Med-Surg: Cancer Treatment Options Flashcards
1
Q
Tumor Reduction
A
can be done through topical procedures (cryosurgery, laser therapy, ablation) or by destruction of the main arteries that provide blood flow to the tumor (artery embolization)
2
Q
Tumor Excision
A
can be open or endoscopic (curettage and electrodissection for skin cancer)
- the tumor and tissue immediately surrounding it (tumor margin) are removed; Goal: all of the outermost tissue that was removed does not contain cancer cells (a negative margin)
- surgery can be done for biopsy (diagnosis and staging), or relief (palliative)
3
Q
Lymph Node Dissection
A
or sentinel lymph node biopsy
-done to determine if the cancer has spread or there is added risk of spread
4
Q
Chemotherapy
A
involves administration of systemic or local cytotoxic medications that damage cells DNA or destroy rapidly dividing cells
5
Q
Chemotherapy Route
A
- given topical (for skin lesions), oral, parenteral, IV, intra-arterial, intraventricular (ventricles of the brain), intracavitary which includes intraperitoneal (abdominal cavity), intravesicular (into bladder), intrapleural (into pleural space), and intrathecal (into spinal cavity)
- specialized training for administration
- oral anticancer medications are just as toxic to the client taking the medication and the nurse handling the medication as are standard chemotherapy medications
- oral medications should not be crushed, split, broken, or chewed
6
Q
Chemotherapy: Catheters
A
a central catheter is usually placed for IV chemotherapy administration or blood testing
- some medications can cause damage to the skin and muscle tissue if they leak outside a vein (vesicants)
- a port is implanted for long-term basis
7
Q
Chemotherapy: Nursing Actions
A
- instruct client on proper use of vascular access devices
- instruct family to dispense oral medications directly into a cup and not to touch pills or liquids with the hands
- closely monitor IV infusions and provide immediate treatment or extravasation; identify the antidote for medication client is receiving
8
Q
Chemotherapy Complications
A
- immunosuppression/neutropenia
- nausea, vomiting, anorexia
- alopecia
- hypersensitivity
- oral mucositis
- anemia/thrombocytopenia
- peripheral neuropathy
- cognitive impairment
9
Q
Chemotherapy Complications: Immunosuppression/Neutropenia
A
due to bone marrow suppression by cytotoxic medications
- pts with neutropenia might not develop a high fever or have purulent drainage even when infection present
- risk of serious infection increases as the absolute neutrophil count (ANC) falls. An ANC less than 1,000/mm3 = weak immune system and need to initiate neutropenic precautions
> Nursing:
- monitor temperature, WBC count, and ANC
- report fever greater than 100 Degrees F to provider
- monitor skin and mucous membranes for infection (breakdown, fissures, and abscess)
- obtain cultures prior to initiating prescribed antimicrobial therapy
> Client Education:
- avoid crowds while undergoing chemotherapy
- take temperature daily. report elevated temp
- avoid food sources that could contain bacteria (fresh fruits and vegetables, undercooked meat, fish, and eggs, pepper, and paprika)
- avoid yard work, gardening, or changing a pet’s litter box; wear disposable gloves when working with house plants or outdoor gardening
- discard liquid beverages that have been sitting at room temperature for longer than 1 hr
- wash all dishes in hot, soapy water or a dishwasher
- wash glasses and cups after each use
- wash toothbrush daily in the dishwasher or rinse in a bleach solution
- do not share toiletry or personal hygiene items with others
- report manifestations of bacterial or viral infections immediately to the provider
10
Q
Neutropenic Precautions
A
- assign a private room; have client remain in the room unless they need to leave for a diagnostic procedure or therapy; place mask on client during transport
- protect from sources of infection (live plants, stagnant water, contaminated equipment)
- perform hand hygiene
- restrict visitors who are ill
- avoid invasive procedures that could cause a break in tissue (rectal temperatures, injections, indwelling urinary catheters) unless necessary
- keep dedicated equipment (blood pressure machine, thermometer, stethoscope) in clients room
- administer colony-stimulating factors (filgrastim) to facilitate WBC production
11
Q
Filgrastim
A
facilitate WBC production
filgraSTIM
12
Q
Chemotherapy Complications: Nausea, vomiting, anorexia
A
many medications used for chemotherapy are emetogenic (induce vomiting) or cause anorexia and an altered taste in the mouth
> Nursing Actions:
- ensure antiemetics are given before chemotherapy and repeated based on the response and duration of CINV
- administer antiemetic medications several days after each treatment, even when CINV appears to be controlled
- remove vomiting cues such as odor and emesis basins
- nonpharmacological methods to reduce nausea (visual imagery, relaxation, acupuncture, distraction)
- calorie counts to determine intake; provide liquid nutritional supplements as needed; add protein powders to food or tube feedings
- administer megestrol to increase appetite if prescribed
- assess for dehydration and fluid or electrolyte imbalance
- perform mouth care prior to serving meals to enhance appetite
> Client Education
- some antiemetics can provide prophylactic treatment if given before meals
- eat several small meals a day if better tolerated
- eating low-fat dry foods (crackers, toast) and avoiding drinking liquids during meals can prevent nausea
- select foods that are served cold and do not require cooking; cooking food can emit odors that stimulate nausea
- encourage consumption of high-protein, high-calorie, nutrient-dense foods
- avoid low or empty calorie foods; use meal supplements as needed
- use plastic eating utensils, suck on hard candy, and avoid consuming red meat to prevent or reduce the sensation of metallic taste
- create food diary to identify items that can trigger nausea
13
Q
Chemotherapy Complications: Alopecia
A
hair loss
- temporary
- can vary, can occur anywhere on the body
> Nursing Actions:
- discuss effect on self-image
- discuss options (hats, turbans, wigs) to deal with hair loss
- reinforce that hair should return about 1 month after chemotherapy is d/c; new hair can differ from original hair in color, texture, and thickness
> Client education
- hair loss occurs 7 to 10 days after treatment begins
- avoid use of damaging hair care measures (electric rollers, curling irons, hair dye, permanent waves)
- a soft hair brush or wide-tooth comb for grooming
- consider cutting the hair short before treatment to decrease weight on hair follicle
- consider collaborating with hairdresser to assist with wig selection; wearing a wig before therapy begins can reduce appearance changes
- after hair loss, protect scalp from sun exposure and use a diaper rash ointment/cream for itching
- use head coverings to reduce body heat loss and protect skin while wearing helmets, headphones, headsets, or wigs
14
Q
Chemotherapy Complications: Hypersensitivity
A
reactions can occur as early as 1 hr following infusion but possible after several doses
> Nursing:
- stop medication immediately if manifestations of hypersensitivity occurs
- assist with administration of emergency treatment
> client education
- watch for and report indications of hypersensitivity reaction immediately
- if hypersensitivity occurs, desensitization to the medication might be required so that the client can continue to receive the treatment most appropriate to combat the cancer
15
Q
Chemotherapy Complications: Oral mucositis
A
inflammation in the mucous lining of the upper GI tract from the mouth to the stomach
> Nursing:
- examine clients mouth several times a day, and inquire about presence of oral lesions
- document the location and size of lesions; for new lesions obtain a specimen for culture and report to provider
- avoid using glycerin-based mouthwashes or swabs; nonalcoholic, anesthetic mouthwashes recommended
- administer topical anesthetic prior to meals
- discourage consumption of salty, acidic, or spicy foods
- offer oral hygiene after and before meals
- use lubricating or moisturizing agents to counteract dry mouth
> Client Education:
- rinse mouth with a solution of 0.9% sodium chloride, room-temperature tap water, or salt and soda water
- gentle flossing and brushing using a soft-bristled toothbrush or foam swabs to avoid traumatizing the oral mucosa
- rinse mouth before and after meals
- avoid mouthwash that contains alcohol or other irritants
- take medications to control infection (nystatin suspension, acyclovir)
- follow recommendations regarding use of coating agents, topical analgesics, topical anesthetics, or oral parenteral analgesics
- choose soft, bland foods and supplements that are high in calories (mashed potatoes, scrambled eggs, cooked cereal, milk shakes, ice cream, frozen yogurt, bananas, and breakfast mixes)
- avoid spicy, salty, acidic, rough, or hard food
- avoid drinking alcohol and the use of tobacco
- drink at least 2 L of water per day unless there is a fluid restriction
