Oncology

There are many risk factors for development of cancer, list 5 factors

Tobacco (#1)

Alcohol

Diet: Low fiber (low residual), increased red meat, increased animal fat, Nitrates (increased sandwich meats), preservatives and additives.

Obesity (#2) or physical inactivity

Immunosupression

Aging (60<)

African American (#1) and Caucasian (#2)

Hereditary

Exposure to ultraviolet radiation

Exposure to carcinogens

Stress

Chronic irritation can cause uncontrolled growth of abnormal cells

Prior history of cancer or chemo

What are primary preventions for cancer?

No smoking

Exercise and good nutrition

Maintain normal body weight

Limit or eliminate alcohol

Hepatitis B and HPV vaccines

Avoid exposure to known carcinogens

Wear sunscreen/avoid sun exposure

Avoid second hand smoke

When thinking about secondary prevention, think what?

Screenings!

Describe breast self exams (BSE)

Done anytime from day 7 to 12 of the menstrual cycle

Postmenopausal or women who had a hysterectomy should perform BSE the same day every month

How often should women over 40 get a clinical breast exam?

Those 20-39 years?

Annually

Every 3 years

How often should those 45 and older have a mammogram performed?

Annually with 2 views of each breast

What should you teach a client prior to a mammogram not to put on their body?

No lotion, deodorant, or powder

Pap smears are done at what age and how often?

Starts at 21 and done every 3 years

What is the co-test done along with Pap smear?

HPV test every 5 years for women 25 to 65

Colorectal screening is done at what age and how often?

Starts at age 45 and done every 10 years

stool based or colonoscopy

At what age do we begin to test for fecal occult blood and how often?

Start at age 45 and done annually

How often should testicular exams be performed?

What is an exception?

Yearly

Testicular tumors grow fast so some clinicians recommend monthly exams

Who is at the most risk for testicular cancer?

Young males aged 15-36

Men over 50 or at risk for cancer should receive what screenings?

Digital rectal exam, Prostate exam, and Prostate specific antigen

How often are colorectal exams performed for men and at what age?

Performed every 10 years beginning at age 45

How often is fecal occult testing done for men and at what age?

Yearly for men over 45

Describe tertiary prevention of cancer

Focused on long term care

Quality of life and survivorship

The acronym CAUTION can be used to describe signs and symptoms of cancer, Review :)

(C)hange in bowel/bladder habits

(A) sore that does not heal

(U)nusual bleeding/discharge

(T)hickening or lump in breast or elsewhere

(I)ndigestion or difficulty swallowing

(O)bvious change in wart or mole

(N)agging cough or hoarseness

Cancer can invade the bone marrow and lead to what?

Anemia, Leukopenia, and thrombocytopenia

What are some bleeding precautions clients should take?

Use an electric razor

use a soft toothbrush

Don’t blow nose hard or scratch inside

No going barefoot

No IM’s

Quiet play for children

What are other signs and symptoms of cancer?

Unexplained weight loss

• Cachexia: extreme wasting and malnutrition (close to death)

Fever

Pain

Fatigue #1 (unrelieved by sleep)

What Labs will we be most concerned for?

CBC and Diff (esp. neutrophils)

Liver enzymes (ALT and AST elevated)

Tumor markers

Name some diagnostic studies done for cancer

Chest x-ray

CT scan

MRI

PET scan

Bone marrow biopsy

Tissue biopsy

Imaging studies

What is a total laryngectomy?

Removal of the entire cords, epiglottis, and thyroid cartilage

After a laryngectomy what will the client have?

A permanent tracheostomy

What are some post op nursing considerations for total laryngectomy?

Semi fowlers (35-45*)

NG feedings to protect suture line

Monitor drains to prevent fluid accumulation

Watch for carotid artery rupture

Frequent mouth care to decrease bacterial count

NPO

What is a complication that can arise with total laryngectomy?

Rupture of the innominate artery: CALL DR massive bleed from trach

What is done to the trach after discharge?

covered by a bib to act as a filter

Can a client with a total laryngectomy talk?

Yes! with an electrolarynx but Blom-singer device is much more common

What can a total laryngectomy client not do?

Whistle, drink through straw, smoke, or swim

Reconstruction surgery is most commonly used for what?

Breast cancer or mastectomy

What are some post op considerations for reconstruction?

Monitor bleeding: check dressings (front and back)

Monitor abdominal site (if adipose tissue used)

Monitor hemovac or JP drains

If any lymph nodes were removed during a mastectomy, what nursing care should be known?

Avoid procedures on arm of the affected side for life!

• No constriction, no BP’s, no tight clothing, no watch, no IV’s or IM’s

• wear gloves when gardening, watch small cuts, no nail biting, no sunburn

What can the patient do to promote new collateral circulation?

Brush hair

squeeze tennis balls

wall climbing

flex and extend elbows

Describe Internal radiation/brachytherapy

Radiation is closer to the cancer or target cells

Client will emit radiation for a period of time and be a hazard to others

Describe unsealed brachytherapy

Client and bodily fluids emit radiation

Radioisotope given PO or IV

Radioactive for 24-48 hours

Describe sealed brachytherapy

Only client emits radiation

Temporary or permanent implant close or inside tumor

What are the general radiation precautions for internal radiation?

Time, distance, and shielding

Should nurses assignment be rotated? why?

Yes, to minimize exposure to radiation

How many patients should the nurse care for with a radiation implant in one shift?

ONLY one

Wear a _______ at all times

film badge

_______ visitors and only allow ______ per day of visiting

restrict

30 minutes

No visitors less than ___ years of age

16

No _____ visitors/nurses

pregnant

How can the nurse help prevent dislodgment of the implant?

Keep on bedrest

Decrease dietary fiber

prevent bladder distention

What do you do if the implant becomes dislodged and you see it?

Put gloves on

Use forceps to pick it up

Place in a lead lined container

Leave in the room and call radiation department

Why should a client receiving radiation be in a private room?

due to immunosuppression

What are some things the client cannot do after radiation?

Sleep in the same bed with others (day 1-11)

Use public transportation

immediately return to work

Share utensils or cook for others

Flush toilet once (flush 2-3 times)

Describe external radiation (teletherapy, external beam radiotherapy)

Most common radiation therapy for cancer treatment

Carefully focused beam of high energy rays is delivered by a machine outside of the body

Client is not radioactive

What are some side effects of external radiation?

Erythema

shedding of skin

Fatigue #1

Pancytopenia

What are some considerations after external radiation?

do not wash off markings or use lotion

Protect from UV or sunlight for 1 year AFTER COMPLETION of therapy

provide good skin care

What is the goal of chemotherapy?

To eliminate or reduce the number of cancer cells by destroying the cells as they are developing

Describe cell specific chemo drugs

Attack a specific phase of cell development

Describe non cell specific chemo drugs

Work at all or any phase of cell development

When do cell specific and non specific drugs work best?

When the tumor cells are actively growing

What are some precautions for administration of chemotherapy?

Given PO, IM, IV, topical, or intracavity (directly into body cavity)

• Contact with skin, mucous membranes, inhalation, ingestion, or accidental injection is dangerous

• Look up drug information prior

Full precautions for chemo require?

Coded gown to prevent contamination

2 pairs of chemo gloves (1 under and 1 over gown)

Goggles or mask

What are excretion precautions for chemo?

Gown, gloves, goggles or mask

Chemo is excreted for 3-7 days after administration

How is chemo disposed?

Yellow rigid chemo waste container (for sharps and IV equipment)

Yellow chemo waste bag (gowns, gloves, disposable items)

Wash hands

How do we manage a chemo spill?

Handle as a hazardous chemical spill

obtain spill kit and use all PPE

Most chemo drugs are given _____ via a ________ line

IV

Central

Peripheral lines are only used if ________

drug is IV push or infuses in less than 1 hour

Describe extravasation

When a vesicant drug infiltrates causing tissue damage and necrosis

What are signs and symptoms of extravasation?

Pain at site

Swelling

no blood return

What is the treatment for extravasation?

Stop the infusion and send for extravasation kit (DO NOT LEAVE CLIENT)

Bone marrow and stem cell transplants are primarily used as treatments for _____

Hematological cancers

Stem cells from the blood or bone marrow can come from the client, a __________, or from an identical sibling or twin

Matched donor

Stem cells are given into a _____, much like a blood transfusion, and overtime they settle in the ___________, and produce healthy RBC’s

Vein

Bone marrow

What is the most common side effect of cancer treatment?

Nausea/Vomiting

• may last 24-48 hours after treatment

• antiemetics given in the 1st week of treatment

Name antiemetic drugs

Ondansetron (serotonin receptor antagonist)

• blocks the effects of serotonin “-tron”

Netupitant/palonosetron

• Combo medication

• 1 dose (1 pill 1 hour prior chemo)

What are non phamacological treatments for nausea/vomiting?

Ginger

aromatherapy

acupuncture

acupressure

distraction

relaxation

What are other side effects of cancer treatment?

Stomatitis

Diarrhea

Fatigue

Pain: Opioids! (watch for constipation, give stool softeners)

• due to direct tumor involvement, mucositis, or peripheral neuropathy

How is the integumentary system affected by cancer treatment?

Alopecia

sense of loss with mastectomy, amputation, or scar

HAVE THEM LOOK at the site

How is the hematopoietic system affected by cancer treatment?

Bone marrow suppression occurs leading to risk of anemia, infection (#1 death), and bleeding because of low RBC’s, WBC’s, and platelets

Neutropenia is a life threatening complication of treatment/ or cancer, describe it and how its treated

A decrease in number of neutrophils (mature WBC’s) in the blood

Absolute neutrophils count is used to measure them (Normal is 2500-8000 cells/mm)

Treatment is antibiotics and implementing neutropenic precautions

DVT’s are the 2nd cause of death for cancer clients, why are they at such risk for developing DVT’s?

Prolonged bedrest

surgery

use of central line

tumor compression of blood vessels

invasion of vessels by the tumor

certain chemo drugs

What are we most afraid of with a DVT’s?

Development of a pulmonary embolism

Describe thrombocytopenia

Decrease in the number of circulating platelets in the blood

platelets = clotting

What are risk factors for thrombocytopenia

Advanced metastatic disease

Hematological malignancies

bleeding disorders (hemophilia, liver disease, ITP)

bacterial infections

Anticoagulant meds (aspirin, heparin, warfarin, apixaban, dabigatran, rivaroxaban)

result of cancer treatment

What assessment changes could have us suspect thrombocytopenia?

History

Vital signs

Pulse oximetry/O2 sats

Change in level of consciousness (headaches, pupil changes)

Conjunctival hemorrhages

Petechiae, ecchymosis, purpura

oozing from the puncture sites

bleeding from the nose, ears, or mouth

What is the treatment of thrombocytopenia?

Platelet replacement (controls and prevents bleeding)

Describe RBC transfusions

For clients with symptomatic anemia

Do not want the Hgb/Hct to drop below 8g/dl and 24%

Blood products will likely be ________

Irradiated to reduce the risk of transfusion related reactions