CA-mgt

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OUR LIVES ARE MADE UP

OF A MILLION MOMENTS,SPENT IN A MILLION

DIFFERENT WAYS. BUT

THERE IS NO GREATERMOMENT THAN WE FIND

THAT LIFE ² WITH ALL

ITS JOYS AND SORROWS² IS MEANT TO BE LIVED

ONE DAY AT A TIME.

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Detection and Prevention of CancerDetection and Prevention of Cancer

PRIMARY PREVENTION

Acquisition of knowledge and skillsnecessary to educate client, communityabout cancer risk.

SECONDARY PREVENTION

Cancer screening programs for individuals who are found to be at high

risk for cancer

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y Prevention and detection Primary Prevention

xReducing modifiable risk factors in theexternal and internal environment

Secondary Prevention

xRecognizing early signs and symptomsand seeking prompt treatment

x

Prompt intervention to halt cancerousprocess

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NURSING RESPONSIBILITIES INNURSING RESPONSIBILITIES INEARLY DETECTION OF CANCER:EARLY DETECTION OF CANCER:STEPS TO REDUCE CANCER RISKWhen teaching individual patients or

groups,nurses can recommend the followingcancer prevention strategies:1. Increase consumption of fresh

vegetables (especially those of thecabbage family.)

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2. Increase fiber intake.3. Increase intake of Vitamin A.

4. Increase intake of foods richin Vitamin C.5. Practice weight control.6. Reduce intake of dietary fat.7. Practice moderation in

consumption of salt-cured,smoked and nitrate-curedfoods.

8. Stop smoking cigarettes andcigars.9. Reduce alcohol intake.10. Avoid overexposure to sun.

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RECOMMENDATION FOR EARLYRECOMMENDATION FOR EARLY

DETECTION OF CANCERDETECTION OF CANCERA. BREAST CANCER

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Risk FactorsRisk Factorsy Menarche before age 11y Menopause after age 50

y Family history of breast cancer ² especially mother

or sistery History of uterine cancer

y Nulliparity or birth of first child after age 30

y History of uterine cancer

y Link with obesity, diabetes and hypertension

y Presence of benign breast cyst.

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Clinical Manifestations/ AssessmentClinical Manifestations/ Assessment

y Most are found in upper outer quadrant orcentral (nipple) portion of the breast

y Firm, non-tender, non-mobile mass

y Solitary, irregularly shaped massy Asymmetry of the breast

y Orange ² peel appearance of the skin ordimpling (late)

y Nipple retraction (late)

y Abnormal discharge from nipple

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ScreeningScreening

y Breast Self

Examination

y Regular

mammograms

(screen all middle

aged woman)

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COLORECTAL CANCERCOLORECTAL CANCER

y COLORECTAL means colon and rectum combined

y

Highest for people older than 85 years of age

y High for people with familyhistor y of colon cancer, polyps adenomatous, of inflammator y bo wel disease, high fat, high protein (with high intake of beef), lo w fiber diet, genital or breast cancer in women

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DIAGNOSTIC PROCEDUREDIAGNOSTIC PROCEDURE

1. Colonoscopy

² an insertion of

fiber optic scope through the

rectum for direct

visualization of the

colon.

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2. Digital Rectal

Examination

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COLON CANCERCOLON CANCER

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PROSTATE CANCERPROSTATE CANCER

y Increasing age, after age 50

y Having father or brother with prostate

cancer doubles the risk of relatives y A diet high in red meat increase risk

y Difficulty and frequent urination, urinar yretention, decreased size and force of the urinar y stream

y Ever y man older than 40 should have DRE( Digital rectal exam ) as part of regular check up

y The more advanced lesion, it becomes ´

stony hard ´ and fixed

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DIAGNOSTIC PROCEDUREDIAGNOSTIC PROCEDURE

y DIGITAL RECTAL

EXAMINATION

y PROSTATE SPECIFIC

ANTIGEN

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TESTICULAR SELF EXAMINATIONTESTICULAR SELF EXAMINATION

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CERVICAL CANCERCERVICAL CANCER

y refers to the cancer of the neck of the uterus.Assessment:y Painless vaginal bleeding post-menstrual and

post-coitaly Foul-smelling or serosanguinous vaginal

dischargey Pelvic, lower back, leg or groin pain

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Normal

Pap smear

Abnormal

Pap smear

Cervical Cancer Screening

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THYROID CANCER

y - Lesions that are

single, hard, & fixed on palpation or associated

with cer vical

lymphadenopathy,

suggest malignancy.

SCREENING:

Use of fine or large bore needle biopsy,

Ultrasound, MRI, CT

Scan & Thyroid Scan

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LUNG CANCER

y Most common from

cigarette smoking.

y Genetic, underlying respirator y diseases, COPD, TB

y most common symptom is a cough or change in cough

y Repeated unresolved URTI

Diagnostic Examination:

Chest x ² ray - is

performed to search for pulmonar y density, a solitar y peripheral nodule (coin lesion), atelectasis and infection.

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Microscopic Appearance of Cancer

Cells

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NURSING PROCESS: THE PATIENTNURSING PROCESS: THE PATIENTWITH CANCERWITH CANCERI. ASSESSMENT

y Regardless of type of cancer treatment or prognosis many

patients with cancer are susceptibleto the following problems and complications.

y An important role of the oncology

nurse is to assess the patient for these problems and complications

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1. Infection

A. Assess factors that promotes infection:

y y

Impaired skin & mucus membrane integrityy y Chemotherapy

y y Radiation Therapy

y y Biologic Response Modifiers

y y Malignancy

y y Malnutrition

y y Urinar y Catheter, Intravenous Catheter

y y Other Invasive Procedures

y y Contaminated Equipment

y y Age

y y Chronic Illness

y y Prolonged Hospitalization

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B. Monitoring laboratory studies to detect

early changes in WBC county y Leukopeniay y Granulocytopeniay y Neutropenia

C. Chest x- ray

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2. Bleeding

A. Assess factors that contribute to bleeding

y y Bone marro w suppression from radiation

y y Chemotherapy

y y Medications that interfere with

coagulation and platelet functioning

B. Common bleeding sites:

y y Skin and mucous membranes

y y Intestinaly y Genito-Urinar y Tract

y y Respirator y tract

y y Brain

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C. Signs of bleeding

y y

Gross hemorrhagey y Blood in the

stools, urine, sputum, or vomitus

yy Oozing at injection

sites

y y Bruising (ecchymosis)

yy Petechiaey Changes in mental

status

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3. Skin Problems

y Assess predisposing factors andother risk factors

4. Hair LossAssess also the

psychological

impact of thisside effect on the

patient and the

family

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5.Nutritional

ConcernsCommon

Nutritional Problems:

1. Anorexia

2. Mal-absorption

3. Cachexia

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A. Impaired nutritional status maycontribute to:

y y Disease progressiony y Immune incompetencey y Increased incidence of infectiony y Delayed tissue repairy y Diminished functional abilityy Decreased capacity to continue

chemotherapy

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y B. Physical signs of weight lossand cachexia is secondary todecreased protein and caloricintake, metabolic, mechanicaleffects of cancer and systemicdisease, side effects of thetreatment or emotional statusof the patient.

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y C. Determine diet

histor y, any

episodes of

anorexia, changes

in appetite, altered

taste, nausea,

diarrhea,

situation and

foods that

aggravate or relieve anorexia

and medication

histor y

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D. Clinical and laboratory data useful inassessing Patient·s nutritional status

y y Anthropometrical measurementsy y Serum protein levelsy y Serum electrolytesy y Skin response to intradermal

injectiony y Hemoglobin and hematocrit levelsy y Serum Iron Levels

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6. Pain

A. Related factors causing pain:y y Underlying diseasey y Pressure exerted by tumory y

Diagnostic proceduresy y Cancer treatmentB. Assess site of pain, pain

perception, pain scales

C. Give emphasis not only to physicalpain but psychosocial as well.

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7. Fatigue

y y Fatigue has been recognized as one of the

significant and frequent symptoms experienced by patients receiving cancer therapy.

y y Assess for feelings of weariness, weakness, lack of energy, inability to carr y out ADL, lack of motivation, and inability to concentrate

y y Assess for physiologic and psychological stressors that contribute to fatigue, (pain,

nausea, constipation, fear, anxiety)8. Psychosocial Status

9. Body Image and Self-Esteem

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II. Nursing Diagnosis

y y Risk for infection related to altered immunologic

responsey y Impaired skin integrity: er ythematous and wet

desquamation reaction to radiation therapy.

y y Impaired oral mucous membranes related to stomatitis.

y y Imbalanced nutrition: less than body requirements related to nausea and vomiting.

y y Fluid and electrolyte imbalance related to anorexia, nausea & vomiting, altered taste, diarrhea

y

Anticipator y grieving related to loss of body parts and altered role functioning

y Disturbed body image and situational lo w self-esteem related to changes in appearance, function and roles

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y Self ² care deficit due to fatigue, malaise, and protective isolation

y Anxiety due to kno wledge deficit and uncertain future

y Disturbed body image r/t changes in appearance, function and roles

y Grieving r/t anticipator y loss and altered role functioning

y Potential for spiritual distress

y Deficient kno wledge about disease process,

treatment, complication management, and self care measures

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III.P lanning

y y Maintenance of tissue integrityy y Maintenance of nutritiony y Relief of painy y Relief of fatiguey y Improve body imagey y Effective progression through

grieving process y Absence of complications

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STOMATITISSTOMATITIS

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IV Nursing Interventions

Managing Stomatitis

o Provide good oral hygiene.

o Use soft bristled toothbrushes and nonabrasive toothpaste.

o Oral s wabs with sponge like applicators maybe use in place of toothbrush.

o Avoid alcohol based mouth rinses.

o Lubricate cracked and dr y lips

y Adequate food and fluid intake is encouraged

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Maintaining T issue Integrity

oHandle affected area gently.oAvoid rubbing or use of hot or cold

water, soaps, powder, lotion and

cosmetics avoidedoAvoid tissue injury by wearing loose-fitting clothing.

oAseptic technique should beobserved during dressing and woundcare.

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Assisting P atients to c ope w ith Al opec ia:

oProvide information about hair loss,support patient and family in copingwith disturbing effects of therapy.

o Instruct to acquire a wig or hairpiecebefore hair loss.

oEncourage use of attractive scarvesand hats.

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Managing Malignant Skin Lesion:yCarefully assessing and cleansing the

skin.yReducing superficial bacteria.yControlling the bleeding.yReducing odor.yProtecting the skin from pain and

further trauma.

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P romoting Nutrition:

oPrepare foods that are appealing.o Patient·s preferences as well asphysiologic and metabolic requirements

are considered when selecting foods.o Encouraged small frequent feedings.o Inform patient the advantage of receiving

alternative methods of feeding byparenteral or enteral route.

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Relieving P ain:

yProvide adequate rest and sleepoPromote diversional activities

oOffer EmpathyoGive pain reliever medications as

ordered

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Decreasing Fatigue:

o Help the patient and the family tounderstand that it is an expected andtemporary side effect of cancer processand of many treatment used.

o Help patient identify sources of fatigueo Plan activities to conserve energy as well

as alternate periods of rest.o Regular, light exercise is recommended

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Assisting in the Grieving process:o Grieving is a normal response to fears and

anticipated losses that include, loss of heath, normal sensations, body image, social interaction, sexuality and intimacy.

o Asses response of patient and family about the diagnosis and planned treatment.

o Assist in ans wering inquiries and questions, identif ying resources and support people.

o Assist patient and family acquire kno wledge to cope with the disease process

o Assist patient and family members to ackno wledge and cope with their reactions and feelings.

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Managing and Monitoring P otential

C omp

l ic ations:

1. Infectiono Strict asepsis technique

o Health teaching on how to recognize signs andsymptoms of infectiono Maintain skin integrity.

o Monitoring laboratory data.o Administration of antibiotics as ordered

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y 2. Septic Shock y Assess signs and symptoms of septic

shock.y Neurologic assessmenty Fluids and electrolyte status monitoringy Administration of intravenous fluids,

blood products, vasopressors, oxygen and

broad spectrum antibiotic as ordered.

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3. Bleeding and Hemorrhage

y Monitor laboratory values especiallyplatelet county Assess the patient for bleedingy

Taking steps to prevent trauma andminimize the risk for bleeding

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PRO MOTING HO ME AND CO MMU NITY B ASED

C ARE:y Teaching Patients Self-Care

y Continuing Care

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NURSING MANAGEMENT FOR DIFFERENTNURSING MANAGEMENT FOR DIFFERENT

MODALITIES OF TREATMENTMODALITIES OF TREATMENT

1. SURGERY

Types :a. Diagnosticb. Prophylactic

c. Palliatived. Reconstructive

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Aimed towards:Aimed towards:

CURE - free of disease aftertreatment normal life

Control - Goal for chroniccancers Palliative Care:

Quality of life maintainedat highest level for the

longest possible time

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y The patient undergoing surgery for cancer

requires general peri-operative nursing carewith specific care relate to the patient·s age,organ impairment, nutritional deficits,disorder of coagulation and altered

immunity that may increase the risk forpost-operative complications.y The nurse provides education and

emotional support by assessing patient andfamily needs.

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y Post operatively, the nurse assess the

patient response to the surgery.y Monitor for possible complicationy Post-operative teaching about wound

care, activity, nutrition andmedication information is given.

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2. Radiation Therapy2. Radiation Therapy-- ionizingionizing radiationradiationthat is used to:that is used to:

y interrupt Cellular gro wth

y Cure the cancer

y Used to control malignant disease when a tumor cannot be removed surgically

y Used when local nodal metastasis is present

y Used prophylactically to prevent leukemia, infiltration to the brain & spinal cord

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Radiotherapy ² directing high-energy ionizingradiation to destroy malignant tumor cells

without harming surrounding tissuesTypes:

² Teletherapy (external): radiation delivered in

uniform dose to tumor; Teletherapy is externalbeam irradiation and uses a device located at adistance from the patient. It produces X-rays of varying energies and is administered by

machines a distance from the body 31Â½ to 39inches (80 to 100 cm).

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Brachytherapy: delivers high dose totumor and less to other tissues;radiation source is placed in tumor ornext to it; In brachytherapy, the

radiation device is placed within orclose to the target tissue. Radiation isdelivered in a high dose to a small tissue

volume with less radiation to adjacentnormal tissue, but requires direct tumoraccess.

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Sources of Radiation TherapySources of Radiation Therapy

1. External RadiationTherapy

(Teletherapy)- administered

through an x-

ray machine.

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2. Internal Radiation

Therapy- administeredwithin or near

the tumor.Types:a. Sealed Source

(Brachytherapy)b. Unsealedsource (oral, IV)

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SIDE EFFECTS OF RADIATION THERAPYSIDE EFFECTS OF RADIATION THERAPY

AND ITS NURSING RESPONSIBILITIESAND ITS NURSING RESPONSIBILITIES1. SKIN REACTIONS

- erythema, dry/moist desquamation

- atrophy, telangiectasia,depigmentation,necrotic/ulcerative lesion.

NURSING RESPONSIBILITIES:* Observe for early signs of skin

reaction and report immediately.

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* Keep area dry

* Wash area with water, no soapand pat dry (do not rub).* Do not apply ointments, powders

or lotion on the area.* Do not apply heat, avoid directsunshine or cold.* Use soft cotton fabrics forclothing.* Do not erase markings on the

skin.

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2. INFECTION3. HEMORRHAGE4. FATIGUE5. WEIGHT LOSS6. STOMATITIS

7. DIARRHEA8. NAUSEA AND VOMITING9. HEADACHE

10. ALOPECIA11. CYSTITIS12. SOCIAL ISOLATION

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Principles of Radiation Protection:Principles of Radiation Protection:

1. DISTANCE

- maintain a distance of at least 3 feetwhen not performing nursing procedures.

2. TIME

- Limit contact for 5 minutes each time, a totalof 30 minutes per shift.

3. SHIELDING- Use lead shield during contact with client.

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Safety Precautions in RadiationSafety Precautions in RadiationTherapyTherapyy Assigning to a private roomy Posting notices

y Wear dosimeter badges

y Not assigning pregnant staff y Prohibits children

y Limit visits 30 minutes daily

y

Maintain 3 feet distance from theradiation source and use the Principle of time,distance and shielding.

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3. Chemotherapy3. Chemotherapy

-antineoplastic agents that are used in an attempt to destroy tumor cells byinterfering with

cellular functions and reproduction.

Goals: cure, control, palliation

Route: topical, oral, IV, IM, Subcutaneous, arterial, intra-cavitar y & intrathecal

Special Problem : EXTRAVASATION

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Contraindications:Contraindications:

1. Infection2. Recent surgery

3. Impaired renal or hepatic function4. Recent radiation therapy5. Pregnancy

6. Bone marrow depression

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CHEMOTHERAPEUTIC AGENTSCHEMOTHERAPEUTIC AGENTS

1. Alk ylating

busulfan, carboplatin, chlorambucil, cisplatin,

cyclosphosphamide, dacarbazine, hexamethyl melamine, ifosfamide, melphalan, nitrogen mustard, thiotepa

Alter DNA structure by misreading D

NA code, initiating breaks in the DNA molecule, cross linking DNAstrands.

Toxic Effects: reversible renaltubular necrosis

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2. Antimetabolites -

cytarabine, 5- flouroracil (5

FU), pentostatine

y - Interfere with the

biosynthesis of

metabolites or nucleic acids necessar y for RNA

and DNA synthesis

Toxic Effects: nausea,

vomiting, stomatitis,diarrhea, alopecia,leukopenia

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3. Plant alkaloids ²

etoposide, teniposide, Vinblastine,

Vincristine,

- Arrest metaphase by

inhibiting mitotic

tubular formation

(spindle), inhibit D

NAand protein synthesis.

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4. Antitumor antibiotics ²

bleomicin doxorubicin, Mitomycin

y Interfere with DNAsynthesis by binding to DNA, prevent RNAsynthesis

Toxic Effect: damageto cardiac muscle

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Indications of extravasations duringIndications of extravasations duringadministration of vesicantsadministration of vesicants includes:includes:

y Absenc e of bl ood return from the

intravenousc atheter

y Resistanc e to f l ow of intravenous

f l uid

y Sw ell ing, pain, redness, at the

site

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If extravasation is suspec ted:If extravasation is suspec ted:

y Medication administration stopped immediately

Ice applied to the site (except for

vesicant vinca alkaloid)y P hysician may aspirate any

infiltrated medications from thetissues and inject neutralizing

solution into the area to reducetissue damage

Examples of neutralizing solutions: (sodiumthiosulfate, hyaluronidase, and sodium bicarbonate

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Side Effects of Chemotherapy:Side Effects of Chemotherapy:

1. Gastro-intestinal systema. Nausea and Vomiting

b. Diarrheac. Constipation2. Integumentary system

a. Pruritus, urticaria and systemic signs

b. Stomatitisc. Alopeciad. Skin Pigmentatione. Nail Changes

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3. Hematopoietic System

a. Anemiab. Neutropeniac. Thrombocytopenia

4. Genito-Urinary Systema. Hemorrhagic Cystitisb. Urine color changes

5. Reproductive system

a. Premature menopause or amenorrhea

S f P i i Ad i i iS f P i i Ad i i i

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Safety Precautions in AdministeringSafety Precautions in AdministeringChemotherapy:Chemotherapy:

y Use of biologic safety cabinet for the preparationof all chemotherapy agents.

y W ear surgical gloves when handling antineoplastic

agents and the excretions of patients who received chemotherapy.

y W ear disposable, long sleeved gowns when preparing and administering chemotherapy agents.

y Use Luer- Lock fittings in all intravenous tubing used to

deliver chemotherapy.y Disposal of all equipment used in chemotherapy

preparation and administration in appropriate, leak- proof, puncture proof containers

y Disposal of all chemotherapy wastes as hazardousmaterials

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CHEMOTHERAPYCHEMOTHERAPY

44 THERMAL THERAPYTHERMAL THERAPY

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4.4. THERMAL THERAPY orTHERMAL THERAPY orHYPERTHERMIAHYPERTHERMIA

- The generation of temperatures greaterthan physiologic fever range ( above 41.5¶C ) has been used for many years to

destroy tumors in human cancer.Using radio waves can produce heat,

ultrasound, microwaves, magnetic waves,

and hot water baths, hot wax immersions.

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I h f h l

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Immunotherapy ² use of chemical

or microbial agents to inducemobilization of immune defenses.� Biologic response modifiers

(BRMs) ² use of agents that altersimmunologic relationship between

tumor and host in a beneficial way

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BRMBRM

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Nursing Management:Nursing Management:y Patients receiving BRM therapy have many of

the same needs as cancer patients undergoingtreatment approaches

y BRM therapies are still investigational aconsidered a last-chance effort by manypatients.

y Essential that the nurse assess the need for

education, support and guidance for thepatient and family in planning and evaluatingpatient care.

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6.6. PHOTODYNAMICPHOTODYNAMIC THERAPYTHERAPY

- a ternar y treatment for cancer involving 3 keycomponents: a photosensitizer, light and tissue oxygen.

- A photosensitizer is a chemical compound (Porfimer) that can be

excited by a light of a specific wavelength.

- Use as a treatment for basal cell carcinoma.

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MAJOR SIDEMAJOR SIDE EFFECT:EFFECT:

PHOTOSENSITIVITY FOR 4 TO 6 WEEKSAFTER TREATMENT

NURSING MANAGEMENT:y

Instruct client to protect themselves fromdirect and indirect sunlight to prevent skinburns.

y Liver and renal function should be monitor.y Offer emotional support and educate theclient and family regarding the therapy.

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8.8. GENE THERAPYGENE THERAPYy A technique for correcting

defective genes responsible

for disease development.

y A gene is inserted into the

genome to replace an abnormal, disease causing

gene.

y Viruses are used as a gene

therapy vectors such as

retrovirus, adenovirus,her pes simplex

virus.

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8. Bone Marrow8. Bone Marrow TransplantationTransplantation

Types

y 1. Autologous ² from

patient

y 2. Allogenic - from a

donor other than a

patient.Eg. family

member, matched

unrelated donor,(bone

marro w registr y)

y 3. Syngeneic - from an

identical t win

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Procedure:Procedure:

y 1. Donor suitability is determined throughtissue antigen typing of human leukocyteantigen (HLA) and mixed leukocyte

culture (MLC)y 2. Donor bone marrow is aspirated from

multiple sites along iliac crest under generalanesthesia

y 3. Donor marrow is infused IV into therecipient

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COMPLICATIONS:COMPLICATIONS:

1. Failure of engraftment2. Infection: highest risk in 3 to 4 weeks3. Pneumonia: non bacterial or intestinal

pneumonia are principal causes of death on the first 3 months post transplant

4. (GVHD) Graft vs., host disease: principalcomplication caused by an immunologic

reaction of engrafted lymphoid cellsagainst the tissue of the recipient

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y - Acute GHVD ² develops within first 100

days post transplant and affectsGUT, liver, marrow, and lymphoidtissue

y

-Chronic GVHD ² Develops 100 ² 400 dayspost transplant manifested by multi- organinvolvement

5. Recurrent malignancy6. Late complications such as cataracts, andendocrine abnormalities

NURSING CARE PRETRANSPLANT

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NURSING CARE PRETRANSPLANT

1. Recipient immunosuppression attained with total body

irradiation (TBI) and chemotherapy to eradicateexisting disease and create space in host marrow toallow transplanted cells to grow.

2. Provide protective environment.y

A. Client should be in laminar airflow room orstrict reverse isolation.y B. Objects must be sterilized before being brought

to the room.y

C. When working with children, introduce newpeople were they can be seen, but outside child·sroom so they can see what they look like withoutisolation garb.

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3. Monitor central lines frequently.

Check patency and obser ve signs of

infection such as fever, redness

around sight.

4. Provide care for client receiving

chemotherapy and radiation therapy

that induce immunosuppression.

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NURSING CARE POST TRANSPLANT

1. Prevent Infection.2. Provide mouth care for stomatitis and

mucositis.

3. Provide skin care.4. Monitor carefully for bleeding.5.Maintain fluid and electrolyte balance and

promote nutrition.

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99 UNPROVEN & UNCONVENTIONALUNPROVEN & UNCONVENTIONAL

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9.9. UNPROVEN & UNCONVENTIONALUNPROVEN & UNCONVENTIONALTHERAPIESTHERAPIES

y also called

Complementar y and

Alternative Medicine.

y CAM treatments are the diverse group of medical

and health care systems,

practices & products that

are not presently

considered to be effective

by the standards of

medicine.

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Nursing ManagementNursing Management

y Trusting relationship, supportive care, andpromotion of hope with the patient and family.

y Truthful responses should be given in

nonjudgmental manner to questions andinquiries about unproven methods.

y The nurse should encourage any patient who

uses unconventional therapies to inform thephysician about such use.

NURSING MANAGEMENT FORNURSING MANAGEMENT FOR

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NURSING MANAGEMENT FORNURSING MANAGEMENT FORONCOLOGIC EMERGENCIES:ONCOLOGIC EMERGENCIES:

1. SUPERIOR VENA CAVA SYNDROME(SVCS)

INTERVENTIONS:y Assess for signs and symptoms of SVCS.y Monitor cardiopulmonary and neurologic status.y Promote energy conservation to minimize

shortness of breath.y Prepare the patient for radiation therapy to the

mediastinal area.

2 SPINAL CORD COMPRESSION

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2. SPINAL CORD COMPRESSION

INTERVENTIONS:

y Assess for back pain and neurologicaldeficits.

y Prepare the client for radiation and/or

chemotherapy.y Surgery may be needed to remove the

tumor and relieve the pressure to spinal

cord.y Instruct the client in the use of neck or back

braces if they are prescribed.

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4. PERICARDIAL EFFUSION &

CAR

DIA

CTAMPONA

DE

INTERVENTIONS:y Monitor vital signs and oxygen saturation

frequently.y Assess for pulsus paradoxus.y Monitor ECG tracingsy

Assess heart and lung sounds.y Monitor and record intake and output

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y Elevate the head of patient·s bed.

y Minimize patient·s physical activity.y Reposition and encourage the patient to

cough.

y Provide frequent oral hygiene.y As needed, maintain patient IV access, reorient

the patient, provide supportive measures and

appropriate patient instruction.

5. DIC/CONSUMPTION

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5. DIC/CONSUMPTION

COAGULOPATHY

INTERVENTIONS:y Measure and document Intake & outputy Inspect all body orifices & tubes for bleeding

y Prevent bleedingy Administer anticoagulant as prescribed.y Administer cryoprecipitated clotting factors

if DIC progress and hemorrhage is theprimary problem.

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6. SIADH

INTERVENTIONS:y Monitor accurate recording of intake and

output.y

Initiate fluid restriction and increased sodiumintake as prescribed.y Administer antidiuretic hormone antagonist

as prescribed.y Monitor serum sodium levels.

7. TUMOR LYSIS SYNDROME

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7. TUMOR LYSIS SYNDROME

INTERVENTIONS:

y Monitor Intake and Output.y Encourage oral/IV hydration.

y Administer diuretics as prescribed.

y

Administer medications that increase the excretionof purine as prescribed.

y Prepare to administer IV infusion of glucose andinsulin to treat hyperkalemia.

y Prepare the client for dialysis if hyperkalemia andhyperuricemia persist despite treatment.

P h i l p t f

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P sychosocial aspects of cancer

care: When cancer becomes a part of life·s journeyit is hard work .

y

Providing support for client (your presence as a caring person)

y Providing support for the family

y Promoting positive self concept

y Promoting coping throughout the cancer continuum

y a Diagnosis and treatment (clients

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y a. Diagnosis and treatment (clients received diagnosis and treatment in

different ways)y b. Sur vivorship (client who entered

successful treatment enter an indeterminate period of long ² term

sur vivorship)y c. Recurrent disease and progression

(most clients live with the threat or realityof recurrent disease)

y

d.

Terminal illness, ´

when everything is donethat can be done, compassion is the only thing that brings beauty and meaning to our lives.

It is the irreplaceable giftµ.

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THEEND«««««.

GOD BLESS US

ALL!

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CA-mgt

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