Interventions for Clients with Cancer Interventions for Clients with Breast Cancer.
Nursing Care & Interventions in Managing Those with Cancer
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Transcript of Nursing Care & Interventions in Managing Those with Cancer
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Nursing Care & Interventions in Managing Those with
CancerKeith Rischer RN, MA, CEN
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Today’s Objectives…1. Identify the goals of cancer therapy.2. Distinguish between cancer surgery for cure and
cancer surgery for palliative care.3. Discuss the nursing care needs for clients
undergoing therapy for cancer.4. Discuss radiation therapy.5. Identify nursing interventions for patients
undergoing chemotherapy.6. Discuss care of patients with neutropenia7. Discuss care of patients with thrombocytopenia8. Explain the rationale for hormonal manipulation
therapy.9. Explain the basis of targeted therapy for cancer.
Consequences of Cancer
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Impaired immune and hematopoietic function Bone marrow
Anemia and thrombocytopenia
Altered gastrointestinal structure and function Tumors obstruct structures Tumors increase metabolic rate Tumors in liver reduce liver function Diet high in protein and carbohydrates
supplement when 5% weight loss Monitor albumin
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Consequences of Cancer
Motor and sensory deficits Bone metastases Spinal cord
compression Pain
Decreased respiratory function Airway obstruction Tumor compression Pleural effusions
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Surgery as Cancer Treatment
Oldest form of cancer treatment used for: Prophylaxis
Remove at risk tissue Diagnosis (biopsy) Cure Control (debulks) Palliation Determining efficacy of therapy
(second look) Reconstruction
Side effects of surgical therapy
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Radiation Therapy
Purpose Mechanism of action
Ionizing radiation Cells die or unable to divide
Exposure amount delivered
Dose amount absorbed
Killing effects of radiation Given in a series of divided
doses Fractionation…180-280
rads qd typical Some organs can tolerate
more radiation YouTube - Radiation Therap
y to Treat Cancer
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Radiation Therapy
Teletherapy (Beam) Distant-external treatment
Brachytherapy Unsealed Body fluids potential hazard
Isotopes given IV or instilled in body cavities Iodine ingestion for thyroid cancer
Sealed Body fluids NOT hazard, but pt. may be
Implanted in proximity to tumor
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Nursing Care w/Sealed Implants
Private room with private bath “Caution: Radioactive Material” note Nurse wears dosimeter film badge No pregnant women or children under 16 not to
visit Limit visitors 30 min/day
Stay 6 ft away Never touch radioactive source with hands Save all dressings and bed linens until
radioactive source is removed.
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Side Effects of Radiation Therapy
Local skin changes Hair loss Altered taste sensations Fatigue
Debilitating Can last for months
Tissue fibrosis and scarring of healthy tissue
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Nursing Care w/Radiation Therapy
Education Skin care
Dry skin in path of radiation Do not use lotions or ointments. Avoid direct exposure of the skin to the sun.
Care for xerostomia (dry mouth). Bone exposed to radiation is more vulnerable to fracture. Reproductive effects
Depends on site Harvest sperm or ova
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Chemotherapy
Mechanism Cytotoxic Some selectivity Damages cell DNA
cell division
Rapidly dividing cells more sensitive to chemo Skin, hair Intestinal tissues Spermatocytes Blood-forming cells
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Chemotherapy Drug Categories Table 28-6 p.492
Antimetabolites Act as counterfeit metabolites so cells can’t divide Cell cycle specific
Antitumor antibodies Interrupt DNA and RNA Cell cycle nonspecific
Alkylating agents Cross link DNA-prevents DNA/RNA synthesis Cell cycle nonspecific
Antimitotic agents Interfere with mitosis-prevent division Cell cycle specific
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5-Fluorouracil (5-FU) Anti-metabolite IV SE
Decr. WBC & plateletsStomatitisAnorexiaDarkening of skin…sun sensitivity
Nursing responsibilitiesUse sunscreen when outsideMenstrual changes…decreased sperm counts
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Cytoxan (Cyclophosphamide) Alkylating agent po or IV SE
N&V 2-4 hours after tx Pancytopenia 14 days after tx Alopecia 2-3 weeks after tx Loss of appetite
Nursing Considerations Can cause hemorrhagic cystitis…incr. po and stop if
hematuria Mesna (Mesnex) often given to protect
po or IV
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Vincristine (Oncovin)
Anti-mitotic IV SE
Constipation/abd. CrampingStomatitisAlopecia 2-3 weeks after tx
Nursing considerations Increase fiber
Chemotherapy Treatment Issues
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Combination chemotherapy More effective-possible more toxic
Drug dosage Dependant on type of cancer & client size
Drug schedule – Usually every 3 to 4 weeks for 6-12x
Drug administration IV route most common Use central lines or ports to avoid vessel irritation
ExtravasationYouTube - P9290001 Getting her port access
ed www.freehelpforcancer.com
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Side Effects of Chemotherapy
Fatigue Alopecia or hair loss Nausea and vomiting
Antiemetics Zofran Ativan Compazine
Mucositis-open sores mouth (stomatitis) see Mouth
care chart 28-6 p.496 Skin changes Bone marrow suppression
Anemia Immunosuppression Thrombocytopenia
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Neutropenia Highest risk
Chemo/radiation Liver/kidney disease Tumors bone marrow, sm. Cell lung CA, lymphoma,
breast cancer, elderly >70 yrs Treatment
Filgrastim: granulocyte colony stimulating factor Red Flag
T>100.4 and ANC <500 Medical management
Cultures IV abx Nursing assessments/priorities
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Neutropenic Precautions chart 28-7 p.497
Good handwashing!!! Private room – cleaned daily Do not use supplies from
common areas – straws, etc. No water pitchers
Limit # of health care providers, visitors
VS q 4 hrs Watch for sepsis
Inspect mouth, skin, mucous membranes q 8 hrs
Inspect any open areas for sx infection
No flowers and potted plants Fungi
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Absolute Neutrophil Count (ANC)
Normal Range > 2,500/mm3 1000-2500…safe to continue chemotherapy 1000-1500 minimal risk 500-1000 moderate risk <500 SEVERE risk
WBC x(%neutrophils + % bands) Example: breast CA after chemo
WBC 2000, neutrophils 14.8%, bands 5%
2000 x (0.148 +.05)= 2000 x 0.198=396
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Thrombocytopenia
Reduction of platelets below normal range Normal = 150,000-400,000 mm3
Etiology: Bone marrow suppression
Critical values 50,000 or less- risk of bleeding <20,000 spontaneous life threatening hemorrhages
(brain bleed) Consider platelet transfusion if febrile or bleeding
<10,000 transfusions recommended
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Nursing Priorities w/Thrombocytopenia chart 28-9 p.497
Handle gently Avoid punctures Apply ice to trauma No rectal temps, lubricate suppositories Electric razor Mouth care –
no flossing, avoid dental work, avoid hard foods, check denture fit
Avoid contact sports Shoes with firm soles
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Hormone Therapy
Patho Types of CA
Breast, prostate, endometrium Treatment
Surgical (remove the hormone producing organ)Pharmocologic suppression
Steroids or estrogen
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Stem Cell/Bone Marrow Transplant
Goal Give higher than usual dose of chemo to prepare way
for engraftment of stem cell transfusion Bone marrow wiped out WBC>0.1
Bone marrow/stem cells harvested from pelvis/iliac crest of matched donor or self (autologous) Strained-administered as IV infusion NHL, multiple myeloma, some breast/testicular CA
Takes 2-4 weeks before stem cells will take very high risk of infection
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Oncology Case Study
70yr male PMH:
metastatic GB CA-dx 2006 w/hepatic resection, radiation therapy completed, currently on weekly chemo
Malignant pleural effusions CAD, HTN
HPI: Progressive worsening of SOB since last thoracentesis 2 weeks ago. Sudden onset of severe SOB early am. Incr. weakness w/nausea. No c/o CP
VS: T-98.2 P-123 (ST) R-22 BP 101/68 sats 90% RA Assessment:
Resp: severely diminished right side Other systems WNL
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Oncology Case Study
Medical/Nursing Priorities… Nursing Assessments… Nursing Interventions…
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Oncology Case Study: Oncology Floor
83 yr. female new admission PMH: rectal CA 1987 w/surgical
resection/colostomy and radiation Chief c/o: Persistent low abd. crampy pain
w/nausea CT: large poorly differentiated carcinoma
in pelvis w/migration to lymph nodesSmall bowel obstruction: ? tumor
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Oncology Case Study: Priorities
Medical…NG to LISNPO IVF: NS @ 100cc/hr
Nursing…Pain controlNausea controlVolume status
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Breast Cancer
Article YouTube - Breast cancer real story