Transcript Chapter 24
Chapter 24 Care of Patients with Cancer Mrs. M. Kreisel MSN, RN NU130 Adult Health 1 Summer 2011 General Disease-Related Consequences of Cancer: Nursing Diagnosis • Impaired immune and bloodproducing function • Altered GI structure and function • Motor and sensory deficits • Decreased respiratory function Surgery as Cancer Treatment • Oldest form of cancer treatment used for: • Prophylaxis • Diagnosis • Cure • Control • Palliation • Second-look surgery • Reconstruction or rehabilitation Resection of Pancreatic Tumor Radiation Therapy for Cancer • Purpose—to destroy cancer cells with minimal exposure of the normal cells to the damaging actions of radiation • Teletherapy: radiation source outside the body • Brachytherapy: (opposite of teletheraphy) the use of implants of radioactive materials such as radium, cesium, iridium or gold at the cancer site Radiation Therapy Copyright © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Side Effects of Radiation Therapy • 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 Nursing Care of Patients Undergoing Radiation Therapy • Teach accurate objective facts to help patient cope. • Do not remove markings. • Administer skin care. • Avoid direct exposure of the skin to the sun. • Care for xerostomia (dry mouth). • Bone exposed to radiation is more vulnerable to fracture. • Do not use lotions or ointments. Chemotherapy • • • • 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 blood-forming cells Chemotherapy Chemotherapy Drugs • • • • • • • Antimetabolites Antitumor antibodies Antimitotic agents Alkylating agents Topoisomerase inhibitors Miscellaneous chemotherapeutic agents Combination chemotherapy Treatment Issues • Drug dosage • Drug schedule • Drug administration: • Extravasation: The escape of fluids into the surrounding tissue • Vesicants: blistering Side Effects of Chemotherapy • • • • • • • • 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 Chemotherapy Patient-Centered Nursing Care • Infection risk • Chemotherapy-induced nausea and vomiting (CIN) • Mucositis • Alopecia • Changes in cognitive function • Peripheral neuropathy Hormonal Manipulation • 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. Side Effects of Hormone Therapy • Androgens (substances that produce male characteristics) 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. • Feminine manifestations often appear in men who take estrogens, progestins, or antiandrogen receptor drugs. • Gynecomastia. Gynecomastia Photodynamic Therapy • 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 Immunotherapy: Biological Response Modifiers (BRMs) • Drugs that modify the patient’s biological responses to tumor cells • Cytokines—enhance the immune system they include Interleukins & interferons (they release proteins and other cell responses to try and prevent the unwanted cell from growing) • Side effects—generalized and sometimes severe inflammatory reactions, peripheral neuropathy, skin rashes Gene Therapy • 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 Targeted Therapy • Combination of gene therapy and immunotherapy • Side effects: • Allergic reaction • Skin, mucous membranes, GI tract lining Oncologic Emergencies • Sepsis and disseminated intravascular coagulation • Collaborative management includes: • Prevention (the best measure) • IV antibiotic therapy • Anticoagulants, cryoprecipitated clotting factors Syndrome of Inappropriate Antidiuretic Hormone (SIADH) • 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: • Patient safety • Restore normal fluid balance • Provide supportive care Spinal Cord Compression Spinal Cord Compression (Cont’d) • Collaborative management includes: • Early recognition and treatment • Palliative • High-dose corticosteroids • High-dose radiation • Surgery • External back or neck braces to reduce pressure in the spinal cord Hypercalcemia • 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 • Collaborative management includes: • Oral hydration • Normal saline IV • Drug therapy • Dialysis Superior Vena Cava Syndrome • 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. Superior Vena Cava Syndrome (Cont’d) Collaborative Care: SVC Syndrome • High-dose radiation therapy • Metal stent in the vena cava Tumor Lysis Syndrome • 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: • Prevention • Hydration • Drug therapy Tumor Lysis Syndrome (Cont’d) NCLEX TIME Question 1 In affluent countries, what percentage of people diagnosed with cancer each year are cured of their disease? A. B. C. D. 25% 40% 50% 65% Question 2 What is the expected outcome related to hair loss for the patient who is undergoing chemotherapy? A. Hair loss may be permanent. B. Hair regrowth usually begins about 1 month after completion of chemotherapy. C. New hair growth will likely be identical to previous hair growth in color and texture. D. Viable treatments exist for the prevention of alopecia. Question 3 A patient who is receiving radiation therapy for breast cancer would experience which side effect? A. B. C. D. Severe fatigue Mucositis Hair loss Nausea and vomiting Question 4 The nurse is assessing for tumor lysis syndrome in a patient who has been receiving chemotherapy. Which findings are possible for tumor lysis syndrome? A. Hypercalcemia B. Edema of the face, progressing later to arms and hands C. Dyspnea and epistaxis D. Hyperkalemia and hyperuricemia Question 5 True or False: The goal of therapy with erythropoiesis stimulating drugs, such as darbepoetin alfa (Aranesp) and epoetin alfa (Epogen and Procrit), is to return hemoglobin or hematocrit levels to normal levels after chemotherapy. A. True B. False