Onco Flashcards
(105 cards)
1
Q
classic s/s bladder ca
A
painless hematuria
2
Q
causes of bladder ca
A
- tobacco/cigarette smoking
- occupational chemical exposure
- ⬆️ fat intake
3
Q
live virus immunization
A
not allowed and also their household contacts
measles, mumps, rubella, polio
varicella
shingles & some flu virus like H1N1
4
Q
polio vaccine alternative
A
Salk vaccine (inactivated)
5
Q
eliminate in child’s room
A
raw fruits & vegetables
fresh flowers & live plants
standing water
6
Q
given to stimulate bone marrow to produce white blood cell
A
(Granulocyte Colony Stimulating Factor)
G CSF / Filgrastim (Neupogen)
7
Q
air flow in rooms
A
(high efficiency particulate air)
HEPA Filter
or
laminar air flow system
- sucks air and thru a filtration, removes pollen, dust, mold, bacteria, airborne particles
8
Q
pedia bleeding prec
A
-measure abdominal girth
-soft toothbrush
-cool to warm soft foods
-avoid injections, if possible
-apply firm and gentle pressure to a needle-stick site for at least 10 minutes
-pad side rails and sharp corners -avoid constrictive or tight clothing. -avoid blowing nose
-avoid the use of rectal suppositories, enemas, and rectal thermometers
-count the number of pads or tampons used if the adolescent girl is menstruating
-avoid NSAIDs and aspirin
9
Q
Late Signs of ⬆️ ICP
A
▪ Bradycardia
▪ Decreased motor response to command
▪ Decreased sensory response to painful stimuli
▪ Alterations in pupil size and reaction
▪ Decerebrate (extension) or decorticate (flexion) posturing
▪ Cheyne-Stokes respirations
▪ Papilledema
▪ Decreased consciousness
▪ Coma
10
Q
early signs of ⬆️ ICP for infants
A
- tense bulgung fontanel
- irritability
- high pitched cry
- poor feeding
- setting sun sign / sunset eyes
- Macewen’s sign (cracked pot sound after percussion)
- increased head circumference
- distended scalp veins
- separated cranial sutures
11
Q
early signs of ⬆️ ICP for children
A
▪ forceful vomiting, nausea
▪ headache
▪ Seizures
▪ Diplopia; blurred vision
12
Q
⬆️ ICP personality & behavior signs
A
▪ Irritability, restlessness
▪ Indifference, drowsiness
▪ Decline in school performance
▪ Diminished physical activity and motor performance
▪ Increased sleeping
▪ Inability to follow simple commands
▪ Lethargy
13
Q
Leukemia
A
malignant increase of immature WBC in the bone marrow resulting in:
💀neutropenia - risk for infection
💀anemia -tired, SOB, weak
💀thrombocytopenia - risk for bleeding
common in boys than in girls
14
Q
most frequent type of cancer in children
A
acute lymphocytic leukemka
15
Q
phases of chemotherapy for leukemia
A
- induction - complete remission or disappearance of leukemic cells
- intensification or consolidation - decreases the tumor burden further
- central nervous system prophylactic therapy - prevents leukemic cells from invading the central nervous system
- maintenance - maintain remission phase
16
Q
confirmatory for leukemia
A
+ bone marrow biopsy of blast cells
17
Q
hair loss may occur from chemotherapy
A
hair regrows in about 3 to 6 months and may be a slightly different color or texture
18
Q
Hodgkins Lymphoma
A
malignancy of the lymph nodes
painless/non tender, firm, enlarged, movable lymph nodes
supraclavicular
or
sentinal node in children
19
Q
confirmatory of hodgkins lymphoma
A
+ Lymph node biopsy of Reed-Sternberg cells
20
Q
nephroblastoma
A
Wilms’ Tumor
peaks at 3y.o.
intraabdominal and kidney tumor
DO NOT PALPATE ABDOMEN
measure abdominal girth daily
➕hypertension (⬆️renin bec tumor)
21
Q
neuroblastoma
A
poor prognosis
peaks before 10y.o.
⬆️immature neuroblast cells forming tumor in adrenal gland or retroperitoneal
+ in urine: vanillylmandelic acid, homovanillic acid, dopamine, and norepinephrine
22
Q
Osteosarcoma
A
osteogenic sarcoma
most common bone cancer in children, peaks 10-25yo
tumor in metaphysis of long bones, mostly in femur
earliest sign: extremity injury or normal growing pains relieved by a flexed position
-limping during weight bearing
-pathological fractures
treatment: limb salvage/limb resection procedure
23
Q
brain tumors
A
-headache severe at waking up & improves within the day
-vomiting
-ataxia
-diplopia
-facial weakness
-clumsiness
no trendelenburg/supine
no to operative side
-infratentorial:flat on either side
-supratentorial: above heart level
monitor temperature!
monitor CSF leakage:
-colorless drainage in the dressing or from ears/nose
-dipstick for +glucose = CSF
24
Q
opisthotonus
A
backward arching of the spine bec of meningitis
25
nadir
the time where bone marrow activity & wbc counts are at lowest
26
types of biopsy
1. needle
2. incisional - part/wedge
3. excisional - whole
4. staging - multiple needle & incisional
27
types of oncological surgeries
1. prophylactic - premalignant
2. curative - affected organ only
3. controlled (cytoreductive/controlling) - affected organ & adjacent
4. palliative - alleviate symptoms
5. reconstructive/rehabilitative - for altered body image
28
external beam radiation
teletherapy
patient NOT RADIOACTIVE
-wash gently each day with warm water alone or with mild soap and water
-use hand rather than a washcloth
-rinse soap thoroughly
-do not to remove the markings
-dry with patting motions rather than rubbing motions; use a clean, soft towel or cloth
-no powders, ointments, lotions, or creams
-wear soft clothing over the skin
-avoid wearing belts, buckles, straps, or any type of clothing that binds or rubs the skin
-avoid exposure to heat and the sun
29
internal radiation
brachytherapy
patient RADIOACTIVE
30
unsealed radiation source
a type of brachytherapy
patient RADIOACTIVE for 48hrs until excreted
given PO or IV into body cavities
thus body fluids are radioactive
excreta is also radioactive
31
sealed radiation source
a temporary or permanent implant, implanted in the target tumor
patient RADIOACTIVE
excreta NON RADIOACTIVE
patient becomes NON RADIOACTIVE after implant removal
32
dislodged sealed radiation implant
lie still
long handled forceps
deposit in a lead container
contact oncologist
document
33
types of donor stem cells
autologous - self sourced
syngeneic - twin
allogeneic - relative or non relative
34
BMT harvest
bone marrow transplantation harvest
-multiple aspirations of stem cells from the iliac crest
-allogeneic or syngeneic marrow, transferred immediately
-autologous marrow, filtered for cancer cells and are frozen (cryopreservation)
35
PBSCT Harvest
peripheral blood stem cell transplantation harvest
-like a dialysis machine, for 4 to 6hrs, blood removed thru central venous catheter and thru apharesis or leukapharesis, removes stem cells and returns the rest of the blood to the blood stream
36
conditioning
done after harvesting
immunosuppresion therapy eradicating all malignant cells creating space in bone marrow for engraftment
37
transplantation (stem cell)
given iv or iv push thru central line like a blood transfusion
38
engraftment
blood cell counts begin to rise
process takes 2 to 5 weeks
39
post transplantation (stem cell)
most critical period
patient at risk for bleeding, infection until engraftment
40
complications of stem cell transplantation
1. failure to graft
2. graft vs host disease - esp in allogeneic, managed thru immunosuppressive agents
3. hepatic veno-occlusive disease - occlusion bec of thrombosis / phlebitis
s&s
right upper quadrant abdominal pain
jaundice
ascites
weight gain
hepatomegaly
41
leukamia pts to avoid doing
changing litter box
working w/ house plants/garden
going to crowds
42
adult bleeding prec
same w/ pedia
-for injection, press for 5mins or more instead of 10 mins
-count tampons/pads for menstruating
-use of electric razor
-soft toothbrush and NO dental floss
-avoid blowing nose
43
remission
-a diminution of the seriousness or intensity of disease or pain;
-a temporary recovery
44
forms of blood cancer
leukemia, lymphoma, myeloma
45
multiple myeloma
-increasing abnormal plasma cells in bone marrow
-decreases production of immunoglobulins and antibodies
-produces an abnormal antibody (myeloma protein or bence jones protein) found in blood and urine (proteinuria)
-⬆️ uric acid (hyperuricemia, gout) and calcium (hypercalcemia) ➡️ Renal failure
-➕osteoporosis & pathological fractures
46
bisphosphonate medications
as prescribed to slow bone damage and reduce pain and risk of fractures
47
testicular ca
-predisposing fx: cryptorchidism (undescended testes)
-early detection: monthly testicular self exam
➕ painless testicular swelling
dragging or pulling sensation
op:
unilateral or radical orchiectomy
retroperitoneal lymph node dissection
💀 avoid heavy lifting
offer: sperm storage, donor insemination or adoption
&
monthly testicular self exam for the remaining testes
48
cervical ca
predisposing: HPV virus, cigarette smoking, early first intercourse <17yo., multiple partners
pap smear
-painless vaginal postmenstrual & postcoital bleeding
-foul smelling/ serosanguinous dischargr
49
cervical ca
predisposing: HPV virus, cigarette smoking, early first intercourse <17yo., multiple partners
pap smear
-painless vaginal postmenstrual & postcoital bleeding
-foul smelling/ serosanguinous dischargr
50
cervical ca: laser therapy
slight vaginal bleeding expected
heals at 6 to 12 weeks
51
cervical ca: cryosurgery
-avoid sexual intercourse
-use tampons
expected:
-cramps during procedure
-heavy water discharge for several weeks post procedure
52
cervical ca: conization
-remove cone shape area of cervix
-reproductive capacity unharmed
-💀 preterm labor for future pregnancies
-💀 long term ff/u
53
cervical ca: hysterectomy
(radical hysterectomy with bilateral lymph node dissection)
removal of uterus & cervix if childbearing is not desired
1month post op
-avoid stairs
-no weight bearing/lifting (>20lbs/9kg)
-no prolonged sitting/ long drive
-no bath tubs
-no sexual intercouse 3-6 weeks
💀 bleeding
>1 saturated pad per hour
54
cervical ca: pelvic exenteration
-remove pelvic contents including bowel, vagina, bladder
-performed ONLY for recurring CA with NO TUMOR outside pelvis and NO lymph node involvement
RIGHT SIDE: for urine/ bladder:
placement of ileal conduit
LEFT SIDE: for feces:
placement of colostomy
-interventions: almost similar to hysterectomy
-sexual counseling: no more sexual intercourse
-perineal opening may drain for several months
-avoid strenuous activity for 6months
-perineal irrigations and sitz baths
55
ovarian ca
aysmptomatic in early stage & fast growing
thus highest mortality rate
north american / european descent
diagnosing: exploratory laparotomy
(TVS/Transvaginal UTZ not definitive but can be done)
elevated tumor marker CA 125
op: Total abdominal hysterectomy and bilateral salpingooophorectomy with tumor debulking
56
endometrial (uterine) ca
slow growing usually in menopausal years
predisposing: estrogen use, nulliparity, pcos, late menopause, obesity, hypertension, DM, family hx of uterine ca & colorectal ca
sign: abN° bleeding postmenopause
for estrogen-dependent tumors:
-progesterone & antiestrogen
op: Total abdominal hysterectomy and bilateral salpingo-oophorectomy
57
breast ca
-predisposing: family hx of breast ca, nulliparity, late first birth, early menarche, late menopause, previous ca of breast uterus/ovaries, obesity, high radiation exposure
early detection: bse
-painless, fixed, irregular, nonencapsulated mass
-peau d orange
58
for human epidermal growth factor receptor 2–positive (HER-2 +)
breast ca
Monoclonal antibodies such as trastuzumab
59
breast ca: lymphedema
-pressure sleeve (looks like a compression stockings but for arms)
-diuretics
-low salt diet
60
breast ca: mastectomy
immediate postop:
semi-Fowler’s position, turn from the back to the unaffected side, with the affected arm elevated above the level of the heart
❌no IVs, no injections, no blood pressure measurements, and no venipunctures should be done in the arm on the side of the mastectomy
61
esophageal ca
squamous cell carcinoma or adenocarcinoma
predisposing: smoking, alcohol, chronic reflux, Barrett’s esophagus, and vitamin deficiencies
➕ dysphagia, odynophagia (painful swallowing)
62
gastric ca
predisposing: H. Pylori, diet of smoked, highly salted, processed, or spiced foods, smoking, alcohol and nitrate ingestion, and a history of gastric ulcers
63
gastric ca complication
dumping syndrome: rapid gastric emptying
64
gastric ca: gastrectomy
postop
-fowlers position
-NPO status as prescribed for 1 to 3 days until peristalsis returns
-assess for bowel sounds
-Monitor nasogastric suction. -drainage from the nasogastric tube is normally bloody for 24 hours postoperatively, changes to brown-tinged, and is then yellow or clear
-‼️Do not irrigate or remove the nasogastric tube
-Advance the diet from NPO to sips of clear water to 6 small bland meals a day, as prescribed
65
pancreatic ca
highly malignant, rapidly growing adenocarcinoma
predisposing: hx of pancreatitis, high fat intake, smoking, DM, alcohol, exposure to chemicals
diagnosing: ERCP Endoscopic retrograde cholangiopancreatography
signs: clay colored stools, jaundice
op: Whipple procedure, which involves a pancreaticoduodenectomy with removal of the distal third of the stomach, pancreaticojejunostomy, gastrojejunostomy, and choledochojejunostomy
post op:
pancreatitis mgt
and gastrectomy mgt
‼️check for blood glucose
66
colorectal ca
predisposing:
family hx of colorectal ca
familial polyposis
colorectal polyps
chronic inflammatory bowel ds
hx of breast, endometrial & gastric ca
-blood in stool (feccal occult, sigmoido- & colonoscopy
-abN° stool
1. ascending colon tumor: diarrhea
2. descending colon tumor: constipation or for partial obstruction: diarrhea, or flat, ribbon-like stool
3. Rectal tumor: Alternating constipation and diarrhea
late sign:
-cachexia - (skeleton like muscle wasting)
-guarding, abd distention or mass
67
colorectal ca
predisposing:
family hx of colorectal ca
familial polyposis
colorectal polyps
chronic inflammatory bowel ds
hx of breast, endometrial & gastric ca
-blood in stool (feccal occult, sigmoido- & colonoscopy
-abN° stool
1. ascending colon tumor: diarrhea
2. descending colon tumor: constipation or for partial obstruction: diarrhea, or flat, ribbon-like stool
3. Rectal tumor: Alternating constipation and diarrhea
late sign:
-cachexia - (skeleton like muscle wasting)
-guarding, abd distention or mass
68
colorectal ca
predisposing:
family hx of colorectal ca
familial polyposis
colorectal polyps
chronic inflammatory bowel ds
hx of breast, endometrial & gastric ca
-blood in stool (feccal occult, sigmoido- & colonoscopy
-abN° stool
1. ascending colon tumor: diarrhea
2. descending colon tumor: constipation or for partial obstruction: diarrhea, or flat, ribbon-like stool
3. Rectal tumor: Alternating constipation and diarrhea
late sign:
-cachexia - (skeleton like muscle wasting)
-guarding, abd distention or mass
69
colorectal ca
predisposing:
family hx of colorectal ca
familial polyposis
colorectal polyps
chronic inflammatory bowel ds
hx of breast, endometrial & gastric ca
-blood in stool (feccal occult, sigmoido- & colonoscopy
-abN° stool
1. ascending colon tumor: diarrhea
2. descending colon tumor: constipation or for partial obstruction: diarrhea, or flat, ribbon-like stool
3. Rectal tumor: Alternating constipation and diarrhea
late sign:
-cachexia - (skeleton like muscle wasting)
-guarding, abd distention or mass
70
colorectal ca
predisposing:
family hx of colorectal ca
familial polyposis
colorectal polyps
chronic inflammatory bowel ds
hx of breast, endometrial & gastric ca
-blood in stool (feccal occult, sigmoido- & colonoscopy
-abN° stool
1. ascending colon tumor: diarrhea
2. descending colon tumor: constipation or for partial obstruction: diarrhea, or flat, ribbon-like stool
3. Rectal tumor: Alternating constipation and diarrhea
late sign:
-cachexia - (skeleton like muscle wasting)
-guarding, abd distention or mass
op: Bowel resection, local lymph node resection, and a colostomy or ileostomy
71
colorectal ca: complications
bowel perforation w/ peritonitis, abscess or fistula formation
intestinal obstruction
hemorrhage (shock)
72
signs of intenstinal obstruction
early sign:
increased peristalsis
increased bowel sounds
vomiting (maybe fecal contents)
pain
constipation
abdominal distention
hypoactive bowel sounds
73
ostomy care
-assess stoma for size, unusual bleeding, color changes, or necrotic tissue
-normal stoma color is red or pink
-Fecal matter should not be allowed to remain on the skin
-instruct the client to avoid foods that cause excessive gas formation and odor
-Instruct the client in stoma care and irrigations
-check for proper fit
-cover with a dry sterile dressing until pouch is placed
74
colostomy stool differences
-Expect that stool will be liquid postoperatively but will become more solid, depending on the area of the colostomy:
a. ascending colon: liquid stool
b. transverse colon: loose to semiformed stool
c. descending colon:close to normal stool from a colostomy
75
ileostomy stool characteristics
Postoperative drainage will be dark green and progress to yellow as the client begins to eat
Stool is liquid
bec it is in the small intestine, risk for dehydration and electrolyte imbalance exists
76
lung ca: op
1. Laser therapy: To relieve endobronchial obstruction
2. Thoracentesis and pleurodesis: To remove pleural fluid and relieve hypoxia
3. Thoracotomy with pneumonectomy: removal of 1 entire lung
4. Thoracotomy with lobectomy: removal of 1 lobe
5. Thoracotomy with segmental resection:removal of a lobe segment
77
special for pneumonectomy
no closed chest drainage
78
laryngeal ca
predisposing: smoking, alcohol, asbestos, wood dust
painless neck mass, change in voice quality, dysphagia
nutritional support via parenteral nutrition, nasogastric tube feedings, or gastrostomy or jejunostomy tube
79
laryngeal ca: op
cordal stripping
cordectomy
partial laryngectomy
total laryngectomy
➡️tracheostomy is performed with a total laryngectomy; this airway opening is permanent and is referred to as a laryngectomy stoma
80
laryngeal ca: health teaching
airway (tracheostomy care)
alternative methods of communication
suctioning
pain control methods
nutritional support
changes in body image and loss of voice
81
prostate ca
slow growing
predisposing: after age 50, african american men, smoking, history of stds, heavy metal exposure
asymptomatic to painless hematuria
diagnosing: biopsy, prostate specific antigen level not a reliable screening test unless with DRE
82
prostate ca: op
-orchiectomy (palliative) limit the production of testosterone
-prostatectomy: radical prostatectomy can be performed via:
a. retropubic - lower abdomen, not opening the bladder
b. perineal -between scrotum & anus
c. suprapubic -right through the bladder
*all can result to sterility; except perineal, all need cbi, and only perineal has higher risk for infection
-Cryosurgical ablation is a minimally invasive procedure that may be an alternative to radical prostatectomy; liquid nitrogen freezes the gland, and the dead cells are absorbed by the body
83
prostate ca: post op
-continuous feeling of urge to void is n°
-avoid attempts to void around catheter: prevent bladder spasms
-
84
turp complicxn
transurethral resection syndrome
water intoxication/ severe hyponatremia
-too much bladder irrigation absorption
confusion
altered mental status
bradycardia
increased blood pressure
85
suprapubic prostatectomy catheter removal
dressing always saturated w/ urine and needs to be changed frequently
2 to 4 days post op
-clamp
-instruct to attempt to void
-unclamp
-check the residual urine
remove if
✓consistent bladder emptying
✓ residual urine 75ml or less
86
bladder ca: complicxn of radiation
a. Abacterial cystitis
b. Proctitis -rectal lining inflmxn
c. Fistula formation
d. Ileitis or colitis - ileum & inner lining of the colon inflmxn
e. Bladder ulceration and hemorrhage
87
bladder ca: chemotherapy
intravesical installation
-meds injected in the urethral catheter and placed for 2hrs
-pt rotated every 15 to 30mins starting with supine, to avoid full bladder
-after 2 hrs, increase fluids, void while sitting, urine is radioactive, send to radioisotope
-disinfect toilet for 6 hrs with household bleach
88
bladder ca: op
1. transurethral resection of bladder tumor (also palliative)
2. partial cystectomy: bladder capacity gradually increases post op from 60ml to 200-400ml, suprapubic catheter removed after 2weeks
3. radical cystectomy and urinary diversion - the latter can be performed w/o former and can also be performed weeks ahead of former
4. ileal conduit/ureteroileostomy
5. kock pouch-creates reservoir attached with ureters & nipple between ileum and ascending colon
6. indiana pouch-same with kock pouch but between ascending colon and terminal ileum (other pouch: Mainz, Florida)
7. neobladder-same with pouches but empties into pelvis thru urethra
8. percutaneous nephrostomy/pyelostomy: nephrostomy tube for drainage
9. ureterostomy: palliative, ureters attached to abdomen and drains w/o conduit
10. vesicostomy: bladder attached to the abdomen creating stoma and drains
89
oncological emergencies:
sepsis & DIC
gram negative bacteria causing sepsis
together w/ DIC
strict asepsis
Antibiotics & Anticoagulants
90
oncological emergencies: SIADH
some tumors mimic ADH
Na: 115-120 ❗ water intoxication
Na< 110 ‼️seizure coma death
⬆️ Na intake
❌ fluid restriction
give ADH Antagonists
91
oncological emergencies: hypercalcemia
late manifestation, sign of malignancy in bones
encourage ambulation & possible dialysis
92
oncological emergencies: spinal cord compression
tumor reached the spine, early sign is back pain before neurological (tingling, numbness etc)
corticostreoid for swelling, neck or back braces
93
oncological emergencies: superior vena cava syndrome
tumor growth from lymphomas or lung ca obstructing svc
early s/s: morning: edema of face, tightness of collar (stokes' sign)
s/s: blockage of blood flow head neck and upper trunk (edema, epistaxis, erythema, swelling of the veins
semifowlers, corticosteroid, diuretics
94
oncological emergencies: tumor lysis syndrome
ca cells destroyed rapidly resulting to rapid release of potassium & uric acid in the blood stream which is difficult to eliminate fast
yperkalemia, hyperphosphatemia with resultant hypocalcemia, and hyperuricemia occur; hyperuricemia can lead to acute kidney injury
oral & iv hydration
glucose & insulin: hyperkalemia
diuretics: general
allopurinol: purine
eventually, dialysis
95
Warning Signs of Cancer—CAUTION
▪ Change in bowel or bladder habits
▪ Any sore that does not heal
▪ Unusual bleeding or discharge
▪ Thickening or lump in breast or elsewhere
▪ Indigestion
▪ Obvious change in wart or mole
▪ Nagging cough or hoarseness
96
Care of the Client with a Sealed Radiation Implant
▪ Place the client in a private room with a private bath.
▪ Place a radiation precaution sign on the client’s door.
▪ Organize nursing tasks to minimize exposure to the radiation source.
▪ Nursing assignments to a client with a radiation implant should be rotated
▪ Limit time to 30 minutes per care provider per shift. ▪ Wear a dosimeter film badge to measure radiation exposure. ▪ Lead shielding may be used to reduce exposure to radiation. ▪ The nurse should never care for more than 1 client with a radiation implant at 1 time. ▪ Do not allow a pregnant nurse to care for the client. ▪ Do not allow children younger than 16 years or a pregnant woman to visit the client. ▪ Limit visitors to 30 minutes per day; visitors should be at least 6 feet from the source. ▪ Save bed linens and dressings until the source is removed; then dispose of the linens and dressings in the usual manner.
97
bse
7 days after onset of menstruation
98
post Radiation Therapy
▪ Wash the irradiated area gently each day with warm water alone or with mild soap and water.
▪ Use the hand rather than a washcloth to wash the area.
▪ Rinse soap thoroughly from the skin.
▪ Take care not to remove the markings that indicate exactly where the beam of radiation is to be focused.
▪ Dry the irradiated area with patting motions rather than rubbing motions; use a clean, soft towel or cloth.
▪ Use no powders, ointments, lotions, or creams on the skin at the radiation site unless they are prescribed by the radiologist.
▪ Wear soft clothing over the skin at the radiation site.
▪ Avoid wearing belts, buckles, straps, or any type of clothing that binds or rubs the skin at the radiation site.
▪ Avoid exposure of the irradiated area to the sun.
▪ Avoid heat exposure.
99
tse
same day each month
after shower
100
post mastectomy
▪ Avoid overuse of the arm during the first few months.
▪ To prevent lymphedema, keep the affected arm elevated;
▪ Provide incision care with an emollient as prescribed, to soften and prevent wound contracture.
▪ Encourage to perform breast self-examination on the remaining breast and surgical site once healed.
▪ Protect the affected hand and arm.
▪ Avoid strong sunlight on the affected arm.
▪ Do not let the affected arm hang dependent.
▪ Do not carry a pocketbook or anything heavy over the affected arm.
▪ Avoid trauma, cuts, bruises, or burns to the affected side.
▪ Avoid wearing constricting clothing or jewelry on the affected side.
▪ Wear gloves when gardening.
▪ Use thick oven mitts when cooking.
▪ Use a thimble when sewing.
▪ Apply hand cream several times daily.
▪ Use cream cuticle remover.
▪ Wear a MedicAlert bracelet stating which arm is at risk for lymphedema.
101
gastrectomy types
Subtotal Gastrectomy
a. Billroth 1 gastroduodenostomy
b. Billroth 2 gastrojejunostomy
Total Gastrectomy
-esophagojejunostomy
102
Stoma Care Following Laryngectomy
▪ Protect the neck from injury.
▪ Instruct in how to clean the incision and provide stoma care.
▪ Instruct to wear a stoma guard to shield the stoma.
▪ Demonstrate ways to prevent debris from entering the stoma.
▪ Advise to wear loose-fitting, high-collared clothing to cover the stoma.
▪ Avoid swimming, showering, and using aerosol sprays.
▪ Teach clean suctioning technique.
▪ Advise to increase humidity in the home.
▪ Increase fluid intake to 3000 mL/day.
▪ Avoid exposure to persons with infections.
▪ Alternate rest periods with activity.
▪ Instruct in range-of-motion exercises for the arms, shoulders, and neck.
103
urinary stoma care
▪ Instruct to change the appliance in the morning, when urinary production is slowest.
▪ Collect equipment, remove collection bag, and use water or commercial solvent to loosen adhesive.
▪ Hold a rolled gauze pad against the stoma to collect and absorb urine during the procedure.
▪ Cleanse the skin around the stoma and under the drainage bag with mild nonresidue soap and water.
▪ Inspect the skin for excoriation, and instruct to prevent urine from coming into contact with the skin.
▪ After the skin is dry, apply skin adhesive around the appliance.
▪ Instruct to cut the stoma opening of the skin barrier just large enough to fit over the stoma (no more than 3 mm larger than the stoma).
▪ Instruct that the stoma will begin to shrink, requiring a smaller stoma opening on the skin barrier.
▪ Apply the skin barrier before attaching the pouch or face plate.
▪ Place the appliance over the stoma and secure in place.
▪ Encourage self-care; teach to use a mirror.
▪ Instruct that the pouch may be drained by a bedside bag or leg bag, especially at night.
▪ Instruct to empty the urinary collection bag when it is one-third full to prevent pulling of the appliance and leakage.
▪ Instruct to check the appliance seal if perspiring occurs.
▪ Instruct to leave the urinary pouch in place as long as it is not leaking and to change it every 5 to 7 days. ▪ During appliance changes, leave the skin open to air for as long as possible.
▪ Use a non–karaya product, because urine erodes karaya.
▪ To control odor, instruct to drink adequate fluids, wash the appliance thoroughly with soap and lukewarm water, and soak the collection pouch in dilute white vinegar for 20 to 30 minutes; a special deodorant tablet can also be placed into the pouch while it is being worn.
▪ Instruct who takes baths to keep the level of the water below the stoma and to avoid oily soaps.
▪ If plans to shower, instruct to direct the flow of water away from the stoma.
104
self irrigation of stoma
▪ Instruct to wash hands and use clean technique.
▪ Instruct to use a catheter and syringe, instill 60 mL of normal saline or water into the reservoir, and aspirate gently or allow to drain.
▪ Instruct to irrigate until the drainage remains free of mucus but to be careful not to overirrigate.
105
self catheterization of stoma
▪ Instruct to wash hands and use clean technique.
▪ Initially, instruct to insert a catheter every 2 to 3 hours to drain the reservoir; during each week thereafter, increase the interval by 1 hour until catheterization is done every 4 to 6 hours.
▪ Lubricate the catheter well with water-soluble lubricant, and instruct never to force the catheter into the reservoir.
▪ If resistance is met, instruct to pause, rotate the catheter, and apply gentle pressure to insert.
▪ Instruct to notify the surgeon if unable to insert the catheter.
▪ When urine has stopped, instruct to take several deep breaths and move the catheter in and out 2 to 3 inches (5 to 7.5 cm) to ensure that the pouch is empty.
▪ Instruct to withdraw the catheter slowly and pinch the catheter when withdrawn so that it does not leak urine.
▪ Instruct to carry catheterization supplies.
