new cellular aberration lecture2010 (1)

7/31/2019 New Cellular Aberration Lecture2010 (1)

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CELLULAR ABERRATION

CANCER

Came from the Latin word CANCRI which

means crab.

It is a disease characterized by stretching out in

many directions like the legs of the crab.

A large group of disease characterized byuncontrolled growth and spread of abnormal

cells.


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Who can get cancer?

75% occur after the age 50

6% occurs in pediatric age group of 0-14 years

In the Philippines, about 80, 000 per year or 1out of every 5 Filipinos who live to age 74 willget cancer

In US, cancer causes more than 550, 000deaths annually. ACS estimates that roughly 83million Americans now living will eventuallyhave some form of cancer.


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Who can get cancer?

Worldwide, about 103 people die of cancereveryday or about 4 in every hour


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Etiologic/Risk Factors

A. INTERNAL RISK FACTORS

AGE

Age of exposure to carcinogens may

increase the cancer risk. Fetuses, infants andchildren are at greater risk because they are still

developing. Blistering sunburns in children

under age 12 may predispose them to skincancer


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Risk Factors

GENDER

Overall, women have a lower cancer incidence

than men and higher survival rate.

In females, breast, colon, lung, and uterine

cancers are the most common.

In males, prostate, lung, GIT and bladdercancers

predominate.


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Risk Factors

RACE

Cancer incidence and mortality are higherin blacks due to economic, social and

environmental factors that may delay prompt

detection and increase exposure to industrial

carcinogens.


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Risk Factors

GENETIC FACTOR

Certain cancers tend to run in families. Forexample, women who have first degree

relatives (mother, sister) with breast cancer are

at greater risk than the general population.


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Risk Factors

IMMUNOLOGIC FACTORS

According to the Immune SurveillanceTheory, antigenic differences between normal

and cancerous cells may help the body

eliminate malignant cells. Thus,

immunosuppression may increase susceptibility

to cancer.


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Risk Factors

PSYCHOLOGICAL FACTORS

Emotional stress may increase a person'scancer risk by leading to poor health habits

(smoking, alcohol drinking), by depressing the

immune system, or by leading him to ignoreearly warning signs.


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Risk Factors

B. EXTERNAL RISK FACTORS

CHEMICAL CARCINOGENS

Chemical exposure like in nickel refiningand

asbestos industry may increase the risk ofan

individual to get cancer.


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Risk Factors

Chemical carcinogens typically causecancer in

two step process:

INITIATION involves exposure to thecarcinogen.

This irreversible step converts normal cells to

latent tumor cells.

In PROMOTION, repeated exposure to the same

or some other substance stimulates the latent cells

to become active neoplastic cells.


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Risk Factors

RADIATIONIonizing radiation of all kinds (from X-rays to

nuclear radiation) are carcinogenic, although

their potencies vary.Fair-skinned people have higher risk for skin

cancer from UV radiation. Skin cancer

develops on exposed extremities, and itsincidence correlates with the amount of

exposure.


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Risk Factors

VIRUSESSome human viruses have carcinogenic

potential.

EPSTEIN-BARR VIRUS has been linkedto lymphoma and nasopharyngeal carcinoma

DEOXYRIBONUCLEIC ACID VIRUS

(Herpes simplex virus type 2) have beenassociated with uterine and cervical cancer .

RIBONUCLEIC ACID VIRUS are linked to

breast cancer in mice.


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Risk FactorsDIET

Certain foods may supply carcinogens (or

precarcinogens), affect carcinogen

formation, or modify carcinogen's effect.

Diet has been implicated in colon cancer,

which may result from low fiber intake and

excessive fat consumption.

Liver tumors are linked to food additives

such as nitrates and alfatoxin ( fungus that

grows on stored grains, nuts and other food

stuff)


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Risk Factors

TOBACCO USE

Lung cancer is the leading cause of cancer

deaths in both men and women. Cigarettesmoking accounts for about 30% of all cancers

and is implicated in cancers of the mouth,

pharynx, larynx, esophagus, pancreas, cervixand bladder. Pipe smoking and chewing

tobacco are linked to oral cancer


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Risk Factors

ALCOHOL USE

Heavy beer consumption may increase the

risk of colorectal cancer through an unknown

mechanism.

CHEMOTHERAPEUTIC DRUGS

Some chemotherapeutic drugs may bedirectly carcinogenic or may enhance

neoplastic development by suppressing the

immune system.


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Risk Factors

HORMONES

By altering the body's normal endocrine

balance, hormones may contribute to neoplastic

development-especially in endocrine sensitive

organs such as breast or prostate.


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Theories of Pathogenesis of

Cancer

CELLULAR TRANSFORMATION AND

DERAGEMENT THEORY Conceptualizes that healthy cells may

transform into cancer cells by unknown

mechanisms whenever exposed to certainetiologic agents.


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FAILURE OF THE IMMUNE RESPONSE

THEORY

Advocates that all individuals possess cancer cells

however these cancer cells are being recognize by

the immune response system and they are beingdestroyed. FAILURE of the immune response

system will lead to inability to destroy cancer

cells.

i i id d


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Diagnostic Aids Used to Detect

Cancer

TEST

Tumor Marker IdentificationDESCRIPTION

Analysis of blood and body fluids

ORGANSBreast, colon, lungs, ovaries, prostate


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diagnostics

TEST

Magnetic Resonance Imaging

DESCRIPTIONUse of magnetic fields and radio frequency

signals to create sectioned images of various

body structuresORGANS/AREA

Pelvic, thoracic, abdomen


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diagnostics

TEST

Computed Tomography (CT Scan)

DESCRIPTION

Use of narrow beam X-ray to scan layers of

tissues for a cross sectional view

ORGANS/AREA

Neurologic, pelvic, skeletal, abdominal,

thoracic


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diagnostics

TEST

Ultrasonography

DESCRIPTIONUse of high frequency sound waves echoing of

body tissues, converted electronically into

images used to assess tissues within the bodyORGANS/AREA

Abdominal, pelvic


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diagnostics

TEST

Endoscopy

DESCRIPTIONDirect visualization of body cavity to passage

way

To aspirate or excise small tumorAREA/ORGAN

Bronchi, GIT


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diagnostics

TEST

Sigmoidoscopy/ ColonoscopyDESCRIPTION

Direct visualization of the intestinal tract

ORGAN/AREAColorectal, sigmoid


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9 warning signals of cancer

C-hange in bowel or bladder habitsA- sore that does not heal

U- nusual bleeding or di9scharge

T- hickening of lumps in breast or elsewhere

I- ndigestion or difficulty in swallowing

O- bvious change in wart or mole

N- agging cough or hoarseness of voice

A- nemia

L- oss of weight

l ifi i f


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Classification of Tumors

CARCINOMAS: EPITHELIAL TISSUEBODY SURFACES, LINING OF BODY CAVITIES

ETC:(ADENOCARCINOMA)

SARCOMAS: CONNECTIVE TISSUE

STRIATED MUSCLE, BONE, ETC (OSTEOSARCOMA)

LYMPHOMAS AND LEUKEMIAS

HEMATOPOIETIC SYSTEM

NERVOUS TISSUE TUMORS

EX. NERVE CELLS-NEUROBLASTOMA MYELOMA

Develops in the plasma cells of bone marrow


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Naming Cancers


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Effects of cancer

1. Malfunction of the organ due to the

destruction of blood vessels

2. Pressure effectTumor can cause pressure which can cause

damage to adjacent structure

3. CachexiaCharacterized by weakness, body malaise,

anemia and weight loss.


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Effects of cancer

4. ObstructionDue to tumor growth, hallow organs are

being compressed and obstructed.

5. Hemorrhage or bleedingTumor growth causes rupture of blood

vessels

6. Effusion

When lymphatic flow is obstructed, it can

cause filling up of fluids on cavities


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Effects of cancer

7. Ulceration and Necrosis

Tumor erodes blood vessels and pressure on

tissue causes ischemia

8. Vascular thrombosis, embolism, thrombophlebitis

9. Pain -a late sign of cancer


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Prevention of cancer

SKIN

Avoid over exposure to sunlight

ORALAnnual oral exam of mouth and teeth

BREAST

Monthly breast self examination from age 20 upLUNGS

Avoid cigarette smoking, DO annual CXR


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Prevention of cancer

COLON

Digital rectal examination for persons over 40

years old, rectal biopsy, proctoscopic exam, guiac

stool exam for person 50 years old and above

UTERUS

Annual Pap smear for female age aged 40

*Annual PE, blood and urine exam

*Choosing the right behavior and preventing

exposure to certain environmental risk factors

DIETARY


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DIETARY

RECOMMENDATION

1. Cut down total fat intake. Eat more high fiber

foods.

2. Be moderate in the consumption of alcoholicbeverages.

3. Be moderate in the consumption of salt-

cured, smoked cured and nitrate-cured foods.4. Include foods rich in Vitamin C and A in

daily diet

DIETARY


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DIETARY

RECOMMENDATION

5. Include anti-oxidant foods in daily diet

Example:

Beta Carotene- found in carrots and orange

Lutein- best known for its association to

healthy eyes found in green leafy vegetables.

Lycopene- a potent anti-oxidant found in

tomatoes, water melon, guava and papaya


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Therapeutic Modalities

of Cancer

A. SURGICAL

INTERVENTIONS


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SURGICAL PROCEDURES

FOR BREAST CANCERPATIENT

C O


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LUMPECTOMY Lumpectomy is the removal

of the breast tumor (the"lump") and some of thenormal tissue that surroundsit. Lumpectomy is a form ofbreast-conserving or "breast

preservation" surgery. Thereare several names used forbreast-conserving surgery:biopsy, lumpectomy, partial

mastectomy, re-excision,quadrantectomy, or wedgeresection. Technically, alumpectomy is a partialmastectomy.

SIMPLE OR TOTAL


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SIMPLE OR TOTAL

MASTECTOMY

Simple or totalmastectomyconcentrates on thebreast tissue itself:

The surgeon removesthe entire breast.

No muscles areremoved from

beneath the breast

MODIFIED RADICAL


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MODIFIED RADICAL

MASTECTOMY Modified radical mastectomy

involves the removal of bothbreast tissue and lymph nodes:

The surgeon removes the entire

breast.

Axillary lymph node dissectionis performed, during whichlevels I and II of underarm

lymph nodes are removed (B andC in illustration).

No muscles are removed frombeneath the breast.

RADICAL MASTECTOMY


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RADICAL MASTECTOMY

Radical mastectomy is the mostextensive type of mastectomy:

The surgeon removes the entirebreast.

Levels I, II, and III of theunderarm lymph nodes areremoved (B, C, and D inillustration).

The surgeon also removes thechest wall muscles under thebreast.

PARTIAL MASTECTOMY


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PARTIAL MASTECTOMY

Partial mastectomy is theremoval of the cancerous

part of the breast tissue and

some normal tissue around

it. While lumpectomy istechnically a form of partial

mastectomy, more tissue is

removed in partial

mastectomy than inlumpectomy.

SUBCUTANEOUS (NIPPLE


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(

SPARING) MASTECTOMY

During subcutaneous ("nipple-sparing") mastectomy, all of thebreast tissue is removed, but thenipple is left alone. Subcutaneous

mastectomy is performed lessoften than simple or totalmastectomy because more breasttissue is left behind afterwardsthat could later develop cancer.

B t


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Breast ca

PREOPERATIVE CAREPsychological support- involve the husband as

necessary

Teach arm exercise to prevent lymph edema

Inform about wound suction drainage

e.g. Hemovac, Jackson Pratt

Deep breathing exercise to prevent post

operative

respiratory complications.


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DOS AND DONTS AFTER

THE SURGERY

Dos


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Before exercising actively, be certain that post-surgery

swelling subsides and that surgical wounds are healing.

Try to start moving as soon as possible after surgery.

Keep arm elevated after surgery to prevent swelling.Use two pillows to support arm when lying down orsitting.

Stretch both sides of upper body a few times per day. 3-5 slow repetitions of each stretch.

Know the difference between discomfort and unusualpain. If pain or fatigue persists, stop and rest.


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After surgery, try to walk around (indoors) for a few

minutes 2 - 3 times daily to regain stamina.

Avoid lifting anything over 2-3 pounds, particularlywith the involved arm.

Enlist anyone you can to accompany you and encourageyou to walk frequently.

Use discretion and follow your intuition. When in doubt,check in with your physician, nurse, or physical

therapist.

Above all, strive for a little improvement every day.Persevere!

Continue an exercise upon unusual


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Continue an exercise upon unusualdiscomfort or persistent pain.

Continue an exercise upon unusualfatigue. Rest for a moment, breathe,relax, and then continue slowly and

carefully. If fatigue persists, stopexercising.

Hesitate to call your physicianimmediately when experiencing unusualor persistent pain or swelling.

Don'ts


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Let mastectomy arm hang down, especially when

holding or carrying objects.

Move arm quickly, or with jerking, pulling motions.Learn to move slowly and smoothly, especially whenchanging positions, lifting bags, opening doors, etc.

Carry anything over two pounds after surgery until youreceive approval from your physician. Limit carryinganything over 5 pounds indefinitely with involved armto prevent swelling.

Wear shoulder bags on involved arm. The pressure ofthe strap on the shoulder can cause lymphedema. Avoiduse of shoulder bags indefinitely.

Breast ca


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Breast ca

POST OPERATIVE CARE

Move arm quickly, or with jerking, pullingmotions. Monitor hemovac output

(serosanguinous for the first 24 hours)

Check behind of the patient for bleeding.Blood flows to back by gravity.

Breast ca


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Breast ca

Post signs warning against taking BP, starting

IV line or drawing blood on affected side.

Initiate exercise to prevent stiffness andcontracture of the shoulder girdle

Reinforce special mastectomy exercise as

prescribedProvide adequate analgesia to promote

ambulation and exercise.

Breast ca


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Breast ca

Encourage regular coughing and deep

breathing exercises

Prepare client for size and appearance of the

incision and provide support when incision is

viewed for the first time

Provide client with detailed informationconcerning breast prosthesis. Fitting is not

possible for 4-6 weeks

Breast ca


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Breast ca

A temporary prosthesis or lightly padded bras

worn until healing is completed.

Teach patient to avoid constrictive clothing andreport persistent edema, redness or infection of

incision.

Teach patient the importance of continuingmonthly BSE on the remaining breast

Prevention of lymph edema


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AVOID

cuts, scratches, pinpricks, hangnails, insect

bites, burns and strong detergent

DONT'S (On the affected arm)

carry purse or anything heavy, wear wrist watch

or jewelry, pick and cut cuticles, work near

thorny plants, dig garden, reach into hot oven,hold a cigarette, injections, BP taking and

withdrawal of bllood.



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DO'S

wear loose rubber gloves when washing dishes,

wear a thimble when sewing, apply lanolin

hand cream to prevent dryness, contact

physician if arms get red, warm or swollen,

return for check up, wear tag CAUTION-LYMPHEDEMA


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POST-OP

EXERCISES

BALL SQUEEZE


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BALL SQUEEZE

Stand or sit comfortably.

Hold a soft rubber ball in thehand on your operated side.

With your elbow slightly bentand your palm toward theceiling, lift your hand higherthan your heart.

Squeeze and relax your hand tentimes, twice a day.

Gradually increase the numberof times you do the exercise eachday.

FRONT ARM RAISE


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FRONT ARM RAISE

Stand or sit comfortably.

Relax your arms and allow them tohang at your sides.

Keeping your palms down, slowlyraise your arms in front of you,taking two counts to reach shoulderlevel.

Slowly lower your arms back downto your sides in two counts.

Repeat this exercise 8 to 10 times,three times a day.

HAND CLAP


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HAND CLAP Stand or sit comfortably.

Relax your arms and allow them to hang atyour sides.

Slowly raise your arms out to the sides, until

they are at shoulder level.

Continue to raise both arms, trying to clapyour hands overhead.

Slowly lower your arms, taking 4 counts toreturn your arms to your sides.

Repeat this exercise 8 to 10 times, three timesa day.

WALL WALKING


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W W NG

Stand with one side of your body facing awall and your feet about 6 inches awayfrom it.

Starting with your hand at eye level,walk your finger up the wall as high asyou can. Hold the stretch for 10 secondsand then walk your fingers back down.

Repeat the exercise with your other arm.

Repeat this exercise 8 to 10 times, twice aday.

SHOULDER SQUEEZE


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Q Standing, bend your elbows and

bring your arms up in front of youto shoulder level.

With one arm stacked on top of theother, align your fingertips with

your elbows.

Next, push your elbows back,squeezing your shoulders together.

Hold for 12 seconds.

Repeat this exercise 8 to 10 times,twice a day.

ARM STRETCH


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Standing, grasp a pole or rod in front of you

with both hands. Try a golf club orbroomstick.

Place the hand on your operated side overthe end.

Gently, use the strength of your good arm topush the end of the stick as high as youcomfortably can.

Hold for 12 seconds.

Repeat this exercise 6 to 8 times, twice a day.

Slowly raise your arms out to the sides, untilthey are at shoulder level.


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LUNG CANCER


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Pneumonectomy

total lung removal.

It can be done in one of two ways:


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y

Traditional Pneumonectomy Only the diseased lung is removed.

Extrapleural Pneumonectomy

The diseased lung is removed, together with a

portion of the membrane covering the

heart(Pericardium), part of the diaphragm, and the

membrane lining the chest cavity (Parietal pleura)

on the same side of the chest.

b


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Lobectomy

surgical removal

of one of the fivelobes of the lung.

Wedge Resection


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Wedge ResectionA surgical procedure during whichthe surgeon removes a small,

wedge-shaped portion of the lung

containing the cancerous cells alongwith healthy tissue that surrounds

the area. The surgery is performed

to remove a small tumor or to

diagnose

Lung Cancer.

S t l R ti


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Segmental Resection

Removes a larger portion

of the lung lobe than a

wedge resection, but does

not remove the whole lobe.


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Shower daily and wash incision and

drain sites.

Let the water stream run over the incision

and drain sites.Leave the incisions uncovered of the chest tubes and

the drain sites may drain for several days, and

therefore may need a Band-Aid.Wear comfortable clean clothing

preferably cotton clothing

Ambulate early. Stop when you are


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bu ate ea y Stop e you a e

short of breath, rest, and thencontinue. Fatigue and tiredness are

expected. It is entirely normal that you

may have to take a nap in the morningor in the afternoon. Avoid spending

prolonged periods of time lying down

during the daytime hours.

Don'ts:


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If you were a smoker, do not restart. If

your environment-your apartment or

house-still contains curtains, linens, and

furniture full of smoke and tobacco odorthat can give you the urge to smoke

again, please have them cleaned.


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Do not lift anything heavier than 10 pounds

for about 4-6 weeks. Remember that your

recovery overall takes about 10-12 weeks.

Do not drive until your surgeon says that

you can. Generally, at about 3 weeks you will

be allowed to drive locally.


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Management for client with cervical cancer


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SURGERY:EXCISIONAL BIOPSY for preinvassive lesions

CRYOSURGERY technique of exposing tissues to

extreme cold in order to produce well demarcatedareas of cell injury and destruction

LASER destruction of the tumor

CONIZATION is removal of the cone shape sectionof the cervix

HYSTERECTOMY for invasive squamous cancer.


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Also called a cone biopsy

A procedure that is used toremove a cone-shaped piece of

tissue from the cervix andcervical canal


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A surgical procedure that is used toremove the uterus, including the

cervix

There are three different

procedures that may be used toperform a total hysterectomy

VAGINAL HYSTERECTOMY

In which the uterus and cervix are


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- In which the uterus and cervix are

taken out through the vagina

TOTAL ABDOMINAL

HYSTERECTOMY

- In which the uterus and cervix

are taken out through a large

incision (cut) in the abdomen

TOTAL LAPAROSCOPIC


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TOTAL LAPAROSCOPIC

HYSTERECTOMY

- In which the uterus and cervix are

taken out through a small incisionin the abdomen using a

laparoscope


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A BSO is a surgical procedure thatis used to remove the ovaries and

the fallopian tubes


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Is a surgical procedure that is usedto remove the uterus, cervix and

part of the vagina

Ovaries, fallopian tubes, or nearby

lymph nodes may also be removed

Surgeons will need to make artificial

i ( t ) f th i d


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openings (stomas) for the urine and

the stool

women may need plastic surgery tomake an artificial vagina after they

have had a pelvic exenteration


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Is a treatment that uses elecrical

current (passed through a thin wireloop) as a knife to remove abnormal

tissue or cancer


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Cervical ca


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PREOPERATIVE PREPARATION:

Advise client to be admitted in the hospital 1

day prior to operation

Take time to talk to the client on what she

expects from the surgery and about her

menstrual and reproductive status after surgery

Review what the surgical approach involves

and the extent of the excision

Cervical ca


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If the client is having an abdominalhysterectomy, tell her that she will need to:

Douche and have an enema the evening before

the surgeryTake a shower with an antibacterial soap shortly

before the surgery

Shave her pubic area*Have an indwelling urinary catheter inserted

because surgery causes urine retention

Cervical ca preop prep


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*Have an NGT or rectal tube inserted if shedevelops abdominal distention

Expect temporary abdominal cramping , pelvis

and lower back pain after the procedure

If the client is scheduled for vaginal

hysterectomy, tell her to expect abdominal

cramping afterwards. She will also have a perinealpad in place because moderate amounts of

drainage occurs post operatively.

Cervical ca preop prep

f h li h f h d


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Inform the client that after surgery, she needs

to lie in a supine position or in low Fowler's

position

Demonstrate the exercises that she will need to

perform to prevent venous stasis

POST OPERATIVE CARE

For- vaginal hysterectomy, change her perineal

pad frequently. Provide analgesics to relieve

cramps.


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Change perineal pads frequentlybecause moderate amounts of drainage

occurs post-operatively

Provide analgesics to relief cramps

Monitor urinary output because urinary

retention commonly occurs

Encourage patient to perform the prescribed


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cou age pat e t to pe o t e p esc bed

exercises and to ambulate early andfrequently to prevent venous stasis

Venous stasis

retardation of the venous outflow

in a part

Cervical ca post op care


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If she has had an abdominal hysterectomy, tellher to remain in a supine position or a low

Fowler's position. Encourage her to perform the

prescribed exercises and to ambulate early andfrequently to prevent venous stasis. Monitor

UO because retention commonly occurs.

If abdominal distention develops, relieve it byinserting NGT or rectal tube as ordered. Note

bowel sounds during routine assessment.


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Avoid heavy lifting to avoid pressure onincision site

Avoid rapid walking, dancing

Advice to eat high protein, high residuediet to avoid constipation

Give 2.8 Liters/day

May resume sexual activity 6 weeksafter surgery

Explain that abrupt hormonal

fluctuations may cause the client to feel


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depressed or irritable for a while Encourage family members to respond

calmly and with understanding

If the ovaries were removed, client mayreceive hormone replacement therapy

Cervical ca


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HOME CARE:

If the client had vaginal hysterectomy, instruct

to report severe cramping, heavy bleeding or

hot flushes (common for Oophorectomy) to her

doctor immediately.

Encourage client to walk a little more each day

and avoid sitting for prolonged period.

Swimming is permissible.


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Surgical removal of

the uterus is


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the uterus is

recommended for all

stages of uterine

cancer unless thecancer is widespread.

In the early stages, itmay be curative.


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A cut is made in the lower abdomen to

expose the tissues and blood vessels that

surround the uterus and cervix


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surround the uterus and cervix

These tissues are cut and the blood

vessels are tied off to remove the uterus

Stitches are placed in these deepstructures, which will eventually

dissolve


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The first night after the surgery, youmay be asked to sit up in bed and walka short distance

If there is no evidence ofcomplications and you are able todrink fluids on your own, the catheter

in your bladder and IV will beremoved

Eat balanced diet rich in fresh fruits


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and vegetables. Dependig on how much blood loss

occurred during surgery, you may

require a daily iron supplement


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Advise to eat high-fiber foods,

drinking plenty of water, and if

necessary, use stool softeners Shower instead of taking a bath for

at least the first two weeks after

surgery

Keep your incision sites clean and

dry to avoid infection


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Do not douche or put anything inyour vagina, such as tampon, until

your doctor tells you otherwise.

Speak to your doctor about when

you may resume having sexual

intercourse

Take daily walks as tolerated

Avoid heavy lifting for four to six


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Avoid heavy lifting for four to six

weeks

Ask your practitioner whether any

type of physical therapy ornutritional counseling may be

helpful to speed your recovery

Management of client with lungcancer


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Explain the anticipated surgery to the client

and inform him that he will receive a general

anesthetic.

Lung ca pre-op prep


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Inform the client that post operatively, he may

have chest tubes in place and may receive

oxygen.

Teach him deep breathing techniques and

explain that he will perform these after surgery

to facilitate lung reexpansion. Also teach him to

use an incentive spirometer; record the volumeshe achieves to provide a baseline.

Lung ca


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POST OPERATIVE CARE:After pneumonectomy, the client should lie only

on the operative side or on his back until stabilized.

This prevents fluids from draining into theunaffected lung if the sutured bronchus opens.

Make sure that the chest tube is functioning, if

present, and observe for signs of tensionpneumothorax.

Provide analgesics as ordered

Lung ca post op care


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Have the client begin coughing and deep breathing

exercises as soon as his condition is stable.

Auscultate his lungs, place him in semi Fowler's

position, and have him splint his incision tofacilitate coughing and deep breathing.

Perform passive range of motion exercises the

evening of surgery and 2-3 times daily thereafter.Progress to active range of motion exercises.

Lung ca home care


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Tell the client to continue his coughing and deepbreathing exercises to prevent complications. Advise

him to report changes in sputum characteristics to

his doctor.Instruct the client to continue performing range of

motion exercises to maintain mobility of his

shoulder and chest wall.

Tell the client to avoid contact with people who

have an URTI and to refrain from smoking

Lung ca home care


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Provide instructions for wound care and

dressing changes as necessary.


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Shower daily and wash incision anddrain sites.

Let the water stream run over the

incision and drain sites.

Leave the incisions for the chest tubes and

drain sites uncovered. The sites may

drain for several days, and therefore

may need a Band-Aid.

Post-OP Care


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Wear comfortable clean clothing preferably

cotton clothing

Ambulate early. Stop when you are short ofbreath, rest, and then continue. You may not

see a daily increase, but over a week's time you

should see an increase in the distance that you

are able to walk

Post-OP Care


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Fatigue and tiredness are expected. It is

entirely normal that you may have to

take a nap in the morning or in the

afternoon.

Avoid spending prolonged periods of

time lying down during the daytime

hours.

Eat nutritious foods.

Post-OP Care


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Dos:

We suggest that you weigh yourself

twice a week and that you keep a

record of your weight.

Post-OP Care


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Do take your pain medications as needed. In the

beginning, you should take your medications on a

regular basis as they were prescribed. Often, you

receive two types of pain medication, one of which

should be taken constantly to produce a steadylevel of analgesia -pain relief-. The other

medication is given for "breakthrough" pain or the

peaks, which you take as needed depending on

your daily activities.

Management of client withprostate cancer

SURGERY;


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SUPRAPUBIC PROSTATECTOMY

A surgical approach that involves a lower

abdominal incision. Operation of choice when

the prostate is too large to be resectedtransurethally.

TRANSURETHRAL PROSTATECTOMY

Excision of part of the prostate glandthrough the urethra.

PERINEAL PROSTATECTOMY


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Excision of part or all the prostate gland

with an incision in the perineum.

PREOPERATIVE CARE:

Assess the client's ability to empty his bladder.

Clients taking any drug or supplement withanti coagulant effects must discontinue before

surgery

Prostate ca preop care

Respond to the concerns of the client and


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significant others with emphatic listening,accurate information and on going support.

POST OPERATIVE CARE:

Observe the vital signs and maintenance of

urinary drainage

Document the urine color, including the

presence of blood clots, each time urine out put

is recorded

Prostate ca post op care


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Ensure catheter patency frequently to make

sure the catheter is draining, blockage of an

irrigated bladder rapidly leads to overdistention, secondary hemorrhage and

formation of blood clots or infections.

Management of client withthyroid cancer


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THYROIDECTOMYSurgical removal of the thyroid gland

PREOPERATIVE CARE:

Administration of anti-thyroid drugs

Preparation is about 2-3 months

Provide adequate rest

Achieve and maintain optimal weight

Maintain good health status

Thyroid ca


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Take vital signs every 15 minutes until stable,

every 1 hour for the next 24 hours

Place client in sitting position with head and

arms well supported as soon as she recovered

from anesthesia

Watch for edema or swelling due to bleedinginto the wound

Thyroid ca post op care

Suction mouth and throat if necessary

C h d d b hi i h


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Cough and deep breathing exercise every hour

Give fluids by mouth as tolerated

Give Morphine SO4 for pain

Observe for hoarseness and evidence of injury

to parathyroid gland

Signs and symptoms:

Tingling and tightness of the fingers, anxiety,

and mental depression

Thyroid ca post op care

H h f ll i b d id


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Have the following at bed side:Tracheostomy set

Endotracheal tube

LaryngoscopeOxygen

Give mist inhalation until chest is clear

Take temperature every 4 hours for 24 hoursAssess for hypocalcemia and monitor calcium,

magnesium and phosphorous.

Management of client withcolorectal cancer

SURGERY:

F t f th di l


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For tumors of the cecum or ascending colon,right hemicolectomy for advanced disease may

include resection of the terminal segment of the

ileum, cecum, ascending colon, and right halfof the transverse colon with corresponding

mesentery.

For tumors of the proximal and middletransverse colon, right colectomy includes

transverse colon and mesentery corresponding

to mid colonic vessels

Colerectal ca

Alternatively, the surgeon may perform

t l ti f th t l d


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segmental resection of the transverse colon andassociated mid colonic vessels.

For sigmoid colon tumors usually limited to

the sigmoid colon and mesentery.

Upper rectum tumors usually call for anterior

or low anterior resection. A newer method,

using a stapler, allows resections much lowerthan were previously possible.

Colorectal ca

F t i th l t


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For tumors in the lower rectum,abdominoperineal resection and permanent

sigmoid colostomy are usually performed.


Before the surgery, arrange for the client to

visit an enterostomal therapist, who can providemore detailed information and for chosing the

best location for the stoma

Colorectal ca preop prep

Try to have the client meet with an ostomy

li t h h hi l i i ht i t


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client who can share his personal insights into

the realities o living with and caring for a stoma

Evaluate his nutritional and fluid status.

Typically, the client will receive TPN toprepare him for the physiologic stress of

surgery.

Record the client's fluid intake and output andweight daily. Watch for early signs of

dehydration.

Colorectal ca preop prep

Expect to draw periodic blood samples for


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Expect to draw periodic blood samples forhematocrit and hemoglobin determinations. Be

prepared to transfuse blood if ordered.


Monitor I and O, and weigh daily. Maintain

fluid and electrolyte balance, and watch forsigns of dehydration (decrease UO, poor skin

turgor) and electrolyte imbalance.

Colorectal ca post op care

Provide analgesics as ordered, Be especially

l t f i i th ti t ith


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alert for pain in the patient with an

abdominoperineal resection because of the

extent and location of the incisions.

Note and record the color, consistency andodor of fecal drainage from the stoma. If the

client has double barrel colostomy, check for

mucus drainage from the inactive (distal)stoma. The nature of fecal drainage is

determined by the type of ostomy

Colorectal ca post op care

S ll th l l ti th t'


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Surgery, generally, the less colon tissue that's

removed, the more closely drainage will

resemble normal stool. For the first few days

after surgery, fecal drainage probably will bemucoid (and probably blood tinged) and mostly

odorless. Report excessive blood and mucus

content, which could indicate hemorrhage orinfection.

Watch out for sepsis

Observe the client for signs of peritonitis or


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Observe the client for signs of peritonitis orsepsis, caused by bowel contents leaking into

the abdominal cavity. Remember that clients

receiving antibiotics or TPN are at an increased

risk for sepsis.

Provide for meticulous wound care, changing

dressings often. Check dressing and drainage

sites frequently for signs of infection (purulent

discharge, foul odor0 or fecal drainage.

Watch for sepsis

If the client has had an abdominoperineal

resection irrigate the perineal area as ordered


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resection, irrigate the perineal area as ordered.

Regularly check the stoma and the surrounding

skin for irritation and excoriation, and take

corrrective measures. Also observe the stoma'sappearance. The stoma should look smooth,

cherry red and slightly edematous, immediately

report any discoloration or excessive swelling,which may indicate circulatory problems that

could lead to ischemia.

Watch out for sepsis


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During the recovery period, encourage the

client to express his feelings and concerns,

reassure an anxious or depressed patient thatthese common post operative reaction should

fade as he adjusts to the ostomy. Continue to

arrange for visits by an enterostomal therapist.

Colorectal ca home care

HOME CARE INSTRUCTIONS FOR


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HOME CARE INSTRUCTIONS FOR

CLIENT WITH COLOSTOMY:

Teach client or caregiver how to apply, remove

and empty the pouch. Teach him how to irrigatethe colostomy with warm tap water to gain

some control over elimination.. Reassure him

that he can regain continence with dietarycontrol and bowel retraining.

Home careInstruct the client to change the stoma

appliance as needed, to wash the stoma site

with warm water and mild soap every 3 days


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with warm water and mild soap every 3 days,and to change the adhesive layer. These

measures help prevent skin irritation and

excoriation.Discuss dietary restrictions and suggestions to

prevent stoma blockage, diarrhea, flatus and

odor. Tell the client to stay on a low fiber dietfor 6-8 weeks and to add new foods to his diet

gradually.

Home careSuggest the use of ostomy deodorant or odor

proof pouch if he include odor producing foodshi di


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proof pouch if he include odor producing foodsto his diet.

Trial and error will help the client determine

which foods cause gas. Gas producing fruitsinclude apples, melons, avocados, and

cantaloupe, gas producing vegetables are beans,

corn, and cabbage.

The client is especially susceptible to fluid and

electrolyte losses. He must drink plenty of

fluids

Home care

Especially in hot weather and when he has

diarrhea Fruit juice and bouillon which


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diarrhea. Fruit juice and bouillon, whichcontain potassium are particularly helpful.

Warn the client to avoid alcohol, laxatives and

diuretics which will increase fluid loss and maycontribute to an imbalance.

If the client had an abdominoperineal

resection,suggest sitz bath to help relieveperineal discomfort. Recommend refraining

from intercouse until the perineum heals.

Acute leukemia

A cancerous WBC precursor called blast


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A cancerous WBC precursor called blastproliferate in the bone marrow or lymph tissue

and then accumulate in peripheral blood, bone

marrow and body tissuesCLASSIFICATIONS:

ACUTE LYMPHOBLASTIC LEUKEMIA

marked by abnormal growth of lymphocyteprecursors (lymphoblast)

Classification of leukemia

ACUTE MYELOGENOUS LEUKEMIA

h t i b id l ti f


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characterize by rapid accumulation of

myeloid precursors (myeloblast)

ACUTE MONOCYTIC LEUKEMIA or

SCHILLING'S TYPE

involves a marked increase in monocyte

precursor (monoblast)

ACUTE MYELOMONOCYTIC and ACUTE

ERYTHROLEUKEMIA

Risk factors of leukemia

The cause of leukemia is unknown but


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The cause of leukemia is unknown, but

according to some experts, the following are the

risk factors

A combination of viruses

Genetic and immunologic factors

Exposure to radiation and certain chemicals

pathophysiology

The pathogenesis of acute leukemia is notl l d d f i i


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The pathogenesis of acute leukemia is notclearly understood. Immature, nonfunctioning

WBCs appears to accumulate first in the tissue

where they originate (lymphocytes in lymph

tissues, granulocyte in bone marrow). These

immature WBCs then spill into the blood

stream and infiltrate other tissues. Eventually,

they cause organ malfunction fromencroachment or hemorrhage.

Signs and symptoms

ACUTE LEUKEMIAHi h f f dd


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CU UHigh fever of sudden onset

Abnormal bleeding

Easy bruising with even minor traumaProlonged menses

NON SPECIFIC SIGNS

Low grade fever

Pallor, weakness and lassitude

Signs and symptoms

ALL, AML,ACUTE MONOCYTIC

LEUKEMIA


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Dyspnea

Fatigue

Malaise

Tachycardia

Palpitations

Systolic ejection murmur

Abdominal or bone pain

Signs and symptoms


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MENINGEAL LEUKEMIA

ConfusionLethargy

headache

Laboratory exams

BONE MARROW BIOPSY

Performed in client with typical clinical


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Performed in client with typical clinical

findings but whose aspirate is dry or free from

leukemic cells. It shows proliferation of

immature WBCs.

WBC differential determines cell type

CBC shows decreased levels of hemogobin

(anemia), platelets (thrombocytopenia) and

neutrophils (neutropenia).

Laboratory exams


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LUMBAR PUNCTURE detects meningeal

involvementURIC ACID measurement may be done to

detect hyperuricemia

Nursing management

Control infection by placing the client inreverse isolation Coordinate care so client


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y p greverse isolation. Coordinate care so client

does not come in contact with staff who also

care for clients with infection or infectious

disease. Avoid using IFC and giving IM

injections, which can pave way for infection.

Screen staff and visitors for contagious disease.

Watch for and report signs and synptoms ofinfection.

Nursing management

Monitor the client's vs q 2-4 hours. Atemperature of 38 3C accompanied by a


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qtemperature of 38.3C accompanied by a

decrease in WBC count calls foe prompt

antibiotic therapy.

Watch for bleeding. If occurs, apply ice

compress and pressure, elevate the affected

extremity. Avoid giving aspirin-containing

drugs, taking rectal temp,,giving rectalsuppositories and performing DRE.

Nursing management

Watch for signs s/s of meningeal leukemia. Ifthese occurs provide care after intrathecal


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these occurs, provide care after intrathecal

chemo. After instillation, place the client in

Trendelenberg position for 30 mnutes. Give

plenty of fluids, and keep him supine for 4-6

hours. Check lumbar puncture site for bleeding.

If the client has receiving cranial radiation,

teach him about potential adverse effects, andtry to minimize them.

Nursing managementTake steps to prevent hyperuricemia- apossible result of rapid chemotherapy induced

leukemic cell lysis. Give the client about 2L offluids daily, and administer acetazolamide,


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fluids daily, and administer acetazolamide,

sodium bicarbonate tablets and allopurinol as

ordered. Check urine pH often-it should be

above 7.5. Watch for rashes and otherhypersensitivity reactions to allopurinol.

Control mouth ulcers by checking often for

obvious ulcers and gum swelling and byproviding frequent mouth care and saline

solution rinses.

Nursing management

Check the rectal area daily for induration,

swelling, erythema, skin discoloration andd i


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drainage.

Minimize stress by providing a calm, quiet

atmosphere that promotes rest and relaxation.Provide psychological support by establishing

a trusting relatioship with the client. Allow him

and his family to expres their anger, anxietyand depression. Encourage them to ;participate

in client care as much as possible.

Nursing managementFor client with terminal disease that resists

chemo, provide supportive care directed at

promoting comfort; managing pain, fever andbl di d ff i i l


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bleeding; and offering emotional support.

Provide the opportunity for religious

counseling, if appropriate. Discuss the option ofhome or hospice care.

Evaluate the patient. He and his family should

understand the rationale for treatment andpotential complications of chemo. They should

also know how to recognize s/s of infection and

Nursing management


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And understand that they must notify the doctor

if these occur. They should be able to discusstreatment options and verbalize concerns about

a poor prognosis..

B. CHEMOTHERAPY

A. DESCRIPTIONOTHER TERM


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OTHER TERM:

chemo, antineoplastic drugs, anticancer, cytotoxic

drugsUsed to describe drugs that kill cancer cells

directly

It promotes tumor cell destruction by interferingwith cellular function and reproduction

Principles of chemotherapy1. The intent of chemo is to destroy as many tumor

cells as possible with minimal effect on healthy cells.

2. Therapeutic strategies


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2. Therapeutic strategies

Adjuvant therapy

Neoadjuvant therapyInduction therapy

Consolidation therapy

3. Cancer cells depend on the same mechanisms forcell division as in normal cells.

Principles of chemo

4. Chemo agents can be effective in one


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4. Chemo agents can be effective in one

of the five phases of the cell cycle

Normal cell cycleG0 PHASE (resting phase)

Cells have not yet started to divide. Last for few

hours to few years.


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G1 PHASE (gap one)

The cells starts making more protein to get ready to

divide.

S PHASE (synthesis)

The proteins containing the genetic code (DNA)

doubles so that both new cells are formed will have

the right amount of DNA.

Normal cell cycle

G2 PHASE (gap two)


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Period of protein and RNA synthesis and the

mitotic spindle apparatus is formed.

M PHASE (mitosis)

The cell actually divides into two identical cells

Goals for chemotherapy treatment

1. To cure a specific cancer

2. To control tumor growth


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g

3. To relieve symptoms caused by cancer

4. To destroy microscopic cancer cells5. To shrink tumors before surgery or radiation

Contraindications of chemotherapy

1. INFECTION. The anti-tumor drugs are

immunosuppressives.


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2. RECENT SURGERY. The drugs may retard

healing process

3. IMPAIRED RENAL AND HEPATIC

FUNCTIONS. The drugs are hepatotoxic and

nephrotoxic

4. RECENT RADIATION THERAPY. Also

immunosuppresive.

Contraindications of chemotherapy

4. PREGNANCY. The drugs may causecongenital defects.


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g

5. BONE MARROW DEPRESSION. The

drugs may aggravate the condition. The WBClevels must be within normal limits.

Classifications of chemo agents

1. ALKALYTING AGENT

ACTION: *Most active during the resting


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phase of the cell.

* It interfere with DNA and RNA

growth

EXAMPLES: Cyclophosphamide, Busulfan,

Carmustine, Carboplastic, Leukeran,

Lomustine, Cisplatin, Dacarbazine, Ifosfamide,

Mesna, Semustine, Melphalan

Alkalyting agents

ADVERSE EFFECTS:

Nausea, vomiting, alopecia, hemorrhagic cystitis,thrombocytopenia myelosuppression


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thrombocytopenia, myelosuppression

NURSING CONSIDERATIONS:

Monitor liver functions and CBC

Drink 2-3L of fluids daily

Reassurance for hair loss

Administer anti emetic drugs as ordered

Observe for hypersensitivity reactions.

Alkylating agents


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Classifications of chemo drugs

2. ANTIMETABOLITESACTIONS:


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Drugs are very similar to normal substances within

the cellAttack cells at very specific phase of the S Phase

Inhibit cell reproduction by interfering with

manufacture of proteinCell cycle specific drug

antimetabolites


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Classifications of chemo drugsEXAMPLES OF ANTIMETABOLITES:

Azacytadine, Cytarabine, 5 Flouraouracil, Hydroxy

Urea, 5-Mercaptopurine, Methotrexate,

Thioguanine Gemcitabine Taxanes Taxotere


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Thioguanine, Gemcitabine, Taxanes, Taxotere

ADVERSE EFFECTS:

N/V,stomatitis

Thrombocytopenia, diarrhea

Myelosuppression, alopecia

Renal and hepatic dysfunctions

Neuropathy

antimetabolites


Monitor liver function, CBC, Urea and


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Creatinine

Provide oral hyieneAdminister antiemetic drugs as ordered

Observe other s/s of side effects


3. ANTINEOPLASTIC ANTIBIOTICSACTIONS:


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Interfere with DNA by stopping enzymes and

mitosis or altering the membranes surrounding thecell

Works in all phases of cell cycle

EXAMPLES:Bleomycin, Dactomycin, Adriamycin, Mitomycin

Antitumorantibiotics


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Antineoplastic antibiotics

ADVERSE REACTIONS:

N/V, stomatitis


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Myelosuppression, thrombocytopenia

Renal and hepatic dysfunctionsAlopecia


Hydration, monitor lab testAntiemetics, oral care

Classifications of chemo drugs4. PLANT ALKALOIDS

Derived from certain types of plantsa. Vinca Alkaloids- made from periiwinkle


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plants Catharantus rosea

b. Taxanes- made from bark of the Pacific fewtree Taxus

c. Podophylotoxins- derived fro the May apple

plant

d. Campotheca acuminata- derived from the

Asian Happy Tree

Plant alkaloidsACTIONS:Attack the cell during various phases of cell

division especially the M PhaseCell cycle specific


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Known as Mitotic o Topoisomerate inhibitors

EXAMPLES:Velba, Vincristine, Vinblastine, Tenipride,

Nevelbine

ADVERSE EFFECTS:Diarrhea, neuropathy, alopecia, stomatitis, paiin in

the IV site

Topoisomerase Inhibitors


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MitoticSpindle Poisons


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NURSING CONSIDERATIONS (PLANTALKALOIDS)

H d i


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Hydration

Avoid handling pointed and breakable objectsReassure that hair will grow again after the

therapy

Provide mouth careObserve IV site


5. HORMONE OR HORMONE MODULATORS

ACTION:

A. Natural Hormones- drugs that are useful in

treating some types of cancer


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treating some types of cancer

EX. Corticosteroids

B. Some sex hormones alter the action or production

of female and male hormone. They are used to

inhibit the new growth of the breast, prostate and

endometrial lining

EX. Tamoxifen or Nalvadex, Testofactone or Teslac

hormone

ADVERSE EFFECTS:

Signs and symptoms of menopauseBone marrow depression, retinopathy


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Teslac may produce altered libido, facial hair

growth, enlargement of the clitorisNURSING CONSIDERATIONS:

Monitor CBC

Health teaching regarding changes on reproductivesystem and vision

Routes of administration for chemo

agents

Oral

IVIM


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Intrathecal or intraventricular

Intraarterial

Intracavitary

Intravesical

topical

Administration of IV chemo agents1. PREPARATORY PHASE

A. Patient Education

Review treatment goals

Review treatment plans and adverse reactions


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Review treatment plans and adverse reactions

Review strategies to manage reactions

Instruct client on a reportable condition

B. Before administering chemo drugs, check for:

Doctors order, medication, history, type of drugs,route, dose, duration of therapy, and current

laboratory results

Administration of IV chemo drugs

C. Calculate the dosage according to mg/kg body

weight or mg/m2 by body surface area.

D. Verify client's name and identification

E. Be aware of the agents that cause anaphylactic


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g p y

reaction

2. PERFORMANCE PHASE

A. Insertion of IV access

Select venipuncture site free from sclerosis,

thrombosis or scar formationCheck for blood return or patency of the site

Administration of IV chemo drugsC. Calculate the dosage according to mg/kg

body weight or mg/m2 by body surface area.

D. Verify client's name and identificationE. Be aware of the agents that cause


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anaphylactic reaction

2. PERFORMANCE PHASE

A. Insertion of IV access

Select venipuncture site free from sclerosis,

thrombosis or scar formation

Check for blood return or patency of the site

Types of vascular access devices

1. Peripherally inserted catheter (Per-Q-Cath)

Placed in the arm and treaded through the vein


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g

up to the near the heart

Allows for continuous access for peripheral

vein for several weeks.

No surgery is needed. Care for the catheter is

required.

Vascular access

2. MID LINE CATHETER (Per-Q-Cath Midline)

Also placed in the arm but the catheter is not inserted as far

as PIC


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Used for intermediate length therapy when a regular

peripheral IV is not advisable. No surgery needed. Care of

the catheter is required.

3. TUNNELED CENTRAL VENOUS CATHETER

(Hickman, Broviac, Groshon)

Catheter with multiple lumens surgically placed in largecentral vein in the chest and the catheter

Vascular access

Tunneled under the skin. Care of the catheter is

needed.

4. IMPLANTABLE VENOUS ACCESS PORT


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(Port-A-Cath, BardPort, Medi-Port)

A port of plastic, stainless steel or titanium with

silicone septum. The catheter is surgically

placed under the skin of the chest or arm in a

large central vein. The port is accessed by aneedle to give chemotherapy.

Vascular access

5. IMPLANTABLE PUMPA titanium pump with an internal power

source surgically implanted to give continuous


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source surgically implanted to give continuous

infusion chemotherapy usually at home. There

is a refillable reservoir for continuous infusion.

Administration of IV chemodrugs

B. ADMINISTRATION PHASE

SEQUENCE OF DRUG ADMINISTRATION

1 The recommended practice is to administer


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1. The recommended practice is to administer

vesicant first. Check IV site for:

Good vein integrity

Vein is stable and less irritated

Assessment for vein patencyLess chance of compromised vascular integrity

Sequence of drug administration2. Apply a disposable absorbent plastic (backed

pack under the area)

3. Put protective gown, gloves and goggles ifnecessary. Order of protective equipment:


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Donning- mask, gown, gloves, goggles

Removing-gown, gloves, goggles, mask

4. Monitor IV site regularly. Observe for

EXTRAVASATIONS or accidental infiltration

of vesicant or irritant chemo drugs from thevein into the surrounding tissues of the IV site.

Extravasation

SIGNS AND SYMPTOMS

Pain, burning sensation and inflammation

IF LEFT UNTREATED


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IF LEFT UNTREATED

There will be hyperpigmentation, sloughing,necrosis and ulceration.

FOR SEVERE EXTRAVISATIONS

May result in damage to tendons and nervesEND RESULT: AMPUTATION

Management for extravisation

STOP vesicant and IV fluids

Wear gloves leave catheter in place


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Wear gloves, leave catheter in place,

disconnect line from IV site

Attach a syringe and aspirate

Notify the physician

Administer prescribed antidote

extravisation

FOR SUBCUTENEOUS EXTRAVISATION:

Wear gloves, remove IV catheter, avoiding

excess pressure on the site


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excess pressure on the site

Inject antidote SC of the affected site. Usegauge 25 neeedle.

Instruct client to rest, elevate the site, apply ice

for 24 -48 hours then resume normal activity.

Assess for a plastic surgery consult

Admin of chemo drugs

C. FOLLOW UP PHASE

Documentation

Monitoring of pain and erythema induration


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Monitoring of pain and erythema, induration

or necrosis

Monitoring for the other adverse effects of the

drug

Side effects of chemo agents andtheir nursing interventions1. GASTROINTESTINAL SYSTEM

N/V, diarrhea, constipationNursing Actions:


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Replace fluids and electrolyte losses

Low fiber diet to relieve diarrhea

Increase fluid intake and high fiber diet to

relieve

constipation

Administration of antiemetic drugs as ordered

NAUSEA AND VOMITING

Chemotherapy drugs cause nausea and

vomiting for a variety of reasons. One reason is

they irritate the lining of the stomach and

duodenum (the first section of the smallintestine). This stimulates certain nerves that

activate the vomiting center (VC) and the


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chemoreceptor trigger zone (CTZ) in the brain

which leads to vomiting. Another way theseareas of the brain can be activated is through

obstruction (intestinal blockage), delayed

gastric emptying, or inflammation

CONSTIPATIONConstipation is the passage

(usually with discomfort) of

infrequent, hard, dry stool. If

you have constipation, you may

also notice bloating, increased

gas, cramping, or pain.


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g , p g, p

Constipation affects about half

of people with cancer and about3 out of 4 of those with

advanced cancer. It can lead to

nausea and a decreased appetite.

DIARRHEA

- is the passage of increased

volume of loose or watery

stools several times a day withor without discomfort. Along

with diarrhea, you may have


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gas, cramping, and bloating.

Diarrhea occurs in about 3 out of4 people who receive

chemotherapy because of the

damage to the rapidly dividing

cells in the digestive(gastrointestinal) tract.

APPETITE LOSS AND WEIGHT CHANGES

Most chemotherapy medicines cause some

degree ofanorexia, a decrease in or complete

loss of appetite. Loss of appetite, as well as

weight loss, may also result directly from

effects of the cancer on the body's metabolism.

Anorexia may be mild. If it is severe, it may

lead to cachexia a form of malnutrition with


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lead to cachexia, a form of malnutrition with

muscle loss. Proper nutrition is important

during cancer treatment. It helps strengthen the

body to fight the disease and infection and also

cope with cancer treatments and their side

effects.

TASTE CHANGES

Cancer treatments and the

cancer itself can change the

way some food tastes. Taste

changes can contribute to

anorexia, poor nutrition, and


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anorexia, poor nutrition, and

weight changes. With taste

changes caused by

chemotherapy,

Side effects of chemo

2. INTEGUMENTARY SYSTEM

*Pruritus, urticariaProvide good skin care

Observe for anaphylactic reactions


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Observe for anaphylactic reactions

*StomatitisProvide good oral care

Avoid hot and spicy foods

*Skin pigmentation

Inform client that it is temporary


* Alopecia

Reassure that it is temporary

Encourage to wear wigs, hat, or

h d f


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headscarf

*Nail Changes

Reassure that nails may grow

normally after chemo


3 HEMATOPOIETIC SYSTEM


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3. HEMATOPOIETIC SYSTEM

Anemia-provide frequent rest period

Neutropenia-protect from infection, avoid

people with infection

FATIGUEFatigue is an extreme

tiredness that is not

relieved with rest. It isone of the most

common side effects of


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cancer and

chemotherapy. It can beone of the most

debilitating side effects

people experience.


*Thrombocytopenia- protect from trauma,

avoid aspirin

4. GENITO-URINARY SYSTEM


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*Hemorrhagic Cystitis

Provide 2-3 L of fluids per day

Monitor UO

Assess for urinary frequency, ugencyMonitor BUN, Creatinine

Side effects of chemo5. REPRODUCTIVE SYSTEM*Amenorrhea and decrease libido for males

Reassure that menstruation and libido willresume after chemo

6 NEUROMUSCULAR SYSTEM


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6. NEUROMUSCULAR SYSTEM

*Paresthesia, Hearing Loss, Blurring of visionDetermine presence of tingling sensations on

toes and fingers

Evaluate muscle weakness

Determine peripheral nerve damage and report

NERVOUS SYSTEM CHANGES

Some chemotherapy drugs can cause

direct or indirect changes in the central

nervous system (brain and spinal cord), thecranial nerves, or peripheral nerves. The

cranial nerves are connected directly to the

brain and are important for movement and


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p

touch sensation (feeling) of the head, face,

and neck. Cranial nerves are also importantfor vision, hearing, taste, and smell.

Peripheral nerves lead to and from the rest of

the body and are important in movement,

touch sensation, and regulating activities of

some internal organs.

Safe handling of

chemotherapeutic agents

1. Wear mask, back closing gown and gloves.

2. Skin contact with drugs must be washedimmediately with soap and water.

3 Eyes must be flushed immediately with


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3. Eyes must be flushed immediately with

copious amounts of water.4. Sterile or alcohol wet pledgets should be

used to wrap around the neck of the ampule

when breakingor withdrawing the drug.

Safe handling5. Expel air bubbles on wet cotton.6. Vent vials to reduce internal pressure when

mixing.

7. Wipe external surfaces of syringes and IV

bottles.


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8. Avoid self inoculation by needle stab.

9. Clearly label the hanging IV bottle with

antineoplastic chemotherapy

10. Contaminated needles and syringes must bedisposed in a clearly marked leak proof and

puncture proof container.


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Personal safety to minimize

exposure via skin ingestion

1. Do not eat, drink, chew gum, or smoke while

preparing or handling chemo agents.2. Keep all food and drink away from

preparation area.


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preparation area.

3. Wash hands before and after handling chemoagents.

4. Avoid hand to mouth or hand to eye contact

while handling chemo agents or body fluids ofthe person receiving chemo.

Personal safety4. Wear nitrite examination gloves at all timeswhen preparing or working with chemo agents.

5. Wash hands before putting on and after

removing gloves

6. Change gloves after each use, tear, puncture

di ti ill ft 60 i t f


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or medication spill every after 60 minutes of

wear.

7. Wear along sleeves non absorbent gown with

elastic at the wrist and back closure.

8. Eyes and face shields should be worn if

splashes are likely to happen.

Personal safety10. Use syringe and IV tubings with Luer locks

(with locking device to hold needle firmly in

place)

11. Label all syringes and IV tubings containing

h t h d t i l


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chemo agents as hazardous material.

12. Place an absorbent pad directly under the

injection site to absorb any accidental spillage.

13. If any contact with the skin occurs,

immediately wash the area thoroughly with

soap and water.

Personal safety14. If contact,made with the eye, immediately

flush the eye with water and seek medical

attention.15. Spills kit should be available in all areas

where chemo agents stored, prepared and


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administered

Safe disposal of antineoplastic

agents, body fluids and excreta1. Discard gloves and gown into a leak proof

container, which should be marked as

contaminated or hazardous waste.

2. Use puncture proof and leak proof containers

f dl d th h d b k bl


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for needles and other sharp and breakable

objects.

3. Linen contaminated with chemotherapy or

excreta from patients who have received the

drug within 48 hours should be contained in

specially marked hazardous waste bags.

III. RADIATION THERAPYROLE IN CANCER PREVENTION:

Primary curative roleAdjunct to other therapy

Palliation


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SOURCES OF RADIATION THERAPY:

1. External Radiation Therapy (Teletherapy).

Administer via an X-ray machine


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Side effects of radiation therapy

1. SKIN REACTIONS

A. Erythema, dry or moist desquamationB. Atopic, telangectasia, depigmentation,

necrotic or ulcerative lesions.


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NURSING RESPONSIBILITIES:Observe early signs of skin reaction and report

Keep area dry

Wash area with water, no soap and pat dry ( donot rub)

Side effects

Do not apply ointments, powders or lotions onthe area

Do not apply heat, avoid direct sunlight or cold


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Use soft cotton fabrics for clothingDo not erase markings on the skin. These serve

as guide for areas of irradiation.

Side effects2. INFECTION

Due to bone marrow suppressionNURSING RESPONSIBILITIES:

Monitor blood count weekly


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Good personal hygiene, nutrition and adequaterest

Teach signs of infection to report to physician

Side effects of radiation3. HEMORRHAGE

Platelets are vulnerable to radiationNURSING RESPONSIBILITIES:

Monitor platelet count


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Avoid physical trauma or use of aspirinTeach signs of hemorrhage

Monitor stool or skin for signs of hemorrhage

Use direct pressure over injection sites untilbleeding stops.

Side effects of radiation

4. FATIQUEResult of high metabolic demands for tissue

repair and toxic waste removal.


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MANAGEMENT:Plenty of rest and good nutrition

5. WEIGHT LOSS

Anorexia, pain and effect of cance


6. STOMATITIS

Ulceration of oral mucus membraneNURSING INTERVENTIONS:

Administer analgesics before meals


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Bland diet, no smoking and alcohol drinkingGood oral hygiene by using saline rinse every

2 hours

Sugarless lemon drops or mint to increasesalivation


7. Diarrhea

8. N/V

9. Headache

10. Alopecia


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10. Alopecia

11. Cystitis

12. Social Isolation

Principles of radiation protection

DISTANCE

Maintain a distance of atleast 3 feet when

not performing nursing procedures

TIME


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TIME

Limit contact for 5 minutes each time, a

total of 30 minutes per shift

SHIELDING

Use lead shield during contact with client

Teaching guidelines regarding

radiation therapy

It is painless

Lie very still in a special table while theintervention is being given and client may be

placed in a special position to maximize tumor


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irradiation.Each treatment may usually last for few

minutes. Client may hear sounds of the machine

being operated, and the machine may moveduring the therapy

Teaching guidelines

As a safety precaution for the therapy personnel,

client will remain alone in the treatment room whilethe machine is in operation.

The technologist will be right outside the room

observing the client through a window or by a


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observing the client through a window or by a

closed circuit TV. Client and technologist may

communicate

There is no residual radioactivity after the therapy.

Safety precautions are necessary only during thetime the client is actually receiving irradiation

IV. BONE MARROW

TRANSPLANTATIONBone marrow cells are collected from the

client or another donor and then administer to

the client after his diseased bone marrow is

destroyed by chemotherapy or radiation.

PATIEN TEACHING:


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PATIEN TEACHING:

Inform the client that bone marrow transplant

will deplete his WBCs, putting him at high risk

for infection immediately after the procedure.

As a safeguard, he will be placed on reverseisolation for several weeks.

Bone marrow transplant

2. Prepare client for pretransplantation regimen,

which may include chemotherapy and radiation.

During this regimen, he should expect adverse

reactions such as parotitis, diarrhea, fever, N/V


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and symptoms of bone marrow depression(fever, fatique, chills, bruising and bleeding)

Nursing management for BMT

1. During transfusion, monitor client's v/s

closely to allow prompt detection of reactionssuch as fever, dyspnea and hypotension.

2. Assess the client every 4 hours for infection


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symptoms, such as fever and chills.3. Maintain strict asepsis when caring for the

client. Take measure to protect him from injury.

Management of BMT

4. Watch for signs of graft-versus-host disease,

such as dermatitis, hepatitis, hemolytic anemia

and thrombocytopenia. GVHD usually occurs

during t

new cellular aberration lecture2010 (1)

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