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Nursing Care of Client with Cancer

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Title: Nursing Care of Client with Cancer


1
Nursing Care of Client with Cancer
  • Presented by
  • Manny Ramos RN, MSN

2
Cancer
  • Normal cells mutate into abnormal cells that take
    over tissue
  • Affect different organs and organ systems
  • Eventually harm and destroy host

3
Incidence and Prevalence
  • Cancer 25 of all deaths annually
  • most common types of cancer
  • Males prostate, lung and bronchial,
    colorectal
  • Females breast, lung and bronchial, and
    colorectal

4
Risk factors for cancer
  • Heredity 5 10 of cancers
  • Age 70 occur in persons gt 65
  • Lower socio-economic status
  • Stress
  • Diet certain preservatives in pickled, salted
    foods fried foods high-fat, low fiber foods
    charred foods
  • Occupational risk exposure to carcinogens,
    radiation, high stress
  • Infections
  • Tobacco Use Lung, oral and laryngeal,
    esophageal, gastric, pancreatic, bladder cancers
  • Alcohol Use
  • Sun Exposure skin cancer

5
Health Promotion
  • Routine medical check up and screenings
  • Screening examination recommendations by American
    Cancer Society specifics are made according to
    age and frequencies
  • Breast Cancer self-breast exam, breast
    examination by health care professionals,
    screening mammogram
  • Colon and Rectal Cancer fecal occult blood,
    flexible sigmoidoscopy, colonoscopy
  • Cervical, Uterine Cancer Papanicolaou (Pap) test
  • Prostate Cancer digital rectal exam,
    Prostate-specific antigen (PSA) test
  • ACT! if symptoms of cancer occur

6
Types of neoplasms
  • Benign
  • encapsulated
  • Stops growing within boundary of another tissue
  • Malignant
  • aggressive growth
  • Cuts through surrounding tissues causing
    bleeding, inflammation, necrosis (death) of tissue

7
Metastasis
  • Malignant tumors can metastasize
  • Tumor cells travel through blood or lymph and
    invade tissues and organs there.
  • Primary tumor original site of the malignancy
  • Secondary tumor common sites of metastasis are
    lymph nodes, liver, lungs, bones, brain

8
Effects of Cancer
  • Disturbed or loss of physiologic functioning,
    from pressure or obstruction
  • Anoxia and necrosis of organs
  • Loss of function bowel or bladder obstruction
  • Increased intracranial pressure
  • Interrupted vascular/venous blockage
  • Ascites
  • Disturbed liver functioning

9
Effects of Cancer
  • Hematologic
  • Abnormal wbcs impaired immunity
  • Diminished rbcs and platelets anemia and
    clotting disorders
  • Infections
  • fistula development
  • tumors may become necrotic
  • erode skin surface
  • Hemorrhage tumor erosion, bleeding, severe
    anemia

10
Effects of Cancer
  • Anorexia-Cachexia Syndrome
  • Unexplained rapid weight loss, anorexia with
    altered smell and taste
  • Catabolic state use of bodys tissues and muscle
    proteins to support cancer cell growth

11
Effects of Cancer
  • Paraneoplastic Syndromes ectopic sites with
    excess hormone production
  • Parathyroid hormone (hypercalcemia)
  • Ectopic secretion of insulin (hypoglycemia)
  • Antidiuretic hormone (ADH fluid retention)
  • Adrenocorticotropic hormone (ACTH)

12
Effects of Cancer
  • Pain
  • Direct tumor involvement including metastatic
    pain
  • Nerve compression
  • Involvement of visceral organs

13
Effects of Cancer
  • Physical Stress
  • Fatigue
  • Weight loss
  • Anemia
  • Dehydration
  • Electrolyte imbalances

14
Effects of Cancer
  • Psychological Stress
  • death sentence
  • Guilt from poor health habits
  • Fear of pain, suffering, death
  • Stigmatized

15
Diagnostic Tests
  • Xrays
  • CT scan
  • Ultrasounds
  • MRI
  • Nuclear imaging
  • Angiography
  • Biopsy, Pap smear, washings
  • Cytology
  • Tumor markers
  • PSA (Prostatic-specific antigen) prostate cancer
  • CEA (Carcinoembryonic antigen) colon cancer
  • Alkaline Phosphatase bone metastasis

16
Classification Grading -- Stagingof Tumors
  • Classification according to the tissue or cell
    of origin, e.g. sarcoma, from supportive
  • Grading degree of differentiation and rate of
    growth,Grade 1 (least aggressive) to Grade 4
    (most aggressive)
  • Staging Relative tumor size and extent of
    disease
  • TNM (Tumor size Nodes lymph node involvement
    Metastases)

17
Direct Visualization
  • Sigmoidoscopy
  • Cystoscopy
  • Endoscopy
  • Bronchoscopy
  • Exploratory surgery lymph node biopsies to
    determine metastases

18
Treatment Goals
  • Cure
  • Control of symptoms and progression of cancer
  • Palliation of symptoms

19
Chemotherapy
  • phase-specific and non-phase specific drugs
  • Cell-kill hypothesis repeating chemo kills more
    cells until those left can be handled by bodys
    immune system

20
Chemotherapy Drugs
  • Alkylating agents create defects in tumor DNA
  • Examples Nitrogen Mustard, Cisplatin
  • 2. Antimetabolites specific for S phase
  • Examples Methotrexate 5 fluorouracil
  • Toxic Effects nausea, vomiting, stomatitis,
    diarrhea, alopecia, leukopenia
  • 3. Antitumor Antibiotics non-phase specific
    interfere with DNA
  • Examples Actinomycin D, Bleomycin
  • Toxic Effect damage to cardiac muscle

21
Chemotherapy Drugs
  • 4. Miotic inhibitors Prevent cell division
    during M phase
  • Examples Vincristine, Vinblastine
  • Toxic Effects affects neurotransmission,
    alopecia, bone marrow depression
  • 5. Hormones stage specific G1
  • Example Corticosteroids
  • 6. Hormone Antagonist block hormones on
    hormone-binding tumors (breast, prostate,
    endometrium cause tumor regression
  • Examples Tamoxifen (breast) Flutamide
    (prostate)
  • Toxic Effects altered secondary sex
    characteristics

22
Chemotherapy
  • Trained and certified personnel
  • Protect personnel from toxic effects
  • double check with physician orders, pharmacists
    preparation
  • Proper management clients excretement

23
Chemotherapy
  • Routes
  • Oral
  • Body cavity (intraperitoneal or intrapleural)
  • Intravenous
  • Vascular access devices
  • PICC lines
  • Tunnelled catheters (Hickman, Groshong)
  • Surgically implanted ports (accessed with 90o
    angle needle)

24
Surgery
  • diagnosis, staging, and treatment of cancer
  • Debulking
  • Reconstruction and rehabilitation

25
Radiation Therapy
  • reduce tumor, relieve pain or obstruction
  • Teletherapy (external) uniform radiation dose to
    tumor
  • Brachytherapy radiation source is placed in
    tumor
  • Caregivers use shields, distancing and limiting
    time with client, following safety protocols

26
Side effects
  • Skin (external radiation) blanching, erythema,
    sloughing
  • Ulcerated mucous membranes pain, lack of saliva
  • GI nausea and vomiting, diarrhea, bleeding,
    sometimes fistula formation
  • Radiation pneumonia

27
Other treatments
  • Biotheraphy monoclonal antibodies (inoculate
    animal with tumor antigen and retrieve antibodies
    against tumor for human)
  • Photodynamic Therapy laser treatment to destroy
    tumor
  • Bone Marrow Transplantation and Peripheral Blood
    Stem Cell Transplantation

28
Pain Control
  • Necessary for continuing function
  • comfort in terminally ill clients
  • maximum relief with minimal side effects
  • narcotic and non-narcotic combo
  • Adjuvants steroids or antidepressants
  • around the clock (ATC) schedule, break-through
    pain
  • injections of anesthetics into nerve
  • surgical severing of nerves radiation
  • tolerance to pain medication

29
Nursing Diagnoses
  • Anxiety
  • Disturbed Body Image
  • Anticipatory Grieving
  • Risk for Infection
  • Risk for Injury
  • Altered Nutrition less than body requirements
  • Impaired Tissue Integrity

30
Oncologic Emergencies
  • Pericaridal Effusion and Neoplastic Cardiac
    Tamponade
  • Treatment pericardiocentesis
  • 2. Superior Vena Cava Syndromefacial and neck
    edema, respiration distress
  • Treatment respiratory support decrease tumor
    size with radiation or chemotherapy
  • 3. Sepsis and Septic Shock

31
Oncologic Emergencies
  • Spinal Cord Compression irreversible paraplegia
  • Treatment early detection and radiation or
    surgical decompression
  • 5. Obstructive Uropathy can result in renal
    failure
  • Treatment restore urine flow
  • 6. Hypercalcemia high calcium from ectopic
    parathyroid hormone or metastases
  • Behaviors fatigue, muscle weakness, polyuria,
    constipation progressing to coma, seizures
  • Treatment restore fluids loop diuretics more
    definitive treatments

32
Oncologic Emergencies
  • 7. Hyperuricemia
  • 1. Concern occurs with rapid necrosis of tumor
    cells as with chemotherapy can result in renal
    damage and failure
  • 2. Prevention and treatment with fluids and
    Alopurinol (Zyloprim)
  • 8. SIADH (Syndrome of Inappropriate Antidiuretic
    Hormone Secretion)
  • 1. Concern ectopic ADH production from tumor
    leads to excessive hyponatremia
  • 2. Treatment restore sodium level
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