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Hurst reviews LPN resources for overview of cancer, Study notes of Nursing

Ocean County College Nursing

Hurst reviews LPN resources for an overview of different types of cancer

Typology: Study notes

2020/2021

Available from 12/14/2022

Iperez0606 🇺🇸

5 documents

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Specific Types of Cancer: An Overview

1. Cervical Cancer:

a. Risk factors:

•The number one risk factor is Human Papilloma Virus.

• Repeated STDs

• Multiple sexual partners

• Smoking and exposure to second hand smoke

• Dietaryfactorssuchascertainnutritionaldeficiencies:folate,

beta-carotene and vitamin C.

• Prolonged hormonal therapy

• Family history.

• Immunosuppression

• Sex at a young age and multiple pregnancies

b. Signs/Symptoms:

•Often asymptomatic in pre-invasive cancer

• Invasivecancerclassicsymptoms:painlessvaginalbleeding

• OthergeneralS/S:watery,blood-tingedvaginaldischarge,pelvicpain

(anditmayoccurwithintercourse),legpainalongsciaticnerve,and

flank/backpain

• Excellent cure rate if detected early

c. Diagnosis:

•What is the test that helps diagnose this? a Pap Smear

What if the Pap Smear is abnormal? Repeat test

d. Treatment:

•Electrosurgical excision

• Laser

• Cryosurgery

• Radiation and chemo for late stages

• Conization- remove part of the cervix

• Hysterectomy

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Specific Types of Cancer: An Overview

Cervical Cancer:

a. Risk factors:

The number one risk factor is Human Papilloma Virus.
Repeated STDs
Multiple sexual partners
Smoking and exposure to second hand smoke
Dietary factors such as certain nutritional deficiencies: folate, beta-carotene and vitamin C.
Prolonged hormonal therapy
Family history.
Immunosuppression
Sex at a young age and multiple pregnancies

b. Signs/Symptoms:

Often asymptomatic in pre-invasive cancer
Invasive cancer classic symptoms: painless vaginal bleeding
Other general S/S: watery, blood-tinged vaginal discharge, pelvic pain (and it may occur with intercourse), leg pain along sciatic nerve, and flank/back pain
Excellent cure rate if detected early

c. Diagnosis:

What is the test that helps diagnose this? a Pap Smear

What if the Pap Smear is abnormal? Repeat test

d. Treatment:

Electrosurgical excision
Laser
Cryosurgery
Radiation and chemo for late stages
Conization- remove part of the cervix
Hysterectomy

Uterine Cancer: (Endometrial Cancer)

a. Risk Factors:

Greater than 50 years of age
Taking estrogen therapy without progesterone
Positive family history
Late menopause
No pregnancy (null parity)

b. Signs/Symptoms:

Major symptoms: post-menopausal bleeding
Other S/S: watery/bloody vaginal discharge, low back/abdominal pain, pelvic pain

c. Diagnosis:

CA-125 (blood test) to R/O ovarian involvement
The most definitive diagnostic test is a D&C (dilatation & curettage) and endometrial biopsy.

d. Treatment:

Surgery: Hysterectomy

TAH (total abdominal hysterectomy) = uterus and cervix only! Bilateral oophorectomy (ovaries) Bilateral salpingectomy (tubes)
Radical Hysterectomy:
May remove all of the pelvic organs
Client may have a colostomy or ileal conduit
The greatest time for hemorrhage following this surgery is during the first? 24 hours
Why? Pelvic congestion of blood
The major complication with an abdominal hysterectomy is hemorrhage
Major complication with vaginal hysterectomy? Think Infection!!
Will probably have an indwelling catheter; if she doesn’t you better make sure she does what in the next 8 hours? Void!
Why is it so important to prevent abdominal distention after this surgery? We do not want tension on the suture line. It can lead to dehiscence and evisceration.

c. Treatment:

Surgery
Chemotherapy drugs
Hormonal Therapy

Estrogen receptor blocking agents
Estrogen synthesis inhibitors

Radiation

Lung Cancer:

a. Risk Factors:

Leading cause of cancer death worldwide
Major risk factor: Smoking *When you have stopped smoking for 15 years, the incidence of lung cancer is almost like that of a non-smoker.

b. Signs/Symptoms:

Hemoptysis, dyspnea (may be confused with TB, but TB has night sweats), hoarseness, cough, change in endurance, chest pain, pleuritic pain on inspiration, displaced trachea
May metastasize to bone

c. Diagnosis:

Bronchoscopy
Chest x-ray
CT
MRI

d. Treatment:

Surgery: The main treatment for stage I and II lung cancer
Lobectomy: only take out part of the lung
Chest tubes and surgical side up
Pneumonectomy: the entire lung is removed
Position on affected side (surgical side down, good lung up).
No chest tubes, Why? There is not lung!
Avoid severe lateral positioning mediastinal shift

Laryngeal Cancer a. Risk Factors: - Smoking, (any form of tobacco use), alcohol, voice abuse, chronic laryngitis, industrial chemicals

b. Signs/Symptoms:

Hoarseness, lump in neck, sore throat, cough, problems breathing, earache, weight loss, no early signs c. Diagnosis:
Laryngeal exam, MRI

d. Treatment:

Surgery:

Total laryngectomy
Humidified environment

Remember, with a total laryngectomy ALL breathing is done through the stoma.

Radiation
Chemotherapy
Speech Rehabilitation

When should client teaching begin? Preoperatively at admission
Be a good client advocate: Refer to International Association of Laryngectomees. *See if there are local groups such as the Lost Cord Group.

Colorectal Cancer (CRC):

a. Risk Factors:

May start as a polyp
2/3s of colorectal cancer occurs in the rectosigmoid region
Most frequent site of metastasis: the Liver *Take bleeding precautions
Other problems to watch for: bowel obstruction, perforation, fistula to bladder/vagina
Additional risk factors: inflammatory bowel diseases, genetic, dietary factors (refined carbs, low fiber, high fat, red meat, fried and broiled foods) if you have a first degree relative with CRC your risk just increased 3X the norm
95% of those who get CRC are greater than 50 years old.

Increase fluids (2,000-3,000 ml of fluid per day).
- Fluids help flush out conduit
Is mucus in the urine normal? Yes
The intestines always make mucus (the bladder is made from a part of intestine).
Change appliance in the morning (This is when output will be at its lowest).

It is OK to place a little piece of 4X4 inside the stoma during skin care to absorb urine....... Just don’t forget to remove it!

Prostate Cancer:

a. Signs/Symptoms:

This client comes to the physician with S/S of benign prostatic hyperplasia (BPH): hesitancy, frequency, frequent infections (because the bladder is not completely emptied), nocturia, urgency, dribbling. Many clients are asymptomatic.
Most common sign is painless hematuria
Digital rectal exam is done and if the prostate is hard/nodular; usually means prostate cancer.

b. Diagnosis:

Lab work:

PSA will be increased. Prostate-specific antigen (PSA) PSA is a protein that is only produced by the prostate. Normal is less than 4 ng/ml. If you have two or more 1st degree relatives with prostate cancer, start PSA screenings by at least age 45
Alkaline phosphatase (if  means bone metastasis) *Prostate cancer likes to go to the spine, sacrum, and pelvis.
Increased acid phosphatase (if  means bone metastasis)

Biopsy:

When prostate cancer is suspected, a biopsy must be done for confirmation prior to surgery.

c. Treatment:

Watchful waiting: in early stages (for asymptomatic, older adults with another illness)
Surgery:

Radical Prostatectomy (done when the cancer is localized to the prostate)

Take out the prostate and the client is cancer free (if there is no metastasis).
May have erectile dysfunction due to pudendal nerve dam age.
May have incontinence (Kegel exercises)
Client is sterile.
If there is no lymph node involvement, no  in acid phosphatase, and no metastasis, the surgeon will try to preserve the pudendal nerve.

Prostatectomy (TURP- transurethral resection of the prostate)

Usually reserved for BPH to help urine flow, NOT a cure for prostate CA
No incision (go through the urethra)
Most common complication? Bleeding
With other procedures you have to explain the risk of impotency/infertility, because with other procedures they have an incision.
Is it normal to see bleeding after this surgery? Yes
Continuous bladder irrigation – maintains patency, flushes out clots.

3-way catheter No kinks Subtract irrigant from output.

Keep up with amount of irrigant instilled
What drug do you give for bladder spasms? belladonna and opium suppository (B&O suppository®), oxybutynin (Ditropan®)
When the catheter is removed what do you watch for? Urinary retention
Temporary incontinence is expected (perineal exercises-Kegel)
Avoid sitting, driving, strenuous exercise; do not lift too much…Why? Can cause them to bleed

d. Tx:

Surgery (preferred): Gastrectomy

Fowlers position, decreases stress on the suture line
Will have NG tube (for decompression)
Two major complications: Dumping syndrome Vitamin B-12 deficient anemia- Pernicious anemia *Schilling’s test: Measures the urinary excretion of Vitamin B-12 for diagnosis of pernicious anemia

No stomach  no intrinsic factor  can’t absorb oral B-12  can’t make good

RBCs  client is anemic

Chemotherapy
Radiation

TESTING STRATEGY Never manually irrigate a catheter with a fresh surgery client, without a physician’s order.

TESTING STRATEGY Always assess prior to selecting an implementation answer. Always assess the client first.

Hurst reviews LPN resources for overview of cancer, Study notes of Nursing

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