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Benign

Benign

May be harmless (depends on location and if it is interfering with or blocking something.)

Malignant

Indicates cancer

Leukemia

a type of cancer with uncontrolled of immature WBC in the Bone marrow

RF

• exposure to ionizing radiation, chemicals, chemotherapy drugs, viruses, genetic predisposition

Laboratory assessment 

• Decreased hemoglobin

• Decreased hematocrit 

• Low platelet count

• Abnormal (low, normal or elevated) WBC count

• Prolonged clotting time 

NI

• Infection is major cause of death in the patient with leukemia.

• A slight temperature elevation is significant for a patient with leukopenia. Fever may not always present if the pt is take corticosteroids. 

• Drug therapy for acute leukemia 

• Stem Cell transplant (if it effects the bone marrow)

Myeloma

Plasma in bone marrow

Lymphoma

Lymphatic glands, nodes, thymus or spleen

The glands will be swollen

What does T mean?

Tumor (size)

What does N mean?

Node (number of nodes)

What does M mean?

Metastasis (M0, M1)

Colorectal Cancer

Etiology and genetic risk

• Overweight/obese

• Physically inactive; DMII

• High red meat/processed meat diet or meat cooked at high temperatures

• Smoking

• Polyps or h/o colon cancer

Assessment

• Change in bowel habits: most common presenting symptom

• Passage of blood in or on the stools: second most common symptom

• Unexplained anemia

• Right-sided (ascending) lesions – dull abdominal pain, melena

• Left-sided (descending) lesions – intestinal obstruction symptoms, bright red blood in the stool

• Rectal lesions

NI

• Preoperative care

  • Providing preoperative education and referral to an enterstomal therapist if indicated

  • Maintaining optimal nutrition & fluid volume balance

  • Preventing infection: bowel prep and prophylactic antibiotics

  • Providing emotional sup

• Postoperative colostomy care

Breast Cancer

Assessment

• Firm, non-tender, fixed mass or lump with irregular borders. May feel like a pearl earring caught under the skin. Use face of clock to describe location.

• Asymmetry of the breast tissue

• Changes to breast skin

  • Redness and warmth

  • Nipple retraction, discharge or ulceration

  • Burning or itchy nipple

  • Dimpling, peau d’orange

Dx

• mammography, ultrasonography, MRI, breast biopsy (definitive diagnosis).

• Pro: Brac gene

• RO metastasis: CXR, bone, liver, brain scans, CT chest/abd

NI

• Medical management

  • Radiation, chemotherapy, hormone or targeted therapy

• Surgical management

  • lumpectomy, lumpectomy with lymph node dissection, simple mastectomy, modified radical mastectomy, breast reconstruction

• Preoperatively

  • psychological preparation and preoperative teaching

• Postop

  • No BP, IV, injections or blood draw on affected side

  • Assess JP drain

  • Promote lymphatic fluid return

  • HOB 30 degrees

  • Elevate affected arm

  • Promote body image acceptance:

  • Promote exercise/work affected arm (ADL’s)

  • Manage discomfort/pain 4-5 days

  • Numbness @ sx site; armpit to elbow; heaviness; burning may persist

Pancreatic Cancer

Etiology

• Most start in the pancreas ducts

  • small channels that carry digestive enzymes to the intestines.

  • adenocarcinoma that begins in the tissue lining the gland.

• Less common: pancreatic tumors of islet cells.

Risk Factor

• Smoking ( 2-3x more common to develop

• Pancreatic adenocarcinoma)

• Age ( > 55)

• Family history ( 9 x more likely to develop Pancreatic CA)

• Race and ethnicity: higher incidence African – Americans

• Obesity ( evidence suggests BMI > 30 increases risk

Assessment

• Pain: upper abdomen and back

• Burning feeling stomach

• Nausea, vomiting

• Unintentional weight loss, fatigue ( constitutional symptoms)

  Inability to digest fatty foods ->results in large greasy stools

• Jaundice

Dx

• Blood tests

  • Hepatic function ( elevated liver enzymes)

  • CA 19-99 (protein that may be elevated)

  • Carcinoembryonic antigen ( CEA): elevated

• Diagnostic imaging: CT, MRI

• Magnetic resonance cholangiopancreatography ( images pancreatic ducts)

• Endoscopic ultrasound (EUS) : detailed US, can obtain biopsy

• Biopsy: gold standard to diagnosis

NI

• Surgical : if limited to pancreas, most are minimally invasive ( robotic)

  • Whipple procedure

  • Pancreatectomy: partial or total

• Chemotherapy and radiation (use of targeted therapy)/ PARP inhibitors

Cancer of the Larynx

Risk Factors

• Carcinogens: tobacco or second hand smoke, combined effects of alcohol and tobacco, asbestos

• Other factors: nutritional deficiencies, Hx of alcohol abuse, genetic predisposition, most common in people over age 65;

Assessment

• Complete Hx of risk factors, family hx, underlying medical conditions, physical examination of the head and neck

• Clinical manifestations

  • Early: hoarseness, persistent cough, sore throat or pain burning in throat, raspy voice, lower pitch, lump in neck

  • Later: dysphagia, dyspnea, nasal obstruction, persistent hoarseness, persistent ulceration, foul breath, general debilitation

Dx

• laryngoscopy, FNA biopsy, barium swallow study, endoscopy, CT, MRI, PET scan

NI

• Treatment/management

  • Stages I and II – Radiation therapy; cordectomy, endoscopic laser excision, partial laryngectomy

  • Stages III and IV – Radiation therapy, chemotherapy, chemoradiation, total laryngectomy

• Postoperative nursing care

  • Maintain patent airway, control secretions

  • Reduce anxiety

  • Support alternative communication

  • Promote adequate nutrition and hydration

  • Promote positive body image, self-esteem

  • Self-care management

Thyroid Cancer

etiology and risk factors

• Female gender

• External radiation of the head, neck or chest in infancy and childhood

Clinical manifestation and diagnostic assessment

• Single, hard and fixed lesions, may associate with cervical lymphadenopathy

• Needle biopsy makes a diagnosis, ultrasound, MRI, CT, thyroid scans, radioactive iodine uptake studies, thyroid suppression tests.

Medical management

• Surgical removal is the treatment of choice – total or near-total thyroidectomy

• Radioactive iodine therapy after surgery

• Thyroid hormone may be required permanently

NI

• Preoperative care

  • avoid tea, coffee, cola and other stimulants

  • Preoperative teaching: how to support the neck with hands post operation

• Postoperative care

  • A tracheostomy set must be kept at bedside at all times – report difficulty in breathing (indication of edema of glottis, hematoma, injury to the laryngeal nerve)

  • Pain management

  • IVT, cold fluids, soft to liquid diet in immediate postop period, high calorie diet may be prescribed later

  • Monitor closely for signs of tetany (indication of parathyroid gland injury)

Hematopoiesis

Creation/formation of blood cells

Signs of hematologic disorders

S&S

• GI (wt loss, mouth sores)

• Overt bleeding (gums, joints, platelet count)

• Bone pain/deformity

• Jaundice

• Enlarged liver/spleen:

  • Overproduction of cells (polycythemia, leukemia)

  • Excessive demands to destroy defective cells (hemolytic anemias)

• Skin changes: brittle or spoon shaped nails

Dx

• CBC with differential

• Iron studies and B12 indices

• Platelets

• Clotting factors : (INR/PT/PTT)

• Liver function indices

• Reticulocyte count

• Bone marrow biopsy

Potential Causes

• Hemorrhage (bleeding)

• Dietary deficiencies

• Malabsorptive disorders

• Infection

• Toxicity (meds/ETOH)

• Malignant overproduction

Nursing Care for the Patient Undergoing Bone Marrow Aspiration and Biopsy

Preop

• Informed consent; provide accurate information and emotional support, antianxiety agents may be indicated; prone or side-lying position

Postop

• Follow up care

• Priority is to prevent and monitor for bleeding and infection;

• Cover the site with a sterile dressing after bleeding is controlled with manual pressure for several minutes

• Elevate the biopsy site. Monitor VS q4 for 24 hrs

• Mild analgesic. Must be aspirin free;

• Ice packs can be used to limit bruising;

• Can return to normal activities after the procedure, avoid

Febrile Transfusion Reactions

Most common transfusion reaction) – caused by anti-WBC antibodies.

• Chills, tachycardia, fever, hypotension, tachypnea. 

Hemolytic Transfusion Reactions

Most Dangerous transfusion reaction) – caused by blood type or Rh incompatibility.

• Fever, chills, apprehension, headache, chest pain, low back pain (flank pain), impending doom

Allergic Transfusion Reactions 

Seen in patients with a history of allergy.

• Urticaria, itching, bronchospasm, or anaphylaxis.

Bacterial Transfusion Reactions

Infusion of contaminated blood products. 

• Tachycardia, hypotension, fever, chills and shock. 

Circulatory Overload 

Blood product infused too quickly. 

• Hypertension, bounding pulse, DJV, dyspnea, restlessness, confusion

Hypoproliferative

Defect in production of RBCs

• Caused by iron, vitamin B12, or folate deficiency, decreased erythropoietin production, cancer, meds  (bone marrow suppression) 

Thalassemia

A Hemolytic type, which means the red blood cells, this causes an inflammatory reaction

Treatment is steroid and then splenectomy( this means they have immunosuppression

• Major

• Minior

  • not to severe, easier to treat if even treated

Polycythemia Vera

Cancer of the RBC(over production

Hyperviscous blood(easy clots)—>Happens with you are more hypoxic

Avoid:

• Iron

• Bleeding

• Tight cloths

its more supportive care, once the blood thickens think what happens and what we should do

• Anticoag

• Hydration

• Venous return

Leukopenia

Low number of leukocytes in blood

Thrombocytopenia

Low number of PLT in body

S&S

• Petechiae, purpura, ecchymosis, prolonged bleeds, nosebleeds, other anemia like symptoms. (non-blanching)

NI

• Nursing: Follow labs, IV immunoglobulin, Corticosteroids, plasma infusion

• Avoid coughing and sneezing, gently blow nose 

• Bleeding precautions

Neutropenia

Low number of neutrophils, a type of white blood cells

Low WBC—> Low/no Fever—> Cant tell if sick

NI

• HAND WASHING, HAND WASHING, HAND WASHING!!!!!!!!!!

• Monitor dx tests:  CBC with diff, absolute neutrophil count [ANC], lymphocyte count.  CALL HEALTHCARE PROVIDER IF ANC IS < 1000/mm3  

• No fresh flowers or plants

• Avoid any bleeding and infection

Hemophilia

Women can carry, Men will show

Clinical manifestation:

• Abnormal bleeding in response to any trauma (any head  trauma requires prompt evaluation and treatment)

• Degenerating joint function related to chronic bleeding into the joints

Types

• Hemophilia A – Factor VIII deficiency 

• Hemophilia B (also called Christmas disease) –Factor IX

Megaloblastic Anemia

Folic acid, vitamin B12, include poor intake of foods containing vitamin B12 (vegetarian diets or diets lacking dairy products) or poor absorption of vitamin B12

Signs & Symptoms:

• Pallor, jaundice, glossitis (tongue), fatigue, wt. loss, neuro: Confusion,  Paresthesia in lower extremities: watch BALANCE/ falls risk?

Management

• Increase the intake of foods rich in vitamin 12 (e.g. animal proteins, eggs, dairy products, leafy green vegetables) if there is dietary deficiency.

Aplastic Anemia

Deficiency of circulating RBCs due to failure of the bone marrow to properly produce these cells.  Cells are too large and cannot exit the bone marrow. (hyperplasia)

• Pancytopenia is common (anemia, leukopenia, thrombocytopenia)

S&S

• Clinical manifestations – symptoms of anemia (e.g. fatigue, pallor, dyspnea), infection, purpura, retinal hemorrhages 

Hodgkins Lymphoma

• Pathologic hallmark and essential diagnostic criterion: presence of specific Reed-Sternberg cells

• Large but painless lymph nodes, not hard, cervical nodes often affected first. 

• SOB, engorged veins

• Chemo and Rad because its all over the body

Non-Hodgkins Lymphoma

• All lymphoid cancers that do not have the Reed-Sternberg cells

• Incidence increases with age

• SOB, engorged veins,

• Enlarged, painless lymph nodes can arise from lymphoid cells in any tissue.

Muliple myeloma

Effect bone, bone pain and weakness with elevated protein levels

• Elevation of serum total protein or detection of a monoclonal protein (Bence-Jones protein) in the blood or urine. 

• Manifestations include bone pain usually in the back or ribs, fatigue, easy bruising at the early stage; 

NI

• Hydration & pain management – analgesics, relaxation techniques, aromatherapy, hypnosis, bisphosphonates. 

Cystitis

• Inflammation of the bladder 

• Bacterial infection by E.Coli by catheters

• Can happen cause of cath 

• Clinical manifestations 

  • frequency, urgency, dysuria. Generalized fatigue, change in cognitive functioning, increased falls, decreased appetite, new incontinence, lethargy, anorexia, hyperventilation, low-grade fever

Benign prostatic hyperplasia (BPH)

• Resulted from aging and the influence of androgens such as dihydrotestosterone (DHT). 

• Risk factors 

  • smoking, heavy alcohol, obesity, reduced activity level, HT, heart disease, diabetes,

• S&S

  • They might have blood in urine

  • Weak urine stream

  • Sensation of incomplete bladder emptying

• Dx

  • PSA 

  • DRE recommended for every man > 40 yoa, screening for prostate CA, measures shape, size & consistency of prostate

• NI

  • Surgery—TURP

  • Medication—Flomax

Prostatitis

Inflamed prostate 

• Clinical manifestations

  • Acute: fever, chills, dysuria, frequency, urgency, hesitancy, nocturia, urethral discharge, a boggy, tender prostate, nausea, vomiting

• Treatment: Anti-inflammatory drugs along with warm sitz baths, analgesics,  antibiotics

Epididymitis

Clinical manifestations:

• Low-grade fever, chills, heaviness in the affected testicles, pain in the inguinal canal along the vas deferens, swelling in the scrotum and groin.

Management

• Bed rest with scrotum elevated with a scrotal bridge or folded towel to prevent traction. 

• Supportive interventions include reduction in physical activity, scrotal support and elevation, ice packs, NSAIDs, analgesics, sitz bath. 

• Avoid urethra instrumentation; avoid straining, lifting, sexual stimulation until the infection is under control 

Urethritis

An inflammation of the urethra 

• Men – often caused by STDs; Women – often occur post menopause and related to low estrogen levels.

Pyelonephritis

Clincal Manifestations

• An inflammation of kidney and renal pelvis 

• Back pain, flank pain, kidney pain 

• Risk factors: recurrent UTIs, pre, E.Coli 

• Dx

  • Urinalysis – occasionally RBCs, casts and protein are present.

  • Urine culture and sensitivity 

• NI 

  • Finish drug therapy 

  • Drink water 

Urethral strictures

• Narrowed areas of the urethra

• May be caused by complications of STDs, trauma during catheterization, urological procedures, or childbirth.

• Clinical manifestations

  • Obstruction of urine flow, overflow incontinence

• NI

  • Surgical dilation of the urethra, stent placement or urethroplasty (long-term cure)

Urolithiasis & Nephrolithiasis

Calculi (stones) in the urinary tract or kidney

• Causes: may be unknown

• Manifestations

  • Depend upon location and presence of obstruction or infection

  • Pain and hematuria(blood in urine) 

• Diagnosis: x-ray, blood chemistries, and stone analysis; strain all urine and save stones

• NI 

  • Hydrate!!!!!!!

  • Drink 2 glasses of water at bedtime and an additional glass at each nighttime awakening to prevent urine from becoming too concentrated during the night

Urothelial cancer

Tobacco use and chemical is the RF 

• S/S

  • Is painless and intermittent hematuria is the first sign; dysuria, frequency and urgency when infection or obstruction present; pelvic or back pain occur with metastasis 

• Diagnostic assessment

  • Bladder-wash specimens and biopsies of the tumor and adjacent mucosa are the most specific tests.

• NI

  • Urinary and chemo precautions 

  • Urinary diversion

Prostate cancer

• Caused by multiple factors including androgens, race(african american) , high fat and low fiber diet,  vasectomy, environmental toxins, genes

• Clinical manifestations

  • Difficulty in urinating, frequency, retention – first symptoms

  • Hematuria – late sign

  • Stony hard palpable irregular nodule by digital rectal examination

• Can spread to the lung liver and kidneys

• NI

  • TURP