Download Oncology: Nursing management in cancer patient

By: Alhanouf Alkhayat
Compare the structure and function of the
normal cell and the cancer cell.
 Differentiate between benign and malignant
tumors.
 Identify agents and factors that have been found
to be carcinogenic.
 Describe the roles of surgery, radiation therapy,
chemotherapy,bone marrow transplantation, and
other therapies in treating cancer.
 Describe the special nursing needs of patients
receivingchemotherapy.
 Use the nursing process as a framework for care
of patients with cancer.
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Pathophysiology of the Malignant Process
Proliferative Patterns
Characteristics of Malignant Cells
Management of Cancer
Radiation Therapy
Types of Radiation
Radiation side Effects
Nursing Management in Radiation Therapy
Chemotherapy
Administration of Chemotherapeutic Agents
Special Problems: Extravasation
Chemotherapy side effects
Nursing Management in Chemotherapy
anaplasia: cells that lack normal cellular
characteristics and differ in shape and organization with
respect to their cells oforigin; usually, anaplastic cells
aremalignant.
 dysplasia: bizarre cell growth resulting in cells that differ
in size, shape, or arrangement from other cells of the same
type of tissue
 hyperplasia: increase in the number of cell of a tissue;
most often associated with periodsof rapid body growth
 neoplasia: uncontrolled cell growth that follows no
physiologic demand
 metaplasia: conversion of one type of mature
 cell into another type of cell
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CHARACTERISTICS
BENIGN
MALIGNANT
Cell characteristics
Well-differentiated cells.
Cells are undifferentiated and often bear
little resemblance to the normal cells of
the tissue of origin.
Mode of growth
Tumor grows by expansion
and does not infiltrate the
surrounding tissues; usually
encapsulated.
Grows at the periphery and sends out
processes that infiltrate and destroy the
surrounding tissues.
Rate of gorwth
Rate of growth is usually
slow.
the more anaplastic the tumor, the
faster its growth.
Metastasis
Does not spread by metastasis Metastasis to the blood and lymphatic
channels and metastasizes to other areas
of the body.
General effects
Is usually a localized
phenomenon that does not
cause generalized effects
unless its location
interferes with vital functions
Often causes generalized effects, such as
anemia,
weakness, and weight loss
Tissue destruction
Does not usually cause tissue
damage unless its
location interferes with blood
flow
Often causes extensive tissue damage as
the tumo outgrows its blood supply or
encroaches on blood flow to the area;
may also produce substances thatcause
cell damage.
Ability to cause
Does not usually cause death
Usually causes death unless growth can
Cancer types can be grouped into broader categories.
The main categories of cancer include:
 Carcinoma
 Sarcoma
 Leukemia
 Lymphoma and myeloma
 Central nervous system cancers
 Tumor
marker identification
 Magnetic resonance imaging(MRI)
 Computed tomography(CT scan)
 Fluoroscopy
 Ultrasonography (ultrasound)
 Endoscopy
 Nuclear medicine imaging
 Positron emission tomography(PET scan)
 Radioimmunoconjugates
There is 3 goals in cancer management:
 Cure
 Control
 Palliation
Surgery
Radiation
Chemotherapy
Bone Marrow Transplant
Biology and Target therapy
There is two type of radiation:
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External radiation
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Internal radiation (brachytherapy):
This internal radiation can be implanted by means of
needles, seeds,beads, or catheters into body cavities
(vagina, abdomen, pleura)or interstitial compartments
(breast). Brachytherapy may also beadministered orally as
with the isotope I131, used to treat thyroidcarcinomas.
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The nurse assesses the patient’s skin, nutritional
status, and general feeling of well-being.
the patient is instructed to avoid using ointments,
lotions, or powders on the area.
Gentle oral hygiene is essential to remove debris,
prevent irritation,and promote healing.
The nurse offers reassurance by explaining that these
symptoms are a result of the treatment and do not
represent deterioration or progression of the disease.
When a patient has a radioactive implant in place,
nurses and other health care providers need to
protect themselves as well as the patient from the
effects of radiation.
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antineoplastic agents are used in an attempt to
destroy tumor cells by interfering with cellular
functions and reproduction.
Chemotherapy is used as Adjuvant therapy or neo
adjuvant therapy
Each time a tumor is exposed to a chemotherapeutic
agent, a percentage of tumor cells (20% to 99%,
depending on dosage) is destroyed.
Repeated doses of chemotherapy are necessary over
prolonged period to achieve regression of the tumor.
Eradication of 100% of the tumor is nearly impossible.
the remaining tumor cells can be destroyed by the
body’s immune system.
As a cell approaches the end
of the G1 phase it is
controlled at a vital
checkpoint, called G1/S,
where the cell determines
whether or not to
replicate its DNA
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Cells with intact DNA
continue to S phase; cells
with damaged DNA that
cannot be repaired are
arrested and ‘‘commit
suicide’’ through apoptosis
2- A second such checkpoint
occurs at the G2 phase
following the synthesis of
DNA in S phase but before
cell division in M phase
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Cyclin Dependent Kinases, or CDKs, are specific enzymes
that use signals to switch on cell cycle mechanisms.
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CDKs are activated by forming complexes with cyclins
(another group of regulatory proteins only present for short
periods in the cell cycle)
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Genetic mutations causing the malfunction or absence of
one or more of the regulatory proteins at cell cycle
checkpoints can result in the ‘‘molecular switch’’ being
turned permanently on, permitting uncontrolled
multiplication of the cell, leading to carcinogenesis, or
tumor development.
 cell
cycle–specific drugs
 cell cycle–nonspecific drugs.
 Oral
chemotherapy.
 Intravenous
 Intramuscular
 subcutaneous
 Intrathecal
 intracavitary
peritoneum
such as
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GIT :nausea,vomiting,stomtitis,mucositis,
anorexia,diarrohea or constipation.
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Hematopoietic System:
myelosuppression,nutropenia, leukopenia,
anemia and thrombocytopenia .
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Renal system: hyperkalemia ,hyperphosphatemia
,hypocalcemia and renal damage.
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Cardiopulmonary System:cardiactoxicities,lung
Fibrosis
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Reprouctive System: Abnormal ovulation, early
menopause, or permanent sterility may result.
In men, temporary or permanent azoospermia may
develop.
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Neurologic System:Peripheral neuropathies, loss of
deep tendon reflexes, and paralytic ileus may occur.
Also, ototoxcisity and hearing loss.
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Miscellaneous: Fatigue is a distressing side effect
for most patients that greatly affects quality of life.
 ASSESSING
FLUID AND ELECTROLYTE STATUS
 MODIFYING RISKS FOR INFECTION AND
BLEEDING
 ADMINISTERING CHEMOTHERAPY
 IMPLEMENTING SAFEGUARDS
 MONITORING THERAPEUTIC AND ADVERSE
EFFECTS
 Extravasation: defined as the accidental leakage from
its intended compartment (the vein) into the surrounding
tissue.Usually, this occurs when intravenous (IV)
medication passes from the blood vessel into the tissue
around the blood vessels and beyond.
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Cancer drugs can be grouped into 3 broad categories,
based on their potential to cause tissue damage upon
extravasation:
■ Non-vesicants
■ Irritants
■ Vesicants
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Step 1 Stop the infusion immediately. DO NOT remove the
cannula at this point.
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Step 2 Disconnect the infusion (not the cannula/needle).
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Step 3 Leave the cannula/needle in place and try to aspirate as
much of the drug as possible from the cannula with a 10 mL
syringe.Avoid applying direct manual pressure tosuspected
extravasation site.
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Step 4 Mark the affected area and take digital images of the
site.
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Step 5 Remove the cannula/ needle.
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Step 6 Collect the extravasation kit (if available), notify the
physician on service
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Step 7 Administer pain relief if required.
step8
• Apply a cold pack to the affected area for 20 min 4 times daily for 1—2
days.
Step9
• NEUTRALISE Neutralise the drug by using the specific antidote.for
drugs without antidotes omit step 9
• Remove the cannula after confirming no more antidote will be
Step 10 prescribed or given.
Step 11
Step12
step13
• Elevate the limb.
• Document the incident using extravasation documentation sheet
• Arrange follow up for the patient as appropriate
STEP 8 –
DISPERSE
STEP 9 –
DILUTE
• Apply a warm compress to the affected area for 20 minutes 4
times daily for 1—2 days
• Give several subcutaneous injections of 150–1500 IU of
hyaluronidase diluted in 1 m
• Document the incident using extravasation documentation
sheet
Step 10
• Arrange follow up for the patient as appropriate.
Step11
 Smeltzer,c
and Bare,b,2008.Medical Surgical
Nursing.11ed.USA:Lippincott William and
Wilkins.
 Gates,R and Fink,R.2008.Oncology Nursing
Secrets.3rd ed. USA: Mospy elsevier.
 Yarbro,C.Wjcik,D and Gobel,B.2011.Cancer
Nursing Principles and Practice.7th ed.UK: Jones
an Bartlett publishers.
 Wengström,y and et al.2007,” Extravasation
guidelines 2007:guideline implementation
toolkit”[online] available at
http://www.cancernurse.eu/