Oncology Nursing

over view
Nursing Management of Patients
with Cancer
 Oncology Nursing

Prepared by

Dr. Hanaa Youssry Hashem

Associate professor of medical-surgical nursing

Faculty of Nursing- Cairo University

E-mail: [email protected]
Code of Conduct
 Objectives
At the end of this session students will be able to:
Identify concept of oncology.
Discuss the 7 common causes of cancer.
Compare between common characteristics of cancer and
benign tumor.
Explain the three common methods of Cancer Spread.
Identify the body defenses against TUMOR.
List the common methods of Cancer Diagnosis.
Be acquainted by cancer grading and staging.
List the 5 GENERAL MEDICAL MANAGEMENT of cancer.
Discuss the 4 GENERAL Promotive and Preventive
Nursing Management of cancer.
Utilize the ACS 7 Warning Signals while conducting
nursing assessment of cancer patients.
 Cont. Objectives
Apply Nursing Intervention to:
1. MAINTAIN TISSUE INTEGRITY
2. MANAGE STOMATITIS
3. MANAGE ALOPECIA
4. PROMOTE NUTRITION
5. RELEIVE PAIN
6. DECREASE FATIGUE
7. IMPROVE BODY IMAGE
8. ASSIST IN THE GRIEVING PROCESS
9. MANAGE COMPLICATION: INFECTION
10. MANAGE COMPLICATION: Septic shock
11. MANAGE COMPLICATION: Bleeding.
 Oncology defined

Branch of medicine that

deals with the study,
detection, treatment and
management of cancer and
neoplasia
 “Root words”
Neo- new
Plasia- growth
Plasm- substance
Trophy- size
+Oma- tumor
Statis- location
 Characteristics of
Neoplasia
Uncontrolled growth of Abnormal cells
1. Benign
2. Malignant
3. Borderline
 Characteristics of
Neoplasia
BENIGN
Well-differentiated
Slow growth
Encapsulated
Non-invasive
Does NOT metastasize
 Characteristics of
Neoplasia
MALIGNANT
Undifferentiated
Erratic and Uncontrolled Growth
Expansive and Invasive
Secretes abnormal proteins
METASTASIZES
 Nomenclature of
Neoplasia
Tumor is named according to:
1. Parenchyma, Organ or Cell
Hepatoma- liver
Osteoma- bone
Myoma- muscle
 Nomenclature of
Neoplasia
Tumor is named according to:
2. Pattern and Structure, either GROSS
or MICROSCOPIC
Fluid-filled CYST
Glandular ADENO
Finger-like PAPILLO
Stalk POLYP
 Nomenclature of
Neoplasia
Tumor is named according to:
3. Embryonic origin
Ectoderm ( usually gives rise to epithelium)
Endoderm (usually gives rise to glands)
Mesoderm (usually gives rise to
Connective tissues)
 MALIGNANT TUMOR
Named according to embryonic cell
origin
1. Ectodermal, Endodermal, Glandular,
Epithelial
Use the suffix- “CARCINOMA”
Pancreatic AdenoCarcinoma
Squamos cell Carcinoma
 CANCER NURSING
Review of Normal Cell Cycle
3 types of cells
1. PERMANENT cells- out of the cell cycle
 Neurons, cardiac muscle cell
2. STABLE cells- Dormant/Resting (G0)
 Liver, kidney
3. LABILE cells- continuously dividing
 GIT cells, Skin, endometrium , Blood cells
 CANCER NURSING
Cell Cycle
G0------------------G1SG2M
G0- Dormant or resting
G1- normal cell activities
S- DNA Synthesis
G2- pre-mitotic, synthesis of proteins for
cellular division
M- Mitotic phase (I-P-M-A-T)
 CANCER NURSING
Proposed Molecular cause of CANCER:
Change in the DNA structure altered
DNA function Cellular aberration
 cellular death
 neoplastic change
Genes in the DNA- “proto-oncogene” And
“anti-oncogene”
 CANCER NURSING
Etiology of cancer
1. PHYSICAL AGENTS
Radiation
Exposure to irritants
Exposure to sunlight
Altitude, humidity
 CANCER NURSING
Etiology of cancer
2. CHEMICAL AGENTS
Smoking
Dietary ingredients
Drugs
 CANCER NURSING
Etiology of cancer
3. Genetics and Family History
Colon Cancer
Premenopausal breast cancer
 CANCER NURSING
Etiology of cancer
4. Dietary Habits
 Low-Fiber
 High-fat
 Processed foods
 alcohol
 CANCER NURSING
Etiology of cancer
5. Viruses and Bacteria
DNA viruses- HepaB, Herpes, EBV,
CMV, Papilloma Virus
RNA Viruses- HIV, HTCLV
Bacterium- H. pylori
 CANCER NURSING
Etiology of cancer
6. Hormonal agents
DES
OCP especially estrogen
 CANCER NURSING
Etiology of cancer
7. Immune Disease
AIDS
 CANCER NURSING
CARCINOGENSIS
Malignant transformation
IPP
Initiation
Promotion
Progression
 CANCER NURSING
CARCINOGENSIS
INITIATION
Carcinogens alter the DNA of the cell
Cell will either die or repair
 CANCER NURSING
CARCINOGENSIS
PROMOTION
Repeated exposure to carcinogens
Abnormal gene will express
Latent period
 CANCER NURSING
CARCINOGENSIS
PROGRESSION
Irreversible period
Cells undergo NEOPLASTIC
transformation then malignancy
 CANCER NURSING
Spread of Cancer
1. LYMPHATIC
 Most common
2. HEMATOGENOUS
 Blood-borne, commonly to Liver and Lungs
3. DIRECT SPREAD
 Seeding of tumors
 CANCER NURSING
Body Defenses Against TUMOR
1. T cell System/ Cellular Immunity
 Cytotoxic T cells kill tumor cells
2. B cell System/ Humoral immunity
B cells can produce antibody
3. Phagocytic cells
 Macrophages can engulf cancer cell debris
 CANCER NURSING
Cancer Diagnosis
1. BIOPSY
 The most definitive
2. CT, MRI
3. Tumor Markers
 CANCER NURSING
Cancer Grading
The degree of DIFFERENTIATION
Grade 1- Low grade
Grade 4- high grade
 CANCER NURSING
Cancer Staging
1. Uses the T-N-M staging system
T- tumor
N- Node
M- Metastasis
2. Stage 1 to Stage 4
 CANCER NURSING
GENERAL MEDICAL MANAGEMENT
1. Surgery- cure, control, palliate
2. Chemotherapy
3. Radiation therapy
4. Immunotherapy
5. Bone Marrow Transplant
 CANCER NURSING
GENERAL Promotive and Preventive
Nursing Management
1. Lifestyle Modification
2. Nutritional management
3. Screening
4. Early detection
 SCREENING
1. Male and female- Occult Blood, CXR,
and DRE
2. Female- SBE, CBE, Mammography
and Pap’s Smear
3. Male- DRE for prostate, Testicular
self-exam
4
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 Nursing Assessment
Utilize the ACS 7 Warning Signals
CAUTION
C- Change in bowel/bladder habits
A- A sore that does not heal
U- Unusual bleeding
T- Thickening or lump in the breast
I- Indigestion
O- Obvious change in warts
N- Nagging cough and hoarseness
 Nursing Assessment
Weight loss
Frequent infection
Skin problems
Pain
Hair Loss
Fatigue
Disturbance in body image/ depression
 Nursing Intervention
MAINTAIN TISSUE INTEGRITY
Handle skin gently
Do NOT rub affected area
Lotion may be applied
Wash skin only with SOAP and Water
 Nursing Intervention
MANAGEMENT of STOMATITIS
Use soft-bristled toothbrush
Oral rinses with saline gargles/ tap
water
Avoid ALCOHOL-based rinses
 Nursing Intervention
 MANAGEMENT of ALOPECIA
Alopecia begins within 2 weeks of therapy
 Regrowth within 8 weeks of termination
 Encourage to acquire wig before hair loss
occurs
 Encourage use of attractive scarves and hats
 Provide information that hair loss is
temporary BUT anticipate change in texture
and color
 Nursing Intervention
 PROMOTE NUTRITION
 Serve food in ways to make it appealing
 Consider patient’s preferences
 Provide small frequent meals
 Avoids giving fluids while eating
 Oral hygiene PRIOR to mealtime
 Vitamin supplements
 Nursing Intervention
 RELIEVE PAIN
 Mild pain- NSAIDS
Moderate pain- Weak opiods
 Severe pain- Morphine
 Administer analgesics round the clock
with additional dose for breakthrough
pain
 Nursing Intervention
 DECREASE FATIGUE
 Plan daily activities to allow alternating
rest periods
 Light exercise is encouraged
 Small frequent meals
 Nursing Intervention
 IMPROVE BODY IMAGE
 Therapeutic communication is essential
 Encourage independence in self-care
and decision making
 Offer cosmetic material like make-up
and wigs
 Nursing Intervention
 ASSIST IN THE GRIEVING PROCESS
 Some cancers are curable
 Grieving can be due to loss of health,
income, sexuality, and body image
 Answer and clarify information about
cancer and treatment options
 Identify resource people
 Refer to support groups
 Nursing Intervention
 MANAGE COMPLICATION: INFECTION
 Fever is the most important sign (38.3)
 Administer prescribed antibiotics X 2weeks
 Maintain aseptic technique
 Avoid exposure to crowds
 Avoid giving fresh fruits and veggie
 Handwashing
 Avoid frequent invasive procedures
 Nursing Intervention
 MANAGE COMPLICATION: Septic
shock
 Monitor VS, BP, temp
 Administer IV antibiotics
 Administer supplemental O2
 Nursing Intervention
 MANAGE COMPLICATION: Bleeding
 Thrombocytopenia (<100,000) is the
most common cause
 <20, 000 spontaneous bleeding
 Use soft toothbrush
 Use electric razor
 Avoid frequent IM, IV, rectal and
catheterization
 Soft foods and stool softeners
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summary

Thank you