OMAN NURSING INSTITUTE

ADULT HEALTH NURSING – I

CANCER (CS – 10 &11) Page: 311-369

Objectives:
 Differentiate between benign and malignant tumors.
 Differentiate among the goals of cancer care: prevention, diagnosis, cure, control, and palliation.
 Identify potential complications for the patient with cancer and discussed associated nursing care.
 Use the nursing process as a framework for the care of patients with cancer.

Definition;
Cancer is a disease process that begins when an abnormal cell is transformed by the genetic mutation of the cellular DNA.

Difference between benign and malignant tumors:

Characteristics Benign Malignant

Cell Well differentiated, resemble normal cells Undifferentiated, little resemblance to

normal cells
Mode of growth Tumor grows by expansion & No infiltration to Grows at the periphery Infiltrate
surrounding cells surrounding tissues
Rate of growth Slow growth Faster growth
Metastasis Does not spread by metastasis Metastasis (spread) to other parts of the
body
General effect Does not cause generalized effects Generalized effects like anemia, wt loss,
weakness
Tissue destruction No tissue damage unless interfere with blood flow Extensive tissue damage

Ability to cause death Does not usually Cause death Causes death if growth is not controlled

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Etiology of Cancer

• Hormonal agents
• Viruses & Bacteria
• Physical agents
• Chemical agents
• Genetic / familial factors
• Dietary factors

Cancer Detection & Prevention - pg -318

 Primary Prevention
 Secondary Prevention
 Tertiary Prevention

 Primary Prevention - Reducing the risk of cancer and Health Promotion strategies
 Help individual to avoid known carcinogens
 Encourage Dietary & life style changes (Smoking cessation ),Decrease caloric & alcohol intake , Increased physical activity
 Clinical Trials- Tamoxifen - reduce incidence of breast cancer, Daily Aspirin – to reduce colorectal cancers

 Secondary Prevention - Promote screening and early detection

Goal – decrease cancer morbidity & mortality
 Screening events- breast & prostate cancer,
 Offer education & appropriate assessment - Mammogram, Digital rectal exam

 Tertiary Prevention- Improved screening , diagnosis & treatment

 Monitoring & preventing recurrence of the primary cancer
 Screening for development of second malignancies in cancer survivors

Diagnosis of cancer

• Physiologic & functional changes & result of diagnostic evaluation

-Physical examination, Imaging studies

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-Lab tests-blood, urine & body fluids
• TNM classification – chart 15- # 321

Management of Cancer

 Cure: - Complete eradication of malignant cells

 Control - Prolonged survival & control of cell growth
 Palliation - Relief of symptoms

Multiple Modalities

 Surgery
 Radiation therapy
 Chemotherapy
 Stem cell transplantation
 Hyperthermia
 Targeted Therapies

 Surgery – the primary treatment

• Diagnostic
• Biopsy
• Surgery as primary treatment
• To remove entire tumor &
• Regional lymp nodes
• Prophylactic
• Colectomy (colon)
• Mastectomy (breast)
• Oophorec tomy (Ovary)
• Palliative
• When surgical cure is not possible - to relieve symptoms & to promote comfort.
• Reconstructive
• Improve function
• Cosmetic

Management of Cancer- Radiation therapy

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  To cure cancer( Thyroid,head & neck ,& cervix)
 To control cancer when tumor cannot be removed surgically
 Prophylactically to prevent spread of the primary cancer
 Palliative –to relieve symptoms of metastatic diseases
Types : External beam radiation, Internal Radiation ( brachytherapy ), Systemic- Radioisotopes
Management of Cancer- Radiation therapy

 Patient
o Bed rest in private room for 72 hrs
o Log rolled to prevent displacement
o Low residue diet
o Limit visitors
 Protecting care giver
• Health care team is guided by time, distance & shielding.
• Radiation safety precautions
• Dosimeter badges
• Visitors maintain- 6 foot distance (30 mts only )
 Toxicity
o Altered skin integrity- Alopecia, Radiation dermatitis
o Alteration in mucosa- stomatitis,, xerostomia, mucositis, anorexia, nausea, vomiting
o Anemia, leukopenia, thrombocytopenia

Management of Cancer- Chemotherapy

Antineoplastic - To destroy cancer cells NURSING MANAGEMENT

May be combined with surgery or radiation therapy
 Encourage adequate fluid & dietary intake
GOAL- Cure, control and palliation
Toxicity  Decrease the risk of infection , bleeding & anemia
Anorexia, Nausea & vomiting, mucositis & diarrhea.
• Fatigue  Prevention of extravasation
• Depression of bone marrow function
• Damage of kidneys  Protecting care givers
• Cardiac toxicity
• Cognitive impairement

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Hematapoietic stem cell transplantation
Types:
 Autologous (from patient)
 Allogeneic ( from a donor)
 Syngeneic (from an identical twin)

Nursing care of patient with Cancer - (Chart 15-7)

o Maintain Tissue Integrity- Stomatitis

o Radiation associated skin impairement , Alopecia ,Skin lesion
o Promote Nutrition- Anorexia, Malabsorption , Cachexia
o Relieve pain
o Decreasing Fatigue
o Improve body image & self esteem
o Monitor and manage complications

Nursing care of patient with Cancer- Infection Prevention

 Place in Private room

 No contact with people with infection
 Careful hand hygiene
 Personal Hygiene
 Food hygiene & Safe handling
 Change water pitcher every day
 Assess I.V sites every day
Nursing care of patient with Cancer - Maintain Tissue Integrity
 Radiation Associated Skin Impairment
 Stomatitis
• Avoid - commercial mouth wash, alcoholic beverages & tobacco
• Use soft tooth brush, Dental flossing • Avoid use of soap, perfume, powder, lotion
• Use bland mouth rinses
• Maintain adequate hydration • Avoid rubbing/scratching the area & sunlight
• Remove dentures
• Apply water soluble lip lubricant • Use cotton clothing, Apply vitamin A & D ointment
• Avoid foods that are spicy & hard

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Nursing care of patient with Cancer -Maintain Tissue Integrity

Alopecia
• Use scalp hypothermia
• Use mild shampoo
• Avoid dryers , electric curlers & hair dye
• Avoid excessive combing
• Lubricate scalp with vitamin A & D

Nursing Management: Promote Nutrition

 Prevent unpleasant sights, odors & sounds in the environment.

 Administer antiemetics
 Ensure adequate fluid hydration
 Encourage frequent oral hygiene
 Provide pain relief measures
 Consult with dietician

Nursing care of patient with Cancer: Bleeding Prevention

• Use soft tooth brush

• Avoid commercial mouth wash
• Use electric razor
• Avoid food that are difficult to chew
• Avoid I.M injection
• Padded side rail

***GOOD LUCK ***

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Malathi.N AHN-1 AY-2017-18