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MedSurg II-Cancer (Class Lecture)

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cdunbar4's version from 2017-04-08 01:34

Goals, Chemo Treatment

Question Answer
treatmentcure, control, palliation. Very few cancers are curable
tx depends ontype of cancer, extent of metastisis and what the pt. wants to do
palliation just meansthey're making the pt comfortable & maintaining QOL; no hope for cure/control
surgerytry to remove as much of the cancer as possible; can be used for prevention (women who get mastectomies who have BRCAG mutations)
surgery can be curative when tumor isencapsulated & they can take out all of the cancer cells
complications of surgerytumor "explodes" when they go in to try to take it out and cancer cells disseminate all over the body, or they go in and can't get all of the cancer cells they want out.
"control" part of surgeryoccurs by debulking-when tumors are impeding other body processes they will go in and reduce the size of the tumor
When would debulking used in palliative care and why?when it is causing patient pain or causing other disruptions in regular functioning; will help to improve QOL by increasing pt. comfort
Chemotherapy drugs (do not need to know specific drugs)*NTK chemo chemicals are used to kill off/stop cancer cells from replicating; the chemicals all do something different and work in a different way.
Problem with chemodoesn't know difference b/t body cells & cancer cells; destroys rapidly-replicating cells
3 types of rapidly replicating cells in bodySkin, hair, gut (skin issues, n/v, lose hair) Chemo also makes them immunocompromised; can get "chemo brain"
Lots of benefits, but also a lot of SE of chemo. What does initial tx aim at?the specific type of cancer they have. later tx is just what they think might work
Who can administer liquid chemo drugs?only trained oncology nurses; other RNs can give oral meds
Why does liquid chemo have to be given via central line? What can pt's get installed for long-term tx of chemo drugs?caustic to veins; pt's usually will get implantable ports to aid in long-term tx's.
Pharmacy has to mix themusually under a hood; usually chemo is given as a combo therapy
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Radiation Therapy

Question Answer
Radiationcan be used alone or in conjunction with chemo
Total dose of radiationDr. will decide on how much total will need to be given and then divide into fractions so pt knows how many days/weeks they will need to be getting it.
Teletherapyexternal therapy such as radiation that is localized directly to tumor
Brachiatherapyinternal therapy where they can implant/insert radioactive material. Ex: rods into vagina for cervical cancer or seeds into or next to breast/lung cancer areas. Seeds eventually become radioactive)
If someone has internal radiation, what type of precautions should be taken?PPE, change gloves frequently; they need to be shielded when you're in the room and you need to wear a dosimeter when you care for them.
Nursing management for someone who has internal radiationcluster care as much as possible; their room will be hot for weeks until radiation goes down in room; pt will have special trays/equip so not everything gets exposed to radiation
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Effects of treatments on patient

Question Answer
Main side effectsFATIGUE; bone marrow suppression (esp. with hodgkins); GI disturbances (GI cells are rapidly replicating cells); stomatitis/sores in mouth so they don't want to eat.
What kind of labs will you be looking at for pts with bone marrow suppression?↓WBCs; CBC counts; anyone who is immunosuppressed will be in reverse isolation (HUGE RF INFECTION, all of the infections out there)
Why should these people not have cats?toxoplasmosis
If you have to give immunosuppressed pt. a blood transfusion, what kind of reaction will they have?not a normal allergic reaction like other people would have, so watch their temp. go up and other s/s of anaphylaxis
Interventions for fatiguelet patient take rest; help with activities throughout the day
Nutrition is an issue from the sores in their mouths, what can you give them to help with that pain?there is a lidocaine wash for their mouth to help "deaden" their mouth to help them eat; can also give antidiarrheals & antinausea meds
What else causes these patients to be a challenge to keep nutritionally stable?they tend to complain that nothing smells or tastes right, less of an appetite; small frequent meals can be given, supplements, anything to keep them going.
Skin reactionsdue to poor wound healing; can be from shaving, other injuries
Hair losslet them know it will happen and that they will lose ALL the hair on their body; inform them that it will most likely come back, but in a different consistency
Why are skin reactions (dry or wet) decreasing in occurrences?because they are pinpointing radiation treatments now
D/C teaching about SE of treatments?when pts go home, they will still have SE from their treatments for awhile. Not uncommon for them to have anemia/fatigue for a few months.
Patients who are at higher risk for cancer?people who get donor organs, people who have one type of cancer (anyone who is immunosuppressed)
Biologics are alllab made drugs (so very expensive, insurance may not cover them); can cause significant side effects ex: Humera; pt. needs to be very well informed of SE and RF death from being on biologics
Most patients will be onsynthetic erythropoetin to help with RBC loss from bone marrow suppression
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Complications

Question Answer
Every body system can have issues*NTK post op care from. ?s will be about post op care, skin care, psychological care.
Life threatening thingssuperior vena cava syndrome (obstructed by tumor or clot) get JVD, massive edema in face can cause seizures
Spinal cord compression tumornot much treatment because they are harder to go in and get them; manis depend on where the tumor/spinal cord compression is at.
3rd spacing can causehypovolemia, low albumin
Lung cancer endocrine issuestumor can release hormones, SIADH is really common amongst pts with lung cancer
Tumor lysisrapidly active cancer lysis tumors and cell "innerds" get released in body as those things are destructive. People can actually die from this.
4 s/s of tumor lysis hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia
Septic shock, DIC, cardiac tamponadeother serious complications
Need to know signs that people go through when they are dying*See end of life page
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