NRSG 3200 Unit 11 Cancer Based on Powerpoint 2022 Exam.

Cellular regulation The functions cells perform to maintain homeostasis and conditions that contribute to alterations. Cancer is a class of diseases characterized by... out-of-control cell growth. 00:10 01:14 There are 100 different types of cancer, each classified by... the type of cell that is initially affected. _____ normally regulates cellular growth and development. Proto-oncogene _____ allow unregulated genetic activity and tumor growth. Oncogenes ______ regulate the effects of oncogenes to decrease wildly proliferating cellular growth. Tumor-suppressor genes Carcinoma Origin Epithelial or lining of organs. Cells that cover internal and external parts of the body such as lung, breast, and colon. Sarcoma Origin Connective Tissue. Cells that are located in bone, cartilage, fat, connective tissue, muscle, and other supportive tissues. Myeloma Origin Plasma cells; B-lymphocytes Lymphoma Origin Lymphocytes. Lymph nodes and immune system tissues. Leukemia Origin Hematopoetic stem cells in blood and bone marrow. Primary Prevention Concerned with reducing the risks of disease through health promotion strategies. Secondary Prevention Promote screening and early detection activities such as breast and testicular self examination and Pap smears. Tertiary Prevention Monitoring for reoccurrence of primary cancer, screening for secondary malignancies. Management of Cancer- Surgery Diagnostic (biopsy) Primary treatment surgery Prophylactic surgery Palliative surgery Reconstructive surgery Radiation therapy uses the least amount of radiation as possible, high dose capable of destroying cancer cells, delivered in ____. fractions Types of Radiation Therapy External Radiation- direct beam Internal Radiation- brachytherapy or medication Radiation therapy can cause ____ or ____ burning; scarring Staff protection from Radiation Time- minimize time spent in close proximity with patient. Distance- increase distance from radioactive material (preferably 6ft). Shielding- use shielding to decrease exposure to radiation. Personnel wear dosimeters. Patient is put in lead lined room. Chemotherapy Antineoplastic agents destroy tumor cells. Kills cells in the cell cycle. Each time a tumor is exposed to a chemotherapy agent, a percentage of the tumor cells are destroyed. Kills actively proliferating cells. Risk for toxicity. Caring for Patients receiving Chemotherapy and 48 hours after While handling bodily fluids wear gown and double glove. After disposing of patient's urine or vomit in the toilet, flush twice. Bedding and clothing are bagged in yellow bags. Chemo gowns and gloves are disposed in yellow containers or hazard-waste receptacle. Sharps are disposed in yellow sharps container. If there is a chemo spill, then notify the charge nurse and follow institution policy. Labs to Monitor CBC WBC ANC- neutropenia RBC Platelets BMP Electrolytes BUN/Creatinine LFTs Tumor Markers CEA- colon and breast PSA- prostate CD20- non-hodgkin lymphoma TNM Classification System T- the extent of the primary tumor. N- the absence or presence of extent of regional lymph node metastasis. M- the absence or presence of distant metastasis. Primary brain tumors Tumors that originate in the brain. Meningiomas (most common site)- 37% of primary tumors. Gliomas- very deadly, poor survival rates (5% at 5 years) Nerve sheath tumors, pituitary tumors, lymphomas, oligodendrogliomas, medulloblastomas. Secondary brain tumors Metastatic tumors, originating elsewhere and migrating to the brain. More common in adults than children. Lung, breast, colon, kidney, and melanoma are the most common primary sites. 80% of patients have multiple tumors. Risk factors for Brain tumors Radiation exposure. No known lifestyle related or environmental causes. Clinical manifestations of brain tumors Increased intracranial pressure- headache, nausea, vomiting, visual disturbances, balance problems, personality changes, seizures, drowsiness, and coma. Localized symptoms- hemiparesis, seizures, mental status changes, sensory and motor abnormalities, visual alterations, and language disturbances. Diagnostic Tests for Brain Tumors MRI CT PET CXR Angiogram Biopsy Lumbar puncture Medical management of Brain Tumors Chemotherapy External-beam radiation therapy Brachytherapy Surgical resection Medications- corticosteroids, mannitol, antiseizure agents, anticoagulants, pain medications, and hormones Nursing Care for Brain Tumors Compensating for self-care deficits. Improving nutrition. Evaluate gag reflex. Prevent aspiration. Neurological assessments. Orientation. Seizure precautions. Assess for increased ICP. Assess vital signs. Relieve anxiety. Enhance family processes. Promote home and community based care. Nursing Diagnoses for Brain Tumors Self-care deficit Imbalanced nutrition Impaired physical mobility Disturbed sensory perception alteration Anxiety Interrupted family processes Chronic pain Complications of Brain Tumors ICP Seizures and neurological problems Hydrocephalus Syndrome of inappropriate secretion of antidiuretic hormone (SIDH) Altered pituitary function Lung Cancer Leading cancer killer among men and women in the US. Second most common cancer. Approximately 70% has spread to lymphatic system and other sites by the time it is diagnosed. 5 year survival rate is 10-13%. Two Classifications of Lung Cancer Small cell lung cancer- cells of the lung (15-20%)- oat cell cancer- spreads rapidly. Non-small cell carcinoma (85%)- most common. *Squamous cell carcinoma (25-30%)- airways. *Adenocarcinoma (40%)- mucus *Large cell carcinoma (10-15%)- any part of the lung Risk factors for Lung Cancer Inhaled carcinogens Cigarette smoke Radon gas Asbestos Inhaled chemicals Diesel exhaust Air pollution Radiation Arsenic in drinking water Genetics Occupational and environmental agents Clinical Manifestations of Lung Cancer Develops insidiously and is asymptomatic until late in course. Cough or change in chronic cough. Dyspnea Blood in sputum. Recurring fever and infections. Chest pain and tightness. Dysphagia Weight loss Poor appetite Head and neck edema Hoarseness Wheezing Pleural or pericardial effusion. Fatigue Diagnostic Tests for Lung Cancer History and physical Imaging Sputum cytology Biopsy Bronchoscopy Pulmonary function tests Frequent Sites of Lung Cancer Metastasis Brain, Bone, Liver, Adrenal gland Medical Management of Lung Cancer Treatment depends on stage. Surgical resection *lobectomy is preferred to remove all cancer Radiation therapy Chemotherapy Palliative therapy Nursing Care for Lung Cancer Manage symptoms Relieve breathing problems. Reduce fatigue. Prevent nausea and vomiting. Help with anorexia. Provide psychological support. Colon Cancer The third leading cause of cancer death in men and women in the US. Third most common cancer. Early diagnosis and prompt treatment saves 3/4 lives annually. 5 year survival rate is 90%. Prevention and early screening are the key to detecting and reducing mortality rates. 95% are adenocarcinomas. Starts in cells that form glands that make mucus to lubricate the colon and rectum. Cancer can form in a polyp. Polyp can grow into the wall of the colon/rectum and into the blood vessels or lymph vessels, then travels through the vessels to other places in the body such as the liver. Risk Factors of Colon Cancer Age Personal history of colorectal polyps or colorectal cancer. Inflammatory bowel disease. Family history. Genetics. High consumption of alcohol. Smoker Obesity History of gasterectomy. High-fat, high-protein, low-fiber diet. Genital cancer Clinical Manifestations of Colon Cancer Change in bowel habits. Passage of blood or blood in stools/ dark stools. Abdominal cramping. Unexplained anemia. Anorexia Weight loss Fatigue/weakness. Feeling that you need to have a BM that is not relieved. Many instances, symptoms do not develop until the cancer is at an advanced stage. Diagnostic Tests for Colon Cancer Colonoscopy CT Stool tests Carcinoembryonic antigen (CEA) Medical Management of Colon Cancer Surgical resection is primary treatment for curative or palliative treatments. Chemotherapy. Radiation therapy used before, during, and after surgery to shrink tumor. Immunotherapy. Nursing Care for Colon Cancer Provide emotional support. Provide postoperative care. Maintain optimal nutrition. Provide wound care. Monitor and manage complications. Colostomy care. Support a positive body image. Discuss sexuality issues. Teach self-care to patient. Promote home and community-based care. Nursing Diagnoses for Colon Cancer Imbalanced nutrition Risk for deficient fluid volume. Anxiety Risk for ineffective therapeutic regimen. Impaired skin integrity. Disturbed body image. Ineffective sexuality patterns. Complications of Colon Cancer Partial or complete bowel obstruction. Ulceration resulting in hemorrhaging. Perforation Abscess formation Sepsis Shock Appearance of BCC Pearly/translucent/or flesh colored Appearance of SCC Red/crusted/scaly/rapidly growing Appearance of Melanoma Asymmetrical/color variation but often dark brown/usually larger than a pencil eraser in size. Types of Skin Cancer Basal cell carcinoma Squamous cell carcinoma Malignant melanoma Basal Cell Carcinoma (BCC) Shares features with lowest layer of epidermis, basal cells. Grows slowly, but if not treated it can spread. Most common type of skin cancer. Usually develops on sun exposed areas. Squamous Cell Carcinoma (SCC) Shares features with squamous cells in the outer layers of the skin. Appears on sun exposed areas. Tends to grow and spread more than BCC Risk Factors for BCC/SCC UV light exposure Light colored skin Older age Male Exposure to certain chemicals Radiation exposure Previous skin cancer Long term skin inflammation or injury HPV infection Smoking Medical Management for BCC/SCC Based on stage Surgical management: Moh's micrographic surgery, electrosurgery, cryosurgery. Local therapy Radiation therapy Chemotherapy Malignant Melanoma Cancer begins in the melanocytes For men, most common sites are chest and back. For women, most common on legs. Less common than BCC/SCC. Most lethal. Superficial and nodular. Risk Factors for Melanoma UV light exposure Moles Fair skin Freckling Light hair Personal history Younger than 30 years old. Gender Genetic- chromosome 9P Clinical manifestations to watch for that could be Melanoma A sore that does not heal. Spread of pigment from the border of a spot to surrounding skin. Redness or a new swelling beyond the border. Change in sensation such as itchiness, tenderness, or pain. Change in the surface of a mole. ABCDE *Asymmetry *Border *Color *Diameter *Evolving Diagnostic Tests for Melanoma Medical history and physical exam Skin biopsy Lymph node biopsy Imaging tests to look for possible spread of melanoma to lymph nodes or other organs. Medical Management for Melanoma Based on stage of cancer. Surgery. Immunotherapy Target therapy Chemotherapy Radiation therapy Nursing Care of Melanoma Teach patients self-care Teach about prevention. Relieve pain and discomfort. Reduce anxiety and depression. Monitor and manage complications. Promote home and community-based care. Nursing Diagnoses and Complications of Melanoma Acute pain Anxiety Depression Deficient knowledge Metastasis Infection Procedure done for skin cancer that conserves the most amount of normal tissue Moh's micrographic surgery Side Effects of Cancer Therapy Myelosuppression (risk for infection, anemia, and bleeding) Impaired skin integrity. Stomatitis. Alopecia. Nausea/vomiting. Nutritional problems. Fatigue. Chronic pain. Body image and self-esteem issues. Grieving. Advanced directives. End-of-life care. Oncologic Emergencies Superior vena cava syndrome. Spinal cord compression. Hypercalcemia Pericardial Effusion Cardiac tamponade DIC SIDH Tumor lysis syndrome ____ is given for decreased WBC Neuopogen ____ is given for decreased RBC Procrit ____ is given for decreased platelets FFP and platelet transfusions Nursing Interventions for Impaired Skin Integrity Avoid using soaps, perfumes, lotions, ointments, deoderants. Use lukewarm water for bathing. Avoid scratching. Avoid shaving with straight edge razor. Avoid hot or cold to the area. Avoid exposure to sunlight. Avoid tight clothing. Apply vitamin A and D ointment. Radiation associated: Clean skin, promote comfort, reduce pain, prevent trauma, prevent and manage infection. Malignant skin lesions: Carefully assess lesions, maintain comfort, pain management, clean skin, prevent infection, control bleeding, prevent future trauma, and teach patient and family how to care for lesions. Nursing Interventions for Stomatitis Good oral hygiene, including brushing with soft toothbrush, flossing, and rinsing. Avoid mouthwashes, alcoholic beverages, tobacco, spicy foods, hard to chew foods, extreme temperatures. Keep lips moist. Nystatin swish and swallow. Nursing Interventions for Alopecia Support the patient and family in coping with changes in body image. Wigs and scarves. Nursing Interventions for Nausea/Vomiting Give antiemetics prior to administration of chemo. Maintain nausea meds at home. Avoid large meals. Eat/drink slowly. Suck on ice cubes, mints, or tart candies. Avoid odors that bother you. Stay away from sweet, fried, or fatty foods. Wear loose clothing. Breathe deeply and slowly. Use relaxation techniques. Nursing Interventions for Nutritional Problems Avoid unpleasant sights, odors, sounds. Suggest food that the patient prefers, high protein, smaller more frequent meals, cold foods. Encourage adequate fluid intake. Promote relaxation and decrease anxiety. Provide pain and nausea relief. Nursing Interventions for Fatigue Encourage rest periods before and after physical exertion. Promote normal sleep habits. Encourage patient to ask for assistance with housework, childcare, shopping, cooking. Encourage reduced job workload. Encourage relaxation techniques. Assess for fluid and electrolyte disturbances. Encourage adequate protein intake. Nursing Interventions for Chronic Pain Use pain scale and administer pain meds as needed. Assess fear, fatigue, and anger. Assess response to pain medications. Encourage strategies for pain relief that patient has used successfully in previous pain experience. Teach patient new strategies to relieve pain- distraction, imagery, relaxation, cutaneous stimulation. Nursing Interventions for Body Image and Self-Esteem Issues Assess feelings about body image and level of self-esteem. Identify potential threats. Encourage participation in activities and decision making. Individualize care. Encourage self-care. Nursing Interventions for Grieving Encourage verbalization of fears, concerns, questions regarding disease, treatment, and future implications. Explore successful coping strategies. Encourage participation of patient or family in treatment decisions. Encourage ventilation of negative feelings. Allow patient to cry and express sadness. Involve spiritual advisor. Advise professional counseling. Allow progression through the grieving process. Nursing Interventions for Advanced Directives Encourage patient to plan end-of-life care with advance directives, living wills, and durable power of attorney. Encourage patient to share decisions with family members. Living wills tell which treatment you want if you are dying or permanently unconscious. You can accept or refuse medical care. *dialysis, ventilators, feeding tubes, organ and tissue donation. Nursing Interventions for End-of-Life Care Hospice: focus on quality of life, palliation of symptoms and provision of psychosocial and spiritual support for patient and families when cure and control of the disease are no longer possible. Palliative care: prevent and relieve suffering and support the best possible quality of life for patients and for their families.