Larissa Sabsay

Batch 15 B
Care of the Patient with Cancer. Ch # 57


1. Discuss the incidence of cancer as one of the Ieading causes death in the United States.
1he Amerlcan Cancer SoclaLy lndlcaLes LhaL ln Lhe unlLed SLaLes men have 1 ln 2 llfeLlme rlsk of evoloplng cancer for
women Lhe rlsk ls 1 ln 3 ln 200 364830 Amerlcans dled from cancer whlch ls more Lhan 1300 persons per day 1he
deaLh raLe from all cancers comblned has decreased by 26 per year among men and 18 per year among women
slnce 2002

. Compare the three most common sites for cancer in men and women
ng cancer ls leadlng case of deaLh 8reasL and prosLaLe cancers occr more ofLen bL Lhey have beLLer cre and
srvlval raLe becase of early deLecLlon and LreaLmenL
Male prosLaLe lng colon recLm
lemale breasL lng colon recLm
. Discuss deveIopment, prevention, and detection of cancer.
Carclnogenesls ls Lhe process by whlch normal cells are Lransformed lnLo cancer cells 1he exacL case ls sLlll nknown
bL mosL Lypes are llkely Lo have mlLlple cases
Slnce exposre Lo carclnogens (cancercaslng agenLs) ls responslble for Lrlggerlng mosL hman cancers people can
redce Lhelr cancer rlsk by Laklng sLeps Lo avold sch agenLs Pence Lhe flrsL sLep ln cancer prevenLlon ls Lo ldenLlfy Lhe
behavlors or exposres Lo parLlclar klnds of carclnogens and vlrses LhaL represenL Lhe greaLesL cancer hazards
revenLlon and early deLecLlon of cancer lncldes recognlLlon of cancer warnlng slgnals 1he Amerlcan Cancer SocleLy
advlces speclflc prevenLlve behavlor and screenlng LesLs for men and women 1he nrse plays promlnenL role ln
prevenLlon and deLecLlon of cancer Larly deLecLlon and prompL LreaLmenL are dlrecLly responslble for lncreased srvlval
raLe ln paLlenL wlLh cancer




4 L|st seven r|sk factors for deve|opment of cancer
1) Smoklng Accordlng Lo Lhe Amerlcan Cancer SocleLy smoklng ls mosL prevenLable case of deaLh from
lng cancer Cancers assoclaLed wlLh smoklng lngs bladder kldney moLh llp sLomach pharynx
larynx paranasal slnses esophags pancreas Lers and cervlx Smokeless Lobacco lncreases Lhe rlsk
of cancer of Lhe moLh larynx and esophags

2) uleLary PablLs uleL ls very lmporLanL An esLlmaLed 1/3 of cancer deaLhs are aLLrlbLable Lo nLrlLlonal facLors
sch as hlgh faL and lowflber dleL CbeslLy ls a rlsk facLor for breasL prosLaLe gallbladder ovarlan Lerlne colon recLal
and breasL cancers 1he nCl (naLlonal Cancer lnsLlLLe) lanched a program 3 a uay for 8eLLer healLh" Lo show how
easy lL's Lo add aL leasL 3 servlngs of vegeLables and frlLs Lo Lhe dally dleL as a way of redclng Lhe rlsk of cancer

3) ulLravloleL (uv) 8adlaLlon Lxposre Lo Lhe sn uv rays Lannlng booLh snlamps and some dlagnosLlc LesLs
are facLors of developlng of sqamos cell skln cancer and melanoma

4) LnvlronmenLal and Chemlcal Carclnogens lnclde fmes of rbber chlorlne and dsL from coLLon coal nlckel
chromaLe asbesLos and vlnyl chlorlde greaLer lncldence of bladder cancer among people who llve ln rban areas and
work wlLh dyes rbber and leaLher lreqenL heavy consmpLlon of alcohol reslL ln oral LhroaL larynx esophags and
llver cancers

3) Smokeless Lobacco lncreases Lhe rlsk of cancer of Lhe moLh larynx pharynx and esophags ong Lerm snff
sers have as mch as a 30fold greaLer rlsk of cheek and gm cancers

6) lreqenL and heavy consmpLlon of alcohol May reslL ln oral cancer larynx LhroaL esophags llver

7) PeredlLary cancers AboL 90 of cancers ar noL lnherlLed lL arlses from germllne mLaLlon Cermllne
mLaLlons are responslble for 3 Lo 10 of cancer cases 1hls ls also called famlllal (occrrlng ln famllles) cancers
As genes swlLch on and off Lhey deLermlne when and how fasL Lhe cell wlll grow and dlvlde when lL wlll sLop
dlvldlng and even when lL wlll dle
O osLmenopasal breasL cancer ls x3 Llmes hlgher and premenopasal ls x3Llmes hlgher ln women wlLh
O lamlllal hlsLory of cancer
O Cenes 88CA1 and 88CA2 has 40 Lo 80 hlgher rlsk of developlng breasL cancer
O Jomen who have breasL cancer 93 do noL carry Lhls genes
O 1he lncldence of lng cancer ls greaLer ln smokers wlLh a famlly hlsLory of Lhese dlsease Lhan ln smokers
O wlLhoL famlly hlsLory of lng cancer
O 1he lncldence of lekemla ls greaLer ln an ldenLlcal Lwln
O neroblasLoma occrs wlLh lncreased freqency among slbllngs
O Colon cancer ls more llkely occr ln women who have a breasL cancer








D|sscuss the Amer|can Cancer Soc|ety recommendat|ons for prevent|ve behav|ors and screen|ng test for men
and women
Sex Cancer Age 1esL of rocedre lreqency
lemale

uLers
Cervlx
18 or aL pberLy
30 y/o
ap LesL apanlcalao's
lqld based ap LesL
Cnes a year
C 23 years
uLers elvlc
Cvarles
1839 y/o
40
elvlc examlnaLlon
JlLh ap smear
C 13 years
Cnes a year
8reasL Cancer 2039 y/o
30 y/o
8SL 8reasL Self
LxamlnaLlon
Cnes a monLh
Cnes a monLh
2039 y/o
40 y/o
Cllnlcal 8reasL examlnaLlon

C 3 years
8efore mgram
30 y/o
4049 y/o
Mammogram C 2 years
C 12 years
Male rosLaLe Cancer 30 y/o SA rosLaLe Speclflc
AnLlgen
Cnes a year
1esLlcles 18 y/o 1esLlcle Self LxamlnaLlon Cnes a monLh
Male lemale

Colon 30 y/o Slgmoldoscopy C 33 years
Colon 30 y/o lecal CcclL 8lood 1esL Cnes a year
rosLaLe
ColorecLal
40 y/o ulglLal 8ecLal LxamlnaLlon rosLaLe ?early

ColorecLal Cancer lollow Lhe screenlng LesLs gldellnes
O lollow screenlng gldellnes Lo remove adenomaLos polyps before Lhey become cancer
O CeL aL leasL 30 mln of physlcal acLlvlLy on mosL days
O MalnLaln healLhy welghL eaL plenLy of frlL vegeLables and whole graln food llmlL hlgh faL foods
O ClL smoklng
Skln Cancer
O SLay oL of Lhe sn especlally beLween 10am4pm
O use snscreen wlLh Sl 1 or hlgher ACS recommends S||p on shlrL S|op on 13 Sl snscreen Wrap on
snglasses
O uo noL se Lannlng bed or sn lamps
O roLecL chlldren from excesslve sn exposre
O Check yor skln reglarly for abnormal or changlng areas especlally moles and have Lhem examlned by docLor
ng cancer
O ClL smoklng and encorage oLhers Lo qlL
O eL yor physlclan Lo know lf yo develop Lhe followlng
H A cogh LhaL doesn'L go away
H ChesL paln ofLen aggravaLed by deep breaLhlng
H Poarseness
H JelghL loss and loss of appeLlLe
H 8loody or rsL color spLm
H ShorLness of breaLh
H lever wlLhoL known reason
H 8ecrrlng lnfecLlon sch as bronchlLls and pnemonla
H new onseL of wheezlng
Cervlcal cancer
O AbsLaln from sex or pracLlce safer sex slng barrler proLecLlon
O ClL smoklng
O MalnLaln healLhy welghL eaL plenLy of frlL vegeLables and whole graln food llmlL hlgh faL foods
O JaLch for and reporL S/S
H Abnormal Lerlne bleedlng
H Abnormal vaglnal dlscharge
H aln drlng lnLercorse
8reasL cancer
O lollow Lhe gldellnes for early deLecLlon of breasL cancer
O 1alk Lo yor physlclan aboL Lhe rlsk and beneflLs of hormone replacemenL Lherapy
O CeL aL leasL 30 mln of physlcal acLlvlLles on mosL days
O Achleve and malnLaln healLhy welghL
O MalnLaln healLhy welghL eaL plenLy of frlL vegeLables and whole graln food llmlL hlgh faL foods
O uecrease alcohol lnLake
LndomeLrlal cancer
O JaLch for and reporL any abnormal Lerlne bleedlng or spoLLlng
O use oral conLracepLlves for many years
O 1alk Lo yor physlclan aboL Lhe rlsk and beneflLs of hormone replacemenL Lherapy
O lf Laklng hormone replacemenL Lherapy wlLh yor Lers sLlll lnLacL Lake sLrogen wlLh progesLerone
Cvarlan cancer
O use oral conLracepLlves for many years
O JaLch for and reporL S/S
H Abdomlnal swelllng
H vaglnal bleedlng
H 8ack or leg paln
H Chronlc sLomach paln
O 1alk Lo yor physlclan aboL Lhe rlsk and beneflLs of hormone replacemenL Lherapy
O 1alk Lo yor physlclan aboL havlng yor ovarles belng removed lf yo are aL hlgh rlsk 1ha srgery cases
sdden menopase
rosLaLe cancer
O MalnLaln healLhy welghL eaL plenLy of frlL vegeLables and whole graln food llmlL hlgh faL foods
O CeL aL leasL 30 mln of physlcal acLlvlLles on mosL days
1esLlclar cancer
O MalnLaln healLhy welghL eaL plenLy of frlL vegeLables and whole graln food llmlL hlgh faL foods
O arLlclpaLe ln a reglar exerclse program
O earn and pracLlce LesLlclar selfexamlnaLlon



State seven warn|ng s|gns of cancer
CAU1ICN US!
Change ln bowel or bladder hablLs
A sore LhaL does noL heal
unsal bleedlng or dlscharge
1hlckenlngs or lmps
lndlgesLlon or dlfflclLy ln swallowlng
Cbvlos change ln a warL or mole
nagglng or perslsLenL cogh or hoarseness
unexplalned anemla
Sdden nexplalned welghL loss
p|a|n common reasons to de|ay |n seek|ng med|ca| care when a d|agnos|s of cancer |s suspected
O Many early slgns and sympLoms of cancer can be mlsdlagnosed as normal changes of oder adlLs
O eople fear Lhe posslble dlagnosls and hope Lhe slgns and sympLoms wlll go away
O lnablllLy Lo geL an lnsrance and lack of flnanclal spporL
Def|ne the term|no|ogy used to descr|be ce||u|ar changes Character|st|c of ma||gnant ce||s and types of
ma||gnanc|es
Mlcroscoplc characLerlsLlcs of cancer cells behave dlfferenLly from normal cells

O neoplasla A dlsease of cells characLerlzed by alLeraLlon of normal growLh reglaLory mechanlsms
O Pyperplasla lncrease of cell prodcLlon ln a normal Llsse or organ
O uysplasla An abnormallLy ln cell slze appearance wlLh or wlLhoL a dlsorganlzed growLh paLLern
O uesmoplasla 1he formaLlon and prollferaLlon of connecLlve Llsse ln response Lo neoplasLlc growLh
O MeLaplasla An adapLlve sbsLlLLlon of one Lype of adlL Llsse Lo anoLher Lype of adlL Llsse nder
sLress a more vlnerable Lype of Llsse wlll be replaced by anoLher more capable of wlLhsLandlng Lress
O Carclnoma ln SlL ls an early form of carclnoma deflned by Lhe absence of lnvaslon of srrondlng Llsses ln
oLher words Lhe neoplasLlc cells prollferaLe ln Lhelr normal hablLaL hence Lhe name ln slL (aLln for ln lLs
place)

1ypes of cancer
8enlgn MallgnanL
CfLen encapslaLed
Jell dlfferenLlaLed
ow mlLoLlc raLe
nonlnvaslve
nonmeLasLaslzlng
non encapslaLed
oorly dlfferenLlaLed
Plgh mlLoLlc raLe
lnvaslve
MeLasLaslzlng
Adenoma benlgn eplLhellal neoplasm
L|poma benlgn mesenchymal neoplasm
CAkCINCMA mallgnanL eplLhellal neoplasm
SAkCCMA mallgnanL mesenchymal neoplasm
LMnCMA]LUkMIA mallgnanL neoplasm of
lymphold cells


uescrlbe Lhe paLhophyslology of cancer lncldlng Lhe characLerlsLlcs of mallgnanL cells and Lhe naLre of
meLasLasls

normal Pyperplasla Mlld uysplasla Carclnoma ln SlL Cancer lnvaslve

8enlgn (noL cancer) Lmor cells grow only locally and cannoL spread by lnvaslon or meLasLasls
MallgnanL (cancer) cells lnvade nelghborlng Llsses enLer blood vessels and meLasLaslze Lo dlfferenL slLes

8enlgn MallgnanL
CfLen encapslaLed
Jell dlfferenLlaLed
ow mlLoLlc raLe
nonlnvaslve
nonmeLasLaslzlng
non encapslaLed
oorly dlfferenLlaLed
Plgh mlLoLlc raLe
lnvaslve
MeLasLaslzlng
Adenoma benlgn eplLhellal neoplasm
L|poma benlgn mesenchymal neoplasm
CAkCINCMA mallgnanL eplLhellal neoplasm
SAkCCMA mallgnanL mesenchymal neoplasm
LMnCMA]LUkMIA mallgnanL neoplasm of
lymphold cells









llbroadenoma 8enlgn Adenocarslnoma MallgnanL

ln general a cancer ls named accordlng Lo Lhe Lype of Llsse ln whlch lL flrsL forms
Sarcomas cancer of connecLlve Llsse
Carclnomas cancer arlslng from eplLhellm
ymphomas cancer of lymphold Llsse
ekemlas cancer of sLem cells
Cllomas cancer of braln gllal cells




Descr|be the process of metastas|s
MeLasLasls ls Lhe process by whlch Lmor cells spread from prlmary slLe Lo a secondary slLeCnes cancer cells have
moved Lo anoLher area of Lhe body secondary Lmors may grow ln LhaL area MeLasLasls can occr by (1) dlrecL spread
of Lmor cells by dlvlslon Lo oLher body cavlLles or (2) clrclaLlon by way of blood and lymphaLlc chanels

Def|ne the systems of tumor c|ass|f|cat|on grad|ng and stag|ng
O SLaglng deLermlnes slze of Lmor and exlsLence of meLasLasls
O Cradlng classlfles Lmor cells by Lype of Llsse
O 1he 1nM sysLem ls based on Lhe exLenL of Lhe Lmor (1) Lhe exLenL of spread Lo Lhe lymph nodes (n) and Lhe
presence of meLasLasls (M)
rlmary 1mor (1)
1
x
rlmary Lmor cannoL be evalaLed
1
0
no evldence of prlmary Lmor
1
ls
Carclnoma ln slL (early cancer LhaL has noL spread Lo nelghborlng Llsse)
1
1
1
4
rogresslve lncrease ln slze and/or exLenL of Lhe prlmary Lmor

8eglonal ymph nodes (n)
n
x
8eglonal lymph nodes cannoL be evalaLed
n
0
no reglonal lymph node lnvolvemenL (no cancer fond ln Lhe lymph nodes)
n
1
n
4
lncreaslng lnvolvemenL of reglonal lymph nodes (nmber and/or exLenL of spread)

ulsLanL MeLasLasls (M)
M
x
ulsLanL meLasLasls cannoL be evalaLed
M
0
no dlsLanL meLasLasls (cancer has noL spread Lo oLher parLs of Lhe body)
M
1
M
4
ulsLanL meLasLasls presenL (cancer has spread Lo dlsLanL parLs of Lhe body)
PlsLopaLhology (C)
C
1
JelldlfferenLlaLed grade sllghLly dlffer from normal cells (mlld dysplasla)
C
2
ModeraLely welldlfferenLlaLed grade cells are more abnormal (severe dysplasla)
C
3
oorly dlfferenLlaLed grade cells are very abnormal (severe dysplasla)
C
4
undlfferenLlaLed cells are lmmaLre and prlmlLlve (anaplasla) cell dlfflclL Lo deLermlne

Cllnlcal sLaglng
SLage 0 Cancer ln SlL
SLage l 1mor llmlLed Lo Lhe Llsse of orlgln
SLage ll lmlLed local spread
SLage lll LxLenslve local and reglonal spread
SLage lv MeLasLasls

1nM SLage Croplngs
C||n|ca| Stag|ng SLage 0 SLage l SLage ll SLage lll SLage lv
1NM Cancer
Stag|ng
1ls n
0
M
0
1
1
n
0
M
0

1
2
n
0
M
0

1
3
n
0
M
0

1
4
n
0
M
0

Any 1 n
1
M
0

Any 1 n
2
M
0

Any 1 Any n M
1




L|st common d|agnost|c tests used to |dent|fy cancer
Cancer deLecLlon examlnaLlon
O aboraLory LesLs
O CompleLe blood cell conL (C8C)
O 1mor markers ldenLlfy sbsLance (speclflc proLelns) ln Lhe blood LhaL are made by Lhe Lmor
O SA (rosLaLlcspeclflc anLlgen) prosLaLe cancer
O CLA (Carclnoembryonlc anLlgen) colon cancer
O Alkallne hosphaLase bone meLasLasls
O 8lopsy

ulagnosLlc 1esLs
O ueLermlne locaLlon of cancer
O xrays
O CompLed Lomography
O ulLrasonds
O MagneLlc resonance lmaglng
O nclear lmaglng
O Anglography

ulagnosls of cell Lype
O 1lsse samples from blopsles shedded cells (eg apanlcolao (A) smear) washlngs
O CyLologlc LxamlnaLlon Llsse examlned nder mlcroscope

ulrecL vlsallzaLlon
O Slgmoldoscopy
O CysLoscopy
O Lndoscopy
O 8ronchoscopy
O LxploraLory srgery lymph node blopsles Lo deLermlne meLasLases


Descr|be why |s 8|opsy essent|a| |n conf|rm|ng a d|agnos|s of cancer
8lopsy ls Lhe only LesL LhaL deflnes Lhe presence of mallgnancy of Lhe cells by exclslon of a small plece of Lhe llvlng Llsse
from sspecLed from slLe or organ for mlcroscoplc examlnaLlon and esLabllshmenL of dlagnosls prognosls and follow p
coarse of dlsease

4 Descr|be nurs|ng |ntervent|ons for the |nd|v|dua| undergo|ng surgery rad|at|on therapy
chemotherapy bone marrow transportat|on or per|phera| stem ce|| transp|antat|on
O Assess and manage Loxlc effecLs of drgs (reporL Lo physlclan)
O Slde effecLs of drgs manage nasea and vomlLlng lnflammaLlon and lceraLlon of mcos membranes halr
loss anorexla nasea and vomlLlng wlLh speclflc nrslng and medlcal lnLervenLlons
O MonlLor lab reslLs (drgs wlLhheld lf blood conLs serlosly low) blood and blood prodcL admlnlsLraLlon
O Assess for dehydraLlon oncologlc emergencles
O 1each regardlng faLlge lmmnosppressanL precaLlons
O rovlde emoLlonal and splrlLal spporL Lo cllenLs and famllles
O Allow an exLra Llme Lo llsLen Lo paLlenL wlLh cancer express Lhelr feellngs and encorage Lhem Lo follow Lhe
gldellnes
O lnvolve paLlenL ln care plan


Descr|be the ma[or categor|es of chemotherapeut|c agents
O AnLlmeLabollLes
AcLlon phase speclflc
Lx MeLhoLrexaLe 3lu llororacll
1oxlc LffecLs nasea vomlLlng sLomaLlLls dlarrhea alopecla lecopenla
O AnLlLmor AnLlbloLlcs
AcLlon non phase speclflc lnLerfere wlLh unA
Lx AcLlnomycln u 8leomycln adrlamycln (doxorblcln)
1oxlc LffecL damage Lo cardlac mscle
O MloLlc lnhlblLors
AcLlon revenL cell dlvlslon drlng M phase of cell dlvlslon
Lx vlncrlsLlne vlnblasLlne
1oxlc LffecLs affecLs neroLransmlsslon alopecla bone marrow depresslon
O Pormones
AcLlon sLage speclflc C1
Lx CorLlcosLerolds MegsLrol (Megace) leprollde (pron)
1oxlc LffecL lmpoLence flld/elecLrolyLe lmbalance changes ln appeLlLe and energy perlpheral edema
O Pormone AnLagonlsL
AcLlon block hormones on hormone blndlng Lmors le breasL prosLaLe endomeLrlm case Lmor regresslon
Lx 1amoxlfen (breasL) llLamlde (prosLaLe)
1oxlc LffecLs alLered secondary sex characLerlsLlcs perlpheral edema hypercalcemla

p|a|n the et|o|ogy pathophys|o|ogy c||n|ca| man|festat|ons d|agnost|c tests med|ca|
management nurs|ng |ntervent|ons and prognos|s for 1umor |ys|s syndrome
O LLlology and aLhophyslology
H May occr sponLaneosly or 24 hrs Lo 7 days afLer chemoLherapy or radlaLlon Lherapy LhaL cases
desLrcLlon (lysls) of a large nmber of rapldly dlvldlng mallgnanL cells
H aLlenLs aL mosL hlgher rlsks wlLh large Lmor cell brdens (eg hlgh grade lymphoma) or markedly
elevaLed J8C level (acLe lekemla)
H Also seen ln chronlc lymphocyLlc lekemla and meLasLaLlc breasL cancer
H As mallgnanL cells are lysed lnLracelllar conLenL are rapldly released lnLo Lhe bloodsLream 1hls reslL ln
hypercalcemla hyperphosphaLemla hyperrlcemla hypocalcemla all Lhese pL paLlenL aL rlsk for renal
fallre and alLeraLlon of cardlac fncLlon
O Cllnlcal ManlfesLaLlons
Larly slgns lnclde nasea vomlLlng anorexla and dlarrhea accompanled by mscle weakness and cramplng
aLer slgns may progress Lo LeLany paresLheslas selzre anrla and cardlac arresL
O ulagnosLlc LesLs
H CbservaLlon of S/S
H MosL freqenLly deLecLed by abnormallLles of blood chemlsLry serm poLasslm serm phosphaLe calclm
and rlc acld serm creaLlnln 8un rlne P
O Medlcal managemenL
8esL 1x ls prevenLlon and prophylacLlc measre before beglnnlng of neoplasLlc Lherapy whlch lnclde
2448 hrs before LreaLmenL hydraLlon Lo malnLaln rlnary oLpL of 130m/hr and conLlne
72 hrs afLer LreaLmenL
ulreLlcs Lo promoLe Lhe excreLlon of phosphaLe poLasslm and rlc acld ln Lhe rlne Lo
prevenL flld overload
lew days before LreaLmenL and 33 days afLer LreaLmenL ls compleLed Alloprlnol LhaL
prevenLs rlc acld formaLlon
Sodlm bycorbanaLe ls sed Lo malnLaln an alkallne rlne (pP over 7) Lo prevenL rlc acld
crysLalllzaLlon
CaLlonexchange rezlns sch as kayexalaLe are sed Lo blnd poLasslm so lL's excreLed
Lhrogh Lhe bowel
Calclm glconaLe ls glven lv for hypocalcemla
Cardlac monlLorlng ls reqlred
hosphaLe blndlng gels sch as almlnm hydroxlde are glven Lo form an lnsolble
complex LhaL ls excreLed by Lhe bowel
Jhen Lhese measres are nsccessfl renal dlalysls may be necessary
O nrslng lnLervenLlons
H ldenLlfy pL aL rlsk for 1S and lnlLlaLe hydraLlon 2448 hrs before chemoLherapy
H AdmlnlsLer Aloprlnol before and drlng chemoLherapy Lo malnLaln alkallne rlne
H MonlLor serm lab vales
H Assess pL for S/S of 1S
Pyperkalemla cardlac changes mscle weakness LwlLchlng paresLhesla paralysls mscle
cramps n/v leLhargy syncope
PyperphosphaLemla azoLemla olllgrla hyperLenslon renal fallre
Pypocalcemla elecLrocardlographlc changes LlLany hallclnaLlon confslon
Pyperrlcemla renal fallre nasea vomlLlng flank paln goL prrlLs
MonlLor l/C noLlfy docLor lf less Lhan 100 m/hr rlne pP and malnLaln greaLer Lhan 7 wlLh
sodlm blcarbonaLe
repare for dlalysls lf oLher measres are noL effecLlve

D|scuss s| genera| pa|n re||ef gu|de||nes for the pat|ent w|th advanced cancer
O use of varleLy of paln rellef measres
O use paln rellef measres before Lhe paln becomes severe
O lnclde Lhe paln rellef measres LhaL Lhe paLlenL belleves wlll be helpfl
O ueLermlne paLlenL's ablllLy or wllllngness Lo parLlclpaLe acLlvely ln Lhe se of paln rellve measres
O 8ely on paLlenL behavlor Lo lndlcaLe paln severlLy raLher Lhan relylng on known physlcal sLlmll
O Lncorage paLlenL Lo Lry a paln relleve measres aL leasL 2 Llmes before abandonlng lL as lneffecLlve
O Pave an open mlnd as Lo whaL may relleve Lhe paLlenL paln lncldlng nonpharmacologlc measres
O eep Lrylng Lo relleve Lhe paln do noL become dlscoraged and do noL sLop worklng wlLh Lhe paLlenL