neoplastic disorder 2

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  1. Cancer prevention
    • Primary
    • secondary
    • Tertiary
  2. 7 warning signs of cancer
    • C- change in bowel and bladder habits
    • A- a sore that doesn't heal
    • U- unusual bleeding or discharge
    • T- thickening or a lump
    • I- indigestion or difficulty swallowing
    • O- obvious change in a wart or mole
    • N- nagging cough or hoarseness
  3. Most Common Types cancers
    • Lung
    • breast
    • prostate
    • colorectal
  4. Assessment
    • History- family, smoking, occupation, habits, activity level, coping
    • Physical exam- common s/s non-specific- wt loss extreme, pain would be a late sign), weakness, fatigue
    • Diagnostic tests- CT, MRI, PET, US, CFA, CA-125, CBC (anemia)
    • Biopsy (definitive-did the cells move seeding)
    • - incisional (part)
    • - excisional (the whole tumor)
  5. Cancer Therapy
    • Goal:
    • - appropriate, effective treatment
    • - minimal functional and structural impairment
  6. Cancer Therapy: multi modal (cam do different things)
    • Surgery
    • radiation therapy (RT)
    • chemotherapy
    • biologic therapy (remicade) boost immune system
    • alone or in combinatrion
  7. Radiation Therapy
    oldest method
    • received by > 50% of all cancer patients
    • primary adjuvant or palliative
    • a highly radiosensitive tumor divides rapidly well vascularized, high O2 content and is sensitive to RT- what is it?
    • (think on cells that grow rapidly- radiation attacks those sites first ie skin, hair, mouth sores (stomatitis)
    • damages DNA: destroys ability to replicate
    • Goal: kill CA cells, spare normal cells
  8. Radiation therapy
    external beam most common
    • exact area to direct the radiation is marked
    • tatooing- bulls eye radiation (kills cancer, save normal cell)
  9. radiation therapy
    internal radiation/brachytherapy
    • into or near tumor, or into blood stream
    • Temporary (insert tube w/radiation ie cervical tampon) or permanent radiation (prostate, radioactive seeds which are implanted then decay and become no longer) localized radiation to cell...
    • principles for protection
    • - time, distance, shielding (next slide)
  10. Internal Radiation
    • 1. time- organize and prioritize
    • - 30 mins per 8 hrs
    • - no pregnant nurses, no children
    • - vistors restricted, 6 feet away
    • 2. distance- greater the distance, less the exposure
    • 3. shielding-lead shields (work behind this), film badges (how much exposure the nurse has)
  11. Internal radiation
    • Private room and bath, post sign
    • bedrest PRN, log roll ( decrease dislodging of seeds)
    • foley catheter
    • only staff trained
    • care with vomit if oral isotope (cover w/absorbent pad over it, double gloves- with any body fluids
    • dislodged: specific policy- q room would have longs tongs in lead container keeping it away from you.
    • radiation safety office
    • - out pt- nothing leaves the room- be careful about who you assign
    • - double gloves, gown, mask, eye protection
  12. Side Effects- radiation
    • Radiation therapy
    • may take 10-14 days, may last weeks
    • skin reactions, fatigue alopecia, stomatitis, GI disturbances (vomiting/dysphagia), bone marrow depression
    • skin cells and skin replicate fast...thats why they are the most affected
  13. Skin reactions
    • mild erythema to moist desquamation (skin slough off, sun burn)
    • acute, chronic
    • basic skin care principles
    • - tepid water, pat dry
    • - dont remove markings
    • - non irritating alcohol/perfume free lotion: RT therapy orders, vita A&D
    • Wet wounds- clean and dry non adherent dsg prescribe ointment
  14. Skin reaction
    nursing management
    • avoid heating pads, ice packs, contrictive clothing, tape, direct sun light, chlorinated pools
    • shave with electric razors after treatment- bc of skin break down
    • looks like a sun burn it looks dry
  15. fatigue
    • Common
    • unclear cause
    • usually begins 3rd or 4th week of treatment
    • gradually fades
    • rest periods, adequate sleep, adequate nutrition, walking programs- evidence based, get them moving helps with fatigue
  16. Chemotherapy
    • cell kill- induced apoptosis
    • works by interfering with cell division
    • cure, control, palliative
    • cycles
    • combination- with other therapies
    • Nadir- us 7-14 (lowest point of blood count and greatest effect marrow bone)
    • - peripheral blood count are lowest due to BM suppression
    • bone marrow at risk for infection
    • 48 hours precautions for all body secretions
    • double gloves
    • chemo lines is to be patent
  17. Chemo types
    • Cell cycle specific
    • - replication/proliferation
    • cell cycle non specific
    • - active replication or rest cycle
    • see handouts on chemo
    • just know meds can be specific or non specific
  18. Chemotherapy
    how to take care
    • specially trained nurses
    • verification by two nurses
    • patient and family education- drugs s/e, NI, what to expect
    • oral, IV routes are most common- various routes
    • care not to touch oral meds
    • IV- irritating, vesicants (damage to tissues, tendons, blood vessel injury), extravasation (leaks out)
    • - usually central line access
    • - careful assessment infiltration, extravasation
  19. Chemotherapy
    what we use
    • infusion pump- IV, Sc, epidural, intra arterial
    • regional chemo
    • topical cream
    • catheters peritoneum
    • into the bladder
  20. Chemotherapy
    drugs- how to take care
    • careful monitoring
    • toxic drug effects vs. disease progression (know normal CBC)- did side effect come from the drug or did the disease progress to the liver
    • tolerable side effects vs acute toxic effects
    • care precautions
    • - gloves/gown when handling (double)
    • - gloves/gown x48hrs w/body secretions
    • - dispose equipment properly leak proof
    • - aware of emergency spill kits (policy)
    • - secure attachments on IV- so no leaking out
  21. Hypersensitivity reactions
    • rare, but serious life threatening
    • higher incidence of causing hypersensitivity: carboplatin (paraplatin), cisplatin (platinol, placitaxel (taxol), bleomycin (blenoxane)
    • stay with patient during entire infusion (initially u stay with patient to watch out for allergic reaction- fever, chest pain, pruitis, dizzy, tachycardia, rash)
    • s/s rx: dyspnea, chest pain, pruritis, urticaria, tachycardia, dizziness, anxiety, hypotension etc
    • s/s rx: dus
  22. hypersensitivity reactions
    • prevention
    • teaching
    • pre medicate steriods, benadryl, tylenol
    • protocol
    • - stop infusion
    • - emergency meds
    • - notify MD
Card Set
neoplastic disorder 2
cancer sucks
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