CELLULAR ABERRATION

CANCER •Came from the Latin word CANCRI which means crab. •It is a disease characterized by stretching out in many directions like the legs of the crab. •A large group of disease characterized by uncontrolled growth and spread of abnormal cells.

Who can get cancer?
•75% occur after the age 50 •6% occurs in pediatric age group of 0-14 years •In the Philippines, about 80, 000 per year or 1 out of every 5 Filipinos who live to age 74 will get cancer •In US, cancer causes more than 550, 000 deaths annually. ACS estimates that roughly 83 million Americans now living will eventually have some form of cancer.

Who can get cancer?

Worldwide, about 103 people die of cancer everyday or about 4 in every hour

Etiologic/Risk Factors
A. INTERNAL RISK FACTORS •AGE Age of exposure to carcinogens may increase the cancer risk. Fetuses, infants and children are at greater risk because they are still developing. Blistering sunburns in children under age 12 may predispose them to skin cancer

Risk Factors
•GENDER Overall, women have a lower cancer incidence than men and higher survival rate. In females, breast, colon, lung, and uterine cancers are the most common. In males, prostate, lung, GIT and bladder cancers predominate.

social and environmental factors that may delay prompt detection and increase exposure to industrial carcinogens.Risk Factors •RACE Cancer incidence and mortality are higher in blacks due to economic. .

Risk Factors •GENETIC FACTOR Certain cancers tend to run in families. . sister) with breast cancer are at greater risk than the general population. women who have first degree relatives (mother. For example.

antigenic differences between normal and cancerous cells may help the body eliminate malignant cells. Thus. immunosuppression may increase susceptibility to cancer. .Risk Factors •IMMUNOLOGIC FACTORS According to the Immune Surveillance Theory.

by depressing the immune system. or by leading him to ignore early warning signs.Risk Factors •PSYCHOLOGICAL FACTORS Emotional stress may increase a person's cancer risk by leading to poor health habits (smoking. . alcohol drinking).

EXTERNAL RISK FACTORS •CHEMICAL CARCINOGENS Chemical exposure like in nickel refining and asbestos industry may increase the risk of an individual to get cancer.Risk Factors B. .

• This irreversible step converts normal cells to latent • tumor cells.Risk Factors Chemical carcinogens typically cause cancer in two step process: • INITIATION involves exposure to the carcinogen. In PROMOTION. repeated exposure to the same or some other substance stimulates the latent cells to become active neoplastic cells. .

although their potencies vary. Fair-skinned people have higher risk for skin cancer from UV radiation.Risk Factors •RADIATION Ionizing radiation of all kinds (from X-rays to nuclear radiation) are carcinogenic. . and its incidence correlates with the amount of exposure. Skin cancer develops on exposed extremities.

.Risk Factors •VIRUSES Some human viruses have carcinogenic potential. RIBONUCLEIC ACID VIRUS are linked to breast cancer in mice. EPSTEIN-BARR VIRUS has been linked to lymphoma and nasopharyngeal carcinoma • DEOXYRIBONUCLEIC ACID VIRUS (Herpes simplex virus type 2) have been associated with uterine and cervical cancer .

•DIET Certain foods may supply carcinogens (or precarcinogens). Liver tumors are linked to food additives such as nitrates and alfatoxin ( fungus that grows on stored grains. which may result from low fiber intake and excessive fat consumption. Diet has been implicated in colon cancer. nuts and other food stuff)‫‏‬ Risk Factors . or modify carcinogen's effect. affect carcinogen formation.

pharynx. esophagus. Pipe smoking and chewing tobacco are linked to oral cancer . Cigarette smoking accounts for about 30% of all cancers and is implicated in cancers of the mouth. cervix and bladder. pancreas. larynx.Risk Factors •TOBACCO USE • Lung cancer is the leading cause of cancer deaths in both men and women.

•CHEMOTHERAPEUTIC DRUGS • Some chemotherapeutic drugs may be directly carcinogenic or may enhance neoplastic development by suppressing the immune system. .Risk Factors •ALCOHOL USE Heavy beer consumption may increase the risk of colorectal cancer through an unknown mechanism.

Risk Factors •HORMONES By altering the body's normal endocrine balance. hormones may contribute to neoplastic development-especially in endocrine sensitive organs such as breast or prostate. .

.Theories of Pathogenesis of Cancer •CELLULAR TRANSFORMATION AND DERAGEMENT THEORY • Conceptualizes that healthy cells may transform into cancer cells by unknown mechanisms whenever exposed to certain etiologic agents.

FAILURE of the immune response system will lead to inability to destroy cancer cells.FAILURE OF THE IMMUNE RESPONSE THEORY Advocates that all individuals possess cancer cells however these cancer cells are being recognize by the immune response system and they are being destroyed. .

lungs. colon. ovaries. prostate .Diagnostic Aids Used to Detect Cancer •TEST •Tumor Marker Identification •DESCRIPTION •Analysis of blood and body fluids •ORGANS •Breast.

abdomen .diagnostics •TEST •Magnetic Resonance Imaging •DESCRIPTION •Use of magnetic fields and radio frequency signals to create sectioned images of various body structures •ORGANS/AREA •Pelvic. thoracic.

pelvic. abdominal.diagnostics •TEST •Computed Tomography (CT Scan)‫‏‬ •DESCRIPTION •Use of narrow beam X-ray to scan layers of tissues for a cross sectional view •ORGANS/AREA •Neurologic. skeletal. thoracic .

converted electronically into images used to assess tissues within the body •ORGANS/AREA •Abdominal. pelvic .diagnostics •TEST •Ultrasonography •DESCRIPTION •Use of high frequency sound waves echoing of body tissues.

diagnostics •TEST •Endoscopy •DESCRIPTION •Direct visualization of body cavity to passage way •To aspirate or excise small tumor •AREA/ORGAN •Bronchi. GIT .

diagnostics •TEST •Sigmoidoscopy/ Colonoscopy •DESCRIPTION •Direct visualization of the intestinal tract •ORGAN/AREA •Colorectal. sigmoid .

hickening of lumps in breast or elsewhere I.nusual bleeding or di9scharge T.agging cough or hoarseness of voice A.ndigestion or difficulty in swallowing O.nemia L.bvious change in wart or mole N.9 warning signals of cancer C-hange in bowel or bladder habits A.sore that does not heal U.oss of weight .

LINING OF BODY CAVITIES ETC:(ADENOCARCINOMA) S ‡ ARCOMAS: CONNECTIVE TISSUE STRIATED MUSCLE.Classification of Tumors • C ‡ ARCINOMAS: EPITHELIAL TISSUE ²BODY SURFACES. NERVE CELLS-NEUROBLASTOMA M ‡ YELOMA – ²Develops in the plasma cells of bone marrow • • • • • • . BONE. ETC (OSTEOSARCOMA) L ‡ YMPHOMAS AND LEUKEMIAS ²HEMATOPOIETIC SYSTEM N ‡ ERVOUS TISSUE TUMORS ²EX.

Naming Cancers .

Cachexia Characterized by weakness.Effects of cancer 1. Malfunction of the organ due to the destruction of blood vessels 2. body malaise. . Pressure effect Tumor can cause pressure which can cause damage to adjacent structure 3. anemia and weight loss.

5. Effusion When lymphatic flow is obstructed.Effects of cancer 4. hallow organs are being compressed and obstructed. Hemorrhage or bleeding Tumor growth causes rupture of blood vessels 6. Obstruction Due to tumor growth. it can cause filling up of fluids on cavities .

Pain -a late sign of cancer . Vascular thrombosis. thrombophlebitis 9. embolism.Effects of cancer 7. Ulceration and Necrosis Tumor erodes blood vessels and pressure on tissue causes ischemia 8.

DO annual CXR  .Prevention of cancer SKIN Avoid over exposure to sunlight ORAL Annual oral exam of mouth and teeth BREAST Monthly breast self examination from age 20 up LUNGS Avoid cigarette smoking.

proctoscopic exam.Prevention of cancer COLON –Digital rectal examination for persons over 40 years old. rectal biopsy. guiac stool exam for person 50 years old and above UTERUS •Annual Pap smear for female age aged 40 *Annual PE. blood and urine exam *Choosing the right behavior and preventing exposure to certain environmental risk factors .

smoked cured and nitrate-cured foods. Include foods rich in Vitamin C and A in daily diet . 2.DIETARY RECOMMENDATION 1. 3. Eat more high fiber foods. Be moderate in the consumption of saltcured. 4. Cut down total fat intake. Be moderate in the consumption of alcoholic beverages.

Lycopene.best known for its association to healthy eyes found in green leafy vegetables. Include anti-oxidant foods in daily diet Example: Beta Carotene. guava and papaya .DIETARY RECOMMENDATION 5.found in carrots and orange Lutein. water melon.a potent anti-oxidant found in tomatoes.

SURGICAL INTERVENTIONS .Therapeutic Modalities of Cancer A.

SURGICAL PROCEDURES FOR BREAST CANCER PATIENT .

Technically. a lumpectomy is a partial mastectomy. . There are several names used for breast-conserving surgery: biopsy. partial mastectomy. or wedge resection. quadrantectomy. re-excision. Lumpectomy is a form of “breast-conserving” or "breast preservation" surgery. lumpectomy.LUMPECTOMY • Lumpectomy is the removal of the breast tumor (the "lump") and some of the normal tissue that surrounds it.

• No muscles are removed from beneath the breast .SIMPLE OR TOTAL MASTECTOMY • Simple or total mastectomy concentrates on the breast tissue itself: • The surgeon removes the entire breast.

.MODIFIED RADICAL MASTECTOMY • Modified radical mastectomy involves the removal of both breast tissue and lymph nodes: • The surgeon removes the entire breast. during which levels I and II of underarm lymph nodes are removed (B and C in illustration). • Axillary lymph node dissection is performed. • No muscles are removed from beneath the breast.

• The surgeon also removes the chest wall muscles under the breast. and D in illustration). II. . C. • Levels I.RADICAL MASTECTOMY • Radical mastectomy is the most extensive type of mastectomy: • The surgeon removes the entire breast. and III of the underarm lymph nodes are removed (B.

more tissue is removed in partial mastectomy than in lumpectomy. While lumpectomy is technically a form of partial mastectomy. .PARTIAL MASTECTOMY • Partial mastectomy is the removal of the cancerous part of the breast tissue and some normal tissue around it.

. Subcutaneous mastectomy is performed less often than simple or total mastectomy because more breast tissue is left behind afterwards that could later develop cancer.SUBCUTANEOUS (NIPPLE SPARING) MASTECTOMY • During subcutaneous ("nipplesparing") mastectomy. but the nipple is left alone. all of the breast tissue is removed.

Jackson Pratt • Deep breathing exercise to prevent post • operative • respiratory complications. .g. Hemovac.involve the husband as necessary •Teach arm exercise to prevent lymph edema • Inform about wound suction drainage • e.Breast ca PREOPERATIVE CARE •Psychological support.

DO’S AND DON’TS AFTER THE SURGERY .

• Stretch both sides of upper body a few times per day.Do’s • Before exercising actively. • Keep arm elevated after surgery to prevent swelling. If pain or fatigue persists. 35 slow repetitions of each stretch. Use two pillows to support arm when lying down or sitting. be certain that post-surgery swelling subsides and that surgical wounds are healing. • Know the difference between discomfort and unusual pain. • Try to start moving as soon as possible after surgery. stop and rest. .

• After surgery. check in with your physician. • Enlist anyone you can to accompany you and encourage you to walk frequently. Persevere! .3 times daily to regain stamina. • Avoid lifting anything over 2-3 pounds. nurse. or physical therapist. • Above all. try to walk around (indoors) for a few minutes 2 . When in doubt. • Use discretion and follow your intuition. particularly with the involved arm. strive for a little improvement every day.

• Continue an exercise upon unusual discomfort or persistent pain. stop exercising. . If fatigue persists. relax. • Hesitate to call your physician immediately when experiencing unusual or persistent pain or swelling. breathe. Rest for a moment. • Continue an exercise upon unusual fatigue. and then continue slowly and carefully.

especially when holding or carrying objects. . lifting bags.Don'ts • Let mastectomy arm hang down. • Carry anything over two pounds after surgery until you receive approval from your physician. Learn to move slowly and smoothly. pulling motions. Limit carrying anything over 5 pounds indefinitely with involved arm to prevent swelling. opening doors. etc. Avoid use of shoulder bags indefinitely. especially when changing positions. • Move arm quickly. or with jerking. The pressure of the strap on the shoulder can cause lymphedema. • Wear shoulder bags on involved arm.

Monitor hemovac output (serosanguinous for the first 24 hours)‫‏‬ •Check behind of the patient for bleeding.Breast ca POST OPERATIVE CARE •Move arm quickly. . Blood flows to back by gravity. or with jerking. pulling motions.

.Breast ca •Post signs warning against taking BP. Initiate exercise to prevent stiffness and contracture of the shoulder girdle •Reinforce special mastectomy exercise as prescribed •Provide adequate analgesia to promote ambulation and exercise. starting IV line or drawing blood on affected side.

Breast ca •Encourage regular coughing and deep breathing exercises •Prepare client for size and appearance of the incision and provide support when incision is viewed for the first time •Provide client with detailed information concerning breast prosthesis. Fitting is not possible for 4-6 weeks .

•Teach patient the importance of continuing monthly BSE on the remaining breast .Breast ca •A temporary prosthesis or lightly padded bras worn until healing is completed. Teach patient to avoid constrictive clothing and report persistent edema. redness or infection of incision.

Prevention of lymph edema AVOID cuts. pick and cut cuticles. work near thorny plants. scratches. BP taking and withdrawal of bllood. hold a cigarette. hangnails. injections. reach into hot oven. insect bites. pinpricks. burns and strong detergent DONT'S (On the affected arm)‫‏‬ carry purse or anything heavy. . wear wrist watch or jewelry. dig garden.

return for check up. wear a thimble when sewing. wear tag “CAUTIONLYMPHEDEMA” . apply lanolin hand cream to prevent dryness. contact physician if arms get red.Prevention of lymph edema DO'S wear loose rubber gloves when washing dishes. warm or swollen.

POST-OP EXERCISES .

twice a day. • Gradually increase the number of times you do the exercise each day.BALL SQUEEZE • Stand or sit comfortably. • Squeeze and relax your hand ten times. • With your elbow slightly bent and your palm toward the ceiling. . • Hold a soft rubber ball in the hand on your operated side. lift your hand higher than your heart.

FRONT ARM RAISE • Stand or sit comfortably. • Relax your arms and allow them to hang at your sides. taking two counts to reach shoulder level. three times a day. slowly raise your arms in front of you. • Repeat this exercise 8 to 10 times. . • Keeping your palms down. • Slowly lower your arms back down to your sides in two counts.

Relax your arms and allow them to hang at your sides. three times a day.HAND CLAP • • Stand or sit comfortably. • . taking 4 counts to return your arms to your sides. trying to clap your hands overhead. Repeat this exercise 8 to 10 times. Slowly raise your arms out to the sides. until they are at shoulder level. Continue to raise both arms. • • • Slowly lower your arms.

twice a day. Repeat the exercise with your other arm.WALL WALKING • Stand with one side of your body facing a wall and your feet about 6 inches away from it. • • • . Repeat this exercise 8 to 10 times. Hold the stretch for 10 seconds and then walk your fingers back down. Starting with your hand at eye level. walk your finger up the wall as high as you can.

• Hold for 12 seconds. twice a day. • With one arm stacked on top of the other. squeezing your shoulders together. . align your fingertips with your elbows. push your elbows back. bend your elbows and bring your arms up in front of you to shoulder level.SHOULDER SQUEEZE • Standing. • Repeat this exercise 8 to 10 times. • Next.

twice a day. Place the hand on your operated side over the end. Gently. grasp a pole or rod in front of you with both hands. • • • • • . use the strength of your good arm to push the end of the stick as high as you comfortably can. Slowly raise your arms out to the sides. Repeat this exercise 6 to 8 times.ARM STRETCH • Standing. Hold for 12 seconds. Try a golf club or broomstick. until they are at shoulder level.

LUNG CANCER .

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Pneumonectomy ► total lung removal. .

It can be done in one of two ways: Traditional Pneumonectomy  Only the diseased lung is removed. . Extrapleural Pneumonectomy  The diseased lung is removed. together with a portion of the membrane covering the heart(Pericardium). and the membrane lining the chest cavity (Parietal pleura) on the same side of the chest. part of the diaphragm.

Lobectomy surgical removal of one of the five lobes of the lung. .

.Wedge Resection ► A surgical procedure during which the surgeon removes a small. The surgery is performed to remove a small tumor or to diagnose Lung Cancer. wedge-shaped portion of the lung containing the cancerous cells along with healthy tissue that surrounds the area.

but does not remove the whole lobe. .Segmental Resection ► Removes a larger portion of the lung lobe than a wedge resection.

Leave the incisions uncovered of the chest tubes and the drain sites may drain for several days.Do’s:  Shower daily and wash incision and drain sites. and therefore may need a Band-Aid. Let the water stream run over the incision and drain sites. Wear comfortable clean clothing preferably cotton clothing .

Stop when you are short of breath. and then continue. Avoid spending prolonged periods of time lying down during the daytime hours.  . Fatigue and tiredness are expected. rest. It is entirely normal that you may have to take a nap in the morning or in the afternoon.Ambulate early.

do not restart. If your environment-your apartment or house-still contains curtains. please have them cleaned.  . and furniture full of smoke and tobacco odor that can give you the urge to smoke again. linens.Don'ts: If you were a smoker.

Do not drive until your surgeon says that you can. at about 3 weeks you will be allowed to drive locally.  . Remember that your recovery overall takes about 10-12 weeks. Generally. Do not lift anything heavier than 10 pounds for about 4-6 weeks.

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Management for client with cervical cancer SURGERY: •EXCISIONAL BIOPSY for preinvassive lesions •CRYOSURGERY technique of exposing tissues to extreme cold in order to produce well demarcated areas of cell injury and destruction •LASER destruction of the tumor •CONIZATION is removal of the cone shape section of the cervix •HYSTERECTOMY for invasive squamous cancer. .

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• Also called a cone biopsy • A procedure that is used to remove a cone-shaped piece of tissue from the cervix and cervical canal .

including the cervix • There are three different procedures that may be used to perform a total hysterectomy .• A surgical procedure that is used to remove the uterus.

VAGINAL HYSTERECTOMY .In which the uterus and cervix are taken out through a large incision (cut) in the abdomen .In which the uterus and cervix are taken out through the vagina TOTAL ABDOMINAL HYSTERECTOMY .

In which the uterus and cervix are taken out through a small incision in the abdomen using a laparoscope .TOTAL LAPAROSCOPIC HYSTERECTOMY .

• A BSO is a surgical procedure that is used to remove the ovaries and the fallopian tubes .

or nearby lymph nodes may also be removed . fallopian tubes.• Is a surgical procedure that is used to remove the uterus. cervix and part of the vagina • Ovaries.

• Surgeons will need to make artificial openings (stomas) for the urine and the stool • women may need plastic surgery to make an artificial vagina after they have had a pelvic exenteration .

• Is a treatment that uses elecrical current (passed through a thin wire loop) as a knife to remove abnormal tissue or cancer .

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Cervical ca PREOPERATIVE PREPARATION: •Advise client to be admitted in the hospital 1 day prior to operation •Take time to talk to the client on what she expects from the surgery and about her menstrual and reproductive status after surgery •Review what the surgical approach involves and the extent of the excision .

tell her that she will need to: •Douche and have an enema the evening before the surgery •Take a shower with an antibacterial soap shortly before the surgery •Shave her pubic area •*Have an indwelling urinary catheter inserted because surgery causes urine retention .Cervical ca •If the client is having an abdominal hysterectomy.

 . She will also have a perineal pad in place because moderate amounts of drainage occurs post operatively.Cervical ca preop prep *Have an NGT or rectal tube inserted if she develops abdominal distention Expect temporary abdominal cramping . tell her to expect abdominal cramping afterwards. pelvis and lower back pain after the procedure  If the client is scheduled for vaginal hysterectomy.

.vaginal hysterectomy. change her perineal pad frequently.Cervical ca preop prep •Inform the client that after surgery. she needs to lie in a supine position or in low Fowler's position •Demonstrate the exercises that she will need to perform to prevent venous stasis POST OPERATIVE CARE •For. Provide analgesics to relieve cramps.

• Change perineal pads frequently because moderate amounts of drainage occurs post-operatively • Provide analgesics to relief cramps • Monitor urinary output because urinary retention commonly occurs .

• Encourage patient to perform the prescribed exercises and to ambulate early and frequently to prevent venous stasis Venous stasis –retardation of the venous outflow in a part .

Note bowel sounds during routine assessment. . relieve it by inserting NGT or rectal tube as ordered. Encourage her to perform the prescribed exercises and to ambulate early and frequently to prevent venous stasis.Cervical ca post op care •If she has had an abdominal hysterectomy. tell her to remain in a supine position or a low Fowler's position. •If abdominal distention develops. Monitor UO because retention commonly occurs.

high residue diet to avoid constipation • Give 2.8 Liters/day • May resume sexual activity 6 weeks after surgery .• Avoid heavy lifting to avoid pressure on incision site • Avoid rapid walking. dancing • Advice to eat high protein.

client may receive hormone replacement therapy .• Explain that abrupt hormonal fluctuations may cause the client to feel depressed or irritable for a while • Encourage family members to respond calmly and with understanding • If the ovaries were removed.

Swimming is permissible. heavy bleeding or hot flushes (common for Oophorectomy) to her doctor immediately. . •Encourage client to walk a little more each day and avoid sitting for prolonged period.Cervical ca HOME CARE: •If the client had vaginal hysterectomy. instruct to report severe cramping.

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In the early stages. . it may be curative.Surgical removal of the uterus is recommended for all stages of uterine cancer unless the cancer is widespread.

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which will eventually dissolve .• A cut is made in the lower abdomen to expose the tissues and blood vessels that surround the uterus and cervix • These tissues are cut and the blood vessels are tied off to remove the uterus • Stitches are placed in these deep structures.

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• The first night after the surgery. the catheter in your bladder and IV will be removed . you may be asked to sit up in bed and walk a short distance • If there is no evidence of complications and you are able to drink fluids on your own.

• Eat balanced diet rich in fresh fruits and vegetables. • Dependig on how much blood loss occurred during surgery, you may require a daily iron supplement

• Advise to eat high-fiber foods, drinking plenty of water, and if necessary, use stool softeners • Shower instead of taking a bath for at least the first two weeks after surgery

• Keep your incision sites clean and dry to avoid infection • Do not douche or put anything in your vagina, such as tampon, until your doctor tells you otherwise. Speak to your doctor about when you may resume having sexual intercourse

• Take daily walks as tolerated • Avoid heavy lifting for four to six weeks • Ask your practitioner whether any type of physical therapy or nutritional counseling may be helpful to speed your recovery

Management of client with lung cancer

PREOPERATIVE PREPARATION: •Explain the anticipated surgery to the client and inform him that he will receive a general anesthetic.

record the volumes he achieves to provide a baseline. . Also teach him to use an incentive spirometer. he may have chest tubes in place and may receive oxygen. •Teach him deep breathing techniques and explain that he will perform these after surgery to facilitate lung reexpansion.Lung ca pre-op prep •Inform the client that post operatively.

•Make sure that the chest tube is functioning. This prevents fluids from draining into the unaffected lung if the sutured bronchus opens. •Provide analgesics as ordered . the client should lie only on the operative side or on his back until stabilized.Lung ca POST OPERATIVE CARE: •After pneumonectomy. if present. and observe for signs of tension pneumothorax.

•Perform passive range of motion exercises the evening of surgery and 2-3 times daily thereafter. place him in semi Fowler's position. Auscultate his lungs. Progress to active range of motion exercises. and have him splint his incision to facilitate coughing and deep breathing. .Lung ca post op care •Have the client begin coughing and deep breathing exercises as soon as his condition is stable.

•Tell the client to avoid contact with people who have an URTI and to refrain from smoking .Lung ca home care •Tell the client to continue his coughing and deep breathing exercises to prevent complications. •Instruct the client to continue performing range of motion exercises to maintain mobility of his shoulder and chest wall. Advise him to report changes in sputum characteristics to his doctor.

Lung ca home care •Provide instructions for wound care and dressing changes as necessary. .

Do’s: Shower daily and wash incision and drain sites. Let the water stream run over the  incision and drain sites. and therefore may need a Band-Aid. Leave the incisions for the chest tubes and  drain sites uncovered. The sites may drain for several days.  .

but over a week's time you should see an increase in the distance that you are able to walk  .Post-OP Care Do’s: Wear comfortable clean clothing preferably  cotton clothing Ambulate early. Stop when you are short of breath. and then continue. rest. You may not see a daily increase.

It is entirely normal that you may have to take a nap in the morning or in the afternoon.  Eat nutritious foods. .Post-OP Care » Do’s:  Fatigue and tiredness are expected. Avoid spending prolonged periods of time lying down during the daytime hours.

Post-OP Care • Do’s: • We suggest that you weigh yourself twice a week and that you keep a record of your weight. .

you should take your medications on a regular basis as they were prescribed. .Post-OP Care  Do take your pain medications as needed. one of which should be taken constantly to produce a steady level of analgesia -pain relief-. In the beginning. you receive two types of pain medication. The other medication is given for "breakthrough" pain or the peaks. which you take as needed depending on your daily activities. Often.

•SUPRAPUBIC PROSTATECTOMY A surgical approach that involves a lower abdominal incision. •TRANSURETHRAL PROSTATECTOMY Excision of part of the prostate gland through the urethra. Operation of choice when the prostate is too large to be resected transurethally. Management of client with prostate cancer .SURGERY.

•PERINEAL PROSTATECTOMY Excision of part or all the prostate gland with an incision in the perineum. •Clients taking any drug or supplement with anti coagulant effects must discontinue before surgery . PREOPERATIVE CARE: •Assess the client's ability to empty his bladder.

each time urine out put is recorded .Prostate ca preop care •Respond to the concerns of the client and significant others with emphatic listening. including the presence of blood clots. POST OPERATIVE CARE: •Observe the vital signs and maintenance of urinary drainage •Document the urine color. accurate information and on going support.

. blockage of an irrigated bladder rapidly leads to over distention.Prostate ca post op care •Ensure catheter patency frequently to make sure the catheter is draining. secondary hemorrhage and formation of blood clots or infections.

Management of client with thyroid cancer THYROIDECTOMY Surgical removal of the thyroid gland PREOPERATIVE CARE: •Administration of anti-thyroid drugs •Preparation is about 2-3 months •Provide adequate rest •Achieve and maintain optimal weight •Maintain good health status .

Thyroid ca POST OPERATIVE CARE: •Take vital signs every 15 minutes until stable. every 1 hour for the next 24 hours •Place client in sitting position with head and arms well supported as soon as she recovered from anesthesia •Watch for edema or swelling due to bleeding into the wound .

anxiety.Thyroid ca post op care •Suction mouth and throat if necessary •Cough and deep breathing exercise every hour •Give fluids by mouth as tolerated •Give Morphine SO4 for pain •Observe for hoarseness and evidence of injury to parathyroid gland •Signs and symptoms: •Tingling and tightness of the fingers. and mental depression .

 .Thyroid ca post op care •Have the following at bed side: Tracheostomy set Endotracheal tube Laryngoscope Oxygen Give mist inhalation until chest is clear Take temperature every 4 hours for 24 hours Assess for hypocalcemia and monitor calcium. magnesium and phosphorous.

Management of client with colorectal cancer SURGERY: •For tumors of the cecum or ascending colon. cecum. right colectomy includes transverse colon and mesentery corresponding to mid colonic vessels . right hemicolectomy for advanced disease may include resection of the terminal segment of the ileum. ascending colon. and right half of the transverse colon with corresponding mesentery. •For tumors of the proximal and middle transverse colon.

A newer method. •For sigmoid colon tumors usually limited to the sigmoid colon and mesentery. •Upper rectum tumors usually call for anterior or low anterior resection.Colerectal ca Alternatively. . the surgeon may perform segmental resection of the transverse colon and associated mid colonic vessels. using a stapler. allows resections much lower than were previously possible.

abdominoperineal resection and permanent sigmoid colostomy are usually performed.Colorectal ca •For tumors in the lower rectum. arrange for the client to visit an enterostomal therapist. who can provide more detailed information and for chosing the best location for the stoma . PREOPERATIVE PREPARATION: •Before the surgery.

Colorectal ca preop prep •Try to have the client meet with an ostomy client who can share his personal insights into the realities o living with and caring for a stoma •Evaluate his nutritional and fluid status. . Watch for early signs of dehydration. •Record the client's fluid intake and output and weight daily. Typically. the client will receive TPN to prepare him for the physiologic stress of surgery.

poor skin turgor) and electrolyte imbalance.Colorectal ca preop prep •Expect to draw periodic blood samples for hematocrit and hemoglobin determinations. POST OPERATIVE CARE: •Monitor I and O. Maintain fluid and electrolyte balance. and watch for signs of dehydration (decrease UO. . and weigh daily. Be prepared to transfuse blood if ordered.

If the client has double barrel colostomy. The nature of fecal drainage is determined by the type of ostomy .Colorectal ca post op care •Provide analgesics as ordered. check for mucus drainage from the inactive (distal) stoma. •Note and record the color. Be especially alert for pain in the patient with an abdominoperineal resection because of the extent and location of the incisions. consistency and odor of fecal drainage from the stoma.

fecal drainage probably will be mucoid (and probably blood tinged) and mostly odorless. . the more closely drainage will resemble normal stool. generally.Colorectal ca post op care Surgery. For the first few days after surgery. the less colon tissue that's removed. Report excessive blood and mucus content. which could indicate hemorrhage or infection.

foul odor0 or fecal drainage. . Remember that clients receiving antibiotics or TPN are at an increased risk for sepsis. changing dressings often.Watch out for sepsis •Observe the client for signs of peritonitis or sepsis. caused by bowel contents leaking into the abdominal cavity. •Provide for meticulous wound care. Check dressing and drainage sites frequently for signs of infection (purulent discharge.

and take corrrective measures. which may indicate circulatory problems that could lead to ischemia. •Regularly check the stoma and the surrounding skin for irritation and excoriation. . The stoma should look smooth. Also observe the stoma's appearance. irrigate the perineal area as ordered.Watch for sepsis If the client has had an abdominoperineal resection. cherry red and slightly edematous. immediately report any discoloration or excessive swelling.

encourage the client to express his feelings and concerns.Watch out for sepsis During the recovery period. Continue to arrange for visits by an enterostomal therapist. . reassure an anxious or depressed patient that these common post operative reaction should fade as he adjusts to the ostomy.

Reassure him that he can regain continence with dietary control and bowel retraining. Teach him how to irrigate the colostomy with warm tap water to gain some control over elimination.. .Colorectal ca home care HOME CARE INSTRUCTIONS FOR CLIENT WITH COLOSTOMY: •Teach client or caregiver how to apply. remove and empty the pouch.

Home care . Tell the client to stay on a low fiber diet for 6-8 weeks and to add new foods to his diet gradually. diarrhea. flatus and odor. and to change the adhesive layer. •Discuss dietary restrictions and suggestions to prevent stoma blockage. These measures help prevent skin irritation and excoriation.•Instruct the client to change the stoma appliance as needed. to wash the stoma site with warm water and mild soap every 3 days.

Home care •Suggest the use of ostomy deodorant or odor proof pouch if he include odor producing foods to his diet. corn. Gas producing fruits include apples. He must drink plenty of fluids . melons. avocados. and cabbage. •The client is especially susceptible to fluid and electrolyte losses. and cantaloupe. •Trial and error will help the client determine which foods cause gas. gas producing vegetables are beans.

If the client had an abdominoperineal resection. Fruit juice and bouillon. .suggest sitz bath to help relieve perineal discomfort. which contain potassium are particularly helpful. •Warn the client to avoid alcohol. laxatives and diuretics which will increase fluid loss and may contribute to an imbalance. Recommend refraining from intercouse until the perineum heals.Home care Especially in hot weather and when he has diarrhea.

Acute leukemia A cancerous WBC precursor called blast proliferate in the bone marrow or lymph tissue and then accumulate in peripheral blood. bone marrow and body tissues CLASSIFICATIONS: •ACUTE LYMPHOBLASTIC LEUKEMIA marked by abnormal growth of lymphocyte precursors (lymphoblast)‫‏‬ .

Classification of leukemia •ACUTE MYELOGENOUS LEUKEMIA characterize by rapid accumulation of myeloid precursors (myeloblast)‫‏‬ •ACUTE MONOCYTIC LEUKEMIA or SCHILLING'S TYPE involves a marked increase in monocyte precursor (monoblast)‫‏‬ •ACUTE MYELOMONOCYTIC and ACUTE ERYTHROLEUKEMIA .

the following are the risk factors •A combination of viruses •Genetic and immunologic factors •Exposure to radiation and certain chemicals . but according to some experts.Risk factors of leukemia The cause of leukemia is unknown.

pathophysiology The pathogenesis of acute leukemia is not clearly understood. These immature WBCs then spill into the blood stream and infiltrate other tissues. nonfunctioning WBCs appears to accumulate first in the tissue where they originate (lymphocytes in lymph tissues. . Immature. they cause organ malfunction from encroachment or hemorrhage. Eventually. granulocyte in bone marrow).

weakness and lassitude .Signs and symptoms ACUTE LEUKEMIA •High fever of sudden onset •Abnormal bleeding •Easy bruising with even minor trauma •Prolonged menses NON SPECIFIC SIGNS •Low grade fever •Pallor.

AML.ACUTE MONOCYTIC LEUKEMIA •Dyspnea •Fatigue •Malaise •Tachycardia •Palpitations •Systolic ejection murmur •Abdominal or bone pain .Signs and symptoms ALL.

Signs and symptoms MENINGEAL LEUKEMIA •Confusion •Lethargy •headache .

•WBC differential determines cell type •CBC shows decreased levels of hemogobin (anemia). platelets (thrombocytopenia) and neutrophils (neutropenia). .Laboratory exams •BONE MARROW BIOPSY Performed in client with typical clinical findings but whose aspirate is dry or free from leukemic cells. It shows proliferation of immature WBCs.

Laboratory exams •LUMBAR PUNCTURE detects meningeal involvement •URIC ACID measurement may be done to detect hyperuricemia .

Watch for and report signs and synptoms of infection. . Screen staff and visitors for contagious disease. which can pave way for infection.Nursing management •Control infection by placing the client in reverse isolation. Coordinate care so client does not come in contact with staff who also care for clients with infection or infectious disease. Avoid using IFC and giving IM injections.

.3C accompanied by a decrease in WBC count calls foe prompt antibiotic therapy. apply ice compress and pressure. •Watch for bleeding. taking rectal temp.. A temperature of 38. If occurs.Nursing management •Monitor the client's vs q 2-4 hours. Avoid giving aspirin-containing drugs. elevate the affected extremity.giving rectal suppositories and performing DRE.

and keep him supine for 4-6 hours. provide care after intrathecal chemo. •If the client has receiving cranial radiation. place the client in Trendelenberg position for 30 mnutes.Nursing management •Watch for signs s/s of meningeal leukemia. teach him about potential adverse effects. Check lumbar puncture site for bleeding. Give plenty of fluids. and try to minimize them. If these occurs. . After instillation.

Watch for rashes and other hypersensitivity reactions to allopurinol. •Control mouth ulcers by checking often for obvious ulcers and gum swelling and by providing frequent mouth care and saline solution rinses.5. sodium bicarbonate tablets and allopurinol as ordered.•TakeNursing management a steps to prevent hyperuricemiapossible result of rapid chemotherapy induced leukemic cell lysis. . Check urine pH often-it should be above 7. Give the client about 2L of fluids daily. and administer acetazolamide.

Nursing management •Check the rectal area daily for induration. erythema. anxiety and depression. quiet atmosphere that promotes rest and relaxation. skin discoloration and drainage.participate in client care as much as possible. Encourage them to . Allow him and his family to expres their anger. . •Minimize stress by providing a calm. swelling. •Provide psychological support by establishing a trusting relatioship with the client.

Provide the opportunity for religious counseling. if appropriate. fever and bleeding.•For client with terminal disease that resists chemo. Discuss the option of home or hospice care. He and his family should understand the rationale for treatment and potential complications of chemo. managing pain. •Evaluate the patient. and offering emotional support. provide supportive care directed at promoting comfort. They should also know how to recognize s/s of infection and Nursing management .

Nursing management And understand that they must notify the doctor if these occur.. They should be able to discuss treatment options and verbalize concerns about a poor prognosis. .

anticancer.B. CHEMOTHERAPY A. antineoplastic drugs. DESCRIPTION OTHER TERM: chemo. cytotoxic drugs •Used to describe drugs that kill cancer cells directly •It promotes tumor cell destruction by interfering with cellular function and reproduction .

The intent of chemo is to destroy as many tumor cells as possible with minimal effect on healthy cells. . Therapeutic strategies •Adjuvant therapy •Neoadjuvant therapy •Induction therapy •Consolidation therapy 3. 2.Principles of chemotherapy 1. Cancer cells depend on the same mechanisms for cell division as in normal cells.

Principles of chemo 4. Chemo agents can be effective in one of the five phases of the cell cycle .

•G1 PHASE (gap one)‫‏‬ The cells starts making more protein to get ready to divide. •S PHASE (synthesis)‫‏‬ The proteins containing the genetic code (DNA) doubles so that both new cells are formed will have the right amount of DNA.Normal cell cycle •G0 PHASE (resting phase)‫‏‬ Cells have not yet started to divide. Last for few hours to few years. .

•M PHASE (mitosis)‫‏‬ The cell actually divides into two identical cells .Normal cell cycle •G2 PHASE (gap two)‫‏‬ Period of protein and RNA synthesis and the mitotic spindle apparatus is formed.

To cure a specific cancer 2.Goals for chemotherapy treatment 1. To destroy microscopic cancer cells 5. To relieve symptoms caused by cancer 4. To control tumor growth 3. To shrink tumors before surgery or radiation .

IMPAIRED RENAL AND HEPATIC FUNCTIONS. RECENT RADIATION THERAPY. The drugs are hepatotoxic and nephrotoxic 4. . The drugs may retard healing process 3.Contraindications of chemotherapy 1. INFECTION. Also immunosuppresive. RECENT SURGERY. 2. The anti-tumor drugs are immunosuppressives.

BONE MARROW DEPRESSION.Contraindications of chemotherapy 4. The drugs may cause congenital defects. PREGNANCY. The WBC levels must be within normal limits. 5. . The drugs may aggravate the condition.

Melphalan . Carboplastic. Ifosfamide. Lomustine. * It interfere with DNA and RNA growth EXAMPLES: Cyclophosphamide. ALKALYTING AGENT ACTION: *Most active during the resting phase of the cell. Mesna.Classifications of chemo agents 1. Dacarbazine. Cisplatin. Leukeran. Semustine. Carmustine. Busulfan.

Alkalyting agents ADVERSE EFFECTS: Nausea. . alopecia. hemorrhagic cystitis. thrombocytopenia. vomiting. myelosuppression NURSING CONSIDERATIONS: •Monitor liver functions and CBC •Drink 2-3L of fluids daily •Reassurance for hair loss •Administer anti emetic drugs as ordered •Observe for hypersensitivity reactions.

Alkylating agents .

Classifications of chemo drugs 2. ANTIMETABOLITES ACTIONS: •Drugs are very similar to normal substances within the cell •Attack cells at very specific phase of the S Phase •Inhibit cell reproduction by interfering with manufacture of protein •Cell cycle specific drug .

antimetabolites .

Cytarabine. diarrhea •Myelosuppression. Taxotere ADVERSE EFFECTS: •N/V.stomatitis •Thrombocytopenia. 5 Flouraouracil. Hydroxy Urea.Classifications of chemo drugs EXAMPLES OF ANTIMETABOLITES: Azacytadine. alopecia •Renal and hepatic dysfunctions •Neuropathy . Methotrexate. Taxanes. 5-Mercaptopurine. Gemcitabine. Thioguanine.

Urea and Creatinine •Provide oral hyiene •Administer antiemetic drugs as ordered •Observe other s/s of side effects . CBC.antimetabolites NURSING CONSIDERATIONS: •Monitor liver function.

Adriamycin. Mitomycin . ANTINEOPLASTIC ANTIBIOTICS ACTIONS: •Interfere with DNA by stopping enzymes and mitosis or altering the membranes surrounding the cell •Works in all phases of cell cycle EXAMPLES: Bleomycin.Classifications of chemo drugs 3. Dactomycin.

Antitumor antibiotics .

stomatitis •Myelosuppression. thrombocytopenia •Renal and hepatic dysfunctions •Alopecia NURSING CONSIDERATIONS: •Hydration.Antineoplastic antibiotics ADVERSE REACTIONS: •N/V. monitor lab test •Antiemetics. oral care .

Vinca Alkaloids. Campotheca acuminata. Podophylotoxins. Taxanes.derived from the Asian “Happy Tree” . PLANT ALKALOIDS Derived from certain types of plants a.derived fro the May apple plant d.Classifications of chemo drugs 4.made from periiwinkle plants Catharantus rosea b.made from bark of the Pacific few tree Taxus c.

neuropathy. Tenipride. Nevelbine ADVERSE EFFECTS: Diarrhea. stomatitis. Vincristine.Plant alkaloids ACTIONS: •Attack the cell during various phases of cell division especially the M Phase •Cell cycle specific •Known as Mitotic o Topoisomerate inhibitors EXAMPLES: Velba. paiin in the IV site . alopecia. Vinblastine.

Topoisomerase Inhibitors .

Mitotic Spindle Poisons .

Classifications of chemo drugs NURSING CONSIDERATIONS (PLANT ALKALOIDS)‫‏‬ •Hydration •Avoid handling pointed and breakable objects •Reassure that hair will grow again after the therapy •Provide mouth care •Observe IV site .

HORMONE OR HORMONE MODULATORS ACTION: A. Corticosteroids B. prostate and endometrial lining EX. They are used to inhibit the new growth of the breast.Classifications of chemo drugs 5. Tamoxifen or Nalvadex. Testofactone or Teslac . Natural Hormones. Some sex hormones alter the action or production of female and male hormone.drugs that are useful in treating some types of cancer EX.

hormone ADVERSE EFFECTS: •Signs and symptoms of menopause •Bone marrow depression. enlargement of the clitoris NURSING CONSIDERATIONS: •Monitor CBC •Health teaching regarding changes on reproductive system and vision . facial hair growth. retinopathy •Teslac may produce altered libido.

Routes of administration for chemo agents •Oral •IV •IM •Intrathecal or intraventricular •Intraarterial •Intracavitary •Intravesical •topical .

dose. and current laboratory results . type of drugs. PREPARATORY PHASE A. Patient Education •Review treatment goals •Review treatment plans and adverse reactions •Review strategies to manage reactions •Instruct client on a reportable condition B. medication.Administration of IV chemo agents 1. route. check for: Doctors order. duration of therapy. history. Before administering chemo drugs.

Verify client's name and identification E. D.Administration of IV chemo drugs C. PERFORMANCE PHASE A. thrombosis or scar formation Check for blood return or patency of the site . Be aware of the agents that cause anaphylactic reaction 2. Insertion of IV access •Select venipuncture site free from sclerosis. Calculate the dosage according to mg/kg body weight or mg/m2 by body surface area.

Administration of IV chemo drugs C. Be aware of the agents that cause anaphylactic reaction 2. D. thrombosis or scar formation Check for blood return or patency of the site . PERFORMANCE PHASE A. Verify client's name and identification E. Calculate the dosage according to mg/kg body weight or mg/m2 by body surface area. Insertion of IV access •Select venipuncture site free from sclerosis.

Types of vascular access devices 1. Care for the catheter is required. Peripherally inserted catheter (Per-Q-Cath)‫‏‬ •Placed in the arm and treaded through the vein up to the near the heart •Allows for continuous access for peripheral vein for several weeks. •No surgery is needed. .

No surgery needed. Care of the catheter is required. MID LINE CATHETER (Per-Q-Cath Midline)‫‏‬ •Also placed in the arm but the catheter is not inserted as far as PIC •Used for intermediate length therapy when a regular peripheral IV is not advisable. 3. Broviac.Vascular access 2. TUNNELED CENTRAL VENOUS CATHETER (Hickman. Groshon)‫‏‬ •Catheter with multiple lumens surgically placed in large central vein in the chest and the catheter .

Vascular access
Tunneled under the skin. Care of the catheter is needed. 4. IMPLANTABLE VENOUS ACCESS PORT (Port-A-Cath, BardPort, Medi-Port)‫‏‬ A port of plastic, stainless steel or titanium with silicone septum. The catheter is surgically placed under the skin of the chest or arm in a large central vein. The port is accessed by a needle to give chemotherapy.

Vascular access
5. IMPLANTABLE PUMP A titanium pump with an internal power source surgically implanted to give continuous infusion chemotherapy usually at home. There is a refillable reservoir for continuous infusion.

Administration of IV chemo drugs
B. ADMINISTRATION PHASE SEQUENCE OF DRUG ADMINISTRATION 1. The recommended practice is to administer vesicant first. Check IV site for: •Good vein integrity •Vein is stable and less irritated •Assessment for vein patency •Less chance of compromised vascular integrity

Sequence of drug administration
2. Apply a disposable absorbent plastic (backed pack under the area)‫‏‬ 3. Put protective gown, gloves and goggles if necessary. Order of protective equipment: •Donning- mask, gown, gloves, goggles •Removing-gown, gloves, goggles, mask 4. Monitor IV site regularly. Observe for EXTRAVASATIONS or accidental infiltration of vesicant or irritant chemo drugs from the vein into the surrounding tissues of the IV site.

Extravasation
SIGNS AND SYMPTOMS •Pain, burning sensation and inflammation IF LEFT UNTREATED •There will be hyperpigmentation, sloughing, necrosis and ulceration. FOR SEVERE EXTRAVISATIONS •May result in damage to tendons and nerves END RESULT: AMPUTATION

leave catheter in place.Management for extravisation •STOP vesicant and IV fluids •Wear gloves. disconnect line from IV site •Attach a syringe and aspirate •Notify the physician •Administer prescribed antidote .

apply ice for 24 -48 hours then resume normal activity. avoiding excess pressure on the site •Inject antidote SC of the affected site. Use gauge 25 neeedle.extravisation FOR SUBCUTENEOUS EXTRAVISATION: •Wear gloves. •Assess for a plastic surgery consult . •Instruct client to rest. remove IV catheter. elevate the site.

FOLLOW UP PHASE •Documentation •Monitoring of pain and erythema. induration or necrosis •Monitoring for the other adverse effects of the drug .Admin of chemo drugs C.

diarrhea. GASTROINTESTINAL SYSTEM •N/V.Side effects of chemo agents and their nursing interventions 1. constipation Nursing Actions: •Replace fluids and electrolyte losses •Low fiber diet to relieve diarrhea •Increase fluid intake and high fiber diet to relieve • constipation •Administration of antiemetic drugs as ordered .

This stimulates certain nerves that activate the vomiting center (VC) and the chemoreceptor trigger zone (CTZ) in the brain which leads to vomiting. Another way these areas of the brain can be activated is through obstruction (intestinal blockage). or inflammation .NAUSEA AND VOMITING Chemotherapy drugs cause nausea and vomiting for a variety of reasons. One reason is they irritate the lining of the stomach and duodenum (the first section of the small intestine). delayed gastric emptying.

It can lead to nausea and a decreased appetite. dry stool. . Constipation affects about half of people with cancer and about 3 out of 4 of those with advanced cancer.CONSTIPATION Constipation is the passage (usually with discomfort) of infrequent. hard. cramping. you may also notice bloating. If you have constipation. or pain. increased gas.

DIARRHEA

- is the passage of increased volume of loose or watery stools several times a day with or without discomfort. Along with diarrhea, you may have gas, cramping, and bloating. Diarrhea occurs in about 3 out of 4 people who receive chemotherapy because of the damage to the rapidly dividing cells in the digestive (gastrointestinal) tract.

APPETITE LOSS AND WEIGHT CHANGES
Most chemotherapy medicines cause some degree of anorexia, a decrease in or complete loss of appetite. Loss of appetite, as well as weight loss, may also result directly from effects of the cancer on the body's metabolism. Anorexia may be mild. If it is severe, it may lead to cachexia, a form of malnutrition with muscle loss. Proper nutrition is important during cancer treatment. It helps strengthen the body to fight the disease and infection and also cope with cancer treatments and their side effects.

TASTE CHANGES
Cancer treatments and the cancer itself can change the way some food tastes. Taste changes can contribute to anorexia, poor nutrition, and weight changes. With taste changes caused by chemotherapy,

Side effects of chemo
2. INTEGUMENTARY SYSTEM *Pruritus, urticaria •Provide good skin care •Observe for anaphylactic reactions *Stomatitis •Provide good oral care •Avoid hot and spicy foods *Skin pigmentation •Inform client that it is temporary

Side effects of chemo
* Alopecia Reassure that it is temporary Encourage to wear wigs, hat, or headscarf *Nail Changes Reassure that nails may grow normally after chemo

Side effects of chemo 3. avoid people with infection . HEMATOPOIETIC SYSTEM •Anemia-provide frequent rest period •Neutropenia-protect from infection.

It can be one of the most debilitating side effects people experience.FATIGUE Fatigue is an extreme tiredness that is not relieved with rest. . It is one of the most common side effects of cancer and chemotherapy.

avoid aspirin 4. Creatinine . ugency •Monitor BUN.protect from trauma. GENITO-URINARY SYSTEM *Hemorrhagic Cystitis •Provide 2-3 L of fluids per day •Monitor UO •Assess for urinary frequency.Side effects of chemo *Thrombocytopenia.

Blurring of vision •Determine presence of tingling sensations on toes and fingers •Evaluate muscle weakness •Determine peripheral nerve damage and report Side effects of chemo . NEUROMUSCULAR SYSTEM *Paresthesia. Hearing Loss. REPRODUCTIVE SYSTEM *Amenorrhea and decrease libido for males •Reassure that menstruation and libido will resume after chemo 6.5.

NERVOUS SYSTEM CHANGES
Some chemotherapy drugs can cause direct or indirect changes in the central nervous system (brain and spinal cord), the cranial nerves, or peripheral nerves. The cranial nerves are connected directly to the brain and are important for movement and touch sensation (feeling) of the head, face, and neck. Cranial nerves are also important for vision, hearing, taste, and smell. Peripheral nerves lead to and from the rest of the body and are important in movement, touch sensation, and regulating activities of some internal organs.

Safe handling of chemotherapeutic agents
1. Wear mask, back closing gown and gloves. 2. Skin contact with drugs must be washed immediately with soap and water. 3. Eyes must be flushed immediately with copious amounts of water. 4. Sterile or alcohol wet pledgets should be used to wrap around the neck of the ampule when breaking or withdrawing the drug.

Safe handling 5. Expel air bubbles on wet cotton.
6. Vent vials to reduce internal pressure when mixing. 7. Wipe external surfaces of syringes and IV bottles. 8. Avoid self inoculation by needle stab. 9. Clearly label the hanging IV bottle with “antineoplastic chemotherapy” 10. Contaminated needles and syringes must be disposed in a clearly marked leak proof and puncture proof container.

Safe handling
11. Dispose half empty ampules, vials, IV bottles by putting into plastic bag. Seal and then put into another plastic bag or box, clearly marked “hazardous waste” before disposal. 12. Only trained personnel should involve in the administration of the drugs. 13. Ideally, preparation of drugs should be in a laminar flow conditions with filtered air.

Personal safety to minimize exposure via skin ingestion
1. Do not eat, drink, chew gum, or smoke while preparing or handling chemo agents. 2. Keep all food and drink away from preparation area. 3. Wash hands before and after handling chemo agents. 4. Avoid hand to mouth or hand to eye contact while handling chemo agents or body fluids of the person receiving chemo.

. Wear along sleeves non absorbent gown with elastic at the wrist and back closure. 8. 5. 7. Eyes and face shields should be worn if splashes are likely to happen. puncture or medication spill every after 60 minutes of wear. Wear nitrite examination gloves when preparing or working with chemo agents. Wash hands before putting on and after removing gloves 6. Change gloves after each use.Personal safety at all times 4. tear.

Use syringe and IV tubings with Luer locks (with locking device to hold needle firmly in place)‫‏‬ 11. If any contact with the skin occurs. Label all syringes and IV tubings containing chemo agents as hazardous material.Personal safety 10. immediately wash the area thoroughly with soap and water. 12. . 13. Place an absorbent pad directly under the injection site to absorb any accidental spillage.

Personal safety 14. immediately flush the eye with water and seek medical attention.made with the eye. 15. Spills kit should be available in all areas where chemo agents stored. prepared and administered . If contact.

. 2. Discard gloves and gown into a leak proof container. 3. body fluids and excreta 1. Linen contaminated with chemotherapy or excreta from patients who have received the drug within 48 hours should be contained in specially marked hazardous waste bags.Safe disposal of antineoplastic agents. which should be marked as contaminated or hazardous waste. Use puncture proof and leak proof containers for needles and other sharp and breakable objects.

RADIATION THERAPY ROLE IN CANCER PREVENTION: •Primary curative role •Adjunct to other therapy •Palliation SOURCES OF RADIATION THERAPY: 1. Administer via an X-ray machine . External Radiation Therapy (Teletherapy).III.

IV)‫‏‬ . Internal Radiation Therapy Administer within or near the tumor TYPES: •Sealed Source (Brachytherapy)‫‏‬ •Unsealed Source (oral.Sources of radiation 2.

Erythema. Atopic. depigmentation. NURSING RESPONSIBILITIES: •Observe early signs of skin reaction and report •Keep area dry •Wash area with water. necrotic or ulcerative lesions. SKIN REACTIONS A. telangectasia. dry or moist desquamation B. no soap and pat dry ( do not rub)‫‏‬ .Side effects of radiation therapy 1.

These serve as guide for areas of irradiation.Side effects •Do not apply ointments. . avoid direct sunlight or cold •Use soft cotton fabrics for clothing •Do not erase markings on the skin. powders or lotions on the area •Do not apply heat.

Side effects 2. INFECTION Due to bone marrow suppression NURSING RESPONSIBILITIES: •Monitor blood count weekly •Good personal hygiene. nutrition and adequate rest •Teach signs of infection to report to physician .

.Side effects of radiation 3. HEMORRHAGE Platelets are vulnerable to radiation NURSING RESPONSIBILITIES: •Monitor platelet count •Avoid physical trauma or use of aspirin •Teach signs of hemorrhage •Monitor stool or skin for signs of hemorrhage •Use direct pressure over injection sites until bleeding stops.

MANAGEMENT: Plenty of rest and good nutrition 5. FATIQUE Result of high metabolic demands for tissue repair and toxic waste removal. WEIGHT LOSS Anorexia.Side effects of radiation 4. pain and effect of cance .

STOMATITIS Ulceration of oral mucus membrane NURSING INTERVENTIONS: •Administer analgesics before meals •Bland diet. no smoking and alcohol drinking •Good oral hygiene by using saline rinse every 2 hours •Sugarless lemon drops or mint to increase salivation .Side effects of radiation 6.

Social Isolation . Alopecia 11.Side effects of radiation 7. Diarrhea 8. Headache 10. N/V 9. Cystitis 12.

Principles of radiation protection DISTANCE Maintain a distance of atleast 3 feet when not performing nursing procedures TIME Limit contact for 5 minutes each time. a total of 30 minutes per shift SHIELDING Use lead shield during contact with client .

and the machine may move during the therapy . Client may hear sounds of the machine being operated. •Each treatment may usually last for few minutes.Teaching guidelines regarding radiation therapy •It is painless •Lie very still in a special table while the intervention is being given and client may be placed in a special position to maximize tumor irradiation.

•The technologist will be right outside the room observing the client through a window or by a closed circuit TV. Safety precautions are necessary only during the time the client is actually receiving irradiation . Client and technologist may communicate •There is no residual radioactivity after the therapy.Teaching guidelines •As a safety precaution for the therapy personnel. client will remain alone in the treatment room while the machine is in operation.

. BONE MARROW TRANSPLANTATION Bone marrow cells are collected from the client or another donor and then administer to the client after his diseased bone marrow is destroyed by chemotherapy or radiation. PATIEN TEACHING: •Inform the client that bone marrow transplant will deplete his WBCs. putting him at high risk for infection immediately after the procedure. he will be placed on reverse isolation for several weeks.IV. As a safeguard.

diarrhea. bruising and bleeding)‫‏‬ . which may include chemotherapy and radiation.Bone marrow transplant 2. During this regimen. he should expect adverse reactions such as parotitis. fatique. Prepare client for pretransplantation regimen. N/V and symptoms of bone marrow depression (fever. chills. fever.

Assess the client every 4 hours for infection symptoms. 3. During transfusion. dyspnea and hypotension. monitor client's v/s closely to allow prompt detection of reactions such as fever. Take measure to protect him from injury. Maintain strict asepsis when caring for the client.Nursing management for BMT 1. . such as fever and chills. 2.

GVHD usually occurs during the first 90 days after transplant and may become chronic. infection o death. hepatitis. such as dermatitis. lymphatic depletion. or it may cause transplant failure.Management of BMT 4. . Watch for signs of graft-versus-host disease. hemolytic anemia and thrombocytopenia.

•Urge him to keep regular medical appointments so doctor can monitor his progress and detect late complications. Warn him that he may remain unusually vulnerable to infection for up to 1 year after BMT.Management of BMT HOME INSTRUCTIONS: •Tell client to guard against infection. .

TYPES OF IMMUNOSUPPRESSANT DRUGS:1. . ANTILYMPHOCYTE SERUM It is a powerful non specific immunosuppressant that destroys circulating lymphocytes. IMMUNOSUPPRESSANT THERAPY Iatrogenic (treatment induced) immunodeficiency may be a complicating adverse effect of chemotherapy or other treatment. thus suppressing cell mediated immunity. It reduces T-cell number and function.V.

Adverse effects of ATG include anaphylaxis and serum sickness.IST Antilymphocyte serum has been used effectively to prevent cell-mediated rejection of tissue grafts or transplants. it is given immediately before transplantation and continued for sometime afterward. Usually. ANTITHYMOCYTE GLOBULIN ATG causes specific destruction of T lymphocytes. 2.arising 1-2 weeks .

malaise. arthalgias and sometimes glomerulonephritis or vasculitis. rash. Serum sickness is marked by fever. CORTICOSTEROIDS These are adrenocortical hormones used widely to treat immune-mediated disorders because of their potent anti-inflammatory and immunos uppressant effects by stabilizing the vascular memebrane.IST After injection. 3. blocking tissue infiltration by neutrophils and .

. resulting in depressed cell-mediated immunity.IST And monocytes and thus inhibiting inflammation. CYCLOSPORINE Selectively suppresses the proliferation and development of T-mediated cells. They also kidnap T-cells in the bone marrow. causing lymphopenia. 4.

Unfortunately. CYTOTOXIC DRUGS Kill immunocompetent cells while they are replicating. As a result.IST 4. most of these agents are not selective. they cause depletion of lymphocytes and phagocytes and interfere with lymphocyte synthesis and release of immunoglobulins and lymphokines. . they intefere with ALL rapidly proliferating cells.

OPIOD ANALGESICS Prescribe to relieve moderate to severe pain TYPES: •AGONIST. hydromophone. morphine .VI. meperidine. PAIN MANAGEMENT 1.are drugs that produce analgesia by binding to CNS opiate receptors. These are the drug of choice for severe chronic examples: codeine.

They are of limited use for clients with chronic pain because many have ceiling effect or upper dosing limit.opiod •AGONIST-ANTAGONISTS. nalbuphine. Examples: buprenorphine. butorphanol. pentazocine .also produce analgesia y binding to CNS receptors.

. During the administration. 2.opiods CONTRAINDICATED FOR CLIENT WITH: •Severe respiratory depression like COPD •Renal and hepatic impairment •Head injuries or any condition that raise ICP NURSING MANAGEMENT: 1. check clients v/s and watch for respiratory depression. Before giving opiods. make sure the client is not taking a CNS depressant such barbiturate.

opiods ADVERSE EFFECTS: •N/V •Constipation •Respiratory depression •Hypotension .

acetaminophen ADVERSE EFFECTS OF NSAIDs: •Inhibit platelet aggregation (rebound when drug stopped)‫‏‬ •GI irritation. ibuprofen. liver damage (in long term use)‫‏‬ . indomethacin.aspirin. Hepatotoxicity. NON OPIODS ANALGESICS Are prescribed to manage mild to moderate pain EXAMPLES: NSAIDs. nephrotoxicity.Pain management 2. headache. naproxen.

Give medication with food or water to minimize GI upset. . 2. Notify the doctor if the client experiences gastric burning or pain.Non opiods NURSING MANAGEMENT: 1. Instruct client to remain standing for 15-20 minutes after taking his medication if he experiences esophageal irritation. 3.

. •Ask client if he experiences persistent tinnitus ( a reversible dose related adverse effect)‫‏‬ •Exercise caution when taking ibuprofen and naproxen when driving or use machinery because they can cause dizziness. •Submit client to periodic blood test to detect possible nepro or hepatotoxicity.Non opiods •Avoid injury that could cause bleeding because NSAIDs increase bleeding time.

ADJUVANT ANALGESICS are drugs that have other primary indications but are used as analgesics in some cicumstances.Pain management 3. Adjuvants may be given in combination with opiods or use alone to treat chronic pain. . Clients receiving adjuvants should be reevaluated periodically to monotor their pain level and check for adverse reactions.

gabapentin.g. e. tetracaine . Amide drugsbupivacaine. Carbamazepine.lidocaine.e. •Ester drugs-cocaine.Adjuvant analgesics EXAMPLES: •ANTICONVULSANTS may be use to treat neuropathic pain ( pain generated by peripheral nerves).g. phenytoin •LOCAL ANESTHETICS may be use to manage neuropathic pain or as alternative to general anesthesia.

and agents used for short term pain relief and muscle spasm •TRICYCLIC ANTIDEPRESSANTS (TCAs) are antidepressant with the longest history in managing neuropathic pain. .Adjuvant analgesics •TOPICAL ANESTHETICS are applied directly to the skin or mucus membranes to prevent or relieve minor pain •MUSCLE RELAXANT S can be classified as neuromuscular agents. antispasmodic agents.

paroxetine)‫‏‬ •BENZODIAZEPINES are used primarily to ease anxiety and muscle spasm.(diazepam. (sertraline.Adjuvant analgesics • SELECTIVE SERATOTIN REUPTAKE INHIBITORS (SSRIs) are anti depressant with pain relief as well.(caffein. midazolam)‫‏‬ •PSYCHOSTIMULANTS are use mainly to treat Parkinson and ADHD. it can also be use in managing acute and chronic pain disorders. dextroamphetamine)‫‏‬ .

They relax muscles and decrease GI secretions. NEUROSURGERY Is an extreme form of pain management and is rarely needed .Adjuvant analgesics •CHOLINERGIC BLOCKERS are used to treat spastic or hyperactive conditions of the GIT. belladonna)‫‏‬ 4. (scopolamine hydrobromide.

neurosurgery EXAMPLES: •NEURECTOMY-resection or partial or total excision of a spinal or cranial nerve. to relieve visceral pain on both side of the body. . •RHIZOTOMY-cutting a nerve to relieve pain •CORDOTOMY-may be unilateral. to relieve pain on one side of the body or bilateral.

. or both.Neurosurgery •CRYOANALGESIA.deactivates a nerve using a cooled probe that causes temporary nerve injury. •RADIO FREQUENCY LESIONING may affect the nerve from the heat generated. the magnetic field created by the radio waves.

guided imagery.Pain management 5. distraction. TRANSCUTENOUS ELECTRIC NERVE STIMULATION Relieves acute and chronic pain by using a mild electric current that stimulates nerve fibers to block the transmission of pain impulses in the brain 6. hypnosis and meditation . COGNITIVE BEHAVIORAL TECHNIQUES May be used to help the client reduce the suffering associated with pain. These techniques include biofeedback.

COMPLICATIONS OF CANCER 1. SVCS may lead to cerebral anoxia ( because not enough oxygen reaches the brain). If untreated.VII. . SUPERIOR VENA CAVA SYNDROME Compression or invasion of tumor in superior vena cava. bronchial obstruction and death. laryngeal edema.

NURSING MANAGEMENT svcs •Identify clients at risk for SVCS •Monitor and report clinical manifestations of SVCS •Monitor cardiopulmonary and neurologic status •Avoid upper extremity venipuncture and blood pressure measurement •Facilitate breathing by positioning the client properly •Promote energy conservation to minimize shortness of breath .

•Provide post op care as appropriate . •Assess for thoracic radiation-related problems such as dysphagia and esophagitis.SVCS •Monitor the client's fluid volume status and administer fluids cautiously to minimize edema. such as myelosuppression. •Monitor for chemo-related problems.

. Compression of the cord and its nerve roots may result from tumor. lymphomas. intervertebral collapse or interruption of blood supply to the nerve tissues.Complications of ca 2. SPINAL CORD COMPRESSION Potentially leading to permanent neurologic impairment and associated morbidity and mortality.

•Maintain muscle tone by assisting with ROM exercises. •Control pain with pharmacologic and non pharmacologic measures.SCC NURSING MANAGEMENT: •Perform ongoing assessment of neulogic function to identify existing and progressing dysfunction. •Prevent complications of immobility resulting from pain and decrease function. .

lifestyle.SCC NURSING MANAGEMENT: •Institute intermittent urinary catheterization and bowel training programs for client with bladder or bowel dysfunction. roles and independence. . •Provide encouragement and support to client and family coping with pain and altered functioning.

HYPERCALCEMIA In clients with cancer.Complications of ca 3. . hypercalcemia is a potentially life-threatening metabolic abnormality resulting when the calcium released from the bones is more than the kidneys can excrete or the bones can reabsorb.

•Educate client and family.hypercalcemia NURSING MANAGEMENT: •Identify clients at risk for hypercalcemia and assess for S/S of hypercalcemia. •Teach at risk clients to recognize and report S/S f hypercalcemia •Encourage clients to consume 2-3L of fluids per day unless contarindicated by existing cardiac disease . prevention and early detection can prevent fatality.

•Promote mobility y emphasizing its importance in preventing demineralization and breakdown of bones. •Discuss antiemetic therapy if N/V occur.hypercalcemia NURSING MANAGEMENT. . •Explain the use of dietary and pharmacologic interventions such as stool softeners and laxatives for constipation. •Advise client to maintain nutritional intake without restricting normal calcium intake.

As ventricular volume and cardiac output fall. PERICARDIAL EFFUSION AND CARDIAC TAMPONADE Cardiac tamponade is an accumulation of fluid in the pericardial space.Complications of ca 4. and circulatory collapse develops. . the heart pump fails. The accumulation compresses the heart thereby impedes expansion of the venticles and cardiac filling during diastole.

respiratory status.Complications of ca NURSING MANAGEMENT: •Monitor V/S and oxygen saturation frequently. neck vein filling. level of consciousness. •Monitor and record I and O . •Assess for pulsus paradoxus (pulse becomes weaker during inspiration)‫‏‬ •Monitor ECG tracings •Assess heart and lung sounds. and skin color and temperature.

Pericardial effusion •Review laboratory findings (ABG. •Provide frequent oral hygiene . administer supplemental oxygen as prescribed. •Minimize client's physical activity to reduce oxygen requirements. electrolytes levels)‫‏‬ •Elevate the head of the client's bed to ease breathing.

and provide supportive measures and appropriate client instruction. •As needed. maintain patent IV access. reorient the client.Pericardial effusion •Reposition and encourage the client to cough and take deep breaths every 2 hours. .

. GIT. and lungs.Complications of ca 5. DIC is most commonly associated with hematologic cancers (leukemia). DESSIMINATED INTRAVASCULAR COAGULATION Complex disorder of coagulation or fibrinolysis (destruction of clots). cancer of prostate. which results in thrombosis and bleeding.

headache. decreased UO. tube insertion site. visual disturbances. chest pain. level of consciousness. bowel sounds. . and abdominal tenderness •Inspect all body orifice. incisions and bodily excretions for bleeding.DIC NURSING MANAGEMENT: •Monitor V/S •Measure and document I and O •Assess skin color and temperature. lung. heart.

DIC •Review laboratory test results •Minimize physical activity to decrease injury risk and oxygen requirements. maintain a safe environment. •Reorient the client if needed. •Prevent bleeding •Assist the client to turn. and provide appropriate client education and supportive measures. and take deep breaths every 2 hours. . cough.

. produced by tumor cells or by the abnormal stimulation of the hypothalamic-pituitary network. uncontrolled releases of antidiuretic hormone (ADH). and excretion of urinary sodium. SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE (SIADH)‫‏‬ The continuous.Complications of ca 6. water intoxication. leads to increased extracellular fluids volume. hyponatremia.

creatinine. BUN. •Monitor lab test results. V/S. . osmolality. edema.SIADH NURSING MANAGEMENT: •Maintain I and O measurements •Assess level of consciousness. daily weight and urine specific gravity. lung and heart sounds. including serum electrolytes. also assess for N/V anorexia. and urinary sodium levels. fatigue and lethargy.

SIADH NURSING MANAGEMENT •Minimize the client's activity. and restrict fluid intake if necessary. •Reorient the client and provide instruction and encouragement as needed. provide appropriate oral hygiene. maintain environmental safety. .

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