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78 Cards in this Set
- Front
- Back
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Incidence and Epidemiology
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-Major health problem in US: More than 8 million Americans are living with cancer
-Incidence rises with age. Most cases affect adults in mid-life and beyond with 77% Dx. after age 55. -Second most common cause of death with half occurring before 65 |
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Epidemiology
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1940's-5 year survival rate: 40%
2000 - 5 year survival rate: 62% 1 out of every 4 deaths in US is from cancer |
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Epidemiology
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-2004 data shows:
Mortality rates for the 4 most common cancers: lung, breast, prostate and colorectal have decreased. -Reasons for decrease: Better methods of detection and increased knowledge of prevention Effective treatment approaches |
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Cost
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-NIH Estimate: 171.6 billion in 2002
-17% of Americans under 65 years have no health insurance -27% of Americans over 65 have only Medicare coverage (not enough to cover cancer pt.) |
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What is Cancer?
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-A series of cellular, genetic aberrations which result in abnormal cell growth
-Unchecked growth allows invasion of surrounding tissue -Ability to spread (metastasize) to sites distant to original growth |
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What is Cancer?
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-More than 200 diseases characterized by unregulated cell growth.
-Cellular proliferation may be defective -Cellular differentiation may be defective |
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Normal Cellular Proliferation
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-Population of predetermined undifferentiated cells
-Characterized by programmed cell death -The number of cells proliferating equals the number of cells dying |
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Cellular Differentiation
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-This is an orderly process
-Cells differentiate to perform their preprogrammed function |
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Cellular Differentiation
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-Protooncogenes: normal cellular genes promote and regulate cell
-Tumor suppressor genes: suppress cellular growth -Mutations may alter these genes and influence the development of cancer |
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Characteristics of Normal Cells
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-Have limited cell division
-Specific morphology (shape and look) -Small nuclear cytoplasmic ratio -Perform specific differentiated functions -Adhere tightly together -Are non-migratory -Grow in orderly, regulated manner -Are contact inhibited |
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Characteristics of Benign Cells
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-Continuous/inappropriate cell growth
-Specific morphology -Small nuclear cytoplasmic ratio -Perform differentiated functions -Adhere tightly together -Are non-migratory -Grow in orderly manner |
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Characteristics of Malignant Cells
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-Rapid or continuous cell division
-Anaplastic morphology (don't look normal) -Large nuclear cytoplasmic ratio -Lose some or all diff. functions -Adhere loosely together -Are able to migrate -Grow by invasion -Are not contact inhibited |
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Cancer Cell Characteristics
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-Immortal
-Able to divide without anchorage -Capable of angiogenesis -Accelerated use of nutrients -Able to invade other tissues |
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Histological Analysis Classification: Grading
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Grade I -- Cells differ slightly from normal cells and are well differentiated: Mild dysplasia
Grade II -- Cells are more abnormal and moderately differentiated: Moderate dysplasia Grade III -- Cells are very abnormal and poorly differentiated: Severe dysplasia Grade IV -- Cells are immature and primitive and undifferentiated: Anaplasia |
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Basic Clinical Staging
(How much cancer does this person have?) |
Stage 0 -- Carcinoma insitu
Stage I -- Localized tumor growth, limited to tissue of origin (clear, clean margins) Stage II -- Limited local spread Stage III -- Extensive local and regional spread (spread to lymph nodes) Stage IV -- Metastatic disease, distant spread |
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"TNM" Classification
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T = tumor size
N = degree of regional spread or lymph nodal status M = metastatic spread |
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Staging
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T1 N2 M0 = small tumor, 2 lymph nodes, no metastasis
T2 N0 Mx = larger tumor, no lymph nodes, unknown metastasis T2 N2 M1 = large tumor, 2 lymph nodes, metastasis |
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Cancer Development
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Carcinogenesis/oncogenesis
Malignant transformation |
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Biology of Cancer
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Initiation
-Irreversible alteration in the cells genetic structure (DNA) Chemical Physical Genetic Promotion -Reversible proliferation of the altered, initiated cell -Latent period - the time between initial genetic alteration and clinical evidence of cancer. (1-40 years) Progression -Increased growth rate of the tumor and increased invasiveness and metastasis |
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Biology of Cancer
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-Metastasis can occur early or late
-follows a somewhat predictable pattern (example: lung cancer check bone and brain for site of metastasis) -Angiogenesis: the ability to establish a blood supply and directly invade tissues. |
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Extrinsic Factors
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-Environmental carcinogens
-Chemical -Physical -Viral -Dietary |
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Intrinsic Factors (Non-Modifiable)
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-Immune function
-Age -Genetic predisposition -Geographic location -Stress -Gender |
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Warning Signs of Cancer
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C-change in bowel/bladder habits
A-sore that doesn't heal U-unusual bleeding or discharge T-thickening or lump in breast I-indigestion or difficulty swallowing O-obvious change in wart or mole N-nagging cough or hoarseness Unintentional weight loss |
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Role of the Immune System
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-Tumor Associated Antigens (TAA's) Antigens found on tumors resulting in cell surface antigen changes
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Role of the Immune System
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-Initiate a response to foreign substances
-Respond to Tumor Associated Antigens -Immune surveillance |
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Escape Mechanisms
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-Cell surface antigens are weak
-Overwhelming antigen exposure -Blocking factors |
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Oncofetal Antigens
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-Type of tumor antigen found on the surfaces and inside cancer cells and fetal cells
-These antigens have been the focus of recent cancer therapies |
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Tumor Surface Antigens
(measures how active cancer is, also called Tumor Markers) |
-Alpha-fetoprotein (AFP)
-CA-125 -CA-15-3 -Human chorionic Gonadotropin (HCG) -Carcinoembryonic Antigen (CEA) colon cancer -Prostate Specific Antigen (PSA) |
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Different Kinds of Cancer
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Some common carcinomas
-Lung -Breast -Colon -Bladder -Prostate Leukemias -Bloodstream Lymphomas -Lymph nodes Some common sarcomas -Fat -Bone -Muscle |
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Naming Cancers
Prefix: adeno |
gland
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Naming Cancers
Prefix: chondro- |
cartilage
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Naming Cancers
Prefix: erythro- |
red blood cell
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Naming Cancers
Prefix: hemangio- |
blood vessels
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Naming Cancers
Prefix: hepato- |
liver
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Naming Cancers
Prefix: lipo- |
fat
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Naming Cancers
Prefix: lympho- |
lymphocyte
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Naming Cancers
Prefix: melano- |
pigment cell
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Naming Cancers
Prefix: myelo- |
bone marrow
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Naming Cancers
Prefix: myo- |
muscle
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Naming Cancers
Prefix: osteo- |
bone
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Naming Cancers
Tissue of Origin: Epithelium |
Malignancy: Adenocarcinoma
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Naming Cancers
Tissue of Origin: Connective Tissue |
Malignancy: Sarcoma
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Naming Cancers
Tissue of Origin: Endothelial Tissue |
Malignancy: Hemangiosarcoma
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Naming Cancers
Tissue of Origin: Neural Tissue |
Malignancy: Glioblastoma, Medulloblastoma
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Naming Cancers
Origin of Tumor: Bone |
Name: -sarcoma
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Naming Cancers
Origin of tumor: Bone |
Name: Osteo
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Naming Cancers
Origin of tumor: Cartilage |
Name: Chondro
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Naming Cancers
Origin of tumor: Fat |
Name: Lipo
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Naming Cancers
Origin of tumor: Skeletal Muscle |
Name: Rhabo
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Naming Cancers
Origin of tumor: Smooth Muscle |
Name: Leiomyo
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Goals and Principals of Cancer Therapies
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-Cure: A complete response that is durable
-Control: An extension of life when we do not expect cure -Palliation: Comfort and reduction in tumor burden that may be causing symptoms |
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Adjuvant Therapy
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-"Added therapy" usually follows definitive treatment
-Therapy may be chemotherapy, radiation therapy, hormonal therapy or immunotherapy -Requires careful evaluation of risk vs benefit. -"Added therapy" usually follows definitive therapy |
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Treatment Modalities: Surgery
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-Preventive: removal of precancerous lesion or suspicious area with cells that are likely to become cancer
Examples: suspicious moles, prophylactic mastectomy, colon polypectomy |
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Surgery
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-Curative, the goal is the removal of the tumor to cure the disease. The trend has been to remove as little tissue as possible and include examination of the lymph nodes
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Surgery: Diagnostic and staging
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-Biopsy
-Staging -Endoscopic "second look" - make sure we removed all the cancer |
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Surgery
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-Palliative
-Restorative (ex: breast reconstruction) -Removal of metastasis -Supportive surgery, may include g tubes, or ports |
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Surgery
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-Cytoreductive Surgery
a.k.a. debulking Remove as much of a cancer as possible, then treat with chemotherapy or radiation therapy -Undertaken when there is a good chance radiation and chemo will be able to destroy residual cancer |
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Radiation Therapy a.k.a. XRT
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-Radiation disrupts the replication process of dividing cells
-The goals of radiation therapy are similar to those of surgery or chemotherapy -Kills cancer cells and non-cancer (healthy) cells |
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Radiation
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-1895-First discovered by Wm. Roentgen
-1896-Radium discovered by Madame Marie Curie and Pierre Curie -1960's-Beginning of research/improved technology and equipment -Today approx. 60% of cancer patients will receive radiation therapy to treat their disease |
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Goals of Radiation Therapy
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-Achieve maximum tumor kill while minimizing injury to surrounding tissue
*Cure *Control *Palliation *Adjuvant |
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Types of Radiation Therapy
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-External beam: radiation is directed from an outside source into the body also referred to as teletherapy (given in divided doses)
-Brachytherapy: could also be called internal therapy, the radioactive source is placed inside the body, near the cancer. |
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Radiation Therapy
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-Usually daily treatment over 2-8 weeks depending on total dose = fractionalization
-Curative course longer than palliative -Given by Fractionalization-goal to give large dose over time, decreasing toxicity, increasing cell kill -Requires simulation = CT Scans (mark field with skin markers or tatoos. Nurse must know not to remove). |
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Simulation
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-Meeting with radiation oncologist and physicist to determine dose, location and methods to be used.
-Client is positioned where mock treatment is to be performed -Skin markings used to mark treatment field-DO NOT WASH OFF! (May even be a tattoo). |
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Brachytherapy
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-Radiation delivered directly by implant or insertion of radioactive source directly into tumor or nearby the tumor
-Treatment usually over short period -Maximum effect to local area with minimal damage to surrounding area Example: Brachytherapy for Prostate Cancer |
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Brachytherapy-Sealed Sources
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-Placed into tumor (interstitial) or body cavity (intracavity)
-Body fluids not contaminated -Notify Radiation Oncologist if dislodged, never touch with bare hands! -Need lead container/forceps in room for accidental dislodgement |
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Brachytherapy-Sealed Sources (cont)
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-Safety issues: private room, usually lead-lined walls
-Caregivers wear dosimeter to monitor radiation exposure -Minimal contact with client -Follow agency protocol re: linens, dressings and dispose of accordingly |
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Brachytherapy, Unsealed source
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-Systemic radioisotope that concentrates in high activity area (ie, the tumor), given IV or PO
-Safety issues: client and potentially body fluids are radioactive up to 3-4 days -Excreted in saliva, sweat, urine, emesis, stool |
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Brachytherapy, Unsealed source (cont)
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-Due to contamination issues, attention must be given to avoiding oral contact with others, wash eating utensils/dishes separately.
-Flush toilet twice, reduces contamination. -Practice good hand hygiene. -Wash clothes separately -Know your agency protocol |
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Time, Distance, Shielding
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-Time: Dose of radiation received based on time near source
-Nursing Implication: Cluster care, organize supplies prior to entering room -Health care provider: 1/2 hour in 8 hour shift -Visitor: no more then 1/2 hour per day -No pregnant persons - either visitors or staff |
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Time, Distance, Shielding (cont)
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-Distance: Dose of radiation received determined by amount or space between source and care giver.
-Nursing implication: The further the distance, the less exposure. -Stand several feet away from client on opposite side as source. -Visit from door rather than entering. -The radiation safety officer may be involved in planning the distance allowable. (How close can I be to the patient?) |
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Time, Distance, Shielding (cont)
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-Shielding: involves placing protective device between source and caregiver.
-Most often used is lead, ie. lead-lined walls or containers -Note: lead aprons NOT advised as don't shield all rays. |
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Will I be radioactive?
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-External Beam: there is NO potential radiation exposure to caregivers or families.
-Internal Radiation: when the source of radiation is an enclosed implant patients are hospitalized in a lead-shielded room to protect others from exposure to the minimal amounts of radiation emitting. |
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Will I be radioactive? (cont)
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-Prostate implants: the amount of radiation to the patient and others is considered safe. Answer: NO
-Radioactive Iodine: patients are isolated from children and from physical contact with others until the iodine is flushed from the body. Answer: YES, need instruction when they leave hospital |
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Radiation Side Effects
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-Fatigue (3-4 weeks into treatment)
-GI symptoms-nausea, vomiting, anorexia, altered taste, diarrhea -Alteration in skin integrity -Bone marrow suppression -Genitourinary tract - cystitis, nephrotoxicity, reproductive dysfunction -Pneumonitis-acute and delayed (pleural effusion need to think about what's in the field) |
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Radiation Side Effects (cont)
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-Fatigue: occurs 3-4 weeks into therapy, may be complicated by depression, anemia or nausea
Nursing Interventions -Education re: energy conservation -Assessment of symptoms -Education re: exercise |
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Radiation Side Effects (cont)
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-Bone marrow surression: occurs relatively soon after beginning therapy, may be worse when client is receiving combination therapy
Nursing Interventions: education related to infection prevention, energy conservation, thrombocytopenia precautions |
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Radiation Side Effects (cont)
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-Local effects will be noted as a result of exposure of the tissues to the radiation. An example would be, pneumonitis (SOB), diarrhea or xerostomia (dry mouth)
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Xerostomia and Mucositis
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-May be related to radiation or chemotherapy
-May compromise nutritional status -Mucositis may involve the entire GI tract Treatment for mucositis: saliva substitutes, vitamin E tablets |
