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Oncology Nursing. NEO 113 JuLy 16, 2011. Oncology defined. Branch of medicine that deals with the study, detection, treatment and management of cancer . “Root words”. Neo- new Plasia- growth Plasm- substance Trophy- size +Oma- tumor Statis- location. “Root words”. A- none Ana- lack

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Oncology nursing

Oncology Nursing

NEO 113

JuLy 16, 2011


Oncology defined

Oncology defined

  • Branch of medicine that deals with the study, detection, treatment and management of cancer


Root words

“Root words”

  • Neo- new

  • Plasia- growth

  • Plasm- substance

  • Trophy- size

  • +Oma- tumor

  • Statis- location


Root words1

“Root words”

  • A- none

  • Ana- lack

  • Hyper- excessive

  • Meta- change

  • Dys- bad, deranged


Cancer nursing

CANCER NURSING

Etiology of cancer

1. PHYSICAL AGENTS

  • Radiation

  • Exposure to irritants

  • Exposure to sunlight

  • Altitude, humidity


Cancer nursing1

CANCER NURSING

Etiology of cancer

2. CHEMICAL AGENTS

  • Smoking

  • Dietary ingredients

  • Drugs


Cancer nursing2

CANCER NURSING

Etiology of cancer

  • Genetics and Family History

  • Colon Cancer

  • Breast cancer


Cancer nursing3

CANCER NURSING

Etiology of cancer

  • Dietary Habits

  • Low-Fiber

  • High-fat

  • Processed foods

  • alcohol


Cancer nursing4

CANCER NURSING

Etiology of cancer

  • Viruses and Bacteria

  • DNA viruses- HepaB, Herpes, EBV, CMV, Papilloma Virus

  • RNA Viruses- HIV, HTCLV

  • Bacterium- H. pylori


Cancer nursing5

CANCER NURSING

Etiology of cancer

  • Hormonal agents

  • DES

  • OCP especially estrogen


Cancer nursing6

CANCER NURSING

Etiology of cancer

  • Immune Disease

    • AIDS


Cancer nursing7

CANCER NURSING

Body Defenses Against TUMOR

  • 1. T cell System/ Cellular Immunity

    • Cytotoxic T cells kill tumor cells

  • 2. B cell System/ Humoral immunity

    • B cells can produce antibody

  • 3. Phagocytic cells

    • Macrophages can engulf cancer cell debris


Cancer nursing8

CANCER NURSING

Cancer Diagnosis

  • 1. BIOPSY

    • The most definitive

  • 2. CT, MRI

  • 3. Tumor Markers


Cancer nursing9

CANCER NURSING

Cancer Staging

The degree of DIFFERENTIATION

  • Stage 1- Low grade

  • Stage 4- high grade


Cancer nursing10

CANCER NURSING

GENERAL MEDICAL MANAGEMENT

  • 1. Surgery- cure, control, palliate

  • 2. Chemotherapy

  • 3. Radiation therapy

  • 4. Immunotherapy

  • 5. Bone Marrow Transplant


Cancer nursing11

CANCER NURSING

GENERAL Pharmacology

  • 1. antimetabolites

  • 2. antibiotics

  • 3. plant alkaloids

  • 4. antiemetics


Cancer nursing12

CANCER NURSING

GENERAL Promotive and Preventive Nursing Management

  • 1. Lifestyle Modification

  • 2. Nutritional management

  • 3. Screening

  • 4. Early detection


Screening

SCREENING

  • 1. Male and female- Occult Blood, CXR, and DRE

  • 2. Female- SBE, CBE, Mammography and Pap’s Smear

  • 3. Male- DRE for prostate, Testicular self-exam


Nursing assessment

Nursing Assessment

Utilize the ACS 7 Warning Signals

  • CAUTION

  • C- Change in bowel/bladder habits

  • A- A sore that does not heal

  • U- Unusual bleeding

  • T- Thickening or lump in the breast

  • I- Indigestion

  • O- Obvious change in warts

  • N- Nagging cough and hoarseness


Nursing assessment1

Nursing Assessment

  • Weight loss

  • Frequent infection

  • Skin problems

  • Pain

  • Hair Loss

  • Fatigue

  • Disturbance in body image/ depression


Nursing intervention

Nursing Intervention

  • MAINTAIN TISSUE INTEGRITY

  • Handle skin gently

  • Do NOT rub affected area

  • Lotion may be applied

  • Wash skin only with SOAP and Water


Nursing intervention1

Nursing Intervention

  • MANAGEMENT OF STOMATITIS

  • Use soft-bristled toothbrush

  • Oral rinses with saline gargles/ tap water

  • Avoid ALCOHOL-based rinses


Nursing intervention2

Nursing Intervention

  • MANAGEMENT OF ALOPECIAAlopecia begins within 2 weeks of therapy

  • Regrowth within 8 weeks of termination

  • Encourage to acquire wig before hair loss occurs

  • Encourage use of attractive scarves and hats

  • Provide information that hair loss is temporary BUT anticipate change in texture and color


Nursing intervention3

Nursing Intervention

  • PROMOTE NUTRITION

  • Serve food in ways to make it appealing

  • Consider patient’s preferences

  • Provide small frequent meals

  • Avoids giving fluids while eating

  • Oral hygiene PRIOR to mealtime

  • Vitamin supplements


Nursing intervention4

Nursing Intervention

  • RELIEVE PAIN

  • Mild pain- NSAIDSModerate pain- Weak opiods

  • Severe pain- Morphine

  • Administer analgesics round the clock with additional dose for breakthrough pain


Nursing intervention5

Nursing Intervention

  • DECREASE FATIGUE

  • Plan daily activities to allow alternating rest periods

  • Light exercise is encouraged

  • Small frequent meals


Nursing intervention6

Nursing Intervention

  • IMPROVE BODY IMAGE

  • Therapeutic communication is essential

  • Encourage independence in self-care and decision making

  • Offer cosmetic material like make-up and wigs


Nursing intervention7

Nursing Intervention

  • ASSIST IN THE GRIEVING PROCESS

  • Some cancers are curable

  • Grieving can be due to loss of health, income, sexuality, and body image

  • Answer and clarify information about cancer and treatment options

  • Identify resource people

  • Refer to support groups


Nursing intervention8

Nursing Intervention

  • MANAGE COMPLICATION: INFECTION

  • Fever is the most important sign (38.3)

  • Administer prescribed antibiotics X 2weeks

  • Maintain aseptic technique

  • Avoid exposure to crowds

  • Avoid giving fresh fruits and veggie

  • Handwashing

  • Avoid frequent invasive procedures


Nursing intervention9

Nursing Intervention

  • MANAGE COMPLICATION: Septic shock

  • Monitor VS, BP, temp

  • Administer IV antibiotics

  • Administer supplemental O2


Nursing intervention10

Nursing Intervention

  • MANAGE COMPLICATION: Bleeding

  • Thrombocytopenia (<100,000) is the most common cause

  • <20, 000 spontaneous bleeding

  • Use soft toothbrush

  • Use electric razor

  • Avoid frequent IM, IV, rectal and catheterization

  • Soft foods and stool softeners


Colon cancer

Colon cancer


Colon cancer1

COLON CANCER

  • Risk factors

  • 1. Increasing age

  • 2. Family history

  • 3. Previous colon CA or polyps

  • 4. History of IBD

  • 5. High fat, High protein, LOW fiber

  • 6. Breast Ca and Genital Ca


Colon cancer2

COLON CANCER

  • Sigmoid colon is the most common site

  • Predominantly adenocarcinoma

  • If early 90% survival

  • 34 % diagnosed early

  • 66% late diagnosis


Colon cancer3

COLON CANCER

  • PATHOPHYSIOLOGY

  • Benign neoplasm DNA alteration malignant transformation malignant neoplasm  cancer growth and invasion  metastasis (liver)


Colon cancer4

COLON CANCER

  • ASSESSMENT FINDINGS1. Change in bowel habits- Most common

  • 2. Blood in the stool

  • 3. Anemia

  • 4. Anorexia and weight loss

  • 5. Fatigue

  • 6. Rectal lesions- tenesmus, alternating D and C


Colon cancer5

Colon cancer

  • Diagnostic findings

  • 1. Fecal occult blood

  • 2. Sigmoidoscopy and colonoscopy

  • 3. BIOPSY

  • 4. CEA- carcino-embryonic antigen


Colon cancer6

Colon cancer

  • Complications of colorectal CA

  • 1. Obstruction

  • 2. Hemorrhage

  • 3. Peritonitis

  • 4. Sepsis


Colon cancer7

Colon cancer

  • MEDICAL MANAGEMENT

  • 1. Chemotherapy- 5-FU

  • 2. Radiation therapy


Colon cancer8

Colon cancer

  • SURGICAL MANAGEMENT

  • Surgery is the primary treatment

  • Based on location and tumor size

  • Resection, anastomosis, and colostomy (temporary or permanent)


Colon cancer9

Colon cancer

NURSING INTERVENTION

Pre-Operative care

  • 1. Provide HIGH protein, HIGH calorie and LOW residue diet

  • 2.Provide information about post-op care and stoma care

  • 3. Administer antibiotics 1 day prior


Colon cancer10

Colon cancer

NURSING INTERVENTION

Pre-Operative care

  • 4. Enema or colonic irrigation the evening and the morning of surgery

  • 5. NGT is inserted to prevent distention

  • 6. Monitor UO, F and E, Abdomen PE


Colon cancer11

Colon cancer

NURSING INTERVENTION

Post-Operative care

  • 1. Monitor for complications

  • Leakage from the site, prolapse of stoma, skin irritation and pulmo complication

  • 2. Assess the abdomen for return of peristalsis


Colon cancer12

Colon cancer

NURSING INTERVENTION

Post-Operative care

  • 3. Assess wound dressing for bleeding

  • 4. Assist patient in ambulation after 24H

  • 5.provide nutritional teaching

  • Limit foods that cause gas-formation and odor

  • Cabbage, beans, eggs, fish, peanuts

  • Low-fiber diet in the early stage of recovery


Colon cancer13

Colon cancer

NURSING INTERVENTION

Post-Operative care

  • 6. Instruct to splint the incision and administer pain meds before exercise

  • 7. The stoma is PINKISH to cherry red, Slightly edematous with minimal pinkish drainage

  • 8. Manage post-operative complication


Colon cancer14

Colon cancer

  • NURSING INTERVENTION: COLOSTOMY CARE

  • Colostomy begins to function 3-6 days after surgery

  • The drainage maybe soft/mushy or semi-solid depending on the site


Colon cancer15

Colon cancer

  • NURSING INTERVENTION: COLOSTOMY CARE

  • BEST time to do skin care is after shower

  • Apply tape to the sides of the pouch before shower

  • Assume a sitting or standing position in changing the pouch


Colon cancer16

Colon cancer

  • NURSING INTERVENTION: COLOSTOMY CARE

  • Instruct to GENTLY push the skin down and the pouch pulling UP

  • Wash the peri-stomal area with soap and water

  • Cover the stoma while washing the peri-stomal area


Colon cancer17

Colon cancer

  • NURSING INTERVENTION: COLOSTOMY CARE

  • Lightly pat dry the area and NEVER rub

  • Lightly dust the peri-stomal area with nystatin powder


Colon cancer18

Colon cancer

  • NURSING INTERVENTION: COLOSTOMY CARE

  • Measure the stomal opening

  • The pouch opening is about 0.3 cm larger than the stomal opening

  • Apply adhesive surface over the stoma and press for 30 seconds


Colon cancer19

Colon cancer

  • NURSING INTERVENTION: COLOSTOMY CARE

  • Empty the pouch or change the pouch when

    • 1/3 to ¼ full


Breast cancer

Breast Cancer

  • The most common cancer in FEMALES

  • Numerous etiologies implicated


Breast cancer1

Breast Cancer

RISK FACTORS

  • 1. Genetics- BRCA1 And BRCA 2

  • 2. Increasing age ( > 50yo)

  • 3. Family History of breast cancer

  • 4. Early menarche and late menopause

  • 5. Nulliparity

  • 6. Late age at pregnancy


Breast cancer2

Breast Cancer

RISK FACTORS

  • 7. Obesity

  • 8. Hormonal replacement

  • 9. Alcohol

  • 10. Exposure to radiation


Breast cancer3

Breast Cancer

PROTECTIVE FACTORS

  • 1. Exercise

  • 2. Breast feeding

  • 3. Pregnancy before 30 yo


Oncology nursing

pathophysiology


Breast cancer4

Breast Cancer

ASSESSMENT FINDINGS

  • 1. MASS- the most common location is the upper outer quadrant

  • 2. Mass is NON-tender. Fixed, hard with irregular borders

  • 3. Skin dimpling

  • 4. Nipple retraction

  • 5. Peau d’ orange


Breast cancer5

Breast Cancer

  • LABORATORY FINDINGS

  • 1. Biopsy procedures

  • 2. Mammography


Breast cancer6

Breast Cancer

  • Breast cancer Staging

  • TNM staging

  • I - < 2cm

  • II - 2 to 5 cm, (+) LN

  • III - > 5 cm, (+) LN

  • IV- metastasis


Breast cancer7

Breast Cancer

  • MEDICAL MANAGEMENT

  • 1. Chemotherapy

  • 2. Tamoxifen therapy

  • 3. Radiation therapy


Breast cancer8

Breast Cancer

  • SURGICAL MANAGEMENT1. Radical mastectomy

    2. Modified radical mastectomy

    3. Lumpectomy

    4. Quadrantectomy


Breast cancer9

Breast Cancer

NURSING INTERVENTION : PRE-OP

  • 1. Explain breast cancer and treatment options

  • 2. Reduce fear and anxiety and improve coping abilities

  • 3. Promote decision making abilities

  • 4. Provide routine pre-op care:

  • Consent, NPO, Meds, Teaching about breathing exercise


Breast cancer10

Breast Cancer

NURSING INTERVENTION : Post-OP

1. Position patient:

  • Supine

  • Affected extremity elevated to reduce edema


Breast cancer11

Breast Cancer

NURSING INTERVENTION : Post-OP

2. Relieve pain and discomfort

  • Moderate elevation of extremity

  • IM/IV injection of pain meds

  • Warm shower on 2nd day post-op


Breast cancer12

Breast Cancer

NURSING INTERVENTION : Post-OP

3. Maintain skin integrity

  • Immediate post-op: snug dressing with drainage

  • Maintain patency of drain (JP)

  • Monitor for hematoma w/in 12H and apply bandage and ice, refer to surgeon


Breast cancer13

Breast Cancer

NURSING INTERVENTION : Post-OP

3. Maintain skin integrity

  • Drainage is removed when the discharge is less than 30 ml in 24 H

  • Lotions, Creams are applied ONLY when the incision is healed in 4-6 weeks


Breast cancer14

Breast Cancer

NURSING INTERVENTION : Post-OP

Promote activity

  • Support operative site when moving

  • Hand, shoulder exercise done on 2ndday

  • Post-op mastectomy exercise 20 mins TID

  • NO BP or IV procedure on operative site


Breast cancer15

Breast Cancer

NURSING INTERVENTION : Post-OP

Promote activity

  • Heavy lifting is avoided

  • Elevate the arm at the level of the heart

  • On a pillow for 45 minutes TID to relieve transient edema


Breast cancer16

Breast Cancer

NURSING INTERVENTION : Post-OP

MANAGE COMPLICATIONS

  • Lymphedema

  • 10-20% of patients

  • Elevate arms, elbow above shoulder and hand above elbow

  • Hand exercise while elevated

  • Refer to surgeon and physical therapist


Breast cancer17

Breast Cancer

NURSING INTERVENTION : Post-OP

MANAGE COMPLICATIONS

  • Hematoma

  • Notify the surgeon

  • Apply bandage wrap (Ace wrap) and ICE pack


Breast cancer18

Breast Cancer

NURSING INTERVENTION : Post-OP

MANAGE COMPLICATIONS

Infection

  • Monitor temperature, redness, swelling and foul-odor

  • IV antibiotics

  • No procedure on affected extremity


Breast cancer19

Breast Cancer

NURSING INTERVENTION : Post-OP

TEACH FOLLOW-UP care

  • Regular check-up

  • Monthly BSE on the other breast

  • Annual mammography


Discussion of

Discussion of

  • Palliative Care

  • Oncologic Emergencies

  • Lung Cancer

  • Male & Female reproductive Cancers

  • Brain Tumors


Critical thinking

Critical Thinking

  • Scenario: A 49 y/o male has a 32 year history of cigarette smoking. He often eats out with associates and typically eats red meat and potatoes. One of his associates is a 51 y/o female whose mother dies of breast cancer. She is 40lbs over her ideal weight because she likes to snack during the day. She is also a heavy coffee drinker because she is from Seattle.


Case study 1

Case Study 1

R.T. is a 64-year-old man who comes to his primary care provider’s (PCP’s) office for a yearly examination. He initially reports having no new health problems; however, on further questioning, he admits to having developed some fatigue, abdominal bloating, and intermittent constipation. His nurse practitioner completes the examination, which includes a normal rectal exam with a stool positive for guaiac. Diagnostic studies include a CBC with differential, chem 14, and carcinoembryonic antigen (CEA). R.T. has not had a recent colonoscopy and is referred to a gastroenterologist for this procedure.

A 5-cm mass found in the sigmoid colon confirms a diagnosis of a polypof the colon. A referral

is made for surgery. The pathology report describes the tumor as stae 11, which means

that the cancer has extended into the mucous layer of the colon. A metastatic work-up is negative.

  • Identify 6 risk factors for colon cancer:

  • Discuss the recommended screening procedures related to colon cancer.

  • What warning sign did R.T. have?

  • What would early signs be for colorectal cancer?

  • What would late signs be?


Case study 11

Case Study 1

R.T. is a 64-year-old man who comes to his primary care provider’s (PCP’s) office for a yearly examination. He initially reports having no new health problems; however, on further questioning, he admits to having developed some fatigue, abdominal bloating, and intermittent constipation. His nurse practitioner completes the examination, which includes a normal rectal exam with a stool positive for guaiac. Diagnostic studies include a CBC with differential, chem 14, and carcinoembryonic antigen (CEA). R.T. has not had a recent colonoscopy and is referred to a gastroenterologist for this procedure.

A 5-cm mass found in the sigmoid colon confirms a diagnosis of a polypof the colon. A referral

is made for surgery. The pathology report describes the tumor as stae 11, which means

that the cancer has extended into the mucous layer of the colon. A metastatic work-up is negative.

  • After bowel prep, R.T. is admitted to the hospital for an exploratory laparotomy, small bowel resection and sigmoid colectomy. - What are five major complications for him?

    7.After surgery, R.T. is admitted to the surgical intensive care unit (SICU) with a large

    abdominal dressing. The nurse rolls R.T. side to side to remove the soiled surgical linen,

    and the dressing becomes saturated with a large amount of serosanguineous drainage.

    Would the drainage be expected after abdominal surgery? Explain.


Case study 2

Case Study 2

You are a home health nurse who has been seeing P.C., who was diagnosed with lung cancer approximately 1 year ago. Her provider recently informed her that her cancer is no longer treatable; the focus of her treatment will change from curative measures to symptom relief. She is confused and somewhat angry with her provider. She vaguely remembers the term palliative treatment when discussing her situation with her provider but doesn’t know what it means.

  • How would you describe palliative treatment?


Case study 21

Case Study 2

You are a home health nurse who has been seeing P.C., who was diagnosed with lung cancer approximately 1 year ago. Her provider recently informed her that her cancer is no longer treatable; the focus of her treatment will change from curative measures to symptom relief. She is confused and somewhat angry with her provider. She vaguely remembers the term palliative treatment when discussing her situation with her provider but doesn’t know what it means.

Case progress Note:

P.C. confides that she always felt that she might not survive her illness, but has never formally written

down her wishes concerning what types of treatment she would or would not want. You advise her

to complete an advance directive and/or living will or to complete a medical durable power of attorney

and/or a surrogate decision maker form. In current practice, it is very likely that a part of the home

health intake process will be completion of a Physicians Order on Life Sustaining Treatments (POLST)

Paradigm form.

2. What is the purpose of these documents?


Case study 22

Case Study 2

3. What health care decisions are considered in these documents?

4. How are advance directives and living wills formalized?

5. P.C. states she is confused and has mixed feelings about her health care wishes right now.

She asks, “If I fill out this form, can I change my mind down the road?” How should you

answer this question?

6. You inform P.C. that you will help with symptomatic control of her illness. What areas

will you focus on, and what question would you ask P.C.?

7. As P.C. becomes more frail and incoherent, what treatment will be given?


Discussion

Discussion

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