid crowds, private room, cooked food only, aseptic technique
what is anemia
- a decrease in Hgb or circulating erythrocytes
- disease/treatment related
- occurs when loss of destruction exceeds production of RBCs
anemia sympt
- malaise
- pale skin and nails
- dizziness
- SOB
- fatigue
- tachycardia
- chest pain or palpitations
- feeling cold or chilled
- headache
what is the most common sympt of anemia
FATIGUE
most reliable source of info in a pain assessment
the PATIENT
what is the best pharmacological intervention for pain
opioids
what are other complications of chemo
- stomatitis: stoma problem
- mucositis: mucus problem
- xerostomia
- parotitis
- gingivitis
assessment of mouth for “other” complications for chemo
- lips, tongue, mucous membrane, teeth, saliva, ability to swallow, voice
- gloves, gauze sponges, tongue depressor, and flashlight
