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Caring for Individuals Experiencing Cancer NURS 2016 Cancer A disease process Abnormal cell is transformed by a genetic mutation of the cellular DNA Abnormal cell forms a clone and proliferates abnormally Chronic disease with acute exacerbations Proliferative Patterns Benign Cells well differentiated Encapsulated Slow growth rate Non-metastasizing Little tissue damage Not usually fatal Malignant Cells poorly differentiated Infiltrate surrounding tissue Growth rate fast Metastasizing Extensive tissue damage Usually fatal if proliferation not controlled Metastatic Mechanisms Lymphatic Hematogenous Angiogenesis Categories/Factors in Carcinogenesis Viruses and Bacteria Physical agents Genetic and Familial factors Dietary factors Hormonal factors Chemical agents Primary Prevention Facilitate participation in cancer prevention programs Promote healthful living Engage in political action to enhance healthy community initiatives Secondary Prevention Detection and screening to achieve early diagnosis and prompt intervention Screening usually involves cancers with highest incidence and survival rates Many factors influence knowledge, attitudes and beliefs about cancer and the health promoting behaviours they practice. Diagnostic Testing Determine the presence and extent of a tumor Identify possible metastatic activity Evaluate the function of involved body systems Obtain tissue for analysis Management of Cancer Surgery Diagnostic Primary treatment Prophylactic Palliative Reconstructive Nursing Care in Ca Surgery Consider patient’s age, organ impairment, nutritional deficits, coagulation disorders, altered immunity. Provide support and presence as patient and family consider possible changes and outcomes of surgery. Monitor possible complications of surgery Peri-operative care Management of Cancer Radiation Therapy Used to interrupt cell growth. External or Internal delivery toxicity Nursing Care in Ca Radiation Protecting skin and oral mucosa Protecting caregivers Management of Cancer Chemotherapy Antineoplastic agents used to interfer with cellular functions and reproduction. Systemic rather than local. Administered via oral, topical, IM, IV, SC, arterial, intracavity, and intrathecal. Considerations with Chemo-x Extravasation Toxicity GI system Hematopoietic system Renal system Cardio pulmonary system Reproductive system Nursing Care in Cancer Chemotherapy Assessing fluid and electrolyte status Modifying risk for infection & bleeding Administering chemotherapy: an advanced and specialty skill. Safety of patient and caregivers Other Cancer Management Strategies Bone marrow transplant Hyperthermia Biological Response Modifiers Photodynamic therapy Gene therapy Unconventional therapies Nursing Assessment of Individuals Living with and Battling Cancer Infection Bleeding Skin Problems Hair Loss Nutritional Concerns Pain Fatigue Psychosocial Status Body Image Assessment Infection Sites: pharynx, skin, perianal area, urinary and respiratory tracts. Signs: increased WBC, pyrexia, swelling, redness, drainage, pain Sepsis Bleeding Sites: skin mucous membranes,intestinal, urinary, respiratory tracts, and brain. Melena, hematuria, hemoptysis and hematemesis Ecchymosis, petechiae, oozing at injection sites. Assessment Skin Problems Predisposing factors Nutritional deficit Bowel and bladder incontinence Immobility Immunosuppression Age Alopecia Location extensiveness Impact on selfimage Assessment Nutritional Concerns Monitor wt and caloric intake daily Obtain diet hx, anorexia, meds, chewing and swallowing, N&V, diarrhea. Clinical and lab data Pain Identify causative factors Identify factors the increase perception of pain. Pain assessment Assessment Fatigue May serve a protective function Weariness, weakness, lack of energy, lack of motivation, difficulty concentrating. Less verbal, pale Phys and psych stressors Psychosocial Status Psychological and mental status Mood and emotional response to results of dx testing and prognosis Family/significant other support Assessment Body Image Depersonalization Reality of illness, possible disability and death Threats to image: surgery, hair loss, cachexia, skin changes, altered comm. patterns, sexual dysfunction