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Oncology - Coggle Diagram
Oncology
General side effects
GI system
: N/V most common side effect of chemotherapy. Routine antiemetics given 1st week of chemo.
-Ondansetron (Zofran): serotonin receptor antagonist.
-Netupitant/palonosetron (Akynzeo): oral combination antiemetic. Only one dose one hour before chemo.
-Non-pharma treatments: ginger, aromatherapy, alternative therapies (acupuncture, acupressure, distraction, relaxation)
-Stomatitis: oral cavity susceptible to irritation
-Diarrhea: worry about nutrition and F/E imbalance.
Integumentary system
: alopecia (hair loss)
-May experience a sense of loss with mastectomy, amputation, or scars from surgery
-We want them to look at the incision
Hematopoietic system
: bone marrow suppression causes dec RBCs, WBCs, PLTs. Risk for anemia, infection, bleeding.
-Infection #1 cause of cancer related deaths.
General precautions to prevent infection
-Private room, limit visitors
-Client's own supplies in room
-Change dressings and IV tubings daily.
-TCDB to prevent pneumonia
-No gardening/cleaning up pets
-Avoid crowds
-Handwashing
-Fresh water only
-Soft toothbrush
-Report to hospital for temps 100.4+ (38C)
Neutropenic precaution
-Antibiotics as prescribed
-Vital signs q4h
-Private room with sign
-Antimicrobial soap
-No invasive procedures
-Avoid indwelling catheters or NG tubes
-Limit use of acetaminophen (masks infection signs like fever)
Fatigue
: every client has some fatigue but some may be related to treatments.
-Rest periods, naps, limit visitation time
-Teach client to do this at home too.
Pain
: essential to treat and not worry about risk for dependence.
-Generally due to tumor involvement but can also be d/t treatments
-Opioids are the gold standard. There is no ceiling for the dose of opioid in a cancer client.
-Limit dose because of side effects and not because of dose/time.
-Call the PCP for increased dosing as needed.
-Other pain management: acupressure, acupuncture, WEED LMAO, distraction therapies, hydrotherapy, massage
Treatments
Surgery
Goals:
Prevention
Diagnosis
Treatment
Curative example: total laryngectomy
All breathing done through the stoma
Watch for carotid artery rupture
NPO tend to get pneumonia
Reconstructive example: mastectomy
If lymph nodes were removed with mastectomy, avoid constriction/BP/blouses/watches/IV/injections on affected side/arm
for life
.
Brush hair, squeeze tennis balls, wall climb, flex/extend elbow to promote new circulation.
Radiation
Internal
: used to get the radiation close to the target tissue
-Client emits radiation for a period of time and is a hazard to others.
-Unsealed: client and body fluids emit radiation. (IV/PO isotopes)
-Sealed: client emits radiation but fluids are not radioactive. (implants)
Precautions
-Rotate nursing assignments DAILY so one nurse is not continuously exposed.
-Only ONE client with radiation implant per shift.
-Wear film badge at all times
-Visitors 6 feet from source and 16yrs+ for 30 mins max.
-No pregnant people
Preventing dislodgement of implant
-Bed rest
-DECREASE fiber in diet
-Prevent bladder distention.
External
: focused beam of energy rays delivered by machine outside the body
-Client is not radioactive
-SE: erythema, shedding of skin, fatigue, pancytopenia
-S/S based on location and dose
-Do not wash off markings or use lotion
-Skin care
Chemotherapy
Action
: goal to eliminate or reduce number of cancer cells by destroying the cells as they are developing.
-cell-specific drugs: target specific phase of cell development
-cell cycle non-specific: work at all or any phase of cell development.
-Work best while tumor cells are actively growing -> early screening/detection.
Precautions
: carcinogenic, mutagenic, teratogenic.
-Beware of exposure via skin, mucous membranes, inhalation, ingestion, or accidental injection.
Full precaution
-Chemotherapy gown (coated). If contaminated, change immediately.
-Two pairs of chemo gloves: thicker/longer than standard gloves. One under gown and one over.
-Goggles/mask if risk of splash/inhalation.
Excretion precaution
Chemotherapy is excreted for 3-7 days after administration.
Disposal
Yellow rigid chemo container used for sharps and IV equipment.
Yellow chemo waste bag for gowns/gloves/disposables.
Wash hands with soap and water after removing gloves.
Major complication: Extravasation
Patho: A vesicant is a type of drug that causes tissue necrosis if it infiltrates.
S/S: pain, swelling, no blood return
Tx: PREVENTION. Stop infusion and get extravasation kit. Stay with client.
Transplants
: bone marrow and stem cell transplants primarily for hematologic cancers.
-Stem cell transplant: stem cells transplanted from blood stream
-Bone marrow transplant: stem cells transplanted from bone marrow.
-Stem cells may come from client, matched donor, or identical sibling/twin.
-Stem cells given into a vein like a blood transfusion and they settle into the marrow over time to produce healthy blood cells.
Prevention and screening
Primary
: ways to prevent actual occurrence
-No smoking
-exercise/nutrition
-Normal weight
-No alcohol Hep B and HPV vaccines
-avoid exposure to carcinogens
Secondary
: screening to pick up on cancer early when there is greater chance for cure or control.
-Female: monthly breast self-exams day 7-12 of menstrual cycle. Yearly clinical exam age >40. q3 years if age 20-39. Mammogram age 40+. Pap smears age 21+ q3yrs. Colonoscopy age 50+ q10yrs. Fecal occult blood 50+ yearly.
-Male: Yearly clinical testicular exam. Monthly self exam. Digital rectal exam and prostate specific antigen age 50+. Colonoscopy 50+. Fecal occult blood 50+ yearly.
Tertiary
: management of long-term care for clients with complex treatments for cancer.
Ex: support groups and rehabilitation programs
Diagnosis
S/S
CAUTION
Change in bowel/bladder habits
A sore that does not heal
Unusual bleed/discharge
Thickening or lump in breast or elsewhere
Indigestion or difficulty swallowing
Obvious change in wart/mole
Nagging cough/hoarseness
Anemia, leukopenia, thrombocytopenia d/t invasion of the bone marrow.
Unexplained weight loss, fever, fatigue, pain
Blood test
Abnormal CBC/diff.
Elevated AST and ALT
Tumor markers (biomarkers)
Positive diagnostic studies
Chest X-ray
CT scan
MRI
PET scan
bone marrow biopsy
tissue biopsy
imaging studies
Life threatening complications
Neutropenia
: a decrease in neutrophils in the blood.
Normal ANC: 2500-8000cells/mm
-Assess by calculating absolute neutrophil count (ANC)
-Indicator of how well a client might handle infection.
-Treatment: antibiotics, neutropenic precautions.
DVTs
second leading cause of death in cancer clients.
Risk factors: prolonged bedrest, surgery, central line, external compression of vessels by tumor, invasion of vessels by tumor, chemo drugs
Thrombocytopenia
: decrease in circulating platelets in blood. Responsible for clotting.
-Risk factors: advanced metastatic disease, hematological malignancies, bleeding disorders, bacterial infections, anticoagulant medications, cancer treatments themselves.
-Treatment: platelet infusion
Thrombocytopenia Assessment
:
Hx, vitals, pulse ox, change in LOC, HA, pupil changes, conjunctival hemorrhage, petechiae, ecchymosis, purpura, oozing from puncture sites or surgical sites, rectal bleeding or ears/nose/mouth.
Blood products
RBC transfusions
: for symptomatic anemia.
-Don't want H/H to drop below 8g/dl and 24%.
Platelet transfusions
: control or prevent bleeding associated with thrombocytopenia
Blood products likely also irradiated to prevent transfusion reactions
Risk factors
-Tobacco #1 preventable cause
-Suspected dietary: low fiber diet, inc red meat, inc animal fat, nitrites, alcohol, preservative/additives
-Obesity, physical inactivity, poor nutrition
-Immunosuppressed
-Aging
-Heredity
-African Americans
-Exposure to ultraviolet radiation
-Stress
-Previous hx of other types of cancer or chemo