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Monday, October 22, 2007

Cancer Nursing :: Medical Surgical Nursing :: Review For Nursing Licensure Examination

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Cancer Nursing :: Medical Surgical Nursing :: Review For Nursing Licensure Examination Slide Transcript
Slide 1: Oncology Nursing Nurse Licensure Examination Review

Slide 2: Oncology defined Branch of medicine that deals with the study, detection, treatment and management of cancer and neoplasia

Slide 3: “Root words” Neo- new Plasia- growth Plasm- substance Trophy- size +Oma- tumor Statis- location

Slide 4: “Root words” A- none Ana- lack Hyper- excessive Meta- change Dys- bad, deranged

Slide 5: Characteristics of Neoplasia Uncontrolled growth of Abnormal cells 1. Benign 2. Malignant 3. Borderline

Slide 6: Characteristics of Neoplasia BENIGN Well-differentiated Slow growth Encapsulated Non-invasive Does NOT metastasize

Slide 7: Characteristics of Neoplasia MALIGNANT Undifferentiated Erratic and Uncontrolled Growth Expansive and Invasive Secretes abnormal proteins METASTASIZES

Slide 10: Nomenclature of Neoplasia Tumor is named according to: 1. Parenchyma, Organ or Cell Hepatoma- liver Osteoma- bone Myoma- muscle

Slide 11: Nomenclature of Neoplasia Tumor is named according to: 2. Pattern and Structure, either GROSS or MICROSCOPIC Fluid-filled CYST Glandular ADENO Finger-like PAPILLO Stalk POLYP

Slide 12: Nomenclature of Neoplasia Tumor is named according to: 3. Embryonic origin Ectoderm ( usually gives rise to epithelium) Endoderm (usually gives rise to glands) Mesoderm (usually gives rise to Connective tissues)

Slide 13: BENIGN TUMORS Suffix- “OMA” is used Adipose tissue- LipOMA Bone- osteOMA Muscle- myOMA Blood vessels- angiOMA Fibrous tissue- fibrOMA

Slide 14: MALIGNANT TUMOR Named according to embryonic cell origin 1. Ectodermal, Endodermal, Glandular, Epithelial Use the suffix- “CARCINOMA” Pancreatic AdenoCarcinoma Squamos cell Carcinoma

Slide 15: MALIGNANT TUMOR Named according to embryonic cell origin 2. Mesodermal, connective tissue origin Use the suffix “SARCOMA FibroSarcoma Myosarcoma AngioSarcoma

Slide 16: “PASAWAY” 1. “OMA” but Malignant HepatOMA, lymphOMA, gliOMA,  melanOMA 2. THREE germ layers “TERATOMA”  3. Non-neoplastic but “OMA” Choristoma   Hamatoma

Slide 17: CANCER NURSING Review of Normal Cell Cycle 3 types of cells 1. PERMANENT cells- out of the cell cycle Neurons, cardiac muscle cell  2. STABLE cells- Dormant/Resting (G0) Liver, kidney  3. LABILE cells- continuously dividing GIT cells, Skin, endometrium , Blood cells 

Slide 18: CANCER NURSING Cell Cycle G0------------------G1SG2M G0- Dormant or resting G1- normal cell activities S- DNA Synthesis G2- pre-mitotic, synthesis of proteins for cellular division M- Mitotic phase (I-P-M-A-T)

Slide 19: CANCER NURSING Proposed Molecular cause of CANCER: Change in the DNA structure altered DNA function Cellular aberration  cellular death  neoplastic change Genes in the DNA- “proto-oncogene” And “anti-oncogene”

Slide 20: CANCER NURSING Etiology of cancer 1. PHYSICAL AGENTS Radiation Exposure to irritants Exposure to sunlight Altitude, humidity

Slide 21: CANCER NURSING Etiology of cancer 2. CHEMICAL AGENTS Smoking Dietary ingredients Drugs

Slide 22: CANCER NURSING Etiology of cancer 3. Genetics and Family History Colon Cancer Premenopausal breast cancer

Slide 23: CANCER NURSING Etiology of cancer 4. Dietary Habits  Low-Fiber  High-fat  Processed foods  alcohol

Slide 24: CANCER NURSING Etiology of cancer 5. Viruses and Bacteria DNA viruses- HepaB, Herpes, EBV, CMV, Papilloma Virus RNA Viruses- HIV, HTCLV Bacterium- H. pylori

Slide 25: CANCER NURSING Etiology of cancer 6. Hormonal agents DES OCP especially estrogen

Slide 26: CANCER NURSING Etiology of cancer 7. Immune Disease AIDS

Slide 27: CANCER NURSING CARCINOGENSIS Malignant transformation IPP Initiation Promotion Progression

Slide 28: CANCER NURSING CARCINOGENSIS INITIATION Carcinogens alter the DNA of the cell Cell will either die or repair

Slide 29: CANCER NURSING CARCINOGENSIS PROMOTION Repeated exposure to carcinogens Abnormal gene will express Latent period

Slide 30: CANCER NURSING CARCINOGENSIS PROGRESSION Irreversible period Cells undergo NEOPLASTIC transformation then malignancy

Slide 31: CANCER NURSING Spread of Cancer 1. LYMPHATIC Most common  2. HEMATOGENOUS Blood-borne, commonly to Liver and Lungs  3. DIRECT SPREAD Seeding of tumors 

Slide 32: CANCER NURSING Body Defenses Against TUMOR 1. T cell System/ Cellular Immunity Cytotoxic T cells kill tumor cells  2. B cell System/ Humoral immunity B cells can produce antibody  3. Phagocytic cells Macrophages can engulf cancer cell debris 

Slide 33: CANCER NURSING Cancer Diagnosis 1. BIOPSY The most definitive  2. CT, MRI 3. Tumor Markers

Slide 34: CANCER NURSING Cancer Grading The degree of DIFFERENTIATION Grade 1- Low grade Grade 4- high grade

Slide 35: CANCER NURSING Cancer Staging 1. Uses the T-N-M staging system T- tumor N- Node M- Metastasis 2. Stage 1 to Stage 4

Slide 36: CANCER NURSING GENERAL MEDICAL MANAGEMENT 1. Surgery- cure, control, palliate 2. Chemotherapy 3. Radiation therapy 4. Immunotherapy 5. Bone Marrow Transplant

Slide 37: CANCER NURSING GENERAL Promotive and Preventive Nursing Management 1. Lifestyle Modification 2. Nutritional management 3. Screening 4. Early detection

Slide 38: SCREENING 1. Male and female- Occult Blood, CXR, and DRE 2. Female- SBE, CBE, Mammography and Pap’s Smear 3. Male- DRE for prostate, Testicular self-exam

Slide 39: Nursing Assessment Utilize the ACS 7 Warning Signals CAUTION C- Change in bowel/bladder habits A- A sore that does not heal U- Unusual bleeding T- Thickening or lump in the breast I- Indigestion O- Obvious change in warts N- Nagging cough and hoarseness

Slide 40: Nursing Assessment Weight loss Frequent infection Skin problems Pain Hair Loss Fatigue Disturbance in body image/ depression

Slide 41: Nursing Intervention MAINTAIN TISSUE INTEGRITY Handle skin gently Do NOT rub affected area Lotion may be applied Wash skin only with SOAP and Water

Slide 42: Nursing Intervention MANAGEMENT OF STOMATITIS Use soft-bristled toothbrush Oral rinses with saline gargles/ tap water Avoid ALCOHOL-based rinses

Slide 43: Nursing Intervention  MANAGEMENT OF ALOPECIA Alopecia begins within 2 weeks of therapy  Regrowth within 8 weeks of termination  Encourage to acquire wig before hair loss occurs  Encourage use of attractive scarves and hats  Provide information that hair loss is temporary BUT anticipate change in texture and color

Slide 44: Nursing Intervention  PROMOTE NUTRITION  Serve food in ways to make it appealing  Consider patient’s preferences  Provide small frequent meals  Avoids giving fluids while eating  Oral hygiene PRIOR to mealtime  Vitamin supplements

Slide 45: Nursing Intervention  RELIEVE PAIN  Mild pain- NSAIDS Moderate pain- Weak opiods  Severe pain- Morphine  Administer analgesics round the clock with additional dose for breakthrough pain

Slide 46: Nursing Intervention  DECREASE FATIGUE  Plan daily activities to allow alternating rest periods  Light exercise is encouraged  Small frequent meals

Slide 47: Nursing Intervention  IMPROVE BODY IMAGE  Therapeutic communication is essential  Encourage independence in self-care and decision making  Offer cosmetic material like make-up and wigs

Slide 48: Nursing Intervention  ASSIST IN THE GRIEVING PROCESS  Some cancers are curable  Grieving can be due to loss of health, income, sexuality, and body image  Answer and clarify information about cancer and treatment options  Identify resource people  Refer to support groups

Slide 49: Nursing Intervention  MANAGE COMPLICATION: INFECTION  Fever is the most important sign (38.3)  Administer prescribed antibiotics X 2weeks  Maintain aseptic technique  Avoid exposure to crowds  Avoid giving fresh fruits and veggie  Handwashing  Avoid frequent invasive procedures

Slide 50: Nursing Intervention  MANAGE COMPLICATION: Septic shock  Monitor VS, BP, temp  Administer IV antibiotics  Administer supplemental O2

Slide 51: Nursing Intervention  MANAGE COMPLICATION: Bleeding  Thrombocytopenia (<100,000) is the most common cause  <20, 000 spontaneous bleeding  Use soft toothbrush  Use electric razor  Avoid frequent IM, IV, rectal and catheterization  Soft foods and stool softeners

Slide 52: Colon cancer

Slide 53: COLON CANCER Risk factors 1. Increasing age 2. Family history 3. Previous colon CA or polyps 4. History of IBD 5. High fat, High protein, LOW fiber 6. Breast Ca and Genital Ca

Slide 54: COLON CANCER Sigmoid colon is the most common site Predominantly adenocarcinoma If early 90% survival 34 % diagnosed early 66% late diagnosis

Slide 55: COLON CANCER PATHOPHYSIOLOGY Benign neoplasm DNA alteration malignant transformation malignant neoplasm  cancer growth and invasion  metastasis (liver)

Slide 56: COLON CANCER  ASSESSMENT FINDINGS 1. Change in bowel habits- Most common 2. Blood in the stool 3. Anemia 4. Anorexia and weight loss 5. Fatigue 6. Rectal lesions- tenesmus, alternating D and C

Slide 57: Colon cancer Diagnostic findings 1. Fecal occult blood 2. Sigmoidoscopy and colonoscopy 3. BIOPSY 4. CEA- carcino-embryonic antigen

Slide 58: Colon cancer Complications of colorectal CA 1. Obstruction 2. Hemorrhage 3. Peritonitis 4. Sepsis

Slide 59: Colon cancer MEDICAL MANAGEMENT 1. Chemotherapy- 5-FU 2. Radiation therapy

Slide 60: Colon cancer SURGICAL MANAGEMENT Surgery is the primary treatment Based on location and tumor size Resection, anastomosis, and colostomy (temporary or permanent)

Slide 61: Colon cancer NURSING INTERVENTION Pre-Operative care 1. Provide HIGH protein, HIGH calorie and LOW residue diet 2.Provide information about post-op care and stoma care 3. Administer antibiotics 1 day prior

Slide 62: Colon cancer NURSING INTERVENTION Pre-Operative care 4. Enema or colonic irrigation the evening and the morning of surgery 5. NGT is inserted to prevent distention 6. Monitor UO, F and E, Abdomen PE

Slide 63: Colon cancer NURSING INTERVENTION Post-Operative care 1. Monitor for complications Leakage from the site, prolapse of stoma, skin irritation and pulmo complication 2. Assess the abdomen for return of peristalsis

Slide 64: Colon cancer NURSING INTERVENTION Post-Operative care 3. Assess wound dressing for bleeding 4. Assist patient in ambulation after 24H 5.provide nutritional teaching Limit foods that cause gas-formation and odor Cabbage, beans, eggs, fish, peanuts Low-fiber diet in the early stage of recovery

Slide 65: Colon cancer NURSING INTERVENTION Post-Operative care 6. Instruct to splint the incision and administer pain meds before exercise 7. The stoma is PINKISH to cherry red, Slightly edematous with minimal pinkish drainage 8. Manage post-operative complication

Slide 67: Colon cancer NURSING INTERVENTION: COLOSTOMY CARE Colostomy begins to function 3-6 days after surgery The drainage maybe soft/mushy or semi-solid depending on the site

Slide 68: Colon cancer NURSING INTERVENTION: COLOSTOMY CARE BEST time to do skin care is after shower Apply tape to the sides of the pouch before shower Assume a sitting or standing position in changing the pouch

Slide 69: Colon cancer NURSING INTERVENTION: COLOSTOMY CARE Instruct to GENTLY push the skin down and the pouch pulling UP Wash the peri-stomal area with soap and water Cover the stoma while washing the peri- stomal area

Slide 70: Colon cancer NURSING INTERVENTION: COLOSTOMY CARE Lightly pat dry the area and NEVER rub Lightly dust the peri-stomal area with nystatin powder

Slide 71: Colon cancer NURSING INTERVENTION: COLOSTOMY CARE Measure the stomal opening The pouch opening is about 0.3 cm larger than the stomal opening Apply adhesive surface over the stoma and press for 30 seconds

Slide 72: Colon cancer NURSING INTERVENTION: COLOSTOMY CARE Empty the pouch or change the pouch when 1/3 to ¼ full (Brunner)   ½ to 1/3 full (Kozier)

Slide 73: Breast Cancer The most common cancer in FEMALES Numerous etiologies implicated

Slide 74: Breast Cancer RISK FACTORS 1. Genetics- BRCA1 And BRCA 2 2. Increasing age ( > 50yo) 3. Family History of breast cancer 4. Early menarche and late menopause 5. Nulliparity 6. Late age at pregnancy

Slide 75: Breast Cancer RISK FACTORS 7. Obesity 8. Hormonal replacement 9. Alcohol 10. Exposure to radiation

Slide 76: Breast Cancer PROTECTIVE FACTORS 1. Exercise 2. Breast feeding 3. Pregnancy before 30 yo

Slide 78: Breast Cancer ASSESSMENT FINDINGS 1. MASS- the most common location is the upper outer quadrant 2. Mass is NON-tender. Fixed, hard with irregular borders 3. Skin dimpling 4. Nipple retraction 5. Peau d’ orange

Slide 79: Breast Cancer LABORATORY FINDINGS 1. Biopsy procedures 2. Mammography

Slide 80: Breast Cancer Breast cancer Staging TNM staging I - < 2cm II - 2 to 5 cm, (+) LN III - > 5 cm, (+) LN IV- metastasis

Slide 81: Breast Cancer MEDICAL MANAGEMENT 1. Chemotherapy 2. Tamoxifen therapy 3. Radiation therapy

Slide 82: Breast Cancer SURGICAL MANAGEMENT 1. Radical mastectomy 2. Modified radical mastectomy 3. Lumpectomy 4. Quadrantectomy

Slide 83: Breast Cancer NURSING INTERVENTION : PRE-OP 1. Explain breast cancer and treatment options 2. Reduce fear and anxiety and improve coping abilities 3. Promote decision making abilities 4. Provide routine pre-op care: Consent, NPO, Meds, Teaching about breathing exercise

Slide 84: Breast Cancer NURSING INTERVENTION : Post-OP 1. Position patient: Supine Affected extremity elevated to reduce edema

Slide 85: Breast Cancer NURSING INTERVENTION : Post-OP 2. Relieve pain and discomfort Moderate elevation of extremity IM/IV injection of pain meds Warm shower on 2nd day post-op

Slide 86: Breast Cancer NURSING INTERVENTION : Post-OP 3. Maintain skin integrity Immediate post-op: snug dressing with drainage Maintain patency of drain (JP) Monitor for hematoma w/in 12H and apply bandage and ice, refer to surgeon

Slide 87: Breast Cancer NURSING INTERVENTION : Post-OP 3. Maintain skin integrity Drainage is removed when the discharge is less than 30 ml in 24 H Lotions, Creams are applied ONLY when the incision is healed in 4-6 weeks

Slide 88: Breast Cancer NURSING INTERVENTION : Post-OP Promote activity Support operative site when moving Hand, shoulder exercise done on 2ndday Post-op mastectomy exercise 20 mins TID NO BP or IV procedure on operative site

Slide 89: Breast Cancer NURSING INTERVENTION : Post-OP Promote activity Heavy lifting is avoided Elevate the arm at the level of the heart On a pillow for 45 minutes TID to relieve transient edema

Slide 90: Breast Cancer NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS Lymphedema 10-20% of patients Elevate arms, elbow above shoulder and hand above elbow Hand exercise while elevated Refer to surgeon and physical therapist

Slide 91: Breast Cancer NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS Hematoma Notify the surgeon Apply bandage wrap (Ace wrap) and ICE pack

Slide 92: Breast Cancer NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS Infection Monitor temperature, redness, swelling and foul-odor IV antibiotics No procedure on affected extremity

Slide 93: Breast Cancer NURSING INTERVENTION : Post-OP TEACH FOLLOW-UP care Regular check-up Monthly BSE on the other breast Annual mammography

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