Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

1. Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Chapter 18: Caring for Clients with Cancer

2. Learning Objectives • Discuss the pathophysiology and etiology of cancer. • Compare benign and malignant tumors. • Name factors that contribute to the development of cancer. • Identify the warning signs of cancer. • Describe ways to reduce risks of cancer.

3. Learning Objectives • Explain methods for diagnosing cancer. • Describe systems for staging and grading malignant tumors. • Differentiate various treatments and methods for managing cancer. • Discuss various adverse effects that occur with cancer treatments and methods used to treat those effects.

4. Learning Objectives • Describe emotions associated with the diagnosis of cancer. • Use the nursing process as a framework for caring for clients with cancer.

5. Cancer Pathophysiology • Abnormal, unrelated cell proliferation • Neoplasms or tumors • Classification of Tumors • Tissue type: Carcinomas; Lymphomas; Leukemias; Sarcomas • Cell of origin and growth • Benign; Malignant • Metastasis: Primary site, secondary sites • Lymph node dissection • Carcinogenesis ; Carcinogens

6. Cancer Etiology • Second leading cause of death in U.S. (lung cancers most prevalent CA) • Men: One-half will develop CA in lifetime • Women: One-third will develop CA in lifetime • Damage to cellular DNA; Inherited cancers • Carcinogens: Chemical agents account for 75% of all CA • Environmental factors; Diet; Viruses, bacteria; Defective genes; Medical interventions • Immune system: Major factor in cancer prevention, development

8. Question Is the following statement true or false? Lung cancer is the second leading cause of death in the U.S.

9. Answer False. Cancer is the second leading cause of death in the U.S., with lung cancers being the most prevalent type of cancer.

10. Cancer Signs/Symptoms • Insidious; Asymptomatic or vague symptoms • Seven Warning Signals • A change in bowel or bladder function • Sores that do not heal • Unusual bleeding or discharge • Thickening or lump in the breast or other parts • Persistent indigestion or difficulty swallowing • A change in a wart or a mole • A persistent nagging cough or hoarseness

11. Diagnostics • Diagnostic Findings • Laboratory tests • Radiologic; Imaging tests • Radiographs; CT; MRI; Nuclear scans; Ultrasound; Fluoroscopy • Other Studies • Biopsy • Frozen section • Endoscopy • Cytology

12. Staging of Tumors • Indicates tumor growth and cell type • TNM classification • Stages: I to IV • Staged according to: Tumor size; Metastasis; Lymph node involvement • Grading of tumors: Well-differentiated; Undifferentiated • Cell differentiation: Grades I to IV • Grade IV: Poorly differentiated cells, very aggressive and unpredictable tumors

13. Cancer Treatment • Surgery: Primary method for diagnosing, staging, treating CA • Tumor Excision • Primary treatment; Debulking • Local excision; Wide or radical excision • Salvage surgery; Prophylactic surgery • Palliative; Reconstructive or plastic surgery • Other surgical interventions

14. Cancer Treatment • Radiation Therapy: High-energy ionizing radiation • How does Radiation work? • External Radiation Therapy • High-energy x-rays aimed at specific locations • Various types • Large body areas- What’s the target? • Internal Radiation Therapy: Short-distance therapy • Uses less radiation • Used alone or in combination • Types • Sealed • Unsealed

15. Cancer Treatment • Internal Radiation Therapy (Cont’d) • Expected side effects: Cumulative • Alopecia; Erythema; Desquamation; Anorexia; N/V; Diarrhea; Fatigue • Radiation Safety Principles • Time • Distance • Shielding

16. Cancer Treatment • Chemotherapy • Antineoplastic agents: Interfere with cellular function, reproduction • Cell cycle–specific drugs: Treat rapidly growing tumors • Affect cells in specific phase • Cell cycle—nonspecific drugs: Effective during any phase • Used for large, slow-growing tumors • Prolonged effect on cells; Combination therapy

17. Cancer Treatment • Chemotherapy (Cont’d) • Administration routes • Administration devices • Dosage • Extravasation prevention; Vesicants • Side effects • Adverse effects • N/V; Stomatitis, mouth soreness; Alopecia; Fatigue; Myelosuppression

18. Cancer Treatment • Blood Stem Cell Transplantation • Autologous stem cell transplantation • Self-donation • Risk ? • Allogeneic stem cell transplantation • Matched donor donation • What is GVHD? • Syngeneic stem cell transplantation • Identical twin donation • Nursing Management

19. Cancer Treatment • Immunotherapy (Trials) • Nonspecific immunotherapy • Treats localized melanoma and bladder cancer • Monoclonal antibody immunotherapy • Uses: Diagnostic; Purge remaining tumor cells; CA therapy • Cancer vaccines

20. Cancer Treatment • Hyperthermia: Heat > 106.7°F • Destroys tumor cells: Radio waves; Ultrasound; Microwaves; Magnetic waves; Hot water baths; Hot wax immersion • Photodynamic Therapy: Photoactive drug via IV • Laser light activates drug; Destroys tumor cells • Gene Therapy • New Theories • Clinical Trials: Animal testing; Four additional phases • Complementary, Alternative therapy

21. Cancer Treatment Nursing Management • Comprehensive Plan • Pain • Fatigue • Infection • Nutrition • Psychological Support • Frightened, overwhelmed clients • Client emotional reactions • Client rights

22. Cancer Treatment Nursing Management • Client/Family Education • Diagnostic procedures; Treatment choices • Complication prevention; Side effects • Adverse signs; Support available • Care of Terminally Ill Client • Physically, emotionally challenging to nurse: Includes client and family • Comfort; Pain relief • Maintain client dignity

23. NCLEX 1 • A nurse is caring for a patient with skin cancer and suspects that the client has an infection. Which assessment finding by the nurse supports the possibility that the client has an infection? • A- Blood in the stool • B- Prolonged vomiting • C- Cloudy urine • D- Extreme Fatigue

24. NCLEX 2 • The nurse notes that the clients mouth bleeds after brushing the teeth. When assisting the client with selecting foods from the menu, which food choice should the nurse suggest? • A- Spaghetti with meatballs • B- Grilled cheese sandwich • C- Salad with French dressing • D- Creamed potato soup

25. NCLEX 3 • A client is receiving chemotherapy for breast cancer and is experiencing bone marrow suppression. The LPN can expect the client to exhibit which of the following signs and symptoms? SELECT ALL THAT APPLY • A. Fatigue • B. Bone Pain • C. Headaches • D. Easy Bruising • E. Bleeding from the gums