A.

B.

C.
D. E. F.

Common Etiology and Predisposing Factors Classifications of Carcinoma, Sarcoma and Lymphoma Effects of Tumor Cancer Screening Common Diagnostic Examinations Common Management and Treatment

II. DIAGNOSTIC, TREATMENT AND NURSING RESPONSIBILITIES WITH CLIENT WITH CELLULAR ABERRATION

ETIOLOGY (CARCINOGENESIS)
1.

Environmental Factors
Physical
i.Radiation

a.

x-rays, radium, nuclear explosion/waste,

ultraviolet

- 80% of exposure is from natural sources

Ionizing

radiation from cosmic rays Radioactive Minerals eg. Radon gas, radium & uranium Sunlight & Tanning beds are 2 sources of Ultraviolet radiation a complete carcinogens

ETIOLOGY AND RISK FACTORS

Generally unknown but may be caused by interacting factors Theories include predisposing factors: constant irritation history of cancer environmental carcinogens radiation

ETIOLOGY (CARCINOGENESIS)
1.

Environmental Factors
Physical

a.

About 15 % of radiation exposure comes from diagnostic procedures that includes :

Radiographs
Radiation

therapy Radio Isotopes use in diagnostic imaging

ETIOLOGY (CARCINOGENESIS)
1.

Environmental Factors

b. Chemical

Nitrites and food additives, polycyclic hydrocarbons, dyes, alkylating agents, saltcured, high calorie diet Drugs: arsenical, stilbestrol, urethane Cigarette smoke Hormones estrogen, hormonal replacement therapy, oral contraceptives

ETIOLOGY (CARCINOGENESIS)
1.

Environmental Factors *Cause of cancer in the US with 30% death rate. Linked not only to cancer of the lungs but as well as oropharyngeal, bladder, pancreatic, cervical,& kidney cancers.

b. Chemical

ETIOLOGY
2. Genetics and Ethnicity Some cancers show familial pattern/inherited genetic defects Biologic or genetic differences, cultural & socioeconomic factors may put an ethnic or racial group at increased or decreased risk of a specific cancer.

ETIOLOGY
3. Viral theory - Nine biologic agents or viruses are associated with cancer causation

Oncoviruses (RNA-type viruses) Viruses like: Hepa B, C liver Ca Herpes simplex II, cytomegalovirus, Human Papilloma virus-dysplacia and cervix Ca HIV Kaposis sarcoma Helicobacter pylori gastric Ca Epstein-Barr virus Burkitt lymphoma, nasopharyngeal Ca, non-hodgkin & Hodgkin dse

ETIOLOGY
4. Immunologic factors a. Failure of the immune system to respond to and eradicate cancer cells b. Immunosuppressed individuals are more susceptible to cancer

PREDISPOSING FACTORS
1.

Age - more in older people than in children

2. Sex - women are more prone to breast, ovarian, and cervical cancer while men are more prone to lung and prostate cancer 3. Urban vs. Rural - urban dweller are more exposed to carcinogen

PREDISPOSING FACTORS
4. Heredity - familial pattern of some breast

and colon cancer has been well documented - lung, ovarian, and prostate cancers have also shown some familial relationship 5. Obesity - sex hormones are synthesized from fat; excessive body fat has been linked to an increased risk to hormone-dependent cancers

PREDISPOSING FACTORS
6. Occupation

- farmers are exposed UV

radiation - x-ray technicians and biomedical researchers are exposed to ionizing agents and carcinogenic substances - people who worked in old buildings are exposed to asbestos

PREDISPOSING FACTORS
7. Stress

- continuous stress that keeps hormones such as epinephrine and cortisol at high levels can result in systemic fatigue and impairment of immune system

8. Poverty - inadequate access to health care, especially preventive screening and counseling

MOST COMMON BENIGN NEOPLASM

Fibromyomas :

May grow anywhere in the body but they frequently make their home in the uterus. They are encapsulated, relatively harmless neoplasms cause no manifestation unless because of their location, they press on a bone or nerve. They can be remove surgically

MOST COMMON BENIGN NEOPLASM

Lipomas
- Arises in adipose tissue - Rarely causes manifestation - Poorly encapsulated and may exert pressure on surrounding tissues as they expand

MOST COMMON BENIGN NEOPLASM

Leiomyomas

- origin in smooth muscle - Most common in women - May develop anywhere in the body but most common in the uterus - Rarely 1% becomes malignant

MALIGNANT NEOPLASM
Carcinoma

in Situ

- Neoplasm of epithelial tissue that remains confined to the site of origin - Can occur in the cervix & in squamous epithelium in other parts of the body - Form of cancer that is localized & thus can be removed surgically - Can be invasive ,eroding into surrounding tissue

MALIGNANT NEOPLASM

Malignant fibrosarcomas : - Similar to benign fibromas - Tends to grow in the same sites & may originate as benign fibromas later becoming malignant - These bulky well differentiated tumor masses are usually responsive to surgery - Fortunately they rarely metastasize

MALIGNANT NEOPLASM

Bronchogenic Carcinomas : - Account for 90% of all cases of lung cancer - Usually develop in the lower trachea & lower bronchi - Surgical excision of tumor is the intervention of choice - Readily gives rise to metastasis ,if this occurs surgery is contraindicated

EFFECTS OF TUMOR
Tissue

Destruction Disruption of Function and Organ Compression Obstruction Infection Anemia

Hormonal

Effects Paraneoplastic Syndromes Anorexia-Cachexia Syndrome Pain Fatigue Hemorrhage

PROBLEMS

TUMOR EVALUATION/CLASSIFY
Primary Tumor (T) Regional Lymph Nodes (N) Distant Metastasis (M)

Primary Tumor (T)

a. TX

- Primary tumor cannot be evaluated b. T0 - No evidence of primary tumor c. Tis - Carcinoma in situ (early cancer that has not spread to neighboring tissue) d. T1, T2, T3, T4 - Size and/or extent of the primary tumor

 Regional

Lymph Nodes (N) NX Regional lymph nodes cannot be evaluated N0 - No regional lymph node involvement (no cancer found in the lymph nodes) N1, N2, N3 Involvement of regional lymph nodes (number and/or extent of spread)

Distant

Metastasis (M) MX -Distant metastasis cannot be evaluated M0 - No distant metastasis (cancer has not spread to other parts of the body) M1 -Distant metastasis (cancer has spread to distant parts of the body)

example:
breast

cancer T3 N2 M0 Prostate cancer T2 N0 M0

CANCER SCREENING
Colorectal

cancer (male/female)

- digital rectal examination annually beginning at age 40. - Fecal occult blood test annually at age 50. - Sigmoidoscopy every 3 to 5 years beginning age 50.

CANCER SCREENING
Breast

cancer (female)

- Monthly breast self-examination - age 20 - Breast exam by physician q 3 yr. beginning 20 - 40 and then annually at age 40. - Mammogram q 1 to 2 yr. beginning at 40 up to 49 and then 50 and over

CANCER SCREENING

Uterine Cancer (Female)

- Papanicolaou smear annually for all women who are sexually active or have reached age 18. (After a woman has had 3 or more consecutive exam, it may be performed less frequently at the discretion of the physician.) - Pelvic exam q 1 to 3 yr. with Pap test at 18 to 40 and annually for 40 and above. - Endometrial tissue sample at menopause if at high risk and thereafter at the discretion

CANCER SCREENING

Prostate Cancer (male) - Prostate examination annually. - Health counselling and cancer checkup (male/female) - Examination for cancers of the thyroid, testicles, ovaries, lymp nodes, oral region, and skin q 3yr over the age 20 and annually over age 40.

Prevention
BSE Rectal exam for those over age 40 Hazards of smoking Oral self-exam and annual exam of mouth/teeth Hazards of excess sun exposure Pap smear Physical exam with lab work:

40 y/o = q 3 years >40 y/o = annually

20

BREAST SELF-EXAMINATION
BSE shld. be conducted once a month. BSE includes inspection as well as palpation. The nurse shld. instruct the client to inspect the breast while standing infront of the mirror, placing the arms in 4 positions: arms at the sides, at rest hands on the hips and pressed into the hips hands over the head torso leaning forward

BREAST SELF-EXAMINATION
Each breast shld be observed for the following: lumps or thickening indentions, rippling, puckering or dimpling asymmetry of the nipples discoloration discharges from the nipple any change in size and shape

BREAST SELF-EXAMINATION

Examine the right breast by placing a pillow or folded towel under the right shoulder and the right hand behind the head - to distribute breast tissue more evenly With the left hand: Press the palmar surfaces of the middle 3 fingers on the skin surface, starting in the upper lateral quadrant, the outermost top of the breast. Use a gentle rotating motion to press the breast tissue against the chest wall.

BREAST SELF-EXAMINATION
Palpate from the periphery to the areola. Move the peripheral starting point around the breast clockwise. Squeeze the nipple between thumb and index finger. Note for discharges Repeat the above for the left breast with a pillow under the left shoulder and the left hand behind the head. Report lump or nipple discharges to the physician.

DIAGNOSTIC STUDIES

Laboratory test, Tumor markers Cytology Radiologic test Radioisotopes studies/Radioimmunoconjugates Ultrasound Biopsy Endoscopy CT-scan, PET scan, PET fusion Fluoroscopy

TUMOR MARKERS
Substances

or chemicals produced in the blood that are produced by certain cancers, can be measured in urine, blood and tissue sample

TUMOR MARKERS
1. Antigens alpha-fetoprotein (AFP) carcinoembryonic antigen (CEA) presence in large amount may reflect an anaplastic process in tumor cells normally present in fetal tissue suppresses after birth presence in large amount may reflect an anaplastic process in tumor cells

TUMOR MARKERS
2. Hormones
elevated

levels not related to other conditions may signify the presence of a hormonesecreting malignancy

3. Proteins
narrow

down the type of tissue that may be malignant levels can point to either hyperplasia or cancer

4. Enzymes
elevated

TUMOR MARKERS
Alpha-fetoprotein (AFP) - liver cancer (hepatocellular carcinoma), testicular cancers Bladder tumor antigen (BTA) - bladder cancer CA 15-3 , CA 27.29- breast cancer CA 125 - epithelial ovarian cancer (the most common type of ovarian cancer Calcitonin- medullary thyroid carcinoma (MTC)

TUMOR MARKERS
Carcinoembryonic antigen (CEA)colorectal cancer Estrogen receptors/progesterone receptors-breast cancer Human chorionic gonadotropin (HCG)choriocarcinoma,testicular and ovarian cancers (germ cell tumors) Prostate-specific antigen (PSA)-prostate cancer

DIAGNOSTIC EXAMINATION
A.

CYTOLOGIC EXAMINATION

2. Aspiration of fluid from body cavities

or blood

3. Needle aspiration of solid tumors

DIAGNOSTIC EXAMINATION
A. CYTOLOGIC EXAMINATION 1. Papanicolaou Test (Pap Smear) - diagnose cervical cancer Health Teachings Instruct woman to empty bladder prior to procedure Teach patient to have the screening every 3 yrs. until age 65 after 2 successive negative results a year apart Schedule test when not menstruating Avoid intercourse, douching or placing any medication in the vagina for 36 hours prior to test

DIAGNOSTIC EXAMINATION
B. IMAGING & DIRECT VISUALIZATION TECHNIQUES

1. Ultrasound 2. Nuclear Magnetic Resonance Imaging (MRI) 3. Radiologic Exams (X-rays) 4. Radiologic Techniques (use of Radioisotopes) 5. Computerized Axial Tomography (CT Scan) 6. Angiography 7. Endoscopy, Bronchoscopy, Cystoscopy, Sigmoidoscopy

TREATMENT
Surgery Chemotherapy Radiation therapy Biotherapy Bone Marrow Transplant

SURGICAL MANAGEMENT
physically

remove the tumor mass tumors along lymphatic channels these channels must be removed along with any involved lymph nodes that contain tumor tissues surgical manipulation may produce large amount of tumor emboli

SURGICAL MANAGEMENT
Benign

tumors; minimal difficulties because of a well-defined, encapsulated tumor in non-critical areas

SURGICAL MANAGEMENT

Malignant tumors; poses great difficulties because of their irregular, invasive growth, edge of the malignant tumor is not welldefined and impossible to excise all without removing some of the adjacent normal tissue

DIAGNOSTIC SURGERY
Excisional and incisional biopsy
Needle

biopsy Types of Surgery

(for recurrence and metastasis) palliative surgery reconstructive surgery preventive surgery

NURSING MANAGEMENT
Surgical Client wound care prevention of infection

CHEMOTHERAPY

Antineoplastic agents are used to destroy tumor cells by interfering with cellular function, including replications Principles Based on the ability of the drug to kill cancer cells; normal cells may also be damaged. Effect is greatest on the rapidly dividing cells Different drugs act on tumor cells in different stages of the cell growth cycle

ADMINISTRATION

ROUTES:

Dosage:

Topical Oral Intravenous Intramuscular Subcutaneous Arterial Intracavitary

Based on the total body surface

CHEMOTHERAPY
Chemotherapeutic Drugs 1. Alkylating Agents

create defects in tumor DNA interfering permanently with replication and transcription toxic effects include nephrotoxicity hemorrhagic cystitis bone marrow failure irreversible infertility

CHEMOTHERAPEUTIC DRUGS
2. Antimetabolites

interfere with nucleic acid synthesis toxic effect includes nausea and vomiting Stomatitis Diarrhea Alopecia leukopenia

CHEMOTHERAPEUTIC DRUGS 3. Antitumor Antibiotics

disrupt DNA replication and RNA transcription create free radicals & interfere with DNA repair toxic effect damage to cardiac muscles

CHEMOTHERAPEUTIC DRUGS
3. Mitotic Inhibitors

act to prevent cell division during the M phase toxic effects depression of deep-tendon reflexes parasthesias and paralytic ileus motor weakness cranial nerve disruption bone marrow suppression nausea and vomiting Hypotension alopecia

CHEMOTHERAPY MANAGEMENT

Client Receiving Chemotherapy monitor laboratory results (bone marrow suppression predisposes the client to infection) antiemetic therapy, hydration, diuresis, electrolyte supplementation educate patient and family on the side effects of the treatment for better home management minimize side effects

OTHER TREATMENT
4. Hormones and Hormone Antagonists a. Hormones bind to specific intracellular receptors, repressing transcription of RNA altering cellular function and growth adverse effects; hyperglycemia and impaired healing hypertension osteoporosis hirsutism severe hypersensitivity

OTHER TREATMENT
b. Hormone-antagonists works with hormone-binding tumors by blocking hormone receptor site on the tumor and prevent it from receiving normal hormonal growth stimulation do not cure but also do not cause regression of tumor adverse effect; alteration in secondary sexual characteristics

OTHER TREATMENT

Immunotherapy

utilize the immune system to combat a growing tumor involves administering a substance (e.g. BCG) with potent antigenic properties with the intended effect of antitumor activity

COMMON SIDE EFFECTS OF CHEMOTHERAPY

GI Nausea, vomiting Diarrhea Stomatitis

Hematologic Thrombocytopenia Leukopenia Anemia Neutropenia

COMMON SIDE EFFECTS OF CHEMOTHERAPY

Integumentary Alopecia Skin pigmentation Nail changes Pruritus Urticaria

Renal Direct damage to kidney by excretion of metabolites cystitis and urine color changes

COMMON SIDE EFFECTS OF CHEMOTHERAPY

Reproductive

Infertility premature menopause and amenorrhea

Neurologic Peripheral neuropathies hearing loss loss of deep tendon reflex, paralytic ileus

SPECIAL PROBLEMS

Extravasation
Vesicants

agents when deposited into the SQ tissue cause necrosis and damage to tendons, nerves, blood vessels
MYSINE,

RUBICIN, VIN, nitrogen MUSTARD

Carefull

selection of VEINS No blood return, resistance to flow, swelling, pain redness at the site :STOP immediately Apply ice unless its VINCA alkaloids

PROBLEMS

Toxicity
GI:

N&V

Meds:

ondan, grani, dola, palono SETRON (blocks serotonin receptors) Metoclopramide (Reglan, Plasil) dopaminergic blocker
Hematopoetic

System

Myelosuppression

Granulocyte colony-stimulating factor (GSF) Granulocyte-macrophage CSF (GM-CSF)

PROBLEMS

Renals System
Methotrexate, mitomycin Nephrotoxic Excretion of Uric Acid damage the kidney
Cisplatin,
Monitor

BUN, crea, serum electrolytes Adequate hydration, alkalinization of urine, allupurinol prevention of these side effects

Reproductive system
Sterility
Sperm

bank, Use birth control

PROBLEMS

Cardiopulmonary

RUBICIN-cardiotoxicity Monitor for cardiac ejection fraction, heart failure Bleomycin, carMUSTINE, busulfan lung damage Pulmonary fibrosis long-term effect

Neurologic

Taxanes and plant alkaloid Peripheral neuropathies, loss of deep tendon reflexes, paralytic ileus, ototoxocity(acoustic nerve damage)

PROBLEMS

Miscellaneous
Fatigue

and depression

SPECIAL CONCERNS OF CARE

Bleeding Skin problems Hair loss Nutrition Pain Fatigue Psychosocial status Body image

Stomatitis Anorexia Malabsorption Cachexia-loss of body weight, adipose, visceral proteins, and skeletal muscle

CACHEXIA

MEDICAL EMERGENCIES (CHEMOTHERAPHY)

Patients may be at an increased risk of infection or bleeding or may experience symptoms from anemia. myelosuppression is the most common side effect that causes chemotherapy treatment delays or chemotherapy treatment dose reductions

MEDICAL EMERGENCIES (CHEMOTHERAPHY)

Myelosuppression reduction of bone marrow to produce blood cells.

any or all of the three main types of blood cells that are normally produced in the bone marrow are decreased in number and/or may take a prolonged period of time toreturnto"normallevels

MEDICAL EMERGENCIES (CHEMOTHERAPHY)

The bone marrow produces 3 main types of mature blood cells: platelets red blood cells white blood cells.

MEDICAL EMERGENCIESCONTINUED

Neutropenia decreased WBC Thrombocytopenia- decreased platelets Neutropenia =A reduced white blood cell count lowers resistance to infection may cause delay in patient receiving chemotherapy

MEDICAL EMERGENCIESCONTINUED

Thrombocytopenia (low platelet count) Platelets - prevent bleeding by causing coagulation Decreased platelets s/s Bruising easily Nosebleeds Excessive bleeding from cuts, wounds, gums (brushing teeth), blood in urine/stool

MEDICAL EMERGENCIESCONTINUED

Thrombocytopenia

Platelet count normal 150,000400,000mm

When platelet count is less than 20,000 pt has risk of hemorrhage Chemo is withheld until platelets increase to >100,000

MEDICAL MANAGEMENT BONE MARROW TRANSPLANTATION

Used as a primary treatment in leukemia and as to counter the toxic effects of chemotherapy
Types
autologous

- harvested from the clientsownbonemarrow allogeneic - bone marrow from a matching donor

NURSING MANAGEMENT PT TEACHING

Thrombocytopenia 1. Use soft toothbrush to avoid bleeding gums 2. When shaving, use electric razor 3. Avoid constipation, enemas, rectal temps 4. Do not use products that contain aspirin, NSAID 5. Avoid IM or sc injection 6. Notify MD/RN if petechiae, bruising, frank or tarry stools, change in color of urine frank blood, dark amber, bleeding from any part of body such as nosebleed

NURSING MANAGEMENT

Minimize Side Effects of Nausea and Vomiting

Serotonin receptor antagonists such as Ondasetron (Zofran) Granisetron (Kytril) Dolasetron (Anzemet)

Avoid offensive odors Small frequent feedings rather than 3 big meals Adjust oral and fluid intake Relaxation exercises, hypnosis, etc.

RADIATION THERAPY

ionizing radiation kill cancer cells and shrink tumors dose to each site depends on a number of factors

RADIATION THERAPY

1. External
-

Source is outside body Beam aimed at specific spot Marked with marker Protect area from heat or cold High protein, high calorie, high fluid intake (2-3 quarts)

RADIATION THERAPY

2. Internal - Source (radioisotopes) is placed

inside the body (into or near tumor itself or into systemic circulation) - types Sealed or unsealed - Radiation is emitted

RADIATION THERAPY
a. Sealed-Source Radiation Therapy radioactive material is enclosed in a nonradioactive sealed container radioisotope cannot circulate through the clientsbodyandcannotcontaminatethe patientsurine,sweatorblood

INTERNAL RADIATION THERAPY

Sealed radiation Source of radiation intracavity, interstitial Private room properly labelled No children under 18 or anyone pregnant Wear film badge

INTERNAL RADIATION THERAPY NURSING MANAGEMENT

Prevent dislodgment
1. Monitor VS every four hours 2. Accurate I&O usually have a usually have a Foley catheter 3. Active ROM

INTERNAL RADIATION THERAPY

b. Unsealed-Source Radiation Therapy radioactive material is administered intravenously, orally or instillation directly into a body cavity radioisotopes circulates through the clientsbodyandthereforetheclients urine. sweat, blood and vomitus contain the radioactive isotope

INTERNAL RADIATION THERAPY

Administered intravenously or orally Used in systemic system Colloid suspension into body tissue Iodine 131 Graves disease, thyroid cancer Strontium chloride (Metastron) for bone metastasis

INTERNAL RADIATION THERAPY

Body fluids are contaminated Special care 1. Flush at least three times 2. Disposable equipment 3. Wear shoe covers, protective equipment 4. Dosimeter- device used to measure an individual's exposure to a hazardous environment

SAFETY PRINCIPLE IN RADIATION THERAPY

Distance

from the source and from the time of exposure Time of exposure Shield (amount of shielding source)
Note: (Stay at least 6 feet away when not giving direct)

RADIATION SAFETY STANDARDS

Distance distance & radiation exposure is inversely related

Time 30 minutes per 8 hour shift

Private room & bath

Shields, lead container, & long-handled forceps in client room If source is dislodged use forceps to pick up and place in the lead container Notify radiation safety officer

Shielding lead shield

Wear film badge or dosimeter do not share

NURSING MANAGEMENT
Client

Receiving Radiation Therapy

provide education to dispel common fears and misconceptions minimize side effects

SIDE EFFECTS AND INTERVENTION

1. Erythema, dry/moist desquamation, atrophy,

telangiectasia, depigmentation, necrotic/ulcerative lesions

- keep area dry - wash area w/ water, NO SOAP, pat dry, DO NOT RUB - DO NOT APPLY OINTMENT, POWDER OR LOTION - DO NOT APPLY HEAT - AVOID DIRECT SUNLIGHT or COLD - use soft cotton fabrics for clothing - DO NOT ERASE MARKINGS ON THE SKIN. These serves as guide for areas of irradiation

SIDE EFFECTS AND INTERVENTION

2. infection - monitor blood count weekly - good personal hygiene, nutrition, adequate rest - tech signs of infection to report

SIDE EFFECTS AND INTERVENTION

3. hemorrhage - monitor platelet count - avoid physical trauma or use of aspirin - teach signs of hemorrhage - monitor stool and skin for signs of hemorrhage - use direct pressure over injection sites until bleeding stops

SIDE EFFECTS AND INTERVENTION

4. fatigue -plenty of rest and good nutrition 5. weight loss 6. stomatitis - administer analgesics before meals - bland diet, no smoking/alcohol - good oral hygiene; saline rinse Q 120

SIDE EFFECTS AND INTERVENTION

7.diarrhea 8. nausea and vomiting 9. headache 10. alopecia - reassure that its temporary - encourage the use of wigs, hats or head scarf 11. cystitis 12.social isolation

BIOTHERAPY
Uses agents called biologic response modifiers to affect a biologic response Hematopoietic Growth Factors agents: interferons, interleukins, monoclonal antibodies, immunomodulators and tumor necrosis factor

COMMON BIOLOGICAL THERAPY

BCG or Bacillus Calmette-Gurin- treats bladder tumors or bladder cancer. IL-2 or Interleukin-2- treats certain types of cancer Interferon alpha - treats certain types of cancer. Rituxan or Rituximab - treats non-Hodgkin's lymphoma. Herceptin or Trastuzumab treats breast cancer.

BIOTHERAPY
BOOST MARROW FUNCTION: THE HEMATOPOIETIC GROWTH FACTORS
Agents that affect the biological process

Colony stimulating factors - granulocyte colony-stimulating

factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) to increase granulocyte production

Monoclonal antibodies (mAb) are antibodies that are

identical because they were produced by one type of immune cell, all clones of a single parent cell

Erythropoietin stimulate RBC production

Neumega stimulates platelet production

NURSING CARE OF CLIENT WITH CANCER

Treatment Phase

Diagnostic Phase

1. Support 2. Denial common 3. Stress signs may be due to something other than cancer 4. Educate on effects of delaying treatment

1. Varies on type of cancer 2. Side effect treatment 3. Neutropenia precautions 4. Nutrition 5. Activity Intolerance 6. Pain control 7. Grieving

Terminal Phase

1. Hospice 2. Grief counseling for both patient and family

NURSING DIAGNOSIS

Fear/anxiety

situational crisis Threat to/change in health/socio-economic status, role functioning, interaction pattern Threat of death Separation from family Loss of physiologic well being (loss of body part, change in body function Perceived potential death

Grieving, anticipatory

NURSING DIAGNOSIS

Situational low self-esteem Biophysical Psychosocial Acute/Chronic Pain Disease process Side-effects of therapeutic agents Altered nutrition, less than body requirements Hypermetabolic state, consequences of chemo, radiation, surgery, emotional distress, fatigue, poor pain control

NURSING DIAGNOSIS

Risk for fluid volume deficit Fatigue Risk for infection Risk for altered mucous membrane Risk for skin/tissue integrity Risk for Constipation/diarrhea Risk for Altered sexuality patterns Knowledge deficit

NURSING MANAGEMENT
Assess

fluid & electrolytes Modify risk for infection & bleeding Administer chemotherapy Protect caregivers

HEALTH PROMOTION
More fresh vegetables Vitamin A - esophageal, laryngeal, lung Ca Vit. C - stomach & esophageal Weight controluterus, gall bladder, breast, colon High fat - breast & prostate Ca

HEALTH PROMOTION

Smoking Alcohol - Liver Ca, larynx, esophagus Sun exposure - skin Ca

GOD BLESS US ALL!