Hello Class of 2007, Welcome to our blog community. This is our area to share information, resources, ask and answer questions. You will have fellow students, past students, and many other assets available to you through this site. Everyone is encouraged to discuss and problem solve here. Check back frequently as we post sample questions and links to relevant sites. We are on the same journey, let's discover it together.
Hello Class of 2007, Welcome to our blog community. This is our area to share information, resources, ask and answer questions. You will have fellow students, past students, and many other assets available to you through this site. Everyone is encouraged to discuss and problem solve here. Check back frequently as we post sample questions and links to relevant sites. We are on the same journey, let's discover it together.
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SLIDE 4
Cyclamates off market in 1970’s. Stevia causes cells to morph in vitro, in situ tests pending.
High ingestion of Aspartame linked to seizure activity in those with seizure disorder(8-10 gallons daily of Kool-aid)
Pesticides and herbicides banned in the US are used in other countries—best stick with in season “fresh” fruits/veggies
Best protection for all cancers is diet with 8-10 servings fruits/veggies daily, whole grains, low meat consumption. Soups/stews.
SLIDE 5
30 % of all men will have experienced prostate cancer by age 70, 30% of all women breast cancer by age 70
Testicular cancer most common in young men 30-35 years old, and in those with undecended testicles.
These cancers become malignant if left untreated—go to lung, brain, bones.
Familial issues, example, Gardner’s Syndrome. Autosomal dominant trait, osteomas of scalp and gI polyps, colon cancer.
SLIDE 6
Risk is higher if your mom took DES, but effects both the person who took it and their offspring.
Consult your practitioner about the combination of fertility drugs used.
SLIDE 7
Skin cancers almost exclusive to areas exposed to sun
People living near nuclear plants are generally safe, however, some areas near nuclear testing sites, downwind of Chernobel, etc, are high risk cancer areas. University of Utah doctoral program specializes in this related to Utah being downwind of Nevada test sites of 1950’s-70’s.
Radon may occur naturally in some soil and building materials. Home radon level detectors available.
X-rays of children with scoliosis linked to increased risk of breast cancer (fred hutchins Ca institute studies, confirmed by NCI)
Cell phone use may encourage tumors of brain to grow. Studies being repeated. Long term, all day exposure to batteries.
EMFs conflicting data from studies. Not the ideal place to live. Magnetic field exposure decreases the levels of melatonin released from the pineal gland, and melatonin protects against breast cancer (fred hutchins cancer institute research) lymphoblastic leukemia related to exposure, including in utero—also consider household exposures, such as electric blankets, appliances, video games.
No change in incidence of cancers for those exposed to radar/nuclear submarines.
SLIDE 8
Exposure to tobacco in any form, whether smoke or “juice,” alters the DNA of cells. Smoke exposure, primary or secondary, not just lung, but nasal and sinus cancers/polyp formation
Tobacco is considered a complete carcinogen because it encourages formation of neoplasms and promotes neoplastic growth.
SLIDE 10
Ag workers constantly breathing chemicals is what finally got the short hoe out of California farm work, unless the crop is grown organically. No more hand weeding unless organic.
Asbestos is found in soil, but was mined and used extensively because of insulatory abilities. Use certified contractors. Mesothelioma.
SLIDE 11
Epstein Barr carried by nearly everyone. Can also lead to Chronic Fatigue syndrome. Mono nucleosis.
Human papilloma virus interferes with the body’s ability to produce human protein 6, which stops growth of tissue. A sexually transmitted disease, over 50 different genotypes have been identified, with half causing cancer. Some directly (cervical)
SV40 has been found in mesothelioma cells, osteosarcoma cells, and non-hodgekins lymphoma. Thousands were inoculated with this in the first week of life in Germany and are being monitored-a 30 year study.
SLIDE 12
Smoking is responsible for 85% of all lung cancers-whether the person smokes or is exposed to second hand smoke. Smokeless tobacco increases the risk for oral, laryngeal, throat, and esophageal cancers.
A diet high in antioxidents vitamins A, E, and C, as well as cruciferous vegetables and carrots, helps protect against skin and GI tract cancers. Limiting cured meats and smoked or barbequed foods. Fiber in all things.
Alcohol increases the likelihood of cancers of the throat, oropharnyx, esophagus, stomach, and liver, as well as intensifying the effects of tobacco use.
Over half a million cases of skin cancer(non melanoma) are diagnosed each year in the US. Persons who have lived in equatorial countries are more likely to develop skin cancer than those living farther north.
Excess exposure to x-rays—generally not a client concern, more for the Rad tech and health care providers.
Exposure to heavy metals in the manufacturing process—currently computer workers at a very high risk, but also vinyls, asbestos, solvents. Risk goes up expotentially with smoking.
Estrogen to help with menopausal symptoms increases the risk of endometrial and breast cancer.
SLIDE 13
Encourage the patient to ask questions and discuss anticipated procedures.
Evaluate learning ability, retention, level of understanding,
Address knowledge deficits: signs, symptoms, risks, causes and available therapies.
Anxiety: Ensure physical comfort.
Encourage expression of thoughts and feelings.
Assist to identify concerns and problems
Foster an atmosphere of acceptance.
Encourage therapeutic coping behaviors
SLIDE 22
Benign or pre-malignant growths are removed before they have the chance to spread or grow. Examples are removal of skin growths, colonoscopy with removal of polyps, and conization of cervical lesions. Some extreme cases are bil mastectomy for persons with recurrent breast lumps.
SLIDE 23
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.
SLIDE 24
Curative surgery seeks 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.
SLIDE 25
Restoration of form and function is possible in various degrees. This has changed the physical and emotional rehabilitation of cancer surgery. With many procedures 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.
SLIDE 26
Palliative procedures may 1. retard the growth of the tumor. Removal of secreting glands to take away hormone source—example, a bilateral oophrectomy will slow or stop the growth of a breast tumor.
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, to be more effective.
3. To relieve distressing manifestations. Cryrosurgery or laser surgery may be used to remove obstructions, or ulcerations when a cure is no longer possible. This reduces pain.
SLIDE 30
Protein is being used for reconstruction of damaged tissues, and the tumor has been taking as many nutrients as it can get. Lower levels of immune globilins are produced.
Monitor vital signs, blood counts, lung sounds, body orifaces, and wounds for signs and symptoms of infection.
Use aseptic technique when working with wounds. Handwashing, patient hygeine.
Maintain level of hydration and nutritional status
SLIDE 31
Monitor the platelet count. Look for petechiae, spontaneous hemorrhages, or areas of breakdown.
Check body fluids for presence of blood(stool, emesis, urine)
Protect individuals from trauma—limit venipunctures, rectal temps, suppositories. Avoid aspirin. Protect from shear and excoriation. Apply direct pressure to wounds until bleeding is stopped.
SLIDE 37
Chemotherapeutic medications lower the production of white cells
Chemotherapy delays wound healing. It can be started 5 to 7 days postop when the wound has sealed off.
Because chemotherapeutic agents are metabolized in the liver and kidneys, unpredictable levels of drug occur when these organs are impaired.
Radiation therapy suppresses cell production in the bone marrow. Chemotherapy is usually withheld for 3-4 weeks to allow recovery so that the body can withstand the effects of the chemo
The first three months of pregnancy are when teratogenic effects would be most devastating.
Chemotherapeutic agents are myelosuppressive, so patients may require transfusions of white cells to boost immunity and avoid superinfections prior to proceeding with chemotherapy.
SLIDE 40
Small, frequent meals of plain foods are most appealing
crackers or hard candy help alleviate medication tastes, which are often metallic
Encourage to eat protein early in the day, as nausea tends to increase as the day goes by
Administer antiemetics prior to chemotherapeutic agent
SLIDE 41
Daily weights
Monitor lab values of electrolytes so IV fluids can be adjusted appropriatly
Low residue diet helps reduce diarrhea
Assess for perianal irritation. Apply petroleum based products
Record number and quality of stools. Administer Immodium or Lomotil prn.
If constipated, adjust diet by including fiber. Consider eliminating iron supplements. Record bowel movements for frequency, quality. Use laxatives, stool softeners, and enemas as needed.
SLIDE 43
For dermatitis provide skin care and lotions as needed. Avoid soaps and hot water. Warm packs to localized areas may provide relief.
Assess oral cavity at least twice daily. Provide oral care every 2 hours while awake—lidocaine and glycerine products are helpful. Normal saline mouth rinses and popscicles of NS are helpful.
Avoid hot or cold foods, spices, citrus, alcohol, smoking. Pureed foods, food supplements. Chapstick
Wear cotton, not synthetic underwear and local anesthetic products—vagisil, for example
Diphenhydramine, tepid baths, and lotions reduce itching
Tenderness may occur over liver—observe for jaundice, lethargy, weakness, and altered liver functions studies.
SLIDE 44
Alopecia usually happens with third dose of chemo. May be sudden or gradual. Hair usually grows back, and use of wigs, hats, turbans help prevent heat loss, sunburn, etc. Long hair needs to be cut prior to loss to promote comfort. Soft bristled hair brush and gentle cleansing of new hair, but comb and brush as little as possible.
Skin will usually darken. Usually transient and resolves when therapy over. Need to avoid sunlight because they are photosensitive.
Nails usually darken and have transverse ridging. After therapy concluded nails will grow in normally again.
SLIDE 45
Monitor BUN and creatnine. May require analgesia or antispasmodics. Increase fluid intake if not contraindicated
Observe for loss of motor ability, decreased reflexes, leg cramps related to numbness and tingling. Usually subsides in 4-6 weeks after therapy discontinued.
Have patient use sunglasses
Remind patient hearing loss may be transient or permanent
Gait and equilibrium may be altered, so use of cane, walker, etc will help patient maintain mobility and increase level of safety.
SLIDE 46
Hematuria, dysuria(painful urination) urgency common. Increase fluids to 2 liters daily to limit discomfort from excretion of chemotherapeutic agents. Test urine for presence of occult blood. Discoloration often goes away after 24 hours.
SLIDE 47
Discuss need to continue contraception. Menses usually return when medications discontinued. Level of libido may change related to androgens or estrogens. Partner may have altered libido related to powerlessness over situation. Include partner in discussions as allowed. Encourage verbalization of concerns. May need referral to therapist specializing in sexual dysfunction
SLIDE 48
Ekg, heart and lung sounds, weight, and leg diameters recorded prior to initial dose of meds to establish baseline.
Observe for tachycardia, ekg changes, and right sided failure (wet lungs)—may need to stop therapy.
Dyspnea on exertion, SOB, cyanosis, rales, wheezing, cough all indicate toxicity. Teach postural drainage and abdominal breathing. Monitor breath sounds
SLIDE 50
External therapy is administered by high-energy x-ray machines
Internal therapy may be from a sealed or unsealed source
Intracavity therapy lasts 24-72 hours—helpful for cerivical or uterine cancers, for example
Interstitial therapy the isotope is packed into needles, beads, seeds, ribbons, whatever, and implanted directly into the tumor. May be temporary or permanent.
Should the implant come out of the patient, you will probably be the first to know since you will be changing sheets, assisting the patient with mobility, answering the call light. There will be tongs and a lead container in the room, so that you can safely pick up the implant and put in the lead box.
Unsealed source is used for systemic therapy, isotopes given via IV or orally. Treatment for Grave’s disease of the thyroid would be low dose and thyroid cancer high dose of unsealed radioactive iodine.
SLIDE 52
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
A person receiving 5000 rads for curative treatment will have more side effects than a person receiving 2000 rads for palliation
SLIDE 53
Fractionation refers to dividing the total radiation dose into small, frequent doses. Often 150-200 centigrays five days a week for 4-6 weeks. 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.
SLIDE 54
The reactions are not burns, per se, but treating them like burns helps them heal. Aloe Vera cream to the site.
Immediate skin reactions have 3 stages: Erythema, Dry Desquamation, Moist Desquamation
Delayed reactions include atrophy from shrinking of the epidermal layer
Telagiectasis (dilation of capillaries due to vessel damage)
Depigmentation
Subcutaneous fibrosis
Skin cancer
Necrotic or ulcerative lesions
Skin reactions are generally reversible, however they may heal over several years
Interventions-notify radiologist. Monitor daily for changes. Keep area dry, wash with water only and pat dry.
Aloe Vera over the counter helps, as do prescription cream preparations.
Keep area away from heat and sunlight. Skin may be sensitive to heat and sunlight for years after therapy, as well as cold air.
Do not wash off the tattoo marks placed by the therapist.
Encourage wearing soft cotton fabrics-knits-that do not rub or chafe the area
SLIDE 55
Bone marrow and lymphatic tissue are very sensitive to radiation. Pelvic area leads to greater marrow depression than other areas.
Monitor blood counts, at least weekly. Teach handwashing and good nutrition, hygiene and rest habits.
Teach signs and symptoms of infection
SLIDE 56
Platelets are quite vulnerable to radiation. Counts below 100,000 should be reported to the MD.
Monitor counts at least weekly. Teach person to avoid trauma and aspirin use—review anticoagulent use with physician. Teach signs of hemorrhage. Monitor stool, urine for occult blood. Apply direct pressure to any bleeding until bleeding stops.
SLIDE 57
Epogen!
Fatigue is an expected side effect of radiation therapy and does not mean the disease is getting worse.
Discuss fatigue with the patient and encourage them to do what they feel like doing, then rest. They need to eat nutrient dense foods, but carbs and fats increase energy.
SLIDE 58
Monitor diet for sufficient calories.
Utilize dietician services—the attention really helps the patient feel well cared for.
Weekly weights. Patient needs to eat sterile foods—avoid raw eggs or oysters, canned rather than fresh or frozen related to possible coliform contamination.
Small, frequent meals will increase food intake—help patient to be aware of nutrients. Need protein.
SLIDE 59
Monitor oral cavity daily and notify radiologist if desquamation occurs.
Administer viscous lidocaine before meals
Bland diet, no smoking or alcohol.
Saline rinse q 2 hours. Professional dental care. Plenty of po fluids.
Sugarless hard candy will increase salivation. Avoid dry, thick foods.
SLIDE 60
Low residue diet and anti diarrheals.
Encourage fluid intake so urine is more normal color and person voids regularly.
Encourage rest before and after meals. Antiemetics as prophylaxis on treatment days, as needed the rest of the time. Monitor fluid and electrolyte status.
Edema resulting from damage to tissues in cranium. Steroids and analgesics help.
SLIDE 61
Encourage verbalization, wearing of wigs, hats, scarves, and brush hair as little as possible, gentle shampooing.
Encourage person to talk on phone, stop by and say hello even when patient is not part of your assignment. Encourage television viewing, radio, music. Discuss need to limit physical contact. Have family bring in photos.
SLIDE 64
Caloric and protein requirements must be met for body to repair itself.
SLIDE 65
The first phase of therapy causes nausea, vomiting, GI tract inflammation, taste changes, and anorexia. After the transplantation mucositis, stomatitis, esophagitis, and intestinal damage occur—resulting in diarrhea.
SLIDE 67
Most patients GI dysfunction resolves within 30 days after transplant. Then the patient can resume oral intake or tube feedings. Greater than 10% weight loss in 6 months indicates malnutrition
Peripheral IVs cannot handle TPN sol’n, so central lines or PICC lines are needed.
SLIDE 69
Albumin indicates protein status of the body. Levels of serum transferrin is a marker for protein status, reflect the patient’s response to stress or nutritional support earlier than albumin levels.
Thank you rupert for posting those! Ena
Adrienne,
You're welcome ! When you download/save the powerpoint presentation to your computer and open the presentation each slide will have the notes at the bottom of the slide. On top of the powerpoint window there is File Edit View, etc. Click the View section and then click the notes page, eventually you will see a whole page in which the slide is on top and the notes at the bottom. If you want to print the notes, Go/Click on the File section and then Print. A window will open up and then look at the bottom where it says print what(it should say print what : slides) click the arrow until you see slides then print the slides. It's a lot of slides and only a portion has notes. Check the pages you want to print. Some of our classmates doesn't have powerpoint and I just copy and pasted the notes to word so I can post it faster. I ask Bonnie on how to print/copy notes but she said just copy and paste it. By the way, We are all here to help one another succeed and be GREAT RN'S !
Ena,
You're welcome !
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