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General disease related consequences of cancer:

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Reduced immunity and blood producing functions Altered GI structure and function Motor and sensory deficits Decreased respiratory function

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Describe: Reduced immunity and blood producing function

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Occurs most often in patients with leukemia and lymphoma Tumor cells invade bone marrow and reduce the production of healthy WBC's This invasion of the bone marrow also decreases RBC's and platelets

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Describe: Altered GI Structure and Function

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Tumors may: compress structures along the GI tract, increase metabolic rate spread to the liver Anorexia Changes in taste

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Describe: Motor and Sensory Deficits

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Can occur when cancers invade bone or the brain/spinal cord and compress nerves Pain (Concept Map..Chronic Cancer Pain p.416)-Study

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Describe: Decreased respiratory function

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Tumors in the airway can cause obstruction If lung tissue affected lung, capacity can be decreased Pulmonary blood flow can be decreased by tumor compression

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Cancer Management: Purpose & Therapies

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Prolong survival time or improve quality of life Surgery Radiation Chemotherapy Hormonal manipulation Photodynamic therapy Immunotherapy Gene therapy Targeted therapy

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Surgery for cancer Tx: Describe what it was used for

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Oldest form of cancer treatment Prophylaxis Diagnosis Cure Control Palliation Second-look surgery Reconstruction or rehabilitation

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Side Effects of surgical therapy

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Loss of all or part of an organ Major scarring or disfigurement Assess psychosocial adjustment

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Role of nurse for surgery

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Provide support for patient and family Help patient to accept changes in body look at incision touch area participate in dressing changes Provide info about support groups

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Radiation therapy for cancer: Describe purpose and radiation energy released, dose, and absorbtion

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Local therapy to destroy cancer cells with minimal damage to normal cells Alpha particles Not used as part of radiation therapy for cancer Beta particles Must be placed very close to cancer cells to be effective Gamma particles Used most commonly, has the ability to penetrate deep tissues Exposure Radiation Dose The dose is always less than the exposure 3 factors determine the absorbed dose: 1. Intensity of exposure 2. Duration of exposure 3. Closeness of the radiation source to the cells

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Describe the two types of radiation delivery

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Teletherapy=distant treatment Marking of site required Brachytherapy=close therapy Radiation source within patient Patient emits radiation

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Side Effects of Radiation Therapy

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Vary according to the site Local skin changes and hair loss will likely be permanent depending on the total absorbed dose Altered taste sensations Fatigue related to increased energy demands Inflammatory responses that cause tissue fibrosis and scarring

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Describe general use of chemotherapy in tx of cancer

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Treating cancer with chemical agents Major role in cancer therapy Used to cure and increase survival time Some selectivity for killing cancer cells over normal cells Useful in treating cancer because of systemic effects Cytotoxic effects are against cancer and normal cells Adjuvant therapy is chemotherapy used along with surgery and radiation

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Describe drug selection in chemotherapy

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Drug selection based on: Tumor sensitivity to the drugs Degree of side effects expected Combination chemotherapy avoids using drugs with a similar nadir Pharmacogenomics

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Describe the treatment issues with drugs in chemotherapy

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Drug dosage Drug schedule Drug administration: Extravasation is a major complication -Drug leaks into surrounding tissues -If drug is a vesicants, can result in pain, infection, and tissue loss Prevention is the most important intervention for extravasation Close monitoring of the access site is critical during chemotherapy administration Cold or warm compresses may be applied depending on the drug, antidotes and chemoprotective agents may also be used to treat Use extreme caution and wear PPE Eye protection Masks Double glove or "chemo gloves" Gown

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Side effects of chemotherapy

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Anemia, neutropenia, thrombocytopenia Alopecia or hair loss Nausea and vomiting Mucositis in the entire GI tract Skin changes Anxiety, sleep disturbance Altered bowel elimination Changes in cognitive function

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Describe chemotherapy as it relates to bone marrow suppression

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Destroys circulating blood cells and suppresses bone marrow function

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Describe anemia, thrombocytopenia as it relates to bone marrow suppression and chemotherapy,and a few interventions that relate to bone marrow suppression.

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Anemia can lead to fatigue and hypoxia Thrombocytopenia increases the risk for excessive bleeding Erythropoiesis stimulating agents (Aranesp, Epogen, Procrit etc) BRM therapy to increase platelets Avoid injury for the patient with thrombocytopenia Handle patient gently Avoid IM injections and venipunctures Apply ice to areas of trauma Test urine and stool for occult blood Monitor IV site every 4 hours for bleeding See TAB 24-6 p.427 and TAB 24-7 p. 428 for more details

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Describe chemotherapy induced N/V, interventions and drugs used

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Most chemotherapy drugs are emetogenic Antiemetics may relieve symptoms Ensure they are given prior to chemotherapy treatment Assess pt for dehydration and F&E imbalances

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Interventions for chemotherapy as it relates to mucositis

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Frequent mouth assessment and oral hygiene Soft bristled toothbrush Rinse mouth q12hr (half/half peroxide and normal saline) Encourage fluids Topical anesthetics as prescribed Avoid tobacco and alcohol Cool liquids Chart 24-9 p 429

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Interventions used for chemotherapy as it relates to alopecia

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Reassure patient that hair loss is temporary Assist patient in coping with a change in body image

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Describe chemotherapy as it relates to changes in cognitive function

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Cause of these side effects is unclear Reduced ability to concentrate Memory loss Difficulty learning new information Support the patient who reports these symptoms

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Describe chemotherapy as it relates to peripheral neuropathy

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Common in patients receiving chemotherapy with nerve damaging drugs Currently there is no known intervention to prevent PN The priority for the nurse is to teach the patient to prevent injury Teaching priorities include: Protect the feet Wear well fitted shoes Inspect feet daily Avoid extreme temperatures Test water temperature Use potholders when cooking Get up slowly Watch wear you are walking Use handrails TAB 24-10 p. 431

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Describe hormonal manipulation

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Some hormones make hormone-sensitive tumors grow more rapidly and some actually require specific hormones to divide. Decreasing the amt of these hormones to hormone-sensitive tumors can slow the cancer growth rate.

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Describe side effects of hormone manipulation

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Androgens and antiestrogen receptor drugs cause masculinizing effects in women. With prolonged androgen therapy men and women may develop: acne hypercalcemia liver dysfunction

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Side effects of hormone manipulation as it relates to women

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Women receiving estrogens or progestins Irregular, heavy menses Fluid retention Breast tenderness Increased risk for DVT (men also) Feminine manifestations often appear in men who take estrogens, progestins, or antiandrogen receptor drugs. Gynecomastia Body fat redistributed Facial skin smoother and facial hair thins

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Describe pt teaching (before) and slight description of gynecomastia- photodynamis therapy

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Different types of laser light selectively destroys cancer cells Patient teaching must begin before treatment sensitivity to light (high risk for sunburn & eye pain) Bring protective clothing Plan to stay home during daylight hours for 1-3 months - have someone else drive you so you can cover yourself in a blanket

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Pt teaching (after) photosensitization

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-Effects last 1-3 months -Wear protective closing, avoid sunlight and high-wattage indoor lights -Drink plenty water -Do not take newly prescribed or over counter drugs without tlking to Dr who did photosensitization -Slowly re-expose body 1inch at a time -Sunscreen, dark glasses

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Describe: Immunotherapy: Biological Response Modifiers (BRMs)

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Drugs that modify pt's biological responses to tumor cells Cytokines Interleukins Interferons Thalomid Side effects may vary depending on treatment type used.

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Describe: Gene therapy

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Experimental as a cancer treatment Not approved treatments yet

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Describe: Targeted therapy

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Combines aspects of gene therapy and immunotherapy (eg.Herceptin, Rituxan, Gleevac) The cancer cells present in the patient has to over express the actual targeted substance Not beneficial to all patients Side effects: Allergic reactions

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Describe: Oncologic emergencies

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Will cover in MSII DIC SIADH Spinal cord compression Superior Vena Cava Syndrome Tumor Lysis syndrome

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Lung Cancer: Pathophysiology: Description, classification, metastasis occurance

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Leading cause of cancer related deaths worldwide Poor prognosis Palliation Bronchogenic carcinomas Classified as: Small cell lung cancer Non small cell cancer Epidermoid cancer Adenocarcinoma Large cell cancer Metastasis occurs: By direct extension Through the blood By invading the lymph glands Interference with oxygenation and tissue perfusion

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Lung Cancer: Pathophysiology: Paraneoplastic syndrome, staging, incidence

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Paraneoplastic syndrome (eg. Cushing's syndrome, hypoglycemia, general edema etc.) Commonly occurs with SCLC Staging TNM system Higher numbers represent later stages/and less chance for cure or survival Leading cause of cancer deaths worldwide Overall 5-year survival for all patients with lung cancer is 14% Cigarette smoking is responsible for 85% of all lung CA deaths

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Lung Cancer: Etiology & Genetic risk

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Second hand smoke Other risk factors: Asbestos Beryllium Chromium Coal distillates Cobalt Iron oxide Radiation Tar And many more.....

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Lung Cancer: Health promotion & maintenance

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Reduce tobacco smoking Reduce occupational hazards EBP section p.643...study shows that annual screening of people at risk for lung CA was effective at increasing survival

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Lung Cancer: Assessment/Hx

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Risk factors Smoking hx Presence of lung cancer manifestations Hoarseness Cough Sputum production Hemoptysis SOB Change in endurance Ask patient to describe any recent changes Chest pain or discomfort

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Lung Cancer: Physical Assessment

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Pneumonia or bronchitis Assess sputum Blood tinged sputum Hemoptysis Assess breathing pattern Abnormal retractions Use of accessory muscles Nasal flaring Stridor Asymmetric diaphragmatic movement -Assess for palpable masses -Fremitus -Trachea -Dull or Flat to percussion

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Lung Cancer: Physical Assessment (nonpulmonary)

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Muffled heart sounds Dysrhythmias Cyanosis Finger clubbing Bones break easily Late manifestations: Fatigue Weight loss Anorexia Dysphagia N &V Lethargy Confusion Bowel and bladder

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Lung Cancer: Psychosocial Assessment

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Guilt Shame Fear

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Lung Cancer: Other Dx Assessment (Tests and determining extent of cancer spread)

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Biopsy Sputum specimens Chest x-rays CT scans Bronchoscopy Thoroscopy Determine extent of cancer spread: Needle biopsy of lymph nodes Direct surgical biopsy Thoracentesis with pleural biopsy MRI's PET scans

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Lung Cancer: Interventions (Aim)

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Curing the disease Increasing survival time Enhancement of QOL through palliation

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Lung Cancer: NonSurgical Management (Name 4 types of therapy)

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Chemotherapy Targeted therapy Radiation therapy Photodynamic therapy

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Lung Cancer: NonSurgical Management (Side Effects):

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Chemotherapy induced N & V Alopecia Mucositis Immunosuppression Anemia Thrombocytopenia

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Lung Cancer: NonSurgical Management: Targeted Therapy (drugs used)

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Erlotinib (Tarceva) Bevacizumab (Avastin) -Targets certain cells

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Lung Cancer: NonSurgical Management: Radiation therapy (Description and SEs)

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Can shrink the size of tumor prior to surgery Usually performed daily for 5-6 weeks Side effects: Skin irritation and peeling Fatigue Nausea Taste changes Esophagitis

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Lung Cancer: NonSurgical Management: Photodynamic therapy- Key points (7)

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Agent injected that sensitizes cell to light During next 48-72 hours Drug enters all cells (leaves normal cells rapidly) In OR under anesthesia and intubation Laser light focused on tumor Inducing irreversible cell damage Special patient teaching before and after procedure

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Lung Cancer: Surgical Management: May include?

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Removal of tumor only Removal of a lung segment Lobectomy Pneumonectomy

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Lung Cancer: Surgical Management: Preop

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Relieve anxiety Encourage expression Reinforce surgeon's explanation or procedure Provide education for post-op care

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Lung Cancer: Surgical Management: Operative (incision types, VATS)

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3 types of incisions: Posterolateral Anterolateral Median sternotomy VATS 3 small incisions on the chest Can be used to remove a lung section, lobe, or entire lung

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Surgical Management: Postop Care (what may be used)

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Closed chest drainage required (except pneumonectomy) Air drainage (front apex) Fluid drainage (side near base) Keep collection device below the chest

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Surgical Management: Chest tube management: Patient

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-Dressing tight, intact around chest. -Assess for difficulty breathing, sounds -Assess breath effectiveness by pulseox -Check trachea alignment -Chest tube site condition. Palpate area for puffiness or crackling (may indicate subQ emphysema) -Observe site for sx of infection (red, purulent) or excessive bleeding -Check for tube eyelets -Assess for pain, location & intensity, administer pain drugs prn -Assist pt to deep breath, cough, perform maximal sustained inhalations, and use incentive spirometer, reposition pt who reports burning pain in chest

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What if chest tube falls out of the patient?

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First, cover w/ dry sterile gauze then notify physician

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What if chest tube disconnects from the drainage system?

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(first, put end of tube in a container of sterile water and keep below the level of pt chest) Then notify physician

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Surgical Management: Chest tube management: Drainage System

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-Don't strip, asses for tidaling, keep lower than lvl of chest, keep straight, avoid kinks loops, securely taped to connector, connector taped to tubing going into collection chamber -Check water lvl in seal chamber, keep @ manufacturer recommendation, check water lvl in suction control chamber, keep @ lvl prescribed by surgeon -Clamp tube only for breif period to change system or checking for leaks -Document amount, color, characteristics of fluid in collection chamber, depending on condition of pt -When needing sample, get from clean chest tube using 20g needle

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Surgical management: Chest tube management: Notify physician or RRT if:

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Tracheal deviation Sudden or increased dyspnea O2 sat 70ml/hr Visible eyelets on chest tube Drainage in tube stops Tube falls out or disconnects from sys

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Lung Cancer: Surgical management: Pain management

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Administer prescribed pain meds PCA education Monitor VS

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Lung Cancer: Surgical management: Respiratory management

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Mechanical ventilation Respiratory assessment Semi fowlers position IS

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Lung Cancer: Surgical Management: Pneumonectomy care

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Pleural cavity on affected side is empty space Closed chest drainage not usually used Complications: Empyema Bronchopleural fistula

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Lung Cancer: Interventions for palliation, What is palliation?

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Humidified oxygen therapy Drug therapy Bronchodilators Corticosteriods Antibiotics Radiation therapy Thoracentesis and pleurodesis Dyspnea management Pain management Hospice care -Relieving symptoms

NURS 225 Patient Care of Pt w/ Cancer, Lung Cancer – Flashcards

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