Nursing Care of Clients with Cancer

OncologyIs the study of cancer.

OncologistsSpecialize in caring for patients with cancer.

Oncology NurseHave special skills in assisting the clients and family with the psychosocial

issues with cancer and terminal illness.

CANCERIs the disease of the body cell’s the microscopic units that proteins and

energy producing compounds the body needs to remain alive and healthy each type of cell has a unique function and each grows in a particular place and at a particular rate.

For various reasons (some known, others not) certain cells become cancerous, that is they suddenly abandon their normal growth pattern and begin to reproduce uncontrollably.

RISK FACTORS

1) HeredityFamily cancer syndrome

2) Age – 70% over age 65FIVE CYCLES OF GENETIC MUTATION seem necessary to cause permanent damage to the afflicted agents.

Long term exposure to high doses of promotional agents. Immune response alters with aging. Hormonal changes. Free radicals (moleculed resulting from body’s metabolic and

oxidative damage and mutation). Tend to accumulate in the cells overtime, causing damage and mutation.

Severe/cumulative losses – ex-spouse, loved ones, stress – changes in immune system.

3) GenderThyroid cancer – womenBladder cancer – men

4) Poverty Inadequate access to health care; preventive screening, counseling Diet, stress

5) Stress Continuous production of hormones- epinephrine results in systemic

fatigue and impaired immunologic surveillance.

6) Diet Preservative, coffee Increase fat, decrease fiber Excessively fried, boiled meat, fish Reaction using fat to fry food

7) Occupation Outdoor workers – solar radiation X-ray tech – ionizing radiation Asbestos Wood, leather dust – woodworkers Chemotherapy drugs

8) Infection Viruses – prevention

9) Tobacco Use Oropharyngeal, esophageal, laryngeal, gastric pancreatic and bladder

cancer. Second hand tobacco source

10) Alcohol Use Modifying the metabolism of carcinogens in the liver and esophagus,

thus increase the effectiveness of carcinogens in some tissues.11) Recreational Drug Use

Drug users – decrease nutrition - Chromosomal damage

12) Obesity Excessive amount of hormones

13) Sun Exposure

MATURE NORMAL CELLS

Are uniform in size With in the nucleus chromosomes contain DNA and polypeptides

(proteins). Genes are subunit of chromosomes and consists of portion of DNA. The genetic code in the DNA of gene is translated into protein structure.

FUNCTIONS OF DNA

Orders production of enzymes. Instruct cells to produce specific chemicals.

Instruct cells to develop specific structures. Determine individual traits and characteristics. Controls other DNA by telling a cell to “switch on” and use some portion of

the genetic information stored in it.

DIFFERENTIATION

Is a normal process occurring over many cell cycles that allows cell to specialize in certain tasks.

UNPRODUCTIVE CELLULAR ALTERATIONS OCCURING DURING CELL DIFFERENTIATION

1) Hyperplasia

Increase in no. or density or normal cells. Increase level of hormones. Occurs in responsive stress; Increase metabolic demands.

2) Metaplasia

Change in the normal pattern of differentiation such that dividing cells differentiate into cell types not normally found in that location in the body.

Protective response to adverse reaction.

3) Dysplasia Represents a loss of DNA control over differentiation occurring in

response to adverse reactions.

4) Anaplasia Regression of a cell to an immature or undifferentiated cell type.

TYPES OF NEOPLASMS

NEOPLASM Is a mass of new tissue that grows independently of its surrounding

structures and has no physiologic purposes. They are said to be autonomous. They grow at a rate uncoordinated with the needs of the body.

They function independently. They store some of the properties of the parent cells but with altered

size and shape. They do not benefit the host and in some cases are actively harmful. They are classified as BENIGN OR MALIGNANT.

1) BENIGN NEOPLASM Localized in growth. Form a solid mass, have well defined boarders encapsulated. Respond to body’s Homeostatic control. Often stop growing when they reach the boundaries of another tissue.

Grow slowly all often remain stable in size. Easily removed and not to recur. Can be constructing if they crowd surrounding tissue and obstruct the

function of organs.

2) MALIGNANT NEOPLASM Grow aggressively and don’t respond to body’s homeostatic control. Irregular in shape. They cut through surrounding tissues causing bleeding, inflammation

and necrosis. Travel through blood stream. Can occur after surgical intervention.

CHARACTERISTICS OF MALIGNANT CELLS

1) Loss of regulation of mitotic rate.2) Loss of cell specialization.3) Loss of contact inhibition.4) Progressive acquisition of the cancerous phenotype and immortality.5) Irreversability of cancerous phenotype to greater aggressiveness.6) Altered cell structure.7) Simplified metabolic activity.8) Transplantability ( metastasis)9) Ability to promote own survival.

TUMOR INVASION AND METASTASIS

INVASION

Ability to cause pressure atrophy – malignancy moves to vacated space.

Ability to distrupt the basement of normal cells – facilitates movement to normal tissues.

Motility – malignant cells are less tightly bound – they easily separate from the neoplasm.

Response to chemical signals from adjacent tissues – chemotaxis – the movement of cells in response to chemical stimulus.

METASTASIS

Occurs by means of one or more mechanisms including embolism in the blood or spread by way of body cavities.

STEPS:

1) Invasion of malignant cells through blood.2) Survival of malignant cells in the blood.3) Extravasations from the circulation and implantation in the new tissue.

FACTORS THAT MAY WEAKEN OR ALTER THE IMMUNE RESPONSE

1) Accumulated stress2) Depression3) Increase Age4) Pregnancy5) Chronic Disease6) Chemotherapy

PHYSIOLOGIC AND PSYCHOLOGIC/PSYCHOSOCIAL EFFECT OF CANCER

1) Disruption of function (due to obst/pressure)2) Hematologic alterations.

Decrease WBC, Decrease RBC etc. Altered erythopoeisis

3) Infection Fistula between non compatible organs. Necrosis of tumor center.

Malignant involvement of organ of immunity.4) Hemorrhage5) Anorexia

Cadexia syndrome Hyperglycemia Catabolism of tissue and muscle proteins Altered taste and smell

6) Creation of ectopic sites of hormones.7) Paraneoplastic Syndromes.

Deep vein thrombosis Peripheral nerve problems Increase ICP Anorexia

8) Pain Acute Chronic

9) Physical Stress Increase general adaptation syndrome. Increase Immunologic activity. Increase in inflammatory response activity. Nutritional fluid and electrolytes alterations.

10) Psychological stress Grief Guilt Anger Hopelessness Fear Isolation

COLLABORATIVE CARE Begins with a variety of specializes laboratory diagnostic test once cancer is

diagnosis the initial focus is on medical treatment, the goals of treatment are:

a) Eliminate the tumor or malignant cells b) Prevent metastasis. c) Reduce the cellular growth or the tumor burden. d) Promote functional abilities, providing pain relief.

LABORATORY AND DIAGNOSTIC TEST

DIAGNOSIS – microscopic and histologic examination of the tissue reveals the type of cell and its structural different from the prevent tissues.

a) Biopsyb) Shedded cellsc) Collection of sputumd) Level of enzyme

CLASSIFICATION OF CANCERClassified by tissues and cells involved blood cells in which it’s originated

most cancerous drive from epithelial tissues are called carcinomas.a) Adenocarcinomas – glandsb) Sarcoma – connective tissues or musclesc) Gliomas – brain and spinal tissuesd) Melanomas – pigmented cellse) Myolomas – plasma cellsf) Lymphomas – lymphaticg) Leukemia – white blood cellsh) Erythroleukemia – red blood cells

ClassificationTo help characterized diagnosis and treatment protocoli an endocrine system has been developed.

a) Naming the tumorb) Describing its aggressiveness ( Grading)c) Spread with in or beyond the tissue of origin ( Staging)

Grading Evaluates the amount of differentiation level of functional maturity of the cell

and estimates the rate or growth based on the mitotic rate. GRADE 1

Cells are the most differentiated – least malignant with better prognosis.

GRADE 2 Reserved from the least differentiated and most aggressively malignant cells.

STAGING Use to classify solid tumors and refers to the relative size of the tumor and the extent of the disease

TNM STAGING AND CLASSIFICATION SYSTEM

T – The extent of the primary tumor

N – The absence or presence and extent of regional lymph node metastasis.M – The absence or presence of distant metastasis.

The use of numerical subsets of the TNM components indicates the progressive extent of the malignant disease.

PRIMARY TUMOR (T)Tx – Primary tumor cannot be assessedT0 – No evidence of primary tumorTis – Carcinoma in situT1, T2, T3, T4 – Increasing size and local extent of the primary tumor.

REGIONAL LYMPH NODES (N)Nx – Regional lymph nodes cannot be assessedN0 – No regional lymph node metastasisN1, N2, N3 – Increasing involvement of regional lymph nodes.

DISTANT METASTASIS (M)Mx – Distant metastasis cannot be assessedM0 – No distant metastasisM1 – Distant metastasis

PHYSICAL ASSESSMENT1) Nutritional Status; basing on height, weight2) Evaluate laboratory results3) Note Signs and Symptoms4) Assess level of hydration status

Input and Output Skin turgor and moisture Vital Sign Tongue Eyeballs Sounds of murmurs Laboratory values

Manifestation of Cancer1) Hair loss 2) Depression3) Fever4) Bleeding gums5) Anorexia

6) Nausea and vomiting7) Diarrhea8) Hypotension9) Odor of decay10) Etc.

NURSING GOAL

1) Support the patient in managing, pain, nutrition, dehydration, fatigue etc.2) Improve quality of life by promoting rehabilitation for survivals of cancer.3) Maintain the dignity.

POSSIBLE DIAGNOSIS

1) ANXIETY Assess level of anxiety Establish therapeutic relationship Encourage to express feelings (develop rapport) Improve specific information Provide Safe environment Crisis Intervention (expect for the worse)

2) DISTURBED BODY IMAGE Discuss the meaning of the loss and change Observe and evaluate the interaction with the relatives. Allow denial but do not participate in the denial. ( do not argue, or do not favor) Assist the client ( significant others to cope with the changes in appearance) Teach way to reduce the alopecia enhance the appearance until the hair grows back. Teach the client to participate to the care of afflicted body area.

3) ANTICIPATORY GRIEVING Use therapeutic communication skills with provide an open environment for the client or significant others to discuss their feelings realistically. Answer question about illness and prognosis honesty but always encourage hope.

Encourage the dying client to make funeral, burial plans ahead of time, be sure that the will is in order. Encourage client to continue taking past in activity he enjoys including maintaining employment as long as possible.

4) RISK FOR INFECTION Monitor Vital signs Monitor WBC Teach to avoid crowded places and practice personal hygiene. Protect skin and mucous membrane from injury. Encourage increase protein, vitamins, and vitamin C.

5) RISK FOR INJURY Assess for sign and symptoms of obstruction. Teach to differentiate minors to serious problem. Monitor laboratory results.

6) ENHANCED NUTRITION LESS THAN BODY REQUIREMENTS Assess current eating pattern. Teach the principles of good nutrition. Manage problem that interfere feeding

cold drinkssoft blend, soft liquid

Teach to supplement meals with nutritional supplements Teach to make food diary. Parenteral Nutrition.

7) IMPAIRED SKIN TISSUE INTEGRITY Oral, pharyngeal, esophageal, mucous membrane. Signs and Symptoms

Ulcers – tongue, mucous membrane in mouth, throat Lesides – ulcerations Fungal Infections Red swollen gums Xerostomia – excessive dryness – mucous membrane

Carefully assessment , evaluate the tissue impairment Teach measured to prevent infection.