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Cancer Background A. Definition 1. Family of complex diseases 2. Affect different organs and organ systems 3. Normal cells mutate into abnormal cells that take over tissue 4. Eventually harm and destroy host 5. Historically, cancer is a dreaded disease
B. Oncology 1. Study of cancers 2. Oncology nurses specialize in the care, treatment of clients with cancer
5 Diet: certain preservatives in pickled, salted foods; fried foods; high-fat, low fiber foods; charred foods, high fat foods, diet high in red meat 6. Occupational risk: exposure to know carcinogens, radiation, high stress 7. Infections, especially specific organisms and organ (e.g. papillomavirus causing genital warts and leading to cervical cancer) 8. Tobacco Use: Lung, oral and laryngeal, esophageal, gastric, pancreatic, bladder cancers 9. Alcohol Use: also tied with smoking 10. Sun Exposure (radiation) e.g. skin cancer
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Chemical Agents a. Industrial and chemical b. Can initiate and promote cancer b. Examples: hydrocarbons in soot ; arsenic in pesticides; chemicals in tobacco 7. Physical Agents a. Exposure to radiation
Ionizing radiation found in x-rays, radium, uranium UV radiation
Sun, tanning beds
8. Immune function
1. Protects the body from cancerous cells 2. Increased rate of cancer in immunocompromised pts
and secondary tumors and other treatments D. Malignant neoplasms vary in differentiation. a. Highly differentiated are more like the originating tissue b. Undifferentiated neoplasms consist of immature cells with no resemblance to parent tissue and have no useful function E. Malignant cells progress in deviation with each generation and do no stop growing and die, as do normal cells F. Malignant cells are irreversible, i.e. do not revert to normal G. Malignant cells promote their own survival by hormone production, cause vascular permeability; angiogenesis; divert nutrition from host cells
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a. Abnormal wbcs: impaired immunity b. Diminished rbcs and platelets: anemia and clotting disorders Infections: fistula development and tumors may become necrotic; erode skin surface Hemorrhage: tumor erosion, bleeding, severe anemia Anorexia-Cachexia Syndrome: wasting away of client a. Unexplained rapid weight loss, anorexia with altered smell and taste b. Catabolic state: use of bodys tissues and muscle proteins to support cancer cell growth
3. Cell-kill hypothesis: with each cell cycle a percentage of cancerous cells are killed but some remain; repeating chemo kills more cells until those left can be handled by bodys immune system
2. Examples: Methotrexate; 5 fluorouracil 3. Toxic Effects: nausea, vomiting, stomatitis, diarrhea, alopecia, leukopenia 3. Antitumor Antibiotics 1. Action: interfere with DNA 2. Examples: Actinomycin D, Bleomycin 3. Toxic Effect: damage to cardiac muscle
6. Hormone Antagonist 1. Action: block hormones on hormonebinding tumors (breast, prostate, endometrium; cause tumor regression
Decreasing the amount of hormones can decrease the cancer growth rate Does not cure, but increases survival rates
2. Examples: Tamoxifen (breast); Flutamide (prostate) 3. Toxic Effects: altered secondary sex characteristics
7. Hormone inhibitors
Aromatase inhibitors (Arimidex, Aromasin)
Prevents production of aromatase which is needed for estrogen production Used in post menopausal women Side effects
Masculinizing effects in women Fluid retention
2. Extreme care for correct dosage; double check with physician orders, pharmacists preparation c. Proper management clients excrement
e.Types of vascular access devices 1. PICC lines (peripherally inserted central catheters) 2. Tunnelled catheters (Hickman, Groshong) 3. Surgically implanted ports (accessed with 90o angle needle
Hickman Catheter
Portacath
PICC Line
Decrease number of WBC (normal 4,500-11,000 mm3) especially neutrophils (normal 3,000-7,000 cells/cc)
Neutropenia-count below 2000 Pt at extreme risk for infection May order granulocyte colony stimulating factor (leukine) to stimulate bone marrow to increase WBC count Neutropenic precautions
Private room Good handwashing Monitor temp q 4 hours, monitor for chills, UTI, pneumonia Limit visitors to healthy adults No flowers or plants Monitor neutrophil count
Thrombocytopenia
Drop in platlet count (normal 150,000-400,000/mm3) below 100,000 Test pt for bleeding in stool and urine Avoid punctures for IV or IM Handle pt gently Use electric razor Avoid placing foley or rectal thermometers Avoid oral trauma with soft bristle brushes, avoid flossing, avoid hard candy Watch for ALOC, pupil changes that might indicate intracranial bleeds Stool softeners to avoid straining
C. Mucocitis
Inflammation and ulceration of mucous membranes and entire GI tract Rinse mouth with normal saline and peroxide every 12 hours Topical analgesic medication Avoid mouthwashes with alcohol Avoid spicy or hard food Watch nutritional status
D. Alopecia
Hair loss 2-3 weeks after treatment is started Affects all the hair, including eyebrows, eyelashes Within 4-8 weeks after treatment hair begins to grow back Before hair loss, have the pt pick out a wig that is similar to hair color
E. Peripheral neuropathy
Numbness and tingling to fingers and toes in a glove and sock pattern May cause gait and possible fall problems
b. Brachytherapy: delivers high dose to tumor and less to other tissues; radiation source is placed in tumor or next to it in the form of seeds
Radiation source within the patient so pt emits radiation for a period of time and is a hazard to others
c. Combination
3. Goals a. Maximum tumor control with minimal damage to normal tissues b. Caregivers must protect selves by using shields, distancing and limiting time with client, following safety protocols
Private room Caution sign on the door for radioactive material Dosimeter film badge by staff No pregnant staff Limit visitors to hour per day and keep them at least 6 ft from the source
b. Ulcerated mucous membranes: pain, lack of saliva (xerostoma) c. Gastrointestinal: nausea and vomiting, diarrhea, bleeding, sometimes fistula formation d. Radiation pneumonitis
1-3 months after treatment Cough, SOB, fever Treated with steroids to decrease inflammation
Gene therapy experimental May insert gene into the tumor cells to make them more susceptible to being killed by antiviral agents May insert genes for cytokines that increase their effectiveness in killing cancer cells
Angiogenesis inhibitor drugs prevent new blood vessels from forming and delivering blood to the tissue
B. Superior Vena Cava Syndrome 1. obstruction of venous system with increased venous pressure and stasis; facial and neck edema with slow progression to respiration distress
Late signs are cyanosis, decreased cardiac output and hypotension
F. Obstructive Uropathy 1. Concern: blockage of urine flow; undiagnosed can result in renal failure 2. Treatment: restore urine flow
G. Hypercalcemia 1. High calcium (normal 9-10.5) usually from bone metastases 2. May also come from cancer of the lung, head, neck, kidney and lymph nodes that secrete parathyroid hormone that causes the bone to release calcium 2. Symptoms include fatigue, muscle weakness, polyuria, constipation, progressing to coma, seizures 3. Treatment
restore fluids with intravenous saline which also increases the excretion of calcium loop diuretics increase calcium excretion Calcium chelators such as mithracin Inhibit calcium resorption from the bone with calcitonin, diphosphonate
H. Tumor Lysis Syndrome 1. Occurs with rapid necrosis of tumor cells with chemotherapy
When tumor cells die they release potassium and purines Potassium (norm 3.5-5.5) elevation causes cardiac arrhthymias, muscle weakness, twitching, cramps Purines convert to uric acid which causes renal failure, flank pain, gout when elevated above 10 mg/dl Hyperphosphatemia with secondary to hypocalcemia causes heart block, HTN, renal failure
Treatment
Hydration Instruct pt to increase fluid intake before and after chemo May need IV hydration Diuretics to increase urine flow Allopurinol to increase uric acid excretion May need dialysis
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