9

MANAGEMENT FOR PATIENT

WITH CANCER

1. Surgery

2. Radiation

3. Chemotherapy

- Removal of the entire cancer- It is indicated to diagnose, stage and treat

cancer- Types:1. Diagnostic Surgery2. Prophylactic Surgery3. Palliative Surgery4. Reconstructive Surgery

SURGERY

Side Effects:1. Loss or loss of function of a specific body part2. Reduced function as a result of organ loss3. Scarring or disfigurement4. Grieving about altered body image and or Imposed change of lifestyle

SURGERY

- Used to kill a tumor- Reduce the tumor size- Relieve obstruction- Decrease pain

RADIATION THERAPY

Brachytherapy

INTERNAL

Teletherapy

EXTERNAL

RADIATION THERAPY

- Sources:1. Implanted into affected tissue or body cavity2. Ingested as a solution3. Injected as a solution into the bloodstream or

body cavity4. Introduced through a catheter into the tumor

INTERNAL RADIATION

Side Effects:1. Fatigue2. Anorexia3. ImmunosuppressionNursing Dx:4. Impaired tissue integrity5. Fatigue

INTERNAL RADIATION

3. Anxiety4. Risk for infection5. Social Isolation6. Imbalanced nutrition less than body

requirements

INTERNAL RADIATION

Nursing Management:1. Protection from radiationa. Timeb. Distancec. Shield2. Place the client in private room3. Ensure proper disposal of body fluids

INTERNAL RADIATION

4. Ensure proper handling of bed linens and clothing5. In the event of a dislodged implant: Use a long

handled forceps and place the implant in a lead container

6. Do not allow pregnant women to come in contact with radiation sources

7. If working routinely near radiation sources, wear a monitoring device to measure exposure

INTERNAL RADIATION

Health Teachings:1. Maintained balanced diet2. If the implant is temporary advised the client

to maintain bed rest3. Excreted body fluids may be radioactive,

double-flush toilets after use

INTERNAL RADIATION

- The radiation oncologist marks specific locations for radiation treatment using a semi-permanent type of ink

- Side effects:1. Tissue damage to target area2. Ulcerations of oral mucosa3. GI effects4. Radiation pneumonia5. Fatigue6. Alopecia7. Immunosuppression

EXTERNAL RADIATION

Nursing Dx:1. Risk for Infection2. Impaired skin integrity3. Social Isolation4. Disturbed body Image5. Anxiety6. Fatigue

EXTERNAL RADIATION

Nursing Management:1. Monitor for side effects2. Monitor for significant decrease in WBC and

platelet3. Health Teachings:a. Washed the marked area with plain water only

and pat skin dryb. Avoid rubbing, scratching, or scrubbing the

treatment site; do not apply extreme temperature

EXTERNAL RADIATION

c. Wear soft, loose-fitting clothing over the treatment area

d. Protect skin from sun exposure during the treatment and for at least 1 year after the treatment is completed

e. Maintain proper rest, diet and fluid intake as essential to promoting health and repair of normal tissues

f. If hair loss occurs: choose a wig, hat or scarf to cover and protect head

EXTERNAL RADIATION

- Involves the administration of cytotoxic medications and chemicals to promote tumor cell death

- The most preferable route is intravenous- Indications:1. Cure2. Increase Survival Time3. Decrease life-threatening complications

CHEMOTHERAPY

1. Alkylating Agents2. Antimetabolites3. Cytotoxic antibiotics4. Hormone and hormones antagonist5. Plant alkaloids6. Miscellaneous agents7. Topoisomerase inhibitors8. Immunomodulator agents: Biological response

modifiers

Antineoplastic Medications

1. Immunosuppression- Risk for infection- Avoid crowds, people with infection, and

small children- Use meticulous personal hygiene- Wash hands before and after eating, after

toileting and after contact with other people and pets

SIDE EFFECTS

- Consumed a low bacteria diet- Be aware of signs and symptoms of infection

and report them immediately to primary care provider

(Early Indication of Infection:)1. Fever2. Tachycardia3. Tachypnea

2. Trombocytopenia- Monitor stools and urine for bleeding- For shaving use electric razor only- Avoid contact sports and other activities that

may cause trauma- Avoid dental work or other invasive

procedures- Avoid aspirin and aspirin containing products- Safety precautions for oral hygiene- Avoid intramuscular injections and limit

venipunctures

4. Xerostomia- Apply lubricating and moisturizing agents to

protect the mucous membranes from trauma and infection

- May consider to use artifical saliva, and hard candy and mints to help with dryness

3. Stomatitis and mucositis- Use soft toothbrush and mouth swabs may be

needed during acute episode- Avoid mouthwashes that contain alcohol- Assess daily for lesions, infection, bleeding or

irritation- Avoid smoking and alcohol - Drink cool liquids and avoid hot, irritating

foods

5. Inadequate nutrition and fluid and electrolyte imbalance

- Small frequent feedings- Avoid spicy and fatty foods - Avoid extremely hot foods- Perform oral hygiene before and after meals- Maintain fluid intake as prescribed- Take nutritional supplements as prescribed- Maintain a daily journal of food and fluid

intake

- Administer anti-emetics prior to chemotherapy

- Weigh the client routinely- Monitor lab values indicative of nutritional

status

6. Fatigue- Assure client that fatigue is a normal response

to chemotherapy- Encourage client to continue daily activities as

much as possible, allowing for rest periodsin between

- Assist client in self-care needs when indicated- Allow for rest periods of rest; cluster activities

7. Alopecia- Encourage client to choose a wig before hair

loss occurs- Care of hair and scalps:1. Wash hair 2-3 times a week with a mild

shampoo2. Pat hair dry3. Do not use blow dryer- Allow client to express feelings concerning

altered body image

1. IMMUNOTHERAPY/BIOLOGIC RESPONSE MODIFIERS (BRM)

- Enhances the person’s immune responses in order to modify the biologic processes in malignant cells

- Ex. Monoclonal antibodies Cytokines ( Interleukin-2, Interferons,

Hematopoetic growth factors) Natural Killer cells (NK cells)

THE CLIENT UNDERGOING OTHER THERAPEUTIC INTERVENTIONS

2. Gene Therapy- Used to render tumor cells susceptible to

damage by other treatments and make the client’s immune system better and able to recognize cancer cells as non-self

THE CLIENT UNDERGOING OTHER THERAPEUTIC INTERVENTIONS

3. Photodynamic Therapy- Used to treat specific tumors such as those of

the surface of bladder, bronchus, chest wall, head, neck and peritoneal cavity

- Photofrin is administered IV- 3 days after, the drug is activated by a laser

treatment- It produces a cytotoxic oxygen molecule

THE CLIENT UNDERGOING OTHER THERAPEUTIC INTERVENTIONS

- Procedures that replace stem cells that have been destroyed by high dose of chemotherapy and/or radiation therapy

- Indication:1. Leukemia2. Lymphoma3. Neuroblastoma4. Multiple Myeloma

BONE MARROW TRANSPLANT and PERIPHERAL BLOOD STEM CELL

TYPES OF DONOR STEM CELLS

TYPES OF DONOR STEM CELLS

2. Syngeneic

TYPES OF DONOR STEM CELLS

3.

TYPES OF DONOR STEM CELLS

PROCEDURE

1. Harvest2. Conditioning- refers to immunosuppression

therapy regimen used to eradicate all malignant cells

3. Transplantation4. Engraftment

POST-TRANSPLANTATION PERIOD

1. The Client remains without any natural immunity until the donor stem cells to proliferate and engraftment

2. Infection, bleeding or neutropenia and thrombocytopenia are major concerns until engraftment occurs

COMPLICATIONS

1. Failure to engraft2. Graft-vs-host disease (allogeneic transplants)3. Veno-occlusive disease