Nsg Management of Cancer

7/28/2019 Nsg Management of Cancer

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DIFFERENT TYPES

OF

CANCER


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SKIN CANCER

Is a malignant lesion of

the skin, which may or

may not metastasize

Skin cancer causes

include chronic friction

and irritation to a skin

area and exposure to

ultraviolet rays.

Diagnosis is confirmedby a skin biopsy that is

positive for cancer cells


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TYPES

1.Basal cell the most common type, basal cell cancer arises from the basalcell contained in the epidermis.

a.Waxy border

b.papule, red, central crater

c.metastasis is rare

2.Squamous cell the second most common type of skin cancer in whites;squamous cell cancer is the tumor of the epidermal epidermal keratinocytes and

can infiltrate surrounding structures, metastasize to lymph nodes, and

subsequently be fatal.

a.Oozing, bleeding, crusting lesion

b.Potentially metastatic

c.Large tumors associated with a higher risk for metastasis

3.Malignant melanoma may occur any place on the body, especially where

birthmarks or new moles are apparent. Cancer of the melanocytes can

metastasize to the brain, bones, lung, liver and skin and is ultimately fatal.

a.Irregular, circular, bordered lesion with hues of tan, black or blue

b.Rapid infiltration into tissue, rapid metastasis, significant rate of morbidity

and mortality


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Nursing Management

Instruct the client regarding preventive measures

Instruct the client to monitor for lesions that do not heal or that

change characteristics

Instruct the client to have moles or lesions removed that are

subject to chronic irritation Instruct the client to avoid contact with chemical irritants

Instruct the client to wear layered clothing and use sunscreen

lotions with an appropriate skin protection factor when

outdoors

Instruct the client to avoid sun exposure between 11 AM and 3PM

Assist with surgical excision of the lesion as prescribed


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BREAST CANCER

Is classified as invasive when

it penetrates the tissue

surrounding the mammary duct

and grows in an irregular pattern

Metastasis occurs via lymph

node

Diagnosis is made by breast

biopsy through a needle

aspiration or by surgical removalof the tumor with microscopic

examination of malignant cells


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Assessment

Mass felt during BSEAsymmetry, with the affected breast

being higher

Skin dimpling, retraction, or

ulceration

Bloody or clear nipple dischargeSkin edema or peau dorange skin

Axillary lymphadenopathy

Lymphedema of the affected arm


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Non-surgical Interventions

Chemotherapy

Radiation therapy

Hormonal manipulation via the

use of medication in post-menopausal women or other

medications such as

tamoxifen (Nolvadex) for

estrogen receptor-positive

tumors.


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Surgical interventions

Lumpectomy

Tumor is excised and removed

Lymph node dissection may also be performed

Simple mastectomy

Breast tissue and the nipple are removed

Lymph nodes are left intact

Modified radical mastectomy

Breast tissue, nipple, and lymph nodes are removed

Muscles are left intact


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Nursing Management

Monitor vital signs

Position the client in Semi-Fowlers position

Turn from the back to the unaffected side, with the

affected arm elevated above the level of the heart to

promote drainage and prevent lymphedema

Encourage coughing and deep breathing

If a drain (usually Jackson Pratt) is in place,

maintain suction and record the amount of drainage

and drainage characteristics


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Assess operative site for infection, swelling, orpresence of fluid collection under the skin flaps or in

the arm

Place a sign above the bed stating: No IVs, No

injections, No BPs, No venipuncture in affected arm;

the affected arm is protected and any intervention thatcould traumatize the affected arm is avoided.

Consult with the physician and physical therapist

regarding the appropriate exercise program and assist

client with prescribed exercise

Nursing Management cont.


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Client instruction following mastectomy:

Avoid overuse of the arm during the first few months To prevent lymphedema, keep the affected arm elevated

Encourage the client to perform BSE on the remaining breast

Protect the affected hand and arm

Do not let the affected arm hang dependent

Do not carry pocketbook or anything heavy over the affected arm Avoid trauma, cuts, or bruises, or burns to the affected side

Avoid wearing constricting clothing or jewelry on the affected side

Wear gloves when gardening

Use thick oven mitts when cooking

Use a thimble when sewing


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LUNG CANCER

Malignant tumor of the bronchi and

peripheral lung tissue, is a leadingcause of cancer-related deaths in men

and women in the United States

The lungs are a common target for

metastasis from other organs

Bronchogenic cancer (tumors originate

in the epithelium of the bronchus)spreads through direct extension and

lymphatic dissemination

Classified according to histological cell

type, there are two main types of lung

cancer, small cell lung cancer and non-small cell lung cancer.

Diagnosis is made by a chest x-ray, CT

scan, or MRI, which will show a lesion or

mass and by bronchoscopy and sputum

studies, which will demonstrate a

positive cytological study for cancer cells


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Cigarette smoking, exposure topassive tobacco smoke

Exposure to environmental and

occupational pollutants


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ASSESSMENT

Cough

Wheezing, dyspnea

Hoarseness

Hemoptysis

Chest pain Anorexia

Weakness

Diminished or absent breath

sounds, respiratory changes


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NURSING MANAGEMENT

Monitor vital sign

Monitor for breathing patterns and breath sounds

Place in a fowlers position to help ease breathing

Administer oxygen as prescribed and humidification to

moisten and loosen secretions Monitor pulse oximetry

Provide a high calorie, high protein, high vitamin diet

Provide activity as tolerated, rest periods, and active and

passive range of motion exercises

Monitor for bleeding and infection


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NONSURGICAL

INTERVENTIONS

Radiation therapy may be

prescribed for localized

intrathoracic lung cancers

and for palliation of

hemoptysis, obstructions,

dysphagia, superior venacava syndrome, and pain

Chemotherapy may be

prescribed for treatment of

nonresectable tumors or

as adjuvant therapy

SURGICAL

INTERVENTIONS

Laser therapy: to relieve

endobronchial obstruction

Thoracentesis and

pleurodesis: to remove pleuralfluid and relive hypoxia

Thoracotomy with

pneumonectomy: surgical

removal of one entire lung

Thoracotomy with segmental

resection: surgical removal of

a lobe segment


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A slow growing malignancy of the

prostate gland; most prostate

tumors are adenocarcinoma arisingfrom androgen-dependent epithelial

cells

The risk increases in men with each

decade after the age of 50 years

Can spread by direct invasion ofsurrounding tissues or by

metastasis, through the blood

stream and lymphatics, to the bony

pelvis and spine

The cause of prostate cancer isunclear, but advancing age, heavy

metal exposure, smoking, and

history of sexually transmitted

disease are contributing factors


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ASSESSMENT

Asymptomatic in early stages

Hard, pea-sized nodule orirregularities palpated on

rectal examination

Gross, painless hematuria

Trouble urinating (dysuria)

Decreased force in the streamof urine

Blood in the urine

Blood in the semen

Swelling in the legs

Discomfort in the pelvic area

Bone pain


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NURSING MANAGEMENT

Provide encouragement to the patient to express his

fears and concerns, including those about changes in

his sexual identity, owing to surgery.

Offer reassurance when possible.

Give analgesics when necessary as ordered.

Provide comfort measures to reduce pain. Encourage

the patient to identify care measures that promote his

comfort and relaxation.


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After Prostatectomy:

Regularly check the dressing, incision, and drainage systems

for excessive blood. Also watch for signs of bleeding (pallor,

restlessness, decreasing blood pressure, and increasing pulse

rate).

Be alert for signs of infection (fever, chills, inflamed incisional

area).

Maintain adequate fluid intake (at least 2,000 ml daily).

Give antispasmodics, as ordered, to control postoperative

bladder spasms. Also provide analgesics as needed.

Because urinary incontinence commonly followsprostatectomy, keep the patients skin clean and dry.


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After Suprapubic Prostatectomy:

Keep the skin around the suprapubic drain dry and free from

drainage and urine leakage.

Encourage the patient to begin perineal exercises between 24

and 48 hours after surgery.

Allow the patients family to assist in his care and encouragethem to provide psychological support.

Give meticulous catheter care.

After prostatectomy, a patient usually has a three-way

catheter with a continuous irrigation system. Check the tubing

for kinks, mucus plugs, and clots, especially if the patientcomplains of pain.

Warn the patient not to pull on the tubes or the catheter.


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After Transurethral Resection

Watch for signs of urethral stricture (dysuria, decreased force

and caliber of urine stream, and straining to urinate).

Also observe for abdominal distention (a result of urethral

stricture or catheter blockage by a blood clot).

Irrigate the catheter, as ordered.

Avoid taking the patients temperature rectally or inserting

enema or other rectal tubes.

Provide pads to absorb draining urine.

Assist the patient with frequent sitz baths to relieve pain and

inflammation.

After Perineal Prostatectomy


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After Perineal or Retropubic Prostatectomy

Give reassurance that urine leakage after catheter removal is

normal and subsides in time.

After Radiation Therapy

Watch for the common adverse effects of radiation to theprostate. These include proctitis, diarrhea, bladder spasms,

and urinary frequency. Internal radiation of the prostate almost

always results in cystitis in the first 2 to 3 weeks of therapy.

Encourage the patient to drink at least 2,000 ml of fluid daily.

Administer analgesics and antispasmodics to increasecomfort.


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After Hormonal Therapy

When a patient receives hormonal therapy with

diethylstilbestrol, watch for adverse effects (gynecomastia,

fluid retention, nausea, and vomiting).

Be alert for thrombophlebitis (pain, tenderness, swelling,warmth, and redness in calf).


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Patient Teaching and Home Health Guide

Nursing Care Plans Prostate Cancer

Before surgery, discuss the expected results. Explain that

radical surgery always produces impotence. Up to 7% of

patients experience urinary incontinence.

To help minimize incontinence, teach the patient how to do

perineal exercises while he sits or stands. To develop his

perineal muscles, tell him to squeeze his buttocks together

and hold this position for a few seconds; then relax. He should

repeat this exercise as frequently as ordered by the physician.

Prepare the patient for postoperative procedures, such as

dressing changes and intubation.


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If appropriate, discuss the adverse effects of radiation

therapy. All patients who receive pelvic radiation therapy

will develop such symptoms as diarrhea, urinary frequency,

nocturia, bladder spasms, rectal irritation, and tenesmus.

Encourage the patient to maintain a lifestyle thats as

nearly normal as possible during recovery.

When appropriate, refer the patient to the social service

department, local home health care agencies, hospices,

and other support organizations.

Patient Teaching and Home Health Guide

Nursing Care Plans Prostate Cancer


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CERVICAL CANCER

Occurs when abnormal cells on the cervix grow out of control. The cervix is the

lower part of the uterus that opens into the vagina.

Can often be cured when it's found early. It is usually found at a very early stagethrough a Pap test

Caused by a virus called human papillomavirus, or HPV.

There are many types of the HPV virus. Not all types of HPV cause cervical

cancer. Some of them cause genital warts, but other types may not cause any

symptoms.

You can have HPV for years and not know it. It stays in your body and can lead tocervical cancer years after you were infected. This is why it is important to have

regular Pap tests. A Pap test can find changes in cervical cells before they turn into

cancer.


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ASSESSMENT

Bleeding from the vagina that

is not normal, or a change inyour menstrual cycle that you

can't explain.

Bleeding when something

comes in contact with yourcervix, such as during sex or

when you put in a diaphragm.

Pain during sex.

Vaginal discharge that is

tinged with blood.


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NURSING MANAGEMENT

o Collaborative If you assist with a biopsy, drape and prepare the patient as for a

routine Pap test and pelvic examination.

Have a container of formaldehyde ready to preserve the

specimen during transfer to the pathology laboratory.

Assist the physician as needed, and provide support for the

patient throughout the procedure. If you assist with cryosurgery or laser therapy, drape and prepare

the patient as for a routine Pap test and pelvic examination.

Assist the physician as necessary, and provide support for the

patient throughout the procedure.

Preinvasive lesions (CIS) can be treated by conization,cryosurgery, laser surgery, or simple hysterectomy (if the

patients reproductive capacity is not an issue). All conservative

treatments require frequent follow-up by Pap tests and

colposcopy because a greater level of risk is always present for

the woman who has had CIS Administer analgesics and

prophylactic antibiotics, as ordered.


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NURSING MANAGEMENT

o

Independent Listen to the patients fears and concerns, and offer reassurance

when appropriate.

Encourage her to use relaxation techniques to promote comfort

during diagnostic procedures.

.When a patient requires surgery, prepare her mentally and

physically for the surgery and the postoperative period.

After any surgery, monitor vital signs every 4 hours.

Watch for and immediately report signs of complications, such as

bleeding, abdominal distention, severe pain, and wheezing or

other breathing difficulties.

Encourage deep breathing and coughing.

Check to see whether the radioactive source is to be inserted

while the patient is in the operating room (preloaded) or at

bedside (afterloaded). If the source is preloaded, the patient

returns to her room hot and safety precautions begin

immediately.


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NURSING MANAGEMENT

Remember that safety precaution time, distance, and shielding begin

as soon as the radioactive source is in place. Inform the patient that

she will require a private room.

Check the patients vital signs every 4 hours

Assist the patient with range-of-motion arm exercises.

Avoid leg exercises and other body movements that coulddislodge the source. If ordered, administer a tranquilizer to help

the patient relax.

Provide activities that require minimal movement.

Watch for treatment complications by listening to and observing

the patient and monitoring laboratory studies and vital signs.

When appropriate, perform measures to prevent or alleviate

complications.


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Patient teaching, discharge and home healthcare

guidelines for patients with Cervical Cancer:

Be sure the patient and family understand any pain medication

prescribed, including dosage, route, action, and side effects.

Reassure the patient that this disease and Cervical Cancer

care treatment should not radically alter her lifestyle or prohibit sexual

intimacy. Tell to the patient all the post procedure complications.

Ensure that the patient understands the need for ongoing Papsmears if appropriate. Vaginal cytological studies are recommended

at 4-month intervals for 2 years, every 6 months for 3 years, and then

annually.

Explain the importance of complying with follow-up visits to the

gynecologist and oncologist. Stress the value of these visits in

detecting disease progression or recurrence


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o Biopsy

Explain to the patient that she may feel pressure, minor

abdominal cramps, or a pinch from the punch forceps.

Reassure her that the pain will be minimal because the cervix

has few nerve endings.

o Cryosurgery

Explain to the patient that the procedure takes about 15 minutes,

during which time the physician uses refrigerant to freeze the

cervix.

Caution to the patients that she may experience abdominalcramps, headache, and sweating, but reassure her that she will

feel little, if any, pain.


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o Laser surgery

Explain to the patient the laser surgery procedure takes about 30

minutes and may cause abdominal cramps.

After excision biopsy, cryosurgery, or laser therapy, tell the

patient to expect a discharge or spotting for about 1 week.

Advise her not to douche, use tampons, or engage in sexualintercourse during this time. Caution her to report signs of

infection.

Stress the need for a follow-up Pap test and a pelvic examination

in 3 to 4 months and periodically thereafter. Also, tell her what to

expect postoperatively if a hysterectomy is necessary. Laser surgery


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o Preloaded internal radiation therapy

Tell to the patient that preloaded internal radiation therapy

procedure requires hospital stay, bowel preparation, a

povidoneiodine vaginal douche, a clear liquid diet, and nothing by

mouth the night before the implantation. It also requires an

indwelling urinary catheter.

Inform the patient that preloaded internal radiation therapy isperformed in the operating room under general anesthesia.

o After loaded internal radiation therapy

Explain to the patient that a member of the radiation team

implants the source after the patient returns to her room from

surgery.

Remind the patient to watch for and report uncomfortable

adverse effects, warn the patient to avoid people with obvious

infections during therapy.

Inform the patient that vaginal narrowing caused by scar tissue

can occur after internal radiation. Describe the complications that

can occur after high-dose radiation therapy.


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LIVER CANCER

Liver cancer (hepatocellular carcinoma)

is a cancer arising from the liver. It is also

known as primary liver cancer or

hepatoma.

Liver is made up of different cell types

(for example, bile ducts, blood vessels,

and fat-storing cells). However, liver cells

(hepatocytes) make up 80% of the livertissue. Thus, the majority of primary liver

cancers (over 90%-95%) arises from liver

cells and is called hepatocellular cancer

or carcinoma.

Third most common cancer in the world.

A deadly cancer, liver cancer will kill

almost all patients who have it within a

year.

Hepatitis B infection is the most common

cause of this cancer worldwide.


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ASSESSMENT

Unexplained weight loss or unexplained fevers are warning

signs of liver cancer in patients with cirrhosis. Sudden appearance of ascites (abdominal fluid and swelling)

Jaundice (yellow color of the skin), or muscle wasting without

causative (precipitating) factors (for example, alcohol

consumption) suggests the possibility of liver cancer


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NURSING MANAGEMENT

Give analgesics as ordered and encourage the patient to identify

care measures that promote comfort.

Provide patient with a special diet that restricts sodium, fluids, andprotein and that prohibits alcohol.

To increase venous return and prevent edema, elevate the patients

legs whenever possible.

Keep the patients fever down.

Provide meticulous skin care. Turn the patient frequently and keep his skin clean to prevent

pressure ulcers.

Prepare the patient for surgery, if indicated.

Provide comprehensive care and emotional assistance.

Monitor the patient for fluid retention and ascites. Monitor respiratory function.

Explain the treatments to the patient and his family, including adverse

reactions the patient may experience.


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COLORECTAL CANCER

Cancer that starts in the large

intestine (colon) or the rectum(end of the colon).

Fourth most commonly

diagnosed cancer in the world,

but it is more common in

developed countries. Around60% of cases were diagnosed

in the developed world.

Most colorectal cancer occurs

due to lifestyle and increasing

age with only a minority ofcases associated with

underlying genetic disorders.

Colon cancer may be

associated with a high-fat, low-

fiber diet and red meat.


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ASSESSMENT

Many cases of colon cancer have no symptoms.

The following symptoms, however, may indicate colon cancer: Abdominal pain and tenderness in the lower abdomen

Blood in the stool

Diarrhea, constipation, or other change in bowel habits

Intestinal obstruction

Narrow stools Unexplained anemia

Weight loss with no known reason


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NURSING MANAGEMENT

Prepare for surgery: Colostomy

Neomycin, cathartics, enema

Diet: Low residue or liquid (1-2 days)Post-Op care:

I and O, IV, NGT

Teaching: Stoma Care:

Wash skin area (not stoma) with soap and water

Protective barrier (Stomahesive/Karaya): Empty 1/3 full: drain, squeeze type bottle with warm water

Change appliance 2-3 days

Stoma: moist pink not dusky blue

Colostomy Irrigation: distal colon/rectum

Time: Same per day, one hour after meal Solution: 500 to 1L lukewarm tap water.

Position: Sitting CR or side of bed

Cath Tip: Not over 4 inches; without force

Height: 12-18 inches/bag bottom at shoulder

Cramps: stop temp: 25-45 min return flow.


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NURSING MANAGEMENT

Diet: Odor causing: Fish, eggs,garlic,cheese, asparagus, onions,

spices

Gas causing:Cabbage,broccoli,onions, mushrooms,corn,peas

Hardens stool: Hard-boiled eggs, liver, meat, cheese, rice,

bananas, chocolate

Clear liquid-noon

NPO after midnight, bowel cleansing


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THYROID CANCER

Four main types: papillary, follicular,

medullary, and anaplastic thyroid cancer.The four types are based on how the

cancer cells look under a microscope.

Three times more common in women

than in men.

Cause of thyroid cancer is unknown, butcertain risk factors have been identified

and include a family history of goiter,

exposure to high levels of radiation, and

certain hereditary syndromes.

The National Cancer Instituterecommends that anyone who received

radiation to the head or neck in childhood

be examined by a doctor every one to

two years to detect potential thyroid

cancer.


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ASSESSMENT

a lump, or thyroid nodule, that can be felt in the neck,

trouble swallowing,

throat or neck pain,

swollen lymph nodes in the neck,

cough,

vocal changes.


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NURSING MANAGEMENT

Review clients and significant others (SOs) previous experience

with cancer. Determine what the doctor has told clientand whatconclusion client has reached. RationaleClarifies clients

perceptions; assists in identification of fear(s)and misconceptions

based on diagnosis and experiencewith cancer.

Ascertain client/SO(s) perception of what is occurring and how this

affects life. Rationale Fear is a natural reaction to frightening events

and how client views the event will determine how he or she will react

Encourage client to share thoughts and feelings. Rationale Provides

opportunity to examine realistic fears and misconceptions about

diagnosis.

Provide open environment in which client feels safe to discuss

feelings or to refrain from talking. Rationale Helps client feelaccepted in present condition without feeling judged and promotes

sense of dignity and control.


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NURSING MANAGEMENT

Be alert to signs of denial/depression. Indicates need for specific

interventions to identify and deal with problems. Rationale Client

may deny problems until unable to deal with situation. Depressionmay accompany problems associated with fear that interfere with

daily activities

Maintain frequent contact with client. Talk with and touch client, as

appropriate. Rationale Provides assurance that the client is not

alone or rejected; conveys respect for and acceptance of the person,

fostering trust.

Be aware of effects of isolation on client when required by

immunosuppression or radiation implant. Limit use of isolation

clothing, as possible. Rationale Sensory deprivation may result when

sufficient stimulation is not available and may intensify feelings of

anxiety, fear, and alienation. Assist client and SO in recognizing and clarifying fears to begin

developing coping strategies for dealing with these fears. Rationale

Coping skills are often stressed after diagnosis and during different

phases of treatment. Support and counseling are often necessary to

enable individual to recognize and deal with fear and to realize that

control and coping strategies are available.


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NURSING MANAGEMENT

Administer anti-anxiety medications, such as lorazepam (Ativan) oralprazolam (Xanax), as indicated. Rationale May be useful for brief

periods of time to help client handle feelings of anxiety related to

diagnosis or situation during periods of high stress, to assist client

with diagnostic procedures, such as lying still during scan, and/or to

minimize nausea.

Refer to additional resources for counseling and support as needed.

Rationale May be useful from time to time to assist client and SO in

dealing with anxiety.

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Nsg Management of Cancer