Cancer Nursing Management

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3 Nursing
Interventions
of N.V

Nutritional support
- No milk, grains, fruits, veg., granolas
- Low Fiber and Residue, High Cal. and Pro.
Fluid/electrolyte replacement
Decrease pungent odors

4 Diarrhea
Tx

Low fiber/residue diet

antidiarrheal medication
Fluid/electrolyte replacement
Skin care - Pericare

Alopecia

Hair Loss
- Radiation-temporary or permanent based on
dose administered
- Chemotherapy-temporary-begins re-growth
3-4 weeks, texture/color changes
Nursing intervention begins at start of
treatment
-Protect head from sunlightwear sunscreen

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Alopecia
Teaching
Points

With chemotherapy, within 3-4 weeks after tx,

hair will grow back for sure
With radiation, depending on dose of drugs,
may or may not grow back

Altered Taste
Sensation

Cancer cells release a substance resembling

amino acids that stimulate bitter taste buds
such as metallic, cotton, decreased taste buds,
or total loss of tastebuds.

Anorexia
Warning
Precautions

" I dont feel good or feel like eating"

"I'm too tired to eat"
Tx: Find foods that are Protein/Calorie Dense
within the smallest amount of food (Boost,
Ensure)

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Anorexia
with
Treatment

GI effects interfere with appetite

- Monitor Nutrition
- Small frequent meals
- High protein, high calorie
- Nutrition supplement if >5% weight loss

BMS: Anemia

Decreased RBC - takes longer because lifespan

of an RBC is 120 Days
Male: 4.7 to 6.1 million cells per microliter (c
Female: 4.2 to 5.4 million cells/mcL

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BMS: Anemia
Tx

Procrit - Promotes RBC development

- Hold if HGB is close to normal
Transfuse PRBCs if they have symptoms

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BMS: Neutropenia

ANC < 15,000 within 14 days

Most Common chemotherapy side
effect
If decreases <15k, increases chance for
infection
Because Bone marrow is suppressed,
PT may not show typical signs of
infection such as increased temp, sore
throat, or pus

BMS: Neutropenia
Drug Tx

Filgrastim (Neopogen)
Promotes WBC Growth
Call Dr. if Temp exceeds 100.5

BMS:
Thrombocytopenia

PLT Count < 100,000 within 2-3 weeks

PT can start to bleed randomly for no
reason

BMS:
Thrombocytopenia
Tx

Administer PLT Transfusion if pt is

bleeding or if platelet count is <20,000
Administer IL-11 - Promotes PLT
Growth

Cachexia

Extreme stage of anorexia where the

body uses alot of muscle mass to
generate calories just to function. Thus
the pt literally is wasting away infront
of you

Cardiovascular
Chemotherapy

- Chemo damage
Anthracyclines (doxorubicin) highest
cardiotoxicity
ECG changes, left ventricular
dysfunction (< ejection fraction)

Cardiovascular
Radiation

- Radiation damage
Pericardium most common
Preexisting CAD increases
vulnerability

Coping
Management

- Diagnoses can take awhile so anxiety

is common
1) Find out how pt/family is coping
2) Let the pt/family vent
3) Assess for AMS because it can lead
to further sub-stressors such as jobless

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Fatigue

Several theories as to cause

Muscle metabolites from breakdown
Cytokine production
Infection, serotonin deregulation

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Gerontology

- Increased lifespan=increased CA
population
- Clinical manifestations mistaken to
age-related changes
- Age is not a good predictor of
tolerance to treatment
- Patient choice (Ethical Dilemma)

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GI Effects

N.V.D
Mucositis
Xerostomia
Anorexia

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Malnutrition

- Muscle/Fat depletion
- Increase Protein
- Knowing the height and weight form the
beginning is important for treatment and to
manage nutritional status
- 5% weight loss - Nutritional Supplements

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Mucositis

Painful inflammation and ulceration of the

mucous membranes lining the digestive
tract, usually as an adverse effect of
chemotherapy and radiotherapy treatment
for cancer.
- Blisters everywhere

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Mucositis and
Xerostomia Tx

Nausea and
Vomiting
Reasons/Stages

- Oral care is key with no ETOH

- Dental care prior to treatment
- Avoid temperature extremes
Keep mouth Moist!
Why? Cells grow fastest in the Mucosa/GI
Drug Control is Key! Before and After Tx
-- Acute (within 24 hours of tx)
--Delayed (after 24 hours)
-- Anticipatory (Trigger response)

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- Release of serotonin stimulates CTZ

(chemoreceptor trigger zone)
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Nursing
Interventions
to manage
Cancer Pain
are?

1) Through Assessment during Each visit

2) Diary
3) Clarify Myths/Misconceptions
- Addiction and Tolerance should not be
issues with cancer pain

- Can happen months to years with the use

of anthracycline drugs
- Where ever the radiation was targeted, the
area/location flares bright red, but not quite
like a rash

Reproductive

Direct radiation Alkylating agents cause the

most issues
Temporary or permanent gonadal failure
- Older women have less damage than
younger women because menses has
stopped = Good
- No repair for ovarian function; lower doses
for testes can result in recovery of sperm
production in 2-5 years = Bad

Dysgeusia - Loss of Taste

Dysphagia - difficulty swallowing
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Radiation
Recall

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Reproductive
Teaching
Points

1) Family planning before Tx

2) Decrease of elasticity of Vagina for
Women
3) Possible Erectile Dysfunction for men
4) Contraception use during and after tx for
a period of time

Reverse /
Neutropenia
Precautions

- Handwashing
- Masks for all family, pt, and staff
- No fruits, vegetables, live flowers
- Try to not go into too many public places
where there potentially may be alot of sick
people

Skin
reactions:
Chemotherapy

- Ranges from erythema to hand-foot

syndrome (PPE)
- So painful, pt may not be able to walk
- Can be dose/treatment limiting because of
pain

Skin
reactions:
Local
Radiation

- Acute - Chronic (Erythma - Burns)

- Chronic-permanent skin changes such as
darker, coarser, dryer skin
-Prevent infection because of breakdown of
skin
- Protect from extremes of temp and sun
exposure
- Keep moist-institutionally determined

Survivorship
of Cancer

Encourage Assessment routine, usually once

a year followup appointment
1) How are you doing?
2) Are you having any long term side effects

Teaching
Point for
Fatigue

- At one point during Cancer tx, will

experience fatigue
- Still need to be active because it is actually
helpful
- May have to schedule activity plan such as
rest, nap, and active time

Teaching Point: As long as the cancer is

there, pain will be there, so we manage the
pain and the symptoms
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Pulmonary
Chemotherapy
Effects

- Chemotherapy effects:
edema (capillary leak syndrome),
pneumonitis
interstitial fibrosis

Pulmonary
Radiation
Effects

Permanent/progressive tissue damage

- Radiation effects (late effects):
pneumonitis
cough
dyspnea
pulmonary edema

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What is the Nadir

Lowest CBC levels during one treatment cycle

Determined by drugs, doses, size of radiation field, patient condition,
number of treatments received

What is the Primary cause of death in Cancer

Patients?

Infection!

What is the Single greatest Barrier of cancer pain?

Inadequate pain assessment

Where is bone marrow created and what happens

when it is suppressed?

Thighs
Pelvis
Sternum
- Chemotherapy will hit all 3 regardless
Radiation depends if area is radiated
- Decrease in cells responsible for providing immunity, thus increasing
infection chance
- Most common side effect of chemotherapy

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Why are 2 reasons Cancer Pain is Under treated?

Fear
Lack of Knowledge

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Xerostomia

Radiation induced saliva changes

- Dental issues
- Loss of taste issues
- Decrease Enzymes to digest/Swallow