Cancer II

1. site

2. histological analysis (grading)

3. extent of diagnosis (staging)

TUmours are classified according to:

Grading

Measurement of abnormal the cells look compared to normal cells

Staging

Measurement of how far the cancer has progressed, looking for metastasis

0- no metastasis

1-

2-

3-

4- distant metastasis

Stages of cancer

blood and lymph

How can cancer cells spread? [2]

benign tumour

tumours are normally encapsulated

similar to parent cells

appearence of benign tumour cells:

◦Tumor size – characteristics, depth of invasion to adjacent tissues or organs

◦Node Involvement – extent & location of lymph node involvement

◦Metastasis – degree of disease spread to other organs

TNM standardization of clinical staging:

1. remove and destroy cancer cells

2. prevent growth and abnormal spreading

Cancer treatment focuses on: [2]

Patient in consultation with oncologist and surgeon (primary HCP)

who decides cancer treatment?

Chemotherapy

combination of cytotoxic medications to cause damage or to kill cells. Also kills healthy cells that are rapidly proliferating.

radiation therapy

◦More localized, targets that specific area only without causing damage to other tissues.

takes the tumour and margin around the tumour.

during surgical therapy what does the surgeon remove?

Palliative surgery

tumour surgery to relieve symptoms, may not necessarily cure the cancer.

to be able to compare to after.

Why get baseline labs before surgiical therapy?

Pregnancy and infection

Why check urines before surgery?

to stop cell destruction in different ways and minimize toxic effects to patient

Why give multiple tyes of chemotherapy drugs?

Oral and IV (can also be topical or inserted in a cavity)

Most common routes of chemotherapy:

1. gi tract

2. hair follicles

3. bone marrow

4. mucous membranes

four types of rapidly growing cells that are the primary reason for adverse efects of chemo:

1. don’t have to poke all the time

2. quick administration (gets diluted quickly in large blood volume)

benefits of a CVAD:

Want the chemo to go in at a controlled rate because of the cytotoxicity. Also want to protect kidneys (give fluid, chemo, more fluid)

Why are IV pumps important when giving chemo?

in the superior vena cava

Where does the tip of the CVAD sit?

before and after eating and before bed

When to rinse with saline to prevent sores

because once they get them they are difficult to treat.

why is it important to treat sores in the mouth even if the patient is not experiencing side effects?

Bulldog clampps: metal clamps criss crossed so child cannot open them up.

multi-loop the line under a dressing.

Safety for pediatric CVAD: [2]

1. prepare for procedure

2. access, change dressing, flush

3. monitor for complications (infection, embolism, dislodgement)

nursing care for CVAD:

smaller doses frequently:

normally 4-5 times a week for a few weeks in a row

how often will patients get radation therapy?

Simulation

When patient goes in before starting radiation treatment to get markings on their skin so the field can be reproduced

• they are considered radioactive

• minimize exposure to other people (especially pregnant)

• no harsh chemicals (scented body washes, etc.)

patient education for internal radiation:

they are usually sedated unless they can sit still

how radiation is given to kids:

fatigue

most commonly reported side effect of cancer treatment:

1. rest and relax

2. nutrition and hydration

3. treat pain

How to treat fatigue: [3]

anorexia

No desire to eat

give something to numb or give cold foods

how to treat oral issues:

at least 2x a week

how often will body weight be taken on patients receiving cancer treatment?

Nader period

When all blood counts are at lowest level

infection (neutrophils are first line of defense)

neutropenia increases the risk for what?

febrile neutropenia (oncologic emergency)

when a neutropenic patient has a temp greater or equal to 38 for more than a hour

Even if the temp goes down the infection is still ongoing

why shouldn’t oncologic patients take tylenol when they have a fever?

reverse isolation precautions: private room, PPE, their own equpiment, visitor restrictions, no raw fruits or vegetables, don’t send flowers (microbes in dirt), dishes in the dishwasher (hot)

Precautions for febrile neutropenia

if peripheral is normal and lumen is infected, then its prbably the central line.

why take blood sample from all three lumens of hickman AND peripheral?

broad spectrum antibiotic until we figure out what is going on?

med treatment for febrile neutropenia:

1. risk for bleeding

2. bruising

3. bleeding gums

4. dark stool

5. electric razor (don’t want to cut self)

6. nose bleeds

Patient education for thrombocytopenia:

1. prevent injury

2. electric razo

3. rsoft toothbrush

how to prevent bleeding: [3]

1. fatigue

2. pallor

3. dizziness

4. SOB

5. High HR

6. low BP

7. low O2

S+S of anemia

Thrombocytopenia

low platelets

hair will regrow 3-4 weeks after treatment ends

how long might alopecia last?

1. get professional to shave it to avoid nicks (risk for infection)

2. apply sunscreen

education for alopecia from cancer treatment: [2]

1. soft, non-irritating, high protein, high calorie foods

2. small frequent meals

3. supplements

diet during cancer treatment: [3]

1. pneumonitis (radiation)

2. pulmonary edema

respiratory effects from cancer treatment: [2]

1. bronchodilators

2. expectorats

3. bed rest

4. o2

treatment for pneumonitis [4]

1. high fowlers

2. o2

3. medications

4. i/o

treatment for pulmonary edema: [4]

Maxeran (metoclopramide)

Antiemetic that increases peristalsis to get it out

zofran

the golden nugget given prohylactically and for a few days after cancer treatment

1. tumour could e pressing on something

2. multiple rocedures

3. blood drawn

4. surgery

5. chemo

6. radiation

7. periheral neuropathy from chemo

Why might a cancer patient be in pain? [7]

Breakthrough pain

when pain comes back before the next dose of pain meds (give a different one)

Tumour lysis syndrome

Tumour cells are dying off are releasing things for the kidneys to filter but that is not working (see issues in a patient getting chemotherapy)

7-14 days

when is the nader period