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CANCER NURSING CANCER

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Refers to a disease whereby cells mutate into abnormal cells that proliferate abnormally NEOPLASIA - refers to an abnormal cell growth or tumor is a mass of new tissue functioning independently & serving no useful purpose PATHOGENESIS OF CANCER

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CELLULAR TRANSFORMATION & DERANGEMENT THEORY = Conceptualizes that normal cells may be transformed into cancer cells due to exposure to some etiological agents

FAILURE OF THE IMMUNE RESPONSE THEORY = Advocates that all individuals possess cancer cells. However, the cancer cells are recognized by the immune response system. So, the cancer cells undergo destruction. Failure of the immune response system leads to inability to destroy the cancer cells ETIOLOGICAL FACTORS 1.VIRUSES = oncogenic viruses = maybe one of the multiple agents acting to initiate carcinogenesis = prolonged or frequent viral infections may cause breakdown of the immune system or overwhelm the immune system 2. CHEMICAL CARCINOGENS = acts by causing cell mutation or alteration in cell enzymes & proteins which leads to cell replication a. Industrial compounds * Vinyl chloride like plastic manufacture, asbestos factories, construction works * Polycyclic aromatic hydrocarbons like refuse burning, auto & truck emissions, oil refineries, air pollution * Fertilizers, weed killers * Dyes like Analine dyes ( beauty shops & home use) and Hair Bleach * Drugs like Tobacco(tar nicotine), alcohol and Cytotoxic drugs like MELPHALAN * Hormones like estrogen and diethylstilbestrol(DES) * Foods preservatives like: 1. Nitrites like bacon, smoked meat 2. Talc like polished rice, salami, chewing gum 3. Food sweeteners 4. Nitrosomines(rubber baby nipples) 5. Aflatoxins (mold in nuts & grains, milk, cheese, peanut butter) 6. Polycylic hydrocarbons (charcoal broiling) b. Physical Agents 1. Radiation = from X-rays or radioactive isotopes = from sunlight/ultraviolet rays 2. Physical irritation/trauma = pipe smoking = multiple deliveries = jagged tooth, irritation of the tongue, overuse of any organ/body parts c. Hormones = ex.: estrogen as replacement therapy increases incidence of vaginal & cervical adenocarcinoma d. Genetics = Oncogene (hidden/repressed genetic code for cancer that exists in all individuals) ———>when exposed to carcinogenes—>changes in cell structure—>becomes MALIGNANT = Regardless of cause, several CA are associated with familial patterns like retiniblastoma, pheochromocytoma, Wilm’s tumor, lung CA, breast CA

 CANCER CAN BE: a. BENIGN NEOPLASMS - are slow growing, localized, & encapsulated non-malignant growths with well-defined borders b. MALIGNANT NEOPLASM - are aggressive growths that invade & destroy surrounding tissues; can lead to DEATH unless interventions are taken *METASTASIS - occurs when malignant cells travel through the blood or lymph system & invade other tissues & organs to form a secondary tumor.
COMPARISON OF CHARACTERISTICS OF BENIGN & MALIGNANT NEOPLASM PATHOPHYSIOLOGY BASIS OF MALIGNANT NEOPLASM Predisposing factors/ Etiologic Factors I CELLULAR ABERRATIONS

CA cell proliferation disrupt normal cell Growth & interfere with tissue function Pressure-Obstruction Pain-Effusion-Ulceration Vascular thrombosisEmbolus-Thrombophlebitis

I________________________I_________________________I Malignant cells Anorexia & produce enzymes Cachexia hormones & other Syndrome substances Tissue wasting (paraneoplastic Syndrome) Severe wt loss Anemia Severe debilitation Hypercalcemia Edema-DIC

 3 STAGES OF METASTATIC PROCESS: 1. INVASION - neoplastic cells from primary tumor invade into surrounding tissue with penetration of blood or lymph; this occurs because cells are not encapsulated 2. SPREAD - tumors cells spread through lymph or circulation or by direct expansion 3. ESTABLISHMENT & GROWTH - at secondary site: in lymph nodes & in organ from venous circulation
INCIDENCE 1. Cancer affects every age group, though most cancer & cancer deaths occur in people older than 65 years of age 2. Highest incidence of all cancer is PROSTATE CANCER 3. Highest cancer incidence in males in order of frequency--prostate cancer, lung cancer, & colorectal cancer 4. Highest cancer incidence in females in order of frequency---breast cancer, lung cancer, & colorectal cancer RISK FACTORS FOR THE DEVELOPMENT OF CANCER 1. AGE - increased risk for people over age of 65 due to longer exposure to carcinogens 2. GENDER - certain cancers are more commonly seen in specific genders 3. GEOGRAPHIC LOCATION - risks for cancer vary according to environment & location due greater exposure 4. GENETICS - 15% of cancers may be attributed to a hereditary components -cancers demonstrating a familial relationship include breast, colon, lung, ovarian, & prostate 5. IMMUNE DISTURBANCE - some viral infections tend to increase risk - infections associated with cancer include Epstein-Barr, Genital Herpes, Papillomavirus, Hepatitis B, & Human cytomegalovirus 6. CHEMICAL AGENTS - over 1000 chemicals are known to be carcinogenic 7. RACE - can affect any population 8. TOBACCO - a strong correlation between smoking & lung cancer exists. - other cancers associated with tobacco use include bladder, esophageal, gastric, laryngeal, oropharyngeal & pancreatic - smokeless tobacco increases the risk of oral & esophageal cancers - long term exposure to secondhand smoke increases the risk for lung & bladder cancers 10. ALCOHOL - serves as promoter in cancers of the liver & esophagus - when combined with tobacco, the risk for other are even higher 11. DIET - diet high in fat, low in fiber, & those containing nitrosamines & nitrosindoles found in preserved meats, & pickled foods promote certain such as colon, breast, esophageal 12. Occupation - like chemical factory workers, farmers, radiology dept personnel 13. HEREDITY - greater risk with positive family history 14. STRESS - due to depression, grief, anger, aggression, despair or life stresses decrease immunocompetence (affects hypothalamus & pituary gland 15. OBESITY - studies have linked obesity to breast and colorectal CA 16 PRECANCEROUS LESSIONS - burn scars, senile keratosis, benign poyps

BASIC = annual physical examination & blood exam CANCER DETECTION EXAMINATIONS 1. prompt intervention may halt the cancerous process in some cases CANCER PREVENTION 1. human chorionic gonadotropin (HCG) c. Retard tumor growth 2.a type of surgery that attempts to relieve the complications of cancer 2. BREAST = Monthly BSE(breast self-examination) from age 20 4. Monoclonal Antibiotics 11.involves detection & case-finding efforts to achieve early diagnosis a. prostatic specific antigen (PSA) d. after detection.is done by 1. COLON = digital rectal examination for persons over age 40 6. . Antigen Skin Test 9. carcinoembryonic antigen (CEA) CANCER MANAGEMENT 1. cancer prevention focuses on reducing modifiable risk factors in the external & internal environment that increase a person’s susceptibility to cancer development b. SECONDARY PREVENTION .used as localized treatment for solid tumors approximately 50% of cancer clients receive radiation therapy.PREVENTION & DETECTION 1. the most commonly treatment modality for CA a. general factors that influence cancer incidence & mortality 2. DIAGNOSTIC SURGERY . colorectal polyps b.. recognizing early & symptoms & seeking prompt treatment can significantly reduce morbidity & mortality of several types of cancer b.involves directing high-energy ionizing radiation to destroy malignant tumor cells without harming surrounding tissues a. CURATIVE SURGERY . RECONSTRUCTIVE SURGERY . Radiologic Exams (X-RAYS) 6. PALLATIVE SURGERY. CURATIVE RADIATION THERAPY .PRIMARY PREVENTION a.used as an adjunct to other therapy with the goal of prolonged & improved survival without disease eradication c. Radiodiagnostic Techniques (use of radioisotopes) 7. Nuclear Magnetic Resonance Imaging(MRI) 5. PREVENTIVE or PROPHYLACTIC SURGERY . alpha-feto-protein b.most widely used CA treatment. Endoscopic Examination 10. c. CONTROL RADIATION THERAPY . SKIN = avoid overexposure to sunlight 2.done to confirm or rule out malignancy from analysis of tissue samples obtained from incisional. Laboratory Tests a. PALLIATIVE RADIATION THERAPY . Computerized Axial Tomography (CT scan) 8. ORAL = annual oral examination 3. Decrease tumor size 3. Relieve distressing manifestations of cancer when cure is no longer possible . LUNGS = avoid cigarette smoking. UTERUS = annual Pap’s smear from age 40 7.aims to improve the quality of life by restoring maximal function & appearance e. annual chest X-ray 5. Biopsy 3. Cytologic Examination or papanicolaou test (PAP SMEAR) Class I Normal Class II Inflammation Class III Mild to moderate dysplasia Class IV Probably malignant Class V Malignant 2.aims to eradicate all disease & give the client the same life expectancy as a person who never had cancer b. excisional or needle biopsy. RADIATION THERAPY . is localized intervention at removing all tumor tissue while limiting structural & functional impairment d.involves removing precancerous lesions like unusual skin growth. Ultrasound 4. SURGERY .is the surgical removal of tumors.

immunotherapy aims to challenge & induce mobilization of immune defenses 6. N1b. FOR DETECTION OF BREAST CANCER * beginning at age 20.is given to relieve or diminish distressing symptoms such as pain. SALVAGE THERAPY . N2a indicate regional nodes involved with increasing degree from N 1a to N 2a.used in advanced CA to relieve symptoms of metastatic disease like pain. pleural effusion 4. CURATIVE THERAPY .obstruction. complete marrow recovery within 6-8wks. .involves administering antineoplastic drugs to promote tumor cell death by interfering with cellular functions & reproduction a. proliferation of donor cells in marrow leading to release of functional blood cells into circulation 5.treats the disease by transfer of genetics material into DNA of the client’s cells. FOR DETECTION OF UTERINE CA * yearly PAP smear for sexually active females & any female over age 18 * at menopause. T1. TUMOR MARKERS . altering the cells using a vector containing the desired gene.T4 indicate progressive degrees of tumor size & involvement N indicates lymph node involvement 1. Tis indicate tumor is situ 3. CONTROL THERAPY . M1. Through administration of chemical or microbial agents.T3. bleeding 3. GENE THERAPY . have yearly digital rectal examination and prostate-specific antigen test STAGING & GRADING OF NEOPLASIA A. M2. B.2nd attempt at curative intervention when disease recurs.the objective of bone marrow transplant is to cure. CHEMOTHERAPY . The TNM tumor system is utilized for classifying tumors: T indicates the tumor are 1.. PALLIATIVE TREATMENT .uses the body’s own immune mechanisms to combat & overcome the CA. no metastasis detected 3.T2. IMMUNOTHERAPY . N 3b indicate regionally lymph nodes involvement with increasing degree from N1b to N 3b. c. BONE MARROW PERIPHERAL STEM CELL TRANSPLANTATION .involves early aggressive treatment aimed at eradicating disease b. BIOLOGIC RESPONSE MODIFIERS (BRMs) - involves agents or treatment methods that have the ability to alter the immunologic relationship between tumor & host in a therapeutically beneficial way. high risk women should have an endometrial tissue sample 4. culturing the cells in a specific medium. N 2b. M0 indicates no evidence of distance metastasis 2. metastasis suspected 4. N 0 indicates no abnormal lymph nodes detected 2. Nx indicates inability to assess regional nodes M indicates distant metastasis 1. FOR DETECTION OF PROSTATE CA * beginning at age 50.aims to cause or sustain tumor regression & diminish symptoms to extend & improve the quality of life when cure is no longer possible d. STAGING a. & reintroduce the cells into the client.are protein substances found in the blood of body fluids . FOR DETECTION OF COLON & RECTAL CANCER * age 50 & older have a yearly fecal occult blood test * digital rectal examination & flexible sigmoidoscopy should be done every 5 yrs * colonoscopy with Barium enema should be dpne 3. N1a. T 0 indicates no evidence of tumor 2. obstruction. M3 indicates ascending degrees of distant metastasis and includes distant lymph nodes. which involves removal of cells. routinely perform monthly breast self-examination * women age 40 & older should have a yearly mammogram & breast examination 2. The objective is the destruction or cessation of malignant growth 7.used as adjunctive therapy RECOMMENDATIONS OF THE AMERICAN CANCER SOCIETY FOR EARLY CANCER DETECTION 1.

SKIN REACTION = erythema.TUMOR MARKERS . Include cruciferous vegetables in the diet . relieve obstruction.present in large quantities in the human body. whole grain cereals 4. or decrease pain Can destroy rapidly multiplying cancer cells Includes the use of external beam and radiation implants SOURCES OF RADIATION THERAPY 1.are derived from tumor itself which includes the following 1. 2. Avoid obesity 2. Include foods rich in Vitamin A & C in daily diet 5. keep area dry c. EXTERNAL RADIATION THERAPY (TELETHERAPY) = administered through an X-ray machine 2. ISOENYMES . incisional biopsy. Histologic & cytologic examination of specimens are performed by pathologist on tissue collected by needle aspiration of solid tumors and aspiration of fluid blood or body cavities 2. cauliflower. high levels of hormones indicate a hormone secreting malignancy 3. no soap & pat dry d. cabbage. dry/ moist desquamation = atrophy. HORMONES . Be moderate in the consumption of alcohol beverages 7. may indicate an anaplastic process in tumor cells. INTERNAL RADIATION THERAPY (BRACHYTHERAPY) = administered within or near the tumor TYPES OF RADIATION THERAPY 1.present normally in fetal tissue. do not apply ointments. vegetables. 2.present in a particular tissue may be released into the bloodstream BIOPSY/CYTOLOGY 1.broccoli.powder or lotion on the area . and needle biopsy DIETARY RECOMMENDATIONS AGAINST CANCER 1. ONCOFETAL ANTIGENS .raw fruits. Sealed Source or Brachytherapy Unsealed Source like oral. observe for early signs of skin reaction & report b. reduce the tumor size. wash area with water. Be moderate in the consumption of salt . Cut down on total fat intake 3. depigmentation. brussel sprouts 6. necrotic/ ulcerative lesions NURSING RESPONSIBILITIES a. Eat more high fiber foods .cured. smoked-cured & nitrate-cured foods 7 WARNING SIGNS OF CA Change in bowel or bladder habits A sore that does not heal Unusual bleeding or discharge Thickening or lump in breast or elsewhere Indigestion or difficulty in swallowing Obvious change in wart or mole Nagging cough or hoarseness Common Nursing Techniques & Procedures RADIATION THERAPY used to kill a tumor. Tissues may be obtained by excisional biopsy. IV SIDE EFFECTS OF RADIATION THERAPY 1.

These serve as a guide for areas of irradiation. do not apply heat. INFECTION = due to bone marrow suppression NURSING RESPONSIBILITIES a.e. teach signs of infection to report to physician 3. do not erase markings on the skin. avoid direct sunshine or cold f. 2. good personal hygiene. monitor blood counts weekly b. nutrition. adequate rest c. use soft cotton fabrics for clothing g. HEMORRHAGE = platelets are vulnerable to radiation .

a total of 30 minutes per shift 2. double-flush toilets after use 7. bland diet. maintain on bed rest to avoid dislodging the implant 6.consider the distance. FATIGUE = result of high metabolic demands for tissue repair & toxic waste removal = plenty of rest & good nutrition 5. allowing for extra rest periods 3. Maintain fluid intake to ensure adequate hydration(2-3liters/day) 5. Introduced through a catheter into the tumor SIDE EFFECTS OF INTERNAL RADIATION 1. Fatigue Anorexia Immunosuppresion CLIENT EDUCATION FOR INTERNAL RADIATION 1. WEIGHT LOSS = anorexia. If implant is temporary. monitor stool & skin for signs of hemorrhage e. NAUSEA & VOMITING 9. HAIR LOSS/ ALOPECIA 11.NURSING RESPONSIBILITIES a. SOCIAL ISOLATION INTERNAL RADIATION SOURCES OF INTERNAL RADIATION 1. TIME . Ingested as a solution 3.minimized time spent in close proximity to radiation sources . Maintain daily activities unless contraindicated.maintain the maximum distance possible from radiation source at .CYSTITIS 12. pain. monitor platelet count b. 2. HEADACHE 10. no smoking/alcohol c. Implanted into affected tissue or body cavity 2. use direct pressure over injection sites until bleeding stops 4. Avoid close contact with others until treatment is completed. avoid physical trauma or use of aspirin c. & effect of CA 6.limit contact time to 5 minutes each time. DIARRHEA 8. Injected as a solution into the bloodstream or body cavity 4. Other side effects specific to chemotherapeutic agent NURSING MANAGEMENT OF INTERNAL RADIATION 1. teach signs of hemorrhage d. sugarless lemon drops or mint to increase salivation 7. Excreted body fluids may be radioactive. 2. DISTANCE . good oral hygiene/saline rinses every 2 hours d. administer analgesics before meals b. Maintain balanced diet 4. 3. time and shielding PRINCIPLES OF RADIATION PROTECTION 1. STOMATITIS = ulcerations of oral mucous membrane NURSING INTERVENTIONS a. Exposure to small amounts of radiation is possible during close contact with person receiving internal radiation .

Tissue damage to target area Ulcerations of oral mucous membranes Gastrointestinal effects such as nausea. 5. The technologist will be right outside your room observing you through a window or by a closed--circuit TV. or scarf to cover & protect head TEACHING GUIDELINES REGARDING RADIATION THERAPY 1. You may resume normal activities of daily living. Ensure proper handling of bed linens & clothing If dislodged implant. 6. 7. diet. 5. 3. 4. Each treatment usually lasts for few minutes. c. SHIELDING . The Oncologist marks specific locations for radiation treatment using semi permanent type of ink Usually given 15-30mins per day. when going outdoors. b. use sun-blocking agents with sun protection factor (SPF) of at least 15 Maintain proper rest. deodorants. scratching or scrubbing the treatment site. & the machine may move during the therapy. Safety precautions are necessary only during the time you are actually receiving irradiation. 7. and fluid intake as essential to promoting health & repair of normal tissues Hair loss may occur. You may hear sounds of the machine being operated. It is painless.use lead shields & other precautions during contact with client 2. 3. CHEMOTHERAPY Involves the administration of cytotoxic medications & chemicals to promote tumor cells death OBJECTIVES a. As a safety precaution for the therapy personnel. 6. Wash the marked area of the skin with plain water only & pat skin dry Do not use soaps. 2. hat. you will remain alone in the treatment room while the machine is in operation. 4. 5. assuring the containers are marked appropriately. topical. lotions. to destroy all malignant tumor cells without excessive destruction of normal cells to control tumor growth if cure is no longer possible Used as adjuvant therapy ADMINISTERED BY Intravenous route is the most preferred for administering chemotherapeutic agents Oral.least 3 feet 3. for 2-7 weeks The client does not pose a risk radiation exposure to other people SIDE EFFECTS OF EXTERNAL RADIATION THERAPY 1. & diarrhea Radiation pneumonia Fatigue Alopecia Immunosuppression CLIENT EDUCATION FOR EXTERNAL RADIATION 1. Avoid rubbing. Lie very still on a special table while the intervention is being given & you may be placed in a special position to maximize tumor irradiation. vomiting. use long-handled forceps & place the implant into a lead container. 7. intra-arterial. perfumes. powders or medications on the site during the duration of the treatment. 4. choose a wig. intrathecal. 2. if shaving use electric razor Wear soft. 5. days per week. NEVER directly touch the implant Do not allow pregnant women to come into any contact with radiation EXTERNAL RADIATION THERAPY 1. 3. Place client in private room Instruct visitors to maintain at least a distance of 6 ft from the client & limit visits to 10-30 mins Ensure proper handling & disposal of body fluids. intracavity & intravesical routes CONTRAINDICATIONS OF CHEMOTHERAPY . There is no residual radioactivity after radiation therapy. 6. 3. 2. 6. You may communicate. loose-fitting clothing over the treatment area Protect skin from sun exposure during the treatment & for at least 1 year after the treatment is completed. 2. 4.

inhibiting cell division b. “puncture-proof” Dispose half . diethylstilbesteroL (DES) b. Antimetabolites . 4. 13. bleomycin (blenoxane) b.disrupts or inhibit DNA or RNA synthesis a. methotrexate 3. vinca alkaloids are phase-specific. 3. RECENT RADIATION THERAPY = also immunosuppressive 5.are phase-specific (GI) an act by interfering with RNA synthesis a. 8. 2. mecholorethamine (mustargen) 2. The WBC levels must be within normal limits. 6. IV bottles by putting into plastic bag.inoculation by needle stab Clearly label the hanging IV bottle with ANTINEOPLASTIC CHEMOTHERAPY Contaminated needles & syringes must be disposed in a clearly marked special container “leak-proof”. Wipe external surface of syringes & IV bottles Avoid self-. 10. BONE MARROW DEPRESSION = the drugs may aggravate the condition. Alkylating agents .empty ampules. seal & then into another plastic bag or box.may be cell-cycle phase-specific or non-phase-specific & interfere with DNA replication SAFE HANDLING OF CHEMOTHERAPEUTIC AGENTS 1. doxorubicin (adriamycin) 4. vincristin (oncovin) a. Eyes must be flushed immediately with copious amount of water Sterile/ alcohol --wet cotton pledgets should be used --wrapped around the neck of the ampule or vial when breaking & withdrawing the drug Expel air bubbles on wet cotton. Wear mask.1. etoposide acts during all cell-cycle phases. INFECTION = the anti-tumor drugs are immunosuppressives 2. 7. 5. CHEMOTHERAPY AGENTS ARE: 1. PREGNANCY = the drugs may cause congenital defects 6. Label as :Hazardous waste” Handwashing should be done before and after removal of gloves Trained personnel only should be involved in use of drugs Ideally. Miscellaneous agents . RECENT SURGERY = the drugs may retard healing process 3. . IMPAIRED RENAL or HEPATIC FUNCTION = the drugs are nephrotoxic & hepatotoxic 4. vials. 5-fluorouracil (5-FU) b. busulfan (myleran) c. prednisone 5. Plant alkaloids . interfering with DNA & cell division at metaphase 6. Cytotoxic antibiotics . 12. Vent vials to reduce internal pressure after mixing. cyclophophamide (cytoxan) b. 9.interfere with metabolites or nucleic acids necessary for RNA and DNA synthesis a. tamoxifen (nolvadex) c. 11. preparation of drugs should be in laminar flow conditions with filtered air. gloves & back --closing gown Skin contact with drug must be washed immediately with soap & water. Hormones & hormones antagonists . clearly marked before placing for removal.vinblastine (velban).are non-specific & act by interfering with DNA replication a.

& avoid hot & irritating foods. 2. 5. Eat small frequent low-fat meals Weigh client routinely. Decrease platelet count (thrombocytopenia) c. Alopecia 5. Gastrointestinal effects: anorexia. or the application of a warm compress Monitor closely for anaphylactic reactions then discontinue infusion Use caution when preparing. is the major complication of IV chemotherapy. the hair loss is temporary & will grow back Encourage the client to choose a wig before hair loss occurs in order to match texture & hair color Care of hair & scalp include washing hair 2 -3 times a wk with mild shampoo & do not use a blow dryer NURSING IMPLICATIONS FOR THE ADMINISTRATION OF CHEMOTHERAPY 1. Use a soft toothbrush. low. decrease WBC count (immunosuppression) b. apply lubricating & moisturizing agents to protect the mucous membranes from trauma & infection Use artificial saliva & hard candy or mints to help with dryness. which can further irritate oral mucosa Drink cool liquids. or disposing of chemotherapeutic agent.the leaking of chemotherapeutic agents into the surrounding tissue. diarrhea. 2. FLUID & ELECTROLYE BALANCE 1. Xerostomia(dry mouth) CLIENT EDUCATION FOR IMMUNOSUPPRESSION 1. 5. administering. CLIENT EDUCATION FOR MAINTAINING ADEQUATE NUTRITION. people with infections.never test vein patency with chemotherapeutic agents If extravasation occurs . G. 4. 3. monitor for weight loss NURSING MANAGEMENT OF FATIGUE 1. Stomatitis (inflammation of the mouth) and mucositosis 4. extreme care must be used Warning. 4. Assure client that fatigue is a normal response to chemotherapy & it does not indicate progression of disease NURSING MANAGEMENT OF CLIENT WITH ALOPECIA 1. 6. the application of cold compress.EFFECTS 1. 2.electrolyte losses. For shaving use electric razor only Avoid contact sports & other activities that may cause trauma If trauma does occur. 2. 2.fiber diet to relieve diarrhea . vomiting & diarrhea 3. Chemotherapy & radiation therapy may cause hair loss.SIDE EFFECTS OF CHEMOTHERAPEUTIC AGENTS 1. decrease hemoglobin & hematocrit (anemia) 2. 3. Fatigue 6.I. 3. SYSTEM = nausea. 2. Intravenous routes may be obtained by subclavian catheters. & small children WBC is low Consume a low bacteria diet.include the injection of an antidote. Bone marrow suppression a. vomiting. 7. Avoid crowds. nausea. 3. 6. NURSING INTERVENTIONS FOR CHEMOTHERAPEUTIC SIDE. apply ice to area & seek medical assistance Avoid dental work or other invasive procedure Avoid ASPIRIN & aspirin-containing products CLIENT EDUCATION FOR STOMATITIS & MUCOSITOSIS 1. Avoid smoking & alcohol. 4. 5. constipation = replace fluid . avoid undercooked meat & raw fruits & vegetables CLIENT EDUCATION FOR THROMBOCYTOPENIA 1. implanted ports or peripherally inserted catheters Extravasation . mouth swabs for acute stage Avoid mouthwashes containing alcohol Consider using PERIDEX to decrease risk of hemorrhage & protect gums from trauma For xerostomia.

= increase fluid intake & fibers in diet to prevent/ relieve constipation 2. alopecia = reassure that it is temporary = encourage to wear wigs. skin pigmentation = inform that it is temporary e. INTEGUMENTARY SYSTEM a. HEMATOPOIETIC SYSTEM a. stomatitis = provide good oral care = avoid hot & spicy food c. hats or head scarf d. thrombocytopenia = protect from trauma = avoid ASA . pruritus. neutropenia = protect from infection = avoid people with infection c. anemia = provide frequent rest periods b. nail changes = reassure that nails may grow normally after chemotherapy 3. urticaria & systemic signs = provide good skin care b.

the client is infused with own bone marrow harvested during remission of disease b. After immunosuppression. the bone marrow is transfused IV through a central line . 5. CLIENT UNDERGOING A BONE MARROW TRANSPLANT (BMT) 1. REPRODUCTIVE SYSTEM a. bleeding. Chemotherapeutic agents should not be used during pregnancy or lactation. then frozen & stored until transfusion 3. usually in conjunction with radiation or chemotherapy a. bone marrow cells. Congenital defects may occur in the fetus.neoplasm. hemorrhagic cystitis = provide 2-3 L of fluids per day b. Dronabinol (Marinol) Ondansetron (Zofran) Granisertron (Kytril) Alprazolam (Zanax) Lorazepam (Ativan) Haloperidol (Haldol) Prochlorperazine (Compazine) SUMMARY OF EFFECTS OF CHEMOTHERAPY   Antineoplastic drugs affect both normal & cancer cells by distrupting cell function & division at various points of cell cycle. The bone marrow is usually harvested from the ILIAC CRESTS. & death are major complications 4. Most cancer drugs are most effective against cells that multiply rapidly. Before receiving the BMT. 2. BMT is used in treatment of leukemias. autologous BMT . allogenic BMT . 4. premature menopause or amenorrhea = reassure that menstruation resumes after chemotherapy ANTIEMETICS TO RELIEVE NAUSEA & VOMITING RELATED TO CHEMOTHERAPY 1.4. 6. GENITO-URINARY SYSTEM a. 3. 7. urine color changes = reassure that it is harmless 5. the client must 1st undergo a phase of immumnosuppressive therapy to destroy the immune system. infection. cells in the GI tract & cells in the skin or hair follicles.the client is infused with donor marrow harvested from a healthy individual 2.   Adverse reactions to cancer drugs tend to occur in these organs.

2. firm surface = this involves use of 2 X-ray films . oral contraceptive use (prolonged use of estrogen replacement therapy Lifestyle factors that link with obesity. 5. note specially for symmetry of the breasts = in lying position. & other means of communication to reduce feelings of isolation BREAST CANCER  In unregulated growth of abnormal cells in breast tissue ETIOLOGY: Cause Unknown RISK FACTORS ASSOCIATED WITH CANCER 1. client will be hospitalized 6-8weeks Encourage contact with significant others by using telephone. Mammogram = this involves X . 3. Monitor for graft-versus-host disease Provide private room for the hospitalized client. fluroscopy PREVENTION OF BREAST CANCER 1. computer. 2. Family history of breast cancer--especially mother or sister Medical history of cancer of other breast. 4. elevate shoulders on the side examined with pillow support = palpate the breast from periphery to the center in circular motion 2. smoking. 6. 3.ray examination of the breast = the breast is supported on flat. breast trauma. ingesting more than 2 alcoholic drinks daily Expose to radiation through chest x-ray. high-fat-diet.SIDE EFFECTS OF BONE MARROW TRANSPLANT 1. Breast self examination (BSE) = start from age 20 = done after examination = during standing position. Malnutrition Infection related to immunosuppression Bleeding related to thrombocytopenia NURSING MANAGEMENT OF CLIENT UNDERGOING A BMT 1. endometrial cancer or atypical hyperplasia Menarche before age 12 or menopause after age 50 Nulliparity or birth of 1st child after age 30. high socioeconomic status. 3. 2.

bone and brain IMPLEMENTATION SURGERY 1. BREAST RECONSTRUCTION = accomplished through submuscular breast implant. 3. pectoralis major muscle & the axillary lymph nodes 4. 2. MODIFIED RADICAL MASTECTOMY = removal of the entire breast.ASSESSMENT CLINICAL MANIFESTATIONS 1. 3. lungs. 4. with axillary and neck lymph nod involvement Stage IV = Metastasis to distant organs like liver. RADICAL MASTECTOMY (Halstead Surgery) = removal of the breast. SIMPLE MASTECTOMY = removal of the complete breast but the pectoralis muscles and the nipples remain intact 3. 4. 2. Mammogram Ultrasonography Tissue biopsy MRI STAGES OF BREAST CANCER 1. 4. nonmobile mass Dimpling of breast tissue surrounding nipple Asymmetry with affected breast being higher Regional lymph nodes are swollen and tender DIAGNOSTIC /LABORATORY TESTS 1.SEGMENTED MASTECTOMY OR LYMPECTOMY/TYLECTOMY = removes the tumor and a margin of breast tissue surrounding the tumor 2. axillary lymph nodes and underlying chest wall muscles 5. Stage I = Tumor size is up to 2cm Stage II = Tumor size is up to 5 cm with axillary lymph node involvement Stage III = Tumor size is more than 5 cm. placing an implant after using a tissue expander CHEMOTHERAPY RADIATION THERAPY MEDICATION THERAPY Tamoxifen (Nolvadex) = interferes with estrogen activity for treating advanced breast cancer and CHEMOTHERAPY when axillary nodes are involved . 3. nontender. 2. Firm.

5. 9. 2. 12. 2. follow guidelines for the rest of life No blood pressure. jackson pratt POSTOPERATIVE CARE 1. Teach arm exercises to prevent lymph edema Inform about wound suction drainage like hemovac. starting IV or drawing blood on affected side Initiate exercise to prevent stiffness & contractures of shoulder girdle Reinforce special mastectomy exercises as prescribed Provide adequate analgesia to promote ambulation & exercise Encourage regular coughing & deep breathing exercises Prepare client for size & appearance of the incision & provide support Provide client with detailed information concerning breast prosthesis Fitting is not possible for 4-6 wks Temporary prosthesis or lightly padded bras worn until healing is complete 13. injections.PREOPERATIVE CARE 1. 3. prevent stiffness and contractures. and restore ROM A mild analgesic or a warm shower may be helpful prior to exercise Initial limitation of lifting (over 5 to 10 lbs) and activity . 4. Place client in semi fowler’s position with arm elevated on pillows. 11. Psychological support. Teach patient to avoid constrictive clothing clothing & report persistent edema. redness or infection Teach patient the importance of continuing monthly breast examination on remaining breast HAND AND ARM CARE        Potential for lymphedema formation after auxiliary lymph node dissection (ALND) Patient education Prevention is vital. abducted to promote venous return * edema Monitor hemovac output for serosangenous for the 1st 24 hours Check behind patient foe bleeding Post signs warning against taking blood pressure. 10. 14. 3. 6. or blood draws in the affected arm Perform exercises 3X a day for 20 minutes to increase circulation and muscle strength. 7. 13. 8.

wear wristwatch/jewelry c. work near thorny plants/dig in garden e.withdrawal of blood. pinpricks d. BP-taking = DO’s a. reach into hot oven f. burns = DON’T’s a.EXERCISES AFTER BREAST SURGERY PREVENTING COMPLICATIONS 1. carry purse/ anything heavy b. warm or hard/swollen e. apply lanolin hand cream to prevent dryness d. LYMPHEDEMA = may occur within a week due to operative trauma or several weeks later = AVOID’S a. wear loose rubber gloves when washing dishes b. insects bites f. cuts b. return for check-up g. injections. hangnails e.report if arm gets red. wear a thimble when sewing c. wear “LIFE GUARD MED AID tag: CAUTION-LYMPHEDEMA . hold a cigarette g. scratches c. pick at/cut cuticles d.

PREVENTING MUSCLE CONTRACTURES & LIMITING SHOULDER MOVEMENT a. deep breathing. cesium or radium is used. Radiation Therapy = use of external bean radiation or an intravaginary implant a. ultimately invades the vagina. b. pulling 3.2. maintain abduction & prevent dangling of the arm c. Colpostat or Ernst applicator applicator is inserted through the vagina & dilated to the uterus Foley catheter is inserted to decompress the bladder and irrigating catheter inserted into the vagina so that solution can be instilled to soothe irritated mucosa and remove necrotic tissue Lie on her back to maintain the proper position of the implant After removal of implant. cobalt. gently massage the incision with cocoa butter. c. pelvis. Hysterectomy . Sexual relations can be resumed in 7-10 days 2. suggested exercises. flexion contractures may develop if arm not exercised b. Chemotherapy 3. d. e. lifting clasped hands. irregular menstrual bleeding & menorrhagia  DIAGNOSIS = Pap Smear . wall bladder. b. Conization = removal of a cone-shaped section of the cervix for diagnosis or to move eroded or infected tissue. catheter is removed & the nurse notes the time & amount of the 1st voiding Slight vaginal bleeding is not unusual for 1-3 months. powder or cornstarch maybe used to absorb perspiration & relive itching d. PROMOTING ACCEPTING OF SELF-CONCEPT a. rectum and regional lymph nodes ASSESSMENT: = watery discharges. cold cream. petroleum jelly to make the incision soft c.survival is 100% if detected early PLANNING & IMPLEMENTATION 1. f. Surgery a. permanent breast forms cannot be worn until healing has completely occurred in about 6 weeks CANCER OF THE UTERUS  PATHOPHYSIOLOGY Tumor is invasive & unless treated in early stages.

high fat. fallopian tubes. Radiotherapy = adjuvant treatment for rectal CA PROSTATE CANCER   Most common to male Predisposing Factor 1. protein & refined cabohydrates c. history colon CA. 2.5 year survival rate GUIDELINES FOR EARLY DETECTION OF COLORECTAL CANCER 1.1. less than 5% . 50 years of age . 4.5 year survival rate Stage B . Occult blood test yearly after age 50 3. Proctosigmoidoscopy every 5 years after age 50. Age above 40 years 2. b.shaped stool = sensation of incomplete bowel emptying  DUKE’S CLASSIFICATION OF COLORECTAL CANCER 1. and ovaries 4. Digital rectal examination yearly after age 40 2. colon polyps   MOST COMMON SITE: Rectosigmoid area which is 70% ASSESSMENT 1. Radical Hysterectomy = also includes the removal of the lymph nodes COLORECTAL CANCER   CAUSE: Unknown PREDISPOSING FACTOR 1. Diet a. low fiber b. 2. Hemicolectomy for ascending & transverse colon cancer Abdomino-P erineal Resection (APR) for rectosigmoid cancer Chemotherapy = FLUROURACIL is the most effective drug for colorectal cancer 3. 3. ASCENDING RIGHT COLON CA = occult blood in stool = anemia = anorexia & weight loss = abdominal pain above umbilicus = palpable mass 2.  Stage A = confined to bowel mucosa 80% to 90% . Surgery a. following 2 negative results of yearly examination MANAGEMENT  1. DISTAL COLON/RECTAL CANCER = rectal bleeding = changed bowel status = constipation or diarrhea = pencil or ribbon . Panhysterosalphingo-Oophorectomy = is removal of uterus. Subtotal Hysterectomy = only the fundus is removed 3.invading muscle wall Stage C = lymph node involvement Stage D = metastases or locally unresectable tumor. Total Hysterectomy = removal of the entire uterus 2. obesity d.

5. textile. rubber.2. 3. batteries containing CADMIUM Viruses .fertilizer. 4. 6.related like Industries . Genetic tendency Hormonal factors = late puberty = high frequency of sexual experience = history of multiple sexual partners = high fertility Diet = high fat Chemical Carcinogens = air pollution = occupation .

radical prostatectomy NURSING INTERVENTIONS    Administer medications as ordered and provide care for the client receiving chemotherapy Provide care for the client receiving radiation therapy Provide care for the client with prostatectomy . 2. 8. 7.  1. 1. 9. 3. 4. 5.  - ASSESSMENT Hesitancy Hematuria Urinary retention Stool changes Pain radiating down hips & legs Cystitis Dribbling Nocturia Pain in defecation NURSING MANAGEMENT Early detection Ultrasound MRI X-ray CT Scan Radiation Therapy Endocrine therapy like DES(diethylstilbestrol) Surgery: Prostatectomy MEDICAL MANAGEMENT Drug therapy:estrogen Chemotherapeutic agents Radiation therapy Surgery: . 8. 5. 3. 4. 7. 6. 6. 2.