cancer
an abnormal growth of cells. can be benign (non-cancerous, surgical resection may be needed) or malignant (cancerous & needs treatment)risk factors: SMOKING!! geneticsdiagnose: biopsy- TNM classification, stagingtreatment goals are... cure, control, palliative.
prevention of cancer
-limit alcohol use-maintain normal body weight-avoid smoking and tobacco-screenings -use sunscreen SPF of at least 15 or higher-healthy diet
warning signs of cancer
C- change in bowel habitsA- a sore that does not healU- unusual bleeding or dischargeT- thickening or a lumpI- indigestion or difficulty swallowingO- obvious change in wart or moleN- nagging cough-hoarseness
stages of cancer
stage 0: cancer in situstage 1: tumor limited to tissue of originstage 2: limited local spreadstage 3: extensive local and regional spreadstage 4: metastasis
chemotherapy
use of chemicals to destroy cancer cells. kills both good & bad cells in body. *must be prepared by those specially trained d/t toxic effects. can be given...IV: irritates and destroys veins.. needs CVAD device to use!! intravesical: chemo given through a catheter to the bladder. intrathecal: used for CNS cancers- inserted by lumbar puncture. s/e of chemo: alopecia, nausea & vomiting, bone marrow suppression, anxiety
radiation
energy emitted from a source to kill cancer. only affects tissues w/in treatment field!!stimulation: dose & amt of treatment is specified, mask made to cover face, small tattoos placed to identify treatment field. external beam radiation: most common. pt is inside a machine that radiates energy to the specified spot of treatment. internal radiation: brachytherapy! seeds implanted internally to directly affect cancer cells. skin damage- desquamation may occur at radiation site. -prevent infection by... rinse with normal salineavoid extreme hot or cold temperaturesavoid sunlight and swimming in chlorineuse electric razor if have to shave in treatment field. avoid tape and bandagesapply nonmedicated nonperfumed lotions or creams that are approved by dr.
protection for brachytherapy.. how to care for.
follow ALARA. as low as reasonably achievable. when providing care. time, distance, and shielding. -limit time spent w/ patient to 30 minutes throughout whole shift. -stay 6 ft away as much as possible.-wear a dosimeter at ALL times when caring for pts to record exposure. -no pregnant individuals can be in room.
side effects of cancer treatment
-fatigue (most common s/e)-bone marrow suppression (neutropenia, thrombocytopenia, anemia)-nausea & vomiting, diarrhea, anorexia, dysguesia, dysphagia-skin changes & alopecia-reproductive effects- need education before treatment.
hematopoietic stem cell transplant
bone marrow transplant-clears diseased bone marrow to make room for healthy cells -allogenic: donor transplant-syngeneic: identical twin transplant-autologous: patients receive their own stem cells back after destroying bad cells. complications: graft vs. host disease. body rejects the transplanted cells. first 100 days after transplant are vital for complications.
oncologic emergencies
tumor lysis syndrome: hyperuricemia, hyperphosphatemia, hyperkalemia, hypocalcemia.can occur 24-48 hrs after chemotherapy. -needs increased hydration, allopurinol, IV sodium bicarbonate. table 15.19 for more.
lung cancer
smoking is the #1 cause of lung cancers. also related to exposure to secondhand smoke, chemicals.**smoking cessation lowers risk after 10-15 yrs of stopping. s/s: persistent cough, dyspnea, wheezing, blood tinged sputum, chest pain. chest x-ray to diagnose. biopsy to confirm diagnosis.
types of lung cancer
non small cell lung cancer: NSCLCTNM staging. surgical resection. often no symptoms until wide metastasis. ***if stage 1-3A, surgical resection. if more progressed, pallative.small cell lung cancer: WORST type. SCLC-very aggressive type. metastasis to brain. poor prognosis. surgery usually not done d/t rapid growth. chemotherapy.may have prophylactic cranial radiation d/t chance for CNS metastasis.
paraneoplastic syndrome
symptoms may manifest before cancer diagnosiss/s: cushings syndrome, polycythmia, SIADH, hypercalcemia.
leukemia
blood cancer affecting the bone marrow, lymph, and spleen. --risk factors: exposure to chemicals, pesticides, smoking, obesity. s/s: anemia, thrombocytopenia, decreased WBC's, bone pain, oral lesions, leukostasis (^WBC's greater than 100,000)2 types: acute- immature cellschronic- mature cells
types of leukemia
acute myelogenous leukemia (AML): abrupt & dramatic. serious infections and abnormal bleedingacute lymphocytic leukemia (ALL):-most common in childrenFEVER and bleeding. chronic myelogenous leukemia(CML):PHILADELPHIA CHROMOSOMEchronic stable phase followed by blastic phase.chronic lymphocytic leukemia (CLL):
stages of chemotherapy
induction: agressive treatment to achieve remission. **watch for neutropenia, thrombocytopenia, and anemia.postinduction: high-dose therapy given to eliminate any remaining cancer cells.maintenance therapy: lower doses given in coming weeks to keep body free of cancer.
Sickle Cell Anemia (SCA)
abnormally shaped RBC. most common in African Americans. -both parents must have trait to pass down to child. s/s: -vaso-occlusive crisis: PAINFUL episode from tissue ischemia (hypoxia)-may have ACS- pneumonia like symptoms (cough, wheezing, tachypnea)-stroke: treated with chronic transfusion therapy. needs Hgb to be at 30% to prevent recurring strokes.*may need chelation therapy to prevent iron overload. diagnosis: --sickle-turbidity test. & Hgb electrophoresis.--ted test: identifies if at risk for stroke by monitoring brain.
treatment for sickle cell anemia
-rest & hydration!!!-pain control-blood replacement therapy-antibiotics-**oral penicillin prophalaxis-Oxygen therapy when hypoxic, not all the time.-chronic transfusion therapy if strokes. -HSCT (curative)-hydroxyurea: decreases the fatality of SCA d/t ^^ fetal hemoglobin. education:-recognize signs of crisis & infection (fever, respiratory distress syndrome, stroke)-specify need for adequate hydration and how to prevent dehydration.-need to be updated on all vaccinations to prevent infection. -give penicillin as ordered
Hodgkins lymphoma
Reed Sternberg cellsrisk factors: Epstein-Barr virus, genetics, toxin exposure, HIV. s/s: enlarged lymph nodes (movable and nontender), itching, pain w/ consumption of alcohol.**B-symptoms: worsen prognosis. fever, night sweats, weight loss.treatment: depends on staging and B-symptoms. -2-8 cycles of chemotherapy.
nonhodgkins lymphoma
most common. more severe. risk factors: infections, environmental factors, immunodeficiency, use of immunosuppressives, previous chemo or radiation.s/s: painless lymph node enlargement, possible B-symptoms, pancytopenia. treatment: chemotherapy, Rituximab (can reactivate hepatitis)
multiple myeloma (MM)
cancerous plasma cells destroy bone. most common in black men. s/s: *skeletal pain* hypercalcemia, pain in pelvis, ribs, spine. diagnosis: Bence Jones (m-protein) in urine. treatment: control of pain and prevention of fractures!! -corticosteroids, chemo, HSCT , biphosphonates (help prevent bone breakdown)
head & neck cancer
tobacco use is #1 cause of head and neck cancers!s/s: feeling of lump in throatsore throatleukoplakia or erythroplakia (white and red patches in mouth.)hoarsenesstreatment:surgerynutritional therapy: patients may have trouble and pain swallowing and eating. may need EN.--elevate HOB when eating--monitor for weight loss and swallow tests. --thickened liquids and supplements to foods.physical therapy and speech therapy to regain neck control and learn how to speak again.MUST STOP SMOKING!!!!!have suctioning ready at bedside. may have NG tube or other tubes for drainage. monitor tubes every hour after surgery then every 4 hrs. **use sugarless gum, candy, nonalcoholic mouth wash, ice chips to help soothe extreme dry mouth.
oral cancer
those at risk are smokers, sun exposure, and HPV. s/s: leukoplakia & erythroplasia in mouth. diagnose: toluidine blue test- cancer cells will turn blue. treatment: surgeryassess for feeding intolerance post op. have suction available.
skin cancer
risk factors: fair skin, blonde/red hair, blue eyeshistory of prolonged sun or tanning exposurefamily history of skin cancerspending lots of time outdoors nonmelanoma skin cancer:-precancerous lesions. usually develop in areas exposed to sun face, neck, back, arms, handsacitinic karatosis, basal cell carcinoma, squamous cell carcinoma. melanoma: causes most skin cancer deaths. can metastasize to any organ.*spots are often dark brown-black. diagnose: microscopic evaluation for tumor thickness. needs wide surgical excision.
ABCDE of melanoma detection
AsymmetryBorder: edges are ragged.Color: brown/blackDiameter: >6mmEvolving: changing appearance
skin infections
bacterial infectionsex.) cellulitisviral infectionsex.) herpes, wartsinfestations and bug bitesimportance of hygiene, clean infected linens.fungal infections:Woods light examination will light up blue/green! ex.) ring worm, athletes foot
allergic skin problems
Stevens Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)-violent immune reactions to medications or infection.usually happens within 4-21 days after starting drug. s/s: fever, cough, headache, anorexia, nausea. these symptoms occur 1-3 days before skin reactions. -skin reaction: red macular rash-blisters PAINFUL!!needs proper wound care, dressings, hydration, airway maintenance commonly in ICU setting.
Psoriasis
chronic autoimmune diseaseassociated with metabolic syndrome, heart disease, type 2 diabetes.-lesions are red, scaly, itchy, painfuldepression related to body image is common.
treatment for skin conditions
phototherapy w/ methoxsalen-treatments given 2-3x/week-need to avoid sunlight after treatments & wear sunglasses-take with food or milk to decrease nausealaser therapycorticosteroids, antibiotics, antihistaminestopical fluorouracil: used to treat precancerous skin lesions. **will produce burning red skin in 3-5 days after beginning therapy. needs corticosteroid creams to help with irritation. inform patient that skin will get better. must continue for 2-4 weeks to see improvement. **Avoid sunlight during treatment-punch surgery-cryotherapy-Mohs surgery- excision of cancer
wound care
wet compresses with sterile watergently pat skin dryavoid heat for itching situationscareful handwashing after caring for wounds