Nursing Management In Cancer Care  Cancer: is a disease process that begins when an abnormal cell is transformed by the genetic mutation of the cellular DNA. This abnormal cell forms a clone and begins to proliferate abnormally, the cells infiltrate these tissues and gain access to lymph and blood vessels, which carry the cells to other areas of the body.

Angiogenesis Angiogenesis is the growth of new capillaries from the host tissue by the release of growth factors and enzymes such as vascular endothelial growth factor (VEGF).

Etiology viruses and bacteria. physical agents. chemical agents. genetic or familial factors. dietary factors. hormonal agents.

Warning Signs (signals) of Cancer weight loss bleeding and fever pain and tiredness persistent cough (thyroid Ca.) skin changes loss of appetite and trouble swallowing bowel movements change in urination change in voice Wound that do not heal

The stage and grade of the tumor The stage and grade of the tumor. Staging determines the size of the tumor and the existence of local invasion and distant metastasis. Grading : describes how much cancer cells look like healthy cells.

Nursing Management in Cancer NURSING DIAGNOSIS: Risk for infection related to inadequate defenses related to myelosuppression secondary to radiation or antineoplastic agents. Nursing Interventions 1. Assess patient for evidence of infection: 2. Report fever (_38.3°C [101°F] or _38°C [100.4°F] for longer than 1 hour), chills, diaphoresis, swelling, heat, pain, erythema. 3. Obtain cultures and sensitivities as indicated before initiation of antimicrobial treatment

NURSING DIAGNOSIS: Impaired skin integrity: Nursing Interventions a NURSING DIAGNOSIS: Impaired skin integrity: Nursing Interventions a. Avoid the use of soaps, cosmetics, perfumes, powders, lotions and ointments, deodorants. b. Use only lukewarm water to bathe the area. c. Avoid rubbing or scratching the area. shaving the area with a straight-edged razor

NURSING DIAGNOSIS: Impaired tissue integrity: alopecia Nursing Interventions 1. Discuss potential hair loss and regrowth with patient and family; advise that hair loss may occur on body parts other than the head. 2. Explore potential impact of hair loss on self-image, interpersonal relationships, and sexuality. 3. Prevent or minimize hair loss through the following: a. Cut long hair before treatment. b. Use mild shampoo and conditioner, gently pat dry, and avoid excessive shampooing. c. Begin to wear wig before hair loss.

NURSING DIAGNOSIS: Imbalanced nutrition, less than body requirements, related to nausea and vomiting Nursing Interventions Suggest foods that are preferred and well tolerated by the patient, preferably high-calorie and high-protein foods. Administer prescribed antiemetics, sedatives, and corticosteroids before chemotherapy and afterward as needed. Suggest smaller, more frequent meals Encourage adequate fluid intake, but limit fluids at mealtime.

NURSING DIAGNOSIS: Chronic pain Nursing Interventions 1 NURSING DIAGNOSIS: Chronic pain Nursing Interventions 1. Use pain scale to assess pain and discomfort characteristics: location, quality, frequency, duration, etc. 2. Assess other factors contributing to patient’s pain: fear, fatigue, anger, etc. 3. Administer analgesics to promote optimum pain relief within limits of physician’s prescription. 4. Use distraction, music therapy, biofeedback, self-hypnosis, relaxation techniques, and guided imagery before, during, and after chemotherapy

Breast Cancer Definition: is a disease begins with abnormal cells are diverted from normal body cells under poorly understood mechanism or change

Incidence and prevalence: Breast cancer is most common malignancy affecting women in the world approximately 1 of every 9 women will develop Breast cancer during her lifetime. The incidence in male is rare (less than 1%) older women those over 65 have twice incidence of Breast cancer as women age 42-64 years; it is more prevalence in the western society

Causes: the main cause is unknown but there are some risk factors Gender: female is high risk Age: higher incidence occurs with women over age 40 and in the post menopausal phase of life Genetic: women who's mothers and sisters have developed cancer, cause about 5% of Breast cancer cases Race: Kokazyan and American are in the upper socioeconomic class Hormonal: oral contraceptive Environmental, chemical agent Radiation exposure

8. Early menarche, increase in women whom menses began before age 12 years 9. Post-menopausal hormone therapy (PHT) 10. History of benign Breast disease 11. Yong women who drink alcohol and high fat diet are more affected 12. Breast feeding protect against Ca breast 13. Other cancer such as ovarian, colon, and if the cancer has appeared in one breast it is more likely to occur in the other breast

Note:- The cancer occurs most often in the upper outer quadrant of the breast and the least occur in the lower inner quadrant

Clinical manifestation: painless breast lump except in very late stage bloody nipple discharge change in appearance: lump near the surface may dimple the skin out side, change the color from pink to orange color and shape and size retraction of the nipple in case of advance stage ulceration and infection of the ulcer

Note: more than 90% of breast cancer are detected by the patient through the teaching of breast self examination of nurse and physician.

Diagnostic tests: breast self examination (BSE) once monthly (clinical examination by inspection and palpation) ultrasound of the breast and Chest x-ray. mammography of both breasts

4. pathological diagnosis: biopsy: a-incisional, b-aspiration (FNAC) fine needle aspiration cytology of the mass

Complications: The main complication of breast cancer is recurrence , may be local or regional, skin or soft tissue near the mastectomy site, axillary or internal lymph node, or distant most commonly, bone, lung, brain (metastasis).

Treatment surgery is the first line of treatment by doing either radical mastectomy or modified mastectomy which remove the entire breast and clears the axillary lymph nodes For stage three and four: adjuvant therapy - chemotherapy, according to the age and stage of cancer. Local excision.