ONCOLOGY NURSING

GENERAL GUIDELINES FOR CANCER SCREENING Mammography ________________ 35-40yo: ____________ 41-50yo: __________ 51yo & : ___________

The testes are normally __________________. Note: size, shape, abnormal tenderness such as firm area on the front or side of the testis. The client should stand in front of the mirror & look for ________________

_________________________. A small ____________________testes should be reported.

Breast clinical exam 29-30yo = _______.; 40yo & = ____ Both 40yo & = ______

COLONOSCOPY To visualize the large intestines. Nursing-alert: ___________________

DRE

_______________________________. Clear liquid diet for _________ prior to the test. __________ on the evening before the test and an _________ before the test. Post-procedure- __________________.

Stool occult blood exam Both 50yo & = ________

Sigmoidoscopy Both 50yo & = ______

BREAST SELF-EXAM >20yo & monthly, a _______________________ To detect monthly breast changes like ___________, _________ & __________. Inspect the areola, nipples for positioning, pigmentation, inversion, discharge, crusting, & masses. Note retraction or dimpling of the skin. Palpation is best done with the client in __________________________________. Client with pendulous breast should be given ____________________________

PAP SMEAR To screen for cervical dysplasia or cancer. It may also help to detect _____________________, ________ and ___________________. >18yo & or when sexually active - q yr. Instruct the client to _______ prior to the procedure. during _________. douching & sexual intercourse for _________. prior to the procedure. Explain: speculum and a spatula will be inserted - the spatula will be rotated. Cervical secretions: smeared on a glass slide + dyes & acids. results = _____ conclusive test for cancer thus needs additional tests.

________________ of the breast being palpated so the tissue is ___________ __________________________________. Palpation is done quadrant per quadrant including the inguinal nodes.

CARCINO-EMBRYONIC AGENT (CEA) TESTICULAR SELF-EXAM To detect the presence of testicular tumor. men aged 15 years & monthly after ________________ Feel each testis between the _______ and _________________of each hand. To determine the extent of some cancer types, especially colorectal cancer. The test is based on the CEA, a ______

__________________________________. At ________, detectable serum levels disappear.

Nursing-alert: the tests is just like a normal blood test. There may be changes in the CEA levels in different conditions. May be ________ in CA clients. Does not detect CA in _____________.

Alopecia Immediate but temporarily Help to select a wig before the start of treatment. Re-growth of hair is usually ________

_______ in recurrence of colon cancer. Heavy ________ may affect the result.

_________________.

Sterility STOOL FOR GUIAC EXAM To monitor for ________________. Nursing-alert: 3 days before the test: _____________________. red meat & high in _____________, iron preparations, iodides, bromide, aspirin, NSAIDS or Vitamin C, enemas or laxatives _____________ & ___________ WBC: _____________________ y y Sperm bank/egg deposit Refer to reproductive counseling

BM & platelet depression CBC

_________________ platelet count: ______________

______________________ MAMMOGRAPHY To detect the (+) of breast tumor. Nursing-alert: ____ deodorant, talcum powder, lotion, perfume & any ointment on the day of the procedure. Breast will be placed between _____ Stomatitis Rinse mouth: ___________________ ________ Common side effects associated with chemotherapeutic agents Anorexia, nausea & vomiting Alopecia BM & platelet depression Stomatitis Sterility Carcinoma Anorexia, nausea & vomiting Anti-emetics ____________ before chemotherapy (Trimethobenzamide, Ondasetron) Small frequent meals Leukemia _____ hot or spicy foods Diet: _________________ Sarcoma Lymphoma CATEGORIES AFFECTED AREAS CATEGORIES OF CANCER Use cotton-tip applicator for ________________ over lesions Brush teeth with soft toothbrush & _______________ Use _____________ dental floss

_______________.

Classification of cancer pain according to duration TYPES OF PAIN DESCRIPTIONS

Lab. Data:

Anemia

ed ___________________, excretory urography, retrograde cystograpy cystoscopy and biopsy

Acute pain

Chronic pain

Treatment: __________________ Ileal loop ileal conduit Continental urinary diversion Ureterostomy

Episodic pain

1. Incident pain

Interventions: Prepare client for surgery and chemotherapy Encourage client to verbalize fears. Teach patient about urinary diversion. Arrange for follow-up care or provide referral to enterostomal therapist.

2. end-of-dose-pain

3. Breakthrough pain

BREAST CANCER Treatment of cancer pain Pain Intensity Mild (1-3) Treatment Moderate (4-6) (+) Of malignant tumors usually in the _________________________________. Also associated with ___________ or having the first child after age 30. IM: ____________(most common sign) Others: Severe (7-10) Pain Emergancy BLADDER CANCER (+) Malignant cells in the bladder. IM: ____________________ Others: Dysuria Urinary frequency Frequent UTI Flank pain Pelvic mass Asymmetrical breast Nipple retraction Orange peel skin Abnormal breast discharge Edema of the arm

Lab. Data: mammography, UTZ & biopsy Interventions: Prepare client for chemotherapy, radiation and surgery. Teach client how to perform BSE.

- Inform client briefly about mammography. Post-mastectomy: Monitor wound site, vital signs & intake and output ____________________________

Instruct patient to exercise hand and arm regularly. Avoid activities that may increase infection like ____________________.

Vaginal bleeding Post-coital pain Vaginal discharge

TYPES OF BREAST SURGERY Lumpectomy: ________________________________ ________________________________

Lab. Data: paps smear Interventions: Instruct client to avoid douching & sexual intercourse 24h before Papsmear. Stress the importance of lifelong follow-up visits, to detect response to treatment. Prepare the client for surgery, chemotherapy & radiation.

Partial mastectomy: ________________________________ ________________________________

Simple mastectomy ________________________________ ________________________________

Modified radical mastectomy ________________________________ ________________________________

ESOPHAGEAL CANCER (+) Malignant tumor in the esophagus r/t alcoholism & smoking. IM: ___________________ Others: Substernal pain Regurgitation Substernal burning after drinking hot liquid

Radical mastectomy ________________________________ ________________________________

General pre-operative care: Teach client the appropriate post-operative exercise. Provide client with opportunity to discuss concerns on washing the face, combing hair, squeezing rubber balls. General post-operative care: The drainage is usually removed in ______________________________. Suction drain is maintained. N: ______________; ________ml/24h. Report: excessive _______ discharge

Lab. Data: Barium swallow with flouroscopy & CT scan Interventions: Prepare client for surgery, radiation therapy & chemotherapy. Administer antacids as ordered. Prepare client for tube or gastrostomy feedings & short course hyperalimentation. Instruct the client to avoid over-eating raw vegetables & fruits postoperatively.

Keep the affected extremity __________ to prevent _______ _______. Encourage client to perform wrist and elbow flexion & exertion. CERVICAL CANCER (+) of malignant cells in the cervix associated with multiple sexual partners & history of sexually transmitted diseases. IM: initially ______________________ Others:

LARYNGEAL CANCER (+) Of malignant cells in the larynx associated with smoking & alcoholism. IM: ______________________________ ________________________ Others: Sore throat Dysphagia

Enlarged lymph nodes Foul breath Dyspnea weakness

Monitor vital signs, intake and output, and effectiveness of pain control. Check for the dressing regularly for ________________________________ ___________________________. Watch for _________________________. Provide emotional support. Assist the client to cope with change in body image.

Lab. Data: laryngoscopy & biopsy Interventions: Prepare client for radiation, chemotherapy & surgery. Teach client to avoid cold air. Swimming is not recommended postlaryngectomy.

PROSTATE CANCER (+) malignant tumor in the prostate gland. IM: ______________________________ Others: Slow urine stream Nocturia Urinary hesitancy Hematuria Incomplete bladder emptying Dysuria

Give I.V. fluids and tube feedings. Maintain patients tracheostomy tube. Support patients neck when moving him. Suction gently. Elevate head of the bed.

OVARIAN CANCER Gynecologic cancer associated with high fat diet and nulliparity. IM: initially asymptomatic; Others: Bloating Weight loss Ascites Flatulence Post-menopausal bleeding Dyspepsia vague abdominal discomfort like indigestion (common symptom)

Lab. Data: ed ______________________ ed ______________________

Interventions: Support the client undergoing radiation therapy. Inform the client that radical prostatectomy, which involves the removal of the ____________________

_________________________________. Laparoscopy Ultrasound Exploratorylaparotomy

Lab. Data: TYPES OF PROSTATE SURGERY TURP Use of endoscopic instrument for resection of prostate; ____________.

Interventions: before the surgery Prepare the client for surgery & chemotherapy. Explain that bilateral oopherectomy ______________________________.

SUPRAPUBIC (+) incision in the _____________ through the bladder wall.

PERINEAL (+) incision in the _______________.; usually leads to _______________.

Interventions: after the surgery

RETROPUBIC (+) incision at the ___________________.

Prepare client for surgery. Teach client about TSE Suspect CA: smooth testicles spongy on palpation

General pre-operative care Provide information: __________________ __________________

Surgery: _________________

After surgery: Apply ________________ to scrotum. Provide analgesics as ordered. Check for ________________________

Discuss potential complications: Impotence ____________________ ____________________

General post-operative care Maintain urinary drainage.

____________________________.

HODKINS DISEASE Report: grossly bloody drainage. Encourage ambulation after 24h. Ensure: secured drainage catheter. Avoid the ff.: (11/2- 2mos. After surgery) Sexual intercourse Heavy lifting Prolonged sitting Straining during BM After radiation therapy: Urge client to drink at least 2qt (2L) of fluid daily. Give analgesics as ordered. TESTICULAR CANCER Malignancy in the testes, usually associated with cryptorchidism. IM: painless swelling or enlargement of the testes, accompanied by sensation of heaviness in the scrotum. Others: Spongy testes Low back pain Lumps or nodules in the testes Scrotal swelling Accumulation of fluids in the scrotum WO: _______________________________ ____________________. Thrombocytopenia Anorexia Hepatomegally Progressive anemia Splenomegally Dysphagia Dyspnea Others: ______________________. IM: ______________________________ Malignancy in the _________________.

Lab. Data: Lymph node biopsy Hematologic test

Interventions: Instruct the client to report any signs of ________________. Prepare the client for chemotherapy & radiation therapy.

Lab. Data: ed HCG & alpha-feto protein. Interventions: