Module II - Care of Clients with Cancer and Hematopoietic and Lymphatic Disorders

cancer uncontrollable growth of cells neoplasm a new growth (tumor) that is either benign or malignant malignant tumor often rapid growth of abnormal cells, often causing necrosis and ulceration of tissue, spreading tumors to other parts of the body (metastasis), with recurrence after surgical removal and following radiation or chemotherapy, resulting in death if uncontrolled; cancer, malignancy, malignant neoplasia benign tumor typically slow expansion of tissue typical of origin with minor tissue damage; seldom recurs after surgical removal; hyperplasia, polyp, benign neoplasia; doesn't cause injury unless pressure or obstruction to vital organs tumor abnormal mass metastasis spread of malignant cell growth to form tumors in other parts of the body Chemical cancer risks air, water, soil, food, drugs, tobacco, smoke, vinyl chloride Ocoviruses exposure to known viruses: Epstein-Barr virus (nEBV), Human papillomavirus (HPV), chronic hepatitis B Long-term use of estrogen hormonal risk for cancer Immune system risk factor impaired immunity, chronic illness and stress Irritant cancer risks snuff, pipe smoke, Nevi (moles), asbestos Radiation cancer risks exposure to excessive sunlight, x-rays, and alpha/beta/gamma rays Diet cancer risks high fat, low fiber, large amount of pickled and charbroiled foods (nitrites) Genetic cancer risk certain breast cancers, skin, colon, ovarian, and prostate cancers have a genetic tendency fibroma benign tumor of fibrous connective tissue lipoma benign tumor of fat tissue carcinoma cancerous tissue of skin, glands, digestive, urinary, and respiratory tract linings leukemia cancer of blood, plasma, cells, and bone marrow lymphoma cancer of lymphatic tissue melanoma cancer of skin cells sarcoma cancer of connective tissue, bone, and muscle Incidence of cancer higher in people age 60-69; second highest group is age 70-79; men develop cancer more than women biopsy definitive way to diagnose cancer; microscopic examination of tissue sample or aspirated fluid cytological study study of formation, structure, and function of cells Laboratory indicators for cancer -Elevated WBC without infection (possible leukemia) -increased levels of bilirubin, alkaline phosphatase, glutamic-oxaloacetic transaminase (possible liver cancer) Tumor markers: -proteins -antigens -genes -hormones -enzymes Radiological tests for cancer diagnosis -X-ray (cancer of bones and hollow organs) -Mammography (detect breast masses) -CT (determine staging of malignancies and minor variations in tissue thickness) Positron Emission Tomography (PET) nuclear imagining procedure; detect spread of cancers of the lung, ovaries, colon, rectum, and breast Ultrasound for cancer screening detect tumors of pelvis and breast; distinguish between benign and malignant breast tumors Magnetic Resonance imaging (MRI) for cancer screening detection, localization, and staging of malignant tumors in central nervous system, spine, head, and musculoskeletal system Endoscopic procedures regarding cancer imaging allows direct visualization of body cavity or opening tumor-node-metastasis (TNM) system most common system used for staging tumors Curative surgery surgically remove the entire tumor prophylactic surgery remove at risk tissue such as moles or lesions tumor debulking surgically removing as much of the tumor as possible palliative surgery surgery to control symptoms of illness, increase comfort and quality of life reconstructive surgery cosmetic enhancement or return of function to body part nursing care for surgery patients -encourage to express fear/concerns -educate wound care, dressing change, drainage tubes to empower patient with sense of control -visual aids re: tumor site and surgical procedures -adequate nutrition (undernourished patients are poor surgical candidates) -increased risk for DVT --ambulate, antiembolism stockings, PCD/SCDs, avoid crossing legs --s/s of DVT (redness, warmth, pain in calf) radiation cancer treatment that uses beams of high-energy waves to destroy fastgrowing cancer cells; can be curative or commonly for cancer control and palliation brachytherapy the use of radioactive materials in contact with or implanted into the tissues to be treated Mucositis inflammation of the mucous membrane xerostomia dry mouth bone marrow depression myelosuppression; low WBC, low RBC, low platelets Nursing care for chemotherapy patients -cluster care for fatigue -high carb, high protein, avoid high fiber d/t N/V -oral care for dry mouth -wash affected skin areas with mild soap and water to pat dry radiation safety principles -limit time -increase distance -use shielding chemotherapy use of cytotoxic drugs to treat disease -curative (complete removal of disease) or palliative (symptom control and increase comfort) -2 or more antineoplastic agents may be used together -oral, IM, IV, and topical routes BITES for chemotherapy and radiation -bleeding (low platelets) -infection (low WBC, ^ risk for infection, limit guests, only healthy adults, check temp, handwashing) -tiredness (anemia) -emesis (altered nutrition, fluid/electrolyte imbalance, oral hygiene, sore/dry mouth, taste change, loss of appetite, constipation, diarrhea) -skin changes (radiation reaction or skin breakdown; loss of hair) Nursing diagnosis for cancer patients -ineffective coping -acute or chronic pain -risk for infection -ineffective protection -imbalanced nutrition -deficient self-care -grieving -risk for ineffective role performance -social isolation -ineffective sexuality pattern -disturbed body image cancer survivorship Begins at the time of cancer diagnosis Includes treatment Extends to the rest of the person's life hospice care holistic, compassionate care for terminal patients (prognosis of less than 6 months) -inpatient provide symptom control (palliative) and respite care (time for family to rest) Oncological emergency for cancer patients -superior vena cava syndrome (SVCS) -spinal cord compression -hypercalcemia Superior vena cava syndrome Tumor or enlarged lymph nodes block circulation to SVC -s/s: swelling of face/neck/arms, JVD, and visible chest veins -remove rings and restrictive clothing -avoid BP and venipuncture in arms -elevate HOB to reduce dyspnea Spinal cord compression Tumor in epidural space of spinal cord -patient risk (cancer spread to bone from lung, breast, or prostate) -loss of motor skills and bowel/bladder control -provide safe environment -neuro status checks -steroids can increase sugar Hypercalcemia excess calcium in blood d/t bone deterioration or ectopic secretion of parathyroid hormone by tumor; hard on kidneys -s/s: lethargy, depression, confusion (coma, death), muscle weakness, hypotonia, decreased reflexes, cardiac arrhythmias, bone pain and fracture -safe environment, I/Os, pain control, heart rate and rhythm hematologic system composed of bone marrow, blood, and blood components to transport substances, regulate body temp, pH, fluid balance, and transport cells to protect body lymphatic system composed of nodes, nodules, and fluid to filter pathogens from blood spleen filters out old red blood cells, produces some white blood cells, and removes dead pathogens and cells Data collection for hematologic and lymphatic systems -v/s -LOC -skin and mucous membranes -fingernails -abdomen -neck,axillae -sternum Diagnostic tests for hematologic and lymphatic systems -blood tests -coagulation tests -bone marrow biopsy -lymphangiography -lymph node biopsy Blood cell values and disorders (Table 27.1) ... Blood products -packed RBCs -frozen RBCs -platelets -albumin fresh frozen plasma -cryoprecipitates blood administration -check order -check labels -baseline v/s -administered by RN -LVN assist with ID patient, allergies, previous reactions, monitor v/s -administer within 30 MINUTES of receiving -NEVER ADD ANY MEDS TO BLOOD -crossmatch with 2 NURSES --ABO-group --RH type --patient name --ID blood band --hospital # --expiration date -DO NOT WARM UNLESS BY SPECIFIC EQUIPMENT: risk hypothermic response -use over 2-4 hours; NO LONGER THAN 4 HOURS -severe reaction within first 15 minutes, first 50 mL transfused transfusion safety steps - Assessment (baseline) - Identification (2 nurses, patient ID, blood match, facility policy) - Use only normal saline (dilute blood and flush before and after transfusion, within 2 hours, no longer than 4 hours) - Filtering (IV tube filters to prevent harmful particles entering patient) - Washing (special round bag, removes almost all plasma to decrease risk or severity of febrile reaction) - Warming (for severe bleeding, prevent hypothermia, heart dysrhythmia, shivering which can destroy blood cells and platelets) transfusion complication -febrile reaction -allergic reaction -hemolytic transfusion reaction nursing implications of blood transfusion complications -stop transfusion and notify MD -change IV tubing at hub and begin NS -treat symptoms if present --O2 --fluids --epinephrine -v/s every 15 minutes -recheck crossmatch and send blood bag/tubing to lab -obtain blood sample -obtain urine sample for hemoglobinuria -monitor fluid/electrolyte balance -evaluate serum calcium levels TNM staging system T = size of Tumor N = Node involvement M = Metastases; most widely used What gauge for blood transfusion? 16-18 gauge for rapid transfusions in adults 20-22 gauge for routine transfusions Needle gauge color code 14G - Orange (magma) 16G - Grey (dirt) 18G - Green (trees) 20G - Pink (balloon) 22G - Blue (cloud) 24G - Yellow (sun) 26G - Violet (sky) Anemia deficiency of red blood cells, hemoglobin, or both Pathophysiology of anemia blood loss, low RBC production, increased RBC destruction Anemia etiologies -dietary deficiencies (iron, folic acid, B12) -pernicious anemia (missing intrinsic factor in stomach secretions, decrease B12 absorption) -hemolysis (destruction of RBCs) -hereditary disorders Signs and symptoms of anemia -pallor -tachycardia -tachypnea -irritability -fatigue -dyspnea Signs and symptoms of pernicious anemia -numb hands or feet (B12 needed for nerve function -sore tongue -beefy red tongue Signs and symptoms of iron deficiency -mouth fissures -spoon shaped fingernails -glossitis (inflamed tongue) Diagnosis of anemia -CBC with microscopic examination -serum iron, ferritin, total iron binding capacity, folate -bone marrow analysis -tests to determine source of bleeding Therapeutic interventions for anemia -eliminate cause -dietary changes -supplements -transfusions Nursing diagnoses for anemia -activity intolerance -imbalanced nutrition -risk for injury -impaired oral mucous membranes iron supplement -vitamin C enhances absorption -1 hour before eating or 2 hours after meals (empty stomach) -continue for several months after Hgb and Hct levels return to normal and rebuild body stores Aplastic anemia (hypoplastic anemia) bone marrow does not produce adequate RBCs, resulting in pancytopenia (reduced number of all cells from bone marrow; RBCs, platelets, WBCs) pancytopenia reduced number of all cells from bone marrow (RBCs, platelets, WBCs) Causes of aplastic anemia (hypoplastic anemia) -congenital -exposure to toxins -chemotherapy bone marrow damage cannot be reversed Signs and symptoms of aplastic anemia weakness, fatigue, pallor, dyspnea, headache, ecchymoses (skin discoloration d/t bleeding underneath; bruising), petechiae, frank bleeding, infection, death Diagnosis of aplastic anemia -CBC -Bone marrow biopsy (MOST DEFINITIVE TEST) -TIBC (total iron-binding capacity) -serum iron Treatment for aplastic anemia -treat cause -colony stimulating factors (natural elements produced synthetically) -steroids -bone marrow transplant Nursing interventions for anemia Box 28.1 and 28.2 -electric razor -soft toothbrush; no flossing -avoid invasive procedures (e.g. enemas, douches, suppositories, rectal temps) -avoid IM injections -BP check by pumping cuff until pulse obliterated -avoid blood draws; use access sites or group labs into once-daily draw