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○ Stage IV: metastatis

Oncologic Nursing - Presentation Transcript 6. WARNING/DANGER SIGNS OF CANCER


1. ONCOLOGIC NURSING Ma. Victoria J. Recinto RN, USRN
○ C-hange in bowel/bladder habits
University of the Philippines Manila Philippine General
Hospital ○ A- sore that does not heal

2. NEOPLASIA DIFFERENCES BENIGN (Tumor) MALIGNANT (CA) ○ U-nusual bleeding/discharge


Differentiation Well Poor Encapsulation (+) (-) Metastasis (-)
(+) Prognosis Good Poor Tx Modalities Surgery Surgery, ○ T-hickening of a lump in breast or elsewhere
Irradiation, Chemotx, BM transplant
○ I-ndigestion/dysphagia
3. Predisposing Factors: Carcinogenesis
○ O-bvious change in a wart or mole
○ G-enetic
○ N-agging cough/hoarseness
○ I-mmunosuppression
○ U-nexplained anemia
○ V-iral (Human Papilloma, Epstein-Barr, Hepa B)
○ S-udden wt loss
○ E-nv’tal
7. EARLY DETECTION OF CANCER
 Physical
○ Mammography
 Radiation, UV rays, nuclear explosion
○ Pap smear
 Chronic irritation, direct trauma
○ Stool for occult blood
 Chemical
○ Sigmoidoscopy, colonoscopy
 Acids, alkalis, hydrocarbons, dye
○ Breast self-examination
 Food (  fat,  fiber) & Food additives
(Nitrites) ○ Testicular self-examination

 Drugs (Stillbestrol, urethane) ○ Skin inspection

 Hormones 8. Breast Self-Examination (BSE)

 Smoking ○ Done 7-10 days after menses

4. Grading of Cancer ○ Postmenopausal or s/p hysterectomy: specific day of


the month
○ Classifies the cellular aspects of CA
○ Inspection: In front of the mirror with arms at sides,
○ Grade I: cells differ slightly from N cells, well-
arms overhead & arms at hips (WOF changes in shape,
differentiated (mild dysplasia)
dimpling of skin or any changes in nipple)
○ Grade II: cells are more abN, mod. differentiated (mod.
9. Breast Self-Examination (BSE)
dysplasia)
○ Palpation: While in shower/bath or lying down with
○ Grade III: cells are very abN, poorly differentiated folded towel under breast being examined
(severe dysplasia)
○ Use the R hand to examine L breast & vice versa
○ Grade IV: cells are immature (anaplasia),
undifferentiated ○ Use the pads of 2 nd , 3 rd & 4 th fingers

5. Staging of Cancer ○ Use small, circular motions in spiral or in an up-and-


down motion to examine entire breast & under the arm
○ Classifies the clinical aspects of CA (WOF lump, hard knot or thickened tissue)

○ Stage O: carcinoma in situ 10. Testicular Self-Examination (TSE)

○ Stage I: tumor limited to the tissue of origin, localized ○ Same day, q month, right after a warm shower (scrotal
tissue growth skin is moist & relaxed)

○ Stage II: limited local spread ○ Gently lift each testicle, each one should feel like an
egg, firm but not hard & smooth without lumps
○ Stage III: extensive local & regional spread
○ Using both hands, place middle fingers underside of 15. CANCER TX MODALITIES: Chemotherapy
each testicle & thumbs on top & gently roll the testicles
(WOF lumps, swelling or mass) ○ Major S/E & Nursing Interventions

11. CANCER TX MODALITIES: Surgery ○ GIT: N/V

○ Prophylactic  Antiemetics 4-6 hrs. pre-chemo & post chemo as


ordered
 With premalignant condition or with strong family
hx of CA  NPO temporarily

○ Curative  Bland diet post chemo

 Removal of all gross & microscopic tumor ○ Stomatitis

○ Control (cytoreductive)  Oral care

 “ debulking” procedure, ↓ the no. of CA cells,   Ice chips/popsicles


the chance of other tx will be successful ○ Diarrhea
12. CANCER TX MODALITIES: Surgery
 Antidiarrheals
○ Palliative
 Monitor VS, I/O, WOF dehydration
 Improves quality of life during survival time
○ WOF paralytic ileus (with Vincristine)
 ↓ pain; relieve obstruction (airway, GI or GU),
16. CANCER TX MODALITIES: Chemotherapy
relieve pressure on brain & spinal cord, prevent
hemorrhage, remove infected or ulcerated ○ Major S/E & Nursing Interventions
tumors or drain abscesses
○ Reproductive tract: sterility
○ Reconstructive or rehabilitative
 Encourage sperm banking for M
 Improves quality of life by restoring maximal
function & appearance (breast reconstruction s/p ○ Renal damage:  uric acid
mastectomy)
 Allopurinol as ordered
13. CANCER TX MODALITIES: Chemotherapy
○ Neuro disturbance: peripheral neuropathy
○ Kills CA cells & rapidly producing cells (skin, hair, BM,
Reproductive tract, GIT,)  Skin, hand & foot care (like in PVD & DM)

 Antimetabolites: N2 mustard 17. Alkylating Meds


 Plant alkaloid: Vincristine & Vinblastine ○ Cell-cycle nonspecific

 Alkylating: Methotrexate ○ Nitrogen Mustards

 Hormones (DES)/ steroids  Chlorambucil (Leukeran) & Mechlorethamine


(Mustargen): hyperuricemia
 Antineoplastic antibiotics

14. CANCER TX MODALITIES: Chemotherapy


 Cyclophosphamide (Cytoxan): taken without food,
S/E: alopecia, hemorrhagic cystitis (hematuria,
○ Major S/E & Nursing Interventions dysuria)

○ Hair: alopecia  Ifosfamide (Ifex)

 Encourage pt to wear wigs, cap  Melphalan (Alkeran)

 Temporary, hair will regrow in 3-6 mos. after  Uracil mustard


chemo with new color & texture
18. Alkylating Meds
○ BM: depression
○ Nitrosoureas
 Anemia: CBR, O2 as ordered
 Carmustine (BiCNU)
 Leukemia: reverse isolation, strict HW, asepsis
 Lomustine (CeeNU)
 Thrombocytopenia: Bleeding precautions
 Streptozocin (Zanosar)
○ Alkylating-like Meds ○ 6-Mercaptopurine (Purinethol): hyperuricemia,
hepatotoxicity
 Altretamine (Hexalen)
○ Procarbazine (Matulane)
 Busulfan (Myleran): hyperuricemia
○ Thioguanide
 Cisplatin (Platinol): ototoxicity & nephrotoxicity
(given amifostine [Ethyol] prior to ↓ risk), hypoK, 23. Mitotic Inhibitors (Vinca Alkaloids)
hypoCa, hypoMg
○ Cell-cycle phase-specific: M phase
 Dacarbazine (DTIC-Dome)
○ Docetaxel (Taxotere)
 Thiotepa (Thioplex)
○ Etoposide (VePesid)
19. Anti-tumor Antibiotics

○ Cell-cycle nonspecific
○ Teniposide (Vumon)

○ Bleomycin SO4 (Blenoxane): pulmonary toxicity ○ Vinblastine SO4 (Velban)

○ Dactinomycin (Actinomycin D, Cosmegan) ○ Vincristine SO4 (Oncovin): neurotoxicity (numbness &


tingling of fingers & toes), peripheral neuropathy, ptosis
○ Daunorubicin (Cerubidine, DaunoXome): causes CHF &
dysrhythmias
○ Vinorelbine (Navelbine)

○ Doxorubicin (Adriamycin) & Idarubicin (Idamycin): 24. Immunomodulator Agents


cardiotoxicity (given Dexraxozane [Zinecard] to prevent
○ Stimulate immune system to recognize CA cells &
cardiomyopathy)
destroy them (Interleukins)
20. Anti-tumor Antibiotics
○ Slow down tumor cell division, causes CA cells to
○ Mitomycin (Mutamycin) differentiate into non-proliferative forms (Interferons)

○ Mitoxantrone (Novantrone) 25. Immunomodulator Agents

○ Pentostatin (Nipent) ○ Aldesleukin (Proleukin, Interleukin-2)

○ Plicamycin (Mithracin): affects bleeding time ○ Interferon alfa-2a

○ Interferon alfa-2b
○ Valrubicin (Valstar)
○ Interferon alfa-n3 (Alferon N) Levamisole (Ergamisole)
21. Antimetabolites

○ Cell-cycle phase-specific (S phase) ○ Recombinant interferon-  (Intron A, Roferon A)

○ Capecitabine (Xeloda) ○ Rituximab (Rituxan)

○ Cladribine (Leustatin) 26. Colony-Stimulating Factors

○ Induce rapid BM recovery after chemotherapy


○ Cytarabine (ara-C, Cytosar-U): alopecia, stomatitis,
hyperuricemia, hepatotoxicity ○ Granulocyte-Macrophage: Sargramostim (Leukin,
Prokine)
○ Floxuridine (FUDR)
○ Granulocyte: Filgrastim (Neupogen)
○ Fludarabine (Fludara)
○ Erythropoetin: Epoetin alfa (Epogen)
22. Antimetabolites
27. CANCER TX MODALITIES: Radiation
○ Methotrexate (Folex) & 5-Fluorouracil (Adrucil):
alopecia, stomatitis, hyperuricemia, photosensitivity, ○ Use of ionizing radiation that kills CA & rapidly growing
hepatotoxicity, hema, GI & skin toxicity cells & inhibit their growth

 Leucovorin rescue (given leucovorin [folinic acid ○ Types of energy


or citrovorum factor) to prevent toxicity r/t
Methotrexate  Alpha rays: don’t penetrate skin tissue

○ Hydroxyurea (Hydrea)  Beta rays: penetrate skin (e.g. internal radiation)


 Gamma rays: penetrate deeper, underlying ○ Unsealed Radiation Source
tissues (e.g. external radiation)
 Administered PO or IV or instillation into body
28. CANCER TX MODALITIES: Radiation cavities

○ Factors Affecting Delivery  It enters body fluids, eliminated via various


excreta (radioactive & harmful to others esp. the
 Half-life: time required for the ½ of the 1 st 48 hrs)
radioisotope to decay
34. CANCER TX MODALITIES: Brachytherapy Radiation
 Time: less time, less exposure
○ Sealed Radiation Source
 Distance: the farther the source, the lesser the
exposure  Temporary or permanent solid implant within
tumor target tissues
 Shielding: Alpha & Beta rays can be blocked by
gloves, Gamma rays can be blocked by thick,  The pt emits radiation while the implant is in
lead gown & concrete place, but the excreta is not radioactive

29. CANCER TX MODALITIES: Radiation  Place the pt in a private room with private bath

○ Methods of Delivery  Place a caution sign on the pt’s door

 Internal: utilizes injection/ implantation of 35. CANCER TX MODALITIES: Brachytherapy Radiation


radioactive isotopes proximal to CA sites for
specified period of time ○ Sealed Radiation Source

 Sealed: within a container, don’t  Organize nursing tasks to minimize exposure to


contaminate with body fluids radiation source

 Unsealed: e.g. Phosphorus 32  Nursing staff assignments should be rotated, a


nurse should never care for more than 1 pt with
 External: uses electromagnetic waves e.g. Cobalt
radiation implant at a time, avoid assigning a
pregnant nurse
30. CANCER TX MODALITIES: Teletherapy/Beam Radiation
 Limit time to 30 mins per care provider/shift
○ Source: external radiation

○ Pt does not emit radiation & does not pose a hazard to


36. CANCER TX MODALITIES: Brachytherapy Radiation
anyone else ○ Sealed Radiation Source
○ Wash area with water & mild soap, using the hand than
 Wear a dosimeter film badge to measure
a washcloth, rinse & pat dry with soft towel
radiation exposure
○ Don’t remove radiation markings from the skin
 Wear a lead shield

31. CANCER TX MODALITIES: Teletherapy/Beam Radiation  Do not allow children <16 y/o or pregnant woman
to visit the pt
○ No powder, ointment, lotion or cream on area unless
ordered  Limit visitors to 30 min./day, at least 6 ft from the
pt
○ Wear soft clothing over the area, avoid constrictive
garments  Save bed linens & dressings until the source is
removed then dispose
○ Avoid sun & heat exposure
 Other equipments can be removed from the room
○ WOF weeping of skin (moist desquamation) & if noted,
at any time
cleanse the area with warm water & pat dry, apply
antibiotic or steroid cream as ordered & expose the site 37. CANCER TX MODALITIES: Brachytherapy Radiation
to air
○ Dislodged Sealed Radiation Source
32. CANCER TX MODALITIES: Brachytherapy Radiation
 Don’t touch it with bare hands, use a long-
○ Source: internal radiation (sealed or unsealed) handled forceps to place the source in a lead
container kept in the pt’s room & notify MD
○ For a pd. of time the pt emits radiation & pose a hazard
to others  If unable to locate the radiation source, bar
visitors & notify MD
33. CANCER TX MODALITIES: Brachytherapy Radiation
38. CANCER TX MODALITIES: Brachytherapy Radiation
○ Sealed Radiation Source Removal  Infection:  T, poor wound healing, sore throat,
bone weakens  fracture, bone & joint pains,
 Pt is no longer radioactive lymphadenopathy

 Inform the pt that sexual partner cannot “catch”  Bleeding: hemorrhage, petechiae, epistaxis,
CA hematoma, hematuria, hematemesis,
hepatosplenomegaly
 Pt may resume sexual intercourse after 7-10 days
for cervical or vaginal implant  Anemia: pallor, fatigue, anorexia, constipation

 Perform povidone-iodine douche as ordered for 44. Signs and Symptoms: LEUKEMIA
cervical implant
○ From invasion of CNS
 Administer Fleet enema as ordered
  ICP: ↓ LOC, severe HA, vomiting, papilledema,
 Notify MD if N/V/D, frequent urination, vaginal or seizures
rectal bleeding, hematuria, foul-smelling vaginal
discharge, abdominal pain/distention or fever  CN VII or spinal nerve involvement
occurs
○ From invasion of kidneys, testes, prostate, ovaries, GI
39. CANCER TX MODALITIES: Radiation and lungs

○ Major S/E & Nursing Interventions 45. LEUKEMIA

 Skin erythema, redness, irritation & sloughing of ○ Diagnostic Tests


tissue
 PBS- (+) immature WBC
 Assist in bathing the pt
 CBC-  immature WBC,  RBC, ↓ platelets
 Force fluids
 Done weekly during maintenance phase of
 Avoid lotion, talcum powder; may use chemotherapy
cornstarch or olive oil
 Lumbar Puncture- CNS affectation
 BM depression (same as in chemo)
 Shrimp/fetal/C-position, avoid neck flexion
 GIT disturbance: Dysgeusia- ↓ taste sensation esp. may occlude airway of infants and children
with internal implant
46. LEUKEMIA
 Oral care, avoid hot & cold foods
○ Diagnostic Tests
40. LEUKEMIA
 Bone Marrow Aspiration- (+) blast cells (immature
○ Group of malignant disease WBC), common site: iliac crest

○ Rapid  immature WBC, competes nutrition with  Post op: apply direct pressure, lie on
mature WBC and production of RBC and platelets affected side to stop bleeding

○ N= 500 RBC: 1 WBC  Bone Scan- to determine bone involvement


(fractures)
41. LEUKEMIA
 CT Scan: to determine organ involvement
42. CLASSIFICATION OF LEUKEMIA
47. LEUKEMIA
○ Lympho- affects lymphocytes
○ Triad Management
○ Myelo- affects myeloblasts
 Surgery (most preferred)
○ Acute/Blastic- affects immature cells
 (Cranial) Irradiation
○ Chronic/Cystic- affects mature cells
 Chemotherapy
○ Most common in children: Acute Lymphocytic Leukemia
○ BM transplant
(ALL), peak onset 2-6 y/o, M>F
48. Nursing Management: LEUKEMIA
○ Acute Myelogenous Leukemia (AML): peak onset 15-39
y/o  Assess for common side effects: anorexia, nausea
and vomiting (give antiemetics 30mins prior to
43. Signs and Symptoms: LEUKEMIA chemo and continue until 1 day post chemo),
WOF dehydration
○ From invasion of BM (“Nadir”)
49. Nursing Management: LEUKEMIA 55. HODGKIN’S DISEASE/LYMPHOMA

 Assure pt that alopecia and hirsutism are ○ Management


temporary side effects, hair will regrow in 3-6
mos. With new color & texture ○ External radiation (tx of choice)

50. Nursing Management: LEUKEMIA ○ Multiagent chemotx (if extensive)

 Assess for stomatitis (oral ulcers) ○ WOF S/E: infection, bleeding

 Oral care: alcohol-free mouthwash, pNSS ○ Sperm banking (possibility of sterility for M)
with or without NaHCO3
56. MULTIPLE MYELOMA
 Use soft-bristled toothbrush, cotton plegets
○ Malignant proliferation of plasma cells and tumors
 Apply Xylocaine (topical anesthetic) on within the bone, destroying the bone & invading the
mouth before meals lymph nodes, spleen & liver

 Diet: soft and bland according to child’s ○ abN plasma cells produce an abN Ab (myeloma protein
preference, small frequent feedings or Bence Jones protein) found in blood & urine

51. Nursing Management: LEUKEMIA ○ ↓ production of Ig & Ab, ↑ uric acid & Ca → RF

 Protect pt from infection


57. S/Sx: MULTIPLE MYELOMA
 Strict hand washing
○ Bone pain (pelvis, spine, ribs)
 Reverse isolation
○ Osteoporesis (bone loss, pathological fractures)
 Protect pt from additional fatigue
○ Spinal cord compression & paraplegia
 Bed rest
○ Weakness & fatigue
 Activities balanced with rest
○ Recurrent infections
52. Nursing Management: LEUKEMIA
○ Anemia
 Protect pt from bleeding
○ Bence Jones proteinuria,  total serum protein, Ca &
 Minimize parenteral injections uric acid levels

 Apply pressure on venipuncture sites ○ RF

 Use electric razor in shaving ○ Thrombocytopenia, granulocytopenia

53. Nursing Management: LEUKEMIA 58. Nursing Interventions: MULTIPLE MYELOMA

 Encourage verbalization of feelings & concerns ○ Administer as ordered

 Introduce the family to other families of children  Chemotherapy


with CA
 IVF & diuretics (to eliminate Ca)
 Consult social services & chaplains as necessary
 BT for anemia
54. HODGKIN’S DISEASE/LYMPHOMA
 Analgesics, antibiotics
○ Involves lymph nodes, tonsils, spleen & BM
○ WOF bleeding, infection, fractures, RF
○ (+) Reed-Sternberg cell in the nodes
○ Force fluids
○ S/Sx
○ Encourage ambulation
○ ↑ T, A/, malaise, fatigue & weakness, wt loss
○ Provide skeletal support during moving, turning &
○ Anemia, thrombocytopenia ambulating

○ Enlarged lymph nodes, spleen & liver ○ Maintain hazard-free env’t

○ (+) bx of cervical lymph nodes (affected 1 st ) 59. TESTICULAR CANCER

○ (+) CT scan of liver & spleen ○ Occurs between ages 15-40


○ Common sites of mets: lymph nodes, bone, lungs, ○ Fixed, irregular, nonencapsulated mass
adrenal glands & liver
○ Painless (early stage) or painful (late stage) mass
○ Types
○ Nipple retraction or elevation
 Germinal tumors (Seminomas, Nonseminomas)
○ Assymetrical breast (affected breast higher)
 Nongerminal tumors (Interstitial cell tumors,
Androblastoma) ○ Bloody or clear nipple d/c

60. S/Sx: TESTICULAR CANCER 65. S/Sx: BREAST CANCER


○ Painless testicular swelling ○ Skin dimpling, retraction or ulceration

○ Dragging sensation in the scrotum ○ Skin edema or peau d’orange skin

○ S/Sx of mets: palpable lymphadenopathy, abdominal ○ Axillary lymphadenopathy


masses, gynecomastia
○ Lymphedema of affected arm
○ Late S/Sx: back or bone pain & respiratory Sx
○ Presence of lesion on mammography
61. Tx: TESTICULAR CANCER
○ S/Sx of lung/bone mets
○ Chemotherapy
66. Nonsurgical Tx: BREAST CANCER
○ Radiation
○ Chemotx
○ Surgery
○ Radiation tx
 Unilateral orchiectomy- for dx & primary surgical
mgt. ○ Hormonal manipulation in post menopausal women

 Radical retroperitoneal lymph node dissection- to ○ Meds: Tamoxifen (Nolvadex) for estrogen receptor-
stage the CA & ↓ tumor vol. positive tumors

○ Reproductive options: sperm storage, donor


67. Surgical Tx: BREAST CANCER
insemination & adoption
○ Lumpectomy: removal of tumor with lymph node
62. Nursing Interventions: s/p Testicular Surgery
dissection
○ Suture removal: 7-10 days post-op
○ Simple Mastectomy: removal of breast tissue & nipple,
○ May resume N activities within 1 week except for lifting lymph nodes left intact
heavy objects > 20 lbs or stair climbing
○ Modified Radical Mastectomy: removal of breast tissue,
○ Perform monthly testicular self-exam on the remaining nipple & lymph nodes, muscles left intact
testicle
○ Halsted Radical Mastectomy: removal of breast tissue,
63. BREAST CANCER nipple, lymph nodes & underlying muscles

○ Common sites of mets: lymph nodes, bone, lungs, brain 68. Surgical Tx: BREAST CANCER
& liver
○ Oophorectomy: for estrogen receptor-positive tumors
○ Precipitating factors
○ Ablative therapy with adrenalectomy or chemical
 Genetics ablation which blocks cortisol, androstenedione &
aldosterone production
 Early menarche & late menopause
69. Nursing Interventions: s/p Breast Surgery
 Nulliparity
○ Semi-Fowlers’ position, turn from back to unaffected
 Obesity side, with affected arm elevated above the heart level
to promote drainage & prevent lymphedema
 High-dose radiation exposure to chest
○ Use a pressure sleeve if edema is severe
64. S/Sx: BREAST CANCER
○ Maintain Jackson-Pratt suction, record the amount &
○ Mass felt during BSE (usually in the upper outer
characteristic of draiange
quadrant or beneath the nipple)
○ No IV, injections, BP, venipunctures in affected arm
○ Low Na-diet, diuretics for severe lymphedema ○ Dysuria, hematuria

○ Refer to MD & PT for appropriate exercise program ○ Pelvic, lower back, leg or groin pain

70. Health Teaching: s/p Breast Surgery ○ A/, wt loss

○ Protect & avoid overuse of the hand & arm during the 1 ○ Changes on Pap smear
st few months
74. Tx: CERVICAL CANCER
○ Keep the affected arm elevated to prevent
○ Nonsurgical
lymphedema

○ Incision care with lanolin to soften & prevent wound  Chemotherapy


contractures
 Cryosurgery
○ BSE on the remaining breast
 External radiation
○ Avoid strong sunlight or heat to the affected arm
 Internal radiation (intracavitary)
○ Don’t carry anything heavy over the affected arm
 Laser therapy
71. Health Teaching: s/p Breast Surgery
○ Surgical
○ Avoid constrictive clothing/jewelry, trauma, cuts,
 Conization
bruises or burns to the affected arm
 Hysterectomy
○ Wear gloves when gardening, washing dishes/clothes
 Pelvic exenteration
○ Use thick oven mitten mitts when cooking
75. CERVICAL CA: Laser Therapy
○ Use a thimble when sewing
○ Energy from the beam is absorbed by fluid in the
○ Apply lanolin hand cream several times daily
tissues, causing them to vaporize
○ Use cream cuticle remover
○ Minimal bleeding & slight vaginal d/c is expected after
○ Notify MD if S/ of inflammation occur in the affected the procedure, healing occurs in 6-12 wks
arm
76. CERVICAL CA: Cryosurgery
○ Wear a Medic-Alert bracelet stating lymphedema arm
○ Involves freezing of the tissues by a probe with
subsequent necrosis
72. CERVICAL CANCER
○ No anesthesia required
○ Premalignant changes: (Stage I) mild dysplasia to
(Stage II) mod. dysplasia to (Stage III) severe dysplasia ○ Cramping may occur during the procedure
to carcinoma in situ
○ A heavy, watery d/c is expected several wks after the
○ Common sites of mets: pelvis & lymphatics procedure, use tampons

○ Precipitating factors ○ Avoid sexual intercourse

 Low socioeconomic groups 77. CERVICAL CA: Conization


 Early 1 st marriage ○ A cone-shaped area of the cervix is removed

 Early & frequent intercourse ○ For women who want further child bearing

 Multiple sex partners ○ Long-term follow-up is needed (new lesions may


develop)
 High parity

 Poor hygiene
○ Cx: hemorrhage, uterine perforation, incompetent
cervix, cervical stenosis & preterm labor
73. S/Sx: CERVICAL CANCER
78. CERVICAL CA: Hysterectomy
○ Painless vaginal bleeding postmenstrually &
○ Vaginal approach for microinvasive CA if childbearing is
postcoitally
not desired
○ Foul-smelling or serosanguinous vaginal d/c

○ Leakage of urine or feces from the vagina


○ Radical hysterectomy & bilateral lymph node dissection ○ Abdominal discomfort or swelling
for CA that spread beyond the cervix but not to the
pelvic wall ○ GI disturbance

79. Nursing Interventions: s/p Hysterectomy ○ Dysfunctional vaginal bleeding

○ Monitor vaginal bleeding (>1 saturated pad/hr) ○ Abdominal mass

○ Avoid stair climbing for 1 mo. 85. Tx: OVARIAN CANCER


○ Avoid tub baths & sitting for long periods ○ External radiation: if with mets

○ Avoid strenous activity or lifting >20 lbs ○ Chemotherapy: done post-op for all stages of CA

○ Avoid sexual intercourse for 3-6 wks ○ Intraperitoneal chemotx: instillation into abdominal
cavity
80. CERVICAL CA: Pelvic exenteration
○ Immunotherapy: promotes tumor resistance
○ Radical surgical procedure for recurrent CA
○ Surgery: TAHBSO
○ When the bladder is removed, an ileal conduit is
created & located at the R side of the abdomen to 86. ENDOMETRIAL CANCER
divert urine
○ Slow-growing tumor asso. with menopausal years
○ A colostomy is created on the L side of the abdomen for
the passage of feces ○ Common sites of mets: ovaries, pelvis, peritoneum,
lymphatics & via blood to the lungs, liver & bone
81. CERVICAL CA: Types of Pelvic Exenteration
○ Precipitating Factors
○ Anterior
 Hx of uterine polyps
 Removal of uterus, ovaries, fallopian tubes,
vagina, bladder, urethra & pelvic lymph nodes  Nulliparity

○ Posterior  Polycystic ovary disease

 Removal of uterus, ovaries, fallopian tubes,  Estrogen stimulation


descending colon, rectum & anal cnal
 Late menopause
○ Total
 Family hx
 Combo of anterior & posterior
87. S/Sx: ENDOMETRIAL CANCER
82. Nursing Interventions: s/p Pelvic exenteration ○ Postmenopausal bleeding
○ Administer perineal irrigation with half-strength H2O2 &
○ Watery, serosanguinous discharge
NS
○ Low back, pelvic or abdominal pain
○ Avoid strenous activity for 6 mos.
○ Enlarged uterus in advanced stages
○ Perineal opening may drain for several mos.
88. Tx: ENDOMETRIAL CANCER
○ Ileal conduit & colostomy care
○ External or internal radiation
○ Sexual counseling: vaginal intercourse is not possible
s/p anterior & total pelvic exenteration ○ Chemotherapy for advanced or recurrent CA

83. OVARIAN CANCER ○ Medroxyprogesterone (Depo-Provera) or Megestrol)


Megace for estrogen-dependent tumors
○ Grows rapidly, spreads fast, often bilateral
○ Tamoxifen (Nolvadex): antiestrogen
○ Common sites of mets: pelvis, lymphatics & peritoneum
○ Surgery: TAHBSO
○ Usually detected late: Poor prognosis
89. GASTRIC CANCER
○ Exploratory laparotomy: to dx & stage the tumor
○ Predisposing Factors
84. S/Sx: OVARIAN CANCER
 Diet: high in complex CHO, grains & salt, low in
fresh green, leafy vegetables & fruits
 Use of nitrates ○ More common in blacks than in whites, in smokers & in
men
 Smoking, alcoholism
○ Linked with DM, alcohol use, hx of pancreatitis, high fat
 Hx of gastric ulcers
diet, env’tal chemicals
○ Cx: hemorrhage, obstruction, mets & dumping ○ With poor prognosis
syndrome
95. S/Sx: PANCREATIC CANCER
○ Goal of Tx: remove the tumor & provide nutritional
support ○ N/V

90. S/Sx: GASTRIC CANCER ○ Jaundice

○ A/N/V, wt loss ○ Unexplained wt. loss

○ Fatigue, anemia ○ Clay-colored stool

○ Indigestion, epigastric discomfort ○ Glucose intolerance

○ A sensation of pressure in the stomach ○ Abdominal pain

○ Dysphagia 96. Tx: PANCREATIC CANCER


○ Ascites ○ Radiation

○ Palpable mass ○ Chemotherapy

91. Tx: GASTRIC CANCER ○ Whipple’s procedure: pancreaticoduodenectomy with


removal of distal third of the stomach,
○ Chemotx pancreaticojejunostomy, gastrojejunostomy &
choledochojejunostomy
○ Radiation
97. INTESTINAL TUMORS
○ Surgery
○ Develop in the cells lining the bowel wall or develop as
 Subtotal gastrectomy polyps in the colon or rectum

 Bilroth I: Gastroduodenostomy ○ Cx: bowel perforation with peritonitis, abscess & fistula
formation, hemorrhage & complete gut obstruction
 Bilroth II: Gastrojejunostomy

 Total gastrectomy
○ Common sites of mets: via lymphatics & blood, colon &
other organs
 Esophagojejunostomy
98. S/Sx: INTESTINAL TUMORS
92. Nursing Interventions: GASTRIC CANCER
○ A/V, malaise, wt loss
○ Fowler’s position for comfort: Pain meds as ordered
○ Blood in stools, anemia
○ Monitor Hgb, Hct: BT as ordered
○ AbN stools
○ NPO for 1-3 days post-op until peristalsis returns
 Ascending colon tumor: diarrhea
○ Monitor I/O: IVF & e+ as ordered
 Descending colon tumor: constipation with some
○ Monitor NGT suction, don’t irrigate or remove NGT diarrhea, ribbon-like stool

93. Nursing Interventions: GASTRIC CANCER  Rectal tumor: alternating constipation & diarrhea

○ Progressive diet to 6 small bland meals/day ○ Guarding or abdominal distention

○ Monitor wt, nutritional status: Small, bland, easy ○ Abdominal mass & cachexia (late signs)
digestible meals with vit & mineral supplements
99. Nursing Interventions: INTESTINAL TUMORS
○ WOF Cx: hemorrhage, dumping syndrome, diarrhea,
hypoglycemia, Vit B12 deficiency ○ WOF bowel perforation: ↓ BP,  HR, ↑ T, weak pulse,
distended abdomen
94. PANCREATIC CANCER
○ WOF intestinal obstruction: (EARLY S/Sx- ↑ peristalsis, ↑ 105.LUNG CANCER
to ↓ bowel sounds) fecal vomiting, pain, constipation,
distended abdomen ○ Lungs: common target for mets from other organs

○ Radiation pre-op ○ Bronchiogenic carcinoma: direct extension & via


lymphatics
○ Chemotherapy post-op
○ 4 Major Types
○ Surgery: bowel resection & creation of colo or ileostomy
 Small (Oat) Cell
100.COLO/ILEOSTOMY PRE-OP CARE
 Epidermal (Squamous Cell)
○ Consult with enterostomal therapist to identify optimal
placement of ostomy  Adenocarcinoma

○ Low-residue diet for 1-2 days pre-op  Large cell anaplastic carcinoma

○ Give intestinal antiseptics & antibiotics, laxatives & 106.LUNG CANCER


enemas as ordered
○ Causes
101.COLOSTOMY POST-OP CARE
 Cigarette smoking
○ Apply petroleum jelly over the stoma to keep it moist
 Env’tal & occupational pollutants
followed by dry sterile gauze if pouch system is not yet
in place ○ Dx: CXR (lesion or mass), bronchoscopy & sputum
○ Monitor the stoma for size, unusual bleeding or necrotic cytological studies
tissue
107.S/Sx: LUNG CANCER
○ Monitor the stoma for color
○ Cough
 N: pink or red indicating ↓ vascularity
○ Dyspnea
 Pale: anemia, Violet/Blue/Black: compromised
○ Hoarseness
circulation
○ Hemoptysis
102.COLOSTOMY POST-OP CARE
○ Chest pain
○ Check pouch system for proper fit & leakage
○ A/ wt loss
○ Ascending colon colostomy: expect liquid stool
○ Weakness
○ Transverse colon colostomy: expect loose to
semiformed stool 108.Nursing Interventions: LUNG CANCER

○ Descending colon: expect close to N stool ○ Monitor VS, pulse oximetry

○ Empty pouch when 1/3 full, remove feces from the skin ○ Fowler’s position
○ Avoid gas/odor-forming foods ○ WOF RR distress, tracheal deviation, bleeding, infection
& e+ imbalance
103.COLOSTOMY POST-OP CARE
○ Activity as tolerated, rest periods, active/passive ROM
○ WOF perineal wound infection (if present)
○ Diet:  calorie, high CHON, ↑ Vit
○ Administer as ordered
○ Administer as ordered
 Analgesics & antibiotics
 O2, bronchodilators, steroids
 Stoma irrigation
 Analgesics
104.ILEOSTOMY POST-OP CARE
 CPT
○ Post-op drainage: dark green to yellow (as the pt begins
to eat)
109.Tx: LUNG CANCER
○ Expect liquid stool
○ Radiation
○ WOF dehydration & e+ imbalance
○ Chemotherapy
○ Avoid suppositories through ileostomy
○ Immunotherapy ○ Radiation & Chemotx for hormone-resistant tumors

○ Surgery 115.Tx: PROSTATE CANCER


 Laser therapy: to relieve endobronchial ○ Palliative surgery: Orchiectomy (to ↓ testosterone
obstruction
production)
 Thoracentesis & pleurodesis: to remove pleural
○ Cryosurgical ablation (liquid nitrogen freezes the
fluid & relieve hypoxia
prostate, dead cells are absorbed by the body)
 Thoracotomy with pneumonectomy or lobectomy
○ Transurethral resection of the prostate (TURP) or
or segmental resection
prostatectomy
110.Pre-op Care: LUNG CANCER
116.PROSTATE CA: TURP
○ Explain the potential post-op need for chest tubes
○ Insertion of a scope into the urethra to excise prostatic
○ Closed chest drainage is not used for pneumonectomy tissue

& the serum fluid that accumulates in the empty ○ Bleeding is common post-op, WOF hemorrhage
thoracic cavity will consolidate, preventing mediastinal
shift ○ Continuous bladder irrigation (CBI) post-op to maintain
the urine at a pink color
111.Post-op Care: LUNG CANCER
○ Bladder spasms are common post-op, give
○ Monitor VS, breath sounds antispasmodics as ordered
○ Maintain chest tube drainage system, WOF SQ ○ WOF dribbling & incontinence
emphysema
○ Sterility may or may not occur post-op
○ Avoid complete lateral turning
117.PROSTATE CA: Prostatectomy Point of comparison
○ Activity as tolerated, active ROM of the operative
Suprapubic Retropubic Perineal Technique Via abdominal &
shoulder
bladder incision Via low abdominal incision without opening
○ Administer O2 as ordered the bladder Via incision bet. scrotum & anus Hemorrhage Yes
No No Bladder spasms Yes Yes but less Urinary incontinence
112.PROSTATE CANCER common

○ Slow-growing, androgen type of adenocarcinoma in M 118.PROSTATE CA: Prostatectomy Point of comparison


>50 y/o Suprapubic Retropubic Perineal CBI Yes Yes - Sterility Yes Yes
Yes Remarks Abdominal dressing soaked frequently with
○ Common sites of mets: bloodstream, lymphatics, pelvis, urine, Longer healing time than TURP Minimal abdominal
spine, bone drainage WOF infection, (No rectal tubes, rectal temp. taking
& enema) Teach perineal exercises
113.S/Sx: PROSTATE CANCER
119.Nursing Interventions: s/p TURP
○ (-) in early stages
○ Monitor VS, U.O., hematuria & clots, Hgb & Hct levels
○ Hard, pea-sized nodule on rectal exam
○ Force fluids
○ Hematuria
○ Expect red to light pink urine for 24 hrs, turning to
○ Late S/Sx: wt loss, urinary obstruction, pain radiating amber in 3 days (then encourage ambulation)
from the lumbosacral area down the leg
○ WOF arterial bleeding (bright red urine with clots): ↑ CBI
○ Prostate-specific Ag test: monitors the pt’s response to & notify MD
tx
○ WOF venous bleeding (burgundy-colored urine): notify
○ ↑ serum acid phosphatase: indicates spread & mets MD who will apply traction on the catheter

114.Tx: PROSTATE CANCER ○ Continuous urge to void is N but not encouraged to


prevent bladder spasms
○ Hormonal manipulation
○ Antibiotics, analgesics, stool softeners &
 LT: leuprolide acetate (Lupron), flutamide antispasmodics as ordered
(Eulexin) or DES
120.Nursing Interventions: s/p TURP
 Goserelin acetate (Zoladex) when orchiectomy or
estrogen administration is not acceptable for the ○ Monitor 3-way foley catheter (for the balloon (30-45 cc),
pt inflow & outflow)
○ Use pNSS only to prevent water intoxication or hypoNa
(  LOC, ↓ HR, ↑ BP)

○ Maintain infusion rate as ordered, if (+) clots:  rate

○ For obstructed catheter: turn off CBI, irrigate with 30-50


ml pNSS, notify MD if it does not resolve

○ CBI is d/c usually after 1-2 days, WOF continence &


urinary retention

121.Discharge Health Teaching: s/p TURP

○ Avoid heavy lifting, stressful exercise, driving, Valsalva


maneuver & sexual intercourse for 2-6 wks

○ Drink 2.4-3L fluids/day before 8 pm

○ Avoid alcohol, caffeine & spicy foods to prevent


overstimulation of the bladder

○ Pt may pass small clots & tissue debris for several days

○ If urine becomes less in amount & bloody, rest & force


fluids, notify MD if persistent

122.Nursing Interventions: s/p Suprapubic Prostatectomy


○ Monitor foley catheter & suprapubic catheter drainage

○ As ordered, clamp the suprapubic cath after foley cath


is removed (2-4 days post-op) & instruct the pt to void,
measure residual urine by unclamping the cath &
measuring the U.O.

○ Prepare for removal of suprapubic cath if pt


consistently empties bladder & residual urine is <75 ml

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