Health alterations class 16: neoplastic disorder treatment, care and oncologic emergencies

Tumors are classed according to

1. Site

2. Histological analysis (grading), how close it is to regular cell 1,2,3,4

3. Extend of diagnosis (staging), how far it’s spread 0,1,2,3,4

Benign tumors

1. Usually encapsulated

2. Recurrence is rare

3. Cells appear similar to parent cells

Malignant tumors

1. Ability to invade and metastasize

2. Cells bear little resemblance to parent cells

TNM staging for cancer

T- tumor size

N-node involvement

M-metastasis

Treatment options for cancer

Based on cell of origin of cancer. Focuses on removing or destroying cancer cells, preventing continued abnormal cell growth.

Surgical therapy, chemotherapy, radiation therapy, biological therapy

Surgical therapy for cancer

Removal of tumor and margin of surrounding tissues. May be Supportive/palliative surgery

Preop surgery

1. NPO amd consent

2. Baseline labs (to compare post op)

3. Urine (infection and pregnancy)

4. Chest x ray/EKG

5. Medications (what to take or hold)

6. Education

Post op surgery

1. Pain management

2. Infection prevention

3. Fluid and electrolytes

4. Moniter bleeding

5. Oxygenation

6. Educations (drains, wound care etc)

7. DVT prevention

Chemotherapy meds

Cytotoxic, use combo to kill cells in different stages of cell life cycle. Kill normal and abnormal fast growing cells

Considerations for administering chemo

Need PPE and special training

Chemotherapy routes of admin

Oral and IV are most common, can also be topical or inserted into a cavity

Adverse effects of chemotherapy

Unintentional harm to normal rapidly dividing cells (GI tract, hair follicles, bone marrow, mucous membranes)

Chemotherapy administration with a CVAD

Diluted quickly becayse CVAD connects to superior vena cava

Why is an IV pump used to administer chemo

Chemo is toxic so it shouldn’t be administered too fast

Peds considerations for a CVAD

May pull or tug on external lumens, so use metal bulldog clips and multi loop lumens with dressing. May not want internal port

CVAD chemo advantage

Reduces risk if damage to tissues, placed for chemo

Most common CVADs

1. PICC

2. Implanted port (used for long term)

3. Hickman catheter (external port)

Nursing care of a CVAD

1. Prepare patient for procedure

2. Accessing, dressing changes, flushes (sterile technique!)

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

Radiation therapy

1. Targets tissues, destroys cells

2. Localized treatment, only cells within treatment field affected

3. Cure, control, palliative

Radiation dosing

Small doses frequently (4-5 times a week)

Types of radiation

1. External (most common)

2. Internal (incision, radiation placed inside)

Internal radiation considerations

Patient is considered radioactive, avoid people especially pregnant or breastfeeding people. May feel isolated

How to protect the skin after radiation

1. No head pads or ice packs

2. No constricting garments

3. No harsh chemicals (scented soaps)

Internal radiation nursing care

Cluster care and minimize direct contact

Peds considerations for radiation

May need to be sedated if can’t stay still

How to manage pain and anxiety with fatigue from cancer treatment

Meds, treat underlying cause, yoga, accupuncture,

What to recommend for patients with anorexia

Small frequent, high protein and high calorie meals

Bone marrow suppression NADIR

Lowest count if blood cells, happens in 1 week to 1 month

WBC affected after 1 week

Platelets affected in 2-3 weeks

RBC affected in 2-3 months

Neutropenia

1. Low WBCs

2. Increased risk of infection and sepsis

3. Expected finding

4. Most susceptible 7-14 days after chemo

Febrile neutropenia

1. Oncologic emergency

2. Neutropenia with fever over 38 degrees

3. Worried about infection

Preventing infection with febrile neutropenia

1. Private room, no visitors and PPE

2. Dedicated supplies

3. Don’t eat raw fruit, veg or meat or eggs. Use dishwasher to sanitize

4. No live plants or soil

5. Avoid large crowds and public spaces

6. Keep room clean

Febrile neutropenia treatment

Don’t take Tylenol, can mask fever. Start with broad spectrum AB

Bone marrow suppression:anemia

1. CBC (Hgb)

2. Fatigue, dizziness, pallor, sob

3. blood transfusions,

4. drugs to stimulate RBC production

5. Cluster care

6. Rest periods

Anemia vital signs findings

O2 sat may be low, low BP and increased pulse

Bone marrow suppression:thrombocytopenia

1. CBC (platelets)

2. Moniter bleeding

3. Prevent bleeding (electric razor, soft toothbrush, prevent injury)

4. Look for signs of bleeding (bruises, bleeding gums, nose bleeds, change in BM)

Alopecia

1. Temporary

2. Regrows 3-4 weeks after treatment ends (may be different texture, colour)

3. Only a professional should shave head to avoid knicks

Common skin reaction from radiation

Erythema

Side effect of decreased saliva from cancer treatment

Xerostomia (dry mouth) loss of taste

How to prevent oral, oralpharyngeal and esophageal reactions

1. Oral care before and after meals and bedtime (saline solution, meds)

2. Diet (soft, non irritating foods, high protein and calorie, small frequent meals, supplements)

3. Weight monitored closely

Pulmonary effect from radiation

Pneumonitis- cough, fever, night sweats. Bronchodilators, expectorants, bed rest, O2

Pulmonary effect from chemo

Pulmonary edema- cough, dyspnea, increased rests, crackles. High fowlers, O2, meds, I/O

GI effects

Nausea, vomiting, diarrhea, dehydration

Nausea meds

Gravel is drowsy, maxeran is good because it stimulates peristalsis, zofran and decadron may be used prophylacticly. (Metoclopramide, ondansetron, dexamethasone)

Reproductive effects of cancer treatment

1. Effect on ovaries and testes depends on dose and type of treatment

2. Testes-highly sensitive to radiation

3. Potential infertility

4. Pretreatment harvesting

Pain management during cancer

Very important

Meds (education in addiction), acupuncture, guided imagery, heat/cold, massage, meds, music

Peripheral neuropathy with chemo

Chemo can damage nerves

Biological and targeted therapy

Modify relationship between host and tumour. May cause cells to stop growing, block release of hormone (prostate, breast cancer)

Flu like symptoms

Considerations for hormone therapy

Symptoms based off what hormone is being blocked

Bone marrow and stem cell transplantation

Intensive procedures, many risks.

Take out and destroy cancer cells then replace with a donor

Obstructive oncologic emergencies

Tumor obstruction of organ or blood vessel

Obstructive oncologic emergency: superior vena cava syndrome

Facial edema, periorbital edema, distension of neck veins, headache, seizures

Obstructive oncologic emergency: spinal cord compression

Back pain, motor weakness, paresthesia, bowel/bladder function changes

Obstructive oncologic emergency: 3rd space syndrome

Fluid from vascular space shifts to IS space

Decreased BP, increased HR, decreased output

Obstructive oncologic emergency: intestinal obstruction

Nausea/vomiting, abdominal pain, bowel obstruction

Metabolic oncologic emergency

From hormones produced by tumor or secondary to treatment

Tumor lysis syndrome

Hyperuricemia, hyperphosphatemia, hyperkalemia, hypocalcemia (similar to AKI)