Medical Surgical Nursing: Cancer

Cancer

The abnormal and unchecked growth of human cells in the body that destroys surrounding tissue and depleting their resources

Most Common Types of cancers

lung, breast, colorectal, prostate, skin, stomach

malignant

cancerous tumor in which cells break away and spread to other parts of the body, causing harm to the organism's health

benign

encapsulated, easily measurable, does not metastasize

Nadir

lowest point

Cancer Nadir

lowest point of blood count

When a PT is at Nadir, what are they at risk of?

Infection, Bleeding, Anemia

When does nadir occur

7-14 days after chemotherapy

Biggest risk of Nadir

Infection

Main sites of metastasis

brain and cerebrospinal fluid, lung, liver, adrenals, bone

Where does breast cancer usually metastasize

Brain, CSF, and lungs

TNM classification system

Tumor size and invasiveness (T)

Spread to lymph nodes (N)

Metastasis (M)

Primary Prevention

Preventing disease before it occurs.

Examples of primary prevention

Vaccines, healthy diet, exercise

Secondary Prevention

screening and early detection

teritary prevention

people who already have the disorder (prevents worsening or rolls back symptoms)

CAUTION signs - C

Cough or Change in Bowel or Bladder Habit

CAUTION signs - A

A sore throat that will not go away

CAUTION signs - U

Unusual Bleeding

CAUTION signs - T

Thickened Tissue

CAUTION signs - I

Indigestion

CAUTION signs - O

Obvious change in mole or wart

CAUTION signs - N

Nagging cough

Gold Standard of Diagnosing Cancer

biopsy

Types of Radiation Therapy

direct and brachytherapy

What is Radiation therapy?

localized delivery of ionizing radiation to intentionally destroy DNA structures within malignant cells and induce cell death

Brachytherapy

radiation therapy in which the source of radiation is implanted in the tissue to be treated

Radiation Seeds

Metallic seeds for localized radiation treatment.

Precautions for Brachytherapy

Limit visitor time, maintain 6ft of distance, flush twice, use shielding.

Antineoplastic Medications

- chemotherapy

- immunological therapy

- targeted agents

- hormonal agents

What is chemotherapy

the use of drugs to treat a disease, mainly cancer, for systemic

Chemotherapy

Kills rapidly dividing cells

Chemotherapy AE

- N/V/D

- Loss of hair and nails

Immunological Therapy

Boosts the immune system

Immunotherapy ending

"-mab"

Immunotherapy adverse effects

Cytokine storms, causing damage to the body

Targeted agents

Medications that target a specific cell receptor to prevent cell growth or to starve the cell from essential nutrients.

Targeted Agents Ending

"-ib"

Hormonal Agents

these drugs block hormone receptors on cells so that growth is inhibited

Tumor Lysis Syndrome

Rapid breakdown of cancer cells causing the release of intracellular contents into the bloodstream.

Labs for TLS

- Hyperkalemia

- Hyperphosphatemia

-Hyperuricemia

-Hypocalcemia

What does TLS cause

Acute Kidney Injury

Complications of TLS

AKI, Cardiac Dysrhythmias, Seizures, Lactic Acidosis

When does tumor lysis syndrome occur?

After the initiation of chemotherapy

Which cancers are most associated with tumor lysis

Leukemia and Lymphoma

What electrolyte imbalance is seen in TLS due to cell lysis?

Hyperkalemia and hyperphosphatemia

treatment for hyperphosphatemia

phosphate binders, dialysis

Medications for Hyperkalemia

- regular insulin and IV glucose

- calcium gluconate

- Polysterestase

Why does uric acid increase in TLS?

Breakdown of nucleic acids.

What happens to calcium in TLS?

Hypocalcemia due to the hyperphosphatemia

Why can TLS cause AKI?

Uric acid and calcium-phosphate crystals deposit in renal tubules, impairing kidney function.

What is the priority nursing intervention for TLS prevention?

Aggressive IV hydration

What Precautions are chemo patients on

Neutropenic Precautions

Protective Chemo Patient Isolation measures

- HEPA filtration

- Mask for everybody

- Do not go in if sick

- Do not go in if recent live vaccine

- No Pepper or Paprika

- Avoid Flowers

- Avoid Raw Food

Medications to help with complications of chemotherapy

- Epoetin Alfa

- Filgastim

Epoetin Alfa

Increases production of RBC to prevent chemo induced anemia

Filgastim

Stimulate neutrophil production to increase WBC for those on chemotherapy

Chemotherapy agents must only be given by

chemotherapy certified nurse

What temperature is too high for a pt on chemo

above 100