CARE OF

PATIENTS
WITH CANCER
◦ Cancer is a
disease
process that begins when an abnormal cell is
transformed by the genetic mutation of the
cellular DNA. This abnormal cell forms a clone and
begins to proliferate abnormally, ignoring
growth-regulating signals in the environment
surrounding the cell. The cells acquire invasive
characteristics, and changes occur in surrounding
tissues. The cells infiltrate these tissues and gain
access to lymph and blood vessels, which carry the
cells to other areas of the body.
REMEMBER THAT CANCER CELLS:

– Have uncontrollable growth

– when we mention carcinoma,
the tumor usually arises from
surface or grandular
epithelium
– sarcoma: arises from the
connective tissues.
– lymphoma and myeloma starts in
the cells of the immune system.
Cellular origin
• Carcinoma: originates in
epithelial tissue
• Adenocarcinoma:
originates in the glandular
tissue
(breast, prostate)
• Sarcoma: originates in fat,
muscle blood vessels,
nerves, bones
Other definitions and characteristics of cancer are:

• Benign Neoplasm – Slow-growing,

 localized, and encapsulated with well
defined borders. Not cancerous.
• Malignant neoplasm – Aggressive form
that invades and destroys tissues.
having cells or processes that are
characteristic of cancer
• Metastasis – Cells travel through the
blood or lymphatic system and invade
other tissue and organs to form a
secondary tumor.
grade, from 1–4.
TUMOR GRADING

◦ – we examine the tumor through biopsy

under a microscope.
◦ – abnormality of the cells determines the
grade of the cancer.
◦ – increasing abnormality increases the
◦ Grade 1 Cells slightly abnormal and
well differentiated
◦ Grade 2 Cells more abnormal and
moderately differentiated
 ◦ Grade 3 Cells very abnormal and poorly ◦ Grade 4 Cells immature and
differentiated undifferentiated

CANCER STAGING

◦Staging is the classification of the extent of the disease.

There are several types of staging methods. The tumor,
node, metastases (TNM) system classifies cancer by tumor
size (T), the degree of regional spread or node involvement
(N), and distat metastasis (M).
A NUMERICAL SYSTEM ALSO IS USED TO CLASSIFY THE
EXTENT OF DISEASE.
Stage 0 Cancer in situ (limited to surface cells)
Stage 1 Cancer limited to the tissue of origin, evidence of
tumor growth
Stage 2 Limited local spread of cancerous cells
Stage 3 Extensive local and regional spread
Stage 4 Distant metastasis

PATHOPHYSIOLOGY

◦ Cancer cells differ from normal cells in size, structure, function, and growth
rate. These malignant cells lack the normal controls of growth seen in healthy
 cells, and grow uncontrollably. This uncontrolled growth allows the cancer
cells to invade adjacent structures and then destroy surrounding tissues and
organs. Malignant cells may also metastasize to other areas of the body
through the cardiovascular or lymphatic systems. This uncontrolled growth
and spread of cancer cells can eventually interfere with one or more of a
person's vital organs or functions and possibly lead to death. The primary
sites of cancer metastasis are the bone, the lymph nodes, the liver, the lungs,
and the brain
There are two broad categories of genes that
are affected:
– Oncogenes – these are cancer causing genes. They may be normal genes
which are expressed at inappropriately high levels in patients with cancers or
they may be altered or changed normal genes due to mutation. In both
cases these genes lead to cancerous changes in the tissues.
– Tumor suppressor genes – these genes normally inhibit cell division and
prevent survival of cells that have damaged DNA. In patients with cancer
these tumor suppressor genes are often disabled. This is caused by cancer
promoting genetic changes. Typically, changes in many genes are required
to transform a normal cell into a cancer cell.

ASSESSMENT (GENERAL)
 Subjective Cues Objective cues
• Fatigue • Lump or area of thickening that can be felt under
• Changes in bowel the skin
or bladder habits
• Difficulty
• Weight changes, including unintended loss or
swallowing gain
• Persistent • Skin changes, such as yellowing, darkening or
indigestion or redness of the skin, sores that won't heal, or
discomfort after changes to existing moles
eating
• Persistent cough or trouble breathing
• Persistent,
unexplained • Hoarseness
muscle or joint • Persistent, unexplained fevers or night sweats
pain • Unexplained bleeding or bruising

MEDICAL MANAGEMENT- PHYSICIAN’S ORDER

Special Notation Laboratory /diagnostic examination
 Medication IV fluid
• Balanced nutrition – X ray examination Antimetabolites
– Computed tomography (ct) – Mammograhy
Treatment may be primary(to kill scans, – Magnetic resonance Antibiotics
– Cytology studies
cancer cells), adjuvant(to kill imaging (mri) – Positron emission – Biopsy Enzymes
remaining cancer cells), or tomography (pet) – Ultrasound o Needle
palliative(to treat signs and scans.
Proteasome
o Incisional
symptoms) inhibitors
– External-beam radiation therapy o Excisional
• Surgery o Tomotherapy Chemotherapeutic drugs Tyrosine kinase
• Stem cell transplants o Proton therapy
• Alkylating agents • inhibitors
• Radiation therapy – Internal radiation therapy o IV as ordered
Topoisomerase inhibitors
• Smoking cessation Brachy therapy
• Mitotic inhibitors •

Nursing Care Plan

 Nursing Intervention Evaluation
Diagnosis
Risk for infection Maintain or teach asepsis for dressing changes and wound care, peripheral IV Patient remains free of
and central venous management, and catheter care and handling. Wash infection, as evidenced by
hands and teach patient and SO to wash hands before contact with patients normal vital signs and
and between procedures with the patient. Instances when to wash hands: absence of signs and
• Before putting on gloves and after taking them off. symptoms of infection.
• Before and after touching a patient, before handling an invasive device (foley
Early recognition of infection
catheter, IV catheter, and so on) regardless of whether or not gloves are used. •
to allow for prompt
After contact with body fluids or excretions, mucous membranes, nonintact skin,
treatment.
or wound dressings.
• If moving from contaminated body site to another site during the care of the Patient will demonstrate
same individual. meticulous hand washing
• After contact with inanimate surfaces and objects in the immediate vicinity of technique.
the patient.
• After removing sterile or nonsterile gloves.
• Before handling medications or preparing food.
Encourage intake of protein-rich and calorie-rich foods.
Encourage fluid intake of 2,000 to 3,000 mL of water per day,
unless contraindicated.
 Nursing Intervention Evaluation
Diagnosi
s Acute pain • Suggest use of non-pharmacological techniques as Client will use
appropriate. pharmacological and
• Encourage increased oral fluid intake (2-3 liters if no nonpharmacological
contraindications).. pain relief strategies.
• Encouraged the use of analgesic (e.g., acetaminophen) or Client will report
antispasmodics (e.g., phenazopyridine) as prescribed • Determine satisfactory pain control
timing or precipitants of “breakthrough” pain when using
at a level less than 3 to 4
around-the-clock agents, whether oral, IV, or patch medications.
on a scale of 0 to 10.
• Provide nonpharmacological comfort measures (massage,
repositioning, backrub) and diversional activities (music,
television)
• Encourage use of stress management skills or complementary
therapies (relaxation techniques, visualization, guided imagery,
biofeedback, laughter, music, aromatherapy, and therapeutic
touch).
• Provide cutaneous stimulation (heat or cold,
massage).
 Nursing Intervention Evaluation
Diagnosis
Altered • Ascertain patient’s dietary program and usual • Ingest appropriate
Nutrition: Less pattern then compare with recent intake. amounts of
Than Body • Discuss eating habits and encourage a diabetic diet calories/nutrients.
Requirements
(balanced diet) as prescribed by the doctor. • Consult • Display usual
dietician and/or physician for further assessment and energy level.
recommendation regarding food preferences and
nutritional support. • Demonstrate
• Provide liquids containing nutrients and electrolytes stabilized weight
as soon as the patient can tolerate oral fluids then or gain toward
progress to a portion of more solid food as usual/desired
tolerated. range with
• Observe for signs of hypoglycemia: changes in normal
LOC, cold and clammy skin, rapid pulse, laboratory
hunger, irritability, anxiety, headache, values.
lightheadedness, shakiness.
• Regular exercise
• Refer the patient to an exercise physiologist, physical
therapist, or cardiac rehabilitation nurse for specific
exercise instructions.
 Nursing Intervention Evaluation
Diagnosis

Risk for • Investigate the patient’s prior efforts to manage the HIV care Patient demonstrates
Ineffective regimen. knowledge of
Therapeuti • Evaluate the patient’s self-management skills, including the diabetes self-care
c Regimen ability to maintain medication administration measures.
Management • Assess for factors that may negatively affect success with
following the regimen.
• Assess the patient’s financial resources for health care. •
Determine and ensure that patient’s knowledge about the
symptoms, causes, treatment, and prevention of
hyperglycemia.
 Nursing Intervention Evaluation
Diagnosis

Risk for • Use foot cradle on the bed. Use space boots Patient’s skin
Impaired on ulcerated heels, elbow protectors, and on legs and
Skin pressure-relief mattresses. feet
Integrity. • Wash feet daily with mild soap and warm remains intact
water. Check water temperature before while the patient
immersing feet in the water. is hospitalized.
• Inspect feet daily for erythema or trauma. • Patient will
Change socks or stockings daily. Encourage
demonstrate
the patient to wear white cotton socks. • Use
proper foot care.
gentle moisturizers on the feet. • Cut toenails
straight across after softening toenails with a
bath.
• The patient should not walk barefoot.
 Nursing Intervention Evaluation
Diagnosis
Anticipatory • Expect initial shock and disbelief following diagnosis of Identify and express
Grieving cancer and traumatizing procedures (disfiguring surgery, feelings appropriately.
colostomy, amputation).
Continue normal
• Provide open, nonjudgmental environment. Use therapeutic
life activities,
communication skills of Active-Listening, acknowledgment,
looking
and so on.
toward/planning for the
• Encourage verbalization of thoughts or concerns and
future, one day at a
accept expressions of sadness, anger, rejection.
time.
Acknowledge normality of these feelings.
• Visit frequently and provide physical contact as appropriate, Verbalize understanding
or provide frequent phone support as appropriate for of the dying process
setting. Arrange for care provider and support person to and feelings of being
stay with patient as needed. supported in grief work.
• Determine way that patient and SO understand and
respond to death such as cultural expectations, learned
behaviors, experience with death (close family members,
friends), beliefs about life after death, faith in Higher
Power (God).