Caring for Individuals Experiencing Cancer NURS 2016

Cancer n A disease process n Abnormal cell is transformed by a genetic mutation of the cellular DNA n Abnormal cell forms a clone and proliferates abnormally n Chronic disease with acute exacerbations

Proliferative Patterns Benign n Cells well differentiated n Encapsulated n Slow growth rate n Non-metastasizing n Little tissue damage n Not usually fatal Malignant n Cells poorly differentiated n Infiltrate surrounding tissue n Growth rate fast n Metastasizing n Extensive tissue damage n Usually fatal if proliferation not controlled

Metastatic Mechanisms n Lymphatic n Hematogenous n Angiogenesis

Categories/Factors in Carcinogenesis n Viruses and Bacteria n Physical agents n Chemical agents n Genetic and Familial factors n Dietary factors n Hormonal factors

Primary Prevention n Facilitate participation in cancer prevention programs n Promote healthful living n Engage in political action to enhance healthy community initiatives

Secondary Prevention n Detection and screening to achieve early diagnosis and prompt intervention n Screening usually involves cancers with highest incidence and survival rates n Many factors influence knowledge, attitudes and beliefs about cancer and the health promoting behaviours they practice.

Diagnostic Testing n Determine the presence and extent of a tumor n Identify possible metastatic activity n Evaluate the function of involved body systems n Obtain tissue for analysis

Management of Cancer Surgery n Diagnostic n Primary treatment n Prophylactic n Palliative n Reconstructive

Nursing Care in Ca Surgery n Consider patient’s age, organ impairment, nutritional deficits, coagulation disorders, altered immunity. n Provide support and presence as patient and family consider possible changes and outcomes of surgery. n Monitor possible complications of surgery n Peri-operative care

Management of Cancer Radiation Therapy n Used to interrupt cell growth. n External or Internal delivery n toxicity

Nursing Care in Ca Radiation n Protecting skin and oral mucosa n Protecting caregivers

Management of Cancer Chemotherapy n Antineoplastic agents used to interfer with cellular functions and reproduction. n Systemic rather than local. n Administered via oral, topical, IM, IV, SC, arterial, intracavity, and intrathecal.

Considerations with Chemo-x Extravasation Toxicity n GI system n Hematopoietic system n Renal system n Cardio pulmonary system n Reproductive system

Nursing Care in Cancer Chemotherapy n Assessing fluid and electrolyte status n Modifying risk for infection & bleeding n Administering chemotherapy: an advanced and specialty skill. n Safety of patient and caregivers

Other Cancer Management Strategies n Bone marrow transplant n Hyperthermia n Biological Response Modifiers n Photodynamic therapy n Gene therapy n Unconventional therapies

Nursing Assessment of Individuals Living with and Battling Cancer n Infection n Bleeding n Skin Problems n Hair Loss n Nutritional Concerns n Pain n Fatigue n Psychosocial Status n Body Image

Assessment Infection n Sites: pharynx, skin, perianal area, urinary and respiratory tracts. n Signs: increased WBC, pyrexia, swelling, redness, drainage, pain n Sepsis Bleeding n Sites: skin mucous membranes,intestinal, urinary, respiratory tracts, and brain. n Melena, hematuria, hemoptysis and hematemesis n Ecchymosis, petechiae, oozing at injection sites.

Assessment Skin Problems n Predisposing factors n Nutritional deficit n Bowel and bladder incontinence n Immobility n Immunosuppression n Age Alopecia n Location extensiveness n Impact on self- image

Assessment Nutritional Concerns n Monitor wt and caloric intake daily n Obtain diet hx, anorexia, meds, chewing and swallowing, N&V, diarrhea. n Clinical and lab data Pain n Identify causative factors n Identify factors the increase perception of pain. n Pain assessment

Assessment Fatigue n May serve a protective function n Weariness, weakness, lack of energy, lack of motivation, difficulty concentrating. n Less verbal, pale n Phys and psych stressors Psychosocial Status n Psychological and mental status n Mood and emotional response to results of dx testing and prognosis n Family/significant other support

Assessment Body Image n Depersonalization n Reality of illness, possible disability and death n Threats to image: surgery, hair loss, cachexia, skin changes, altered comm. patterns, sexual dysfunction