Cancer-Med Sug II (PPT)

olanjones's version from 2017-04-19 20:53

Goals of treatment & Chemotherapy

Question Answer
Goalscure, control, palliation
Tx depends on Cell type Location and size of tumor Extent of disease Physiologic and psychologic status Expressed needs and desires
Palliation goalrelief or control of symptoms; maintain QOL
Examples of tx in which palliation is primary goalradiation therapy or chemotherapy to reduce tumor size and relieve subsequent symptoms such as the pain of bone metastasis.
SurgeryOldest form of cancer treatment Meets a variety of goals The trend is toward less radical surgeries
PreventionSurgery used to eliminate or reduce risk of cancer in at-risk patients Prophylactic removal of nonvital organs has been successful in reducing the incidence of some malignancies Usual sites of regional spread may be removed
Cure and controlRemove only as much tissue as necessary and spare normal tissue; Debulking procedure may be used if tumor cannot be completely removed
Supportive care includesInsertion of gastric feeding tube Placement of central venous access device Prophylactic surgical fixation of bones at risk for pathologic fracture
ChemotherapyUse of chemicals given as a systemic therapy for cancer Mainstay for most solid tumors and hematologic cancers Can offer cure, control, or palliative care
Chemo Goals offer cure for some cancers, control other cancers for long periods of time, and in some instances offer palliative relief of symptoms when cure or control is no longer possible.
Chemo effect on cellskills all dividing cells, cancer cells escape death by staying in Go phase
Class of chemo drugs classified bymolecular structure and MOA
Cell cycle phase nonspecificAlkylating agents Nitrosoureas Platinum drugs Antitumor antibiotics Corticosteroids Hormone therapy
Cell cycle phase specificAntimetabolites Mitotic inhibitors Topoisomerase inhibitors
Preparation and handling of chemo agentscan pose occupational hazard; can be absorbed through skin; inhalation during prep, transportation & administration; only properly trained personnel should handle drugs
Chemo methods/routes of administrationOral IM IV (most common) Intracavitary Intrathecal Intraarterial
Extravasation InjuryIrritants will damage the intima of the vein, causing phlebitis & sclerosis, limiting future peripheral venous access, but will not cause tissue damage if infiltrated. Vesicants, if inadvertently infiltrated into the skin, may cause severe local tissue breakdown & necrosis. It is extremely important to monitor for & promptly recognize symptoms associated w/ extravasation of a vesicant and to take immediate action if it occurs
What device can be used to minimize the associated physical discomforts, stress, risk of infection/infiltration that IV chemo has?Central venous access device (CVADS)
What else aside from chemo can be administered via CVADs?other fluids: blood, electrolytes, etc.
What is chemotherapy via regional administration?delivery of drug directly into tumor site. Can be intraarterial, intraperitoneal, intrathecal or intraventricular and intravesical in the bladder.
Advantage of regional chemo administration?higher concentrations of the drug can be delivered with less systemic toxicity.
Side effects of chemo on normal tissuechemo agents can't distinguish b/t normal & cancer cells. SE are the result of the destruction of normal cells.

Radiation Therapy

Question Answer
radiation therapyemission of energy from a source and travels through space or some material
immobilization devicepatient is positioned on a simulator, which is a diagnostic x-ray machine that recreates the actions of the linear accelerator. Simulation uses immobilization devices to help the patient maintain a stable position.
radiation therapyonly has an effect on tissues within the treatment field, it is not appropriate as the primary treatment for systemic disease.
Radiation is used to treat a carefully defined area of the bodyNot a primary treatment for systemic disease May be used by itself, or with chemotherapy or surgery To treat primary tumors For palliation of metastatic lesions
external radiation (teletherapy)Most common radiation treatment; Patient exposed to radiation from a megavolt machine
Internal radiation (brachytherapy)Implantation or insertion of radioactive materials into or close to tumor; Minimal exposure to healthy tissue; Commonly used in combination with external radiation
EBRT involves the delivery of ionizing radiation to kill cancer cells. the patient is exposed to radiation (typically high-energy photons) generated from a megavoltage treatment machine known as a linear accelerator (or linac).
Linear acceleratorPatient is positioned on radiation treatment table for treatment of head and neck cancer.
internal radiationPatient is emitting radioactivity; Limit amount of time near patients being treated. Organize care; Use shielding; Wear film badge to monitor exposure
internal radiation devices permanent implants; temporary seeds; pt is radioactive

Nursing Management

Question Answer
Cancer CAUTION signs
(pt's may report these S/S)
Change in bladder/bowel habits; A sore that won't heal; Unusual bleeding/discharge from an oriface; Thickening/lump in breast or elsewhere; Indigestion/difficulty swallowing; Obvious change in wart/mole; Nagging hoarseness/cough
Nursing implicationsimportant role in helping patients deal with the side effects of chemotherapy and radiation therapy.
Nursing management of the patient encompasses interventions to counter the effects of myelosuppression:Bone marrow suppression (thrombocytopenia); Fatigue; GI disturbances; Integumentary and mucosal reactions (stomatitis); pulmonary effects; reproductive effects
Treatment-induced reductions in RBCs and WBCs can result in:Infection, Hemorrhage, Overwhelming fatigue
Nursing interventions for immunocompromised clients experiencing excessive fatigueEncourage conservation strategies; Rest before activity; Get assistance with activity; Remain active during periods of time patients feel better; Maintain nutritional and hydration status; Assess for reversible causes of fatigue
Nursing interventions for common GI effects of chemoprophylactic administration of antiemetics; assess for alkalosis/dehydration; I/Os; antidiarrheals, antimotilities, antispasmodic meds
Diet for patients on chemo to prevent GI irritationNonirritating, low-fiber, high-calorie, high-protein diet
NI AnorexiaMonitor carefully to avoid weight loss; Weigh twice weekly; Recommend small, frequent, high-protein, high-calorie meals; Encourage nutritional supplements
Vomitting may occur how long after chemo administration, how long after radiation therapy?1 hour after chemo and a few hours after radiation therapy. Could persist for 24+ hours
Integumentary reactionsd/t radiation; acute or chronic (develops 1-24 hours after tx and is progressive as tx dose increases); prevent infection, facilitate wound healing, protect irritated skin temp extremes, avoid constricting garments, harsh chemicals & deodorants; help with hair loss issues
Erythemaacute response followed by dry desquamation; use nonirritating lotion (aloe) w/o metal, alcohol, perfume or additives
Pulmonary effects & treatmentMay be progressive and irreversible Cough, dyspnea, pneumonitis, pulmonary edema.Treatment: Bronchodilators Expectorants/cough suppressants Bed rest Oxygen
CV effects Patients with preexisting coronary artery disease are more vulnerable Radiation-induced heart disease is more likely in patients given high doses of radiation and doxorubicin Herceptin is cardiotoxic
Reproductive effectsoccurs when reproductive organs get radiated; testes are highly sensitive to radiation (use shield to protect them); radiation dose that induces ovarian failure changes with age (no way to repair ovarian function) *discuss this potential SE with pts
Late effects of chemo and radiation↑ RF secondary malignancies: multiple myeloma, non-hodgkin's lymphoma, other cancers of parts of body;
What lifestyle choice significantly increases RF secondary malignancies?smoking; secondary malignancies are usu resistant to therapy

Biologic & Targeted Therapies

Question Answer
Fourth type of cancer tx modalitybiologic & targeted therapy
Biologic therapyagents that alter biologic response to tumor cells
Targeted therapyTargets and binds cell receptors important to tumor growth
SE of targeted therapy drugsTachycardia and orthostatic hypotension are common; CNS system effects; Hepatotoxicity; Renal system side effects
SE of biologic therapiesFlulike symptoms Anorexia/weight loss Fatigue, malaise, weakness, Nausea/vomiting, Photosensitivity
Hematopoietic growth factors (biologic therapy)Glycoproteins that stimulate production, maturation, regulation, and activation of cells in hematologic system

Complications of Cancer

Question Answer
malnutritionFat and muscle depletion: Nutritional counseling When 5% weight loss is noted. Patient has potential for protein and calorie malnutrition
altered taste sensationPhysiologic basis of altered taste is unknown. Teach patient to: Avoid foods that are disliked; Experiment with spices and seasonings to mask alterations
Primary cause of deathinfection.
Usual sites of infectionlungs, GU tract, Mouth/rectum, peritoneal cavity, blood
Infection occurs due toulceration, compression of vital organs by tumor, neutropenia
Oncologic emergencieslifethreatening; occur d/t disease/tx
Types of EmergenciesObstructive; Metabolic; Infiltrative
Oncologic Emergencies commonly include what disorders?superior vena cava syndrome, spinal cord compression, syndrome of inappropriate antidiuretic hormone secretion, hypercalcemia, tumor lysis syndrome, disseminated intravascular coagulopathy, and cardiac tamponade.
Superior Vena Cava SyndromeObstruction by tumor or thrombosis. S/S facial & periorbital edema; distention of head, neck, chest; seizures, h/a (photo in slide 46 of lady who's upper chest shows engorged veins).
Spinal Cord Compressiontumor in epidural space of spinal cord. S/S intense, localized persistent back pain; motor weakness; sensory paresthesia & loss; change in bladder/bowel function
Tx spinal cord compressionsurgical laminectomy ,radiation
Third space syndromeSigns of hypovolemia including hypotension, tachycardia, low central venous pressure, and ↓ urine output
3rd space syndrome treatmentReplacement of fluids, electrolytes, and plasma protein
Metabolic ER'sSyndrome of inappropriate antidiuretic hormone (ADH) secretion; Hypercalcemia; Tumor lysis syndrome; Septic shock; Disseminated intravascular coagulation (DIC)
Tumor lysis syndromeTriggered by chemotherapy’s rapid destruction of large numbers of tumor cells. ↑ Serum phosphate causes calcium to go ↓ resulting in hypocalcemia. Can cause biochemical changes resulting in renal failure
Four hallmark signs of tumor lysis syndromeHYPER uricemia/phosphatemia/kalemia and HYPOcalcemia (usu 24-48 hrs after chemo)
Cancer painPatient report should always be believed and accepted as primary source for pain assessment data
Undertreatment of pain causesneedless suffering, decreased QOL, increased burden of family/caregivers
Single greatest barrier to effective cancer pain mgmtinadequate pain assessment
Drug Therapy for Management of cancer painNSAIDS, opioids, adjuvant pain meds. Teach patient to keep pain diary
Other adjuvant pain therapiesantidepressants/antiseizure drugs may beneficial in neuropathic pain, which is often resistant to opioids.

Section 6

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