Post on 11-Jan-2016
Objectives
Discuss nursing care for patients with musculoskeletal tumors.
Describe complications of treatment, including chemotherapy, radiation and surgery.
#1) Mr. A has just been diagnosed with an osteosarcoma. He shows an understanding of his treatment options when he states:
a) “I accept that I have to lose my leg.”
b) “I.m glad they can take out the cancer with such a small scar.”
c) “The chemotherapy before surgery will shrink the tumor.”
d) “This tumor is related to the colon cancer I had 6 years ago.”
#1 Answer: c)
Rationale: Chemotherapy and radiation are utilized prior to surgery to shrink the tumor and improve chances for limb salvage.
ASSESSMENT
What is “chief complaint”?
What modalities have been attempted?What beliefs?What support?
Diagnostic Tests
A/P and lateral x-ray Suspicious lesion
CT and/or MRI
X-ray/chest CT to rule out mets
Bone scan
Lab studies
Biopsy Open, Closed, Excisional
Arteriogram
Non-Surgical Interventions: Chemotherapy
Shrink primary tumor, facilitate resection
Destroy or shrink pulmonary metastasis/micrometastasis
Evaluate efficacy of cytotoxic drugs preoperatively
Non-Surgical Interventions: Radiation Therapy
Adjuvant bone
Palliative bone
Adjuvant soft tissue
Brachytherapy
Neuron beam therapy
#2) Mr. A has just undergone a below-the-knee amputation. During his postoperative course, measures to prevent flexion contractures of the proximal joint include:
a) placing bed in reverse trendelenburg.b) encouraging side lying position on affected side at
least t.i.d.c) placing pillow under his thigh.d) instructing him to maintain leg in neutral
rotation.
#2 Answer: d)
Rationale: Instruct Mr. A to maintain leg in neutral rotation, as other positions would not be beneficial, or actually lead to flexion contracture.
#3) Mr. Q, age 50, is preparing for removal of a liposarcoma with reconstructive surgery. Upon discussing pain management, Mr. Q states he had PCA-morpine after a prior surgery, but he is concerned he will become addicted if he uses it again. He takes one oral non-narcotic analgesic at bedtime & no other meds. An appropriate response would be:
a) “Maybe you should talk to the M.D. about Demerol PCA.”b) “Please tell me more about why you think you’ll become
addicted.”c) “I don’t think you should worry about addiction at your age.”d) “Would it help if we gave you morphine IM rather than a
PCA?”
#3 Answer: b)
Rationale: you need to discuss with the patient his misconception regarding pain management.
Pain:Barriers to Cancer Pain
Management
Problems related to:Healthcare professionalsPatientsHealthcare system
ABCDE Approach to Pain
A = Ask / Assess
B = Believe patient & family
C = Choose options
D = Deliver interventions
E = Empower / Enable
Nursing Diagnosis
Impaired physical mobility
Alteration in comfort
Outcome
Patient ambulates independently unless bedrest warranted
Patient verbalizes decreased or relieved pain
#4) Mr. J has been receiving preop chemotherapy & develops stomatitis. Dietary suggestions to help alleviate this discomfort would include:
a) orange juice mixed with protein powder.
b) spaghetti marinara.
c) mashed potatoes with butter.
d) raw vegetables.
Nursing Diagnosis
Self-care deficit
Ineffective individual & family coping
Alteration in sexuality
Outcome
Promote self-care & ability to carry out ADLs
Facilitate use of + coping skills
Patient/s.o. find means t express sexuality
#5) Mrs, M, age 30, has been diagnosed with osteosarcoma of the pelvis. Which of the following statements indicate her understanding of the reproductive issues which occur during chemo?
a) “I will never be able to have a baby.”
b) “My menstrual periods will remain regular.”
c) “I am worried my cancer will spread if I have sex.”
d) “My husband will continue to use condoms.”
#5 Answer: d)
Rationale: During chemotherapy, females undergo irregular menstrual cycles & infertility. However, conception is still possible & birth control is to be used during sexual intercourse to prevent complications.
Nursing Diagnosis
Alteration in skin integrity
Alteration in emotional integrity
Outcome
Skin integrity remains intact
Patient verbalizes feelings freely
#6) Jim, age 15, is about to undergo surgery for a 4cm. X 4cm. lesion following radiation therapy. You realize he will be at risk for a deficit in wound healing due to:
a) prior radiation therapy.
b) large area of resection.
c) his father’s hx of wound healing problems.
d) he doesn’t like to eat breakfast.
#6 Answer: a)
Rationale: Radiation therapy puts patients at greater risk for wound healing problems.