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2 Oncology - Nursing notes
bs nursing (Southwestern University PHINMA)
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Notes of Zairra
Oncology
• Risk Factor
increase the odds of developing cancer
Theories on Cancer:
Misused
Overused
Unused
Terms:
·Cancer
Number 1 Killer
Have 1 nucleus (generally)
Except osteoclast (many nuclei)
Neoplastic Disorder
Undergo mitosis
·Neoplasm
Have APOPTOSIS
new tissue growth
Cell could detect abnormal DNA or
·Mitosis
chromosomes --> cell can commit suicide
Have CONTACT INHIBITION
cell division
Cells stop replicating at a specific rate
·Metastasis
if the quantity is too much to avoid
spread of cancer cells in the body
overpopulation
Uncontrolled proliferation of cancer
With function
Characteristics of Cancerous Cells
cells
Cancer cells continue to grow and divide
·Benign
Variations in size and shapes of cells
(-oma)
Nucleus that is larger and darker than
Example: Adenoma
normal
Maturation of normal cells --> small nucleus
• Malignant
Abnormal number of chromosomes
(-carcinoma)
arranged in a disorganized fashion
Cluster of cells without a boundary
Example: Adenocarcinoma
• Stable cells
growth in # prn (cell growth when
damaged)
Example: Liver cells are able to
Tissues: group of cells
regenerate
Organ: group of tissues
• Labile cells
Abnormal cells > abnormal tissue >
abnormal organ > tumor
growth in # is continuous
Abnormal organs do not have a function
Example: Lung cells (are always
“Pseudo-organ”
replacing cells)
Two types of tumor
Benign
• Differentiation
Harmless
specialization
Can become malignant
Differentiated Cell
Must still be removed
cell with a specific function
Slow growth
Without metastasis
Undifferentiated Cell
Encapsulated
cell with no function; abnormal
Non-invasive: cells are within the
• Risk Factor
tumor
will increase the odds of developing
Malignant
cancer
Harmful
Rapid growth
With metastasis
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-Causes of metastasis
Circulatory spread
Lymphatic spread
Unencapsulated
Invasive
-Tumor cells are spread
-Could enter circulation (circulatory
spread)
Could reach more places than
lymphatic spread
-Could enter the lymph (lymphatic
spread)
Cell of origin --> daughter cells
Normal cells produce normal daughter
cells. (It may produce abnormal cells via
mutation)
Abnormal cells produce abnormal
daughter cells which continues the lineage
WARNING SIGNS OF CANCER
C
A
U
T
I
O
CAUTIONUS
change in bowel and bladder function
(habits)
• Subjective data
a sore that doesn’t heal
• Subjective data
unusual bleeding
thickening or lump in breast or
elsewhere
indigestion
N
U
S
obvious change in warts or mole
Inherently objective but comparison
will come from the patient which can
be considered as subjective
nagging cough or hoarseness of voice
STAGING
Numerical Staging
Stage 1: Limited (local)
Stage 2: Limited (regional)
Stage 3: Extensive local and regional
spread
Stage 4: Distant metastasis
Stage 5: DOES NOT EXIST
TNM Staging
T – tumor (size)
T0 – no tumor
Tx – tumor cannot be identified
(tumor may be behind an organ;
hidden tumor)
Tis – In situ (not proliferative)
T1 - < 2 cm
T2 ¬- < 5 cm
T3 - > 5 cm
T4 - > 5 cm (with metastasis)
N – nodes (number of lymph nodes
involved)
N0 – no lymph nodes
Nx – lymph node cannot be identified
N1 – nodes
4
N2 – nodes > 4
Important lymph nodes
• Cervical – neck
• Supra-clavicular – collarbone
• Axillary – armpits
• Inguinal – groin
• Mediastinal
• Aortic
Lymph Nodes
• Canal system:
-Edema (extremities) --> elevation
of extremity --> absorption by lymph
nodes --> jugular vein --> heart -->
kidneys
M – metastasis (with or without)
M0 – no metastasis
Mx – metastasis cannot be identified
M1 – with metastasis
T0N0M0 – no cancer
unexplained anemia
sudden weight loss
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Ann-Arber
(process comes in the
exam, not the name)
Stage 1 – only 1 lymph node involved
Radiation therapy
Stage 2 – two or more lymph nodes
involved, 1 side
Reference point: diaphragm
Radiation therapy
Stage 3 – two or more lymph nodes
involved, both sides
Reference point: diaphragm
Chemotherapy and radiation therapy
Stage 4 – extralymphatic (outside of lymph
nodes)
Chemotherapy and radiation therapy
DIAGNOSTICS
Biopsy
– confirmatory test
-Tissue sample taken --> microscopy
(cytologic study)
-Even if positive in all of CAUTIONUS, it
does not mean that you have cancer
-Types of biopsy
Aspiration
• Needle is inserted in body cavity to
aspirate tissue sample
Incision
• Scalpel is used to remove tissue
sample
Excision
• Whole mass removed
• Possibly curative
-Considerations
•Invasive
•Need consent
•Anesthesia
•Sedation
• Cancer has pain
o Pain is usually felt at the later part
• Bone Cancer: most painful cancer
• REASON OF PAIN MNEMONIC (COD)
o Compression
Ex: Nerve compression
o Obstruction
Ex: Organ obstruction
o Destruction
Ex: Destruction of bone
• Pain management
o Relaxation with guided imagery
o Massage
Massage around the tumor; not on
the tumor
o Alternating warm and cold compress
Could be only one; could be both
(alternating)
o Medication
Mild pain
• Tylenol
Analgesic
• NSAIDs
Anti-inflammatory & analgesic
Severe pain
• Sulfates
Codeine sulfate
Morphine sulfate
Does Cancer have a cure?
CXR
– lung cancer
Mammography
– breast cancer
Pap smear
– cervical cancer
• Indefinite yes
• CURE mnemonic
o C – chemotherapy
o U – Upera (Surgery)
o R – Radiation
o E – Emotional support
• Chemotherapy
o Anti-neoplastic medications
o Spreads throughout the body
o Internal (common)
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o External
Topical
administration
of
chemotherapy
o Hazardous
o Duration of Administration: 3 – 6
months, preferably
Sometimes extended up to 8
months (physician’s discretion)
• If benefits outweigh the risks
o Mode of Action: kills cancer cells
o Lacks specificity
Can kill normal cells - produce
side effects
o More likely to kill cancer cells than
normal cells
o Attracted to rapidly dividing cells
o Side Effects: (NANDA)
N-nausea and vomiting (common
side effect)
A-alopecia
N-neutropenia: decreased neutrophils
• < 500 count
•makes patient immunocompromised
D-diarrhea
A-anemia
o Nursing Considerations: (CHEMO)
C -caring
• N/V --> anti-emetics
o Ideally given before
chemotherapy
as
prophylaxis
• Diarrhea --> IVF
o
To
counteract
dehydration due to diarrhea
H– handling
• Never by a pregnant nurse
o Teratogenic
o Easily absorbed (if splashed
on skin)
• Goggles, mask, gown, gloves –
for chemotherapy
o Cap, goggles, mask, gown,
gloves – to prevent cross
contamination
• Dispose in hazardous container
o Spill kit
E– education
• Avoid large crowds
o Immunocompromised due to
neutropenia
• Avoid fiber
o To prevent aggravation of
fluid loss due to diarrhea
M– monitoring
• Monitor lab values
o Uric acid levels
฀ Normal: < 7 mg
฀ Abnormal: > 7mg
฀ Allopurinol
o Platelet count
฀ Dictates what kind of bleeding
฀ Normal: 150,000 – 450,000
฀ Bleeding tendencies present:
50,000 and below
฀ Spontaneous bleeding: 20,000
and below
O– observation
• Alopecia
o Inform client that this is
temporary
฀ Best way to alleviate altered
body image
o Offer wig (and even makeup)
฀ Before alopecia
•To
minimize
obvious/major
changes (especially if during
alopecia)
• Phlebitis
o Change access (transfer to
another vessel)
• Radiation Therapy
o High energy waves (High-dose
radiation)
฀ Low-dose radiation – risk factor
for cancer
฀ High-dose radiation – treatment
for cancer
o Localized (generally)
o Internal
฀ Brachytherapy – radiation is injected
o External (common)
฀ Teletherapy
o Hazardous
o Duration of Administration: as
ordered
o Mode of Action: reduce the size of
tumor
o Side Effects:
F– fatigue (most common side
effect)
A– alopecia
S– skin changes (discoloration)
T– taste alterations
o Types of Radiation
฀ Internal Radiation
• Patient is a source of radiation
o Teratogenic
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• Radiation is inserted inside the body
o Liquid or solid form
• Sealed
o Solid form – cesium/iridium
฀ Example: colorectal cancer –
cesium inserted next to colon
o Patient is radioactive, but
excreta are not
• Unsealed
o May be spread
o Liquid form – via IV/oral route
o Patient AND excreta are
radioactive
฀ Flush toilet three (3) times
• Nursing Considerations
o Private room – because patient is
radioactive
o Place caution on the door
o Wear a dosimeter film
฀ Like a watch – tells radiation
level
฀ Could be dosimeter badge
o Wear a lead shield before
entering room
฀Lead – element designed to
repel radiation
o 1 nurse: 1 patient
o Limit exposure to 30 minutes
o No pregnant nurse
o No visitors below 16 y/o
฀ People below 16 y/o are still
rapidly growing
฀ External Radiation
• Patient is not a source of radiation
• Radiation can be felt
o Instruct client to avoid exposure
to sunlight
o Avoid restrictive clothing
฀ To avoid skin irritation
o Wash area with lukewarm water
฀
Cold
water
causes
vasoconstriction --> decreased
tissue perfusion
฀ Hot water irritates skin
o Rinse with hand, not washcloth
฀ Washcloth promotes friction
o Dry with patting, not rubbing
motion
MEDICATIONS
• Hormonal Medications (hormone sensitive
tumors)
o To decrease size of tumors because
some tumors are hormone-sensitive
o Drugs
T– Tamoxifen (most important drug)
A– Arimidex
D– Diethylstilbestrol
• Vinca Alkaloids (anti-mitosis)
o Drugs
V– Velban
O- Oncovin (most important drug)
N-Navelbine
• Alkylating Agents (DNA replication
antagonist)
o Drugs
A– Altretamine
B - Busulfan (most important drug)
O– Oxaliplatin
•Immunomodulator (immune manipulation)
o So that the immune system kills the
cancer cells
o Cytokines --> stimulates immune
cells to attack foreign bodies
o Drugs
฀ Interleukins: destroy cancer cells
• Chemo counterpart
฀Interferons: slows down
growth
• Radiation counterpart
tumor
฀Monoclonal antibodies: antibodies
that attack cancer cells
Kinds of Cancer
TESTICULAR CANCER
• Concepts
Testicles: germinal epithelium
฀ Produce sperm cells
฀ Produce testosterone
• Note: Men have low amounts of estrogen
• RISK FACTORS
Age: 15 – 40 y/o
฀Teach males to do self-examination
starting at 15 y/o
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Undescended testicles
฀ Testicles located first at the
abdomen --> descends during
development (9 months)
฀ Cryptorchidism
• MANIFESTATIONS
Initially painless
Irregularities in Testicular Self-Exam
฀ Self-exam should be done after a
shower
•
Due
to
body’s
cooling
mechanism
฀ Testicles should be smooth
฀ Self-exam is not confirmatory
฀ Self-exam must be done every
month on a specific date
Painless testicular mass
“Heavy Pull”
฀ Due to mass
Late:
฀ Pain
• Bone pain
• Back pain
฀ Gynecomastia
• Tumor impairs testosterone
production
• Note: Tumor impairs sperm
production (can cause infertility)
• MANAGEMENT
Pain management
฀ Mild pain
• Tylenol
฀ Severe pain
• Morphine sulfate
• Codeine sulfate
Chemotherapy
Radiation
Surgery: Orchiectomy
฀ Types of Orchiectomy
• Unilateral: only one testicle
Still fertile
• Bilateral: both testicles
฀ Avoid lifting heavy objects
฀ Risk for herniation
• Intestines may drop into the
scrotum – inguinal hernia
PROSTATE CANCER
• Concepts
Testes produce sperm cells
Prostate produces seminal fluid
• RISK FACTORS
Age: more than 50 y/o
STDs
Heavy metal exposure
• MANIFESTATIONS
Irregularities – Digital Rectal Exam
฀Highly
suggestive;
not
confirmatory
Painless post-coital bleeding
(+) PSA – Prostate-Specific Antigen
฀Highly
suggestive;
not
confirmatory
Late:
฀ Pain
• Lumbar Pain
• Leg Pain
• MANAGEMENT
Pain Management
Chemotherapy
Radiation therapy
Surgery:
TURP
(Transurethral
Resection of the Prostate)
฀ Using a Resectoscope
฀ Bleeding is normal
฀ Hematuria is normal
฀Subject
patient
to
CBI
(Continuous Bladder Irrigation)
• Use a solution to wash out
debris
• Dilutes salt in the body
o Precipitates hyponatremia
฀ Watch out for:
•Cerebral Edema
•Increased
Intercranial
Presssure
o Triad signs of ICP
฀ Hypertension
฀ Bradycardia
฀ Bradypnea
CERVICAL CANCER
• Concept:
Tumor squeezes the
neighboring structures
• RISK FACTORS
HPV
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and
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Multiple sex partners
฀ HPV can be spread
Early intercourse
฀
16 y/o
Smoking
• MANIFESTATIONS
Painless vaginal bleeding
Painless vaginal discharge
(Vesicovaginal) Fistula formation ->leakage of feces and urine
฀ Mucous membranes are stuck
into each other
฀
Two
mucous
membranes
become connected >> a hole is
formed >> fluids are being shared
• “It’s like I’m peeing through
my vagina”
Late:
฀ Pain
• Lumbar Pain
• Leg Pain
• Pelvic Area Pain
• MANAGEMENT
Chemotherapy
Radiation Therapy
Surgery: Hysterectomy
BREAST CANCER
• Concept:
Lobules: produce milk in response to
prolactin
• RISK FACTORS
Chest X-Ray
Family History
Nulliparity
Early Menarche
Late Menopause
• MANIFESTATIONS
Painless breast mass
Irregularities in BSE (Breast SelfExam)
฀ BSE should be done every
month; 7-10 days after the
menses
• During a bath
฀ To assess left breast, raise left
arm; assess with right hand
• Outer to inner or outer to
inner motion
Higher breast is the affected breast
฀Women’s breasts are normally
asymmetrical
Peau d’orange (dimpling similar to the
skin of an orange)
Men can have breast cancer
฀ Men have worse breast cancer
Common sites of breast cancer:
฀ Upper outer
฀ Axillae
฀ Below the nipple line
• TYPES OF BREAST CANCER
Non-invasive breast cancer
฀ Stays in the mammary duct
฀ Reason why breast cancer is
common in women
Invasive breast cancer
฀ Spreads outside
฀ Men have it worse because men
do not have mammary ducts >>
immediately invasive
• MANAGEMENT
Position patient in Semi-Fowler’s
position
฀ Most comfortable position
฀ 30 – 45 degrees angle of the head
of the bed
Chemotherapy
Radiation Therapy
Administer Tamoxifen as ordered
Surgery:
฀ Lumpectomy
• Removal of the lump
฀ Mastectomy
• Also a lumpectomy
• Removal of lump + breast
tissues
฀MRM
(Modified
Radical
Mastectomy)
• Also a mastectomy
• Removal of lump + breast
tissues + axillary lymph node +
nipple
฀ COMPLICATIONS
• Fluid shifting is possible >>
edema >> lymphedema
o Right breast removal >>
right arm has edema >>
elevate
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LUNG CANCER
฀ To maximize lung compliance
• Concepts:
“I go in with oxygen as I go out with
carbon dioxide.”
฀ “I go in with microorganisms as I
go out with microorganisms.”
• Tumor prevents exit of
microorganisms >> energy is
needed to be used >> blood
vessels become semi-permeable
>> WBCs enter respiratory tract
to destroy microorganisms (this
process requires energy and the
semi-permeability
of
blood
vessels)
Anatomical structures: trachea >>
bronchi >> bronchioles >> alveoli
(gas exchange occurs here)
• RISK FACTORS
Chest X-Ray
Radon: colorless, odorless gaseous
chemical
฀ Usually on the ground or soil
Smoking
• MANIFESTATIONS
Wheezes
฀ Due to constricted airway
to
Hemoptysis
฀ Due to intense coughing
Fever
Weakness and Fatigue
฀Due to energy expenditure caused
by the use of energy to make blood
vessels semi-permeable
Shortness of breath
Pulmonary edema
฀Due to semi-permeability of blood
vessels
• MANAGEMENT
Priority: AIRWAY
Oxygen as ordered
High-Fowler’s position
฀ Pneumonectomy
• Removal of entire lung
Post Op:
฀ Key Concepts
• Pleural cavity usually has negative
pressure
• Surgical procedures cause fluid shifting
>> fluid in pleural cavity >> positive
pressure
• One lung >> difficulty breathing >> lung
occupies the space left by the removed
lung >> Mediastinal Shift >> Tracheal
Deviation >> not good
• After a pneumonectomy, CTT (Chest Tube
Thoracostomy) is contraindicated
• Positive pressure in the affected chest is
the desired outcome
• Do not allow patient to lie on side of
unaffected chest
LARYNGEAL
CANCER
Dyspnea
฀ Due to obstruction of airway
Cough
฀Compensatory
mechanism
expel foreign bodies
Bronchodilators as ordered
Chemotherapy
Radiation Therapy
Surgery:
฀ Lobectomy
• Removal of lung lobe
• Left lung – 2 lobes
• Right lung – 3 lobes
• RISK FACTORS
Smoking
Alcohol
Pollutants
Radiation
฀ Frequent neck radiation
• MANIFESTIONS
Feeling of a lump in throat
Dysphagia: difficulty in swallowing
Weight loss
฀Due to impairment of eating
because of dysphagia
Dyspnea: difficulty breathing
฀Due to obstruction
Cough
฀Lump stimulates cough reflex
Hemoptysis
฀ due to excessive cough >> injury
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• MANAGEMENT
Aspiration precaution
฀Lump
in
the
throat
causes
impairment of movement of food in
the throat
฀High-Fowler’s while feeding
• Do not let patient eat while lying
down
฀High-Fowler’s even while not eating
• To maximize lung expansion
Epiglottis opens ฀ lower esophageal
sphincter closes
฀ Otherwise, reflux occurs
Food is in the stomach >> pyloric
sphincter opens after 2 – 4 hours
฀ NOTE: Pyloric sphincter may also
open or close depending on the
pressure on the duodenum
• RISK FACTORS
Oxygen as ordered
Alternative Routes for Food
฀ Total Parenteral Nurtrition
฀ NGT
฀ Gastrostomy
฀ Jejunostomy
Surgery: Laryngectomy
฀Total Laryngectomy – if tumor
occupies a big amount of the larynx
฀Cordal Stripping – if superficial
tumor
Spicy foods
Highly seasoned food
Smoking
Alcohol
Carcinogens
฀ Overcooked food – Benzopyrene
฀ Preservatives – Nitrosamine
฀ Peanut – Afflatoxin
• MANIFESTATIONS
Tumor is near LES >> LES does not close
>>
฀ Difficulty swallowing
• Oral fluids are needed to pass food
Post-Op:
฀Total
Laryngectomy
tracheostomy is permanent
฀Assess gag and cough reflexes
• To assess laryngeal nerve damage
฀High-Fowler’s position
• To maximize lung compliance
฀ Mech vent as ordered
฀ Watch out for
• Hemorrhage
o Use a penlight
฀ Maintain surgical drains
฀ Refer to speech therapist
GASTRIC CANCER
Tumor is near Pyloric Sphincter >>
Pyloric Sphincter does not close
฀ Heartburn (pyrosis)
• Food goes up
฀ Vomiting
• Area Postrema (vomiting center
of the brain) is stimulated
Diffused type of cancer
฀ Satiety: feeling of fullness
฀ Hematemesis
• Due to injured tumors drenched in
Hydrochloric Acid
฀ Melena
• Due to injured tumors drenched in
Hydrochloric Acid
• Bleeding in the upper GI >> blood
is processed >> darkened stools
Pain
฀ Initially, generalized abdominal pain
฀ Later on, pain is focused in the middle
• Concepts
Anatomical structures: esophagus,
lower esophageal sphincter, stomach,
fundus, pylorus, pyloric sphincter
Hydrochloric Acid in the stomach
Swallowing >> epiglottis closes >> food
goes towards the stomach >> lower
• MANAGEMENT
esophageal sphincter opens
Avoid carcinogens
Avoid smoking
Avoid alcohol
Small frequent feeding
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Administer antacids as ordered
Blood transfusion as ordered
Chemotherapy
Radiation Therapy
Surgery:
฀Total gastrectomy: removal of the
entire stomach
•Achlorhydria:
absence
of
hydrochloric acid (due to absence of
stomach in total gastrectomy)
•Anastomosis: surgical connection of
two structures
•Hydrochloric Acid + Food = Chyme
(an acidic substance)
o Duodenal cells are able to produce
alkaline substances
o Considerations:
฀ Goal is to delay gastric
emptying
฀ Low residue diet
฀ Fluids only after meals (PC)
฀ Lie flat on bed after meals
(PC)
฀ Antispasmodics to delay
gastric emptying
฀ Solid foods are preferred
over wet food
•Lubrication
increases
gastric emptying
COLON CANCER
•Achlorhydria >> duodenal cells
produce acidic substances >> food is Concepts
Jejunum:
maximum
absorption
of
digested
nutrients
• Diet as tolerated
Colon: maximum absorption of fluids
Parts of the colon:
฀ Billroth I (gastroduodenostomy)
฀Appendix
฀ Billroth II (gastrojejunostomy)
฀Cecum
฀Ascending colon – stool is in liquid form
Post-Op
฀Transverse colon – stool is semisolid
฀ NPO 1-3 days depending on peristalsis
฀Descending colon – stool is in solid form
• Because surgery was performed
฀Sigmoid
฀Rectum
directly on the stomach
• Ask patient about flatus
• RISK FACTORS
o Best way to determine GI function
More than 50 y/o
฀ Advance from NPO to sips of water >>
Polyps
if tolerated, soft diet
Family History
Inflammatory Bowel Disease (IBD)
฀ Monitor for electrolyte imbalances
฀ Crohn’s Disease
฀ Administer IVF and electrolytes as
฀ Ulcerative Colitis
ordered
฀ Administer TPN as ordered
• MANIFESTATIONS
฀ Watch out for:
Blood in the stools
•Dumping
Syndrome
(Increased
฀
Tumor is injured because of the flow of
Gastric Motility): food is dumped
feces
o Manifestations:
฀ Red blood (Lower GI bleeding)
฀ Increased peristalsis
Anemia
฀ Hyperactive bowel sounds
Weight loss
฀Impaired
fluid absorption >> fluid
฀ Diarrhea
volume deficit
฀ Abdominal cramping
Vomiting
฀ Palpitations (and tachycardia)
฀ Complete bowel obstruction
฀ Diaphoresis
Tumor in Ascending Colon (AC)
฀ Fluid is not absorbed properly >>
Diarrhea
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Tumor in Descending Colon (DC)
฀Only soft feces are passed
Ribbonlike Stool
>>
• METASTASIS
Lymphatic spread
Circulatory spread
• MANAGEMENT
Watch out for:
฀ Peritonitis
฀ Perforation
• Board-like abdomen
• Pain
• Fever
• Dullness upon percussion
฀ Intestinal Obstruction
Urinary obstruction (clot-induced)
฀Tumor bleeds >> blood clot formation
>> urethra is blocked >> urinary
obstruction >> UTI >> renal failure
• MANAGEMENT
Chemotherapy
Radiation therapy
Surgery:
Cystectomy
(bladder
removal)
฀ Ureters are connected to the:
• Ileum
o Ileal conduit
• Colon
o Colon conduit
MULTIPLE
MYELOMA
Chemotherapy
Radiation Therapy
Surgery:
Bowel
Resection
with
Colostomy
• Concepts
฀ Petroleum jelly gauze is given to cover
Cancer of the plasma
stoma
Plasma produces immunoglobulins
฀ Watch out for bleeding
Plasma contains hematopoietic stem
฀ Note color of stoma
cells
• Normal color: red/pink
฀Hematopoietic stem cells >> becomes
RBCs, WBCs, Plasma
฀ Watch out for pouch leakage
฀ AC – liquid stools
Too much plasma >> bone marrow is
฀ TC – semiformed stools
squeezed
฀ DC – solid stools
Abnormal plasma attacks the bone >>
contains calcium, purine >> causing
hyperuricemia,
osteoporosis,
hypercalcemia
BLADDER CANCER
• Concepts
Bladder is the reservoir of urine
Bladder contracts >> urine is released
Tumor makes bladder think that it is full
(of urine)
• RISK FACTORS
Smoking
Chemical Exposure
Radiation
฀ Bones contain:
• Calcium >> bone is attacked
o Calcium is released in the
blood >> hypercalcemia
o Decreased calcium in the
bones >> osteoporosis
• Purine >> bone is attacked >> uric
acid is released in the blood >>
hyperuricemia
฀ Bones contain Bence Jones Protein
• MANIFESTATIONS
>> not filtered >> present in urinalysis
Urgency
• RISK FACTORS
Frequency
Dysuria: difficulty in urinating
Age: 60+
Painless hematuria – most frequent
Radiation exposure
manifestation
Chemical exposure
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lOMoARcPSD|16207318
• MANIFESTATIONS
• MANAGEMENT
Infection precaution
Decreased RBCs
฀ Observe aseptic technique for all
Decreased WBCs
procedures
Decreased Platelets
฀ Isolate patient
Note: Leukemia has worse decrease of
blood components
•Reverse isolation: prevents patient
Risk for fractures
from
being infected by others
Renal calculi
•Reverse
isolation:
positive
air
฀Kidneys compensate for hypercalcemia
pressure
>> calcium oxalate stones formed >>
•Direct isolation: negative air pressure
urinary tract obstruction >> renal failure
so that air comes in
•Direct or Reverse – room must be end
• MANAGEMENT
of the hallway
Chemotherapy
Radiation therapy
฀ Limit exposure
Bone marrow transplant
• Limit visitation hours/visitors
LEUKEMIA
• Concepts
Hematopoietic stems cells are no longer
producing useful RBCs and Platelets >>
drop of blood components
Bone marrow produces RBCs, WBCs,
Platelets
In leukemia, blood components produced
are abnormal or useless
฀ RBCs – cannot carry oxygen
฀ WBCs – does not fight infection
฀ Platelets – does not prevent clotting
• RISK FACTORS
Smoking
Chemical exposure
Family history
• MANIFESTATIONS
Decreased RBC
฀ Anemia
฀ Paleness
฀ Weakness and fatigue
฀ Shortness of breath
Decreased WBC
฀ Client is immunocompromised >> risk
for infection
฀ AVOID!!!
• Fresh fruits
• Fresh vegetables
• Fresh flowers
฀Monitor temperature
฀Anticipate
administration
of
oral
antibiotics for infection
• Injections are not allowed due to
bleeding tendencies
Bleeding Precaution
฀ Watch out for
• Nadir: point of lowest platelet
฀ Avoid
• Exposure to sharps
• IV fluids
• IV medications
•Acetylsalicylic
Aspirin
platelet/platelet aggregator
• NSAIDs – gastric irritants
–
anti-
Fatigue
฀ Promote rest
฀ Assist client with ambulation
฀ Schedule activities (plan activities)
฀ Packed RBC as ordered
• Only time to use injection
Decreased Platelet
฀ Risk for bleeding
฀ Presence of bruises
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lOMoARcPSD|16207318
฀ Non-Hodgkin’s
HODGKIN’S
DISEASE
• Concepts
Cancer of the lymph nodes
Lymphatic system is a canal system for
fluids
Fluids >> lymph nodes >> jugular vein
Lymphatic system helps in immune
function >> lymphocytes
Reed Sternberg cells or Owl’s eyes:
hallmark tumor of Hodgkin’s Disease
฀ Multiple nuclei instead of only one
฀ Instead of lymphocytes
Phases of Hodgkin’s Disease
฀ Lymphocyte Predominant
• More normal cells than abnormal
cells
฀ Nodular Sclerosis
• Equal number of
abnormal cells
• Cells are separated
• Without RSB cells
• Late detection
False Negative at first
• Poor prognosis
• Risk: HIV
• Risk: Burkitt’s lymphoma
• Chemotherapy
• Radiation Therapy
• Deadlier
DIFFERENTIATION OF BLOOD
CANCERS
normal
and • MULTIPLE MYELOMA
Abnormal plasma
Bone marrow to bone affected >>
decreased bone density
฀ Mixed Cellularity
Blood cancer
• Equal number of normal and
Chemotherapy
abnormal cells
Radiation therapy
• Normal and abnormal cells have
mixed
• HODGKIN’S
Abnormal lymphocytes
฀ Lymphocyte Depletion
Lymph nodes are affected >> presence of
• More abnormal cells than normal
RSB Blood cancer
cells
Blood cancer
Chemotherapy
• MANIFESTATIONS
Radiation therapy
Painless lymphadenopathy
Risk for infection
• LEUKEMIA
Cough
Abnormal HSC
B-symptoms (suggestive of Hodgkin’s to
Bone marrow to blood affected
>>
be extralymphatic)
decreased
blood
components
฀ Fever
Blood cancer
฀ Night sweats
Chemotherapy
฀ Weight loss
Radiation therapy
Hodgkin’s vs Non-hodgkin’s
฀ Hodgkin’s
• With RSB cells
• Early detection
• Better prognosis
• Risk: Bimodal age
15-30 y/o or more than 50 y/o
• Chemotherapy
• Radiation Therapy
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NOTESBYZAIRRA