nursing care of cancer patients – Flashcards
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cure
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eradicate
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palliation
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control symptoms
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treatment guidelines
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American Society of Clinical Oncologists, National Comprehensive Cancer Network, National Cancer Insitute
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treatment modalities/options
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Surgery Radiation Therapy Chemotherapy Biologic & Targeted Therapy Hematopoietic Stem Cell Transplantation Gene Therapies Complementary Therapies
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control
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maintain with treatment
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surgery
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Prevention Diagnosis Primary Treatment (Cure & Control) Palliation of Symptoms Rehabilitative/Reconstruction
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nursing care for surgery
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based on type and location of surgery
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radiation therapy
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Local treatment No distinction between normal cells and cancer cells Energy produced by radiation disrupts chemical bonds in DNA; Cancer cells lose ability to replicate Cellular sensitivity to radiation varies throughout the cell cycle; useful for cells that are rapidly dividing Goal: Achieve maximum tumor control with minimum of damage to normal tissue teletherapy, brachy therapy
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teletherapy
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delivery of radiation from a source at some distance from the patient
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brachytherapy
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radioactive material placed directly into or adjacent to tumor
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reason for radiation therapy
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Cure& Control Alone or combined with other treatments Pre-op, Post-op, or Intra-op Inoperable Tumors Palliation
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sealed brachytherapy
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"seeds, ribbons"- implanted directly into or close to tumor. e.g. prostate gland
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unsealed brachytherapy
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e.g. isotopes given PO or IV; I 131 for thyroid cancer
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brachytherapy: precautions
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Wear film badge (dosimeter) - detects exposure Distance of 6 feet Proper attire - shielding Private Room Pregnancy precautions Special care with body fluids and linens If source is dislodged - do not touch -lead container
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radiation therapy: skin changes
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blanching, erythema, desquamation, sloughing, hemorrhage, ulcerations of mucous membranes, decreased oral secretions (dry mouth, infections, cavities), hair loss
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radiation therapy: GI
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Nausea, vomiting, diarrhea, bleeding, dehydration Lungs: pneumonitis, radiation pneumonia, cough, dyspnea
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radiation therapy: cardiac
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pericarditis
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skin nursing care: skin
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No heating pads, ice packs, use non-irritating lotions, mild soaps Protect treatment field Pat skin dry Avoid sun exposure
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chemotherapy
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-Chemicals as systemic and regional therapy -Goal: eliminate or reduce number of malignant cells in primary and secondary tumors -Effect on Cells: disrupts the cell cycle; Damage the DNA; interfere with synthesis of enzymes and chemicals needed by the cell -Classified according to effects of agent on the cell and pharmacologic properties -Often administered in combination
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chemotherapy: preparation/administration
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Prepared specially trained pharmacists, physicians, nurses, advanced practice practitioners Safe handling to avoid exposure Dosing based on body surface area (height/weight) Irritant Vesicant Central Vascular Access Devices
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systemic chemo
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intravenous, oral, intramuscular
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regional chemo
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intracavitary, intrathecal, intraventricular, intraarterial, intravesical
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chemo side effects
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No distinction between normal cells and cancer cells Side effects result of destruction of normal cells Bone marrow Lining of GI tract Integumentary system Acute: anaphylaxis, anticipatory nausea/vomiting, cardiac dysrhythmias, hemorrhagic cystitis Delayed: nausea, vomiting, mucositis, alopecia, skin rashes, bone marrow suppression, diarrhea, constipation, neurotoxicities, fatigue Chronic: damage to heart, liver, kidneys, lungs, reproductive dysfunction
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hematopietic effects
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Anemia Neutropenia Leukopenia Thrombocytopenia Pancytopenia Nadir
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chemotherapy: nursing care
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Education, identification, management of hematopoietic effects Anemia Neutropenia/Leukopenia Thrombocytopenia (petechiae) Pancytopenia
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hematopoietic growth factors
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-Stimulate production, maturation, regulation, and activation, of the cells of the hematopoietic system -Neupogen/Neulasta- granulocyte colony-stimulating factor G-CSF -Epogen/Procrit/Aranesp-Erythropoietin -Neumega-Interleukin-11
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biotherapy
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-Consists of agents that alter the biologic response of the host to the tumor cells. -Targeted therapies; interfere with cancer growth; selective for specific molecular targets, so kill cancer cells without damaging normal cells -Have direct anti-tumor effects -Modulate host immune system mechanisms -Interfere with cancer cell's ability to metastasize
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biotherapy side effects
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Flu-like symptoms Headache, fever, chills, myalgias, fatigue, malaise, weakness, photosensitivity, anorexia, nausea Tachycardia Orthostatic hypotension Confusion, memory loss, insomnia
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biologic therapy: nursing care
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education, treat flu-like symptoms
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hematopoietic stem cell transplantation
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Bone Marrow Peripheral Blood Stem Cell Umbilical Cord Blood Stem Cell
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gene therapy
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Genetic material introduced into patient's cells to fight disease Enhance health cells' ability to fight cancer Target cancer cells to destroy or prevent growth Investigational
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nursing diagnoses
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Anxiety Disturbed Body Image Anticipatory Grieving Risk for Infection Risk for Injury Imbalanced Nutrition: Less than body requirements Impaired Tissue Integrity Acute Pain Chronic Pain Powerlessness
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nursing care for the patient with cancer
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Education Pain Stomatitis, mucositis, esophagitis Nausea/vomiting/Nutrition Anorexia Diarrhea Constipation Hepatotoxicity Alopecia Skin changes Fatigue Hematopoietic effects Emotional support
