Republic of the Philippines

Tarlac State University

College of Science
Department of Nursing
Lucinda Campus, Brgy. Ungot, Tarlac City Philippines 2300
Accredited Level 3 Status by the Accrediting Agency of Chartered College and Universities in the
Philippines (AACCUP). Inc.

A Case Study Presented to the

Faculty of the Department of Nursing, Tarlac State University
Villa Lucinda Campus, Brgy. Ungot, Tarlac City Philippines
In Partial Fulfillment of the Requirements of the Subject

Report on
“Principle of Management for Altered”
(Cellular Aberration)

Submitted to:
Ma’am Susan Z. Maglaqui RN, MAN
Clinical Instructor

Submitted by:
Sugala, Rhajeeb Aennas A.
Domingo, Richard Joseph M.
CELLULAR ABERRATION

Cancer – a disease process that begins when an abnormal cell is transformed by the genetic
mutation of the cellular DNA

In cancer, the abnormal cell forms a clone and begins to proliferate abnormally, ignoring growth-
regulating signals in the environment surrounding the cell

 Hyperplasia
 Metaplasia
 Dysplasia
 Anaplasia
 Neoplasia – new growth; tumor; can be benign or malignant; uncontrolled cell growth
that follows no physiologic demand
 Benign – not malignant; an abnormal growth that is stable, treatable and generally not
life-threatening
 Malignant – cancerous; cells that are invasive and tend to metastasize, uncontrollable or
resistant to therapy; rapidly spreading
 Invasion – refers to the growth of the primary tumor into the surrounding host tissues
 Metastasis – the dissemination or spread of malignant cells to distant sites by direct
spread of tumor cells to body cavities or through lymphatic and blood circulation

Characteristics of Benign and Malignant Neoplasms

Characteristics Benign Malignant

Cell characteristics Well-differentiated that Cells are undifferentiated and

resemble normal cells of the often bear little resemblance
tissue from which the tumor to the normal cells of the
originated tissue from which they arose

Mode of growth Tumor grows by expansion Grows at the periphery and

and does not infiltrate the send out processes that
surrounding tissues; usually infiltrate and destroy the
encapsulated surrounding tissues
Rate of growth Usually slow
metastasis Negative
General effects Is usually a localized
phenomenon that does not
cause generalized effects
unless its location interferes
with vital functions
Tumor destruction Does not usually cause tissue
damage unless its location
interferes with blood flow
Ability to cause death does not usually cause death
unless its location interferes
with vital functions
Variable and depends on level
of differentiation; the more
anaplastic the tumor, the
faster its growth
Gains access to the blood and
lymphatic channels and
metastasizes to other areas
of the body
Often causes generalized
effects, such as anemia,
weakness, and weight loss
Of the cause tissue damage
as the tumor outgrows its
blood supply or encroaches
on blood flow to the area;
may also produce substance
that cause cell damage
Usually causes death unless
growth can be controlled
A. Determination and management of cause

Grading versus staging

 Grading – identification of the type of tissue from which the tumor originated and the
degree to which the tumor cells retain the functional and structural characteristics of
the tissue of origin.
 Staging – process of
determining the
extent of disease,
including tumor size
and spread or
metastasis to distant
sites.
 TNM Staging
T – Primary tumor
N – regional nodal
metastasis
M – distant
metastasis
TNM Classification System

 Primary tumor

Tx – Primary tumor cannot be assessed

T0 – No evidence of primary tumor

Tis – carcinoma in-situ

T1, T2, T3, T4 – increase size and/or

local extent of the primary tumor

 Regional lymph node metastasis

Nx – Regional LN cannot be assessed

N0 – No regional LN metastasis

N1, N2, N3 – Increasing involvement of regional LN

 Distant metastasis

Mx – Distant metastases cannot be assessed

M0 – No distant metastases
 M1 – Distant metastases

Causes of cancer

The substances that cause cancer are called carcinogens. A carcinogen may be a chemical
substance, such as certain molecules in tobacco smoke. The cause of cancer may be
environmental agents, viral or genetic factors.

We should bear in mind, though, that in the majority of cancer cases we cannot attribute the
disease to a single cause.
cancer risk factors are dividing into the following groups:

1. biological or internal factors, such as age, gender, inherited genetic defects and skin type
2. environmental exposure, for instance to radon and UV radiation, and fine particulate
matter
3. occupational risk factors, including carcinogens such as many chemicals, radioactive
materials and asbestos
4. lifestyle-related factors.

Lifestyle-related factors that cause cancer:

 tobacco
 alcohol
 UV radiation in sunlight
 some food-related factors, such as nitrites and poly aromatic hydrocarbons generated by
barbecuing food).

Cancer causing factors related to work and living environments:

 asbestos fibers
 tar and pitch
 polynuclear hydrocarbons (e.g. benzopyrene)
 Some metal compounds
 Some plastic chemicals (e.g. Vinyl chloride)

Bacteria and viruses can cause cancer:

 Helicobacter pylori (H. pylori, which causes gastritis)

 HBV, HCV (hepatitis viruses that cause hepatitis)
 HPV (human papilloma virus, papilloma virus, which causes changes eg. Cervical cells)
 EBV (Epstein-Barr virus, the herpes virus that causes inflammation of the throat
lymphoid)

Radiation can cause cancer:

 ionizing radiation (e.g. X-ray radiation, soil radon)

 non-ionized radiation (the sun’s ultraviolet radiation)

drugs may increase the risk of cancer:

  certain antineoplastic agents
 certain hormones
 medicines that cause immune deficiency

Diagnostic aids used to

detect cancer

 Tumor markers –
Breast, colon, lung,
ovarian, testicular,
prostate cancer
 MRI – Neurologic,
pelvic, abdominal,
thoracic cancer
 Fluoroscopy –
Neurologic, pelvic,
skeletal, abdominal,
thoracic cancers
 UTZ – Abdominal
and pelvic cancers
 Endoscopy –
Bronchial, GIT
cancer
 Nuclear Medicine imagine –
Bone, liver, kidney, spleen,
brain, thyroid cancers
 PET (Positron emission
tomography) – Lung, colon,
liver, pancreatic, head and
neck cancers; Hodgkin and
non-hodgkin lymphoma and
melanoma
 PET fusion – Same as PET
 Radioimmunoconjugates –
colorectal, breast, ovarian,
head and neck cancers;
lymphoma and melanoma
B. Definitive management; surgery, chemotherapy, radiation therapy, biotherapy

Management of cancer

 Surgical removal of the entire cancer remains the ideal and most frequently used
treatment method

A. Curative surgery
Curative surgery removes the cancerous tumor or growth from the body.
B. Preventive surgery
Preventive surgery is used to remove tissue that does not contain cancerous cells
but may develop into a malignant tumor.
C. Diagnostic surgery
Diagnostic surgery helps to determine whether cells are cancerous.
D. Staging surgery
Staging surgery works to uncover the extent of cancer, or the extent of the
disease in the body.
E. Debulking surgery
Debulking surgery removes a portion, though not all, of a cancerous tumor.
F. Palliative surgery
Palliative surgery is used to treat cancer at advanced stages.
G. Supportive surgery
Supportive surgery is similar to palliative surgery because it does not work to cure
cancer.
H. Restorative surgery is sometimes used as a follow-up to curative or other
surgeries to change or restore a person’s appearance or the function of a body
part

 Nursing Management in cancer surgery

A. The nurse completes a through preoperative assessment for factors that may
affect the patient undergoing the surgical procedure
B. The nurse provides education and emotional support by assessing the needs of
the patient and family and by discussing their fear and coping mechanism with
them
C. After surgery, the nurse assesses the patient’s responses to the surgery and
monitors the patient for possible complications such as infection, bleeding,
thrombophlebitis, fluid electrolyte imbalance, and organ dysfunction
D. The nurse also provides for the patient’s comfort. Post-operative teaching
addresses wound care, activity, nutrition, and medication information.
 E. Plans for discharge, follow-up and home care, and treatment are initiated as early
as possible to ensure continuity of care from hospital to home or from a cancer
referral center to the patient; s local hospital and health care provider.

 Radiation therapy
A. External radiation
B. Internal radiation or brachytherapy
C. Radiation dosage – dependent on the sensitivity of the target tissue to radiation
and on the tumor size
D. Toxicity – localized to the region being irradiated

 Nursing management in Radiation therapy

A. The nurse can explain the procedure for delivering radiation and describe the
equipment, the duration of the procedure, the possible need for immobilizing the
patient during the procedure
B. The nurse informs the family about restrictions place on the visitor and health
personnel and other radiation precautions

 Chemotherapy
A. Anti-neoplastic agents are used in an attempt to destroy tumor cells by
interfering with cellular functions, including replication
B. Used primarily to treat systemic disease rather than localized lesions that are
amenable to surgery or radiation
C. May be combined with surgery, radiation therapy, or both to reduce tumor size
preoperatively
D. To destroy any remaining tumor cells, post operatively
E. Goals: cure, control and palliation

 Classifications of Chemotherapeutic agent

A. Alkylationg agents – busulfan, carboplatin, cisplatin, cyclophosphamide
B. Nitrosureas – carmusine, streptozocin
C. Topoisomerase I inhibitors – irinotecan, topotecan
D. Anti-metabolites – cytarabine, 5-FU, hydroxyurea, methotrexate
E. Anti-tumor antibiotics – bleomycin, daunorubicin, doxorubicin, mitomycin

 Nursing management in chemotherapy

A. Assess fluid and electrolyte imbalance
 B. Modify risk for infection and bleeding
C. Administering chemotherapy
D. Protecting caregivers

 Bone marrow transplantation

A. Allogenic (from a donor other the patient); either a related donor or a match
unrelated donor
B. Autologous (from patient)
C. Syngeneic (from an identical twin)

 Nursing management in bone marrow transplantation

A. Implementing pre-transplantation care
B. Providing care during treatment
C. Providing post-transplantation care.

C. Blood Component replacement

D. O2 Therapy

Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized setting. The
normal air we breathe only contains about 22 percent oxygen. While people generally get
enough oxygen from the air, there are health benefits to breathing air with a higher
concentration of oxygen. Using pressure, either in a tube or an entire room, allows the lungs to
take in more oxygen than they would at normal pressure. The pressure may be as much as three
times higher than normal atmospheric pressure during hyperbaric oxygen therapy.

Benefits of Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy may be prescribed for a number of conditions. However,

there are ways this therapy promotes general healing. Oxygen is normally transported through
the bloodstream to all parts of the body. Oxygen promotes healing by stimulating the release of
substances like growth factors and stem cells. The body also uses oxygen to fight infections and
bacteria. More oxygen traveling through the body increases these processes, which promotes
faster healing
Hyperbaric Oxygen for Cancer Patients

Pressurized oxygen treatment has been used for centuries. As researchers gain a greater
understanding of cancers, like mesothelioma, the usefulness and risks of hyperbaric oxygen have
been debated. Because oxygen is necessary for cell growth, experts originally thought extra
oxygen would promote tumor growth. While research on hyperbaric oxygen and cancer patients
is limited, it appears to be safe and does not promote tumor growth.

E. Drug Therapy

 Anti-neoplastic drugs

Undesirable Effects:

- B one marrow depression

- A lopecia
- R etching-nausea/vomiting
- F ear and anxiety
- S tomatits
 General Guidelines for Antineoplastic Drugs:
- C BC platelets – monitor
- A ntiemetics before taking drug
- N ephrotoxicity – undesirable effect
- C ounseling regarding reproduction issues
- E ncourage handwashing
- R ecommend wig for alopecia
 Types of Antineoplastic Drugs
- Alkylating Agents
Action: causes cell death or mutation of malignant growth by
changing the structure of malignant cell growth
Indications: palliative treatment of chronic lymphocytic leukemia;
malignant lymphomas; Hodgkin’s disease; breast lung and ovarian
cancers.
Adverse Effects:
- Bone marrow depression
- Anorexia
- Alopecia
- Distressful nausea and vomiting

Drugs: Busulfan; carboplatin; carmustine

 Antimetabolites
 Action: interferes with the building blocks of DNA synthesis
Indications: Myelocytic leukemia; acute lymphocytic
leukemia; cancer of the breast; cervix; colon; liver; ovary.
Adverse effects: GI disturbance; oral and anal inflammation;
bone marrow depression; alopecia; renal dysfunction;
thrombocytopenia.
Drugs: Capecitabine; cytarabine
 General Guidelines in Giving Antimetabolites
- Monitor CBC and platelets weekly
- Evaluate renal function test
- Temperature assessment q 4-6hours
- Asepsis (strict)
- Bleeding
- Oral hygiene- brush with soft toothbrush
- Lots of fluid (2-3L/day)
- Intake and output; nutritional intake
- The protocols of handling and administering – follow
- Emphasize protective isolation
 Antitumor Antibiotics
- Action: binding to DNA making it unable to separate (2)
inhibiting ribonucleic acid (RNA) preventing enzyme
synthesis.

Plant Extracts

- Vinca Alkaloids – inhibits mitotic division

- Taxanes – inhibits mitotic division
- Toposoimerase Inhibitors – breaks the DNA strands
therefore altering the integrity of the genome
 Biologic Response Modifiers
- Interferons (IFNs)
-cytokines secreted by lymphocytes and macrophages
-slow the spread of viral infections
-Based on the patient’s prognostic factors the remission induction chemotherapy program general
includes some if not all of the following drugs:

1. Cyclophosphamide
2. Vincristine
3. Dexamethasone or Prednisone
4. L-asparaginase
5. Doxorubicin.

-Some programs include high doses of methotrexate and cytosine arabinose as part of the
induction scheme.

-Others use a drug called etoposide

-Consolidation is several weeks long and includes courses of methotrexate or cyatarabine

-At the consolidation of treatment maintenance therapy begins with drugs used in a combination
rotational schedule.

Maintenance therapy may include:

1. Cyatarabine
2. Thioguanine
3. Methotrexate
4. Cyclophosphamide
5. Vincristine
6. Predniose/dexamethasone
7. Doxorubicin
8. L-aspariginase
9. Mitoxantrone
10. 6-mercaptopurine.

-The rotational therapy is administered over a 2 to 3-year course.

F. hydration

-electrolyte is essential for normal physiologic function of nerves; muscles; are monitored closely
in the patient with cancer; elevated or decreased electrolyte levels can have life-threatening
effects.

-the nurse must anticipate problems such as cardiac dysrhythmias or controlled bleeding and
intervene quickly. Intravenous fluids; oral electrolyte supplements and or total parenteral nutrition
(TPN) can influence electrolyte balance.

-the nurse must be able to report current lab values and all sources of ingested parenteral
electrolytes to oncology specialists.

g. prevention of infection

- An immunocompromised state makes it difficult for the patient with cancer to combat even
minor colds; sepsis can result. When assigned to care for a patient who is neutropenic; the nurse
must review guidelines regarding care of an immunocompromised patient.

H. Supportive management

 Central to palliative care are symptom relief and support for the patients and their families,
including regard for emotional, cultural and other needs.
 A role for palliative care is best considered early in the course of disease, possibly at
diagnosis.
  Optimal palliative care depends on adequate infrastructure (personnel, facilities, drugs)
and methodology (modes of delivery, dose adjustment by the patient); its outcome should
be evaluated.
 Adequate pain control is an essential component of cancer care. Supportive treatment is
not limited to immediate medical needs but should also take account of individual and
community traditions.

I. Prevention of complication

Things people with cancer can do to help prevent infections

Here are some things you can do that might help prevent infection and illness when your
immune system is weak due to cancer and/or cancer treatment:

 Wash your hands often with soap and warm water. Be sure to wash your hands before
eating and before touching your face or mucous membranes (eyes, nose, mouth, etc.).
 Wash your hands after using the bathroom, blowing your nose, coughing, or sneezing.
 Wash your hands after touching animals, collecting trash, or taking out garbage.
 Wash your hands after visiting a public place or touching items used by others.
 Carry an alcohol-based hand sanitizer to clean your hands when you’re out.
 Use moist cleaning wipes to clean surfaces and things that you touch, such as door
handles, ATM or credit card keypads, and any items that are used by other people.
 Avoid large crowds of people such as school, travel, shopping, social events, and public
gatherings.
 Stay away from anyone with a fever, the flu, or other infection.
 Get your flu shot every fall. Encourage other members of your household to get it,
too. DO NOT get the nasal mist flu vaccine.
 Bathe every day. Be sure to wash your feet, groin, armpits, and other moist, sweaty
areas.
 After bathing, look for redness, swelling, and/or soreness where any tubes or catheters
go into your body.
 Wear gloves when you garden and wash up afterward.
 Brush your teeth twice each day. Ask your doctor or nurse if it’s OK to gently floss your
teeth. Tell them if your gums bleed. Your doctor or nurse may give you a special
mouthwash to help clean your mouth. Do not use alcohol-based mouthwash.
 Keep your groin and anal areas clean. Use soft moist tissues such as disposable baby
wipes or bathroom towelettes after using the toilet and anytime you notice irritation or
itching. Tell your doctor about any bleeding, redness, or swelling (lumps) in this area.
 Do not get manicures or pedicures at salons or spas (you can use your own personal and
well-cleaned tools at home). Do not use false nails or nail tips.
 Do not wade, play, or swim in ponds, lakes, rivers, or water parks.
 Do not get into hot tubs.
 Wear shoes all the time – in the hospital, outdoors, and at home. This helps you avoid
injury and keep germs off your feet.
 Use an electric shaver instead of a razor to avoid cuts and nicks. Do not share shavers.
 If you cut or scrape your skin, clean the area right away with soap and warm water. Cover
the area with a clean bandage to protect it. If the bandage gets wet or dirty, clean the
area and put on a new bandage. Tell your doctor if you notice redness, swelling, pain, or
tenderness.
 Prevent constipation and straining to move your bowels (poop) by drinking 2 quarts of
fluid each day. Exercising each day can help, too. Let your doctor or nurse know if you are
having bowel problems. If needed, your doctor may give you medicine that softens your
poop. Do not put anything in your rectum, including enemas, thermometers, and
suppositories.
 Women should not use tampons, vaginal suppositories, or douche.
 Use water-based lubricants during sex to avoid injury or abrasion of the skin and mucous
membranes. Use latex or plastic condoms to reduce the risk of sexually transmitted
infections.
 Do not keep fresh flowers or live plants in your bedroom.
 Do not clean up droppings from your pets. Do not clean bird cages, litter boxes, or fish or
turtle tanks. Have someone else do this for you.
 Do not touch soil that may contain feces (poop) of animals or people.
 Do not change diapers, but if you do, wash your hands very well afterward.
 If you use disposable gloves to avoid touching things like soil or waste, wash your hands
after you take off the gloves. (Gloves can have tiny holes that you can’t see.)
  Stay away from all standing water, for example, in vases, denture cups, and soap dishes.
If you store your dentures in a cup, wash the cup and change the water with each use.
 Use hot water to clean your dishes.
 Do not share bath towels or drinking glasses with anyone, including family members.
 Stay away from chicken coops, caves, and any place where dust from the ground is being
blown into the air, such as construction sites.
 Talk with your doctor or nurse if you are planning any travel during this time.

j. Rehabilitation

 Rehabilitation involves restoring cancer patients to their highest achievable level of

physical and psycho-intellectual capacity despite the impact of disease, thus improving
quality of life.
 Medical, physical, cultural, financial and emotional needs of individuals must be
considered.
 A comprehensive interdisciplinary team provides the optimal means.