Test #2 Chapter 24: Care of Patients with Cancer Flashcards Preview

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Flashcards in Test #2 Chapter 24: Care of Patients with Cancer Deck (21):
1

Cancer can develop in any organ or tissue, destroys the normal tissue, which leads to

the tissue losing its normal functioning.

2

Reduced immunity and blood producing function-

WBC’s will decrease.

Normal WBC is 5000, 10,000.

Interventions include- Wash hands, no sick family members. With RBC’s, the cancer can invade the bone marrow and cause anemia.

Decreased platelets- fall precautions, limit iv sticks, bleed easily, brush teeth with soft brissled tooth brush. Weak fatigue at risk for falls.

3

Altered GI structure and function-

Alterations in GI functioning will impair our nutritional intake. If you have a tumor there, it is going to take away the nutrients that our body needs.

May notice abdomen protrusion. Tumors as a whole will increase your metabolism rate and need for nutrients. This causes people to not even want to eat because they do not have energy to do so.

They can catatexia- wasting away appearance. Food does not taste good anymore.

Nutrition- Teach High Carb, High Protein, bland diet

4

Motor and Sensory Deficits-

Cancer can invade the bone and brain and can compress on nerves. If they had a tumor in their spine, depending on how big it gets, they can have numbness and tingling in their legs, trouble ambulating.

What if they had a tumor in their brain, and it was compressing on cranial nerve III, occulomotor,?

PERRLA will be altered. If it is in the frontal lobe, it can affect judgement. The person could say inappropriate things.

5

If the cancer invades the bone, it is a little different.

Bone cancer is very painful, bones easily break. Doesn’t matter if it is primary or mets. Interventions would be- pain management (DON”T BE LATE),

use the draw sheet to move them in the bed (ALWAYS).

If a person has breast cancer, and they come to the ER complaining of pain in their legs and bones, you will send them to get an x-ray or CT, could mean mets.

6

Reduced Oxygenation-

Lung Cancer- Tumors can obstruct your airway, block blood flow, thicken alveoli,

Things that are supposed to work right are not working right.

Lung cancer with big tumor- skin color would look cyanotic or pale, o2 stats low, need oxygen, HOB elevated,

7

Cancer Management - in General
Surgery-

You can remove the tissue that is diseased, diagnose with it, cure it, control it, can be pallitive just depends on the situation.

Your side effects just depend on your nursing interventions. If they had to have part of their lung removed, they will have breathing issues, might need oxygen, they will have activity intolerance that cannot be fixed,

Need to rest. Psychosocially, they can be diagnosed with cancer on monday and in to have surgery on wednesday, they do not have a lot of time to take a hold of the whole situation. Understand this. They might be angry, sad, upset.

8

Radiation-

Local treatment under a machine in the area that they have cancer. Radiation is trying to kill or damage the bad cells so that they will not divide any more. That is the goal with radiation. Interventions- Education- What we try to do is deliver a small amount of radiation for a longer period of time. Example - Small amount of radiation on Monday, Then again on Wednesday, and then again on Friday. We do not want them having a large amount of radiation once a month. They have found that that does not kill the cancer as well as the little doses. Patients will ask you this.

Educate- do not go into the sun after radiation therapy. Need to stay out of sun for a whole year.

Do not apply sunscreen. No sun at all. If they have radiation of the throat and the chest- monitor their airway and make sure that they are breathing ok.

They will have dysphagia.
Intervention- Assess if they can swallow before they can eat.

Xerostomia- dry mouth- teach can give you cavities, dehydration, focus is mouth care. Brush teeth after you eat and before you go to bed.

9

Chemotherapy-

We usually treat cancer with chemical agents. They can be given PO and by IV. It is calculated by their weight, size, type of cancer they have. They get them at regular intervals (not once a month) depending on their cancer.

One general rule from a nurses standpoint is that you have to protect yourself when you are around someone’s chemotherapy. You can do this by PPE, Gloves Gowns. Do not handle with out gloves. EVER.

Complications- there are several- Accidental Extravasation of the chemotherapy into the extravascular space. This can happen with any IV meds, but when it happens with chemo medication, that is huge. It will damage the healthy tissue.

Nursing Interventions for this is prevention, check patency by flushing with saline first and then monitor it closely. The patient might tell you that it is burning or hurting or you may see a big knot above the IV. If they say this, you STOP whatever is flowing ASAP.

10

Chemotherapy Side Effects:

Anemia

Neutropenia

Thrombocytopenia

Chemo induced Nausea and vomiting-

Mucostitis-

Alopecia-

Psychosocial- (Anxiety, sleep changes)


Chemo Brain-

Chemotherapy Induced Peipheral Neuropathy CIPN-

Sepsis

DIC

Hypercalcemia

11

Anemia-

S/S SOB, Fatigue, pale. Interventions- depends on the etiology- Fall Risks.

12

Neutropenia-

Means low WBC. Interventions- Protect them from infections, help prevent, Low bacteria diet (No fresh flowers, fruit or veggies, or bloody meat, no over easy eggs. fish) Check their temp (even a little bit of a temp is a big deal) Wash hands. If they say that it hurts when they urinate, it is a big deal. Cough important.

13

Thrombocytopenia-

Bleeding risk- Interventions include - Fall Risk, No Aspirins, No NSAIDS, constipation give stool softener, soft bristled tooth brush, (They can have Tylenol)

14

Chemo induced Nausea and vomiting-

This is a big problem that the drugs will give the. Nursing interventions- Give Zofran and Morphine 30 min prior to chemo to prevent nausea and vomiting.

15

Mucostitis-

sores in mucus membranes that line the GI tract. Can be anywhere. Interventions are: Stomatitis- oral care, soft bristled tooth brush, no listerine, can use saline.

16

Alopecia-

hair loss, generally maybe about a month or so after chemo it will start growing back, but it may be different than their original hair, (texture). Educate to cover the head to protect them from the sun.

17

Chemo Brain-

temporary. May last months to years. More common with breast cancer treatment. They experience changes with their concentration and their memory learning ect.

18

Chemotherapy Induced Peipheral Neuropathy CIPN-

lose sensory and motor because chemo damages it. Usually is permanent. Diabetes people, this effect them more. Nursing interventions are preventing injuries and falls.

19

Sepsis-

Organism enters the blood stream. Can lead to septic shock which is life threatening situation. Want to catch before it gets that bad. Cancer patients are at risk for sepsis because their WBC’s are low. Always get a RAINBOW, and need blood cultures as well. Blood has to be drawn from 2 seperate sites. Two bottles make up 1 blood culture. Label it where you got the blood from. Takes three days to grow. Assessment is the most important- notice when something is wrong and intervine. Might see fever and elevated HR and respirations. As they go from sepsis to septic shock, you start adding more symptoms to the problem such as cool pale skin, blood pressure drops, LOC changes. When they are checking the labs you will see a shift to the left.

20

DIC-

Disseminated Intravascular Coagulation- ICU patient. Cancer patients are at risk for this. They can develop sepsis and then DIC. Blood vessels throughout the body will form clots, circulation is impaired, if it is in the kidneys it will damage them. It can be acute or chronic but cancer patients are prone to more chronic DIC. Chronic is not years but weeks to months. Platelets go to all of the areas and form clots. Eventually fewer platelets are circulating, which leads to serious bleeding. (Nose bleeds, mouth bleeding, IV sites might ooze blood,) Urine output will be decreased;

21

Hypercalcemia-

Increased Serum calcium levels. Normal Calcium is 9-10.5. Normally patients with bone cancer, calcium is released from the bone into the bloodstream making the calcium level elevate. Calcium is needed in bones, heart, muscle contractions, hormones, S/S of hypercalcemia- twitching, dehydrated, fatigued, GI Nausea and Vomiting, Constipation, Polyuria, loss of appetite. Interventions- Fall risk, increase their fluids (PO or IV) assist in and out of bed. Moans Stones Groans and Bones.