General Interventions for Clients with Cancer

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Chapter 28

General Interventions for Clients with Cancer


General Disease-Related Consequences of Cancer

• Impaired immune and hematopoietic function

• Altered gastrointestinal structure and function

• Motor and sensory deficits

• Decreased respiratory function

• Impaired immune and hematopoietic function

• Altered gastrointestinal structure and function

• Motor and sensory deficits

• Decreased respiratory function


Surgery as Cancer Treatment

• Oldest form of cancer treatment used for:

– Prophylaxis

– Diagnosis

– Cure

– Control

– Palliation

– Determining efficacy of therapy

– Reconstruction

• Oldest form of cancer treatment used for:

– Prophylaxis

– Diagnosis

– Cure

– Control

– Palliation

– Determining efficacy of therapy

– Reconstruction


Radiation Therapy for Cancer

• Purpose: to destroy cancer cells with minimal exposure of the normal cells to the damaging actions of radiation

• Mechanism of action

• Killing effects of radiation

• Teletherapy

• Brachytherapy

• Purpose: to destroy cancer cells with minimal exposure of the normal cells to the damaging actions of radiation

• Mechanism of action

• Killing effects of radiation

• Teletherapy

• Brachytherapy


Side Effects of Radiation Therapy

• Vary according to the site

• Local skin changes and hair loss that will likely be permanent depending on the total absorbed dose

• Altered taste sensations

• Fatigue related to increased energy demands

• Inflammatory responses that cause tissue fibrosis and scarring

• Vary according to the site

• Local skin changes and hair loss that will likely be permanent depending on the total absorbed dose

• Altered taste sensations

• Fatigue related to increased energy demands

• Inflammatory responses that cause tissue fibrosis and scarring


Nursing Care of Clients Undergoing Radiation Therapy

• Teach accurate objective facts to help client cope.

• Do not remove markings.

• Administer skin care.

• Do not use lotions or ointments.

(Continued)

• Teach accurate objective facts to help client cope.

• Do not remove markings.

• Administer skin care.

• Do not use lotions or ointments.

(Continued)


Nursing Care of Clients Undergoing Radiation Therapy (Continued)

• Avoid direct exposure of the skin to the sun.

• Care for xerostomia (dry mouth).

• Bone exposed to radiation is more vulnerable to fracture.

• Avoid direct exposure of the skin to the sun.

• Care for xerostomia (dry mouth).

• Bone exposed to radiation is more vulnerable to fracture.


Chemotherapy

• Treating cancer with chemical agents

• Major role in cancer therapy

• Used to cure and increase survival time

• Some selectivity for killing cancer cells over normal cells

• Normal cells most affected: the skin, hair, intestinal tissues, spermatocytes, and blood-forming cells

• Treating cancer with chemical agents

• Major role in cancer therapy

• Used to cure and increase survival time

• Some selectivity for killing cancer cells over normal cells

• Normal cells most affected: the skin, hair, intestinal tissues, spermatocytes, and blood-forming cells


Chemotherapy Drugs

• Antimetabolites

• Antitumor antibodies

• Alkylating agents

• Antimitotic agents

• Topoisomerase inhibitors

• Miscellaneous chemotherapeutic agents

• Combination chemotherapy

• Antimetabolites

• Antitumor antibodies

• Alkylating agents

• Antimitotic agents

• Topoisomerase inhibitors

• Miscellaneous chemotherapeutic agents

• Combination chemotherapy


Treatment Issues

• Drug dosage

• Drug schedule

• Drug administration:

– Extravasation

– Vesicants

• Drug dosage

• Drug schedule

• Drug administration:

– Extravasation

– Vesicants


Side Effects of Chemotherapy

• Alopecia or hair loss

• Nausea and vomiting

• Mucositis in the entire gastrointestinal tract

• Skin changes

• Anxiety, sleep disturbance

(Continued)

• Alopecia or hair loss

• Nausea and vomiting

• Mucositis in the entire gastrointestinal tract

• Skin changes

• Anxiety, sleep disturbance

(Continued)


Side Effects of Chemotherapy (Continued)

• Altered bowel elimination

• Decreased mobility

• Hematopoietic system changes

• Bone marrow suppression

• Altered bowel elimination

• Decreased mobility

• Hematopoietic system changes

• Bone marrow suppression


Nursing Care of Clients Undergoing Chemotherapy

• Drug therapy

• Protection from infection

• Complementary and alternative therapies

• Drug therapy

• Protection from infection

• Complementary and alternative therapies


Hormonal Manipulation

• Some hormones make hormone-sensitive tumors grow more rapidly.

• Some tumors actually require specific hormones to divide, therefore decreasing the amount of these hormones to hormone-sensitive tumors can slow the cancer growth rate and increase survival time.

• Some hormones make hormone-sensitive tumors grow more rapidly.

• Some tumors actually require specific hormones to divide, therefore decreasing the amount of these hormones to hormone-sensitive tumors can slow the cancer growth rate and increase survival time.


Side Effects of Hormone Therapy

• Androgens and antiestrogen receptor drugs cause masculinizing effects in women.

• For men and women receiving androgens, acne may develop, hypercalcemia is common, and liver dysfunction may occur with prolonged therapy.

(Continued)

• Androgens and antiestrogen receptor drugs cause masculinizing effects in women.

• For men and women receiving androgens, acne may develop, hypercalcemia is common, and liver dysfunction may occur with prolonged therapy.

(Continued)


Side Effects of Hormone Therapy (Continued)

• Feminine manifestations often appear in men who take estrogens, and gynecomastia can occur.

• Feminine manifestations often appear in men who take estrogens, and gynecomastia can occur.


Immunotherapy: Biological Response Modifiers

• Drugs that modify the client’s biologic responses to tumor cells

• Cytokines: enhance the immune system

• Interleukins, interferons

• Side effects: generalized and sometimes severe inflammatory reactions, peripheral neuropathy, skin rashes, increased depression

• Drugs that modify the client’s biologic responses to tumor cells

• Cytokines: enhance the immune system

• Interleukins, interferons

• Side effects: generalized and sometimes severe inflammatory reactions, peripheral neuropathy, skin rashes, increased depression


Gene Therapy

• Experimental as a cancer treatment

• Renders tumor cells more susceptible to damage or death by other treatments

• Injection into tumor cells, enabling the immune system to better recognize cancer cells as foreign and kill them

• Monoclonal antibodies

• Antisense drugs

• Experimental as a cancer treatment

• Renders tumor cells more susceptible to damage or death by other treatments

• Injection into tumor cells, enabling the immune system to better recognize cancer cells as foreign and kill them

• Monoclonal antibodies

• Antisense drugs


Oncologic Emergencies

• Sepsis and disseminated intravascular coagulation

• Collaborative management includes:

– Prevention (the best measure)

– Intravenous antibiotic therapy

– Anticoagulants, cryoprecipitated clotting factors

• Sepsis and disseminated intravascular coagulation


– Prevention (the best measure)

– Intravenous antibiotic therapy

– Anticoagulants, cryoprecipitated clotting factors


Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

• Water is reabsorbed to excess by the kidney and put into system circulation.

• SIADH is most commonly found in carcinoma of the lung


– Fluid restriction

– Increased sodium intake

– Drug therapy with demeclocycline that works in opposition to antidiuretic hormone

• Water is reabsorbed to excess by the kidney and put into system circulation.

• SIADH is most commonly found in carcinoma of the lung


– Fluid restriction

– Increased sodium intake

– Drug therapy with demeclocycline that works in opposition to antidiuretic hormone


Spinal Cord Compression

• Tumor directly enters the spinal cord or the vertebrae collapse from tumor degradation of the bone.

(Continued)

• Tumor directly enters the spinal cord or the vertebrae collapse from tumor degradation of the bone.

(Continued)


Spinal Cord Compression (Continued)


– Early recognition and treatment

– Palliative

– High-dose corticosteroids

– High-dose radiation

– Surgery

– External back or neck braces to reduce pressure in the spinal cord


– Early recognition and treatment

– Palliative

– High-dose corticosteroids

– High-dose radiation

– Surgery

– External back or neck braces to reduce pressure in the spinal cord


Hypercalcemia

• Occurs most often in clients with bone metastasis

• Fatigue, loss of appetite, nausea and vomiting, constipation, polyuria, severe muscle weakness, loss of deep tendon reflexes, paralytic ileus, dehydration, electrocardiographic changes

(Continued)

• Occurs most often in clients with bone metastasis

• Fatigue, loss of appetite, nausea and vomiting, constipation, polyuria, severe muscle weakness, loss of deep tendon reflexes, paralytic ileus, dehydration, electrocardiographic changes

(Continued)


Hypercalcemia (Continued)


– Oral hydration

– Drug therapy

– Dialysis


– Oral hydration

– Drug therapy

– Dialysis


Superior Vena Cava Syndrome

• Superior vena cava is compressed or obstructed by tumor growth.

• Condition can lead to a painful, life-threatening emergency.

• Signs include edema of face, Stokes’ sign, edema of arms and hands, dyspnea, erythema, and epistaxis.

(Continued)

• Superior vena cava is compressed or obstructed by tumor growth.

• Condition can lead to a painful, life-threatening emergency.

• Signs include edema of face, Stokes’ sign, edema of arms and hands, dyspnea, erythema, and epistaxis.

(Continued)


Superior Vena Cava Syndrome (Continued)

• Late-stage signs include hemorrhage, cyanosis, change in mental status, decreased cardiac output, and hypotension.

• Collaborative management includes high-dose radiation therapy, but surgery only rarely.

• Late-stage signs include hemorrhage, cyanosis, change in mental status, decreased cardiac output, and hypotension.

• Collaborative management includes high-dose radiation therapy, but surgery only rarely.


Tumor Lysis Syndrome

• Large numbers of tumor cells are destroyed rapidly, resulting in intracellular contents being released into the bloodstream faster than the body can eliminate them.


– Prevention

– Hydration

– Drug therapy

• Large numbers of tumor cells are destroyed rapidly, resulting in intracellular contents being released into the bloodstream faster than the body can eliminate them.


– Prevention

– Hydration

– Drug therapy

General Interventions for Clients with Cancer

Health & Medicine

Transcript of General Interventions for Clients with Cancer