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○ Stage I: tumor limited to the tissue of origin, localized ○ Same day, q month, right after a warm shower (scrotal
tissue growth skin is moist & relaxed)
○ Stage II: limited local spread ○ Gently lift each testicle, each one should feel like an
egg, firm but not hard & smooth without lumps
○ Stage III: extensive local & regional spread
○ Using both hands, place middle fingers underside of 15. CANCER TX MODALITIES: Chemotherapy
each testicle & thumbs on top & gently roll the testicles
(WOF lumps, swelling or mass) ○ Major S/E & Nursing Interventions
○ Cell-cycle nonspecific
○ Teniposide (Vumon)
○ Interferon alfa-2b
○ Valrubicin (Valstar)
○ Interferon alfa-n3 (Alferon N) Levamisole (Ergamisole)
21. Antimetabolites
29. CANCER TX MODALITIES: Radiation Place the pt in a private room with private bath
31. CANCER TX MODALITIES: Teletherapy/Beam Radiation Do not allow children <16 y/o or pregnant woman
to visit the pt
○ No powder, ointment, lotion or cream on area unless
ordered Limit visitors to 30 min./day, at least 6 ft from the
pt
○ Wear soft clothing over the area, avoid constrictive
garments Save bed linens & dressings until the source is
removed then dispose
○ Avoid sun & heat exposure
Other equipments can be removed from the room
○ WOF weeping of skin (moist desquamation) & if noted,
at any time
cleanse the area with warm water & pat dry, apply
antibiotic or steroid cream as ordered & expose the site 37. CANCER TX MODALITIES: Brachytherapy Radiation
to air
○ Dislodged Sealed Radiation Source
32. CANCER TX MODALITIES: Brachytherapy Radiation
Don’t touch it with bare hands, use a long-
○ Source: internal radiation (sealed or unsealed) handled forceps to place the source in a lead
container kept in the pt’s room & notify MD
○ For a pd. of time the pt emits radiation & pose a hazard
to others If unable to locate the radiation source, bar
visitors & notify MD
33. CANCER TX MODALITIES: Brachytherapy Radiation
38. CANCER TX MODALITIES: Brachytherapy Radiation
○ Sealed Radiation Source Removal Infection: T, poor wound healing, sore throat,
bone weakens fracture, bone & joint pains,
Pt is no longer radioactive lymphadenopathy
Inform the pt that sexual partner cannot “catch” Bleeding: hemorrhage, petechiae, epistaxis,
CA hematoma, hematuria, hematemesis,
hepatosplenomegaly
Pt may resume sexual intercourse after 7-10 days
for cervical or vaginal implant Anemia: pallor, fatigue, anorexia, constipation
Perform povidone-iodine douche as ordered for 44. Signs and Symptoms: LEUKEMIA
cervical implant
○ From invasion of CNS
Administer Fleet enema as ordered
ICP: ↓ LOC, severe HA, vomiting, papilledema,
Notify MD if N/V/D, frequent urination, vaginal or seizures
rectal bleeding, hematuria, foul-smelling vaginal
discharge, abdominal pain/distention or fever CN VII or spinal nerve involvement
occurs
○ From invasion of kidneys, testes, prostate, ovaries, GI
39. CANCER TX MODALITIES: Radiation and lungs
○ Rapid immature WBC, competes nutrition with Post op: apply direct pressure, lie on
mature WBC and production of RBC and platelets affected side to stop bleeding
Oral care: alcohol-free mouthwash, pNSS ○ Sperm banking (possibility of sterility for M)
with or without NaHCO3
56. MULTIPLE MYELOMA
Use soft-bristled toothbrush, cotton plegets
○ Malignant proliferation of plasma cells and tumors
Apply Xylocaine (topical anesthetic) on within the bone, destroying the bone & invading the
mouth before meals lymph nodes, spleen & liver
Diet: soft and bland according to child’s ○ abN plasma cells produce an abN Ab (myeloma protein
preference, small frequent feedings or Bence Jones protein) found in blood & urine
51. Nursing Management: LEUKEMIA ○ ↓ production of Ig & Ab, ↑ uric acid & Ca → RF
Radical retroperitoneal lymph node dissection- to ○ Meds: Tamoxifen (Nolvadex) for estrogen receptor-
stage the CA & ↓ tumor vol. positive tumors
○ Common sites of mets: lymph nodes, bone, lungs, brain 68. Surgical Tx: BREAST CANCER
& liver
○ Oophorectomy: for estrogen receptor-positive tumors
○ Precipitating factors
○ Ablative therapy with adrenalectomy or chemical
Genetics ablation which blocks cortisol, androstenedione &
aldosterone production
Early menarche & late menopause
69. Nursing Interventions: s/p Breast Surgery
Nulliparity
○ Semi-Fowlers’ position, turn from back to unaffected
Obesity side, with affected arm elevated above the heart level
to promote drainage & prevent lymphedema
High-dose radiation exposure to chest
○ Use a pressure sleeve if edema is severe
64. S/Sx: BREAST CANCER
○ Maintain Jackson-Pratt suction, record the amount &
○ Mass felt during BSE (usually in the upper outer
characteristic of draiange
quadrant or beneath the nipple)
○ No IV, injections, BP, venipunctures in affected arm
○ Low Na-diet, diuretics for severe lymphedema ○ Dysuria, hematuria
○ Refer to MD & PT for appropriate exercise program ○ Pelvic, lower back, leg or groin pain
○ Protect & avoid overuse of the hand & arm during the 1 ○ Changes on Pap smear
st few months
74. Tx: CERVICAL CANCER
○ Keep the affected arm elevated to prevent
○ Nonsurgical
lymphedema
Early & frequent intercourse ○ For women who want further child bearing
Poor hygiene
○ Cx: hemorrhage, uterine perforation, incompetent
cervix, cervical stenosis & preterm labor
73. S/Sx: CERVICAL CANCER
78. CERVICAL CA: Hysterectomy
○ Painless vaginal bleeding postmenstrually &
○ Vaginal approach for microinvasive CA if childbearing is
postcoitally
not desired
○ Foul-smelling or serosanguinous vaginal d/c
○ Avoid strenous activity or lifting >20 lbs ○ Chemotherapy: done post-op for all stages of CA
○ Avoid sexual intercourse for 3-6 wks ○ Intraperitoneal chemotx: instillation into abdominal
cavity
80. CERVICAL CA: Pelvic exenteration
○ Immunotherapy: promotes tumor resistance
○ Radical surgical procedure for recurrent CA
○ Surgery: TAHBSO
○ When the bladder is removed, an ileal conduit is
created & located at the R side of the abdomen to 86. ENDOMETRIAL CANCER
divert urine
○ Slow-growing tumor asso. with menopausal years
○ A colostomy is created on the L side of the abdomen for
the passage of feces ○ Common sites of mets: ovaries, pelvis, peritoneum,
lymphatics & via blood to the lungs, liver & bone
81. CERVICAL CA: Types of Pelvic Exenteration
○ Precipitating Factors
○ Anterior
Hx of uterine polyps
Removal of uterus, ovaries, fallopian tubes,
vagina, bladder, urethra & pelvic lymph nodes Nulliparity
Bilroth I: Gastroduodenostomy ○ Cx: bowel perforation with peritonitis, abscess & fistula
formation, hemorrhage & complete gut obstruction
Bilroth II: Gastrojejunostomy
Total gastrectomy
○ Common sites of mets: via lymphatics & blood, colon &
other organs
Esophagojejunostomy
98. S/Sx: INTESTINAL TUMORS
92. Nursing Interventions: GASTRIC CANCER
○ A/V, malaise, wt loss
○ Fowler’s position for comfort: Pain meds as ordered
○ Blood in stools, anemia
○ Monitor Hgb, Hct: BT as ordered
○ AbN stools
○ NPO for 1-3 days post-op until peristalsis returns
Ascending colon tumor: diarrhea
○ Monitor I/O: IVF & e+ as ordered
Descending colon tumor: constipation with some
○ Monitor NGT suction, don’t irrigate or remove NGT diarrhea, ribbon-like stool
93. Nursing Interventions: GASTRIC CANCER Rectal tumor: alternating constipation & diarrhea
○ Monitor wt, nutritional status: Small, bland, easy ○ Abdominal mass & cachexia (late signs)
digestible meals with vit & mineral supplements
99. Nursing Interventions: INTESTINAL TUMORS
○ WOF Cx: hemorrhage, dumping syndrome, diarrhea,
hypoglycemia, Vit B12 deficiency ○ WOF bowel perforation: ↓ BP, HR, ↑ T, weak pulse,
distended abdomen
94. PANCREATIC CANCER
○ WOF intestinal obstruction: (EARLY S/Sx- ↑ peristalsis, ↑ 105.LUNG CANCER
to ↓ bowel sounds) fecal vomiting, pain, constipation,
distended abdomen ○ Lungs: common target for mets from other organs
○ Low-residue diet for 1-2 days pre-op Large cell anaplastic carcinoma
○ Empty pouch when 1/3 full, remove feces from the skin ○ Fowler’s position
○ Avoid gas/odor-forming foods ○ WOF RR distress, tracheal deviation, bleeding, infection
& e+ imbalance
103.COLOSTOMY POST-OP CARE
○ Activity as tolerated, rest periods, active/passive ROM
○ WOF perineal wound infection (if present)
○ Diet: calorie, high CHON, ↑ Vit
○ Administer as ordered
○ Administer as ordered
Analgesics & antibiotics
O2, bronchodilators, steroids
Stoma irrigation
Analgesics
104.ILEOSTOMY POST-OP CARE
CPT
○ Post-op drainage: dark green to yellow (as the pt begins
to eat)
109.Tx: LUNG CANCER
○ Expect liquid stool
○ Radiation
○ WOF dehydration & e+ imbalance
○ Chemotherapy
○ Avoid suppositories through ileostomy
○ Immunotherapy ○ Radiation & Chemotx for hormone-resistant tumors
& the serum fluid that accumulates in the empty ○ Bleeding is common post-op, WOF hemorrhage
thoracic cavity will consolidate, preventing mediastinal
shift ○ Continuous bladder irrigation (CBI) post-op to maintain
the urine at a pink color
111.Post-op Care: LUNG CANCER
○ Bladder spasms are common post-op, give
○ Monitor VS, breath sounds antispasmodics as ordered
○ Maintain chest tube drainage system, WOF SQ ○ WOF dribbling & incontinence
emphysema
○ Sterility may or may not occur post-op
○ Avoid complete lateral turning
117.PROSTATE CA: Prostatectomy Point of comparison
○ Activity as tolerated, active ROM of the operative
Suprapubic Retropubic Perineal Technique Via abdominal &
shoulder
bladder incision Via low abdominal incision without opening
○ Administer O2 as ordered the bladder Via incision bet. scrotum & anus Hemorrhage Yes
No No Bladder spasms Yes Yes but less Urinary incontinence
112.PROSTATE CANCER common
○ Pt may pass small clots & tissue debris for several days