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CELLULAR ABERRATION
CANCER
Came from the Latin word CANCRI which
means crab.
It is a disease characterized by stretching out in
many directions like the legs of the crab.
A large group of disease characterized byuncontrolled growth and spread of abnormal
cells.
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Who can get cancer?
75% occur after the age 50
6% occurs in pediatric age group of 0-14 years
In the Philippines, about 80, 000 per year or 1out of every 5 Filipinos who live to age 74 willget cancer
In US, cancer causes more than 550, 000deaths annually. ACS estimates that roughly 83million Americans now living will eventuallyhave some form of cancer.
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Who can get cancer?
Worldwide, about 103 people die of cancereveryday or about 4 in every hour
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Etiologic/Risk Factors
A. INTERNAL RISK FACTORS
AGE
Age of exposure to carcinogens may
increase the cancer risk. Fetuses, infants andchildren are at greater risk because they are still
developing. Blistering sunburns in children
under age 12 may predispose them to skincancer
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Risk Factors
GENDER
Overall, women have a lower cancer incidence
than men and higher survival rate.
In females, breast, colon, lung, and uterine
cancers are the most common.
In males, prostate, lung, GIT and bladdercancers
predominate.
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Risk Factors
RACE
Cancer incidence and mortality are higherin blacks due to economic, social and
environmental factors that may delay prompt
detection and increase exposure to industrial
carcinogens.
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Risk Factors
GENETIC FACTOR
Certain cancers tend to run in families. Forexample, women who have first degree
relatives (mother, sister) with breast cancer are
at greater risk than the general population.
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Risk Factors
IMMUNOLOGIC FACTORS
According to the Immune SurveillanceTheory, antigenic differences between normal
and cancerous cells may help the body
eliminate malignant cells. Thus,
immunosuppression may increase susceptibility
to cancer.
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Risk Factors
PSYCHOLOGICAL FACTORS
Emotional stress may increase a person'scancer risk by leading to poor health habits
(smoking, alcohol drinking), by depressing the
immune system, or by leading him to ignoreearly warning signs.
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Risk Factors
B. EXTERNAL RISK FACTORS
CHEMICAL CARCINOGENS
Chemical exposure like in nickel refiningand
asbestos industry may increase the risk ofan
individual to get cancer.
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Risk Factors
Chemical carcinogens typically causecancer in
two step process:
INITIATION involves exposure to thecarcinogen.
This irreversible step converts normal cells to
latent tumor cells.
In PROMOTION, repeated exposure to the same
or some other substance stimulates the latent cells
to become active neoplastic cells.
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Risk Factors
RADIATIONIonizing radiation of all kinds (from X-rays to
nuclear radiation) are carcinogenic, although
their potencies vary.Fair-skinned people have higher risk for skin
cancer from UV radiation. Skin cancer
develops on exposed extremities, and itsincidence correlates with the amount of
exposure.
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Risk Factors
VIRUSESSome human viruses have carcinogenic
potential.
EPSTEIN-BARR VIRUS has been linkedto lymphoma and nasopharyngeal carcinoma
DEOXYRIBONUCLEIC ACID VIRUS
(Herpes simplex virus type 2) have beenassociated with uterine and cervical cancer .
RIBONUCLEIC ACID VIRUS are linked to
breast cancer in mice.
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Risk FactorsDIET
Certain foods may supply carcinogens (or
precarcinogens), affect carcinogen
formation, or modify carcinogen's effect.
Diet has been implicated in colon cancer,
which may result from low fiber intake and
excessive fat consumption.
Liver tumors are linked to food additives
such as nitrates and alfatoxin ( fungus that
grows on stored grains, nuts and other food
stuff)
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Risk Factors
TOBACCO USE
Lung cancer is the leading cause of cancer
deaths in both men and women. Cigarettesmoking accounts for about 30% of all cancers
and is implicated in cancers of the mouth,
pharynx, larynx, esophagus, pancreas, cervixand bladder. Pipe smoking and chewing
tobacco are linked to oral cancer
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Risk Factors
ALCOHOL USE
Heavy beer consumption may increase the
risk of colorectal cancer through an unknown
mechanism.
CHEMOTHERAPEUTIC DRUGS
Some chemotherapeutic drugs may bedirectly carcinogenic or may enhance
neoplastic development by suppressing the
immune system.
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Risk Factors
HORMONES
By altering the body's normal endocrine
balance, hormones may contribute to neoplastic
development-especially in endocrine sensitive
organs such as breast or prostate.
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Theories of Pathogenesis of
Cancer
CELLULAR TRANSFORMATION AND
DERAGEMENT THEORY Conceptualizes that healthy cells may
transform into cancer cells by unknown
mechanisms whenever exposed to certainetiologic agents.
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FAILURE OF THE IMMUNE RESPONSE
THEORY
Advocates that all individuals possess cancer cells
however these cancer cells are being recognize by
the immune response system and they are beingdestroyed. FAILURE of the immune response
system will lead to inability to destroy cancer
cells.
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Diagnostic Aids Used to Detect
Cancer
TEST
Tumor Marker IdentificationDESCRIPTION
Analysis of blood and body fluids
ORGANSBreast, colon, lungs, ovaries, prostate
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diagnostics
TEST
Magnetic Resonance Imaging
DESCRIPTIONUse of magnetic fields and radio frequency
signals to create sectioned images of various
body structuresORGANS/AREA
Pelvic, thoracic, abdomen
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diagnostics
TEST
Computed Tomography (CT Scan)
DESCRIPTION
Use of narrow beam X-ray to scan layers of
tissues for a cross sectional view
ORGANS/AREA
Neurologic, pelvic, skeletal, abdominal,
thoracic
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diagnostics
TEST
Ultrasonography
DESCRIPTIONUse of high frequency sound waves echoing of
body tissues, converted electronically into
images used to assess tissues within the bodyORGANS/AREA
Abdominal, pelvic
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diagnostics
TEST
Endoscopy
DESCRIPTIONDirect visualization of body cavity to passage
way
To aspirate or excise small tumorAREA/ORGAN
Bronchi, GIT
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diagnostics
TEST
Sigmoidoscopy/ ColonoscopyDESCRIPTION
Direct visualization of the intestinal tract
ORGAN/AREAColorectal, sigmoid
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9 warning signals of cancer
C-hange in bowel or bladder habitsA- sore that does not heal
U- nusual bleeding or di9scharge
T- hickening of lumps in breast or elsewhere
I- ndigestion or difficulty in swallowing
O- bvious change in wart or mole
N- agging cough or hoarseness of voice
A- nemia
L- oss of weight
l ifi i f
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Classification of Tumors
CARCINOMAS: EPITHELIAL TISSUEBODY SURFACES, LINING OF BODY CAVITIES
ETC:(ADENOCARCINOMA)
SARCOMAS: CONNECTIVE TISSUE
STRIATED MUSCLE, BONE, ETC (OSTEOSARCOMA)
LYMPHOMAS AND LEUKEMIAS
HEMATOPOIETIC SYSTEM
NERVOUS TISSUE TUMORS
EX. NERVE CELLS-NEUROBLASTOMA MYELOMA
Develops in the plasma cells of bone marrow
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Naming Cancers
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Effects of cancer
1. Malfunction of the organ due to the
destruction of blood vessels
2. Pressure effectTumor can cause pressure which can cause
damage to adjacent structure
3. CachexiaCharacterized by weakness, body malaise,
anemia and weight loss.
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Effects of cancer
4. ObstructionDue to tumor growth, hallow organs are
being compressed and obstructed.
5. Hemorrhage or bleedingTumor growth causes rupture of blood
vessels
6. Effusion
When lymphatic flow is obstructed, it can
cause filling up of fluids on cavities
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Effects of cancer
7. Ulceration and Necrosis
Tumor erodes blood vessels and pressure on
tissue causes ischemia
8. Vascular thrombosis, embolism, thrombophlebitis
9. Pain -a late sign of cancer
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Prevention of cancer
SKIN
Avoid over exposure to sunlight
ORALAnnual oral exam of mouth and teeth
BREAST
Monthly breast self examination from age 20 upLUNGS
Avoid cigarette smoking, DO annual CXR
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Prevention of cancer
COLON
Digital rectal examination for persons over 40
years old, rectal biopsy, proctoscopic exam, guiac
stool exam for person 50 years old and above
UTERUS
Annual Pap smear for female age aged 40
*Annual PE, blood and urine exam
*Choosing the right behavior and preventing
exposure to certain environmental risk factors
DIETARY
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DIETARY
RECOMMENDATION
1. Cut down total fat intake. Eat more high fiber
foods.
2. Be moderate in the consumption of alcoholicbeverages.
3. Be moderate in the consumption of salt-
cured, smoked cured and nitrate-cured foods.4. Include foods rich in Vitamin C and A in
daily diet
DIETARY
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DIETARY
RECOMMENDATION
5. Include anti-oxidant foods in daily diet
Example:
Beta Carotene- found in carrots and orange
Lutein- best known for its association to
healthy eyes found in green leafy vegetables.
Lycopene- a potent anti-oxidant found in
tomatoes, water melon, guava and papaya
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Therapeutic Modalities
of Cancer
A. SURGICAL
INTERVENTIONS
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SURGICAL PROCEDURES
FOR BREAST CANCERPATIENT
C O
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LUMPECTOMY Lumpectomy is the removal
of the breast tumor (the"lump") and some of thenormal tissue that surroundsit. Lumpectomy is a form ofbreast-conserving or "breast
preservation" surgery. Thereare several names used forbreast-conserving surgery:biopsy, lumpectomy, partial
mastectomy, re-excision,quadrantectomy, or wedgeresection. Technically, alumpectomy is a partialmastectomy.
SIMPLE OR TOTAL
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SIMPLE OR TOTAL
MASTECTOMY
Simple or totalmastectomyconcentrates on thebreast tissue itself:
The surgeon removesthe entire breast.
No muscles areremoved from
beneath the breast
MODIFIED RADICAL
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MODIFIED RADICAL
MASTECTOMY Modified radical mastectomy
involves the removal of bothbreast tissue and lymph nodes:
The surgeon removes the entire
breast.
Axillary lymph node dissectionis performed, during whichlevels I and II of underarm
lymph nodes are removed (B andC in illustration).
No muscles are removed frombeneath the breast.
RADICAL MASTECTOMY
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RADICAL MASTECTOMY
Radical mastectomy is the mostextensive type of mastectomy:
The surgeon removes the entirebreast.
Levels I, II, and III of theunderarm lymph nodes areremoved (B, C, and D inillustration).
The surgeon also removes thechest wall muscles under thebreast.
PARTIAL MASTECTOMY
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PARTIAL MASTECTOMY
Partial mastectomy is theremoval of the cancerous
part of the breast tissue and
some normal tissue around
it. While lumpectomy istechnically a form of partial
mastectomy, more tissue is
removed in partial
mastectomy than inlumpectomy.
SUBCUTANEOUS (NIPPLE
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(
SPARING) MASTECTOMY
During subcutaneous ("nipple-sparing") mastectomy, all of thebreast tissue is removed, but thenipple is left alone. Subcutaneous
mastectomy is performed lessoften than simple or totalmastectomy because more breasttissue is left behind afterwardsthat could later develop cancer.
B t
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Breast ca
PREOPERATIVE CAREPsychological support- involve the husband as
necessary
Teach arm exercise to prevent lymph edema
Inform about wound suction drainage
e.g. Hemovac, Jackson Pratt
Deep breathing exercise to prevent post
operative
respiratory complications.
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DOS AND DONTS AFTER
THE SURGERY
Dos
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Before exercising actively, be certain that post-surgery
swelling subsides and that surgical wounds are healing.
Try to start moving as soon as possible after surgery.
Keep arm elevated after surgery to prevent swelling.Use two pillows to support arm when lying down orsitting.
Stretch both sides of upper body a few times per day. 3-5 slow repetitions of each stretch.
Know the difference between discomfort and unusualpain. If pain or fatigue persists, stop and rest.
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After surgery, try to walk around (indoors) for a few
minutes 2 - 3 times daily to regain stamina.
Avoid lifting anything over 2-3 pounds, particularlywith the involved arm.
Enlist anyone you can to accompany you and encourageyou to walk frequently.
Use discretion and follow your intuition. When in doubt,check in with your physician, nurse, or physical
therapist.
Above all, strive for a little improvement every day.Persevere!
Continue an exercise upon unusual
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Continue an exercise upon unusualdiscomfort or persistent pain.
Continue an exercise upon unusualfatigue. Rest for a moment, breathe,relax, and then continue slowly and
carefully. If fatigue persists, stopexercising.
Hesitate to call your physicianimmediately when experiencing unusualor persistent pain or swelling.
Don'ts
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Let mastectomy arm hang down, especially when
holding or carrying objects.
Move arm quickly, or with jerking, pulling motions.Learn to move slowly and smoothly, especially whenchanging positions, lifting bags, opening doors, etc.
Carry anything over two pounds after surgery until youreceive approval from your physician. Limit carryinganything over 5 pounds indefinitely with involved armto prevent swelling.
Wear shoulder bags on involved arm. The pressure ofthe strap on the shoulder can cause lymphedema. Avoiduse of shoulder bags indefinitely.
Breast ca
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Breast ca
POST OPERATIVE CARE
Move arm quickly, or with jerking, pullingmotions. Monitor hemovac output
(serosanguinous for the first 24 hours)
Check behind of the patient for bleeding.Blood flows to back by gravity.
Breast ca
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Breast ca
Post signs warning against taking BP, starting
IV line or drawing blood on affected side.
Initiate exercise to prevent stiffness andcontracture of the shoulder girdle
Reinforce special mastectomy exercise as
prescribedProvide adequate analgesia to promote
ambulation and exercise.
Breast ca
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Breast ca
Encourage regular coughing and deep
breathing exercises
Prepare client for size and appearance of the
incision and provide support when incision is
viewed for the first time
Provide client with detailed informationconcerning breast prosthesis. Fitting is not
possible for 4-6 weeks
Breast ca
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Breast ca
A temporary prosthesis or lightly padded bras
worn until healing is completed.
Teach patient to avoid constrictive clothing andreport persistent edema, redness or infection of
incision.
Teach patient the importance of continuingmonthly BSE on the remaining breast
Prevention of lymph edema
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Prevention of lymph edema
AVOID
cuts, scratches, pinpricks, hangnails, insect
bites, burns and strong detergent
DONT'S (On the affected arm)
carry purse or anything heavy, wear wrist watch
or jewelry, pick and cut cuticles, work near
thorny plants, dig garden, reach into hot oven,hold a cigarette, injections, BP taking and
withdrawal of bllood.
Prevention of lymph edema
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Prevention of lymph edema
DO'S
wear loose rubber gloves when washing dishes,
wear a thimble when sewing, apply lanolin
hand cream to prevent dryness, contact
physician if arms get red, warm or swollen,
return for check up, wear tag CAUTION-LYMPHEDEMA
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POST-OP
EXERCISES
BALL SQUEEZE
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BALL SQUEEZE
Stand or sit comfortably.
Hold a soft rubber ball in thehand on your operated side.
With your elbow slightly bentand your palm toward theceiling, lift your hand higherthan your heart.
Squeeze and relax your hand tentimes, twice a day.
Gradually increase the numberof times you do the exercise eachday.
FRONT ARM RAISE
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FRONT ARM RAISE
Stand or sit comfortably.
Relax your arms and allow them tohang at your sides.
Keeping your palms down, slowlyraise your arms in front of you,taking two counts to reach shoulderlevel.
Slowly lower your arms back downto your sides in two counts.
Repeat this exercise 8 to 10 times,three times a day.
HAND CLAP
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HAND CLAP Stand or sit comfortably.
Relax your arms and allow them to hang atyour sides.
Slowly raise your arms out to the sides, until
they are at shoulder level.
Continue to raise both arms, trying to clapyour hands overhead.
Slowly lower your arms, taking 4 counts toreturn your arms to your sides.
Repeat this exercise 8 to 10 times, three timesa day.
WALL WALKING
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W W NG
Stand with one side of your body facing awall and your feet about 6 inches awayfrom it.
Starting with your hand at eye level,walk your finger up the wall as high asyou can. Hold the stretch for 10 secondsand then walk your fingers back down.
Repeat the exercise with your other arm.
Repeat this exercise 8 to 10 times, twice aday.
SHOULDER SQUEEZE
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Q Standing, bend your elbows and
bring your arms up in front of youto shoulder level.
With one arm stacked on top of theother, align your fingertips with
your elbows.
Next, push your elbows back,squeezing your shoulders together.
Hold for 12 seconds.
Repeat this exercise 8 to 10 times,twice a day.
ARM STRETCH
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Standing, grasp a pole or rod in front of you
with both hands. Try a golf club orbroomstick.
Place the hand on your operated side overthe end.
Gently, use the strength of your good arm topush the end of the stick as high as youcomfortably can.
Hold for 12 seconds.
Repeat this exercise 6 to 8 times, twice a day.
Slowly raise your arms out to the sides, untilthey are at shoulder level.
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LUNG CANCER
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Pneumonectomy
total lung removal.
It can be done in one of two ways:
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y
Traditional Pneumonectomy Only the diseased lung is removed.
Extrapleural Pneumonectomy
The diseased lung is removed, together with a
portion of the membrane covering the
heart(Pericardium), part of the diaphragm, and the
membrane lining the chest cavity (Parietal pleura)
on the same side of the chest.
b
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Lobectomy
surgical removal
of one of the fivelobes of the lung.
Wedge Resection
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Wedge ResectionA surgical procedure during whichthe surgeon removes a small,
wedge-shaped portion of the lung
containing the cancerous cells alongwith healthy tissue that surrounds
the area. The surgery is performed
to remove a small tumor or to
diagnose
Lung Cancer.
S t l R ti
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Segmental Resection
Removes a larger portion
of the lung lobe than a
wedge resection, but does
not remove the whole lobe.
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Shower daily and wash incision and
drain sites.
Let the water stream run over the incision
and drain sites.Leave the incisions uncovered of the chest tubes and
the drain sites may drain for several days, and
therefore may need a Band-Aid.Wear comfortable clean clothing
preferably cotton clothing
Ambulate early. Stop when you are
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bu ate ea y Stop e you a e
short of breath, rest, and thencontinue. Fatigue and tiredness are
expected. It is entirely normal that you
may have to take a nap in the morningor in the afternoon. Avoid spending
prolonged periods of time lying down
during the daytime hours.
Don'ts:
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If you were a smoker, do not restart. If
your environment-your apartment or
house-still contains curtains, linens, and
furniture full of smoke and tobacco odorthat can give you the urge to smoke
again, please have them cleaned.
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Do not lift anything heavier than 10 pounds
for about 4-6 weeks. Remember that your
recovery overall takes about 10-12 weeks.
Do not drive until your surgeon says that
you can. Generally, at about 3 weeks you will
be allowed to drive locally.
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Management for client with cervical cancer
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SURGERY:EXCISIONAL BIOPSY for preinvassive lesions
CRYOSURGERY technique of exposing tissues to
extreme cold in order to produce well demarcatedareas of cell injury and destruction
LASER destruction of the tumor
CONIZATION is removal of the cone shape sectionof the cervix
HYSTERECTOMY for invasive squamous cancer.
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Also called a cone biopsy
A procedure that is used toremove a cone-shaped piece of
tissue from the cervix andcervical canal
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A surgical procedure that is used toremove the uterus, including the
cervix
There are three different
procedures that may be used toperform a total hysterectomy
VAGINAL HYSTERECTOMY
In which the uterus and cervix are
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- In which the uterus and cervix are
taken out through the vagina
TOTAL ABDOMINAL
HYSTERECTOMY
- In which the uterus and cervix
are taken out through a large
incision (cut) in the abdomen
TOTAL LAPAROSCOPIC
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TOTAL LAPAROSCOPIC
HYSTERECTOMY
- In which the uterus and cervix are
taken out through a small incisionin the abdomen using a
laparoscope
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A BSO is a surgical procedure thatis used to remove the ovaries and
the fallopian tubes
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Is a surgical procedure that is usedto remove the uterus, cervix and
part of the vagina
Ovaries, fallopian tubes, or nearby
lymph nodes may also be removed
Surgeons will need to make artificial
i ( t ) f th i d
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openings (stomas) for the urine and
the stool
women may need plastic surgery tomake an artificial vagina after they
have had a pelvic exenteration
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Is a treatment that uses elecrical
current (passed through a thin wireloop) as a knife to remove abnormal
tissue or cancer
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Cervical ca
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PREOPERATIVE PREPARATION:
Advise client to be admitted in the hospital 1
day prior to operation
Take time to talk to the client on what she
expects from the surgery and about her
menstrual and reproductive status after surgery
Review what the surgical approach involves
and the extent of the excision
Cervical ca
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If the client is having an abdominalhysterectomy, tell her that she will need to:
Douche and have an enema the evening before
the surgeryTake a shower with an antibacterial soap shortly
before the surgery
Shave her pubic area*Have an indwelling urinary catheter inserted
because surgery causes urine retention
Cervical ca preop prep
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*Have an NGT or rectal tube inserted if shedevelops abdominal distention
Expect temporary abdominal cramping , pelvis
and lower back pain after the procedure
If the client is scheduled for vaginal
hysterectomy, tell her to expect abdominal
cramping afterwards. She will also have a perinealpad in place because moderate amounts of
drainage occurs post operatively.
Cervical ca preop prep
f h li h f h d
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Inform the client that after surgery, she needs
to lie in a supine position or in low Fowler's
position
Demonstrate the exercises that she will need to
perform to prevent venous stasis
POST OPERATIVE CARE
For- vaginal hysterectomy, change her perineal
pad frequently. Provide analgesics to relieve
cramps.
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Change perineal pads frequentlybecause moderate amounts of drainage
occurs post-operatively
Provide analgesics to relief cramps
Monitor urinary output because urinary
retention commonly occurs
Encourage patient to perform the prescribed
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cou age pat e t to pe o t e p esc bed
exercises and to ambulate early andfrequently to prevent venous stasis
Venous stasis
retardation of the venous outflow
in a part
Cervical ca post op care
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If she has had an abdominal hysterectomy, tellher to remain in a supine position or a low
Fowler's position. Encourage her to perform the
prescribed exercises and to ambulate early andfrequently to prevent venous stasis. Monitor
UO because retention commonly occurs.
If abdominal distention develops, relieve it byinserting NGT or rectal tube as ordered. Note
bowel sounds during routine assessment.
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Avoid heavy lifting to avoid pressure onincision site
Avoid rapid walking, dancing
Advice to eat high protein, high residuediet to avoid constipation
Give 2.8 Liters/day
May resume sexual activity 6 weeksafter surgery
Explain that abrupt hormonal
fluctuations may cause the client to feel
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depressed or irritable for a while Encourage family members to respond
calmly and with understanding
If the ovaries were removed, client mayreceive hormone replacement therapy
Cervical ca
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HOME CARE:
If the client had vaginal hysterectomy, instruct
to report severe cramping, heavy bleeding or
hot flushes (common for Oophorectomy) to her
doctor immediately.
Encourage client to walk a little more each day
and avoid sitting for prolonged period.
Swimming is permissible.
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Surgical removal of
the uterus is
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the uterus is
recommended for all
stages of uterine
cancer unless thecancer is widespread.
In the early stages, itmay be curative.
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A cut is made in the lower abdomen to
expose the tissues and blood vessels that
surround the uterus and cervix
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surround the uterus and cervix
These tissues are cut and the blood
vessels are tied off to remove the uterus
Stitches are placed in these deepstructures, which will eventually
dissolve
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The first night after the surgery, youmay be asked to sit up in bed and walka short distance
If there is no evidence ofcomplications and you are able todrink fluids on your own, the catheter
in your bladder and IV will beremoved
Eat balanced diet rich in fresh fruits
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and vegetables. Dependig on how much blood loss
occurred during surgery, you may
require a daily iron supplement
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Advise to eat high-fiber foods,
drinking plenty of water, and if
necessary, use stool softeners Shower instead of taking a bath for
at least the first two weeks after
surgery
Keep your incision sites clean and
dry to avoid infection
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Do not douche or put anything inyour vagina, such as tampon, until
your doctor tells you otherwise.
Speak to your doctor about when
you may resume having sexual
intercourse
Take daily walks as tolerated
Avoid heavy lifting for four to six
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Avoid heavy lifting for four to six
weeks
Ask your practitioner whether any
type of physical therapy ornutritional counseling may be
helpful to speed your recovery
Management of client with lungcancer
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PREOPERATIVE PREPARATION:
Explain the anticipated surgery to the client
and inform him that he will receive a general
anesthetic.
Lung ca pre-op prep
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Inform the client that post operatively, he may
have chest tubes in place and may receive
oxygen.
Teach him deep breathing techniques and
explain that he will perform these after surgery
to facilitate lung reexpansion. Also teach him to
use an incentive spirometer; record the volumeshe achieves to provide a baseline.
Lung ca
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POST OPERATIVE CARE:After pneumonectomy, the client should lie only
on the operative side or on his back until stabilized.
This prevents fluids from draining into theunaffected lung if the sutured bronchus opens.
Make sure that the chest tube is functioning, if
present, and observe for signs of tensionpneumothorax.
Provide analgesics as ordered
Lung ca post op care
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Have the client begin coughing and deep breathing
exercises as soon as his condition is stable.
Auscultate his lungs, place him in semi Fowler's
position, and have him splint his incision tofacilitate coughing and deep breathing.
Perform passive range of motion exercises the
evening of surgery and 2-3 times daily thereafter.Progress to active range of motion exercises.
Lung ca home care
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Tell the client to continue his coughing and deepbreathing exercises to prevent complications. Advise
him to report changes in sputum characteristics to
his doctor.Instruct the client to continue performing range of
motion exercises to maintain mobility of his
shoulder and chest wall.
Tell the client to avoid contact with people who
have an URTI and to refrain from smoking
Lung ca home care
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Provide instructions for wound care and
dressing changes as necessary.
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Shower daily and wash incision anddrain sites.
Let the water stream run over the
incision and drain sites.
Leave the incisions for the chest tubes and
drain sites uncovered. The sites may
drain for several days, and therefore
may need a Band-Aid.
Post-OP Care
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Wear comfortable clean clothing preferably
cotton clothing
Ambulate early. Stop when you are short ofbreath, rest, and then continue. You may not
see a daily increase, but over a week's time you
should see an increase in the distance that you
are able to walk
Post-OP Care
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Fatigue and tiredness are expected. It is
entirely normal that you may have to
take a nap in the morning or in the
afternoon.
Avoid spending prolonged periods of
time lying down during the daytime
hours.
Eat nutritious foods.
Post-OP Care
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Dos:
We suggest that you weigh yourself
twice a week and that you keep a
record of your weight.
Post-OP Care
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Do take your pain medications as needed. In the
beginning, you should take your medications on a
regular basis as they were prescribed. Often, you
receive two types of pain medication, one of which
should be taken constantly to produce a steadylevel of analgesia -pain relief-. The other
medication is given for "breakthrough" pain or the
peaks, which you take as needed depending on
your daily activities.
Management of client withprostate cancer
SURGERY;
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SUPRAPUBIC PROSTATECTOMY
A surgical approach that involves a lower
abdominal incision. Operation of choice when
the prostate is too large to be resectedtransurethally.
TRANSURETHRAL PROSTATECTOMY
Excision of part of the prostate glandthrough the urethra.
PERINEAL PROSTATECTOMY
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Excision of part or all the prostate gland
with an incision in the perineum.
PREOPERATIVE CARE:
Assess the client's ability to empty his bladder.
Clients taking any drug or supplement withanti coagulant effects must discontinue before
surgery
Prostate ca preop care
Respond to the concerns of the client and
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significant others with emphatic listening,accurate information and on going support.
POST OPERATIVE CARE:
Observe the vital signs and maintenance of
urinary drainage
Document the urine color, including the
presence of blood clots, each time urine out put
is recorded
Prostate ca post op care
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Ensure catheter patency frequently to make
sure the catheter is draining, blockage of an
irrigated bladder rapidly leads to overdistention, secondary hemorrhage and
formation of blood clots or infections.
Management of client withthyroid cancer
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THYROIDECTOMYSurgical removal of the thyroid gland
PREOPERATIVE CARE:
Administration of anti-thyroid drugs
Preparation is about 2-3 months
Provide adequate rest
Achieve and maintain optimal weight
Maintain good health status
Thyroid ca
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POST OPERATIVE CARE:
Take vital signs every 15 minutes until stable,
every 1 hour for the next 24 hours
Place client in sitting position with head and
arms well supported as soon as she recovered
from anesthesia
Watch for edema or swelling due to bleedinginto the wound
Thyroid ca post op care
Suction mouth and throat if necessary
C h d d b hi i h
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Cough and deep breathing exercise every hour
Give fluids by mouth as tolerated
Give Morphine SO4 for pain
Observe for hoarseness and evidence of injury
to parathyroid gland
Signs and symptoms:
Tingling and tightness of the fingers, anxiety,
and mental depression
Thyroid ca post op care
H h f ll i b d id
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Have the following at bed side:Tracheostomy set
Endotracheal tube
LaryngoscopeOxygen
Give mist inhalation until chest is clear
Take temperature every 4 hours for 24 hoursAssess for hypocalcemia and monitor calcium,
magnesium and phosphorous.
Management of client withcolorectal cancer
SURGERY:
F t f th di l
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For tumors of the cecum or ascending colon,right hemicolectomy for advanced disease may
include resection of the terminal segment of the
ileum, cecum, ascending colon, and right halfof the transverse colon with corresponding
mesentery.
For tumors of the proximal and middletransverse colon, right colectomy includes
transverse colon and mesentery corresponding
to mid colonic vessels
Colerectal ca
Alternatively, the surgeon may perform
t l ti f th t l d
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segmental resection of the transverse colon andassociated mid colonic vessels.
For sigmoid colon tumors usually limited to
the sigmoid colon and mesentery.
Upper rectum tumors usually call for anterior
or low anterior resection. A newer method,
using a stapler, allows resections much lowerthan were previously possible.
Colorectal ca
F t i th l t
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For tumors in the lower rectum,abdominoperineal resection and permanent
sigmoid colostomy are usually performed.
PREOPERATIVE PREPARATION:
Before the surgery, arrange for the client to
visit an enterostomal therapist, who can providemore detailed information and for chosing the
best location for the stoma
Colorectal ca preop prep
Try to have the client meet with an ostomy
li t h h hi l i i ht i t
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client who can share his personal insights into
the realities o living with and caring for a stoma
Evaluate his nutritional and fluid status.
Typically, the client will receive TPN toprepare him for the physiologic stress of
surgery.
Record the client's fluid intake and output andweight daily. Watch for early signs of
dehydration.
Colorectal ca preop prep
Expect to draw periodic blood samples for
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Expect to draw periodic blood samples forhematocrit and hemoglobin determinations. Be
prepared to transfuse blood if ordered.
POST OPERATIVE CARE:
Monitor I and O, and weigh daily. Maintain
fluid and electrolyte balance, and watch forsigns of dehydration (decrease UO, poor skin
turgor) and electrolyte imbalance.
Colorectal ca post op care
Provide analgesics as ordered, Be especially
l t f i i th ti t ith
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alert for pain in the patient with an
abdominoperineal resection because of the
extent and location of the incisions.
Note and record the color, consistency andodor of fecal drainage from the stoma. If the
client has double barrel colostomy, check for
mucus drainage from the inactive (distal)stoma. The nature of fecal drainage is
determined by the type of ostomy
Colorectal ca post op care
S ll th l l ti th t'
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Surgery, generally, the less colon tissue that's
removed, the more closely drainage will
resemble normal stool. For the first few days
after surgery, fecal drainage probably will bemucoid (and probably blood tinged) and mostly
odorless. Report excessive blood and mucus
content, which could indicate hemorrhage orinfection.
Watch out for sepsis
Observe the client for signs of peritonitis or
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Observe the client for signs of peritonitis orsepsis, caused by bowel contents leaking into
the abdominal cavity. Remember that clients
receiving antibiotics or TPN are at an increased
risk for sepsis.
Provide for meticulous wound care, changing
dressings often. Check dressing and drainage
sites frequently for signs of infection (purulent
discharge, foul odor0 or fecal drainage.
Watch for sepsis
If the client has had an abdominoperineal
resection irrigate the perineal area as ordered
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resection, irrigate the perineal area as ordered.
Regularly check the stoma and the surrounding
skin for irritation and excoriation, and take
corrrective measures. Also observe the stoma'sappearance. The stoma should look smooth,
cherry red and slightly edematous, immediately
report any discoloration or excessive swelling,which may indicate circulatory problems that
could lead to ischemia.
Watch out for sepsis
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During the recovery period, encourage the
client to express his feelings and concerns,
reassure an anxious or depressed patient thatthese common post operative reaction should
fade as he adjusts to the ostomy. Continue to
arrange for visits by an enterostomal therapist.
Colorectal ca home care
HOME CARE INSTRUCTIONS FOR
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HOME CARE INSTRUCTIONS FOR
CLIENT WITH COLOSTOMY:
Teach client or caregiver how to apply, remove
and empty the pouch. Teach him how to irrigatethe colostomy with warm tap water to gain
some control over elimination.. Reassure him
that he can regain continence with dietarycontrol and bowel retraining.
Home careInstruct the client to change the stoma
appliance as needed, to wash the stoma site
with warm water and mild soap every 3 days
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with warm water and mild soap every 3 days,and to change the adhesive layer. These
measures help prevent skin irritation and
excoriation.Discuss dietary restrictions and suggestions to
prevent stoma blockage, diarrhea, flatus and
odor. Tell the client to stay on a low fiber dietfor 6-8 weeks and to add new foods to his diet
gradually.
Home careSuggest the use of ostomy deodorant or odor
proof pouch if he include odor producing foodshi di
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proof pouch if he include odor producing foodsto his diet.
Trial and error will help the client determine
which foods cause gas. Gas producing fruitsinclude apples, melons, avocados, and
cantaloupe, gas producing vegetables are beans,
corn, and cabbage.
The client is especially susceptible to fluid and
electrolyte losses. He must drink plenty of
fluids
Home care
Especially in hot weather and when he has
diarrhea Fruit juice and bouillon which
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diarrhea. Fruit juice and bouillon, whichcontain potassium are particularly helpful.
Warn the client to avoid alcohol, laxatives and
diuretics which will increase fluid loss and maycontribute to an imbalance.
If the client had an abdominoperineal
resection,suggest sitz bath to help relieveperineal discomfort. Recommend refraining
from intercouse until the perineum heals.
Acute leukemia
A cancerous WBC precursor called blast
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A cancerous WBC precursor called blastproliferate in the bone marrow or lymph tissue
and then accumulate in peripheral blood, bone
marrow and body tissuesCLASSIFICATIONS:
ACUTE LYMPHOBLASTIC LEUKEMIA
marked by abnormal growth of lymphocyteprecursors (lymphoblast)
Classification of leukemia
ACUTE MYELOGENOUS LEUKEMIA
h t i b id l ti f
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characterize by rapid accumulation of
myeloid precursors (myeloblast)
ACUTE MONOCYTIC LEUKEMIA or
SCHILLING'S TYPE
involves a marked increase in monocyte
precursor (monoblast)
ACUTE MYELOMONOCYTIC and ACUTE
ERYTHROLEUKEMIA
Risk factors of leukemia
The cause of leukemia is unknown but
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The cause of leukemia is unknown, but
according to some experts, the following are the
risk factors
A combination of viruses
Genetic and immunologic factors
Exposure to radiation and certain chemicals
pathophysiology
The pathogenesis of acute leukemia is notl l d d f i i
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The pathogenesis of acute leukemia is notclearly understood. Immature, nonfunctioning
WBCs appears to accumulate first in the tissue
where they originate (lymphocytes in lymph
tissues, granulocyte in bone marrow). These
immature WBCs then spill into the blood
stream and infiltrate other tissues. Eventually,
they cause organ malfunction fromencroachment or hemorrhage.
Signs and symptoms
ACUTE LEUKEMIAHi h f f dd
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CU UHigh fever of sudden onset
Abnormal bleeding
Easy bruising with even minor traumaProlonged menses
NON SPECIFIC SIGNS
Low grade fever
Pallor, weakness and lassitude
Signs and symptoms
ALL, AML,ACUTE MONOCYTIC
LEUKEMIA
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Dyspnea
Fatigue
Malaise
Tachycardia
Palpitations
Systolic ejection murmur
Abdominal or bone pain
Signs and symptoms
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MENINGEAL LEUKEMIA
ConfusionLethargy
headache
Laboratory exams
BONE MARROW BIOPSY
Performed in client with typical clinical
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Performed in client with typical clinical
findings but whose aspirate is dry or free from
leukemic cells. It shows proliferation of
immature WBCs.
WBC differential determines cell type
CBC shows decreased levels of hemogobin
(anemia), platelets (thrombocytopenia) and
neutrophils (neutropenia).
Laboratory exams
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LUMBAR PUNCTURE detects meningeal
involvementURIC ACID measurement may be done to
detect hyperuricemia
Nursing management
Control infection by placing the client inreverse isolation Coordinate care so client
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y p greverse isolation. Coordinate care so client
does not come in contact with staff who also
care for clients with infection or infectious
disease. Avoid using IFC and giving IM
injections, which can pave way for infection.
Screen staff and visitors for contagious disease.
Watch for and report signs and synptoms ofinfection.
Nursing management
Monitor the client's vs q 2-4 hours. Atemperature of 38 3C accompanied by a
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qtemperature of 38.3C accompanied by a
decrease in WBC count calls foe prompt
antibiotic therapy.
Watch for bleeding. If occurs, apply ice
compress and pressure, elevate the affected
extremity. Avoid giving aspirin-containing
drugs, taking rectal temp,,giving rectalsuppositories and performing DRE.
Nursing management
Watch for signs s/s of meningeal leukemia. Ifthese occurs provide care after intrathecal
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these occurs, provide care after intrathecal
chemo. After instillation, place the client in
Trendelenberg position for 30 mnutes. Give
plenty of fluids, and keep him supine for 4-6
hours. Check lumbar puncture site for bleeding.
If the client has receiving cranial radiation,
teach him about potential adverse effects, andtry to minimize them.
Nursing managementTake steps to prevent hyperuricemia- apossible result of rapid chemotherapy induced
leukemic cell lysis. Give the client about 2L offluids daily, and administer acetazolamide,
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fluids daily, and administer acetazolamide,
sodium bicarbonate tablets and allopurinol as
ordered. Check urine pH often-it should be
above 7.5. Watch for rashes and otherhypersensitivity reactions to allopurinol.
Control mouth ulcers by checking often for
obvious ulcers and gum swelling and byproviding frequent mouth care and saline
solution rinses.
Nursing management
Check the rectal area daily for induration,
swelling, erythema, skin discoloration andd i
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drainage.
Minimize stress by providing a calm, quiet
atmosphere that promotes rest and relaxation.Provide psychological support by establishing
a trusting relatioship with the client. Allow him
and his family to expres their anger, anxietyand depression. Encourage them to ;participate
in client care as much as possible.
Nursing managementFor client with terminal disease that resists
chemo, provide supportive care directed at
promoting comfort; managing pain, fever andbl di d ff i i l
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bleeding; and offering emotional support.
Provide the opportunity for religious
counseling, if appropriate. Discuss the option ofhome or hospice care.
Evaluate the patient. He and his family should
understand the rationale for treatment andpotential complications of chemo. They should
also know how to recognize s/s of infection and
Nursing management
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And understand that they must notify the doctor
if these occur. They should be able to discusstreatment options and verbalize concerns about
a poor prognosis..
B. CHEMOTHERAPY
A. DESCRIPTIONOTHER TERM
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OTHER TERM:
chemo, antineoplastic drugs, anticancer, cytotoxic
drugsUsed to describe drugs that kill cancer cells
directly
It promotes tumor cell destruction by interferingwith cellular function and reproduction
Principles of chemotherapy1. The intent of chemo is to destroy as many tumor
cells as possible with minimal effect on healthy cells.
2. Therapeutic strategies
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2. Therapeutic strategies
Adjuvant therapy
Neoadjuvant therapyInduction therapy
Consolidation therapy
3. Cancer cells depend on the same mechanisms forcell division as in normal cells.
Principles of chemo
4. Chemo agents can be effective in one
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4. Chemo agents can be effective in one
of the five phases of the cell cycle
Normal cell cycleG0 PHASE (resting phase)
Cells have not yet started to divide. Last for few
hours to few years.
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G1 PHASE (gap one)
The cells starts making more protein to get ready to
divide.
S PHASE (synthesis)
The proteins containing the genetic code (DNA)
doubles so that both new cells are formed will have
the right amount of DNA.
Normal cell cycle
G2 PHASE (gap two)
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Period of protein and RNA synthesis and the
mitotic spindle apparatus is formed.
M PHASE (mitosis)
The cell actually divides into two identical cells
Goals for chemotherapy treatment
1. To cure a specific cancer
2. To control tumor growth
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g
3. To relieve symptoms caused by cancer
4. To destroy microscopic cancer cells5. To shrink tumors before surgery or radiation
Contraindications of chemotherapy
1. INFECTION. The anti-tumor drugs are
immunosuppressives.
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2. RECENT SURGERY. The drugs may retard
healing process
3. IMPAIRED RENAL AND HEPATIC
FUNCTIONS. The drugs are hepatotoxic and
nephrotoxic
4. RECENT RADIATION THERAPY. Also
immunosuppresive.
Contraindications of chemotherapy
4. PREGNANCY. The drugs may causecongenital defects.
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g
5. BONE MARROW DEPRESSION. The
drugs may aggravate the condition. The WBClevels must be within normal limits.
Classifications of chemo agents
1. ALKALYTING AGENT
ACTION: *Most active during the resting
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phase of the cell.
* It interfere with DNA and RNA
growth
EXAMPLES: Cyclophosphamide, Busulfan,
Carmustine, Carboplastic, Leukeran,
Lomustine, Cisplatin, Dacarbazine, Ifosfamide,
Mesna, Semustine, Melphalan
Alkalyting agents
ADVERSE EFFECTS:
Nausea, vomiting, alopecia, hemorrhagic cystitis,thrombocytopenia myelosuppression
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thrombocytopenia, myelosuppression
NURSING CONSIDERATIONS:
Monitor liver functions and CBC
Drink 2-3L of fluids daily
Reassurance for hair loss
Administer anti emetic drugs as ordered
Observe for hypersensitivity reactions.
Alkylating agents
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Classifications of chemo drugs
2. ANTIMETABOLITESACTIONS:
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Drugs are very similar to normal substances within
the cellAttack cells at very specific phase of the S Phase
Inhibit cell reproduction by interfering with
manufacture of proteinCell cycle specific drug
antimetabolites
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Classifications of chemo drugsEXAMPLES OF ANTIMETABOLITES:
Azacytadine, Cytarabine, 5 Flouraouracil, Hydroxy
Urea, 5-Mercaptopurine, Methotrexate,
Thioguanine Gemcitabine Taxanes Taxotere
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Thioguanine, Gemcitabine, Taxanes, Taxotere
ADVERSE EFFECTS:
N/V,stomatitis
Thrombocytopenia, diarrhea
Myelosuppression, alopecia
Renal and hepatic dysfunctions
Neuropathy
antimetabolites
NURSING CONSIDERATIONS:
Monitor liver function, CBC, Urea and
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Creatinine
Provide oral hyieneAdminister antiemetic drugs as ordered
Observe other s/s of side effects
Classifications of chemo drugs
3. ANTINEOPLASTIC ANTIBIOTICSACTIONS:
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Interfere with DNA by stopping enzymes and
mitosis or altering the membranes surrounding thecell
Works in all phases of cell cycle
EXAMPLES:Bleomycin, Dactomycin, Adriamycin, Mitomycin
Antitumorantibiotics
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Antineoplastic antibiotics
ADVERSE REACTIONS:
N/V, stomatitis
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Myelosuppression, thrombocytopenia
Renal and hepatic dysfunctionsAlopecia
NURSING CONSIDERATIONS:
Hydration, monitor lab testAntiemetics, oral care
Classifications of chemo drugs4. PLANT ALKALOIDS
Derived from certain types of plantsa. Vinca Alkaloids- made from periiwinkle
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plants Catharantus rosea
b. Taxanes- made from bark of the Pacific fewtree Taxus
c. Podophylotoxins- derived fro the May apple
plant
d. Campotheca acuminata- derived from the
Asian Happy Tree
Plant alkaloidsACTIONS:Attack the cell during various phases of cell
division especially the M PhaseCell cycle specific
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Known as Mitotic o Topoisomerate inhibitors
EXAMPLES:Velba, Vincristine, Vinblastine, Tenipride,
Nevelbine
ADVERSE EFFECTS:Diarrhea, neuropathy, alopecia, stomatitis, paiin in
the IV site
Topoisomerase Inhibitors
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MitoticSpindle Poisons
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Classifications of chemo drugs
NURSING CONSIDERATIONS (PLANTALKALOIDS)
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Hydration
Avoid handling pointed and breakable objectsReassure that hair will grow again after the
therapy
Provide mouth careObserve IV site
Classifications of chemo drugs
5. HORMONE OR HORMONE MODULATORS
ACTION:
A. Natural Hormones- drugs that are useful in
treating some types of cancer
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treating some types of cancer
EX. Corticosteroids
B. Some sex hormones alter the action or production
of female and male hormone. They are used to
inhibit the new growth of the breast, prostate and
endometrial lining
EX. Tamoxifen or Nalvadex, Testofactone or Teslac
hormone
ADVERSE EFFECTS:
Signs and symptoms of menopauseBone marrow depression, retinopathy
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Teslac may produce altered libido, facial hair
growth, enlargement of the clitorisNURSING CONSIDERATIONS:
Monitor CBC
Health teaching regarding changes on reproductivesystem and vision
Routes of administration for chemo
agents
Oral
IVIM
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Intrathecal or intraventricular
Intraarterial
Intracavitary
Intravesical
topical
Administration of IV chemo agents1. PREPARATORY PHASE
A. Patient Education
Review treatment goals
Review treatment plans and adverse reactions
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Review treatment plans and adverse reactions
Review strategies to manage reactions
Instruct client on a reportable condition
B. Before administering chemo drugs, check for:
Doctors order, medication, history, type of drugs,route, dose, duration of therapy, and current
laboratory results
Administration of IV chemo drugs
C. Calculate the dosage according to mg/kg body
weight or mg/m2 by body surface area.
D. Verify client's name and identification
E. Be aware of the agents that cause anaphylactic
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g p y
reaction
2. PERFORMANCE PHASE
A. Insertion of IV access
Select venipuncture site free from sclerosis,
thrombosis or scar formationCheck for blood return or patency of the site
Administration of IV chemo drugsC. Calculate the dosage according to mg/kg
body weight or mg/m2 by body surface area.
D. Verify client's name and identificationE. Be aware of the agents that cause
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anaphylactic reaction
2. PERFORMANCE PHASE
A. Insertion of IV access
Select venipuncture site free from sclerosis,
thrombosis or scar formation
Check for blood return or patency of the site
Types of vascular access devices
1. Peripherally inserted catheter (Per-Q-Cath)
Placed in the arm and treaded through the vein
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g
up to the near the heart
Allows for continuous access for peripheral
vein for several weeks.
No surgery is needed. Care for the catheter is
required.
Vascular access
2. MID LINE CATHETER (Per-Q-Cath Midline)
Also placed in the arm but the catheter is not inserted as far
as PIC
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Used for intermediate length therapy when a regular
peripheral IV is not advisable. No surgery needed. Care of
the catheter is required.
3. TUNNELED CENTRAL VENOUS CATHETER
(Hickman, Broviac, Groshon)
Catheter with multiple lumens surgically placed in largecentral vein in the chest and the catheter
Vascular access
Tunneled under the skin. Care of the catheter is
needed.
4. IMPLANTABLE VENOUS ACCESS PORT
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(Port-A-Cath, BardPort, Medi-Port)
A port of plastic, stainless steel or titanium with
silicone septum. The catheter is surgically
placed under the skin of the chest or arm in a
large central vein. The port is accessed by aneedle to give chemotherapy.
Vascular access
5. IMPLANTABLE PUMPA titanium pump with an internal power
source surgically implanted to give continuous
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source surgically implanted to give continuous
infusion chemotherapy usually at home. There
is a refillable reservoir for continuous infusion.
Administration of IV chemodrugs
B. ADMINISTRATION PHASE
SEQUENCE OF DRUG ADMINISTRATION
1 The recommended practice is to administer
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1. The recommended practice is to administer
vesicant first. Check IV site for:
Good vein integrity
Vein is stable and less irritated
Assessment for vein patencyLess chance of compromised vascular integrity
Sequence of drug administration2. Apply a disposable absorbent plastic (backed
pack under the area)
3. Put protective gown, gloves and goggles ifnecessary. Order of protective equipment:
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Donning- mask, gown, gloves, goggles
Removing-gown, gloves, goggles, mask
4. Monitor IV site regularly. Observe for
EXTRAVASATIONS or accidental infiltration
of vesicant or irritant chemo drugs from thevein into the surrounding tissues of the IV site.
Extravasation
SIGNS AND SYMPTOMS
Pain, burning sensation and inflammation
IF LEFT UNTREATED
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IF LEFT UNTREATED
There will be hyperpigmentation, sloughing,necrosis and ulceration.
FOR SEVERE EXTRAVISATIONS
May result in damage to tendons and nervesEND RESULT: AMPUTATION
Management for extravisation
STOP vesicant and IV fluids
Wear gloves leave catheter in place
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Wear gloves, leave catheter in place,
disconnect line from IV site
Attach a syringe and aspirate
Notify the physician
Administer prescribed antidote
extravisation
FOR SUBCUTENEOUS EXTRAVISATION:
Wear gloves, remove IV catheter, avoiding
excess pressure on the site
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excess pressure on the site
Inject antidote SC of the affected site. Usegauge 25 neeedle.
Instruct client to rest, elevate the site, apply ice
for 24 -48 hours then resume normal activity.
Assess for a plastic surgery consult
Admin of chemo drugs
C. FOLLOW UP PHASE
Documentation
Monitoring of pain and erythema induration
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Monitoring of pain and erythema, induration
or necrosis
Monitoring for the other adverse effects of the
drug
Side effects of chemo agents andtheir nursing interventions1. GASTROINTESTINAL SYSTEM
N/V, diarrhea, constipationNursing Actions:
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Replace fluids and electrolyte losses
Low fiber diet to relieve diarrhea
Increase fluid intake and high fiber diet to
relieve
constipation
Administration of antiemetic drugs as ordered
NAUSEA AND VOMITING
Chemotherapy drugs cause nausea and
vomiting for a variety of reasons. One reason is
they irritate the lining of the stomach and
duodenum (the first section of the smallintestine). This stimulates certain nerves that
activate the vomiting center (VC) and the
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chemoreceptor trigger zone (CTZ) in the brain
which leads to vomiting. Another way theseareas of the brain can be activated is through
obstruction (intestinal blockage), delayed
gastric emptying, or inflammation
CONSTIPATIONConstipation is the passage
(usually with discomfort) of
infrequent, hard, dry stool. If
you have constipation, you may
also notice bloating, increased
gas, cramping, or pain.
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g , p g, p
Constipation affects about half
of people with cancer and about3 out of 4 of those with
advanced cancer. It can lead to
nausea and a decreased appetite.
DIARRHEA
- is the passage of increased
volume of loose or watery
stools several times a day withor without discomfort. Along
with diarrhea, you may have
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gas, cramping, and bloating.
Diarrhea occurs in about 3 out of4 people who receive
chemotherapy because of the
damage to the rapidly dividing
cells in the digestive(gastrointestinal) tract.
APPETITE LOSS AND WEIGHT CHANGES
Most chemotherapy medicines cause some
degree ofanorexia, a decrease in or complete
loss of appetite. Loss of appetite, as well as
weight loss, may also result directly from
effects of the cancer on the body's metabolism.
Anorexia may be mild. If it is severe, it may
lead to cachexia a form of malnutrition with
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lead to cachexia, a form of malnutrition with
muscle loss. Proper nutrition is important
during cancer treatment. It helps strengthen the
body to fight the disease and infection and also
cope with cancer treatments and their side
effects.
TASTE CHANGES
Cancer treatments and the
cancer itself can change the
way some food tastes. Taste
changes can contribute to
anorexia, poor nutrition, and
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anorexia, poor nutrition, and
weight changes. With taste
changes caused by
chemotherapy,
Side effects of chemo
2. INTEGUMENTARY SYSTEM
*Pruritus, urticariaProvide good skin care
Observe for anaphylactic reactions
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Observe for anaphylactic reactions
*StomatitisProvide good oral care
Avoid hot and spicy foods
*Skin pigmentation
Inform client that it is temporary
Side effects of chemo
* Alopecia
Reassure that it is temporary
Encourage to wear wigs, hat, or
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headscarf
*Nail Changes
Reassure that nails may grow
normally after chemo
Side effects of chemo
3 HEMATOPOIETIC SYSTEM
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3. HEMATOPOIETIC SYSTEM
Anemia-provide frequent rest period
Neutropenia-protect from infection, avoid
people with infection
FATIGUEFatigue is an extreme
tiredness that is not
relieved with rest. It isone of the most
common side effects of
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cancer and
chemotherapy. It can beone of the most
debilitating side effects
people experience.
Side effects of chemo
*Thrombocytopenia- protect from trauma,
avoid aspirin
4. GENITO-URINARY SYSTEM
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*Hemorrhagic Cystitis
Provide 2-3 L of fluids per day
Monitor UO
Assess for urinary frequency, ugencyMonitor BUN, Creatinine
Side effects of chemo5. REPRODUCTIVE SYSTEM*Amenorrhea and decrease libido for males
Reassure that menstruation and libido willresume after chemo
6 NEUROMUSCULAR SYSTEM
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6. NEUROMUSCULAR SYSTEM
*Paresthesia, Hearing Loss, Blurring of visionDetermine presence of tingling sensations on
toes and fingers
Evaluate muscle weakness
Determine peripheral nerve damage and report
NERVOUS SYSTEM CHANGES
Some chemotherapy drugs can cause
direct or indirect changes in the central
nervous system (brain and spinal cord), thecranial nerves, or peripheral nerves. The
cranial nerves are connected directly to the
brain and are important for movement and
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p
touch sensation (feeling) of the head, face,
and neck. Cranial nerves are also importantfor vision, hearing, taste, and smell.
Peripheral nerves lead to and from the rest of
the body and are important in movement,
touch sensation, and regulating activities of
some internal organs.
Safe handling of
chemotherapeutic agents
1. Wear mask, back closing gown and gloves.
2. Skin contact with drugs must be washedimmediately with soap and water.
3 Eyes must be flushed immediately with
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3. Eyes must be flushed immediately with
copious amounts of water.4. Sterile or alcohol wet pledgets should be
used to wrap around the neck of the ampule
when breakingor withdrawing the drug.
Safe handling5. Expel air bubbles on wet cotton.6. Vent vials to reduce internal pressure when
mixing.
7. Wipe external surfaces of syringes and IV
bottles.
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8. Avoid self inoculation by needle stab.
9. Clearly label the hanging IV bottle with
antineoplastic chemotherapy
10. Contaminated needles and syringes must bedisposed in a clearly marked leak proof and
puncture proof container.
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Personal safety to minimize
exposure via skin ingestion
1. Do not eat, drink, chew gum, or smoke while
preparing or handling chemo agents.2. Keep all food and drink away from
preparation area.
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preparation area.
3. Wash hands before and after handling chemoagents.
4. Avoid hand to mouth or hand to eye contact
while handling chemo agents or body fluids ofthe person receiving chemo.
Personal safety4. Wear nitrite examination gloves at all timeswhen preparing or working with chemo agents.
5. Wash hands before putting on and after
removing gloves
6. Change gloves after each use, tear, puncture
di ti ill ft 60 i t f
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or medication spill every after 60 minutes of
wear.
7. Wear along sleeves non absorbent gown with
elastic at the wrist and back closure.
8. Eyes and face shields should be worn if
splashes are likely to happen.
Personal safety10. Use syringe and IV tubings with Luer locks
(with locking device to hold needle firmly in
place)
11. Label all syringes and IV tubings containing
h t h d t i l
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chemo agents as hazardous material.
12. Place an absorbent pad directly under the
injection site to absorb any accidental spillage.
13. If any contact with the skin occurs,
immediately wash the area thoroughly with
soap and water.
Personal safety14. If contact,made with the eye, immediately
flush the eye with water and seek medical
attention.15. Spills kit should be available in all areas
where chemo agents stored, prepared and
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administered
Safe disposal of antineoplastic
agents, body fluids and excreta1. Discard gloves and gown into a leak proof
container, which should be marked as
contaminated or hazardous waste.
2. Use puncture proof and leak proof containers
f dl d th h d b k bl
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for needles and other sharp and breakable
objects.
3. Linen contaminated with chemotherapy or
excreta from patients who have received the
drug within 48 hours should be contained in
specially marked hazardous waste bags.
III. RADIATION THERAPYROLE IN CANCER PREVENTION:
Primary curative roleAdjunct to other therapy
Palliation
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SOURCES OF RADIATION THERAPY:
1. External Radiation Therapy (Teletherapy).
Administer via an X-ray machine
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Side effects of radiation therapy
1. SKIN REACTIONS
A. Erythema, dry or moist desquamationB. Atopic, telangectasia, depigmentation,
necrotic or ulcerative lesions.
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NURSING RESPONSIBILITIES:Observe early signs of skin reaction and report
Keep area dry
Wash area with water, no soap and pat dry ( donot rub)
Side effects
Do not apply ointments, powders or lotions onthe area
Do not apply heat, avoid direct sunlight or cold
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Use soft cotton fabrics for clothingDo not erase markings on the skin. These serve
as guide for areas of irradiation.
Side effects2. INFECTION
Due to bone marrow suppressionNURSING RESPONSIBILITIES:
Monitor blood count weekly
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Good personal hygiene, nutrition and adequaterest
Teach signs of infection to report to physician
Side effects of radiation3. HEMORRHAGE
Platelets are vulnerable to radiationNURSING RESPONSIBILITIES:
Monitor platelet count
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Avoid physical trauma or use of aspirinTeach signs of hemorrhage
Monitor stool or skin for signs of hemorrhage
Use direct pressure over injection sites untilbleeding stops.
Side effects of radiation
4. FATIQUEResult of high metabolic demands for tissue
repair and toxic waste removal.
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MANAGEMENT:Plenty of rest and good nutrition
5. WEIGHT LOSS
Anorexia, pain and effect of cance
Side effects of radiation
6. STOMATITIS
Ulceration of oral mucus membraneNURSING INTERVENTIONS:
Administer analgesics before meals
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Bland diet, no smoking and alcohol drinkingGood oral hygiene by using saline rinse every
2 hours
Sugarless lemon drops or mint to increasesalivation
Side effects of radiation
7. Diarrhea
8. N/V
9. Headache
10. Alopecia
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10. Alopecia
11. Cystitis
12. Social Isolation
Principles of radiation protection
DISTANCE
Maintain a distance of atleast 3 feet when
not performing nursing procedures
TIME
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TIME
Limit contact for 5 minutes each time, a
total of 30 minutes per shift
SHIELDING
Use lead shield during contact with client
Teaching guidelines regarding
radiation therapy
It is painless
Lie very still in a special table while theintervention is being given and client may be
placed in a special position to maximize tumor
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irradiation.Each treatment may usually last for few
minutes. Client may hear sounds of the machine
being operated, and the machine may moveduring the therapy
Teaching guidelines
As a safety precaution for the therapy personnel,
client will remain alone in the treatment room whilethe machine is in operation.
The technologist will be right outside the room
observing the client through a window or by a
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observing the client through a window or by a
closed circuit TV. Client and technologist may
communicate
There is no residual radioactivity after the therapy.
Safety precautions are necessary only during thetime the client is actually receiving irradiation
IV. BONE MARROW
TRANSPLANTATIONBone marrow cells are collected from the
client or another donor and then administer to
the client after his diseased bone marrow is
destroyed by chemotherapy or radiation.
PATIEN TEACHING:
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PATIEN TEACHING:
Inform the client that bone marrow transplant
will deplete his WBCs, putting him at high risk
for infection immediately after the procedure.
As a safeguard, he will be placed on reverseisolation for several weeks.
Bone marrow transplant
2. Prepare client for pretransplantation regimen,
which may include chemotherapy and radiation.
During this regimen, he should expect adverse
reactions such as parotitis, diarrhea, fever, N/V
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and symptoms of bone marrow depression(fever, fatique, chills, bruising and bleeding)
Nursing management for BMT
1. During transfusion, monitor client's v/s
closely to allow prompt detection of reactionssuch as fever, dyspnea and hypotension.
2. Assess the client every 4 hours for infection
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symptoms, such as fever and chills.3. Maintain strict asepsis when caring for the
client. Take measure to protect him from injury.
Management of BMT
4. Watch for signs of graft-versus-host disease,
such as dermatitis, hepatitis, hemolytic anemia
and thrombocytopenia. GVHD usually occurs
during t