MUSCULOSKELETAL TUMORS

1. MUSCULOSKELETAL TUMORS

2. Objectives • Discuss nursing care for patients with musculoskeletal tumors. • Describe complications of treatment, including chemotherapy, radiation and surgery.

3. Overview and Pathophysiology • Tumor-like Lesions • Benign Tumors • Malignant Tumors

4. #1)Mr. A has just been diagnosed with an osteosarcoma. He shows an understanding of his treatment options when he states: “I accept that I have to lose my leg.” “I.m glad they can take out the cancer with such a small scar.” “The chemotherapy before surgery will shrink the tumor.” “This tumor is related to the colon cancer I had 6 years ago.”

5. #1 Answer: c) • Rationale: Chemotherapy and radiation are utilized prior to surgery to shrink the tumor and improve chances for limb salvage.

6. ASSESSMENT • What is “chief complaint”? • What modalities have been attempted? • What beliefs? • What support?

7. A/P and lateral x-ray Suspicious lesion CT and/or MRI X-ray/chest CT to rule out mets Bone scan Lab studies Biopsy Open, Closed, Excisional Arteriogram Diagnostic Tests

10. Non-Surgical Interventions: Chemotherapy • Shrink primary tumor, facilitate resection • Destroy or shrink pulmonary metastasis/micrometastasis • Evaluate efficacy of cytotoxic drugs preoperatively

11. Chemotherapy • Types of drug • Routes of administration • Side Effects

12. Non-Surgical Interventions: Radiation Therapy • Adjuvant bone • Palliative bone • Adjuvant soft tissue • Brachytherapy • Neuron beam therapy

13. Surgical Interventions:Considerations • Amputation vs Limb Preservation • Resection / Reconstruction

15. #2)Mr. A has just undergone a below-the-knee amputation. During his postoperative course, measures to prevent flexion contractures of the proximal joint include: placing bed in reverse trendelenburg. encouraging side lying position on affected side at least t.i.d. placing pillow under his thigh. instructing him to maintain leg in neutralrotation.

16. #2 Answer: d) • Rationale: Instruct Mr. A to maintain leg in neutral rotation, as other positions would not be beneficial, or actually lead to flexion contracture.

17. Nursing DiagnosesOutcomesInterventions

18. #3)Mr. Q, age 50, is preparing for removal of a liposarcoma with reconstructive surgery. Upon discussing pain management, Mr. Q states he had PCA-morpine after a prior surgery, but he is concerned he will become addicted if he uses it again. He takes one oral non-narcotic analgesic at bedtime & no other meds. An appropriate response would be: “Maybe you should talk to the M.D. about Demerol PCA.” “Please tell me more about why you think you’ll become addicted.” “I don’t think you should worry about addiction at your age.” “Would it help if we gave you morphine IM rather than a PCA?”

19. #3 Answer: b) • Rationale: you need to discuss with the patient his misconception regarding pain management.

20. Pain:Barriers to Cancer Pain Management • Problems related to: • Healthcare professionals • Patients • Healthcare system

21. ABCDE Approach to Pain • A = Ask / Assess • B = Believe patient & family • C = Choose options • D = Deliver interventions • E = Empower / Enable

22. Nursing Diagnosis Impaired physical mobility Alteration in comfort Outcome Patient ambulates independently unless bedrest warranted Patient verbalizes decreased or relieved pain

23. #4)Mr. J has been receiving preop chemotherapy & develops stomatitis. Dietary suggestions to help alleviate this discomfort would include: orange juice mixed with protein powder. spaghetti marinara. mashed potatoes with butter. raw vegetables.

24. #4 Answer: c) • Rationale: All other choices would exacerbate stomatitis because they are not bland.

25. Nursing Diagnosis Self-care deficit Ineffective individual & family coping Alteration in sexuality Outcome Promote self-care & ability to carry out ADLs Facilitate use of + coping skills Patient/s.o. find means t express sexuality

26. #5) Mrs, M, age 30, has been diagnosed with osteosarcoma of the pelvis. Which of the following statements indicate her understanding of the reproductive issues which occur during chemo? “I will never be able to have a baby.” “My menstrual periods will remain regular.” “I am worried my cancer will spread if I have sex.” “My husband will continue to use condoms.”

27. #5 Answer: d) • Rationale: During chemotherapy, females undergo irregular menstrual cycles & infertility. However, conception is still possible & birth control is to be used during sexual intercourse to prevent complications.

28. Nursing Diagnosis Alteration in skin integrity Alteration in emotional integrity Outcome Skin integrity remains intact Patient verbalizes feelings freely

29. Perioperative Considerations • Pain management • Anemia • Wound healing • Anxiety / Loss / Depression

30. #6)Jim, age 15, is about to undergo surgery for a 4cm. X 4cm. lesion following radiation therapy. You realize he will be at risk for a deficit in wound healing due to: prior radiation therapy. large area of resection. his father’s hx of wound healing problems. he doesn’t like to eat breakfast.

31. #6 Answer: a) • Rationale: Radiation therapy puts patients at greater risk for wound healing problems.

32. Bony Mets & Pathological Fractures

33. Summary • “Life over limb” • “Communication is key” • “Caring for the patient with a musculoskeletal tumor can combine the ‘acute’ and ‘chronic’ aspects of nursing”