ATI Cancer Treatment Options – Flashcards
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cancer treatment
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-based on the cell of origin of the cancer -when metastasis occurs, treatment is still based on the primary tumor origin even though the malignancy is located elsewhere in the body
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cancer treatment options
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-focus on removing or destroying cancer cells and preventing the continued abnormal cell growth and differentiation -treatments may be curative or palliative
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treatment plan
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-is guided by many patient factors and may involve several treatment methods
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adjuvant treatment
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-is what is given in addition to the primary treatment standard, and can include hormone, radiation, and targeted therapies; immunotherapy; and chemotherapy
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nursing care
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-for patients who have cancer should include collaboration with supportive therapies and services, counseling, and transfer of care to another provider at discharge
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manipulation or removal of the tumor
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-tumors may be reduced through topical procedures or by destruction of the main arteries that provide blood flow to the tumor -tumor excision may be open or endoscopic -tumor and tissue immediately surrounding it are removed. the goal is that all of the outermost tissue that was removed doesn't contain cancer cells -surgery may be done for excision, biopsy, or for relief, based on clinical findings -lymph node dissection or sentinel lymph node biopsy is done if the cancer spreads or there is added risk of spread -more extensive surgeries increase the risk of complications and typically require longer recovery periods. intensive care may be required
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procedures, nursing actions
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-obtain signed informed consent form -prepare the patient for procedure -provide postoperative care as indicated by tumor location and procedure type -prevent general postoperative complications -prevent and treat pain as prescribed using pharmacological and nonpharmacological measures -educate the patient on care for drains, wounds, and implanted devices -teach the patient to monitor for complications after discharge
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chemotherapy
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-involves the administration of systemic or local cytoxic medications that damage a cell's DNA or destroy rapidly dividing cells *chemotherapeutic agents are often selected in relation to their effect on various stages of cell division. subsequently, combinations of anticancer medications are used to enhance destruction of cancer cells *most chemotherapy agents are cytotoxic. the adverse effects of these agents are related to the unintentional harm done to normal rapidly proliferating cells, such as those found in the mucous membranes in the GI tract, hair follicles, and bone marrow *can be administered in a health care setting, provider's office, clinic, or home *depending on the agent, it can be given by the oral, parenteral, IV, intracavity, or intrathecal route. special training/certification is necessary for the administration of some agents
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implanted port
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-used when therapy is intended to be given on a long-term basis *the port is comprised of a small reservoir that is covered by a thick septume
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central catheter
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-usually placed for chemotherapy administration or laboratory blood testing -types include nontunneled percutaneous central catheter and implanted port
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intracavitary chemotherapy
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-involves the administration of chemotherapy directly into a body cavity (pleural space, bladder). a small catheter may be used *local irritation may be increased, but systemic adverse effects are usually prevented *in some cases, the medication may be removed following a "dwell time"
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intracavitary chemotherapy, nursing actions
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-inform patient that some discomfort may be present during infusion -instruct patient to monitor for evidence of infection at the site of administration
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chemotherapy, indications
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-can be used to cure a disease, help control its progression, or as palliative treatment for individuals who have a terminal disease -most commonly used for treatment of cancer, but it may also be used for other disorders such as autoimmune diseases
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chemotherapy, preprocedure
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-because administration of chemotherapeutic medications is limited to certified individuals, management of adverse effects is the primary focus of health care personnel -instruct patient on findings which indicate potential complications. patient should report findings immediately
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chemotherapy, complications
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-immunosuppression due to bone marrow suppression by cytotoxic medications is the most significant effect of chemotherapy
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immunosuppression, nursing actions
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-monitor temperature and WBC count -fever greater than 100 F should be reported to the provider immediately -monitor skin and mucous membranes for infection -cultures should be obtained prior to initiating antimicrobial therapy -if patients WBC drops below 1000, place the patient in a private room and initiate neutropenic precautions
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neutropenic precations
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-patient remains in room unless they need to leave for diagnostic procedure or therapy; place mask on for transport -protect the patient from possible sources of infection -have patient, staff, and visitors perform frequent hand hygiene; restrict visitors who are ill -avoid invasive procedures that could cause a break in tissue unless necessary -keep dedicated equipment in the patients room -administer colony-stimulating factors filgrastim as prescribed to stimulate WBC production
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neutropenic, patient education
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-encourage patient to avoid crowds while undergoing chemotherapy -take temp daily, report elevated temps to provider -avoid food sources that could contain bacteria -avoid yard work, gardening, changing a pet's litter box -avoid fluids that have been sitting at room temperature for longer than 1 hour -wash all dishes in hot, soapy water or dishwasher -wash toothbrush daily in dishwasher or rinse in bleach solution -don't share toiletry or personal hygiene items with others
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nausea and vomiting/anorexia
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-many of the medications used for chemotherapy are emetogenic or cause anorexia as well as an altered taste in the mouth -serotonin blockers, such as ondansetron, have been found to be effective and are often administered with corticosteroids, phenothiazines, and antihistamines
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nausea and vomiting/anorexia, nursing actions
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-administer antiemetic medications at times that are appropriate for chemotherapeutic agent -administer antiemetic medication for several days after each treatment as needed -remove vomiting cues, such as odor and supplies associate with nausea -implement nonpharmacological methods to reduce nausea -perform calorie counts to determine intake. provide liquid nutritional supplements as needed. add protein powders to food or tube feedings -administer megestrol to increase the appetite if prescribed -assess for findings of dehydration or fluid and electrolyte imbalance -perform mouth care prior to serving meals to enhance the patients appetite
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nausea and vomiting/anorexia, patient education
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-instruct the patient about administration of antiemetics and schedule them prior to meals -encourage the patient to eat several small meals a day if better tolerated. low-fat and dry foods and avoiding drinking liquids during meals can prevent nausea -suggest that the patient select foods that are served cold and don't require cooking, which can emit odors that stimulate nausea -encourage consumption of high-protein, high-calorie, nutrient-dense foods and avoidance of low-calorie foods. use meal supplements as needed -encourage the use of plastic eating utensils, sucking on hard candy, and avoiding red meats to prevent or reduce the sensation of metallic taste -teach the patient to create a food diary to identify items that can trigger nausea
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alopecia
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-an adverse effect of certain chemotherapeutic medications related to their interference with the life cycle of rapidly proliferating cells
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alopecia, nursing actions
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-discuss the impact of alopecia on self-image. discuss options such as hats, turbans, and wigs to deal with hair loss -recommend soliciting information from the American Cancer Society regarding products for patients experience alopecia -inform patient that hair loss occurs 7 to 10 days after treatment begins. encourage patient to select hairpiece before treatment starts -reinforce that alopecia is temporary, and hair should return when chemotherapy is discontinued
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alopecia, patient education
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-instruct the patients to avoid the use of damaging hair-cream measures, such as electric rollers and curling irons, hair dye, and permanent waves. use of a soft hair brush or wide-tooth comb for grooming is preferred -suggest that the patient cut her hair short before treatment to decrease weight on the hair follicle -after hair loss, the patient should protect the scale from sun exposure and use a diaper rash ointment/cream for itching
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mucositis
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-inflammation of tissues in the mouth, such as the gums, tongue, roof and floor of mouth, and inside the lips and cheeks
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mucositis, nursing actions
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-examine the patients mouth several ties a day, and inquire about the presence of oral lesions -document the location and size of lesions that are present. lesions should be cultured and reported to the provider -avoid using glycerin-based mouthwashes or mouth swabs. nonalcoholic, anesthetic mouthwashes are recommended -administer a topical anesthetic prior to meals -discourage consumption of salty, acidic, or spicy foods -offer oral hygiene before and after each meal. use lubricating or moisturizing agents to counteract dry mouth
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mucositis, patient education
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-encourage the patient to rinse mouth with a solution of half 0.9% sodium chloride and half peroxide at least twice a day, and to brush teeth using a soft-bristled toothbrush -instruct patient to take medications to control infection as prescribed -encourage the patient to eat soft, bland foods and supplements that are high in calories
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anemia and thrombocytopenia
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-occur secondary to bone marrow suppression
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anemia, nursing actions
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-monitor for fatigue, pallor, dizziness, and SOB -help the patient manage anemia-related fatigue by scheduling activities with rest periods in between and using energy saving measures -administer erythropoietic medications such as epoetin alfa (Epogen) and antianemic medications such as ferrous sulfate as prescribed -monitor Hgb values to determine response to medications. be prepared to administer blood if prescribed
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thrombocytopenia, nursing actions
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-monitor for petechiae, ecchymosis, bleeding of the gums, nosebleeds, and occult or frank blood in stools, urine, or vomitus -institute bleeding precautions -administer thrombopoietic medications to stimulate platelet production. monitor platelet count, and be prepared to administer platelets if the count falls below 30,000/mm3
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thombocytopenia, patient education
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-instruct the patient and family how to manage active bleeding -instruct patient about measures to prevent bleeding -avoid the use of NSAIDs -prevent injury when ambulating and apply cold if injury occurs
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radiation therapy
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-involves the use of ionizing radiation to target tissues and destroy cells -adverse effects include skin changes, hair loss, and debilitating fatigue -can be administered internally with an implant or externally with a radiation beam -patients body fluids are contaminated with radiation and should be disposed of appropriately, as directed by the facility -radiation therapy can be given preoperatively to decrease the size of a tumor -radiation exposure to health care personnel and visitors to reduce by limiting indirect contact time, maintaining indicated distances from sources of radiation, and preventing direct contact with the source
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internal radiation therapy
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-brachytherapy describes internal radiation that is placed close to the target tissue. this is done via placement in a body orifice or body cavity or delivered via IV such as with radionuclide iodine, which is absorbed by the thyroid
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radiation therapy, nursing actions
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-place patient in a private room away from other patients when possible -place appropriate sign on the door warning of the radiation source -wear a dosimeter film badge that records personal amount of radiation exposure -limit visitors to 30 min visits, and have visitors maintain a distance of 6 ft from the source -visitors and health care personnel who are pregnant or under the age of 16 shouldn't come into contact with the patient or radiation source -keep a lead container in the patients room if the delivery method could allow spontaneous loss of radioactive material. tongs are available for placing radioactive material into this container -precautions listed above should be carried out at home if the patient is discharged during therapy
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radiation therapy, patient education
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-the need to remain in an indicated position to prevent dislodgement of the radiation implant -call the nurse for assistance with elimination -radiation precautions needed in the health care and home environment
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external radiation therapy
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-delivered over the course of several weeks and aimed at the body from an external source
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external radiation therapy, nursing actions
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-patients skin over the targeted area is marked with "tattoos" that guide the positioning of the external radiation source -provide well-balanced diet that doesn't contain red meat. radiation can cause dysgeusia, making foods such as red meat unpalatable -help patient manage fatigue by scheduling activities with rest periods in between and using energy-saving measures -monitor for radiation injury to skin and mucous membranes and implement a skin care regimen -monitor CBC
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external radiation therapy, patient education
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-review nutrition considerations related to mucositis -gently wash the skin over the irradiated area with mild soap and water. dry the area thoroughly using patting motions -don't remove or wash off radiation "tattoos" that are used to guide therapy. don't apply powders, ointments, lotions, deodorants, or perfumes to the irradiated skin -wear soft clothing and avoid tight or constricting clothes -don't expose the irradiated skin to sun or a heat source -inspect skin for evidence of damage and report to the provider
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hormonal therapy
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-effective against tumors that are supported or suppressed by hormones -by giving a similar hormone, uptake of the support hormone is blocked, or production reduced. hormone agonists, gonadotropin-releasing hormone agonists (GnRH) like leuprolide are effective against tumors that require a particular hormone for support *the use of androgenic hormones in a patient who has estrogen-dependent cancer can suppress growth of this type of cancer *conversely, the use of estrogenic hormones for a testosterone-dependent cancer can suppress growth of this type of cancer
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hormone antagonists
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-compete with support hormone for binding sites on or in the tumor cell and are effective against tumors that require a particular hormone for support *the use of an anti-estrogen hormone in a patient who has a estrogen-dependent cancer can suppress growth of this type of cancer *the same is true for anti-testosterone hormones
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GnRH, nursing actions
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-monitor cardiac status, along with blood pressure and for the occurrence of pulmonary edema
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GnRH, patient education
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-inform male patients about the impact on sexual functions and feminizing effects of hormone therapy -increase calcium and vitamin D -female patients may experience masculinity effects
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androgen antagonists
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-flutamide -monitor laboratory findings
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androgen antagonists, patient education
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-male patients may experience femininity effects -notify provider of sore throat or bruising
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estrogen antagonists
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-tamoxifen -ongoing care: *monitor CBC, clotting times, lipid profiles, calcium and cholesterol serum levels, and liver function for medication-related changes *neurologic and cardiovascular functioning is monitored for changes
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estrogen antagonists, patient education
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-inform the patient of adverse effects, which include nausea, vomiting, hot flashes, weight gain, vaginal bleeding, and increased risk of thrombosis -reinforce the need for yearly gynecologic exams and the need to take calcium and vitamin D supplements
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immunotherapy
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-uses biologic responses modifiers (BRMs), which is alter a patients biological response to cancerous tumor cells. antibodies, cytokines, and other immune substances normally produced by the immune system are administered to increase the body's defense against cancer *interleukins and interferons are the two primary cytokines (immune response modulators) used in immunotherapy *cytokines are the primary BRMs currently used and they work to enhance the immune system. they help the patients immune system recognize cancer cells and use the body's natural defenses to destroy them
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immunotherapy, nursing actions
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-interleukins -interferons *monitor for peripheral neuropathy that may affect vision, hearing, balance, and gait *take precautions for orthostatic hypotension
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interluekins
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-monitor for influenza-like symptoms and edema
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interferons
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-monitor for altered mental status and lethargy
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immunotherapy, patient education
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-immediately report influenza-like manifestations or changes consistent with peripheral neuropathy -skin rashes are common and use a perfume-free moisturizer may be helpful -avoid sun exposure and swimming if manifestations develop
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photodynamic therapy
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-involves the injection of photosensitizing agent that is absorbed by all the cells in the body. one to three days later when the agent remains in only the cancer cells, the tumor is exposed to a specific wavelength of light via endoscope. cells are subsequently destroyed and tumors are eliminated or reduced in size *used to treat non-small cell lung cancer and esophageal cancer *effective with small tumors close to body surface (within 1 cm) *adverse effects are related to the area of the body being treated
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photodynamic therapy, nursing actions
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-instruct the patient to avoid sun exposure for 6 weeks (limit time outdoors, wear sunglasses)
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supportive treatment
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-in addition to cancer treatment, the patient may require assistance for altered body function or to meet emotional and spiritual needs -patients who have cancer are at risk for inadequate nutrition related to diagnosis or treatment
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support treatment, nursing actions
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-administer nutritional supplements of substitutes as prescribed -monitor feeding tube or central line as appropriate -encourage the addition of protein- and calorie-dense foods -monitor for effectiveness of nutrition modifications -monitor weight -consult nutrition services
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altered elimination, nursing actions
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-assist with alternate means of elimination -monitor urine and bowel output -instruct the patient on self-management of elimination
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body images changes, nursing actions
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-encourage the patient to express feelings -encourage patient to look at or touch affected body areas -assist the patient with prosthetic devices, as indicated -encourage the patient to use positive measures to promote proper body image
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altered sexuality, nursing actions
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-encourage patient and partner to communicate feelings to each other -administer hormone therapy, as prescribed -instruct the patient about medications to promote erection or manage pain sensation, as prescribed
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ability to cope, nursing actions
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-administer medications for anxiety or depression, as prescribed -encourage the patient to express feelings verbally or through journaling and blogging -encourage the patient to participate in a support group for patients who have similar cancers. mark referral to community resources -make referral to counseling services for the patient and family, as needed -educate the patient on anticipatory grief and the stages of grief -consult palliative services, as indicated -incorporate patients belief's and preferences regarding spirituality and illness/death
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immunocomprised state, nursing action
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-teach patient to avoid individuals with colds/infections/viruses
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other supportive nursing actions
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-facilitate safe activity, providing assistive devices when necessary for patients who have altered mobility or require assistance with self-care activities -coordinate transfer of patients care to home health, hospice, or tertiary care setting as appropriate -provide alternate means of communication for patients who have cancer affecting the mouth, throat, larynx, or vocal cords -use assistive aids and devices for patients who have visual and hearing impairment -consult physical therapy, and genetic or other counseling services as indicated -consult pain management for persistent or uncontrolled pain
