Transcript Systemic side effects Nursing Management in Radiation Therapy

Oncology
Assessment and Management of
Patients With Cancer Breast
Prepared by Dr. Iman Abdullah
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Pathophysiology of the Malignant Process
Proliferative Patterns
Characteristics of Malignant Cells
Management of Cancer
Radiation Therapy
Types of Radiation
Toxicity
Nursing Management in Radiation Therapy
Chemotherapy
Administration of Chemotherapeutic Agents
Special Problems Extravasation
Toxicity
Nursing Management in Chemotherapy
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Anatomic and Physiologic Overview of Breast
Assessment
Malignant Conditions of the Breast
Types of Breast Cancer
Risk Factors
Breast Cancer Prevention Strategies in the High-Risk Patient
Clinical Manifestations
Assessment and Diagnostic Findings
Staging or Classification of Tumors
Prognosis
Surgical Management
Nursing Process
Systemic Treatments
Learning Objectives
On completion of this lecture, the student will be able to:
Compare the structure and function of the normal
cell and the cancer cell
Differentiate between benign and malignant
tumors.
Describe the roles of radiation therapy, and
chemotherapy in treating cancer.
Describes the special nursing needs of patients
receiving chemotherapy.
Develop a teaching plan for breast selfexamination
Cont.
Identify the diagnostic tests used to detect the
breast disorders.
Use the nursing process as a framework for care
of the patient undergoing breast cancer surgery.
Compare the therapeutic usefulness of
chemotherapy, surgery and radiation in treating
breast cancer
Describe the physical, psychological and
rehabilitative needs of the patient who has had
mastectomy
Pathophysiology of the Malignant Process
Cancer is a disease process that begins when an
abnormal cell is transformed by the genetic mutation of
the cellular DNA.
Proliferative Patterns
Characteristics of Malignant Cells
Management of Cancer
Surgery
Radiation therapy
Chemotherapy
Bone Marrow Transplantation
Hyperthermia
Targeted therapies
Photodynamic therapy
Radiation Therapy
Types of Radiation
External Radiation
Internal radiation
Radiation Dosage
Toxicity
 Altered skin integrity is a common effect
 Alterations in oral mucosa
 The entire gastrointestinal mucosa may be involved
 Anorexia nausea, and vomiting, and diarrhea
 If sites containing bone marrow (Anemia, Leukopenia,
Thrombocytopenia (bleeding)
 Systemic side effects
Nursing Management in Radiation Therapy
Protecting skin and oral mucosa
Protecting caregivers
Chemotherapy
Administration of Chemotherapeutic Agents
The route of administration usually depends on:
The type of agent
The required dose
The type, location, and extent of tumor being
treated
Special Problems Extravasation
 Indications of extravasation during administration of
vesicant agents
Toxicity
Cells with rapid growth rates (eg, epithelium, bone marrow,
hair follicles, sperm) are very susceptible to damage, and
various body systems may be affected as well.
Gastrointestinal System
Hematopoietic System
Cardiopulmonary System
Renal System
Reproductive System
Neurologic System
Miscellaneous
Nursing Management in Chemotherapy
Assessing fluid and electrolyte status
Modifying risks for infection and bleeding
Administering chemotherapy
Protecting caregivers
Anatomic and Physiologic Overview
Assessment
Health History
Physical Assessment:
Female Breast
Diagnostic Evaluation
Malignant Conditions of the Breast
Types of Breast Cancer
 Ductal Carcinoma in Situ (DCIS)
 Invasive Cancer
• Infiltrating Ductal Carcinoma
• Infiltrating Lobular Carcinoma
• Medullary Carcinoma
• Mucinous Carcinoma
• Tubular Ductal Carcinoma
• Inflammatory Carcinoma
• Paget Disease
Risk Factors
Non Genetic Risk Factors
Gender and Age
Personal History
Hormonal Factors
Radiation Exposure
Benign Proliferative Breast Disease
Fat Intake and Obesity
Alcohol Use
Other Possible Risk Factors
Genetic Risk Factors
More than 80% of all breast cancer cases have no known
family history of the disease.
In familial cases, the risk is determined by which family
member has the disease. Having a first-degree relative
increase the risk twofold.
Protective Factors
Breast Cancer Prevention Strategies in the
High-Risk Patient
Long-Term Surveillance
Chemoprevention
Chemoprevention
Prophylactic Mastectomy
Clinical Manifestations
Assessment and Diagnostic Findings
Techniques to determine the diagnosis of breast cancer
include various types of biopsy, which have been
discussed previously.
Staging or Classification of Tumors
Stage 0
Stage 1
Stage II and stage III, stage IV
Prognosis
The two most important
factors when determining
the prognosis of a patient
with breast cancer are:
 Tumor size
 Whether the tumor has
spread to the lymph nodes
under the arm (axilla).
Surgical Management
Modified Radical Mastectomy
Total Mastectomy
Breast Conservation Treatment
Nursing Process
The Patient Undergoing Surgery for Breast Cancer
Assessment
Diagnosis (Preoperative Nursing Diagnosis)
Diagnosis (Postoperative Nursing Diagnosis)
Potential Complications
Planning and Goals
Preoperative Nursing Interventions
Postoperative Nursing Interventions
Monitoring and managing potential complications
Lymphedem
Hematoma Formation
Seroma Formation
Infection
Promoting Home and Community-Based Care
Radiation Therapy
Types of radiation
External-beam radiation
Brachytherapy
Intraoperative radiation therapy
Acute Side Effects
Nursing Management
Systemic Treatments
I- Chemotherapy
Common physical side effects of chemotherapy for
breast cancer
Specific side effects vary with the type of
chemotherapeutic agent used.
The side effects of the anthracyclines
Nursing Management
II- Hormonal Therapy
Managing Side Effects of Adjuvant Hormonal
Therapy in Breast Cancer
 Hot Flashes
 Vaginal Dryness
 Nausea and Vomiting
 Musculoskeletal Symptoms
 Risk of Endometrial Cancer
 Risk for Thromboembolic Events
 Risk for Osteoporosis or Fractures
III- Targeted Therapy
Trastuzumab (Herceptin) is a monoclonal antibody that
binds specifically to the HER-2/neuprotein.
This protein, which regulates cell growth, is present in small
amounts on the surface of normal breast cells and in most
breast cancers.
Trastuzumab targets and inactivates the HER-2/neuprotein,
thus slowing tumor growth.
Unlike chemotherapy, trastuzumab spares the normal cells
and has limited adverse reactions, which may include fever,
chills, nausea, vomiting, diarrhea, and headache.
Reference
Brunner, L. and Suddarath, D. (2010). Text Book of
Medical Surgical Nursing. 12th Edition. J.B. Lippincott
Williams & Wilikins, Library of Congress Catalging-inPublication Data.]
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