Download Cancer

Chapter 25
The Patient with
Cancer
Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
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Normal Body Cells
• A normal cell has the following characteristics
• Distinct, recognizable appearance typical of all cells from a
particular tissue (“tissue of origin”); has a single small nucleus
• The ability to perform a specific function when mature
• The production of substances that hold cells from the same
type of tissue closely together
• Ability to recognize other cells and identify their tissue of origin
• Reproduce in a controlled manner to produce additional
identical cells only as needed for growth and replacement
• Cell division inhibited by inadequate space or insufficient
nutrients
• Remain in their tissue of origin (except for blood cells, which
migrate)
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Benign Tumors
• Relatively harmless, primarily because they do
not spread to other parts of the body
• Problems, however, if they create pressure on
or obstruct body organs
• Surgical removal of benign tumors often
recommended
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Malignant Tumors
• Characteristics of cancer cells are
• Change in appearance from normal cells
• Inability to properly perform function of tissue of
origin; may assume functions of other cells
• Not readily recognized by other cells
• Abnormal proteins (tumor markers) on cell surface
• Random, disorganized, uncontrolled growth pattern
• Continue dividing even when no need for additional
cells, inadequate space, or inadequate nutrients
• Ability to migrate from one tissue or organ to
another
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Classification of Tumors
• Anatomic site
• Type of tissue from which they developed
• Staging system for cancer
• TNM system
• T refers to the tumor
• N to regional lymph nodes
• M to distant metastases
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Risk Factors
• Genetic and environmental
• Changes in genetic information of a normal cell can
cause alterations that lead to malignancies
• Carcinogens
• Cigarette smoke, asbestos, and nitrites
• Drugs
• Diethylstilbestrol, androgenic steroids, and high-dose
unopposed synthetic estrogens
• Familial cancers
• Appear at a higher rate than expected in one family
• Hereditary cancers
• Predictable patterns of inheritance based on a single gene
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Prevention and Early Detection
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Health promotion
Avoidance of carcinogens
Identification of high-risk people
Screening for cancer
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Diagnosis of Cancer
• Health history
• Physical examination
• Diagnostic procedures
• When cancer is suspected, when high-risk people
are screened, or when determining the extent of
known disease
• Tissue examinations, imaging studies, endoscopic
procedures, and laboratory tests
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Surgery
• To diagnose and stage the cancer, relieve
symptoms, maintain function, effect a cure, or
reconstruct affected structures
• May be extensive or simple
• Treatment based on type of cancer, location,
staging, and extent of metastasis
• Surgeon often consults with a radiologist and
an oncologist to determine the best therapy
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Radiotherapy
• Radiotherapy: given internally or externally
• Immediate and delayed effects on cells
• Immediate: cell death due to damage to cell
membrane
• The delayed effect is alteration of DNA, which
impairs the cell’s ability to reproduce
• External radiation
• Internal radiation
• Side effects
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Figure 25-3
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Chemotherapy
• Chemical agents to treat disease
• Antineoplastic
• Destroy rapidly dividing cells; may be used alone or in
combination with other forms of treatment
• Types of antineoplastic drugs
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Cytotoxic agents
Hormones and hormone antagonists
Biologic response modifiers
Radioimmunotherapy
• Administered by physician or nurse who has had
specialized education
• Route: oral, intramuscular, intravenous, intracavity,
intrathecal
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Biotherapy
• Hematopoietic growth factors
• Colony-stimulating factors: stimulate the bone
marrow to produce platelets, red, and white blood
cells
• Biologic response modifiers (BRMs)
• Intended to boost the body’s existing defenses
• Act directly on malignant cells or stimulate the
immune system to act against them
• Monoclonal antibodies
• Specific for proteins on surface of certain cancer
cells
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Bone Marrow and
Stem Cell Transplantation
• Bone marrow transplantation: used after
treatment of leukemia and lymphoma with
chemotherapy and/or radiation that destroys
bone marrow
• Stem cell transplantation: treats the destruction
of the bone marrow caused by the
chemotherapy and radiotherapy
• Transplantation of bone marrow or peripheral
blood stem cells: restores the blood
manufacturing cells
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Hormone Therapy
• Various treatments to suppress natural
hormone secretion, block hormone actions, or
provide supplemental hormones
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Complementary and
Alternative Therapies
• Nontraditional treatments
• Relaxation techniques, guided imagery, music,
meditation, herbal remedies, and acupuncture
• Complementary therapy
• Nontraditional therapy used with conventional
treatment
• Alternative therapy
• The patient uses nontraditional therapy in place of
traditional treatment
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Assessment: Health History
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Chief complaint
Functional assessment
Review of systems
Physical Examination
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Assessment: Health History
• Note patient’s diagnosis and treatment plan
• Complete drug profile; record allergies prominently
• Review the systems to detect significant symptoms
related to cancer or treatment: fatigue, weakness,
headache, sore or dry mouth, dyspnea, palpitations,
altered taste sensations, nausea, diarrhea,
constipation, blood in stools, change in urinary
frequency, hematuria or dysuria, sexual dysfunction,
numbness, and tingling sensations
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Assessment: Physical
Examination
• Note general appearance, level of
consciousness, posture, and gait
• Assess mental and emotional state
• Measure weight and vital signs and compare
with previous measurements
• Assess skin for lesions/bruises; scalp for hair
loss
• Inspect the oral mucous membranes for
lesions and inflammation
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Nursing Diagnoses
• Anxiety
• Ineffective Denial:
• Deficient Knowledge:
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Anxiety
• Encourage patient to express feelings and
identify the source of the anxiety
• Listening and touch can be very effective in
reducing anxiety
• Recognize need for patient teaching or
referrals
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Ineffective Coping
• Strategies to promote coping include teaching,
encouraging self-care within the patient’s
limitations, treating physical signs and
symptoms, emphasizing abilities, coaching in
relaxation strategies, and encouraging the use
of coping strategies that have been effective in
the past
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Risk for Injury
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Pneumonitis and pulmonary fibrosis
Cardiac toxicity
Neurotoxicity
Thrombocytopenia
Anemia
Reproductive cells
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Risk for Infection
• Avoid crowds and close contact with others
who have infectious diseases
• Promptly report any signs of infection
• Compromised host precautions
• Private room
• Strict hand washing by all who enter the room
• Fresh flowers, fruits, and vegetables not allowed
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Imbalanced Nutrition:
Less Than Body Requirements
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High-protein, high-calorie diet
Small, frequent feedings
Light exercise before meals may stimulate the appetite
Nutritional supplements (such as Carnation Instant
Breakfast, Ensure, or Sustacal), enteral feedings, or
both may be ordered if the patient has excessive
weight loss
• Be familiar with the specific antineoplastic agents so
that the patient can be advised of any specific food
restrictions
• Various combinations of antiemetics and sedatives can
be tried as ordered to obtain relief from nausea
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Impaired Oral Mucous
Membranes
• Frequent, gentle mouth care
• Artificial saliva
• Encourage increased fluid intake, chew
sugarless gum or candies, suck on ice chips,
and moisten dry food before eating
• Eat soft foods, and avoid foods that are acidic,
salty, or spicy
• Use soft-bristled or foam toothbrush
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Constipation
• Monitor patient’s bowel movements
• The physician may prescribe a high-fiber diet,
stool softeners, laxatives, and phosphate or
bisphosphate enemas to prevent or treat
constipation
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Fatigue
• Assess the patient’s need for assistance and
schedule activities to conserve energy
• Encourage patient to prioritize activities and
ask others to assume less important ones
• Daily naps and mild exercise helpful
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Disturbed Body Image
• Be sensitive to patient’s concern about hair
loss
• Use wigs, scarves, or hats
• The American Cancer Society lends wigs to
patients free of charge
• The society also sponsors the “Look GoodFeel Better” program to help patients look their
best during therapy
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Dysfunctional Grieving
• Listen in an accepting way that lets the patient
know the feelings are understood
• Support patient and provide practical
information about adapting to the loss
• Participation in a support group may help the
patient learn new coping strategies and begin
to resolve the grief process
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Impaired Family Processes
• Encourage family to remain involved
• Family members may need help to handle their
responses to the patient’s illness
• Obtain a social work consultation if necessary
to assist them with insurance and disability
claims and financial assistance referrals
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Ineffective Therapeutic Regimen
Management
• Pretreatment teaching plan informs patient of
what the prescribed therapy involves
• Chemotherapy
• Teaching plan includes drugs administered,
potential side effects, related precautions
• Provide written information to supplement the verbal
teaching
• Explore what patient has heard about
chemotherapy; correct any misconceptions
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Recovery and Rehabilitation
• If the outcome of treatment appears to be a cure, the
patient and family are usually overjoyed
• Some patients become excessively concerned with
their bodies, constantly looking for new evidence of
cancer
• Periodic checkups essential but may be dreaded
because the patient realizes that complete or
permanent recovery cannot be guaranteed
• If signs of possible recurrence, patients are concerned
• As patients recover from the effects of cancer and
cancer therapy, rehabilitation may be needed to
restore them to the highest possible level of functioning
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Terminal Illness
• Although increasing numbers of people are
surviving cancer, it is still the second leading
cause of death
• If treatment is unsuccessful, patient begins to
decline
• For patients who wish to die at home, hospice
provides support and teaching
• Focus: keep patient’s symptoms, especially pain,
under control during the final period of the illness
• Provides bereavement care after the patient’s death
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Oncologic Emergencies
• Conditions sometimes develop that require
emergency intervention as a result of the
disease process or therapy
• Examples: hypercalcemia, syndrome of
inappropriate antidiuretic hormone,
disseminated intravascular coagulation, and
spinal cord compression
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