Documente Academic
Documente Profesional
Documente Cultură
By: EABSM
Common Terminologies
Oncogene cancer genes that alter normal genes Proto oncogenes repressed oncogene that can activated by etiologic and risk factors Anaplasia no resemblance to tissues of origin Metaplasia replacement of the original cell with another type of cell Carcinoma cancer cell composed of epithelial cells that can spread Neoplasm growth of new tissue Tumor same with neoplasm
No metastasis
Classification of Cancer: Squamous cell carcinoma surface epithelial Adenosarcoma glandular epithelial Fibrosarcoma fibrous connective tissue Liposarcoma adipose tissue Chondrosarcoma cartilage Osteosarcoma bone
Hemangiosarcoma blood vessels Lymphangiosarcoma lymph vessels Leiomyosarcoma smooth muscles Rhabdomyosarcoma striated muscles Glioma glial cells Neurolemic sarcoma nerve sheath Leukemia blood
Classification of Benign Neoplasia: Glandular tissue adenoma Bone osteotoma Nerve cells neuroma Fibrous tissue - fibroma
Etiology
Exact cause is still unknown Viruses cancer of the liver, burkitts lymphoma Chemical Agents tar, asphalt, arsenicals, fuels, oil Drugs chemodrugs Physical Agents radiation
Predisposing Factors: Age (60% of cancer clients are over 65 y/o) Sex Breast cancer for females and Prostate CA for males Geographic location cancer of the stomach (Japan)
Occupation factory workers (lung cancer) Hereditary breast, ovaries and colon Diet cured and salted foods (stomach) Stress decreased immune system Precancerous lesions moles, polyps (colon and stomach)
Early Detection: Chest xray and sputum cytology (lung cancer) Physical exam (every year for over 40 y/o) skin, lymph nodes, mouth, thyroid, breast, testes, rectum, prostate Oral Exam - annually TSE monthly following shower Digital Rectal Exam annually for 40y/o and above
BSE every month after menstruation Breast Clinical Exam done by physician (every 3 years for 202040 y/o then yearly for over 40 y/o) Mammography once for 35-40 y/o, then yearly for over 50 y/o 35 Pap smear age 18 and all sexually active women then yearly after 3 negative results Pelvic Exam same with pap smear Endometrial tissue sampling menopause Sigmoidoscopy for 50 y/o and above annually for 2 years then every 3 years if negative Fecal Occult Blood doctors recommendation
7 Warning Signals: C hange in bowel and bladder habits A sore that does not heal U nusual bleeding or discharge T hickening or lump in breast or elsewhere I ndigestion or difficulty in swallowing O bvious change in wart or mole N agging cough or hoarseness of the voice U nexplained anemia S udden weight loss
7 SAFEGUARDS U terus annual pap smear B reast regular BSE B asic PE yearly for all adults L ung control or preferably stop smoking annual chest xray for high risk O ral annual oral exam by the doctor C olon or Rectum DE, proctosigmoidoscopy (40y/o) S kin avoid undue exposure to sunlight (10-2 PM) (10-
Diagnostic Exam
Biopsy FNA Incision Excision CT scan MRI PET Direct Visualization Bronchoscopy Gastroscopy Proctosigmoidoscopy
Points to Remember
Most client fear of death upon confirmation of Cancer Clients usually ignored cardinal signs of Cancer Most often cancer is detected during routine exam Questions that need to be answered: Example (Is the disease curable or not?)
Confrontational Redefine or revise Passive acceptance Disengagement Externalization or Projection Moral masochism Compliance and cooperational
Intervention Phase
Therapeutic communications (silence, non judgemental, acceptance, active friendliness, setting limits) Strategizing how to use effective coping mechanism (client and SO) Cancer management will involve surgery, radiatioo, chemo and immunotherapy in combination.
Surgery
Used in diagnosing, staging and treating the client FNA, I&E biopsy Cytology specimens Palliative relieves pain, airway obstruction. Reconstructive restore maximal function and appearance Preventive removal of target organ
Radiation Therapy
Alpha particle-fast moving helium nucleus particle(slight penetration) Beta particle-fast moving electron (moderate particlepenetration) Gamma ray-similar to light ray (high raypenetration) Sodium Iodide (131 I)-for thyroid gland I) Gold (198 Au)-effective for ascites and pleural Au)effusion
Sodium Phosphate (32 P)-for RBC P) Destroys the ability of the cell to reproduce by damaging the DNA Range will be 2,000-5,000 centigrays (cGy) 2,000 o 5,000 cGy will o SE Normal cells and cancer cells are both affected
The goal is to destroy malignant cells without harming normal cells by: FractionationFractionation-small frequent dose Alternating the site
Radiation Safety
Distance-the greater the distance the lesser the Distanceexposure Time-the less time spent close to radiation the Timeless exposure Shielding-use lead aprons and gloves Shielding Standards-kept as low as reasonably achievable Standards Monitoring device-film badge (measure the devicewhole exposure of the nurse)
Types
External Radiation Administered by high energy xray machine (radioisotope Cobalt for Prostate and Lung CA) Internal Radiation Via injection or orally Sealed source-radioisotope is placed into needles, beads, seeds, sourceribbons or catheter then implanted directly into the tumor. Requires a private room and bathroom Room must be lead-shield proof lead Lead container and long forcep on bedside Check linen and other materials for the presence of isotope
Unsealed source-radioisotope is administered IV or sourceorally NaP04 (32 P) IV for polycythemia vera (131 I) PO for graves disease Potential hazard exist because its not encased Isotope maybe excreted via body fluids Flush the toilet several times after use Protect staff and visitors Marked room and kardex with RADIATION HAZARD
Chemotherapy
Use of chemicals to destroy cancer cells Interferes DNA & RNA activities associated with cell division Often used in combination with radiation therapy Cytotoxic-is an agent capable of destroying cells Cytotoxic Cytotoxic drug-alkylating and antimetabolites drug-
Goal
Destroy all malignant cells without excessive destruction of normal cell Control growth of tumor when cure is not possible Note: all rapid dividing cells (GI mucosa, hair follicles and bone marrow) are susceptible to the action of chemo and radiation therapy.
Antineoplastic Drugs
Alkylating Agents Attack the DNA of rapidly dividing cell Nitrosurea: Carmustine (BCNU) Nitrogen Mustard: Chlorambucil (Leukeran) Cyclophosphamide (Cytoxan)
Vinca Alkaloids Interfere with mitosis (M phase) Vincristine (Oncovin) Vinblastine (Velban) Antimetabolites Inhibits protein synthesis (S phase) Azathioprine (Imuran) Fluorouracil (5-FU) Methotrexate (5(Mexate) Antibiotics Inhibit RNA Doxorubicin HCl (Adriamycin) Mithramycin (Mithracin)
Hormone Inhibit RNA and protein synthesis in tissues that are dependent on the opposite sex Androgens, Estrogens, Progestins, Steroids (Analogue, Exogenous) Hormone Antagonist: Mitotane (Lysodren) cortisol antagonist, Tamoxifen Citrate (Nolvadex) estrogen antagonist Immune Agents Introduction of an agent to stimulate production of antibodies Bacillus Calmette-Guerin (BCG) Calmette-
GIT Stomatitis Esophagitis Pharyngitis Taste alteration Anorexia Nausea and vomiting Constipation and diarrhea Weight loss
Reproductive Loss of libido Impotence Amenorrhea Irregular menses Menopausal symptoms Azoospermia Sterility Gynecomastia
Hepatic Hepatotoxicity Integumentary Alopecia Dermatitis and ulcers Hematopoietic q bone marrow activity anemia, prone to infection and bleeding tendency Metabolic TLS and Hyperkalemia
Type of loss
symbols of sexuality social acceptability (colostomy) ability to communicate (laryngectomy, aphasia) anatomic changes (amputation)
Terminally Ill
50% die from the disease time from diagnosis to death ranges from weeksweeks- years not all clients become terminally ill others die during initial treatment; others die from complications of treatment Endpoint: no response to treatment and progressions cannot be controlled
HOSPICE CARE
standard of care for terminally ill cancer clients symptom control pain management providing comfort and dignity 24 hour 7 day coverage services given is based on clients need not on its ability to pay
Ethical Issues
caring can be just successful as curing; when curing is not an option care is exercised during the final stage of life
Goals of Intervention
to care without functional and structural impairment if cure is not possible goals must prevent further metastasis relieve symptoms maintain high quality of life