Chapter 11: Nursing Care of Patients with Cancer – Flashcards
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Nucleus
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Control center of a cell, contains DNA sequence.
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Genes
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DNA coding regions. A gene is the code for 1 protein.
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Neoplasm Tumor
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Neoplastic growth is difficult to detect until it contains about 500 cells and is about 1 cm in diameter.
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Cancer Pathophysiology
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No cell division limit. Normal cells limited to 50-60 divisions.
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Cancer Etiology: Initiation
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Initiation- The first step, causes an alteration in the genetic structure of the cell (DNA).
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Cancer Etiology
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Cell alteration is associated with carcinogen exposure.
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Cancer Etiology: Promotion
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The second step. Occurs after repeated exposure to carcinogens which causes the initiated cell to mutate and a tumor forms.
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Benign Tumors
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Typically slow growth rate. Metastasis is not seen. Seldom reoccurs after removal.
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Malignant Tumors
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Often rapid growth. Malignant cells infiltrate surrounding tissue. Often spreads to form tumors in other parts of the body. Reoccurrence can be seen after treatment.
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Oncoviruses
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RNA type viruses.
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Diet Risk Factors for Cancer
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High-fat, low-fiber diet are more prone to develop colon cancers. Diets high in fiber reduce the risk of colon cancer. High-fat diets are linked to breast cancer in women and prostate cancer in men. Consumption of large amounts of pickled, smoked, and charbroiled foods has been linked with esophageal and stomach cancers. A diet low in vitamins A, C, and E is associated with cancers of the lungs, esophagus, mouth, larynx, cervix, and breast.
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Carcinoma Tumor
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Cancerous; Tissue of the skin, glands, and digestive, urinary, and respiratory tract linings.
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Leukemia Tumor
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Cancerous; Blood, plasma cells, and bone marrow.
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Lymphoma Tumor
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Cancerous; Lymph tissue.
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Melanoma Tumor
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Cancerous; Skin cells.
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Sarcoma Tumor
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Cancerous; Connective tissue, including bone and muscle.
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Metastasis
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Metastatic tumors carry with them the cell characteristics of the original of primary tumor site. As a result surgeons are able to determine the original tumor site based on the metastatic cell characteristics.
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Estimated New Cancer Cases
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Females: Breast 29%. Lung and bronchus 14%.
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Estimated Cancer Deaths
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Males: Lung and bronchus 30%. Females: Lung and bronchus 26%.
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Reducing Cancer Risk: Nutrition Notes
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Consumption of the following should be limited: excessive red meat, especially when processed (smoked, salted), charbroiled or cooked at high temperatures. Excessive fat, especially saturated fat.
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Biopsy
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Fine needle breast biopsy.
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Tumor Markers and Associated Cancers
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Prostate-specific antigen (PSA) for prostate cancer.
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Primary Tumor: TX
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Primary tumor cannot be evaluated.
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Primary Tumor: TO
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No evidence of primary tumor.
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Primary Tumor: Tis
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Carcinoma in situ (early cancer that has not spread to neighboring tissue).
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Primary Tumor: T1, T2, T3, T4
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Size and/or extent of the primary tumor.
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Regional Lymph Nodes: NX
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Regional lymph nodes cannot be evaluated.
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Regional Lymph Nodes: NO
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No regional lymph node involvement.
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Regional Lymph Nodes: N1, N2, N3
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Involvement of regional lymph nodes (number and location of lymph nodes).
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Distant Metastasis: MX
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Distant metastasis cannot be evaluated.
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Distant Metastasis: MO
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No distant metastasis.
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Distant Metastasis: M1
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Distant metastasis.
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Bone Marrow Depression
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Low blood cell counts occur with both radiation and chemotherapy because they can attack all rapidly dividing cells, not just cancer cells.
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Chemotherapy: Routes of Administration
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Oral, IM, IV, Topical. Vesicant drugs are to be given only by IV into a large vein.
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Erythropoietin
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Epoetin alfa (Epogen, Procrit), darbepoetin alpha (Aransep). Black box warning for heart disease risk. Monnitor blood pressure and hematocrit. Teach subcutaneous administration if drug will be given at home. Aransep is long acting.
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BITES
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Used when assessing patients with possible side effects of chemotherapy and radiation. BLEEDING- Suggest low platelet count. Potential for bleeding exists when platelet count is at 50,000 or less. Risk for spontaneous bleeding occurs when platelet count is less than 20,000. INFECTION- Suggest low WBC TIREDNESS- Suggest anemia EMESIS- at risk for altered nutrition and fluid and electrolyte imbalance SKIN CHANGES- can be evidence of radiation reaction or skin breakdown
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Nursing Care Plan for the Patient with Cancer: Risk for Infection: Intervention #1
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Promote good hand-washing technique before interaction with the patient.
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Nursing Care Plan for the Patient with Cancer: Risk for Infection: Intervention #2
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Monitor body temperature every 4 hours.
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Nursing Care Plan for the Patient with Cancer: Risk for Infection: Intervention #3
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Monitor WBC count daily.
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Nursing Care Plan for the Patient with Cancer: Risk for Infection: Intervention #4
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Assess for signs of inflammation or drainage at potential infection sites, such as old aspirate sites, venipuncture sites, oral and rectal mucosae, perineal area, axillae, incisions, pierced earlobes, under breasts, and between toes.
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Nursing Care Plan for the Patient with Cancer: Risk for Infection: Intervention #5
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Watch for signs of respiratory infection, such as sore throat, cough, shortness of breath, and sputum production.
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Nursing Care Plan for the Patient with Cancer: Risk for Infection: Intervention #6
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Assess for signs of UTI including burning, pain, urgency, blood in urine.
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Nursing Care Plan for the Patient with Cancer: Risk for Infection: Intervention #7
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Teach administration of G-CSF as ordered.
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Nursing Care Plan for the Patient with Cancer: Risk for Infection: Intervention #8
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Limit visitors to only healthy adults.
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Nursing Care Plan for the Patient with Cancer: Risk for Infection: Intervention #9
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Teach patient to ask HCP about avoiding unwashed, unpeeled fruits and vegetables.
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Nursing Care Plan for the Patient with Cancer: Risk for Infection: Intervention #10
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Keep fresh flowers and potted plants out of the patient's room.
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Nursing Diagnosis: Ineffective Protection related to thrombocytopenia associate with chemotherapy and radiation: Intervention #1
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Monitor platelet counts. A platelet count of less than 50,000 indicates potential for bleeding.
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Nursing Diagnosis: Ineffective Protection related to thrombocytopenia associate with chemotherapy and radiation: Intervention #2
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Teach self-administration of oprelvekin as ordered. Oprelvekin stimulates production of platelets.
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Nursing Diagnosis: Ineffective Protection related to thrombocytopenia associate with chemotherapy and radiation: Intervention #3
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Test all urine and stool for occult blood to detect the presence of blood.
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Nursing Diagnosis: Ineffective Protection related to thrombocytopenia associate with chemotherapy and radiation: Intervention #4
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Avoid gibing intramuscular, subcutaneous, or rectal medications. Medications given via invasive routes can cause bleeding.
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Nursing Diagnosis: Ineffective Protection related to thrombocytopenia associate with chemotherapy and radiation: Intervention #5
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Apply pressure for at least 5 minutes to venipuncture or injection sites. Pressure for a longer time is needed at sites of invasive procedures to stop bleeding.
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Nursing Diagnosis: Ineffective Protection related to thrombocytopenia associate with chemotherapy and radiation: Intervention #6
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Teach the patient about gentle mouth care including no flossing, a soft toothbrush, and wearing properly fitting dentures to help prevent trauma and bleeding.
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Nursing Diagnosis: Ineffective Protection related to thrombocytopenia associate with chemotherapy and radiation: Intervention #7
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Avoid trauma to rectal tissue by avoiding rectal temperatures and enemas. Teach importance of avoiding anal intercourse. Trauma to rectal tissue can cause bleeding.
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Nursing Diagnosis: Ineffective Protection related to thrombocytopenia associate with chemotherapy and radiation: Intervention #8
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Instruct the patient not to take any salicylates or nonsteroidal anti-inflammatory drugs because they can interfere with platelet function and cause bleeding in the GI tract.
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Nursing Diagnosis: Ineffective Protection related to thrombocytopenia associate with chemotherapy and radiation: Intervention #9
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Observe for bruising, petechiae, bleeding gums, tarry stools, and black or coffee-ground appearing emesis. These are signs of bleeding.
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Nursing Diagnosis: Ineffective Protection related to thrombocytopenia associate with chemotherapy and radiation: Intervention #10
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Advise the patient to use an electric razor to decrease risk for trauma and bleeding.
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Nursing Diagnosis: Ineffective Protection related to thrombocytopenia associate with chemotherapy and radiation: Intervention #11
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Teach the patient to avoid forcefully blowing his or her nose or inserting objects into the nose to reduce trauma to nasal mucosa to prevent spontaneous bleeding.
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Nursing Diagnosis: Ineffective Protection related to thrombocytopenia associate with chemotherapy and radiation: Intervention #12
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Teach the patient to monitor for bleeding with intercourse because of the risk of trauma tissues.
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Nursing Diagnosis: Imbalanced Nutrition Related to Anorexia, Nausea, or Vomiting associated with Disease, Pain, and Treatment: Intervention #1
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Monitor food and fluid intake and output every 8 hours. This will provide objective data for the amount of nutrients and fluids taken in.
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Nursing Diagnosis: Imbalanced Nutrition Related to Anorexia, Nausea, or Vomiting associated with Disease, Pain, and Treatment: Intervention #2
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Wight the patient daily. Weight is an objective measurement to determine if intake is adequate enough to maintain weight.
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Nursing Diagnosis: Imbalanced Nutrition Related to Anorexia, Nausea, or Vomiting associated with Disease, Pain, and Treatment: Intervention #3
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Consult a dietitian for dietary supplements. Dietitians can calculate the calories needed for adequate nutrition and make recommendations for supplements.
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Nursing Diagnosis: Imbalanced Nutrition Related to Anorexia, Nausea, or Vomiting associated with Disease, Pain, and Treatment: Intervention #4
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Consult with PCP for medications to control nausea, vomiting, and diarrhea. If these symptoms are controlled, then the patient is better able to eat.
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Nursing Diagnosis: Imbalanced Nutrition Related to Anorexia, Nausea, or Vomiting associated with Disease, Pain, and Treatment: Intervention #5
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Keep the environment free of strong odors, such as disinfectants, perfumes, deodorizers, and body wastes. Strong odors can induce nausea.
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Nursing Diagnosis: Imbalanced Nutrition Related to Anorexia, Nausea, or Vomiting associated with Disease, Pain, and Treatment: Intervention #6
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Provide room-temperature or cold foods and clear liquids. These foods have fewer odors and may be more comfortable for the patient to eat.
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Nursing Diagnosis: Imbalanced Nutrition Related to Anorexia, Nausea, or Vomiting associated with Disease, Pain, and Treatment: Intervention #7
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Offer sour foods such as hard candy and lemon. These can help control nausea.
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Nursing Diagnosis: Imbalanced Nutrition Related to Anorexia, Nausea, or Vomiting associated with Disease, Pain, and Treatment: Intervention #8
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Add nutmeg to foods. Nutmeg may help slow the motility of the GI tract and decrease the risk of nausea and vomiting.
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Nursing Diagnosis: Imbalanced Nutrition Related to Anorexia, Nausea, or Vomiting associated with Disease, Pain, and Treatment: Intervention #9
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Provide mouth care before meals. Oral care allows for a better taste in the mouth, and saliva is needed for digestion of food.
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Nursing Diagnosis: Imbalanced Nutrition Related to Anorexia, Nausea, or Vomiting associated with Disease, Pain, and Treatment: Intervention #10
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Provide small, high-calorie meals. Eating smaller, more frequent meals prevents the patient from feeling full and nauseated.
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Nursing Diagnosis: Imbalanced Nutrition Related to Anorexia, Nausea, or Vomiting associated with Disease, Pain, and Treatment: Intervention #11
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Administer pain medication before meals to help reduce the impact of pain on appetite.
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Nursing Diagnosis: Imbalanced Nutrition Related to Anorexia, Nausea, or Vomiting associated with Disease, Pain, and Treatment: Intervention #12
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Instruct the patient to avoid fluids with meals to prevent premature feelings of fullness.
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Nursing Diagnosis: Imbalanced Nutrition Related to Anorexia, Nausea, or Vomiting associated with Disease, Pain, and Treatment: Intervention #13
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Teach the patient to avoid exercise before meals. If the patient is fatigued, he or she will not have the energy to eat and digest foods.
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Hypercalcemia
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An elevation of calcium levels above 11mg/dL. May result from the release of calcium into the blood from bone deterioration or from ectopic secretion of parathyroid hormone by a tumor. It is common in patients with bone metastasis, especially metastasis from breast cancer.
