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Nursing Management in Cancer Care

Nursing Management in Cancer Care. Learning to make a difference !. Inspirational Quote:. Those who show strength and character even in the most difficult times and can inspire others with their courage; are the kind of people others look up to as true heroes!.

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Nursing Management in Cancer Care

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  1. Nursing Management in Cancer Care Learning to make a difference!

  2. Inspirational Quote: Those who show strength and character even in the most difficult times and can inspire others with their courage; are the kind of people others look up to as true heroes!

  3. Resource Information Canadian Cancer Societywww.cancer.ca1-888-939-3333

  4. Last class focus was on: • Development of cancer & relationship to the immune system • Comparison of normal & abnormal cells • Importance of understanding cell cycle and how physicians try to making best use of medical treatment specific to phases of cycle • Staging & grading

  5. Today’s Class: • Warning signs of cancer • Overview of psychosocial impact, treatment methods • Fatigue • Cachexia • Nausea & vomiting • Stomatitis • Constipation & diarrhea • Pain management

  6. Today’s Class Objectives • Discuss the warning signs of cancer • Discuss broadly the nurse’s role in planning treatment • List the different treatment methods for cancer • Describe goals for quality end-of-life care • Discuss symptom management related to fatigue, nausea, vomiting, cachexia, stomatitis , constipation & diarrhea, pain

  7. Warning Signs Cancer C -Change in bowel or bladder A - A sore that does not heal U -Unusual bleeding or discharge T -Thickening or lump I -Indigestion or difficulty swallowing O -Obvious change in wart or mole N - Nagging cough or hoarseness

  8. Cancer & the Person: How will the person with cancer deal with initial diagnosis, treatment, & short/long term consequences to self & to significant others?

  9. Cancer has taken me twice and flung me to a new space. The first time, I overcame the fear of cancer. This time, I’m working on the anger of recurrence. Always a strong person, I feel both experiences have given me strengths I never have believed I was capable of. I have a deeper sense of life and joy. So in spite of the hair loss, the energy loss, and the protocols, I am becoming tempered, like steel. My metal is tested, and I am not found wanting. I’m living on a higher plane of existence (Ferrell, 1995).

  10. Have you experienced situations where you wished you could have intervened more positively to help persons with cancer?Identify a few?

  11. Cancer Affects: All levels of functioning: Intellectual Psychological Self-concept Physical Spiritual

  12. Psychosocial Aspects of Cancer Cancer is a feared and dreaded disease because: • Maybe present in advanced stages with no manifestations • Compliance with vigorous and often disfiguring treatments doesn’t guarantee a cure. • Cancer may recur after many years of remission. • A healthy life-style does not ensure escape from the disease.

  13. Coping: Coping: is a dynamic process by which a client responds to a problem to bring about relief or equilibrium.

  14. General Coping Strategies: -Rational inquiry -Negiotation -Affect reversal -Tension reduction -Suppression - Disengagement -Mutuality - Projection -Displacement/redirection -Cooperative compliance -Confrontation -Moral masochism -Redefinition/revision -Fatalism/passive acceptance -Impulsivity

  15. Individual’s Responses to Cancer Depend upon: • The clients & client’s psychological make-up • The client’s family & social community • The disease, disabilities & disfigurement it may cause • Preexisting medical conditions that may limit treatment options.

  16. Enabling Factors in Coping with Cancer: Social support systems Problem-solving ability Religion Perception of control Self-esteem Humor Positive appraisal Hardiness Hopefulness Information-seeking Positive comparisons Social skills Open communication Jalowiec & Dundas (1991)

  17. Hindering factors in Coping with Cancer: Denial Avoidance Helplessness Powerlessness Hopelessness Depression Guilt Isolation Wishful thinking Erosion of autonomy Anger Blaming others Noncompliance Jalowiec & Dundas (1991)

  18. Purpose of Nursing Interventions The purpose of nursing interventions is to help individuals cope with the experience of illness & suffering, and if necessary to find meaning in such experiences. Helping the sick to maintain hope & avoid helplessness is a major responsibility for the nurse (Rustoen & Hanestad, p. 19, 1998). How would you do this?

  19. Responsibilities of the Nurse in Cancer Care • Support the idea that cancer is a chronic illness • Assess own level of knowledge relative to the pathophysiology • Make use of current research findings and practices in care of clients with cancer • Identify clients at high risk for cancer • Participate in primary and secondary prevention • Assess nursing care needs of client with cancer • Assess learning needs, desires and capabilities • Assess social supports of client and family • Plan and implement appropriate interventions in collaboration with the multidisciplinary team. • Evaluate goals and outcome and modify plan of care as necessary.

  20. Nursing Interventions in Supporting the Cancer client • Be available, especially during difficult times • Exhibit a caring attitude • Listen actively to fears & concerns • Provide relief from distressing symptoms • Provide essential info regarding cancer & care • Maintain a relationship build on trust & confidence (be honest) • Appropriate use of touch exhibits caring • Assist in setting realistic, reachable goals • Assist in maintaining usual lifestyle patterns • Maintain hope

  21. Maintaining Hope in Persons With Cancer Nursing Interventions Encouraging: • Belief in oneself & ability (affirm the individual’s worth) • Encourage emotional expression • Help recall positive memories, times of joy and fulfillment • Help maintain meaningful relationships with others • Active involvement • Support spiritual beliefs & values • Help conserve or enhance available energy, control pain • Be honest & clear in delivery of “info” • Focus on the present – day by day – rather then an uncertain future. • Help find images symbols or rituals that foster hope

  22. Planning Treatment:Nursing Role • Build upon clients strengths • Clarify Misconceptions (FEARS) • Teach treatment process including simulation component • Teach potential reactions • Support client & their support persons • Permit the client with uninterrupted time to talk • Mobilizing social support systems

  23. Treatment Modalities & Cancer Symptom Management .

  24. Cancer Treatment may be aimed at: Cure: • Complete eradication of malignant disease Control: • Containment of cancer cell growth; long term survival Palliation: • Relief or control of symptoms and maintenance of quality of life

  25. Treatment Methods for Cancer • Surgery • Radio-therapy • Chemotherapy • Hormone-therapy • Immuno-therapy • Photodynamic therapy • Intraoperative Radiation • Whole Body Hyperthermia • Recombinant Interferon • Bone marrow transplant

  26. Whole Body Hyperthermia Photodynamic Therapy Immunotherapy Using antibodies to target killer cells directly to cancer cells: Antibodies are bound to the surface of killer cells, and they recognize specific markers on the cancer cell leading to its extermination

  27. Symptoms of Cancer & treatments: Fatigue Cachexia Nausea & Vomiting Stomatitis Constipation/diarrhea Skin reactions (Chemo/radiation) Pain (separate class)

  28. Assessment: Symptoms of Cancer & Treatments • Infection • Bleeding • Skin reactions, mucositis/stomatitis, hair loss • Nutritional Concerns (anorexia, cachexia) • GI disturbances (diarrhea, constipation, nausea & vomiting) • Pain • Fatigue • Psychosocial status • Body Image

  29. Nursing Diagnoses of Client with Cancer • Risk for infection related to altered immunologic response • Impaired tissue integrity: alopecia r/t the effects of treatment & disease • Impaired oral mucous membranes: stomatitis • Altered nutrition: less than body requirements r/t anorexia & GI changes. • Pain & discomfort r/to disease & treatment effects.

  30. Nursing Diagnoses of Client with Cancer • Fatigue r/t physical and psychological stressors. • Anticipatory grieving r/t anticipated loss and altered role function. • Body image disturbance r/t changes in appearance and role function. • PC: Bleeding

  31. Infection • Infection is the leading cause of death • Predisposing factors includes chemo, radiation treatment, malnutrition, catheters, IV’s, age, impaired skin & mucous membranes, contaminated equipment, meds, chronic illnesses • Prolonged hospitalizations

  32. More predisposing Factors to infection:

  33. Nurse Monitors WBC Counts • Leukopenia is a decrease in WBC • Neutrophils make up 60-70% of the body’s WBCs WBCs play a major role in combating infection by engulfing and destroying infective agents in a process called phagocytosis. Both the total WBC and the concentration of WBCs are important in determining the patient’s ability to fight infection. • Neutropenia puts clients at risk for infection • Nadir is the lowest ANC after myelosuppressive chemo or RT • An ANC below 1.0 x 109/L causes severe risk for infection

  34. ANC: Absolute Neutrophil countCalculation ANC < 1.0 x 109 = severe risk for infection

  35. Interventions for Infection • Monitor blood cell counts • Protect client from infection • Aseptic technique • Hand washing • Client/family teaching • Assess for infection: blood cultures, sputum, stool, urine, catheter or wounds CXR

  36. Important to Know Lab Values

  37. has been described as the most prevalent & disturbing symptom of cancer & its treatment – • 80-96% of people on chemo experience fatigue • Fatigue can be Acute or Chronic

  38. Fatigue like pain, has 4 components: • A) Physical • B) Psychological • C) Social • D) Spiritual aspects

  39. The Impact of Fatigue on Quality of Life A: PHYSICAL WELL-BEING • energy • functional ability • pain • sleep • rest • strength

  40. The Impact of Fatigue on Quality of Life B: SOCIAL WELL-BEING • caregiver burden • impact on work- home & workplace • financial burden • family/ other roles, relationships • affection & sexual function

  41. The Impact of Fatigue on Quality of Life C: PSYCHOLOGICAL WELL-BEING • anxiety • frustration • fear experiencing fatigue • feeling useless • coping & acceptance • loss of independence • Loss of cognition/attention • depression

  42. The Impact of Fatigue on Quality of Life D: SPIRITUAL WELL-BEING • Can experience a change in spirituality • altered priorities • hopelessness • meaning of fatigue

  43. Nursing Interventions : Fatigued Cancer Client • Careful assessment of ability to carry out ADL • Mild exercise, pace activities & rest periods • Rest, naps, sleep (8hrs) & conserve energy, don’t overdo it • direct /provide counseling • Manage other manifestations leading to fatigue • Keep fatigue diary (scale) … “have to” activities 1st • Get help with least important tasks • Eat small frequent attractive meals • Evaluate medications client is taking (over-the-counter) Important

  44. Cachexia-Anorexia Syndrome Name given to symptoms comprising: • Anorexia • Early satiety • Weight loss • Anemia • Asthenia • Tissue wasting • Organ dysfunction

  45. Four Causes of Cachexia in Cancer Clients: 1.Decreased nutritional intake due to: Anorexia (present 80% terminal ca) Malfunction of GI tract Psychological factors 2. Increased nutritional losses: Bleeding Protein losses through intestine diarrhea tumor-related catabolism has little effect

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