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Nursing Care of Clients with Cellular Aberration

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by

Chara Tira

on 4 August 2014

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Transcript of Nursing Care of Clients with Cellular Aberration

Hereditary
Age
Gender
Poverty
Stress
Diet
Infections
Cigarette Smoking and Tobacco Use
Recreational drugs
Obesity
Environmental Risk Factors
Sun exposure

Hereditary
Only a small portion of cancers are due to an inherited condition. If cancer is common in your family, it’s possible that mutations are being passed from one generation to the next. You might be a candidate for genetic testing to see whether you have inherited mutation that might increase your risk of certain cancers. Keep in mind that having an inherited genetic mutation doesn’t necessarily mean you’ll get cancer.
Subjective:
Health History
Subjective:
Risk Factors
Risk for Infection as Evidenced by tissue trauma or impaired immune response
Ineffective Protection as evidenced by impaired immunity related to cancer therapy or HIV disease
Ineffective Heath Management as evidenced by lack of preventive care or health screening
Planning for Health Promotion and Maintenance
1. Cancer Prevention and Control
Planning for Health Restoration
1. Surgery
a. Diagnostic
b. Primary Treatment
c. Prophylactic
d. Palliative
c. Reconstructive
ASSESSMENT
NURSING DIAGNOSIS
PLANNING
Nursing Care of Clients
with Cellular Aberration

Risk for trauma as evidenced by high-risk personal behaviors
Natural defense mechanisms are inadequate to protect them from the inevitable injuries and exposures that occur throughout the course of living.
Infections occur when an organism (bacterium, virus, fungus, or other parasite) invades a susceptible host.
If the host's (patient's) immune system cannot combat the invading organism adequately, an infection occurs.
Open wounds, traumatic or surgical, can be sites for infection; soft tissues (cells, fat, muscle) and organs (kidneys, lungs) can also be sites for infection either after trauma, invasive procedures, or by invasion of pathogens carried through the bloodstream or lymphatic system.

Transmission of Infection
Infections can be transmitted, either by contact or through airborne transmission, sexual contact, or sharing of intravenous (IV) drug paraphernalia.
Being malnourished, having inadequate resources for sanitary living conditions, and lacking knowledge about disease transmission place individuals at risk for infection.

Inadequate primary defenses: broken skin, injured tissue, body fluid stasis
Inadequate secondary defenses: immunosuppression, leukopenia
Malnutrition
Intubation
Indwelling catheters, drains
Intravenous (IV) devices
Invasive procedures
Rupture of amniotic membranes
Chronic disease
Failure to avoid pathogens (exposure)
Inadequate acquired immunity

Assess for presence, existence of, and history of risk factors such as:
Monitor white blood count (WBC).
Monitor for the following signs of infection:
• Redness, swelling, increased pain, or purulent drainage at incisions, injured sites, exit sites of tubes, drains, or catheters.
• Elevated temperature.
• Appearance of urine.
• Color of respiratory secretions.


Assess nutritional status, including weight, history of weight loss, and serum albumin.
Assess for history of drug use or treatment modalities that may cause immunosuppression
Altered health maintenance reflects a change in an individual's ability to perform the functions necessary to maintain health or wellness.
Risk Factors:
Presence of adverse personal habits
Evidence of impaired perception
Low income
Lack of knowledge
Poor housing conditions
Risk-taking behaviors
Inability to communicate needs adequately (e.g., deafness, speech impediment)
Dramatic change in health status
Lack of support systems
Denial of need to change current habits

Behavioral Characteristics
• Demonstrated lack of knowledge
• Failure to keep appointments
• Expressed interest in improving behaviors
• Failure to recognize or respond to important symptoms reflective of changing health state
• Inability to follow instructions or programs for health maintenance
Physical Characteristics
• Body or mouth odor
• Unusual skin color, pallor
• Poor hygiene
• Soiled clothing
• Frequent infections (e.g., URI, UTI)
• Frequent toothaches
• Obesity or anorexia
• Anemia
• Chronic fatigue
• Apathetic attitude
• Substance abuse

Expected Outcomes
Patient describes positive health maintenance behaviors such as keeping scheduled appointments, participating in smoking and substance abuse programs, making diet and exercise changes, improving home environment, and following treatment regimen.
Patient identifies available resources.
Patient uses available resources.

Assess for physical defining characteristics
Assess patient's knowledge of health maintenance behaviors
Assess health history over past 5 years
Assess to what degree environmental, social, intrafamilial disruptions or changes have correlated with poor health behaviors
Determine patient's specific questions related to health maintenance

Determine patient's motives for failing to report symptoms reflecting changes in health status
Discuss noncompliance with instructions or programs with patient to determine rationale for failure
Assess the patient's educational preparation and ability to integrate and relate to information.
Assess history of other adverse personal habits, including the following: smoking, obesity, lack of exercise, and alcohol or substance
abuse
Determine whether the patient's manual dexterity or lack of mobility is a factor in patient's altered capacity for health maintenance
Determine to what degree patient's cultural beliefs and personality contribute to altered health habits
Access ramps, motor vehicle modifications, shower bar or chair, and others) are available to patient.
Assess whether economic problems present a barrier to maintaining health behaviors
Assess hearing, and orientation to time, place, and person to determine the patient's perceptual abilities
Make a home visit to determine safety, accessibility, and quality of living conditions
Assess patient's experience of stress and disruptors as they relate to health habits.
Age

Cancer can take decades to develop. That’s why most people diagnosed with cancer are 65 or older. While it’s more common in older adults, cancer is not exclusively an adult disease. Cancer can be diagnosed at any age.

Gender

Females have a generally lower risk of cancer incidence.

Stress
Although stress can cause a number of physical health problems, the evidence that it can cause cancer is weak. Some studies have indicated a link between various psychological factors and an increased risk of developing cancer, but others have not.

Apparent links between psychological stress and cancer could arise in several ways. For example, people under stress may develop certain behaviors, such as smoking, overeating, or drinking alcohol, which increase a person’s risk for cancer. Or someone who has a relative with cancer may have a higher risk for cancer because of a shared inherited risk factor, not because of the stress induced by the family member’s diagnosis.

Poverty
Poverty is associated with a huge array of human ills, not the least of which is seriously undermining the impoverished populations’ health. Due to their limited financial resources, the poor are recurrently subjected to environmental risks due to unavailability of suitable housing, are less well nourished, have less knowledge and are less able to access health care and appropriate insurance.
Diet
The foods that you eat on a regular basis make up your diet. Diet is being studied as a risk factor for cancer. It is hard to study the effects of diet on cancer because a person’s diet includes foods that may protect against cancer and foods that may increase the risk of cancer.
It is also hard for people who take part in the studies to keep track of what they eat over a long period of time. This may explain why studies have different results about how diet affects the risk of cancer.

Infections
Certain viruses and bacteria are able to cause cancer. Viruses and other infection -causing agents cause more cases of cancer in the developing world (about 1 in 4 cases of cancer) than in developed nations (less than 1 in 10 cases of cancer). Examples of cancer-causing viruses and bacteria include:

• Human papillomavirus (HPV) increases the risk for cancers of the cervix, penis, vagina, anus, andoropharynx.
• Hepatitis B and hepatitis C viruses increase the risk for liver cancer.
• Epstein-Barr virus increases the risk for Burkitt lymphoma.
• Helicobacter pylori increases the risk for gastric cancer.

Cigarette Smoking & Tobacco use
Tobacco use is strongly linked to an increased risk for many kinds of cancer. Smoking cigarettes is the leading cause of the following types of cancer:
• Acute myelogenous leukemia (AML).
• Bladder cancer.
• Esophageal cancer.
• Kidney cancer.
• Lung cancer.
• Oral cavity cancer.
• Pancreatic cancer.
• Stomach cancer.
Not smoking or quitting smoking lowers the risk of getting cancer and dying from cancer. Scientists believe that cigarette smoking causes about 30% of all cancer deaths in the United States.

Recreational Drugs
A new study from the University of Southern California (USC) has found a link between recreational marijuana use and an increased risk of developing subtypes of testicular cancer that tend to carry a somewhat worse prognosis.
Obesity
Obesity is associated with increased risks of the following cancer types, and possibly others as well:
• Esophagus
• Pancreas
• Colon and rectum
• Breast (after menopause)
• Endometrium (lining of the uterus)
• Kidney
• Thyroid
• Gallbladder

Environmental Risk Factors
Being exposed to chemicals and other substances in the environment has been linked to some cancers:
• Links between air pollution and cancer risk have been found. These include links between lung cancer andsecondhand tobacco smoke, outdoor air pollution, and asbestos.
• Drinking water that contains a large amount of arsenic has been linked to skin, bladder, and lung cancers.
Studies have been done to see if pesticides and other pollutants increase the risk of cancer. The results of those studies have been unclear because other factors can change the results of the studies.

Sun exposure
Most skin cancers are caused by exposure to the sun. This may be long term exposure, or short periods of intense sun exposure and burning.

The ultraviolet light in sunlight damages the DNA in the skin cells. This damage can happen years before a cancer develops. The sun’s rays contain 3 types of ultraviolet light
Primary Prevention
- is concerned with reducing the risks of cancer in healthy people

Secondary Prevention
- involves detection and screening to achieve early diagnosis
2. Prevention, Screening, and Early
Detection
Diagnostic
BIOPSY
performed to obtain a tissue sample for analysis of cells suspected to be malignant
Primary Treatment
When SURGERY is the primary approach in treating cancer, the goal is to remove the entire tumor or as much as is feasible and any involved surrounding tissue, including regional lymph nodes
Reconstructive
May follow curative or radical surgery and is carried out in an attempt to improve function or obtain a more desirable cosmetic effect

May be indicated for: breast, head and neck and skin cancers
Palliative
When cure is not possible, the goals of treatment are to make the patient as comfortable as possible and to promote satisfying and productive life for as long as possible.

Palliative surgery is done in an attempt to relieve complications of cancer such as: ulcerations, obstructions, hemorrhage, pain, and malignant effusions
Prophylactic
Involves removing nonvital tissues or organs that are likely to develop cancer.
Nursing Responsibilities
Before:
The nurse provided education and emotional support by assessing patient and family needs and exploring with the patient and family their fears and coping mechanisms
It is important that the nurse communicates with the physician and other health team members to be certain that the information provided to the relatives is consistent
Factors to consider:
Family history and genetic predisposition
Presence or absence of symptoms
Potential risk or benefits
Ability to detect cancer at and early stage
Patient's acceptance of the postoperative outcome

After:
Asses patient's responses to surgery and monitors for possible complications
Provide patient comfort
Postoperative teaching addresses wound care, activity, nutrition, and medication info
Plans for discharge, follow-up, and home care are initiated as early as possible

2. Radiation Therapy
- ionizing radiation is used to interrupt cellular growth
- ionizing radiation breaks the strands of DNA helix = cell death
1. External Radiation
-
one of several delivery methods may be chosen, depending on the depth of the tumor (Kilovolatge, Linear accelerators, Gamma rays)

2. Internal Radiation -
or brachytherapy, delivers a high dose of radiation to a localized area. Implanted via needles, seeds, beads, or catheters into body cavities or interstitial compartments
Nursing Responsibilities
Protecting the skin and oral mucosa
Protecting the caregivers
3. Chemotherapy

- antieneoplastic agents are used in an attempt to destroy tumor ells by interfering with cellular functions and reproduction.

- used primarily to treat systemic disease rather then lesions that are localized and amenable to surgery or radiation

- GOAL must be realistic because they will define the medications to be used and the aggressiveness of the treatment plan



Nursing Responsibilities
Assessing fluid electrolyte status
Modifying risks for infection and bleeding
Administering chemotherapy
Implementing safeguards
Espinosa, Madellaine
San Pedro, Eilene
San Pedro, Patrica Mikaela
Tira, Chara Faith
Cancer Therapy
HIV
High Risk Personal Behaviors
TOBACCO USE
OBESITY: PHYSICAL ACTIVITY AND DIET
SEXUAL PATTERNS
DISEASE SCREENING PRACTICES
Full transcript