Oncology
Content
ONCOLOGIC NURSING
ONCOLOGY – study of neoplasia new growth
Differentiated Encapulation Metastasis – Prognosis Therapeutic
BENIGN (Tumor) well differentiated (+) (-) good modality surgery
MALIGNANCY (Cancer) poorly or undifferentiated (-) (+) poor 1. Chemotherapy plenty S/E 2. Radiation 3. Surgery most preferred treatment 4. Bone marrow transplant - Leukemia only
PREDISPOSING FACTORS: (carcinogenesis) G – genetic factors I – immunologic factors V – viral factors a. Human papiloma virus – causing warts b. Epstein barr virus E – environmental Factors 90% a. Physical – irradiation, UV rays, nuclear explosion, chronic irritation, direct trauma b. Chemical factors – - Food additives (nitrates - Hydrocarbon vesicants, alkalies - Drugs (stillbestrol) - Uraehane - Hormones - Smoking
MALE
3.) Prostate cancer - common 40 & above (middle age & above) BPH – 50 & above 1.) Lung cancer 2.) Liver cancer
FEMALE
1. Breast cancer – 40 yrs old & up – mammography 15 – 20 mins (SBE – 7 days after mens) 2. Cervical cancer – 90% multi sexual partners 5% early pregnancy 3. Ovarian cancer
CLASSES OF CANCER
TISSUE TYPING 1. Carcinoma – arises from surface epithelium & glandular tissues Sarcoma- from connective tissue or bones 3. Multiple myeloma – from bone marrow Pathological fracture of ribs & back pain 4. Lymphoma – from lymph glands 5. Leukemia – from blood
2.
WARNING / DANGER SIGNS OF CA C – change in bowel /bladder habits A – a sore that doesn’t heal U – unusual bleeding/ Discharge T – thickening of lump – breast or elsewhere I – indigestion? Dysphagia O – obvious change in wart/ mole N – nagging cough/ hoarseness U – unexplained anemia A - anemia S – sudden wt loss L – loss of wt
THERAPEUTIC MODALITY
1. Chemotherapy – use various chemotherapeutic agents that kills cancer cells & kills normal rapidly producing cells – GIT, bone marrow, and hair follicle. CLASSIFICATION: a.) Alkylating agents – b.) Plant alkaloids – vincristine c.) Anti metabolites – nitrogen mustard d.) Hormones – DES Steroids e.) Antineoplastic antibiotics S/E & MANAGEMENT • GIT - -Nausea & vomiting Nsg Mgt: 1. Administer anti emetic 4 – 6h before start of chemo Plasil 2.Withhold food/ fluid before start of chemo 3.Provide bland diet post chemo 1.Non irritating / non spicy - Diarrhea 1. Administer anti diarrheal 4 – 6h before start of chemo 2. Monitor urine, I&O qh - Stomatitis/ mouth sores 1. Oral care – offer ice chips/ popsickles 2. Inform pt – hair loss – temporary alopecia Hair will grow back after 4 – 6 months post chemo. -Bone marrow depression – anemia 1.Enforce CBR 2.O2 inhalation 3.Reverse isolation 4.Monitor signs of bleeding Repro organ – sterility 1. Do sperm banking before start of chemo
Renal system – increase uric acid 1. Administer allopurinol/ xyloprin (gout) 2. Inhibits uric acid 3. Acute gout – colchicines 4. Increase secretion of uric acid Neurological changes – peristalsis – paralytic ileus Most feared complication ff any abdominal surgery Vincristine – plant alkaloid causes peripheral neuropathy 2. Radiation therapy – involves use of ionizing radiation that kills cancer cells & inhibit their growth & kill N rapidly producing cells. TYPES OF ENERGY EMITTED 1. Alpha rays – rarely used – doesn’t penetrate skin tissues 2. Beta rays – internal radiation – more penetration 3. Gamma ray – external radiation – penetrates deeper underlying tissues METHODS OF DELIVERY 1. External radiation- involves electro magnetic waves Ex. cobalt therapy 2. Internal radiation – injection/ implantation of radioisotopes proximal to CA site for a specific period of time. 2 types: a.) Sealed implant – radioisotope with a container & doesn’t contaminate body fluid. b.) Unsealed implant – radioisotope without a container & contaminates body fluid. Ex. Phosphorus 32
3 FACTORS AFFECTING EXPOSURE A.) Half life – time period required for half of radioisotopes to decay. - At end of half life – less exposure B.) Distance – the farther the distance – lesser exposure C. ) Time – the shorter the time, the lesser exposure D.) Shielding – rays can be shielded or blocked by using rubber gloves – α & β gamma – use thick lead on concrete. S/E & MANAGEMENT Skin errythema, redness, sloughing 1. Assist in battling pt 2. Force fluid – 2,000 – 3,000 ml/day 3. Avoid lotion or talcum powder – skin irritation 4. Apply cornstarch or olive oil GIT –nausea / vomiting 1. Administer antiemetic 4 – 6h before start of chemo - Plasil 2 Withhold food/ fluid before start of chemo 3. Provide bland diet post chemo - Non irritating / non spicy - Dysglusia – decrease taste sensitivity - When atrophy papilla (taste buds) – 40 yo - Stomatitis • Bone marrow depression 1. Enforce CBR 2. O2 inhalation 3. Reverse isolation 4. Monitor signs of bleeding
ONCOLOGY – study of neoplasia new growth
Differentiated Encapulation Metastasis – Prognosis Therapeutic
BENIGN (Tumor) well differentiated (+) (-) good modality surgery
MALIGNANCY (Cancer) poorly or undifferentiated (-) (+) poor 1. Chemotherapy plenty S/E 2. Radiation 3. Surgery most preferred treatment 4. Bone marrow transplant - Leukemia only
PREDISPOSING FACTORS: (carcinogenesis) G – genetic factors I – immunologic factors V – viral factors a. Human papiloma virus – causing warts b. Epstein barr virus E – environmental Factors 90% a. Physical – irradiation, UV rays, nuclear explosion, chronic irritation, direct trauma b. Chemical factors – - Food additives (nitrates - Hydrocarbon vesicants, alkalies - Drugs (stillbestrol) - Uraehane - Hormones - Smoking
MALE
3.) Prostate cancer - common 40 & above (middle age & above) BPH – 50 & above 1.) Lung cancer 2.) Liver cancer
FEMALE
1. Breast cancer – 40 yrs old & up – mammography 15 – 20 mins (SBE – 7 days after mens) 2. Cervical cancer – 90% multi sexual partners 5% early pregnancy 3. Ovarian cancer
CLASSES OF CANCER
TISSUE TYPING 1. Carcinoma – arises from surface epithelium & glandular tissues Sarcoma- from connective tissue or bones 3. Multiple myeloma – from bone marrow Pathological fracture of ribs & back pain 4. Lymphoma – from lymph glands 5. Leukemia – from blood
2.
WARNING / DANGER SIGNS OF CA C – change in bowel /bladder habits A – a sore that doesn’t heal U – unusual bleeding/ Discharge T – thickening of lump – breast or elsewhere I – indigestion? Dysphagia O – obvious change in wart/ mole N – nagging cough/ hoarseness U – unexplained anemia A - anemia S – sudden wt loss L – loss of wt
THERAPEUTIC MODALITY
1. Chemotherapy – use various chemotherapeutic agents that kills cancer cells & kills normal rapidly producing cells – GIT, bone marrow, and hair follicle. CLASSIFICATION: a.) Alkylating agents – b.) Plant alkaloids – vincristine c.) Anti metabolites – nitrogen mustard d.) Hormones – DES Steroids e.) Antineoplastic antibiotics S/E & MANAGEMENT • GIT - -Nausea & vomiting Nsg Mgt: 1. Administer anti emetic 4 – 6h before start of chemo Plasil 2.Withhold food/ fluid before start of chemo 3.Provide bland diet post chemo 1.Non irritating / non spicy - Diarrhea 1. Administer anti diarrheal 4 – 6h before start of chemo 2. Monitor urine, I&O qh - Stomatitis/ mouth sores 1. Oral care – offer ice chips/ popsickles 2. Inform pt – hair loss – temporary alopecia Hair will grow back after 4 – 6 months post chemo. -Bone marrow depression – anemia 1.Enforce CBR 2.O2 inhalation 3.Reverse isolation 4.Monitor signs of bleeding Repro organ – sterility 1. Do sperm banking before start of chemo
Renal system – increase uric acid 1. Administer allopurinol/ xyloprin (gout) 2. Inhibits uric acid 3. Acute gout – colchicines 4. Increase secretion of uric acid Neurological changes – peristalsis – paralytic ileus Most feared complication ff any abdominal surgery Vincristine – plant alkaloid causes peripheral neuropathy 2. Radiation therapy – involves use of ionizing radiation that kills cancer cells & inhibit their growth & kill N rapidly producing cells. TYPES OF ENERGY EMITTED 1. Alpha rays – rarely used – doesn’t penetrate skin tissues 2. Beta rays – internal radiation – more penetration 3. Gamma ray – external radiation – penetrates deeper underlying tissues METHODS OF DELIVERY 1. External radiation- involves electro magnetic waves Ex. cobalt therapy 2. Internal radiation – injection/ implantation of radioisotopes proximal to CA site for a specific period of time. 2 types: a.) Sealed implant – radioisotope with a container & doesn’t contaminate body fluid. b.) Unsealed implant – radioisotope without a container & contaminates body fluid. Ex. Phosphorus 32
3 FACTORS AFFECTING EXPOSURE A.) Half life – time period required for half of radioisotopes to decay. - At end of half life – less exposure B.) Distance – the farther the distance – lesser exposure C. ) Time – the shorter the time, the lesser exposure D.) Shielding – rays can be shielded or blocked by using rubber gloves – α & β gamma – use thick lead on concrete. S/E & MANAGEMENT Skin errythema, redness, sloughing 1. Assist in battling pt 2. Force fluid – 2,000 – 3,000 ml/day 3. Avoid lotion or talcum powder – skin irritation 4. Apply cornstarch or olive oil GIT –nausea / vomiting 1. Administer antiemetic 4 – 6h before start of chemo - Plasil 2 Withhold food/ fluid before start of chemo 3. Provide bland diet post chemo - Non irritating / non spicy - Dysglusia – decrease taste sensitivity - When atrophy papilla (taste buds) – 40 yo - Stomatitis • Bone marrow depression 1. Enforce CBR 2. O2 inhalation 3. Reverse isolation 4. Monitor signs of bleeding
