NURSING BS 242Z1- Oncology Study Guide

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REQUIRED READINGS:

Ignatavicius, D. D., & Workman, M. L., (2016). Medical-surgical nursing: patient-centered collaborative care.
(8th ed.). St Louis, MO; Elsevier Inc. Chapters 7, 21, 22, 40 (pp. 806-819)

NORMAL LABS:
WBC: 5-10K HCT: M:42-52%; F:37-47%
RBC: M: 4.7-6.1; F: 4.2-5.4 HGB: M:14-18; F:12-16
PLT: 150-400 CA+: 9-10.5

TOPICAL OUTLINE:
I. End-of-Life Care
a. Overview of Death and Dying
-Concept of “good” (with dignity) death and “bad” (without dignity) death
-Nurses can greatly impact dying process
-Virginia Henderson’s definition of nsg: “assisting individuals to gain independence in relation to the performance of
activities contributing to health or its recovery or a peaceful death” (1966)


• Nurse must:
o Have compassion

o Be a patient/family advocate

o Have good communication skills


i. Death in the United States
Statistics on Death in U.S.
• Over 2.6 million deaths in 2014
• Most deaths occur after a long period of illness (<10% = sudden deaths)
• 75% deaths occur age 65 or greater
• 25% deaths occur in home
• 75% deaths occur in hospital/nsg home


ii. Pathophysiology of Dying
-Death— cessation of heartbeat, absence of spontaneous respirations, or irreversible brain
dysfunction
-Most common cause of death U.S. = heart disease, followed by cancer
-Direct causes of death = heart failure, resp failure, shock


iii. Planning for End-of-Life and Advance Directives
Advance Directives (always ask patients about these)
• Written documents specifying the medical care provided or not provided if one becomes incapacitated.

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• Person must have decision-making ability when advance directives written
• 2 common advance directives:
o Durable power of attorney (DPOAHC)

• legal document assigning decision-making power to another person in the event person
becomes incapable of making decisions (ex p. 93)


o Living will

• legal document that instructs physicians and family about what life-sustaining treatment a
person does or does not want at some future time (CPR, respirator, tube feeding, DNR
status)


iv. Hospice and Palliative care
-Hospice - interdisciplinary approach to assess & address holistic needs of pts & families to
facilitate quality of life & a peaceful death
-assess home, patient, family
-goals: pain meds (morphine-sublingual, PO), supplies, do they know how to do
things when they get home
-Does not hasten or prolong death
-Free standing hospice, home, hospital, nsg home, assisted living facilities
• Benefits paid if prognosis of 6 months or less to live (Medicare guidelines)
• Hospice treated as last resort option
• Studies show hospice improves quality of life and lowers costs
• Symptom relief kit, chart 7-3 (p. 97)
o Pain

• Morphine (20mg/1ML solution) 0.25-0.5ML orally or SL q2hp
o Dyspnea (raise HOB)

• Morphine (20mg/1ML solution) 0.25-0.5ML orally or SL q2hp
• **Offer oxygen to any patient with dyspnea near death regardless of his/her
oxygen saturation, because comfort is desired outcome
o Agitation and restlessness

• Determine if pt in pain, treat accordingly
• If pt experiencing urinary retention, insert cath
• Haloperidol 0.5-1mg orally or SL q6h
• Lorazepam 0.5-1mg elixir or tab q4h
o Oral secretions

• Atropine drops 1% (2 drops orally or SL) q4hp



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• Palliative Care
o a philosophy of care and a system for delivering care for pts with a life-threatening illness
(not going to die within 6 mos)
o Goals:

• to identify pts/family’s goals of care
• assist with informed decisions making
• facilitate quality symptom management
o Comparison of hospice & palliative care – table 7-2 (p. 95)

HOSPICE CARE PALLIATIVE CARE
-patients have prognosis of 6 mos or -patients can be in any stage of serious
less to live illness
-care is provided when curative -a consult is provided that is concurrent
treatment such as chemo, has been with curative therapies or therapies that
stopped prolong life
-care is provided in 60 and 90 day -care is not limited by specific time periods
periods with an opportunity to continue -care is in the form of consult visit by a
if eligibility criteria is met physician or advanced practice nurse who
-ongoing care is provided by RNs, makes recommendations, follow-up visits
social workers, chaplains and volunteers may be provided.


Symptoms at End of Life
• Pts often have s/s of decline in physical function:
• Weakness
• Anorexia
• Changes in cardiovascular function (BP, P then ceases)
• Changes in breathing patterns
(Cheyne-Stokes, apnea, death rattle)
• Changes in GI function (no H2O/food)
• Changes in GU function (decreased UOP)
Physical Assessment
• Common physical s/s of approaching death - Chart 7-1 (p. 96)
• Coolness of Extremities
• cover the pt with blanket (not electric blanket)
• Increased sleeping (23 hrs)
• Do not force to stay awake
• Talk to the person normally
• Fluid/food decrease intake
• Do not force them to eat/drink
• Offer small sips or ice chips


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• Use swabs to keep mouth/lips moist
• Incontinence
• Keep perineal area clean and dry
• Maybe use a foley
• Congestion and gurgling
• Position them on their side
• Breathing pattern change
• Elevate person’s head, put them on their side
• Disorientation
• Identify yourself when you communicate with them
• Reorient as needed
• Restlessness
• Play soft music, room dimly lit, noise to a minimum
• Do not restrain them
• Reduce number of people in room
• Talk quietly


Psychosocial Assessment
• Assessment
o Fear and anxiety

o Difficulty coping

o Feelings of patient and significant others

 Help pt/family talk about feelings (asking for forgiveness, etc.)
 Find out their spiritual needs
o Common emotional s/s of approaching death – Chart 7-2

 Withdrawal
• Preparing to let go from surroundings/relationships
 Vision-like experiences
• Do not deny/argue with them, affirm the experience
 Letting go
• Tell them it’s okay to let go
 Saying goodbye
• Touch, hug, cry, say I love you, I’m sorry
• Nursing Care: Pain Management


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