Nursing Care of Client with Cancer

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Nursing Care of Client with Cancer

• Presented by
• Manny Ramos RN, MSN

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Cancer

• Normal cells mutate into abnormal cells that take
  over tissue
• Affect different organs and organ systems
• Eventually harm and destroy host

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Incidence and Prevalence

• Cancer 25 of all deaths annually
• most common types of cancer
• Males prostate, lung and bronchial,
  colorectal
• Females breast, lung and bronchial, and
  colorectal

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Risk factors for cancer

• Heredity 5 10 of cancers
• Age 70 occur in persons gt 65
• Lower socio-economic status
• Stress
• Diet certain preservatives in pickled, salted
  foods fried foods high-fat, low fiber foods
  charred foods
• Occupational risk exposure to carcinogens,
  radiation, high stress
• Infections
• Tobacco Use Lung, oral and laryngeal,
  esophageal, gastric, pancreatic, bladder cancers
• Alcohol Use
• Sun Exposure skin cancer

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Health Promotion

• Routine medical check up and screenings
• Screening examination recommendations by American
  Cancer Society specifics are made according to
  age and frequencies
• Breast Cancer self-breast exam, breast
  examination by health care professionals,
  screening mammogram
• Colon and Rectal Cancer fecal occult blood,
  flexible sigmoidoscopy, colonoscopy
• Cervical, Uterine Cancer Papanicolaou (Pap) test
• Prostate Cancer digital rectal exam,
  Prostate-specific antigen (PSA) test
• ACT! if symptoms of cancer occur

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Types of neoplasms

• Benign
• encapsulated
• Stops growing within boundary of another tissue
• Malignant
• aggressive growth
• Cuts through surrounding tissues causing
  bleeding, inflammation, necrosis (death) of tissue

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Metastasis

• Malignant tumors can metastasize
• Tumor cells travel through blood or lymph and
  invade tissues and organs there.
• Primary tumor original site of the malignancy
• Secondary tumor common sites of metastasis are
  lymph nodes, liver, lungs, bones, brain

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Effects of Cancer

• Disturbed or loss of physiologic functioning,
  from pressure or obstruction
• Anoxia and necrosis of organs
• Loss of function bowel or bladder obstruction
• Increased intracranial pressure
• Interrupted vascular/venous blockage
• Ascites
• Disturbed liver functioning

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Effects of Cancer

• Hematologic
• Abnormal wbcs impaired immunity
• Diminished rbcs and platelets anemia and
  clotting disorders
• Infections
• fistula development
• tumors may become necrotic
• erode skin surface
• Hemorrhage tumor erosion, bleeding, severe
  anemia

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Effects of Cancer

• Anorexia-Cachexia Syndrome
• Unexplained rapid weight loss, anorexia with
  altered smell and taste
• Catabolic state use of bodys tissues and muscle
  proteins to support cancer cell growth

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Effects of Cancer

• Paraneoplastic Syndromes ectopic sites with
  excess hormone production
• Parathyroid hormone (hypercalcemia)
• Ectopic secretion of insulin (hypoglycemia)
• Antidiuretic hormone (ADH fluid retention)
• Adrenocorticotropic hormone (ACTH)

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Effects of Cancer

• Pain
• Direct tumor involvement including metastatic
  pain
• Nerve compression
• Involvement of visceral organs

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Effects of Cancer

• Physical Stress
• Fatigue
• Weight loss
• Anemia
• Dehydration
• Electrolyte imbalances

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Effects of Cancer

• Psychological Stress
• death sentence
• Guilt from poor health habits
• Fear of pain, suffering, death
• Stigmatized

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Diagnostic Tests

• Xrays
• CT scan
• Ultrasounds
• MRI
• Nuclear imaging
• Angiography
• Biopsy, Pap smear, washings
• Cytology

• Tumor markers
• PSA (Prostatic-specific antigen) prostate cancer
• CEA (Carcinoembryonic antigen) colon cancer
• Alkaline Phosphatase bone metastasis

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Classification Grading -- Stagingof Tumors

• Classification according to the tissue or cell
  of origin, e.g. sarcoma, from supportive
• Grading degree of differentiation and rate of
  growth,Grade 1 (least aggressive) to Grade 4
  (most aggressive)
• Staging Relative tumor size and extent of
  disease
• TNM (Tumor size Nodes lymph node involvement
  Metastases)

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Direct Visualization

• Sigmoidoscopy
• Cystoscopy
• Endoscopy
• Bronchoscopy
• Exploratory surgery lymph node biopsies to
  determine metastases

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Treatment Goals

• Cure
• Control of symptoms and progression of cancer
• Palliation of symptoms

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Chemotherapy

• phase-specific and non-phase specific drugs
• Cell-kill hypothesis repeating chemo kills more
  cells until those left can be handled by bodys
  immune system

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Chemotherapy Drugs

• Alkylating agents create defects in tumor DNA
• Examples Nitrogen Mustard, Cisplatin
• 2. Antimetabolites specific for S phase
• Examples Methotrexate 5 fluorouracil
• Toxic Effects nausea, vomiting, stomatitis,
  diarrhea, alopecia, leukopenia
• 3. Antitumor Antibiotics non-phase specific
  interfere with DNA
• Examples Actinomycin D, Bleomycin
• Toxic Effect damage to cardiac muscle

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Chemotherapy Drugs

• 4. Miotic inhibitors Prevent cell division
  during M phase
• Examples Vincristine, Vinblastine
• Toxic Effects affects neurotransmission,
  alopecia, bone marrow depression
• 5. Hormones stage specific G1
• Example Corticosteroids
• 6. Hormone Antagonist block hormones on
  hormone-binding tumors (breast, prostate,
  endometrium cause tumor regression
• Examples Tamoxifen (breast) Flutamide
  (prostate)
• Toxic Effects altered secondary sex
  characteristics

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Chemotherapy

• Trained and certified personnel
• Protect personnel from toxic effects
• double check with physician orders, pharmacists
  preparation
• Proper management clients excretement

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Chemotherapy

• Routes
• Oral
• Body cavity (intraperitoneal or intrapleural)
• Intravenous
• Vascular access devices
• PICC lines
• Tunnelled catheters (Hickman, Groshong)
• Surgically implanted ports (accessed with 90o
  angle needle)

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Surgery

• diagnosis, staging, and treatment of cancer
• Debulking
• Reconstruction and rehabilitation

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Radiation Therapy

• reduce tumor, relieve pain or obstruction
• Teletherapy (external) uniform radiation dose to
  tumor
• Brachytherapy radiation source is placed in
  tumor
• Caregivers use shields, distancing and limiting
  time with client, following safety protocols

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Side effects

• Skin (external radiation) blanching, erythema,
  sloughing
• Ulcerated mucous membranes pain, lack of saliva
• GI nausea and vomiting, diarrhea, bleeding,
  sometimes fistula formation
• Radiation pneumonia

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Other treatments

• Biotheraphy monoclonal antibodies (inoculate
  animal with tumor antigen and retrieve antibodies
  against tumor for human)
• Photodynamic Therapy laser treatment to destroy
  tumor
• Bone Marrow Transplantation and Peripheral Blood
  Stem Cell Transplantation

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Pain Control

• Necessary for continuing function
• comfort in terminally ill clients
• maximum relief with minimal side effects
• narcotic and non-narcotic combo
• Adjuvants steroids or antidepressants
• around the clock (ATC) schedule, break-through
  pain
• injections of anesthetics into nerve
• surgical severing of nerves radiation
• tolerance to pain medication

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Nursing Diagnoses

• Anxiety
• Disturbed Body Image
• Anticipatory Grieving
• Risk for Infection
• Risk for Injury
• Altered Nutrition less than body requirements
• Impaired Tissue Integrity

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Oncologic Emergencies

• Pericaridal Effusion and Neoplastic Cardiac
  Tamponade
• Treatment pericardiocentesis
• 2. Superior Vena Cava Syndromefacial and neck
  edema, respiration distress
• Treatment respiratory support decrease tumor
  size with radiation or chemotherapy
• 3. Sepsis and Septic Shock

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Oncologic Emergencies

• Spinal Cord Compression irreversible paraplegia
• Treatment early detection and radiation or
  surgical decompression
• 5. Obstructive Uropathy can result in renal
  failure
• Treatment restore urine flow
• 6. Hypercalcemia high calcium from ectopic
  parathyroid hormone or metastases
• Behaviors fatigue, muscle weakness, polyuria,
  constipation progressing to coma, seizures
• Treatment restore fluids loop diuretics more
  definitive treatments

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Oncologic Emergencies

• 7. Hyperuricemia
• 1. Concern occurs with rapid necrosis of tumor
  cells as with chemotherapy can result in renal
  damage and failure
• 2. Prevention and treatment with fluids and
  Alopurinol (Zyloprim)
• 8. SIADH (Syndrome of Inappropriate Antidiuretic
  Hormone Secretion)
• 1. Concern ectopic ADH production from tumor
  leads to excessive hyponatremia
• 2. Treatment restore sodium level