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Oncology Nursing Review

Oncology defined Branch of medicine that deals with the study, detection, treatment and management of cancer and neoplasia

Characteristics of Neoplasia
Uncontrolled growth of Abnormal cells 1. Benign 2. Malignant

Characteristics of Neoplasia
BENIGN Well-differentiated Slow growth Encapsulated Non-invasive Does NOT metastasize

Characteristics of Neoplasia
MALIGNANT Undifferentiated Erratic and Uncontrolled Growth Expansive and Invasive Secretes abnormal proteins METASTASIZES

CANCER NURSING
Proposed Molecular cause of CANCER: Change in the DNA structure altered DNA function Cellular aberration cellular death neoplastic change Genes in the DNA- proto-oncogene And anti-oncogene

CANCER NURSING
Etiology of cancer 1. PHYSICAL AGENTS Radiation x-rays Exposure to irritants Exposure to sunlight Altitude, humidity

CANCER NURSING
Etiology of cancer 2. CHEMICAL AGENTS Smoking and alcohol Dietary ingredients Drugs

CANCER NURSING
Etiology of cancer 3. Genetics and Family History Colon Cancer Premenopausal breast cancer

CANCER NURSING
Etiology of cancer 4. Dietary Habits Low-Fiber High-fat Processed foods alcohol

CANCER NURSING
Etiology of cancer 5. Viruses and Bacteria DNA viruses- HepaB, Herpes, EBV, CMV, Papilloma Virus RNA Viruses- HIV, HTCLV Bacterium- H. pylori

CANCER NURSING
Etiology of cancer 6. Hormonal agents DES OCP especially estrogen

CANCER NURSING
Etiology of cancer 7. Immune Disease AIDS

CANCER NURSING
Cancer Diagnosis 1. BIOPSY
The most definitive

2. CT, MRI 3. Tumor Markers

CANCER NURSING
GENERAL MEDICAL MANAGEMENT 1. Surgery- cure, control, palliate 2. Chemotherapy 3. Radiation therapy 4. Immunotherapy 5. Bone Marrow Transplant

CANCER NURSING
GENERAL Promotive and Preventive Nursing Management 1. Lifestyle Modification 2. Nutritional management 3. Screening 4. Early detection

SCREENING
1. Male and female- Occult Blood, CXR, and DRE 2. Female- SBE, CBE, Mammography and Paps Smear 3. Male- DRE for prostate, Testicular self-exam

Nursing Assessment
Utilize the ACS 7 Warning Signals CAUTION C- Change in bowel/bladder habits A- A sore that does not heal U- Unusual bleeding T- Thickening or lump in the breast I- Indigestion O- Obvious change in warts N- Nagging cough and hoarseness

Nursing Assessment
Weight loss Frequent infection Skin problems Pain Hair Loss Fatigue Disturbance in body image/ depression

Nursing Intervention
MAINTAIN TISSUE INTEGRITY Handle skin gently Do NOT rub affected area Lotion may be applied Wash skin only with SOAP and Water

Nursing Intervention
MANAGEMENT OF STOMATITIS Use soft-bristled toothbrush Oral rinses with saline gargles/ tap water Avoid ALCOHOL-based rinses

Nursing Intervention
MANAGEMENT OF ALOPECIA Alopecia begins within 2 weeks of therapy Regrowth within 8 weeks of termination Encourage to acquire wig before hair loss occurs Encourage use of attractive scarves and hats Provide information that hair loss is temporary BUT anticipate change in texture and color

Nursing Intervention
PROMOTE NUTRITION Serve food in ways to make it appealing Consider patients preferences Provide small frequent meals Avoid giving fluids while eating Oral hygiene PRIOR to mealtime Vitamin supplements

Nursing Intervention
RELIEVE PAIN Mild pain- NSAIDS Moderate pain- Weak opioids Severe pain- Morphine Administer analgesics round the clock with additional dose for breakthrough pain

Nursing Intervention
DECREASE FATIGUE Plan daily activities to allow alternating rest periods Light exercise is encouraged Small frequent meals

Nursing Intervention
IMPROVE BODY IMAGE Therapeutic communication is essential Encourage independence in self-care and decision making Offer cosmetic material like make-up and wigs

Nursing Intervention
ASSIST IN THE GRIEVING PROCESS Some cancers are curable Grieving can be due to loss of health, income, sexuality, and body image Answer and clarify information about cancer and treatment options Identify resource people Refer to support groups

Nursing Intervention
MANAGE COMPLICATION: INFECTION Fever is the most important sign (38.3) Administer prescribed antibiotics X 2weeks Maintain aseptic technique Avoid exposure to crowds Avoid giving fresh fruits and veggie Hand-washing Avoid frequent invasive procedures

Nursing Intervention
MANAGE COMPLICATION: Septic shock Monitor VS, BP, temp Administer IV antibiotics Administer supplemental O2

Nursing Intervention
MANAGE COMPLICATION: Bleeding Thrombocytopenia (<100,000) is the most common cause <20, 000 spontaneous bleeding Use soft toothbrush Use electric razor Avoid frequent IM, IV, rectal and catheterization Soft foods and stool softeners

Nursing Intervention
MANAGE radiation implants Place in private room with caution sign Limit to hour of care with lead shield Limit visitors: 6 feet from the source Limit client movement: stay on bed Use a LONG forcep to handle dislodged item Dispose all soiled items sealed

Colon cancer

COLON CANCER
Risk factors 1. Increasing age 2. Family history 3. Previous colon CA or polyps 4. History of IBD 5. High fat, High protein, LOW fiber 6. Breast Ca and Genital Ca

COLON CANCER
Sigmoid colon is the most common site Predominantly adenocarcinoma If early 90% survival 34 % diagnosed early 66% late diagnosis

COLON CANCER
PATHOPHYSIOLOGY
Benign neoplasm
DNA alteration malignant transformation malignant neoplasm cancer growth and invasion metastasis (liver)

COLON CANCER
ASSESSMENT FINDINGS 1. Change in bowel habits- Most common 2. Blood in the stool 3. Anemia 4. Anorexia and weight loss 5. Fatigue 6. Rectal lesions- tenesmus, alternating D and C

Colon cancer

LEFT
Obstructive Stool caliber Fresh bleed

RIGHT
Expansive Anemia Occult blood

Colon cancer
Diagnostic findings 1. BIOPSY 2. Stool occult blood 3. Sigmoidoscopy and colonoscopy 4. CEA- carcino-embryonic antigen

Colon cancer
Complications of colorectal CA 1. Obstruction 2. Hemorrhage 3. Peritonitis 4. Sepsis

Colon cancer
MEDICAL MANAGEMENT 1. Chemotherapy- 5-FU 2. Radiation therapy

Colon surgery
SURGICAL MANAGEMENT Surgery is the primary treatment Based on location and tumor size Resection, anastomosis, and colostomy (temporary or permanent)

Colon surgery
NURSING INTERVENTION Pre-Operative care 1. Provide HIGH protein, HIGH calorie and LOW residue diet 2.Provide information about post-op care and stoma care 3. Administer antibiotics 1 day prior

Colon surgery
NURSING INTERVENTION Pre-Operative care 4. Enema or colonic irrigation the evening and the morning of surgery 5. NGT is inserted to prevent distention 6. Monitor UO, F and E, Abdomen PE

Colon surgery
NURSING INTERVENTION Post-Operative care 1. Monitor for complications
Leakage from the site, prolapse of stoma, skin irritation and pulmo complication

2. Assess the abdomen for return of peristalsis

Colon surgery
NURSING INTERVENTION Post-Operative care 3. Assess wound dressing for bleeding 4. Assist patient in ambulation after 24H 5. Provide nutritional teaching
Limit foods that cause gas-formation and odor Cabbage, beans, eggs, fish, peanuts Low-fiber diet in the early stage of recovery

Colon surgery
NURSING INTERVENTION Post-Operative care 6. Instruct to splint the incision and administer pain meds before exercise
7. The stoma is PINKISH to cherry red, Slightly edematous with minimal pinkish drainage 8. Manage post-operative complication

Colon surgery
NURSING INTERVENTION: COLOSTOMY CARE Empty the pouch or change the pouch when
1/3 to full (Brunner) to 1/3 full (Kozier)

Breast Cancer
The most common cancer in FEMALES Numerous etiologies implicated

Breast Cancer
RISK FACTORS 1. Genetics- BRCA1 And BRCA 2 2. Increasing age ( > 50yo) 3. Family History of breast cancer 4. Early menarche and late menopause 5. Nulliparity 6. Late age at pregnancy

Breast Cancer
RISK FACTORS 7. Obesity 8. Hormonal replacement 9. Alcohol 10. Exposure to radiation

Breast Cancer
PROTECTIVE FACTORS 1. Exercise 2. Breast feeding 3. Pregnancy before 30 yo

Breast Cancer
ASSESSMENT FINDINGS 1. MASS- the most common location is the upper outer quadrant 2. Mass is NON-tender. Fixed, hard with irregular borders 3. Skin dimpling 4. Nipple retraction 5. Peau d orange

Breast Cancer
LABORATORY FINDINGS 1. Biopsy procedures 2. Mammography

Breast Cancer
Breast cancer Staging TNM staging I - < 2cm II - 2 to 5 cm, (+) LN III - > 5 cm, (+) LN IV- metastasis

Breast Cancer
MEDICAL MANAGEMENT 1. Chemotherapy 2. Tamoxifen therapy 3. Radiation therapy

Breast Cancer
SURGICAL MANAGEMENT 1. Radical mastectomy 2. Modified radical mastectomy 3. Lumpectomy 4. Quadrantectomy

Breast Cancer
NURSING INTERVENTION : PRE-OP 1. Explain breast cancer and treatment options 2. Reduce fear and anxiety and improve coping abilities 3. Promote decision making abilities 4. Provide routine pre-op care: Consent, NPO, Meds, Teaching about breathing exercise

Breast Cancer
NURSING INTERVENTION : Post-OP 1. Position patient: Supine Affected extremity elevated to reduce edema

Breast Cancer
NURSING INTERVENTION : Post-OP 2. Relieve pain and discomfort Moderate elevation of extremity IM/IV injection of pain meds on the unaffected area Warm shower on 2nd day post-op

Breast Cancer
NURSING INTERVENTION : Post-OP 3. Maintain skin integrity Immediate post-op: snug dressing with drainage Maintain patency of drain (JP) Monitor for hematoma w/in 12H and apply bandage and ice, refer to surgeon

Breast Cancer
NURSING INTERVENTION : Post-OP 3. Maintain skin integrity Drainage is removed when the discharge is less than 30 ml in 24 H Lotions, Creams are applied ONLY when the incision is healed in 4-6 weeks

Breast Cancer
NURSING INTERVENTION : Post-OP Promote activity Support operative site when moving Hand, shoulder exercise done on 2ndday Post-op mastectomy exercise 20 mins TID NO BP or IV procedure on operative site

Breast Cancer
NURSING INTERVENTION : Post-OP Promote activity Heavy lifting is avoided Elevate the arm at the level of the heart On a pillow for 45 minutes TID to relieve transient edema

Breast Cancer
NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS Lymphedema 10-20% of patients Elevate arms, elbow above shoulder and hand above elbow Hand exercise while elevated Refer to surgeon and physical therapist

Breast Cancer
NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS Hematoma Notify the surgeon Apply bandage wrap (Ace wrap) and ICE pack

Breast Cancer
NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS Infection Monitor temperature, redness, swelling and foul-odor IV antibiotics No procedure on affected extremity

Breast Cancer
NURSING INTERVENTION : Post-OP TEACH FOLLOW-UP care Regular check-up Monthly BSE on the other breast Annual mammography

Breast Cancer
BREAST B= BP not on affected area R= Reach for recovery E= Elevate affected arm A= Abduction and external rotation at home S= SBE every month, Mammo every year T= Teach to promote body image

Hodgkins
Malignancy of the lymph nodes that originates in a single node Involves the spleen, tonsils, lymph nodes and bone marrow

Common in young adults

Hodgkins
1. 2. 3. Possible causes Viral infection Chemical Previous exposures

Hodgkins
Assessment 1. Fever, malaise and fatigue 2. Enlarged lymph node, especially cervical nodes 3. Anorexia 4. Weight loss

Hodgkins
Diagnosis Positive Reed-Sternbergs cells in nodes CT and MRI

Hodgkins
Medical Management 1. Radiation therapy 2. Multi agent chemotherapy: MOPP

Hodgkins
Nursing Management 1. Monitor for side effects of the chemo and radiotherapy 2. Monitor for infection and bleeding 3. Discuss the possibility of sterility

Male reproductive disorders


BPH Prostatic cancer

Male reproductive disorders


DIGITAL RECTAL EXAMINATION- DRE Recommended for men annually with age over 40 years Screening test for cancer Ask patient to BEAR DOWN

Male reproductive disorders


TESTICULAR EXAMINATION Palpation of scrotum for nodules and masses or inflammation BEGINS DURING ADOLESCENCE

Male reproductive disorders


Prostate specific antigen (PSA) Elevated in prostate cancer Normal is 0.2 to 4 nanograms/mL Cancer= over 4

Male reproductive disorders


BENIGN PROSTATIC HYPERPLASIA Enlargement of the prostate that causes outflow obstruction Common in men older than 50 years old

Male reproductive disorders


BENIGN PROSTATIC HYPERPLASIA Assessment findings 1. DRE: enlarged prostate gland that is rubbery, large and NON-tender 2. Increased frequency, urgency and hesitancy 3. Nocturia, DECREASE IN THE VOLUME AND FORCE OF URINE STREAM

Male reproductive disorders


BENIGN PROSTATIC HYPERPLASIA Medical management 1. Immediate catheterization 2. Prostatectomy 3. TRANSURETHRAL RESECTION of the PROSTATE (TURP) 4. Pharmacology: alpha-blockers, alphareductase inhibitors. SAW palmetto

BPH
NURSING INTERVENTION 1. Encourage fluids up to 2 liters per day 2. Insert catheter for urinary drainage 3. Administer medications alpha adrenergic blockers and finasteride 4. Avoid anticholinergics 5. Prepare for surgery or TURP 6. Teach the patient perineal muscle exercises. Avoid valsalva until healing

BPH
NURSING INTERVENTION: TURP Maintain the three way bladder irrigation to prevent hemorrhage Only initially the drainage is pink-tinged and never reddish Administer anti-spasmodic to prevent bladder spasms

Prostate Cancer
a slow growing malignancy of the prostate gland Usually an adenocarcinoma This usualy spread via blood stream to the vertebrae

Prostate Cancer
Predisposing factor
Age

Prostate Cancer
Assessment Findings 1. DRE: hard, pea-sized nodules on the anterior rectum 2. Hematuria 3. Urinary obstruction 4. Pain on the perineum radiating to the leg

Prostate Cancer
Diagnostic tests 1. Prostatic specific antigen (PSA) 2. Elevated SERUM ACID PHOSPHATASE indicates SPREAD or Metastasis

Prostate Cancer
Medical and surgical management 1. Prostatectomy 2. TURP 3. Chemotherapy: hormonal therapy to slow the rate of tumor growth 4. Radiation therapy

Prostate Cancer
Nursing Interventions 1. Prepare patient for chemotherapy 2. Prepare for surgery

Prostate Cancer
Nursing Interventions: Post-prostatectomy 1. Maintain continuous bladder irrigation. Note that drainage is pink tinged w/in 24 hours 2. Monitor urine for the presence of blood clots and hemorrhage 3. Ambulate the patient as soon as urine begins to clear in color

Laryngeal Cancer

A malignant tumor of the larynx More frequent in men 50-70 years old

Laryngeal Cancer
RISK FACTORS 1. Smoking 2. Alcohol 3. Exposure to chemicals 4. Straining of voice 5. chronic laryngitis 6. Deficiency of Riboflavin 7. family history

Laryngeal Cancer
Growth can be anywhere in the larynx 1. Supraglottic- above the vocal cords 2. glottic- vocal cord area 3. infraglottic- below the vocal cords

Most tumors are found in the glottic area

Laryngeal Cancer
ASSESSMENT FINDINGS Hoarseness of more than TWO weeks duration Cough and sore throat Burning and pain in the throat Neck lump Dysphagia, dyspnea, foul breath, CLAD

Laryngeal Cancer
LABORATORY FINDINGS 1. Indirect laryngoscopy 2. direct laryngoscopy 3. Biopsy 4. CT and MRI Most commonly- squamos carcinoma

Laryngeal Cancer
MEDICAL MANAGEMENT Radiation therapy Chemotherapy Surgery
Partial laryngectomy Supraglottic laryngectomy Hemilaryngectomy Total laryngectomy

Laryngeal Cancer
NURSING MANAGEMENT: PRE-operative 1. Provide the patient pre-operative teachings Tell that the natural voice will be lost Teach communication alternatives Collaborate with other team members

Laryngeal Cancer
NURSING MANAGEMENT 2. Reduce patient ANXIETY Provide opportunities for patient and family members to ask questions Referrals to previous patients with laryngeal cancers and cancer groups

Laryngeal Cancer
NURSING MANAGEMENT: POST-op 3. Maintain PATENT Airway Position patient: Semi or High Fowlers Suction secretions Encourage to deep breath, turn and cough

Laryngeal Cancer
NURSING MANAGEMENT: POST-op 4. Administer care of the laryngectomy tube Suction as needed Cleanse the stoma with saline Administer humidified oxygen Laryngectomy tube is usually removed within 36 weeks after surgery

Laryngeal Cancer
NURSING MANAGEMENT: POST-op 5. Promote alternative communication Call bell or hand bell Magic Slate Hand signals Collaborate with speech therapist

Laryngeal Cancer
NURSING MANAGEMENT: POST-op 6. Promote adequate Nutrition NPO after operation No foods or drinks per orem for 10 days IVF, TPN are alternative nutrition routes Start oral feedings with thick liquids, avoid sweet foods

Laryngeal Cancer
NURSING MANAGEMENT: POST-op 7. Promote positive body image and self-esteem Encourage verbalization of feelings Allow independence in self-care

Laryngeal Cancer
NURSING MANAGEMENT: POST-op 8. Monitor for COMPLICATIONS Respiratory Distress
Suction Coughing and deep breathing Humidified oxygen Alert the surgeon

Laryngeal Cancer
NURSING MANAGEMENT: POST-op 8. Monitor for Complications Hemorrhage
Monitor for bleeding Monitor vital signs Apply direct pressure over the bleeding artery Summon assistance and alert the surgeon

Laryngeal Cancer
NURSING MANAGEMENT: POST-op 8. Monitor for COMPLICATIONS Wound infection and breakdown Monitor for increased temperature, purulent drainage and increased redness/tenderness Administer antibiotics Clean and change dressing OD

Laryngeal Cancer
NURSING MANAGEMENT: HOME CARE Humidification system at home is needed AVOID swimming Cover the stoma with hands or plastic bib over the opening Advise beauty salons to avoid hair sprays, powders and loose hair near the opening Oral hygiene frequently

Lung Cancer

Primary pulmonary tumors arise from the bronchial epithelium and are therefore referred to as bronchogenic carcinomas.

Lung Cancer
FACTORS Possibly caused by inhaled carcinogens (primarily cigarette smoke but also asbestos, nickel, iron oxides, air silicone pollution; preexisting pulmonary disorders PTB, COPD)

Lung Cancer
Assessment findings Persistent cough (blood tinged) chest pain dyspnea unilateral wheezing, friction rub, possible unilateral paralysis of the diaphragm Fatigue, anorexia, nausea, vomiting, pallor

Lung Cancer
Diagnostic tests Chest x-ray may show presence of tumor or evidence of metastasis to surrounding structures Sputum for cytology reveals malignant cells Bronchoscopy: biopsy reveals malignancy Thoracentesis: pleural fluid contains malignant cells

Lung Cancer
1. Provide support and guidance to client as needed. 2. Provide relief/control of pain. 3. Administer medications as ordered and monitor effects/side effects. 4. Control nausea: administer medications as ordered, provide good oral hygiene, provide small and more frequent feedings.

Lung Cancer
5. Provide nursing care for a client with a thoracic surgery 6. Provide client teaching and discharge planning concerning
a. Disease process, diagnostic and therapeutic interventions b. Side effects of radiation and chemotherapy c. Realistic information about prognosis

Lung Cancer
Medical management 1. Radiation therapy 2. Chemotherapy: usually includes cyclophosphamide, methotrexate, vincristine, doxorubicin, and procarbazine; concurrently in some combination 3. Surgery: when entire tumor can be removed

Lung Cancer
Quick Notes on Bronchogenic Cancer Predisposing factors Cigarette smoking Asbestosis CPD Smoke from burnt wood

Lung Cancer
Quick Notes on Bronchogenic Cancer Types Squamous cell Ca- with good prognosis Adenocarcinoma- with good prognosis Oat cell Ca- with good prognosis Undifferentiated Ca- with poor prognosis

Lung Cancer
Quick Notes on Bronchogenic Cancer Nursing Interventions Patent airway O2 / Aerosol therapy Deep breathing exercises Relief of pain Protection from infection Adequate nutrition Chest tube management

Lung Cancer
Quick Notes on Bronchogenic Cancer Surgery Pneumonectomy=Removal of a lung (either left or right) Lobectomy=Removal of a lobe.