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cancer notes

by: Brenna Notetaker

cancer notes Nurs 4020

Brenna Notetaker
GPA 3.4
Mrs. Swift

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About this Document

med surg cancer notes
Mrs. Swift
Class Notes
med surg nursing, cancer
25 ?




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This 0 page Class Notes was uploaded by Brenna Notetaker on Monday February 8, 2016. The Class Notes belongs to Nurs 4020 at East Carolina University taught by Mrs. Swift in Fall 2015. Since its upload, it has received 25 views.


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Date Created: 02/08/16
11202015 Breast Cancer 0 Early detection and screening is important 0 Risk factors for women O 0000 O O O O FEMALE GENDER AND ADVANCING AGE are the top two First degree relatives BRCA1 or BRCA2 genes Recurrence Caucasian women are more likely to develop it but AA woman are more likely to die from it The more menstrual cycles a woman has had the higher the risk of getting breast cancer early period late menopause Having no children or having rst child after 30 Estrogen and progesterone therapy after menopause increases risk Breastfeeding decreases risk only for extended period of time Alcohol increases risk Obesity increases risk Physically active decreases risk 0 Risk factors for men 0 O O 0 Advanced age BRCA1 or BRCA2 Testicular removed or undescended testicle Occupations jobs when they re hot Prognosis 0 Stage Stage 1 ve year survival rate is 100 Stage 2 ve year survival rate is 93 Stage 3 ve year survival rate is 72 Stage 4 ve year survival rate is 24 0 Human epidermal growth factor receptor 2 status makes breast cells grow faster than normal and divide in an uncontrolled way cancer is more likely to be fast growing and aggressive o Estrogenreceptor positivenegative trying to see if cancer has receptors for estrogen if it is estrogenreceptor positive it means the cancer is more likely to be contained have a lower chance of recurrence and be very responsive to hormone therapy if they re receptor negative it means tumors do not have good margins higher risk of recurrence and it is unlikely to respond to hormone therapy Clinical manifestations o lnverted nipples o Peau d orange orange peel texture More likely to occur in the outer upper quadrant of the breast Diagnosis 0 History and exam Imaging test of choice is a mammogram MRI is used if there is a suspicious image on a mammogram Tumor or cyst use ultrasound Biopsy ultrasound guidance needle is so small they don t need local anesthesia Nipple discharge tested for cancer cells 0 Surgery Lumpectomy need to do chemo and radiation as well least invasive only the lump removed 0000 O SLND sentinel lymph node dissection Radical mastectomy breast tissue armpit lymph nodes and pectoral muscle removed Modi ed radical mastectomy remove breast tissue armpit lymph nodes and the lining of the muscle Complications o Lymphedema raise arm above heart level immediately after surgery to prevent this do not take BP on this arm teach them exercises where they need to raise their arms and move their hands and ngers 0 Phantom pain from damage to brachial nerves 0 Nursing implementation after surgery 0 Take analgesics 30 min before exercising Surgical therapy follow up 0 Exams every 6 months for 2 years then annually 0 Scans every 3 months 0 Most common site of recurrence is at the surgical site 0 Adjuvant therapy 0 Doxorubicin is most common chemotherapy watch for cardio toxicity 0 Tamoxifen is an estrogen blocker increased risk for DVT and PE vaginal bleeding Recurrence 0 Local same area 0 Regional other breast o Distant metastatic Colorectal Cancer 0 3rd most common cause of death in the US risk factors 0 BEING MALE AND ADVANCED AGE ARE MOST COMMON RISK FACTORS 0 Diet high in red meat and low in fruits and vegetables 0 Obesity and sedentary lifestyle Clinical manifestations o Rectal bleeding or blood in stools Iron de ciency anemia Change in bowel habits Abdominal pain Often not found until it causes an intestinal obstruction or perforation Diagnosis 0 CEA normally only done if pt has had cancer and had it treated to monitor for reoccurrence CEA levels dropped can show treatment is effective Surgical treatment 0 Polypectomy o Bowel resection is surrounding colon is still healthy so they can reanastomos remaining portions o If it s a large amounts then a colostomy is needed 0 May also remove lymph nodes in abdomen 0 Chemo and radiation before andor after Nursing implementation 0 Need one of the listed not all 0 For colposcopy tell them not to have anything red red juice fruit ect 24 hours before the test 0000 Leukemia Cancer of the blood cells 0 Can affect the blood components the bone marrow or the spleen and anything in the lymphatic system 0 Mortality depends on age extent of leukemia type Classi cations 0 Acute Worse symptoms Greater rate of abnormal cell replication Leukemia cells replace WBC cant ght infection 0 Chronic Not as severe Found at routine check up Has slow onset Risk factors 0 Radiation damages normal cells occurs after someone has been treated for some other type of cancer exposure from work sources 0 Viruses o Benzene 0 Family history doesn t play a big role 0 Symptoms o Vague symptoms fever fatigue weakness pale bleeding from decreased platelets joint or bone pain splenomegaly swollen lymph nodes that don t hurt night sweats loss of appetite o Worse in acute O O o O 0 Diagnosis Most common blood test is a CBC very high white count 240000 but they re not effective platelets decreased RBC decreased Hgb and Hct decreased Bone marrow biopsy Collaborative care Complete remission the patient is feeling good no signs via blood work Partial remission normal blood work and feel okay but bone marrow shows signs of disease Molecular remission seen in chronic normal blood work and normal bone marrow but they still have physical symptoms Four stages of therapy Start with high doses of chemo then move to maintenance doses Only do chemo for leukemia not radiation Lung cancer 0 0 Causes more deaths than the next three combined Five year survival rate is lower than any other cancer Causes Number one cause is smoking 8090 cases are caused by smoking if someone quits within 1015 years their lungs can fully recover secondhand smoke poHqun asbestos o nonsmall cell more common non smokers 0 small cell clinical manifestations o persistent cough with sputum o SOB doing things they used to be able to do 0 O O O O O O O 0 WV Changes in voice Care of chest tubes Assess for kinks make sure they re not laying on it tape it well so they can move Sew in with occlusive dressing on top Listen for equal breath sounds Place them on the side of missing lung to try and rein ate the lung Other treatments Radiation can be used to cure or treat palliative care or adjunct therapy Chemo primary treatment for small cell treatment for non resect able tumors Biological targeted therapy Nursing implementation 0 Teach about 55 of colon cancer since lung cancer often moves to colon Head and neck cancer 0 Risk factors 0 People who use alcohol and tobacco products in excess 0000 O 0 Treatment HPV Radiation to head and neck Poor oral hygiene Asbestos Advancing age 0 Laryngectomy Partial n Cordectomy removes part of one vocal cord for really small cancer still have voice a Supraglottic laryngectomy only portion of larynx above vocal cords removed treats higher up cancers can still talk epiglottis is removed gt aspiration risk will need a trach n Hemilaryngectomy removal of one vocal cord for small cancers of vocal cords can still speak Total entire larynx is removed and trachea is brought up through the neck and stoma is made can no longer speak normally connection between throat and esophagus is not effected so they can eat and do not have problems with aspiration o Radical neck dissection Post operative care 0 First 24 hours Really high risk for airway obstruction Will have JP drain on both sides and have to keep them empty and to suction if you notice swelling around any of it be worried about airway obstruction early signs of airway obstruction is irritability and LOC changes High risk for hemorrhage Cant tak establish communication 0 After the rst 24 hours High risk for aspiration thick liquids sit HOB up Suction trach carefully to reduce risk of trauma Humidi ed air cool mist in room to keep secretions thin


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