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Nursing III test II

Neoplastic disorders –
1. Describe the process involved in the development of Cancer:
Most tissues contain predetermined undifferentiated stem cells, these cells
give rise to mature cells of the type of tissue where they reside. These
cells ( and all cells) are controlled by an intracellular mechanism that
determines proliferation (growth by the rapid multiplication of parts).
Normal cells respond to intracellular signals regulating equilibrium.
Cancer cells do not. Cancer cells have no regard to cellular boundaries
and divide indiscriminately. This is caused by a loss of contact in the
inhibition cells, and results in the mutation of the stem cell(called the stem
cell theory). After this occurs the cell can either kill itself (apoptosis),
recognize damage and repair itself, or survive and pass along damage
(mutated cells can become malignant). Cancer cells secrete biochemicals
that cut through the tissue and other biochemicals that stimulate growth
of blood vessels that nurture the tumor growth. IMP: CANCER CELLS
DO NOT GROW FASTER THAN REGULAR CELLS BUT DIVIDE HALF
HAZARDLY GIVING OFF MORE THAN ONE DAUGHTER CELL AT A
TIME WHICH IN TURN CAUSES THEM TO POPULATE AND AREA
QUICKER THAN A NORMAL CELL. (this is known as the pyramid
effect)
2. Differentiate between the phases of cancer:
First phase of cancer is initiation; during this phase the cell’s genetic
structure is mutated, it has potential to develop into a clone of neoplastic
cells, (this mutation is caused by exposure to a carcinogen). This cell has
not established the ability to self replicate and grow, and these mutations
may remain undetected throughout the lifetime. The second phase of
cancer is promotion; its characterized by a reversible proliferation of the
altered cells. The odds of developing cancer increases with the presence
of promoting agents like fat, obesity, cigarettes and alcohol. Lifestyle
changes in this stage will reduce the risks. The third and final stage in
cancer is the progression stage, this stage is characterized by increased
growth rate of the tumor, invasiveness of the tumor, metastasis, and the
most frequent sites for metastasis are the adrenal glands, bone, brain,
liver, and lungs.
3. Describe the classification systems of caner:
Benign/Malignant:
Benign Neoplasms are well differentiated and do not spread while
Malignant neoplasms range from well differentiated to undifferentiated
and this tumor can invade and metastasize. Normally is invasive and
spreads outward
Anatomic Site:
Carcinomas originate from embroyonal ectoderm (skin and glands) and
endoderm (mucous membrand lining of resp. tract, gi and gu tract);
Sarcomas originate from embroyonal mesoderm (connective tissue,
muscle, bone, and fat); and Lymphomas and leukemias originate from
hematopoietic systems.
Histologic grading :
this is classified by the appearance and degree of differentiation; poorly
differentiated appearance has a worse prognosis than a closely defined
one. Grade I cells differ slightly from normal cells (mild dysplasia) and
are well differentiated. Grade II cells are more abnormal (moderate
dysplasia and moderately differentiated. Grade III cells are very
abnormal (severe dysplasia) and are poorly differentiated. Grade IV cells
are immature and primitive (anaplasia) and undifferentiated, cell of
origin is difficult to determine.
Staging based on description of extent
Clinical stageing, Stage 0 is cancer in situ which means it has not
metastasized or invaded surrounding tissue. Stage 1 is localized tumor
growth. Stage II is limited local spread. Stage III is extensive local and
regional spread. Stage IV is matastasis
TNM Classifications:
Determines the anatomic extent of the disease involvement according to
the following. T would be the tumor size and invasiveness. N would be
the presence or absence of regional spread to lymph nodes. M would be
the metastasis to distant organ sites
4. Role of the nurse in the prevention, protection and care of cancer patient:
Nurses are in a position with the patients to provide and educate, they can
help the pt understand , reduce or eliminate the pts’s risk of cancer development, help
them comply with cancer management regimens, help patients cope with the effects of
cancer and related treatment. And they can help change the attitude of cancer
5. Lab values associated with cancer
• WBC 4,500-11,000
• Neutrophils 4,000-11,000
• Neutropena 1,000-1,500
• Plateletts 150,000-450,000
• Thrombocytopena below 50,000
• Hemoglobin 12-18 g/dl
• Anemia below11g/dl
6, 7, 8, differentiate b/w the types of therapy, describe the effects of each on the pt as well
as effects on normal tissue and side effects and describe complications that can occur
within each therapy
Biopsy:
Only definitve means of diagnosing cancer with help with treatment plan,
whether to cure, control, or palliation
Goals of treatment:
To cure treatment is offered to have greatest chance of disease
eradication such as surgery and radiation. To control the cancer may not
be completely eradicated but cancer may be responsive to anticancer
therapies and can be managed for a long period of time. To palliate relief
or control of symptoms aand maintenance of satisfactory quality of life,
can go on for months or years
Surgical Treatment
This is the oldest for of treatment. Can be used to eliminate or reduce risk
of ca development (preventative). Can also cure and control only the necessary diseased
tissue is removed, additional therapy is used to tread unresectable masses. Reduction of
seeding measured utilized, surgical removal of unusual sites of regional spread.
Chemotherapy
Goal is to eliminate or reduce malignant cells primary tumor and metastic
sites, is a systemic therapy, mainstay of cancer therapy for most solid
tumors and hamatologic malignanceies, administered multiple routes such
as vascular access, peripherally inserted central venous access or
implanted infusion ports. Chemo can cause schlerosis, phylbitis,
infiltration,necrosis of the vein. It can be absorbed through the skin and
inhaled during administration. Advantages is that it devievers the drug
directly to the tumor site and a higher concentration of drug with reduced
systemic toxicity. Intraarterial chemotherapy is delivered to the tumor via
arterial vessels supplying the tumor. Used for the treatment of cancers of
the head neck, bladder brain, cervix, melanomas, primary liver cancer,
metastic liver disease. Intraperitoneal chemotherapy – delivers to the
peritoneal cavity for treatment of peritoneal metastases, treatment of
primary colorectal, ovarian cancers, given via hickman or groshong
catheters for short time administration. Complications of intraperitoneal
chemo is abdomal pain, the catherter may become occluded, dislodged,
migrate or an infection my occur. Intrathecal or intraventricular chemos
involve lumbar punctures and injection of chemotherapy to subarachnoid
spaces. Used to tread ca that metastasized to the CNS (most common
breast, lung, gi tumors, leukemia and lymphoma). Can cause headache,
nausea, vomiting, fever and nuchal rigidity (neck) surgically injected
resivior place in cerebrum. Intravesical bladder chemo is the installation
of chemotherapeutic agents into the bladder via urinary catheter and
retained for 1-3 hrs. treatment of bladder cancer. Pt has already
undergone tradional surgical therapy. Benefits are reduced urinary and
sexual dysfunction. Complications can be dysuria, urinary freguency,
hematuria, bladder spasms. ALL CHEMO THERAPIES: chemotherapy
response is based on mitotic rate, size, location, and presence of resistant
tumor cells. Chemotherapeutic agent cannot distinguish between normal
and cancer cells, causes fatigue, anorxia, taste alterations, acute toxicity
occurs during and immediately after drug administration this is seen by
vomiting, nausea, allergic reactions, dysrhythmias, extravasation.
Delayed effects are mucositis, alopecia, bone marrow suppression,
delayed nausea and vomiting, skin rashes, bone marrow suppression,
altered bowel function, cumulative neurotoxicities, and can cause damage
to the heart, kidneys, liver, lungs because the normal cells are killed with
the cancerous cells

Alkylating agents (used in chemo)


Damages dna by breaking the double stranded helix therefore preventing
protein synthesis, works throughout the entire cell life cycle, exp wld be
nitrogen mustard, cytoxan, neosar, temodar. Used for endometrium
cancers, bladder head and neck cancers. Causes nausea, vomiting
alopecia, anemia, hypocalcemia, hypomagnesemia,seizures, lost of taste
Antimetabolites (used in chemo)
Used for Leukemias, interfere with enzyme function or dna synthesis by
imitation the body’s own enzymes, types are mercaptopurine, ara-c, 5-fu,
methorexate. Side effects are headache, gingivitits, malaise, undue
fatigue, photosensitivity
Antitumor antibiotics (used in chemo)
Used in whelms tumors, soft tissue and bone sarcomas, breast and ovary
carsonomas, Kaposi sarcomas, infants. Bind directly to dna and inhibit
synthesis of dna, highly destructive to rapidly proliferating cells and slow
developing carcinomas, given slowly, types are doxorubicin, rubex,
bleomycin, side effects are: myocardial toxicity, stomatitis, severe
myelosuppression, hyperpigmentation of nails, buccal mucosa
Hormone Antagonists
Antiestrogens – down regulation of strrogen receptors and inhibit tumor
growth exp, tamoxifen; it causes bone pain hot flashes loss of hair skin
rashes and weight gain taken approx 5 years
Estrogens – interferes with hormone receptors and proteins – exp is
estrace causes nausea, vomiting, anorexia, increased appetite, increased
right for stroke, hypertension,
Aramatase Inhibitors – inhibits the enzyme that concers androgens to
estrogen. Exp arimides, femara,, this results is regression of estrogen
dependant tumors
Vinc Alkaloid / Mitotic Inhibitors
Comes from the periwinkle plant, blocks cell division at the M phase of
the cell cycles. Exp Velban – used for cancer of testes, breast, kidneys,
lymphomas, wilms tumors; Oncovin – cancer of breast lungs, cervix,
multiple myelomas; Nevelbine – first line tx for advanced unresectable
non small cell lung cancers
Radiations:
Damages dna. Lethal – cell is unable to replicate. Sublethal – potential
for repair in between doses or potential for accumulated damage to occur
with repetitive doses. Is given to a defined area of the body to achieve
local control of the cancer (is NOT systemic) tx determined by tumor
volume, type, and treatment setting, timing is determined by mitotic rate of
tissue. Goal of tx is to avoid toxicity and long term complication of
treatment to the surrounding tissues. Permist max tx of tumor with
minimal damage to normal tissue. Tx will use the immobilization devices
to maintain position. Target is defined by variety of imaging techniques,
physical examination and surgical reports. Marks are placed on the skin
to outline treatment area, Not appropriate as a independent modality tx
for systemic disease. Can cure, control ro palliate,
• Primary setting – independent/ curative intent
• Neoadjuvant – with or w/o chemo preop
• Adjuvant – following surgery or chemo
• Prophylaxis – prevent further ca development
• Disease control – limiting tumor growth
• Palliation – to prevent or relieve distressing symptoms and
preservation of neurologic function and make pain more tolerable
Delivery modes
• External – teletherapy most common
• Internal – pt remains hospitalized seeds placed via chath or tude
fft in place until dose reached. Seen in head nck lung and
gynecological cancers. Brachytherapy( rn must be aware of this,
organize time to limit direct patient contact, shielding, no care w/o
film badge, dnt share film badge) implantation or insertion of
radioactive materials directly onto the tumor or close proximity;
Radiopharmaceutical therapy administered orally
Side effects of radiation are stomatitis, mucositis, esophagitis, fatigue
(begins during the 3rd week of tx persists after tx ends and gradually
subsides) nausea and vomiting, diarrhea, constipation, erythema, anemia
b/c it is non selective to what cells it kills
Biologic response modifiers –
Agents that modify relationship b/w the host and the tumor by altering the
biologic response of the host to the tumor cell, have a direct antitumor
effect, restore augment or modulate host immunde system mechanisms,
and have other biologic effects ( interfere with metastasizing or
differentiating.). it is the only specific treatment, it targes specific cellular
receptors or pathways in tumor growth, lock and key for each cell. Side
effects are flu like, tachycardia, orthostatic hypotension, neurologic
deficits such as confusion, memory loss, skin rashes. ( large amounts of
fluids increase the flu like symptoms) Nursing management; vitals q 4
hrs., capillary leak syndrome and pulmonary edema require critical care,
bone marrow depression more transient less severe, fatigue extrememly
severe, dose limiting toxicity
9. Nursing management of a cancer patient
Identify when pt is feeling better may allow more activity. Allow rest
before activity, get assistance w/ activity, maintain nutritional and
hydration status, continue this. Prophylactic administration of
antiemetics, assess for signs and symptoms of dehydration and monitor I’s
and O’s. non irritation low fiber, high cal hig protein diet, antidiarrheal,
antimotility and antispasmodic meds. Dry skin should be lubricated with
non irritations lotion, avoid metals, alcohol, perfume or asdditives, we
reaction must be kept clean and protected, prevent infection, teach to
examine oral cavity and maintain oral care, pain relief, saliva substitutes
or drink water frequently, soft nonirritation, hight protein high cal foods,
avoid extreme temps, alcohol and tobacco, inform pt on expected sec side
effects, use shielding, encourages discussions of issues r/t sexuality, refer
to coundseling if needed. For ped pt’s address the developmental issue,
family support, careful med administration, address pain management,
address social issues. Gerontologic – clinical manisfestations may be
mistaken for aging, more vulnerable to complications of cancer and tx,
functional state should be considered when selecting a tx plan
10. Nursing diagnosis r/t cancer
infection (#1 complication)
altered nutrition status
dehydation