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CARING FOR CLIENTS WITH CANCER

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Cancer is characterized by abnormal, unrestricted cell growth. ... Internal radiation therapy sealed brachytherapy-done as inpt-radioactive ... – PowerPoint PPT presentation

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Title: CARING FOR CLIENTS WITH CANCER


1
CHAPTER 21
  • CARING FOR CLIENTS WITH CANCER

2
PATHOPHYSIOLOGY
  • Cancer is characterized by abnormal, unrestricted
    cell growth.
  • NEOPLASMS/TUMORS-new growth of abnormal tissue
  • CLASSIFIED BY
  • Origin
  • Manner of growth
  • benign not invasive or spreading
  • malignant invasive capable of
    spreading box 21-1

3
Classification of Tumor Cells table 21-1
  • CARCINOMAS originate from epithelial cells
  • LYMPHOMAS originate from organs that fight
    infection
  • LEUKEMIAS originate from organs that form blood
  • SARCOMAS originate from connective tissue, like
    bone or muscle

4
  • METASTASIS or spreading
  • Primary site areas where the tumor first
    forms
  • Secondary site areas where the cancerous
    cells move or metastasis
  • BENIGN TUMORS do not move, may just slowly grow
    larger

5
ETIOLOGY
  • Cancer is the 2nd leading cause of death in the
    US
  • Lung cancer is 1 cause of cancer deaths
  • Most common cancers in men prostate, lung
    colon
  • Most common cancers in womenbreast, lung colon
  • chemical agents such as tobacco smoke, asbestos,
    coal dust account for about 75 of cancers
  • environmental factors such as prolonged exposure
    to sunlight, radiation, pollutants
  • diet box 21-2
  • viruses bacteria
  • defective genes
  • medically prescribed interventions such as
    immunosuppressive drugs, hormone replacements
    anticancer drugs

6
SIGNS SYMPTOMS OF CANCER
  • Change in bowel/bladder function
  • Sores that do not heal
  • Unusual bleeding or discharge
  • Thickening or lump in breast or other body parts
  • Indigestion or difficulty in swallowing
  • Recent change in a wart or mole
  • Nagging cough or hoarseness

7
DIAGNOSTIC TESTS
  • Labs
  • tumor markers table 21-3
  • Radiological Imaging Tests
  • Xrays
  • CT
  • Nuclear medicine scans using radioisotopes
  • MRI
  • PET scans
  • Radioimmunoconjugates
  • Ultrasound
  • Fluoroscopy

8
OTHER STUDIES
  • BIOPSY tissue examined under microscope
  • FROZEN SECTION sample frozen and then thinly
    sliced to see under microscope quicker decision
    maker
  • ENDOSCOPY done with scope to upper or lower GI
    system
  • CYTOLOGY cells examined under microscope

9
STAGING OF TUMORS
  • Table 21-4
  • Stage I Malignant cells are confined to the
    tissue of origin, no signs of metastasis
  • Stage II Spread of cancer is limited to the
    local area, usually to area lymph nodes
  • Stage III Tumor is larger, probably has invaded
    surrounding tissue or both
  • Stage IV Cancer has invaded or metastasized to
    other parts of the body

10
SURGERY
  • RANGE OF SURGICAL INTERVENTION
  • Extent of the disease
  • actual pathology
  • age and physical condition of pt
  • anticipated results

11
SURGERY
  • Primary treatment used when tumors are confined
    have not invaded vital organs considered
    curative
  • Salvage surgery is when there has been a local
    recurrence of cancer
  • Prophalactic surgery is when the client is at
    considerable risk for cancer
  • Palliative surgery is used to relieve
    uncomfortable symptoms or prolong life
  • Reconstructive or plastic surgery done after
    extensive surgery or to correct defects caused by
    the original surgery

12
RADIATION THERAPY
  • Uses high-energy ionizing radiation to destroy
    cancer cells
  • External radiation therapy aimed at specific
    body location usually done daily for a specified
    number of times outpt
  • Internal radiation therapy sealed
    brachytherapy-done as inpt-radioactive source
    implanted directly into the tumor-box 21-5 safety
    measures
  • Possible side effects alopecia, n/v/d,
    cystitis, pneumontitis, fatigue,stomatitis,
    leukopenia, thrombocytopenia, fibrosis
  • Nursing guidelines 21-1, client family teaching
    21-1

13
Nursing care of pt receiving radiation
  • Provide information on procedure and possible
    side effects
  • Protect skin
  • Maintain intact oral mucous membranes
  • Provide emotional support
  • Monitor for s/s of bone marrow suppression
  • Monitor for s/s of bleeding due to low platelet
    count

14
CHEMOTHERAPY
  • Drug Therapy Table 21-1
  • Antineoplastic drugs are used to destroy tumor
    cells by interfering with cellular function and
    reproduction
  • Cell Cycle-Specific Drugs work when the cell
    is in a specific stage of reproduction used for
    rapidly growing tumors
  • Cell Cycle-Nonspecific drugs effective during
    any phase of the cell cycle or even when not
    reproducing

15
Routes Devices
  • Oral IV are the most common routes
  • IV must monitor for s/s of extravasation at
    site or leakage of the drug into the surrounding
    tissue Table 21-5
  • Common Vascular Devices PICC lines, Hickman or
    Broviac Catheters, implanated ports
  • Advantages
  • long term use
  • less venipunctures
  • less problems when a client has poor veins
  • drug can go directly into the heart central
    circulation

16
ADVERSE EFFECTS AND NURSING CARE
  • Adverse effects
  • n/v most common within first 24 hrs
  • stomatitis
  • alopecia
  • bone marrow depression
  • fatigue
  • Nursing care-nursing guidelines 21-2
  • Safety measures for nurses when administering
    chemo Box 21-6
  • monitor for s/s of anaphylactic reactions
  • increase fluid intake
  • administer antiemetic drugs
  • dietary modifications

17
Bone Marrow Transplantation
  • Nursing Guidelines 21-3
  • Autologous client receives own bone marrow that
    was harvested
  • Allogeneic receives bone marrow from a
    histocompatible, but unrelated donor
  • Syngeneic client receives bone marrow from an
    identical twin
  • Stem cell receive their own stem cells that
    have been grown due to infusion of hematopoietic
    growth factors

18
Other Cancer Treatments
  • Immunotherapy uses biologic response modifiers
    (BRM) to stimulate the bodys natural immune
    system to restrict destroy the cancer cells
  • Hyperthermia uses temperatures gt 106.4F to
    destroy tumor cells
  • Gene therapy replaces altered genes with correct
    genes
  • Clinical trials testing new treatments for
    specific cancers

19
Complementary Alternative Therapy Table 21-7
  • Imagery
  • Medicinal therapy
  • Special diets
  • Mystical spiritual approaches

20
Nursing Care-Nursing Care Plan 21-1
  • Pain management
  • Fatigue
  • Infection
  • Anxiety, fear depression
  • Client family teaching
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