Download Care of the Patient Experiencing Cancer

RNSG 2535 – Integrated Client Care Management
Unit V - Care of the Client Experiencing Cancer
1.
Behavioral Objectives
Apply the terms listed in the
content column appropriate to the
client situations.
Content Outline
I. Application of terms
A. Adjuvant Therapy
B. Combination Chemotherapy
C. Cytology
D. Gene Therapy
E. Intravesical
F. Metastasis
G. Palliation
H. Polyps
I. Progenitor cell
J. Tumor lysis syndrome
K. Tumor marker
L. Spinal Cord Compression
M. Superior Vena Cava Syndrome
N. Wilm’s Tumor
Clinical Objectives
Work with client and
interdisciplinary health care team
for planning health care delivery
to improve the quality of care
across the life span.
Compare and contrast the
etiology and related
pathophysiology of excessive
cellular proliferation across the
lifespan.
II. Overview of typical/atypical cells
A. Developmental considerations
1. Infant
2. Child
3. Adolescent
4. Adult
5. Older adult
B. Pathophysiology
1. Proliferation growth patterns
2. Neoplastic pathology
3. Neoplastic classification systems
4. Staging/grading
C. Cellular differentiation
D. Carcinogenesis
1. Phases
2. Etiologies
a. Viruses
b. Physical agents
c. Chemical Agents (Environmental)
d. Oncogenes
e. Tumor suppressor genes
f. Genetic Predisposition
g. Immune Surveillance Theory
h. Stem Cell theory
Lehne (2010)
McKinney (2009)
Assess the adequacy of the
support system of the client.
Identify clients and families
unmet needs.
Identify providers and resources
to meet the needs of clients.
Perform health screening.
2.
Learning opportunities
READ:
Lewis (2011)
Contribute to the interdisciplinary
plan of care.
Prioritize client care and followup on problems that warrant
investigation.
Read and discuss relevant, current
nursing practice journal articles
and apply to practice.
Inform and support health care
rights of clients.
Support the client’s right of selfdetermination and choice even
when these choices conflict with
values of the individual
professional.
Identify learning needs of clients
related to health promotion,
maintenance and risk reduction.
VIDEOS:
VCR #0077 – Until I Die
VCR #0093 – Care of Colostomies &
Ileostomies.
VCR #M122 – Preparing the Ostomy patient
for discharge.
RNSG 2535 – Integrated Client Care Management
Unit V - Care of the Client Experiencing Cancer
3.
Behavioral Objectives
Analyze factors included in the
assessment of the client
experiencing problems of
cellular deviation (Cancer).
Content Outline
III. Cancer assessment
A. Interview
1. Chief complaint
2. History of present illness
3. Prior medical history
4. Treatment/ Medication History
(Prescribed/Non-prescribed)
5. Family/social/occupational history
6. Psychosocial Assessment
a. Role Behavior
b. Body Image
c. Coping Mechanisms
7. Knowledge of health maintenance
8. Identify risk factors
B. Physical exam
1. Head to toe
2. Assess for implication of disease and
treatment/medications
3. Pain – chronic vs. acute
C. Diagnostic tests
1. Laboratory studies
a. Carcinogenic Embryonic Antigen
(CEA)
b. Deoxyriboneucleic Acid
(DNA) Ploidy
c. CA 15-3
d. CA 125
e. Her 2NU
f. Papanicolaou (PAP) test
g. Prostate Surface Antigen (PSA)
h. CBC
(1) RBC
(2) Hgb/Hct
(3) Platelet
(4) WBC
(a) Differential
(b) Absolute Neutrophil Count
(ANC)
i. Estrogen Receptor Assay
j. Progesterone Receptor Assay
Clinical Objectives
Participate in interdisciplinary
health care team
meetings/conferences.
Select and carry out safe and
appropriate activities to assist
client to meet basic physiologic
needs, including: circulation,
nutrition, oxygenation, activity,
elimination, comfort, rest and
sleep.
Learning opportunities
RNSG 2535 – Integrated Client Care Management
Unit V - Care of the Client Experiencing Cancer
Behavioral Objectives
4.
Differentiate between the
etiology, pathophysiology, and
clinical manifestations of selected
problems of cellular proliferation.
Content Outline
k. Alpha Feto Protein (AFP)
2. Radiology/Imaging
a. Chest X-ray
b. Magnetic Resonance Imaging (MRI)
c. Computerized Axial Tomography
(CT)
d. Ultrasound
e. Brain Scan
f. Bone Scan
g. Liver Scan
h. Metastatic Survey
i. Mammogram
3. Invasive/biopsies
a. Punch
b. Thin Needle
c. Bone Marrow
d. Frozen sections
D. Cultural influences
1. Hereditary
2. Environmental
3. Health beliefs/practices
E. Developmental
F. Age specific assessment data
1. Behavioral/emotional response to health
care providers
2. Behavioral/emotional response to death
and dying
IV. Selected problems of cellular proliferation.
A. Hematopoetic system
1. Leukemia
B. Lymphatic
1. Lymphoma
a. Hodgkins
b. Non-Hodgkins
C. Skin
D. Gastrointestinal
1. Liver
2. Pancreas
3. Colorectal
Clinical Objectives
Learning opportunities
RNSG 2535 – Integrated Client Care Management
Unit V - Care of the Client Experiencing Cancer
Behavioral Objectives
E.
F.
G.
H.
I.
J.
5. Discuss the various treatment
options for clients experiencing
problems of cellular proliferation.
Content Outline
Lung
Brain
Bladder
Larnyx
Reproductive Female
1. Uterine
2. Cervical
3. Ovarian
4. Breast
5. Vulvar
Reproductive – Male
1. Testicular
2. Prostate
V. Treatment modalities
A. Chemotherapy
1. Systemic
2. Intravesical
3. Intrathecal
B. Radiation
1. External Beam
2. Internal
C. Hormonal Therapy
D. Transplantation
1. Bone Marrow
2. Solid Organ
E. Immune Modulated Therapy
1. Biological Response Modifiers (BRM)
(Cytokines)
a. Colony Stimulating Factors (CSF)
b. Interferon
c. Interleukins
2. Gene therapy
3. Alternative Treatments
F. Pain Control
G. Physiologic dying process
Clinical Objectives
Learning opportunities
RNSG 2535 – Integrated Client Care Management
Unit V - Care of the Client Experiencing Cancer
Behavioral Objectives
6. Discuss analysis, planning,
implementation and evaluation
for the nursing management of
clients with selected problems of
cellular proliferation.
Content Outline
VI. Selected nursing diagnoses/nursing
implementation/evaluation.
A. High risk for complications: Medical treatment
1. Independent nursing interventions
a. See head to toe assessment
b. Age related hydration status
c. Intake and output
d. Monitor pertinent diagnostic tests
e. Maintain skin integrity
f. Immune suppressed precautions
g. Bleeding precautions
h. Nutritional status
i. Oral hygiene
j. Vital signs
k. Protect photosensitive skin
2. Collaborate interventions
a. Administer replacement fluid
(1) Intravenous
(2) Total parental nutrition (TPN)
b. Administer medications and monitor
for desired effects/adverse effects/side
effects
(1) Antiemetics
(2) Antidiarrheal
(3) Antineoplastic drugs
(4) Biologic response modifiers
(BRM)
(5) Antianxiety
(6) Topical anesthetics
(7) Antacids
(8) Antibiotics
(9) Vitamins/minerals
(10) Stool softeners
(11) Laxatives
(12) GI stimulants
(13) Pain medication
(14) Steroids
c. Blood products
d. Refer dietary for nutritional support
Clinical Objectives
Learning opportunities
RNSG 2535 – Integrated Client Care Management
Unit V - Care of the Client Experiencing Cancer
Behavioral Objectives
3.
4.
Content Outline
Recognition of complications
a. Hemorrhage
b. Nephrotoxity
c. Cardiotoxicity
d. Neurotoxicity
e. Sepsis/infection
f. Pulmonary fibrosis
g. Gastrointestinal
h. Hyperuricemia
i. Hypercalcemia
j. Malnutrition
k. Bowel obstruction
l. Impaired skin integrity
m. Death
n. Pruritis
o. Alopecia
p. Alteration in reproduction
q. Blood dyscrasia
r. Fatigue/malaise
s. Second primary neoplasm
t. Neutropenia
u. Thrombocytopenia
v. Anemia
The client will have decreased risk for
medical complications as evidenced by:
a. No infection/sepsis
b. No impared skin integrity
c. No excessive weight loss
d. No bleeding
e. Maintains adequate bowel elimination
f. Vital signs WNL
g. Skin integrity intact
h. Gastrointestinal mucosa intact
i. Lab work within normal limits
j. No evidence of congestive heart
failure
k. Pulmonary function test WNL
l. Hydration status WNL
m. Absence of graft versus host disease
Clinical Objectives
Learning opportunities
RNSG 2535 – Integrated Client Care Management
Unit V - Care of the Client Experiencing Cancer
Behavioral Objectives
Content Outline
B. High risk for post op complications
1. Surgical modalities
a. Pancreataduodenectomy (Whipple)
b. Gastrectomy
c. Segmental Resection with
Anastamosis
d. Abdominal Perineal with colostomy
e. Ureteroenterocutaneous Diversions
f. Laryngectomy
g. Orchiectomy
h. Prostatectomy
i. Hysterectomy
j. Mastectomy
k. Cryotherapy
l. Palliative
2. Independent interventions
a. Colostomy
(1) Drains/assess perineal packing
(2) Fecal drainage
(3) Bowel sounds
b. Laryngectomy
(1) Maintain airway
(2) Promoting communication and
speech
(3) Neck exercises
(4) Hemorrhaging
(5) Drains
(6) Semi-fowler’s position
c. Mastectomy
(1) Monitor edema
(2) Avoid cuffs/sticks to affected side
(3) Progressive range of motion
exercises
(4) Drains
3. Collaborative interventions
a. Administer medications and monitor
for desired effects/adverse effects/
side effects
(1) Antibiotics
(2) Narcotics
Clinical Objectives
Learning opportunities
RNSG 2535 – Integrated Client Care Management
Unit V - Care of the Client Experiencing Cancer
Behavioral Objectives
Content Outline
(3) Prophylactic heparin /lovenox
b. Collaborate with enterostomal
therapist
c. Collaborate with Reach To Recovery
d. Collaborate with Lost Chords
e. Oxygen support
4. Recognition of complications
a. Hemorrhage
b. Infection: wound and systemic
c. Fistula formation
d. Peritonitis
e. Delayed wound healing: dehiscence,
evisceration
f. Malnutrition
g. Lymphedema
h. Bowel obstruction
i.
Adhesions
j.
Carotid artery rupture
5. The client will not experience post-op
complications as evidenced by:
a. Wound healing
b. Vital signs
c. Bowel sounds
d. Abdominal girth
e. Homan’s sign
f. Tolerates diet
g. Laboratory studies
h. Patent airway
i. No lymphedema
j. Adequate elimination
k. Fluid volume status
C. Altered health maintenance: Knowledge Deficit
1. Client teaching
a. Assess readiness to learn, ability,
knowledge
b. Health promotion/early diagnosis
(1) Ten steps of cancer prevention
(2) Seven warning signs
(3) Screening tests
Clinical Objectives
Learning opportunities
RNSG 2535 – Integrated Client Care Management
Unit V - Care of the Client Experiencing Cancer
Behavioral Objectives
Content Outline
Reportable signs/symptoms
(1) Post radiation
(2) Post chemotherapy
(3) Post operative
d. Laryngeal stoma care
e. Ostomy care
f. Medication teaching
g. Rest/activity
h. Life style modifications
i. Nutritional
j. Maintenance of fluid balance (Age
specific)
k. Communication
Community Resources
a. American Ostomy Association
b. United Ostomy Association of
America
c. National Cancer Information Service
d. American Cancer Society
e. Leukemia Society of America
f. Home health
g. Hospice
The client will have improved health
maintenance as evidenced by:
a. Listing health promotion activities
b. Identifying reportable signs and
symptoms
c. Describing the purpose, correct
administration and side effects of
meds
d. Ability to discuss diagnosis,
surgical procedure, and post-op care
e. Demonstrates laryngeal stoma care
f. Increasing activity as tolerated
g. Achieves optimum level of nutrition
through prescribed diet
h. Utilizing community resources
i. Range of motion exercises
j. Demonstrates ostomy care
c.
2.
3.
Clinical Objectives
Learning opportunities
RNSG 2535 – Integrated Client Care Management
Unit V - Care of the Client Experiencing Cancer
Behavioral Objectives
Content Outline
D. Body Image Disturbance
1. Independent nursing interventions
a. Establish trust and rapport
b. Utilize therapeutic communication
techniques to encourage verbalization
of feelings
c. Assess prior coping strategies and
encourage development of new
strategies
d. Encourage continued participation in
activities and decision making
e. Facilitate the client’s progression
through stages of loss
f. Encourage good hygiene, grooming,
and sex appropriate items
g. Encourage client to ask questions
2. Collaborative
a. Refer to appropriate support group
(1) Lost Chords
(2) Reach To Recovery
(3) Ostomate (Ostomy Association)
(4) CanSurmount
(5) CanCope
(6) Dialogue
(7) A Time for Me
(8) Breast cancer support group for
men
(9) Leukemia Society of America
3. The client will acknowledge change in
body image as evidenced by:
a. Participating in self care
b. Verbalizing feelings to
nurse/significant other
c. Facilitating client from sick role to
well role
d. Appearing well groomed and
attractively dressed
e. Able to communicate effectively
Clinical Objectives
Learning opportunities
RNSG 2535 – Integrated Client Care Management
Unit V - Care of the Client Experiencing Cancer
Behavioral Objectives
Content Outline
E. Anticipatory grieving
1. Independent nursing interventions
a. Establish a trusting relationship that
encourages communication
b. Clarify, re-focus, and supply
information as needed
c. Help family plan care of client
throughout stages of illness
d. Provide and assist in arrangement for
hospice care
e. Arrange for spiritual support in
accordance with family’s beliefs
and/or affiliations
f. Help family to acknowledge loss
2. Collaborative
a. Refer to appropriate support group
(1) Make a Wish Foundation
(2) Ronald McDonald House
(3) Candle Lighters
(4) Hospice
(5) Pastoral services
3. The client/family will progress through the
phases of grief as evidenced by:
a. Increased verbalization and expression
of grief
b. Identifying resources available to aide
coping strategies during grieving
c. Use resources and supports
appropriately
d. Discussing the future openly with
each other
F. Alteration in comfort: Acute/chronic pain
1. Independent interventions
a. Assessment of chronic pain
b. Provide psychological support
c. Teach about pharmacological pain
control regimens
d. Teach distraction techniques
(1) Benson’s Relaxation Technique
(2) Guided Imagery
Clinical Objectives
Learning opportunities
RNSG 2535 – Integrated Client Care Management
Unit V - Care of the Client Experiencing Cancer
Behavioral Objectives
2.
3.
4.
n:soph\fall\UnitVCancer
Content Outline
(3) Music Therapy
e. Position for comfort
Collaborative Interventions
a. Administer medications and monitor
for desired effects/adverse effects/side
effects.
(1) Analgesics
(a) Narcotics
(b) Non-Narcotic
(2) Anti-anxiety
(3) Anti-depressants
(4) Sedative
(5) Hypnotics
(6) Equal analgesic dosing
b. Refer to:
(1) Physical therapy
(2) Social services
(3) Clergy
(4) Psychological counselor
(5) Cancer support groups
(6) Hospice
(7) Home Health
(8) Pain clinic
Recognition of complications
a. Intractable pain
b. Respiratory depression
c. Depression
d. Immobility
The client will have relief of pain as
evidenced by:
a. Stating a 1 of pain on a pain scale of
1-10
b. Participating in ADL’s and other
activities
c. Demonstrating use of distraction
techniques
d. Verbalizing 3 techniques to maintain
pain at an acceptable level to client
Clinical Objectives
Learning opportunities
Revised 07/11