آية البقرة ٣٢سورة

Prepared By Nesreen Farouk

2nd Term Doctorate

Prepared By Nesreen Farouk

2nd Term Doctorate

Under Supervision of Prof. Dr. Kamilia Fouad

Head of Department of Medical Surgical Nursing Faculty of Nursing Ain Shams University

2010

Under Supervision of Prof. Dr. Kamilia Fouad

Head of Department of Medical Surgical Nursing Faculty of Nursing Ain Shams University

2010

Introduction Introduction Operational definitionsOperational definitions Pathophysiology Pathophysiology Etiology Etiology Staging of cancer Staging of cancer Signs and Symptoms Signs and Symptoms Diagnostic findings Diagnostic findings Medical and surgical treatment Medical and surgical treatment

Surgery Surgery Radiotherapy Radiotherapy ChemotherapyChemotherapy

Nursing care for patients with cancer Nursing care for patients with cancer

Introduction:Introduction: Oncology nursing, are as diverse and Oncology nursing, are as diverse and

complex as those of any nursing specialty. complex as those of any nursing specialty.

Because many people associate cancer Because many people associate cancer

with pain and death.with pain and death.

The cancer nurse must be prepared to The cancer nurse must be prepared to

support the patient and family through a support the patient and family through a

wide range of physical, emotional, social, wide range of physical, emotional, social,

cultural, and spiritual crises.cultural, and spiritual crises.

CancerCancer is a class of diseases in which a group of cells is a class of diseases in which a group of cells display uncontrolled growth, invasion, and display uncontrolled growth, invasion, and sometimes metastasis (spread to other locations in sometimes metastasis (spread to other locations in the body via lymph or blood). Most cancers form a the body via lymph or blood). Most cancers form a tumor but some, like leukemia, do not. The branch tumor but some, like leukemia, do not. The branch of medicine concerned with the study, diagnosis, of medicine concerned with the study, diagnosis, treatment, and prevention of cancer is oncology.treatment, and prevention of cancer is oncology.

Although cancer affects every age group, most Although cancer affects every age group, most cancers occur in people older than 65 years of age. cancers occur in people older than 65 years of age. Overall, the incidence of cancer is higher in men Overall, the incidence of cancer is higher in men than in women and higher in industrialized sectors .than in women and higher in industrialized sectors .

Operational definitions: Operational definitions: Cancer: Cancer: a disease process whereby cells a disease process whereby cells

proliferate abnormally, ignoring growth proliferate abnormally, ignoring growth

regulating signals in the environment regulating signals in the environment

surrounding the cells.surrounding the cells.

Oncology:Oncology: field or study of cancer. field or study of cancer.

Neoplasia:Neoplasia: uncontrolled cell growth that uncontrolled cell growth that

follows no physiologic demand.follows no physiologic demand.

Carcinogenesis:Carcinogenesis: process of transforming process of transforming

normal cells into malignant cells.normal cells into malignant cells.

Chemotherapy:Chemotherapy: use of drugs to kill tumor use of drugs to kill tumor

cells by interfering with cellular functions cells by interfering with cellular functions

and reproduction.and reproduction.

Radiation therapy:Radiation therapy: use of ionizing radiation use of ionizing radiation

to interrupt the growth of malignant cells.to interrupt the growth of malignant cells.

Malignant:Malignant: having cells or processes that are having cells or processes that are

characteristic of cancer.characteristic of cancer.

Metastasis:Metastasis: spread of cancer cells from the spread of cancer cells from the

primary tumor to distant sites.primary tumor to distant sites.

NeoplasmNeoplasm (neo = new; plasm = tissue). (neo = new; plasm = tissue).

Pathophysiology of the malignant Pathophysiology of the malignant process;process;Cancer is not a single disease with a single cause; rather, it is a Cancer is not a single disease with a single cause; rather, it is a group of distinct diseases with different causes, manifestations, group of distinct diseases with different causes, manifestations, treatments, and prognoses.treatments, and prognoses.

Cancer is fundamentally a disease of Cancer is fundamentally a disease of regulation of tissue growth. In order for a regulation of tissue growth. In order for a normal cell to normal cell to transform into a cancer cell, into a cancer cell, genes which regulate cell growth and differentiation which regulate cell growth and differentiation must be altered Genetic changes can occur at must be altered Genetic changes can occur at many levels, from gain or loss of entire many levels, from gain or loss of entire chromosomes to a mutation affecting a chromosomes to a mutation affecting a single DNA nucleotide. There are two broad . There are two broad categories of genes which are affected by these categories of genes which are affected by these changes.changes.

Oncogenes may be normal genes Oncogenes may be normal genes which are expressed at which are expressed at

inappropriately high levels, or altered inappropriately high levels, or altered genes which have novel properties. genes which have novel properties.

Tumor suppressor genes are genes Tumor suppressor genes are genes which inhibit cell division, survival, or which inhibit cell division, survival, or

other properties of cancer cells. other properties of cancer cells. Tumor suppressor genes are often Tumor suppressor genes are often

disabled by cancer-promoting genetic disabled by cancer-promoting genetic changes. Typically, changes in many changes. Typically, changes in many

genes are required to transform genes are required to transform anormal cell into a cancer cellanormal cell into a cancer cell

A comparison of benign and malignant tumor A comparison of benign and malignant tumor characteristics. characteristics.

Cancers are caused by series of mutationCancers are caused by series of mutation

Characteristics of Malignant Characteristics of Malignant Cells:Cells: All cancer cells share some common cellular All cancer cells share some common cellular

characteristics in relation to the cell membrane, characteristics in relation to the cell membrane, special special proteins,proteins, the the nuclei,nuclei, chromosomalchromosomal abnormalities, and abnormalities, and the rate of growth. The cell membrane of malignant the rate of growth. The cell membrane of malignant cells also contains proteins called tumor-specific cells also contains proteins called tumor-specific antigens (for example, carcinoembryonic antigen and antigens (for example, carcinoembryonic antigen and prostate-specific antigen).prostate-specific antigen).

Malignant cellular membranes also contain less Malignant cellular membranes also contain less fibronectin,fibronectin, a a cellular cement.cellular cement. They are therefore less They are therefore less cohesive and do not adhere to adjacent cells readily.cohesive and do not adhere to adjacent cells readily.

Classification:Classification: Cancers are classified by the type of cell that Cancers are classified by the type of cell that

resembles the tumor and, therefore, the tissue resembles the tumor and, therefore, the tissue

presumed to be the origin of the tumor. These presumed to be the origin of the tumor. These

are the histology and the location, respectively. are the histology and the location, respectively.

Examples of general categories include:Examples of general categories include:

Carcinoma: Carcinoma: Malignant tumors derived from Malignant tumors derived from

epithelial cells. This group represents the most epithelial cells. This group represents the most

common cancers, including the common forms common cancers, including the common forms

of breast, prostate, lung and colon cancer. of breast, prostate, lung and colon cancer.

Sarcoma:Sarcoma: Malignant tumors derived from connective Malignant tumors derived from connective

tissue, or mesenchymal cells. tissue, or mesenchymal cells.

Lymphoma and leukemia:Lymphoma and leukemia: Malignancies derived from Malignancies derived from

hematopoietic (blood-forming) cells hematopoietic (blood-forming) cells

Germ cell tumor:Germ cell tumor: Tumors derived from totipotent cells. Tumors derived from totipotent cells.

In adults most often found in the testicle and ovary; in In adults most often found in the testicle and ovary; in

fetuses, babies, and young children most often found on fetuses, babies, and young children most often found on

the body midline, particularly at the tip of the tailbone; in the body midline, particularly at the tip of the tailbone; in

horses most often found at the poll (base of the skull). horses most often found at the poll (base of the skull).

Blastic tumor or blastoma:Blastic tumor or blastoma: A tumor (usually malignant) A tumor (usually malignant)

which resembles an immature or embryonic tissue. Many which resembles an immature or embryonic tissue. Many

of these tumors are most common in children. of these tumors are most common in children.

Hepatocarcinoma:Hepatocarcinoma: Malignant tumors (cancers) are usually named Malignant tumors (cancers) are usually named

using -carcinoma, -sarcoma or -blastoma as a using -carcinoma, -sarcoma or -blastoma as a

suffix, with the Latin or Greek word for the organ suffix, with the Latin or Greek word for the organ

of origin as the root. For instance, a cancer of the of origin as the root. For instance, a cancer of the

liver is called hepatocarcinoma; a cancer of the fat liver is called hepatocarcinoma; a cancer of the fat

cells is called liposarcoma. cells is called liposarcoma.

Leiomyoma: Leiomyoma: Tumor of the smooth muscle of the uterus is called Tumor of the smooth muscle of the uterus is called

leiomyoma (the common name of this frequent leiomyoma (the common name of this frequent

tumor is fibroid). tumor is fibroid).

Typical macroscopic Typical macroscopic appearance of cancer. appearance of cancer. This invasive ductal This invasive ductal

carcinoma of the carcinoma of the breast (pale area at the breast (pale area at the center) shows an oval center) shows an oval tumor surrounded by tumor surrounded by spikes of whitish scar spikes of whitish scar

tissue in the tissue in the surrounding yellow surrounding yellow

fatty tissue. The fatty tissue. The silhouette vaguely silhouette vaguely resembles a crab.resembles a crab.

An invasive An invasive colorectal colorectal carcinoma carcinoma

(top center) in (top center) in a colectomy a colectomy specimen.specimen.

A squamous A squamous cell cell

carcinoma carcinoma (the whitish (the whitish tumor) near tumor) near

the bronchi in the bronchi in a lung a lung

specimen.specimen.

A large A large invasive invasive ductal ductal

carcinoma in carcinoma in a mastectomy a mastectomy

specimenspecimen

Chemical agents: Chemical agents: Chemical substances in workplaces can Chemical substances in workplaces can cause cancer as smoking.cause cancer as smoking.

Environmental factors: Environmental factors: Prolonged exposures to sunlight, Prolonged exposures to sunlight, radiation, and pollutants. Electromagnetic fields from radiation, and pollutants. Electromagnetic fields from microwaves, power lines, and cellular phones are other microwaves, power lines, and cellular phones are other possible carcinogens.possible carcinogens.

Diet: Diet: Foods high in fat and those smoked or preserved Foods high in fat and those smoked or preserved with salt, alcohol, or nitrates are associated with an with salt, alcohol, or nitrates are associated with an increased cancer risk.increased cancer risk.

Viruses and Bacteria: Viruses and Bacteria: The cell changes that a virus The cell changes that a virus incorporates into the genetic information may cause incorporates into the genetic information may cause cancerous cells to form. An example of a viral connection cancerous cells to form. An example of a viral connection to cancer is Kaposi's sarcoma.to cancer is Kaposi's sarcoma.

Genetic and Familial Factors:Genetic and Familial Factors: Genetic factors Genetic factors

play a role in cancer cell development. Abnormal play a role in cancer cell development. Abnormal

chromosomal patterns and cancer have been chromosomal patterns and cancer have been

associated with extra chromosomes, too few associated with extra chromosomes, too few

chromosomes, or translocated chromosomes.chromosomes, or translocated chromosomes.

Dietary Factors:Dietary Factors: Dietary substances can be Dietary substances can be

proactive (protective), carcinogenic, or co-proactive (protective), carcinogenic, or co-

carcinogenic. The risk for cancer increases with carcinogenic. The risk for cancer increases with

long-term ingestion of carcinogens or chronic long-term ingestion of carcinogens or chronic

absence of proactive substances in the diet.absence of proactive substances in the diet.

Signs and symptomsSigns and symptoms

Local Local symptomssymptoms

Local Local symptomssymptoms

Systemic Systemic symptomssymptomsSystemic Systemic

symptomssymptoms

Unusual lumps or Unusual lumps or swelling (tumor), swelling (tumor),

hemorrhage hemorrhage (bleeding), pain (bleeding), pain

and/or ulceration. and/or ulceration. Compression of Compression of

surrounding tissuessurrounding tissues

Weight loss, poor Weight loss, poor appetite, fatigue appetite, fatigue

and excessive and excessive sweating (night sweating (night weats), anemiaweats), anemia

Enlarged lymph - Enlarged lymph - nodes, cough and nodes, cough and

hemoptysis, hemoptysis, hepatomegaly hepatomegaly

(enlarged liver), (enlarged liver), bone pain, fracture bone pain, fracture

of affected bonesof affected bones

Symptoms of Symptoms of metastasis metastasis (spreading)(spreading)

Symptoms of Symptoms of metastasis metastasis (spreading)(spreading)

Tumors and tissue typesTumors and tissue typesTissue type Benign tumors Malignant tumors

Surface Glandular Adenoma Adenocarcinoma

Connective Fibrous Adipose

CartilageBone

Blood vessels

Fibroma Lipoma

Chondroma Osteoma

Hemangioma

FibrosarcomaLiposarcoma

ChondrosarcomaOsteosarcoma

Hemangiosarcoma

Muscle Smooth Striated

Leiomyoma Rhabdomyoma

LeiomyosarcomaRhabdomyosarcoma

Neural tissue Nerve cell

Glial tissue Nerve sheaths

Meninges

Neuroma Glioma (benign)

NeuroblastomaGlioblastoma, astrocytoma,

medulloblastoma, oligodendrogliomaNeurilemmal sarcoma

Meningeal sarcoma

Endothelial tissue Blood vessels

Lymph vessels Endothelial lining

Hemangioma Lymphangioma

HemangiosarcomaLymphangiosarcoma

Ewing's sarcoma

Characteristics of Benign and malignant Characteristics of Benign and malignant

neoplasms neoplasms Characteristics Benign Malignant

Cell characteristics Well-differentiated cells that resemble normal cells of the tissue

Cells are undifferentiated and often bear little resemblance to the normal cells

Mode of growth Tumor grows by expansion and does not infiltrate the surrounding tissues

Grows at the periphery and sends out processes that infiltrate and destroy the surrounding tissues.

Rate of growth Rate of growth is usually slow Rate of growth is variable and depends on level of differentiation

Metastasis Does not spread by metastasis Gains access to the blood and lymphatic channels

General effects Is usually a localized phenomenon that does not cause generalized effects with vital functions

Often causes generalized effects, such as anemia, weakness, and weight loss

Tissue destruction Does not usually cause tissue damage

Often causes extensive tissue damage as the tumor outgrows its blood supply

Ability to cause death

Does not usually cause death unless its location interferes with vital functions

Usually causes death unless growth can be controlled.

Detection and Prevention of Detection and Prevention of

Cancer:Cancer:

Nurses and physicians have traditionally been Nurses and physicians have traditionally been

involved with tertiary prevention, the care and involved with tertiary prevention, the care and

rehabilitation of the patient after cancer rehabilitation of the patient after cancer

diagnosis and treatment.diagnosis and treatment.

Primary preventionPrimary prevention is concerned with reducing the is concerned with reducing the

risks of cancer in healthy people. risks of cancer in healthy people. Secondary Secondary

preventionprevention involves detection and screening to involves detection and screening to

achieve early diagnosis and prompt intervention to achieve early diagnosis and prompt intervention to

halt the cancer process.halt the cancer process.

Taking Steps To Reduce Cancer Taking Steps To Reduce Cancer Risk:Risk:

When teaching individual patients or groups, When teaching individual patients or groups,

nurses can recommend the following cancer prevention nurses can recommend the following cancer prevention

strategies:strategies:

1.1. Increase consumption of fresh vegetables. Increase consumption of fresh vegetables.

2.2. Increase fiber intake because high-fiber diets may Increase fiber intake because high-fiber diets may

reduce the risk.reduce the risk.

3.3. Increase intake of vitamin A.Increase intake of vitamin A.

4.4. Increase intake of foods rich in vitamin C. to protect Increase intake of foods rich in vitamin C. to protect

against stomach and esophageal cancers.against stomach and esophageal cancers.

5.5. Practice weight control because obesity is linked to Practice weight control because obesity is linked to

cancers of the uterus.cancers of the uterus.

6.6. Reduce intake of dietary fat because a high-fat Reduce intake of dietary fat because a high-fat

diet increases the risk for breast, colon, and diet increases the risk for breast, colon, and

prostate cancers.prostate cancers.

7.7. Stop smoking cigarettes which are carcinogens. Stop smoking cigarettes which are carcinogens.

8.8. Reduce alcohol intake with increases the risk Reduce alcohol intake with increases the risk

of liver cancer.of liver cancer.

9.9. Avoid overexposure to the sun, wear protective Avoid overexposure to the sun, wear protective

clothing.clothing.

Imaging Tests Used to Detect CancerImaging Tests Used to Detect CancerTest Description Diagnostic uses

Tumor marker identification

Analysis of substances found in blood

Breast, colon, lung, ovarian cancers.

Magnetic resonance imaging (MRI)

Use of magnetic fields and radiofrequency

Neurologic, pelvic, abdominal, thoracic cancers

Computed tomography (CT scan)

Use of narrow beam x-ray Neurologic, pelvic, skeletal, abdominal, thoracic cancers

FluoroscopyUse of x-rays that identify contrasts in body tissue densities;

Skeletal, lung, gastrointestinal cancers

Ultrasonography (ultrasound)

High-frequency sound waves echoing off body tissues

Abdominal and pelvic cancers

EndoscopyDirect visualization of a body cavity by insertion of an endoscope

Bronchial, gastrointestinal cancers

Nuclear medicine imaging

Uses intravenous injection or ingestion of radioisotope substances

Bone, liver, kidney, spleen, brain, thyroid cancers

Positron emission tomography(PET scan)

Computed cross-sectional images of increased concentration of radioisotopes in malignant

Lung, colon, liver, pancreatic, and non-Hodgkin’s lymphoma

CT scan brainCT scan brain

Endoscopic Endoscopic

procedureprocedure

Tumor Staging And Grading:Tumor Staging And Grading:

Treatment options and prognosis are Treatment options and prognosis are

determined on the basis of staging and grading.determined on the basis of staging and grading.

Staging Staging determines the size of the tumor and the determines the size of the tumor and the

existence of metastasis. Several systems exist for existence of metastasis. Several systems exist for

classifying the anatomic extent of disease.classifying the anatomic extent of disease.

GradingGrading refers to the classification of the tumor refers to the classification of the tumor

cells. Grading systems seek to define the type of cells. Grading systems seek to define the type of

tissue from which the tumor originated and the tissue from which the tumor originated and the

degree of tumor. degree of tumor.

The range of possible treatment goals may include The range of possible treatment goals may include complete eradication of malignant disease complete eradication of malignant disease (cure),(cure), prolonged prolonged survival and containment of cancer cell growth survival and containment of cancer cell growth (control),(control), or or relief of symptoms associated with the disease relief of symptoms associated with the disease (palliation).(palliation).

Surgical removal of the entire cancer remains the Surgical removal of the entire cancer remains the ideal and most frequently used treatment method:ideal and most frequently used treatment method: Diagnostic Surgery: Diagnostic Surgery: such as a biopsy, is usually such as a biopsy, is usually

performed to obtain a tissue sample for analysis of performed to obtain a tissue sample for analysis of cells suspected to be malignant. cells suspected to be malignant. Surgery as Primary Surgery as Primary Treatment:Treatment: the goal is to remove the entire tumor or as the goal is to remove the entire tumor or as much as is feasible (a procedure sometimes called much as is feasible (a procedure sometimes called debulking). debulking).

SurgerySurgery

Prophylactic Surgery:Prophylactic Surgery: Prophylactic surgery Prophylactic surgery involves removing nonvital tissues or organs that involves removing nonvital tissues or organs that are likely to develop cancer. Colectomy, are likely to develop cancer. Colectomy, mastectomy.mastectomy.

Palliative Surgery:Palliative Surgery: When cure is not possible, the When cure is not possible, the goals of treatment are to make the patient as goals of treatment are to make the patient as comfortable as possible and to promote a comfortable as possible and to promote a satisfying and productive life for as long as satisfying and productive life for as long as possible and performed in an attempt to relieve possible and performed in an attempt to relieve complications of cancer, such as ulcerations, complications of cancer, such as ulcerations, obstructions, hemorrhage, pain, and malignant obstructions, hemorrhage, pain, and malignant effusions effusions ex ex Pleural drainage tube placement for Pleural drainage tube placement for Pleural effusion.Pleural effusion.

In radiation therapy, ionizing radiation is In radiation therapy, ionizing radiation is

used to interrupt cellular growth. used to interrupt cellular growth.

Radiation may be used to cure the cancer, Radiation may be used to cure the cancer,

as in Hodgkin’s disease, thyroid as in Hodgkin’s disease, thyroid

carcinomas, localized cancers and control of carcinomas, localized cancers and control of

malignant disease or it can be used malignant disease or it can be used

prophylactically to prevent leukemic in-prophylactically to prevent leukemic in-

filtration to the brain or spinal cord.filtration to the brain or spinal cord.

Radiation TherapyRadiation Therapy

Radiation therapy Radiation therapy

1.External Radiation:1.External Radiation: If external radiation therapy is used, one of several If external radiation therapy is used, one of several

delivery methods may be chosen, depending on the depth delivery methods may be chosen, depending on the depth

of the tumor. Depending on the amount of energy they of the tumor. Depending on the amount of energy they

contain, x-rays can be used to destroy cancerous cells at contain, x-rays can be used to destroy cancerous cells at

the skin surface or deeper in the body. The higher the the skin surface or deeper in the body. The higher the

energy, the deeper the penetration into the body.energy, the deeper the penetration into the body.

Kilovoltage therapy devices deliver the maximal Kilovoltage therapy devices deliver the maximal

radiation dose to superficial lesions, such as radiation dose to superficial lesions, such as

lesions of the skin and breast .lesions of the skin and breast .

2.Internal Radiation:2.Internal Radiation: Internal radiation implantation, or brachytherapy, Internal radiation implantation, or brachytherapy,

delivers a high dose of radiation to a localized area.delivers a high dose of radiation to a localized area. This internal radiation can be implanted by means of This internal radiation can be implanted by means of

needles, seeds, beads, or catheters into body cavities needles, seeds, beads, or catheters into body cavities (vagina, abdomen, pleura) or interstitial compartments (vagina, abdomen, pleura) or interstitial compartments (breast) also used to treat thyroid carcinomas.(breast) also used to treat thyroid carcinomas.

Radiation Dosage:Radiation Dosage: The radiation dosage is dependent on the sensitivity of the The radiation dosage is dependent on the sensitivity of the

target tissues to radiation and on the tumor size. target tissues to radiation and on the tumor size. The total radiation dose is delivered over several weeks to The total radiation dose is delivered over several weeks to

allow healthy tissue to repair and to achieve greater cell allow healthy tissue to repair and to achieve greater cell kill by exposing more cells to the radiation.kill by exposing more cells to the radiation.

This increases the radiosensitivity of the tumor, thereby This increases the radiosensitivity of the tumor, thereby increasing tumor cell death.increasing tumor cell death.

Toxicity:Toxicity:

Toxicity may be increased when concomitant Toxicity may be increased when concomitant

radiotherapy is administered. Acute local radiotherapy is administered. Acute local

reactions occur when normal cells in the reactions occur when normal cells in the

treatment area are also destroyed and cellular treatment area are also destroyed and cellular

death exceeds cellular regeneration. death exceeds cellular regeneration.

These manifestations, which are generalized, These manifestations, which are generalized,

include fatigue, malaise, and anorexia.include fatigue, malaise, and anorexia.

Nursing Management of patient Radiation Therapy:Nursing Management of patient Radiation Therapy: The patient receiving radiation therapy and the family The patient receiving radiation therapy and the family

often have questions and concerns about its safety. To often have questions and concerns about its safety. To answer questions and allay fears about the effects of answer questions and allay fears about the effects of radiation on others.radiation on others.

The nurse can explain the procedure for delivering The nurse can explain the procedure for delivering radiation and describe the equipment, the duration of radiation and describe the equipment, the duration of the procedure (often minutes only).the procedure (often minutes only).

The possible need for immobilizing the patient during The possible need for immobilizing the patient during the procedure, and the absence of new sensations, the procedure, and the absence of new sensations, including pain, during the procedure.including pain, during the procedure.

Patients also need to understand their own role before, Patients also need to understand their own role before, during, and after the procedure.during, and after the procedure.

Protecting The Skin And Oral Mucosa.Protecting The Skin And Oral Mucosa. Protecting The Caregivers.Protecting The Caregivers.

In chemotherapy, antineoplastic agents are used in In chemotherapy, antineoplastic agents are used in

an attempt to destroy tumor cells by interfering an attempt to destroy tumor cells by interfering

with cellular functions and reproduction. with cellular functions and reproduction.

Chemotherapy is used primarily to treat systemic Chemotherapy is used primarily to treat systemic

disease rather than lesions that are localized and disease rather than lesions that are localized and

amenable to surgery or radiation.amenable to surgery or radiation.

Chemotherapy treat some forms of leukemia. The Chemotherapy treat some forms of leukemia. The

goals of chemotherapy (cure, control, palliation) goals of chemotherapy (cure, control, palliation)

must be realistic because they will define the must be realistic because they will define the

medications to be used and the aggressiveness of the medications to be used and the aggressiveness of the

treatment plan.treatment plan.

ChemotherapyChemotherapy

Classification of Chemotherapeutic Classification of Chemotherapeutic Agents:Agents: Chemotherapeutic agents are also classified according to Chemotherapeutic agents are also classified according to

various chemical groups, each with a different mechanism various chemical groups, each with a different mechanism

of action. These include of action. These include the alkylating agents,the alkylating agents, nitrosureas,nitrosureas,

antimetabolites,antimetabolites, antitumor antibiotics,antitumor antibiotics, plant alkaloids, plant alkaloids,

hormonal agents,hormonal agents, and and miscellaneous agents.miscellaneous agents.

Administration of Chemotherapeutic Agents:Administration of Chemotherapeutic Agents: Chemotherapeutic agents may be administered in the Chemotherapeutic agents may be administered in the

hospital, clinic, or home setting by topical, oral, hospital, clinic, or home setting by topical, oral,

intravenous,intravenous, intramuscularintramuscular, , subcutaneoussubcutaneous, , arterialarterial, ,

intracavitaryintracavitary, and intrathecal routes., and intrathecal routes.

The administration route usually depends on the type of The administration route usually depends on the type of

agent, the required dose, and the type, location, and extent agent, the required dose, and the type, location, and extent

of tumor being treated.of tumor being treated.

Dosage:Dosage: Dosage of antineoplastic agents is based primarily on the Dosage of antineoplastic agents is based primarily on the

patient’s total body surface area, previous response to patient’s total body surface area, previous response to

chemotherapy or radiation therapy, and major organ chemotherapy or radiation therapy, and major organ

function.function.

Right atrial Right atrial catheter. catheter.

Huber needles Huber needles

Triple lumen in Triple lumen in jugular vein jugular vein

Implanted portImplanted port

Special Problems:Special Problems:

1.1. Extravasation.Extravasation.

2.2. Toxicity.Toxicity.

3.3. Gastrointestinal problems (vomiting, for up to 24 Gastrointestinal problems (vomiting, for up to 24

hours).hours).

4.4. Cognitive stimulation (central nervous system disease, Cognitive stimulation (central nervous system disease,

anticipatory nausea and vomiting).anticipatory nausea and vomiting).

Nursing Management in Nursing Management in

Chemotherapy:Chemotherapy:

Assessing Fluid and Electrolyte Status.Assessing Fluid and Electrolyte Status.

Modifying Risks for Infection and Bleeding.Modifying Risks for Infection and Bleeding.

This is true of hematologic cancers that affect the This is true of hematologic cancers that affect the

bone marrow and solid tumor cancers treated with bone marrow and solid tumor cancers treated with

lower doses of antineoplastics to spare the bone marrow lower doses of antineoplastics to spare the bone marrow

from larger, ablative doses of chemotherapy or from larger, ablative doses of chemotherapy or

radiation therapy.radiation therapy.

Types of BMT based on the source of donor cells Types of BMT based on the source of donor cells

include:include:

Allogeneic (from a donor other than the patient).Allogeneic (from a donor other than the patient).

Autologous (from patient).Autologous (from patient).

Syngeneic (from an identical twin).Syngeneic (from an identical twin).

Bone Marrow TransplantationBone Marrow Transplantation

Nursing Management in Bone Marrow Nursing Management in Bone Marrow Transplantation:Transplantation:

Nursing care of patients undergoing BMT is complex and Nursing care of patients undergoing BMT is complex and demands a high level of skill. Transplantation nursing can be demands a high level of skill. Transplantation nursing can be extremely rewarding yet extremely stressful. The success of extremely rewarding yet extremely stressful. The success of BMT is greatly influenced by nursing care throughout the BMT is greatly influenced by nursing care throughout the transplantation process.transplantation process. Implementing Pretransplantation Care: Implementing Pretransplantation Care: All patients must All patients must

undergo extensive pretransplantation evaluations to assess the undergo extensive pretransplantation evaluations to assess the current clinical status of the diseasecurrent clinical status of the disease

Providing Care during Treatment: Providing Care during Treatment: Nursing management during Nursing management during the bone marrow or stem cell infusions consists of monitoring the the bone marrow or stem cell infusions consists of monitoring the patient’s vital signs and blood oxygen saturation; assessing for patient’s vital signs and blood oxygen saturation; assessing for adverse effects, such as fever, chills, shortness of breath, chest adverse effects, such as fever, chills, shortness of breath, chest pain, nausea, vomiting, hypotension, anxiety, and taste changes.pain, nausea, vomiting, hypotension, anxiety, and taste changes.

An important role of the nurse on the oncology An important role of the nurse on the oncology team is to assess the patient for these problems and team is to assess the patient for these problems and complications:complications: Infection.Infection. Bleeding.Bleeding. Skin problems.Skin problems. Hair loss.Hair loss. Nutritional concerns.Nutritional concerns. Pain.Pain. Fatigue.Fatigue. Psychological status. Psychological status. Body image.Body image.

AssessmentAssessment

Nursing Diagnoses:Nursing Diagnoses: Based on the assessment data, nursing diagnoses of the Based on the assessment data, nursing diagnoses of the

patient with cancer may include the following:patient with cancer may include the following: Impaired oral mucous membrane.Impaired oral mucous membrane. Impaired tissue integrity: Impaired tissue integrity: alopecia.alopecia. Impaired tissue integrity: Impaired tissue integrity: malignant skin lesions.malignant skin lesions. Imbalanced nutrition, less than body requirements.Imbalanced nutrition, less than body requirements. Anorexia.Anorexia. Malabsorption.Malabsorption. Chronic pain.Chronic pain. Fatigue.Fatigue. Disturbed body image.Disturbed body image.

Diagnosis Diagnosis

The findings of this study demonstrate that women whose The findings of this study demonstrate that women whose sleep is disrupted at midpoints of chemotherapy cycles are at sleep is disrupted at midpoints of chemotherapy cycles are at risk for CRF. risk for CRF.

During chemotherapy may result in decreased activity and During chemotherapy may result in decreased activity and increased fatigue.increased fatigue.

Potential Complications:Potential Complications: Based on the assessment data, potential complications that Based on the assessment data, potential complications that

may develop include the following:may develop include the following: Infection and sepsis.Infection and sepsis. Hemorrhage.Hemorrhage. Superior vena cava syndrome.Superior vena cava syndrome. Spinal cord compression.Spinal cord compression. Hypercalcemia.Hypercalcemia.

Nursing ImplicationsNursing Implications

The major goals for the patient may include management of The major goals for the patient may include management of stomatitis, maintenance of tissue integrity, maintenance of stomatitis, maintenance of tissue integrity, maintenance of nutrition, relief of pain, relief of fatigue, improved body image, nutrition, relief of pain, relief of fatigue, improved body image, effective progression through the grieving process, and absence effective progression through the grieving process, and absence of complications.of complications.

Planning and GoalsPlanning and Goals

The patient with cancer is at risk for various adverse effects of The patient with cancer is at risk for various adverse effects of therapy and complications.therapy and complications. Maintaining tissue integrity.Maintaining tissue integrity. Promoting nutrition.Promoting nutrition. Anorexia.Anorexia. Malabsorption.Malabsorption. Relieving Pain.Relieving Pain. Decreasing Fatigue.Decreasing Fatigue. Improving Body Image And Self-Esteem.Improving Body Image And Self-Esteem. Promoting Home And Community-Based Care.Promoting Home And Community-Based Care.

Nursing InterventionsNursing Interventions

For specific patient outcomes, see the Plan of Nursing For specific patient outcomes, see the Plan of Nursing Care. Expected patient outcomes may include:Care. Expected patient outcomes may include:

1.1. Maintains integrity of oral mucous membranes.Maintains integrity of oral mucous membranes.

2.2. Maintains adequate tissue integrity.Maintains adequate tissue integrity.

3.3. Maintains adequate nutritional status.Maintains adequate nutritional status.

4.4. Achieves relief of pain and discomfort.Achieves relief of pain and discomfort.

5.5. Demonstrates increased activity tolerance and decreased Demonstrates increased activity tolerance and decreased fatigue.fatigue.

6.6. Exhibits improved body image and self-esteem.Exhibits improved body image and self-esteem.

7.7. Experiences no complications, such as infection, or sepsis, Experiences no complications, such as infection, or sepsis, and no episodes of bleeding or hemorrhage.and no episodes of bleeding or hemorrhage.

EvaluationEvaluation

Assessing Patient Needs Assessing Patient Needs for Cancer Rehabilitationfor Cancer Rehabilitation

Cancer RehabilitationCancer Rehabilitation

Support the idea that cancer is a chronic illness that has Support the idea that cancer is a chronic illness that has acute exacerbations rather than one that is synonymous with acute exacerbations rather than one that is synonymous with death and suffering.death and suffering.

Assess own level of knowledge relative to the pathophysiology Assess own level of knowledge relative to the pathophysiology of the disease process. of the disease process.

Make use of current research findings and practices in the Make use of current research findings and practices in the care of the patient with cancer and his or her family. care of the patient with cancer and his or her family.

Identify patients at high risk for cancer.Identify patients at high risk for cancer.

Participate in primary and secondary prevention efforts.Participate in primary and secondary prevention efforts.

Assess the nursing care needs of the patient with cancer.Assess the nursing care needs of the patient with cancer.

Assess the learning needs, desires, and capabilities of the Assess the learning needs, desires, and capabilities of the patient with cancer.patient with cancer.

The role of the nurse in cancer care The role of the nurse in cancer care

Identify nursing problems of the patient and the family.Identify nursing problems of the patient and the family.

Assess the social support networks available to the patient.Assess the social support networks available to the patient.

Plan appropriate interventions with the patient and the family.Plan appropriate interventions with the patient and the family.

Assist the patient to identify strengths and limitations.Assist the patient to identify strengths and limitations.

Assist the patient to design short-term and long-term goals for Assist the patient to design short-term and long-term goals for

care.care.

Implement a nursing care plan that interfaces with the medical Implement a nursing care plan that interfaces with the medical

care regimen and that is consistent with the established goals.care regimen and that is consistent with the established goals.

Collaborate with members of a multidisciplinary team to foster Collaborate with members of a multidisciplinary team to foster

continuity of care.continuity of care.

Evaluate the goals and resultant outcomes of care with the Evaluate the goals and resultant outcomes of care with the

patient, the family, and members of the multidisciplinary team.patient, the family, and members of the multidisciplinary team.

Reassess and redesign the direction of the care as determined by Reassess and redesign the direction of the care as determined by

the evaluation.the evaluation.