Chapter 24

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Transcript Chapter 24

Chapter 24
Care of Patients with Cancer
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General Disease-Related
Consequences of Cancer
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Impaired immune and blood-producing
function
Altered GI structure and function
Motor and sensory deficits
Decreased respiratory function
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Surgery as Cancer Treatment
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Oldest form of cancer treatment used for:
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Prophylaxis
Diagnosis
Cure
Control
Palliation
Second-look surgery
Reconstruction or rehabilitation
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Resection of Pancreatic Tumor
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Radiation Therapy for Cancer
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Purpose—to destroy cancer cells with
minimal exposure of the normal cells to the
damaging actions of radiation
Teletherapy
Brachytherapy
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Radiation Therapy
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Side Effects of Radiation
Therapy
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Vary according to the site
Local skin changes and hair loss that will
likely be permanent depending on the total
absorbed dose
Altered taste sensations
Fatigue related to increased energy
demands
Inflammatory responses that cause tissue
fibrosis and scarring
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Nursing Care of Patients
Undergoing Radiation Therapy
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Teach accurate objective facts to help
patient cope.
Do not remove markings.
Administer skin care.
Do not use lotions or ointments.
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Nursing Care of Patients Undergoing
Radiation Therapy (Cont’d)
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Avoid direct exposure of the skin to the
sun.
Care for xerostomia (dry mouth).
Bone exposed to radiation is more
vulnerable to fracture.
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Chemotherapy
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Treating cancer with
chemical agents
Major role in cancer
therapy
Used to cure and increase
survival time
Some selectivity for killing
cancer cells over normal
cells
Normal cells most
affected—the skin, hair,
intestinal tissues,
spermatocytes, and bloodforming cells
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Chemotherapy
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Chemotherapy Drugs
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Antimetabolites
Antitumor antibodies
Antimitotic agents
Alkylating agents
Topoisomerase inhibitors
Miscellaneous chemotherapeutic agents
Combination chemotherapy
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Treatment Issues
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Drug dosage
Drug schedule
Drug administration:
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Extravasation
Vesicants
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Side Effects of Chemotherapy
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Anemia, neutropenia, thrombocytopenia
Alopecia or hair loss
Nausea and vomiting
Mucositis in the entire GI tract
Skin changes
Anxiety, sleep disturbance
Altered bowel elimination
Changes in cognitive function
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Chemotherapy PatientCentered Nursing Care
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Infection risk
Chemotherapy-induced nausea and
vomiting (CIN)
Mucositis
Alopecia
Changes in cognitive function
Peripheral neuropathy
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Hormonal Manipulation
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Some hormones make hormone-sensitive
tumors grow more rapidly.
Some tumors actually require specific
hormones to divide. Therefore decreasing
the amount of these hormones to
hormone-sensitive tumors can slow the
cancer growth rate.
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Side Effects of Hormone
Therapy
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Androgens and antiestrogen receptor
drugs cause masculinizing effects in
women.
For men and women receiving androgens,
acne may develop, hypercalcemia is
common, and liver dysfunction may occur
with prolonged therapy.
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Side Effects of Hormone
Therapy (Cont’d)
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Feminine manifestations often appear in
men who take estrogens, progestins, or
antiandrogen receptor drugs.
Gynecomastia.
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Gynecomastia
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Photodynamic Therapy
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Selective destruction of cancer cells
through a chemical reaction triggered by
different types of laser light
Patient teaching
General sensitivity to light for up to 12
weeks after the photosensitizing drug is
injected
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Immunotherapy: Biological
Response Modifiers (BRMs)
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Drugs that modify the patient’s biological
responses to tumor cells
Cytokines—enhance the immune system
Interleukins, interferons
Side effects—generalized and sometimes
severe inflammatory reactions, peripheral
neuropathy, skin rashes
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Gene Therapy
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Experimental as a cancer treatment
Renders tumor cells more susceptible to
damage or death by other treatments
Injection into tumor cells, enabling the
immune system to better recognize cancer
cells as foreign and kill them
Human leukocyte antigen (HLA)
Cytokines, IL-2
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Targeted Therapy
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Combination of gene therapy and
immunotherapy
Side effects:
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Allergic reaction
Skin, mucous membranes, GI tract lining
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Oncologic Emergencies
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Sepsis and disseminated intravascular
coagulation
Collaborative management includes:
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Prevention (the best measure)
IV antibiotic therapy
Anticoagulants, cryoprecipitated clotting factors
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Syndrome of Inappropriate Antidiuretic
Hormone (SIADH)
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Water is reabsorbed to excess by the
kidney and put into system circulation.
SIADH is most commonly found in
carcinoma of the lung.
Collaborative care:
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Patient safety
Restore normal fluid balance
Provide supportive care
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Spinal Cord Compression
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Spinal Cord Compression
(Cont’d)
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Collaborative management includes:
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Early recognition and treatment
Palliative
High-dose corticosteroids
High-dose radiation
Surgery
External back or neck braces to reduce
pressure in the spinal cord
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Hypercalcemia
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Occurs most often in patients with bone
metastasis
Fatigue, loss of appetite, nausea and
vomiting, constipation, polyuria, severe
muscle weakness, loss of deep tendon
reflexes, paralytic ileus, dehydration,
electrocardiographic changes
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Hypercalcemia (Cont’d)
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Collaborative management includes:
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Oral hydration
Normal saline IV
Drug therapy
Dialysis
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Superior Vena Cava Syndrome
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Superior vena cava is compressed or
obstructed by tumor growth.
Condition can lead to a painful, lifethreatening emergency.
Signs include edema of face, Stokes’ sign,
edema of arms and hands, dyspnea,
erythema, and epistaxis.
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Superior Vena Cava Syndrome
(Cont’d)
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Collaborative Care: SVC
Syndrome
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High-dose radiation therapy
Metal stent in the vena cava
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Tumor Lysis Syndrome
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Large numbers of tumor cells are
destroyed rapidly, resulting in intracellular
contents being released into the
bloodstream faster than the body can
eliminate them.
Collaborative management includes:
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Prevention
 Hydration
 Drug therapy
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Tumor Lysis Syndrome
(Cont’d)
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