Oncology Janna Wickham RN MSN LSSC Spring 2014
Jan 15, 2016
OncologyJanna Wickham RN MSN
LSSC Spring 2014
Statistics & Definition Cancer
1500 people die every day from cancer 1 out of 4 deaths is caused by cancer Lung cancer 28% of all deaths
Cancer Any age, gender, ethnicity, or geographic region Normal cells change and acquire malignant properties
Risk Factors Heredity
Age
Gender
Poverty
Risk Factors Stress
Diet High fat Low fiber
Occupation
Infection Virus (Epstein –Barr for example)
Tobacco Use
Risk Factors Alcohol Use
Recreational Drug Use
Obesity
Sun Exposure
Figure 14–1 Interaction of factors that promote cancer.
Cell Cycle G0
Gap 1 (G1) Synthesis (S) Gap 2 (G2) Mitosis (M)
Differentiation
Hyperplasia Under normal DNA control
Metaplasia
Dysplasia Abnormal variation in size, shape, and appearance
HPV causes dysplasia of the cervix
Anaplasia
Theories of Carcinogenesis Cellular Mutation
Carcinogens cause mutations in cellular DNA Oncogene
BRCA1 BRCA2
Tumor Suppression Genes Suppress oncogene
p53
Carcinogens Genotoxic
Directly alter DNA
Promotor Substances Adverse biologic effects
Cytotoxicity Hormonal imbalances Altered immunity Chronic tissue damage
Carcinogens Viruses
Drugs and Hormones
Chemical agents
Physical Agents
Metastasis Blood or lymph
Target organs
Cell morphology
Immune response
Types of Neoplasms
Physiologic Effects of Cancer Disruption of Function
Hematologic Anemia Neutropenia Thrombocytopenia
Infection Tumor necrosis
Physiologic Effects of Cancer
Hemorrhage
Anorexia-Cachexia Syndrome Unexplained rapid weight loss Emaciation Malnutrition Loss of energy
Paraneoplastic Syndrome Endocrine related
Physiologic Effects of Cancer Pain
Acute
Chronic
Physical Stress
Psychological Effects of Cancer Stress
Diagnosis Assess
Lab Diagnostic workup Biopsy
Classification
Cytologic Examination Exfoliation from an epitheleal base
Aspiration of fluid from Body cavity Blood
Needle aspiration of solid tumors
Grading/Staging Differentiation – level of functional maturity Grade 1 – Grade 4
Grade 1 most like parent cell Grade 4 least differentiated
TNM –used to stage solid tumors
Example 45 year female with lobular breast cancer Tumor 0.8cm 1 positive axillary lymph node No evidence of metastasis
Laboratory Tests Table 14-8
CBC Normal Abnormal Critical
Nadir
The nadir is the time point after cancer treatment when your blood counts (white blood cell, hemoglobin and platelets) are at their lowest
complications of low counts; including infection risk (due to low white blood cell count), bleeding risk (due to low platelet count), poor oxygen delivery to tissues which can cause fatigue, chest pain, shortness of breath, dizziness (due to low hemoglobin, also called anemia)
The nadir most commonly occurs 10-14 days after chemotherapy treatment, but this time can vary depending on the chemotherapy
Neutropenic Precautions
https://www2.ons.org/ClinicalResources/media/ons/docs/research/outcomes/infection/quickview.pdf
Thrombocytopenia <100,000 How to take care of yourself if your platelets are low: Watch for unexplained bruises Try not to bump or cut yourself. Be careful with knives and other sharp instruments. If you develop bleeding, place pressure over the area for 5–10 minutes with ice. Use a soft tooth brush for mouth care. Do not use aspirin or products Take any steroid medications such as prednisone or decadron with milk, food, or an
antacid A platelet transfusion may be necessary if platelet count is below 20,000 or
bleeding Use an electric shaver rather than blades to shave with. Avoid constipation—when straining to have a bowel movement. Do not use suppositories, enemas, or a rectal thermometer. Avoid intra-muscular (IM) injections if possible. Monitor for bleeding with intercourse. Try to avoid blowing your nose too hard or coughing too hard.
Tumor Markers Antigens
Hormones
Proteins
Enzymes
Imaging Scans
Computerized tomography Has the tumor metastasized
MRI Nuclear Imaging
Bone metastasis Thyroid cancer
PET Metastasis
End of Day One
Pharmacologic Management
Chemotherapy Alkylating Agents Antimetabolites Antitumor Antibiotics Mitotic Inhibitors Hormones and Hormone Antagonists
Cell Cycle Specific Table 14-10
Toxic Reaction
Miotic Inhibitor Vincristine Depression of deep
tendon reflexes (motor weakness)
Paresthesias (pain and altered sensations)
Alkylating Agent busulfan- Myleran Bone Marrow Failure Assess for infection
Venous Access Devices PICC
Port
Tunneled Catheter
Nursing Management of Patients Receiving Chemotherapy Bone Marrow Suppression
Gastrointestinal Effects Stomstitis Nausea & Vomiting
Alopecia
Non-pharmacologic Management Surgery
Non-pharmacologic Management Radiation External(teletherapy)
Adverse effects Nursing Care
Internal (brachytherapy) Box 14-6 Safety principles Adverse effects Nursing care
Bone Marrow
Lead shieldDosimeterLimit time
Non-pharmacologic Management Biotherapy(Immunotherapy)
Monoclomal antibodies Cytokines Natural Killer Cells
Non-pharmacologic Management Photodynamic Therapy
Adverse Effects Nursing Care
Non-pharmacologic Management Bone Marrow and Stem Cell Transplants Complementary Therapies
Oncologic Emergencies Superior Vena Cava Syndrome Sepsis & Septic Shock Tumor Lysis Syndrome Hypercalcemia
Physiologic Needs in Advanced Stages of Cancer Comfort
Round the clock and breakthrough pain management Nutrition Elimination Mobility Hygiene
Supportive Care Grieving Fear Caregiver Support
Nursing Diagnosis Anxiety
Disturbed Body Image
Anticipatory Grief
Nursing Diagnosis Risk for Infection
Intervention to avoid large crowds
Risk for Injury
Imbalanced Nutrition: Less than body requirements related to anorexia
Nursing Diagnosis Impaired Tissue Integrity
Palliative Care
Terminal Diagnosis Comfort care Family Care
Pediatric Considerations Effects the whole family Lifespan considerations