Oncology

Understanding Medical Surgical Nursing 4th ed., Ch 11OBJECTIVES: 1. Explain the differences between benign & malignant tumors.2. List risk factors for the development of cancer.3. State 7 warning signs of CA.4. Define terms used to name & classify CA.5. List the most common sites of CA in men & women.6. List nursing responsibilities in the care of patients having diagnostic tests to detect possible CA.7. Explain the nursing care of clients undergoing each type of CA therapy: surgery, radiation, chemotherapy, biologic response modifiers.

Health Statistics

American Cancer Society: www.cancer.org

Males: over ½ Prostate, lung, & colorectal

Women: ~½ breast, lung, & colorectal

Children (0-14yrs)

Colorectal CA is the 3rd most common CA in both men & women.

U.S. 2014Deaths• CA is the 2nd leading cause of

death in the US, exceeded only by heart disease.

• Breast, Prostate, Lung, & Colorectal CA’s account for ½ of all deaths, men & women.

Health Statistics

Older Adult Considerations

•More cases of CA

•CA î with aging

•S&S of CA may be misdiagnosed

Cancer (CA)

Large group of diseases characterized by uncontrolled growth & spread of abnormal cells. (American Cancer Society)http://www.youtube.com/watch?v=bKEptX-fwP0

Neoplasms or Tumors

Cells that reproduce abnormally & in an uncontrolled manner.

Normal Cell Growth

Uniform shape

Cell cohesiveness

Controlled growth

Well differentiated

Programmed cell death (apoptosis)

CA cells divide & multiply, in an abnormal manner. http://www.youtube.com/watch?v=A1Fkdt-2veM

• Mutation of Cellular Genes

• Abnormal Cell Growth

• No Cell Division Limit

• Lack of Contact Inhibition

Cancer Pathophysiology

Cancer Cell Growth

• Abnormal appearance

• Lack of cohesiveness

• Rapid, disorderly division

• Poorly differentiated

• No apoptosis

Benign Tumors

• Slow, steady growth

• Remains localized

• Usually contained within a capsule

• Smooth, well-defined; movable when palpated

• Resembles parent tissue

• Crowds normal tissue

• Rarely recurs after removal

• Rarely fatal

Malignant Tumorshttp://www.youtube.com/watch?v=LEpTTolebqo

• Rate of growth varies – usually rapid

• Metastasizes

• Rarely contained within a capsule

• Irregular; more immobile when palpated

• Little resemblance to parent tissue

• May recur after removal

• Fatal without treatment

Metastasis

Process by which tumor cells are spread to distant parts of body; used to describe movement of CA cells from primary to secondary site. http://www.youtube.com/watch?v=rrMq8uA_6iA

• Invade Blood or Lymph Vessels

• Move by Mechanical Means

• Lodge & Grow in New Location

The process by which normal cells are transformed into CA cells.

Etiology:

• Carcinogen Exposure

• Initiation

• Promotion

Carcinogenesis

Carcinogenesis

Initiation

Carcinogens: CA causing agents

1.Repair itself

2.Permanently ∆’ed, don’t cause CA

3.Transformed & produce new line of CA cells

Promotion

Process by which CA promoters aid in alternation or injury to DNA.

Progression

The expression of malignant mutation acquiring more aggressive characteristics over time.

• Carcinoma

• Sarcoma

• Melanoma• Leukemia • Lymphoma

Cancer Typeshttp://www.youtube.com/watch?v=mqx-R_sjM7g

Most Common Cancers• Men

–Prostate–Lung–Colon

• Women–Breast–Lung–Colon

Skin CancerMalignant lesion of skin; may or may not metastasize

– Types: basal cell, squamous cell, malignant melanoma

– Assessment: change in color, size, shape of preexisting lesion; pruritus; local soreness

– Interventions• Instruct in preventive measures (limiting

exposure to sun, use of sunscreens)• Instruct to monitor lesions for changes,

nonhealing lesions; report to primary health care provider immediately

• Assist with surgical excision of lesion as prescribed

Leukemia• Malignant exacerbation in number of leukocytes, usually at immature stage, in bone marrow

–Data collection• Normal, elevated, or reduced white blood cell count; decreased H/H; thrombocytopenia; positive bone marrow biopsy; anorexia; fatigue; bleeding; fever; lymphadenopathy; splenomegaly; bone pain, swelling

Lymphoma: Hodgkin’s Disease• Malignancy of lymph nodes; originates in single lymph node or single chain of nodes

–Data collection• Presence of Reed-Sternberg cells in nodes

• Fever; malaise; night sweats; anorexia; anemia & thrombocytopenia; enlarged lymph glands, including nodes, spleen, liver

Hodgin’s disease cont’d

characterized by painless, progressive enlargement of lymphoid tissue

InterventionsProvide care before & after external radiation as prescribed

Provide care before & after chemotherapy as prescribed

Monitor for signs of infection, bleeding

Follow bleeding precautions

Non-Hodgkin’s lymphoma (NHL)

Any of a heterogeneous group of malignant tumors involving lymphoid tissue.

Lung Cancer• Malignant tumor of lung; may be primary or metastatic

– Causes• Cigarette smoking; exposure to environmental pollutants; exposure to occupational pollutants

– Data collection• Cough; dyspnea; hoarseness; hemoptysis; chest pain; anorexia; wt loss; weakness

– Interventions• Place in Fowler’s position• Administer oxygen as prescribed

Lung CA

• Small-cell lung CA: hormonal cells

• Non-small lung CA:

-squamous-cell: larger airways

-adenocarcinomas: (large-cell carcinomas), in secretory

portion

-bronchoalveolar carcinomas: small air sacs, or alveoli

Multiple Myeloma

Malignant proliferation of plasma cells, tumors within bone

Data collection• Bone, skeletal pain, especially in

ribs, spine, pelvis• Osteoporosis • Recurrent infections; fatigue;

anemia; thrombocytopenia; granulocytopenia; elevated uric acid & calcium serum levels

Risk factors •Smoking

•Exposure to radiation

•Exposure to environmental & chemical carcinogens

•Smokeless tobacco

•Frequent heavy consumption of alcohol

Risk factors

• Dietary habits

• Pickled, smoked, charbroiled • High-fat, low-fiber diets • High-fat diets • Diet low in vitamins A, C, & E

Risk Factors

• Oncoviruses• Irritants• Hormones• Altered Immunity

Hereditary Cancers

~ 90% of cancers are not inherited

Genetic Susceptibility:•Postmenopausal breast CA

•Lung CA – Smokers

•Leukemia – identical twin

•Neuroblastoma – siblings

•Colon CA – breast CA

American Cancer Society

Cancer’s 7 Warning Signals: CAUTION

1. Change in bowel or bladder habits

2. A sore that does not heal

3. Unusual bleeding or discharge

4. Thickening lump in breast or elsewhere

5. Indigestion or swallowing difficulties

6. Obvious ∆ in warts or moles

7. Nagging cough or hoarseness

Prevention

•Early Detection

•Regular Screening

•Genetic Testing

•Healthy Lifestyle

Breast Self-Examination (BSE)– Performing BSE

• 7 to 10 days after menses• If postmenopausal or posthysterectomy,

select specific day of month, perform regularly

– Client instructions• In shower or bath, examine breasts• Use pads of second, third, and fourth fingers

to press firmly on every part of breasts, using right hand to examine left breast and vice versa

• Use small circular motions in a spiral or up and down motion so that entire breast is examined, checking for any lump, knot, thickening of tissue

Breast Self-Examination (BSE) (continued)

• Look at breasts in mirror, raising arms over head to determine any changes in size, dimpling of skin, changes in nipple, asymmetry; repeat with hands on hips

• Lying down, feel breasts as when in shower or bath; when examining right breast, place right hand behind your head and vice versa for left breast

• Any changes noted should be reported immediately to health care provider

Testicular Self-Examination (TSE)

– Performing testicular self-examination• Select day of month; perform on that

day every month– Client instructions

• In shower, gently lift each testicle; each one should feel like an egg: firm but not hard, smooth with no lumps

• Using both hands, place middle fingers on underside of each testicle, thumbs on top; gently roll testicle between thumb and fingers to feel for swelling, lumps, or mass

• Any changes noted should be reported immediately to health care provider

Prevention

• Protectant Foods–Folic Acid–Omega-3 Fatty Acids–Fruits & Vegetables

• Vaccines

Diagnosis of CA

Biopsy: sample of tissue for pathological examination.

• Incisional bx: removal of a portion of tissue for examination. http://www.youtube.com/watch?v=nbdmmukko4s

• Excisional bx: removal of complete lesion, with little or no margin of surrounding normal tissue removed. http://

www.youtube.com/watch?v=QcjGCBO83DQ

Diagnosis of Cancer

• Needle aspiration bx: aspiration of fluid or tissue by means of needle. http://

www.youtube.com/watch?v=H1x_dTKAU34

• Endoscopy: directly visualize an internal structure through a body cavity or through a small incision; can also obtain cells or tissue. http://www.youtube.com/watch?v=Tz2ktVJVWcI

Diagnostic Imaging

•Bone scanning

•Tomography

•Computed tomography (CT) scan

•Radioisotope studies

•Cytological studies

Diagnostic Imaging

•Ultrasound testing

•Magnetic resonance imaging (MRI)

•Positron Emission Tomograph (PET)•http://www.youtube.com/watch?v=d9iOxMFmPlA

Laboratory Tests

•Alkaline phosphatase

•Serum calcium

•Serum calcitionin

•Carcinoembryonic antigen (CEA)

•PSA & CA-125

•Stool examination

• Tumor

• Nodes

• Metastasis

Indicate tumor size, spread to lymph nodes, & extent of metastasis.

Direct tx, predict prognosis, & contribute to CA research.

Staging http://www.youtube.com/watch?v=X8MEoi4Tqho

T* Subclasses

• T×: tumor can’t be adequately assessed

• To: no evidence of primary tumor

• Tis: carcinoma in situ

• T1, T2, T3, T4: progressive î in tumor size & involvement regional lymph

Nt Subclasses

• N×: regional lymph nodes cannot be assessed

• No: no regional lymph nodes cannot be assessed

• N1, N2, N3: î involvement regional lymph nodes

M‡ Subclasses

• M×: not assessed

• Mo: no (known) distant metastasis

• M1: distant metastasis present, specify site(s)

Grading

Histopathology

• G1: well differentiated

• G2: mod well-differentiated

• G3: poorly differentiated

• G4: undifferentiated

Staging Classification for CA

Stage 1: malignant cell confined

Stage 2: limited spread, local area, nearby lymph nodes.

Stage 3: larger or spread to nearby tissues or both; regional lymph node likely involved.

Stage 4: metastasized to distant parts of body.

• Surgery• Radiation Therapy• Chemotherapy

Therapeutic Interventions

Cancer Therapies

Surgeryremoval of all malignant cells; may include removal of tumor, surrounding tissue & regional lymph nodes.

• Preventive, Diagnostic, Curative

• Palliative: relieve or reduce intensity of uncomfortable symptoms. [not a cure]

• Reconstructive

Laser Surgery

Laser beam vaporizes tissue with little bleeding & low risk of infection. http://www.youtube.com/watch?v=BHHvzNm7oR0

• ophthalmology

• gynecology

• urology

• neurosurgery

• otolaryngology

Nursing Interventions

• Monitor VSs• Monitor labs• Monitor client’s wt.• Monitor I&O• Monitor for bleeding,

S&S of infection• Psychosocial issue

Nursing Interventions

When surgery may result in a Δ of body image, client may benefit from support groups:

• The American Cancer Society

• Reach to Recovery

• The Lost Chord Club

• I Can Cope

• Look Good, Feel Good

• The Ostomy Club

Radiation Therapyhttp://www.youtube.com/watch?v=tzO0y6-YBEI

• Cure or control CA that has spread to local lymph nodes or to tx tumors that can’t be removed.

•Preop to ↓ size of tumor

• Postop to destroy malignant cells not removed by surgery. http://www.youtube.com/watch?v=m46t834g_90&feature=related

External Radiation

• tx’s based on radiologist’s recommendations. ~ 5x/wk for 2 to 8 wks.

• Directed toward superficial lesions or targeted to deeper structures within body. http://

www.youtube.com/watch?v=VyoCUWxqcNQ

• Body marked, not washed off

•Marking areas to be radiated

•Explain procedure & instruct pt on how to protect markings

•Skin care & protection from sunlight

•Avoid applications of heat or cold

External Radiation

Nursing Interventions

External Radiation

Nursing Interventions Cont’d

•Diet- high protein & calories

•Fluid intake: 2 or 3 quarts/day

•Assess for lethargy & fatigue

•Provide frequent periods of rest

External Radiation

Nursing Interventions Cont’d

Mucositis

• Frequent oral care

• Advise use of neutral mouthwash (diphenhydramine (Benadryl) & water

• Discourage use of alcohol & tobacco.

• Avoid very cold foods & drinks.

Internal Radiation

Unsealed internal radiation

Sealed radioactive materialshttp://www.youtube.com/watch?v=Orf-fhsSrgQ

http://www.youtube.com/watch?v=iusnn76nnvU

1. Private room

2. Sign on door – radiation area

3. Time - film badges. (30 mins./shift)

4. The pt. Must be as self-sufficient as possible.

5. The radioactive material may leave the pt. Accidentally; immediately notify physician & radiation safety personnel.

Internal radiation safety measures (Sealed)

Pts will receive the following instructions

• Restricted to your room. • Use disposable eating utensils. These utensils should be placed in special waste container after use.

• Wear gloves when handling items that are not protected by coverings, such as personal items the pt. may wish to take home.

•  Flush toilet 2 or 3 times after each use. This will insure that all radioactive urine is washed from toilet bowl.

• Avoid physical contact with visitors.

Visitors have the following restrictions

• Visits should be limited to 30 hour/day. No pregnant women or persons under age 18 should visit the patient without special permission.

• Remain at least 6 ft. from the pt. • Must be protected with gowns, shoe covers, & gloves. Should not handle any items in the room.

• Must not smoke, eat, or drink while in the client's room.

Radioactive implant (brachytherapy)http://www.youtube.com/watch?v=nyTEmYLSTak

Usually combined with a course of external radiation therapy to ↑ dosage to a specific site.

Visitors limited to 60 mins. Standing away from area.

Liquid Radiation Tx (Zevalin therapy)

Non-Hodgkins’s lymphoma

Internal radiation safety measures

Unsealed

Additional considerations:

1.Gloves

2. Contaminated materials may require special care. (lead-lined container & long-handled forceps); Follow hospital policy for radioactive waste cleanup

Radiation Safety• Time• Distance• Shielding

Radiation Side Effects

Normal cell sensitivity:

• Alopecia (hair follicle),

• Bone marrow suppression

• Lining of the digestive & urinary tracts, ovaries, testes, &

lymph tissue

Radiation Side Effects

• Fatigue

• Nausea, Vomiting, Anorexia

• Mucositis

• Xerostomia

• Skin Reactions

Robotic Surgery

Computerized, 3-D, 360-degree ROM

A surgeon-guided robotic machine

•Improved surgical accuracy

•Better pt. outcomes

•↓ recovery times

Chemotherapy

Drugs used to ↓ or slow growth of metastatic CA.

• Hematopoietic system

• Hair follicles

• GI systemhttp://www.youtube.com/watch?v=eJq4xvjd_MU

Chemotherapy Medications

•Alkylating agents

•Antitumor Antibiotics

•Antimetabolites

•Hormonal agents

•Vinca Alkaloids

•Antineoplastic drugs•http://www.youtube.com/watch?v=vKIRWY-LMYc

Chemotherapy Medications

•Different Antineoplastic Classes Are Given

•Different classes affect different stages of the CA’s life cycle

•Allows lower dosages of each agent

• Reducing toxicity

• Slowing development of resistance

Alkylating Agents•Most widely used antineoplastic drug•Form bonds or linkages with DNA• Called alkylation• Changes the shape of DNA• Prevents normal DNA function

•Kill or slow down replication of tumor cells

Adverse effect• Bone marrow suppression• Damage epithelial cells lining GI tract

Cyclophosphamide (Cytoxan), nitrogen mustard

Antimetabolites•Chemically similar to essential building blocks of the cell•Resemble purines or pyrimidines

•Building blocks of DNA & RNA•CA cells use this drug to construct proteins or DNA

•Block DNA synthesis•Kill CA cells or slow growth

Methotrexate (Mexate)

Antitumor Antibiotics

•Not widely prescribed

•Interact with DNA in a manner similar to alkylating agents

Doxorubicin (Adriamycin)

Plant Alkaloids/Natural Products

•Structurally very different•Common ability to arrest cell

division•Sometimes called mitotic inhibitors

Vincristine (Oncovin)

Hormones & Hormone Blockers•Used to slow growth of hormone-dependant tumors• Certain tumors stimulated by natural

hormones• Specific hormones or hormone blockers can block receptor sites

Hormones used in CA chemotherapy• Use of testosterone or antiestrogen to slow breast cancer (Tamoxifen)

• Estrogen to slow growth of prostate CA• Other major class is corticosteroids

Biologic Response Modifiers & Miscellaneous Antineoplastics

•Biologic response modifiers stimulate the body’s immune system•Limit the severe immunosuppressive effects of other anticancer drugs

•Immunotherapy http://www.youtube.com/watch?v=tBaFNkw5bh4

•Some used to minimize the toxic effects of other antineoplastics

Miscellaneous Anticancer Drugs

Have Different Mechanisms of ActionsAsparaginase deprives CA cells of an essential amino acid

Mitotane (Lysodren) - similar to the insecticide DDT

Poisons CA cells by forming links to proteins

Miscellaneous Anticancer Drugs Others given to counteract the toxicity of antineoplastics Colony Stimulating Factors: G-CSF, GM-CSF

Oprelvekin (Neumega) - stimulates platelet production

Epoetin alfa; Erythropoientin EPO (Epogen) - stimulates RBC production

Interleukin-2 – stimulates T-cells

Next Generation Drugs

tyrosin kinase inhibitors: a chemical that helps govern growth of CA cells. Targets a specific “receptor” site found on surface of CA cell.

Iressa -bowel, breast, head, ovary, prostate, bladder & kidney

Herceptin (trastuzumab) –breast CA

Gleevec –chronic myelogenous leukemia

Chemotherapy Side Effects

Antineoplastic drugs:

doxorubicin (Adriamycin): red urine

•Bone marrow suppression• Leukopenia

• Thrombocytopenia

• Anemia

•N/V & diarrhea

Chemotherapy Side Effects

• Alopecia

• Stomatitis

• Reproductive Alterations

• Neurotoxicity

BITES

• Bleeding• Infection• Tiredness• Emesis• Skin Changes

• G-CSF• GM-CSF• Erythropoietin• Interleukin-II

Colony Stimulating Factors

Biotherapy

[immunotherapy] tx with agents derived from biological sources or affecting biological responses.

Biological response modifiers (BRM)

1.↑ & restores, or modifies host defenses against the tumors (CSFs, Neupogen, erythropoetin, GM-CSFs)

Biotherapy

Biological response modifiers (BRM)

2. Directly, toxic to tumors (interleukins, IL-2, bacille Calmette-Gue’rin vaccine [BCG]).

3. Modifies tumor biology (interferons alpha, beta, & gamma)

Non-traditional approaches

Alternative Therapies:

Biofeedback

Reflexology

Herbal supplements

Enzyme therapy

Reiki

Cultural factors

Spiritual factors

Bone Marrow Transplantation (BMT)

Tx leukemia -though high-dose chemotherapy, total body irradiation

Types of donor stem cellsAllogeneic, syngeneic, autologous

ProcedureHarvest: marrow harvested through multiple aspirations from iliac crest to retrieve sufficient bone marrow for transplantationConditioning: refers to immunosuppressive therapy regimen to eradicate all malignant cells

Bone Marrow Transplantation

Replacing diseased or damaged bone marrow with normally functioning bone marrow.http://www.youtube.com/watch?v=GIy2nMnuGGI

Stem Cell Transplants

Used in some solid tumor CA’s

Bone Marrow Transplantation

• Risks: Infection, Septic

• Protective Isolation

• Prophylactic systemic antibiotics & antiviral agents

• Routine cultures (blood, urine, throat, & stool)

Bone Marrow Transplantation

Nursing interventions

• Reinforce info., explained by physicians regarding expectations of specific tx’s.

• Allow pt express their feelings & enc. them to follow guidelines of conventional medical practice.

Nursing Intervention

Bone Marrow Suppression

• Monitor CBC, & WBC

• Allow for periods of rest

• Prevent overtiring

• Protect from infection

• Protective isolation

Hematopoietic System

Leukopenia (low WBC’s d/t depression of bone marrow)

Life-threatening infections

Normal WBC: 4,500 – 11,000/mm³

Neutropenia: a low absolute neutrophil count ANC

measured is in the setting of chemotherapy for CA.

A normal absolute neutrophil count (ANC) is above 1,500. An ANC less than 500 is defined as neutropenia & significantly ↑’s the risk of infection.

Neutropenia

↓ pneumonia, septicemia, infections.

Tx: colony-stimulating factors (CSFs)

Granulocyte colony-stimulating factors (G-CSF)

Granulocyte CSF (filgrastim [Neupogen]), Granulocyte-macrohage CSF (GM-CSF) (sargramostim[leukine or Prokine]) SQ or IV.

Nursing Interventions

Neutropenic precautions:

•protective isolation

•Monitor VS

•Report î temp

•Assess for signs of infection

Anemia: ↓ RBCs Fatigue

Tx: recombinant human erythropoietin, or epoetin alfa (Epogen, Procrit) SQ or IV. (side effect: ↑ BP)

Transfusions

Normal hemoglobin: 12-15 g/dL female; 14-16.5 g/dL

male

Normal hematocrit: 35-47% female; 42-52% males

Thrombocytopenia low platelets, d/t depression of bone marrow.

Potential for bleeding 50,000 mm³

Less than 20,000 mm³ spontaneous bleeding

Tx: Transfusion

Normal Platelet Count: 150,000 - 300,000 mm³

Thrombocytopenia

Nursing Interventions

•Monitor for bleeding

•Venous punctures or injections – apply pressure for 5 mins

•Instruct use of soft tooth brush, & electric razor.

Integumentary System

Alopecia loss of hair d/t destruction of hair follicles, never permanent.

GI System

Stomatitis Tx: Viscous Xylocaine

Candida infection of mouth & esophagus Tx: nystatin p.o.

Nausea, Vomiting & Diarrhea d/t breakdown of normal GI cells.

Metoclopramide (Reglan)

Check serum protein level for nutritional status

Nursing Intervention - GI

• Antiemetics prochlorperazine (Compazine); promethazine (Phenergan)

• Serum albumin less than 3 g/dL indicates poor nutrition & possible need for support

•Dehydration, Anorexia, Constipation

•Cardiac

•Pulm

GI System

Physiological Symptoms or Psychological Responses

• Depression

• Withdrawal

Pain Management

Pain - a late symptom of CA

Tx: Opioids – MS, hydromorphone (Dilaudid), fentanyl, methadone. Sustained-release MS p.o. – MS Contin or Roxanol SR for terminally ill pts with pain

Cocktails

Pain Control

Causes of painBone destruction; obstruction of an organ; compression of peripheral nerves; infiltration or distention of tissue; inflammation or necrosis; psychological causes, such as fear

InterventionsAssess pain as fifth VSCollaborate with pain management teamAdminister salicylates, acetaminophen (Tylenol), anti-inflammatories, opioid analgesics orally or parenterally as prescribedProvide nonpharmacological techniques of pain control

Relationships of Food & CA

Thought to be carcinogenic:

•Nitrates in cured & smoked foods

•High-fat diets•Excessive caloric intake•Alcohol & cigarettes

Relationships of Food & CA

• Certain diets seem to have health benefits –Diets high in fiber –Diets rich in vitamin C –Diets high in vitamin A

Relationships of Food & CA• Health benefits

–Phytochemicals - anticarcinogenic.

–Legumes contain vitamins, minerals, protein, & fiber

–High intake of soy foods

The Effects of CA

• May cause unexplained wt. loss, weakness, early satiety, & anorexia

• May lead to loss of muscle tissue, hypoalbuminemia, & anemia

• Effect of CA on the pt. depends on the location of the tumor

Nutritional Care• Calorie needs of the pt with CA

are greater than before the illness.

• Pts who can eat normally tolerate the side effects of therapy better.

• Pts can form aversions to food, making anorexia worse.

Nutritional Care• Soft diet• Low-residue diet• High-protein, high-calorie diets

and plenty of fluids for pts undergoing radiation or chemotherapy

• 45 to 50 calories per kg of body weight per day

Nutritional Care• Carbohydrates & fat needed to

provide energy & spare protein for tissue building & the immune system

• 1.0 to 1.2 g of protein per kg of body wt. a day

• Malnourished pts may need from 1.3 to 2.0 g of protein per kg of body wt. a day.

• Vitamins & minerals are essential.

Nutritional Care

• Encourage foods that will ↑ appetite

• Salad dressings, gravies, sauces, & syrups

• Several small meals • Drugs to control nausea &

pain.• Nutritional supplements

A pt. with CA may feel that comments to encourage eating are depressing reminders of the CA & the situation.

How can the health care professional be helpful to the pt?

Nutritional Therapy

Malnutrition

•High-calorie foods

•Nutritional supplements (5% wt loss)

•Parenteral nutrition

Most common fears • disfigurement, dependency, pain,

emaciation, financial depletion, abandonment, & death.

Coping factors for fear • shock, anger, denial, bargaining,

depression, helplessness, hopelessness, rationalization, acceptance, & intellectualization.

Communication & Psychological Support

Coping factors

1.Ability to cope with stressful events in past.

2. Availability of significant others.

3. Ability to express feelings & concerns.

4. Age at the time of dx.

5.Extent of disease.

Coping factors cont’d

6.Disruption of body image.

7. Presence of symptoms

8. Past experience with CA

9. Attitude associated with the CA

Nursing Interventions

1. Be available

2. Exhibit a caring attitude

3. Listen actively to fears & concerns

4. Provide relief from distressing symptoms

Nursing Interventions cont’d

5. Provide essential info. Regarding CA & CA care

6. Maintain a relationship based on trust & confidence, be open, honest & caring

7. Use touch to exhibit caring

Nursing Interventions cont’d

8. Assist in setting realistic, reachable short-term & long-term goals

9. Assist in maintaining usual lifestyle patterns

10. Maintain hope

Terminal Prognosis

Honesty & openness

Spiritual help

Social worker assistance

Hospice Care

• Less than 6-Month Prognosis

• Inpatient

• Outpatient

Nursing Diagnoses

• Ineffective Protection

• Imbalanced Nutrition

• Deficient Self-Care

• Anticipatory Grieving

Nursing Diagnoses

• Caregiver Role Strain

• Social Isolation

• Ineffective Sexuality Pattern

• Disturbed Body Image

Oncological Emergencies

• Superior Vena Cava Syndrome• Spinal Cord Compression• Hypercalcemia• Pericardial Effusion/Cardiac

Tamponade• Disseminated Intravascular

Coagulation

Oncological Emergencies- Sepsis, disseminated intravascular coagulation (DIC)

• Maintain strict aseptic technique; administer antibiotics, anticoagulants, cryoprecipitated clotting factors as prescribed

– Syndrome of inappropriate antidiuretic hormone (SIADH)

• Tumors can produce, secrete, stimulate brain to synthesize ADH

• Initiate fluid restriction, increased sodium intake as prescribed; administer demeclocycline (Declomycin) as prescribed

– Spinal cord compression• Occurs when tumor directly enters spinal cord• Assess for back pain, neurological deficits; prepare

client for radiation, chemotherapy as prescribed

Oncological Emergencies (cont’d)

. Hypercalcemia• Late manifestation of extensive malignancy, often

in clients with bone cancer• Monitor serum calcium level; administer oral or

parenteral fluids as prescribed; administer medications to lower calcium levels as prescribed

– Superior vena cava syndrome• Occurs when vein compressed, obstructed by

tumor growth• Prepare client for radiation therapy as prescribed

– Tumor lysis syndrome• Occurs when large numbers of tumor cells are

destroyed rapidly, indicating CA tx is effective• Encourage oral hydration; administer diuretics as

prescribed