Oncology nursing management in Cancer care Is a

Oncology nursing management in Cancer care Is a disease process that begins when an abnormal cell is transformed by the genetic mutation of the cellular DNA, is an abnormal growth of cells. There are more than 100 types of cancer, including skin ca, lung ca, colon ca, prostate ca, and lymphoma.

Diagnosis of cancer Patient with suspected cancer undergo extensive testing to: 1 - determine the present and extent of tumor. 2 - identify possible spread(metastasis)of disease or invasion of other body tissue. 3 - evaluate the function of involved and uninvolved body systems and organs. 4 - obtain tissue and cells for analysis, including evaluation of tumor stage and grade.

Terminology Cancer: a disease process whereby cells proliferate abnormally, ignoring growthregulating signals in the environment surrounding the cell. alopecia: hair loss benign: not cancerous, benign tumors may grow but are unable to spread to other area. Malignant: having cells or processes that are characteristic of cancer. Metastasis: spread of cancer cells from the primary tumor to distant sites. Biopsy: a diagnostic procedure to remove a small sample of tissue to be examined microscopically to detect malignant cells. Carcinogenesis: process of transforming normal cells into malignant cells. Chemotherapy: use of medications to kill tumor by interfering with cellular functions and reproduction. Targeted therapies: cancer treatments that seek to minimize the negative effects on health tissues by disrupting specific cancer cell function, such as malignant transformation, communication pathways, processes for growth and metastasis, and genetic coping.

The diagnostic evaluation include 1 - A review of system 2 - Physical examination 3 - Imaging studies 4 - Laboratory tests of blood 5 - Urine and other body fluids 6 - Surgical and pathology reports

Tumor staging and Grading Staging determines the size of the existence of local invasion and distant metastasis. several systems exist for classifying the anatomic extent of disease. The tumor, nodes, and metastasis(TNM) T, the extent of the primary tumor. N, the absence or presence and distant of regional lymph node metastasis. M, the absence or presence of distant metastasis. Grading refers to the classification of the tumor cells. The tumor is assigned a numeric value ranging from 1 to 4.

Diagnostic used to detect cancer: 1 - tumor marker identification. 2 - genetic profiling. 3 - mammography 4 - magnetic resonance imaging 5 - Computed tomography 6 - fluoroscopy 7 - ultrasonography 8 - endoscopy 9 - nuclear medicine imaging (table 16 -3)

Management of cancer Treatment options offered to cancer patients should be based on treatment goals for each specific type of cancer. The range of possible treatment goals may include complete eradication of malignant disease (cure). Prolonged survival and containment of cancer cell growth(control). Relief of symptoms associated with the disease(palliative).

Management of cancer 1 -Surgery Diagnostic surgery- (biopsy) Prophylactic surgery Palliative surgery Reconstructive surgery Surgery as primary treatment

Management of cancer 2 -Radiation therapy a. Internal radiation b. External radiation 3 - chemotherapy 4 - Bone marrow transplantation

Management of cancer 5 - Hyperthermia 6 - Targeted therapies: a: Biologic response modifiers B: Gene therapy C: Complementary and alternative medicine (CAM) D: Unproven and unconventional therapies � �

Nursing care of patients with cancer Nursing diagnosis: Risk for infection related to inadequate defenses related to mylosuppresion secondary to radiation of antineoplastic agents Goal: prevention of infection Nursing intervention: 1. Assess patient for evidence of infection. 2 -Report fever, chills, diaphrosis, swelling, heat, pain, erythema, exudates on any body surface. Also report changes in respiratory or mental status. Urinary frequency or burning, rash, or diarrhea. 3 -obtain culture sensitivities as indicated before initiation of antimicrobial treatment wound exudates, sputum, urine, stool, blood). 4 -initiate measures to minimize infection. 5 -assess intravenous sites every day for evidence of infection. 6 -avoid intramuscular injection. 7 -avoid insertion of urinary catheter. 8 -advice patient to avoid exposure to animal excreta.

Nursing diagnosis: Impaired skin integrity: erythematous and wet desquamation reaction to radiation therapy. Nursing interventions 1 -In erythematous areas: a: avoid the use soaps, cosmetics, performs, powders, lotions and ointments deodorants. B: use only lukewarm water to bath the area. C: avoid rubbing or scratching the area. D: avoid shaving the area with a straight- edged razor. E : avoid applying hot water bottles, heating pads, ice, and adhesive tape to the area. F: avoid exposing the area to sunlight or cold weather. G: avoid tight clothing in the area. Use cotton clothing. H: apply vitamin A and D ointment to the area. 2 - if wet desquamation occurs: A: do not disrupt any blisters that have formed. B: avoid frequent washing of the area. C: report any blistering. D: use prescribed creams or ointments. E: if area weeps, apply a nonadhesive absorbent dressing. F: if the area is with out drainage, use moisture and vapor- permeable dressings such as hydrocolloids and hydrogeis on noninfected areas. G: consult with enterostomal therapist if eschar forms.

Nursing care of patients with cancer Nursing diagnosis: Impaired skin integrity: alopecia Goal: maintenance of tissue integrity; coping with hair loss. Nursing interventions 1 - Discuss potential hair loss and regrowth with patient and family; advice that hair loss occur on body parts than the head. 2 - explore potential impact of hair loss on self-image, interpersonal relation ships. 3 - prevent trauma to scalp. 4 - encourage patient to wear own clothes and return social contacts. 5 - explain that hair growth usually begins again once therapy is completed.

Nursing diagnosis: Impaired oral mucous membrane: stomatitis. Goal: maintenance of intact oral mucous membrane. Nursing interventions A: Assess oral cavity daily B: instruct patient to report oral burning, pain, areas of redness, open lesions on the lips, pain associated with swallowing. C: encourage and assist in oral hygiene.

Nursing diagnosis: imbalanced nutrition, less than body requirements, related to nausea and vomiting. Goal: patient experiences less nausea and vomiting associated with chemotherapy; weight loss is minimized Nursing interventions 1 -assess patient previous experiences and expectations of nausea and vomiting, including causes and interventions used. 2 - adjust diet before and after drug administration according to patient preference and tolerance. 2 - prevent unpleasant sights, odors, and sounds in the environment. 4 - use distraction, music therapy, biofeedback, self-hypnosis, relaxation techniques, and guided imagery before, during, and after chemotherapy. 5 - administer prescribed antiemetics, sedation, and corticosteroids before chemotherapy and afterward as needed. 6 - ensure adequate fluid hydration before, during, and after drug administration; assess intake and output. 7 - encourage frequent oral hygiene. 8 - provide pain relief measure, if necessary. 9 - consult with dietician as needed. 10 - assess and address other contributed factors to nausea and vomiting such as other symptoms, constipation, gastrointestinal irritation, electrolyte imbalance, radiation therapy, medications, and central nervous system

Nursing care of patients with cancer Nursing diagnosis: fatigue Goal: increased activity Nursing interventions 1 - Encourage rest periods during the day, especially before and after physical exertion. 2 - at minimum, promote patient normal sleep habits. 3 - rearrange daily schedule and organize activities to conserve energy expenditure. 4 - encourage patient to ask for others assistance with necessary choers, such as housework, child care, shopping, cooking. 5 - encourage reduced job workload, if necessary and possible, by reducing number of hours worked per week. 6 - encourage adequate protein and calorie intake. 7 - encourage use of relaxation techniques, mental imaging. 8 - encourage participation in planned exercise program. 9 - administer blood products as prescribed for collaborative management. 10 - assess for fluid and electrolyte disturbances. 11 - assess for sources of discomfort. 12 - provide strategies to facilitate mobility.

Nursing care of patients with cancer Nursing diagnosis: chronic pain Goal: relief of pain and discomfort Nursing interventions 1 -Use pain scale to assess pain and discomfort characteristics: location, quality, frequency, duration, etc. 2 - assess other factors contributing to patients pain: fear, fatigue, anger, etc. 3 - administer analgesics to promote optimum pain relief within limits of physicians prescription. 4 - assess patient behavioral responses to pain and pain experience. 5 - collaborate with patient, physician, and other health care team members when changes in pain management are necessary. 6 - encourage strategies of pain relief that patient has used successfully in previous pain experience. 7 - teach patient new strategies to relieve pain and discomfort distraction, imaging, relaxation, cutaneous stimulation, etc.