1 / 81

Nursing Management in Cancer Care

Nursing Management in Cancer Care. Learning to make a difference !. Inspirational Quote:. Those who show strength and character even in the most difficult times and can inspire others with their courage; are the kind of people others look up to as true heroes!.

bruis
Download Presentation

Nursing Management in Cancer Care

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Nursing Management in Cancer Care Learning to make a difference!

  2. Inspirational Quote: Those who show strength and character even in the most difficult times and can inspire others with their courage; are the kind of people others look up to as true heroes!

  3. Resource Information Canadian Cancer Societywww.cancer.ca1-888-939-3333

  4. Last class focus was on: • Development of cancer & relationship to the immune system • Comparison of normal & abnormal cells • Importance of understanding cell cycle and how physicians try to making best use of medical treatment specific to phases of cycle • Staging & grading

  5. Today’s Class: • Warning signs of cancer • Overview of psychosocial impact, treatment methods • Fatigue • Cachexia • Nausea & vomiting • Stomatitis • Constipation & diarrhea • Pain management

  6. Today’s Class Objectives • Discuss the warning signs of cancer • Discuss broadly the nurse’s role in planning treatment • List the different treatment methods for cancer • Describe goals for quality end-of-life care • Discuss symptom management related to fatigue, nausea, vomiting, cachexia, stomatitis , constipation & diarrhea, pain

  7. Warning Signs Cancer C -Change in bowel or bladder A - A sore that does not heal U -Unusual bleeding or discharge T -Thickening or lump I -Indigestion or difficulty swallowing O -Obvious change in wart or mole N - Nagging cough or hoarseness

  8. Cancer & the Person: How will the person with cancer deal with initial diagnosis, treatment, & short/long term consequences to self & to significant others?

  9. Cancer has taken me twice and flung me to a new space. The first time, I overcame the fear of cancer. This time, I’m working on the anger of recurrence. Always a strong person, I feel both experiences have given me strengths I never have believed I was capable of. I have a deeper sense of life and joy. So in spite of the hair loss, the energy loss, and the protocols, I am becoming tempered, like steel. My metal is tested, and I am not found wanting. I’m living on a higher plane of existence (Ferrell, 1995).

  10. Have you experienced situations where you wished you could have intervened more positively to help persons with cancer?Identify a few?

  11. Cancer Affects: All levels of functioning: Intellectual Psychological Self-concept Physical Spiritual

  12. Psychosocial Aspects of Cancer Cancer is a feared and dreaded disease because: • Maybe present in advanced stages with no manifestations • Compliance with vigorous and often disfiguring treatments doesn’t guarantee a cure. • Cancer may recur after many years of remission. • A healthy life-style does not ensure escape from the disease.

  13. Coping: Coping: is a dynamic process by which a client responds to a problem to bring about relief or equilibrium.

  14. General Coping Strategies: -Rational inquiry -Negiotation -Affect reversal -Tension reduction -Suppression - Disengagement -Mutuality - Projection -Displacement/redirection -Cooperative compliance -Confrontation -Moral masochism -Redefinition/revision -Fatalism/passive acceptance -Impulsivity

  15. Individual’s Responses to Cancer Depend upon: • The clients & client’s psychological make-up • The client’s family & social community • The disease, disabilities & disfigurement it may cause • Preexisting medical conditions that may limit treatment options.

  16. Enabling Factors in Coping with Cancer: Social support systems Problem-solving ability Religion Perception of control Self-esteem Humor Positive appraisal Hardiness Hopefulness Information-seeking Positive comparisons Social skills Open communication Jalowiec & Dundas (1991)

  17. Hindering factors in Coping with Cancer: Denial Avoidance Helplessness Powerlessness Hopelessness Depression Guilt Isolation Wishful thinking Erosion of autonomy Anger Blaming others Noncompliance Jalowiec & Dundas (1991)

  18. Purpose of Nursing Interventions The purpose of nursing interventions is to help individuals cope with the experience of illness & suffering, and if necessary to find meaning in such experiences. Helping the sick to maintain hope & avoid helplessness is a major responsibility for the nurse (Rustoen & Hanestad, p. 19, 1998). How would you do this?

  19. Responsibilities of the Nurse in Cancer Care • Support the idea that cancer is a chronic illness • Assess own level of knowledge relative to the pathophysiology • Make use of current research findings and practices in care of clients with cancer • Identify clients at high risk for cancer • Participate in primary and secondary prevention • Assess nursing care needs of client with cancer • Assess learning needs, desires and capabilities • Assess social supports of client and family • Plan and implement appropriate interventions in collaboration with the multidisciplinary team. • Evaluate goals and outcome and modify plan of care as necessary.

  20. Nursing Interventions in Supporting the Cancer client • Be available, especially during difficult times • Exhibit a caring attitude • Listen actively to fears & concerns • Provide relief from distressing symptoms • Provide essential info regarding cancer & care • Maintain a relationship build on trust & confidence (be honest) • Appropriate use of touch exhibits caring • Assist in setting realistic, reachable goals • Assist in maintaining usual lifestyle patterns • Maintain hope

  21. Maintaining Hope in Persons With Cancer Nursing Interventions Encouraging: • Belief in oneself & ability (affirm the individual’s worth) • Encourage emotional expression • Help recall positive memories, times of joy and fulfillment • Help maintain meaningful relationships with others • Active involvement • Support spiritual beliefs & values • Help conserve or enhance available energy, control pain • Be honest & clear in delivery of “info” • Focus on the present – day by day – rather then an uncertain future. • Help find images symbols or rituals that foster hope

  22. Planning Treatment:Nursing Role • Build upon clients strengths • Clarify Misconceptions (FEARS) • Teach treatment process including simulation component • Teach potential reactions • Support client & their support persons • Permit the client with uninterrupted time to talk • Mobilizing social support systems

  23. Treatment Modalities & Cancer Symptom Management .

  24. Cancer Treatment may be aimed at: Cure: • Complete eradication of malignant disease Control: • Containment of cancer cell growth; long term survival Palliation: • Relief or control of symptoms and maintenance of quality of life

  25. Treatment Methods for Cancer • Surgery • Radio-therapy • Chemotherapy • Hormone-therapy • Immuno-therapy • Photodynamic therapy • Intraoperative Radiation • Whole Body Hyperthermia • Recombinant Interferon • Bone marrow transplant

  26. Whole Body Hyperthermia Photodynamic Therapy Immunotherapy Using antibodies to target killer cells directly to cancer cells: Antibodies are bound to the surface of killer cells, and they recognize specific markers on the cancer cell leading to its extermination

  27. Symptoms of Cancer & treatments: Fatigue Cachexia Nausea & Vomiting Stomatitis Constipation/diarrhea Skin reactions (Chemo/radiation) Pain (separate class)

  28. Assessment: Symptoms of Cancer & Treatments • Infection • Bleeding • Skin reactions, mucositis/stomatitis, hair loss • Nutritional Concerns (anorexia, cachexia) • GI disturbances (diarrhea, constipation, nausea & vomiting) • Pain • Fatigue • Psychosocial status • Body Image

  29. Nursing Diagnoses of Client with Cancer • Risk for infection related to altered immunologic response • Impaired tissue integrity: alopecia r/t the effects of treatment & disease • Impaired oral mucous membranes: stomatitis • Altered nutrition: less than body requirements r/t anorexia & GI changes. • Pain & discomfort r/to disease & treatment effects.

  30. Nursing Diagnoses of Client with Cancer • Fatigue r/t physical and psychological stressors. • Anticipatory grieving r/t anticipated loss and altered role function. • Body image disturbance r/t changes in appearance and role function. • PC: Bleeding

  31. Infection • Infection is the leading cause of death • Predisposing factors includes chemo, radiation treatment, malnutrition, catheters, IV’s, age, impaired skin & mucous membranes, contaminated equipment, meds, chronic illnesses • Prolonged hospitalizations

  32. More predisposing Factors to infection:

  33. Nurse Monitors WBC Counts • Leukopenia is a decrease in WBC • Neutrophils make up 60-70% of the body’s WBCs WBCs play a major role in combating infection by engulfing and destroying infective agents in a process called phagocytosis. Both the total WBC and the concentration of WBCs are important in determining the patient’s ability to fight infection. • Neutropenia puts clients at risk for infection • Nadir is the lowest ANC after myelosuppressive chemo or RT • An ANC below 1.0 x 109/L causes severe risk for infection

  34. ANC: Absolute Neutrophil countCalculation ANC < 1.0 x 109 = severe risk for infection

  35. Interventions for Infection • Monitor blood cell counts • Protect client from infection • Aseptic technique • Hand washing • Client/family teaching • Assess for infection: blood cultures, sputum, stool, urine, catheter or wounds CXR

  36. Important to Know Lab Values

  37. has been described as the most prevalent & disturbing symptom of cancer & its treatment – • 80-96% of people on chemo experience fatigue • Fatigue can be Acute or Chronic

  38. Fatigue like pain, has 4 components: • A) Physical • B) Psychological • C) Social • D) Spiritual aspects

  39. The Impact of Fatigue on Quality of Life A: PHYSICAL WELL-BEING • energy • functional ability • pain • sleep • rest • strength

  40. The Impact of Fatigue on Quality of Life B: SOCIAL WELL-BEING • caregiver burden • impact on work- home & workplace • financial burden • family/ other roles, relationships • affection & sexual function

  41. The Impact of Fatigue on Quality of Life C: PSYCHOLOGICAL WELL-BEING • anxiety • frustration • fear experiencing fatigue • feeling useless • coping & acceptance • loss of independence • Loss of cognition/attention • depression

  42. The Impact of Fatigue on Quality of Life D: SPIRITUAL WELL-BEING • Can experience a change in spirituality • altered priorities • hopelessness • meaning of fatigue

  43. Nursing Interventions : Fatigued Cancer Client • Careful assessment of ability to carry out ADL • Mild exercise, pace activities & rest periods • Rest, naps, sleep (8hrs) & conserve energy, don’t overdo it • direct /provide counseling • Manage other manifestations leading to fatigue • Keep fatigue diary (scale) … “have to” activities 1st • Get help with least important tasks • Eat small frequent attractive meals • Evaluate medications client is taking (over-the-counter) Important

  44. Cachexia-Anorexia Syndrome Name given to symptoms comprising: • Anorexia • Early satiety • Weight loss • Anemia • Asthenia • Tissue wasting • Organ dysfunction

  45. Four Causes of Cachexia in Cancer Clients: 1.Decreased nutritional intake due to: Anorexia (present 80% terminal ca) Malfunction of GI tract Psychological factors 2. Increased nutritional losses: Bleeding Protein losses through intestine diarrhea tumor-related catabolism has little effect

More Related