Cancer development and cancer nursing created by Marsha Woodall MBA, MSN, RN
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Transcript of cancer nursing
Oncology NursingNurse Licensure
Examination Review
Oncology defined
Branch of medicine that deals with the study, detection, treatment and management of cancer and neoplasia
“Root words”
Neo- new
Plasia- growth
Plasm- substance
Trophy- size
+Oma- tumor
Statis- location
“Root words”
A- none
Ana- lack
Hyper- excessive
Meta- change
Dys- bad, deranged
Characteristics of Neoplasia
Uncontrolled growth of Abnormal cells
1. Benign
2. Malignant
3. Borderline
Characteristics of Neoplasia
BENIGN
Well-differentiated
Slow growth
Encapsulated
Non-invasive
Does NOT metastasize
Characteristics of Neoplasia
MALIGNANT
Undifferentiated
Erratic and Uncontrolled Growth
Expansive and Invasive
Secretes abnormal proteins
METASTASIZES
Nomenclature of Neoplasia
Tumor is named according to:
1. Parenchyma, Organ or Cell
Hepatoma- liver
Osteoma- bone
Myoma- muscle
Nomenclature of Neoplasia
Tumor is named according to:
2. Pattern and Structure, either GROSS or MICROSCOPIC
Fluid-filled CYST
Glandular ADENO
Finger-like PAPILLO
Stalk POLYP
Nomenclature of Neoplasia
Tumor is named according to:
3. Embryonic origin
Ectoderm ( usually gives rise to epithelium)
Endoderm (usually gives rise to glands)
Mesoderm (usually gives rise to Connective tissues)
BENIGN TUMORS
Suffix- “OMA” is used
Adipose tissue- LipOMA
Bone- osteOMA
Muscle- myOMA
Blood vessels- angiOMA
Fibrous tissue- fibrOMA
MALIGNANT TUMOR
Named according to embryonic cell origin
1. Ectodermal, Endodermal, Glandular, Epithelial
Use the suffix- “CARCINOMA”
Pancreatic AdenoCarcinoma
Squamos cell Carcinoma
MALIGNANT TUMOR
Named according to embryonic cell origin
2. Mesodermal, connective tissue origin
Use the suffix “SARCOMA
FibroSarcoma
Myosarcoma
AngioSarcoma
“PASAWAY”
1. “OMA” but MalignantHepatOMA, lymphOMA, gliOMA,
melanOMA
2. THREE germ layers “TERATOMA”
3. Non-neoplastic but “OMA”ChoristomaHamatoma
CANCER NURSING
Review of Normal Cell Cycle
3 types of cells
1. PERMANENT cells- out of the cell cycle Neurons, cardiac muscle cell
2. STABLE cells- Dormant/Resting (G0) Liver, kidney
3. LABILE cells- continuously dividing GIT cells, Skin, endometrium , Blood cells
CANCER NURSING
Cell Cycle
G0------------------G1SG2M
G0- Dormant or resting
G1- normal cell activities
S- DNA Synthesis
G2- pre-mitotic, synthesis of proteins for cellular division
M- Mitotic phase (I-P-M-A-T)
CANCER NURSING
Proposed Molecular cause of CANCER:
Change in the DNA structure altered DNA function Cellular aberration
cellular death
neoplastic change
Genes in the DNA- “proto-oncogene” And “anti-oncogene”
CANCER NURSING
Etiology of cancer
1. PHYSICAL AGENTS
Radiation
Exposure to irritants
Exposure to sunlight
Altitude, humidity
CANCER NURSING
Etiology of cancer
2. CHEMICAL AGENTS
Smoking
Dietary ingredients
Drugs
CANCER NURSING
Etiology of cancer
3. Genetics and Family History
Colon Cancer
Premenopausal breast cancer
CANCER NURSING
Etiology of cancer
4. Dietary Habits Low-Fiber High-fat Processed foods alcohol
CANCER NURSING
Etiology of cancer
5. Viruses and Bacteria
DNA viruses- HepaB, Herpes, EBV, CMV, Papilloma Virus
RNA Viruses- HIV, HTCLV
Bacterium- H. pylori
CANCER NURSING
Etiology of cancer
6. Hormonal agents
DES
OCP especially estrogen
CANCER NURSING
Etiology of cancer
7. Immune Disease
AIDS
CANCER NURSING
CARCINOGENSIS
Malignant transformation
IPP
Initiation
Promotion
Progression
CANCER NURSING
CARCINOGENSIS
INITIATION
Carcinogens alter the DNA of the cell
Cell will either die or repair
CANCER NURSING
CARCINOGENSIS
PROMOTION
Repeated exposure to carcinogens
Abnormal gene will express
Latent period
CANCER NURSING
CARCINOGENSIS
PROGRESSION
Irreversible period
Cells undergo NEOPLASTIC transformation then malignancy
CANCER NURSING
Spread of Cancer
1. LYMPHATICMost common
2. HEMATOGENOUSBlood-borne, commonly to Liver and Lungs
3. DIRECT SPREADSeeding of tumors
CANCER NURSING
Body Defenses Against TUMOR
1. T cell System/ Cellular ImmunityCytotoxic T cells kill tumor cells
2. B cell System/ Humoral immunityB cells can produce antibody
3. Phagocytic cellsMacrophages can engulf cancer cell debris
CANCER NURSING
Cancer Diagnosis
1. BIOPSY The most definitive
2. CT, MRI
3. Tumor Markers
CANCER NURSING
Cancer Grading
The degree of DIFFERENTIATION
Grade 1- Low grade
Grade 4- high grade
CANCER NURSING
Cancer Staging
1. Uses the T-N-M staging system
T- tumor
N- Node
M- Metastasis
2. Stage 1 to Stage 4
CANCER NURSING
GENERAL MEDICAL MANAGEMENT
1. Surgery- cure, control, palliate
2. Chemotherapy
3. Radiation therapy
4. Immunotherapy
5. Bone Marrow Transplant
CANCER NURSING
GENERAL Promotive and Preventive Nursing Management
1. Lifestyle Modification
2. Nutritional management
3. Screening
4. Early detection
SCREENING
1. Male and female- Occult Blood, CXR, and DRE
2. Female- SBE, CBE, Mammography and Pap’s Smear
3. Male- DRE for prostate, Testicular self-exam
Nursing Assessment
Utilize the ACS 7 Warning SignalsCAUTIONC- Change in bowel/bladder habitsA- A sore that does not healU- Unusual bleedingT- Thickening or lump in the breastI- IndigestionO- Obvious change in wartsN- Nagging cough and hoarseness
Nursing Assessment
Weight loss
Frequent infection
Skin problems
Pain
Hair Loss
Fatigue
Disturbance in body image/ depression
Nursing Intervention
MAINTAIN TISSUE INTEGRITY
Handle skin gently
Do NOT rub affected area
Lotion may be applied
Wash skin only with SOAP and Water
Nursing Intervention
MANAGEMENT OF STOMATITIS
Use soft-bristled toothbrush
Oral rinses with saline gargles/ tap water
Avoid ALCOHOL-based rinses
Nursing Intervention MANAGEMENT OF ALOPECIA
Alopecia begins within 2 weeks of therapy Regrowth within 8 weeks of termination Encourage to acquire wig before hair loss
occurs Encourage use of attractive scarves and hats Provide information that hair loss is temporary
BUT anticipate change in texture and color
Nursing Intervention PROMOTE NUTRITION Serve food in ways to make it appealing Consider patient’s preferences Provide small frequent meals Avoids giving fluids while eating Oral hygiene PRIOR to mealtime Vitamin supplements
Nursing Intervention RELIEVE PAIN Mild pain- NSAIDS
Moderate pain- Weak opiods Severe pain- Morphine Administer analgesics round the clock
with additional dose for breakthrough pain
Nursing Intervention DECREASE FATIGUE Plan daily activities to allow alternating
rest periods Light exercise is encouraged Small frequent meals
Nursing Intervention IMPROVE BODY IMAGE Therapeutic communication is essential Encourage independence in self-care
and decision making Offer cosmetic material like make-up
and wigs
Nursing Intervention ASSIST IN THE GRIEVING PROCESS Some cancers are curable Grieving can be due to loss of health,
income, sexuality, and body image Answer and clarify information about
cancer and treatment options Identify resource people Refer to support groups
Nursing Intervention MANAGE COMPLICATION: INFECTION Fever is the most important sign (38.3) Administer prescribed antibiotics X 2weeks Maintain aseptic technique Avoid exposure to crowds Avoid giving fresh fruits and veggie Handwashing Avoid frequent invasive procedures
Nursing Intervention MANAGE COMPLICATION: Septic
shock Monitor VS, BP, temp Administer IV antibiotics Administer supplemental O2
Nursing Intervention MANAGE COMPLICATION: Bleeding Thrombocytopenia (<100,000) is the
most common cause <20, 000 spontaneous bleeding Use soft toothbrush Use electric razor Avoid frequent IM, IV, rectal and
catheterization Soft foods and stool softeners
Colon cancer
COLON CANCER
Risk factors
1. Increasing age
2. Family history
3. Previous colon CA or polyps
4. History of IBD
5. High fat, High protein, LOW fiber
6. Breast Ca and Genital Ca
COLON CANCER
Sigmoid colon is the most common site
Predominantly adenocarcinoma
If early 90% survival
34 % diagnosed early
66% late diagnosis
COLON CANCER
PATHOPHYSIOLOGY
Benign neoplasm DNA alteration malignant transformation malignant neoplasm cancer growth and invasion metastasis (liver)
COLON CANCER
ASSESSMENT FINDINGS1. Change in bowel habits- Most common
2. Blood in the stool
3. Anemia
4. Anorexia and weight loss
5. Fatigue
6. Rectal lesions- tenesmus, alternating D and C
Colon cancer
Diagnostic findings
1. Fecal occult blood
2. Sigmoidoscopy and colonoscopy
3. BIOPSY
4. CEA- carcino-embryonic antigen
Colon cancer
Complications of colorectal CA
1. Obstruction
2. Hemorrhage
3. Peritonitis
4. Sepsis
Colon cancer
MEDICAL MANAGEMENT
1. Chemotherapy- 5-FU
2. Radiation therapy
Colon cancer
SURGICAL MANAGEMENT
Surgery is the primary treatment
Based on location and tumor size
Resection, anastomosis, and colostomy (temporary or permanent)
Colon cancer
NURSING INTERVENTION
Pre-Operative care
1. Provide HIGH protein, HIGH calorie and LOW residue diet
2.Provide information about post-op care and stoma care
3. Administer antibiotics 1 day prior
Colon cancer
NURSING INTERVENTION
Pre-Operative care
4. Enema or colonic irrigation the evening and the morning of surgery
5. NGT is inserted to prevent distention
6. Monitor UO, F and E, Abdomen PE
Colon cancer
NURSING INTERVENTIONPost-Operative care
1. Monitor for complicationsLeakage from the site, prolapse of stoma, skin irritation and pulmo complication2. Assess the abdomen for return of peristalsis
Colon cancer
NURSING INTERVENTIONPost-Operative care
3. Assess wound dressing for bleeding4. Assist patient in ambulation after 24H5.provide nutritional teachingLimit foods that cause gas-formation and odorCabbage, beans, eggs, fish, peanutsLow-fiber diet in the early stage of recovery
Colon cancer
NURSING INTERVENTION
Post-Operative care
6. Instruct to splint the incision and administer pain meds before exercise
7. The stoma is PINKISH to cherry red, Slightly edematous with minimal pinkish drainage
8. Manage post-operative complication
Colon cancer
NURSING INTERVENTION: COLOSTOMY CARE
Colostomy begins to function 3-6 days after surgery
The drainage maybe soft/mushy or semi-solid depending on the site
Colon cancer
NURSING INTERVENTION: COLOSTOMY CAREBEST time to do skin care is after showerApply tape to the sides of the pouch before showerAssume a sitting or standing position in changing the pouch
Colon cancer
NURSING INTERVENTION: COLOSTOMY CAREInstruct to GENTLY push the skin down and the pouch pulling UPWash the peri-stomal area with soap and waterCover the stoma while washing the peri-stomal area
Colon cancer
NURSING INTERVENTION: COLOSTOMY CARE
Lightly pat dry the area and NEVER rub
Lightly dust the peri-stomal area with nystatin powder
Colon cancer
NURSING INTERVENTION: COLOSTOMY CARE
Measure the stomal opening
The pouch opening is about 0.3 cm larger than the stomal opening
Apply adhesive surface over the stoma and press for 30 seconds
Colon cancer
NURSING INTERVENTION: COLOSTOMY CARE
Empty the pouch or change the pouch when1/3 to ¼ full (Brunner)½ to 1/3 full (Kozier)
Breast Cancer
The most common cancer in FEMALES
Numerous etiologies implicated
Breast Cancer
RISK FACTORS
1. Genetics- BRCA1 And BRCA 2
2. Increasing age ( > 50yo)
3. Family History of breast cancer
4. Early menarche and late menopause
5. Nulliparity
6. Late age at pregnancy
Breast Cancer
RISK FACTORS
7. Obesity
8. Hormonal replacement
9. Alcohol
10. Exposure to radiation
Breast Cancer
PROTECTIVE FACTORS
1. Exercise
2. Breast feeding
3. Pregnancy before 30 yo
Breast Cancer
ASSESSMENT FINDINGS1. MASS- the most common location is the upper outer quadrant2. Mass is NON-tender. Fixed, hard with irregular borders3. Skin dimpling4. Nipple retraction5. Peau d’ orange
Breast Cancer
LABORATORY FINDINGS
1. Biopsy procedures
2. Mammography
Breast Cancer
Breast cancer Staging
TNM staging
I - < 2cm
II - 2 to 5 cm, (+) LN
III - > 5 cm, (+) LN
IV- metastasis
Breast Cancer
MEDICAL MANAGEMENT
1. Chemotherapy
2. Tamoxifen therapy
3. Radiation therapy
Breast Cancer
SURGICAL MANAGEMENT1. Radical mastectomy
2. Modified radical mastectomy
3. Lumpectomy
4. Quadrantectomy
Breast Cancer
NURSING INTERVENTION : PRE-OP1. Explain breast cancer and treatment options2. Reduce fear and anxiety and improve coping abilities3. Promote decision making abilities4. Provide routine pre-op care:Consent, NPO, Meds, Teaching about breathing exercise
Breast Cancer
NURSING INTERVENTION : Post-OP
1. Position patient:
Supine
Affected extremity elevated to reduce edema
Breast Cancer
NURSING INTERVENTION : Post-OP
2. Relieve pain and discomfort
Moderate elevation of extremity
IM/IV injection of pain meds
Warm shower on 2nd day post-op
Breast Cancer
NURSING INTERVENTION : Post-OP
3. Maintain skin integrity
Immediate post-op: snug dressing with drainage
Maintain patency of drain (JP)
Monitor for hematoma w/in 12H and apply bandage and ice, refer to surgeon
Breast Cancer
NURSING INTERVENTION : Post-OP
3. Maintain skin integrity
Drainage is removed when the discharge is less than 30 ml in 24 H
Lotions, Creams are applied ONLY when the incision is healed in 4-6 weeks
Breast CancerNURSING INTERVENTION : Post-OP
Promote activity
Support operative site when moving
Hand, shoulder exercise done on 2ndday
Post-op mastectomy exercise 20 mins TID
NO BP or IV procedure on operative site
Breast Cancer
NURSING INTERVENTION : Post-OP
Promote activity
Heavy lifting is avoided
Elevate the arm at the level of the heart
On a pillow for 45 minutes TID to relieve transient edema
Breast Cancer
NURSING INTERVENTION : Post-OP
MANAGE COMPLICATIONS
Lymphedema
10-20% of patients
Elevate arms, elbow above shoulder and hand above elbow
Hand exercise while elevated
Refer to surgeon and physical therapist
Breast Cancer
NURSING INTERVENTION : Post-OP
MANAGE COMPLICATIONS
Hematoma
Notify the surgeon
Apply bandage wrap (Ace wrap) and ICE pack
Breast Cancer
NURSING INTERVENTION : Post-OP
MANAGE COMPLICATIONS
Infection
Monitor temperature, redness, swelling and foul-odor
IV antibiotics
No procedure on affected extremity
Breast Cancer
NURSING INTERVENTION : Post-OP
TEACH FOLLOW-UP care
Regular check-up
Monthly BSE on the other breast
Annual mammography