Transcript Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 17

Medical-Surgical Nursing: An
Integrated Approach, 2E
Chapter 17
NURSING CARE OF
THE ONCOLOGY
CLIENT
Cancer
A disease resulting from the uncontrolled
growth of cells, which causes malignant
cellular tumors.
 The second leading cause of death in the
United States.
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Incidence of Cancer
In the U.S., men have a 1 in 2 lifetime risk
of developing cancer, while women have
a 1 in 3 risk.
 Incidence and mortality rates higher for
African Americans than for Anglo
Americans.
 Most cancers are curable if treated early.
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Most Common Cancers
In men, most common cancers are
prostate, lung, and colorectal.
 In women, they are breast, colorectal,
lung, and uterine.

Cancer and Tobacco

In 2000, approximately 173,000 cancer
deaths were estimated to be caused by
tobacco.
Pathophysiology
Cancer characterized by neoplasms,
abnormal growth of new tissue.
 Neoplasms can be benign (not
progressive, and thus, favorable for
recovery) or malignant (becoming
progressively worse and often resulting in
death).
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Metastasis
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The rapid multiplication of malignant
neoplasms which spread to distant body
parts through the bloodstream or the
lymph system.
Four Main Classifications of
Cancer
Lymphomas (cancers occurring in
infection-fighting organs, such as
lymphatic tissue).
 Leukemias (cancers occurring in bloodforming organs, such as the spleen, and
in bone marrow).
 Sarcomas (cancers occurring in
connective tissue, such as bone).
 Carcinomas (cancers occurring in
epithelial tissue, such as the skin).

Carcinogens
Chemical substances that initiate or
promote the development of cancer.
 These agents are thought to alter the
DNA in the cell nucleus.
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Significant Risk Factors for
Developing Cancer
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Environmental
(occupational
exposure,
secondhand smoke).
Lifestyle Factors
(tobacco and alcohol
use, diet, sun
exposure).
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Genetic Factors (high
incidence in some
families of certain
types of cancer, e.g.
breast cancer).
Viral Factors
(possible link to
certain viruses).
Common Diagnostic Tests for
Cancer Detection
Laboratory Tests
 Radiologic Studies
 Invasive Diagnostic Techniques
 Biopsy is the most accurate diagnostic
test for cancer.

Staging and Grading of Tumors
Staging determines the extent of the
spread of cancer.
 Grading evaluates tumor cells in
comparison to normal cells.

Most Common
Treatment Modalities
Surgery
 Radiation Therapy
 Chemotherapy

Detection of Cancer
The earlier cancer is detected, the more
likely it is to be controlled.
 Cancer checkup is recommended every 3
years for persons ages 20 to 39 and
annually for those 40 and over.

Surgery
The oldest form of cancer treatment and
still the most common today.
 Surgery is classified as:

Curative (to heal or restore to health).
 Palliative (to relieve symptoms in more
advanced stages).
 Reconstructive (may follow curative or radical
surgery to reestablish function or rebuild for
better cosmetic effect).

Radiation Therapy
Second most common treatment,
radiation therapy, or radiotherapy, uses
high-energy ionizing radiation to kill
cancer.
 Two types:

External.
 Internal.

Chemotherapy
May be used to cure, prevent, or relieve
cancer symptoms.
 Drugs used in chemotherapy are called
antineoplastics because they inhibit the
growth and reproduction of malignant
cells.
 Chemotherapy is the treatment of choice
for metastatic cancers. It is also the
treatment most responsible for increasing
cancer cure rates in recent years.

Biotherapy
Performed with biologic response
modifiers (BRMs), agents that stimulate
the body’s natural immune system to
control and destroy malignant cells.
 Most BRMs are still being evaluated in
trial studies.

Bone Marrow Transplantation
Used for cancers that respond to high
doses of chemotherapy or radiation
therapy.
 Treatment involves aspirating and storing
a fraction of bone marrow, exposing the
client to high-dose drug therapy or total
body irradiation, and then reinfusing the
bone marrow after the treatment is
complete.
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Symptom Management
The oncology nurse must formulate nursing
interventions to manage these problems:
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Bone Marrow
Dysfunction.
Nutritional
Alterations.
Pain.
Fatigue.
Alopecia.
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Dyspnea.
Bowel Dysfunctions.
Pathological
Fractures.
Ascites.
Sexual Alterations.
Odors.
Bone Marrow Dysfunction
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Blood counts must be monitored carefully
during and after treatment.
Clients with platelet count below 50,000/mm3
should be monitored for bleeding.
Skin should be inspected daily for bruises or
petechiae. Stool and urine should be monitored
for occult blood. Client should be observed for
bleeding from nose, vagina, rectum, mouth, and
venipuncture sites.
Nutritional Alterations
Cachexia, a state of malnutrition and
protein (muscle) wasting occurs in
conjunction with lung, pancreatic,
stomach, bowel, and prostate cancers,
but rarely with breast cancer.
 In some cases, untreated cachexia is the
cause of death.
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Symptoms of Nutritional
Alterations
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Anorexia (loss of appetite).
Nausea and vomiting.
Altered taste sensation.
Dysphagia (difficulty in swallowing, occurring in
clients with esophageal cancers or in those
receiving radiotheraphy).
Mucosal Inflammation.
 Particularly stomatitis, inflammation of the
mucous membrane of the oral cavity.
Pain
Approximately 60% to 90% of all
individuals with progressive malignancy
will experience pain.
 Pain usually does not occur until
advanced stages of disease.
 Most common causes are metastatic
bone disease, venous or lymphatic
obstruction, or nerve compression.

Fatigue
Occurs as a direct result of cancer
treatment or because of anemia, chronic
pain, stress, depression, insufficient rest,
or inadequate nutritional intake.
 Frequent rest periods should be provided
for the client.
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Alopecia
Defined as the thinning or loss of hair,
which may be induced by chemotherapy
or radiation treatments.
 Drug induced alopecia is not permanent.
Hair usually begins to grow back within 8
weeks after completion of treatment.
Color and consistency of hair may
change.
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Odors
Unpleasant odors emanating from the
cancer client may be a source of
embarrassment. These odors may be
associated with drainage, exudates, or
incontinence.
 Meticulous nursing care can eliminate
most offending odors.
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Dyspnea

One half of all clients with terminal cancer
experience dyspnea, or difficulty in
breathing.
Bowel Dysfunctions
Cancer clients frequently exhibit changes
in bowel patterns.
 Constipation, diarrhea, and subsequent
perineal skin breakdown and bowel
obstructions are common elimination
disorders.
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Pathological Fractures
These are a major problem in cancers
that metastasize to bone.
 The cancers weaken the bone to the point
that normal activities can cause painful
breaks.
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Ascites
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Abdominal cancers may cause ascites, or
fluid accumulation in the abdomen.
Sexual Alterations
Many chemotherapy drugs can interfere
with sexual functioning and reproduction.
 Premenopausal women may become
infertile.
 Men may experience impotence,
decreased libido, interrupted sperm
production, and ejaculation problems.
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Medical Emergencies Associated with
Advanced Stage Cancers
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Hypercalcemia. (occurs when serum calcium
level rises higher than 10.5mg./dL. Often
signals final stages of cancer).
Spinal Cord Compression (can result in
permanent paralysis).
Superior Vena Cava Syndrome (collection of
symptoms caused by obstruction of the superior
vena cava).
Cardiac Tamponade (caused by the formation
of pericardial fluid, which reduces cardiac
output by compressing the heart).
Psychosocial Alterations
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Clients may see themselves as burdens to their
families.
Family caregivers may be angry that their own
needs must go unmet.
Family caregivers may feel inadequate with
regard to caring for the client.
Medical equipment (e.g. hospital bed,
commode chair, or wheelchair) may need to be
brought into the home. These may have an
impact on family member state of mind and
disposition with regard to family member with
cancer.
A Cancer Client’s Goal

Quality of life, not quantity of life, is the
ultimate goal for clients living with cancer.