Oncology

Care of the Patient with Cancer

Objectives
Differentiate between benign and malignant tumors Screening procedures for cancer

General signs and symptoms of cancer

Discuss the prevalence of cancer Identify risk factors for cancer Treatment and nursing care of patients with cancer with cancer

What Is Cancer?
Cancer = abnormal, uncontrolled cellular growth Benign versus malignant tumors Malignant tumor = cancerous and capable of spreading; neoplasm Benign tumor = noncancerous and nonspreading 1.3 million cases of cancer per year; 550,000 deaths

Oncology branch of medicine that deals with the study of tumors Pathophysiology of Cancer Defect in cellular proliferation No contact inhibition Proliferate indiscriminately

How Cancer Spreads: Metastasis

Metastasis = spread of cancer cells from one part of the body to another Blood vessels Lymphatic system Secondary tumors or metastases Carcinogen = any substance that causes cancer

Statistics
Cancer is the second leading cause death in the United States

Men have a 1 in 2 lifetime risk of developing cancer

Women have a 1 in 3 lifetime risk developing cancer Lung cancer is the leading cause of death in both men and women death in both men and women

Tumor Development

Normal Body Cells

Look like other cells from the tissue of origin

When mature serve a specific purpose

Reproduce in a controlled predictable manner Stop dividing when nutrients are insufficient or space is inadequate Remain in tissue of origin, except blood cells

Benign Tumors
Slow steady growth Enlarges and expands but remains localized but remains localized Resembles parent tissue Rarely recurs

Malignant Tumors
Varied rate of growth, often rapid metastasizes

Little or no resemblance to parent tissue to parent tissue

Commonly recurs after removal Can cause tissue necrosis, ulceration, perforation, tissue sloughing, and can be fatal Irregular edges, more immobile when palpated

Usually does not cause tissue destruction in compression or obstruction Smooth, well defined edges, may be movable edges, when palpated

Malignant
Characteristic Encapsulated Differentiated Metastasis Recurrence Vascularity Mode of growth Malignant Rarely Poorly Frequently present Frequent Moderate to marked Infiltrative & Expansive

&

Benign

Benign Usually Partially Absent Rare Slight Expansive

Cell Characteristics

Cells not similar to parent cells

Fairly normal similar to parent cells

Metastasis

Process by which tumor cells are spread to distant parts of body to distant parts of body

Occurs several different ways: Direst spread of cells by diffusion Circulation by way of blood and lymph
Accidental transplant during procedures

Staging
Staging is a way of describing a cancer, such as the size of the tumor and where it has spread Clinical diagnostic staging Bone and liver scan Ultrasonography Computed tomography MRI

Staging is the most important tool doctors have to determine a patients prognosis
The type of treatment a person receives depends on the stage of the cancer

Surgical Staging Describe extent of the disease after biopsy or surgical exploration

Grading and Staging of Tumors

Grading: based on the degree of malignancy, how alike the cells are to the parent tissue or differentiated Staging: general extent of cancer and spread of disease rather than cell appearance

Grade 1 most differentiated

Grade 4 least differentiated, most malignant

Stage 1 No invasion of other tissues, localized

Stage IV Metastasized to distant parts

Grading and Staging of Tumors

T=Primary Tumor Size N=lymph node involvement M = distant metastases

T0- no evidence of metastasis Tis tumor is in epithelial tumor is in epithelial T1 T1 minimal size and extension T2, T3, T4 progressively larger and extensive larger and extensive

N0- indicates no abnormal M0 = no evidence lymph nodes detected metastasis

N1 minimal involvement
N2,N3,N4 progressively more involvement more involvement

M1 distant metastasis present (specify site/s)

Risk Factors
The following promotes additional damage to cells causing further genetic alteration Dietary fats Cigarette smoking Alcohol consumption Prolonged severe stress

Reversible proliferation of altered cells is a key concept in cancer prevention

Risk Factors of Cancer

Heredity Age - Inactivity and obesity

Diet
Dietary fat and meat Fruits and vegetables

Chemical Agents
Tobacco

Carotenoids Antioxidants Phytochemicals

Environmental
Carcinogens in the environment Ingested chemicals Environmental and industrial pollution Radiation Microorganisms

Alcohol

Percentage of All Cancer Deaths Linked to Risk Factors

Seven Major Warning Signs of Cancer

The Causes of Cancer: Role of DNA DNA basics

DNA = deoxyribonucleic acid, a chemical substance that
carries genetic information

Chromosome = threadlike body in a cell nucleus that

contains molecules of DNA

Gene = section of chromosome that contains the

instructions for making a particular protein

The Causes of Cancer: Role of DNA

DNA mutations and cancer A mutated gene no longer contains the proper code for producing its protein

Oncogene = gene involved in the transformation of a normal cell into a cancer cell

Cancer promoters = compounds that accelerate cell growth

Dietary Guidelines for Cancer Prevention

Eat a varied plant-based diet Eat 59 servings of fruits and vegetables each day Cruciferous vegetables Citrus fruits and berries Dark-green leafy vegetables Dark-yellow, orange, or red fruits or vegetables Eat high-fiber foods Limit consumption of meat and total fat; favor monounsaturated and omega-3 polyunsaturated fats Limit consumption of charred, blackened, cured, and smoked meat and fish Be moderate in consumption of alcohol

SOURCE: National Cancer Institute

Levels of Disease Prevention

Primary Prevention Avoidance of causative agent Secondary Prevention Early detection, screening Tertiary Prevention Treatment, symptom control, rehabilitation

Primary Prevention
Avoidance of causative agent
Alteration in lifestyle behaviors to eliminate or reduce exposure to carcinogens Avoid smoking. Tobacco is linked with lung, oropharyngeal, bladder, pancreatic, cervical, kidney cancer Risk is related to: Pack Years number of packs of cigarettes smoked per day multiplied by the number of years a person has smoked Example Patient smoked 1 pack per day for 30 years 1x 30 = 30 pack years

Primary Prevention continued

Avoidance of causative agent
(1) Abstain from smoking Major single cause of cancer death in US Most preventable cause of premature death

(2) Dietary Eat variety of foods, with emphasis on plant sources Limit consumption of red meat, especially high in fat and processed

Primary Prevention continued

Avoidance of causative agent
(3) Adopt a physically active lifestyle Moderate activity 30 minutes or more 5x or more days of the week Vigorous activity 45 minutes or more further decrease risk of breast and colon cancer (4) Maintain a healthy weight throughout lifetime Overweight increase risk of cancer breast, colon, endometrium, kidney, etc.

Primary Prevention continued

(5)Alcoholic beverage limit consumption Alcohol increases risk of cancers of mouth, pharynx, larynx, esophagus, liver, breast, colon (6) Sunlight & Ultraviolet Exposure UV exposure can increase skin cancer risk Actinic keratosis small (<1/4 inch) rough or scaly spots. Found on face, ears, back of hands, arms. Can turn into squamous cell carcinoma Two types of UV (a) UVA and (B) UVB Both cause damage of DNA of skin Artificial sources of UV sunlamps, tanning booths- may increase source of skin cancer

Avoidance of causative agent

Preventing Cancer
Avoid tobacco Control diet and weight Exercise regularly Protect skin from sun

Avoid environmental and occupational carcinogens

Be aware of warning signs, and get recommended screening tests

Preventing Cancer

Secondary Prevention Early detection, screening

Secondary Prevention early detection

Methods
1) Inspection 2) Palpation 3) Use of tests or procedures screening recommendations
Women Self breast exam monthly Over 40 mammogram Men Prostate rectal exam 40 years old yearly Both Men & Woman Colon & Rectum at 50 baseline colonoscopy and follow up colonoscopy q10years

Tertiary Prevention Treatment, symptom control, rehabilitation

Tertiary prevention reducing morbidity by Prompt, effective treatment Symptom control Rehabilitation Reconstructive surgery after breast cancer Surgery to reverse a temporary colostomy after colon cancer treatment Strategies to maintain quality of life

Diagnosis of Cancer

Health history
Identification of risk factors Physical exam Diagnostic procedures

Clinical Manifestations of Cancer

Depends on size and site

Local Effects

Benign obstruct lumen of tubular structure such as ureters,

trachea, or intestinal tract Intraspinal or intracranial pressure within the close space

Malignant
Destroy or infiltrate surrounding tissues Obstruction Hemorrhage Ulceration Secondary infection

Systemic Effects
Problems Cause

Vascular

Hemorrhage

Blood vessel erosion by tumor Degenerative changes as in central nervous system and respiratory Malabsorption, chronic blood loss, impaired digestion Metastastic implant in abdomen in pleural cavity

Neuromuscular

Cachexia, weakness, cerebellar disease, pneumonia Weakness, fatigue, weight loss Ascitis, pleural effusion

GI

General disorders

Clinical Signs
Cachexia sign of advanced cancer Anorexia Early satiety & early filling Weight loss Anemia

Pain 75% of pt will experience pain. Incidence and severity depends on site

Diagnostic Tests
Labs CBC, H/H, WBC Blood or serum Calcium increases
Hypercalcemia is often associated with malignant disease. Causes of elevated serum-calcium levels in the absence of bony metastases; (a) parathyroid-hormone production by the tumor (b) osteolytic factors made by the tumor (dissolution of bone, especially the loss of calcium from bone) coexistent primary hyperparathyroidism

Acid phosphatase increases

an enzyme that works under acid conditions and is made in the liver, spleen, bone marrow and the prostate gland. Abnormally high serum levels of the enzyme may, for example, indicate prostate disease (infection, injury, or Cancer).

Diagnostic Tests
Tumor markers
PSA prostate specific antigen (0.4ng/ml) increases

CEA carcino embryonic antigen

Most commonly ordered when a patient has a cancer of the GI system-colon, rectum, stomach, esophagus, liver, or pancreas Once treatment for the cancer has begun, CEA tests have a valuable role in monitoring the patient's progress. A decreasing CEA level means therapy is effective in fighting the cancer. A stable or increasing CEA level may mean the treatment is not working, and/or that the tumor is growing.

AFP Alpha-fetoprotein
Used to detect tumors that mark cancers of the liver, testes, ovaries The higher the AFP level in patients with cancer, the bigger the tumor. AFP decreases when your body responds to anti-cancer therapy. If AFP does not return to normal within about one month after cancer therapy, some of the tumor may still be present.

Common Cancers: Lung Cancer

Leading cause of cancer death Chief risk factor = smoking

Estimated causes about 3000 lung cancer deaths per year

Symptoms = persistent cough, chest pain

Treatment = combination of surgery, radiation, chemotherapy

Survival rate = 15% after five years

Common Cancers: Colon and Rectal Cancer

Second leading cause of cancer death Risk factors Age Preexisting polyps

Heredity
Inactivity and obesity

Diets high in red meat, smoked foods, simple sugars

Excessive alcohol consumption

Smoking

Common Cancers: Colon and Rectal Cancer

Symptoms Bleeding from the rectum Change in bowel habits

Testing Stool blood test Sigmoidoscopy or colonoscopy

Treatment Surgery is primary method of treatment

Common Cancers: Breast Cancer

Most common cancer in women and second to lung cancer in the number of cancer deaths among women Causes/risk factors Heredity Long-term exposure to high blood levels of estrogen Early onset of menstruation Late onset of menopause No children or first child after age 30 Obesity Current use of Hormone Replacement Therapy HRT Alcohol use Inactivity Diet low in vegetables and fiber

Common Cancers: Breast Cancer

Early detection Mammography (low-dose X ray) after age 40 Clinical breast exams Breast awareness and self-examinations Diagnosis Ultrasonography = imaging method using high-pitched sound Biopsy = removal and examination of a small piece of body tissue Treatment Surgery (lumpectomy, mastectomy) Chemotherapy or radiation, social support

Common Cancers: Prostate Cancer

Most common cancer in men and second to lung cancer in the number of cancer deaths among men Risk factors Age African American ethnicity Heredity Lifestyle factors Diets high in calories, dairy products, and animal fat and low in plant foods Obesity and inactivity History of STDs

Common Cancers: Prostate Cancer

Detection and diagnosis Rectal exam PSA (prostate-specific antigen) blood test Ultrasound Biopsy Treatment Surgery Radioactive seeds Survival rate = 98% at 5 years

Cancers of the Female Reproductive Tract

Cervical cancer Linked to infection with HPV (genital warts)

Detected with the Pap test = scraping of cells from the cervix for examination
Abnormal cells are monitored over time; if they progress toward malignancy, they are removed

Cancers of the Female Reproductive Tract

Uterine or endometrial Cancer
Risk factors similar to those for breast cancer

Usually detected by pelvic examination

Treatment = surgery, possibly combined with radiation and chemotherapy Survival rate = 96% at 5 years

Cancers of the Female Reproductive Tract

Ovarian cancer Risk factors similar to breast and endometrial cancer Anything that lowers the lifetime number of ovulation cycles reduces risk Usually has no symptoms and is difficult to detect Treatment = surgery Survival rate is low due to late detection Other female reproductive tract cancers Clear cell cancer of vagina or cervix is more common among daughters of women who took DES during pregnancy

Skin Cancers
Most common type of cancer when cases of the highly curable forms are included Primary risk factor is exposure to ultraviolet (UV) radiation UVA = longer wavelength; damages connective tissue, leads to premature aging of the skin, causes skin cancer

UVB = shorter wavelength; causes sunburn, damages eyes and immune system, causes skin cancer

Skin Cancers

Basal cell carcinoma = cancer of the deepest layers of the skin

Squamous cell carcinoma = cancer of the surface layers of the skin Melanoma = a malignant tumor of the skin that arises from pigmented cells, usually a mole; the most dangerous form of skin cancer

ABCD Test for Melanoma

Preventing Skin Cancer

Cover to protect skin -Wear long-sleeved shirts, long pants, hats Use sunscreen - a broad-spectrum sunscreen with a high SPF (30+) Apply sunscreen 30 minutes before sun exposure, 1530 minutes after exposure begins, and frequently after that; apply extra if you are using DEET Avoid sun exposure between 10 AM and 4 PM Wear sunglasses that block UV Check UV index Avoid tanning salons

UV Index

Common Cancers
Oral cancer Key risk factors are tobacco use (including spit tobacco) and consumption of alcohol Easy to detect but difficult to treat Testicular cancer Rare overall, but most common cancer in men age 2035 years Can be detected with self-examination

Other Cancers
Pancreatic cancer = very deadly form of cancer Bladder cancer Kidney cancer Brain cancer

Leukemia = cancer of white blood cells

Lymphoma = cancer that begins in the lymph nodes

Diagnosis of Cancer
Clinical History and Presentation

Biopsys (1) Incisional Biopsy

This refers to the removal of part of the tumor from the larger tumor mass. An incisional biopsy is employed for tumors located deep within the body and after an initial needle biopsy has failed to supply enough tissue for diagnosis.

(3)Needle Aspiration
Biopsy Removal of a sample of fluid and cells through a needle.

(2) Excisional Biopsy Also known as surgical biopsy, the excisional biopsy entails the surgical removal of the entire tumor mass and is a diagnostic technique that simultaneously serves as a treatment

Tissue Sampling (4)Cytology Biopsy- deals

with the formation, structure, and function of cells The removal and examination of a sample of tissue for diagnostic purposes

Diagnostic Tests
Bone scanning
A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected and travels through the bloodstream. It collects in the bones, especially in abnormal areas of the bones, and is detected by special instrument called a scanner. The image of the bones is recorded on a special film for permanent viewing.

Direct Imaging Tests

Fiberoptic endoscopy - use of a very flexible tube with a lens or
camera (and a light on the end), which is connected to a computer screen, allowing the physician to see inside the body cavities, such as the uterus or upper GI, to examine the area in question for any abnormality Biopsy samples can be taken through the tube.

Diagnostic Testing

Indirect Imaging tests, such as:

x-ray non-invasive Computed tomography (CT or CAT scan) - a non-invasive
procedure that takes cross-sectional images of the brain or other internal organs; to detect any abnormalities that may not show up on an ordinary xray. The CT scan may indicate enlarged lymph nodes - a possible sign of a spreading cancer or of an infection.

Radionuclide scan - an imaging scan in which a small amount of

radioactive substance is injected into the vein. A machine measures levels of radioactivity in certain organs, thereby detecting any abnormal areas or tumors.

Diagnostic Testing Indirect Imaging Tests

Ultrasound non-invasive -an imaging technique that uses sound
waves to produce an image on a monitor of the abdominal organs, such as the uterus, liver, and kidneys. A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echo patterns are shown on the screen of an ultrasound machine, forming a picture of body tissues called a sonogram or ultrasonogram

Magnetic resonance imaging (MRI) - a non-invasive procedure

that produces a two-dimensional view of an internal organ or structure, especially the brain and spinal cord. The MRI may show abnormal nodules in bones or lymph nodes - a sign that cancer may be spreading.

Mammogram non invasive -A low voltage X-ray photograph of the

breast. It allows early detection of malignant or benign tumors and other microcalcification-containing lesions

Diagnostic Testing

Indirect Imaging Tests

GI Series (a) Upper GI -X-rays of the esophagus, stomach, and duodenum (the first section of the small intestine). The patient swallows barium first. Barium makes the organs show up on x-rays. The upper GI series can show a blockage, abnormal growth, ulcer, or a problem with the way an organ is working. (b) Lower GI -X-rays of the rectum, colon, and lower part of the small intestine. A barium enema is given first. Barium coats the organs so they will show up on the x-ray. Barium enema is used to check for tumors of the colon and rectum. It also can check for polyps (abnormal growths attached to the intestinal lining by a stalk), diverticulosis or other problems.

Lab Studies
Tumor markers are measurable biochemicals that are associated with a
malignancy. They are either produced by tumor cells (tumor-derived) or by the body in response to tumor cells (tumor-associated). They are typically substances that are released into the circulation and thus measured in the blood

CEA (carcinoembryonic antigen) is a protein found in many types of cells but

associated with tumors

PSA - Prostate-specific antigen. A substance produced by the prostate that

may be found in an increased amount in the blood of men who have prostate cancer, benign prostatic hyperplasia, or infection or inflammation of the prostate

Acid Phosphatase - an enzyme found throughout the body, but

primarily in the prostate gland. Acid phosphatase testing is done to diagnose whether prostate cancer has metastasized and to check the effectiveness of treatment.

Lab Studies
CBC A complete blood count (CBC) provides important information about the
RBC red blood cells , WBC white blood cells , and platelets.

A CBC evaluate symptoms (such as weakness, fatigue, or bruising) and diagnose conditions (such as anemia, infection, and many other disorders) and diagnose diseases of the blood, such as leukemia. The number of white blood cells is sometimes used to identify an infection or monitor the body's response to cancer treatment. Monitor the response to some types of drug or radiation treatment.

Hemetest- detects blood in stool

CA-125 -A protein that can be made by abnormal ovary cells. It can be

a tumor marker. If it is present in high levels in the blood or in other body fluids or tissues, it may be a sign of ovarian cancer

Diagnostic Testing
laboratory tests to examine any/all of the following: blood urine other fluids tumor tissue

biopsy to remove a sample of the suspicious tissue for examination in a laboratory by a pathologist
Thinprep - A Pap Test Alternative Approved by the US Food and Drug Administration (FDA), Thinprep is a liquid-based procedure in which cells from the cervix are put into a vial of liquid instead of being "smeared" onto a slide. The liquid is then filtered and only the cervical cells are placed onto a slide for examination.

Medical Treatment of Cancer

Surgery Radiation Therapy

Chemotherapy
Biotherapy Bone Marrow Transplant

Radiation Therapy
Ionizing radiation destroys cells ability to produce by damaging its DNA Cellular sensitivity varies throughout cell cycles

Safety time of exposure, distance from time of exposure, distance from source, amount of shielding source
Stay at least 6 feet away when not giving direct External Source is outside body Beam aimed at specific spot Marked with marker Protect area from heat or cold High protein, high calorie, high fluid intake (2-3 quarts)

Radiation Therapy Internal Radiation Therapy

Internal Radiation Therapy Source is placed inside the body Sealed or unsealed Radiation is emitted

Radiation Therapy Internal Radiation Therapy Sealed radiation

Sealed source of radiation intracavity, interstitial Radioisotope cannot circulate thru clients body nor contaminate urine, blood or vomit. Body fluids NOT contaminated Clients excretion- not radioactive Private room properly labeled Private room properly labeled No children under 18 or anyone pregnant Wear film badge Prevent dislodgment Monitor VS every four hours Accurate I&O usually have a usually have a foley Active ROM

Radiation Therapy Unsealed Source Radiation

Administered intravenously or orally Used in systemic system
Colloid suspension into body tissue Iodine 131 Graves disease, thyroid cancer Strontium chloride (Metastron) for bone metastasis

Radioisotopes do circulate through the body fluids. Sweat, blood, urine, and vomit contains radioactive isotopes

Body fluids are contaminated special care special care

Flush at least three times Disposable equipment Wear shoe covers, protective equipment Dosimeter- device used to measure an individual's exposure to a hazardous environment

Radiation Safety Standards

Distance distance & radiation exposure is inversely related Time 30 minutes per 8 hour shift Shielding lead shield Private room & bath Shields, lead container, & long-handled forceps in client room If source is dislodged use forceps to pick up and place in the lead container Notify radiation safety officer

Wear film badge or dosimeter do not share

Client with Implant

Remember Sealed radiation Sealed source of radiation intracavity, interstitial Radioisotope cannot circulate thru clients body nor contaminate urine, blood or vomit Body Fluids NOT Contaminated Clients excretion- not radioactive

Implant in abdominal cavity

Confined to bed Indwelling catheter inserted and low fiber diet No bowel movement before the device is removed in 2-3 days

Internal Radiation with Unsealed Sources

Remember that Unsealed Source Radiation is; Administered intravenously or orally Used in systemic system Radioisotopes do circulate through the body fluids. Sweat, blood, urine, and vomit contains radioactive isotopes

Body fluids are contaminated special care

Internal Radiation with Unsealed Sources

Private room and bath

Precautions on all secretions

Wear gloves if handling body fluids Emesis after ingesting oral isotope cover with absorbent pad and notify radiation safety officer Use of disposable utensils Covering floor areas with chux, papers Flush toilet at least 3 times after each use Limited visitor and staff contact

Nursing Management
Provide Education Skin care within the treatment field Keep skin dry Wash with mild soap, rinse well, pat dry Use cool water, not hot Do not remove lines or ink marks Protect skin from exposure to sunlight, chlorinated swimming pools, extreme temp Minimize side effects

Chemotherapy
Reduce or slow the growth of cancer Anti-neoplastic agents; anti-cancer agents

Interfere with cells replication process therefore damaging the cell and causing cell death
Different types of cancer respond differently to various combinations of chemotherapy

Side Effects of Chemotherapy

Most dangerous bone marrow suppression Nausea & vomiting

Alopecia
Stomatitis Heart Failure

Biotherapy
boost marrow function: the hematopoietic growth factors
Agents that affect the biological process
Colony stimulating factors - granulocyte colony-stimulating factor
(G-CSF) and granulocyte-macrophage colony-stimulating factor (GMCSF) to increase granulocyte production

Monoclonal antibodies (mAb) are antibodies that are identical

because they were produced by one type of immune cell, all clones of a single parent cell

Erythropoietin stimulate RBC production Neumega stimulates platelet production

Medical Emergencies
The bone marrow produces 3 main types of mature blood cells:
platelets red blood cells white blood cells.

Myelosuppression
reduction of bone marrow to produce blood cells. any or all of the three main types of blood cells that are normally produced in the bone marrow are decreased in number and/or may take a prolonged period of time to return to "normal levels Patients may be at an increased risk of infection or bleeding or may experience symptoms from anemia.

myelosuppression is the most common side effect that causes

chemotherapy treatment delays or chemotherapy treatment dose reductions

Medical Emergencies- continued

Neutropenia decreased WBC Thrombocytopenia- decreased platelets
Neutropenia =A reduced white blood cell count lowers resistance to infection may cause delay in patient receiving chemotherapy

Thrombocytopenia (low platelet count) Platelets - prevent bleeding by causing coagulation Decreased platelets s/s Bruising easily Nosebleeds Excessive bleeding from cuts, wounds, gums (brushing teeth), blood in urine/stool

Medical Emergencies- continued

Thrombocytopenia Platelet count normal 150,000-400,000mm When platelet count is less than 20,000 pt has risk of hemorrhage Chemo is withheld until platelets increase to >100,000

Nursing Management Pt Teaching

Thrombocytopenia Use soft toothbrush to avoid bleeding gums When shaving, use electric razor Avoid constipation, enemas, rectal temps Do not use products that contain aspirin, NSAID Avoid IM or sc injection Notify MD/RN if petechiae, bruising, frank or tarry stools, change in color of urine frank blood, dark amber, bleeding from any part of body such as nosebleed

Nursing Management
Minimize Side Effects of Nausea and Vomiting Serotonin receptor antagonists such as Ondasetron (Zofran) Granisetron (Kytril) Dolasetron (Anzemet) Avoid offensive odors Small frequent feedings rather than 3 big meals Adjust oral and fluid intake Relaxation exercises, hypnosis, etc.

Nursing Care of Client with Cancer

Treatment Phase Varies on type of cancer Side effect treatment Neutropenia precautions Nutrition Activity Intolerance Pain control Grieving Terminal Phase Hospice Grief counseling for both patient and family

Diagnostic Phase Support Denial common Stress signs may be due to something other than cancer Educate on effects of delaying treatment

References
American Cancer Society www.cancer.org Chemo, Radiation & Cancer Therapy Center, Cancer Help Online, A division of Health Centers Online http://cancer.healthcentersonline.com/chemoradiationcancerther apy/?WT.srch=1 Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness www.umich.edu/~exphysio/ mvs.240/Lectures/Cancer.ch12.ppt Health A to Z Innovating Consumer Health http://www.healthatoz.com Lab Tests Online http://www.labtestonline.org

National Cancer Institute http://www.cancer.gov