NCLEX-RN & PN TEST PREP COURSE Cancer

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NCLEX® - RN & PN TEST PREP COURSE Conductedby:

GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,[email protected]#714-679-9320Fax#909-247-2721

NCLEX-RN & PN TEST PREP COURSE

Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN

[email protected]#714-679-9320Fax#909-247-2721

Cancer Ø Abnormal,unrelatedcellproliferaAon

Ø Neoplasm'sortumorsØ ClassificaAonoftumors

Ø Tissuetype:Carcinomas;lymphomas;

leukemia's;sarcomasØ Celloforiginandgrowth:BenignorMalignant

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PREDISPOSING FACTORS

•  Age•  Sex• OccupaAon• GeographicDistribuAon

• Heredity•  Stress•  PrecancerousLesions

• Obesity




Characteristics Benign Malignant

Speed of Growth Usually slow, steady rate of growth

Grows rapidly, unpredictable

Mode of Growth Remains localized invades surrounding tissues

Capsule Encapsulated rarely encapsulated Cell Characteristic When palpated, are

smooth, easily defined, & movable

Have irregular borders; immobile

Recurrence Recurrence is rare when removed

When removed, recurrence is more common

Metastasis Never occur Very common Effect of Neoplasm Rarely fatal Fatal if not treated

Prognosis Very good Poor prognosis

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Stages of Cancer




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WARNING SIGNALS OF CANCER� C–changeinbowelorbladderhabits� A–sorethatdoesnotheal� U–unusualbleedingordischargeU–unexplainedsuddenweightlossU–unexplainedanemia� T–thickeningorlumpinthebreastor elsewhere� I–indigesAonordifficultyinswallowing� O–obviouschangeinwartormole� N–naggingcoughorhoarseness




Diagnostic Findings Ø  X-rayStudiesØ  CytologicorPapanicolaoutest(PapSmear)Ø  NuclearMagneAcResourceImaging(MRI)Ø  UltrasoundØ  BiopsyØ  EndoscopyØ  LaboratoryTests:(TumorMarkers)

–  Alpha–feto–protein(Liver,Testes)–  HCG(humanchorionicgonadotrophins)–  ProstaAcAcidPhosphatase(PAP)–  ProstaAcSpecificAnAgen(PSA)–  CA-125–(GI,Ovaries)–  CEA(CarcinoembryonicanAgen)–Breast,

Colon,Lung

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Ø  ColonØ  UterusØ  Basic

CANCER PREVENTION

Ø  Skin Ø  Oral Ø  Breast Ø  Lungs




Dietary Guidelines Against Cancer •  Avoidobesity.•  Cutdownontotalfatintake.•  Eatmorehighfiberfoods.•  IncludefoodsrichinVitaminA,C,EandmineralSeleniumindailydiet.

•  Includecruciferousvegetablesinthediet.

•  BemoderateintheconsumpAonofalcoholicbeverages.

•  BemoderateintheconsumpAonofsalt–cured,smokedandnitrite–curedfoods.

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Cancer Management Ø SurgeryØ Radia2onTherapy:

ü External(BeamRadiotherapyorTeletheraphy)ü Internal:1.sealed

2.unsealedØ ChemotherapyØ ImmunotherapyØ BoneMarrowTransplanta2on




Patient and Family Teaching Regarding EXTERNAL RADIATION THERAPY

1.   Thisispainless.2.   AssessforskindesquamaAon.Noointments,creams,

soaps,powders,cosmeAcs,perfumesanddeodorantsinthetreatedareaduringtreatmentperiods

3.   Avoidextremesheatorcold:heaAngpads,UVlight,sauna,steambaths,ordirectsunlight.

4.   Donotwashoffskinmarkings.5.   LieverysAllonaspecialtable,youmaybeplacedina

specialposiAontomaximizetumorirradiaAon.Eachtreatmentusuallylastsforfewminutes.

6.   ThereisnoresidualradioacAvityaferradiaAontherapy.

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Ø FoleyCatheterwillbeinsertedØ CleansingEnemaØ CompleteBedRest(FlatinBed)Ø PersonalProtec2veEquipments

Ø DosimeterBadgeØ LeadApronØ LeadContainerØ LongForceps

Ø Maintain6Q.Distancefromthepa2entØ Stayfor5minutesforatotalof30minutespershiQ

Client and Family Teaching Regarding INTERNAL RADIATION THERAPY

(Sealed - with Implant)




Ø Clothing's,bodysecre2onsarecontaminatedfor48hours

Ø PrivateroomwithbathroomØ Flushbowl2x,Rinsebasin2xØ Eatusingdisposableutensils,laundryclothing'sseparately

Ø Offisola2onaQer48hours

Patient and Family Teaching Regarding INTERNAL RADIATION THERAPY

(unsealed – without Implant)

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SIDE EFFECTS OF CHEMOTHERAPY AND RADIATION THERAPY

Ø  NauseaØ  VomiAngØ  DiarrheaØ  ConsApaAonØ  StomaAAsØ  PruritusØ  AlopeciaØ  SkinpigmentaAonØ  Nailchanges

Ø  Anemia Ø  Neutropenia Ø  Thrombocytopenia Ø  Hemorrhagic cystitis

ü  Urine color changes (Blood)

Ø  Premature menopause or Amenorrhea




CLIENT WITH BREAST CANCER

Ø RiskFactors•  MenstruaAonbeforeage11.•  Menopauseaferage50.•  Familyhistoryofbreastcancer.•  Birthoffirstchildaferage30.•  Nulliparity.•  Useofhormones(birthcontrolpills)•  Historyofuterinecancer.•  Associatedwithobesity,DMandHypertension.

•  Presenceofbenignbreastdisease.

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Ø  Firm,non-tender,non-mobilemasses.Ø  Solitary,irregularlyshapedmass.Ø  Adherencetomuscleorskincausingdimplingeffect.

Ø  InvolvementofupperouterquadrantorcentralnippleporAonofbreast.

Ø  Asymmetryofthebreasts.Ø  “orangepeel”skin.Ø  RetracAonofnipple.Ø  Abnormaldischargefromnipple.

Classic Symptoms of Breast Cancer

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STAGESOFCANCEROFTHEBREAST

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COLLABORATIVE MANAGEMENT Ø Surgery

ü Lumpectomy ü Simple Mastectomy ü Modified Radical Mastectomy (MRM) ü Radical Mastectomy (Halstead Surgery)

Ø Chemotherapy Ø Radiation Therapy




Ø Nursing Managements Ø Psychosocial Support. Ø Arm exercises. Ø Wound suction drainage. Ø DBCT exercises.

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Ø  PostOperaAveNursingIntervenAons

§  Semi–Fowler’sposiAonwitharmabductedandelevatedonpillows.

§  PostsignonARMPRECAUTION.§  IniAateexercisestopreventsAffnessandcontracturesofshouldergirdle.

§  Reinforcespecialmastectomyexercisesasprescribed.

§  ProvideadequateanalgesiatopromoteambulaAonandexercise.

§  Encourageregularcoughinganddeepbreathingexercises.

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n  Teach patient to avoid constrictive clothing and report persistent edema, redness, or infection of incision.

n  Teach patient importance of continuing monthly breast examination on remaining breast.




COMPLICATIONS OF BREAST CANCER SURGERY

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n Prevention of Lymphedema n  “AVOID’s”

n  Cuts n  Scratches n  Pinpricks n  Hangnails n  Insect bites n  Burns n  Strong detergents




n  “DONT’s” n Carry purse or anything

heavy n Wear wristwatch or jewelry n Pick at or cut cuticles n Work near thorny plants or

dig in garden n Reach into hot oven n Injections, withdrawal of

blood, BP – taking

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n  “DO’s” n Wear loose rubber gloves n Wear a thimble n Apply lanolin hand cream n Contact PMD if arm gets red, warm,

or hard or swollen n Return for check – up n Wear “Medic Alert” tag: CAUTION -

LYMPHEDEMA




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NCLEX-RN & PN TEST PREP COURSE Cancer