Oncology is part of study focused on the cancer

oncology contans different cancer types

1. Introduction to oncology nursing By Mr. Gedion Zerihun (BSc, MSc in Adult health nursing) Comprehensive BSc May , 2024 Mizan-Aman , Ethiopia 13/05/2024 1

2. Objective Define oncology, neoplastic Describe Risk factor/causes Describe Biology of cancer cells Describe Pathophysiology of cancer cells Identify Types of malignancy Discuss nomenclature and features neoplasm Identify common types of cancer (Breast, Lung, Prostate…) Cancer Detection and diagnostic modalities (2hrs) Treatment modalities and nursing role (4hrs)

3. Introduction To Cancer Concepts Oncology is the branch of medicine dealing with tumors . Oncology nursing is also called cancer nursing; it is an important component of medical-surgical nursing care. Cancer is second only to heart disease in mortality rates in the United States . Documentation of the benefits of early cancer detection and its impact on treatment exist from the beginning of the nineteenth century. Today microscopic technology and genetic engineering provide physicians with a better understanding of tumor growth and cell activity and a means for early cancer detection and intervention.

4. Benign Tumors Normal cells that reproduce abnormally result in neoplasms, or tumors . Neoplasm is a term that combines the Greek word neo, meaning “new,” and plasia , meaning “growth ,” to suggest new tissue growth . A neoplasm is an enlargement of tissue and the formation of an abnormal mass . A neoplasm develops as cells multiply. Not all neoplasms contain cancer cells; however, a neoplastic cell is responsible for producing a tumor and shows a lively growing cell . New neoplastic growth is very difficult to detect until it contains about 500 cells and is approximately 1 cm.

5. Cont ’…. A benign tumor is defined as a cluster of cells that is not normal to the body but is noncancerous. Benign tumors grow more slowly and have cells that are the same as the original tissue. An organ containing a benign tumor usually continues to function normally , whereas an organ affected with a cancerous tumor eventually ceases to function . Malignant , a term often used as a synonym for cancer , is defined as a growth that resists treatment .

6. A comparison of benign and malignant tumors Benign Malignant Growth Rate Typically slow expansion Often rapid with cell numbers doubling normal cell growth; malignant cells infiltrate surrounding tissue Cell Features Typical of the tissue of origin Atypical in varying degrees of the tissue or origin; altered cell membrane; contains tumor -specific antigens Tissue Damage Minor Often causes necrosis and ulceration of tissue Metastasis Not seen; remains localized at origin site Often spreads to form tumors in other parts of the body Recurrence after Treatment Seldom recurrence after surgical removal Recurrence can be seen after surgical removal and following radiation and chemotherapy Related Terminology Hyperplasia, polyp, and benign neoplasia Cancer, malignancy, and malignant neoplasia Prognosis Not injurious unless location causes pressure or obstruction to vital organs Death if uncontrolled

7. Cancer Cancer is a group of cells that grows out of control , taking over the function of the affected organ. Cancer cells are described as poorly constructed, loosely formed, and without organization . A simplistic definition is “ confused cell ” Cancer is not contagious.

8. Pathophysiology Cancer is not one disease, but many diseases with different causes , manifestations, treatments, and prognoses. Caused by mutation of cellular genes. Cancer takes on the characteristics of the cell it mutates and then takes on characteristics of the mutation. Growth-regulating signals in the cell’s surrounding environment are ignored as the abnormal cell growth increases. Normal cells are limited to about 50 to 60 divisions before they die.

9. Pathophysiology Cancer cells do not have a division limit and are considered immortal. The progression from a normal cell to a malignant cell follows a pattern of mutation, defective division and abnormal growth cycles, and defective cell communication. Cell mutation occurs when a sudden change affects the chromosomes, causing the new cell to differ from the parent. The malignant cell enzymes destroy the gluelike substance found between normal cells, which disrupts the transfer of information used for normal cell structure.

10. Cont ’.. Cancer cell growth and reproduction involves a two-step process . The first step in cancer growth is called initiation . Initiation causes an alteration in the genetic structure of the cell (DNA). Cell alteration is associated with exposure to a carcinogen. The cellular change primes the cell to become cancerous.

11. Cont …. Promotion is the second type of cancer cell growth. It occurs after repeated exposure to carcinogens causes initiated cells to mutate. During the promotion step, a tumor forms from mutated cell reproduction. A healthy immune system can often destroy cancer cells before they replicate and become a tumor . It is important to remember that any substance that weakens or alters the immune system puts the individual at risk for cell mutation.

12. Cancer Classification/ nomenclature Cancers are identified by the tissue affected, speed of cell growth , cell appearance, and location . Neoplasms occurring in the epithelial cells are called carcinomas . Carcinoma is the most common type of cancer and includes cells of the skin , gastrointestinal system, and lungs. Cancer cells affecting connective tissue , including fat , the sheath that contains nerves, cartilage, muscle, and bone , are called sarcomas . Leukemia is the term used to describe the abnormal growth of white blood cells . Cancers involving cells of the lymphatic system , lymph nodes, and spleen are called lymphomas .

13. Spread of Cancer Neoplastic cells that remain in one area are considered localized, or in situ, cancers. These tumors may be difficult to visualize on clinical examination and are detected through microscopic cell examination . In situ tumors are often removed surgically and require no further treatment. Metastasis is the term used to describe the spread of the tumor from the primary site into separate and distinct areas .

14. Cont ’… Metastasis is the stage at which cancer cells acquire invasive behavior characteristics and cause the surrounding tissue to change. Metastasis occurs primarily because cancer cells break away more easily than normal cells and can survive for a time independently from other cells. There are three steps in the formation of a metastasis. Cancer cells are able to (1) invade blood or lymph vessels, (2) move by mechanical means, and ( 3) lodge and grow in a new location.

15. Con’… Metastatic tumors carry with them the cell characteristics of the original or primary tumor site . As a result, surgeons are able to determine the original tumor site based on metastatic cell characteristics. For example, lung tissue found in the brain suggests a primary lung tumor with metastasis to brain tissue. Common sites of metastasis are the lungs, liver, bones, and brain.

16. Risk Factors Risk Factors Increased risk of cancer is linked to several environmental factors . An evaluation of cancer begins with assessment of well-known risk factors such as specific Viruses; Exposure to radiation , Chemicals, and irritants; Genetics; Diet; and General immunity .

17. Viruses Certain viruses, such as the oncoviruses ( RNAtype viruses ), are linked to cancer in humans . Retrovirus is an enzyme produced by RNA tumor viruses and is found in human leukemia cells. The Epstein-Barr virus (EBV) , which causes infectious mononucleosis , is also associated with Burkitt’s lymphoma . Herpes simplex virus II has been associated with cervical and penile cancers. Papillomavirus associated with genital warts is considered one cause of cervical cancer in women. Chronic hepatitis B is linked with liver cancer .

18. Radiation There is an increased incidence of cancer in persons exposed to prolonged or large amounts of radiation . Ionizing radiation involving x-rays; alpha, beta, and gamma rays ; and ultraviolet rays such as sunlight play a major role in promoting leukemia and skin cancers, primarily melanomas. Persons exposed to radioactive materials in large doses, such as a radiation leak or an atomic bomb, are at risk for leukemia , breast, bone, lung, and thyroid cancer. Controlled radiation therapy is used to treat cancer patients by destroying rapidly dividing cancer cells. Radiation can also damage normal cells. The decision to use radiation is made after careful evaluation of the tumor’s location and vulnerability to other treatments.

19. Chemicals Chemicals are present in air, water, soil, food, drugs , and tobacco smoke. Chemical carcinogens are implicated as triggering mechanisms in malignant tumor development . Length of exposure time and degree of exposure intensity to chemical carcinogens are associated with risk for cancer development. Smoking accounts for 87 % of lung cancer worldwide. Chemical agents, as in tobacco, are more toxic when used with alcohol. Alcohol and tobacco are the most frequent causes of cancers of the mouth and throat. Chemicals used in manufacturing, such as vinyl chloride, are associated with liver cancer.

20. Cont.’… Irritants;- Chronic irritation or inflammation caused by irritants such as snuff or pipe smoke often cause cancer in local areas. Nevi (moles) that are chronically irritated by clothing , especially clothing contaminated by chemical residue , may become malignant. Asbestos found in temperature and sound insulation has been proven to cause a particularly virulent type of lung cancer . Genetics:- Genetics plays a large part in cancer formation. Certain breast cancers are linked to a specific gene mutation. Skin and colon cancers have a genetic tendency. People with Down syndrome (a chromosomal abnormality) have a higher risk of developing acute leukemia .

21. Diet Diet is a large factor in both cause and prevention of malignancies . People who eat high-fat , low- fiber diets are more prone to develop colon cancers. Diets high in fiber reduce the risk of colon cancer. High-fat diets are linked to breast cancer in women and prostate cancer in men. Consumption of large amounts of pickled, smoked, and charbroiled foods has been linked with esophageal and stomach cancers . A diet low in vitamins A, C, and E is associated with cancers of the lungs, esophagus , mouth, larynx, cervix, and breast.

22. Hormones Hormonal agents that disturb the balance of the body may also promote cancer . Long-term use of the female hormone estrogen is associated with cancer of the breast , uterus, ovaries, cervix, and vagina . It has been found that children born of mothers who took diethylstilbestrol (DES ) during pregnancy have an increased incidence of reproductive cancers. DES is a synthetic hormone with estrogen -like properties used in the past to prevent miscarriage. Tumors of the breast and uterus are tested for estrogen or progesterone influence. If a breast tumor is malignant, the tumor is tested and treatment varies depending on whether it is positive for estrogen or progesterone dependence.

23. Immune Factors A healthy immune system destroys mutant cells quickly on formation. An individual with altered immunity is more susceptible to cancer formation when exposed to small amounts of carcinogens compared with someone with a healthy immune system. Immune system suppression allows malignant cells to develop in large numbers. Individuals with acquired immunodeficiency syndrome (AIDS) have a compromised immune system and an increased risk for certain cancers .

24. Diagnosis of Cancer A diagnosis of cancer can be a very frightening experience. Often people try to mask symptoms because they are so frightened of the disease. Exploring patient attitudes and perceptions about the disease helps you construct an effective teaching plan. A careful and thorough assessment of the patient’s present and past medical and surgical history and pertinent family history are obtained. A complete physical examination provides both objective and subjective data. The most conclusive information about the health of tissue is acquired by examining cell activity through biopsy .

25. Diagnosis of Cancer ……. Biopsy Accurate identification of a cancer can only be done by biopsy (the surgical removal of tissue cells). Microscopic examination of a piece of suspected tissue or aspirated body fluid can confirm the presence of mutant cells. Incisional biopsy is an invasive procedure that involves the surgical removal of a small amount of tissue for inspection. Tissue can also be removed during endoscopic procedures (insertion of a tube to observe the inside of a hollow organ or cavity), such as a lung biopsy done during bronchoscopy .

26. Diagnosis of Ca ….. Biopsy Excisional biopsy is used to remove an entire tissue mass . Needle aspiration biopsy involves insertion of a needle into tissue for fluid or tissue aspiration Transcutaneous aspiration involves the insertion of a fine needle into tissue such as breast, prostate, or salivary gland and is used for diagnosing metastatic cancers.

27. Diagnosis of cancer … Laboratory Tests Blood, serum, and urine tests are important in establishing baseline values and general health status. Laboratory values are used with other assessment findings. An elevated white blood cell (WBC) count is expected if the patient has evidence of infection; however, an increase in WBCs without infection raises suspicion of leukemia . Fifty percent of patients with liver cancer have increased levels of bilirubin, alkaline phosphatase , and glutamic- oxaloacetic transaminase . Bone marrow aspiration is a major tool for diagnosis of leukemia .

28. Diagnosis of cancer … Tumor markers , also called biochemical markers , are proteins, antigens , genes, hormones, and enzymes produced and secreted by tumor cells. Tumor markers help confirm a diagnosis of cancer , detect cancer origin, monitor the effect of cancer therapy, and determine cancer remission.

29. Tumor markers….. Tumor markers include the following: Prostatic acid phosphatase (PAP )—high levels noted in prostate cancer PSA —elevated levels associated with prostate cancer Cancer antigen (CA) 15-3—elevated levels noted in breast cancer ; useful in monitoring patient response to therapy for metastatic breast cancer CA 125—increased levels in ovarian, cervical, liver, and pancreas cancers CA 19-9—used to diagnose and evaluate pancreatic and hepatobiliary cancer; levels elevated in cancer Carcinoembryonic antigen (CEA)— increased levels suggest tumor activity

30. Cytological Study Cytology is the study of the formation, structure, and function of cells. Cytological diagnosis of cancer is obtained primarily through Pap smears of cells shed from a mucous membrane (e.g., cervical or oral smear). Test results are based on the degree of cell abnormality . Normal results reflect no cellular changes. Slight cellular changes are considered normal , with a possible link to abnormal cells seen in infection. Severe cellular changes reflect a higher probability of precancerous or cancerous cellular activity.

31. Radiological Procedures X-ray examination is a valuable diagnostic tool in detecting cancer of the bones and hollow organs. Routine chest x-ray examination is one diagnostic test used in detecting lung cancer . Mammography is a reliable and non invasive low radiation x-ray procedure for detecting breast masses. Contrast media x-ray studies are used to detect abnormalities of bone and the gastrointestinal and urinary systems . Computed tomography (CT) provides a three-dimensional, cross-sectional , computerized picture of the body. CT scans are important in the diagnosis and staging of malignancies and can detect minor variations in tissue thickness.

32. Nuclear Imaging Procedures Nuclear medicine imaging involves camera imaging of organs or tissues containing radioactive media . Positron emission tomography (PET) scanning provides information about cellular biochemical and metabolic activity . PET scans have been useful in brain imaging . Ultrasound Procedures This technology helps detect tumors of the pelvis and breast . Ultrasound may also be used to distinguish between benign and malignant breast tumors . Magnetic Resonance Imaging Endoscopic Procedures

33. Staging Tumor staging is used to determine the stage of solid- tumor masses , providing valuable information about the potential success of treatment plans. Tumor staging is important in the development of an international system that can compare statistics among cancer centers . The most common system used for staging tumors is called tumor , node, metastasis (TNM ).

34. Tumor , Node, Metastasis, (TNM)Staging, and Tissue Involvement Classification Staging Tissue Involvement Primary tumor (T) Tis Stage I Tumor in situ, indicates no invasion of other tissues T1, T2, T3, T4 Stage II Ranges indicate progressive increase in tumor size with local metastasis Regional lymph node involvement (N) N0 (No nodes) N1, N2, N3 Stage III Metastasis to regional lymph nodes Metastasis (M) M0 (No metastasis) M1 Stage IV Distant metastasis

35. Treatment for Cancer There are three main types of treatment for cancer: Surgery, Radiation therapy, and Chemotherapy. Surgery Surgery can be used to cure cancer when it is possible to remove the entire tumor . Prophylactic surgery is used to remove moles or lesions that have the potential to become malignant. Surgery may also be done for palliation (symptom control ). The goals of palliative surgery are less discomfort and an improved quality of life . Reconstructive surgery can be done for cosmetic enhancement or for return of function of a body part.

36. Radiation Radiation is used commonly in the treatment of cancer for control or palliation , and it can be curative if the disease is localized. The decision to use radiation is commonly based on cancer site and size . Radiation destroys cancer cells by affecting cell structure and the cell environment . Palliative radiation is used to reduce the size of a large cancerous lesion and consequently reduce pressure and pain.

37. Nursing care of the patient receiving radiation treatment. Symptoms of tissue reaction to radiation treatment can be expected Fatigue . Nausea, vomiting, and anorexia . Mucositis (inflammation of the mucous membranes, especially of the mouth and throat ). Xerostomia (dry mouth ). Skin reactions. a second-degree burn Bone marrow depression .

38. Chemotherapy Chemotherapy is chemical therapy that uses cytotoxic drugs to treat cancer. Cytotoxic drugs can be used for cure, control , or palliation of and are described according to how they affect cell activity . Chemotherapy is usually more effective when multiple drugs are given in multiple doses . Factors influencing the effectiveness of chemotherapy are tumor type, available chemotherapeutic drugs, and genetics. Routes of administration;-Drugs may be given via oral , intramuscular, intravenous, or topical routes.

39. Chemotherapy cont ’.. Alkylating agents bind with DNA to stop the production of RNA; Carmustine ( BCNU), Cisplatin Antimetabolites substitute for nutrients or enzymes in the cell life cycle; Floxuridine ( FUDR), Fludarabine ( Fludara ) Mitotic inhibitors interfere with cell division ; Irinotecan ( Camptosar ) Antibiotics inhibit DNA and RNA synthesis; and Bleomycin , Dactinomycin ( Cosmegen ), Daunorubicin Hormonal agents alter the hormonal structure of the body.

40. Chemotherapy con’… Vesicant drugs are given only by the (IV)intravenous route. These drugs cause blistering of tissue that eventually leads to necrosis if they infiltrate, or leak out of the blood vessel, into soft tissue Central Lines. Central lines are intravenous catheters that terminate in the superior vena cava near the right atrium of the heart. This is a large vessel that allows for dilution of vesicant drugs and reduces the risk of infiltration . Side effects of chemotherapy. Toxicities in patients receiving chemotherapy vary according to the medications given ; however, some general side effects are commonly associated with chemotherapy drugs.

41. Side effect of Chemotherapy cont ’… Bone Marrow. Chemotherapy is toxic to the bone marrow, where the blood cells are produced . Patient may develop:- Low WBC counts (leukopenia), increasing their susceptibility to infection and sepsis . A reduction in platelets (thrombocytopenia) increases the risk of bruising and bleeding and can require platelet transfusions. Increased risk of anemia occurs with the reduction of red blood cells and may require blood transfusions . Gastrointestinal Tract. Patients often become nauseated and vomit or experience diarrhea . Stomatitis is a common complaint and is discussed under side effects of radiation.

42. Side effect of Chemotherapy cont ’… Hair. Alopecia (hair loss) is common with many chemotherapy drugs. This is a temporary condition, and growth of the new hair usually starts when the chemotherapy medication is stopped. Alopecia involves the entire body and includes eyebrows, eyelashes, and axillary and pubic hair . Reproductive System. The effects of chemotherapy or radiation can cause temporary or permanent alterations of the reproductive system .

43. Side effect of Chemotherapy cont ’… Neurological System. Drugs may affect the neurological system. An adverse reaction to vincristine is neurotoxicity , Which may result in tingling or numbness in the extremities and in severe cases may cause foot drop from muscle weakness . Less common complications include renal toxicities , such as pain and burning on urination, and hematuria . Doxorubicin (Adriamycin) has been associated with permanent heart damage, and bleomycin can cause pulmonary fibrosis . Severe toxic side effects can be controlled by carefully limiting the amount of medication given and constantly monitoring the patient for complications.

44. Complications And Nursing Implications Malnutrition Anorexia, malabsorption , and cachexia are common examples of nutritional problems . Cachexia is characterized by loss of body weight, adipose tissue, visceral protein, and skeletal muscle Clients who have cancer are at increased risk for weight loss and anorexia . The presence of carcinoma in the body increases the amount of energy required for metabolic function. Cancer can impair the body’s ability to ingest, digest, and absorb nutrients. Adverse effects of cancer treatment can affect the desire for food or the ability to eat. Findings include nausea and vomiting, changes in taste, anorexia, pain, diarrhea , early satiety, dry mouth, thickened saliva, and irritation to the gastrointestinal tract.

45. Complications and Nursing Implications Nursing Actions Educate the client about managing the expected effects of treatment. Administer antiemetics and antacids as prescribed. Monitor relevant laboratory data (albumin, ferritin, transferrin). Encourage frequent oral hygiene. Incorporate client preferences into meal planning, when possible. Teach the client to consume adequate protein and calories.

46. Complications and Nursing Implications Paraneoplastic syndromes Paraneoplastic syndromes result when T cells in the body attack normal cells rather than cancerous ones. They result in changes in neurological function (movement, sensation, mental function). Management includes minimizing the immune system response by administration of steroids, immune factors, plasmapheresis , or irradiation.

47. Complications and Nursing Implications Nursing Actions Recognize manifestations of paraneoplastic syndrome. Administer medications as prescribed. Provide a safe environment until client returns to baseline mental status. Use aids for vision or hearing deficits, as indicated

48. Oncologic Emergencies Superior Vena Cava Syndrome (SVCS) Compression or invasion of the superior vena cava by tumor , enlarged lymph nodes, intraluminal thrombus that obstructs venous circulation, or drainage of the head, neck, arms, and thorax. Typically associated with lung cancer, SVCS can also occur with breast cancer, Kaposi’s sarcoma, thymoma , lymphoma, and mediastinal metastases. If untreated, SVCS may lead to cerebral anoxia (because not enough oxygen reaches the brain), laryngeal edema , bronchial obstruction, and death . Clinical manifestations Gradually or suddenly impaired venous drainage giving rise to: Progressive shortness of breath ( dyspnea ), cough, hoarseness, chest pain, and facial swelling Edema of the neck, arms, hands, and thorax and reported sensation of skin tightness and difficulty swallowing

49. Superior Vena Cava Syndrome (SVCS) oncologic eme …. Possibly engorged and distended jugular, temporal, and arm veins Dilated thoracic vessels causing prominent venous patterns on the chest wall Increased intracranial pressure, associated visual disturbances, headache, and altered mental status Diagnosis is confirmed by: Clinical findings Chest x-ray Thoracic computed tomography (CT) scan Thoracic magnetic resonance imaging (MRI) Intraluminal thrombosis is identified by venogram .

50. (SVCS ) management Medical Radiation therapy to shrink tumor size and relieve symptoms Chemotherapy for chemosensitive cancers Anticoagulant or thrombolytic therapy for intraluminal thrombosis Percutaneously placed intravascular stents are increasingly being used to reopen the occluded SVC Surgery (less common), Supportive measures such as oxygen therapy, corticosteroids, and diuretics

51. (SVCS) management Nursing Identify patients at risk for SVCS Monitor and report clinical manifestations of SVCS Monitor cardiopulmonary and neurologic status Avoid upper extremity venipuncture and blood pressure measurement Facilitate breathing by positioning the patient properly; this helps to promote comfort and reduce anxiety produced by difficulty breathing resulting from progressive edema Promote energy conservation to minimize shortness of breath

52. Oncologic Emergencies Syndrome of inappropriate antidiuretic hormone (SIADH) SIADH occurs when excessive levels of antidiuretic hormones are produced. Because antidiuretic hormones help the kidneys and body to conserve the correct amount of water, SIADH causes the body to retain water. This results in a dilution of electrolytes (such as sodium) in the blood. It is most commonly associated with lung and brain cancers. Key findings include nausea and vomiting (early); lethargy, hostility, seizures, and coma.

53. Clinical manifestation Serum sodium levels lower than 125 mEq /L (125 mmol /L ): symptoms of hyponatremia including personality changes, irritability, nausea, anorexia, vomiting, weight gain, fatigue, muscular pain (myalgia), headache, lethargy, and confusion Serum sodium levels lower than 115 mEq /L (11 mmol /L): seizure, abnormal reflexes and gait, papilledema, coma, and death; edema is rare Diagnostic Decreased serum sodium level Increased urine osmolality Increased urinary sodium level

54. Oncologic Emergencies Nursing Actions Monitor the client for hyponatremia and low serum osmolality. Administer furosemide (Lasix), 0.9% sodium chloride IV, and/or hypertonic sodium chloride solution as prescribed for severe hyponatremia . Monitor vital signs and serum sodium as Lasix promotes sodium excretion and hypertonic sodium chloride can cause fluid overload.

55. Oncologic Emergencies Hypercalcemia Serum calcium level exceeding 11 mg/ dL (2.74 mmol /L) A common complication of breast, lung, head, and neck cancers; leukemias and lymphomas; multiple myelomas; and bony metastases of any cancer . Manifestations include anorexia, nausea, vomiting, shortened QT interval, kidney stones, bone pain, and changes in mental status. Nursing Actions – Administer 0.9% sodium chloride IV, furosemide (Lasix), pamidronate , and phosphates as prescribed.

56. Oncologic Emergencies Superior vena cava syndrome Results from obstruction (metastases from breast or lung cancers) of venous return and engorgement of the vessels from the head and upper body. Manifestations include periorbital and facial edema , erythema of the upper body, dyspnea , and epistaxis. Nursing Actions – Position the client in a high-Fowler’s position initially to facilitate lung expansion. Use high-dose radiation therapy for emergency temporary relief.

57. Oncologic Emergencies Disseminated intravascular coagulation Complex disorder of coagulation or fibrinolysis (destruction of clots), which results in thrombosis or bleeding. DIC is most commonly associated with hematologic cancers ( leukemia and lymphoma); cancer of prostate, gastrointestinal (GI) tract, and lungs; chemotherapy (methotrexate, vincristine ,

58. Oncologic Emergencies DIC Clinical manifestation Chronic DIC: Few or no observable symptoms or easy bruising, prolonged bleeding from venipuncture and injection sites, bleeding of the gums, and slow GI bleeding Acute DIC: Life-threatening hemorrhage and infarction; clinical symptoms of this syndrome are varied and depend on the organ system involved in thrombus and infarction or bleeding episodes Diagnostic Prolonged prothrombin time (PT or protime ) Prolonged partial thromboplastin time (PTT) Prolonged thrombin time (TT)

59. Oncologic Emergencies DIC Medical Chemotherapy , biologic response modifier therapy, radiation therapy, or surgery is used to treat the underlying cancer Antibiotic therapy is used for sepsis Anticoagulants , such as heparin or antithrombin III, Nursing Actions Observe the client for bleeding, and apply pressure as needed. Be prepared to administer blood clotting factors that have been lost through bleeding and may need to be replaced with plasma transfusions.

60. Oncologic Emergencies Spinal Cord Compression Spinal cord compression may develop in patients with bone metastasis when the bones collapse. This is a very painful problem and requires pain management while radiation is given to relieve the symptoms. Patients may develop some motor loss when this occurs. Often a myelogram or bone scan is used for diagnosis.

61. Oncologic Emergencies …… Pericardial Effusion/Cardiac Tamponade Pericardial effusion, or cardiac tamponade , is a condition usually caused by direct invasion of the cancer, causing the pericardial sac to fill with fluid. Treatment involves draining the fluid from the heart sac by pericardiocentesis and using sclerosing agents to keep the pericardial sac from refilling with fluid.

62. Health Promotion and Disease Prevention Consume a healthy diet (low-fat diet with increased consumption of fruits, vegetables, and lean protein foods). Limit intake of sugar and salt. Maintain a healthy body weight/body mass index (BMI). Avoid smoking and alcohol consumption.

63. Health Promotion and Disease Prevention Avoid risky lifestyle choices (recreational drug use, needle sharing, unprotected sexual intercourse). Avoid exposure to environmental hazards (radiation, chemicals). Use proper protection when unavoidable. Breast feed infant exclusively for the first 6 months of life. Engage in physical activity or exercise routinely

64. Thank you!!!!!!!