Haematological and Oncological Disorder Medical surgical nursing

• Grading:- Grading is cellular aspect

•  Staging:- Staging is clinical and metastasis at diagnosis

 Biopsy :-

•               Biopsy is the definitive means of diagnosis cancer 

Types of biopsy:-

                  Surgery :–

• It is done to remove the tissue or organ a at risk and that prevent development of cancer

•  Removal of large portion of locally invasive tumor

• Surgery decreases the number of Cancer cell.

• Palliative surgery is performed to improve quality of life during the survival time example to reduce pain, relieve obstruction of gastrointestinal, drain abscess.

•  Chemotherapy kills or in production of Cancer causing cells and kills normal cell also

•  Normal sale most affected includes skin ,hair lining of the gi tract ,hematopoietic cell.

• ** common side effect include fatigue alopecia nausea vomiting.

•  Radiation therapy:–

• Most common side effect is fatigue alopecia irritation skin changes.

•  actual source is external to patient

• Patient does not emit radiation

•  Radiation source comes into directly continuous contact with a tumor tissue for a specific time

•  Patient can emit radiation.

• Administration is via the oral route or by iv route for bi instillation into body cavities

•  Body Fluids and urine maybe radioactive before the 48 hours

• Patient can EMIT radiation while the implant is in place but not the excreta for body fluids

• **Steps to be taken if sealed radiation implant is dislodged

•  Instruct the patient to lie still

•  ***Use a long handled forcep to place implant in the lead container

•  If the radiation source cannot be located the nurse should ensure no bedsheet or other article in the room are disposed off and do not allow anyone in the room and notify radiologist.

• Ovarion cancer – CA 125
•  Breast cancer – CA 15-3

•  Stomach tumor – CA 50 , CA 72-4

•  Most commonly used in treatment of leukaemia and lymphoma

***Post transplantation :: infection bleeding or neutropenia and thrombocytopenia are major concern.

                            Leukemia:-

• Abnormal overproduction of leukocytes usually at immature stage in bone marrow

•  Acute lymphocytic leukemia is most common and its age of onset is before 15 age.

•  ***Positive bone marrow biopsy confirms leukemic blast phase cells

 Infection :

•  Infection is most common may occur in leukaemia because of low WBC count

• Most site of infection are in skin, respiratory system and gastrointestinal tract

•  Maintain the patient in a private room with door closed

•  Do not keep fresh fruit and vegetable in patient room

• Teach the patient to avoid the live virus vaccine immunization

•  Provide high calorie high protein high carbohydrate diet.

•  Platelet count lower than 20000 should be kept under bleeding precautions

        Lymphoma ( Hodgking’s Disease)

•  It is malignancy of lymph nodes that originate in a single lymph node or a chain of nodes

•  Positive biopsy of lymph node most commonly cervical nodes are affected first

•  ***Presence of Reed sternberg cells in node confirm the hodgking’s disease

                            Multiple myeloma :-

•  Multiple myeloma  is malignant proliferation of plasma cells within the bone.

•  Abnormal plasma cell produce abnormal antibody (Myeloma protein or Bence Jones protein)  found in blood and urine.

•  Increase level of uric acid and Calcium may lead to kidney failure

•  Patient with multiple myeloma is at risk of pathological fracture so provide hazardous free environment

•  Instruct the patient fir conjumption of 2 litre of fluid daily. 

• Painless testicular swelling occurs

• **Dragging aur pulling sensation is experienced in the scrotum

•  **Testicular self examination is best time performed after a shower when scrotal skin is moist and relaxed

•  Unilateral orchiectomy may performed

•  Postoperatively monitor signs of bleeding and wound infection antibiotics as Prescribed.

            Cervical cancer  :-

•  Risk factor Include human papillomavirus infection(hpv).

•  ***Monitor vaginal bleeding following hysterectomy than one saturated pad per hour medicate excessive bleeding.

• If patient complain calf pain check the area for temperature colour and size which may indicate DVT

               Breast cancer :-

•  Metastasis occurs via lymph node

•  Common site of metastasis are bone and lung.

• Assessment include mass felt during breast self examination in which mass is felt in upper outer quadrant beneath the nipple or in axilla.

•  Breast self examination should be performed every month 7 to 10 days after menses

Postoperative :–

•  Position the patient in semi Fowler position, turn from back to unaffected side with affected arm elected above the level of heart to promote drainage.

•  Encourage coughing and deep breathing.

•  No IV injection for blood pressure measure or venipuncture should be done on affected side mastectomy.

               Gastractomy:-

• **Billroth 1st :- partial gastractomy with remaining segment attached to duodenum

• ** Billroth 2nd :- partial gastractomy with remaining segment attached to jejunum.

•  Postoperatively place a patient in Fowler position for comfort

• Teach coughing and deep breathing exercise to prevent atelectasis which is the most common complication of surgery

• Do not irrigate the nasogastric tube or remove it without physician order

• Patient is kept in NPO for one to three days until the peristalsis returns.
• 
  

                Intestinal tumor :-

•  Tumor develops age adenomatous polyps in the colon and rectum.

•  Complication include bowel perforation with peritonitis

•  Assessment :–

• 1.  *** Most common is Malena

• 2.  Anorexia vomiting and weight loss

•  **Abnormal stool:-

1. Ascending colon tumours : diarrhea
2. Descending colon tumor: constipation, some diarrhea or flat ribbon like stool caused by obstruction.
3. Rectal tumor: alternating constipation and diarrhea

•  Cachexia ( malnutrition which has reached the stage of tissue distruction) late sign

• > Monitor signs of bowel perforation – low bp, rapid and weak pulse, constipation and abdominal distension

•  Postoperative care colostomy :-

• ** if a pouch system is not place apply a petroleum jelly over the stoma to keep it moist and cover it with dry sterile dressing.

•  ** Liquid stool from ascending colon colostomy.

•  **loose to semi solid from transverse colon colostomy

•  Close to normal stool in ascending colon colostomy

       Post operative ileostomy: 

•  Healthy stoma is red in colour

•  Postoperative drainage will be dark green progress to yellow as patient begin to eat

•  *** stool is liquid (very important)

•  monitor risk of dehydration and electrolyte imbalance

•  Prostate Cancer

•  Risk increses in men after age of 50

•  Assessment :

•  **Hard pea sizes nodule palpated on rectal examination

• Gross painless hematuria

• ** luteinizing hormone may be prescribed to slow the rate of growth of tumor.

    surgery includes TURP(Transurethral resection of prostate) :–

•  This involves insertion of a scope in urethra to excise prostatic tissue.

•  *** monitor for hemorrhage , bleeding is common following TURP

•  Continuous bladder irrigation maybe prescribed using normal saline sterile solution

• Monitor for arterial bleeding as bright red urine with numerous clot if it occurs increase continues bladder irrigation and notify doctor.

•  Monitor for venous bleeding as evidenced by burgundy colour urine output and inform to doctor Who may apply traction to the catheter.

•  instruct the patient to keep the leg straight and tape the catheter to thigh.

• ** suprapubic catheter is removed when the patient empty the bladder and residual urine is 75 ml or less

•  Bladder cancer

• Gross or microscopic painless hematuria

•  Frequency and urgency occurs

•  Treatment includes radiation , chemotherapy and surgery

•  Chemotherapy :- >1. alkalysing chemotherapeutic agent is instilled into bladder

•  2. Medicine is retained into bladder for 2 hrs and patient position is rotated every 15 to 30 min avoid lying on full bladder

•  3. After 2 hours patient voids in sitting position

Surgical:-

• **Ileal conduit:- also called Bricker’s procedure

•  Urator are implanted into a segment of ileum with formation of an abdominal stoma.

•  Stoma bag should not be cut larger than 3 mm (0.3cm) size of stoma

•  The patient to empty the urine bag when it is one third (1/3rd) full.

•  Change urinary bag or pouch after 5 to 7 days

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