ࡱ> {}z 9bjbjVV D<<o1w` ` 8\'._____:::'''''''*)+n'::'__'!!!V__'!'!!n%&_@Q@V?;^& ''0'& :,:,@&:,&:hJ!<(:::''o:::':,:::::::::` i: Behavioral ObjectivesContent OutlineClinical ObjectivesLearning opportunitiesApply the terms listed in the content column appropriate to the client situations. Compare and contrast the etiology and related pathophysiology of excessive cellular proliferation across the lifespan. Analyze factors included in the assessment of the client experiencing problems of cellular deviation (Cancer). Differentiate between the etiology, pathophysiology, and clinical manifestations of selected problems of cellular proliferation. Discuss the various treatment options for clients experiencing problems of cellular proliferation. Discuss analysis, planning, implementation and evaluation for the nursing management of clients with selected problems of cellular proliferation.Application of terms Adjuvant Therapy Combination Chemotherapy Cytology Gene Therapy Intravesical Metastasis Palliation Polyps Progenitor cell Tumor lysis syndrome Tumor marker Spinal Cord Compression Superior Vena Cava Syndrome N. Wilms Tumor Overview of typical/atypical cells Developmental considerations Infant Child Adolescent Adult Older adult Pathophysiology Proliferation growth patterns Neoplastic pathology Neoplastic classification systems Staging/grading Cellular differentiation Carcinogenesis Phases Etiologies Viruses Physical agents Chemical Agents (Environmental) Oncogenes Tumor suppressor genes Genetic Predisposition Immune Surveillance Theory Stem Cell theory Cancer assessment Interview Chief complaint History of present illness Prior medical history Treatment/ Medication History (Prescribed/Non-prescribed) Family/social/occupational history Psychosocial Assessment Role Behavior Body Image Coping Mechanisms Knowledge of health maintenance Identify risk factors Physical exam Head to toe Assess for implication of disease and treatment/medications Pain chronic vs. acute Diagnostic tests Laboratory studies Carcinogenic Embryonic Antigen (CEA) Deoxyriboneucleic Acid (DNA) Ploidy CA 15-3 CA 125 Her 2NU Papanicolaou (PAP) test Prostate Surface Antigen (PSA) CBC RBC Hgb/Hct Platelet WBC Differential Absolute Neutrophil Count (ANC) Estrogen Receptor Assay Progesterone Receptor Assay Alpha Feto Protein (AFP) Radiology/Imaging Chest X-ray Magnetic Resonance Imaging (MRI) Computerized Axial Tomography (CT) Ultrasound Brain Scan Bone Scan Liver Scan Metastatic Survey Mammogram Invasive/biopsies Punch Thin Needle Bone Marrow Frozen sections Cultural influences Hereditary Environmental Health beliefs/practices Developmental Age specific assessment data Behavioral/emotional response to health care providers Behavioral/emotional response to death and dying Selected problems of cellular proliferation. Hematopoetic system Leukemia Lymphatic Lymphoma Hodgkins Non-Hodgkins Skin Gastrointestinal Liver Pancreas Colorectal Lung Brain Bladder Larnyx Reproductive Female Uterine Cervical Ovarian Breast Vulvar Reproductive Male Testicular Prostate Treatment modalities Chemotherapy Systemic Intravesical Intrathecal Radiation External Beam Internal Hormonal Therapy Transplantation Bone Marrow Solid Organ Immune Modulated Therapy Biological Response Modifiers (BRM) (Cytokines) Colony Stimulating Factors (CSF) Interferon Interleukins Gene therapy Alternative Treatments Pain Control Physiologic dying process Selected nursing diagnoses/nursing implementation/evaluation. High risk for complications: Medical treatment Independent nursing interventions See head to toe assessment Age related hydration status Intake and output Monitor pertinent diagnostic tests Maintain skin integrity Immune suppressed precautions Bleeding precautions Nutritional status Oral hygiene Vital signs Protect photosensitive skin Collaborate interventions Administer replacement fluid Intravenous Total parental nutrition (TPN) Administer medications and monitor for desired effects/adverse effects/side effects Antiemetics Antidiarrheal Antineoplastic drugs Biologic response modifiers (BRM) Antianxiety Topical anesthetics Antacids Antibiotics Vitamins/minerals Stool softeners Laxatives GI stimulants Pain medication Steroids Blood products Refer dietary for nutritional support Recognition of complications Hemorrhage Nephrotoxity Cardiotoxicity Neurotoxicity Sepsis/infection Pulmonary fibrosis Gastrointestinal Hyperuricemia Hypercalcemia Malnutrition Bowel obstruction Impaired skin integrity Death Pruritis Alopecia Alteration in reproduction Blood dyscrasia Fatigue/malaise Second primary neoplasm Neutropenia Thrombocytopenia Anemia The client will have decreased risk for medical complications as evidenced by: No infection/sepsis No impared skin integrity No excessive weight loss No bleeding Maintains adequate bowel elimination Vital signs WNL Skin integrity intact Gastrointestinal mucosa intact Lab work within normal limits No evidence of congestive heart failure Pulmonary function test WNL Hydration status WNL Absence of graft versus host disease High risk for post op complications Surgical modalities Pancreataduodenectomy (Whipple) Gastrectomy Segmental Resection with Anastamosis Abdominal Perineal with colostomy Ureteroenterocutaneous Diversions Laryngectomy Orchiectomy Prostatectomy Hysterectomy Mastectomy Cryotherapy Palliative Independent interventions Colostomy Drains/assess perineal packing Fecal drainage Bowel sounds Laryngectomy Maintain airway Promoting communication and speech Neck exercises Hemorrhaging Drains Semi-fowlers position Mastectomy Monitor edema Avoid cuffs/sticks to affected side Progressive range of motion exercises Drains Collaborative interventions Administer medications and monitor for desired effects/adverse effects/ side effects Antibiotics Narcotics Prophylactic heparin /lovenox Collaborate with enterostomal therapist Collaborate with Reach To Recovery Collaborate with Lost Chords Oxygen support Recognition of complications Hemorrhage Infection: wound and systemic Fistula formation Peritonitis Delayed wound healing: dehiscence, evisceration Malnutrition Lymphedema Bowel obstruction Adhesions Carotid artery rupture The client will not experience post-op complications as evidenced by: Wound healing Vital signs Bowel sounds Abdominal girth Homans sign Tolerates diet Laboratory studies Patent airway No lymphedema Adequate elimination Fluid volume status Altered health maintenance: Knowledge Deficit Client teaching Assess readiness to learn, ability, knowledge Health promotion/early diagnosis Ten steps of cancer prevention Seven warning signs Screening tests Work with client and interdisciplinary health care team for planning health care delivery to improve the quality of care across the life span. Assess the adequacy of the support system of the client. Identify clients and families unmet needs. Identify providers and resources to meet the needs of clients. Perform health screening. Contribute to the interdisciplinary plan of care. Prioritize client care and follow-up on problems that warrant investigation. Read and discuss relevant, current nursing practice journal articles and apply to practice. Inform and support health care rights of clients. Support the clients right of self-determination and choice even when these choices conflict with values of the individual professional. Identify learning needs of clients related to health promotion, maintenance and risk reduction. Participate in interdisciplinary health care team meetings/conferences. Select and carry out safe and appropriate activities to assist client to meet basic physiologic needs, including: circulation, nutrition, oxygenation, activity, elimination, comfort, rest and sleep. READ: Lewis (2011) Lehne (2010) McKinney (2009) VIDEOS: VCR #0077 Until I Die VCR #0093 Care of Colostomies & Ileostomies. VCR #M122 Preparing the Ostomy patient for discharge.  Reportable signs/symptoms Post radiation Post chemotherapy Post operative Laryngeal stoma care Ostomy care Medication teaching Rest/activity Life style modifications Nutritional Maintenance of fluid balance (Age specific) Communication Community Resources American Ostomy Association United Ostomy Association of America National Cancer Information Service American Cancer Society Leukemia Society of America Home health Hospice The client will have improved health maintenance as evidenced by: Listing health promotion activities Identifying reportable signs and symptoms Describing the purpose, correct administration and side effects of meds Ability to discuss diagnosis, surgical procedure, and post-op care Demonstrates laryngeal stoma care Increasing activity as tolerated Achieves optimum level of nutrition through prescribed diet Utilizing community resources Range of motion exercises Demonstrates ostomy care Body Image Disturbance Independent nursing interventions Establish trust and rapport Utilize therapeutic communication techniques to encourage verbalization of feelings Assess prior coping strategies and encourage development of new strategies Encourage continued participation in activities and decision making Facilitate the clients progression through stages of loss Encourage good hygiene, grooming, and sex appropriate items Encourage client to ask questions Collaborative Refer to appropriate support group Lost Chords Reach To Recovery Ostomate (Ostomy Association) CanSurmount CanCope Dialogue A Time for Me Breast cancer support group for men Leukemia Society of America The client will acknowledge change in body image as evidenced by: Participating in self care Verbalizing feelings to nurse/significant other Facilitating client from sick role to well role Appearing well groomed and attractively dressed Able to communicate effectively Anticipatory grieving Independent nursing interventions Establish a trusting relationship that encourages communication Clarify, re-focus, and supply information as needed Help family plan care of client throughout stages of illness Provide and assist in arrangement for hospice care Arrange for spiritual support in accordance with familys beliefs and/or affiliations Help family to acknowledge loss Collaborative Refer to appropriate support group Make a Wish Foundation Ronald McDonald House Candle Lighters Hospice Pastoral services The client/family will progress through the phases of grief as evidenced by: Increased verbalization and expression of grief Identifying resources available to aide coping strategies during grieving Use resources and supports appropriately Discussing the future openly with each other Alteration in comfort: Acute/chronic pain Independent interventions Assessment of chronic pain Provide psychological support Teach about pharmacological pain control regimens Teach distraction techniques Bensons Relaxation Technique Guided Imagery Music Therapy Position for comfort Collaborative Interventions Administer medications and monitor for desired effects/adverse effects/side effects. 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