Cancer N150 Short

8/4/2019 Cancer N150 Short

1/11

9/14/11

1

Nursing Care of the Patient with

Cancer

Ju-An Broyles, RN, MSN, FNP

N200

Resources

CancerSourceRN.com http://www.cancer.org (American

Cancer Society)

http://www.nci.nih.gov/

Cancer Pathophysiology

Abnormal cells DNA Oncogenes Abnormal growth Cells become invasive Metastasis

Breast Cancer Cell

Cancer is classified by tissues or blood cells in which it

originates:

Glandular tissues (adenocarcinoma) Connective, muscle, bone tissue (sarcoma) Tissue of the brain and spinal cord (gliomas)

Pigment cell (Melanoma) Plasma cell (myeloma) Lymphatic tissue (lymphomas) Leukocytes (leukemia)

Cancer Risk Factors

Environmental Genetic susceptibility Host susceptibility Lifestyle


2/11

9/14/11

2

Environmental

Viruses Chemicals Sunlight Radiation Tobacco use

Environmental

Lung cancer Aspirin and other NSAIDs Tamoxifen SERMs Finasteride

Genetic Susceptibility

About 5-10% of cancers have familialtendency

Examples of cancers that show familialinheritance are: retinoblastomas, breast,

ovarian, endometrial, colorectal, stomach,

prostate, and lung cancer

BRCA-1 (and 2) gene

Dietary Factors (Lifestyle)

Dietary factors related to 35% of allenvironmental cancers

Diet-

Host Susceptibility

Immune system Carcinogens

Host Susceptibility

New, additional cause of cancer is priortreatment with chemo or radiation therapy

for a prior malignancy

Can cause leukemias (latency period 2-5yrs) or solid tumors (10-20 years)

Prognosis for these are usually poor


3/11

9/14/11

3

Seven Warning Signs and

Health Seeking Behaviors Nurses Role Primary prevention Secondary prevention

(early detection)

Seven Signs of Cancer

Change in bowel or bladder habits could be a sign of colorectalcancer.

A sore that does not heal on the skin or in the mouth could be amalignancy and should be c hecked by a doctor.

Unusual bleeding or discharge from the rectum, bladder or vaginacould mean colorectal, prostate, bladder or cervical cancer.

Thickening of breast tissue or a new lump in the breast is awarning sign of breast cancer. A lump in the testes could mean

testicular cancer.

Indigestion or trouble swallowing could be cancer of the mouth,throat, esophagus or stomach.

Obvious changes to moles or warts could mean skin cancer. Nagging cough or hoarseness that persists for four to six weeks

could be a sign of lung or throat cancer.

Benign vs Malignant Tumors

Benign Tumors

Malignant Tumors

Staging Cancer

TNMT: extent primary tumorN: Lymph node involvementM: Metastasis

Breast Cancer 70% occur in women over age of 70 BRCA1 & 2 gene Other risks


4/11

9/14/11

4

Breast Cancer Locations

Breast assessmentSymptoms that may indicate breast cancer

Breast lump

* Breast pain

* Change in the size or shape of the breast* Swelling of the arm (lymphoedema)

* Dimpling of the breast skin* Involution or inversion of the nipple

* Axillary lymphadenopathy* Nipple discharge or bleeding

* Ulceration of the breast skin

* Bone or abdominal pain / jaundiceSymptoms requiring specialist referral

Lumps

* All new discrete breast lumps

* A new lump in pre-existing nodularityAsymmetrical nodularity persisting after menstruation

* Breast abscess

* Persistently refilling or recurrent cysts* Axillary lymphadenopathy

* Breast pain

* Pain associated with a lump* Persistent unilateral pain in a postmenopausal woman

Nipple discharge

* All women aged over 50 years

* Women aged below 50 years with:

* Bilateral discharge sufficient to stain clothes

* Blood-stained nipple discharge* Persistent discharge from a single duct

Family history

Breast Cancer 1:7 women will develop in lifetime in OC If already had breast cancer, 3-4x more

likely to develop it again

DetectionMammogram (5-17% missed cancers)Digital mammogramMRI (finds 2x cancers vs mammo+ US)Positron Emission Tomography scan-

radioactive sugar injected.

Self Breast Exam (SBE)

Breast Cancer-New treatments

Monoclonal Antibody therapy- Herceptin- Antiangiogenesis - Avastin


5/11

9/14/11

5

Breast Cancer-New treatments

Chemotherapy-new version of Taxol,Abraxane, better tolerated tumors shrunk

better.

Aromatase Inhibitors-drugs preventestrogen from forming, used after 2 years of

tamoxifen in clinical trials

Breast Cancer

Breast cancer in men-approximately 1690new cases will be diagnosed in men this

year.

100x more common in women than men

Malignant Melanoma

*

Melanoma is a malignancy of pigment-producingcells (melanocytes)

Melanoma accounts for only 4% of all skin cancers

70% arise from pre-existing mole

Risks: excessive sunlight exposure, increased nevi

(moles), tendency to freckle from the sun, familyhistory, red hair, fair skin, blue eyes, susceptibility

to sunburn, celtic or scandinavian ancestry

(Melanoma rare in african-americans)

Malignant Melanoma Malignant Melanoma


6/11

9/14/11

6

Colon Cancer

Colonoscopy versus Virtual Colonoscopy 1:20 will have colon cancer in lifetime Approximately 150,000 new cases each yr in USA Early detection critical; 5 yr survival rate is 92%. Growth of polyp: takes approximately 5 yrs to grow 1/2 inch,

takes approximately 5-10 years for these to become malignant

Colon Cancer

Higher risk in smokers Diets high in vegetables & fruits lower risk Right-sided (ascending colon) tumors present with

anemia, fatigue. Lesions can grow large without

obstructive symptoms as stool liquid in ascending

colon

Left sided (descending colon) tumors present withobstructive symptoms

Aspirin and Calcium (1500 mg) may lower risk

Tests to Diagnose Colorectal

Cancer

Digital rectal exam (detects 15%) Fecal occult bloood Sigmoidoscopy (2/3 of cancers detected) Colonoscopy-visualize, photograph, &

biopsy up to the ileocecal valve

Barium enema (detects lesions not visible orpalpable)

CT scan-detects cancer spread

Lab Tests Used in Cancer

Detection

Tumor Markers-

MRI-

Lab Tests Used in Cancer

Detection

Ultrasound: Mammogram: PET scans, CT scans


7/11

9/14/11

7

Diagnosis

Self exam Stool guaiac Rectal exam &

sigmoidoscopy

Blood studies Tissue Biopsy Pap smear Digital exam PSA

Nursing Diagnosis

Anxiety r/t lack of knowledge Dx & Tx Disturbed self concept r/t Ineffective individual coping Sexual dysfunction r/t Knowledge deficit Altered Nutrition r/t intake, N & V,

anorexia

Potential for injury r/t susceptibility At risk for infection

Nursing Diagnosis

Pain r/t dx and tx Impaired physical mobility r/tActivity intolerance r/t malnutrition & tx

Noncompliance Collaborative: hemorrhage, infection,

bladder neck obstruction, many of the above

Etc.. Etc. Etc.

Nursing Care of Patient with

Cancer

Assessment for infection Bleeding Skin Problems Hair loss, body imageNutrition Pain Fatigue

Therapies

Surgery & lymphnode staging

chemotherapy radiation hormonal palliative treatment

Nurses role with Surgery patient

monitor VS good assessment

I & O wound complications

teachingpre-oppost-op


8/11

9/14/11

8

Management of Cancer-Surgery

Diagnostic-Biopsy Primary Treatment- Prophylactic surgery Pallative-

Nurses role with Radiation

Safety distance length of time shielding

Teaching Prevent complications Expected side effects

Radiation Therapy

Goal: palliative, cure, or control of cancer. Types: electromagnetic, particulate (alpha,

beta, electron neutrons)

External (beam) or internal delivery(implant)

Safety interventions: Time, Distance,Shielding

Radiation Therapy

Cells that undergo frequent cell division aremost effected by radiation

Slower growing tissues are nearly resistant

Types of Radiation

External-amount of energy determine howdeep radiation can treat externally

Internal-high dose to a localized area;Implant (needles, seeds, beads into vagina,

abdomen, pleura, breast)

Radiation Therapy Ionizing radiation used to interrupt cell growth. High-energy particles Normal cells can tolerate a specified dose of radiation

before complications occur.

Cancers are most radiosensitive because they dividerapidly, are well-oxygenated, and poorly differentiated.


9/11

9/14/11

9

Radiation Therapy

Ionizing radiation Pallative radiation can relieve symptoms

Radiation Safety-Implant

Teach patient:Stay 3 feet minimum away from others for 1-3

days after discharge

Minimize time with other individualsWash hands with plenty of soap and water after

void. Rinse bathroom sink and tub thoroughly

after each use

Radiation Safety-Implant Absorbent pads cover floor around toilet. Cover telephone,

overbed table with plastic, hampers marked radioactive

No pregnant staff member may care for patient Film badges worn by all staff entering room (at chest level) Verbal contact every 2 hours via telephone or call system

(or per hospital policy)

Double glove for handling urinals, bedpans, emesis basinsor any contact body fluids.

Instruct flush toilet 3 times with each use. Disposable food trays. Lead shield to be used if implants

Nursing Care of Patient with

Radiation Therapy

Protect skin and oral mucosa- assessmentfrequently, avoid ointments, lotions, or

powders to treated area. Teach weakness,

fatigue, etc is from therapy, not worsening

of cancer. Use lukewarm water, avoid

rubbing/scratching area, avoid sun, report

blistering. Apply vitamin A&D ointment to

irritated areas, avoid tight clothes

Radiation Therapy

If implant, protect caregivers Encourage rest periods throughout day Encourage adequate protein and calorie

intake

Chemotherapy

Destroys tumor cells by interrupting cellularfunctions and reproduction.

Each time tumor exposed to chemo,percentage of tumor cells (20-90%) are

destroyed.


10/11

9/14/11

10

Chemotherapy

Chemo attacks rapidly dividing cells, cancercells are rapidly dividing cells

Other cells that divide rapidly Chemotherapy drugs remain in urine, stool,

saliva, blood, emesis up to 48 hours after

administration completed

Nursing Care for Patient

Receiving Chemo

Monitor for extravasation Nausea and vomiting Oral care Teach to flush toilet 2 x after each use Double latex gloves for 2 days after chemo for any

body secretions

Nursing Care for Patients

Receiving Chemo

Patients on bleeding precautions Incontinent patients Chemo spill kit Pathogen-free diet: no raw fruits, vegetables, tea,

pepper, avoid most spices except salt and sugar

Nurses role with Hormonal therapy

Teaching side effects Tamoxifen, Lupron,

Zoladex, etc

Therapeuticcommunication

sexuality impotence

Nursing Care of Cancer Patient

Problem: FatigueMost common and most distressing symptom,

No single cause

Ways to Manage Fatigue

Encourage exercise. Encourage rest periods throughout day,

space activities

Identify anxiety/depression, refer or treat Avoid patient chilling


11/11

9/14/11

11

Mucositis/Stomatitis

cancersourceRN.com the chemotherapy made my mouth and throat so raw

I could not talk or swallow my own saliva. The

constant pain in my throat was like being stuck with a

fiery hot poker. Thank goodness for Morphine-a

cancer patient suffering from stomatitis

Mucositis/Stomatitis

Signs & symptoms include taste changes,oral pain, ulceration, edema, bleeding, drymouth, infection,altered nutritional status

40% of people with cancer will develop oralcomplications

Can occur 2-14 days from the time ofchemo administration, varies with type of

chemo

Nursing Care-Mucositis

Nursing care includes: assessment-normalmucosa is pink, moist, clean, intact

(Use flashlight if needed), assess forerythema, edema, signs of candidiasis

(white patches), ulcers, exudate, discolored

lesions, pallor. Check for altered texture

and shininess, amount of saliva, coating,

bad odors, cracks, fissures, blisters

Nursing Care-Mucositis Teach to avoid spicy food, alcohol based

OTC mouthwashes, good oral hygiene

including flossing, brushing, rinsing,

moisturizing.Toothpastes with sodium

bicarb aid in dissolving mucus, reduce

acidity of inflammation. Rinse agents:

water, saline, salt&soda, 1/2 strength

H2O2 orPeridex mouthwash. At risk for

dental caries as can have 95% decline in

salivation

Nursing Care of Mucositis

Topical anesthetics (20% Benzocaine,viscous lidocaine, Orabase)

oral capsaicin in form of candy is beingstudied

Gels that congeal to form an occlusivecovering: Zilactin, Oratect, Gelclair

Mycelex troches, Mycostatin, Bacitracin

Nurses role with Palliative Care

We cant save everyone We can care for all. DNR does not = no care Although you cant save their

life, be their lifesaver.

Improve pain control & qualityof life

Reduce side effects

Documents

Cancer N150 Short