Nursing Management: Cancer

What is it?  Definition: A group of more than 200 diseases  uncontrolled and unregulated cell growth  2 nd leading cause of death  Disparities

Pathophysiology Cellular dysfunction 1. Differentiation 2. Proliferation By Cancer Research UK, CC BY-SA 4.0, via Wikimedia Commons

Development of Cancer Carcinogens:  Chemicals  Viruses  Radiation Reversible proliferation of altered cells InitiationPromotionProgression   growth rate  Invasiveness  Metastasis

Initiation Progression Promotion

Clinical Manifestations: General  Unexplained weight loss  Fatigue  Skin changes  Thickening or lumps  Unusual bleeding or discharge  Sores that do not heal National Cancer Institute, Public Domain

Assessment: Subjective History of present illness: Symptoms Past Medical History: Viral infections, cancer, immunizations Social History: Tobacco use, UV exposure, environmental or occupational toxins Family History: Hereditary cancer syndromes

Assessment: Objective General: VS, appearance Review of Systems Focused Physical Exam

Assessment: Labs Labs: CBC, CMP Cancer gene mutation ex. BRCA1 and BRCA2 Tumor Markers ex. PSA, Alpha-fetoprotein Tissue Biopsy

Bone Marrow Harvest, By Photographer’s Mate 2nd Class Chad McNeeley (Navy News Service, N-0696M-180) [Public domain], via Wikimedia Commons

Assessment: Imaging Imaging:  X-ray  CT  MRI  Nuclear (PET, SPECT)  Ultrasound

Physiological: ABCD  Acute pain  Imbalanced nutrition: less than body requirements  Activity intolerance  Self-care deficit  Risk for infection

Psychological  Fear  Death anxiety  Ineffective role performance  Spiritual distress  Disturbed body image

Interventions Administer:  Chemotherapy  Biologic Therapy  Supportive medications Assist/Prep:  Surgical procedures  Radiation Therapy National Cancer Institute, Public Domain

Adjuvant Neoadjuvant

Chemotherapy  Purpose  Mechanism(s) of action  Complications Induction Consolidation Salvage Conditioning (HSCT)

Immunosuppression  Disorder vs. secondary immunosuppression  Neutropenia  Mild: ANC<1500 cells/microL  Severe: ANC<500 cells/microL  Risk for infection  Neutropenic precautions Scanning electron micrograph image of a human neutrophil ingesting MRSA. National Institute of Allergy and Infectious Diseases (NIAID). Public Domain

Interventions Monitor & Support: Side effects, risk for infection, central lines, psychosocial needs Educate: Neutropenic precautions, genetic counseling, therapy, end-of-life planning, coping strategies & survivorship By Cancer Research UK [CC BY-SA 4.0] via Wikimedia Commons

Complications  Infection  Acute/chronic adverse effects  Psychological distress  Secondary cancer diagnoses or recurrence of primary cancer

Evaluation: Desired Outcomes  Pain control  Optimal level of activity and functioning (ADLs)  Balanced nutritional intake  Free of infection  Healthy coping strategies and psychosocial stability