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NEO 113JuLy 16, 2011
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Oncology defined
Branch of medicine that deals with the study, detection, treatment and management of cancer
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“Root words”Neo- newPlasia- growthPlasm- substanceTrophy- size+Oma- tumorStatis- location
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“Root words”A- noneAna- lackHyper- excessiveMeta- changeDys- bad, deranged
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CANCER NURSINGEtiology of cancer
1. PHYSICAL AGENTSRadiationExposure to irritantsExposure to sunlightAltitude, humidity
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CANCER NURSINGEtiology of cancer
2. CHEMICAL AGENTS Smoking Dietary ingredients Drugs
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CANCER NURSINGEtiology of cancer
Genetics and Family History Colon Cancer Breast cancer
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CANCER NURSING
Etiology of cancer Dietary Habits Low-Fiber High-fat Processed foods alcohol
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CANCER NURSINGEtiology of cancer
Viruses and BacteriaDNA viruses- HepaB, Herpes, EBV, CMV,
Papilloma VirusRNA Viruses- HIV, HTCLVBacterium- H. pylori
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CANCER NURSINGEtiology of cancer
Hormonal agentsDESOCP especially estrogen
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CANCER NURSINGEtiology of cancer
Immune DiseaseAIDS
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CANCER NURSINGBody Defenses Against TUMOR
1. T cell System/ Cellular ImmunityCytotoxic T cells kill tumor cells
2. B cell System/ Humoral immunityB cells can produce antibody
3. Phagocytic cellsMacrophages can engulf cancer cell debris
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CANCER NURSINGCancer Diagnosis
1. BIOPSY The most definitive
2. CT, MRI3. Tumor Markers
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CANCER NURSINGCancer Staging
The degree of DIFFERENTIATIONStage 1- Low gradeStage 4- high grade
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CANCER NURSINGGENERAL MEDICAL MANAGEMENT1. Surgery- cure, control, palliate2. Chemotherapy3. Radiation therapy4. Immunotherapy5. Bone Marrow Transplant
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CANCER NURSINGGENERAL Pharmacology1. antimetabolites2. antibiotics3. plant alkaloids4. antiemetics
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CANCER NURSINGGENERAL Promotive and Preventive Nursing
Management1. Lifestyle Modification2. Nutritional management3. Screening4. Early detection
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SCREENING1. Male and female- Occult Blood, CXR, and
DRE2. Female- SBE, CBE, Mammography and
Pap’s Smear3. Male- DRE for prostate, Testicular self-
exam
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Nursing AssessmentUtilize the ACS 7 Warning SignalsCAUTIONC- Change in bowel/bladder habitsA- A sore that does not healU- Unusual bleedingT- Thickening or lump in the breastI- IndigestionO- Obvious change in wartsN- Nagging cough and hoarseness
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Nursing AssessmentWeight lossFrequent infectionSkin problemsPainHair LossFatigueDisturbance in body image/ depression
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Nursing InterventionMAINTAIN TISSUE INTEGRITYHandle skin gentlyDo NOT rub affected areaLotion may be appliedWash skin only with SOAP and Water
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Nursing InterventionMANAGEMENT OF STOMATITISUse soft-bristled toothbrush Oral rinses with saline gargles/ tap waterAvoid ALCOHOL-based rinses
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Nursing InterventionMANAGEMENT OF ALOPECIA
Alopecia begins within 2 weeks of therapy
Regrowth within 8 weeks of terminationEncourage to acquire wig before hair loss
occursEncourage use of attractive scarves and
hatsProvide information that hair loss is
temporary BUT anticipate change in texture and color
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Nursing InterventionPROMOTE NUTRITIONServe food in ways to make it appealingConsider patient’s preferencesProvide small frequent mealsAvoids giving fluids while eatingOral hygiene PRIOR to mealtimeVitamin supplements
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Nursing InterventionRELIEVE PAINMild pain- NSAIDS
Moderate pain- Weak opiodsSevere pain- MorphineAdminister analgesics round the clock with
additional dose for breakthrough pain
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Nursing InterventionDECREASE FATIGUEPlan daily activities to allow alternating
rest periodsLight exercise is encouragedSmall frequent meals
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Nursing InterventionIMPROVE BODY IMAGETherapeutic communication is essentialEncourage independence in self-care and
decision makingOffer cosmetic material like make-up and
wigs
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Nursing InterventionASSIST IN THE GRIEVING PROCESSSome cancers are curableGrieving can be due to loss of health,
income, sexuality, and body imageAnswer and clarify information about
cancer and treatment optionsIdentify resource peopleRefer to support groups
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Nursing InterventionMANAGE COMPLICATION:
INFECTIONFever is the most important sign (38.3)Administer prescribed antibiotics X
2weeksMaintain aseptic technique Avoid exposure to crowds Avoid giving fresh fruits and veggieHandwashingAvoid frequent invasive procedures
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Nursing InterventionMANAGE COMPLICATION: Septic shockMonitor VS, BP, tempAdminister IV antibioticsAdminister supplemental O2
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Nursing InterventionMANAGE COMPLICATION: BleedingThrombocytopenia (<100,000) is the most
common cause <20, 000 spontaneous bleedingUse soft toothbrushUse electric razorAvoid frequent IM, IV, rectal and
catheterizationSoft foods and stool softeners
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COLON CANCERRisk factors1. Increasing age2. Family history3. Previous colon CA or polyps4. History of IBD5. High fat, High protein, LOW fiber6. Breast Ca and Genital Ca
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COLON CANCERSigmoid colon is the most common sitePredominantly adenocarcinomaIf early 90% survival34 % diagnosed early66% late diagnosis
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COLON CANCERPATHOPHYSIOLOGYBenign neoplasm DNA alteration
malignant transformation malignant neoplasm cancer growth and invasion metastasis (liver)
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COLON CANCERASSESSMENT FINDINGS
1. Change in bowel habits- Most common
2. Blood in the stool3. Anemia4. Anorexia and weight loss5. Fatigue6. Rectal lesions- tenesmus, alternating D
and C
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Colon cancerDiagnostic findings1. Fecal occult blood2. Sigmoidoscopy and colonoscopy3. BIOPSY4. CEA- carcino-embryonic antigen
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Colon cancerComplications of colorectal CA1. Obstruction2. Hemorrhage3. Peritonitis4. Sepsis
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Colon cancerMEDICAL MANAGEMENT1. Chemotherapy- 5-FU2. Radiation therapy
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Colon cancerSURGICAL MANAGEMENTSurgery is the primary treatmentBased on location and tumor sizeResection, anastomosis, and colostomy
(temporary or permanent)
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Colon cancerNURSING INTERVENTIONPre-Operative care1. Provide HIGH protein, HIGH calorie and
LOW residue diet2.Provide information about post-op care and
stoma care3. Administer antibiotics 1 day prior
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Colon cancerNURSING INTERVENTIONPre-Operative care4. Enema or colonic irrigation the evening
and the morning of surgery5. NGT is inserted to prevent distention6. Monitor UO, F and E, Abdomen PE
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Colon cancerNURSING INTERVENTIONPost-Operative care1. Monitor for complicationsLeakage from the site, prolapse of stoma,
skin irritation and pulmo complication2. Assess the abdomen for return of
peristalsis
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Colon cancerNURSING INTERVENTIONPost-Operative care3. Assess wound dressing for bleeding4. Assist patient in ambulation after
24H5.provide nutritional teachingLimit foods that cause gas-formation
and odorCabbage, beans, eggs, fish, peanutsLow-fiber diet in the early stage of
recovery
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Colon cancer
NURSING INTERVENTIONPost-Operative care6. Instruct to splint the incision and
administer pain meds before exercise7. The stoma is PINKISH to cherry
red, Slightly edematous with minimal pinkish drainage
8. Manage post-operative complication
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Colon cancerNURSING INTERVENTION: COLOSTOMY
CAREColostomy begins to function 3-6 days after
surgeryThe drainage maybe soft/mushy or semi-solid
depending on the site
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Colon cancerNURSING INTERVENTION: COLOSTOMY
CAREBEST time to do skin care is after showerApply tape to the sides of the pouch before
showerAssume a sitting or standing position in
changing the pouch
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Colon cancerNURSING INTERVENTION: COLOSTOMY
CAREInstruct to GENTLY push the skin down and
the pouch pulling UPWash the peri-stomal area with soap and
waterCover the stoma while washing the peri-
stomal area
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Colon cancerNURSING INTERVENTION: COLOSTOMY
CARELightly pat dry the area and NEVER rubLightly dust the peri-stomal area with
nystatin powder
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Colon cancerNURSING INTERVENTION: COLOSTOMY
CAREMeasure the stomal openingThe pouch opening is about 0.3 cm larger
than the stomal openingApply adhesive surface over the stoma and
press for 30 seconds
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Colon cancerNURSING INTERVENTION: COLOSTOMY
CAREEmpty the pouch or change the pouch
when1/3 to ¼ full
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Breast CancerThe most common cancer in FEMALESNumerous etiologies implicated
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Breast CancerRISK FACTORS1. Genetics- BRCA1 And BRCA 22. Increasing age ( > 50yo)3. Family History of breast cancer4. Early menarche and late menopause5. Nulliparity6. Late age at pregnancy
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Breast CancerRISK FACTORS7. Obesity8. Hormonal replacement9. Alcohol10. Exposure to radiation
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Breast CancerPROTECTIVE FACTORS1. Exercise2. Breast feeding3. Pregnancy before 30 yo
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Breast CancerASSESSMENT FINDINGS1. MASS- the most common location is the
upper outer quadrant2. Mass is NON-tender. Fixed, hard with
irregular borders3. Skin dimpling4. Nipple retraction5. Peau d’ orange
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Breast CancerLABORATORY FINDINGS1. Biopsy procedures2. Mammography
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Breast CancerBreast cancer StagingTNM stagingI - < 2cmII - 2 to 5 cm, (+) LNIII - > 5 cm, (+) LNIV- metastasis
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Breast CancerMEDICAL MANAGEMENT1. Chemotherapy2. Tamoxifen therapy3. Radiation therapy
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Breast CancerSURGICAL MANAGEMENT
1. Radical mastectomy2. Modified radical mastectomy3. Lumpectomy4. Quadrantectomy
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Breast CancerNURSING INTERVENTION : PRE-OP1. Explain breast cancer and
treatment options2. Reduce fear and anxiety and
improve coping abilities3. Promote decision making abilities4. Provide routine pre-op care:Consent, NPO, Meds, Teaching about
breathing exercise
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Breast CancerNURSING INTERVENTION : Post-OP1. Position patient: SupineAffected extremity elevated to reduce
edema
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Breast CancerNURSING INTERVENTION : Post-OP2. Relieve pain and discomfortModerate elevation of extremityIM/IV injection of pain medsWarm shower on 2nd day post-op
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Breast CancerNURSING INTERVENTION : Post-OP3. Maintain skin integrityImmediate post-op: snug dressing with
drainageMaintain patency of drain (JP)Monitor for hematoma w/in 12H and apply
bandage and ice, refer to surgeon
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Breast CancerNURSING INTERVENTION : Post-OP3. Maintain skin integrityDrainage is removed when the discharge
is less than 30 ml in 24 HLotions, Creams are applied ONLY when
the incision is healed in 4-6 weeks
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Breast CancerNURSING INTERVENTION : Post-OPPromote activitySupport operative site when movingHand, shoulder exercise done on
2nddayPost-op mastectomy exercise 20 mins
TIDNO BP or IV procedure on operative
site
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Breast Cancer
NURSING INTERVENTION : Post-OPPromote activityHeavy lifting is avoidedElevate the arm at the level of the
heartOn a pillow for 45 minutes TID to
relieve transient edema
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Breast Cancer
NURSING INTERVENTION : Post-OPMANAGE COMPLICATIONSLymphedema10-20% of patientsElevate arms, elbow above shoulder
and hand above elbowHand exercise while elevatedRefer to surgeon and physical
therapist
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Breast Cancer
NURSING INTERVENTION : Post-OPMANAGE COMPLICATIONSHematomaNotify the surgeonApply bandage wrap (Ace wrap) and
ICE pack
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Breast CancerNURSING INTERVENTION : Post-OPMANAGE COMPLICATIONSInfectionMonitor temperature, redness, swelling
and foul-odorIV antibioticsNo procedure on affected extremity
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Breast CancerNURSING INTERVENTION : Post-OPTEACH FOLLOW-UP careRegular check-upMonthly BSE on the other breastAnnual mammography
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Discussion of
Palliative CareOncologic EmergenciesLung CancerMale & Female reproductive CancersBrain Tumors
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Critical ThinkingScenario: A 49 y/o male has a 32 year
history of cigarette smoking. He often eats out with associates and typically eats red meat and potatoes. One of his associates is a 51 y/o female whose mother dies of breast cancer. She is 40lbs over her ideal weight because she likes to snack during the day. She is also a heavy coffee drinker because she is from Seattle.
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Case Study 1R.T. is a 64-year-old man who comes to his primary care provider’s (PCP’s) offi ce for a
yearly examination. He initially reports having no new health problems; however, on further questioning, he admits to having developed some fatigue, abdominal bloating, and intermittent constipation. His nurse practitioner completes the examination, which includes a normal rectal exam with a stool positive for guaiac. Diagnostic studies include a CBC with differential, chem 14, and carcinoembryonic antigen (CEA). R.T. has not had a recent colonoscopy and is referred to a gastroenterologist for this procedure.
A 5-cm mass found in the sigmoid colon confirms a diagnosis of a polypof the colon. A referral
is made for surgery. The pathology report describes the tumor as stae 11, which meansthat the cancer has extended into the mucous layer of the colon. A metastatic work-up is
negative.
1. Identify 6 risk factors for colon cancer:2. Discuss the recommended screening procedures related to colon cancer.3. What warning sign did R.T. have?4. What would early signs be for colorectal cancer?5. What would late signs be?
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Case Study 1R.T. is a 64-year-old man who comes to his primary care provider’s (PCP’s) offi ce for a
yearly examination. He initially reports having no new health problems; however, on further questioning, he admits to having developed some fatigue, abdominal bloating, and intermittent constipation. His nurse practitioner completes the examination, which includes a normal rectal exam with a stool positive for guaiac. Diagnostic studies include a CBC with differential, chem 14, and carcinoembryonic antigen (CEA). R.T. has not had a recent colonoscopy and is referred to a gastroenterologist for this procedure.
A 5-cm mass found in the sigmoid colon confirms a diagnosis of a polypof the colon. A referral
is made for surgery. The pathology report describes the tumor as stae 11, which meansthat the cancer has extended into the mucous layer of the colon. A metastatic work-up is
negative.
6. After bowel prep, R.T. is admitted to the hospital for an exploratory laparotomy, small bowel resection and sigmoid colectomy. - What are five major complications for him?
7. After surgery, R.T. is admitted to the surgical intensive care unit (SICU) with a largeabdominal dressing. The nurse rolls R.T. side to side to remove the soiled surgical linen,and the dressing becomes saturated with a large amount of serosanguineous drainage.Would the drainage be expected after abdominal surgery? Explain.
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Case Study 2You are a home health nurse who has been seeing P.C., who was diagnosed with lung
cancer approximately 1 year ago. Her provider recently informed her that her cancer is no longer treatable; the focus of her treatment will change from curative measures to symptom relief. She is confused and somewhat angry with her provider. She vaguely remembers the term palliative treatment when discussing her situation with her provider but doesn’t know what it means.
1. How would you describe palliative treatment?
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Case Study 2You are a home health nurse who has been seeing P.C., who was diagnosed with lung cancer
approximately 1 year ago. Her provider recently informed her that her cancer is no longer treatable; the focus of her treatment will change from curative measures to symptom relief. She is confused and somewhat angry with her provider. She vaguely remembers the term palliative treatment when discussing her situation with her provider but doesn’t know what it means.
Case progress Note:P.C. confides that she always felt that she might not survive her illness, but has never formally
writtendown her wishes concerning what types of treatment she would or would not want. You advise
herto complete an advance directive and/or living will or to complete a medical durable power of
attorneyand/or a surrogate decision maker form. In current practice, it is very likely that a part of the
homehealth intake process will be completion of a Physicians Order on Life Sustaining Treatments
(POLST)Paradigm form.
2. What is the purpose of these documents?
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Case Study 23. What health care decisions are considered in these documents?
4. How are advance directives and living wills formalized?
5. P.C. states she is confused and has mixed feelings about her health care wishes right now.
She asks, “If I fill out this form, can I change my mind down the road?” How should you
answer this question?
6. You inform P.C. that you will help with symptomatic control of her illness. What areas
will you focus on, and what question would you ask P.C.?
7. As P.C. becomes more frail and incoherent, what treatment will be given?
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Discussion
Culturally appropriate treatmentShare your experiences