Cancer Powerpoint

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 16

Oncology: Nursing Management
in Cancer Care

Cancer
Disease process that begins when abnormal cell is
transformed by genetic mutation of cellular DNA
Metastasis: abnormal cells have invasive characteristics,
infiltrate other tissues
Malignant cancer cells: demonstrate uncontrolled growth
that does not follow physiologic demand
Malignant Process
Cell proliferation: uncontrolled growth with ability to
metastasize and destroy tissue, and cause death
Cell characteristics: presence of tumor-specific antigens,
altered of shape, structure, metabolism
Metastasis:
Lymphatic spread
Hematogenous spread
Angiogenesis
Carcinogenesis
Characteristics of Benign and Malignant
Neoplasms
Cell characteristics
Mode of growth
Rate of growth
Metastasis
General effects
Tissue destruction
Ability to cause disease
Question
Tell whether the following statement is true or false:
Malignant tumors spread by way of blood and lymph
channels to other areas of the body.

Answer
True.
Rationale: Malignant tumors spread by way of blood and
lymph channels to other areas of the body. Cells bear
little resemblance to the normal cells of the tissue from
which they arose.

Carcinogenic Agents and Factors
Viruses, bacteria
Physical factors: sunlight, radiation, chronic irritation
Chemical agents: tobacco, asbestos
Genetic, familial factors
Diet
Hormones
Question
Which specific agents or factors are associated with the
etiology of cancer?
A. Dietary and genetic factors
B. Hormonal and chemical agents
C. Viruses
D. All of the above
Answer
D. All of the Above
Rationale: Specific agents or factors associated with the
etiology of cancer include viruses and bacteria, physical
factors; sunlight, radiation, chronic irritation, chemical
agents; tobacco, asbestos, genetic and familial factors,
diet, hormones.

Primary and Secondary Prevention
Primary prevention: concerned with reducing cancer risk
in healthy people
Secondary prevention: involves detection, screening to
achieve early diagnosis, intervention
Now great emphasis on primary, secondary prevention of
cancer
Primary Prevention
Avoid known carcinogens
Lifestyle, dietary changes to reduce cancer risk
Public, patient education
Secondary Prevention
Identification of patients at high cancer risk
Cancer screening
Self-breast exam
Self-testicular exam
Screening colonoscopy
PAP test
Public, patient education
Diagnosis of Cancer
Determine presence, extent of tumor
Identify possible spread (metastasis) of disease or
invasion of other body tissues
Evaluate function of involved, uninvolved body systems,
organs
Obtain tissue, cells for analysis, including evaluation of
tumor stage, grade
Tumor Staging and Grading
Staging: determines size of tumor, existence of
metastasis
Grading: classification of tumor cells
TNM
T: extent of primary tumor
N: lymph node involvement
M: extent of metastasis
Cancer Management
Cure
Control
Palliation

Surgical Treatment
Diagnostic surgery
Biopsy: excisional, needle, incisional
Tumor removal: wide excision, local excision
Prophylactic surgery
Reconstructive surgery
Question
Which type of surgery is being done when lesions that
are removed are likely to develop into cancer?
A. Diagnostic
B. Palliative
C. Prophylactic
D. Reconstructive
Answer
C. Prophylactic
Rationale: The type of surgery being done when lesions
that are removed are likely to develop into cancer is
called prophylactic surgery. Diagnostic surgery such as a
biopsy is usually performed to obtain a tissue sample for
analysis of cells suspected to be malignant. Palliative
surgery is performed in an attempt to relieve
complications of surgery. Reconstructive surgery is
carried out in an attempt to improve function or obtain a
more desirable cosmetic effect.
Radiation Therapy
Curative, control, or palliative
External radiation
Internal radiation
Radiation reactions
Effect on GI system
Effect on bone marrow
Systemic effects
Long-term effects, tissue changes
Nursing Care of the Patient Undergoing
Radiation Therapy
Patient, family education
Restrictions, precautions
Skin care
Oral care
Protection of care providers
Chemotherapy
Agents used to destroy tumor cells by interfering with
cellar function, replication
Curative, control, or palliative
Cell kill, cell cycle
Chemotherapeutic Agents
Classification
Administration
Dosage
Extravasation
Hypersensitivity reactions
Chemotherapy Toxicity
Gastrointestinal
Hematopoietic
Renal
Cardiopulmonary
Reproductive
Neurologic
Fatigue

Nursing Management in Chemotherapy
Assessing fluid, electrolyte status
Modifying risks for infection, bleeding
Administering chemotherapy
Protecting caregivers
Bone Marrow Transplantation (BMT)
Used for hematological cancers that effect marrow or
solid tumors treated with chemotherapy dosage that
ablates bone marrow
Types of BMT
Allogenic
Autologous
(Syngeneic)
Graft vs. host disease
Venous occlusive disease
Nursing Management in Bone Marrow
Transplantation
Implementing pretransplantation care
Providing care during treatment
Providing posttransplantation care
Caring for recipients
Caring for donors
Impaired Skin Integrity: Erythematous
Areas
Avoid use of soaps, cosmetics, perfumes, powders, lotions and
ointments, deodorants
Use only lukewarm water to bathe area
Avoid rubbing or scratching area
Avoid shaving area with straight-edged razor
Avoid applying hot-water bottles, heating pads, ice, adhesive
tape to area
Avoid exposing area to sunlight or cold weather
Avoid tight clothing in area; use cotton clothing
Apply vitamin A & D ointment to area
Impaired Skin Integrity: Wet
Desquamation
Do not disrupt any blisters that have formed
Avoid frequent washing of area
Report any blistering
Use prescribed creams or ointments
If area weeps, apply nonadhesive absorbent dressing
If area is without drainage, use moisture-, vapor-
permeable dressings such as hydrocolloids, hydro gels on
noninfected areas (Swearingen, 2008)
Consult with enterostomal therapist (ET), physician if
eschar forms

Alopecia
Discuss potential hair loss, regrowth with patient, family
Explore potential impact of hair loss on self-image,
interpersonal relationships, sexuality
Prevent or minimize hair loss
Prevent trauma to scalp
Suggest ways to assist in coping with hair loss:
Encourage patient to wear own clothes, retain social
contacts
Explain that hair growth usually begins again once
therapy is completed
Altered Nutrition: Nausea and Vomiting
Assess patients previous experiences, expectations of
nausea and vomiting, including causes, interventions
used
Adjust diet before, after drug administration according to
patient preference, tolerance
Prevent unpleasant sights, odors, sounds in environment
Use distraction, music therapy, biofeedback, self-
hypnosis, relaxation techniques, guided imagery before,
during, after chemotherapy
Altered Nutrition: Nausea and Vomiting
(contd)
Administer prescribed antiemetic, sedatives,
corticosteroids before chemotherapy, afterward as
needed
Ensure adequate fluid hydration before, during, after
drug administration; assess intake, output
Encourage frequent oral hygiene
Provide pain relief measures if necessary
Consult with dietician as needed
Assess, address other contributing factors to nausea,
vomiting

Nutritional Problems
Anorexia
Malabsoprtion
Cachexia
Nutritional Problems: Expected Outcomes
Exhibits weight loss no greater than 10% of pretreatment
weight
Reports decreasing anorexia, increased interest in eating
Demonstrates normal skin turgor
Identifies rationale for dietary modifications
Patient, family verbalize strategies to address,
minimize nutritional deficits
Participates in calorie counts, diet histories
(contd)
Uses appropriate relaxation, imagery before meals
Exhibits laboratory, clinical findings indicative of
adequate nutritional intake
Consumes diet high in required nutrients
Carries out oral hygiene before meals
Reports that pain does not interfere with meals

(contd)
Reports decreasing episodes of nausea, vomiting
Participates in increasing levels of activity
States rationale for use of tube feedings or parenteral
nutrition
Participates in management of tube feedings or
parenteral nutrition if prescribed

Altered Body Image
Assess patients feelings about body image, level of self-
esteem
Identify potential threats to patients self-esteem
Validate concerns with patient
Encourage continued participation in activities, decision
making
Encourage patient to verbalize concerns
Individualize care for patient
Altered Body Image (contd)
Assist patient in self-care when fatigue, lethargy, nausea,
vomiting, other symptoms prevent independence
Assist patient in selecting and using cosmetics, scarves,
hair pieces, clothing that increase his or her sense of
attractiveness
Encourage patient, partner to share concerns about
altered sexuality and sexual function, to explore
alternatives to usual sexual expression
Refer to collaborating specialists as needed

Question
Which measure should the RN not teach a client about
protecting the skin between radiation treatments?
A. Handle the area gently.
B. Avoid irritation with soap and water.
C. Use a heating pad every day on the area.
D. Wear loose fitting clothes.
Answer
C. Use a heating pad every day on the area.
Rationale: Measures to protect a clients skin between
radiation treatments include handling the area gently,
avoiding irritation with soap and water, and wearing
loose-fitting clothing. The client should not use a heating
pad every day on the area because it will not promote
tissue repair.
Monitoring and Managing Potential
Complications
Infection
Septic shock
Bleeding, hemorrhage
Factors Contributing to Infection
Impaired skin, mucous membrane integrity
Chemotherapy
Radiation therapy
Biologic response modifiers
Malignancy
Malnutrition
Medications
Urinary catheter
Intravenous catheter
Factors Contributing to Infection (cont.)
Other invasive procedures
Contaminated equipment
Age
Chronic illness
Prior infections
Recent travel
Pet excreta
Prolonged hospitalization

Septic Shock
Septicemia, septic shock life-threatening complications
that must be prevented or detected, treated promptly
Patients who are neutropenic and/or who have
hematologic malignancies are at greatest risk
Signs, symptoms include altered mental status, either
subnormal or elevated temperature, cool and clammy
skin, decreased urine output, hypotension, tachycardia,
other dysrhythmias, electrolyte imbalances, tachypnea,
abnormal arterial blood gas values
Bleeding and Hemorrhage
Thrombocytopenia (decrease in circulating platelet
count): most common cause of bleeding in patients with
cancer, usually defined as platelet count of less than
100,000/mm3 (0.1 1012/L)
Plan of nursing care addresses nursing assessment
parameters, interventions for patients at risk for bleeding
Question
Tell whether the following statement is true or false:
Rationale: The most common cause of bleeding in cancer
patients is thrombocytopenia.
Answer
True.
Rationale: The most common cause of bleeding in cancer
patients is thrombocytopenia.

Hospice
Comprehensive, multidisciplinary approach to care of
patients with terminal illness, their families
Focuses on
Quality of life
Palliation of symptoms
Psychosocial, spiritual care
Oncologic Emergencies
Superior vena cave syndrome
Spinal cord compression
Pericardial effusion, cardiac tamponade
Disseminated intravascular coagulation (DIC)
Syndrome of inappropriate secretion of antidiuretic
hormone
Tumor lysis syndrome

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Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

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