hodgkin & non hodgkin
TRANSCRIPT
-
8/6/2019 Hodgkin & Non Hodgkin
1/6
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
-
8/6/2019 Hodgkin & Non Hodgkin
2/6
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
-
8/6/2019 Hodgkin & Non Hodgkin
3/6
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
-
8/6/2019 Hodgkin & Non Hodgkin
4/6
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
-
8/6/2019 Hodgkin & Non Hodgkin
5/6
-
8/6/2019 Hodgkin & Non Hodgkin
6/6
RECURRENT High Dose Chemotherapy Radiation Therapy
Stem Cell Transplantation