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ONCOLOGY

LECTURER: IDOL L. BONDOC,M.D.,M.A.N.

Cell cycle phases

M (mitosis: prophase metaphase anaphase telophase) G1 (growth). Rapidly dividing cells S (synthesis of DNA) G2 (growth) G0 (quiescent G1 phase). Most normal cells are in this phase

CLASSIFICATION OF NEOPLASMS
A.

BENIGN NEOPLASIA
1. CELLS ADHERE TO EACH OTHER AND THE GROWTH REMAINS CIRCUMSCRIBED.

2. GENERALLY NOT LIFE THREATENING UNLESS THEY OCCUR IN A RESTRICTED AREA (E.G., SKULL)

CLASSIFICATION OF NEOPLASMS
B.

MALIGNANT NEOPLASIA
1. CELLS INFILTRATE SURROUNDING TISSUE 2. CELLS INVADE OTHER TISSUES AND PRODUCE SECONDARY LESIONS

3. MAY SPREAD (METASTASIZE) BY DIRECT EXTENSION, LYMPHATIC PERMEATION AND EMBOLIZATION, AND DIFFUSION OF CANCER CELLS BY MECHANICAL MEANS

BENIGN NEOPLASIA CLASSIFIED ACCORDING TO THE INVOLVED


1.

2.
3. 4. 5.

6.
7. 8. 9. 10. 11.

ADENOMA GLANDULAR TISSUE LEIOMYOMA SMOOTH MUSCLE CHONDROMA CARTILAGINOUS TISSUE OSTEOMA BONE OSTEOBLAST HEMANGIOMA BLOOD VESSELS LYMPHANGIOMA LYMPHATICS NEUROMA NERVE CELLS LIPOMA ADIPOSE TISSUE PAPILLOMA ETHELIAL TISSUE RHABDOMYOMA SKELETAL TISSUE FIBROMA FIBROUS TISSUE

MALIGNANT TUMORS ARE CLASSIFIED ACCORDING TO THE TISSUE INVOLVED


1. 2. 3.

4.
5. 6. 7. 8. 9.

ADENOCARCINOMA GLANDULAR EPITHELIAL TISSUE CARCINOMA EPITHELIAL SURFACE TISSUE SARCOMA CONNECTIVE TISSUE OSTEOSARCOMA BONE OSTEOBLASTS HEMANGIOSARCOMA BLOOD VESSELS LYMPHANGIOSARCOMA LYMPHATICS NEUROFIBROSARCOMA (NEURILEMIC SARCOMA) NERVE SHEATH LIPOSARCOMA ADIPOSE TISSUE MELANOMA - MELANOCYTES

MALIGNANT TUMORS ARE CLASSIFIED BY A UNIVERSAL SYSTEM OF STAGING CLASSIFICATION, THE TNM SYSTEM
1. 2.

T DESIGNATES A PRIMARY TUMOR N DESIGNATES LYMPH NODE INVOLVEMENT

3.
4.

M DESIGNATES METASTASIS
NUMBERS 0 TO 4 DESIGNATE DEGREE OF INVOLVEMENT TIS DESIGNATES CARCINOMA IN SITU, OR ONE WHICH IS NONINFILTRATING

5.

TUMOR GRADING AND STAGING


1.

STAGING
DETERMINES THE SIZE OF THE TUMOR AND THE EXISTENCE OF STAGING THE TNM SYSTEM IS FREQUENTLY USED

2.

GRADING
REFERS TO THE CLASSIFICATION OF THE TUMOR CELLS DEFINES THE TYPE OF TISSUE ORIGIN OF THE TUMOR AND THE DEGREE TO WHICH THE TUMOR CELLS RETAIN THE FUNCTIONAL AND HISTOLOGIC CHARACTERISTICS OF THE TISSUE ORIGIN

TNM CLASSIFICATION SYSTEM


STAGE
T SUBCLASSES TX TO TIS T1,T2,T3,T4
TUMOR NO

DESCRIPTION
CANNOT BE ADEQUATELY ASSESSED

EVIDENCE OF PRIMARY TUMOR IN SITU INCREASE IN TUMOR SIZE AND INVOLVEMENT

CARCINOMA

PROGRESSIVE

N SUBCLASSES NX N0 N1,N2,N3,N4

REGIONAL REGIONAL

LYMPH NODES CANNOT BE ASSESSED CLINICALLY LYMPH NODES DEMONSTRABLY NORMAL

INCREASING

DEGREES OF DEMONSTRABLE ABNORMALITIES OF REGIONAL LYMPH NODES

TNM CLASSIFICATION SYSTEM


STAGE
M SUBCLASSES MX MO MI HISTOPATHOLOGY G1
NOT NO

DESCRIPTION
ASSESSED

(KNOWN) DISTANT METASTASIS METASTASIS PRESENT, SPECIFY SITE/S

DISTANT

WELL-DIFFERENTIATED

GRADE

G2
G3,G4

MODERATELY
POORLY

WELL-DIFFERENTIATED GRADE

TO VERY POORLY DIFFERENTIATED GRADE

EPIDEMIOLOGY OF CANCER

CANCER CAN STRIKE AT ANY ADVANCING AGE INCREASES THE RISK

AGE;

NINETY PERCENT (90%) OF ALL CANCERS ARE RELATED TO LIFESTYLE AND ENVIRONMENTAL FACTORS COMBINATION OF RISK FACTORS PROVIDE A HIGHER INCIDENCE OF SPECIFIC CANCERS

PATHOPHYSIOLOGY OF THE MALIGNANT PROCESS


CANCER BEGINS WHEN AN ABNORMAL CELL IS TRANFORMED BY GENETIC DNA MUTATION

FORMING A CLONE AND BEGINS TO PROLIFERATE ABNORMALLY

ACQUIRING INVASIVE CHARACTERISTICS THAT THEY CAN INFILTRATE TISSUES AND GAIN ACCESS TO LYMPH AND BLOOD VESSELS

CANCER DETECTION AND PREVENTION


1.

PRIMARY AIMED AT REDUCING THE RISK OF CANCER IN HEALTHY PEOPLE

2.

SECONDARY INVOLVES DETECTION AND SCREENING TO ACHIEVE EARLY DIAGNOSIS AND PROMPT INTERVENTION TO HALT THE CANCER PROCESS

EARLY WARNING SIGNS OF CANCER (CAUTIONUS)


C-HANGES IN BOWEL OR BLADDER HABITS A SORE THAT DOES NOT HEAL IN 6 WEEKS U-NUSUAL BLEEDING OR DISCHARGE T-HICKENING OR LUMP IN BREAST OR ELSEWHERE I-NDIGESTION OR DIFFICULTY IN SWALLOWING O-BVIOUS CHANGE IN A WART OR MOLE N-AGGING COUGH OR HOARSENESS U-NEXPLAINED ANEMIA S-UDDEN UNEXPLAINED WEIGHT LOSS

DIAGNOSTIC TESTS USED TO DETECT CANCER


TEST
TUMOR MARKER IDENTIFICATION

DESCRIPTION
ANALYSIS

POTENTIAL USES

OF BREAST, COLON, LUNG, SUBSTANCES FOUND IN OVARIAN, TESTICULAR, THE BODY OR BODY FLIDS PROSTATE CANCERS MADE BY THE TUMOR OR BY THE BODY RESPONSE TO A PARTICULAR TUMOR NEUROLOGIC, PELVIC, ABDOMINAL, THORACIC CANCERS

MAGNETIC CREATES SECTIONAL RESONANCE IMAGING IMAGES OF BODY STRUCTURES USING MAGNETIC FIELDS AND RADIOFREQUENCY SIGNALS

DIAGNOSTIC TESTS USED TO DETECT CANCER


TEST
CT SCAN

DESCRIPTION POTENTIAL USES


SCANS

SUCCESSIVE LAYERS OF TISSUE FOR CROSS-SECTIONAL VIEW THROUGH THE USE OF NARROW X-RAY BEAM
IDENTIFIES

NEUROLOGIC, PELVIC, SKELETAL, ABDOMINAL, THORACIC CANCERS SKELETAL, LUNG, GASTROINTESTINAL CANCERS

FLUOROSCOPY

CONTRASTS IN BODY TISSUE DENSITIES

DIAGNOSTIC TESTS USED TO DETECT CANCER


TEST
ULTRASONOGRAPHY (ULTRASOUND)

DESCRIPTION
HIGH-FREQUENCY

POTENTIAL USES
ABDOMINAL AND PELVIC CANCERS

SOUND WAVES ECHOING OFF BODY TISSUES ARE CONVERTED ELECTRONICALLY INTO IMAGES
USED

TO ASSESS DEEPER TISSUES OF THE BODY ENDOSCOPY


DIRECT

VISUALIZATION OF A BODY CAVITY OR PASSAGEWAY BY INSERTION OF AN ENDOSCOPE INTO A BODY CAVITY OR OPENING
ALLOWS

BRONCHIAL AND GASTROINTESTINAL CANCERS

TISSUE BIOPSY, FLUID ASPIRATION AND EXCISION


BOTH

DIAGNOSTIC AND THERAPEUTIC

DIAGNOSTIC TESTS USED TO DETECT CANCER


TEST
NUCLEAR MEDICINE

DESCRIPTION
USES

POTENTIAL USES
BONE, LIVER, KIDNEY, SPLEEN, BRAIN, THYROID CANCERS

INTRAVENOUS INJECTION OR INGESTION OF RADIOISOTOPE SUBSTANCES FOLLOWED BY IMAGING OF TISSUES THAT HAVE CONCENTRATED THE RADIOISOTOPES

RADIOIMMUNOCONJUGATES

MONOCLONAL

ANTIBODIES ARE LABELED WITH A RADIOISOTOPE AND INJECTED INTRAVENOUSLY INTO THE PATIENT
THE

COLORECTAL,

BREAST, OVARIAN, HEAD AND NECK CANCERS


LYMPHOMA

AND MELANOMA

ANTIBODIES THAT AGGREGATE AT HE TUMOR SITE ARE VISUALIZED WITH SCANNERS

DIAGNOSTIC TESTS USED TO DETECT CANCER


TEST
POSITRON EMISSION TOMOGRAPHY (PET) SCAN

DESCRIPTION
COMPUTED

POTENTIAL USES
LUNG, LIVER, COLON, AND PANCREATIC CANCERS

CROSSSECTIONAL IMAGES OF INCREASED CONCENTRATION OF RADIOISOTOPES IN MALIGNANT CELLS


PROVIDES

INFORMATION ABOUT BIOLOGICAL ACTIVITY OF MALIGNANT CELLS


HELPS

DISTINGUISH BETWEEN BENIGN AND MALIGNANT PROCESSES AND RESPONSE TO TREATMENT

METHODS OF EARLY DETECTION OF CANCER IN ASYMPTOMATIC PEOPLE


TEST
SIGMOIDOSCOPY

GENDER
MALE AND FEMALES MALES AND FEMALES MALES AND FEMALES MALES

AGE
50 AND OLDER

FREQUENCY
EVERY 5 YEARS

FECAL OCCULT BLOOD TEST DIGITAL RECTAL EXAMINATION PROSTATE EXAMINATION BREAST SELFEXAMINATION

50 AND OLDER

EVERY YEAR

40 AND OLDER

EVERY YEAR

50 AND OLDER

EVERY YEAR

FEMALES

20 AND OLDER

EVERY MONTH

METHODS OF EARLY DETECTION OF CANCER IN ASYMPTOMATIC PEOPLE


TEST
PAP SMEAR

GENDER
FEMALES
ALL

AGE

FREQUENCY

WOMEN WHO ARE OR WHO HAVE BEEN SEXUALLY ACTIVE,WHO HAVE REACHED 18 YEARS OF AGE, SHOULD HAVE AN ANNUAL PAPS SMEAR TEST AND PELVIC EXAMINATION
AFTER

A WOMAN HAS HAD 3 OR MORE CONSECUTIVE SATISFACTORY NORMAL ANNUAL EXAMINATIONS, THE PAP TEST MAY BE PERFORMED LESS FREQUENTLY AT HER PHYSICIANS DIISCRETION BREAST CLINICAL FEMALES EXAMINATION MAMMOGRAPHY FEMALES 20 TO 40 OLDER THAN 40 40 AND OLDER EVERY 3 YEARS EVERY YEAR EVERY YEAR

PHARMACOLOGY RELATED TO NEOPLASTIC DISORDERS: BASIC CONCEPTS

1.

USED TO DESTROY MALIGNANT CELLS BY INTERFERING WITH REPRODUCTION OF THE CANCER CELL ACT AT SPECIFIC POINTS IN THE CYCLE OF CELL DIVISION (CELL-CYCLE SPECIFIC) OR AT ANY PHASE OF THE CYCLE OF CELL DIVISION (CELL-CYCLE NONSPECIFIC)

1.

PHARMACOLOGY RELATED TO NEOPLASTIC DISORDERS: BASIC CONCEPTS


3.

AFFECT ANY RAPID DIVIDING CELL WITHIN THE BODY, THUS HAVING THE POTENTIAL FOR TOXICITY DEVELOPMENT IN HEALTHY, FUNCTIONAL TISSUE (BONE MARROW, HAIR FOLLICLES, GI MUCOSA); TO REDUCE THE POSSIBILITY OF TOXICITY, COMBINATION THERAPY IS OFTEN USED AVAILABLE IN ORAL, PARENTERAL (IM, SC, IV), INTRAARTERIAL, INTRATHECAL, AND TOPICAL PREPARATIONS

4.

NURSING CONSIDERATION

ONLY NURSES FAMILIAR WITH ADVERSE EFFECTS AND TOXICITIES OF CHEMOTHERAPY AND BIOTHERAPY SHOULD ADMINISTER THESE DRUGS

ANTICANCER AGENTS ARE CONSIDERED MUTAGENIC, TERATOGENIC, AND CARCINOGENIC AND SHOULD BE HANDLED, ADMINISTERED AND DISPOSED ACCORDINGLY
PATIENT SHOULD BE ENCOURAGED TO REPORT UNUSUAL SYMPTOMS AND ADVERSE EFFECTS.

CANCER TREATMENT GOALS

CURE, TO ERADICATE THE CANCER AND PROMOTE LONG TERM PATIENT SURVIVAL CONTROL, TO ARREST TUMOR GROWTH

PALLIATION, TO ALLEVIATE SYMPTOMS WHEN THE DISEASE IS BEYOND CONTROL


PROPHYLAXIS, TO PROVIDE TREATMENT WHEN NO TUMOR IS DETECTABLE BUT THE PATIENT IS KNOWN TO BE AT HIGH RISK FOR TUMOR DEVELOPMENT OR RECURRENCE

Chemotherapy

Goal is to kill rapidly dividing cells with drugs and leave other cells unharmed
Certain normal cells also divide rapidly
Hair cells Bone marrow Epithelial cells lining the digestive tract

Cause DNA damage or inhibit replication and transcription May trigger apoptosis

ANTINEOPLASTIC DRUGS
1.

2.
3. 4. 5. 6. 7.

ALKYLATING AGENTS ANTIBIOTICS ANTIMETABOLITES HORMONES IMMUNE AGENTS MISCELLANEOUS AGENTS COMMON COMBINATIONS OF NEOPLASTIC AGENTS

ALKYLATING AGENTS
A.

CELL-CYCLE NONSPECIFIC; ATTACK THE DNA OF RAPIDLY DIVIDING CELLS EXAMPLES


1. 2. 3. 4. 5. 6. BUSULFAN CHLORAMBUCIL CISPLATIN CYCLOPHOSPHAMIDE LOMUSTINE MELPHALAN

B.

ANTIBIOTICS
A.

CELL-CYCLE NON-SPECIFIC; INHIBIT RNA AND PROTEIN SYNTHESIS IN RAPIDLY DIVIDING CELLS EXAMPLES
1. 2. 3. 4. 5. 6. DACTINOMYCIN DAUNORUBICIN DOXORUBICIN HYDROCHLORIDE MITHRAMYCIN MITOMYCIN PROCARBAZINE HYDROCHORIDE

B.

ANTIMETABOLITES
A.

CELL-CYCLE SPECIFIC; INHIBIT PROTEIN SYNTHESIS IN RAPIDLY DIVIDING CELLS DURING S PHASE EXAMPLES
1. 2. 3. 4. 5. 6. 7. AZATHIOPRINE CYTARABINE FLOXURIDINE FLUOROURACIL HYDROXYUREA MERCAPTOPURINE METHOTREXATE

B.

HORMONES
A.

CELL CYCLE NON-SPECIFIC; INHIBIT RNA AND PROTEIN SYNTHESIS IN TISSUES THAT ARE DEPENDENT ON THE OPPOSITE (SEX) HORMONE FOR DEVELOPMENT

B.

EXAMPLES
1. 2. 3. 4. 5. ANDROGENS ESTROGENS PROGESTINS STEROIDS (PREDNISONE) OTHER

a) MITOTANE CORTISOL ANTAGONIST b) TAMOXIFEN CITRATE ESTROGEN ANTAGONIST

IMMUNE AGENTS
A.

INVOLVES INTRODUCTION OF NONCANCEROUS ANTIGENS OR OTHER AGENTS INTO THE BODY TO STIMULATE PRODUCTION OF LYMPHOCYTES AND ANTIBODIES

B.

EXAMPLES
1. BACILLUS OF CALMETTE-GUERIN (BCG) VACCINE: PROVIDE ACTIVE IMMUNITY 2. INTERFERON ALFA-2a AND 2b

MISCELLANEOUS AGENTS
A.

LEUCOVORIN CALCIUM
1. A REDUCED FORM OF FOLIC ACID 2. ANTIDOTE TO FOLIC ACID ANTAGONISTS

MISCELLANEOUS AGENTS
B.

PACLITAXEL
1. INHIBITS THE REORGANIZATION OF THE MICROTUBULE NETWORK THAT IS NEEDED FOR INTERPHASE AND MITOTIC CELLULAR FUNCTIONS

2. CAUSES ABNORMAL BUNDLES OF MICROTUBULES DURING CELL CYCLE AND MULTIPLE ESTERS OF MICROTUBULE DURING MITOSIS

MISCELLANEOUS AGENTS
C.

VINBLASTIN
1. AN ALKALOID EXTRACTED FROM PERIWINKLE 2. ARRESTS MITOSIS DURING METAPHASE, BLOCKING CELL DEVISION

MAJOR SIDE EFFECTS


1.

2.
3. 4. 5.

6.
7. 8. 9. 10. 11. 12.

ANOREXIA, NAUSEA, VOMITING DIARRHEA BONE MARROW DEPRESSION STOMATITIS BLOOD DYSCRASIA BONE MARROW DEPRESSSION ALOPECIA NEUROTOXICITY HEPATOTOXICITY HYPERURICEMIA KIDNEY FAILURE DOXORUBICIN: CARDIAC TOXICITY BCG: ALLERGIC REACTIONS, ANAPHYLAXIS

RADIATION
PURPOSE:
A. B.

DIAGNOSIS TREATMENT
1. 2. 3. CURATIVE: DESTROYS NEOPLASM BY IRRADIATION PALLIATIVE: SHRINKS NEOPLASM BY IRRADIATION ADJUVANT: USED IN CONJUNCTION WITH CHEMOTHERAPY OR SURGERY TO SHRINK OR DESTROY NEOPLASM

RADIATION
EXAMPLES
A.

ALPHA PARTICLE: FAST-MOVING HELIUM NUCLES


1. 2. 3. WEIGHT: 4 ATOMIC WEIGHT UNITS (AWU) CHARGE: 2+ PENETRATION: SLIGHT

B.

BETA PARTICLE: FAST-MOVING ELECTRON


1. 2. 3. WEIGHT: PRACTICALLY 0 AWU CHARGE: 1PENETRATION: MODERATE

RADIATION
EXAMPLES
C.

1. 2. 3.
D.

GAMMA RAY: PENETRATING RAY, SIMILAR TO LIGHT RAY


WEIGHT: NONE CHARGE: NONE PENETRATION: HIGH

GOLD (198 AU): ASCITES; PLEURAL EFFUSIONS

E.
F.

SODIUM IODIDE (131 I ): THYROID GLAND


SODIUM PHOSPHATE (32 P): ERYTHROCYTE

RADIATION MAJOR SIDE EFFECTS


A. B.

LOCALIZED SKIN IRRITATION VARIES BASED ON SITE


1. GASTROINTESTINAL TRACT
a) NAUSEA b) VOMITING c) DIARRHEA

2. GONADS

a) TEMPORARY STERILITY b) PERMANENT STERILITY

RADIATION MAJOR SIDE EFFECTS


B.

VARIES BASED ON SITE


3. BONE MARROW
a) LEUKOPENIA b) THROMBOCYTOPENIA c) ANEMIA

4. RESPIRATORY TRACT PNEUMONITIS


5. GENITOURINARY TRACT - CYSTITIS

RADIATION METHODS OF DELIVERY


A.

EXTERNAL BEAM RADIOTHERAPY OR TELETHERAPY DELIVERS RADIATION TO A TUMOR BY MEANS OF AN EXTERNAL MACHINE (COBALT OR LINEAR ACCELERATOR) AT A PREDERMINED DISTANCE.

RADIATION METHODS OF DELIVERY


B.

INTERNAL RADIATION THERAPY OR BRACHYTHERAPY DELIVERS RADIATION BY SYSTEMIC, INTERSTITIAL, OR INTRACAVITY MEANS
1. SYSTEMIC (METABOLIZED) INVOLVES ADMINISTRATION BY INTRAVENOUS OR ORAL ROUTES INTERSTITIAL INVOLVES IMPLANTATION WIRES, OR SEEDS INTO THE TISSUE OF NEEDLES,

2.

3.

INTRACAVITY RADIATION INVOLVES PLACING AN IMPLANT INTO A BODY CAVITY AND MAY REQUIRE A SURGICAL PROCEDURE

RADIATION INFLUENCING FACTORS


A. B. C. D. E. F.

TYPE OF TUMOR LOCATION OF THE TUMOR

TOLERANCE OF ADJACENT TISSUE


EXTENT OF THE DISEASE PROCESS HEALTH STATUS OF THE CLIENT AGE OF THE CLIENT

BIOTHERAPY
ALSO USE

KNOWN AS IMMUNOTHERAPY

OF SUBSTANCES (NATURAL OR SYNTHETIC) THAT STIMULATE THE BODYS IMMUNE SYSTEM TO FIGHT DISEASE BY AFFECTING BIOLOGICAL RESPONSES IN HOST-TUMOR INTERACTIONS

SURGICAL TREATMENTS

DEBULKING
REMOVE THE ENTIRE TUMOR INCLUDING LYMPH NODES USED WHEN THE SIZE OF THE TUMOR HAS GROWN LARGE ENOUGH TO CAUSE SYMPTOMS THAT AFFECT QUALITY OF LIFE. ADJUVANT THERAPY IS MORE EFFECTIVE AFTER THIS TYPE OF SURGERY

WIDE AND LOCAL EXCISION


SURGICAL REMOVAL OF A SMALL TUMOR MASS RADICAL SURGICAL RESECTION IS PERFORMED FOR LOCAL CONTROL OR PALLIATION OF SYMPTOMS REMOVES THE PRIMARY ALONG THE LYMPH NODES. TUMOR

PALLIATIVE

SURGERY

USED TO RELIEVE COMPLICATIONS, SUCH AS PAIN, ULCERATION, OBSTRUCTION, HEMORRHAGE OR PRESSURE. EXAMPLE IS CORDOTOMY TO RELIEVE INTRACTABLE PAIN

PROPHYLACTIC

SURGERY

INVOLVES THE REMOVAL OF NONVITAL TISSUES OR ORGANS WITH A HIGH POTENTIAL FOR DEVELOPING CANCER IN PATIENTS WITH PERSONAL OR FAMILIAL RISK FACTORS FOR A PARTICULAR TYPE OF CANCER.

EXAMPLE IS PROPHYLACTIC MASTECTOMY

GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY

ASSESSMENT:
1.

OBTAIN A DESCRIPTION OF ONSET AND PROGRESSION OF SYMPTOMS PERFORM PHYSICAL ASSESSMENT TO DETERMINE GENERAL STATE OF HEALTH AND NUTRITION DETERMINE CLIENTS UNDERSTANDING OF DISEASE AND TREATMENT PLAN

2.

3.

GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY

ANALYSIS/NURSING DIAGNOSES
1.

DECISIONAL CONFLICT (CHOICES REGARDING HEALTH OR DEATH) RELATED TO:


a. CHOICE OR CONTINUATION OF TREATMENT MODALITY b. RELIGIOUS, MORAL, OR ETHICAL BELIEFS

2.

FATIGUE RELATED TO DEPLETION OF BODY RESERVE

GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY

ANALYSIS/NURSING DIAGNOSES
3.

FEAR RELATED TO:


a. DIAGNOSIS b. DEATH c. INTRACTABLE PAIN

4.

RISK FOR INFECTION RELATED TO ALTERED IMMUNE RESPONSE


RISK FOR INJURY PROCESS/THERAPEUTIC CHEMOTHERAPY) RELATED TO DISEASE MODALITIES (RADIATION,

5.

GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY

6.

ALTERED NUTRITION: LESS THAN BODY REQUIREMENTS RELATED TO:


a. DISEASE PROCESS b. THERAPEUTIC MODALITIES

7.

ALTERED ORAL RELATED TO:

MUCOUS

MEMBRANE

a. DISEASE PROCESS b. THERAPEUTIC MODALITIES

GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY

8.

PAIN RELATED TO:


a. DISEASE PROCESS b. THERAPEUTIC MODALITIES

9.

POWERLESSNESS RELATED DIAGNOSIS/PROGNOSIS

TO

10.

IMPAIRED TISSUE INTEGRITY RELATED TO TREATMENT MODALITIES

GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY

PLANNING/IMPLEMENTATION:
1.

REVIEW INFECTION CONTROL GUIDELINES WITH CLIENT

2.

TEACH CLIENT TO REPORT TEMPERATURE HIGHER THAN 100F (37.7C) TO PHYSICIAN

GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY

3.

INSTRUCT CLIENT REGARDING SPECIAL MEASURES TO LIMIT INFECTION AND INJURY (E.G., GENTLE ORAL HYGIENE, PREVENTION OF PATHOLOGIC FRACTURES)
EXPLAIN SIDE EFFECTS THAT INFLUENCE APPEARANCE AND ENCOURAGE POSITIVE ADAPTATIONS (E.G, PURCHASE OF WIGS, SCARVES, HATS)

4.

GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY

5.

IMPLEMENT MEASURES TO REDUCE OR ELIMINATE NAUSEA SUCH AS ANTIEMETICS, HYPNOSIS, RELAXATION MODALITIES, SMALL FREQUENT FEEDINGS, ADJUSTMENT OF MEAL TIMES IN RELATION TO THERAPY, AVOIDANCE OF SPICY FOODS

GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY

6.

MONITOR BLOOD WORK DURING THERAPY


a. b. c. d. WHITE BLOOD CELLS RED BLOOD CELLS PLATELETS TUMOR MARKERS
1) ALPHA-FETOPROTEIN LIVER, TESTES 2) CA-125 OVARIES, GI 3) CARCINOEMBRYONIC ANTIGEN (CEA) BREAST, COLON, LUNG 4) PROSTATIC SPECIFIC ANTIGEN (PSA) - PROSTATE

GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY

7.

OFFER EMOTIONAL SUPPORT TO CLIENT AND FAMILY; ANSWER QUESTIONS AND ENCOURAGE VERBALIZATION OF FEARS

8.

ENCOURAGE CONSERVATION OF CLIENTS DECREASING ENERGY ENCOURAGE CLIENT TO LOOK GOOD, FEEL GOOD PROGRAM

9.

GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY
10.

SUPPORT NATURAL DEFENSE MECHANISMS OF CLIENT; ENCOURAGE INTAKE OF FOODS RICH IN THE IMMUNE=STIMULATING NUTRIENTS, ESPECIALLY VITAMINS A,C, AND E, AND MINERAL SELENIUM (WHOLE GRAINS AND SEEDS); IF CLIENT IS TAKING METHOTREXATE, ENCOURAGE INTAKE OF FOODS HIGH IN FOLIC ACID OR SUPPLEMENTAL FOLIC ACID WHICH IS NEEDED BY BLOODFORMING ORGANS

GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY

11.ENCOURAGE

OPTIMAL INTAKE OF HIGH NUTRIENT DENSITY FOODS; BLAND OR MECHANICAL SOFT DIET MAY BE INDICATED IF STOMATITIS EXISTS; ROUTINELY MONITOR WEIGHT

GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY

12. ENCOURAGE

WOMEN OF CHILDBEARING AGE TO USE BIRTH CONTROL MEASURES WHILE RECEIVING THERAPY BECAUSE OF MUTAGENIC/TERATOGENIC EFFECTS; AVOID USE OF BIRTH CONTROL PILL MALE CLIENTS REGARDING USE OF SPERM BANK IF PERMANENT INFERTILITY MAY RESULT

13. COUNSEL

GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY

14. KEEP

CLIENT WELL HYDRATED (3000 ML/24 HR); MONITOR INTAKE AND OUTPUT CLIENT FOR PAIN; ADMINISTER ANALGESICS AS NEEDED; PROVIDE FOR CLIENT COMFORT

15. ASSESS

GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY

16.

ENCOURAGE CLIENT TO BECOME INVOLVED IN DECISION MAKING; SUPPORT CLIENTS DECISIONS WHENEVER POSSIBLE, EVEN IF THEY DIFFER FROM THE NURSES PHILOSOPHY

GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY
17.

SPECIFIC CARE FOR CLIENTS RECEIVING CHEMOTHERAPY


a. b. MONITOR INTRAVENOUS INFUSION SITE FOR INFILTRATION TO PREVENT LOCAL TISSUE NECROSIS FOLLOW ESTABLISHED PROTOCOLS FOR HANDLING CHEMOTHERAPEUTIC AGENTS AND EQUIPMENT TO MINIMIZE EXPOSURE INSTITUTE PROTECTIVE ISOLATION IF WBCs ARE LOW

c.

d.
e.

WEAR DOUBLE GLOVES WHEN HANDLING URINE AND OTHER EXCRETIONS


OBSERVE FOR SIGNS OF BLEEDING; AVOID ANTICOAGULANTS BECAUSE OF DECREASED PLATELETS

GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY
17.

SPECIFIC CARE CHEMOTHERAPY


f.

FOR

CLIENTS

RECEIVING

AVOID SKIN CONTACT WITH DRUGS DURING PREPARATION FOR ADMINISTRATION; WEAR GLOVES; IF CONTACT OCCURS, RINSE AREA WELL WITH WATER

g. AVOID USE OF RECTAL THERMOMETERS, ENEMAS, IM INJECTIONS, AND RAZOR BLADES BECAUSE OF INCREASED BLEEDING TENDENCY h. MONITOR RENAL FUNCTION FOR NEPHROTOXICITY i. MONITOR TOXICITY VITAL SIGNS; MONITOR FOR CARDIAC

GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY

18.

SPECIFIC CARE FOR CLIENTS RECEIVING EXTERNAL RADIATION


a. AVOID WASHING OFF THE MARKS PLACED BY THE RADIOLOGIST b. INSTRUCT CLIENT TO AVOID CREAMS, SOAPS, POWDERS, AND DEODORANTS IN THE AREA DURING THE TREATMENT PERIODS c. ASSESS SKIN BURNING FOR ERYTHEMA, DRYNESS,

GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY

18.

SPECIFIC CARE FOR CLIENTS RECEIVING EXTERNAL RADIATION


d. INSTRUCT CLIENT TO WEAR COTTON, LOOSEFITTING CLOTHING e. PROTECT SKIN FROM SUNLIGHT

f. APPLY A NONADHERENT DRESSING TO AREAS OF SKIN BREAKDOWN


g. REASSURE OTHERS THAT THE CLIENT WILL NOT BE A SOURCE OF RADIATION

GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY

19. SPECIFIC

CARE FOR CLIENTS RECEIVING INTERNAL RADIATION

a. AVOID OVEREXPOSURE TO THE CLIENT AND USE THE PRINCIPLE OF TIME, DISTANCE, AND SHIELDING
b. POSTPONE ROUTINE IMPLANT IS IN PLACE HYGIENE WHILE

GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY

19.

SPECIFIC CARE FOR CLIENTS RECEIVING INTERNAL RADIATION


c. ASCERTAIN IF BODY EXCRETA HAS TO BE PLACED IN LEAD CONTAINERS FOR DISPOSAL WHEN SYSTEMIC (METABOLIZED) RADIATION IS USED d. STORE RADIUM IN LEAD CONTAINERS TO PREVENT CONTAMINATION OF ENVIRONEMENT

GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY EVALUATION/OUTCOMES
1. 2. 3. 4. 5.

REMAINS FREE FROM INFECTION

VERBALIZES FEELINGS ABOUT DISEASE AND TREATMENT


MAINTAINS SKIN INTEGRITY CONSUMES NUTRITIONALLY ADEQUATE DIET VERBALIZES DETAILS CONCERNING SELF-CARE RELATED TO TREATMENT REGIMEN

REVIEWING COMMON CANCERS


1.

2.
3. 4. 5. 6. 7.

ACUTE LEUKEMIA BLADDER CANCER BONE CANCER BREAST CANCER CERVICAL CANCER COLORECTAL CANCER ESOPHAGEAL CANCER

REVIEWING COMMON CANCERS


8.

9.
10. 11. 12. 13. 14.

HODGKINS DISEASE LARYNGEAL CANCER LIVER CANCER LUNG CANCER MALIGNANT BRAIN TUMOR PANCREATIC CANCER OVARIAN CANCER

REVIEWING COMMON CANCERS


15.

16.
17. 18. 19. 20.

PROSTATE CANCER RENAL CANCER STOMACH CANCER TESTICULAR CANCER THYROID CANCER UTERINE (ENDOMETRIAL) CANCER