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Nursing Care of the Client with Cancer

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Title: Nursing Care of the Client with Cancer


1
Nursing Care of the Client with Cancer
  • Cancer Background
  • A. Definition
  • 1. Family of complex diseases
  • 2. Affect different organs and organ systems
  • 3. Normal cells mutate into abnormal cells that
    take over tissue
  • 4. Eventually harm and destroy host
  • 5. Historically, cancer is a dreaded disease
  • B. Oncology
  • 1. Study of cancers
  • 2. Oncology nurses specialize in the care,
    treatment of clients with cancer

2
Nursing Care of the Client with Cancer
  • Incidence and Prevalence
  • 1. Cancer accounts for about 25 of death on
    yearly basis
  • 2. Males 3 most common types of cancer are
    prostate, lung and bronchial, colorectal
  • 3. Females 3 most common types of cancer are
    breast, lung and bronchial, and colorectal

3
Nursing Care of the Client with Cancer
  • Risk factors for cancer (some are controllable
    some are not)
  • 1. Heredity 5 10 of cancers documented with
    some breast and colon cancers
  • 2. Age 70 of all cancers occur in persons gt 65
  • 3. Lower socio-economic status
  • 4. Stress
  • a. Leads to greater wear and tear on body in
    general
  • 5 Diet certain preservatives in pickled, salted
    foods fried foods high-fat, low fiber foods
    charred foods, high fat foods, diet high in red
    meat
  • 6. Occupational risk exposure to know
    carcinogens, radiation, high stress
  • 7. Infections, especially specific organisms and
    organ (e.g. papillomavirus causing genital warts
    and leading to cervical cancer)
  • 8. Tobacco Use Lung, oral and laryngeal,
    esophageal, gastric, pancreatic, bladder cancers
  • 9. Alcohol Use also tied with smoking
  • 10. Sun Exposure (radiation) e.g. skin cancer

4
Nursing Care of the Client with Cancer
  • Nursing role includes health promotion to lower
    the controllable risks
  • 1. Routine medical check up and screenings
  • 2. Client awareness to act if symptoms of cancer
    occur
  • 3. Screening examination recommendations by
    American Cancer Society specifics are made
    according to age and frequencies
  • a. Breast Cancer self-breast exam, breast
    examination by health care professionals,
    screening mammogram
  • b. Colon and Rectal Cancer fecal occult blood,
    flexible sigmoidoscopy, colonoscopy
  • c. Cervical, Uterine Cancer Papanicolaou (Pap)
    test
  • d. Prostate Cancer digital rectal exam,
    Prostate-specific antigen (PSA) test

5
Nursing Care of the Client with Cancer
  • Physiology of Cancer
  • A. Background
  • 1. Normal Cell Growth includes two events
  • a. Replication of cellular DNA
  • b. Mitosis (cell division)

6
Nursing Care of the Client with Cancer
  • 2. Cell cycle is under control of cyclins, and
    suppresor gene products which control process by
    working with enzymes
  • cyclins promote cell division
  • suppresor gene products limit cell
    division
  • 3. Forms the basis of how some chemotherapeutic
    agents work against cancers

7
Nursing Care of the Client with Cancer
  • Theories of Carcinogenesis (what causes cancer to
    occur)
  • 1. Cellular Mutation
  • a. Cells begin to mutate (change the DNA to
    unnatural cell reproduction)
  • 2. Oncogenes/Tumor Suppressor Genes Abnormalities
  • a. Oncogenes are genes that promote cell
    proliferation and can trigger cancer
  • b. Tumor suppressor genes normally suppress
    oncogenes but are damaged
  • 3. Exposure to Known Carcinogens
  • a. Act by directly altering the cellular DNA
    (genotoxic)
  • b. Act by affecting the immune system
    (promotional)

8
Nursing Care of the Client with Cancer
  • 4. Viruses
  • viruses break the DNA chain and mutates the
    normal cells DNA
  • Epstein-Barr virus
  • Human papilloma virus
  • Hepatitis virus
  • 5. Drugs and Hormones
  • a. Sex hormones often affect cancers of the
    reproductive systems (estrogen in some breast
    cancers testosterone in prostate cancer)
  • b. Glucocorticoids and steroids alter immune
    system

9
  • 6. Chemical Agents
  • a. Industrial and chemical
  • b. Can initiate and promote cancer
  • b. Examples hydrocarbons in soot arsenic in
    pesticides chemicals in tobacco
  • 7. Physical Agents
  • a. Exposure to radiation
  • Ionizing radiation found in x-rays, radium,
    uranium
  • UV radiation
  • Sun, tanning beds
  • Immune function
  • Protects the body from cancerous cells
  • Increased rate of cancer in immunocompromised pts

10
Nursing Care of the Client with Cancer
  • Neoplasms also called tumors (mass of new tissue
    that grows independently of surrounding organs
  • 1. Types of neoplasms
  • a. Benign
  • 1. Localized growths respond to bodys
    homeostatic controls
  • 2. Encapsulated
  • 3. Stop growing when they meet a boundary of
    another tissue
  • 4. Can be destructive
  • b. Malignant
  • 1. Have aggressive growth, rapid cell division
    outside the normal cell cycle
  • 2. Not under bodys homeostatic controls
  • 3. Cut through surrounding tissues causing
    bleeding, inflammation, necrosis (death) of tissue

11
Nursing Care of the Client with Cancer
  • Malignant tumors can metastasize
  • a. Tumor cells travel through blood or lymph
    circulation to other body areas and invade
    tissues and organs there.
  • 1. Primary tumor the original site of the
    malignancy
  • 2. Secondary tumor (sites) areas where
    malignancy has spread i.e. metastasis (metastatic
    tumor)
  • 3. Common sites of metastasis are lymph nodes,
    liver, lungs, bones, brain
  • 4. 50 60 of tumors have metastasized by time
    primary tumor identified
  • b. Cancerous cells must avoid detection by immune
    system

12
Nursing Care of the Client with Cancer
  • C. Malignant neoplasms can recur after surgical
    removal of primary and secondary tumors and other
    treatments
  • D. Malignant neoplasms vary in differentiation.
  • a. Highly differentiated are more like the
    originating tissue
  • b. Undifferentiated neoplasms consist of immature
    cells with no resemblance to parent tissue and
    have no useful function
  • E. Malignant cells progress in deviation with
    each generation and do no stop growing and die,
    as do normal cells
  • F. Malignant cells are irreversible, i.e. do not
    revert to normal
  • G. Malignant cells promote their own survival by
    hormone production, cause vascular permeability
    angiogenesis divert nutrition from host cells

13
The steps of metastasis
14
Nursing Care of the Client with Cancer
  • Effects of Cancer
  • 1. Disturbed or loss of physiologic functioning,
    from pressure or obstruction
  • a. Anoxia and necrosis of organs
  • b. Loss of function bowel or bladder obstruction
  • c. Increased intracranial pressure
  • d. Interrupted vascular/venous blockage
  • e. Ascites
  • f. Disturbed liver functioning
  • G. Motor and sensory deficits
  • Cancer invades bone, brain or compresses nerves
  • Respiratory difficulties
  • Airway obstruction
  • Decreased lung capacity

15
Nursing Care of the Client with Cancer
  • 2. Hematologic Alterations Impaired function of
    blood cells
  • Secondary to any cancer that invades the bone
    marrow (leukemia)
  • May also be caused by the treatment
  • a. Abnormal wbcs impaired immunity
  • b. Diminished rbcs and platelets anemia and
    clotting disorders
  • 3. Infections fistula development and tumors may
    become necrotic erode skin surface
  • 4. Hemorrhage tumor erosion, bleeding, severe
    anemia
  • 5. Anorexia-Cachexia Syndrome wasting away of
    client
  • a. Unexplained rapid weight loss, anorexia with
    altered smell and taste
  • b. Catabolic state use of bodys tissues and
    muscle proteins to support cancer cell growth

16
Nursing Care of the Client with Cancer
  • 6. Paraneoplastic Syndromes ectopic sites with
    excess hormone production
  • a. Parathyroid hormone (hypercalcemia)
  • b. Ectopic secretion of insulin (hypoglycemia)
  • c. Antidiuretic hormone (ADH fluid retention)
  • d. Adrenocorticotropic hormone (ACTH)
  • 7. Pain major concern of clients and families
  • a. Types of cancer pain
  • 1. Acute symptom that led to diagnosis
  • 2. Chronic may be related to treatment or to
    progression of disease
  • b. Causes of pain
  • 1. Direct tumor involvement including metastatic
    pain
  • 2. Nerve compression
  • 3. Involvement of visceral organs

17
Nursing Care of the Client with Cancer
  • 8. Physical Stress body tries to respond and
    destroy neoplasm
  • a. Fatigue
  • b. Weight loss
  • c. Anemia
  • d. Dehydration
  • e. Electrolyte imbalances
  • 9. Psychological Stress
  • a. Cancer equals death sentence
  • b. Guilt from poor health habits
  • c. Fear of pain, suffering, death
  • d. Stigmatized

18
Nursing Care of the Client with Cancer
  • Collaborative Care
  • A. Diagnostic Tests used to diagnose cancer
  • 1. Determine location of cancer
  • a. Xrays
  • b. Computed tomography
  • c. Ultrasounds
  • d. Magnetic resonance imaging
  • e. Nuclear imaging
  • f. Angiography
  • 2. Diagnosis of cellular type of can be done
    through tissue samples from biopsies, shedded
    cells (e.g. Papanicolaou smear) washings
  • a. Cytologic Examination tissue examined under
    microscope
  • b. Identification System of Tumors
    Classification Grading -- Staging

19
Nursing Care of the Client with Cancer
  • 1. Classification according to the tissue or
    cell of origin, e.g. sarcoma, from supportive
  • 2. Grading
  • a. Evaluates degree of differentiation and rate
    of growth
  • b. Grade 1 (least aggressive) to Grade 4 (most
    aggressive)
  • 3. Staging
  • a. Relative tumor size and extent of disease
  • b. TNM (Tumor size Nodes lymph node
    involvement Metastases)

20
Nursing Care of the Client with Cancer
  • 3. Tumor markers specific proteins which
    indicate malignancy
  • a. PSA (Prostatic-specific antigen) prostate
    cancer
  • b. CEA (Carcinoembryonic antigen) colon cancer
  • c. Alkaline Phosphatase bone metastasis
  • 4 Direct Visualization
  • a. Sigmoidoscopy
  • b. Cystoscopy
  • c. Endoscopy
  • d. Bronchoscopy
  • e. Exploratory surgery lymph node biopsies to
    determine metastases

21
Nursing Care of the Client with Cancer
  • Other non-specific tests
  • a. CBC, Differential
  • b. Electrolytes
  • c. Blood Chemistries (liver enzymes alanine
    aminotransferase (ALT) aspartate
    aminotransferase (AST) lactic dehydrogenase (LDH)

22
Nursing Care of the Client with Cancer
  • Treatment Goals depending on type and stage of
    cancer
  • A. Cure
  • 1. Recover from specific cancer with treatment
  • 2. Alert for reoccurrence
  • 3. May involve rehabilitation with physical and
    occupational therapy
  • B. Control of symptoms and progression of cancer
  • 1. Continued surveillance
  • 2. Treatment when indicated (e.g. some bladder
    cancer, prostate cancer)
  • C. Palliation of symptoms may involve terminal
    care if clients cancer is not responding to
    treatment

23
Nursing Care of the Client with Cancer
  • Treatment Options (depend on type of cancer)
    alone or with combination
  • A. Chemotherapy
  • 1. Effects are systemic and kills the metastatic
    cells
  • 2. Often combinations of drugs in specific
    protocols over varying time periods
  • Much more effective then a single agent
  • Consider the timing of the nadir of each drug
  • The time when the bone marrow activity and WBC
    counts are at their lowest levels after chemo
  • Different times for different drugs

24
  • 3. Cell-kill hypothesis with each cell cycle a
    percentage of cancerous cells are killed but some
    remain repeating chemo kills more cells until
    those left can be handled by bodys immune system

25
Nursing Care of the Client with Cancer
  • B. Classes of Chemotherapy Drugs
  • 1. Alkylating agents
  • 1. Action create defects in tumor DNA
  • 2. Examples Nitrogen Mustard, Cisplatin
  • 2. Antimetabolites
  • 1. Action similar to metabolites needed for
    vital cell processes
  • Counterfeit metabolites interfere with cell
    division
  • 2. Examples Methotrexate 5 fluorouracil
  • 3. Toxic Effects nausea, vomiting, stomatitis,
    diarrhea, alopecia, leukopenia
  • 3. Antitumor Antibiotics
  • 1. Action interfere with DNA
  • 2. Examples Actinomycin D, Bleomycin
  • 3. Toxic Effect damage to cardiac muscle

26
Nursing Care of the Client with Cancer
  • 4. Antimiotic agents
  • 1. Action Prevent cell division
  • 2. Examples Vincristine, Vinblastine
  • 3. Toxic Effects affects neurotransmission,
    alopecia, bone marrow depression
  • 5. Hormone agonist
  • 1. Action large amounts of hormones upset the
    balance and alter the uptake of other hormones
    necessary for cell division
  • 2. Example estrogen, progestin, androgen

27
  • 6. Hormone Antagonist
  • 1. Action block hormones on hormone-binding
    tumors (breast, prostate, endometrium cause
    tumor regression
  • Decreasing the amount of hormones can decrease
    the cancer growth rate
  • Does not cure, but increases survival rates
  • 2. Examples Tamoxifen (breast) Flutamide
    (prostate)
  • 3. Toxic Effects altered secondary sex
    characteristics

28
  • 7. Hormone inhibitors
  • Aromatase inhibitors (Arimidex, Aromasin)
  • Prevents production of aromatase which is needed
    for estrogen production
  • Used in post menopausal women
  • Side effects
  • Masculinizing effects in women
  • Fluid retention

29
Nursing Care of the Client with Cancer
  • Effects of Chemotherapy
  • a. Tissues (fast growing) frequently affected
  • b. Examples mucous membranes, hair cells, bone
    marrow, specific organs with specific agents,
    reproductive organs (all fetal toxic, impair
    ability to reproduce).
  • Administration of chemotherapeutic agents
  • a. Trained and certified personnel, according to
    established guidelines
  • b. Preparation
  • 1. Protect personnel from toxic effects
  • Drugs absorbed through skin and mucous membranes
  • Protective clothing and extreme care
  • 2. Extreme care for correct dosage double check
    with physician orders, pharmacists preparation
  • c. Proper management clients excrement

30
Nursing Care of the Client with Cancer
  • d. Routes
  • 1. Oral
  • 2. Body cavity (intraperitoneal or intrapleural)
  • 3. Intravenous
  • Use of vascular access devices because of threat
    of extravasation (leakage into tissues) and
    long-term therapy
  • If the drug is a vessicant it may result in pain,
    infection and tissue loss

31
  • e. Types of vascular access devices
  • 1. PICC lines (peripherally inserted central
    catheters)
  • 2. Tunnelled catheters (Hickman, Groshong)
  • 3. Surgically implanted ports (accessed with 90o
    angle needle

32
Hickman Catheter
33
Portacath
34
PICC Line
35
Nursing Care of the Client with Cancer
  • Managing side effects of chemotherapy
  • A. Nausea and vomiting
  • 80 of patients will develop it
  • Antiemetics such as Zofran, Tigan, Compazine as
    well as Ativan to control the symptoms
  • Monitor for dehydration and need for IV fluids

36
  • B. Bone marrow suppression
  • Decreased number of RBC
  • Leads to hypoxia, fatigue
  • Hgb 9.5-10 gm/dl require oral iron supplements
  • Hgb below 8 gm/dl require transfusion
  • May use Epogen to stimulate RBC production

37
  • Decrease number of WBC (normal 4,500-11,000
    mm3) especially neutrophils (normal 3,000-7,000
    cells/cc)
  • Neutropenia-count below 2000
  • Pt at extreme risk for infection
  • May order granulocyte colony stimulating factor
    (leukine) to stimulate bone marrow to increase
    WBC count
  • Neutropenic precautions
  • Private room
  • Good handwashing
  • Monitor temp q 4 hours, monitor for chills, UTI,
    pneumonia
  • Limit visitors to healthy adults
  • No flowers or plants
  • Monitor neutrophil count

38
  • Thrombocytopenia
  • Drop in platlet count (normal 150,000-400,000/mm3)
    below 100,000
  • Test pt for bleeding in stool and urine
  • Avoid punctures for IV or IM
  • Handle pt gently
  • Use electric razor
  • Avoid placing foley or rectal thermometers
  • Avoid oral trauma with soft bristle brushes,
    avoid flossing, avoid hard candy
  • Watch for ALOC, pupil changes that might indicate
    intracranial bleeds
  • Stool softeners to avoid straining

39
  • C. Mucocitis
  • Inflammation and ulceration of mucous membranes
    and entire GI tract
  • Rinse mouth with ½ normal saline and ½ peroxide
    every 12 hours
  • Topical analgesic medication
  • Avoid mouthwashes with alcohol
  • Avoid spicy or hard food
  • Watch nutritional status

40
  • D. Alopecia
  • Hair loss
  • 2-3 weeks after treatment is started
  • Affects all the hair, including eyebrows,
    eyelashes
  • Within 4-8 weeks after treatment hair begins to
    grow back
  • Before hair loss, have the pt pick out a wig that
    is similar to hair color

41
  • E. Peripheral neuropathy
  • Numbness and tingling to fingers and toes in a
    glove and sock pattern
  • May cause gait and possible fall problems
  • F. Provide emotional and spiritual support to
    patient and families

42
Nursing Care of the Client with Cancer
  • Surgery
  • 1. Diagnosis, staging, and sometimes treatment of
    cancer
  • 2. May be prophylaxis or removal of at risk
    tissue or organ prior to development of cancer
    (breast cancer)
  • 3. Involves removal of body part, organ,
    sometimes with altered functioning (e.g.
    colostomy)
  • 4. Debulking (decrease size of) tumors in
    advanced cases
  • 5. Reconstruction and rehabilitation (e.g. breast
    implant post mastectomy)
  • 6. Palliative surgery to improve the quality
    of life
  • Removal of tumor tissue that is causing pain or
    obstruction
  • 5. Psychological support to deal with surgery as
    well as cancer diagnosis

43
Nursing Care of the Client with Cancer
  • Radiation Therapy
  • 1. Treatment of choice for some tumors to kill
    or reduce tumor, relieve pain or obstruction
  • Destroy cancer cells with minimal exposure to
    normal cells
  • Cells die or are unable to divide
  • 2. Delivery
  • a. Teletherapy (external) radiation delivered in
    uniform dose to tumor
  • Beam radiation
  • b. Brachytherapy delivers high dose to tumor and
    less to other tissues radiation source is placed
    in tumor or next to it in the form of seeds
  • Radiation source within the patient so pt emits
    radiation for a period of time and is a hazard to
    others
  • c. Combination

44
  • 3. Goals
  • a. Maximum tumor control with minimal damage to
    normal tissues
  • b. Caregivers must protect selves by using
    shields, distancing and limiting time with
    client, following safety protocols
  • Private room
  • Caution sign on the door for radioactive material
  • Dosimeter film badge by staff
  • No pregnant staff
  • Limit visitors to ½ hour per day and keep them at
    least 6 ft from the source

45
Nursing Care of the Client with Cancer
  • 4. Treatment Schedules
  • a. Planned according to radiosensitivity of
    tumor, tolerance of client
  • b. Monitor blood cell counts
  • 5. Side Effects
  • a. Skin (external radiation) blanching,
    erythema, sloughing, breakdown
  • Use mild soak
  • Dry skin with a patting motion, not rubbing
  • Dont use powders or lotions unless prescribed by
    radiologist
  • Wear soft clothing over the site
  • Avoid the sun and heat

46
  • b. Ulcerated mucous membranes pain, lack of
    saliva (xerostoma)
  • c. Gastrointestinal nausea and vomiting,
    diarrhea, bleeding, sometimes fistula formation
  • d. Radiation pneumonitis
  • 1-3 months after treatment
  • Cough, SOB, fever
  • Treated with steroids to decrease inflammation

47
Nursing Care of the Client with Cancer
  • Monoclonal antibodies (inoculate animal with
    tumor antigen and retrieve antibodies against
    tumor for human)
  • Antibodies target specific substances needed by
    the cancer cell for growth (Herceptin for breast
    cancer)

48
  • Gene therapy
  • experimental
  • May insert gene into the tumor cells to make them
    more susceptible to being killed by antiviral
    agents
  • May insert genes for cytokines that increase
    their effectiveness in killing cancer cells

49
  • Angiogenesis inhibitor drugs
  • prevent new blood vessels from forming and
    delivering blood to the tissue

50
Nursing Care of the Client with Cancer
  • F. Bone Marrow Transplantation and Peripheral
    Blood Stem Cell Transplantation
  • 1. Stimulation of nonfunctioning marrow or
    replace bone marrow
  • 2. Common treatment for leukemias
  • G. Pain Control
  • 1. Includes pain directly from cancer, treatment,
    or unrelated
  • 2. Necessary for continuing function or comfort
    in terminally ill clients
  • 3. Goal is maximum relief with minimal side
    effects
  • 4. Multiple combinations of analgesics (narcotic
    and non-narcotic) and adjuvants such as steroids
    or antidepressants includes around the clock
    (ATC) schedule with additional medications for
    break-through pain
  • 5. Multiple routes of medications
  • 6. May involve injections of anesthetics into
    nerve, surgical severing of nerves radiation
  • 7. May need to progress to stronger pain
    medications as pain increases and client develops
    tolerance to pain medication

51
Nursing Care of the Client with Cancer
  • Nursing Diagnoses for Clients with Cancer
  • A. Anxiety
  • 1. Therapeutic interactions with client and
    family community resources such as American
    Cancer Society, I Can Cope
  • 2. Availability of community resources for
    terminally ill (Hospice care in-patient, home
    care)
  • B. Disturbed Body Image
  • 1. Includes loss of body parts (e.g.
    amputations) appearance changes (skin, hair)
    altered functions (e.g. colostomy) cachexic
    appearance, loss of energy, ability to be
    productive
  • 2. Fear of rejection, stigma
  • C. Anticipatory Grieving
  • 1. Facing death and making preparations for
    death will be consideration
  • 2. Offer realistic hope that cancer treatment may
    be successful

52
Nursing Care of the Client with Cancer
  • D. Risk for Infection
  • E. Risk for Injury
  • 1. Organ obstruction
  • 2. Pathological fractures
  • F. Altered Nutrition less than body requirements
  • 1. Consultation with dietician, lab evaluation of
    nutritional status
  • 2. Managing problems with eating anorexia,
    nausea and vomiting
  • 3. May involve use of parenteral nutrition
  • G. Impaired Tissue Integrity
  • 1. Oral, pharyngeal, esophageal tissues (due to
    chemotherapy, bleeding due to low platelet
    counts, fungal infections such as thrush)
  • 2. Teach inspection, frequent oral hygiene,
    specific non-irritating products, thrush control

53
Nursing Care of the Client with Cancer
  • Oncologic Emergencies
  • A. Pericaridal Effusion and Neoplastic Cardiac
    Tamponade
  • 1. Concern compression of heart by fluid in
    pericardial sac, compromised cardiac output
  • 2. Treatment pericardiocentesis

54
  • B. Superior Vena Cava Syndrome
  • 1. obstruction of venous system with increased
    venous pressure and stasis facial and neck edema
    with slow progression to respiration distress
  • Late signs are cyanosis, decreased cardiac output
    and hypotension
  • 2. Treatment respiratory support decrease tumor
    size with radiation or chemotherapy

55
Compression of the superior vena cava in SVC
syndrome
56
  • C. Sepsis and Septic Shock
  • 1. Early recognition of infection
  • Patients at risk secondary to low WBC and
    impaired immune system
  • 2. Treatment prompt intervention with
    antibiotics and vasopressors

57
  • D. DIC disseminated intravascular coagulation
  • Triggered by severe illness, usually sepsis in
    cancer patients
  • Abnormal clotting uses up existing clotting
    factors and platelets quickly then the pt
    hemorrhages
  • Mortality rate is 70
  • Prevention of sepsis is key

58
Nursing Care of the Client with Cancer
  • E. Spinal Cord Compression
  • 1. Pressure from expanding tumor or vertebral
    collapse can cause irreversible paraplegia
  • 2. Back pain initial symptom with progressive
    paresthesia and paralysis
  • Paralysis is usually permanent
  • 3. Treatment early detection
  • High dose corticosteroid to decrease the swelling
  • radiation or surgical decompression

59
  • F. Obstructive Uropathy
  • 1. Concern blockage of urine flow undiagnosed
    can result in renal failure
  • 2. Treatment restore urine flow

60
  • G. Hypercalcemia
  • 1. High calcium (normal 9-10.5) usually from
    bone metastases
  • 2. May also come from cancer of the lung, head,
    neck, kidney and lymph nodes that secrete
    parathyroid hormone that causes the bone to
    release calcium
  • 2. Symptoms include fatigue, muscle weakness,
    polyuria, constipation, progressing to coma,
    seizures
  • 3. Treatment
  • restore fluids with intravenous saline which
    also increases the excretion of calcium
  • loop diuretics increase calcium excretion
  • Calcium chelators such as mithracin
  • Inhibit calcium resorption from the bone with
    calcitonin, diphosphonate

61
  • H. Tumor Lysis Syndrome
  • 1. Occurs with rapid necrosis of tumor cells with
    chemotherapy
  • When tumor cells die they release potassium and
    purines
  • Potassium (norm 3.5-5.5) elevation causes cardiac
    arrhthymias, muscle weakness, twitching, cramps
  • Purines convert to uric acid which causes renal
    failure, flank pain, gout when elevated above 10
    mg/dl
  • Hyperphosphatemia with secondary to hypocalcemia
    causes heart block, HTN, renal failure

62
  • Treatment
  • Hydration
  • Instruct pt to increase fluid intake before and
    after chemo
  • May need IV hydration
  • Diuretics to increase urine flow
  • Allopurinol to increase uric acid excretion
  • May need dialysis

63
Nursing Care of the Client with Cancer
  • I. SIADH (Syndrome of Inappropriate Antidiuretic
    Hormone Secretion)
  • 1. Ectopic ADH production from tumor leads to
    excessive hyponatremia
  • 2. holds onto too much fluid which decreases
    sodium level (normal 135-145)
  • 3. Symptoms
  • Weakness, muscle cramps, fatigue, ALOC, headache,
    seizures
  • 2. Treatment restore sodium level
  • Fluid restriction
  • Increase sodium
  • Antibiotic demeclocycline works in opposition to
    ADH
  • Limits ADH effect on distal renal tubules so they
    can excrete water
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