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Oncology Nursing
Ram Sharan Mehta
UNIT I:
Introduction of the Cell
INTRODUCTION: THE CELL
Cell Membrane
Chemical Composition
Structure of the Unit Membrane
Endocytosis and Exocytosis
Structural Aspects of Increasing the Cell Surface
THE NUCLEUS
Function of the Nucleus
Morphology of the Nucleus
INTRACELLULAR MEMBRANE SYSTEMS
Nuclear Envelope
Endoplasmic Reticulum
Rough ER
Smooth ER
Golgi Apparatus
Lysosomes
Peroxisomes
Mitochondria
Microtubules and Microfilaments
Microtubules and Centrioles
Cilia and Flagella
Microfilaments
Junctional Complex
CELL INJURY AND ADAPTATION
Pathophysiological Processes at Cellular Level
Mechanisms of Cell Damage
Hypoxia
Temperature Extremes
Thermal or Burn Injury
Ionizing Radiation
Electrical Injury
Chemical Injury
Bacterial Injury
Viral Injury
Mechanical Injury
Nutritional Imbalance
CELL DEATH AND NECROSIS
CELLULAR ADAPTATIONS
Hypertrophy
Atrophy
Hyperplasia
Metaplasia
Dysplasia
RESPONSE TO THE INJURY INFLAMMATION
TYPES OF INFLAMMATION
Acute Inflammation
Chronic Inflammation
Sub Acute Inflammation
REPAIR
Healing by Regeneration
Healing by Replacement
UNIT II:
Etiology of Cancer
CRITERIA FOR CAUSATION (BRADFORD HILL CRITERIA)
HOST FACTOR
Genetic Factors
Hormones
Immune Mechanisms
ENVIRONMENTAL FACTORS
Chemical Factors
Known/Suspected Chemical Carcinogens in Humans
Physical Factors
Radiation
Asbestos
Viral Oncogenesis
Oncogenic Human Viruses
DNA Viruses
RNA Viruses
Diet
a) Naturally Occurring Dietary Carcinogens
b) Products of Food Preparation and Processing
c) Synthetic Carcinogens in Diet (Synthetic additives)
Trauma and Inflammation
UNIT III:
Cancer Specific Diagnostic Tests
HISTORY AND PHYSICAL ASSESSMENT
RADIOGRAPHIC PROCEDURES
Basic X-ray Studies
COMPUTED TOMOGRAPHY
Purpose and Procedure
Pre Procedure Care
Post Procedure Care
ANGIOGRAPHY
Procedure
Pre Procedure Care
Post Procedure Care
THERMOGRAPHY
Procedure
Preparation
Drawbacks
ULTRASOUND
Advantages/Purpose
Pre Procedure Care
Disadvantages
MAGNETIC RESONANCE IMAGING
Procedure
Pre Procedure Care
Post Procedure Care
BRONCHOSCOPY
Procedure
Purpose
Preparation
After Care
Complication
THORACOSCOPY (PLEUROSCOPY)
Indications
Upper Gastrointestinal Endoscopy
Indications
Lower Intestinal Endoscopy
Indications
Pre Procedure Care
Post Procedure Care
MAMMOGRAPHY
Purpose
Procedure
Pre Procedure Care
Contradiction
Accuracy Rate
XEROGRAPHY (XERORADIOGRAPHY)
RADIOISOTOPE STUDIES (SCANS)
Magnetic Resonance Imaging
Antigen Skin Testing
Cytological Examinations
Exfoliative Cytology
Tumor Markers
BLOOD STUDIES (HORMONAL STUDIES)
Purpose
Histological Examination
Biopsy
Procedure
CANCER SCREENING
Screen Early and Wisely
Early Detection of Cancer Helps
When to Screen for Cancer?
How to Screen for Cancer?
PET: Cutting-Edge Technology to Detect Cancer Cells
RADIOACTIVITY REVEALS MALIGNANCY
Unique Imaging Technique
Be Prepared for PET Scan
UNIT IV:
Carcinoma of Oral Cavity
TYPES OF ORAL CARCINOMA
Basal Cell Carcinoma
Squamous Cell Carcinoma
Risk Factors
Pathophysiology
Clinical Manifestations
Diagnosis
Management
Surgical Management
Pharmacological Management
NURSING MANAGEMENT
Nursing Assessment
Physical Examination
Nursing Diagnoses
Overall Nursing Goals
NURSING INTERVENTIONS
Promoting Mouth Care
Xerostomia
Stomatitis
Assuring Food and Fluid Intake
Minimizing Discomfort and Pain
Promoting Infection Control
Supporting a Positive Self-image
Promoting Effective Communication
Patient Education and Home Care Considerations
UNIT V:
Brain Tumor
INCIDENCE AND ETIOLOGY
CLASSIFICATION OF BRAIN TUMORS
Primary Versus Secondary Brain Tumors
Neuroembryonic Origins
Intra-axial Versus Extra-axial Brain Tumors
HISTOLOGICAL ORIGIN
PATHOPHYSIOLOGY
Key Features of Common Brain Tumors
Cerebral Tumors
Brainstem Tumors
Conventional Surgery
Craniotomy
Trans-sphenoidal Hypophysectomy
Laser Surgery
Radiation Therapy (Stereotactic Radiosurgery)
Chemotherapy
UNIT VI:
Breast Cancer
RISK FACTORS
Etiology
PATHOPHYSIOLOGY
Intraductal Carcinoma
Infiltrating Ductal Carcinoma
Medullary Carcinoma
Mucinous (Colloid) Carcinoma
Tubular Carcinoma
Lobular Carcinoma In situ
Infiltrating Lobular Carcinoma
Inflammatory Breast Cancer
Paget's Disease
CLINICAL MANIFESTATIONS
Nursing Care of Clients with Breast Disorders
Surgical Management
Lumpectomy
Quadrantectomy
Modified Radical Mastectomy
Axillary Node Dissection
Total (Simple) Mastectomy
Standard Radical Mastectomy
Extended Radical Mastectomy
Surgical Hormonal Manipulation
Breast Reconstruction
Medical Management
Radiation Therapy
CHEMOTHERAPY
Adjuvant Chemotherapy
Neoadjuvant Chemotherapy
SYSTEMIC THERAPY FOR METASTATIC BREAST CANCER
Hormonal Therapy
Preoperative: Nursing Diagnosis
Focus Assessment Criteria
Interventions
Clinical Significance
Rational
POSTOPERATIVE: COLLABORATIVE PROBLEMS
Potential Complication: Neurovascular Compromise
Interventions
Rationale
Nursing Diagnoses
Focus Assessment Criteria
Interventions
Clinical Significance
Rational
HAND AND ARM CARE AFTER AXILLARY DISSECTION
UNIT VII:
Colorectal Cancer
INTRODUCTION
Definition: Cancer of the Colon is usually Adenocarcinoma
Incidence
Etiology
Risk Factors
Distribution of Cancer in Large Intestine
Types of Cancer Found in the Large Bowel
Pathophysiology
Clinical Manifestations
Symptoms most commonly associated with:
Diagnostic Assessment
MANAGEMENT
Medical Management
Radiotherapy
Adjuvant Chemotherapy
FECAL DIVERSIONS FOR CANCER OF THE COLON AND RECTUM
NURSING MANAGEMENT
Assessment
Nursing Diagnosis
Potential Complications
PLANNING AND IMPLEMENTATION
Nursing Goals
Preoperative Nursing Interventions
Postoperative Nursing Interventions
Positive Body Image
Monitoring and Managing Complications
PATIENT REQUIRING A COLOSTOMY: PREOPERATIVE NURSING INTERVENTIONS
Psychosocial Support
Preparation for Surgery
Postoperative Nursing Interventions
Managing the Colostomy
Skin Care
Applying the Drainage Pouch
Managing the Drainage Pouch
Removing the Appliance
Irrigating the Colostomy
PATIENT EDUCATION AND HOME CARE CONSIDERATIONS
Nutritional Status
Sexuality and Sexual Function
Body Image
Bereavement
Counseling
A Nursing Framework
Complications of Colostomy
CONCLUSION
UNIT VIII:
Ovarian Cancer
SCREENING
Early Detection
Emotions, Support and Care After Diagnosis
STAGES OF OVARIAN CANCER
TREATMENT
Surgery
Fertility and Sexuality After Surgery
Diet After Surgery
Chemotherapy
The most common side effects are
Read the Consumer Medicine Information
RADIATION THERAPY (RADIOTHERAPY)
CHECK-UPS AFTER TREATMENT
Looking After Yourself
Questions Checklist
UNIT IX:
Leukemia and Bone Marrow Transplantation
WHERE DOES LEUKEMIA BEGIN?
Blood
Bone Marrow
WHAT DO BLOOD CELLS DO?
Task
Platelets
Blood Cell Families
HOW BOTH FAMILIES FIGHT INFECTION
WHAT IS LEUKEMIA?
Related Blood Diseases
WHAT CAUSES LEUKEMIA?
Genetic Factors
Radiation
Chemicals
Viruses
HOW LEUKEMIA IS DIAGNOSES?
Types of leukemia
Acute Lymphoblastic Leukemia (ALL): (Also called Acute Lymphocytic or Acute Lymphatic Leukemia)
Chronic Lymphocytic Leukemia (CLL) (Also called Chronic Lymphatic or Chronic Lymphoid Leukemia)
Acute Myeloid Leukemia (AML) (Also called Acute Myelocytic, Acute Granulocytic or Acute Myelogenous Leukemia)
Chronic Myeloid Leukemia (CML): (Also called Chronic Myelogenous, Chronic Granulocytic or Chronic Myelocytic Leukemia)
RELATED BLOOD DISEASES
Hodgkin′s Disease
Aplastic Anemia
Myelodysplastic Syndrome
OTHER RELATED BONE MARROW DISEASES
Treatment
Chemotherapy
Possible Side Effects
Bone Marrow Effects
Gastrointestinal Effects
Effects on Hair
Effects on Fertility
Late Effects
Radiation Therapy
STEM CELL OR BONE MARROW TRANSPLANTATION
Sources of Stem Cells
Bone Marrow
Peripheral Blood
Umbilical Cord Blood
Donors of Stem Cells
LIVING WITH LEUKEMIA
INFORMATION AND SUPPORT
OTHER CAN HELP
LEUKEMIA – NURSING MANAGEMENT
Nursing Assessment
NURSING CARE
Nursing Diagnosis
Implementation
Implementation
Implementation
Implementation
Implementation
Implementation
Introduction
Mobilization
Purging – GVHD
Purging – Residual Disease
In vitro Expansion
Gene Therapy
UNIT X:
Cervical Cancer
INTRODUCTION
Definition
Anatomy
Etiology and Risk Factors
Risk Factors
Pathophysiology
STAGING OF CERVICAL CARCINOMA
Clinical Manifestation
Symptoms
Physical Signs
Diagnostic Evaluation
MANAGEMENT
Surgical Management
Radiotherapy
Chemotherapy
Combined Therapy
PREVENTIVE MEASURES
Nursing management of the surgical client
Nursing Preparation
During Procedure
After Care
A PATIENT UNDERGOING A HYSTERECTOMY
Preoperative Care
Postoperative care
Discharge Teaching
Chemotherapy
Radiation Therapy
Intracavitary Brachytherapy
Post Treatment Care
UNIT XI:
Childhood Cancer
COMMON TYPES OF CHILD CANCER
MULTIDISCIPLINARY SUPPORT IN CANCER TREATMENT
THE MOLECULAR BIOLOGY OF CHILDHOOD CANCER
UNIT XII:
Skin Cancer
WHAT IS SKIN CANCER?
Facts About Skin Cancer
HOW IS SKIN CANCER DIAGNOSED?
Need to Know
HOW CAN SKIN CANCER BE PREVENTED?
Need to Know
HOW TO GET INFORMATION: HOW TO DO A SKIN SELF-EXAM
The Quest for a Cure
UNIT XIII:
Nutrition Therapy for Cancer Patients
EATING HINTS FOR CANCER PATIENTS: BEFORE, DURING, AND AFTER TREATMENT
Nutrition Screening and Assessment
Weight Changes Over the Past 6 Months
Ability to Walk and Perform the Activities of Daily Living
GOALS OF NUTRITION THERAPY
Enteral Nutrition
Parenteral Nutrition
YOUR DIET IS AN IMPORTANT PART OF YOUR TREATMENT
Before Treatment Begins
NUTRITION RECOMMENDATIONS CAN BE DIFFERENT FOR CANCER PATIENTS
PREPARING YOURSELF FOR CANCER TREATMENT
Think Positively
Eat a Healthy Diet
Plan Ahead
Managing Eating Problems during Treatment
Coping with Side Effects
Loss of Appetite
Weight Loss
Weight Gain
Sore Mouth or Throat
Here's a Simple Blender Recipe that's Easy on a Sore Mouth
Dry Mouth
Dental and Gum Problems
CHANGED SENSE OF TASTE OR SMELL
Nausea
Vomiting
Diarrhea
Lactose Intolerance
Constipation
Fatigue and Depression
Preventing Food-Borne Illness
Extra Vitamins and Minerals - Will They Help?
What About Alternative Therapies?
EFFECT OF CANCER TREATMENT ON NUTRITION
Nutrition-related Side Effects May Occur as a Result of Surgery
Nutrition Therapy Can Treat the Nutrition-related Side Effects of Surgery
Surgery May Cause Fatigue, Pain and Loss of Appetite
EFFECT OF CHEMOTHERAPY ON NUTRITION: CHEMOTHERAPY MAY AFFECT THE WHOLE BODY
Nutrition-related Side Effects May Occur During Chemotherapy
Nutrition Therapy Can Treat the Nutrition-related Side Effects of Chemotherapy
EFFECT OF RADIATION THERAPY ON NUTRITION
Nutrition-related Side Effects MayOccur During Radiation Therapy
Nutrition Therapy Can Treat the Nutrition-related Side Effects of Radiation Therapy
EFFECT OF IMMUNOTHERAPY ON NUTRITION
Nutrition-related Side Effects MayOccur During Immunotherapy
Effect of Bone Marrow and Stem CellTransplantation on Nutrition
Recipes
Banana Milkshake:
Fortified Milk
Use Fortified Milk When Making:
High-protein Milkshake
Peanut Butter Snack Spread
Lactose-free Double Chocolate Pudding
Apple/Prune Sauce
SPECIAL NOTES FOR CAREGIVERS
Keeping Track of Side Effects
After Treatment Ends
WAYS TO GET BACK INTO EATING
UNIT XIV:
Pain Management
WHAT IS PAIN?
WHAT ARE MY TREATMENT OPTIONS?
WHICH PAIN-RELIEVING MEDICINE IS MY DOCTOR LIKELY TO GIVE ME?
DO OPIOID HAVE SIDE EFFECTS?
WILL I BECOME ADDICTED TO OPIOIDS?
WHAT IF THE OPIOID I AM TAKING STOPS WORKING?
WHAT NON-DRUG PAIN TREATMENT SHOULD I BE AWARE OF?
Muscle Relaxation
Distraction
Nerve Stimulation and Acupuncture
Things to Keep in Mind
THE WHO BASIC RULES FOR THE MANAGEMENT OF CANCER PAIN
UNIT XV:
Chemotherapy
INTRODUCTION
Chemotherapy
Objective of Chemotherapy
HOW CHEMOTHERAPY WORKS
CHEMOTHERAPY DRUGS
Classification of Chemotherapy
CONCEPTS IN CHEMOTHERAPY
Routes of Administration
Intravenous Routes
Peripheral Access
Vascular Access
ALTERNATIVE ROUTES
Extravasations
Management
TOXIC EFFECTS OF CHEMOTHERAPY
Gastrointestinal System
Anorexia and Weight Loss
Stomatitis or Oral Mucositis
Integumentary System
Skin Reactions
Reproductive System
CARE OF PATIENT WITH CHEMOTHERAPY
ANTINEOPLASTIC CHEMOTHERAPY
Assessment
NURSING DIAGNOSIS, GOALS AND INTERVENTIONS
Nursing/Collaborative Diagnosis
COMPLICATIONS IN CHEMOTHERAPY
Discharge Criteria
UNIT XVI:
Radiotherapy
INTRODUCTION
HISTORICAL BACKGROUND
PHYSICAL BASIS
Types of Radiation
Electromagnetic Radiation
Particulate Radiation
Electrons
Protons
Alpha Particles
Neutrons
Negative Pi-mesons
Heavy Ions
Photons
PRODUCTION OF RADIATION FOR THERAPEUTIC APPLICATION
The Photoelectric Effect
The Compton Effect
The Pair Production
Inverse Square Law
Biological Effect
DOSE—ITS MEASUREMENTS AND MEANING
Measurement of Dose
Radiation Dosage
EXTERNAL BEAM UNITS: X-RAY MACHINES
LINEAR ACCELERATORS AND BETATRONS
COBALT-60
TYPES OF RADIATION THERAPY
External Radiation Therapy
Internal Radiation Therapy
Sealed Source RT
Unsealed Source RT
Multi-field Therapy
Conformal Radiation Therapy
NURSING CONSIDERATIONS
HOW RADIATION THERAPY WORKS
COMMON FEARS AND MISCONCEPTIONS ABOUT RT
Skin Care Within the Treatment Field
SIDE EFFECTS OF RT
NURSING MEASURES IN RADIOTHERAPY
Maintaining Accurate Dosage
Proper Care of the Involved Area
Treatment of Radiation Sickness
Maintaining Good Physical and Mental Conditions
Radiation Safety
CARE OF PATIENT UNDERGOING RADIOTHERAPY
Introduction
Nursing Management
Radiotherapy Nursing Care
UNIT XVII:
Nursing Management of Patient with Cancer
NURSING PROCESS APPROACH
NURSING ASSESSMENT
Subjective Data
Knowledge of Diagnosis
Coping Skills
Psychosocial Status
Body Image
Objective Data
NURSING DIAGNOSIS
REHABILITATION
CLIENT EDUCATION AND HOME CARE CONSIDERATION
Family Support
The Terminally Ill and Hospice Care
SAFETY MEASURE AGAINST CHEMOTHERAPY AND RADIATION
Chemotherapy
Personnel Safety
Environmental Safety
Radiotherapy
RADIATION SAFETY STANDARDS
External Radiotherapy
Internal Radiotherapy
UNIT XVIII:
Warning Signs and Preventions of Cancer
INTRODUCTION
Predisposing Factors of Cancer
Ten Steps of Cancer Prevention:
Potential Sources of Fatigue in Cancer Patient
CANCER CONTROL
Primary prevention
Secondary Prevention
Cancer Registration
Warning Signs and Prevention of Cancer
Diagnostic Period
Conformation of Diagnosis
Behavioral Response
Treatment Phase
Cancer Detection and Prevention
General
SPECIFIC CANCER CAUSES AND PREVENTION (AVOIDING CANCER)
Skin Cancer
Cancer of Head and Neck
Lung Cancer
Esophagus and stomach Cancer
Colorectal Cancer
RENAL, PELVIS, AND BLADDER CANCER AND CANCER OF URETERS AND URETHRA
Testicular Cancer
Prostate Cancer
Breast Cancer
Ovarian Cancer
Cervical Cancer
Uterine Cancer (Endometrial)
Hodgkin's Disease (Lymph nodes)
APPENDIX I:
Terminology Related to Cancer
APPENDIX II:
A Helpful Hints for Cancer Patients
APPENDIX III:
Oncology Nursing as a Specialty
PATIENT ASSESSMENT
PATIENT EDUCATION
COORDINATION OF CARE
DIRECT PATIENT CARE
SYMPTOM MANAGEMENT
SUPPORTIVE CARE
PSYCHO-ONCOLOGY
APPENDIX IV:
Professional Standard of Oncology Nursing Practice
STANDARDS OF CARE
STANDARDS OF PROFESSIONAL PERFORMANCE
APPENDIX V:
Recent Advances in Chemotherapy
CANCER CHEMOTHERAPY
STEPS OF CENTRAL VENOUS ACCESS DEVICE CHEMOTHERAPY ADMINISTRATION
APPENDIX VI:
Recent Advances in Radiotherapy
RADIOTHERAPY TREATMENT PLANNING AND RADIATION PROTECTION
Introduction
External Beam Therapy (Teletherapy)
Brachytherapy
TREATMENT PLANNING
RADIATION PROTECTION
A. Radiotherapy
B. Radiology
C. Nuclear Medicine
APPENDIX VII:
Role of A Nurse in Preventive Oncology
Bibliography
INDEX
TOC
Index
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