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Cancer prevention
- Primary
- secondary
- Tertiary
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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
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Most Common Types cancers
- Lung
- breast
- prostate
- colorectal
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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)
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Cancer Therapy
- Goal:
- - appropriate, effective treatment
- - minimal functional and structural impairment
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Cancer Therapy: multi modal (cam do different things)
- Surgery
- radiation therapy (RT)
- chemotherapy
- biologic therapy (remicade) boost immune system
- alone or in combinatrion
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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
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Radiation therapy
external beam most common
- exact area to direct the radiation is marked
- tatooing- bulls eye radiation (kills cancer, save normal cell)
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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)
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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)
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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
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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
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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
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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
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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
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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
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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
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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
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Chemotherapy
what we use
- infusion pump- IV, Sc, epidural, intra arterial
- regional chemo
- topical cream
- catheters peritoneum
- into the bladder
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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
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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
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hypersensitivity reactions
tx
- prevention
- teaching
- pre medicate steriods, benadryl, tylenol
- protocol
- - stop infusion
- - emergency meds
- - notify MD
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