NO EXAM THURSDAY!!!!!!!!!

In Etudes under messages is a message from Mrs. Durston. It reads:

Message ID: #1
From: Instructor 10/31/2006 2:57 PM
Exam 1, Cancer/Death and Dying

Please don't shoot me.
I am sorry if there has been a misunderstanding.
You have not had all of the lecture material for the first exam, and it will be given November 9.
Please share this with your classmates.
Shelba Durston

N3 Exam 3 grades posted

now on RSevilla's docushare!

link to grades

#1

1. Review risk factors, screening procedures and warning signs of cancer.

RISK FACTORS
(Lewis pg 293-294) (more from Ill. Study Guide For NCLEX)
Chemical Agents: sun, smoke, dyes, asbestos – alter DNA; most often affect liver, lung, & kidneys
Physical Agents: radiation, sunlight, chronic irritation or infection, tobacco use
Viruses: incorporate into genetic cell structure (oncogenic) Ebstein Barr, AIDS
Genetic & familiar factors: DNA damage occurs in cells where chrom. patterns are abnormal - Wilms’ tumor, acute leukemias, etc
Dietary factors: long term ingestion of fats/oils from animal sources, alcoholic bevs., salt cured/smoked meat and nitrate containing foods (and from lecture… charred meats)
Hormonal Agents: disturbances in the body’s endogenous hormones or administration of exogenous hormones (diethylstilbestrol, prolonged ERT, oral contraceptives)
Idiopathic: arise from unknown causes


SCREENING PROCEDURES

Screening
(National Cancer Institute website)
http://www.cancer.gov/cancerinfo/pdq/screening/overview#Section_2

>Screening is a means of detecting disease early in asymptomatic people.
>Positive results of examinations, tests, or procedures used in screening are usually not diagnostic but identify persons at increased risk for the presence of cancer who warrant further evaluation.
>Diagnosis is confirmation of disease by biopsy or tissue examination in the work-up following positive screening tests. (Following a positive screening result, cancer can often be ruled out by procedures other than biopsy or tissue examination.)

Detection
>Direct or assisted visual observation is the most widely available examination for the detection of cancer. It is useful in identifying suspicious lesions in the skin, retina, lip, mouth, larynx, external genitalia, and cervix.
>The second most available detection procedure is palpation to detect lumps, nodules, or tumors in the breast, mouth, salivary glands, thyroid, subcutaneous tissues, anus, rectum, prostate, testes, ovaries, and uterus and enlarged lymph nodes in the neck, axilla, or groin.
>Internal cancers require procedures and tests such as endoscopy, x-rays, magnetic resonance imaging, or ultrasound. Laboratory tests, such as the Pap smear or the fecal occult blood test have been employed for detection of specific cancers.

See Lewis pg 300 Table 15-7
ACS Recommendations for Early Detection of Cancer in Asymptomatic People


WARNING SIGNS "CAUTION"

Change in bladder or bowel habits
A sore that does not heal
Unusual bleeding or discharge from any body orifice
Thickening or a lump in the breast or elsewhere
Indigestion or difficulty swallowing
Obvious change in a wart or mole
Nagging cough or hoarseness

#3.

3. Be Able to Identify Appropriate Nursing Diagnosis for Patient Experiencing Cancer Treatment:
Nursing Diagnosis for persons experiencing cancer surgery
Anxiety due to diagnosis and intervention
Knowledge deficit regarding cancer
Alteration in tissue perfusion
Potential for infection
Potential for injury due to decrease in Platelets
Nursing Diagnosis for persons experiencing chemotherapy
Alteration in Nutrition less than body requirements related to
Nausea/vomiting
Anorexia
Taste distortion
Diarrhea leads to
Fluid Volume deficit
Electrolyte deficit
Alteration in comfort
Altered bowel elimination
Rarely, constipation occurs related to dehydration and poor dietary intake
Alteration in comfort:
Pain due to dermatitis
Pain due to stomatitis
Pain due to perianal and vulvar ulcers
Due to pruritus
Due to liver enlargement
Disturbance in self-concept:
Due to alopecia
Due to skin pigmentation
Due to nail changes
Alterations in sensory-perceptual abilities
Due to impaired renal function
Kinesthetic due to paresthesia
Visual due to photosenstivity
Auditory due to ototoxicity
Impaired physical mobility due to cerebellar dysfunction
Alteration in Urinary Elimination Pattern due to hemorrhagic cystitis
Anxiety due to change in urine color
Sexual dysfunction and alteration of self-concept due to
Premature menopause
Amenorrhea
Decreased spermatogenesis
Altered cardiac output: decreased due to cardiotoxicity of specific antineoplastic agents.
Ineffective breathing pattern and ineffective airway clearance due to pulmonary toxicity
Nursing diagnoses for persons experiencing radiation therapy
Impaired skin integrity
Immediate skin reactions
Delayed skin reactions
Potential for infection related to bone marrow depression
Potential bleeding related to bone marrow depression
Activity intolerance related to anemia
Alteration in nutrition: less than body requirements
Alteration in oral mucous membrane due to irradation
Alteration in bowel elimination due to irradiation
Alteration in urinary elimination patterns
Alteration in comfort: nausea and vomiting
Alteration in comfort: headache
Disturbance of self concept related to alopecia

1/2 the answer for Question #2

I tried to do all of it but it's getting late and I have to get ready for tomorrow. So I did half of the question I covered Surgery and Radiation if someone else can do Chemo and Biological that would be great. Please feel free to put any input if something else can be added or you find an error. Good night ladies!

Treatment Modalities of CA: (Chemo, Radiation, Surgery, and Biologic Therapy) May be used alone or in combination in the initial treatment phase or retreatment phasesà two or more treatment modalities are used to cure or control the CA for a long period of time.
SURGICAL THERAPY: In order for surgical therapy to be applied the following priciples are applicable: **Cure, control and palliation **
i. Cancer that arises from a tissue c slow rate of cellular proliferation or replication is most amenable to surgical treatment
ii. A margin of normal tissue must surroung the tumeor at the time or resection
iii. Only as much tissue as necessary is removed, and adjuvant therapy is used
iv. Preventive measures are used to reduce the surgical seeding of cancer cells
v. The usual sites of regional spread may be surgically removed à a debulking procedure may be used if the tumor cannot be completely removed (i.e attched to a vital organ)
TYPES OF SURGICAL THERAPY
i. Diagnostic surgeries confirms or rules out malignancy. It establishes type, extent, and classification to tumor.Examples: needle biopsies, incisional or excisional biopsies. Samples of the tumor are taken if complete removal of a lesion or tumor is not possible or undesirable (location, etc) Removable tumors with excisional surgery are usually less than 3 cm in size. Size and location determine the best procedure to perform.
ii. Curative surgery is used to remove all of the tumor with minimal damage to structures surrounding the tumor and minimal functional impairment. Removal often means loss of an organ, resulting in an alteration in body image.The process of rehabilitation continues long after discharge, utilizing outpatient services. Groups of people who have experienced similar cancers often have formed support groups.
iii. Reconstructive Surgery helps restore form and function of whatever was removed (i.e breast reconstruction). It is possible for the reconstruction to occur at the same time as the curative surgery. The goal of reconstruction is to improve the person’s quality of life by restoring maximal funciton and appearance.**helps increase the quality of life**
iv. Palliative Surgery is used to retard the growth of the tumor. Removal of secreting glands to take away hormone source—Decrease the size of an existing tumor. Removal of all of the tumor may not be possible, so debulking the tumor reduces the “tumor burden” on the person, making it possible for other therapies, such as chemotherapy or radiation. Cryrosurgery or laser surgery may be used to remove obstructions, or ulcerations when a cure is no longer possible. This reduces pain. (Examples: colostomy for relief of a bowel obstruction, laminectomy for relief of a spinal cord compression.
v. Supportive Care are surgical procedures used throughout the DZ process of CA to provide support. They include insertion of feeding tubes, creation of a colostomy to allow healing of rectal abscess, suprapubic cysttostomy for the patient c advanced prostatic CA


RADIATION THERAPY: **Cure when therapy is used alone; control: palliation most often goalàcan be used to reduce tumor size to relieve symptoms such as pain and obstruction** local treatment modality for CA . Works by producing high energy ionization, taking a way the cells ability to reproduce. Works best on rapidly dividing cells thus cells in the GI tract, o;ral mucosa and bone marrow will die fast and exhibit early acute responses to radiation. The larger the treatment area, the greater the amount of side effects. Hair over treated area will likely fall out, and probably not grow back. The higher the number of rads the higher chance that they will have a reaction. Factors most commonly used to reduce side effects or radiation Fractionation give healthy cells time to repair themselves between doses and increases the chance that the tumor cells will be hit during a growth phase. Alternate sites allow for hitting the tumor from the front, back, and either side of the tumor. The area that all angles have in common is the tumor, but by alternating the directions normal cells contact with the radiation is minimized, thus normal cells will not be harmed as badly.
i. External Radiation (external beam radiation therapy): is the most common form of treatment delivery. Adm. By high radiation machines
ii. Internal Radiation (brachytherapy): is administered by an implantation or insertion fo radioactive material directly into the tumor or in close proximity. It may be temp or permanent. ** Nurses must be aware that the patient is radioactive. Nursing care should be organized so that limited time is spent with the patient. Sheilding if available should be used usually with a film badge.

iii. Side Effects: Nurse has an important role in helping patient deal with side effects.
1. Fatigue: Patient must be aware that fatigue is an expected side effect, and not a sign that treatment is not working. Encourage patient to rest when fatigued, to maintain usual lifestyle patterns a s closely as possible and to pace activities in accordance with energy level.
2. Anorexia: May develop as a general reaction to treatment. Monitor weight to make sure weigth loss is not excessive. Provide small frequent meals of high protein, gently encourage patient to eat but avoid nagging, serve food in a pleasant environment.
3. Bone Marrow Suppression: Monitor CBC (WBC are usually more affected). If anemia occurs and Hgb drops below 10g/dl the patient may require blood transfusion.
4. Skin Reactions: Protect skin from trauma, lubricate dry skin with nonirritating creams, avoid the use of harsh soaps.
5. Oral, Oropharynx, and esophageal reactions: Be aware that eating,swallowing, and talking ae difficult. Encourage patient to use artificial saliva, assess oral mucosa daily and teach patient to do this. Discourage use of irritatnts such as tobacco and ETOH.
6. Pulmonary Effects: effects may be include both acute and late reactions. For pneumonitis monitor for dry, hacking cough, fecre and exertional dyspnea.
7. GI effects: Monitor manifestataions such as urgency, frequency,a nd hematuria. For Nausea and vomiting: administer antiemetics, use diversional activities, teach to eat and drink when not nauseated, assess for s/sx of dehydration and alkolosis. For Diarhhea: Give anitdiarrheal agents as needed, assess volume, consistency and number of stools produced a day and encourage fluid intake.
8.Reproductive effects: Be sure to discuss these changes with patients àaspermia in males and potential infertility. Inform of the possibility of harvesting sperm

Nursing 2, Exam 1 Study Guide

I have moved it to the top of the list for discussion.


from SDurston's Docushare
link

Study Guide for Nursing 2, Exam 1
1. Review risk factors, screening procedures, and warning signs of cancer.

2. Review treatment modalities for cancer, including Chemotherapy, Radiation, Biological Mediators, and Surgery. Be aware of the variety of goals for each modality.

3. Be able to identify appropriate Nursing Diagnosis for patients experiencing cancer treatment. Using Nursing Diagnosis, be able to select the best intervention for a described circumstance experienced by a cancer patient

4. Be able to select the best responses to patient statements about their experiences and concerns about their cancer and related treatment.

5. Review information in your text about death and dying. Be able to identify responses to news of impending demise as they are described in the text and lecture material.

6. Develop an awareness of the effects of end-stage illness on family members, significant others, and care givers. Recognize appropriate responses vs. those that are less than optimal.

7. Review pain assessment, medication practices, and goals of pain treatments. Understand the World Health Organization’s schematic for pain control. Understand combinations of medications and therapies than have a synergistic effect to relieve pain.

8. Review the physiology of pain, as well as how complimentary and alternative therapies assist in relief of pain. Be able to select the best definition of pain. Study

Great Info. Resource

Hi Everyone !

Just wanted to let you all know about the great information resource we have available to us at the Evolve website that goes with our text..........there are NCLEX questions for every chapter, concept map maker for each chapter, case studies and even a printable glossary of key terms.

Happy Studying

http://evolve.elsevier.com/productPages/s_0323016103.html

Sorry.........the NCLEX questions are the same ones from the book.......oops!

Teaching aid - Neutropenia

From the Oncology Nursing Society website http://www.ons.org/patientEd/
a great resource for patient education....

Neutrophil Teaching Booklet
An educational guide developed to help patients understand neutropenia.
link to pt ed booklet

MEDICAL BLOOPERS!

xpost from another nursing site

1. A man comes into the ER and yells, "My wife's going to have her baby in the cab!" I grabbed my stuff, rushed out to the cab, lifted the lady's dress, and began to take off her underwear. Suddenly I noticed that there were several cabs - and I was in the wrong one.

Submitted by Dr. Mark MacDonald, San Antonio , TX .

2. At the beginning of my shift I placed a stethoscope on an elderly and slightly deaf female patient's anterior chest wall.
"Big breaths, "I instructed." "Yes, they used to be," replied the patient. Submitted by Dr.Richard Byrnes, Seattle , WA

3. One day I had to be the bearer of bad news when I told a wife that her husband had died of a massive myocardial infarct. Not more than five minutes later, I heard her reporting to the rest of the family that he had died of a "massive internal fart."
Submitted by Dr. Susan Steinberg, Manitoba

4. During a patient's two week follow-up appointment with his cardiologist, he informed me, his doctor, that he was having trouble with one of his medications. Which one?" I asked. "The patch. The nurse told me to put on a new one every six hours and now I'm running out of places to put it!" I had him quickly undress and discovered what I hoped I wouldn't see.
Yes, the man had over fifty patches on his body! Now, the instructions include removal of the old patch before applying
a new one.
Submitted by Dr. Rebecca St. Clair, Norfolk ,

5. While acquainting myself with a new elderly patient, I asked, "How long have you been bedridden?"
After a look of complete confusion she answered..."Why, not for about twenty years - when my husband was alive."
Submitted by Dr. Steven Swanson, Corvallis , OR

6. I was caring for a woman and asked, "So how's your breakfast this morning?" "It's very good, except for the Kentucky Jelly. I can't seem to get used to the taste", the patient replied. I then asked to see the jelly and the woman produced a foil packet labeled "KY Jelly."
Submitted by Dr. Leonard Kransdorf, Detroit , MI

7. A nurse was on duty in the Emergency Room when a young woman with purple hair styled into a punk rocker Mohawk, sporting a variety of tattoos, and wearing strange clothing entered. It was quickly determined that the patient had acute appendicitis, so she was scheduled for immediate surgery. When she was completely disrobed on the operating table, the staff noticed that her pubic hair had been dyed green, and above it there was a tattoo that read, "Keep off the grass."
Once the surgery was completed, the surgeon wrote a short note on the patient's dressing, which said, "Sorry, had to mow the lawn."
Submitted by RN.... no name

AND FINALLY!!!................
8. As a new, young MD doing his residency in OB , I was quite embarrassed when performing female pelvic exams. To cover my embarrassment, I had unconsciously formed a habit of whistling softly. The middle-aged lady upon whom I was performing this exam suddenly burst out laughing and further embarrassing me. I looked up from my work and sheepishly said, "I'm sorry. Was I tickling you?" She replied, "No doctor, but the song you were whistling was, "I wish I was an Oscar Meyer Wiener".
Dr. wouldn't submit his name

N2 Managing Chemotherapy Problems

Follow these guidelines to help your patient overcome adverse reactions.

Myelosuppression

* Monitor complete blood cell count before each treatment.

* Administer packed red blood cells (RBCs) as ordered.

* Administer growth factors as prescribed: granulocyte colony-stimulating factor, to decrease duration of nadir and epoetin alfa (Procrit) or darbepoetin alfa (Aranesp) to increase RBC production.

* Assess the patient for signs and symptoms of infection. Educate him about decreased absolute neutrophil count and infection risk.

* Monitor temperature daily. Call the oncologist/hematologist if the patient's oral temperature exceeds 100.5°F (38°C).

Pulmonary toxicity

* Obtain baseline pulmonary function tests.

* Assess the patient's pulmonary status before each infusion.

* Teach him to report cough, dyspnea, or shortness of breath.

* Hold bleomycin if he reports any symptoms of altered pulmonary status.

Cardiac toxicity

* Make sure that the patient undergoes a MUGA (multiple-gated acquisition) scan or an echocardiogram to determine adequate left ventricular ejection fraction before his first chemotherapy dose.

* Teach him to report shortness of breath or palpitations.

* Monitor his total doxorubicin dose.

* Perform ongoing assessments for signs and symptoms of heart failure, including dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, and fatigue.

Nausea and vomiting

* Administer antiemetics before administering chemotherapy.

* Assess the patient's level of nausea and vomiting with each treatment and modify his antiemetic regimen as indicated.

* Teach him how to use his prescribed antiemetic to prevent or treat delayed nausea and vomiting.

Extravasation

* Assess your patient's veins before and during each chemotherapy infusion.

* Teach him about the benefits of a central venous access device if peripheral access is poor.

* Assess blood return frequently during administration of vesicants such as doxorubicin, vinblastine, and dacarbazine.

* Treat extravasation promptly, according to facility policy.

Hypersensitivity reactions

* Assess your patient's baseline vital signs. Bleomycin in particular can cause fever.

* Administer premedications such as acetaminophen and steroids before therapy and have emergency equipment readily available in case of anaphylactic or anaphylactoid reaction.

* Teach him to promptly report any unusual symptoms such as dizziness, itching, or pain.

* Monitor his vital signs throughout the infusion. Increase the infusion rate every 30 minutes only if his vital signs remain stable and he doesn't develop signs of an adverse reaction.

* Stop the infusion if he develops a reaction.

Neuropathy

* Assess him for sensory and perceptual changes before each treatment.

* Notify the oncologist of any changes (peripheral, gastrointestinal) that develop after he receives vinca alkaloids.

Pain at injection site: ABVD

* Administer dacarbazine in 100 to 250 ml of I.V. fluid and infuse slowly over 1 hour.

* Apply heat or ice above the injection site.

Flulike syndrome

* Premedicate with acetaminophen.

* Encourage the patient to drink plenty of fluids.

Hyperglycemia

* Monitor his serum glucose level.

* Increase monitoring frequency if he has diabetes. The prescriber may need to modify his antihyperglycemic therapy.

Skilled care, teaching, emotional support

Anyone with lymphoma or leukemia requires skilled nursing care to cope with the diagnosis and to minimize adverse reactions to treatment. Remind your patient that most adverse effects of therapy can be managed and that many people continue working during treatment. To help him manage immediate and long-term problems, teach him about the following effects of his illness and therapy.

* Emotional issues. Encourage him to discuss his feelings; provide reassurance and support when he does. Teach him relaxation techniques and encourage him to seek help through a support group or counselor. If he's taking prednisone, advise him to take it with breakfast or lunch to prevent insomnia and to notify the oncologist/hematologist if he has mood changes, which can occur with prednisone therapy.

* Infection. Teach him about infection risk. Review the signs and symptoms and tell him to contact the oncologist/hematologist if he develops signs of infection.

* Hair loss and skin changes. Tell the patient about the potential for hair loss and explain that his hair will probably grow back after he finishes therapy. Encourage him to purchase a wig or hat before his first chemotherapy infusion. Tell him that his skin may dry and become more sensitive to sunlight so he may need to apply sunblock and wear protective clothing in the sunshine. He may also notice changes in his nails.

* Fatigue. Encourage your patient to pace his activities, rest frequently, and get help with activities of daily living.

* Reproductive issues. Discuss the potential for chemotherapy-induced sterility. For a male, review the need to prevent pregnancy in his partner because chromosome damage to sperm can negatively affect the fetus. Discuss sperm banking and provide resource information if he chooses this option. Teach a female patient that treatment can cause menstrual changes and menopause-like symptoms and make her susceptible to vaginal infections.

* Stomatitis. Encourage your patient to see a dentist before starting chemotherapy. Teach him to rinse his mouth with a solution of salt and baking soda in water to prevent infection and advise him to avoid drinking alcohol. Tell him to call the oncologist/hematologist if he develops mouth sores.

* Bladder and bowel changes. Advise your patient to drink plenty of fluids and to void frequently to prevent cystitis. Teach him to check his urine for blood and to call his health care provider if he develops frequency or discomfort with urination. Teach him to include fiber in his diet and encourage him to use a laxative if he can't move his bowels every 2 days. Tell him to call his health care provider if he develops diarrhea. Monitor his response to antidiarrheal medication and assess him for dehydration.

* Gastric irritation. If your patient takes prednisone, tell him to take it with food or milk. If he reports midepigastric distress, ask the oncologist/hematologist to prescribe medication to prevent gastrointestinal irritation.

Keeping current

N2 End of Life

Watch the video/tutorial at Medscape nurses on
The Last Hours of Living
Have Kleenex handy
There is a quiz in the comments
Also in the comments are signs and symptoms you would expect to see in the dying person.

N2 End of Life links

• Helping Yourself When You Are Dying
• A Dying Person's Guide to Dying
• http://www.hospicenet.org.
  
• National Cancer Institute. End of Life: Questions and Answers. http://www.cancer.gov//cancertopics/factsheet/Support.
  
• Palliative Care Resource Center.
• http://www.medscape.com/resource/hospice.

Wound Quiz

The chapter to read for the wound Quiz in skills is chapter 30 not 31.

Lindsey and Chrissy's walking club!!!!

for any of you nursing students out there... doesn't matter what semester... every thursday around 4:45 chrissy and i will be walking laps at delta's track... anyone who wants to come and beat those nursing pounds feel free!!
takes about an hour to walk 12 laps and thats 3 miles... we were done today around 5:45

Question of the week 10.23.06

A young adult male has been diagnosed with testicular cancer. Which of these statements by this client would need to be explored by the nurse to clarify his understanding?

1. "This surgical procedure involves removing one or both testicles through a cut in the groin. My lymph nodes in my lower belly also may be removed."
2. "I have a good chance to regain my fertility later. However if I am concerned, I can have my sperm frozen and preserved (cryopreserved) before chemotherapy."
3. "If I have cancer at stage 3 it means I have less involvement of the cancer."
4. "After the surgical removal of a testicle, I can have an artificial testicle (prosthesis) placed inside my scrotum. This artificial implant has the weight and feel of a normal testicle."

lab values

you will need to know lab values and what they mean as you progress further in the program. Here is a website that explains everything.

">www.dalesplace.net/lab_values.php

St. Joseph's Group 1

PHARM

PHARM TEST SCORES ARE POSTED

Congrats everyone on passing Nursing 1.