Loading presentation...

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

Make your likes visible on Facebook?

Connect your Facebook account to Prezi and let your likes appear on your timeline.
You can change this under Settings & Account at any time.

No, thanks

Cancer

No description
by

Kathrin Brewer

on 17 March 2014

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of Cancer

Cancer
Cancer
2. Ineffective tissue perfusion and decreased cardiac output R/T chemotherapy-induced cardiac toxicity and capillary leak system
SCDS: Nursing Diagnosis
General Lab Values/Findings
1. Perform hand hygiene with patient.
Interventions
Within breast tissue, lobules & ducts are lined with epithelial cells, which can grow uncontrolled, forming a malignant tumor.
Cancerous cells then invade surrounding breast tissue.
Can metastasize to other areas of the body
Occurs in men (also have ducts & lobules) & women, though 100 times more often in women.
Breast Cancer
Refer to handout.
Treatment/medication options
Need
Education
Interventions
Assessment
Endometrial Cancer
Assessment
Nursing Diagnosis
Expected Lab Values/Findings
Interventions
Prevention Education
Nursing Diagnosis
Lab Values
Ovarian Cancer
Assessment
Lab Values
Nursing Diagnosis
Interventions
Education
Treatment/medication options
-Elevated/lowered sodium, elevated potassium,
elevated creatine and BUN, elevated liver
function tests.

-Lowered WBC, platelets, RBC, Hgb, Hct
- Increased levels of epinepherine, norepinepherine,
metanephrine,and vanillylmandelic acid
-Elevated CA125 antigen (tumor marker)
-Elevated CEA (carcinoembyronic antigen)
-Positive HCG (human chorionic gonadoropin)
-Elevated LDH (Lactate Dehydrogenase)
Nonneoplastic growth patterns:

1. Hypertrophy
2. Hyperplasia
3. Metaplasia
4. Dysplasia
Risk Factors:
1. Age
2. Hormones
3. Immune Dysfunction
4. Drugs and chemicals
5. Tobacco
6. Nutrition and Physical
Activity

7. Sexual Activity
8. Alcohol
9. Radiation
10. Viruses
11. Psychosocial aspects
**Smoking cessation and diet regulation
are key preventive measures.
1. Risk for infection R/T skin reactions, skin breakdown, multiple invasive lines, and myelosuppression.
3. Risk for impaired gas exchange and ineffective airway clearance R/T chemotherapy, biotherapy, and transplant-induced pulmonary toxicity.
4. Activity intolerance R/T fatigue, bone marrow suppression, anorexia, and hepatotoxicity.
5. Imbalanced nutrition:less than body requirements R/T chemotheryapy and biotherapy-induced nausea, vomiting, hepatotoxicity, and anorexia.
6. Pain R/T skin reactions, chemotherapy-induced pancreatitis, chemotherapy and bio therapy-induced neuoropathy and bone pain, invasive procedures and disease.
Include, but not limited to:
2. Monitor vital signs, and report any
changes to a health care provider
3. Instruct patient to cough and deep breathe.
Risk for Infection
Ineffective tissue perfusion
Risk for impaired gas exchange
4. Encourage frequent rest periods.
Activity intolerance
5. Monitor accurate intake and output and then record.
Imbalanced nutrition
6. Provide complementary strategies to relieve pain and discomfort such as: guided imagery, relaxation techniques, distraction, and cutaneous stimulation.
Pain
Risk Factors
-Obesity
-Early menarche
-Late menopause
- Nullipara
-Infertility
-DM
-HTN
-Family history
- Tamoxifen
therapy
- Hormone imbalance
Subjective/Objective
-Abnormal uterine
bleeding
-Non bloody vaginal
discharge
-Lower back pain
-Lower pelvic pain


Late Symptoms
- Uterine
enlargement
- Weight loss
*Diagnosed with Biopsy.
Fallopian Cancer
Assessment
Education
Treatment/Medication
Cervical Cancer
Assessment
Vulvar Cancer
Assessment
Education
Treatment/Medication
-Elevated CA125 for advanced
endometrial Cancer.

- Typically diagnosed with a Biopsy.
*Treated with hysterectomy.
-Impaired tissue integrity R/T disruption of tissue associated with hysterectomy.
1. Assess for and report signs and symptoms of impaired wound healing (e.g. increasing periwound swelling and redness, pale or necrotic tissue in wounds healing by secondary intention, separation of wound edges in wounds healing by primary intention).

2. Instruct and assist client to splint abdominal wounds when coughing.


Risk Factors:
- HPV
-smoking
-immunosuppression
-multiple partners
- chlamydia infection
-taking oral contraceptives
longer than 5 years

Physiology: Cervical cancer occurs when abnormal cells on the cervix grow out of control.
Signs and symptoms:
-Pre-invasion is often asymptomatic
-Pain during sex
-Invasion shows postcoital bleeding
-Late symptoms include: rectal bleeding,
hematuria, back
and leg pain, and
anemia

Signs and Symptoms:
Ovarian and fallopian cancers share the same assessment protocol

*Fallopian cancer is typically
secondary to
, so inspection of nearby tissue for lesions is critical
-young age with first pregnancy
-genetic predisposition
-poverty
-race
*Treated with removal of pelvic lymph nodes, partial hysterectomy, or total hysterectomy or a combination.
Treatments
1. Surgery (pain, infection)

2. Radiation (fatigue, immunosuppression, N/V)

3. Chemotherapy
(pain,
alopecia, N/V, diarhhea, mouth sores, fatigue)

Risk Factors:
- Smoking
- Lichen schlerosis
- Other genital cancers
- Melanoma
Symptoms:
- Vulvar puritus
- Burning pain
- Tumor growth
- Raw surface
- white rough area in vagina
- Local wide excision
- Vulvectomy
- External Radiation
Questions to ask your patient:

1. When did you first have sex?
2. How many partners have you had?
3. Have you ever had an abnormal pap smear?
4. When did you start to notice changes?
5. Have you ever been tested for HPV?

How can I prevent it?!

Elevated CA125 (antigen, tumor marker)



Elevated CEA (carcinoembryonic antigen,
tumor marker)

smokers > 4.0 ng/mL
nonsmokers > 2.4 ng/mL
Abnormal: >35 IU/mL
-Test HCG (human chorionic gonadotropin) to see response to treatment

- Radiographic
imagining such as:
x-ray, CT scan, and
Mammogram
- Ultrasonic studies
- Biopsies
-Monoclonal Antibodies
-Targeted Therapies
- Nitrogen Mustards
- Antimetabolites
- Vinca Alkaloids
- Taxanes
- Hormone Therapy
Medications:
Treatment:
- radiation - chemotherapy
- biotherapy - mastectomy
- lymphnode removal - hypnosis
- removal of the mass
(effective for pain,
reducing distress
and other side effects
associated with cancer)
7. Disturbed body image related to skin reactions, alopecia, long-term venous access devices, decreased sexual function, role changes, and other cancer treatments.
Disturbed body Image
7. Assess patient's feelings about body image and level of self esteems. Validate concerns.
- Disturbed body image related to
mastectomy or alopecia (hair loss)
- Deficient knowledge r/t disease process
1. Provide information to the patient regarding the
disease process.

2. Encourage patient to use pain control measures
before pain becomes severe.

3. Help the patient select cosmetic devices
that increase sense of attractiveness.
Teaching and discharge priorities for Post-Mastectomy Breast Cancer
Teaching
Knowledge of disease
process and prognosis
Home care: verbal & written instructions for: follow-up treatment plan for physical therapy, chemotherapy, and hormone therapy; activity restrictions; follow-up visit with surgeon.
Understanding of
medications
Use of analgesics and oral tamoxifen. Includes purpose, does, and side effects.
Care of chest wound
and reconstruction
Importance of keeping wound clean. Wounds should be kept dry for
48 hours, then washed gently according to directions. Look at surgical wound daily for redness, drainage or swelling. Check temp daily.
Disease prevention
Encourage to avoid those with
upper respiratory infections.
Avoid obesity, avoid injury or
infection to the affected arm, and reducing hand use to lower
the risk for lymphedema
Lymphedema
prevention or
control
If edema begins, teach patient use of deep breathing, abdominal massage, axillary clearance, gentle manipulation of the arm, use of the compression sleeve, proper skin care, and avoidance of constriction of the arm or axilla.
Vaginal Cancer
References
Pathophysiology
Diagnosed By:
Cancer in Situ
(confined to mammary ducts or lobules)

Paget's Disease
(intraductal carcinoma spreads, invading epidermis of nipple and areola; presents as chronic, crusting rash of nipple)

Inflammatory Breast Cancer
(cancer cells block lymph vessels in skin, causing inflammation; breast is red, warm, swollen; induration & peau d'orange, rarely a mass)

Invasive or infiltrative carcinoma
(most common BC, begins in lobules or ducts, invades surrounding fatty breast tissue, usually upper outer quadrant)
- Gender
- Age
- Genetics
- Ethnicity
- BRCA mutations
- Family history
- History of breast cancer
- Childbirth

- Oral contraceptive use
- Hormone replacement therapy
- Alcohol
- Overweight or Obesity
- High-fat diet
- Night work
- Abnormal breast biopsy report
- Menstrual periods
- Previous chest radiation
Risk Factors:
Health Promotion
- Clinical Breast Exam, yearly
- Self Breast Exam, monthly (Males also!)
- Mammogram every 2 years after age 40.
- Maintain healthy weight
- Avoid excessive alcohol use
- Caution use of hormone replacement therapy
during menopause
- Encourage physical activity
- Promote breast feeding

Signs and symptoms:
- hard, painless, irregulary shaped mass, usually in upper-outer quadrant
- poorly defined, irregular margins
- mass fixed to surrounding skin and soft tissue
- skin dimpling, or puckering
- assymetry
- itchy, scaly sore or rash on the nipple
- enlarged lymph nodes in surrounding area
- swelling, warmth, redness
- change in breast size and shape
- darkening of breast
- inverted nipple
- sudden nipple discharge
- new pain in one spot that does not go away
Burges, A. & Schmalfeldt, B. (2011). Ovarian cancer: Diagnosis and treatment. Deutsches Ä rzteblatt International, 108(308), 635-41.
Chen, L. & Powell, C. (2006). Combating ovarian cancer with salpingo-oophorectomy. Contemporary OB/GYN, 5, 86-92.
Clarke, L. & Bailey, C. (2010). Managing women with ovarian cancer: The role of the nurse. Nursing Standard, 25(5), 41-49.
Koman.org. (2014). Breast cancer risk factors table. Retrieved from http://ww5.komen.org/BreastCancer/BreastCancerRiskFactorsTable.html.
Mayoclinic.org. (2012). Vulvar cancer definition. Retrieved from http://www.mayoclinic.org/ diseases-conditions/vulvar-cancer/basics/definition/con-20043483.
OMIM. (2014). Breast cancer 1 gene; BRCA1 (113705). Retrieved from http://omim.org/entry/113705.
Osborn, K., Wraa, C., Watson, A. & Holleran, R. (2014). Caring for the patient with female reproductive disorders in Medical-surgical nursing, 1254-85. Upper Saddle River, NJ: Pearson.
Porth, C. (2011). Essentials of pathophysiology (3rd Ed.). Lippincott Williams & Wilkins: Philadelphia, PA.
Rooth, C. (2013). Ovarian cancer: Risk factors, treatment, and management. British Journal of Nursing, 22(17), 23-30.
Sparks-R. & Taylor, C. (2013). Sparks & Taylor’s nursing diagnosis reference manual (9th Ed.). Lippincott Williams & Wilkins: Philadelphia, PA.
WebMD.com. (2011). General Information About Vaginal Cancer. Retrieved from http://www.webmd.com/cancer/tc/vaginal-cancer-treatment-patient-information-nci-pdq- general-information-about-vaginal-cancer.

Burges, A. & Schmalfeldt, B. (2011). Ovarian cancer: Diagnosis and treatment. Deutsches Ä rzteblatt International, 108(308), 635-41.
Chen, L. & Powell, C. (2006). Combating ovarian cancer with salpingo-oophorectomy. Contemporary OB/GYN, 5, 86-92.
Clarke, L. & Bailey, C. (2010). Managing women with ovarian cancer: The role of the nurse. Nursing Standard, 25(5), 41-49.
Koman.org. (2014). Breast cancer risk factors table. Retrieved from http://ww5.komen.org/BreastCancer/BreastCancerRiskFactorsTable.html.
Mayoclinic.org. (2012). Vulvar cancer definition. Retrieved from http://www.mayoclinic.org/ diseases-conditions/vulvar-cancer/basics/definition/con-20043483.
OMIM. (2014). Breast cancer 1 gene; BRCA1 (113705). Retrieved from http://omim.org/entry/113705.
Osborn, K., Wraa, C., Watson, A. & Holleran, R. (2014). Caring for the patient with female reproductive disorders in Medical-surgical nursing, 1254-85. Upper Saddle River, NJ: Pearson.
Porth, C. (2011). Essentials of pathophysiology (3rd Ed.). Lippincott Williams & Wilkins: Philadelphia, PA.
Rooth, C. (2013). Ovarian cancer: Risk factors, treatment, and management. British Journal of Nursing, 22(17), 23-30.
Sparks-R. & Taylor, C. (2013). Sparks & Taylor’s nursing diagnosis reference manual (9th Ed.). Lippincott Williams & Wilkins: Philadelphia, PA.
WebMD.com. (2011). General Information About Vaginal Cancer. Retrieved from http://www.webmd.com/cancer/tc/vaginal-cancer-treatment-patient-information-nci-pdq- general-information-about-vaginal-cancer.

Most lethal of all genital cancers
Risk factors: BRCA1 SNPs & "ovulatory age"
- higher risk associated w/ nulliparity
Very difficult to detect
- Early warning signs are nonspecific
- Abdominal pain, rapid satiety, urinary frequency, abnormal bleeding
Risk for Malignancy Index (RMI) score:
(Ultrasound)(Menapausal status)(CA125)
CA125 > 35IU/mL
- non-specific
- not necessarily pathological
Powerlessness r/t perceived loss of control over life situation 2° to ovarian/fallopian cancer AEB....

Deficient knowledge r/t ovarian/fallopian cancer and associated treatment protocol AEB....
Primary intervention is surgery
- debulk
- stage/diagnose
- surgery is diagnostic, preventive, and curative
Secondary intervention is chemotherapy
- radiation is controversial for this type of cancer
1. Realistic goals (e.g., POA, employer/family conversations)
2. MDT should positively reinforce independent self-care
3. Pt should take active role in social/recreational activities
4. Recognize pt's right to express feelings
5. Encourage education from MDT
Signficantly more rare than ovarian cancer
Risk factors are same as ovarian (i.e., BRCA1 SNPs and "ovulatory age")
Equally as challenging to detect as ovarian
RMI score still valid
Primary intervention is surgery
- debulk
- stage/diagnose
- surgery is diagnostic, preventive, and curative
Secondary intervention is chemotherapy
- radiation is controversial for this type of cancer
Diagnostic procedures
Drug therapy
Surgical intervention
Post surgery care
Follow-up and monitoring
Vagina (birth canal)
epithelial lining: thin layer of
squamous
cells
some linings have glandular cells in areas instead of squamous cells- "
adenosis
"
Two main types of vaginal cancer
1. Squamous cell carcinoma
2. Adenocarcinoma
Vaginal Cancer
1. Squamous cell carcinoma
70% of vaginal cancers
begins in squamous cell lining
more common in ages 60-80
2. Adenocarcinoma
15% of vaginal cancers
begins in gland cells of lining
more common over age 50
Normal squamous or glandular cells change to pre-cancerous cells
Pre-cancerous cells turn into cancer cells, growing beyond epithelial layer
Can take several years
Untreated, cancer spreads from epithelial layer vaginal wall connective tissue nearby organs lymph nodes & distant organs
Assessment
Abnormal vaginal bleeding (often after intercourse)

Abnormal vaginal discharge

Palpable mass

Pain during intercourse

Painful urination

Constipation

Continuous pelvic pain
Risk Factors
Vaginal Cancer
Age
DES (Diethylstilbestrol)
Vaginal adenosis
HPV (human papilloma virus)
HIV (human immunodeficiency virus)
Smoking
Cervical cancer/pre-cancer
Uterine cancer/pre-cancer
Education
Encourage clients to modify risk factors
within their control, be proactive
(HPV vaccine, safe sex, quit smoking)

Symptoms often not evident until later stage

Routine pelvic exam & pap smear may detect cancer

Diagnostic tests & procedures:
pelvic exam, pap smear, colposcopy, biopsy

Vaginal Cancer
Vaginal Cancer
Presenting Symptoms
Vaginal Cancer
Education
Diagnosis & Intervention
Vaginal Cancer
Nursing Diagnosis
:

Disturbed body image related to decreased sexual function
Intervention:

Encourage dialogue between client and partner regarding sexual function
*Many women have NO known risk factors*
Pathophysiology
Types of Breast Cancer
Breast Cancer
Breast Cancer
Breast Cancer
- Acute pain r/t mastalgia (pain in breast),
tests, or procedures
Breast Cancer
Breast Cancer
Breast Cancer
Breast Cancer

1. Teach the client to observe her breasts in front of a mirror and in good lighting.
-Look for lumps, dimpling, deviation, and discharge
2.Teach to palpate while sitting upright or standing.
-Shower is easy
-Light, Medium, then Deep
3. Instruct the client to palpate her breasts again while lying down.
-Towel under shoulder
-Arm on head
4. Palpate the nipple for discharge
5 Instruct the client to keep a record of when she performs the BSE.
-5 days after menstrual cycle
6. Remind post-menopausal women they should still perform the exam monthly.

Breast self examiniation
Diagnostic procedures
Drug therapy
Surgical intervention
Post surgery care
Follow-up and monitoring
-Weight loss programs
-Hypertension control
-Insulin regulation
-Progestins(may cause breast cancer)
Questions to Ask
-Have you ever used Tamoxifin for breast cancer?

-Do you have a family history of gynecologic cancer?

-Do you currently take or have taken estrogen or progestins in the past?

-How long have you been menstrating?
Full transcript