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General Concepts of Oncology Nursing

General Concepts of Oncology Nursing 34
General Concepts of Oncology Nursing Joyce Marrs, RN, BSN, OCNTop Ten Reasons 10. No more bedpans, no more mitered corners. 9. The excuse “Chemo Brain” sounds better than “I’m Blonde.” 8. Trying to beat Dracula at blood drawing competition, good place to practice. 7. Will never need to buy school pens again. 6. Cross multiply and divide was my favorite math equation in school.Top Ten Reasons 5. Wearing scrubs to work is like being in my PJ’s all day. 4. I consider hanging IV bags all day my daily stretching exercise. 3. Lunch is usually provided, provided you have time to eat. 2. I’m too young to be a greeter at Wal Mart. 1. It’s the best job I’ve ever had.Estimated 2002 New Cases ♦ Male:♦ Female: ♦ Prostate 30♦ Breast 31 ♦ Lung/Bronchus 14♦ Lung/Bronchus 12 ♦ Colon/Rectum 11♦ Colon/Rectum 12 ♦ Urinary/Bladder 7♦ Uterine 6 ♦ Melanoma 5♦ NonHodgkin’s 4 ♦ NonHodgkin’s 4♦ Melanoma 4 ♦ Kidney 3♦ Ovary 4Estimated 2002 Deaths ♦ Male:♦ Female: ♦ Lung/Bronchus 31♦ Lung/Bronchus 25 ♦ Prostate 11♦ Breast 15 ♦ Colon/Rectum 10♦ Colon/Rectum 11 ♦ Pancreas 5♦ Pancreas 6 ♦ NonHodgkin’s 5♦ Ovary 5 ♦ Leukemia 4♦ NonHodgkin’s 4 ♦ Esophagus 3♦ Leukemia 4Cultural Considerations: ♦ AfricanAmericans have Higher Incidence ♦ AfricanAmericans have Higher Rate of Death ♦ Native Americans have Poorer Survival even though they have Lower Incidence An Organized Society ♦ Tight Regulation of – Cell Division – Proliferation – Differentiation • Goal is to maintain balanceReview of Definitions ♦ Neoplasm ♦ Tumor ♦ Oncos ♦ Oncology ♦ CancerTerminology ♦ Benign Tumors♦ Malignant Tumors ♦ Add “oma” to the cell ♦ Add “carcinoma” to of origin cellular origin ♦ Capable of Mitosis♦ Have no Purpose ♦ Adhere Tightly ♦ Complete Cell Cycle ♦ Not capable of ♦ Anaplastic Metastasis ♦ Adhere Loosely ♦ Can SpreadTerminology: Benign or Cancerous ♦ Benign♦ Cancerous ♦ Gland/Duct:♦ Gland/Duct: – Adenoma – Adenocarcinoma Melanocyte: Melanocyte: Nevus Malignant Melanoma Fatty Tissue: Fatty Tissue: Lipoma Liposarcoma Muscle: Muscle: Leiomyoma LeiomyosarcomaTheories of Carcinogensis ♦ InitiationPromotionProgression Model ♦ Oncogene and Tumor suppressor gene Model ♦ Disease of Differentiation ♦ Stem Cell Disease ♦ Disease of Intercellular CommunicationPromotion Promotion Initiation Promotion Metastasis Higher Tumor Normal Altered Grade Cell Malignancy ProgressionBody Defense: Immune Surveillance System ♦ Recognition of nonself ♦ Tumor Antigens found on certain Ca Cells –CEA – PSA –CA 2729 –CA 127 –CA 199Tumor Staging ♦ TTumor ♦ N Nodes ♦ M Metastasis – T 03 – N 02 – M 02Tumor Grading ♦ Well Differentiated ♦ Moderately Differentiated ♦ Poorly Differentiated ♦ AnaplasticRisk Factors ♦ Environmental Risk Factors ♦ Personal Behaviors ♦ Occupation ♦ HormonesRisk Factor Reduction ♦ Lifestyle Modification – Eliminate tobacco use – Moderate alcohol consumption – Diet – Exposure to Ultraviolet LightNursing Impact on Cancer: Primary Prevention ♦ Educate, Educate, Educate ♦ Warning Signs of Cancer: –Change in Bowel or Bladder –A sore that does not heal –Unusual bleeding or discharge –Thickening or a lump in the breast or elsewhere –Indigestion or difficulty swallowing –Obvious change in mole or wart –Nagging cough or hoarsenessSigns of Cancer ♦ Pain ♦ Fatigue ♦ Cachexia ♦ Anemia ♦ Infection ♦ Leukopenia and Thrombocytopenia ♦ Paraneoplastic SyndromesPrimary Prevention: Screenings ♦ Promote Lifestyle changes that reduce the risk of developing cancer ♦ Colon and Rectal: Guiac testing and DRE annually at age 40, sigmoidoscopy age 50. ♦ Prostate: PSA and DRE annually age 50. ♦ Cervical: Pap test and pelvic exam yearly. ♦ Breast: Monthly SBE, Yearly Breast exam, and mammography. Secondary Prevention: After the diagnosis ♦ Surgery ♦ Radiation ♦ Chemotherapy or Biotherapy ♦ Nursing responsibility is to educate the patient to help prevent against further problems. Assess, Intervene, and MonitorSurgical Goals CURE PALLIATION Rehabillitation Supportive CareRadiation Therapy ♦ External Radiation ♦ Internal Radiation – BrachytherapySide Effects of Radiation ♦ Fatigue ♦ Anorexia ♦ Skin Reactions ♦ Bone Marrow SuppressionPatient Education ♦ What to expect ♦ How to care for the area ♦ What precautions are neededFatigue Management ♦ Diet ♦ Exercise ♦ Fluids ♦ Journals ♦ Balance of Rest and ActivitySkin Reaction Management ♦ Dry desquamation: Use lotion without irritating additives ♦ Wet desquamation: Keep clean and protect against infection.Chemotherapy ♦ Systemic Treatment: Affects the cellular level. – Cell Cycle Specific • Antimetabolites: Methotrexate, 5FU, Fludara – Cell Cycle NonSpecific • Antitumor Metabolites: Adriamycin, Bleomycin • Alkylating Agents: Cytoxan, Cisplat, CarboplatinMethod of Administration ♦ Intravenous: – Infusion Port, PICC line, Midline ♦ Intramuscular ♦ Subcutaneous ♦ Oral ♦ Intrathecal ♦ Intracavitary ♦ TopicalNursing Assessment for Chemotherapy Administration ♦ Venous Status ♦ Oral Cavity Status ♦ GI Status ♦ Hematological Status ♦ Psychosocial Issues ♦ Educational NeedsSafe Handling Practice ♦ Prepare Chemotherapy in Biological Safety Cabinet ♦ Use Personal Protective Equipment: Gown, Gloves, Plastic backed Liner ♦ Dispose in Approved Containers ♦ Spill Kit AvailablePatient Teaching Guidelines ♦ For 48 Hours following Chemo: – Flush Toilet Twice – Rinse Toilet with Bleach Once a Day – Caregiver should wear Gloves, if in contact with any body fluids – Use Condom for Sexual InteractionPatient Teaching Guidelines ♦ Between Chemotherapy Sessions: – Weekly CBC – NADIR – Expectation of Side Effect Timing – What to ReportManaging Side Effects ♦ Fatigue ♦ Nausea and Vomiting ♦ Alopecia ♦ Diarrhea ♦ Stomatitis ♦ Bone Marrow Suppression ♦ Peripheral NeuropathyIntimacy ♦ Body Image Changes ♦ Role Changes ♦ Pregnancy Concerns ♦ When to Abstain From Sexual Intercourse ♦ Managing Patient Concerns: PLISSIT ♦ Use Open Ended Questions in Discussion with PatientBiological Therapy ♦ Interferons ♦ Interleukins ♦ Monoclonal AntibodiesHematopoietic Growth Factors ♦ GCSF (Granulocyte Colony Stimulating Factor) ♦ GMCSF (GranulocyteMacrophage CSF) ♦ MCSF (Macrophage CSF) ♦ Multicolony Stimulating Factor ♦ Erythropoietin ♦ NeumegaBone Marrow Transplantation ♦ Allogeneic ♦ Autologous ♦ Syngeneic ♦ Peripheral Stem Cell TransplantationAlternative/Complimentary Therapy ♦ Herbal Supplements ♦ Special Diets: Macrobiotics ♦ Vitamin Therapy ♦ Relaxation Therapy ♦ Guided Imagery ♦ Massage TherapyOncologic Emergencies ♦ Superior Vena Cava Syndrome ♦ Hypercalcemia ♦ Tumor Lysis Syndrome ♦ Spinal Cord Compression ♦ SIADHSuperior Vena Cava Syndrome ♦ SVC – Thinwalled – Lowpressure vessel – Collapses easily with external pressure – Clinical picture is due to venous hypertensionHypercalcemia ♦ Normal serum calcium 911 mg/dl ♦ If ionized calcium level not done, check albumin ♦ If not properly treated: 50 mortality rateTumor Lysis Syndrome ♦ Metabolic Complication of Treatment ♦ High Risk Individuals are those with bulky disease that is responsive to therapy. ♦ Caused by the breakdown of tumor cells. ♦ Can be PreventedSpinal Cord Compression ♦ Occurs in Approximately 1015 of oncology patients. ♦ Results from direct extension of nodes to spinal cord or metastatic involvement. – 70 Thoracic area – 20 Lumbosacral area – 10 Cervical areaSIADH ♦ Syndrome of Inappropriate Antidiuretic Hormone – Results in a Low Sodium Level – Frequent Disorder seen in Lung Cancer – Treated by restricting fluid or administering 3 NaCl intravenously – Slowly raise sodium level to reduce risk of cerebral edemaNursing Management: Tertiary Care/ Palliation ♦ When to Refer to Hospice or Palliative Care – Symptom Management – Psychological Support Tertiary Care: Pain Management ♦ Assessment: Location, Duration, Radiation, Measures used. ♦ WHO pain relief ladder – Step 1: Nonopioid, Adjuvant – Step 2: Addition of Opioid – Step 3: Opioid, Nonopiod, Adjuvant, Assess need for additional pain control measures such as nerve block, epidural catheter Maintaining Your Enthusiasm ♦ Remember there is Hope and Optimism ♦ Empower your Patient ♦ Help your patient to live with, through, and beyond the diagnosis of cancer ♦ Take the time to listen, you have just given that patient something priceless. ♦ You may be only a temporary part of the journey, make it a pleasant one. Great Web Sites ♦ www.ons.org ♦ www.asco.org ♦ www.plwc.org ♦ www.cansearch.org ♦ www.patientadvocate.org ♦ www.phrma.org ♦ www.cancer.orgDeveloping Your Potential ♦ Join your Professional Nursing Organization: Sigma Theta Tau ♦ Become an Active Participant in a Local Organization ♦ Take Advantage of Learning Opportunities ♦ Find a Mentor: www.ons.org Student’s Virtual Community ♦ Be Involved
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