The Nurse's Role Pt-3 Flashcards
How do we prevent patient’s from developing cancer?
We do that through education and encouraging them to maintain healthy weight and lifestyle. Educating them on what that means, not everybody knows what that means.
There is always stuff in the news about healthy ____ but be cautious because in the past there has not been a lot of research behind them. It’s people saying eat this or eat that, and you think that it makes sense, but recently in the news there has been a lot of talk about the _______ diet and I do believe that there is research to actually back that up; just be careful when you are promoting healthy diets, to be sure that what you are talking about does have some research base otherwise it’s just opinion.
Diets
Mediterranean
What are the primary ways to prevent cancer?
Maintain healthy weight
Physically active lifestyle
Healthy diet, emphasis on plant sources
What are secondary sources to prevent cancer?
Screening, encourage men and women to:
Self-breast & testicular exams, cancer screening, mammograms,
PSA: an antigen specific to prostate cancer that as men get older there is controversy about whether or not that is really necessary to do PSA’s because it doesn’t really have any impact on outcomes, but there are just a lot of things we can do for screening.
Men should do self-breast exams too they can get cancer, monthly testicular exams.
There are also many screening tools for those that may be more at risk also; it will be more specific to your pt and what their risk factors, family and personal history are
What should you ask a pt diagnosed w/ cancer? -All hospital pts after having a dx are probably a bit worried.
How are you feeling? Allow the pt to talk about how they’re feeling. -This is meaningful and has an impact on the pt. Those are the pts that say I had this nurse who was wonderful, she was an angel, she made me feel ok, they gave me hope,
Please don’t be afraid to ask how they are feeling and how they are dealing with it; a lot of times someone gets the dx of cancer everybody they know abandons them friends don’t call anymore, family might stay away because they don’t know what to say; there is nothing that you can say that will make it go away; there is nothing that they have to say; what you need to do is be present, be there for them, let them talk and don’t worry about saying the right thing because you are not going to make it worse, just be there.
What are the 3 main treatment modalities?
- Surgery
- Radiation
- Chemotherapy
Any one patient can have 1 or all of these, it just depends on what the cancer is, type of cancer, where it’s located and what the desired outcome is.
What do you do for care of the pt undergoing surgery? General _____ care, your pre-op teaching, all the consents, labs, there might be extra lab work depending on what the dx of cancer is, the type of cancer it is;
Perioperative
What to do for post-op care: Post-op care is going to be the same, basically ;you need to know that when you have a pt with cancer that has surgery they are at increased risk for _____, they are increase risk of infection, and impaired wound healing because why?
complications
Their immune system might be compromised; remember that somebody that has cancer their immune system dropped the ball already because it’s your immune system, your T cells specifically, remember those T lymphocytes that are supposed to destroy any abnormal cells any mutated cells, so the immune system let he cancer cells slip by and allowed it to reproduce and become a problem in the form of the cancer; so that is still going on so whatever that defect was and that can make the pt more vulnerable to infection and also delay wound healing.
What are more risk of complications?
Infection, Impaired wound healing, Altered pulmonary function: this is a problem post op; you might have somebody who has lung cancer or something else that is going on related to their specific cancer that can cause respiratory difficulties
Altered ____ function: the kidneys are really affected by substances, medications, things like that;
Deep vein thrombosis: all perioperative pts are at risk for DVT, but pts with cancer sometimes have altered _____ and is called coagulopathy, so the will also have an increased risk of a DVT or a VTE which is a venous ________; they are especially at risk and more so if this surgery pt is also receiving chemo and radiation; so it is just riskier with a pt with cancer.
renal
coagulation
thromboembolism
What might this patient have surrounding surgery?
Anxiety- remember that this is fear of the unknown, or worry about the unknown, fear is specific “oh I’m afraid of spiders” anxiety is just oh something might be wrong but I don’t know what it is.
Anxiety regarding: What is the Outcome going to be; sometimes surgery is done to ____ or grade tumors so they might be wondering what’s going to happen, how bad is it,
Changes in body image if they had to have something removed particularly if it is something that’s associated with sexual identity like a breast or maybe a testicle;
Changes in body functioning: am I going to be able to do what I was doing before surgery
______: if we have done staging or grading of tumors that lets us prognosticate and the prognosis is the likely outcome; are they going to survive was it open and shut, sometimes they will take a pt to surgery and they will open the up and the cancer just everywhere and so they just don’t do anything they just close them right back up and those ppl have a poor prognosis.
stage
Prognosis
What types of things does the nurse do for a patient after surgery? Assesses patient needs and doesn’t just focus on the _____ needs. Provides _____ and ______ support. Allow them time to discuss fears and just their ability to talk to somebody openly and honestly about their fears is very therapeutic for the pts. Encourage them to discuss and encourage family members to talk to each other. Encourage ____ role in care if you are doing dressing changes or if there is some other thing that they can do to participate, give them choices about things.
physical
emotional
educational
When telling a pt to talk to family= This is on an individual basis; you can’t just use one approach for everybody.
active
Choices= The more that they do the more they will be able to have some type of power and control.
What does the nurse do if a patient does not understand something?
Clarify information
If the doctor comes in and tells them something and the pt doesn’t really understand it or thinks they understand it and they start thinking about it more and then they don’t you as the nurse can clarify that; you can say well this is what that meant; help them if they have questions, to maybe write them down so the next time the physician is in they can ask questions; they might be meeting with other depts., like PT, dietary or social services so you can work as a liaison and help them if they need more information or things clarified; if you can’t clarify you can get in touch with another member of the health team to get it clarified for the pt
What other things does a nurse do after surgery for a pt?_______ with physician, other health team members.
D/C _____ starts when the pt is admitted, but they need to know about follow up care, home care, if they are going to have home health are they going to have dressing changes or need a home health nurse for something else they might be going to a skilled nursing facility for a brief period of time.
Communication
planning
What should you encourage the patient to use after surgery?
Remember to treat your whole pt _____, spiritually, and physically to get all realms of them
Use any resources that they have available to them, so like any surgical pt but there is an added depth to it because of the emotional impact of a cancer dx but also the physical impact.
emotionally
This pt may have also under gone surgery; and if you think about _____, like the radiation from the sun, it can be damaging to tissues; if somebody has had surgery and then they had radiation in the same area that would be a reason that radiation might make it more difficult for _____ to occur because it extends the damage; radiation is prescribed by a radiation oncologist and they’ll say give this pt 4000 centigrays of radiation (centigrays is the unit of measure used for radiation therapy) they will write a total dose, so 4000 Cgy and then the fractionation is how much they get for each visit; so the fractionation might be 250 Cgy; so that pt to get their 4000 Cgy of radiation will have 16 treatments; they are usually done Mon-Fri and will give them 2 days off; so that pt will basically go for 3 weeks for radiation oncology. Dose and _____ dependent, Measured in _____ (Cgy)
radiation
healing
fractionation
centigrays
Most frequently affected tissues by radiation side effects are what?
Skin, Mucosal lining of GI tract, Bone marrow
If you have somebody who is getting radiation in their lung, let’s say that there is a perihilar mass, and that is right in the middle of the chest, we have radiation that the radiation oncologist has mapped out exactly where that beam of radiation needs to be focused so that the highest concentration of the radiation is hitting that mass that is in the lung, but it is going through tissue to get there and it’s coming in at a cone shaped so it’s spread over a larger area and then concentrates down into a point when it gets to that tumor so all that tissue that it’s going through will be effected by radiation; it is going through the skin 1st, the skin can get burned, if it is near the esophagus, where this perihilar mass would be it can affect the lining of the esophagus and if you think about it, your GI tract goes from your mouth to your anus so any radiation around it can affect your GI tract and then bone marrow is a problem if large bones are in the field of radiation; it does not affect the bone if they are not in the field.
These side effects depend on how much radiation the pt gets and they can be: ____ or Chronic, Mild or _____ Usually local but can be a few ____ effects
Acute
Severe
systemic
What are things that affect the degree of severity of the side effects of radiation treatments?
- Size and location of area treated-If it’s a bigger area it’s going to be more severe and depending on where it is, that example I gave you of the mass in the lungs in the perihilar area and that’s where the lungs branch off, that’s the hilum, in that area we have lungs, esophagus, the heart so there are a lot of things that can be affected and those can all suffer from side effects of radiation treatment; some of it now like the GI tract might have short term complications, but years down the road they may suffer from pericarditis because of the radiation.
- Type of radiation used; there are actually types that can encircle an area, some are straight beams so it will go right into the target tissue and not maybe damage as much of the other tissue; it is also dependent on how much they are getting; so the Total dose and fractionation schedule; if they have other treatments: chemo and Ra+ combined that would make it more severe; and don’t forget that they might have other illnesses, so our pt with lung cancer may also have COPD or diabetes and diabetes is going to make everything worse so just pay attention to that
- Performance status of Co-morbidities
Early/ Acute: Nausea especially when the GI tract is in the field of _____; can also get diarrhea. Skin Reactions; the skin will have a burned _____, flake and blister.
Mucositis is the inflammation of the _____ of the GI tract; it can be very unpleasant if it happens in their mouth. Some1 that is getting their neck radiated if they have head or neck cancer the mouth is going to be in there, the salivary glands, the trachea, the esophagus, and the skin also; _____ is dry mouth so if we have the salivary glands affected by radiation they could have a very dry mouth which can be pretty uncomfortable. ____ is a systemic effect and it affects up to 100% of pts; they’re not really sure why, but they have this overwhelming fatigue. ____ has to do with bone marrow suppression; so with bone marrow suppression you will have pts that are immune-compromised because they have decreased lymphocytes you will also have decreased platelets, so they are at risk for infection and bleeding. ____ which is hair loss occurs in the field of radiation; so if someone gets their stomach radiated the hair on the head will not fall out but if they have chemo also then the chemo might make it happen if they are getting radiated to their brain, then their hair is going to fall out.
radiation appearance mucosa xerostomia Fatigue Myleosuppression Alopecia
Nausea: usually occurs ___ hours after chemo so it’s an early effect. You as a nurse want to maintain fluid ____. Small ____ meals. Consider premed with _____.
I would make that a standard of care that somebody would have an anti-nausea medication ordered and it’s not just like anti-emetics we might use GI stimulants like metoclopramide, sometimes we use _____ like dexamethasone can be used to help prevent nausea too.
1-2 intake frequent antiemetic corticosteroids
It’s better to prevent side effects than to treat them after they have happened and with nausea that is especially true
The goal with nausea is to what?
We also: Avoid ____ from clothing, perfume, deodorants, heat, trauma unless prescribed; lotions and creams that are prescribed from the doctor are ok, but perfumes and deodorants should not be used on the site, keep it from extremes in temperature both heat & cold and prevent injury to the site. _____ dressings, prn if clothing is going to be over it like a telfa or something like that non-adhesive (telfa is the brand name) these won’t stick and they generally have a shiny appearance and you put the shiny side to the skin and it won’t stick the way a gauze would stick. Keep ___, if possible. Topical creams, per order of health care practitioner. _____ avoid direct sunlight because this is already a burn; sunlight will just make it worse.
Keep skin intact
To prevent this from happening if at all possible so we will want to avoid anything that will irritate the skin if possible it is good for them to leave it open to air.
irritation
Non-adhesive
dry
ABSOLUTELY
Mucositis/Xerostomia affects: mouth, pharynx, esophagus, trachea, bowel, bladder, rectum; it is going to be site ____, It’s part of the mucous that is in the field of ____ and remember that radiation spreads out a little bit so anything that is in the neighborhood of the cancer can be affected by the radiation.
specific
radiation
Mucositis/Xerostomia symptoms: pain anywhere from the mouth to the rectum, dysphagia, altered taste/smell and think about it how important it is for a pt with cancer to maintain their _____ _____; sometimes their favorite foods will have a funny taste and if they are on chemo it can make it even worse like foods will taste _____ or they just won’t have any taste at all and sometimes there are only a couple of types of foods that they can even stand because of the _____ taste and smell, they might have a cough, hoarseness if it’s up the area of the larynx, the vocal chords, ____-difficulty urinating, abdominal cramping, diarrhea.
nutritional status
metallic
altered
dysuria
