hodgkin & non hodgkin

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    LARYNGEAL CANCER- malignant tumor of the larynx- malignant ulcerations with underlying infiltration

    RISK FACTORS1. cigarette smoking2.heavy alcohol use and the combined use of tobacco and alcohol3.Exposure to environmental pollutants4. Exposure to radiation.5. straining the voice

    6.Gender more common in men7. Race more prevalent in Afro American8. Second hand smoke9. GERD

    CLINICAL MANIFESTATIONS1.Persistent hoarseness or sore throat for more than two weeks.2. Painless neck mass3. Feeling of lump in the throat

    4. Burning sensation in the throat especially when consuming hot or citrusjuices.5. Dysphagia6. change in voice quality7. dyspnea8. weakness and weight loss9. Hemoptysis10. foul breath odor

    DIAGNOSTIC EXAMS1. Physical exam - swollen lymph nodes2. LARYNGOSCOPY3. biopsy of tissues4. chest radiography5. CT scan6. MRI are used for staging

    NURSING INTERVENTIONS

    1. Place in fowlers position2. monitor respiratory status3. Monitor for signs of aspiration of food and fluid.4. provide respiratory treatments as prescribed.5. Provide activity as tolerated.6. Provide high calorie and high protein diet.7. Administer O2 as prescribed.8. Provide nutritional support NGT, gastrostomy, jejunostom9. Administer analgesic as prescribed.

    NON SURGICAL INTERVENTIONS

    1.Radiation therapy

    2. Chemotherapy

    SURGICAL INTERVENTIONS

    Partial Laryngectomy

    is recommended in the early stages of cancer in the glottic ar

    one vocal cord is involvedSupraglottic Laryngectomy

    is indicated in the management of early (stage 1) supraglotticlesions

    Cordectomy

    Removal of one or both vocal cordsLymph Node DissectionThyroidectomyHemilaryngectomy

    performed when the tumor extends beyond the vocal cord bucm in size and limited to the subglottic area

    Total Laryngectomy

    performed in most advanced stage IV laryngeal cancer

    MOST COMMON TECHNIQUES OF ALARYNGEAL COMMUNICATIO

    Esophageal speech

    taught to patient once oral feeding begins 1 week after surge

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    Electro Larynx

    battery powered apparatus projects sound into the oral cavity

    Tracheoesophageal Puncture

    most widely used because the speech associated with it most resemblesnormal speech

    once the puncture is surgically created and healed, a voice prosthesis isfitted (Blom Singer) over the puncture site

    NURSING MANAGEMENT

    PreOp CarePost op Care

    Observe for hemorrhage and edema in the neck if present.

    Monitor IV fluids or parenteral nutrition until nutrition is administered viaNGT, gastrostomy, or jejunostomy.

    Assess gag and cough reflexes and the ability to swallow.

    Provide stoma and laryngectomy care

    instruct how to clean the incision and provide stoma care.

    protect the neck from injury

    Avoid swimming, showering, and using aerosol sprays. Advise the client to wear loose fitting, high collared clothing to cover the

    stoma.

    Advise the client to increase humidity in the home.

    Avoid exposure to infections.

    LUNG CANCER Malignant tumor of the lung that may be primary or metastatic

    MAJOR TYPES

    Small cell (oat cell)

    Epidermal (squamous)

    Adenocarcinoma

    Carcinoma

    INCIDENCE

    most common cause of cancer-related death in men second most common in women

    1.3 million deaths worldwide annually

    RISK FACTORS

    Cigarette smoking

    Second hand smoke

    Exposure to environmental pollutants

    Exposure to occupational pollutants

    genetic factors radon gas

    Asbestos

    air pollution

    CLINICAL MANIFSETATIONSSUBJECTIVE

    1. DYSPNEA2. CHILLS

    3. FATIGUE4. CHEST PAIN5. SHOULDER6. PAIN

    OBJECTIVE1. PERSISTENT COUGH2. CHANGE IN VOICE QUALITY3. HEMOPTYSIS4. UNILATERAL WHEEZES5. WEIGHT LOSS6. CLUBBING OF FINGERS7. PLEURAL EFFUSION8. COIN LESIONS

    9. (+) CYSTOLOGIC TEST10. FEVER11. DYSPHAGIA12. HEAD AND NECK EDEMA

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    13. S/S OF PERICARDIAL EFFUSION

    DIAGNOSTIC EXAMS1. CXR2. CT-SCAN3. SPUTUM CYTOLOGY4. FIBEROPTIC BRONCHOSCOPHY5. FINE NEEDLE ASPIRATION6. ENDOSCOPY WITH UTZ7. BONE SCANS8. LIVER UTZ

    9.

    CT OF THE BRAIN10. MRI11. MEDIASTINOSCOPY

    TREATMENTNonsurgical

    Radiation Therapy

    Chemotherapy

    Immunotherapy

    SURGERY

    1. LOBECTOMY2. WEDGE RESECTION3. BILOBECTOMY4. SLEEVE RESECTION5. PNEUMONECTOMY6. SEGMENTECTOMY7. CHEST WALL RESECTION

    8. THORACENTESIS

    NURSING INTERVENTIONS

    PRE-OP

    1. Explain the potential postoperative need for chest tubes.

    CHEST TUBE DRAINAGE SYSTEM

    Post- Op

    1. Monitor V/s

    2. Assess cardiac and respiratory status, monitor for the preseabsence of lung sounds.

    3. maintain the chest drainage system.

    4. Assess chest tube insertion site for crepitus ( subcutaneous eair leak in the system.

    5. Check physicians orders regarding client positioning, avoid lateral turning.

    6. Reduce fatigue by educating the patient in energy conservtechniques

    NURSING DIAGNOSIS1. IMPAIRED GAS EXCHANGE2. INEFFECTIVE AIRWAY CLEARANCE3. PAIN

    NURSING MANAGEMENT1. MONITOR V/S, breathing patterns, BS, tracheal deviation2. ENCOURAGE COUGHING AND DBE3. CHANGE POSITION FREQUENTLY4. POSITION @ AFFECTED SIDE5. ACCESS POSITION OF TRACHEA6. IMPROVE DIET7. TEACH ON ENERGY CONSERVATION AND AIRWAY CLEAR

    TECHNIQUES8. MANAGE PAIN9. Monitor pulse oximetry10. Administer bronchodilators & corticosteroids11. Provide activity as tolerated, ROM exercises

    12. Monitor for bleeding, infection and electrolyte imbalances

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    HODGKINS LYMPHOMA-

    cancer of lymph tissue found in the lymph nodes, spleen, liver, bonemarrow, and other sites

    - begins when a lymphocyte

    -

    Reed-Sternberg (RS) cell

    INCIDENCE more common in men than women two peaks of incidence: one in the early 20s and after 50 years of age

    RISK FACTORSo VIRUSES : HIV, Epstein Barr Viruso Weakened Immune Systemo Age : among teens and adults aged 15 to 35 years and adults aged 55 years

    and oldero Family History

    TYPES

    Classical Hodgkin lymphoma Nodular lymphocyte

    CLINICAL MANIFESTATIONS

    1.

    PAINLESS ENLARGEMENT OF 1 OR MORE LYMPHNODES ON 1 SIDE OFTHE NECK2. (+) MEDIASTINAL MASS3. PRURITUS4. PAIN5. COUGH AND PULMONARY EFFUSION6. JAUNDICE7. ABDOMINAL PAIN8. MILD ANEMIA

    9. INCREASED OR DECREASED WBC10. NORMAL PLATELET COUNT11. B symproms12. IMPAIRED CELLULAR IMMUNITY

    DIAGNOSTIC EXAMS

    CBC CXR Biopsy: CONFIRMATORY!

    o Excisional

    o incisional Bone marrow biopsy Blood chemistry tests including protein levels, liver function te

    function tests, and uric acid level CT scans of the chest, abdomen, and pelvis PETScan MRI

    STAGING

    Factors to consider:

    y The number of lymph nodes that have Hodgkin lymphoma c

    y Whether these lymph nodes are on one or both sides of the dy Whether the disease has spread to the bone marrow, spleen,

    STAGES

    Stage I: The lymphoma cells are in one lymph node group (suneck or underarm). Or, if the lymphoma cells are not in the lthey are in only one part of a tissue or an organ (such as the Stage II: The lymphoma cells are in at least two lymph node same side of (either above or below) the diaphragm. Or, thecells are in one part of a tissue or an organ and the lymph noorgan (on the same side of the diaphragm). There may be lyin other lymph node groups on the same side of the diaphrag

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    RECURRENT High Dose Chemotherapy Radiation Therapy

    Stem Cell Transplantation