Oncology
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Oncology Janna Wickham RN MSN LSSC Spring 2014 Statistics & Definition Cancer 1500 people die every day from cancer 1 out of 4 deaths is caused by cancer Lung cancer 28% of all deaths Cancer Any age, gender, ethnicity, or geographic region Normal cells change and acquire malignant properties Risk Factors Heredity Age Gender Poverty Risk Factors Stress Diet High fat Low fiber Occupation Infection Virus (Epstein –Barr for example) Tobacco Use Risk Factors Alcohol Use Recreational Drug Use Obesity Sun Exposure Figure 14–1 Interaction of factors that promote cancer. Cell Cycle G0 Gap 1 (G1) Synthesis (S) Gap 2 (G2) Mitosis (M) Differentiation Hyperplasia Under normal DNA control Metaplasia Dysplasia Abnormal variation in size, shape, and appearance HPV causes dysplasia of the cervix Anaplasia Theories of Carcinogenesis Cellular Mutation Oncogene Carcinogens cause mutations in cellular DNA BRCA1 BRCA2 Tumor Suppression Genes Suppress oncogene p53 Carcinogens Genotoxic Directly alter DNA Promotor Substances Adverse biologic effects Cytotoxicity Hormonal imbalances Altered immunity Chronic tissue damage Carcinogens Viruses Drugs and Hormones Chemical agents Physical Agents Metastasis Blood or lymph Target organs Cell morphology Immune response Types of Neoplasms Physiologic Effects of Cancer Disruption of Function Hematologic Anemia Neutropenia Thrombocytopenia Infection Tumor necrosis Physiologic Effects of Cancer Hemorrhage Anorexia-Cachexia Syndrome Unexplained rapid weight loss Emaciation Malnutrition Loss of energy Paraneoplastic Syndrome Endocrine related Physiologic Effects of Cancer Pain Acute Chronic Physical Stress Psychological Effects of Cancer Stress Diagnosis Assess Lab Diagnostic workup Biopsy Classification Cytologic Examination Exfoliation from an epitheleal base Aspiration of fluid from Body cavity Blood Needle aspiration of solid tumors Grading/Staging Differentiation – level of functional maturity Grade 1 – Grade 4 Grade 1 most like parent cell Grade 4 least differentiated TNM –used to stage solid tumors Example 45 year female with lobular breast cancer Tumor 0.8cm 1 positive axillary lymph node No evidence of metastasis Laboratory Tests Table 14-8 CBC Normal Abnormal Critical Nadir The nadir is the time point after cancer treatment when your blood counts (white blood cell, hemoglobin and platelets) are at their lowest complications of low counts; including infection risk (due to low white blood cell count), bleeding risk (due to low platelet count), poor oxygen delivery to tissues which can cause fatigue, chest pain, shortness of breath, dizziness (due to low hemoglobin, also called anemia) The nadir most commonly occurs 10-14 days after chemotherapy treatment, but this time can vary depending on the chemotherapy Neutropenic Precautions https://www2.ons.org/ClinicalResources/media/ons/docs/rese arch/outcomes/infection/quickview.pdf Thrombocytopenia <100,000 How to take care of yourself if your platelets are low: Watch for unexplained bruises Try not to bump or cut yourself. Be careful with knives and other sharp instruments. If you develop bleeding, place pressure over the area for 5–10 minutes with ice. Use a soft tooth brush for mouth care. Do not use aspirin or products Take any steroid medications such as prednisone or decadron with milk, food, or an antacid A platelet transfusion may be necessary if platelet count is below 20,000 or bleeding Use an electric shaver rather than blades to shave with. Avoid constipation—when straining to have a bowel movement. Do not use suppositories, enemas, or a rectal thermometer. Avoid intra-muscular (IM) injections if possible. Monitor for bleeding with intercourse. Try to avoid blowing your nose too hard or coughing too hard. Tumor Markers Antigens Hormones Proteins Enzymes Imaging Scans MRI Nuclear Imaging Computerized tomography Has the tumor metastasized Bone metastasis Thyroid cancer PET Metastasis Pharmacologic Management Chemotherapy Alkylating Agents Antimetabolites Antitumor Antibiotics Mitotic Inhibitors Hormones and Hormone Antagonists Cell Cycle Specific Table 14-10 Toxic Reaction Miotic Inhibitor Vincristine Depression of deep tendon reflexes (motor weakness) Paresthesias (pain and altered sensations) Alkylating Agent busulfan- Myleran Bone Marrow Failure Assess for infection Venous Access Devices PICC Port Tunneled Catheter Nursing Management of Patients Receiving Chemotherapy Bone Marrow Suppression Gastrointestinal Effects Stomstitis Nausea & Vomiting Alopecia Non-pharmacologic Management Surgery Non-pharmacologic Management Radiation External(teletherapy) Adverse effects Nursing Care Internal (brachytherapy) Box 14-6 Safety principles Adverse effects Nursing care Lead shield Dosimeter Limit time Bone Marrow Non-pharmacologic Management Biotherapy(Immunotherapy) Monoclomal antibodies Cytokines Natural Killer Cells Non-pharmacologic Management Photodynamic Therapy Adverse Effects Nursing Care Non-pharmacologic Management Bone Marrow and Stem Cell Transplants Complementary Therapies Oncologic Emergencies Superior Vena Cava Syndrome Sepsis & Septic Shock Tumor Lysis Syndrome Hypercalcemia Physiologic Needs in Advanced Stages of Cancer Comfort Round the clock and breakthrough pain management Nutrition Elimination Mobility Hygiene Supportive Care Grieving Fear Caregiver Support Nursing Diagnosis Anxiety Disturbed Body Image Anticipatory Grief Nursing Diagnosis Risk for Infection Intervention to avoid large crowds Risk for Injury Imbalanced Nutrition: Less than body requirements related to anorexia Nursing Diagnosis Impaired Tissue Integrity Palliative Care Terminal Diagnosis Comfort care Family Care Pediatric Considerations Effects the whole family Lifespan considerations
