Power point for the purpose of education 14 & 15 cancer.pptx

Power point for the purpose of education

1. Management of Clients with Cancer Adult Medical Surgical Nursing II Theory- BSN311 SEMESTER 1 /2023-2024 Weeks 14 & 15 Adult Medical Surgical Nursing II

2. By the end of the session, students will be able to: Identify a variety of cancer types. Explain the causes, risk factors, signs, prevention and management of cancer. Describe the assessment, nursing diagnoses and interventions of each cancer type. Discuss the health education and home care needs of the patient with cancer. Objectives 2 Adult Medical Surgical Nursing II

3. Lecture Outline Statistics Pathophysiology Classification Risk factors Warning signs Prevention Diagnostic tests Management (chemotherapy, radiotherapy, surgery ) Nursing care Lung cancer Pancreatic cancer Breast cancer Prostate cancer 3 Adult Medical Surgical Nursing II

4. Cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal bleeding, prolonged cough, unexplained weight loss, and a change in bowel movements. 4 Adult Medical Surgical Nursing II

5. Cancer types Cancer is characterized by abnormal growth of new tissue = Neoplasm Neoplasms can be: Benign: Encapsulated and local. Not progressive, and thus, favorable for recovery. Malignant: Uncontrolled rapid growth of tumor  spread to distant body parts  become worse  destroy tissue 5 Adult Medical Surgical Nursing II

6. Incidence & Prevalence Cancer affects people of all ages. Mostly occur in people older than 65 . 2 nd leading cause of death in U.S. 3 rd leading cause of death in the UAE. 11 to 13% of all deaths in the Emirate 1 out of 3 persons will be affected by cancer sometime in their lifetime. Men has more risk to develop cancer than women. Most cancers are curable if treated early. 6 Adult Medical Surgical Nursing II

7. Most Common Cancers world wide : In men : Prostate, Lung, and Colorectal. In women : Breast, Colorectal, Lung, and Uterine. Lung Cancer --- leading cause of death Colon cancer- -- 2 nd largest incidence of cancer (Approximately 193,000 cancer deaths were estimated to be caused by tobacco). 7 Incidence & Prevalence Adult Medical Surgical Nursing II

8. The Most common Cancers 8 Adult Medical Surgical Nursing II

9. Risk Factors of Cancer Development Age Gender Geographic location Genetics Immune disturbance Chemical agents Tobacco Alcohol (NCI 2016) 9 Adult Medical Surgical Nursing II

10. Carcinogenesis: Malignant transformation Physical stressors (UV rays) Chemical stressors (chemical subs, Tabaco) Biological stressors (bacteria , viruses) Genetic and familial factors Dietary factors (fats , alcohol, nitrate and nitrite containing food, red meat, high caloric food ) Hormonal (prolonged estrogen therapy , oral contraceptives) 10 Adult Medical Surgical Nursing II

11. Carcinogenesis: Malignant transformation Oncoviruses : viruses that can cause cancer HBV, HPV ( human papillomavirus) , HIV, HSV. These cancers might be easily prevented through vaccination. Oncogenes: mutated normal gene. Altered tumor suppressor genes. 11 Adult Medical Surgical Nursing II

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13. Metastasis Metastasis is a pathogenic agent's spread from an initial or primary site to a different or secondary non adjacent organ or tissue within the host's body. The term is typically used when referring to metastasis by a cancerous tumor. Metastasis occurs through : Lymphatic spread Hematogenous spread Angiogenesis: is the formation of new blood vessels . 13 Adult Medical Surgical Nursing II

14. How cancer spreads 14 Cancer: Metastasis Adult Medical Surgical Nursing II TNM: A system to describe the amount and spread of cancer in a patient's body. T: describes the size of the tumor and any spread of cancer into nearby tissue; N: describes spread of cancer to nearby lymph nodes; and M: describes metastasis (spread of cancer to other parts of the body).

15. Classifications of Cancer Lymphoma : Cancers occurring in infection-fighting organs, such as lymphatic tissue. Leukemia : C ancers occurring in blood-forming organs, such as the spleen, and in bone marrow . Sarcoma: Cancers occurring in connective tissue , such as bone. Carcinoma : Cancers occurring in epithelial tissue , such as the skin. 15 Adult Medical Surgical Nursing II

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19. Cancer early warning signs: A sore that does not heal O bvious change in a mole or wart T hickening or lump in breast or elsewhere U nusual bleeding or discharge C hange in bowel or bladder habits I ndigestion or difficulty in swallowing N agging cough or hoarseness 19 Adult Medical Surgical Nursing II

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21. Primary Prevention : reduce cancer risk Avoid known carcinogens Lifestyle, dietary changes to reduce cancer risk Public education and patient education 21 Adult Medical Surgical Nursing II

22. Secondary prevention : I nvolves Identification of patients at high cancer risk Cancer screening Public & patient education Leads to early detection/diagnosis and treatment Now great emphasis on prevention of cancer 22 Adult Medical Surgical Nursing II

23. Recommendations for the early detection of cancer Test Gender Age Frequency Bowel Cancer: Faecal Occult Blood (FOB) Flexible Sigmoidoscopy M & F 50 yrs and over FOB every 2 yrs. Sigmoidoscopy – every 5 yrs Breast Cancer Self-examination Mammogram F 20 yrs : women should be told about the benefits and limitations of BSE. All women 50 – 69yrs (begin younger if at increased risk) Monthly Yearly + clinical check-ups when have other screening done Cervical Cancer Pap Smear F 18-70yrs . Earlier if sexually active Every 2 years Prostate Cancer Digital Rectal Examination (DRE) and Serum Prostate Specific Antigen (PSA) M Discuss with doctor. Generally 50+yrs Screening not completely accurate – discuss with doctor 23 Adult Medical Surgical Nursing II

24. Management of Cancer Treatment options of cancer should be based on type, site , and size of the cancer and aim to: Cure  E radication of cancer. no evidence of disease Control  P rolonged survival & containment of cancer cell growth. Provides symptom free periods Palliative  R elief of symptoms associated with the disease Often combined modalities: Surgery, Chemo, Radiation Newer therapy: Interleukin (Interleukins regulate immune responses) , interferons (proteins that are part of the natural defenses. They tell immune system that germs or cancer cells are in your body), stem cell transplant, gene therapy, hormonal agents. Understanding of the treatment options and goals . Open communication and support 24 Adult Medical Surgical Nursing II

25. Surgery Diagnostic surgery Biopsy : needle, excisional, incisional Tumor removal : wide excision, local excision Prophylactic surgery Reconstructive surgery 25 Adult Medical Surgical Nursing II

26. Radiation Therapy The use of ionizing radiation to treat cancer by killing/destroying cancer cells. Can both cure and cause cancer. The second most common treatment. Can be used as curative alone or combined with other treatment. Control cancer by: shrinking the size or stopping them from spreading. 26 Adult Medical Surgical Nursing II

27. Used to: reduce cancer symptoms & prolong quality of life. Radiation therapy damages cells by destroying the genetic material that controls how cells grow and divide . While both healthy and cancerous cells are damaged by radiation therapy, the goal of radiation therapy is to destroy as few normal, healthy cells as possible. 27 Radiation Therapy Adult Medical Surgical Nursing II

28. Administration of radiation therapy: External Radiation Beam ( T eletherapy ) Internal Radiation (Brachytherapy): is a form of radiotherapy where a sealed radiation source is placed inside or next to the area requiring treatment. - Systemic (radioisotopes) 28 Radiation Therapy Adult Medical Surgical Nursing II

29. External Radiation External Beam Radiation Therapy (EBRT) is the most common type used. Computerized software programs transmit an invisible beam of highly charged electrons and target a tumor with pinpoint accuracy. During this type of radiation, the high-energy beams come from a machine outside the body that aims the beams at a precise point on the body.  Nursing Responsibilities after the procedure: Monitor the patient skin for side effects, such as blanching, erythema, desquamation, or hemorrhage. 29 Adult Medical Surgical Nursing II

30. Internal Radiation: Brachytherapy Sealed Unsealed A. Sealed sources : A solid radioisotope (wires, seeds, grains, ribbons or tubes) encased in an inert container, such as titanium and placed within body tissues or a cavity. This allows treatment with a high dose of radiation to a small body site e.g. head and neck, prostate, lung. 30 Adult Medical Surgical Nursing II

31. Internal Radiation: Brachytherapy B. Unsealed sources : Liquid isotopes administered intravenously or orally (e.g. radioactive iodine for thyroid cancer). The liquid radiation travels throughout the body and uptakes into various parts of the body (e.g. non- Hodgkins lymphoma). The patient is systemically radioactive , all body fluids are considered to be contaminated. 31 Adult Medical Surgical Nursing II

32. Side Effects May or may not feel any pain or discomfort. They are not radioactive : safe to contact with others Possible local effects such as: Skin irritation Cough or shortness of breath Erythema (dry, red and itchy skin) Sloughing or bleeding Mucositis ( ulceration of the mucous membranes) Fatigue, and nausea 32 External Radiation Adult Medical Surgical Nursing II

33. 33 Proton beam therapy enables a dose of high energy protons to be precisely targeted at a tumour , reducing the damage to surrounding healthy tissues and vital organs

34. Side effects: Bone marrow suppression: myelosuppression: A condition in which bone marrow activity is decreased Infection, Bleeding, Anaemia GI complications- Anorexia, nausea, vomiting, and taste alterations, Mucositis, xerostomia ( dry mouth) , stomatitis ( inflammation of the mouth and lips) , & diarrhoea. Skin reactions – dry/wet desquamation. dry desquamation — ie , scaly, flaking skin Wet desquamation: resembles a second-degree burn, Alopecia 34 Internal Radiation Adult Medical Surgical Nursing II

35. Implement safety measures Use a private room Display caution signs on the door for radioactive material Caregivers must protect themselves by using shields, distancing and limiting time with the client, following safety protocols Dosimeter film badge by staff No pregnant staff/visitors in the patient room No visitor or Limit visitors to ½ hour per day keep at least 6 feet distance between the nurse and the radiation source (patient). 35 Nursing Management of Patients Receiving Internal Radiation Adult Medical Surgical Nursing II

36. Chemotherapy Chemotherapy is a drug treatment that uses powerful chemicals to kill fast-growing cells in your body. Chemotherapy is most often used to treat cancer, since cancer cells grow and multiply much more quickly than most cells in the body. Chemotherapy drugs can be used alone or in combination to treat a wide variety of cancers. Chemotherapy is an effective way to treat many types of cancer, chemotherapy treatment also carries a risk of side effects. 36 Adult Medical Surgical Nursing II

37. Destroy tumor cells by interfering with cellar function & cellular replication. Chemotherapy is called antineoplastic drugs:  I nhibit the growth and reproduction of malignant cells ( damage DNA & inhibit stages of cell cycle ). Some chemotherapy side effects are mild and treatable, while others can cause serious complications. 37 Chemotherapy Adult Medical Surgical Nursing II

38. Treatment of choice for metastatic cancers. Cure, prevent, or relieve cancer symptoms . Increase cure rate of cancer. Treat systemic diseases Chemotherapy treatment can be classified into: Primary treatment Adjuvant treatment – post op Neo-Adjuvant treatment – pre op Radiosensitization - pre- radiotherapy 38 Chemotherapy Adult Medical Surgical Nursing II

39. Chemotherapy Administration Setting : Hospital, outpatient center, or home setting. Routes Intravenous : IV access or use of vascular devices: ( eg ; IVC, PICC line, Hickman catheter). Prevent extravasation by the use of vascular devices Topical, oral, intramuscular, subcutaneous, arterial, and intrathecal routes. Cyclic: A cycle is the time between one round of treatment until the start of the next. depend of the cell cycle 39 A peripherally inserted central catheter (PICC): is a form of intravenous access that can be used for a prolonged period of time or for administration of substances that should not be done peripherally. A Hickman catheter is a small, soft tube inserted in the neck or chest with several channels (called lumens) on the ends. Adult Medical Surgical Nursing II

40. Atrial Catheter 40 Adult Medical Surgical Nursing II

41. Chemotherapy (continued) Combination of chemotherapy agents : Works more effectively- synergistic effect (An effect arising between two or more agents, entities, factors, or substances that produces an effect greater than the sum of their individual effects .) Reduce toxicities Improved action and reduce the development of resistance 41 Adult Medical Surgical Nursing II

42. Chemotherapy Side Effects /Toxicity Dosage , agent and duration of treatment Individually calculated to reduce the side effect/toxic effect Enhance medication action Common side effects include: Nausea and vomiting Stomatitis ( sore or inflammation inside of the mouth) Gastrointestinal disturbances Fatigue Organ toxicities (neuro, cardio, renal, reproductive, hematopoietic) leukopenea Immunosuppression (increased risk of infection). Alopecia Serious side effects – Sepsis, bowel necrosis, organ damage 42 Adult Medical Surgical Nursing II

43. Nursing Management of Patients Receiving Chemotherapy Monitor and Manage fluid and electrolyte status Encourage adequate fluid and electrolytes intake . increased risk of nutritional & fluid & electrolyte disturbances Maintain i ntravenous fluids as prescribed. 43 Adult Medical Surgical Nursing II

44. Monitor and Manage Nutritional Status Assess nutritional status - monitor weight daily. Refer to dietician. Give antiemetics as required. Administer medication to increase appetite. Administer diet with high protein calories. Encourage frequent small meals. Provide liquid supplements as required. Perform mouth care prior to serving meals to enhance appetite. 44 Nursing Management of Patients Receiving Chemotherapy Adult Medical Surgical Nursing II

45. Suppression of the bone marrow : Myelosuppression = ↑ risk of infection, anemia, & bleeding. Reduce risks of infection* Use a private room Protect the patient from sources of possible infection. Use the correct hand hygiene techniques. Encourage family member to perform hand hygiene. Encourage the client to avoid crowds while undergoing chemotherapy. Monitor WBC and neutrophils level Administer medication as prescribed to stimulate WBC (Neupogen ) No flowers or plants in the room. 45 Nursing Management of Patients Receiving Chemotherapy Adult Medical Surgical Nursing II

46. Management of anemia . Administer oxygen as needed for fatigue Encourage rest periods between periods of activity. Check lab values (RBC, Hg and HCT level). Administer recombinant erythropoietin alpha as prescribed. ( Epogen ): (erythropoietin alpha is a human erythropoietin produced in cell culture using recombinant DNA technology) 46 Nursing Management of Patients Receiving Chemotherapy Adult Medical Surgical Nursing II

47. Reduce risk of bleeding . Avoid ASA/NSAIDs and IM injections if platelet count is decreased. Use electric razor. Use of soft tooth brush. No supp. /enema. Maintain intravenous fluids as prescribed. Use stool softeners to avoid straining 47 Nursing Management of Patients Receiving Chemotherapy Adult Medical Surgical Nursing II

48. Management of Mucocitis : Rinse mouth with ½ normal saline and ½ peroxide every 12 hours. Topical analgesic medication. Avoid mouthwashes with alcohol. Avoid spicy or hard food. Watch nutritional status. Management of Alopecia: Encourage female patients to wear a hat or wig. Listen to the patients' concerns.. Allow time for the patient to discuss feelings regarding loss. 48 Nursing Management of Patients Receiving Chemotherapy Adult Medical Surgical Nursing II

49. Supportive Care Education and Information – needs of the person with cancer change over time. Navigating the healthcare system - how to help them receive what they need. Attitude of nurses – enthusiasm, sympathise and engage with the patient and family, be available . 49 Adult Medical Surgical Nursing II

50. Palliative Care Is a multidisciplinary approach to specialized medical and nursing care for people with serious illness. It focuses on providing patients with relief from the symptoms, pain, physical stress, and mental stress of a serious illness—whatever the diagnosis. The goal of such therapy is to improve quality of life for both the patient and the family. 50 Adult Medical Surgical Nursing II

51. I. Lung Cancer Lung cancer is a leading cause of cancer-related deaths in the world. Most common cancer among Arab men. One of the leading causes of death in the UAE. The 5-year survival rate for lung cancer is less than 15%. Often diagnosed after metastasis. Early detection of lung cancer increases the survival rate. 51 Adult Medical Surgical Nursing II

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54. Risk factors : Smoking or passive smoking, age, gender, hereditary, Immune disturbance, exposure to chemical agents, dietary deficits (fibers, whole grains). Clinical Manifestations : Persistent cough, with or without rust-colored or blood-tinged sputum. Dyspnea. Unilateral wheezing, if the airway is obstructed. Chest wall pain. Muffled heart sounds. Fatigue, weight loss, anorexia. 54 I. Lung Cancer Adult Medical Surgical Nursing II

55. Diagnostic Tests: Chest x-ray and Computed Tomography (CT) Scan Bronchoscopy Biopsy/cytology 55 I. Lung Cancer Adult Medical Surgical Nursing II

56. Treatment Chemotherapy is the primary choice of treatment. - It is often used in combination with radiation and/or surgery. 56 I. Lung Cancer Adult Medical Surgical Nursing II

57. Nursing interventions Assess the patient’s history regarding Use of tobacco products. Determine number of pack-year history Exposure to second hand smoking, occupational or environmental risks . Monitor the patient’s pain ,vital signs, airway patency, lung sounds, respiratory rate, use of accessory muscles, oxygenation status, Sa02 & nutritional status. Administer oxygen as prescribed. Raise the head of the bed: an upright or high-Fowler’s position to facilitate ventilation. Suction the patient as required. 57 I. Lung Cancer Adult Medical Surgical Nursing II

58. Nursing Interventions (cont’d) Promote a nutritious high-calorie and high-protein diet. Offer education and psychological support. Answer any questions the patient or family have. Monitor the patient for sign/symptoms & complications of radiation and chemotherapy. Allow the patient to express feelings. Listen well to the patient’s fears and concerns. 58 I. Lung Cancer Adult Medical Surgical Nursing II

59. Surgical Management: Pneumonectomy  removal of a lung Lobectomy  removal of lobe of the lung Segmentectomy : removal of one segment Wedge resection : is a surgical procedure to remove a triangle-shaped slice of tissue. 59 I. Lung Cancer Adult Medical Surgical Nursing II

60. II. Pancreatic Cancer Benign: pancreatic adenoma Malignant: pancreatic carcinoma Symptoms are typically nonspecific or vague: Patients usually do not seek medical attention until late in the disease. Most cases are diagnosed in advanced stage High mortality rate due to rapid growth Less than 20% live longer than 1 year after diagnosis. 5% survival rate at 5 years. 60 Adult Medical Surgical Nursing II

61. Cause is unknown but it is thought to be linked to: Age; rate increases with age 60 or older. Smoking Alcohol Exposure to industrial chemicals or toxins in the environment Previous pancreatitis. Diet high in fat and red meat. 61 II. Pancreatic Cancer Adult Medical Surgical Nursing II

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63. Pancreatic Cancer: Clinical Manifestations Pain: Vague abdominal pain. Anorexia , weight loss, nausea, and vomiting. Fatigue Signs of obstruction: Jaundice (late sign) Clay colored stools Dark urine Diabetes Mellitus type 2  Insulin deficiency: Glucosuria Hyperglycemia: increase sugar level in blood 63 Adult Medical Surgical Nursing II

64. Diagnostic Tests Serum amylase and lipase, serum alkaline phosphatase, bilirubin and carcinoembryonic antigen (CEA): Elevated Computed tomography (CT): Visualization of tumor ERCP: Allows for placement of drain or stent for biliary drainage: Endoscopic retrograde cholangiopancreatography is a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems. Abdominal paracentesis: Tests for malignant cells needle is inserted into the peritoneal cavity and ascitic fluid is removed. 64 II. Pancreatic Cancer Adult Medical Surgical Nursing II

65. ERCP – Endoscopic Retrograde cholangiopancreatography 65 Adult Medical Surgical Nursing II

66. Pancreatic Cancer: Medical Management Chemotherapy  monitor for myelosuppression and pancytopenia (reduction in the # of RBCs, platelets, and white blood cells). Always administer antiemetic drug before administration of chemotherapy to prevent nausea and vomiting Radiation  ( monitor fatigue and diarrhea ) 66 Adult Medical Surgical Nursing II

67. Surgical Management : Whipple procedure: removal of pancreas head, duodenum, common Bile duct (CBD), parts of the jejunum and stomach, gallbladder, and possibly the spleen. The pancreatic duct and hepatic duct connected to the jejunum . The stomach is connected to the jejunum. 67 Pancreatic Cancer: Medical Management Adult Medical Surgical Nursing II

68. Whipples Procedure 68 Adult Medical Surgical Nursing II

69. III. Breast Cancer Most common cancer among women in UAE. High mortality rate for women in the UAE. Sex: Female > male (less than 1% of males develop breast cancer). Classified as Invasive tumor: Metastasis via lymph nodes to bones and lung 69 Adult Medical Surgical Nursing II

70. Early detection reduces mortality rate Breast self-examination (BSE) Clinical breast exam (CBE) Mammography An annual clinical breast exam and mammogram should be performed earlier for women at risk for breast cancer. 70 III. Breast Cancer Adult Medical Surgical Nursing II

71. Breast Cancer: Risk Factors Genetic: First-degree relative. Age over 40 Early menarche, late menopause. Nulliparity or pregnancy after age 30. Endometrial or ovarian cancer. Use of oral contraceptives. Diet: high-fat diet and low-fiber diet. Excessive alcohol intake & cigarette smoking. Exposure to low level radiation. Hormone replacement therapy (HRT). Obesity. 71 Adult Medical Surgical Nursing II

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73. Breast Cancer: Clinical Manifestations Skin color changes /ulceration. Breast soreness/tenderness with menstruation -benign mass. Dimpling: of the breast causes the skin to look like the pitting and uneven skin of an orange. Mass (Lump) felt during BSE Outer quadrant beneath the nipple or in axilla. Fixed irregular, encapsulated, painless mass. Increased vascularity. Nipple retraction or ulceration / Nipple discharges. nipple  that turns inward instead of outward Asymmetry of the breasts. Enlarged lymph nodes. 73 Adult Medical Surgical Nursing II

74. Breast Cancer: Clinical Manifestations 74 Adult Medical Surgical Nursing II

75. Breast Cancer: Diagnostic tests 1. Mammogram Preparation for mammogram: Instruct the client to not use talcum powder or deodorant before the procedure. Best done in the first 2 weeks of the menstrual cycle. 2. Biopsy: Definitive Diagnosis Incisional biopsy is the surgical removal of tissue from a breast mass. Excisional biopsy removes the mass itself for histologic exam . 3. Aspiration therapy Is the removal of tissue or fluid from the breast mass through a large-bore needle. 75 Adult Medical Surgical Nursing II

76. Breast Cancer: screening All women > age 20 : Monthly breast self-examination ( BSE ) and annual clinical breast examination ( CBE) Age 40: Baseline screening mammogram Age 40 to 50: Yearly screening mammograms 76 Adult Medical Surgical Nursing II

77. Breast Cancer: Treatment The choice of treatment depends on the stage and size of the tumor , as well as nodal involvement. Surgical procedures include: Lumpectomy (breast-conserving): only a portion of the breast is removed Partial mastectomy: is another name for a lumpectomy, a breast-conserving surgery that only removes the part of the breast that has cancer and a small rim around it to help prevent recurrence. or total mastectomy. Radical mastectomy: Removal of breast, underlying chest muscle, and lymph nodes of the axilla as a treatment for breast cancer Reconstructive surgery. 77 Adult Medical Surgical Nursing II

78. Adjuvant therapy: Radiation therapy chemotherapy hormonal therapy Chemoprevention: is the use of medication to lower cancer risk in healthy but high-risk people. Selective estrogen receptor modifiers (SERMs), such as tamoxifen (Tamofen) and raloxifene ( Evista ), - Women at high risk for breast cancer are often prescribed SERMS.. 78 Breast Cancer: Treatment Adult Medical Surgical Nursing II

79. . Wear loose fitting clothes. Handle the area gently. Use lukewarm water to bathe the area. Apply the prescribed ointments (vitamins A and D). Avoid irritation with soaps, cosmetics, perfumes, rants, or ointments. Avoid rubbing or scratching the area. Avoid heating pads or plasters. Avoid exposure to sunlight or cold weather . Avoid shaving the area with a straight edged razor. 79 Home Education : skin care post radiation therapy Adult Medical Surgical Nursing II

80. IV. Prostate Cancer: Unregulated growth of abnormal cell in the prostate gland. Most common cancer in men aging 40-50. Common among UAE men. 1 in 6 men will be diagnosed with prostate cancer over the course of their life. High mortality rate for men in the UAE. 10-year survival rate is about 98%. Characterized by slow growth. Cause is unknown. Metastasis via blood and lymphatics to bone, lungs, liver and kidneys. 80 Adult Medical Surgical Nursing II

81. Prostate Cancer Risk factors Family history Advanced age Increased androgen or estrogen levels 81 Adult Medical Surgical Nursing II

82. Prostate Cancer: Clinical Manifestations Asymptomatic in early stages Irregular hard, pea-sized nodule Urinary hesitancy: trouble starting to urinate or maintaining urine flow. Decreases size and force of urinary stream Recurrent bladder infections Urinary retention Painless hematuria 82 Adult Medical Surgical Nursing II

83. In late stage of the disease Weight lost Urinary obstruction Pain Elevated prostate-specific antigen (PSA) 83 Prostate Cancer: Clinical Manifestations Adult Medical Surgical Nursing II

84. Signs of Metastasis Backache Hip pain Perineal and rectal discomfort Anemia Weakness Nausea Oliguria Pathologic fractures 84 Prostate Cancer: Clinical Manifestations Adult Medical Surgical Nursing II

85. Prostate Cancer: Diagnostic Tests Digital rectal exam (DRE) – physical exam of the prostate for size and consistency. Prostate becomes hard, palpable, and with irregularities. Prostate-Specific Antigen (PSA) serum levels: Elevated with prostate cancer (normal levels are less than 4 ng/mL). Needle or aspiration biopsy of prostate: Performed to definitively diagnose or rule out prostate cancer. CT scans, PET (positron emission tomography), MRI, x-ray, & bone scans : Performed to assess for metastases from prostate cancer. 85 Adult Medical Surgical Nursing II

86. Prostate Cancer: Medical Treatment Hormone therapy: Estrogen therapy or luteinizing hormone agonist (SE: hot flashes ) Leuprolide acetate (Lupron): given to slow the rate of growth and extension of tumor. Pain medication Administration of Radiation therapy External beam radiation therapy or implanted radioactive seeds. Brachytherapy Administration of Chemotherapy 86 Adult Medical Surgical Nursing II

87. Prostate Cancer: Treatment Surgical interventions 1 . A radical prostatectomy or prostatectomy Retropubic, suprapubic, or perineal approach Removal of the entire prostate gland, along with the seminal vesicles, the cuff at the bladder neck, and the regional lymph nodes. 2. Removing the enlarged section of the Prostate : TURP – transurethral resection of the enlarged segment via a resectoscope 87 Adult Medical Surgical Nursing II

88. 88 Perineal prostatectomy Retropubic prostatectomy Transurethral incision Suprapubic prostatectomy Transurethral Resection

89. Prostate Cancer: Post operative care Monitor vital signs. Monitor for pain and administer pain medication and antispasmodics as ordered. Monitor for deep vein thrombosis or bleeding. Monitor urinary output (indwelling catheter). Elevate scrotum and apply ice intermittently. Provide sequential compression device and/or antiembolic stockings. Bladder irrigation 89 Adult Medical Surgical Nursing II

90. Irrigation of the indwelling catheter 90 Adult Medical Surgical Nursing II

91. Prostate Cancer: Patient Education Teach the patient and family about the nature of the health problem and treatment plan. Teach the patient and family how to manage Urinary incontinence Pain Impact of chemotherapy or radiation 91 Adult Medical Surgical Nursing II

92. Prostate Cancer: Question Which is the American Cancer Society's recommendation for early detection of prostate cancer? A. Yearly PSA and DRE starting from 50yrs B. Biannual rectal exam starting from 40yrs. C. Semi-annual alkaline phosphatase level from 45yrs. D. Yearly urinalysis to determine presence of prostatic fluid. 92 Adult Medical Surgical Nursing II

93. A prostate cancer patient has been placed on luteinizing hormone releasing hormone ( LHRH) agonist therapy. Which statement indicates that the patient understands the treatment? A. I will be never develop prostate cancer in the future . B. I may have hot flashes while taking this drug C. This medication will cure the prostate cancer. D. There are no side effects with these medications. 93 Prostate Cancer: Question Adult Medical Surgical Nursing II

94. Question. Which cancer has the highest mortality rate in males between fifty and seventy? A. cancer of the prostate B. cancer of the lung. C. cancer of the pancreas D. cancer of the bowel 94 Adult Medical Surgical Nursing II

95. Conclusion Early diagnosis is important Patients and family need education and psychological support The nursing care is central to achieving a positive outcome Multidisciplinary team approach make treatment more effective 95 Adult Medical Surgical Nursing II

96. References Smeltzer, S.C., Bare, B.G., Hinkle, J.L., & Cheever, K.H. (2010). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (13th ed.). Philadelphia: Lippincott Williams & Wilkins. Al-Alfi N (2015) Palliative Care in the United Arab Emirates: A Nurse’s Perspectives. J Palliative Care Med S5: S5-005. doi: 10.4172/2165-7386.1000S5-006 "NCI Dictionary of Cancer Terms" . National Cancer Institute. Retrieved 15 March 2016. Oncology Nursing Society (ONS) in USA:– http://qopi.asco.org/index.html accessed 04.16 96 Adult Medical Surgical Nursing II