PERIOPERATIVE NURSING ▪Orchiopexy – repair of undescended

testes.
PHASES OF PERIOPERATIVE ➢ Reconstructive – involves repair of damaged
organ
Preoperative phase
✓ Extends from the time the patient is admitted to ✓ Palliative- To relieve distressing signs and
the surgical unit, to the time he/ she is prepared symptoms, not necessarily to cure the disease
physically, psychosocially, spiritually and legally ▪ Colostomy, debridement of necrotic
for the surgical procedure. tissues, resection of nerve roots.

Intraoperative phase ✓ Preventive- Inhibit transformation of

✓ Extends from the time the patient is admitted to precancerous lesions or benign tumors to
the operating room, to the time of administration malignant tumors
of anesthesia, surgical procedure is done, until ▪ Removal of fibrocystic breast mass
he/she is transported to the recovery room. before it becomes malignant, removal of
nasal polyps to prevent cancer, removal
Postoperative phase of mole before it becomes malignant.
✓ Extends from the time the patient is admitted to
the recovery room, to the time he is transported ✓ Cosmetic – for aesthetic purpose
back into the surgical unit, discharged from the ▪ Nose-face breast lifting, repair of eyelids
hospital, until the follow-up care (blepharoplasty), rhinoplasty, liposuction
procedure.
Classification of Surgical Procedures

ACCORDING TO PURPOSE ACCORDING TO DEGREE OF RISK/ MAGNITUDE/ EXTENT

Diagnostic: Confirms the presence of a disease MAJOR SURGERY

✓ Exploratory - determine the extent of the disease Criteria for major surgery
• Involves high risk of morbidity or mortality
✓ Curative - to treat the disease condition • Extensive and prolonged
➢ Ablative – involves removal of an organ. Suffix • Involve large amount of blood loss
used is ectomy. • Vital organs are removed or manipulated
▪ Appendectomy – removal of the • Involves great risk of occurrence of
appendix. complications
▪ Hysterectomy – removal of the ➢ Examples
uterus ▪ Craniotomy
▪ Oophorectomy – removal of the ▪ Open heart surgery
ovary ▪ Pneumonectomy
▪ Mastectomy – removal of the breast ▪ TAHBSO
▪ Pneumonectomy - removal of the
lungs MINOR SURGERY
▪ Tonsillectomy – removal of tonsils.
▪ Cholecystectomy – removal of the Criteria for minor surgery
gall bladder. • Procedure is not prolonged
• Involves lesser risk
➢ Constructive – involves repair of congenitally • Does not usually involve serious
defective organ. Suffixes used are plasty, complications
orrhaphy, pexy. ➢ Examples
▪ Cheiloplasty – repair of cleft lip. • Appendectomy
▪ Uranoplasty – repair of cleft palate. • Tonsillectomy
▪ Herniorraphy – repair of hernia • Blepharoplasty
ACCORDING TO URGENCY
 ➢ Fear of disturbance of body image
Emergency- Should be done immediately to save the ➢ Fear and worries from loss of
client’s life or limb finances, employment, social and
➢ Emergency hysterectomy due to ruptured family roles
uterus. Anxiety- most common response to surgery
➢ Emergency appendectomy due to ruptured
appendix. The consent should be signed before the client receives
preoperative medications
Imperative - Should be done within 24-48 hours
➢ Profusely bleeding peptic ulcer. INFORMED CONSENT
➢ Evacuation of blood clots from the brain. Protects the patient from unsanctioned surgery and
protects the surgeons from claims of an unauthorized
Planned Required – the procedure is necessary for the operation.
well-being of the client. However, it may be scheduled for
weeks or months. Nurse may ask the patient to sign the form and witness
➢ Tonsillectomy, thyroidectomy, cataract the patient’s signature.

Elective- Not absolutely necessary for survival. Delay or The physician provides appropriate information:
omission will not cause adverse effect • Flow of surgery
➢ Removal of simple, non-toxic goiter. • Alternatives
• Possible risks, complication, disfigurement
Optional This procedure is requested by the patient. For • What to expect early and late post operation
aesthetic purposes
➢ Rhinoplasty Indications of informed consent
• Invasive procedure
ACCORDING TO SURGICAL SETTING • Use of anesthesia
• Nonsurgical procedures which might be risky
Inpatient surgery- Patients are admitted to the hospital. • Radiation
Needs to stay for more than 24 hours
Criteria for Valid Informed Consent
Outpatient surgery- Ambulatory. Conducted in • Voluntary consent
emergency departments, endoscopy departments, • Competent patient
doctor’s clinics, surgical clinics, and outpatient surgery. • Informed patient
Stay is less than 24 hours

NURSING RESPONSIBILITIES
GENERAL RISK FACTORS TO SURGERY • Physical examination must be brief but
• Aging complete
• Obesity • Advise the patient to stop smoking 6 weeks
• Poor nutrition prior to surgery
• Fluid and electrolyte imbalances • Teach breathing exercises
• Presence of diseases • if client has respiratory infection, postpone
• Diabetes Mellitus the surgery
• Alcoholism • if the client is hypertensive postpone surgery
• Pulmonary and upper respiratory disease • hypoglycemia may develop during anesthesia
or post-op nurses should assess the blood
Surgery is a frightening event for a great majority of sugar of the patient
patients even when the procedure is relatively minor • hyperglycemia may occur due to stress
• Common causes of fears • determine the presence of allergies
➢ Fear of the unknown • strict asepsis should be ensured
➢ Fear of anesthesia • assess previous medication history
➢ Fear of pain • adrenal corticosteroid
➢ Fear of death
 ➢ do not discontinue abruptly as ▪ Setting-up sterile field
cardiovascular collapse may occur ▪ Prepares sutures, ligatures,
• diuretic and special equipment
➢ thiazide diuretics may cause ▪ Assist the surgeon and
excessive respiratory depression surgeon’s assistant during
• chlorpromazine the procedure by
➢ increases the hypotensive effect of anticipating the required
anesthetics instruments, sponges, drain,
• diazepam etc.
➢ may cause anxiety, tension and ▪ Keeps track of time the
seizures patient is under anesthesia
• insulin and time the wound is open
➢ IV insulin may need to be ▪ Counts needles, sponges
administered to keep the blood and instrument
glucose within the normal range ▪ Specimen care
• Erythromycin • Anesthesiologist and anesthetist
➢ If combined with curariform muscle ➢ Responsible for the patient’s
relaxant, nerve transmission is neurological vital signs, levels of
interrupted and apnea may result sedation and anesthesia
• Warfarin • Surgeon
➢ Should be discontinued due to ➢ Performs the operation
increased risk of bleeding
• Antiseizure ZONES IN THE OPERATING ROOM
➢ IV administration may be needed to • Unrestricted - street clothes are allowed
keep the patient seizure-free during • Semi-restricted - scrubs, shoe covers, cap and
surgery mask
• Levothyroxine • Restricted zone - scrubs, shoe covers, cap and
➢ Keeps the patient in a euthyroid state mask, sterile OR gown, closed gloving

DIET POSITIONING
• NPO if ordered • Autograft
• Eating a light breakfast 6 hours before the ➢ Immobilized site for 3-7 days after
procedure surgery
• Consumption of clear liquids up to 2 hours • Burns of face and head
before elective surgery ➢ Elevate head of bed
• A heavier meal of 8 hours before surgery • Circumferential burns of extremities
• Fasting for 8 hours prior to surgery ➢ Elevate extremities above level of
• Fasting for 4 hours prior to surgery after the heart
ingesting milk • Skin graft
➢ Elevate and immobilize graft site
The Surgical Team ➢ Avoid weight bearing
• Circulating nurse • Mastectomy
➢ Manager, coordinator, monitor ➢ Head of bed elevated at least 30
➢ Verifies consent degrees with affected arm elevated
➢ Ensures adequacy of supplies on a pillow to promote lymphatic
➢ Skin preparation fluid return
➢ Handles documentation ➢ Turn only to the back and unaffected
➢ Handles sterile equipment by forceps side
• Scrub nurse • Perineal and vaginal procedures
➢ SCRUBBING should be 2-5 minutes ➢ Place on lithotomy position
➢ Counted-stroke method • Hypophysectomy
▪ Handles equipment and ➢ Elevate head of bed
materials to the surgeon
• Thyroidectomy • Thoracentesis
➢ Place in Semi-Fowler’s position ➢ Position sitting on the edge of bed
➢ Sandbags or pillows and leaning forward over the
• Hemorrhoidectomy bedside table with feet supported on
➢ Assist to a lateral side-lying position a stool, or lying in bed on the
• GERD unaffected side with the head of bed
➢ Reverse Trendelenburg elevated about 45 degrees Fowler’s
• Liver biopsy position
➢ During • Thoracotomy
▪ Supine, with the right side of ➢ Check physician’s order
the upper abdomen exposed • Abdominal aneurysm resection
▪ Right arm is raised and ➢ Limit elevation of head to 45 degrees
extended over the left fowler’s
shoulder behind the head ➢ May be turn from side to side
▪ Liver is located on the right • Amputation of lower extremity
side, and this position ➢ First 24 hours elevate foot
provides maximal exposure • Arterial vascular grafting
of the right intercostal space ➢ Bed rest
➢ After ➢ Limit movement and avoid flexion
▪ Assist to a lateral (side-lying) • Cardiac catheterization
position ➢ Bed rest if femoral artery is used
▪ Place a small pillow or folded ➢ Affected extremity is kept straight
towel under the puncture and head is elevated no greater than
site 30 degrees
• Nasogastric tube • CHF and pulmonary edema
➢ Insertion ➢ Position upright with legs dangling
▪ High-fowler’s with head over the side of the bed
tilted forward • Peripheral arterial
➢ Irrigations and tube feedings ➢ Do not raise above heart level
▪ Elevate head of bed 30 • Deep vein thrombosis
degrees semi-fowler ➢ Bed rest with leg elevation
▪ Maintain head elevation • Varicose veins
after feeding ➢ Leg elevation above the heart
▪ Head of bed should remain • Venous leg ulcer
elevated for continuous ➢ Leg elevation
feeding • Cataract surgery
• Rectal enema/irrigation ➢ Elevate head of bed in semi-fowlers
➢ Left sim’s position • Retinal detachment
• Sengstaken-Blakemore (3 lumen) and ➢ Bed rest
Minnesota tubes (4 lumen) ➢ Restrict activity
➢ Maintain elevation of head • Autonomic dysreflexia
• COPD ➢ Elevate head of bed to high-fowlers
➢ Place in a sitting position • Cerebral aneurysm
➢ Leaning forward with arm over ➢ Bed rest with head of bed elevated
several pillows semi to fowlers position
• Laryngectomy • Cerebral angiography
➢ Place in a Semi-fowler to Fowler’s ➢ Bed rest 12-24 hours
position ➢ Extremity that is injected is kept
• Bronchoscopy straight and immobilized for 8 hours
➢ Place in Semi-Fowler’s position • Craniotomy
• Postural drainage ➢ Don’t position on the operated side
➢ Lung segment to drained should be
in the uppermost position
 ➢ Elevated head of bed semi-fowler to ✓ #4-0 to close dural incisions
fowler
➢ Avoid extreme hip and neck flexion
• Laminectomy ABSORBABE SUTURES - capable of being absorbed by
➢ Logroll mammalian tissue but may be treated to resist absorption
• Increased ICP
➢ Elevate Surgical gut- Digested by enzymes and absorbed by tissue
➢ Avoid extreme hip and neck flexion so that no permanent foreign body remain
• Lumbar puncture
➢ During MONOFILAMENT ABSORBABLE
▪ Side-ling with back bowed at ✓ Plain Gut
the edge of the examining • Used to ligate small vessels and to suture
table, knees flexed up to subcutaneous fat
abdomen, and head bent so • Yellow tan color or dyed blue or black
that chin is resting on the
chest ✓ Chromic Gut
➢ After • Dark brown or dyed blue or black
▪ Place in supine position for • Use for large vessel ligation may be used in
4-12 hours peritoneum and fascia
• Myelogram
➢ If water soluble die ✓ Polydioxanone suture
▪ Head of bed elevated to 30- • Silver package
60 degrees for 12 hours • Used in slow healing tissues such as fascia
➢ If oil based • Used in presence of infection
▪ Supine for several hour
• Spinal cord injury ✓ Poliglecaprone
➢ Immobilize on spinal board ▪ Coral/peach pacage
▪ Most pliable
Sutures ▪ Indicated for soft tissue approximation
such as gynecologic, urologic and plastic
Medical device used to hold skin, internal organs, blood surgery
vessels and all other tissues of the human body
MULTIFILAMENT ABSORBABLE

TYPES OF SUTURE MATERIAL ✓ Polyglactin (Vicryl, Ethicon)

Absorbable: capable of being absorbed by tissues within a ▪ violet
given period of time ▪ Tissues that require long-term tensile
strength and absorbable suture is
Nonabsorbable: resists enzymatic digestion or absorption desired; general soft tissue
by tissues approximation and/or ligation

Monofilament: made of single thread-like structures MONOFILAMENT NONABSORBABLE

Multifilament: made of multiple thread-like structures ✓ Polypropylene

braided or twisted into a single strand • Most inert of the synthetic
• May be left in place for prolonged healing
SUTURE SIZES • Material of choice for plastic and
✓ Largest available suture use for surgery is gauge cardiovascular procedures
#5 and the smallest is gauge #11-0
✓ #1 and #0 for closure of orthopedic wounds ✓ Surgical nylon
✓ #4-0 and #5-0 for aortic anastomosis • Mint green package
✓ #6-0 and #7-0 for smaller vessel anastomosis • For skin closure
✓ #8-0 through #11-0 for eye procedures • Produces minimal tissue reaction
 • Has high tensile strength ▪ Before beginning the surgery
• May be used in all tissues that can be sutured ▪ Closure of every layer (peritoneum, fascia,
by nonabsorbable material muscle, subcutaneous, skin)
▪ Change of shift of nurses
✓ Surgical stainless steel
• Yellow-ochre package WOUND HEALING
• Insert in tissue and has great tensil strength
• For abdominal wall or sterna First intention/ primary union
• Desired after primary union of an incised,
MULTIFILAMENT NON-ABSORBABLE aseptic, accurately approximately wound
• Elements
➢ No tissue loss
✓ Surgical silk ➢ Well-approximated edges
• Baby blue package ➢ Minimal or no postoperative swelling
• Provides good support to wounds ➢ No serous discharge or local
• Used in serosa of the gastrointestinal tract infection
and to close uninfected fascia ➢ No separation of wound edges
➢ Minimal scare formation
✓ Surgical cotton
• One of the weakest nonabsorbable suture Second intention
• Gains tensile strength when wet • Healing by granulation, eventual re-
epithelization and wound contraction
✓ Polyester fiber
• Useful in respiratory tract Third intention
• Delayed primary closure
✓ Polyethylene • Suturing is delayed or secondary for the
• Used when monofilament is desirable purpose of walling off an area of gross
infection
Removal of Sutures • Debridement
• Facial wounds - 3-5 days
• Scalp wounds- 7-10 days
• Limbs- 10-14 days CLASSIFICATION OF SURGICAL WOUNDS
• Joints- 14 days Clean wound
• Trunk of the body- 7-10 days ▪ No break in sterile technique during the surgical
procedure
LAYER CLOSURE ▪ No inflammation
Abdominal wounds are closed in layer. ▪ Primary closure, wound not drained
From inner to outer: “PFMS”
✓ Peritoneum: a continuous 3-0 absorbable vicryl Clean- contaminated
suture is used ▪ Primary closure, wound drained
✓ Fascia – interrupted, heavy gauge, ▪ Minor beak in sterile technique occurred
nonabsorbable silk sutures with multifilament ▪ No inflammation
strands are preferred for added strength
✓ Muscle approximated with interrupted Contaminated wound
absorbable sutures ▪ Open, fresh traumatic wound of less than 4
✓ Subcutaneous: few interrupted plain gut sutures hours
to prevent dead space ▪ Nonpurulent inflammation is present

Surgical count Dirty and infected wound

▪ Old traumatic wound of more than 4 hours
Done by the scrub nurse and circulating nurse in the
▪ Organisms present in surgical field
following situations
▪ Opening sterile packs
PHYSICAL STATUS CLASSIFICATION SYSTEM
 o Epidural
❖ P1 – normal patient ▪ Injection of anesthetic into the
❖ P2 – patient with mild systemic diseases, without epidural space that surrounds
functional limitation the dura matter of the spinal
❖ P3 – patient with sever systemic diseases cord
associated with functional limitation ▪ Absence of spinal headache
❖ P4 – incapacitating systemic disease that is a o Spinal
constant threat to life ▪ Injection of anesthetic into the
❖ P5 – moribund patient who is not expected to subarachnoid space usually
survive for 24 hours between L4 and L5
❖ P6 – patient is brain dead and is being prepared ▪ Produces anesthesia of the
for organ donation lower extremities, perineum and
lower abdomen
Stages of Anesthesia ▪ Patient usually lies on the side in
Beginning anesthesia knee-chest position
• Patient feels warmth, dizziness and feelings ▪ May cause nausea, vomiting and
of detachment pain
• There is ringing, roaring or buzzing in the ears ▪ Cause headache due to leakage
• Patient is aware of being unable to move of CSF
extremities o Local conduction blocks
• Noises are exaggerated ▪ Brachial plexus block – produces
anesthesia of the arm
Excitement ▪ Paravertebral block – produces
• Patient is struggling, shouting, talking, anesthesia of the nerves
singing, laughing, crying supplying the chest, abdominal
• Pupil dilates but constricts in light wall and extremities
• Pulse rate is rapid ▪ Transsacral (caudal) block:
• Respiratory rate is irregular produces anesthesia of the
• Restraints may be applied perineum and occasionally, the
lower abdomen
Surgical anesthesia
▪ Moderate sedation/ analgesia
• Patient is unconscious
o IV administration of sedative and/or
• Pupils are small but reactive
analgesic medications to reduce the
• Respiratory rate is irregular
patient’s anxiety and to control pain
• Pulse rate is normal
during diagnostic or therapeutic
• Skin is pink and flushed procedures.
Medullary depression ▪ Local anesthesia
• Overdosage of anesthesia o Anesthetized a specific area/nerve
• RR is shallow o In combination with epinephrine to
• Pulse is weak and thready prevent rapid absorption of the
• Pupils are widely dilated and nonreactive anesthetic agent
• Cyanosis can occur and eventually death
DRESSING
TYPES OF ANESTHESIA AND SEDATION
Purpose
General Anesthesia ▪ Protection from injury, bacterial contamination
▪ Patients are not arousable even to painful stimuli ▪ Provide humidity
▪ Inhaled or administered IV ▪ Insulation
▪ Absorb drainage
Regional Anesthesia ▪ Debride the wound
▪ Anesthetized around a region of nerves ▪ Prevent hemorrhage
 ▪ Comfort

Types
✓ dry to dry – trap necrotic debris and exudate
✓ wet to dry – soften debris as it dries; dilutes
exudate
✓ wet to damp – wound debrided if gauze is
removed
✓ wet to wet – moisture dilutes exudates

Pressure Ulcer Dressing

- tegaderm/ hydrcolloid – stages 1 and 2
- hydrogel – stages 2 and 3
- absorptive dressing – stage 3
- dry gauze stage – stage 2-4

SURGICAL DRAINS
Penrose – thin walled cylinder of radiopaque latex;
secured with a suture or sterile safety pin attached on the
outside to close the skin and to keep the drain from
retracting into the wound
- most commonly used wound drain
- has a large safety pin outside to maintain its
position

Closed wound drainage – used to apply suction to an

infected close-wound site in the chest-wall, upper
abdomen, and in the areas of joint replacement
(HEMOVAC, JACKSON-PRATT)
- Jackson-pratt
o Bulb drain
o Used after abdominal, breast, and
thoracic surgery with small amounts of
drainage

- Hemovac drain
o consists of a large round drainage
reservoir that connects to an internal
source
o Used for large amounts of drainage

RECORD JP DRAIN SEPARATELY ON INTAKE AND OUTPUT

ONCOLOGY
 Physical Agents
Cancer - Radiation – X-ray / radioactive isotopes and
- Defective cellular proliferation (growth) and sunlight / UV Rays
defective cellular differentiation Hormonal Agents
- Estrogen as replacement therapy ↑ incidence of
Cell Cycle vaginal and cervical adenocarcinoma
- Estrogen, diethylstilbestrol (DES)
1. G1 / Gap Phase
CANCER PROMOTING AGENTS
- Lasts from hours to days / longer - Alkylating agent acute myeloid leukemia, bladder
- RNA and Protein synthesis occurs in preparation cancer
for DNA replication - Androgens – prostate cancer
- Arsenic – cancer of the lung, skin
2. S Phase / Synthesis Phase - Asbestos – cancer of the lung, pleura, peritoneum
- DES – Vaginal cancer
- Lasts from 10 – 20 hours - Epstein-barr – burkitt’s lymphoma, nasal T-cell
- DNA replication in preparation for division - Estrogens – cancer of the endometrium, liver, breast
- Ethyl alcohol – cancer of the liver, esophagus
3. G2 / Gap 2 - Helicobacter pylori – gastric cancer
- Hepatitis B or C virus – liver cancer
- Ranges from 2 – 10 hours - Human immunodeficiency virus – non-hodgkin’s
- DNA synthesis while RNA and Protein synthesis lympha, Kaposi sarcoma, squamous cell carcinoma
continues - Human papilloma virus – cervical cancer
- Human T cell lymphotropic virus – adult T cell
leukemia/ lymphoma
4. M Phase / Mitosis Phase - Immunosuppressive agents – non-hodgkin’s lympha
- Lasts from 30 – 60 minutes - Schistosomiasis – bladder cancer
- Cell division occurs - Sunlight -skin cancer
- After mitosis the daughter cells enter the G1 - Tobacco – cancer of the upper aerodigestive tract,
bladder
Phase and begin the reproductive cycle again - Vinyl chloride – liver cancer

5. G0 / Resting Phase Genetics and Familial Factors

- Is activity to reenter the cell cycle in response to
various stimuli that signal for cell renewal FACTORS TO CONSIDER
- Mr. Juan De La Cruz

M Marital
TOP 5 Cancer Incidences by Site and Sex Status
R Race
J Job
U Ur Life Style
Male Female A Age
1. Prostate 1. Breast N Nutrition
2. Lungs 2. Lungs D Drugs
3. Colon 3. Colon E Educational
Attainment
4. Urinary Tract 4. Uterus L Living
5. Leukemia 5. Leukemia and Lymphoma Conditions
A Ask family
History
C Culture
Etiologic Agents R Radiation
Therapy
Viruses and Bacteria U Ur Activity
- “Oncogenic viruses” Z Zex
- Prolonged / frequent viral infections may
cause breakdown of the immune system / BENIGN GROWTH PATTERNS
overwhelm theimmune system
Hypertrophy
Chemical Carcinogens - Increase In cell size resulting in an increase in
- E.g. Industrial compounds – vinyl organ size
chloride, polycyclic aromatic
hydrocarbons, fertilizers, weed killers, Hyperplasia
dyes and drugs - A reversible increase in the number of cells in an
organ or tissue in response to a specific growth
 stimulus Liver Cells Liver cell adenoma Hepatocellular
Carcinoma
Metaplasia Placental Hydatidiform Mole
- Conversion of one cell type to another cell type epithelium
not usually found in the involved tissue (Trophoblast)

Dysplasia Invasion
- Characterized by abnormal changes in the size, - Occurs when cancer cells infiltrate adjacent
shape, or organization of cells tissues surrounding the neoplasm
- Reversible when stimulus is removed
Metastasis
Anaplasia - Occurs when malignant cells travel through the
- Disorganized irregular cells that have no structure blood / lymph and invade other tissues and organs
to form a secondary tumor
and have loss of differentiation, the result is
almost malignant

Comparison of the Characteristics of Benign vs Malignant

CLASSIFICATIONS OF TUMORS Benign Malignant
Benign Speed of Slow growth Aggressive growth; rapid
Growth Grows by expansion cell division and growth
➢ Are tumors designated by attaching the suffix ‘–oma’ Mode of Localizes and Establishes new site
to the cells of organ Growth encapsulation malignant lesion
➢ E.g. Fibroma, Chondroma,, Osteoma Invade surrounding tissues
Cellular Well-differentiated With poor cellular
Malignant Characteristics differentiation
Metastasis It does not metastasizes
➢ Tumors that are capable of spreading by invasion and metastasize
metastasis No tissue damage
➢ E.g. Fibrosarcoma, Chondrosarcoma Prognosis Very good prognosis Poor prognosis
Does not cause
CATEGORIES OF MALIGNANT NEOPLASMS death, unless
localization
✓ Carcinogens – Growth from epithelial cells, usually affects vital
solid tumors functions
✓ Sarcoma – Arise from muscle, bone, fat and
connective tissue, may be solid
✓ Lymphoma – Arise from lymphoid tissues WARNING SIGNS OF CANCER (CAUTIONUS)
✓ Leukemia and Myeloma – Grows from blood forming
C Change in bowel / bladder habits
organs
A A sore that does not heal
U Unusual bleeding / discharge
Tissue of Organ Benign Malignant
T Thickening / lump in the breast or elsewhere
Connective Fibroma Fibrosarcoma
tissue and I Indigestion or difficulty in swallowing
Lipoma Liposarcoma
derivatives Chondroma Chondrosarcoma
O Obvious change in wart / mole
Osteoma Osteogenic Sarcoma N Nagging cough / hoarseness
Blood Vessels Hemangioma Angiosarcoma U Unexplained Anemia
Lymphatic Lympangioma Lymphangiosarcoma S Sudden weight loss
Vessels
Brain Meningioma Invasive Meningioma
Hematopoietic Leukemia SCREENING TEST
Cells
Lymphatics Malignant lymph*** Familial and environmental history
Smooth Muscles Leiomyoma Leiomyosarcoma
Stratified Rhabdomyoma Rhabdomyomasarcoma Physical Examination
Muscles
Epithelial Tumors Evaluation of laboratory findings and test findings
Stratified Squamous cell Squamous cell carcinoma
Squamous papilloma Screening methods
Basal Cells Basal Cells carcinoma - Breast
 o Monthly BSE = all women ages 20 and Human Chorionic With germ cell ovarian tumors in men with
above 1 week after menses Gonadotropin (HCG) and non-seminomatous
o Mammography every year from age 40 Alpha-fetoprotein (AFP)
years old TESTICULAR CANCER = Elevated HCG and
AFP
- Colon and Rectum Proportionately ↑ to the size of tumors
o Fecal occult blood test every year AFP levels may also be increased in
beginning at age 50 CHRONIC HEPATITIS
o Proctosigmoidoscopy every 3- 5 years
after 50 years old following 2 negative
annual exams STAGING
- Uterus - Done during the pre-treatment phase
o Yearly pelvic examination and PAP Smear - After surgical resection
test for sexually active girls and any
woman over 18 or less often for 3 STAGING A TUMOR
consecutive negative results
o An endometrial sample at menopause Tumor TNM Staging System
for high risk women T0 No end of primary tumor
Tis Carcinoma in situ
- Prostate T1, T2, T3, Progressive increase in tumor size and
o Digital Rectal Exam (DRE) yearly T4 involvement
beginning at age 50 Tx Tumor cannot be assessed
o Prostate-Specific Antigen (PSA) test
yearly beginning at age 50 STAGES

TUMOR MARKERS Stage The tumor is small, local, detected early

I
Stage The tumor is somewhat larger and has started
Tumor Marker Description
II to spread to nearby lymph nodes
Oncofetal Antigen Present in fetal tissue normally suppressed Stage The tumor has spread to nearby lymph nodes
after birth III
Hormones Present in considerable amount Stage Cancer has spread to other parts of the body
High levels in hormone-secreting IV and is generally in an advanced stage
malignancies
Isoenzymes Elevated levels can promote hyperplasia of
the tissue (Prostate acid STAGING – NODE
phosphatase)
Tissue-Specific Protein Narrows down the type of malignancy that N0 Regional lymph nodes
can be increased in hyperplastic disorders N1, N2, ↑ degree of demonstrable abnormality of
Prostate-Specific Antigen Useful in evaluating response to treatment, N3 regional lymph nodes
recurrent surgery / radiation Nx Regional lymph nodes cannot be assessed
therapy clinically

Elevated in prostate cancer, can be STAGING – METASTASIS

elevated in BPH in older men, should be
accompanied with DRE M0 No evidence of distant metastasis
S-100 Found in melanoma cells M1, Ascending degree of distant metastasis,
M2, including metastasis to different lymph nodes
Elevated means METASTATIC MELANOMA
M3
Thyroglobulin Protein made by the thyroid gland

Removal of the entire gland with or without GRADING

radiation therapyRise in thyroglobulin levels Gx Grade cannot be assessed
indicate cancer recurrence G1 Well differentiated
Ca 15 – 3 and Ca 27 – 29 Specific for BREAST CANCER G2 Moderately well-differentiated
Found in the blood of an affected patient G3 and G4 Poorly to very poorly differentiated
Ca 27 – 29 test is MORE sensitive than Ca 15 Poorer differentiation – poorer prognosis
–3
Carcinoembryonic Elevated in ADVANCED COLORECTAL
Antigen (CEA) CANCER CHEMOTHERAPY
↑ CEA level before surgery – POORER
PROGNOSIS
A systematic mode of treatment that uses cytotoxins and - Most affects there in the S Phase of interfering
chemicals to effectively CURE (Leukemia, Lymphomas, with DNA and RNA synthesis
some solid tumors) - M Phase (Vinca / Plant Alkaloids: Halt spindle
➢ ↓Tumor size function)
➢ Adjunct to surgery / radiation
➢ Prevent / treat suspected metastasis Cycle Non-Specific Agents

Most effective when the tumor is small and cell replication - Act independently of the cell cycle place
- Usually have prolonged effects or cells leading
is rapid Individualized to the patient and is often
to cell death and damage
prescribed according to the patient’s calculated body
surface area and type of cancer Alkylating Agents

Route of Chemotherapy - Contains alkyl groups which binds to DNA and

prevents replication and mitosis
- Cell Cycle Non-Specific
✓ Oral – Hodgkin’s Lymphoma, Leukemia - Effective against many types of cancer,
(Maintenance phase), Lung Cancer including acute and chronic leukemia, solid
✓ Intravenous – Leukemia tumors
✓ Intra-arterial – Hepatic tumors, head and neck - Common Side Effects
✓ Bone marrow suppression
cancer ✓ N/V
✓ Intracavity – Ovarian cancer ✓ Alopecia
✓ Intraperitoneal – Brain tumors ✓ Sterility
✓ Intraventricular – Brain tumor ✓ Cystic cyclophosphamide
✓ Intravesical – Bladder tumors ✓ Stomatitis
✓ Renal Toxicity (Cisplastin)
- Examples
• Bisulfiram (Bisulflex)
TISSUES NORMALLY BY CHEMOTHERAPY AFFECTED ARE: • Cyclophosphamide (Cytoxan)
• Chlorambucil (Leukeran)
Mucous Membranes • Cisplastin (Planitol-AQ)
- Mouth, tongue, esophagus, stomach, intestine
and rectum - Nursing Implications:
▪ Maintain good hydration
- Results in anorexia, loss of taste, aversion to food, ▪ Administer anti-emetics prior to
Erythema, painful ulceration of GIT, NV, diarrhea chemotherapy
Hair ▪ Monitor WBC, Uric Acid
- alopecia ▪ Assess for possible infection
▪ Discuss concerns for hair loss
Bone Marrow Depression
Nitrosoureas
- Affects: Granulocytes, lymphocytes,
thrombocytes, erythrocytes o Similar to the alkylating agent
- Impaired ability to respond to infection, blood o ONLY CHEMODRUG THAT CAN CROSS THE BLOOD
BRAIN BARRIER (BBB) [Important for Central
clot and severe anemia Nervous System diseases]
o Examples
Organ o Carmustine and lomustine
o Side Effects:
- Heart, lungs, bladder, kidney - Delayed cumulative myelosuppression (In 3 – 5
- Due to specific agents weeks) especially thrombocytopenia;
- E.g. Cardiac toxicity (Doxorubicin) - N/V
- Pneumocystis (Bleomycin) - Nursing Implications:
o Maintain good hydration
o Administer anti-emetics prior to
Classification of Chemotherapeutic Drugs chemotherapy
Related to the cell cycle o Monitor WBC, Uric Acid
Cycle Specific Agents o Assess for possible infection
o Discuss concerns for hair loss
- They are specific to certain phases of the cell
cycle Anti- Metabolites
- Destroy cells that are actively reproducing
Interferes with the biosynthesis of metabolism or nucleic
acid needed for RNA and DNA synthesis Plant Alkaloids
- Cell specific (Best in S Phase)
- Used to treat acute leukemia, breast cancer, head Two main Groups (From natural products)
and neck cancer, lung cancer, and osteosarcoma ➢ Vinca Alkaloids – Mitosis phase, inhibit mitotic
- Side Effects: tubular formation (spindle); inhibit DNA and
➢ Bone Marrow suppression (Anemia, protein synthesis
leukopenia) ➢ Etoposide (VP-16) or Mitotic Inhibitors – All
➢ Stomatitis phases; causes breaks in DNA and metaphase
➢ N/V arrest
➢ Alopecia
➢ E.g.
➢ Hepatitis and renal dysfunction
➢ Renal toxicity (Methotrexate) 1. Vincristine (Oncovin) Vinblastin
➢ Hepatotoxicity (Velban)
➢ Bone Marrow suppression: Reaches NADIR 2. Etoposide (Toposar) Teniposide
in 1 – 2 weeks; with leukopenia being most (Venom)
➢ Side Effect:
severe
- Example: Methotrexate o Hypotension (Too rapid IV
❖ Lethal in high doses, must give antidote administration), muscle weakness,
(Leucovorin) within 24 – 36 hours after areflexia, constipation, N/V, alopecia
initiation of therapy ➢ Nursing Implications:
❖ 5-Flurouracil (5-FU) o Assess neuromuscular functions
❖ Cytarabine (Depocyt, Tarabine) o Monitor CBC, GI function
o Manage constipation
- Nursing Implications o Hydration
✓ Monitor CBC, WBC, Uric acid o Discuss concerns for hair loss
✓ Assess oral mucus membranes
✓ Assess for infection, bleeding Hormonal Agents
✓ Provide oral care ➢ alter the deviate / environment to depress /
✓ Administer anti-emetics PRN prevent cell proliferation
✓ Discuss concern for hair loss ➢ Corticosteroids (e.g. Prednisone: Mostly used
✓ Evaluate hydration and nutritional status in CA therapy; G1 Phase)
o E.g.
Antitumor Antibiotics ▪ Androgen, estrogen, anti-
➢ Inhibit RNA synthesis and bind DNA causing androgens, anti-estrogens
fragmentation; interfere with DNA repair ➢ Side Effects
➢ These drugs bind to almost everything they o N/V
contact and kill cells o Hyperglycemia
➢ Main toxic effect is cardiac muscle toxicity o Hypertension
(Limits the amount and duration of treatment) o Weight gain; gynecomastia
➢ Side Effects are the same with other anti- o Mood changes
Cancer drugs o Cessation of menstruation
➢ E.g. o Acne, alopecia
▪ Doxorubicin (Adriamycin)
▪ Bleomycin (Blenoxane) Nursing Interventions for Chemical Side Effects
▪ Dactinomycin (Cosmegen)
➢ Nursing Implications GI System = N/V, diarrhea, constipation
o Monitor ECG, CBC ➢ Administer anti-emetics to relieve N/V
o Assess for bleeding ➢ Replace fluids and electrolyte losses, low fiber
o Assess for hydration and nutritional diet to relieve diarrhea
status ➢ ↑ fluid intake and fibers in diet to prevent /
o Check for fever 36 hours after relieve constipation
administration
o Administer anti-emetic PRN Integumentary System
 ➢ Pruritus; urticaria and systemic signs o Doxorubicin
➢ Provide good skin care o Vincristine
➢ Clinical manifestations
Stomatitis o Pain
➢ Provide good oral care, avoid HOT and SPICY o Erythema
food o Swelling
Alopecia o Lack of blood return
➢ Reassure that it is temporary, wear wigs / hats ➢ Nursing interventions
o Stop the drug administration
Skin Pigmentation o Leave the needle in place, and attempt to
➢ Inform that it is temporary aspirate any residual drug
o Administer an antidote as prescribe
Nail changes (Grow normally after chemotherapy) o Apply warm or cold compress
➢ Hematopoietic System o Document the appearance

Anemia Oncologic emergencies

➢ Frequent rest periods, eat foods high in Iron!
Infection and pain
➢ Arises from neutropenia
Neutropenia
➢ Pain management is the priority
➢ Protect from infection
➢ Avoid people with infection
Hypocalcemia
➢ Due to bone resorption (mineralization)
Thrombocytopenia
➢ Serum calcium is higher than 11mg/dl
➢ Protect from trauma
➢ Calcitonin and oral glucocorticoids to lower
➢ Avoid ASA
serum calcium level
Genito-Urinary System
Tumor lysis syndrome
➢ Hemorrhagic Cystitis
➢ Destruction of large number of malignant cells
➢ Provide 2 – 3 L of fluids per day
may rapidly release intracellular potassium,
phosphorus and nucleic acid
Urine color changes
➢ Manifestations
➢ Reassure that it is harmless
o Weakness
o Nausea
o Diarrhea
ADVERSE REACTIONS TO CHEMOTHERAPY
o Flaccid paralysis
➢ Interventions
Hypersensitivity
o Intravenous hydration
➢ Clinical manifestations
o Allopurinol to decrease uric acid
o Dyspnea
concentration
o Chest tightness
o Sodium bicarbonate
o Pruritus
o Lowering of serum potassium levels with
o Urticaria
retention enemas, IV 50% DEXTROSE
o Tachycardia
➢ If anaphylactic reaction occurs
RADIATION THERAPY
o Stop the drug administration
o Maintain IV access with 0.9% NaCl
Destroy cell by exposure to radiation
o Keep an open airway
Internal radiation
o Keep client in Modified Trendelenburg
The radiation source is within the client; for a period of
position
time, the client emits radiation and can pose a hazard to
others
Extravasation

➢ Vesicant chemotherapeutic drugs Sealed

 ➢ Temporary or permanent – solid implant used to treat other cancers, such as neuroblastoma
➢ Client emits radiation except excreta and multiple myeloma
➢ If implant cervical/ vaginal – resume sexual
intercourse after 7-10 days. Types
➢ Fleet enema prn - Allogenic – stem cells are acquired from a
➢ Refer – if diarrhea, N and V, bleeding, pain, donor who through human leukocyte antigen
distention or fever, urinary changes or foul tissue typing, has been determined to be HLA
discharge matched to the recipient
- Syngeneic – obtaining stem cells from one
Unsealed identical twin
- Oral, IV or installation into cavity - Autologous – the patients receive their own
- Not-confined- one area – enters body fluids stem cells back following myeloblative
eliminated via various excreta – radioactive (destroying bone marrow) chemotherapy.
and harmful to others within 48 hours . MOST COMMON TYPE.

Nursing interventions Complications:

- Rotate assignments - Failure to engraft: If the transplanted stem
▪ One radiation client at a time cells fail to engraft, the client will die unless
▪ 30 mins. Max exposure another transplantation is attempted and is
▪ Docimeter film badge successful.
- Private room and bath - Graft-versus-host disease in allogeneic
- Caution sign transplants
▪ No pregnant children ▪ is managed cautiously with
▪ Visitors – 6 feet away from source immunosuppressive agents to avoid
▪ Lines and dressings save till source suppressing the new immune system
removed - Hepatic veno-occlusive disease
▪ The disease involves occlusion of the
TELETHERAPHY hepatic venules by thrombosis or
phlebitis.
Wash with water with mild soap ▪ Signs include right upper quadrant
abdominal pain, jaundice, ascites,
Do not remove radiation markings weight gain, and hepatomegaly.

No cosmetic/ nothing on area LEUKEMIA

Soft clothing no constrictions Leukemias are a group of hematological malignancies

involving abnormal overproduction of leukocytes,
No sun or heat exposure usually at an immature stage, in the bone marrow.

Skin weeping – if moist desquamation occurs Leukemia may be acute, with a sudden onset, or chronic,
- Cleanse warm water, pat dry with a slow onset and persistent symptoms over a
- Steroids/ antibiotic cream as pres. period of years.
- Skin sparring effect
Leukemia affects the bone marrow, causing anemia,
Hematopoetic Stem Cell Transplantation leukopenia, the production of immature cells,
thrombocytopenia, and a decline in immunity
➢ Bone marrow transplantation and peripheral stem
cell transplantation are effective, lifesaving
procedures for a number of malignant and non- CLASSIFCATIONS OF LEUKEMIA
malignant diseases Acute Lymphocytic Leukemia
➢ The goal is to cure. - Mostly lymphoblasts present in bone marrow
➢ BMT and PBSCT are most commonly used in the - Age of onset is younger than 15 years.
treatment of leukemia and lymphoma, but are also
Acute Myelogenous Leukemia The client with multiple myeloma is at risk for
- Mostly myeloblasts present in bone marrow ▪ pathological fractures. Therefore, provide skeletal
- Age of onset is between 15 and 39 years. support during moving, turning, and ambulating and
provide a hazard-free environment
Chronic Myelogenous Leukemia
- Mostly granulocytes present in bone marrow Interventions
- Age of onset is in the fourth decade. - Chemotherapy
- Provide supportive care to control symptoms
Chronic Lymphocytic Leukemia and prevent complications, especially bone
- Mostly lymphocytes present in bone marrow fractures, hypercalcemia, kidney failure, and
- Age of onset is after 50 years infections.
- Encourage the consumption of at least 2 L of
LYMPHOMA fluids per day
- Encourage ambulation to prevent renal
Lymphomas, classified as Hodgkin’s and non- Hodgkin’s problems and to slow down bone resorption
depending on the cell type, are characterized by - Administer bisphosphonate medications as
abnormal proliferation of lymphocytes. prescribed to slow bone damage and reduce
pain and risk of fractures.
Hodgkin’s disease is a malignancy of the lymph nodes
that originates in a single lymph node or a chain of nodes. TESTICULAR CACNCER

The disease usually involves lymph nodes, tonsils, Testicular cancer arises from germinal epithelium from
spleen, and bone marrow and is characterized by the the sperm-producing germ cells or from nongerminal
presence of Reed-Sternberg cells in the nodes epithelium from other structures in the testicles.

Signs and symptoms Testicular cancer most often occurs between the ages of
- Fever 15 and 40 years
- Malaise, fatigue, and weakness
- Night sweats The cause of testicular cancer is unknown, but a history
- Loss of appetite and significant weight loss of undescended testicle (cryptorchidism) and genetic
- Anemia and thrombocytopenia predisposition have been associated with testicular
- Enlarged lymph nodes, spleen, and liver tumor development
- Positive biopsy of lymph nodes, with cervical
nodes most often affected first Early detection
- Presence of Reed-Sternberg cells in nodes - Performing testicular self-examination:
- Positive computed tomography (CT) scan of Perform monthly; a day of the month is
the liver and spleen selected and the examination is performed on
the same day each month.
Interventions - The best time to perform this examination is
- Stage 1 and 2 without mediastinal node, right after a shower when your scrotal skin is
involvement, the treatment of choice is moist and relaxed, making the testicles easy to
extensive external radiation feel.
- With more extensive disease, radiation and
multiagent chemotherapy are used. CERVICAL CANCER

MULTIPLE MYELOMA Preinvasive cancer is limited to the cervix.

malignant proliferation of plasma cells within the bone Invasive cancer is in the cervix and other pelvic
The abnormal plasma cells produce an abnormal structures
antibody (myeloma protein or the Bence Jones protein)
found in the blood and urine. Premalignant changes are described on a continuum
from dysplasia, which is the earliest pre-malignancy
change, to carcinoma in situ, the most advanced - Total abdominal hysterectomy and bilateral
premalignant change. salpingo-oophorectomy with tumor
debulking may be necessary
Risk factors - intraperitoneal radioisotopes may be instilled
- Human papillomavirus (HPV) infection for stage I disease
(vaccination against HPV is effective to avoid
HPV infection, and thus cervical cancer ENDOMETRIAL CANCER
- Cigarette smoking
- Screening via regular gynecological Endometrial cancer is a slow-growing tumor arising from
examinations and Pap test the endometrial mucosa of the uterus, associated with
the menopausal years.
Treatment
- Laser therapy is used when all boundaries of Risk factors
the lesion are visible during colposcopic - Use of estrogen replacement therapy (ERT)
examination - Nulliparity
- Cryosurgery involves freezing of the tissues, - Polycystic ovary disease
using a probe, with subsequent necrosis and - Increased age
sloughing. - Late menopause
- Conization - Conization allows the woman to
retain reproductive capacity Low back, pelvic, or abdominal pain (pain occurs late in
- Hysterectomy – removal of the uterus the disease process)
▪ Monitor vaginal bleeding following
hysterectomy. More than 1 saturated Enlarged uterus (in advanced stages)
pad per hour may indicate excessive
bleeding. Interventions
- Pelvic exenteration, the removal of all pelvic - External or internal radiation
contents, including bowel, vagina, and - Chemotherapy
bladder, is a radical surgical procedure - Progesterone prescribed for estrogen-
performed for recurrent cancer if no evidence dependent tumors
of tumor outside the pelvis and no lymph node - Tamoxifen, an antiestrogen medication, also
involvement exist. may be prescribed.
- Total abdominal hysterectomy and bilateral
OVARIAN CANCER salpingo-oophorectomy

Ovarian cancer grows rapidly, spreads fast, and is often BREAST CANCER
bilateral.
Breast cancer is classified as invasive when it penetrates
Metastasis occurs by direct spread to the organs in the the tissue surrounding the mammary duct and grows in
pelvis, an irregular pattern

Ovarian cancer has a higher mortality rate than any other Metastasis occurs via lymph node.
cancer of the female reproductive system, particularly
among white women between 55 and 65 years of age of
North American or European descent Common sites of metastasis are the bone and lungs

metastasis may also occur to the brain and liver.

Elevated tumor marker (i.e., CA-125)
Diagnosis is made by breast biopsy through a needle
Interventions aspiration or by surgical removal of the tumor with
- External radiation may be used if the tumor microscopic examination for malignant cells.
has invaded other organs
- Chemotherapy is used postoperatively for
most stages of ovarian cancer.
Risk factors
 - Age No IVs, no injections, no blood pressure measurements,
- Family history of breast cancer due to genetic and no venipunctures should be done in the arm on the
predisposition side of the mastectomy. The arm on the side of the
- Early menarche and late menopause mastectomy is protected, and any intervention that
- Previous cancer of the breast, uterus, or could traumatize the affected arm is avoided because of
ovaries the risk for lymphedema on this side.
- Nulliparity, late first birth
ESOPHAGEAL CANCER
- Obesity
- High-dose radiation exposure to chest Esophageal cancer is a malignancy found in the
esophageal mucosa, formed by squamous cell
carcinoma (SCC) or adenocarcinoma
Mass felt during BSE (usually felt in the upper outer
The cause is unknown but major risk factors include
quadrant, beneath the nipple, or in axilla).
cigarette smoking, alcohol consumption, chronic reflux,
Barrett’s esophagus, and vitamin deficiencies.

Early detection: REGULAR BSE Interventions

Performing BSE - Monitor nutritional status

- Instruct client about diet changes
- Perform regularly 7 to 10 days after menses.
- Chemotherapy and radiation therapy
- Postmenopausal clients or clients who have
- Surgical resection as prescribed
had a hysterectomy should perform BSE
regularly as well.

Non-surgical interventions GASTRIC CANCER

- Chemotherapy Gastric cancer is a malignant growth of the mucosal cells

- Radiation therapy in the inner lining of the stomach, with invasion to the
- Monoclonal antibodies such as trastuzumab muscle and beyond in advanced disease.
for human epidermal growth factor receptor
No single causative agent has been identified but it is
2- positive (HER-2 +) breast cancer
believed that H. pylori infection and a diet of smoked,
highly salted, processed, or spiced foods have
carcinogenic effects; other risk factors include smoking,
Surgical breast procedures
alcohol and nitrate ingestion, and a history of gastric
- Lumpectomy ulcers
▪ Tumor is excised and removed.
Interventions
▪ Lymph node dissection may also be
performed. - Monitor vital signs
- Monitor hemoglobin and hematocrit
- Simple Mastectomy - Monitor weight
▪ Breast tissue and the nipple are - Chemotherapy
removed. - Radiation therapy
▪ Lymph nodes are usually left intact. - Prepare client for surgical resection

SURGICAL INTERVENTION FOR GASTRIC CANCER

- Modified Radical Mastectomy Billroth I

▪ Breast tissue, nipple, and lymph nodes
- Also called gastroduodenostomy
are removed.
- Partial gastrectomy, with remaining segment
▪ Muscles are left intact
anastomosed to the duodenum
Billroth II LUNG CANCER

- Also called gastrojejunostomy Lung cancer is a malignant tumor of the bronchi and
- Partial gastrectomy, with remaining segment peripheral lung tissue
anastomosed to the jejunum
lungs are a common target for metastasis from other
Total Gastrectomy
organs
- Also called esophagojejunostomy
- Removal of the stomach, with attachment of Bronchogenic cancer (tumors originate in the epithelium
the esophagus to the jejunum or duodenum of the bronchus) spreads through direct extension and
lymphatic dissemination
PANCREATIC CANCER
Types
Most pancreatic tumors are highly malignant, rapidly • (SCLC) and non– small cell lung cancer (NSCLC);
growing adenocarcinomas originating from the epidermal (squamous cell), adenocarcinoma,
epithelium of the ductal system. and large cell anaplastic carcinoma are classified
as NSCLC because of their similar responses to
Pancreatic cancer is associated with increased age, a
treatment
history of diabetes mellitus, alcohol use, history of
previous pancreatitis, smoking, ingestion of a high-fat CAUSE
diet, and exposure to environmental chemicals - Cigarette smoking
Interventions - Exposure to environmental and chemical
pollutants
- Radiation
- Chemotherapy Interventions
- Whipple procedure - Chemotherapy
▪ Whipple procedure, which involves a - Radiation therapy
pancreaticoduodenectomy with
Surgical interventions
removal of the distal third of the
- Laser therapy: To relieve endobronchial
stomach
obstruction
INTESTINAL CANCER - Thoracentesis and pleurodesis: To remove
pleural fluid and relieve hypoxia
Intestinal tumors are malignant lesions that develop in - Thoracotomy (opening into the thoracic
the cells lining the bowel wall or develop as cavity)
adenomatous polyps in the colon or rectum - pneumonectomy: Surgical removal of
11entire lung
Tumor spread is by direct invasion and through the - Thoracotomy with lobectomy: Surgical
lymphatic and circulatory systems. removal of 1 lobe of the lung for tumors
confined to a single lobe
Blood in stool (most common manifestation) detected
- Thoracotomy with segmental resection:
by fecal occult blood testing, sigmoidoscopy, and
Surgical removal of a lobe segment
colonoscopy.

Cachexia (late sign) The airway is the priority for a client with lung or
laryngeal cancer
Interventions
LARYNGEAL CANCER
- Chemoteraphy
- Colostomy Laryngeal cancer is a malignant tumor of the larynx
- Ileostomy Diagnosis is made by laryngoscopy and biopsy showing a
- Monitor stoma color. A dark blue, purple, or positive cytological study for cancer cells.
black stoma indicates compromised
circulation, requiring HCP notification Interventions
 Following TURP, monitor for transurethral resection
The goal is to remove the cancer while preserving as syndrome or severe hyponatremia (water intoxication)
much normal function as possible. caused by the excessive absorption of bladder irrigation
during surgery. (Signs include altered mental status,
Surgical intervention depends on the tumor size, bradycardia, increased blood pressure, and confusion.)
location, and amount of tissue to be resected.
BLADDER CANCER
Types of resection include cordal stripping, cordectomy,
partial laryngectomy, and total laryngectomy. Bladder cancer is a papillomatous growth in the bladder
urothelium that undergoes malignant changes and that
A tracheostomy is performed with a total may infiltrate the bladder wall.
laryngectomy; this airway opening is permanent and is
referred to as a laryngectomy stoma Predisposing factors include cigarette smoking,
exposure to industrial chemicals, and exposure to
PROSTATE CANCER radiation.

Prostate cancer, a slow-growing malignancy of the Intervention

prostate gland, is a common cancer in American men; - Chemotherapy
most prostate tumors are adenocarcinomas arising from ▪ Intravesical instillation
androgen-dependent epithelial cells. ▪ An alkylating chemotherapeutic
agent is instilled into the
The risk increases in men with each decade after the age bladder.
of 50 years ▪ Systemic chemotherapy: Used to treat
inoperable tumors or distant metastasis
s/sx - Transurethral resection of bladder tumor
- Asymptomatic in early stages ▪ Local resection and fulguration
- Hard, pea-sized nodule or irregularities (destruction of tissue by electrical
palpated on rectal examination current through electrodes placed in
- Gross, painless hematuria direct contact with the tissue)
- Late symptoms such as weight loss, urinary - Partial cystectomy
obstruction, and bone pain radiating from the ▪ removal of up to half the bladder
lumbosacral area down the le ▪ Maintenance of a continuous output of
- PSA: elevated urine following surgery is critical to
prevent bladder distention and stress on
Interventions the suture line
- Transurethral resection of the prostate - Ileal conduit
(TURP) may be performed for palliation in ▪ The ileal conduit is also called a
prostate cancer clients. ureteroileostomy, or Bricker’s
▪ The procedure involves insertion of a procedure.
scope into the urethra to excise prostatic ▪ Ureters are implanted into a segment of
tissue the ileum, with the formation of an
▪ Monitor for hemorrhage; bleeding is abdominal stoma.
common following TURP. ▪ The urine flows into the conduit and is
- Suprapubic prostatectomy is removal of the propelled continuously out through the
prostate gland by an abdominal incision with stoma by peristalsis.
a bladder incision. ▪ The client is required to wear an
- Retropubic prostatectomy is removal of the appliance over the stoma to collect the
prostate gland by a low abdominal incision urine
without opening the bladder. - Koch pouch
- The prostate gland is removed through an ▪ continent internal ileal reservoir created
incision made between the scrotum and anus from a segment of the ileum and
ascending colon
 ▪ The ureters are implanted into the side
of the reservoir, and a special nipple
valve is constructed to attach the
reservoir to the skin
- Indiana pouch
▪ A continent reservoir is created from the
ascending colon and terminal ileum,
making a pouch larger than the Kock
pouch (addiional continent reservoirs
include the Mainz and Florida pouch
systems)
- Percutaneous nephrostomy or pyelostomy
▪ These procedures are used to prevent
or treat obstruction
- Ureterostomy
▪ Ureterostomy may be performed as a
palliative procedure if the ureters are
obstructed by the tumor
- Vesicostomy
▪ The bladder is sutured to the abdomen,
and a stoma is created in the bladder
wall.
The bladder empties through the stomach.