% San Beda College - College of Nursing ONCOLOGY NURSING ONCOLOGY NURSING Radioisotope implant 1. Back is turned towards the door. > minimize exposure 2. Turn to sides 3. Complete bed rest. > prevent distodgement 4. Give enema before the procedure. > prevent dislodgement. 5. Low- fiber diet > inhibitdefecation during 6. Foley catheter during the procedure. > preventbladder ‘distention and prevent irradiation of the bladder. > cause fistula formation Forceps and lead container available. > pick up dislodged radioisotope and place tin the lead container. All surfaces are covered with Chux or paper. ‘Serve foods on disposable plates and utensils. Trash and linens are kept inthe client’ room and are not removed unl he client is ready for discharge. In general, linens are not changed untl they are {grossly soiled. This is to minimize radiation exposure of caregivers. after ‘tooth brushing and to flush te tolet several imes after each use. > prevent radiation contamination of other people and the environment Anyone ‘vacking the radioisotope Wear gloves wien handling body fluid. Any emesis (vomiting should be covered with absorbent pads, and the radiation safety officer should be called immediately. > prevent ‘Teaching guidelines as regarding to external radiation therapy LItls painiess. 2. Lie very still on a special table while the intervention is being given and you may be placed in a special position to maximize tumor irradiation. 3, Each veatment usually lasts, for few minutes. You may hear sounds of the machine being operated, and the machine may move during the therapy. 4, As a safely precaution for the therapy personnel, you will remain alone in the treatment room while the ‘machine isin operation. 5. The technologist will be right outside your room observing you through a window or by a closed — circuit TV. You may communicate. 6. There is no residual radioactivity after radiation Client Education on Skin Care in External Radi therapy. Safely precautions are necessary only during the ime you are actually recelving tradition. You may resume normal activites of daily living ‘Skin care within following: v y the teatment area includes the ‘Keep your skin cry Do not wash the treatment area unt you are instructed to do so. When permited. fash the treated skin gently wth mild soap, rinse well and pat dry. Use warm viater or cool water nt nt wit. Do not remove the lines or ink marks placed on your skin ‘Avold using powders, lotions, creams, alcohol ‘and deodorants on tne treated shin Wear loose ~ fting clothing t avoid trtion over the reamentarea. Do not apply tape to the treatmentareail dressings are appied Shave vith an electric razor. Do not use pre-shave rafter — shave lotons Protect your skin from exposure to direct sunlight, chiornaies swimming pools, and. temperature extremes (e.g. not water ottes, heating pads, ice packs) ‘rongeaby:3186 7/22/20 ¥ Consult your radiation therapist or nurse about specific measures for individual skin reactions Nursing Interventions for Side Effects of Radiation Therapy 1. SKIN REACTIONS Eythema, dry! moist desquamation ‘Avophy, telangiectasia, necroticlulcerative lesions, depigmentation. > Nursing interventions: © Obseive for early signs of skin reaction and report to the physician, © Keep area dry. © Wash area with water, no soap and pat dry (do not ‘ub). Mild soap is permitted © Do not apply ointments, powders or lotion on the area. Cornstarch may be used © Do not apply heat, avoid direct sunshine or cold on the area. Use soft cotton fabrics for clothing. To prevent skin ‘nritation, © Do not erase markings on the skin. These serve as guide for areas of irradiation. 2. INFECTION ‘+ Thisis due to bone marrow suppression > Nursing interventions: © Monitor blood counts weekly, especially WBC © Good personal hygiene, nutition, adequate rest. © Teach ine client signs of intecton to report to physician, 3. HEMORRHAGE Platelets are vulnerable to radiation, Nursing Interventions: Monitor platelet count, ‘Avoid physical uma or use of aspirin (ASA). Teach signs of hemorthage to report (e.g. gum bleeding nose bleeding, black stools), Monitor stool and skin for signs of hemorrhage. Use direct pressure over injection sites until bleeding stops. 4, FATIGUE + Result of high metabolic demands for issue repait and toxie waste removal + Plenty of rest and good nutrition, 5, WEIGHT Loss + Anorexia, pain and effect of cancer 6. Stomatitis and Xerostomia (Dry mouth) + Ulceration of oral mucous membrane accurs. > ‘Nursing Interventions: © Administer analgesics before meals, as prescribed. © Bland diet, avoid smoking and alcoho! ‘© Good oral hygiene with saline rinses every 2 hours. © Sugarless lemon drops or mint increase salvation, 7. Diarrhea, nausea and vomiting, headache, alopecia (hair oss) and, cystitis may also occur. 8, Social isolation is also experienced by the client due to fear of contaminating others with radiation. Chemotherapy The goals of chemotherapy: may be cure, control, or Daliation cf maniestaions. Risa systemic Intervention. Ris recommended when: + Disease is widespread + Thernsk of undetectable disease is high +The tumor cannot be resected and is resistant rr 1 00 Ay, 1031% San Beda College - College of Nursing ONCOLOGY NURSING OBJECTIVE: To destoy all malignant tumor cells without q Chemother ‘excessive destruction of normal cells, hemotherapy has the following characteristics: It affects both normal and cancer cells. The rapidly dividing cells, both the normal and cancer cells are vulnerable to destruction by chemotherapy by distupting cell function and division. Mucous, membrane, blood cells, hair follcies, skin cells are rapidly dividing cells. Side effects of chemotherapy tend t occurin these structures, Chemotherapy has fraction cell — Kill, Only a certain number of cancer cells are killed with each course of chemotherapy. Therefore, chemotherapy mustbe given ina series. ‘1. Cell — eyele specific (CCS) may destroy cancer cells at specific stage of cell division. 2. Cell -cycle nonspecific (CCNS). may destroy cancer cells at_any stage of cell division. Thus, combination chemotherapy destroys more malignant cells and produces fewer side effects because each drug stikes the cancer cells at different stages in the cell cycle. Classification of Chemotherapeutic Agents: 1, Cell Cycle — Specitic Groups ‘a. Antimetabolites inhibit cell reproduction by interfering with the manufacture of protein necessary tor DNA synthesis Cytarabine (Ara —C, Cytosar) 5 Fluorouracil (5-FU) 6 — Mercaptopurine (6-MP, Purinetnol) Methotrexate (Mexate) 6 — Thioguanine (6-T6) Fludarabine (Fludara) Pentostatin (Nipent) Vinca Alkaloids Vinorelbine (Navelbine) Vincristine (Oncovin) Vinblastine (Veiban) Epipodopnyliotoxins. Etoposide (VP-16) Teniposide (VM-26, Vumion) Taxanes Paclitaxel (Taxol) Miscellaneous LAsparaginase Hydroxyurea (Hydrea) 2. Cell Cycle — Nonspecific Groups ‘Alkaiyting Agents -interfere with DNA replication synthesis Busulfan (Myleran) Carboplatin (Paraplatin) Cisplatin (CDDP, Platinol — AQ) Cyclophosphamide (Cytoxan) Mosfamide (rex) Mechlorethamine HC! {Mustargen) Thiotepa Antitumor Antibioties - interfere with or inhibit DNA or RNA synthesis Chlorambueil (Leukeran) Bieamyein (Blenoxane) actinomycin (Cosmegen) Daunorubicin (Genbidine) Doxorubicin (Adriamycin) Idarubicin (kdamycin) ‘Mitomycin C (Mitomycin) ‘Mitoxantrone (Novantrone) Plicamycin (Mithracin) ‘rongeaby:3186 7/22/20 jormonal Therapy Glucocorticoids Prednisone (Deltasone) Methyiprednisolone (Solu-Medrol, Medrol) Dexamethasone (Decadron) Estrogens Chlorotrianisene (race) Diethyistibestrol (DES) Estradiol (Estrace) Antiestrogens ‘Tamoxifen (Nolvadex) Progestins Depo-Provera (Megace) Leuproliae (Lupron) ‘Casmustine (BCNU) Lomustine (CCNU) Strepiozocin (Zanesar) Routes of Administration of Chemotherapy ‘L Intravenous Chemotherapy ¥ Extravasation (escape trom the vein) of some ‘chemotherapeuicagentscan cause tissue necrosis In the area. Use of vaseular access devices (VAD's) are now pretened as venous access. This provides continuous chemotherapy, multiple access, route foradminisvation of parenteral fluids, antibiotes, and frequent blood testing, Y YAD's can be implanted (e.g. Port-A-Cath), central ines (eg. wnneled and non — waneled), and peripherally inserted central catheters (PICC lines) ¥ The most commonly reported complications of VADs are > infection and obstruction. (Each Insutution provides protocol tor care of VADs, eg, change of dressing, flushing, blood araw. ete.) 2. Regional Chemotherapy + Allows high concentrations of drugs to be directed 10 localized tumors. The methods are as follows: 4. Topical * Fluorouracil cream may be applied to the skin o teat actinic keratoses. 2.Intra-arterial * Intraarterial infusions enable major organs or tumor sites to receive maximal exposure with limited serum levels of medications. 3. intracavity * intracavity therapy instills the medication directly into fan area such as the abdomen, bladder, or pleural space. 4. Intraperitoneal + Intraperitoneal chematherapyis dane for eancerin the intabdominal area, eg., ovarian cancer. This allows high concentration of a chemotherapeutic Agent to be delivered to the actual tumor site with minimal exposure of healthy tissues, 5. Intrathecal + Intrathecal chemotherapy involves _instiling chemotherapeutic agents into te CNS through a reservoir placed in the venice via an Omnaya reservoit fr via a lumbar puncture, This Is done because most medications given systematicaly are noteftective against CNS tumors because they cannot crass the blood — brain barter. Contraindications to Chemotherapy are as follows: © Infection. Anti — tumor drugs are, Immunosuppressives. © Recent surgery. The drugs may retard healing process. 2 BON AY. 10.11% San Beda College - College of Nursing ONCOLOGY NURSING © Impaired Renal or Hepatic function. The drugs are nephrotoxic and hepatotoxic. © Recent’ Radiation Therapy. Also immunosuppressive © Pregnancy. The drugsmay cause congenital defects © Bone Marrow Depression. The drugs may aggravate the condition. The whe levels must be ‘within norma limits MNEMONICS: RIPRIP Safe Handling of Chemotherapeutic Agents 1 Wear mask, eye shield, gloves and back — closing gown. 2. Skin contact with drug must be washed immediately with Soap and water. Eyes mustbe flushed immediately with copious amount of water 2, Sterile! alcohol — wet cotton pledgets should be used, ‘wrapped around the neck of the ampule or vial when breaking and withdrawing te drug, 4. Expel air bubbles on wet cotton, 5. Vent vials to reduce internal pressure after mixing, 6. Wipe external surface of syringes and IV bottles 7. Avold self — inoculation by needle stab. 8. Clearly label the hanging IV bottle with, © Avold fresh fruits, raw meat, fish, vegetables, fresh tlowers, potied plants, © Change IV sites every otner day. © Change all solutions and IV infusion sets every 48 hours. Thrombocytopenia © Protectfrom tauma, © AvOld ASA © Nadi, Is the time after chemotherapy. administration when whe or platelet count is at the lowest point. It occurs within 7 to 14 days after drug administation, 4. Genito — Urinary System ‘Hemorrhagic cystitis © Provide 2— 3 Lof fluids per day. Urine color changes © Reassure that itis harmless. 5. Reproductive System Premature menopause or amenonthea © Reassure that menstruation resumes after chematherapy. Antiemetics to Relieve Nausea and Vomiting Related ' Chemotnerapy 8. Contaminated needles and syringes must be disposed In a clearly marked special container. “leak — proof, “puncture — proot” 10. Dispose half — empty ampules, vials, IV bottles by ‘Bulting into plastic bag, seal and then into another plastic bag of box, clearly marked before placing for removal. Label as"Hazardous waste 111. Hand washing should be done before and atterremoval ot gloves. 12, Only trained personnel should be involved in use of drugs (preferably, chemotherapy ceriied nurses) 13. Ideally, preparation of chemotherapeutic drugs should ‘be In laminar flow conditions with filtered alr to prevent contamination with microorganisms. ‘Nursing interventions for Chemotherapy Side — Effects 1. Gu. System —nausea and vomiting, diarrhea, constipation ‘© Administer antiemetic to relieve nausea and vomiting, 0 Replace ‘fluid — electrolyte losses, low — fiber dietto relieve diarthea. © Merease fluid intake and fibers in diet 10 prevent [relieve constipation 2. Integumentary System - Pruritus, urticaria and systemic signs 2 Provide good skin care. Stomatitis (oral mucositis) Provide good oral care © Avold hot and spicy food Alopecia © Reassure that tis temporary, Encourage to wear wigs, hats or head sca. Skin pigmentation 2 tnform that itis temporary, ‘ail changes © Reassure that nalls may grow normally after chemotherapy. 3. Hematopoietic System “Anemia «©. piovide frequent rest periods. Nout Protect from infection. © Avoid people with infection © Report fever, chills, dlaphoresis, heat, pain, erythema, or exudates on any body surface. © Avoid recial or vaginal procedures. ‘rongeaby:3186 7/22/20 Dronabinol (Marinol) Ondansetron (Zotran) Granisetron (Kyril) Alprazolam (Zanax) Lorazepam (Ativan) Haloperidol (Haldo!) Prochlorperazine (Compazine) Kaa 068 Adverse reactions to chemotherapy are as follows: > tanaphylactic reaction occurs, the following nursing interventions are implemented, 8, Stop the drug adminisvation, b. Maintain IV access with 0.9% NS (NaC), ©. Keep an open airway. 4. Keep dlientin modified Trendelenburg position (supine with legs elevated at 20 to 30"), unless contraindicated. . Notity he physician, {Monitor the clients vital signs unti ne is stable. @ Administer epinephrine, am nophyline, diphenhydramine and’ corticosteroids as prescribed, > Extravasation ¥ Vesicant chemotherapeutic agents can cause or form a blister and cause tissue destuction.E.g., Adriamycin (Doxorubicin), Oncovin (Vincristine) ¥-Initant drugs ean produce venous pain athe site and along the vein. ¥ Pain, erythema, swelling and lack of blood return indicate an extravasation. ‘Nursing interventions tor extravasation inclucie Stop the drug administration. Leave the needle in place, and attempt aspirate any residual drug from the tubing, needle, and site © Administer an antidote, as prescribed. Then remove the needle. © Apply warm or cold compresses as indicated. © Document the appearance of the site before and after chemotherapy. > Bone marrow transplantation for hematologic affecting cancers. © Allogenie (ram unrellated donor) © Autologous (fram self) © Syngenic (from an identical win) © Stem cell tansplantation by apheresis, 3 BON Ay. 10-11% San Beda College - College of Nursing Oncologic emergencies {L.nfection and Pain ¥ Due to neuwopenia, ¥ Experiences pain. Y Severe infection and pain can interfere with the person's ability to enjoy quality life ¥-Priotty in care : PAIN MANAGEMENT 2, Hypercalcemia . {due to bone resorption (demineralization). Serum calclum tevelis >11 mgidL. ¥- occurs in solid tumors like breast, lung, head, neck and renal cancers; also occurs in hematologic cancer like multiple myeloma, leukemia. Severe hypercalcemia may lead to —> renal failure, coma, cardiac arrest and death, ¥ Calcitonin (Miacaicin) and oral glucocorticoids are given to lower serum calcium, 3. Tumor Lysis Syndrome The destruction of large number of malignant cells may ‘rapidly release intracellular potassium, phosphorous and nucleic acid into the circulation. ¥ Clients with malignancies that are very responsive to treatment are at highest risk, especially if they have large tumor burden (lymphomas, leukemiasand small cell carcinoma). 4. SIADH (Syndrome of inappropriate Secretion of Anidiuretic Hormone) ‘results from the abnormal production of antidiuretic hormone (ADH). This maybe caused by small cell ung cancer, infecton, pulmonary disorders, emotional stress, CNS disorders and some drugs, including antineoplastic agents like Cytoxan (Cyclophosphamide), Oncovin (Vincnstine), Velban (Vinbiastin), Platnol - AQ (Cisplatin). v SIADH is ‘manifested by water_retention_and decrease in sodium. 5. Disseminated intravascular Coagulation (DIC) > The medical management for DIC are as follows: Correction ofthe basic problem (e.g, infection) Administer blood products and "medication as prescribed WV heparin if with manifestations of thrombosis (although, controversial. Monitor the elient for signs and symptoms of bleeding, 6. Spinal Cord Compression © Itis caused by direct pressure on or compromise of vascular supply to the spinal card. © Back pain is often. the only presenting clinical manifestation in majority of cients. © This may result iweversible neurofogic damage with paralysis and loss of bowel and bladder control. © Treatment is usually with RT. © Alaminectomy may be an alternative. Steroids may be given to reduce inflammation and swelling around the spinal cord) 7. Superior Vena Cava Syndrome (SVC) It results from the superior vena cave, The obsttuction reduces venous relurn to the heart and decreases cardiac output, © SVC syndrome is usually secondary to lung cancer or lymphoma. ‘rongeaby:3186 7/22/20 follows: ONCOLOGY NURSING The clinical manifestations of SVC syndrome are as Dyspnea Facial swelling + Jugular vein distention + Situng up and leaning forward to breathe. + Swelling of arms, chest pain, dysphagia, © External - beam RT and curative chemotherapy are Used for palliation, 8. Cardiac Tamponade ‘> Fluid collects in the pericardial sac Surgery 5 Lumpectomy 1 Tyiectomy. Involves removal of the lump. © Simple Mastectomy. Involves removal of the entire breast. The pectoralis muscles and the nipple remain intact. Modified Radical Mastectomy (MRM). Involves removal of the entire breast and the axillary lymph nodes. The pectoralis muscles are conserved. © Radical Mastectomy (Halstead Surgery). Involves removal of the entire breast, pectoralis major and minor muscles and the axiliary Iymph nodes. is followed by skin grafting. This is rarely done nowadays. > Chemotherapy Radiation Therapy > surgery Care of the Client Undergoing Breast Surgery > Preoperative Care ‘© Psychosocial Support. Include the husband when necessary. + Teach aim exercises to prevent lymph edema * Inform about wound suction drainage, e.g. hemovac, Jackson — Pratt * DBCT exercises to prevent postop respiratory ‘complications, © Place client in semi — Fowler's position with arm ‘abducted and elevated on pillows. Fawler's position promotes lung expansion, Abduction and elevation ff arm on the affected side promotes venous return and prevents lymphedema, + Monitor Hemovac output (normal drainage is Sserosanguinous for the first. 24 hours) ‘rongeaby:3186 7/22/20 ‘Serosanguinous drainage is composed of plasma ‘and small amounts of rbc. itis pinkish or reddish in appearance but not viscous, + Check behind patient for bleeding. Blood flows to the back by grawity + Post signs warning against taking blood pressure, starting IVs, or drawing blood on affected side. To prevent obstruction of venous and lymphatic tow, + Initiate exercise to prevent stiffness and contractures of shoulder gltdle. Give analgesic before initiating exercises. + Reinforce special mastectomy exercises as prescribed. To prevent ymphedema. + Provide adequate analgesia to promote ambulation and exercise. The client cooperates ‘with ambulation and exercise if she is free from pain or discomfort, + Encourage regular coughing and deep breathing exercises. To promote lung expansion and prevent atelectasis + Prepare client for size and appearance of the Incision and provide support when incision is Viewed far first ime. + Provide client with detailed information concerning breast prosthesis. Fiting Is not possible for 4—6 wks. A temporary prosthesis or lightly padded bras may be worn unillheaiing is complete. + Teach patient to avoid constrictive clothing and report persistent edema, redness, or infection of Incision + Teach patient importance of continuing monthly breast examination on remaining breast Prevention of Lymphedema “avoww's* Cuts + Scratches + Pinpricks Hangnails + Inseetbites + Bums + Song detergents “DONT's" (on the arm on affected side). ‘Camry purse or anything heavy, Wear wristwatch or jewelry. Pick at or cut cuticles. Work near thorny plants or dig in garden. Reach into notoven, Hold a cigarette. Injections, withdrawal of blood, BP —taking. “Do's ‘+ Wear loose rubber gloves when washing dishes. Wear a thimble when sewing. ‘Apply lanolin hand cream to prevent dryness. Contact attending physician if arm gets red, warm, or hard and swollen. Return for check — up « Wear “Life Guard Med. Aid” tag: CAUTION — LYMPHEDEMA LUNG CANCER © Tobacco abuse © Asbestos ‘© Radiation exposure © Airpoltuton arise form a single transformed epithelial cell in the ‘wacheobronchial airways. sase © Dry, persistent cough, without sputum production Dyspnea, Hemopiysis, © Pain (+) 3. BRAINTUMOR 5 BON AY. 10-11% San Beda College - College of Nursing ONCOLOGY NURSING Effect in the brain are compression & infiltration of lissues, Increase ICP Seizure actviy Hydrocephalus Allered pitutary function GScan Brain Cancer Nursing management. Brain Ca Evaluate gag reflex & ability to swallow Risk for aspiraton ‘Measures to decrease ICP Reorient person to place. time, place Assess for self care deficits Enhance coping 4, COLORECTAL CANCER © Greater incidence in men © Benign polyp © Uleerative colitis © High-fat, low-tiber diet Colorectal cancer sign & symptoms: ‘© Change in bowel habit Passage of blood in stools Abdominal pain, cramping, narrowing of stools, constipation. © Feeling of inadequate evacuation post bowel movement Prepare patient for surgery Providing emotional support Body image disturbance Providng wound care & teaching stoma care rors 5. LEUKEMIAS Unregulated proliferation of WAC's in the bone marrow Assessment: ‘Weakiiess & fatigue, Fever, weight loss Preventinfecton & bleeding + Manage mucositis + Improve nutvitonal intake + Decrease fatigue + Maintain fluid & electrolyte balance + Improving sett care Cancer ofthe Blood Leukemia ‘© unregulated proliferation or accumulation of white cells in the bone marrow, replacing normal marrow elements. © proliferation in te liver, spleen, and tymphnodes ‘© Invasion of nonhematologic organs. © cause: is UNKNOWN. Classification a. Lymphocytic (Leukemia, Lymphocytic, Acute) ‘a malignant proliferavon of lymphoblasts. ‘most common in young children males are attected more than females peak incidence at4 years of age, = 60% of children survive atleast years. Clinical Manifestations Skeletal = Immature lymphocytes proliferate in marrow and peripheral tissue and crowd development of normal cells © Notmal hematopoiesis inhibited and leukopenia, ‘anemia, and thrombocytopenia develop. ‘© Enyhrocyte and platelet counts low. ‘rongeaby:3186 7/22/20 © Leukocyte counts low or high but always include immature cells, Malignancy Manifestations of leukemic cell inflation into other organs more common with ALL than other forms of leukemia. Management Major form of teatmentis chemotherapy 1. Combinations of vinctistine, prednisone, daunorubicin, and ‘asparaginase used for initial therapy, 2. Combinations of mercaptopurine, metiovexate, vincristine, ‘and prednisone for maintenance. 3. Iadiation of the cerebrospinal region and intrathecal injection of chemotherapeutic drugs help prevent central nervous system recurrence. Leukemia, Lymphocytic, Chronic ‘isorder fat primarily affects persons beween 50 and 70 years of age. © mosteommon leukemia © diagnosed during physical examination or weatment tor anomer disease. Clinical Manifestations ‘© Many are asymptomatic © Possible manifestations are those of anemia, Infection, oF enlargement of lymph nodes and abdominal organs. © Erythrocyte and platelet counts may be normal or decreased, ‘© Lymphocytosis is always present. ‘Management and prognosis 1. If mild, CLL may tequire no teatment. When symptoms. are’ Severe, chemotherapy with steroids and cchorambueil (Leukeran)is often used. 2. Patients who do not respond to ordinary therapy may ‘achieve remission by fludarabine monophosphateor pentostatin 3. Intravenous immunoglobulin (VIG) is an effective prophylactic treatment for selected patients. 4. The average survivalis 7 years. ‘Complications I. Bleeding and infection are the major causes of death. 2. Renal stone formation, anemia, and gastointestinal problems, 3, Bleeding correlates wih level of thrombocytopenia: presents with petechiae, ecchymoses, and major hemorthages when platelet count below 20,000 mms, Fever or infection increases bleeding, Nursing Process for a Patient with Leukemia ‘Assessment 1. Identify range of signs and symptoms reported by patientin nursing history and physical examination, 2. Clinical picture will vary with the type af leukemia involved like weakness and fatigue, bleeding tendencies, petechiae and ecchymosis, pain, headache, vomiting, fever and infecton. 3. Blood studies may show alterations of white blood cells, anemia, and thrombocytopenia, ‘Major Nursing Diagnosis 1. Pain related to leukocytcintilation of systemic tissue. 2. Altered nutrition, less than body requirements, related {o gastrointestinal proliferative changes and toxic effects of chemotherapeutic agents Fatigue and activity intolerance related to anemia. Grieving related ta anticipatory loss and altered role functioning. Impaired skin imegrity, alopecia related to toxic effects, of chemotherapy. 6. Disturbance in body Image related to change in appearance, function, and role. Collaborative Problems 6 BON AY. 10-11% San Beda College - College of Nursing ONCOLOGY NURSING 1. Infection 2. Bleeding Planning and implementation Major goals ¥ablliy to cope with the diagnosis and prognosis. ¥ Tolerance of activity attainment or maintenance of comfort attainment or maintenance of adequate ution ¥__ promotion of positive body image, ¥ absence of complications Interventions Coping wit the Diagnosis and Prognosis, 1. Contribute t patient comfort. by explaining procedures, anticipating side effects of ‘medication, and encouraging to participate in the therapeute regimen, 2. Be a sympathetclistener and help patientand family ‘mobilize defenses to cope with emotional and physical stresses. in 1. Assess for thrombocytopenia, granulocytopenia, and anemia, 2. Report any increase in petechiae, melena, hematuria, or nosebleeds, 3. Avoid trauma and injections; use small-gauge needles when analgesics’ are administered parenterally and apply pressure after injections, 1 avoid bleeding, 4, Used acetaminophen instead of aspirin for analgesia. 5. Give prescribed hormonal therapy to prevent menses. 6, Treat hemorthage with bed rest and transfusions 0 blood cells and platelets, Preventing Infection (a major cause of death) 1 Assess temperature elevation, flushed appearance, chills, tachycardia, appearance of white patches in the mouth. 2. Observe for redness, swelling, heat, or pain in eyes, ears, throat, skin, joints, abdomen, rectal and perineal areas, 3, Assess for cough and changes in character or colar of sputum. 4, Give frequent oral nygiene, 5. Wear sterile gloves to stat infusions 6. Provide daily IV site care; observe for signs of infection. 7. Ensure ‘normal elimination; avoid rectal thermometer, enemas, and ‘rectal trauma; avoid vaginal tampons, 8, Avoid catheterization unless essential, Practice scrupulous asepsis if catheterization is necessary. Improving Activity Tolerance 1. Assistin choosing acivily priorities. 2) ‘Offer alternate rest and actvity periods if patient ‘weak and easily fatigued. 3. Assess for dyspnea, tachycardia, and other evidence of inadequate oxygen supply to vital organs. 1. Prevent undue pain in the abdomen, lymph node areas, bones, and joints with careful positioning of patient 2. Avold sudden movements and promote comfort with soft support such as pillows, 3, Administer acetaminophen rather than aspirin for analgesia. 4, Give high fluid intake to prevent crystallization ot Ure acid and subsequent painful stone formation, AttainingiMaintaining Adequate Nutrition ‘rongeaby:3186 7/22/20 1. Supply good nuviton by careful tming of chemotherapeutic drug _administation: prophylactic use of anliemetic; and encouragement of foods and fluids that are Teast tating, 2. Give irequent oral hygiene to prevent oral lesions ‘and promote appetite 3, Maintain nutriion with small, trequent feedings ot foods and fluids that are high in protein and vitamins, and palatable, > Promoting Positive Body imac T. Prepare patentfor the occurrence of alopecia and help to express and resolve feelings. 2. Help patient adjust to body image problems by encouraging involverentand supportot family or support system. > Care inthe Home and Community 1. Ensure that patients and their familieshave aclear understanding of disease and prognosis. 2. Respect patient's choices about treatment including measures to prolong life, when they rho longer respond to therapy. Provide tor advance difectives and living wills to give patient control during terminal phase. 3. Support families and coordinate home care services to alleviate anxiety about managing patient’ care in the home. 4, Teach family members about home care while patient is stl in hospital. 5. Provide respite for caregivers and patient with hospice volunteers. 6. Give patient and caregivers assistance 10 cope with changes in tei roles and responsibilities like anticipatory grieving. 7. Provide information concerning hospital-based hospice programs for patients to receive palliative care in the hospital wnen care at home is no longer possible. c. Leukemia, Myelogenous, Acute ‘he hematopotete stem cell that differentiates myeloid cells: + monocytes + granulocytes (basophils, neutrophils, eosinophils) + erythrocytes + platelets © allage groups are affected © incidence rises with age ‘© mostcommon nonlymphocytic leukemia, Clinical Manifestations 1L. Most signs and symptoms evolve from insufficient production of normal blood cells ‘Vulnerability to Infection results trom granulacytopenia + Weakness and fatigue are due to anemia. Bleeding tendencies are a result of thrombocytopenia 2, Proliferation of ieukemic cells within organs leads to a varie of additional symptoms: = pain from enlarged liver or spleen = lymphadenopathy | Readiache or vomiting secondary to meningeal leukemia + _ bone pain from expansion of marrow. 3. Onset insidious with symptoms occurring aver 1-6 months 4. Peripheral blood shows decreased erythrocyte and platelet counts 5. Leukocyte count iow, normal, high, percentage of normal cells usually decreased. Diagnostic Evaluation 1, Bone marrow specimen (excess of immature blast cells) > Auer rods presentin the cytoplasm. 7 BON AY, 10:11% San Beda College - College of Nursing ONCOLOGY NURSING ‘Management * Chemotherapy is the major form of therapy and in some instances result in remissions lasing @ year or longer. Chemotherapy 1. Daunorubicin hydrochloride (Cerubidine) 2) cytarabine (Cytosar- U) 3, Mercaptopurine (Purinephol) Supportive Care 1, Administration of blood products. 2. Promptueatmentof infections Bone Marrow Transplantation 1, Used when a Ussue match of a close relative can be ‘obtained. 2. Transplant follows destuction of leukemic marrow by chemotherapy. Prognosis * ‘Survival of reated patients averages only 1 year, with death usually a result of infection or hemorrhage. * Untreated patients survive only about 2-5 months. d Leukemia, Myelogenous, Chronic ‘malignancy of myeloid stem cells © genetic abnormally termed the Philadelphia Ehromosome is found in 90 ~ 95% of patents. ‘© Uncommon before aye 20 © ineldence rises with age Clinical Manifestations ‘L. Onset insidious 2, Leukocytosis always present, sometimes at extraordinary levels. 3. Splenomegaly is common. ‘Management 1. Therapies of choice are busulfan (Myleran) and Hydroxyurea, chlorambucil (Leukeran) alone or with steroids, 2. Bone marrow transplantation increases survival significantly. 3. Other drug choices; alpha-interferon and fludarabine (Fludara), Prognosis > Patients live for 3-4 years, * Death usually results from infection or hemorrhage. ‘Nursing Process * Similar to that of Chronic Iymphocytic leukemia. 6. PROSTATE CANCER ‘Common among males whoa te 50 years old and older © African Americans have the highest incidence of prostate cancer in ine world 2 Positive family history © Exposure to cadmium Prostate Ca (4) PSA -Prostaic spectc amigen Sax: © Varying alterations in he urinary pattern S Pain © Weightloss Promotion af early detection Monitor 1&0 Management of pain, emotional support Nutritional support May undergo dialysis 7. LIVER CANCER © Female> Male; Specially females who used contraceptives ‘rongeaby:3186 7/22/20 Dull ache in the upper R quadrant or epigastric. Weight loss Anorexia, Jaundice Ascites o Teach self-care © Potential bleeding tendencies > Improve Nutition Cancer of the Liver ¥ may be malignant or benign. occur in patients with chronic liver disease (cirthosis) > Hepatocellular Carcinoma ‘most common type of primary liver tumor. © usually nonresectable because of rapid extension and metastasis elsewhere > Cholanglocellular Carcinoma © If found early, resection may be possible, however, aly detection is rare. Etlology of L 1. Cirrhosis 2. Hepatitis B 3. Exposure to certain chemical toxir 4 Cigarette smoking when combined with alcohol use 5. Aflatoxins or carcinogens in herbal medicines and nitrosamines. Clinical Manifestations 1. Early manifestations include signs and symptoms of any cancer that interferes with nutrition; recent loss of weight, loss of strength, anorexia, and anemia 2. Abdominal pain may be present, accompanied by rapid liver_enlargement and irregular surface upon palpation Jaundice is present only i larger bile ducts are occluded. ‘Ascites occurs if portal veins are obstucted or tumor is, seeded in the peritoneal cavity. Diagnostic Evaluation ‘© clinical signs and symptoms ‘© history and physical examination © results of laboratory and x-ray findings. Nonsurgical Management > Radiation Therapy 1. Intravenous injection of antbodies that specifically attack tumor-associated antigens, 2, Percutaneous placement of a high-intensity source for Ierstiial radiation therapy. > Chemotherapy 4. Systemic chemotherapy and regional infusion used to ‘administer antineoplastic agents, 2. An implantable pump is used 1 deliver a high- ‘concentration chemotherapy tthe liver through the hepatic artery Percutaneous Biliary Drainage Used to bypass billaty ducts obstructed by the liver, pancreatic, or bile ducts in patients with inoperable ‘tumors. 2. Complications include sepsis, leakage of bile, hemorhage, and reobstuction of the biliary system. 3. Observe patients for fever and chills, bile drainage ‘around the cateter, changes in vital signs, and ‘evidence af Bilary obstucton, including increased pain ot pressure, pruritus, and recurrence of Jaundice. 8 BON AY. 10-11% San Beda College - College of Nursing ONCOLOGY NURSING Other Nonsurgical Treatment Modalities 1. Hyperthermia; heat is directed to wmors to cause hhecrosis of the tumors while sparing normal tissue, 2, Cryosurgery and laser therapy are never treatment ‘modalities, 3. Embolization of the arterial blood flow to the ‘tumor effective n small tumors Immunotherapy; lymphocytes with antitumor reactivity are administered to the patient. ‘Surgical Management * Hepatic lobectomy can be performed: ‘+ when the primary hepatic tumor Is localized ‘+ when the primary site can be completely excised + the metastasis is limited, * Presence of cirrhosis limits the ably of the liver to regenerate Preoperative Evaluation and Preparation 1, Evaluate and address patient's nutritional, luid, emotional, ‘and physical needs prior to surgery. 2. Prepare the intestinal wact with eathartios, colonic, Imigation, and intestinal ansbiotes. Nursing Interventions; Postoperative 1. Assess for potential problems related to cardiopulmonary involvement, vascular complications and respiratory and liver dystunction 2. Give careful attention to metabolic abnormalities. 3, Give constant close monitoring and care for the first 2-3, ays. 4, Encourage early ambulation. Care in the Home and Community 1. Collaborative with the health care team, patient, and family to identity and implement pain management svategies and approaches to management of other problems, 2. Assist patient and family in decision making about hospice care and initation of referrals. 8. Provide reassurance and instiuctons fo patient and family to reduce fear that the percutaneous biliary drainage catheter will fall out 4, Provide verbal and writen instruction as well as demonstration of biliary catheter care to patient and family; 5. Instruct regarding signs and symptoms of complications and ‘encourage 10 nolily nurse or physiclan if problems or ‘questions occur 8. HODGKIN'S LYMPHOMA Rare malignancy that has an impressive cure rate MoE © (#) Reed-Sternberg celts morphoiogicatly unique © Begin with painless enlargement of one or more lymph nodes in one side of tne neck. Immature Iymphoia 9. SKIN CANCER © Individual with fair complexion Positive family history Moles (nevi) Exposure 10 coal tar, creosote, arsenic, radium Sun exposure between Liam-3pm Uviight > Malignant melanoma + Presentin both epidermis & dermis + Mostletnal ofall skin cancer + Can oceur anywhere in the body v~ Reduce anxiety Y Monitoring & managing potential complications —» Metastasis, ¥__ Relieve pain & discomfort ¥ spinal cord tumor ‘rongeaby:3186 7/22/20 ¥YExert pressurein the spinal cord & cause localized or shooting pain & weakness and loss of reflex which can lead to loss of sensation & paralysis ¥ Manage pain Monitoring and managing complications 10. WILM’S TUMOR (Neprhoblastoma) © Tumor of the kidney primarily occurring in infants & children. Embryonic origin trom mesoderm. Large, rapidly growing lesions wie may reach considerable Size before they are detected. Sasx: + Abdominal mass wie may be accompanied by abdominal enlargement. Fever Malaise Nausea & vomiting 11.CERVICAL CANCER Sexual behavior First intercourse atan early age ‘Multiple sexual parnners ‘Sexual partner who has had muliple sexual partner 12, HEAD AND NECK CANCER 2 More common among males Alcohol and tobacco use Poor oral hygiene ‘Long term sun exposure Occipational exposures ~asbestos, tar, nickel, textile, wood or leather work, and machine tool experience 13.Cancer of the Lung (Bronchogenic Carcinoma) © a malignant tumor arising from the bronchial epithelium, © [ow survival rate because of spread to regional ymphaties by the time of diagnosis. Four major cell types of lung cancer 1. epidermoid (squamous cell) carcinoma 2. small-cell (oat-cell) carcinoma 3, adenocarcinoma 4. large-cell (undifferentiated) carcinoma. Prognosis ‘Y epidermoid and adenocarcinomas —+ favorable for Y undifferentiated small-cell (oat-cell) tumors — poor tor Risk factors ‘tobacco smoke secondhand smoke airpollution ‘occupational exposure radon Vitamin & deticiency Genetic predisposition ther underlying respiratory disease like COPD and tuberculosis. Clinical Manifestations 1, Begins insidiously over several decades and often is asymptomatic untl ate in its course 2. Signs and symptoms depend on locaton, wmor size, degree of obstruction, and existence of metastases. 3. Most frequent symptom is cough, hacking, non productive, later progresses to producing thick purtlent sputum. 9 BON AY. 10-11% San Beda College - College of Nursing ONCOLOGY NURSING 4, Wheezing occurs when the bronchus becomes partially ‘obsttucted; expectoration of blood-tnged sputum is, common in the morning, A recutring fever may existin some patients. Pain isa late symptoms; often related to bone metastasis ‘Chest pain, tightness, hoarseness, dysphagia, head and neck edema, and symptoms of pleural or pericardial infusion exist ne tumor spreads to adjacent swuctures and lymph nodes, 8. Common sites of metastases are lymph nodes, bone, brail contvalateral lung, and adrenal glands, 8. Weakness, anorexia, weight loss, and anemia appear late Diagnostic Evaluation 1. Chest films, sputum exam, bronchoscopy, fluorescent bronchofibroscopy, and injected hematoporphytin. 2. Various CT scan and magnetic resonance imaging (MRD. lve of management to provide the maximum likelihood of cure. treatment depends on cell ype, stage of the disease, and physiologic staus. treatment may involve surgery, radiation therapy, chemotherapy, and immunotherapy used separately rin combination. Monitor and Manage Potential Complications 1. Surgery; respiratory allure 2) Radiation; diminished cardiopulmonary function 3, Chemotherapy; pulmonary toxicity, leukemia; pneumonitis (when chemotherapy and radiation are combined.) Nursing Interventions ‘= Maintain airway patency; remove secretions + Encourage deep breathing, aerosol therapy, oxygen therapy; mectanical ventilation may be necessary. ‘+ Assess psychological aspects and assist patient to cope. 14.Cancer of the Oral Cavity © oceurin any partof the mouth or throat highly curable f discovered early. associated wih use of alcohol and tobacco. Risk factors ‘Age (over 60), Increasing in person under age 30, used of smokeless topacco chronic ration ay a warm pipe stem prolonged exposure to sun and wind. Clinical Manifestations 1. Most common complaint; painiess sore/mass that will not heal. 2. Typical esion is a painful indurated ulcer with raised edges, 8, “As the cancer progresses patient may complain of tenderness; difficulty in chewing, swallowing, and speaking; coughing of blood-tinged sputum or enlarged cervical Iymph nodes. Diagnostic Evaluation 1, Oral exam 2. Assessmentof lymph nodes 3. Biopsies on suspiciouslesions (not healed within 2 weeks) ‘Management 1. Lip cancer; small lesions are excised liberally; larger lesions may be treated by radiation therapy. 2, Tongue cancer: teated aggressively, recurrence rate is, high. 3, Radical neck dissection for metastases of oral cancer to lymphatic channel in the neck region, Nursing Process Assessment 1. Assess patient's history to determine teaching and Teaming needs and symptoms requiring medical evaluation © oral and dental hygiene © alcohol and tobacco use ‘rongeaby:3186 7/22/20 © use of smokeless, chewing tobacco © lesions or inated areas in the mouth, Tongue, or throat © recent history of sore throat or bloody sputum © discomfort caused by certain foods, 2. Perform physical exam + inspectand palpate internal and external structures of the mouth and throat. + examine for moisture, color, texture, symmetry, and ~ presence of lesions * examine neck for enlarged lymph nodes. Major Nursing Diagnosis 1. Altered oral mucous membrane related to pathologic Condition, infection, or chemicalmechanical trauma (medications, l-fiting dentures) 2. Altered nubition, less than body requirements, related to Inability to ingest adequate nuients secondary to oraliiental conditions, 2. Body image disturbance related to a physical change in appearance resulting from a disease condition or its treatment, 4, Pain related to oral lesion or veatment. 5. Impaired verbal communication related to veatment 6. Risk for infection related to disease or treatment 7. Knowledge deticit about disease process and teatment plan. Planning and implementation ‘¥ Improvement in the condition of the oral mucous ‘membrane. ¥-_ improvement in nutritional intake, ¥_attainmentof a posive self-image ¥ _atlainmentof comfort alternative communication methods ¥ nointecton ‘Nursing interventions Promoting mouth care = Identify patients at risk for oral complications and assist with methods to decrease complications. ‘© Instruct the patient in importance and techniques of preventive mouth care lke using soft toothbrush, floss, oF ligating solution, ‘Combating Xerostomia (dryness of mouth) ‘+ Advise to avoid dry, bulky, and initating foods and fluids, aswell as alcohol and tobacco. + Encourage to increase fluids; use a humidifier during sleep. ‘+ Use synthetic saliva if helpful Relieving Stomatitis or Mucositis, ‘Start prophylacticmouth care as soon as chemotherapy or radiation therapy begins. (venzydamine hydrochloride rinse.) Assuring Adequate Food and Fluid intake + Perform dietary assessment and recommend changes in consistency of foods and frequency of eating based on disease condition and patient preferences, + Help azain and maintain desirable body weight and level of energy; promote the healing of tissue. ‘Supporting a Positive Self-Image + Encourage to verbalize perceived change in body appearance; realistically discuss actual changes orlasses, ‘+ Offer supportwnile verbalizing tears and negative feelings (withdrawal, depression, anger). ‘+ Reinforce strengths, achievements, and positive attributes. + Be alert to signs of grieving and record emotional changes, Minimizing Discomfort and Pain 10 BON AY. 10:11% San Beda College - College of Nursing ONCOLOGY NURSING Provide patient with an analgesic lke viscious lidocaine ‘Avoid foods that are spicy, hot, or hard. Promoting Etfective Communication Assess patient's ability to communicate in writing preoperauvely + Provide @ magic slate or pen and paper to communicate postoperatively. + Provide a communication board if unable to write; involve ‘a speech therapist postoperatively. Promoting Infection Gontrot + Evaluate laboratory results frequently; check temperature every 6-8 hours for elevation that may indicate infection. ‘+ Prohibit visitors who may tansmit micro-organism + Avoid trauma to sensitve skin tssues; use strict aseptic technique when changing dressing. © Report signs of wound infecton; use antibioues prophylactically Care inthe Home and Community + Prepare an individualized plan of care. + Determine what equipment s needed, + Give consideration to humidification and aeration of patient's room and measures to control odors. + Instuct patient and family in use of enteral or parenteral feedings + Provide information regarding signs of obstruction, hemorthage, infection, depression, and withdrawal to caregivers ‘© Instct in the importance of follow-up visits to determine progression or regression, and to receive directions about ‘modifications or general care. 15.Cancer of Ovary ‘© peak incidence isin the 5° decade 4° most prevalent cause of cancer death in women. © oral contraceptives provide a protective effect. Serous adenocareinama Is te most requent ype of tumor Risk factors High-fataiet smoking, alcohol Use of talcum powder history of breast, colon, or endometvial cancer family history of breast or ovarian cancer Nullipanty, interuity, and anovulation Clinical Manifestations regular menses, increasing premenstrual tension, menorrhagia with breast tenderness, early menopause, abdominal discomfort, dyspepsia, pelvic pressure, and urinary frequency. 2. Flatulence, fullness after a light meal, and increasing ‘abdominal gith are significant symptoms. Diagnostic Evaluation > Any enlarged ovary must be investigated > pelvic examination will not detect early ovarian Management Surgical removal isthe treatmentof choice, Preoperative work-up can include barium enema, proctosigmoidoscopy, upper GI series, chest radiograph, and IVP. ¥ Staging of the wmor is done to direct weament accordingly ¥- Total abdominal hysterectomy with-bllateral salpingo- ophorectomy and amentectomy for early disease, Radiation therapy and intraperitoneal isotopes. Hormanal regulation with tamoxifen. Chemotherapy isthe mostcommon form of treatment tor advanced disease (cisplatin, Taxol) Internal (intracavitary) radiation, Immunotherapy Invacavity brachytherapy SAS KK ‘rongeaby:3186 7/22/20 ‘Nursing Management 1. Nursing measures include treatment related to surgery, radiation, chemotherapy, and palliaton. 2. Emotional support provided by giving comfort measures, showing atlentiveness and caring, Allow patients 10 express feeling about condition and death 16. Cancer of the Pancreas © 4" leading cause of cancer death In US. © occur most frequent in the 6 and 7% decades of ite, Risk factors include: "exposure 10 industial chemicals or toxin in the environment + ahigh-fataiet * cigarette smoking + person with hereditary pancreatitis, diabetes mellitus, land chronic pancreatitis. + lowest 5- year survival rate of 60 cancer sites surveyed, Clinical Manifestations T. Weight loss, abdominal pain, and jaundice are the classic signs and may develop only when the disease is far advanced. 2. Rapid, prolonged, and progressive weightloss. 3. Vague upper or midabdominal pain or discomfort unrelated ‘o any gastointestinal Tunction; radiates as a boring pain in the midback; is mare severe at night, formation bf ascites is common. 4 Onset of symptoms of insulin deficiency; glucosuria, hyperalycemia, and abnormal glucose tolerance: diabetes may be an early sigh of carcinoma, Diagnostic Evaluation > Endoscople retrograde cholanglopancreatography (ERCP). Management ¥- Surgical procedure is extensive to remove resectable localized tumors. ¥Treatmentis usually limited to palliatve measures. Y Radiatan and chemoterapy may be used: Intraoperative radiation therapy (IORT) is used for relief of pain. ‘Nursing Interventions ¥ Provide pain management and attention to nutition. Y Provide skin eare and measures to relieve pain and discomfort associated with jaundice, anorexia, and profound weight loss, ¥ Consider patient- controlled analgesia (PCA) for severe escalating pain. 17.Bone Tumors ‘Neoplasms of the musculoskeletal system. Types of Bone Tumors © Slow growing and well circumscribed, present few symptoms, and nota cause of death. ‘© Benign primary neoplasm of the musculoskeletal system include osteochondroma, enchondroma, ostoid osteoma, bone cys, rhabdomyoma, and fibroma, © Benign tumors of the soft issue are more common than malignant tumors. © Bone cyst are expanding lesions within the bone (aneurysmal and unicamera) © Osteochondromaisthe most common benign bone tumor. © Enchondromaisacommon tumorot the hyaline cartlage © Ostoid osteoma is a painful tumor that occurs in children and young adults, © Osteociastoma (giant cell tumors) are benign for long Periods, but may invade local tssue and cause destruction; may undergo malignant ranstormation and metastasize. Malignant Bone Tumors a BON AY. 10:11% San Beda College - College of Nursing ONCOLOGY NURSING © Primary malignant musculoskeletal tumors are relatively rare andatise trom connective and supporive tissue cells, (sarcomas) or bone marrow elements (myelomas). Soft {issue sarcomas include liposarcoma, fibrosarcoma, and thabdomyosarcoma, Metastasis to the lungs is common, © Osteogenic sarcoma © most commen and often fatal (early hematogenous ‘metastasis to the lungs) © appears most requentlyin males between 10 to 25 years. © manifested by pain, swelling, limitation of motion, and weight loss, © bony mass may be palpable, tender, and fixed, © common sites are distal femur, proximal bia, and proximal humerus. Metastatic Bone Cancer (Secondary Bone Tumor) ‘Tumors that metastasize to the bone are: 1. Carcinoma of the kidney - "prostate . lung s+ * breast Clinical Manifestations ‘© Asymptomatic or pain ( mildioccasional to constanvsevere) © Varying degrees of disablliy; and at imes obvious bone growth © Weight loss, malaise, and fever may be present. Diagnostic Evaluation ¥ May be diagnosed incidentally after pathologic fracture ¥ Computenzed tomography, bone scans, magnetic resonance imaging, arteriography, and x-ray. ¥ Biochemical assays of the blood and urine (alkaline phosphatase frequently elevated with osteogenic sarcoma; serum acid phosphatase elevated with ‘metastatic carcinoma of the prostate; hypercalcemia present with breast. lung, and kidney cancer bone metastasis. ¥ Surgical biopsy for histologic identification; staging is based on tumor size, grade, location, and metastasis. Management Goal of treatment >To destioy o remove the tumor ‘Treatment modalities 1, Surgical excision (ranging trom local incision to amputation) Disarticulation Radiation Chemotherapy F Softtissile sarcomas treated with radiation, jimb- sparing excision, and adjuvant chemotherapy. > Metastatic bone cancer treatment is palliaive, and therapeutic goal isto relieve pain and discomfort as ‘much as possible > intemal fixaton of pathologic fractures minimizes associated disability and pain. Nursing Process Assessment 1. Encourage patient to discuss problem and course of symptoms. 2, Palpate mass gently on physical examination. 3. Assess neurovascular status and range of motion of extremity 4, Evaluate mobility and ability t pertorm actvities of daily ving, ‘Major Nursing Diagnosis 1. Knowiedge defiett about the disease process and the therapeute regimen, 2, Pain related to pathologie process and surgery. 3, Risk for injury: pathologic fracture related to tumor, 4, Ineffective coping elated o fear of the unknown, perception of disease process, and inadequate support system. ‘rongeaby:3186 7/22/20 5. Disturbance in self-esteem related to loss of body part or alteration in role performance Collaborative Problems 1. Delayed wound healing 2. Nutibonal deficiency 2. Infection Planning and implementation Major goals. © knowledge of the disease process and treatment regimen, * Conttol of pain + Absence of pathologic fractures + Effective patterns of coping © Improved seli-esteem * Absence of complication. Interventions: Preoperative 1. Explain dlagnoste test, treatments and expected resus 2. Reinforce and clarity information provided by the physician. 2, Encourage independence and function as long as possible. Interventions: Postoperative 1. Monitor vital signs: assess blood loss and development ot complications (DVT, pulmonary emboli, infection, contracture, and disuse atrophy. 2. Elevate operative part’ to control swelling; assess neurovascular Status of extremity, immobilize the area by splints, casts, or elastic bandages untl the bone heals. Controlling Pain © Use psychologic and pharmacologic “management techniques. © Work With patient to design the most effective pain management © Prepare patient and give support during painful procedures, Preventing Pathologic Fracture ‘© Support affected bones and handle gently during nursing cate. Use external supports (splints) for additional protection Follow prescribed weight-bearing restrictions, Teach how to use ambulatory devices safely and how to stengthen unaffected extremities. oping Effectively 5 Encourage patient and family 10 verbalize feelings honesty. © Support and accept them as they deal with the impact of the malignant bone tumor. 2 Expectfeelings of shock, despair, and griet. > Refer to health professionals for specific psychological help. Improving Selt-Esteem Support family in worklng through adjustments that must be! made, revognize changes in body Image due 1 surgery and possible amputation, © Provide realise reassurance about te tuure ane resumption of role-elaled aclvves; encourage se-care and socialization © volvepatent and family thoughout geatmentto promote sense of being in contol of one's if , ‘© Minimize pressure on wound site © promote circulation. © Promote healing with an aseptic, nontraumatic wound ‘dressing © Monitor and report laboratory findings to taciltate teament, ‘© Reposition patient frequently to prevent skin breakdown, R BON AY. 1011