1/3/2008. Karen Burke Priscilla LeMone Elaine Mohn-Brown. Medical-Surgical Nursing Care, 2e Karen Burke, Priscilla LeMone, and Elaine Mohn-Brown

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1 Medical-Surgical Nursing Care Second Edition Karen Burke Priscilla LeMone Elaine Mohn-Brown Chapter 12 Caring for Clients with Cancer Cancer Disease that results when normal cells mutate into abnormal, deviant cells Abnormal deviant cells reproduce within the body Affects people of any age, gender, ethnicity, or geographic region Neoplasms Mass of abnormal cells that grows independently of its surroundings Two types: Benign Malignant 1

2 TABLE 12-1 Comparison of Benign and Malignant Neoplasms. Pathophysiology of Cancer Change or disruption in a gene can result in: Inaccurate blueprint coding in DNA Production of abnormal cells that become cancerous Metastasis Spread of malignant cells Impairment or alteration of the immune system contributes to metastatic lesions 2

3 TABLE 12-2 Various Cancers and Sites of Metastases. Causal Factors of Cancer External Chemicals Radiation Viruses Internal Hormones, chemotherapeutic drugs, recreational drugs Immune conditions Inherited mutations Risk Factors of Cancer Uncontrollable risk factors Heredity Age Gender Poverty 3

4 Risk Factors of Cancer Controllable risk factors Emotion Diet Weight Occupation Infection Drug and alcohol use Sun exposure Continued stress Cigarette smoking Physiologic Manifestations Characteristic of Cancer Acute or chronic pain Disruption of function Hematologic alterations Infection Hemorrhage Anorexia-cachexia syndrome Creation of ectopic sites of hormone production Physical stress Physiologic Manifestations Characteristic of Cancer 4

5 Psychologic Manifestations Characteristic of Cancer Stress Grief Guilt Fear and anxiety Powerlessness Isolation Concern for body image Sexual dysfunction Routine Cancer Checkups Breast Colon and rectum Cervix/uterus Prostate ACS Goals of Medical Treatment To eliminate the tumor or malignant cells To prevent metastasis To reduce cellular growth and tumor burden To promote functional abilities and provide pain relief to those whose disease does not respond to treatment 5

6 Procedures to Diagnose Cancer X-ray imaging Computed tomography Ultrasonography Magnetic resonance imaging Microscopic histologic examination Cytologic examination Radioisotope scans Angiography Monoclonal antibodies Direct visualization Lab Tests to Diagnose Cancer Blood, urine, and other body fluid tests Liver enzymes (ALT), (LDH) Tumor markers Tumor Identification Classification Classified and named by the tissue or cell of origin Grading Evaluates the amount of differentiation of the cell and estimates the rate of growth Staging Relative size of the tumor and extent of the disease 6

7 TABLE 12-3 TNM Staging Classification System. Cancer Treatments Surgery Radiation therapy Internal radiation External radiation Chemotherapy Biotherapy or immunotherapy Bone marrow transplant Complementary therapies Teaching for Discharge Teach client to differentiate minor from serious problems Teach client when to call for help 7

8 Prevention Teaching Avoid tobacco, secondhand smoke, alcohol Avoid obesity Eat a low-fat, high-fiber diet and antioxidant foods; avoid foods with carcinogenic additives, dyes, chemicals Take medications as ordered Prevention Teaching Limit exposure to radiation, sun exposure Use caution with carcinogenic chemicals or airborne particles Protect against viral disease Improve immunity by maintaining healthy lifestyle and managing stress Rehabilitation Assist with lifestyle changes and emotional support Attendance at self-help support groups 8

9 Home Care Teach client and family how to manage at home Wound care Diet Medications and treatments Equipment and supplies Follow-up care Hospice Care Assisting with decisions Interdisciplinary care Assessment Collect focused assessment data Be alert for: Adverse affects of cancer treatments Infection or bleeding Decreased blood cell counts Psychosocial or spiritual distress 9

10 Diagnosing, Planning, and Implementing Give psychologic support Anxiety Disturbed Body Image Anticipatory Grieving Teach areas of fk knowledge ld deficit dfiit Monitor for risk for infection, risk for injury, impaired tissue integrity Monitor nutrition Treat pain management Evaluation Monitor for exacerbation or remission of the disease process Make changes in nursing care as indicated Utilize interdisciplinary care and referrals as needed Oncologic Emergencies Pericardial effusion and neoplastic cardiac tamponade Superior vena cava syndrome Sepsis and septic shock Spinal cord compression Obstructive uropathy Hypercalcemia Hyperuricemia Tumor lysis syndrome 10