RNSG 2535 – Integrated Client Care Management

Unit V - Care of the Client Experiencing Cancer

Behavioral Objectives / Content Outline / Clinical Objectives / Learning opportunities
  1. Apply the terms listed in the content column appropriate to the client situations.
  1. Compare and contrast the etiology and related pathophysiology of excessive cellular proliferation across the lifespan.
  1. Analyze factors included in the
assessment of the client
experiencing problems of
cellular deviation (Cancer).
  1. Differentiate between the etiology, pathophysiology, and clinical manifestations of selected problems of cellular proliferation.
  1. Discuss the various treatment options for clients experiencing problems of cellular proliferation.
  1. Discuss analysis, planning, implementation and evaluation for the nursing management of clients with selected problems of cellular proliferation.
/
  1. Application of terms
  1. Adjuvant Therapy
  2. Combination Chemotherapy
  3. Cytology
  4. Gene Therapy
  5. Intravesical
  6. Metastasis
  7. Palliation
  8. Polyps
  9. Progenitor cell
  10. Tumor lysis syndrome
  11. Tumor marker
  12. Spinal Cord Compression
  13. Superior Vena Cava Syndrome
N. Wilm’s Tumor
  1. Overview of typical/atypical cells
  1. Developmental considerations
  1. Infant
  2. Child
  3. Adolescent
  4. Adult
  5. Older adult
  1. Pathophysiology
  1. Proliferation growth patterns
  2. Neoplastic pathology
  3. Neoplastic classification systems
  4. Staging/grading
  1. Cellular differentiation
  2. Carcinogenesis
  1. Phases
  2. Etiologies
  1. Viruses
  2. Physical agents
  3. Chemical Agents (Environmental)
  4. Oncogenes
  5. Tumor suppressor genes
  6. Genetic Predisposition
  7. Immune Surveillance Theory
  8. Stem Cell theory
  1. Cancer assessment
  2. Interview
  3. Chief complaint
  4. History of present illness
  5. Prior medical history
  6. Treatment/ MedicationHistory(Prescribed/Non-prescribed)
  7. Family/social/occupational history
  8. Psychosocial Assessment
  9. Role Behavior
  10. Body Image
  11. Coping Mechanisms
  12. Knowledge of health maintenance
  13. Identify risk factors
  14. Physical exam
  15. Head to toe
  16. Assess for implication of disease and treatment/medications
  17. Pain – chronic vs. acute
  18. Diagnostic tests
  19. Laboratory studies
  20. Carcinogenic Embryonic Antigen (CEA)
  21. Deoxyriboneucleic Acid (DNA) Ploidy
  22. CA 15-3
  23. CA 125
  24. Her 2NU
  25. Papanicolaou (PAP) test
  26. Prostate Surface Antigen (PSA)
  27. CBC
(1)RBC
(2)Hgb/Hct
(3)Platelet
(4)WBC
(a)Differential
(b)Absolute Neutrophil Count (ANC)
  1. Estrogen Receptor Assay
  2. Progesterone Receptor Assay
  3. Alpha Feto Protein (AFP)
  1. Radiology/Imaging
  2. Chest X-ray
  3. Magnetic Resonance Imaging (MRI)
  4. Computerized Axial Tomography (CT)
  5. Ultrasound
  6. Brain Scan
  7. Bone Scan
  8. Liver Scan
  9. Metastatic Survey
  10. Mammogram
  11. Invasive/biopsies
  12. Punch
  13. Thin Needle
  14. Bone Marrow
  15. Frozen sections
  1. Cultural influences
  2. Hereditary
  3. Environmental
  4. Health beliefs/practices
  5. Developmental
  6. Age specific assessment data
  7. Behavioral/emotional response to health care providers
  8. Behavioral/emotional response to death and dying
  1. Selected problems of cellular proliferation.
  2. Hematopoetic system
  3. Leukemia
  4. Lymphatic
  5. Lymphoma
  6. Hodgkins
  7. Non-Hodgkins
  8. Skin
  9. Gastrointestinal
  10. Liver
  11. Pancreas
  12. Colorectal
  13. Lung
  14. Brain
  15. Bladder
  16. Larnyx
  17. Reproductive Female
  18. Uterine
  19. Cervical
  20. Ovarian
  21. Breast
  22. Vulvar
  23. Reproductive – Male
  24. Testicular
  25. Prostate
  1. Treatment modalities
  2. Chemotherapy
  3. Systemic
  4. Intravesical
  5. Intrathecal
  6. Radiation
  7. External Beam
  8. Internal
  9. Hormonal Therapy
  10. Transplantation
  11. Bone Marrow
  12. Solid Organ
  13. Immune Modulated Therapy
  14. Biological Response Modifiers (BRM) (Cytokines)
  15. Colony Stimulating Factors (CSF)
  16. Interferon
  17. Interleukins
  18. Gene therapy
  19. Alternative Treatments
  20. Pain Control
  21. Physiologic dying process
  1. Selected nursing diagnoses/nursing implementation/evaluation.
  2. High risk for complications: Medical treatment
  3. Independent nursing interventions
  4. See head to toe assessment
  5. Age related hydration status
  6. Intake and output
  7. Monitor pertinent diagnostic tests
  8. Maintain skin integrity
  9. Immune suppressed precautions
  10. Bleeding precautions
  11. Nutritional status
  12. Oral hygiene
  13. Vital signs
  14. Protect photosensitive skin
  15. Collaborate interventions
  16. Administer replacement fluid
(1)Intravenous
(2)Total parental nutrition (TPN)
  1. Administer medications and monitor for desired effects/adverse effects/side effects
(1)Antiemetics
(2)Antidiarrheal
(3)Antineoplastic drugs
(4)Biologic response modifiers (BRM)
(5)Antianxiety
(6)Topical anesthetics
(7)Antacids
(8)Antibiotics
(9)Vitamins/minerals
(10)Stool softeners
(11)Laxatives
(12)GI stimulants
(13)Pain medication
(14)Steroids
  1. Blood products
  2. Refer dietary for nutritional support
  1. Recognition of complications
  2. Hemorrhage
  3. Nephrotoxity
  4. Cardiotoxicity
  5. Neurotoxicity
  6. Sepsis/infection
  7. Pulmonary fibrosis
  8. Gastrointestinal
  9. Hyperuricemia
  10. Hypercalcemia
  11. Malnutrition
  12. Bowel obstruction
  13. Impaired skin integrity
  14. Death
  15. Pruritis
  16. Alopecia
  17. Alteration in reproduction
  18. Blood dyscrasia
  19. Fatigue/malaise
  20. Second primary neoplasm
  21. Neutropenia
  22. Thrombocytopenia
  23. Anemia
  24. The client will have decreased risk for medical complications as evidenced by:
  25. No infection/sepsis
  26. No impared skin integrity
  27. No excessive weight loss
  28. No bleeding
  29. Maintains adequate bowel elimination
  30. Vital signs WNL
  31. Skin integrity intact
  32. Gastrointestinal mucosa intact
  33. Lab work within normal limits
  34. No evidence of congestive heart failure
  35. Pulmonary function test WNL
  36. Hydration status WNL
  37. Absence of graft versus host disease
  1. High risk for post op complications
  2. Surgical modalities
  3. Pancreataduodenectomy (Whipple)
  4. Gastrectomy
  5. Segmental Resection with Anastamosis
  6. Abdominal Perineal with colostomy
  7. Ureteroenterocutaneous Diversions
  8. Laryngectomy
  9. Orchiectomy
  10. Prostatectomy
  11. Hysterectomy
  12. Mastectomy
  13. Cryotherapy
  14. Palliative
  15. Independent interventions
  16. Colostomy
(1)Drains/assess perineal packing
(2)Fecal drainage
(3)Bowel sounds
  1. Laryngectomy
(1)Maintain airway
(2)Promoting communication and speech
(3)Neck exercises
(4)Hemorrhaging
(5)Drains
(6)Semi-fowler’s position
  1. Mastectomy
(1)Monitor edema
(2)Avoid cuffs/sticks to affected side
(3)Progressive range of motion exercises
(4)Drains
  1. Collaborative interventions
  2. Administer medications and monitor for desired effects/adverse effects/ side effects
(1)Antibiotics
(2)Narcotics
(3)Prophylactic heparin /lovenox
  1. Collaborate with enterostomal therapist
  2. Collaborate with Reach To Recovery
  3. Collaborate with Lost Chords
  4. Oxygen support
  1. Recognition of complications
  2. Hemorrhage
  3. Infection: wound and systemic
  4. Fistula formation
  5. Peritonitis
  6. Delayed wound healing: dehiscence, evisceration
  7. Malnutrition
  8. Lymphedema
  9. Bowel obstruction
  10. Adhesions
  11. Carotid artery rupture
  12. The client will not experience post-op complications as evidenced by:
  13. Wound healing
  14. Vital signs
  15. Bowel sounds
  16. Abdominal girth
  17. Homan’s sign
  18. Tolerates diet
  19. Laboratory studies
  20. Patent airway
  21. No lymphedema
  22. Adequate elimination
  23. Fluid volume status
  1. Altered health maintenance: Knowledge Deficit
  2. Client teaching
  3. Assess readiness to learn, ability, knowledge
  4. Health promotion/early diagnosis
(1)Ten steps of cancer prevention
(2)Seven warning signs
(3)Screening tests / Work with client and interdisciplinary health care team for planning health care delivery to improve the quality of care across the life span.
Assess the adequacy of the support system of the client.
Identify clients and families unmet needs.
Identify providers and resources to meet the needs of clients.
Perform health screening.
Contribute to the interdisciplinary plan of care.
Prioritize client care and follow-up on problems that warrant investigation.
Read and discuss relevant, current nursing practice journal articles and apply to practice.
Inform and support health care rights of clients.
Support the client’s right of self-determination and choice even when these choices conflict with values of the individual professional.
Identify learning needs of clients related to health promotion, maintenance and risk reduction.
Participate in interdisciplinary health care team meetings/conferences.
Select and carry out safe and appropriate activities to assist client to meet basic physiologic needs, including: circulation, nutrition, oxygenation, activity, elimination, comfort, rest and sleep. / READ:
Lewis (2011)
Lehne (2010)
McKinney (2009)
VIDEOS:
VCR #0077 – Until I Die
VCR #0093 – Care of Colostomies & Ileostomies.
VCR #M122 – Preparing the Ostomy patient for discharge.
  1. Reportable signs/symptoms
(1)Post radiation
(2)Post chemotherapy
(3)Post operative
  1. Laryngeal stoma care
  2. Ostomy care
  3. Medication teaching
  4. Rest/activity
  5. Life style modifications
  6. Nutritional
  7. Maintenance of fluid balance (Age specific)
  8. Communication
  1. Community Resources
  2. American Ostomy Association
  3. United Ostomy Association of America
  4. National Cancer Information Service
  5. American Cancer Society
  6. Leukemia Society of America
  7. Home health
  8. Hospice
  9. The client will have improved health maintenance as evidenced by:
  10. Listing health promotion activities
  11. Identifying reportable signs and symptoms
  12. Describing the purpose, correct administration and side effects of meds
  13. Ability to discuss diagnosis, surgical procedure, and post-op care
  14. Demonstrates laryngeal stoma care
  15. Increasing activity as tolerated
  16. Achieves optimum level of nutrition through prescribed diet
  17. Utilizing community resources
  18. Range of motion exercises
  19. Demonstrates ostomy care
  1. Body Image Disturbance
  2. Independent nursing interventions
  3. Establish trust and rapport
  4. Utilize therapeutic communication
techniques to encourage verbalization
of feelings
  1. Assess prior coping strategies and encourage development of new strategies
  2. Encourage continued participation in activities and decision making
  3. Facilitate the client’s progression through stages of loss
  4. Encourage good hygiene, grooming, and sex appropriate items
  5. Encourage client to ask questions
  1. Collaborative
  2. Refer to appropriate support group
(1)Lost Chords
(2)Reach To Recovery
(3)Ostomate (Ostomy Association)
(4)CanSurmount
(5)CanCope
(6)Dialogue
(7)A Time for Me
(8)Breast cancer support group for
men
(9)Leukemia Society of America
  1. The client will acknowledge change in body image as evidenced by:
  2. Participating in self care
  3. Verbalizing feelings to nurse/significant other
  4. Facilitating client from sick role to well role
  5. Appearing well groomed and attractively dressed
  6. Able to communicate effectively
  1. Anticipatory grieving
  2. Independent nursing interventions
  3. Establish a trusting relationship that encourages communication
  4. Clarify, re-focus, and supply information as needed
  5. Help family plan care of client throughout stages of illness
  6. Provide and assist in arrangement for hospice care
  7. Arrange for spiritual support in accordance with family’s beliefs and/or affiliations
  8. Help family to acknowledge loss
  9. Collaborative
  10. Refer to appropriate support group
(1)Make a Wish Foundation
(2)Ronald McDonald House
(3)Candle Lighters
(4)Hospice
(5)Pastoral services
  1. The client/family will progress through the
phases of grief as evidenced by:
  1. Increased verbalization and expression of grief
  2. Identifying resources available to aide coping strategies during grieving
  3. Use resources and supports appropriately
  4. Discussing the future openly with each other
  1. Alteration in comfort: Acute/chronic pain
  2. Independent interventions
  3. Assessment of chronic pain
  4. Provide psychological support
  5. Teach about pharmacological pain control regimens
  6. Teach distraction techniques
(1)Benson’s Relaxation Technique
(2)Guided Imagery
(3)Music Therapy
  1. Position for comfort
  1. Collaborative Interventions
  2. Administer medications and monitor for desired effects/adverse effects/side effects.
(1)Analgesics
(a)Narcotics
(b)Non-Narcotic
(2)Anti-anxiety
(3)Anti-depressants
(4)Sedative
(5)Hypnotics
(6)Equal analgesic dosing
  1. Refer to:
(1)Physical therapy
(2)Social services
(3)Clergy
(4)Psychological counselor
(5)Cancer support groups
(6)Hospice
(7)Home Health
(8)Pain clinic
  1. Recognition of complications
  2. Intractable pain
  3. Respiratory depression
  4. Depression
  5. Immobility
  6. The client will have relief of pain as evidenced by:
  7. Stating a 1 of pain on a pain scale of 1-10
  8. Participating in ADL’s and other activities
  9. Demonstrating use of distraction techniques
  10. Verbalizing 3 techniques to maintain pain at an acceptable level to client

n:soph\fall\UnitVCancerRevised 07/11